Assessment of needs, health-related quality of life, and satisfaction with care in breast cancer patients to better target supportive care.

BACKGROUND: This study assessed whether breast cancer (BC) patients express similar levels of needs for equivalent severity of symptoms, functioning difficulties, or degrees of satisfaction with care aspects. BC patients who did (or not) report needs in spite of similar difficulties were identified among their sociodemographic or clinical characteristics. PATIENTS AND METHODS: Three hundred and eighty-four (73% response rate) BC patients recruited in ambulatory or surgery hospital services completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ)-C30 quality of life [health-related quality of life (HRQOL)], the EORTC IN-PATSAT32 (in-patient) or OUT-PATSAT35 (out-patient) satisfaction with care, and the supportive care needs survey short form 34-item (SCNS-SF34) measures. RESULTS: HRQOL or satisfaction with care scale scores explained 41%, 45%, 40% and 22% of variance in, respectively, psychological, physical/daily living needs, information/health system, and care/support needs (P < 0.001). BC patients' education level, having children, hospital service attendance, and anxiety/depression levels significantly predicted differences in psychological needs relative to corresponding difficulties (adjusted R(2) = 0.11). Medical history and anxiety/depression levels significantly predicted differences in information/health system needs relative to degrees of satisfaction with doctors, nurses, or radiotherapy technicians and general satisfaction (adjusted R(2) = 0.12). Unmet needs were most prevalent in the psychological domains across hospital services. CONCLUSIONS: Assessment of needs, HRQOL, and satisfaction with care highlights the subgroups of BC patients requiring better supportive care targeting.

Aspectos e fatores da produtividade em pesquisa, desenvolvimento e inova����o

Comparison of national budgets for R&D is often made but it should consider the relative productivity and their factors. In Brazil, inefficiency factors as well as their causes have been diagnosed since the late 60's and solutions have been proposed within various governmental organisms, from CNPq to the strategy think tanks. Problems that hinder R&D and innovation in Brazil are reviewed from a historical perspective together with the proposed solutions providing a detailed analysis of the difficulties that have to be overcome to achieve a more effective innovation environment, adequate for the present times, challenges and opportunities.

Perception of difficulties with vision-related activities of daily living among patients undergoing unilateral posterior capsulotomy

OBJECTIVES: To assess the influence of Nd:YAG (neodymium: yttrium-aluminum- garnet) laser unilateral posterior capsulotomy on visual acuity and patients' perception of difficulties with vision-related activities of daily life. METHODS: We conducted an interventional survey that included 48 patients between 40 and 80 years of age with uni- or bilateral pseudophakia, posterior capsule opacification, and visual acuity <0.30 (logMAR) in one eye who were seen at a Brazilian university hospital. All patients underwent posterior capsulotomy using an Nd:YAG laser. Before and after the intervention, patients were asked to complete a questionnaire that was developed in an exploratory study. RESULTS: Before posterior capsulotomy, the median visual acuity (logMAR) of the included patients was 0.52 (range 0.30-1.60). After posterior capsulotomy, the median visual acuity of the included patients improved to 0.10 (range 0.0-0.52). According to the subjects' perceptions, their ability to perform most of their daily life activities improved after the intervention (p<0.05). CONCLUSIONS: After patients underwent posterior capsulotomy with an Nd:YAG laser, a significant improvement in the visual acuity of the treated eye was observed. Additionally, subjects felt that they experienced less difficulty performing most of their vision-dependent activities of daily living.

