Restoration of self-awareness of hypoglycemia in adults with long-standing type 1 diabetes: hyperinsulinemic-hypoglycemic clamp substudy results from the HypoCOMPaSS trial.

OBJECTIVE: Impaired awareness of hypoglycemia (IAH) and defective counterregulation significantly increase severe hypoglycemia risk in type 1 diabetes (T1D). We evaluated restoration of IAH/defective counterregulation by a treatment strategy targeted at hypoglycemia avoidance in adults with T1D with IAH (Gold score ≥4) participating in the U.K.-based multicenter HypoCOMPaSS randomized controlled trial. RESEARCH DESIGN AND METHODS: Eighteen subjects with T1D and IAH (mean ± SD age 50 ± 9 years, T1D duration 35 ± 10 years, HbA1c 8.1 ± 1.0% [65 ± 10.9 mmol/mol]) underwent stepped hyperinsulinemic-hypoglycemic clamp studies before and after a 6-month intervention. The intervention comprised the HypoCOMPaSS education tool in all and randomized allocation, in a 2 × 2 factorial study design, to multiple daily insulin analog injections or continuous subcutaneous insulin infusion therapy and conventional glucose monitoring or real-time continuous glucose monitoring. Symptoms, cognitive function, and counterregulatory hormones were measured at each glucose plateau (5.0, 3.8, 3.4, 2.8, and 2.4 mmol/L), with each step lasting 40 min with subjects kept blinded to their actual glucose value throughout clamp studies. RESULTS: After intervention, glucose concentrations at which subjects first felt hypoglycemic increased (mean ± SE from 2.6 ± 0.1 to 3.1 ± 0.2 mmol/L, P = 0.02), and symptom and plasma metanephrine responses to hypoglycemia were higher (median area under curve for symptoms, 580 [interquartile range {IQR} 420-780] vs. 710 [460-1,260], P = 0.02; metanephrine, 2,412 [-3,026 to 7,279] vs. 5,180 [-771 to 11,513], P = 0.01). Glycemic threshold for deterioration of cognitive function measured by four-choice reaction time was unchanged, while the color-word Stroop test showed a degree of adaptation. CONCLUSIONS: Even in long-standing T1D, IAH and defective counterregulation may be improved by a clinical strategy aimed at hypoglycemia avoidance.

Cardiovascular prevention model from Kenyan slums to migrants in the Netherlands

Cardiovascular diseases (CVD) are the main cause of morbidity and mortality worldwide. As prevention and treatment of CVD often requires active screening and lifelong follow up it is a challenge for health systems both in high-income and low and middle-income countries to deliver adequate care to those in need, with efficient use of resources.We developed a health service model for primary prevention of CVD suitable for implementation in the Nairobi slums, based on best practices from public health and the private sectors. The model consists of four key intervention elements focusing on increasing awareness, incentives for promoting access to screening and treatment, and improvement of long-term adherence to prescribed medications. More than 5,000 slum dwellers aged ≥35 years and above have been screened in the study resulting in more than 1000 diagnosed with hypertension and referred to the clinic.Some marginalized groups in high-income countries like African migrants in the Netherlands also have low rates of awareness, treatment and control of hypertension as the slum population in Nairobi. The parallel between both groups is that they have a combination of risky lifestyle, are prone to chronic diseases such as hypertension, have limited knowledge about hypertension and its complications, and a tendency to stay away from clinics partly due to cultural beliefs in alternative forms of treatment, and lack of trust in health providers. Based on these similarities it was suggested by several policymakers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries. The model can be contextualized to the local situation by adapting the key steps of the model to the local settings.The involvement and support of African communities' infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries. Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers' perspective and health effects in the target population, similar to the study design for Nairobi.

Awareness of energy drink intake guidelines and associated consumption practices: a cross-sectional study

BACKGROUND: Despite concern regarding harms of energy drink (ED) consumption, no research has been conducted to determine awareness and compliance with ED intake guidelines displayed on product packaging in Australia (a novel approach internationally).

