Which patients with chronic kidney disease have the greatest symptom burden? A comparative study of advanced CKD stage and dialysis modality

Background Chronic kidney disease (CKD) leads to a range of symptoms, which are often under-recognised and little is known about the multidimensional symptom experience in advanced CKD. Objectives To examine (1) symptom burden at CKD stages 4 and 5, and dialysis modalities, and (2) demographic and renal history correlates of symptom burden. Methods Using a cross-sectional design, a convenience sample of 436 people with CKD was recruited from three hospitals. The CKD Symptom Burden Index (CKD-SBI) was used to measure the prevalence, severity, distress and frequency of 32 symptoms. Demographic and renal history data were also collected. Results Of the sample, 75.5 % were receiving dialysis (haemodialysis, n = 287; peritoneal dialysis, n = 42) and 24.5 % were not undergoing dialysis (stage 4, n = 69; stage 5, n = 38). Participants reported an average of 13.01 ± 7.67 symptoms. Fatigue and pain were common and burdensome across all symptom dimensions. While approximately one-third experienced sexual symptoms, when reported these symptoms were frequent, severe and distressing. Haemodialysis, older age and being female were independently associated with greater symptom burden. Conclusions In CKD, symptom burden is better understood when capturing the multidimensional aspects of a range of physical and psychological symptoms. Fatigue, pain and sexual dysfunction are key contributors to symptom burden, and these symptoms are often under-recognised and warrant routine assessment. The CKD-SBI offers a valuable tool for renal clinicians to assess symptom burden, leading to the commencement of timely and appropriate interventions.

Regards des praticiens en design industriel sur les dimensions identitaires de la pratique du design au Québec

Cette recherche pose un regard sur l’articulation des changements sociétaux émergeant de la négociation entre les mondes globaux et locaux et leurs impacts sur la sphère professionnelle du design industriel au Québec. Nous proposons de mettre en lumière les dimensions identitaires qui caractérisent la pratique du design industriel. Nous référons aux théories de l’identité, aux théories de la globalisation et au contexte particulier de la pratique du design québécois à travers ses aspects socioculturel, politique et économique. Le concept d’identité nous permet d’explorer l’interprétation des designers de leur pratique professionnelle dans un contexte désormais glocal (Robertson, 1995). Suivant une démarche qualitative basée sur les entretiens en profondeur, nous explorons l’interprétation du caractère identitaire de l’activité professionnelle auprès de trois générations de designers. Nous examinons également le sens qu’ils prêtent au concept de communauté du design, à leur système de valeurs et à l’avenir du design industriel québécois.

Measuring regional sustainability: lessons to be learned

Developing tools for measuring progress toward sustainability has proven a challenging task. Indicators offer an excellent means to explore the success or otherwise of management strategies. They also allow reporting social, economic and environmental aspects of sustainability. To ensure that the tools developed are effective in measuring the progress toward sustainable futures, an evaluation of the methods and the indicators used must be undertaken so that with progress there is learning and with the new knowledge methods can be redesigned to better advance sustainability. This paper discusses a study carried out in the south west region of Victoria, Australia, using indicators as the basis for developing a tool to measure progress toward sustainability. By evaluating the methods and indicators used in the study this paper provides an insight into the challenges encountered and the lessons learned. Issues explored include selecting indicators, collating data, integrating social, economic and environmental aspects of sustainability and using an adaptive approach.

