356 resultados para 1174


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This paper presents an optimization-based approach to the design of asymmetrical filter structures having the maximum number of return- or insertion-loss ripples in the passband such as those based upon Chebyshev function prototypes. The proposed approach. has the following advantages over the general purpose optimization techniques adopted previously such as: less frequency sampling is required, optimization is carried out with respect to the Chebyshev (or minimax) criterion, the problem of local minima does not arise, and optimization is usually only required for the passband. When implemented around an accurate circuit simulation, the method can be used to include all the effects of discontinuities, junctions, fringing, etc. to reduce the amount of tuning required in the final filter. The design of asymmetrical ridged-waveguide bandpass filters is considered as an example. Measurements on a fabricated filter confirm the accuracy of the design procedure.

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Objectives
To evaluate how involvement in life situations (participation) in children with cerebral palsy varies with type and severity of impairment and to investigate geographical variation in participation.

Design
Cross sectional study. Trained interviewers visited parents of children with cerebral palsy; multilevel multivariable regression related participation to impairments, pain, and sociodemographic characteristics.

Setting
Eight European regions with population registers of children with cerebral palsy; one further region recruited children from multiple sources.

Participants
1174 children aged 8-12 with cerebral palsy randomly selected from the population registers, 743 (63%) joined in the study; the further region recruited 75 children.

Main outcome measure
Children’s participation assessed by the Life-H questionnaire covering 10 main areas of daily life. Scoring ignored adaptations or assistance required for participation.

Results
Children with pain and those with more severely impaired walking, fine motor skills, communication, and intellectual abilities had lower participation across most domains. Type of cerebral palsy and problems with feeding and vision were associated with lower participation for specific domains, but the sociodemographic factors examined were not. Impairment and pain accounted for up to a sixth of the variation in participation. Participation on all domains varied substantially between regions: children in east Denmark had consistently higher participation than children in other regions. For most participation domains, about a third of the unexplained variation could be ascribed to variation between regions and about two thirds to variation between individuals.

Conclusions
Participation in children with cerebral palsy should be assessed in clinical practice to guide intervention and assess its effect. Pain should be carefully assessed. Some European countries facilitate participation better than others, implying some countries could make better provision. Legislation and regulation should be directed to ensuring this happens.

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‘Risk’ in social work is typically read as risk-of-bads, and specifically extreme bads. This paper develops the implications of the logical objection to attempts to predict low frequency extreme events (such as child homicides). Our argument is that if we focus on these low probability high cost outcomes—these heart wrenching, but unpredictable, tragedies—we take social work away from the good that it can do, leave it open to inappropriate disapprobation, and, in terms of outcomes, do less well by the vulnerable. This point is reinforced by discussion of developments in other academic fields, and by further examination of the logic (and the morality) of protection under uncertainty. We explore the implications for the way social work should be evaluated. A proper academic understanding of risk, and decision making under uncertainty, has, we argue clear practical implications.

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Objective:
To evaluate how participation of children with cerebral palsy (CP) varied with their environment.

Design:
Home visits to children. Administration of Assessment of Life Habits and European Child Environment Questionnaires. Structural equation modeling of putative associations between specific domains of participation and environment, while allowing for severity of child's impairments and pain.

Setting:
European regions with population-based registries of children with CP.

Participants:
Children (n=1174) aged 8 to 12 years were randomly selected from 8 population-based registries of children with CP in 6 European countries. Of these, 743 (63%) agreed to participate; 1 further region recruited 75 children from multiple sources. Thus, there were 818 children in the study.

Interventions:
Not applicable.

Main Outcome Measure:
Participation in life situations.

Results:
For the hypothesized associations, the models confirmed that higher participation was associated with better availability of environmental items. Higher participation in daily activities—mealtimes, health hygiene, personal care, and home life—was significantly associated with a better physical environment at home (P<.01). Mobility was associated with transport and physical environment in the community. Participation in social roles (responsibilities, relationships, recreation) was associated with attitudes of classmates and social support at home. School participation was associated with attitudes of teachers and therapists. Environment explained between 14% and 52% of the variation in participation.

Conclusions:
The findings confirmed the social model of disability. The physical, social, and attitudinal environment of disabled children influences their participation in everyday activities and social roles.