Application of Gage R&R methodology for improving the training and evaluation of automatic optical inspection machine operators

The current level of demand by customers in the electronics industry requires the production of parts with an extremely high level of reliability and quality to ensure complete confidence on the end customer. Automatic Optical Inspection (AOI) machines have an important role in the monitoring and detection of errors during the manufacturing process for printed circuit boards. These machines present images of products with probable assembly mistakes to an operator and him decide whether the product has a real defect or if in turn this was an automated false detection. Operator training is an important aspect for obtaining a lower rate of evaluation failure by the operator and consequently a lower rate of actual defects that slip through to the following processes. The Gage R&R methodology for attributes is part of a Six Sigma strategy to examine the repeatability and reproducibility of an evaluation system, thus giving important feedback on the suitability of each operator in classifying defects. This methodology was already applied in several industry sectors and services at different processes, with excellent results in the evaluation of subjective parameters. An application for training operators of AOI machines was developed, in order to be able to check their fitness and improve future evaluation performance. This application will provide a better understanding of the specific training needs for each operator, and also to accompany the evolution of the training program for new components which in turn present additional new difficulties for the operator evaluation. The use of this application will contribute to reduce the number of defects misclassified by the operators that are passed on to the following steps in the productive process. This defect reduction will also contribute to the continuous improvement of the operator evaluation performance, which is seen as a quality management goal.

O Contributo do sistema SAP R/3 no controlo interno na REFER

Disserta����o apresentada ao Instituto Superior de Contabilidade para a obten����o do Grau de Mestre em Auditoria Orientador: Mestre Agostinho Sousa Pinto

Assessing the assignation of public subsidies: Do the experts choose the most efficient R&D projects?

The implementation of public programs to support business R&D projects requires the establishment of a selection process. This selection process faces various difficulties, which include the measurement of the impact of the R&D projects as well as selection process optimization among projects with multiple, and sometimes incomparable, performance indicators. To this end, public agencies generally use the peer review method, which, while presenting some advantages, also demonstrates significant drawbacks. Private firms, on the other hand, tend toward more quantitative methods, such as Data Envelopment Analysis (DEA), in their pursuit of R&D investment optimization. In this paper, the performance of a public agency peer review method of project selection is compared with an alternative DEA method.

Difficulties associated with out-patient management of drug abusers by general practitioners. A cross sectional survey of general practitioners with and without methadone patients in Switzerland

R��sum�� de l'article Contexte : En Suisse, les m��decins de premier recours traitent la plupart des patients d��pendants aux opiac��s m��thadone en tant que traitement de substitution. M��thode : Nous avons ��tudi�� les difficult��s rencontr��es dans la prise en charge des patients toxicod��pendants en envoyant par poste un questionnaire d'enqu��te. Nous avons envoy�� ce questionnaire �� tous les m��decins de premier recours de Suisse Romande prescrivant de la m��thadone (556 m��decins). Nous avons envoy�� un autre questionnaire, plus court, �� des m��decins de premier recours du Canton de Vaud qui ne prescrivent pas de m��thadone. R��sultats : le taux de r��ponse global est de 63,3 %. La plus haute dose de m��thadone donn��e par les m��decins de premier recours est de 120,4 mg/j (moyenne). Questionn��s au sujet de l'aide qu'ils d��sireraient recevoir face �� ces patients, les m��decins de premier recours avec patients substitu��s par m��thadone ont mentionn�� premi��rement l'importance d'un meilleur remboursement des services prodigu��s. Les autres ��l��ments demand��s ont ��t�� une meilleure formation, de meilleures connaissances des pathologies psychiatriques et des groupes de discussion de cas cliniques. Les m��decins sans patients sous m��thadone refusent de traiter ces patients surtout pour des raisons ��motionnelles et relationnelles. En conclusion : les m��decins acceptant des patients sous m��thadone rencontrent des difficult��s relationnelles et ��motionnelles. Ils d��sirent un meilleur remboursement pour les services prodigu��s.

Assessing the assignation of public subsidies: Do the experts choose the most efficient R and D projects?

[spa] La implementaci��n de un programa de subvenciones p��blicas a proyectos empresariales de I+D comporta establecer un sistema de selecci��n de proyectos. Esta selecci��n se enfrenta a problemas relevantes, como son la medici��n del posible rendimiento de los proyectos de I+D y la optimizaci��n del proceso de selecci��n entre proyectos con m��ltiples y a veces incomparables medidas de resultados. Las agencias p��blicas utilizan mayoritariamente el m��todo peer review que, aunque presenta ventajas, no est�� exento de cr��ticas. En cambio, las empresas privadas con el objetivo de optimizar su inversi��n en I+D utilizan m��todos m��s cuantitativos, como el Data Envelopment An��lisis (DEA). En este trabajo se compara la actuaci��n de los evaluadores de una agencia p��blica (peer review) con una metodolog��a alternativa de selecci��n de proyectos como es el DEA.

