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Sample records for ajusted clinical groups-acgs

  1. Validación retrospectiva del Johns-Hopkins ACG Case-Mix System en la población Española Validating the Adjusted Clinical Groups [ACG] Case-mix System in a Spanish population setting: a multicenter study

    Directory of Open Access Journals (Sweden)

    Antoni Sicras-Mainar

    2009-06-01

    Full Text Available Introducción: Validar la aplicación retrospectiva de los Adjusted Clinical Groups (ACG en varios centros de atención primaria y especializada en la población española. Métodos: Estudio restrospectivo-multicéntrico, realizado a partir de los registros de sujetos atendidos en 5 equipos de atención primaria (AP y dos hospitalarios, durante el año 2005. Las principales mediciones fueron dependientes (visitas, episodios, coste en AP y coste total y de casuística/morbilidad con el ACG Case-Mix-System. Cálculo del poder explicativo: cociente de determinación, pPurpose: To validate the Johns Hopkins ACG case-mix system used in various primary and specialized care centers attending a defined population in Spain. Methods: A retrospective, multicenter study was carried out by applying the ACG case-mix system to the clinical records of patients attending five primary care teams and two hospitals over a 1-year period in 2005. The main measurements were dependent variables (visits, episodes, primary care costs, and total costs, and morbidity. The determination coefficient (R²; p<0.05 was used to measure the explained variability. Results: A total of 81,873 patients were included with a mean (standard deviation number of 4.8 (3.5 episodes and 8.0 (8.1 visits/patient/year. The explained variance (R² of ACG classification was 73.1% (75.5% log transformation for episodes, 43.2% (54.0% log transformation for visits, 19.6% (54.8% log transformation for primary care costs, and 22.7% (48.3% log transformation for total costs (p<0.001. Conclusion: The ACG system classified a defined population on the basis of morbidity and individual resource consumption. Moreover, the ACG system was useful to assess the clinical (comorbidity and economical information of each center.

  2. Variability in prescription drug expenditures explained by adjusted clinical groups (ACG case-mix: A cross-sectional study of patient electronic records in primary care

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    Serrat Josep

    2008-03-01

    Full Text Available Abstract Background In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. Methods We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. Results No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%. For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%. Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41 and -0.52 in pediatricians (p = 0.08, N = 12. Conclusion In our setting, ACG is the variable studied that explains more variability in pharmacy cost in adults compared to physician and center. In children there is greater variability among physicians and centers not related to case-mix. In our sites, ACG is useful to profile physicians and centers using electronic records in real practical conditions. Physicians with lower pharmaceutical expenditure have higher scores for a prescription quality index.

  3. The importance of aquaculture community group (ACG) in social media (Facebook) towards the aquaculture knowledge and financial improvement of small scale fish farmers (SSFF) in rural areas of Central Java

    Science.gov (United States)

    Elfitasari, T.; Nugroho, R. A.; Nugroho, A. P.

    2018-04-01

    Internet is now widely used by people all over the world, including small scale fisheries communities such as fish farmers. Many applications are being created including social media Facebook which are used by small scale fish farmers (SSFF) for its ease and convenience. The objective of this research is to identify the impact of aquaculture community group (ACG) in social media Facebook towards the improvement of aquaculture knowledge and financial condition of small scale fish farmers in Central Java. This research used quantitative approach where questionnaires were distributed into two groups: SSFF who are member of ACG in social media Facebook and who are not. Sampling technique used random sampling, used 60 samples of SSFF in Central Java. Data obtained were tested using the test statistic Independent t-test using SPSS v.20. Result showed a significant effect of group who are member of ACG in social media Facebook and those who are not, towards the aquaculture knowledge (t count -7.424 and sig 0.000) and financial improvement (t -3.775 and sig 0.000). The results of the average value of the SSFF who are ACG member in Facebook are also higher than farmers who are not.

  4. Estilos relacionales parentales y ajuste adolescente

    OpenAIRE

    Oliva Delgado, Alfredo; Parra Jiménez, Agueda; Arranz Freijo, Enrique

    2008-01-01

    En este artículo se presentan los resultados de un estudio realizado sobre una muestra de 848 adolescentes de edades comprendidas entre los 12 y los 17 años, que cumplimentaron un cuestionario que incluía una escala con 6 dimensiones sobre su percepción del estilo parental o relacional materno y paterno y otros instrumentos para evaluar el ajuste adolescente. La realización de un análisis de conglomerados a partir de las puntuaciones en las 6 dimensiones que componían la escala re...

  5. Prueba para el error de ajuste de un modelo multivariante

    OpenAIRE

    Rodríguez, Luis H.

    2012-01-01

    En el ajuste de un modelo a una serie de observaciones se presenta el interesante problema de decidir sobre lo adecuado del modelo para describir tales observaciones .. Una prueba para esta clase de decisión se denomina "Error de ajuste", No conocíamos una tal prueba para el caso de un modelo multivariante  (cada observación es un vector), por lo que este articulo hacemos una extensión de la  técnica de  "error de ajuste" utilizada en el análisis  univariante al caso multivariante,  y se prod...

  6. Document de travail no.8: Ajustement structurel et consolidation de ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    13 déc. 2010 ... Marie-France Guimond ... Très peu de recherches ont été faites sur le rôle des plans d'ajustement structurel dans le contexte des pays ... Gender and climate change-induced conflict in pastoral communities: Turkana, Kenya.

