870 resultados para Confusion Assessment Method


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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Efficient implementation of recycling networks requires appropriate logistical structures for managing the reverse flow of materials from users to producers. The steel sheet distributor studied had established a protocol for scrap recovery with the steel plant and its customers. The company invested in producing containers, hiring a specialized labor force and in purchasing trucks for container transportation to implement the logistics network for recycling. That network interconnected the company with two kinds of customers: the ones returning scrap and the ones who preferred to continue business-as-usual. The logistical network was analyzed using emergy synthesis, and the data obtained were used to evaluate and compare the system's environmental costs and benefits from the perspective of the distributor and the steel plant operator. The use of emergy ternary diagrams provided a way to assess recycle strategies to compare the relative economic and environmental benefits of the logistical network implemented. The minimum quantity of scrap that the distributor must recover to improve environmental benefits was determined allowing decision on whether it is worth keeping the system running. The new assessment method proposed also may help policy-makers to create strategies to reward or incentive users of reverse logistics, and help to establish regulations, by decreasing taxes or stimulating innovation, for effectively implement the National Policy on Solid Waste. (C) 2013 Elsevier Ltd. All rights reserved.

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OBJECTIVE: Differentiation between benign and malignant ovarian neoplasms is essential for creating a system for patient referrals. Therefore, the contributions of the tumor markers CA125 and human epididymis protein 4 (HE4) as well as the risk ovarian malignancy algorithm (ROMA) and risk malignancy index (RMI) values were considered individually and in combination to evaluate their utility for establishing this type of patient referral system. METHODS: Patients who had been diagnosed with ovarian masses through imaging analyses (n = 128) were assessed for their expression of the tumor markers CA125 and HE4. The ROMA and RMI values were also determined. The sensitivity and specificity of each parameter were calculated using receiver operating characteristic curves according to the area under the curve (AUC) for each method. RESULTS: The sensitivities associated with the ability of CA125, HE4, ROMA, or RMI to distinguish between malignant versus benign ovarian masses were 70.4%, 79.6%, 74.1%, and 63%, respectively. Among carcinomas, the sensitivities of CA125, HE4, ROMA (pre-and post-menopausal), and RMI were 93.5%, 87.1%, 80%, 95.2%, and 87.1%, respectively. The most accurate numerical values were obtained with RMI, although the four parameters were shown to be statistically equivalent. CONCLUSION: There were no differences in accuracy between CA125, HE4, ROMA, and RMI for differentiating between types of ovarian masses. RMI had the lowest sensitivity but was the most numerically accurate method. HE4 demonstrated the best overall sensitivity for the evaluation of malignant ovarian tumors and the differential diagnosis of endometriosis. All of the parameters demonstrated increased sensitivity when tumors with low malignancy potential were considered low-risk, which may be used as an acceptable assessment method for referring patients to reference centers.

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Background and objective: Field exercise tests have been increasingly used for pulmonary risk assessment. The 6-min walking distance (6MWD) is a field test commonly employed in clinical practice; however, there is limited evidence supporting its use as a risk assessment method in abdominal surgery. The aim was to assess if the 6MWD can predict the development of post-operative pulmonary complications (PPCs) in patients having upper abdominal surgery (UAS). Methods: This prospective cohort study included 137 consecutive subjects undergoing elective UAS. Subjects performed the 6MWD on the day prior to surgery, and their performance were compared with predicted values of 6MWD (p6MWD) using a previously validated formula. PPCs (including pneumonia, tracheobronchitis, atelectasis with clinical repercussions, bronchospasm and acute respiratory failure) were assessed daily by a pulmonologist blinded to the 6MWD results. 6MWD and p6MWD were compared between subjects who developed PPC (PPC group) and those who did not (no PPC group) using Student's t-test. Results: Ten subjects experienced PPC (7.2%) and no significant difference was observed between the 6MWD obtained in the PPC group and no PPC group (466.0 +/- 97.0 m vs 485.3 +/- 107.1 m; P = 0.57, respectively). There was also no significant difference observed between groups for the p6MWD (100.7 +/- 29.1% vs 90.6 -/+ 20.9%; P > 0.05). Conclusions: The results of the present study suggest that the 6-min walking test is not a useful tool to identify subjects with increased risk of developing PPC following UAS.

