The evidence-based development of an intervention to address the information needs of adults newly diagnosed with primary brain tumours and their carers

Adults diagnosed with primary brain tumours often experience physical, cognitive and neuropsychiatric impairments and decline in quality of life. Although disease and treatment-related information is commonly provided to cancer patients and carers, newly diagnosed brain tumour patients and their carers report unmet information needs. Few interventions have been designed or proven to address these information needs. Accordingly, a three-study research program, that incorporated both qualitative and quantitative research methods, was designed to: 1) identify and select an intervention to improve the provision of information, and meet the needs of patients with a brain tumour; 2) use an evidence-based approach to establish the content, language and format for the intervention; and 3) assess the acceptability of the intervention, and the feasibility of evaluation, with newly diagnosed brain tumour patients. Study 1: Structured concept mapping techniques were undertaken with 30 health professionals, who identified strategies or items for improving care, and rated each of 42 items for importance, feasibility, and the extent to which such care was provided. Participants also provided data to interpret the relationship between items, which were translated into ‘maps’ of relationships between information and other aspects of health care using multidimensional scaling and hierarchical cluster analysis. Results were discussed by participants in small groups and individual interviews to understand the ratings, and facilitators and barriers to implementation. A care coordinator was rated as the most important strategy by health professionals. Two items directly related to information provision were also seen as highly important: "information to enable the patient or carer to ask questions" and "for doctors to encourage patients to ask questions". Qualitative analyses revealed that information provision was individualised, depending on patients’ information needs and preferences, demographic variables and distress, the characteristics of health professionals who provide information, the relationship between the individual patient and health professional, and influenced by the fragmented nature of the health care system. Based on quantitative and qualitative findings, a brain tumour specific question prompt list (QPL) was chosen for development and feasibility testing. A QPL consists of a list of questions that patients and carers may want to ask their doctors. It is designed to encourage the asking of questions in the medical consultation, allowing patients to control the content, and amount of information provided by health professionals. Study 2: The initial structure and content of the brain tumour specific QPL developed was based upon thematic analyses of 1) patient materials for brain tumour patients, 2) QPLs designed for other patient populations, and 3) clinical practice guidelines for the psychosocial care of glioma patients. An iterative process of review and refinement of content was undertaken via telephone interviews with a convenience sample of 18 patients and/or carers. Successive drafts of QPLs were sent to patients and carers and changes made until no new topics or suggestions arose in four successive interviews (saturation). Once QPL content was established, readability analyses and redrafting were conducted to achieve a sixth-grade reading level. The draft QPL was also reviewed by eight health professionals, and shortened and modified based on their feedback. Professional design of the QPL was conducted and sent to patients and carers for further review. The final QPL contained questions in seven colour-coded sections: 1) diagnosis; 2) prognosis; 3) symptoms and problems; 4) treatment; 5) support; 6) after treatment finishes; and 7) the health professional team. Study 3: A feasibility study was conducted to determine the acceptability of the QPL and the appropriateness of methods, to inform a potential future randomised trial to evaluate its effectiveness. A pre-test post-test design was used with a nonrandomised control group. The control group was provided with ‘standard information’, the intervention group with ‘standard information’ plus the QPL. The primary outcome measure was acceptability of the QPL to participants. Twenty patients from four hospitals were recruited a median of 1 month (range 0-46 months) after diagnosis, and 17 completed baseline and follow-up interviews. Six participants would have preferred to receive the information booklet (standard information or QPL) at a different time, most commonly at diagnosis. Seven participants reported on the acceptability of the QPL: all said that the QPL was helpful, and that it contained questions that were useful to them; six said it made it easier to ask questions. Compared with control group participants’ ratings of ‘standard information’, QPL group participants’ views of the QPL were more positive; the QPL had been read more times, was less likely to be reported as ‘overwhelming’ to read, and was more likely to prompt participants to ask questions of their health professionals. The results from the three studies of this research program add to the body of literature on information provision for brain tumour patients. Together, these studies suggest that a QPL may be appropriate for the neuro-oncology setting and acceptable to patients. The QPL aims to assist patients to express their information needs, enabling health professionals to better provide the type and amount of information that patients need to prepare for treatment and the future. This may help health professionals meet the challenge of giving patients sufficient information, without providing ‘too much’ or ‘unnecessary’ information, or taking away hope. Future studies with rigorous designs are now needed to determine the effectiveness of the QPL.