  7. Ajustement structurel et consolidation de la paix Une source de ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    mguimond

    Tableau 4 : Corrélation : Indicateurs-pays pour la politique étrangère et ajustement .... incorporés aux réformes macroéconomiques du cadre stratégique de lutte ...... Le plafond sur le recrutement de fonctionnaires a été considéré comme une ...

  8. LA POLÍTICA SOCIAL EN TIEMPOS DE AJUSTE

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    Leonardo Garnier Rímolo

    2011-09-01

    Full Text Available La política social está nuevamente de moda. Hace unos años, eran la estabilización y el ajuste los temas que dominaban la literatura, los debates y hasta las conversaciones de los economistas. Hoy, es cada vez más frecuente la referencia a la pobreza, el costo social del ajuste, el rostro humano de la política económica, el gasto social, la salud, la educación, en fin, todos aquellos temas relativos a la calidad de vida y el desarrollo humano. A diferencia del pasado, sin embargo, este redescubrimiento de los objetivos sociales del desarrollo no olvida, sino que parte precisamente del reconocimiento de las limitaciones materiales y financieras que enfrentan las sociedades menos desarrolladas. La discusión actual busca redefinir el sentido de la política social en los tiempos del ajuste o, si se quiere, redefinir los procesos de ajuste a la luz de su verdadero objetivo: el desarrollo social.

  9. Incertidumbre y ajuste por las cantidades en the General Theory

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    Adolfo Rodríguez Herrera

    2009-06-01

    Full Text Available Robert Clower desarrolla una interpretación de la crítica de Keynes al funcionamiento de la economía capitalista en la cual la incertidumbre explica la incapacidad del sistema para alcanzar un equilibrio en todos los mercados, y en particular en el mercado de trabajo. El incumplimiento del principal supuesto de la economía neoclásica, la información perfecta, hace que la tasa de interés pierda su papel regulador y el sistema la capacidad de ajustarse instantáneamente a través de movimientos de los precios: en presencia de desempleo el ingreso individual deja de ser objeto de optimización por parte de los agentes y cualquier shock externo desencadena un ajuste por las cantidades que Keynes denomina efecto multiplicador y que deja al mercado de empleo sin instrumentos para alcanzar su equilibrio.

  10. [Comparison of quality of life of patients treated for SUI by surgical approaches AJUST and TVT-O - a 3-month results from randomized trial].

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    Smažinka, M; Švabík, K; Hubka, P; Haddad El, R; Mašata, J

    2015-06-01

    The aim of this study is to compare quality of life in 3-month follow-up after the use of transobturator tape TVT-O and single incision tape AJUST in the treatment of urodynamic stress urinary incontinence (USI). Randomized trial. Gynekologicko-porodnická klinika LF UK a FN Plzeň, Gynekologicko-porodnická klinika 1. LF UK a VFN Praha. Between May 2010 and May 2012 100 women with proven urodynamic stress urinary incontinence were included in this randomized trial. These patients were randomly chosen and devided into two group: 50 patients for TVT-O procedure and 50 patients for AJUST procedure. All of the patients underwent a complete urogynecological examination prior to the actual procedure (clinical examination, urodynamic examination, ultrasound examination) and filled in ICIQ-SF and iQol questionnaires. After the surgery, the patients satisfaction was evaluated by visual analoque scale (VAS) and Likert scale and by ICIQ-SF and iQol questionnaires. The intensity and length of postoperative pain was monitored using the visual analogue scale. The patients underwent an examination after 3 months. In both groups of participants no significant differences regarding age, BMI, parity, history of surgery for gynecological disorders, were found. Preoperative urodynamic, ICIQ-SF and iQol parameters were also not significantly different. In the 3-month follow-up 48 participants from TVT-O group and 50 participants from the AJUST group were monitored. No statistically significant differences in subjective and objective parameters were found. Subjectively stress incontinence was not present in 97.9% in the TVT-O and 96.0% in the group AJUST. Objectively stress test was negative in 93.8% in the TVT-O and 94% in group AJUST. By evaluating the ICIQ and iQol were found no statistical differences in the quality of life in both operating groups. At 3-months follow up we did not find any statistical difference between subjective and objective outcome for single incision tape

  11. El ajuste de plantillas: el papel de los despidos por causas objetivas

    OpenAIRE

    Castillo Lorenzo, Jesús

    2016-01-01

    Este estudio académico sobre el ajuste de plantillas en las empresas lo he redactado, centrándome en los ajustes que se realizan por despidos por causas objetivas,que en la mayoría de los casos son despidos económicos. El trabajo que he desarrollado me parece un trabajo interesante, porque trata un tema actual como es la crisis económica y social que padece España y los países de la UE. Me agrada haber tratado este tema,porque me interesa la legislación la...

