Criação de um banco de itens para avaliar o conhecimento do câncer de cabeça e pescoço

Pós-graduação em Odontologia Preventiva e Social - FOA

Construção de uma escala para avaliação da pro ciência em conteúdos matemáticos básicos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Atividades de educação em saúde sobre leishmaniose visceral para escolares

This study aimed at evaluating the knowledge on visceral leishmaniasis gained after the application of an educative project for the 6th and 7th grade students from three public schools of Birigui, SP, Brazil. A questionnaire before (Phase I) and after (Phase II) activities that comprehended one conference by a health agent, a comic contest and one crossword about VL was used to measure scholar’s knowledge. We interviewed 711 students in Phase I and 693 in Phase II. A criterion of VL knowledge was adopted as “Good”, “Medium” and “Bad” when, out of 10 questions analyzed by Item Response Theory, 10 to 8, 7 to 4, and 3 to 0 were right, respectively. We observed a statistically significant increase in the students’ knowledge level after the educational project, since the number of students with “Good” concept changed from 35.7% (Phase I) to 59.7% (Phase II). The educational activities carried out led to gains in knowledge among students suggesting that continuing education can bring good results to public health.

Spin accumulation encoded in electronic noise for mesoscopic billiards with finite tunneling rates

We study the effects of spin accumulation (inside reservoirs) on electronic transport with tunneling and reflections at the gates of a quantum dot. Within the stub model, the calculations focus on the current-current correlation function for the flux of electrons injected into the quantum dot. The linear response theory used allows us to obtain the noise power in the regime of thermal crossover as a function of parameters that reveal the spin polarization at the reservoirs. The calculation is performed employing diagrammatic integration within the universal groups (ensembles of Dyson) for a nonideal, nonequilibrium chaotic quantum dot. We show that changes in the spin distribution determine significant alterations in noise behavior at values of the tunneling rates close to zero, in the regime of strong reflection at the gates.

Parameter recovery for a skew-normal IRT model under a Bayesian approach: hierarchical framework, prior and kernel sensitivity and sample size

Item response theory (IRT) comprises a set of statistical models which are useful in many fields, especially when there is an interest in studying latent variables (or latent traits). Usually such latent traits are assumed to be random variables and a convenient distribution is assigned to them. A very common choice for such a distribution has been the standard normal. Recently, Azevedo et al. [Bayesian inference for a skew-normal IRT model under the centred parameterization, Comput. Stat. Data Anal. 55 (2011), pp. 353-365] proposed a skew-normal distribution under the centred parameterization (SNCP) as had been studied in [R. B. Arellano-Valle and A. Azzalini, The centred parametrization for the multivariate skew-normal distribution, J. Multivariate Anal. 99(7) (2008), pp. 1362-1382], to model the latent trait distribution. This approach allows one to represent any asymmetric behaviour concerning the latent trait distribution. Also, they developed a Metropolis-Hastings within the Gibbs sampling (MHWGS) algorithm based on the density of the SNCP. They showed that the algorithm recovers all parameters properly. Their results indicated that, in the presence of asymmetry, the proposed model and the estimation algorithm perform better than the usual model and estimation methods. Our main goal in this paper is to propose another type of MHWGS algorithm based on a stochastic representation (hierarchical structure) of the SNCP studied in [N. Henze, A probabilistic representation of the skew-normal distribution, Scand. J. Statist. 13 (1986), pp. 271-275]. Our algorithm has only one Metropolis-Hastings step, in opposition to the algorithm developed by Azevedo et al., which has two such steps. This not only makes the implementation easier but also reduces the number of proposal densities to be used, which can be a problem in the implementation of MHWGS algorithms, as can be seen in [R.J. Patz and B.W. Junker, A straightforward approach to Markov Chain Monte Carlo methods for item response models, J. Educ. Behav. Stat. 24(2) (1999), pp. 146-178; R. J. Patz and B. W. Junker, The applications and extensions of MCMC in IRT: Multiple item types, missing data, and rated responses, J. Educ. Behav. Stat. 24(4) (1999), pp. 342-366; A. Gelman, G.O. Roberts, and W.R. Gilks, Efficient Metropolis jumping rules, Bayesian Stat. 5 (1996), pp. 599-607]. Moreover, we consider a modified beta prior (which generalizes the one considered in [3]) and a Jeffreys prior for the asymmetry parameter. Furthermore, we study the sensitivity of such priors as well as the use of different kernel densities for this parameter. Finally, we assess the impact of the number of examinees, number of items and the asymmetry level on the parameter recovery. Results of the simulation study indicated that our approach performed equally as well as that in [3], in terms of parameter recovery, mainly using the Jeffreys prior. Also, they indicated that the asymmetry level has the highest impact on parameter recovery, even though it is relatively small. A real data analysis is considered jointly with the development of model fitting assessment tools. The results are compared with the ones obtained by Azevedo et al. The results indicate that using the hierarchical approach allows us to implement MCMC algorithms more easily, it facilitates diagnosis of the convergence and also it can be very useful to fit more complex skew IRT models.