METHODS: A convenience sample of 1922 people completed an online survey. Participants reported their knowledge of maximum recommended daily ED intake according to Australian guidelines.

RESULTS: Guideline awareness was reported by 38, 23 and 19 % of past year consumers, lifetime, and non-consumers, respectively. Amongst past year consumers, 'accurate estimators' reported greater ED intake and were more likely to exceed intake guidelines and consume alcohol mixed with ED (AmED). After controlling for demographics and frequency of use, guideline awareness predicted increased likelihood of exceeding guidelines in ED sessions, but was not associated with exceeding ED guidelines in AmED sessions.

CONCLUSIONS: Australia is considered to have the most stringent regulatory approach to EDs internationally. However, advisory statements are not associated with greater awareness and compliance with intake guidelines. Failure to comply with standards for efficacious product labelling, and absence of broader education regarding guidelines, needs to be addressed.

Enhancing English language learners’ text understanding through metaphor awareness

 The study examined awareness of metaphor as a tool to enhance English language learners’ understanding of texts with embedded metaphors. Findings revealed that an enhanced awareness of metaphor, as indicated by greater use of the metalanguage of metaphor, longer turns conversation and reflective journals, helped them get deeper text meaning.

April 2007: Stress Awareness Month

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As mudanças da cadeia produtiva têxtil em Valença-RJ: das indústrias do setor de tecidos para o APL do setor de Confecções

This study shows how the Industrial Cluster of garments in Valença, RJ ¿ comprised of micro and small enterprises ¿ contributes to overcome the problems left by the declining period of the textile industry. At first, the city took advantage of its talent for textile work and turned to the clothing sector, which now relies on garment factories, subcontractors, cooperatives and laundries in order to create jobs. There is institutional support, but the analysis of the situation identified the need for higher involvement of cluster players, as well as a higher interaction among them to help their own development. In regard to public and private institutions, there is room for steps to guide informal companies that find it difficult to afford labor, financial, and environmental costs towards formalization, the offer of management and labor skill programs, as well as entrepreneurs¿ awareness about the acquisition of modern-technology machinery. It is important to encourage higher participation of Valença firms in the national fashion events, since this draws attention to the name of the city, discloses the work that is carried out there, and attracts new businesses. The entry of Valença companies in the fashion arena of the southern region of Rio de Janeiro state is beneficial, especially to make them better prepared for the Fashion Rio/Fashion Business event. Informality as a way out of the unemployment problem is a growing trend in Valença, as well as in most of Brazilian cities. In this sense, the entrepreneurs need to find favorable steps to make them feel motivated to formalize their businesses.

Microinsurance in Brazil: current situation and outlook

O trabalho aqui apresentado teve como objetivo investigar as oportunidades do microseguro no Brasil levando em conta o atual contexto de microfinanças no país e as potencias sinergias quem poderiam facilitar a implementação e o desenvolvimento do conceito. Cumpre lembrar que o microseguro não pode ser um substituto do microcrédito, mas; é um necessario complemento para continuar no caminho da inclusão social e financeira. A primeira parte desse trabalho aborda o tema de microfinanças no mundo e depois no Brasil, para poder entender o papel do microseguro como uma das ferramentas de microfinanças. A segunda parte é dedicada ao microseguro, com uma apresentação do conceito geral e de algumas iniciativas no mundo antes de se focar sobre o microseguro no Brasil. Apresentamos o quadro legal e os incentivos, juntos com o mercado potencial e os canais de distribuição no Brasil. A última parte apresenta o estudo de caso do Banco Bradesco e do órgão regulatório Susep, realizado através de entrevistas.