  12. Impacto del ajuste por inflación financiero en la gestión empresarial

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    Oda Hilda Gómez de Angulo

    2009-01-01

    Full Text Available La inflación es un fenómeno económico que afecta la situación financiera de las organizaciones, por lo que existe la Declaración de Principios de Contabilidad No. 10 (DPC-10 que establece las normas para efectuar el ajuste por inflación a los estados financieros. Con el propósito de conocer el impacto de este ajuste, se seleccionaron dos empresas que realizan actividades diferentes. Se efectuó una revisión bibliográfica y documental de la DPC-10 y, con base a los informes al cierre de cada ejercicio económico de las empresas objeto de estudio, se recopilaron y prepararon los datos en una misma unidad de medida para efectos de comparación, análisis e interpretación. Los resultados obtenidos indican que en la empresa regida por la Comisión Nacional de Valores se justifica el ajuste por inflación financiero debido a la naturaleza de la estructura financiera y a que la toma de decisiones administrativas y legales se realiza con base a esta información; mientras que en la institución regida por la Superintendencia de Cajas de Ahorro no se justifica la presentación del ajuste por inflación financiero, ya que no aporta ningún valor agregado a la organización y la toma de decisiones se realiza con base a los estados financieros históricos.

  13. ¿Existe rigidez en el ajuste del empleo en Chile?

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    Jorge Dresdner

    2017-01-01

    Full Text Available Antecedentes: Estudiamos c mo el nivel de empleo agregado se ajust en la eco- nom a chilena, posterior a la llamada crisis asi tica. Contrastamos distintas hi- p tesis que se han esgrimido en el debate p blico, y que no han sido probadas formalmente, sobre las razones por las cuales el nivel de empleo tard tanto tiempo en recuperar los niveles precrisis. M todos: Especi camos y estimamos un modelo de vectores autorregresivos con series de tiempo para el trimestre 1995.1-2007.4 y aplicamos el m todo de Jo- hansen para identi car vectores de cointegraci n. Resultados: Estimamos un vector de cointegraci n que representa la funci n de demanda laboral. Realizamos las siguientes pruebas de hip tesis sobre esta fun- ci n: homogeneidad de grado cero en precios, elasticidad producto de la de- manda unitaria; quiebre estructural en el intercepto de esta funci n; cambio en la elasticidad producto de la demanda laboral de largo plazo entre subperiodos y existencia de costos de ajuste. Conclusiones: Inestabilidad en la elasticidad demanda del ingreso en la funci n de demanda por trabajo en Chile posterior a la crisis asi tica, pero no en la direc- ci n sugerida por el debate previo. Adicionalmente, el factor que contribuy en forma m s decisiva a la lenta recuperaci n del empleo posterior a la crisis fue el costo de ajuste presentes en la econom a chilena.

  14. Representación de la Enfermedad, Afrontamiento y Ajuste en los Trastornos Alimentarios

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    Yolanda Quiles Marcos

    2009-01-01

    Full Text Available El objetivo de esta investigación es evaluar la representación de la enfermedad en pacientes con un trastorno alimentario (TA, así como su relación con el afrontamiento y el ajuste, utilizando como marco teórico el Modelo del Sentido Común de Leventhal. Método: Participaron 98 mujeres diagnosticadas de un TA. La media de edad fue 20.8 años (dt=5.61. Para evaluar la representación de la enfermedad se administró la adaptación española para los TA del Cuestionario de Percepción de la Enfermedad Revisado (IPQ-R. Resultados: Respecto a la identidad, los síntomas más señalados fueron la "pérdida de peso" (89.8% y las "alteraciones en la menstruación" (81.6%. Consideran que su enfermedad tiene una larga duración y serias consecuencias, así como que tienen control y siguiendo un tratamiento es posible su curación. El 21% de la varianza de las estrategias evitativas fue explicado por diferentes dimensiones de la representación de la enfermedad. Se confirman los efectos directos de la representación de la enfermedad sobre el ajuste, pero no los del afrontamiento. Conclusiones: Los resultados apoyan la necesidad de intervenir sobre las creencias que tienen estas pacientes sobre su enfermedad con el fin de mejorar su ajuste psicosocial.

  15. El ajuste temporal: criterio de ejecución distintivo de la inteligencia deportiva

    OpenAIRE

    Roca i Balasch, Josep

    1998-01-01

    En este artículo se propone una consideración de la actividad física y el deporte como una actividad inteligente en base a una concepción amplia de inteligencia y en base a la atención al parámetro tiempo como criterio de ajuste psicológico. Por lo que respecta a la primera afirmación, se afirma que tanto las habilidades perceptivo-motrices como las habilidades interactivas constituyen dos dimensiones de adaptación humana tradicionalmente infravaloradas en aras de las habilidades cognoscitiva...

  16. Ajuste del Índice de Pont para mujeres y hombres

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    Paula María Nava–Salcedo