The Role of Molecular Conformation and Polarizable Embedding for One- and Two-Photon Absorption of Disperse Orange 3 in Solution

Solvent effects on the one- and two-photon absorption (IPA and 2PA) of disperse orange 3 (DO3) in dimethyl sulfoxide (DMSO) are studied using a discrete polarizable embedding (PE) response theory. The scheme comprises a quantum region containing the chromophore and an atomically granulated classical region for the solvent accounting for full interactions within and between the two regions. Either classical molecular dynamics (MD) or hybrid Car-Parrinello (CP) quantum/classical (QM/MM) molecular dynamics simulations are employed to describe the solvation of DO3 in DMSO, allowing for an analysis of the effect of the intermolecular short-range repulsion, long-range attraction, and electrostatic interactions on the conformational changes of the chromophore and also the effect of the solute-solvent polarization. PE linear response calculations are performed to verify the character, solvatochromic shift, and overlap of the two lowest energy transitions responsible for the linear absorption spectrum of DO3 in DMSO in the visible spectral region. Results of the PE linear and quadratic response calculations, performed using uncorrelated solute-solvent configurations sampled from either the classical or hybrid CP QM/MM MD simulations, are used to estimate the width of the line shape function of the two electronic lowest energy excited states, which allow a prediction of the 2PA cross-sections without the use of empirical parameters. Appropriate exchange-correlation functionals have been employed in order to describe the charge-transfer process following the electronic transitions of the chromophore in solution.

Psychometric properties of the Beck Depression Inventory-II: a comprehensive review

OBJECTIVE: To review the psychometric properties of the Beck Depression Inventory-II (BDI-II) as a self-report measure of depression in a variety of settings and populations. METHODS: Relevant studies of the BDI-II were retrieved through a search of electronic databases, a hand search, and contact with authors. Retained studies (k = 118) were allocated into three groups: non-clinical, psychiatric/institutionalized, and medical samples. RESULTS: The internal consistency was described as around 0.9 and the retest reliability ranged from 0.73 to 0.96. The correlation between BDI-II and the Beck Depression Inventory (BDI-I) was high and substantial overlap with measures of depression and anxiety was reported. The criterion-based validity showed good sensitivity and specificity for detecting depression in comparison to the adopted gold standard. However, the cutoff score to screen for depression varied according to the type of sample. Factor analysis showed a robust dimension of general depression composed by two constructs: cognitive-affective and somatic-vegetative. CONCLUSIONS: The BDI-II is a relevant psychometric instrument, showing high reliability, capacity to discriminate between depressed and non-depressed subjects, and improved concurrent, content, and structural validity. Based on available psychometric evidence, the BDI-II can be viewed as a cost-effective questionnaire for measuring the severity of depression, with broad applicability for research and clinical practice worldwide.