Understanding the process of greening of Brazilian business schools

This study analyses business schools' incorporating environmental management issues into their core activities, defined through teaching, research, outreach and management. Taking into account the relative lack of literature on this theme, case study fieldwork is utilized. Two case studies were conducted at Brazilian business schools. The results were analyzed using the conceptual background of barriers to organizational change, transition to a more sustainable society, and path dependence. The main findings indicate that: (a) the incorporation of environmental management issues tends to begin with researching and teaching; (b) this incorporation process depends on the personal motivation of few or single faculty researchers; (c) the trajectory of the analyzed business schools is marked by advances and stagnation, when analyzing the incorporation of environmental management issues to its four core activities; (d) paradoxically, the analyzed business schools can be considered academic leaders in the field, but have had difficulties in adopting environmental management practices internally; (e) there is a path dependence effect in this process; (f) there are barriers to organizational change towards green business schools; (g) institutional entrepreneurs are important to the process of greening. This research represents the first research shedding light to understanding the process of greening of Brazilian business schools while considering the multidimensional aspects (teaching, research, outreach and university management). © 2013 Elsevier Ltd. All rights reserved.

Indicadores para avaliação de efeitos de intervenções de saneamento básico: a questão da sustentabilidade

As intervenções de saneamento básico, ou seja, as obras para implantação ou ampliação de sistemas de abastecimento de água e de esgotamento sanitário têm sido relacionadas à redução das taxas de mortalidade infantil ocorrida no estado de São Paulo nas últimas décadas. De fato, a relação entre saneamento básico e saúde pública é antiga, principalmente no que se refere ao controle das doenças de veiculação hídrica. Entretanto, ela se mostra muito fraca, ou até nula, para regiões onde os índices de cobertura por redes de água e esgotos já se encontram em patamares acima da média nacional, como é o caso de grande parte dos municípios do estado de São Paulo. Uma abordagem do saneamento básico, sob o ponto de vista da complexidade de suas relações, considerando aspectos multidimensionais, faz-se necessária como forma de repensar o setor de forma mais ampla, fugindo do senso comum. O objetivo desta pesquisa foi identificar, analisar e descrever indicadores de sustentabilidade que pudessem estabelecer uma nova base para avaliação de efeitos de intervenções de saneamento básico, melhorando a determinação e acompanhamento dos impactos decorrentes, constituindo, então, uma matriz de indicadores específicos para a área, a partir da investigação dos conceitos de sustentabilidade e seus desdobramentos para o setor saneamento básico e o ambiente empresarial. Pesquisas em bases de dados públicas permitiram a identificação e seleção de indicadores multidimensionais para o saneamento, assim como a análise de correlação entre os indicadores selecionados possibilitou identificar possíveis benefícios de curto, médio e longo prazos, oriundos das intervenções de saneamento para os municípios do Vale do Ribeira. Utilizando modelos de organização de indicadores, como o Triple Bottom Line (TBL) e a matriz de indicadores FPSEEA, da Organização Mundial da Saúde (OMS), com algumas adaptações, foi possível agrupar os indicadores de forma a permitir uma visão integrada das dimensões da sustentabilidade e, dessa maneira, determinar que as intervenções de saneamento básico possuem relações sistêmicas com indicadores sociais, ambientais e econômicos, que possibilitem, a partir de sua execução, o estabelecimento de um círculo virtuoso para os municípios

Automatized Generation of Personalized Learning Paths through Aspects in Multidimensional Spaces

Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2016

Comprehending adverbs of doubt and certainty in health communication: A multidimensional scaling approach

This research explored the feasibility of using multidimensional scaling (MDS) analysis in novel combination with other techniques to study comprehension of epistemic adverbs expressing doubt and certainty (e.g., evidently, obviously, probably) as they relate to health communication in clinical settings. In Study 1, Australian English speakers performed a dissimilarity-rating task with sentence pairs containing the target stimuli, presented as "doctors' opinions". Ratings were analyzed using a combination of cultural consensus analysis (factor analysis across participants), weighted-data classical-MDS, and cluster analysis. Analyses revealed strong within-community consistency for a 3-dimensional semantic space solution that took into account individual differences, strong statistical acceptability of the MDS results in terms of stress and explained variance, and semantic configurations that were interpretable in terms of linguistic analyses of the target adverbs. The results confirmed the feasibility of using MDS in this context. Study 2 replicated the results with Canadian English speakers on the same task. Semantic analyses and stress decomposition analysis were performed on the Australian and Canadian data sets, revealing similarities and differences between the two groups. Overall, the results support using MDS to study comprehension of words critical for health communication, including in future studies, for example, second language speaking patients and/or practitioners. More broadly, the results indicate that the techniques described should be promising for comprehension studies in many communicative domains, in both clinical settings and beyond, and including those targeting other aspects of language and focusing on comparisons across different speech communities.