    2014-07-01

    Full Text Available La forma de arco dental de mujeres y hombres es diferente, en los hombres es amplio y en mujeres de forma parabólica. En ortodoncia existen índices y métodos para la predicción del ancho y forma del arco ideal, uno de estos índices es el de Pont que no toma en cuenta las diferencias entre sexos. Objetivos: determinar la efectividad del índice de Pont al emplearlo en hombres y mujeres, realizar el ajuste si fuera necesario a las formulas del índice de Pont para poder aplicarlo en hombres y mujeres. Materiales y métodos: investigación descriptiva, no experimental y transversal. La muestra fue de 139 modelos de estudio, 94 de pacientes femeninos y 45 de pacientes masculinos, por lo que se seleccionaron 45 modelos de pacientes femeninos de forma aleatoria para igualar las muestras. Se compararon mediante una t de Student los valores reales de la muestra de hombres con los de las mujeres y el resultado del análisis de Pont en hombres y mujeres. Se realizó el ajuste de las constantes del índice de Pont para mujeres y  hombres, se aplicó a ambas poblaciones, el resultado se  comparó con los valores reales interpremolar e intermolar en maxilar y mandíbula. Resultados: el análisis de Pont no es efectivo para utilizarse en mujeres y hombres de Nayarit, se encontraron diferencias transversales entre ambas poblaciones, los ajustes realizados para la población femenina y masculinafue efectiva para utilizase en la población de Nayarit. Conclusiones: El índice de Pont no es aplicable debido a que sobreestima los valores de la población femenina y masculinade la población de Nayarit. Los ajustes realizados fueron efectivos y se recomienda evaluarlo en otras poblaciones.

  17. Ajuste de la fuerza de infección del dengue

    OpenAIRE

    Aldana-Bermúdez, Eliécer; Restrepo-Triviño, Maribel; Muñoz-Loaiza, Aníbal

    2017-01-01

    RESUMEN Objetivo Plantear un modelo matemático hospedero vector para el ajuste de la fuerza de infección del dengue en una población variable con crecimiento logístico y ciclo de vida del mosquito con tasa de ovoposición periódica, considerando inmunidad a un serotipo. Métodos El modelo matemático propuesto está representado por ocho ecuaciones diferenciales a las que se les calcula la fuerza de infección por el método de las redes libres de escala. Resultados Se presenta una simulación...

  18. Diferencias en el ajuste psicológico, familiar y escolar en adolescentes agresores de cyberbullying

    OpenAIRE

    Ortega-Barón, J.; Buelga, S.; Carrascosa, L.; Cava, M.J.

    2016-01-01

    INTRODUCCIÓN: El acoso a través de las TICs entre niños y adolescentes suscita gran preocupación en la comunidad científica. Sin embargo, en comparación con la amplia investigación realizada sobre las cibervíctimas, todavía no son muchos los estudios realizados sobre los ciberagresores. El objetivo principal del presente estudio fue analizar la existencia de diferencias entre ciberagresores (severos y ocasionales) y adolescentes no implicados en cyberbullying en los indicadores de ajuste psic...

  19. Sistema Computacional para Ajuste de Funções Densidade de Probabilidade

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    Daniel Henrique Breda Binoti

    Full Text Available RESUMO Este trabalho teve por objetivo iniciar, implementar e validar um projeto de construção de um sistema computadorizado para ajuste de funções densidade de probabilidade. O FitFD foi desenvolvido utilizando-se a linguagem de programação Java. Como ambiente de desenvolvimento foram utilizadas a IDE (Integrated Development Environment Netbeans 7.1 e a JDK 7.3 (Java Development Kit. Os testes do sistema foram realizados em ambiente Windows. Foram implementadas no sistema as seguintes funções densidade de probabilidade: Weibull (2P, 3P, 2P com dap mínimo como locação, 3P truncada, hiperbólica (2P, 3P, 2P com dap mínimo como locação, 3P truncada, log-logística (2P, 3P, 2P com dap mínimo como locação, logística generalizada, Fatigue life (2P e 3P e Frechet (2P e 3P. O sistema desenvolvido auxilia os usuários na definição e escolha da fdp que melhor atenda suas necessidades, contudo melhorias são necessárias. O projeto iniciado mostrou-se eficiente para ajustes de funções de densidade probabilidade.

  20. La inteligencia emocional y el ajuste psicológico: un estudio transcultural

    OpenAIRE

    Fulquez Castro, Sandra Carina

    2011-01-01

    La intel·ligència emocional (IE) és una competència de l'ésser humà. Així mateix, elements psicològics com l'autoestima, l-autoconfiança, les relacions amb els iguals i les relacions amb els pares -en el cas dels adolescents- constitueixen eines que guien la salut mental i l'adaptació social de l'individu. L'estudi que es presenta demostra l'associació existent entre la IE (atenció emocional -AE- claredat emocional -CE- i reparació emocional -RE) i les variables d'ajust psicològic, així com d...

  1. Uso de herramientas numéricas y computacionales en el ajuste de curvas

    OpenAIRE

    Ascheri, María; Pizarro, Rubén

    2006-01-01

    Nuestro objetivo es introducir a los alumnos de Cálculo Numérico en el uso de la técnica de ajuste de curvas por medio de la regresión con mínimos cuadrados en la solución de problemas de ingeniería, de física y de matemática aplicada, utilizando herramientas numéricas y computacionales. La metodología usada para apoyar el proceso de enseñanza-aprendizaje de este temática particular de Cálculo Numérico con computadora es la siguiente: se combina la enseñanza tradicional, las técnicas grupales...

  2. Efectos de entrenar para cumplir criterios de congruencia en tareas de ajuste lector

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    Germán Morales-Chávez

    2010-01-01

    Full Text Available La presente investigación evaluó los efectos de entrenar estudiantes universitarios para satisfacer criterios de congruencia en tareas de ajuste lector con base en parámetros de congruencia y de coherencia. El grupo experimental fue entrenado para satisfacer criterios de congruencia y fue expuesto a dos pruebas de evaluación en satisfacción de criterios de congruencia y coherencia. El grupo control solo fue sometido a las pruebas de evaluación. Los resultados revelan que el entrenamiento favoreció la satisfacción de criterios tanto de congruencia como de coherencia. Se discute la relevancia del desempeño efectivo en una situación lectora con criterios de congruencia como condición para el desarrollo de conductas lectoras funcionalmente más complejas.