Modified Information Criteria and Selection of Long Memory Time Series Models

The problem of model selection of a univariate long memory time series is investigated once a semi parametric estimator for the long memory parameter has been used. Standard information criteria are not consistent in this case. A Modified Information Criterion (MIC) that overcomes these difficulties is introduced and proofs that show its asymptotic validity are provided. The results are general and cover a wide range of short memory processes. Simulation evidence compares the new and existing methodologies and empirical applications in monthly inflation and daily realized volatility are presented.

It’s okay to ask : development and pilot testing of a question prompt list for patients with brain tumours

Background: Previous research identified that primary brain tumour patients have significant psychological morbidity and unmet needs, particularly the need for more information and support. However, the utility of strategies to improve information provision in this setting is unknown. This study involved the development and piloting of a brain tumour specific question prompt list (QPL). A QPL is a list of questions patients may find useful to ask their health professionals, and is designed to facilitate communication and information exchange. Methods: Thematic analysis of QPLs developed for other chronic diseases and brain tumour specific patient resources informed a draft QPL. Subsequent refinement of the QPL involved an iterative process of interviews and review with 12 recently diagnosed patients and six caregivers. Final revisions were made following readability analyses and review by health professionals. Piloting of the QPL is underway using a non-randomised control group trial with patients undergoing treatment for a primary brain tumour in Brisbane, Queensland. Following baseline interviews, consenting participants are provided with the QPL or standard information materials. Follow-up interviews four to 6 weeks later allow assessment of the acceptability of the QPL, how it is used by patients, impact on information needs, and feasibility of recruitment, implementation and outcome assessment. Results: The final QPL was determined to be readable at the sixth grade level. It contains seven sections: diagnosis, prognosis, symptoms and changes, the health professional team, support, treatment and management, and post-treatment concerns. At this time, fourteen participants have been recruited for the pilot, and data collection completed for eleven. Data collection and preliminary analysis are expected to be completed by and presented at the conference. Conclusions: If acceptable to participants, the QPL may encourage patients, doctors and nurses to communicate more effectively, reducing unmet information needs and ultimately improving psychological wellbeing.

A critical success factors model for enterprise resource planning implementation

Enterprise Resource Planning (ERP) systems are integrated enterprise-wide standard information systems that automate all aspects of an organisations’ business processes. The ERP philosophy is that business systems incorporating sales, marketing, manufacturing, distribution, personnel and finance modules can be supported by a single integrated system with all of the company’s data captured in a central database. The ERP packages of vendors such as SAP, Baan, J.D. Edwards and Intentia represent more than a common systems platform for a business. They prescribe information blueprints of how organisation’s business processes should operate. In this paper, the scale and strategic importance of ERP systems is identified and the problem of ERP implementation is defined. Five company examples are analysed using a Critical Success Factors (CSFs) theoretical framework. The paper offers a framework for managers which provides the basis for developing an ERP implementation strategy. The case analysis identifies different approaches to ERP implementation, highlights the critical role of legacy systems in influencing the implementation process, and identifies the importance of business process change and software configuration in addition to factors already cited in the literature such as top management support and communication. The implications of the results and future research opportunities are outlined.