Assessing the assignation of public subsidies: Do the experts choose the most efficient R and D projects?

[spa] La implementaci��n de un programa de subvenciones p��blicas a proyectos empresariales de I+D comporta establecer un sistema de selecci��n de proyectos. Esta selecci��n se enfrenta a problemas relevantes, como son la medici��n del posible rendimiento de los proyectos de I+D y la optimizaci��n del proceso de selecci��n entre proyectos con m��ltiples y a veces incomparables medidas de resultados. Las agencias p��blicas utilizan mayoritariamente el m��todo peer review que, aunque presenta ventajas, no est�� exento de cr��ticas. En cambio, las empresas privadas con el objetivo de optimizar su inversi��n en I+D utilizan m��todos m��s cuantitativos, como el Data Envelopment An��lisis (DEA). En este trabajo se compara la actuaci��n de los evaluadores de una agencia p��blica (peer review) con una metodolog��a alternativa de selecci��n de proyectos como es el DEA.

Assessing the assignation of public subsidies: Do the experts choose the most efficient R and D projects?

[spa] La implementaci��n de un programa de subvenciones p��blicas a proyectos empresariales de I+D comporta establecer un sistema de selecci��n de proyectos. Esta selecci��n se enfrenta a problemas relevantes, como son la medici��n del posible rendimiento de los proyectos de I+D y la optimizaci��n del proceso de selecci��n entre proyectos con m��ltiples y a veces incomparables medidas de resultados. Las agencias p��blicas utilizan mayoritariamente el m��todo peer review que, aunque presenta ventajas, no est�� exento de cr��ticas. En cambio, las empresas privadas con el objetivo de optimizar su inversi��n en I+D utilizan m��todos m��s cuantitativos, como el Data Envelopment An��lisis (DEA). En este trabajo se compara la actuaci��n de los evaluadores de una agencia p��blica (peer review) con una metodolog��a alternativa de selecci��n de proyectos como es el DEA.

The Strengths and Difficulties Questionnaire (SDQ-Fin) among Finnish children and adolescents

Objective: The psychometric properties of The Strengths and Difficulties Questionnaire (SDQ-Fin), a Finnish version of a brief screening instrument were studied. Emotional and behavioural problems of 7- to 15-year-olds measured by the SDQ were reported, as well as the occurrence of self-reported eating disturbance symptoms and alcohol use among adolescents. Methods and samples: The cross-sectional school survey included 25 items of the SDQ-Fin, items about eating disturbance, alchol use and child psychiatric help-seeking. The study consists of three community samples: 1. The SDQ-Fin parent (n = 703) and teacher (n = 376) versions of 7 ��� 12 ���year-olds, and self-report versions (n = 528) of 11 ��� 16 years-olds were obtained, and 2. the parent (n = 81) and self-report versions of 15-16 ���year olds (n = 129) were obtained in Laitila and Pyh��ranta. 3. The self-report versions of 13 ��� 16 ��� year-olds (n = 1458) in Salo and Rovaniemi were obtained. Results: The psychometric properties of the SDQ-Fin were for the most part comparable with the other European SDQ research results. The internal consistency (Cronbach���s alpha = 0.71 in all informants��� reports) and inter-rater reliability (between the pairs of reports r = 0.38 - 0.44) were adequate. The concurrent validity (r = 0.75 between the SDQ and the CBCL total scores; r = 0.71 between the SDQ and the YSR total scores) was sufficient. Factor analysis of the SDQ self-report generally confirmed the postulated structure for girls and boys, except for the conduct problems scale of boys, which was fused with emotional symptoms and with hyperactivity. The response rates, means and cut-off points of the SDQ self-report scores were similar to those found, e.g. in Norway and in Britain. A high level of psychological problems, especially emotional and conduct problems and hyperactivity-inattention, were associated with high level of eating disturbance symptoms and alcohol use. Conclusion: The results showed that the psychometric properties of the SDQ-Fin are adequate and provide additional confirmation of the usefulness of the SDQ-Fin for, e.g. screening, epidemiological research and clinical purposes.