Multidimensional scaling analysis of the dynamics of a country economy

This paper analyzes the Portuguese short-run business cycles over the last 150 years and presents the multidimensional scaling (MDS) for visualizing the results. The analytical and numerical assessment of this long-run perspective reveals periods with close connections between the macroeconomic variables related to government accounts equilibrium, balance of payments equilibrium, and economic growth. The MDS method is adopted for a quantitative statistical analysis. In this way, similarity clusters of several historical periods emerge in the MDS maps, namely, in identifying similarities and dissimilarities that identify periods of prosperity and crises, growth, and stagnation. Such features are major aspects of collective national achievement, to which can be associated the impact of international problems such as the World Wars, the Great Depression, or the current global financial crisis, as well as national events in the context of broad political blueprints for the Portuguese society in the rising globalization process.

A Classificação Internacional de Funcionalidade, Incapacidade e Saúde : um modelo multidimensional e multideterminado da funcionalidade em idosos assistidos na Rede

RESUMO: Os estudos sobre a funcionalidade da população idosa têm uma representação importante naquilo que é o atual conhecimento da demografia do mundo. Portugal posiciona-se e perspetiva-se como pertencendo aos países mais envelhecidos, possuindo uma rede de cuidados pós-agudos – a Rede Nacional de Cuidados Continuados Integrados (RNCCI)– que assiste uma parcela importante dessa população. Os aspetos conceptuais da funcionalidade de acordo com a OMS e operacionalizados pela Classificação Internacional de Funcionalidade (CIF), não mereceram até agora suficiente aplicabilidade no nosso país, inviabilizando a possibilidade de oferecermos contributos para a sua operacionalização. Da mesma forma, também os Core Sets da Classificação não têm sido sujeitos a processos de validação que contemplem amostras portuguesas, mantendo-se desconhecimento da especificidade dos fatores contextuais na nossa população. O presente estudo tem como objetivos conhecer a evolução da funcionalidade dos idosos assistidos na RNCCI na região do Algarve nas unidades de convalescença e média duração, validar o Core Set Geriátrico da OMS e propor uma versão abreviada da sua modalidade abrangente, no contexto destes cuidados. A amostra constituída por 451 idosos, dos quais 62,1% eram mulheres, revelou na pré-morbilidade níveis favoráveis de funcionalidade, com exceção para as Atividades Domésticas. Contudo, os mais idosos (≥ 85 anos), os indivíduos sem escolaridade, as mulheres e os viúvos/solteiros apresentaram mais casos desfavoráveis quando comparados com os seus pares. Na evolução da funcionalidade observámos melhorias significativas em todos os domínios avaliados, com diferenças relativamente à idade e à escolaridade; apesar dos resultados positivos os mais idosos e os indivíduos sem escolaridade apresentaram níveis inferiores de evolução. No entanto, a funcionalidade alcançada revelou ficar com resultados significativamente inferiores na comparação com aquela que os indivíduos possuíam na pré-morbilidade. Os modelos de regressão revelaram que as Funções Mentais, a Perceção do Estado de Saúde e a atividade Usar o Telefone, foram as variáveis que melhor explicaram os outcomes da funcionalidade alcançada. A validação do Core Set Geriátrico foi possível na maioria das categorias, sendo que foi no componente das Funções do Corpo onde esse processo revelou maior fragilidade. As Funções Neuromusculoesqueléticas e Relacionadas com o Movimento foram aquelas que registaram em ambos os momentos avaliativos frequências mais elevadas de deficiência, enquanto no componente Atividades & Participação isso ocorreu na atividade Utilização dos Movimentos Finos da Mão. Os capítulos Apoios e Relacionamentos e Atitudes foram considerados os Fatores Ambientais mais Facilitadores mas também com maior impacto Barreira. A