L'impiego del modello di Rash per la valutazione della soddisfazione del paziente nell'ambito delle strutture sanitarie di ricovero

Hospitals and health service providers are use to collect data about patient’s opinion to improve patient health status and communication with them and to upgrade the management and the organization of the health service provided. A lot of survey are carry out for this purpose and several questionnaire are built to measure patient satisfaction. In particular patient satisfaction is a way to describe and assess the level of hospital service from the patient’s point of view. It is a cognitive and an emotional response to the hospital experience. Methodologically patient satisfaction is defined as a multidimensional latent variable. To assess patient satisfaction Item Response Theory has greater advantages compared to Classical Test Theory. Rasch model is a one-parameter model which belongs to Item Response Theory. Rasch model yield objective measure of the construct that are independent of the set of people interviewed and of set of items used. Rasch estimates are continuous and can be useful to “calibrate” the scale of the latent trait. This research attempt to investigate the questionnaire currently adopted to measure patient satisfaction in an Italian hospital, completed by a large sample of 3390 patients. We verify the multidimensional nature of the variable, the properties of the instrument and the level of satisfaction in the hospital. Successively we used Rasch estimates to describe the most satisfied and the less satisfied patients.

A bayesian model for mixed responses and skew laten variable to measure HRQoL in children

The aim of the thesi is to formulate a suitable Item Response Theory (IRT) based model to measure HRQoL (as latent variable) using a mixed responses questionnaire and relaxing the hypothesis of normal distributed latent variable. The new model is a combination of two models already presented in literature, that is, a latent trait model for mixed responses and an IRT model for Skew Normal latent variable. It is developed in a Bayesian framework, a Markov chain Monte Carlo procedure is used to generate samples of the posterior distribution of the parameters of interest. The proposed model is test on a questionnaire composed by 5 discrete items and one continuous to measure HRQoL in children, the EQ-5D-Y questionnaire. A large sample of children collected in the schools was used. In comparison with a model for only discrete responses and a model for mixed responses and normal latent variable, the new model has better performances, in term of deviance information criterion (DIC), chain convergences times and precision of the estimates.

Femtosecond laser-based investigations of magnetic circular dichroism in near-threshold photoemission

During the last decades magnetic circular dichroism (MCD) has attracted much interest and evolved into various experimental methods for the investigation of magnetic thin films. For example, synchrotron-based X-ray magnetic circular dichroism (XMCD) displays the absolute values of spin and orbital magnetic moments. It thereby benefits from large asymmetry values of more than 30% due to the excitation of atomic core-levels. Similarly large values are also expected for threshold photoemission magnetic circular dichroism (TPMCD). Using lasers with photon energies in the range of the sample work function this method gives access to the occupied electronic structure close to the Fermi level. However, except for the case of Ni(001) there exist only few studies on TPMCD moreover revealing much smaller asymmetries than XMCD-measurements. Also the basic physical mechanisms of TPMCD are not satisfactorily understood. In this work we therefore investigate TPMCD in one- and two-photon photoemission (1PPE and 2PPE) for ferromagnetic Heusler alloys and ultrathin Co films using ultrashort pulsed laser light. The observed dichroism is explained by a non-conventional photoemission model using spin-resolved band-structure calculations and linear response theory. For the two Heusler alloys Ni2MnGa and Co2FeSi we give first evidence of TPMCD in the regime of two-photon photoemission. Systematic investigations concerning general properties of TPMCD in 1PPE and 2PPE are carried out at ultrathin Co films grown on Pt(111). Here, photon-energy dependent measurements reveal asymmetries of 1.9% in 1PPE and 11.7% in 2PPE. TPMCD measurements at decreased work function even yield larger asymmetries of 6.2% (1PPE) and 17% (2PPE), respectively. This demonstrates that enlarged asymmetries are also attainable for the TPMCD effect on Co(111). Furthermore, we find that the TPMCD asymmetry is bulk-sensitive for 1PPE and 2PPE. This means that the basic mechanism leading to the observed dichroism must be connected to Co bulk properties; surface effects do not play a crucial role. Finally, the enhanced TPMCD asymmetries in 2PPE compared to the 1PPE case are traced back to the dominant influence of the first excitation step and the existence of a real intermediate state. The observed TPMCD asymmetries cannot be interpreted by conventional photoemission theory which only considers direct interband transitions in the direction of observation (Γ-L). For Co(111), these transitions lead to evanescent final states. The excitation to such states, however, is incompatible with the measured bulk-sensitivity of the asymmetry. Therefore, we generalize this model by proposing the TPMCD signal to arise mostly from direct interband transitions in crystallographic directions other than (Γ-L). The necessary additional momentum transfer to the excited electrons is most probably provided by electron-phonon or -magnon scattering processes. Corresponding calculations on the basis of this model are in reasonable agreement with the experimental results so that this approach represents a promising tool for a quantitative description of the TPMCD effect. The present findings encourage an implementation of our experimental technique to time- and spatially-resolved photoemission electron microscopy, thereby enabling a real time imaging of magnetization dynamics of single excited states in a ferromagnetic material on a femtosecond timescale.