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Transportation planning is currently being confronted with a broader planning view, which is given by the concept of mobility. The Index of Sustainable Urban Mobility (I_SUM) is among the tools developed for supporting this new concept implementation. It is a tool to assess the current mobility conditions of any city, which can also be applied for policy formulation. This study focus on the application of I_SUM in the city of Curitiba, Brazil. Considering that the city is known worldwide as a reference of successful urban and transportation planning, the index application must confirm it. An additional objective of the study was to evaluate the index itself, or the subjacent assessment method and reference values. A global I_SUM value of 0.747 confirmed that the city has indeed very positive characteristics regarding sustainable mobility policies. However, some deficiencies were also detected, particularly with respect to non-motorized transport modes. The application has also served to show that a few I_SUM indicators were not able to capture some of the positive aspects of the city, what may suggest the need of changes in their formulation. Finally, the index application in parts of the city suggests that the city provides fair and equitable mobility conditions to all citizens throughout the city. This is certainly a good attribute for becoming a benchmark of sustainable mobility, even if it is not yet the ideal model. (C) 2012 Elsevier Ltd. All rights reserved.

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[ES]El presente artículo de investigación tiene como objetivo principal evaluar cómo el uso de los textos musicales –canciones, como popularmente se conocen– influye en el aprendizaje del inglés como lengua extranjera. Una investigación llevada a cabo con estudiantes de una clase de 2º de ESO nos ha servido para confirmar las hipótesis que en un principio teníamos en lo concerniente a la adquisición de las ocho competencias básicas mediante tareas en las clases de lengua inglesa. Así, el diseño de rúbricas con unos criterios e instrumentos de evaluación específicos nos ha permitido evaluar el grado de adquisición de competencias básicas concretas. [EN]This paper focuses on the impact that the use of music texts –commonly referred to with the term ‘songs’– has on students in teaching English as a foreign language. Through a survey carried out with students of a 2nd year class of Spanish Secondary Education, our initial assumptions in terms of acquisition of key competences in English learning were validated. in acquiring specific key competences by using tasks, rubrics –consisting of detailed assessment criteria and tools– were designed and implemented as the assessment method in order for students to successfully attain specific learning objectives.

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Bei einer Risikoabschätzung bezüglich einer Gefährdung des Schutzgutes Grundwasser müssen alle relevanten Transportpfade, auf denen Schadstoffe durch die Bodenzone bis ins Grundwasser verlagert werden, identifiziert und quantifiziert werden. Die Verlagerung von Schadstoffen gebunden an mobile Partikel im Sickerwasser wird dabei oft vernachlässigt. In dieser Arbeit wurden sowohl experimentelle Untersuchungen zum Partikeltransport in der Bodenzone als auch Szenarienmodellierungen hinsichtlich der Wechselwirkung Partikel/Schadstoff durchgeführt. Die experimentellen ungesättigten Säulenversuche wurden unter naturnahen stationären und instationären hydraulischen und hydrochemischen Bedingungen durchgeführt. Dabei wurde der Einfluss der Parameter Durchmesser Bodenmatrix, Partikelgröße, Beregnungsintensität, Oberflächenspannung und Hydrochemie auf den Transport von natürlichen und synthetischen Partikeln untersucht. Des Weiteren wurden Untersuchungen zur partikelgebundenen Verlagerung von Phenanthren durchgeführt. In einer numerischen Szenarienmodellierung mit dem Modell SMART wurde untersucht, unter welchen Randbedingungen der Transport von Partikeln gleichzeitig zu signifikanten partikelgebundenen Schadstoffkonzentrationen im Grundwasser führt. Dabei wurden die Parameter Lithologie Partikel/Boden, Hydrophobizität Schadstoff, Partikelkonzentration, Partikeldurchmesser sowie Körnung Bodenmatrix variiert. Die Ergebnisse dieser Arbeit zeigen, dass der partikelgebundene Schadstofftransportpfad in der ungesättigten Bodenzone in verschiedenen Szenarien den Anteil mobiler Schadstoffe, die mit dem Sickerwasser ins Grundwasser gelangen, signifikant erhöht. Auf Basis der experimentellen und theoretischen Untersuchungen wurde ein zweistufiges Bewertungsschema entwickelt, das bereits im Vorfeld einer Risikoabschätzung als Entscheidungshilfe hinsichtlich der Relevanz einer Mobilisierung, eines Transports und des Rückhalts von partikelgebundenen Schadstoffen in der ungesättigten Zone dient.

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What's known on the subject? and What does the study add? One area of particular growth for robotic surgery has been partial nephrectomy. Despite a perceived notion that robotic-assisted partial nephrectomy is more easily adaptable compared to laparoscopic partial nephrectomy, there is nonetheless an associated learning curve. Validated training models with a corresponding assessment method for robotic-assisted partial nephrectomy were previously unavailable. We have designed and validated a RAPN surgical model appropriate for resident and fellow training.