Sistemas de informação ao público nos transportes públicos de passageiros: análise crítica

Dissertação para obtenção do grau de Mestre em Engenharia na Área de especialização em Vias de Comunicação e Transportes

Forecasting accuracy and estimation uncertainty using VAR models with short- and long-term economic restrictions: a Monte-Carlo study

Using vector autoregressive (VAR) models and Monte-Carlo simulation methods we investigate the potential gains for forecasting accuracy and estimation uncertainty of two commonly used restrictions arising from economic relationships. The Örst reduces parameter space by imposing long-term restrictions on the behavior of economic variables as discussed by the literature on cointegration, and the second reduces parameter space by imposing short-term restrictions as discussed by the literature on serial-correlation common features (SCCF). Our simulations cover three important issues on model building, estimation, and forecasting. First, we examine the performance of standard and modiÖed information criteria in choosing lag length for cointegrated VARs with SCCF restrictions. Second, we provide a comparison of forecasting accuracy of Ötted VARs when only cointegration restrictions are imposed and when cointegration and SCCF restrictions are jointly imposed. Third, we propose a new estimation algorithm where short- and long-term restrictions interact to estimate the cointegrating and the cofeature spaces respectively. We have three basic results. First, ignoring SCCF restrictions has a high cost in terms of model selection, because standard information criteria chooses too frequently inconsistent models, with too small a lag length. Criteria selecting lag and rank simultaneously have a superior performance in this case. Second, this translates into a superior forecasting performance of the restricted VECM over the VECM, with important improvements in forecasting accuracy ñreaching more than 100% in extreme cases. Third, the new algorithm proposed here fares very well in terms of parameter estimation, even when we consider the estimation of long-term parameters, opening up the discussion of joint estimation of short- and long-term parameters in VAR models.

Price discovery in dual-class shares across multiple markets

We extend the standard price discovery analysis to estimate the information share of dual-class shares across domestic and foreign markets. By examining both common and preferred shares, we aim to extract information not only about the fundamental value of the rm, but also about the dual-class premium. In particular, our interest lies on the price discovery mechanism regulating the prices of common and preferred shares in the BM&FBovespa as well as the prices of their ADR counterparts in the NYSE and in the Arca platform. However, in the presence of contemporaneous correlation between the innovations, the standard information share measure depends heavily on the ordering we attribute to prices in the system. To remain agnostic about which are the leading share class and market, one could for instance compute some weighted average information share across all possible orderings. This is extremely inconvenient given that we are dealing with 2 share prices in Brazil, 4 share prices in the US, plus the exchange rate (and hence over 5,000 permutations!). We thus develop a novel methodology to carry out price discovery analyses that does not impose any ex-ante assumption about which share class or trading platform conveys more information about shocks in the fundamental price. As such, our procedure yields a single measure of information share, which is invariant to the ordering of the variables in the system. Simulations of a simple market microstructure model show that our information share estimator works pretty well in practice. We then employ transactions data to study price discovery in two dual-class Brazilian stocks and their ADRs. We uncover two interesting ndings. First, the foreign market is at least as informative as the home market. Second, shocks in the dual-class premium entail a permanent e ect in normal times, but transitory in periods of nancial distress. We argue that the latter is consistent with the expropriation of preferred shareholders as a class.

Goals Software Construction Process

Generalized hyper competitiveness in the world markets has determined the need to offer better products to potential and actual clients in order to mark an advantagefrom other competitors. To ensure the production of an adequate product, enterprises need to work on the efficiency and efficacy of their business processes (BPs) by means of the construction of Interactive Information Systems (IISs, including Interactive Multimedia Documents) so that they are processed more fluidly and correctly.The construction of the correct IIS is a major task that can only be successful if the needs from every intervenient are taken into account. Their requirements must bedefined with precision, extensively analyzed and consequently the system must be accurately designed in order to minimize implementation problems so that the IIS isproduced on schedule and with the fewer mistakes as possible. The main contribution of this thesis is the proposal of Goals, a software (engineering) construction process which aims at defining the tasks to be carried out in order to develop software. This process defines the stakeholders, the artifacts, and the techniques that should be applied to achieve correctness of the IIS. Complementarily, this process suggests two methodologies to be applied in the initial phases of the lifecycle of the Software Engineering process: Process Use Cases for the phase of requirements, and; MultiGoals for the phases of analysis and design. Process Use Cases is a UML-based (Unified Modeling Language), goal-driven and use case oriented methodology for the definition of functional requirements. It uses an information oriented strategy in order to identify BPs while constructing the enterprise’s information structure, and finalizes with the identification of use cases within the design of these BPs. This approach provides a useful tool for both activities of Business Process Management and Software Engineering. MultiGoals is a UML-based, use case-driven and architectural centric methodology for the analysis and design of IISs with support for Multimedia. It proposes the analysis of user tasks as the basis of the design of the: (i) user interface; (ii) the system behaviour that is modeled by means of patterns which can combine Multimedia and standard information, and; (iii) the database and media contents. This thesis makes the theoretic presentation of these approaches accompanied with examples from a real project which provide the necessary support for the understanding of the used techniques.