  3. EFECTOS DE ENTRENAR PARA CUMPLIR CRITERIOS DE CONGRUENCIA EN TAREAS DE AJUSTE LECTOR

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    Germán Morales-Chávez

    2010-01-01

    Full Text Available La presente investigación evaluó los efectos de entrenar estudiantes universitarios para satisfacer criterios de congruenciaen tareas de ajuste lector con base en parámetros de congruenciay de coherencia. El grupo experimental fue entrenadopara satisfacer criterios de congruencia y fue expuestoa dos pruebas de evaluación en satisfacción de criterios decongruencia y coherencia. El grupo control solo fue sometidoa las pruebas de evaluación. Los resultados revelan que elentrenamiento favoreció la satisfacción de criterios tanto decongruencia como de coherencia. Se discute la relevancia deldesempeño efectivo en una situación lectora con criterios decongruencia como condición para el desarrollo de conductaslectoras funcionalmente más complejas.

  4. El papel de la concertación social ante la política de ajuste

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    Juan Raso Delgue

    2015-10-01

    Full Text Available Contenido: Introducción. Ajuste. Modos de producción y concertación. Nuevos actores y nuevas dimensiones del conflictos. Las dimensiones de la nueva concertación. Contenidos de la nueva concertación. Conclusiones

  5. Relación entre variables familiares y el ajuste conyugal

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    Nerea Jiménez-Picón

    2018-04-01

    Full Text Available Resumen: Objetivo: Analizar si las variables familiares tales como tipo de relación de pareja, años de matrimonio, existencia de hijos, número de miembros de la unidad familiar, etapas del ciclo vital familiar, transición entre etapas, apoyo social percibido y/o acontecimientos vitales estresantes se relacionan con el ajuste conyugal. Diseño: Estudio transversal y correlacional mediante encuestas. Emplazamiento: Consultas de atención primaria y unidades de hospitalización de los centros seleccionados de la provincia de Sevilla, España. Participantes: Muestra consecutiva estratificada por cuotas de 369 parejas, mayores de 18 años, heterosexuales, que mantenían una relación de pareja, con o sin hijos, residentes en Sevilla. Mediciones principales: Se emplea cuestionario autoadministrado con las variables sociodemográficas y las escalas Versión Breve de la Escala de Ajuste Diádico, Cuestionario de MOS de Apoyo Social Percibido y Escala de Reajuste Social. Se realizó análisis descriptivo e inferencial con estadísticos de correlación y regresión multivariante. Resultados: Relaciones estadísticamente significativas entre el ajuste conyugal y los años de matrimonio (r = −0,10; p < 0,05, la etapa del ciclo vital familiar (F = 2,65; p < 0,05, la transición entre etapas (rpb = 0,11; p < 0,05 y el apoyo social percibido (r = 0,44; p < 0,001. El modelo de regresión mostró la capacidad predictiva del apoyo social percibido y etapa del ciclo vital familiar (etapa madura-anciana sobre el ajuste conyugal (R2 = 0,21; F = 9,9; DF = 356; p < 0,001. Conclusiones: Desde atención primaria, se puede valorar a las parejas, ofrecer recursos y proporcionar apoyo. También pueden identificarse variables que ayuden a mejorar la relación conyugal. Abstract: Objective: To determine whether family variables, such as type of relationship, years of marriage, existence of offspring, number of members of family, stage of family

  6. Comparación entre varias poblaciones estándar para el ajuste por edades

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    Javier Llorca Díaz

    2000-01-01

    Full Text Available FUNDAMENTO: Analizar el efecto que tiene la elección de una población de referencia sobre diferentes indicadores derivados de las tasas de mortalidad ajustadas por edad. MÉTODOS: Las tasas de mortalidad por diferentes causas de muerte en España de 1971 a 1992 son ajustadas empleando cuatro poblaciones de referencia: poblaciones españolas de 1971 y 1992, población estándar europea y población estándar mundial. Los resultados obtenidos con las cuatro poblaciones se comparan empleando tres indicadores: diferencia entre las tasas de 1992 y 1971, razón entre las tasas de 1992 y 1971y cambio anual porcentual entre 1971 y 1992. RESULTADOS: En la mayor parte de las causas de muerte estudiadas incluyendo el total de causas, la cardiopatía isquémica y casi todos los tumores, la razón de tasas y el porcentaje de cambio anual son similares con independencia de cuál sea la población estándar empleada. En cambio, la diferencia de tasas es muy diferente en función de la población de referencia. En las enfermedades infecciosas y el cáncer de testículo se produce la situación contraria: la diferencia de tasas es robusta mientras que la razón de tasas varía con la población estándar. Finalmente, la mortalidad por neumonía, enfermedad de Parkinson y cáncer de encéfalo muestra cambios en los tres indicadores utilizados. CONCLUSIONES: Es necesario realizar un análisis de las tasas específicas por edad antes de proceder a su ajuste. Este análisis permite averiguar si el ajuste por edades es correcto y qué indicador (diferencia, razón o cambio porcentual será adecuado para realizar comparaciones.