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The increasing deployment of mobile communication base stations led to an increasing demand for epidemiological studies on possible health effects of radio frequency emissions. The methodological challenges of such studies have been critically evaluated by a panel of scientists in the fields of radiofrequency engineering/dosimetry and epidemiology. Strengths and weaknesses of previous studies have been identified. Dosimetric concepts and crucial aspects in exposure assessment were evaluated in terms of epidemiological studies on different types of outcomes. We conclude that in principle base station epidemiological studies are feasible. However, the exposure contributions from all relevant radio frequency sources have to be taken into account. The applied exposure assessment method should be piloted and validated. Short to medium term effects on physiology or health related quality of life are best investigated by cohort studies. For long term effects, groups with a potential for high exposure need to first be identified; for immediate effect, human laboratory studies are the preferred approach.

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CONCLUSION: Our self-developed planning and navigation system has proven its capacity for accurate surgery on the anterior and lateral skull base. With the incorporation of augmented reality, image-guided surgery will evolve into 'information-guided surgery'. OBJECTIVE: Microscopic or endoscopic skull base surgery is technically demanding and its outcome has a great impact on a patient's quality of life. The goal of the project was aimed at developing and evaluating enabling navigation surgery tools for simulation, planning, training, education, and performance. This clinically applied technological research was complemented by a series of patients (n=406) who were treated by anterior and lateral skull base procedures between 1997 and 2006. MATERIALS AND METHODS: Optical tracking technology was used for positional sensing of instruments. A newly designed dynamic reference base with specific registration techniques using fine needle pointer or ultrasound enables the surgeon to work with a target error of < 1 mm. An automatic registration assessment method, which provides the user with a color-coded fused representation of CT and MR images, indicates to the surgeon the location and extent of registration (in)accuracy. Integration of a small tracker camera mounted directly on the microscope permits an advantageous ergonomic way of working in the operating room. Additionally, guidance information (augmented reality) from multimodal datasets (CT, MRI, angiography) can be overlaid directly onto the surgical microscope view. The virtual simulator as a training tool in endonasal and otological skull base surgery provides an understanding of the anatomy as well as preoperative practice using real patient data. RESULTS: Using our navigation system, no major complications occurred in spite of the fact that the series included difficult skull base procedures. An improved quality in the surgical outcome was identified compared with our control group without navigation and compared with the literature. The surgical time consumption was reduced and more minimally invasive approaches were possible. According to the participants' questionnaires, the educational effect of the virtual simulator in our residency program received a high ranking.

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INTRODUCTION Herbal and dietary supplements are widely used as measures to improve and preserve health and well-being. Among the bestselling preparations are dietary supplement containing glucosamine and chondroitine sulfate taken to improve symptoms of osteoarthritis. METHODS AND RESULTS We here present a case of a male patient with biopsy-proven acute and severe autoimmune hepatitis subsequent to intake of a preparation containing glucosamine and chondroitine sulfate. Response to steroids was favorable and resulted in complete remission of the patient. Diagnostic work-up of the case revealed no other possible cause of liver injury, and causality assessment using the Roussel Uclaf Causality Assessment Method (RUCAM) resulted in a possible causal relationship between intake of glucosamine and chondroitine sulfate and the adverse hepatic reaction. CONCLUSION The present case recalls that products containing glucosamine and chondroitine sulfate can occasionally cause acute liver injury mimicking autoimmune hepatitis, and reminds of the potential dangers of compounds with poor efficacy and ill-defined safety records.

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The basis of personalized medicine in oncology is the prediction of an individual's risk of relapse and death from disease. The presence of tumor budding (TB) at the tumor-host interface of gastrointestinal cancers has been recognized as a hallmark of unfavorable disease biology. TB is defined as the presence of dedifferentiated cells or small clusters of up to five cells at the tumor invasive front and can be observed in aggressive carcinomas of the esophagus, stomach, pancreas, ampulla, colon, and rectum. Presence of TB reproducibly correlates with advanced tumor stage, frequent lymphovascular invasion, nodal, and distant metastasis. The UICC has officially recognized TB as additional independent prognostic factor in cancers of the colon and rectum. Recent studies have also characterized TB as a promising prognostic indicator for clinical management of esophageal squamous cell carcinoma, adenocarcinoma of the gastro-esophageal junction, and gastric adenocarcinoma. However, several important issues have to be addressed for application in daily diagnostic practice: (1) validation of prognostic scoring systems for TB in large, multi-center studies, (2) consensus on the optimal assessment method, and (3) inter-observer reproducibility. This review provides a comprehensive analysis of TB in cancers of the upper gastrointestinal tract including critical appraisal of perspectives for further study.