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In this article, we take advantage of the recent availability of data from the special module on material deprivation in the 2009 European Union Statistics on Income and Living Conditions to develop a more comprehensive understanding of the relationship between material deprivation and economic stress, the mediating and moderating roles played by cross-national differences in levels of income and income inequality, and the implications for competing perspectives on the nature of reference groups in Europe. The article establishes the critical role of basic deprivation, relating to inability to enjoy customary standards of living, in influencing economic stress levels. National income levels and inequality had no direct influence on economic stress. However, the impact of basic deprivation was stronger in countries with higher levels of income, indicating the crucial role of national reference groups. An interaction between basic deprivation and income inequality was also observed. However, contrary to the expectation that experiencing basic deprivation in a national context of high income inequality is likely to be particularly stressful, the consequences of such deprivation were most negative in low inequality countries. Experiencing basic deprivation where high income levels and lower inequality would lead to the expectation that such deprivation is eminently avoidable exacerbates its impact. © The Author 2013.

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This paper reports data from an on-line peer tutoring project, the objective being the learning and improvement of the Spanish and English language. Pupils aged between 9 and 12 years old from Scotland and Catalonia were paired for the purpose of each pupil acting as a tutor of their own language within his or her pair. The aim was to improve the knowledge and use of their own language (by correcting their tutee) as well as the modern language (through the help of their tutor) acting as tutors and also as a tutees. The research combines a quasi-experimental design, using control groups, and in depth analysis of the process throughout the exchanges (texts and corrections) and interviews with the subjects. The results show that the degree of help offered by the tutors appears to be a very relevant factor when assessing the improvement detected in the linguistic abilities. © 2010 Fundación Infancia y Aprendizaje.

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Background This study evaluated the effect of statins in Primary biliary cirrhosis (PBC) on endothelial function, anti-oxidant status and vascular compliance. Methods Primary biliary cirrhosis patients with hypercholesterolaemia were randomized to receive 20mg simvastatin or placebo in a single blind, randomized controlled trial. Body mass index, blood pressure, glucose, liver function, lipid profile, immunoglobulin levels, serological markers of endothelial function and anti-oxidant status were measured as well as vascular compliance, calculated from pulse wave analysis and velocity, at recruitment and again at 3, 6, 9 and 12months. Results Twenty-one PBC patients (F=20, mean age = 55) were randomized to simvastatin 20mg (n=11) or matched placebo (n=10). At completion of the trial, serum cholesterol levels in the simvastatin group were significantly lower compared with the placebo group (4.91mmol/L vs. 6.15mmol/L, P=0.01). Low-density lipoprotein (LDL) levels after 12months were also significantly lower in the simvastatin group (2.33mmol/L vs. 3.53mmol/L, P=0.01). After 12months of treatment, lipid hydroperoxides were lower (0.49mol/L vs. 0.59mol/L, P=0.10) while vitamin C levels were higher (80.54mol/L vs. 77.40mol/L, P=0.95) in the simvastatin group. Pulse wave velocity remained similar between treatment groups at 12months (8.45m/s vs. 8.80m/s, P=0.66). Only one patient discontinued medication owing to side effects. No deterioration in liver transaminases was noted in the simvastatin group. Conclusions Statin therapy in patients with PBC appears safe and effective towards overall reductions in total cholesterol and LDL levels. Our initial study suggests that simvastatin may also confer advantageous effects on endothelial function and antioxidant status.

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Generative algorithms for random graphs have yielded insights into the structure and evolution of real-world networks. Most networks exhibit a well-known set of properties, such as heavy-tailed degree distributions, clustering and community formation. Usually, random graph models consider only structural information, but many real-world networks also have labelled vertices and weighted edges. In this paper, we present a generative model for random graphs with discrete vertex labels and numeric edge weights. The weights are represented as a set of Beta Mixture Models (BMMs) with an arbitrary number of mixtures, which are learned from real-world networks. We propose a Bayesian Variational Inference (VI) approach, which yields an accurate estimation while keeping computation times tractable. We compare our approach to state-of-the-art random labelled graph generators and an earlier approach based on Gaussian Mixture Models (GMMs). Our results allow us to draw conclusions about the contribution of vertex labels and edge weights to graph structure.