  7. Elementos para el análisis de los programas de ajuste

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    Villamizar Helena

    1991-12-01

    Full Text Available

    La aplicación de las políticas generales, preconizadas por los programas de ajuste en América Latina, en la mayoría de los casos no dieron los resultados deseados. Su éxito necesariamente requería del cumplimiento de ciertos supuestos y condiciones que permitieran que las políticas de "gestión de demanda no generaran efectos negativos sobre el crecimiento en el largo plazo. Al no cumplirse algunos de 105 supuestos teóricos básicos, y al no contar los países con flujos de capitales adecuados y con un entorno externo abierto, la aplicación de estos programas se tradujo en grandes sacrificios en el crecimiento y muchas veces en la perpetuación de situaciones recesivas. Puesto que la región aun no ha encontrado una verdadera vía de solución, se hace imperioso abordar la construcción de una nueva perspectiva teórica, basada en supuestos realistas, que permita abordar los apremiantes problemas del desarrollo latinoamericano.

  8. La influencia de las diferencias entre el padre y la madre sobre el ajuste adolescente

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    Antonia Jiménez-Iglesias

    2015-01-01

    Full Text Available Este trabajo se centra en analizar cómo influyen en el consumo de sustancias (tabaco, alcohol y cannabis y el bienestar psicológico adolescente (calidad de vida relacionada con la salud y satisfacción vital las diferencias entre el padre y la madre en afecto, promoción de la autonomía, revelación, interés y conocimiento. La muestra estuvo compuesta por 10170 chicos y chicas españoles de 13 a 18 años de familias biparentales que participaron en la edición 2006 del estudio Health Behaviour in School-aged Children (HBSC. Los resultados mostraron que los adolescentes que indicaron que su padre y madre coincidían en presentar altos niveles en las dimensiones familiares analizadas consumieron menos sustancias y tuvieron mejor bienestar psicológico. Por el contrario, el ajuste de los adolescentes cuyos progenitores (padre y madre tenían bajos niveles en esas dimensiones familiares fue peor. Concretamente, la dimensión más importante para el consumo de sustancias fue el conocimiento parental y para el bienestar psicológico lo fue el afecto parental; la revelación adolescente solo fue relevante para el consumo de alcohol y la calidad de vida, mientras que la promoción parental de la autonomía lo fue para la calidad de vida.

  9. Ajuste econômico e desemprego recente no Brasil metropolitano

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    MARCIO POCHMANN

    2015-12-01

    Full Text Available resumo O presente artigo trata da evolução da taxa de desemprego no início do ano 2015. Três partes compõem de forma consecutiva e encadeada a partir da premissa de que as mudanças no interior do mercado de trabalho sinalizadas principalmente pelo aumento dos desempregados são geradas fundamentalmente pelo avanço da recessão na economia brasileira. A primeira parte aponta as principais alterações no rendimento e emprego da mão de obra no mercado de trabalho do Brasil metropolitano durante os meses de janeiro a julho de 2015, enquanto a segunda parte descreve brevemente as características mais importantes que decorrem do aumento recente da taxa de desemprego. Por fim, a terceira parte registra comparativamente os reflexos da adoção das políticas de ajustes econômicos no desemprego em anos selecionados durante as últimas três décadas. Dessa forma, constata-se o grau de intensidade atual na evolução da taxa de desemprego com a de outros momentos vividos no país.

  10. Lucha popular, democracia, neoliberalismo: protesta popular en América Latina en los años del ajuste

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    Martha Cecilia García V.

    2000-01-01

    Full Text Available Margarita López Maya (editora. Lucha popular, democracia, neoliberalismo: protesta popular en América Latina en los años del ajuste. Caracas: Nueva Sociedad, 1999, 264 páginas. Este libro presenta una compilación de diez artículos elaborados por investigadores de Argentina, México, Colombia, Guatemala, Brasil, República Dominicana y Venezuela, producto de sus investigaciones sobre luchas y movimientos sociales en estos países. La intención del libro, según la compiladora, es tratar de llegar de manera conjunta a algunas hipótesis sobre los procesos de protesta y sus relaciones con el neoliberalismo y descubrir el modo en que los sectores más golpeados en sus expectativas y condiciones de vida por las políticas de ajuste han comenzado a demandar sus derechos.

  11. Inteligência emocional percebida (IEP ajuste emocional e actividade física na terceira idade

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    Maria Manuela Lima de Figueiredo Queirós

    2007-06-01

    Full Text Available O interesse deste estudo está centrado na forma como interage a inteligência emocional percebida (IEP com a prática da actividade física e que peso específi co tem cada uma das variáveis estudadas sobre o ajuste emocional das pessoas nesta faixa etária e, consequentemente, na sua qualidade de vida.