Distressed situation and renegotiation plan: a case study

Este trabalho apresenta um caso real de uma empresa em situação de estresse financeiro: a PlywoodCo. O objetivo deste trabalho é de entender porque a PlywoodCo. chegou na atual situação de estresse e, baseado nisso, propor um plano de renegociação de passivos compatível com esta situação com o objetivo de tornar a PlywoodCo. em uma empresa viável. Uma introdução é feita, a fim de colocar o leitor em contato com a PlywoodCo., apresentado as suas atividades, principais produtos, posição de mercado, bem como brevemente introduzindo sua atual situação. Após a introdução, a revisão bibliográfica é apresentada, descrevendo a teoria relacionada e utilizada neste trabalho. Mais adiante, a metodologia é apresentada, seguida por mais informações a respeito das operações da PlywoodCo., informações financeiras, relacionamento com stakeholders, índices operacionais, demonstrações financeiras, cronograma de pagamento da dívida e depreciação. Depois, as premissas, analises e projeções não apresentadas, consistindo de duas partes: (1) uma seção de diagnóstico endereçando a atual situação da empresa; e (2) uma seção de projeção, que será dividida em duas partes: (a) projeções financeiras da PlywoodCo. na atual situação; e (b) projeções financeiras da PlywoodCo. no novo plano proposto. Finalmente, se conclui que a empresa precisará de esforços além da renegociação de passivos a fim de superar sua situação de estresse financeiro. Após a renegociação da dívida, a empresa precisará de R$ 23 MM até o fim de 2013.

Componentes com marcas: modelo conceitual e investigação empírica do comportamento do consumidor

Estudos comprovam que determinados componentes exercem uma função fundamental para o desempenho do produto final, por exemplo o microprocessador Intel e o revestimento Teflon. Assim como os exemplos, alguns destes componentes de produtos possuem marca, as quais tem notoriedade para o consumidor final. Ou seja, o fabricante de componente começa a ter reconhecimento de marca na mente do consumidor. Devido a esta tendência de mercado, este estudo verificará inicialmente, os fatores que determinam a lembrança de marca de componentes por parte do consumidor final. E posteriormente, analisará as influências desta percepção de marca, e do reconhecimento dos benefícios do componente para a decisão de compra do consumidor. Para tanto, o estudo propõe o desenvolvimento de um modelo conceitual, o qual será testado empiricamente. Este modelo tem como base o modelo de decisão de compra do consumidor para produto final, com sugeridas adaptações para a situação de marcas de componentes.

O papel da tecnologia da informação e comunicação na inclusão financeira da população ribeirinha da Ilha de Marajó: o caso Agência Barco

O desafio de ofertar infraestrutura de serviços públicos nas regiões menos desenvolvidas do Brasil, geralmente mais afastadas dos grandes centros urbanos, mobiliza setores da sociedade na busca de abordagens novas e criativas que possam diminuir as grandes disparidades inter-regionais. Uma das carências vivenciadas por parte da população brasileira é a falta de acesso ao sistema financeiro, comprometendo a capacidade de plena participação dessas pessoas na economia, dificultando a geração e acúmulo de riqueza, situação essa presente na Ilha de Marajó, no estado do Pará, cuja maioria de seus dezesseis municípios apresenta Índice de Desenvolvimento Humano (IDH) baixo ou muito baixo. Para mudar essa realidade, uma iniciativa inovadora é a agência bancária itinerante instalada em barco, para atendimento a populações ribeirinhas de regiões com vasta extensão territorial, baixa densidade demográfica, dificuldades de transporte e limitações na oferta de tecnologia da informação e comunicação (TIC). Assim, essa pesquisa, com propósito exploratório e descritivo, tem como objetivo principal identificar, sob o ponto de vista das TIC, como os indicadores de inclusão financeira são influenciados pela atuação da Agência Barco na Ilha de Marajó. Além do estudo teórico, foi realizada investigação empírica, por meio de observação direta e entrevistas semiestruturadas com clientes e funcionários da Agência Barco, realizadas ao longo de quatro dias, em duas cidades da Ilha de Marajó. Para análise dos dados, foram aplicadas técnicas de análise de conteúdo às entrevistas, com objetivo de identificar a presença de elementos de inclusão financeira, transpondo os resultados para um modelo heurístico de infoinclusão dinâmica (2iD), o qual foi adaptado para contemplar constructos de inclusão financeira. O resultado da pesquisa demonstra que a Agência Barco consegue suprir as necessidades de acesso a serviços e produtos financeiros pela população da Ilha de Marajó, ao mesmo tempo em que se identifica oportunidades para ampliação de aspectos relacionados à educação financeira, possibilitando fortalecer os componentes dinâmicos do processo de inclusão financeira, com aumento da conscientização e consequente aumento da demanda por serviços e produtos financeiros.