Ocorrência de opacidade difusa em molares decíduos como fator preditivo no diagnóstico de fluorose dentária em dentes permanentes

Pós-graduação em Ciência Odontólogica - FOA

Recognizing and tagging temporal expressions in Spanish

This paper shows a system about the recognition of temporal expressions in Spanish and the resolution of their temporal reference. For the identification and recognition of temporal expressions we have based on a temporal expression grammar and for the resolution on an inference engine, where we have the information necessary to do the date operation based on the recognized expressions. For further information treatment, the output is proposed by means of XML tags in order to add standard information of the resolution obtained. Different kinds of annotation of temporal expressions are explained in another articles [WILSON2001][KATZ2001]. In the evaluation of our proposal we have obtained successful results.

The effects of emotional awareness training on teachers' ability to manage the emotions of preschool children: an experimental study

This article describes the process and results of a Randomized Controlled Trial (RCT) on teachers' ability to manage the emotions of preschool children during a constrained play activity. Thirty early childhood education teachers participated in the study. Half of the participants were taught strategies to enhance their own emotional competence. The control group was provided with standard information on child development. The experimental group was trained in active strategies on emotion coaching, emotional schemas, reflective practice focused on emotions, and mindfulness training. The teachers' outcomes were assessed in situ during a pretend play session with small groups of preschoolers. The dependent variables were observed occurrences of different components of emotional competence in teachers. Significant statistical differences were found between the two groups across the three different emotional competence skills (regulation, expression, and knowledge) demonstrated by the early childhood teachers during a game situation. This experimental study highlights the processes through which teachers support the emotional competence of young children, and the importance of the role of early childhood teachers' own emotional competence on the socialisation of children's emotions. Most importantly, it provides evidence, based on the influence of emotion-focused teacher-training and reflective practices, that teachers' emotional skills should be supported such that they can optimally meet the emotional needs of young children.

Morbilidade evitável relacionada com medicamentos: Desenvolvimento de novos indicadores e validação preliminar para cuidados primários em Portugal