proposta para o Core Set Geriátrico Abreviado resultou das categorias independentes que explicaram os modelos da funcionalidade alcançada e cujo resultado engloba um conjunto de 27 categorias, com um enfoque importante no componente Atividades/Participação de onde se destacam os domínios da Mobilidade e dos Auto Cuidados. A funcionalidade dos indivíduos e das populações deve ser considerada uma variável incontornável da Saúde Pública, cuja avaliação deve refletir uma abordagem biopsicossocial, apoiada na Classificação Internacional de Funcionalidade. A operacionalização da Classificação a partir dos Core Sets necessita de pesquisa mais aprofundada relativamente às caraterísticas psicométricas dos seus qualificadores e dos seus processos de validação.-----------ABSTRACT: The studies about the functioning of the elderly play an important role on what the present knowledge of the demography in the world is. Portugal figures high on the most aged countries, having a network of post-acute care - the National Network of Integrated Continuous Care (RNCCI) - which assists a large part of that population. The conceptual aspects of functioning according to WHO and operated by the International Classification of Functioning (ICF), have been insufficiently addressed concerning its adequate applicability in our country, hindering the contributions of its operation. In the same way, also the Core Sets of the Classification have not been subjected to validation procedures that include portuguese samples, keeping the unawareness of specificity of the contextual factors in our population. The objectives of the present study were to know the evolution of the functioning of the elderly assisted in the RNCCI in the Algarve region in units of convalescence and average duration, validate the WHO Geriatric Core Set and propose an abridged version of this comprehensive core set in this healthcare context. The sample was composed by 451 elderly people, of which 62.1% were women, they showed favourable levels in functioning in the pre-morbid state, except for Domestic Activities. However, the oldest (≥ 85 years), the individuals with no education, women and widowed/ unmarried showed more unfavourable cases when compared to their peers. In the evolution of functioning we observed significant improvements in all domains assessed, with diferences with respect to age and education. In spite of positive results, the oldest and the individuals with no education showed lower levels of evolution. However, the functioning achieved showed significantly lower results when compared to the those observed in pre-morbidity state. Regression models reveal that Mental Functions, the Perceived Health Status and the Use of the Phone activity, were the variables that better explain the functioning of the outcomes achieved. The validation of the Geriatric Core Set of ICF was possible in most categories, and Body Functions was the component where this process showed greatest weakness. Neuromusculoskeletal and Movement-Related Functions experienced in both evaluation times with higher rates of disability, while in the Activities & Participation component this occurred in the Fine Hand Use activity. The Support and Relationships and Attitudes chapters were considered the Environmental Factors most Facilitators but also with greater impact Barrier. The proposal for the Brief Geriatric Core Set has resulted from the independent categories that explained the regression models of functioning and includes a set of 27 categories, with na important emphasis on Activities & Participation component where we can highlight the areas of Mobility and Self Care domains. The functioning of individuals and populations should be considered as an unavoidable variable of Public Health, of which the assessment should reflect a biopsychosocial approach, based on the International Classification of Functioning. The operationalization of the Classification from the Core Sets requires further research regarding the psychometric characteristics of their qualifiers and their validation procedure.