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OBJECTIVE: To provide a detailed phenotype/genotype characterization of Bietti crystalline dystrophy (BCD). DESIGN: Observational case series. PARTICIPANTS: Twenty patients from 17 families recruited from a multiethnic British population. METHODS: Patients underwent color fundus photography, near-infrared (NIR) imaging, fundus autofluorescence (FAF) imaging, spectral domain optical coherence tomography (SD-OCT), and electroretinogram (ERG) assessment. The gene CYP4V2 was sequenced. MAIN OUTCOME MEASURES: Clinical, imaging, electrophysiologic, and molecular genetics findings. RESULTS: Patients ranged in age from 19 to 72 years (median, 40 years), with a visual acuity of 6/5 to perception of light (median, 6/12). There was wide intrafamilial and interfamilial variability in clinical severity. The FAF imaging showed well-defined areas of retinal pigment epithelium (RPE) loss that corresponded on SD-OCT to well-demarcated areas of outer retinal atrophy. Retinal crystals were not evident on FAF imaging and were best visualized with NIR imaging. Spectral domain OCT showed them to be principally located on or in the RPE/Bruch's membrane complex. Disappearance of the crystals, revealed by serial recording, was associated with severe disruption and thinning of the RPE/Bruch's membrane complex. Cases with extensive RPE degeneration (N = 5) had ERGs consistent with generalized rod and cone dysfunction, but those with more focal RPE atrophy showed amplitude reduction without delay (N = 3), consistent with restricted loss of function, or that was normal (N = 2). Likely disease-causing variants were identified in 34 chromosomes from 17 families. Seven were novel, including p.Met66Arg, found in all 11 patients from 8 families of South Asian descent. This mutation appears to be associated with earlier onset (median age, 30 years) compared with other substitutions (median age, 41 years). Deletions of exon 7 were associated with more severe disease. CONCLUSIONS: The phenotype is highly variable. Several novel variants are reported, including a highly prevalent substitution in patients of South Asian descent that is associated with earlier-onset disease. Autofluorescence showed sharply demarcated areas of RPE loss that coincided with abrupt edges of outer retinal atrophy on SD-OCT; crystals were generally situated on or in the RPE/Bruch's complex but could disappear over time with associated RPE disruption. These results support a role for the RPE in disease pathogenesis.

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As mulheres com cancro da mama obtiveram, nos últimos anos, um aumento significativo da esperança média de vida; contudo, muitas destas mulheres vivem com as complicações crónicas resultantes do tratamento. O objetivo deste estudo é caracterizar as complicações músculo-esqueléticas (CME) nas sobreviventes de cancro da mama e enfatizar a necessidade de desenvolver terapêuticas preventivas para estas complicações. Métodos – Noventa e quatro mulheres sobreviventes de cancro da mama responderam a um questionário sobre potenciais CME. Resultados – Foi detetada associação significativa entre idade e linfedema (p=0,004), dor no braço (DB) (p=0,000), dor no ombro (DO) (p=0,004), dificuldade em elevar o braço (DEB) (p=0,022) e cervicalgia (p=0,000), verificando-se uma maior incidência nas mulheres com mais de 50 anos. Uma associação significativa foi detetada entre linfadenectomia e linfedema (p=0,000), DB (p=0,000), DO (p=0,008), verificando-se que as mulheres sujeitas a linfadenectomia apresentam maior incidência de linfedema, de DB e de DO. Quanto à sobrevivência constatou-se que as mulheres com mais de 10 anos de sobrevivência têm mais CME. Relativamente à mastectomia foi detetada associação significativa com o linfedema (p=0,012), DB (p=0,020), DO (p=0,003), DEB (p=0,037) e cervicalgia (p=0,020). Verificou-se que as mulheres mastectomizadas têm maior tendência para apresentar linfedema, DB, DO, DEB e cervicalgia. Conclusão – No nosso estudo, as mulheres acima dos 50 anos, as que realizaram a linfadenectomia, as com mais de 10 anos de sobrevivência e as mastectomizadas apresentaram maior incidência de CME.

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1887/06/04 (Numéro 1174).