Sumário: A morbilidade evitável relacionada com medicamentos (MERM) é um problema de saúde pública com considerável impacto negativo para os doentes e os sistemas de saúde. Os indicadores de MERM constituem medidas operacionais de gestão do risco terapêutico, uma vez que permitem identificar processos de cuidados de saúde que predizem um resultado clínico negativo potencialmente evitável. O uso destes indicadores pode contribuir para reduzir a morbilidade evitável relacionada com medicamentos, evitando danos desnecessários e desperdício de recursos. Objectivo: Desenvolver novos indicadores de MERM para cuidados primários em Portugal a partir da análise de resumos das características de medicamentos (RCM's) e determinar a validade preliminar de face e de conteúdo dos indicadores derivados para este setting. Métodos: A primeira fase deste estudo consistiu num ensaio piloto, com o intuito de testar uma metodologia de inclusão dos RCM's com base na frequência de dispensa da especialidade farmacêutica no ambulatório. Seguidamente procedeu-se ao desenvolvimento de mais indicadores de MERM utilizando a metodologia testada no ensaio piloto. Os indicadores obtidos foram alvo de uma primeira análise com base em aspectos como duplicações e relevância para cuidados primários, de modo a seleccionar os que poderiam passar à fase de validade preliminar de face e de conteúdo. Procedeu­ se então à pesquisa de evidência clínica em fontes de referência para estes indicadores. Na última fase do estudo estes indicadores, bem como a respectiva evidência clínica, foram analisados por um painel de peritos constituído por quatro académicos (dois médicos de família e dois farmacêuticos), sendo aprovados ou eliminados com base num critério de consenso. Resultados: Obteve-se um total de 64 indicadores de MERM, a partir da análise de 35 RCM's. Sujeitaram-se à determinação da validade preliminar de face e de conteúdo 44 indicadores. Foram aprovados por consenso 28 indicadores, tendo sido excluídos 17 (4 por consenso e 13 sem obtenção de consenso). Conclusão: É exequível derivar novos indicadores de MERM para cuidados primários a partir da análise de RCM's. A validade formal de face e de conteúdo destes indicadores obtidos será objecto de estudo de ulterior investigação. /ABSTRACT: Backgroud: Preventable drug-relate morbidity (PDRM) is a public health problem with significant negative impact at a patient and system level. PDRM indicators are operational measures of therapeutic risk management; they identifying processes of care leading to preventable adverse outcomes. The use of these indicators may contribute to tackle preventable drug related morbidity, avoiding unnecessary harm and waste of resources. Objective: To develop new PDRM indicators to Portuguese primary care based on the analysis of summaries of product characteristics (SPC’s) and to determine their preliminary face and content validity to this setting. Methods: Firstly a pilot study was conducted to test a methodology for including SPC's based on the most frequently sold medicines in the ambulatory. Then more indicators were developed using the previously tested methodology. The indicators obtained were analyzed in respect to aspects such as duplications and relevance for primary care to select those that could proceed to the next stage. Clinical evidence was searched for each of these indicators in gold-standard information sources. Finally, this set of indicators and the respective clinical evidence were analysised by a panel of four experts (two academic general practitioners and two academic pharmacists). Preliminary face and content validity was established by means of consensus. Results: A total of 64 indicators was obtained, based on the analysis of 35 SPCs. Forty­ four indicators were subjected to a preliminary assessment of face and content validity, resulting in 28 consensus-approved indicators. Seventeen indicators were excluded (4 rejected by consensus and 13 that did not reach consensus). Conclusion: lt is feasible to derive new PDRM indicators for primary care based on SPC's. The formal face and content validity of the indicators will be determined in a further study.

Verification Of The Standard Vector Data Model For Interoperability Of River-Geospatial Information

Recently, two international standard organizations, ISO and OGC, have done the work of standardization for GIS. Current standardization work for providing interoperability among GIS DB focuses on the design of open interfaces. But, this work has not considered procedures and methods for designing river geospatial data. Eventually, river geospatial data has its own model. When we share the data by open interface among heterogeneous GIS DB, differences between models result in the loss of information. In this study a plan was suggested both to respond to these changes in the information envirnment and to provide a future Smart River-based river information service by understanding the current state of river geospatial data model, improving, redesigning the database. Therefore, primary and foreign key, which can distinguish attribute information and entity linkages, were redefined to increase the usability. Database construction of attribute information and entity relationship diagram have been newly redefined to redesign linkages among tables from the perspective of a river standard database. In addition, this study was undertaken to expand the current supplier-oriented operating system to a demand-oriented operating system by establishing an efficient management of river-related information and a utilization system, capable of adapting to the changes of a river management paradigm.

Information access law and disclosing of information by joint-stock companies in Brazil: open data and Extensible Business Reporting Language (XBRL) standard

The strategic management of information plays a fundamental role in the organizational management process since the decision-making process depend on the need for survival in a highly competitive market. Companies are constantly concerned about information transparency and good practices of corporate governance (CG) which, in turn, directs relations between the controlling power of the company and investors. In this context, this article presents the relationship between the disclosing of information of joint-stock companies by means of using XBRL, the open data model adopted by the Brazilian government, a model that boosted the publication of Information Access Law (Lei de Acesso à Informação), nº 12,527 of 18 November 2011. Information access should be permeated by a mediation policy in order to subsidize the knowledge construction and decision-making of investors. The XBRL is the main model for the publishing of financial information. The use of XBRL by means of new semantic standard created for Linked Data, strengthens the information dissemination, as well as creates analysis mechanisms and cross-referencing of data with different open databases available on the Internet, providing added value to the data/information accessed by civil society.