A multidimensional measurement approach and analysis of children's motivation for reading, attributional style, and reading achievement

The present study investigates the usefulness of a multi-method approach to the measurement of reading motivation and achievement. A sample of 127 elementary and middle-school children aged 10 to 14 responded to measures of motivation, attributions, and achievement both longitudinally and in a challenging reading context. Novel measures of motivation and attributions were constructed, validated, and utilized to examine the relationship between ~ motivation, attributions, and achievement over a one-year period (Study I). The impact of classroom contexts and instructional practices was also explored through a study of the influence of topic interest and challenge on motivation, attributions, and persistence (Study II), as well as through interviews with children regarding motivation and reading in the classroom (Study III). Creation and validation of novel measures of motivation and attributions supported the use of a self-report measure of motivation in situation-specific contexts, and confirmed a three-factor structure of attributions for reading performance in both hypothetical and situation-specific contexts. A one-year follow up study of children's motivation and reading achievement demonstrated declines in all components of motivation beginning at age 10 through 12, and particularly strong decreases in motivation with the transition to middle school. Past perceived competence for reading predicted current achievement after controlling for past achievement, and showed the strongest relationships with reading-related skills in both elementary and middle school. Motivation and attributions were strongly related, and children with higher motivation Fulmer III displayed more adaptive attributions for reading success and failure. In the context of a developmentally inappropriate challenging reading task, children's motivation for reading, especially in terms of perceived competence, was threatened. However, interest in the story buffered some ofthe negative impacts of challenge, sustaining children's motivation, adaptive attributions, and reading persistence. Finally, children's responses during interviews outlined several emotions, perceptions, and aspects of reading tasks and contexts that influence reading motivation and achievement. Findings revealed that children with comparable motivation and achievement profiles respond in a similar way to particular reading situations, such as excessive challenge, but also that motivation is dynamic and individualistic and can change over time and across contexts. Overall, the present study outlines the importance of motivation and adaptive attributions for reading success, and the necessity of integrating various methodologies to study the dynamic construct of achievement motivation.

Lenguaje y Teoría de la mente: una aproximación multidimensional

El propósito de este trabajo es realizar una puesta al día sobre las relaciones entre el desarrollo del lenguaje y el desarrollo de la Teoría de la Mente. Entre las hipótesis propuestas para conceptualizar dichas relaciones, realizamos un examen más exhaustivo de aquellos modelos que apoyan una implicación directa entre lenguaje y Teoría de la Mente. En este contexto, en primer lugar subrayamos la necesidad de ampliar dicha noción para incluir habilidades anteriores y posteriores a la comprensión de la falsa creencia. En segundo lugar, examinamos las diferentes hipótesis acerca de los aspectos del lenguaje más vinculados al desarrollo sociocognitivo, y las principales evidencias empíricas que las sustentan. Finalmente, discutimos un modelo de causalidad recíproca donde los vínculos entre lenguaje y Teoría de la Mente variarán según el momento del desarrollo considerado

The multidimensional measurement of the positive symptoms of psychosis

The measures most frequently used to assess psychotic symptoms fail to reflect important dimensions. The Psychotic Symptom Rating Scale (PSYRATS) aims to capture the multidimensional nature of auditory hallucinations and delusions. Individuals (N = 276) who had recently relapsed with positive symptoms completed the auditory hallucinations and delusions PSYRATS scales. These scores were compared with the relevant items from the SAPS and PANSS, and with measures of current mood. Total scores and distribution of items of the PSYRATS scales are presented and correlated with other measures. Positive symptom items from the SAPS and PANSS reflected the more objective aspects of PSYRATS ratings of auditory hallucinations and delusions (frequency and conviction) but were relatively poor at measuring distress. A major strength of the PSYRATS scales is the specific measurement of the distress dimension of symptoms, which is a key target of psychological intervention. It is advised that the PSYRATS should not be used as a total score alone, whilst further research is needed to clarify the best use of potential subscales. Copyright (c) 2007 John Wiley & Sons, Ltd.