Young Firms and R&D subsidies in Catalonia

Based on four different public R&D calls from the Catalan government, this article evaluates the propensity of entrants and young firms to apply for R&D public grants and, as compared to their counterparts, their capacity for obtaining subsides. This analysis is particularly relevant since entrants and young firms encounter greater market difficulties. Our sample contains 22,139 firms and corresponds to a merge of two databases: one from the Catalan agency responsible for promoting private innovation (ACC1��) and the other from the Mercantile Register. Merging these databases has two advantages. Firstly, participants and non-participants in the public R&D call (���InnoEmpresa���) are included and, secondly, it provides us with information at firm and project level. The period of observation is between 2006 and 2010, since some explanatory variables are lagged by one period. We apply a two-step methodology. Our results show that entrants and young firms show a lower propensity to apply for R&D subsidies and to obtain R&D public grants. Firm size, exports and participation in a previous call show a positive impact on the likelihood of applying, and firms located in the Barcelona metropolitan area have a greater propensity to apply. Additionally, project quality and R&D cooperative reports presented jointly with other partners have a positive impact on the likelihood of obtaining the R&D subsidy. Finally, firms that have previously obtained an R&D subsidy do not exhibit a greater propensity for obtaining subsequent grants. Keywords: R&D subsidies, entrants and young firms Classification JEL: L53, L25, O38

Identifying first graders at risk of reading and writing difficulties : creating a group-based screening tool in kiswahili in Tanzania

Early identification of beginning readers at risk of developing reading and writing difficulties plays an important role in the prevention and provision of appropriate intervention. In Tanzania, as in other countries, there are children in schools who are at risk of developing reading and writing difficulties. Many of these children complete school without being identified and without proper and relevant support. The main language in Tanzania is Kiswahili, a transparent language. Contextually relevant, reliable and valid instruments of identification are needed in Tanzanian schools. This study aimed at the construction and validation of a group-based screening instrument in the Kiswahili language for identifying beginning readers at risk of reading and writing difficulties. In studying the function of the test there was special interest in analyzing the explanatory power of certain contextual factors related to the home and school. Halfway through grade one, 337 children from four purposively selected primary schools in Morogoro municipality were screened with a group test consisting of 7 subscales measuring phonological awareness, word and letter knowledge and spelling. A questionnaire about background factors and the home and school environments related to literacy was also used. The schools were chosen based on performance status (i.e. high, good, average and low performing schools) in order to include variation. For validation, 64 children were chosen from the original sample to take an individual test measuring nonsense word reading, word reading, actual text reading, one-minute reading and writing. School marks from grade one and a follow-up test half way through grade two were also used for validation. The correlations between the results from the group test and the three measures used for validation were very high (.83-.95). Content validity of the group test was established by using items drawn from authorized text books for reading in grade one. Construct validity was analyzed through item analysis and principal component analysis. The difficulty level of most items in both the group test and the follow-up test was good. The items also discriminated well. Principal component analysis revealed one powerful latent dimension (initial literacy factor), accounting for 93% of the variance. This implies that it could be possible to use any set of the subtests of the group test for screening and prediction. The K-Means cluster analysis revealed four clusters: at-risk children, strugglers, readers and good readers. The main concern in this study was with the groups of at-risk children (24%) and strugglers (22%), who need the most assistance. The predictive validity of the group test was analyzed by correlating the measures from the two school years and by cross tabulating grade one and grade two clusters. All the correlations were positive and very high, and 94% of the at-risk children in grade two were already identified in the group test in grade one. The explanatory power of some of the home and school factors was very strong. The number of books at home accounted for 38% of the variance in reading and writing ability measured by the group test. Parents�� reading ability and the support children received at home for schoolwork were also influential factors. Among the studied school factors school attendance had the strongest explanatory power, accounting for 21% of the variance in reading and writing ability. Having been in nursery school was also of importance. Based on the findings in the study a short version of the group test was created. It is suggested for use in the screening processes in grade one aiming at identifying children at risk of reading and writing difficulties in the Tanzanian context. Suggestions for further research as well as for actions for improving the literacy skills of Tanzanian children are presented.