  12. ESTRATEGIAS DE AJUSTE ANTE CHOQUES HIPOTÉTICOS DE OFERTA Y DEMANDA. Resultados de una encuesta a empresas mexicanas

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    Paula Sánchez-Romeu

    2015-01-01

    Full Text Available En este artículo se analizan estrategias de ajuste para hacer frente a choques hipotéticos de oferta y demanda utilizadas por 1 138 empresas mexicanas encuestadas por el Banco de México en 2012. Los resultados del análisis muestran que la respuesta de las empresas ante los dos tipos de choque en general no es simétrica y que éstas reaccionan combinando estrategias (principalmente eligen reducir costos, con lo cual moderan los ajustes a precios y producción. Más competencia hace que las empresas utilicen con más intensidad las estrategias de ajuste y favorece la flexibilidad de los precios. Ante cualquier choque, los costos que más se reducen son los no laborales y los que genera el empleo temporal. Una alta competencia y un mayor porcentaje de costos laborales intensifican el traspaso de los choques al empleo; por el contrario, los acuerdos colectivos de trabajo mitigan dicho traspaso. No se observa un traspaso de los choques a las percepciones salariales, lo cual, aunado a la baja incidencia de la reducción del salario base, evidencia rigidez en los salarios nominales de las empresas entrevistadas.

  13. Père ou pair? Décalages et ajustements co-énonciatifs

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    Christiane Préneron

    2010-12-01

    Full Text Available

    L’objet de notre analyse dialogique et co-énonciative concerne la forme prise par la relation entre un père et son fi ls au cours d’échanges verbaux. Dans cette dimension relationnelle, nous avons cherché plus particulièrement à éclairer le statut d’énonciateur que chacun octroie à lui-même et à l’autre. Les images qu’un père et un fi ls ont l’un de l’autre et les places qu’ils occupent dans le dialogue sont en partie déterminées par leur statut de père et d’enfant. Ces places ne confi gurent pas un mode relationnel homogène. Au contraire, cet extrait de corpus est frappant par la grande diversité d’attitudes adoptées par le père avec son enfant: tour à tour il lui donne des ordres, des permissions, le réconforte, joue avec lui, lui propose des défi s ou rivalise avec lui. Daniel peut entrer dans le jeu proposé par son père ou s’y opposer, se laisser guider ou refuser, mais aussi être à l’initiative par des demandes ou des jeux. C’est cette diversité que nous tentons de mettre au jour, sachant que certaines séquences se caractérisent plus particulièrement par des décalages entre les interlocuteurs, alors que d’autres conduisent à des ajustements. Si la diversité qui caractérise cet extrait ne saurait être étendue comme caractérisant toute interaction père/enfant, l’analyse qui en est faite peut servir de repère pour l’étude de nouvelles interactions parent/enfant.

  14. Técnica de suturas ajustables: Resultados Technique of adjustable sutures: Results

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    Lourdes R. Hernández Santos

    2001-06-01

    Full Text Available Se realizó un estudio sensorial y motor preoperatorio y posoperatorio a 84 pacientes que acudieron a la consulta de Visión Binocular con el diagnóstico de estrabismo horizontal a partir de los 13 años de edad. El método estadístico utilizado fue "t" o Chi cuadrado. Nos trazamos como objetivo determinar los resultados posoperatorios de la cirugía de estrabismo realizada con la técnica de suturas ajustables, que fueron los siguientes: el 61 % de los pacientes con exotropía y el 71,4 % con el diagnóstico de exotropía se encontraban en ortotropía a los 6 meses de la intervención. El 71,4 % de los pacientes con esotropía y el 83,3 % con el diagnóstico de esotropía se encontraban en ortotropía al año de la intervención. Esta técnica quirúrgica permite la modificación de la desviación en el posoperatorio inmediato.A preoperative and postoperative sensorial and motor study was conducted among 84 patients who received attention at the consultation room of Binocular Vision with the diagnosis of horizontal strabismus from the age of 13 years old on. The statistical method used was "t" or chi square test. Our objective was to determine the postoperative results of the strabismus surgery performed by the technique of adjustable sutures. The results were as follows: 61 % of the patients with exotropia and 71.4 % with the diagnosis of exotropia were in orthotropia 6 months after the operation. 71.4 % of the patients with exotropia and 83.3 % with the diagnosis of exotropia were in orthotropia a year after the operation. This surgical technique allows the modification of the deviation in the immediate postoperative.

  15. Inteligencia emocional y ajuste psicosocial en la adolescencia: El papel de la percepción emocional

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    José M. Salguero

    2011-12-01

    Full Text Available La inteligencia emocional (IE, definida como la habilidad para percibir, usar, comprender y regular las emociones, se ha mostrado como una variable importante a la hora de explicar el ajuste psicosocial de las personas. Pese a ello, la mayor parte de la investigación en torno a la IE ha sido realizada con muestras de población adulta y son escasos los trabajos que, utilizando medidas de ejecución, exploren su papel en la adolescencia. El objetivo del presente estudio fue el de analizar la influencia de la percepción emocional, una de las habilidades recogidas dentro de la IE, sobre el ajuste personal y social de una muestra de adolescentes españoles. Un total de 255 alumnos completaron una tarea de ejecución diseñada para evaluar la percepción emocional en la adolescencia así como diferentes medidas de ajuste social y personal. Los resultados de los análisis de correlación y regresión mostraron cómo los adolescentes con una mayor habilidad para reconocer los estados emocionales de los demás informaron de mejores relaciones sociales con iguales y padres, menor tensión en sus relaciones sociales, así como de un mayor nivel de confianza y competencia percibida. Además, estos resultados se mantuvieron tras controlar los efectos de la edad, el sexo y la personalidad. Se discuten los resultados en el contexto de la investigación sobre la inteligencia emocional y se proponen implicaciones prácticas para el diseño de programas de prevención y tratamiento