Electroelasticity of charged black branes

We present the first-order corrected dynamics of fluid branes carrying higher-form charge by obtaining the general form of their equations of motion to pole-dipole order in the absence of external forces. Assuming linear response theory, we characterize the corresponding effective theory of stationary bent charged (an)isotropic fluid branes in terms of two sets of response coefficients, the Young modulus and the piezoelectric moduli. We subsequently find large classes of examples in gravity of this effective theory, by constructing stationary strained charged black brane solutions to first order in a derivative expansion. Using solution generating techniques and bent neutral black branes as a seed solution, we obtain a class of charged black brane geometries carrying smeared Maxwell charge in Einstein-Maxwell-dilaton gravity. In the specific case of ten-dimensional space-time we furthermore use T-duality to generate bent black branes with higher-form charge, including smeared D-branes of type II string theory. By subsequently measuring the bending moment and the electric dipole moment which these geometries acquire due to the strain, we uncover that their form is captured by classical electroelasticity theory. In particular, we find that the Young modulus and the piezoelectric moduli of our strained charged black brane solutions are parameterized by a total of 4 response coefficients, both for the isotropic as well as anisotropic cases.

A quality of life subscale for terminally ill cancer patients

A subscale was developed to assess the quality of life of cancer patients with a life expectancy of six months or less. Phase I of this study identified the major concerns of 74 terminally ill cancer patients (19 with breast cancer, 19 with lung cancer, 18 with colorectal cancer, 9 with renal cell cancer, 9 with prostate cancer), 39 family caregivers, and 20 health care professionals. Patients interviewed were being treated at the University of Texas M. D. Anderson Cancer Center or at the Hospice at the Texas Medical Center in Houston. In Phase II, 120 patients (30 with breast cancer, 30 with lung cancer, 30 with colorectal cancer, 15 with prostate cancer, and 15 with renal cell cancer) rated the importance of these concerns for quality of life. Items retained for the subscale were rated as "extremely important" or "very important" by at least 60% of the sample and were reported as being applicable by at least two-thirds of the sample. The 61 concerns that were identified were formatted as a questionnaire for Phase III. In Phase III, 356 patients (89 with breast cancer, 88 with lung cancer, 88 with colorectal cancer, 44 with prostate cancer, and 47 with renal cell cancer) were interviewed to determine the subscale's reliability and sensitivity to change in clinical status. Both factor analysis and item response theory supported the inclusion of the same 35 items for the subscale. Internal consistency reliability was moderate to high for the subscale's domains: spiritual (0.87), existential (0.76), medical care (0.68), symptoms (0.67), social/family (0.66), and emotional (0.61). Test-retest correlation coefficients also were high for the domains: social/family (0.86), emotional (0.83), medical care (0.83), spiritual (0.75), existential (0.75), and symptoms (0.81).^ In addition, concurrent validity was supported by the high correlation between the subscale's symptom domain and symptom items from the European Organization for Research and Treatment of Cancer (EORTC) scale (r = 0.74). Patients' functional status was assessed with the Eastern Cooperative Oncology Group (ECOG) Performance status rating. When ECOG categories were compared to subscale domains, patients who scored lower in functional status had lower scores in the spiritual, existential, social/family, and emotional domains. Patients who scored lower in physical well-being had higher scores in the symptom domain. Patient scores in the medical care domain were similar for each ECOG category. The results of this study support the subscale's use in assessing quality of life and the outcomes of palliative treatment for cancer patients in their last six months of life. ^

Lessons from Ellen: A Case Study Investigation of Comprehension Strategy Instruction in Action