The effectiveness of short-term literacy skills intervention on children at risk of reading and writing difficulties in Tanzania : a study of grade one children with dynamic assessment approach

The aim of the study was to create and evaluate an intervention programme for Tanzanian children from a low-income area who are at risk of reading and writing difficulties. The learning difficulties, including reading and writing difficulties, are likely to be behind many of the common school problems in Tanzania, but they are not well understood, and research is needed. The design of the study included an identification and intervention phase with follow-up. A group based dynamic assessment approach was used in identifying children at risk of difficulties in reading and writing. The same approach was used in the intervention. The study was a randomized experiment with one experimental and two control groups. For the experimental and the control groups, a total of 96 (46 girls and 50 boys) children from grade one were screened out of 301 children from two schools in a low income urban area of Dar-es-Salaam. One third of the children, the experimental group, participated in an intensive training programme in literacy skills for five weeks, six hours per week, aimed at promoting reading and writing ability, while the children in the control groups had a mathematics and art programme. Follow-up was performed five months after the intervention. The intervention programme and the tests were based on the Zambian BASAT (Basic Skill Assessment Tool, Ketonen & Mulenga, 2003), but the content was drawn from the Kiswahili school curriculum in Tanzania. The main components of the training and testing programme were the same, only differing in content. The training process was different from traditional training in Tanzanian schools in that principles of teaching and training in dynamic assessment were followed. Feedback was the cornerstone of the training and the focus was on supporting the children in exploring knowledge and strategies in performing the tasks. The experimental group improved significantly more (p = .000) than the control groups during the intervention from pre-test to follow-up (repeated measures ANOVA). No differences between the control groups were noticed. The effect was significant on all the measures: phonological awareness, reading skills, writing skills and overall literacy skills. A transfer effect on school marks in Kiswahili and English was found. Following a discussion of the results, suggestions for further research and adaptation of the programme are presented.

High frequencies of plexiform neurofibromas, mental retardation, learning difficulties, and scoliosis in Brazilian patients with neurofibromatosis type 1

A clinical study of Brazilian patients with neurofibromatosis type 1 (NF1) was performed in a multidisciplinary Neurofibromatosis Program called CEPAN (Center of Research and Service in Neurofibromatosis). Among 55 patients (60% females, 40% males) who met the NIH criteria for the diagnosis of NF1, 98% had more than six caf��-au-lait patches, 94.5% had axillary freckling, 45% had inguinal freckling, and 87.5% had Lisch nodules. Cutaneous neurofibromas were observed in 96%, and 40% presented plexiform neurofibromas. A positive family history of NF1 was found in 60%, and mental retardation occurred in 35%. Some degree of scoliosis was noted in 49%, 51% had macrocephaly, 40% had short stature, 76% had learning difficulties, and 2% had optic gliomas. Unexpectedly high frequencies of plexiform neurofibromas, mental retardation, learning difficulties, and scoliosis were observed, probably reflecting the detailed clinical analysis methods adopted by the Neurofibromatosis Program. These same patients were screened for mutations in the GAP-related domain/GRD (exons 20-27a) by single-strand conformation polymorphism. Four different mutations (Q1189X, 3525-3526delAA, E1356G, c.4111-1G>A) and four polymorphisms (c.3315-27G>A, V1146I, V1317A, c.4514+11C>G) were identified. These data were recently published.