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El aumento del número de alumnos en la carrera de Ingeniería Agronómica de la Facultad de Ciencias Agrarias, UNCuyo, al no estar acompañado por un incremento en la cantidad de docentes, puso en crisis el método de mensuración de conocimientos de los alumnos que era practicado con excelentes resultados a través de la clásica evaluación oral individual. Por ello hubo que reemplazar este método por otro, que manteniendo la calidad de la mensuración, requiriera menos tiempo y docentes por alumno evaluado. A diferencia de otras asignaturas que sustituyeron el sistema tradicional por una evaluación escrita, la asignatura Meteorología Agrícola optó por un sistema mixto constituido por cinco evaluaciones individuales escritas sobre objetivos parciales durante el curso, más una evaluación final integradora. Debido al carácter integrador de esta evaluación final, se decidió realizarla oralmente y para hacerla posible con el tiempo y número de docentes disponibles, se evalúan simultáneamente los conocimientos de cinco alumnos, siendo la calificación individual para cada alumno. Para analizar los resultados de ambos métodos, se realizó: a. la comparación de las frecuencias de notas de evaluaciones orales individuales (antiguo método) y de evaluaciones orales grupales (nuevo método), con un coeficiente de correlación de 0.64 b. la comparación de la nota obtenida por cada alumno con su nota promedio en la carrera, con un coeficiente de correlación de 0.50 c. encuestas a docentes y alumnos. Los resultados obtenidos permiten afirmar que la evaluación oral grupal constituye una forma idónea para evaluar el grado de integración de conocimientos en Meteorología Agrícola

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La Provincia de Río Negro, a través de su Constitución y de leyes específicas, adhiere “a los principios que sustentan el desarrollo sustentable de conformidad con la Carta de Naciones Unidas." En la costa marítima de Río Negro existen poblaciones relativamente densas y en aumento básicamente por la inmigración en busca de nuevos horizontes laborales. Los conflictos ambientales que se presentan son comunes a otras zonas costeras: contaminación de las aguas costeras por insuficiente o falta de servicios de tratamiento de aguas residuales, modificación, para desarrollo urbano, industrial y comercial, de hábitats críticos para el sostenimiento de pesquerías, vida silvestre, desarrollo de infraestructura costera inapropiada o mal diseñada que favorece procesos erosivos acelerados y/o interrumpen procesos ecológicos básicos, ocupación espacial desordenada que impide el acceso público a playas y otros terrenos públicos, manejo inapropiado de desechos sólidos, incumplimiento de la legislación en la zona costera; generación de conflictos intersectoriales, desarrollo desordenado de infraestructura con altos costos socioeconómicos, crecimiento de la frontera agropecuaria, deterioro de los suelos (sobrepastoreo, desertificación), introducción de especies exóticas, etc. En Río Negro se han relevado, aunque a diferente escala y muchas veces en forma discontinua, la mayor parte de los ambientes costeros considerados de mayor interés desde el punto de vista ecológico y/o productivo. Ejemplo de productos de estos estudios son las Areas Naturales Protegidas de Punta Bermeja, Caleta de Loros, Bahía de San Antonio, Complejo Islote Lobos y Puerto Lobos, así como la Reserva Pesquera Golfo San Matías. Sin embargo, la información se halla dispersa, por lo que la mayor parte de las veces no se puede contar con un panorama actualizado y globalizador que permita la toma de decisión en forma ágil y un real manejo de las especies y/o de su ambiente. Por ello se considera necesario g enerar un Plan de Manejo de la Costa Marítima de Río Negro, esto es, una clasificación del territorio de acuerdo a su grado de sensibilidad ecológica, expresado en unidades cartográficas ambientales, y estableciendo pautas de manejo para las mismas. Se optó por un Sistema de Inventario y Planificación de Recursos, adaptado a un método de Planificación Participativa en el que se involucra en forma directa, a través de encuentros y talleres, a los diferentes estamentos provinciales, municipales, centros de investigación, organizaciones no gubernamentales ambientalistas, organizaciones intermedias, especialistas. Para la Evaluación de los Elementos e identificación de Zonas de Mayor Sensibilidad Ecológica se utilizó un Método de Evaluación de Riesgos que permite cartografiar grado de Amenazas, Vulnerabilidad y Riesgo.