In the past ten years, reading comprehension instruction has received significant attention from educational researchers. Drawing on studies from cognitive psychology, reader response theory, and language arts research, current best practice in reading comprehension instruction is characterized by a strategies approach in which students are taught to think like proficient readers who visualize, infer, activate schema, question, and summarize as they read. Studies investigating the impact of comprehension strategy instruction on student achievement in reading suggest that when implemented consistently the intervention has a positive effect on achievement. Research also shows, however, that few teachers embrace this approach to reading instruction despite its effectiveness, even when the conditions for substantive professional development (i.e. prolonged engagement, support, resources, time) are present. The interpretive case study reported in this dissertation examined the year-long experience of one fourth grade teacher, Ellen, as she leanled about comprehension strategy instruction and attempted to integrate the approach in her reading program. The goal of the study was to extend current understanding of the factors that support or inhibit an individual teacher's instructional decision making. The research explored how Ellen's academic preparation, beliefs about reading comprehension instruction, and attitudes toward teacher-student interaction influenced her efforts to employ comprehension strategy instruction. Qualitative methods were the basis of this study's research design. The primary methods for collecting data included pre- and post-interviews, field notes from classroom observations and staff development sessions, infonnal interviews, e-mail correspondence, and artifacts such as reading assignments, professional writing, school newsletters, and photographs of the classroom. Transcripts from interviews, as well as field notes, e-mail, and artifacts, were analyzed according to grounded theory's constant-comparative method. The results of the study suggest that three factors were pivotal in Ellen's successful implementation of reading strategy instruction: Pedagogical beliefs, classroom relationships, and professional community. Research on instructional change generally focuses on issues of time, resources, feedback, and follow-through. The research reported here recognizes the importance of these components, but expands contemporary thinking by showing how, in Ellen's case, a teacher's existing theories, her relationship with her students, and her professional interaction with peers impact instructional decisions.

A Confirmatory Factor Analytic Study Examining the Dimensionality of Educational Achievement Tests

It is important to check the fundamental assumption of most popular Item Response Theory models, unidimensionality. However, it is hard for educational and psychological tests to be strictly unidimensional. The tests studied in this paper are from a standardized high-stake testing program. They feature potential multidimensionality by presenting various item types and item sets. Confirmatory factor analyses with one-factor and bifactor models, and based on both linear structural equation modeling approach and nonlinear IRT approach were conducted. The competing models were compared and the implications of the bifactor model for checking essential unidimensionality were discussed.

INTEGRATIVE BIOMARKER IDENTIFICATION AND CLASSIFICATION USING HIGH THROUGHPUT ASSAYS

It is well accepted that tumorigenesis is a multi-step procedure involving aberrant functioning of genes regulating cell proliferation, differentiation, apoptosis, genome stability, angiogenesis and motility. To obtain a full understanding of tumorigenesis, it is necessary to collect information on all aspects of cell activity. Recent advances in high throughput technologies allow biologists to generate massive amounts of data, more than might have been imagined decades ago. These advances have made it possible to launch comprehensive projects such as (TCGA) and (ICGC) which systematically characterize the molecular fingerprints of cancer cells using gene expression, methylation, copy number, microRNA and SNP microarrays as well as next generation sequencing assays interrogating somatic mutation, insertion, deletion, translocation and structural rearrangements. Given the massive amount of data, a major challenge is to integrate information from multiple sources and formulate testable hypotheses. This thesis focuses on developing methodologies for integrative analyses of genomic assays profiled on the same set of samples. We have developed several novel methods for integrative biomarker identification and cancer classification. We introduce a regression-based approach to identify biomarkers predictive to therapy response or survival by integrating multiple assays including gene expression, methylation and copy number data through penalized regression. To identify key cancer-specific genes accounting for multiple mechanisms of regulation, we have developed the integIRTy software that provides robust and reliable inferences about gene alteration by automatically adjusting for sample heterogeneity as well as technical artifacts using Item Response Theory. To cope with the increasing need for accurate cancer diagnosis and individualized therapy, we have developed a robust and powerful algorithm called SIBER to systematically identify bimodally expressed genes using next generation RNAseq data. We have shown that prediction models built from these bimodal genes have the same accuracy as models built from all genes. Further, prediction models with dichotomized gene expression measurements based on their bimodal shapes still perform well. The effectiveness of outcome prediction using discretized signals paves the road for more accurate and interpretable cancer classification by integrating signals from multiple sources.