Hudumia: a platform to support spontaneous volunteers' situational awareness, coordination and safety underemergency scenarios

Spontaneous volunteers always emerge under emergency scenarios and are vital to a successful community response, yet some uncertainty subsists around their role and its inherent acceptance by official entities under emergency scenarios. In our research we have identified that most of the spontaneous volunteers do have none or little support from official entities, hence they end up facing critical problems as situational awareness, safety instructions and guidance, motivation and group organization. We argue that official entities still play a crucial role and should change some of their behaviors regarding spontaneous volunteerism. We aim with this thesis to design a software architecture and a framework in order to implement a solution to support spontaneous volunteerism under emergency scenarios along with a set of guidelines for the design of open information management systems. Together with the collaboration from both citizens and emergency professionals we have been able to attain several important contributions, as the clear identification of the roles taken by both spontaneous volunteers and professionals, the importance of volunteerism in overall community response and the role which open collaborative information management systems have in the community volunteering efforts. These conclusions have directly supported the design guidelines of our software solution proposal. In what concerns to methodology, we first review literature on technologies support to emergencies and how spontaneous volunteers actually challenge these systems. Following, we have performed a field research where we have observed that the emerging of spontaneous volunteer’s efforts imposes new requirements for the design of such systems, which leaded to the creation of a cluster of design guidelines that supported our software solution proposal to address the volunteers’ requirements. Finally we have architected and developed an online open information management tool which has been evaluated via usability engineering methods, usability user tests and heuristic evaluations.

O outro diálogo: uma compreensão do diálogo interno

This thesis aims to enable a wider comprehension on thought operation as well as suggest alternatives for the formation of reflexive, critical, autonomous and creative individuals. The research defends the idea that it is possible for an individual to develop vigilant attention that makes thought flexibilization and change in the course of action, possible. This operation is called Internal Dialogue and is essentially characterized by a continuous openness towards novelty and learning. This makes it possible to minimize the usual way thought operates, in a automatic fashion (automatism). The research was based on theoretical references and ideas of David Bohm (1989;1994;2005) and Michael Polanyi (1983). The main emphasis was the understanding that a crisis situation enables awareness and state of alert that favors a more flexible thought pattern (Aragão Gomes, 1994, 1997). The methodology used was presentation and analysis of these moments through autobibliographical records with indication of crisis on behalf of the subjects. Other criteria were also used that enabled the composition of the analyzed material such as the fact that: the subjects were public and real, the data was available through accessible material; the subjects identified themselves as in crisis; these crisis were of varied kinds; they had different social, cultural and professional profiles. Thus, three auto-bibliographical elements were selected: the Infidel: the story of a woman that challenged Islam (2007), written by the political Muslim author Ayaan Hirsi; Still me: memories (2001), of the actor Christopher Reeve as well as Confessions of a Philosopher (2001), by the philosopher Bryan Magee. In these books an analysis was made related to parts that stated action an though operation that express internal dialogue. These were organized into categories that were pointed out as relevant for the identification of internal dialogue such as: Perceptions of physical reaction; emotions, beliefs and issues, individual actions, self judgment and thought, self questioning, comprehension, observation and empirical investigation, perception of the changes they performed in the world, escape of conditioning as well as action that resulted in new meaning. The analysis performed reinforces our goal once it sated that internal dialogue is an important tool that allows thought awareness, minimizing common automatism and making consciousness possible as well as favoring the occurrence of critical and reflexive thought. Thus, final considerations deal with the need for the development of teaching methodologies that address internal dialogue as a counterpoint to the many daily action that reinforce the automatism of thought