The influence of various aspects of enjoyment on participation in leisure time physical activity

This study examines the direct and indirect influence of various aspects of enjoyment, including activity enjoyment, enjoyment conceptualised as physical/environmental, and enjoyment conceptualised as social interaction, on regular participation in leisure-time physical activity (LTPA). The study was cross-sectional and used self-report questionnaires to collect data from a random sample of 250 people aged 19-87 years living in an Australian city. Questionnaires included demographic items and scales to measure enjoyment of LTPA, prioritisation of LTPA and regularity of participation in LTPA. The findings suggest that the influence of enjoyment on participation in LTPA is complex. Aspects of enjoyment have varying levels of influence on participation in LTPA and this influence is indirect through preference for LTPA, life priority of LTPA and making time for LTPA. Policies, programs and strategies by government and practitioners that aim to increase participation in LTPA should primarily aim to enhance activity enjoyment, rather than focusing on other aspects of participation. Theoretically, this study suggests that enjoyment is a multidimensional concept and that enjoyment is a part of a larger decision-making process influencing participation in LTPA.

Computational aspects of the numerical solution of SDEs

In the last 30 to 40 years, many researchers have combined to build the knowledge base of theory and solution techniques that can be applied to the case of differential equations which include the effects of noise. This class of ``noisy'' differential equations is now known as stochastic differential equations (SDEs). Markov diffusion processes are included within the field of SDEs through the drift and diffusion components of the Itô form of an SDE. When these drift and diffusion components are moderately smooth functions, then the processes' transition probability densities satisfy the Fokker-Planck-Kolmogorov (FPK) equation -- an ordinary partial differential equation (PDE). Thus there is a mathematical inter-relationship that allows solutions of SDEs to be determined from the solution of a noise free differential equation which has been extensively studied since the 1920s. The main numerical solution technique employed to solve the FPK equation is the classical Finite Element Method (FEM). The FEM is of particular importance to engineers when used to solve FPK systems that describe noisy oscillators. The FEM is a powerful tool but is limited in that it is cumbersome when applied to multidimensional systems and can lead to large and complex matrix systems with their inherent solution and storage problems. I show in this thesis that the stochastic Taylor series (TS) based time discretisation approach to the solution of SDEs is an efficient and accurate technique that provides transition and steady state solutions to the associated FPK equation. The TS approach to the solution of SDEs has certain advantages over the classical techniques. These advantages include their ability to effectively tackle stiff systems, their simplicity of derivation and their ease of implementation and re-use. Unlike the FEM approach, which is difficult to apply in even only two dimensions, the simplicity of the TS approach is independant of the dimension of the system under investigation. Their main disadvantage, that of requiring a large number of simulations and the associated CPU requirements, is countered by their underlying structure which makes them perfectly suited for use on the now prevalent parallel or distributed processing systems. In summary, l will compare the TS solution of SDEs to the solution of the associated FPK equations using the classical FEM technique. One, two and three dimensional FPK systems that describe noisy oscillators have been chosen for the analysis. As higher dimensional FPK systems are rarely mentioned in the literature, the TS approach will be extended to essentially infinite dimensional systems through the solution of stochastic PDEs. In making these comparisons, the advantages of modern computing tools such as computer algebra systems and simulation software, when used as an adjunct to the solution of SDEs or their associated FPK equations, are demonstrated.

Convergência ou divergência no desenvolvimento? um estudo multidimensional para o sudeste e o nordeste do Brasil, 1990-2010

The analysis of some aspects of development in Brazil in the past three decades reveals an improvement on a range of indicators isolated in the south east the richest region and north east the poorest region. From a database of twenty variables, the main purpose the study was to verify if there are indications of convergence or divergence in five dimensions of development between the two regions from 1990 to 2010. Aiming to identify the states more similar and different, and to verify changes in the composition of low development groups and high development in the adressed period, was used the analysis of groupings (Cluster Analysis). Additionally, to test equality of distance between states all the time, was used the non-parametric Test of Wilcoxon. This makes it possible to verify IF the distance between the states of two regions has been increasing or has been falling, showing signs of divergence or convergence. The results of Cluster s analysis suggest that there are indications of convergence inside the cluster of north east, but the distance between two regions has not changed. The results of test of Wilcoxon suggests that there have been no changes statistically significant in the distance between the states, in the two regions the standards of development became more homogenous, but the two regions will be far apart