  16. Os benefícios da hipoterapia nos ajustes posturais em crianças portadoras de paralisia cerebral

    OpenAIRE

    Daniela Carrogi Vianna; Maria Elisabete Salina Saldanha; Leide Masieiro Taques Moeckel Amaral

    2017-01-01

    Paralisia Cerebral é uma afecção encefálica que ocorre na fase maturacional, apresentando seqüelas variáveis, envolvendo desordens de postura e movimentos. Examinaram-se alterações posturais de pacientes portadores de Paralisia Cerebral durante e após a realização de Hipoterapia, observando ajustes posturais. Participaram oito crianças, entre 6 e 12 anos, com tetraparesia espástica, apresentando déficics das reações básicas de endireitamento, proteção e equilíbrio. Utilizou-se a Hipoterapia c...

  17. Ajuste psicosocial y vivencia de la adopción en niños/as adoptados/as internacionalmente

    OpenAIRE

    Reinoso Bernuz, Marta

    2013-01-01

    [esp] La adopción internacional ha adquirido en España unas muy notables dimensiones y el desarrollo y la adaptación de estos niños se ha convertido en un asunto de gran importancia. La presente tesis doctoral pretende contribuir al conocimiento en esta área y tiene por objetivo analizar el nivel de ajuste psicosocial, la vivencia de la adopción y el afrontamiento del estrés en la mediana infancia (8-12 años) de los niños adoptados internacionalmente en nuestro país. Esta tesis se con...

  18. COMPARACIÓN DE HABILIDADES SOCIALES Y AJUSTE PSICOLÓGICO EN NIÑOS MEXICANOS DE TRES CONDICIONES

    OpenAIRE

    Claudia González Fragoso; Amada Ampudia Rueda; Yolanda Guevara Benítez

    2014-01-01

    Las habilidades sociales en la infancia guardan una estrech a relación con aspectos como autoestima, ansiedad y depresión. Tales variables son indicadoras del ajuste psicológico, que puede alterarse en los niños que son víctimas de violencia o que viven en institucion es. Para contar con datos sobre niños mexicanos, el presente estudio exploratorio evaluó y comparó los niveles mostrados en habilidades sociales, autoestima, ansiedad y depresión en tres grupos de niños que se hallaban en cond...

  19. Consumo de sustancias durante la adolescencia:trayectorias evolutivas y consecuencias para el ajuste psicológico

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    Alfredo Oliva

    2008-01-01

    Full Text Available Este estudio ha perseguido dos objetivos fundamentales: encontrar diferentes trayectorias en el consumo de sustancias a lo largo de la adolescencia y analizar las consecuencias que este consumo en la adolescencia temprana y media tiene para el ajuste emocional y comportamental al final de la adolescencia. El estudio, con un diseño descriptivo longitudinal mediante cuestionarios, se llevó a cabo sobre una muestra de 101 adolescentes (63 varones y 38 mujeres que fueron estudiados en 3 ocasiones: a los 13, 15 y 18 años de edad. Los resultados mostraron tres grupos de adolescentes en función de las trayectorias seguidas por su consumo de sustancias: consumo bajo, consumo ascendente y experimentación precoz. La comparación entre estos tres grupos indicó un mejor ajuste psicológico en la adolescencia tardía entre los varones y mujeres del grupo de experimentadores, mientras que los problemas de conducta fueron más frecuentes entre los incluidos en el grupo de consumo ascendente. Por otra parte, los análisis de regresión señalaron que el consumo moderado de sustancias en la adolescencia temprana estaba relacionado con una autoestima más alta y con menos problemas emocionales al final de la adolescencia, pero no con más problemas externos.

  20. ALTAS HABILIDADES/SUPERDOTAÇÃO: um olhar para o desenvolvimento cognitivo, ajuste emocional e seus impactos na vida profissional

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    Alberto Padrón Abad

    2016-12-01

    El objetivo del presente artículo es analizar los factores de desarrollo cognitivo, ajuste emocional del individuo AH/SD y sus impactos en la vida profesional y laboral. La metodología empleada está basada en una investigación bibliográfica, exploratoria y descriptiva realizada a partir de referencias teóricas, referentes al tema, previamente analizadas y publicadas. En este sentido, se iniciará considerando los factores que facilitan el ajuste emocional de individuos AH/SD (familiares, escolares, laborales e interpersonales. Posteriormente, se analizará la pregunta: ¿por qué existen personas que a pesar de vivir en situaciones sociales y económicas desfavorables pueden desarrollar sus AH/SD y ser profesionales de éxito, mientras otros, con todas las oportunidades en la vida no llegan al éxito profesional ni contribuyen efectivamente con la sociedad? Con la intención de responder esa pregunta se estudiarán: el concepto de resiliencia, la Teoría de la Evaluación Cognitiva de Lazarus y la Teoría de la Desintegración Positiva de Dabrowski. De esta manera, se concluye la importancia de aplicar de manera efectiva los modelos teóricos ya propuestos, de modo comprensivo y explicativo, de las AH/SD acerca de los aspectos del desarrollo cognitivo y emocional de los individuos.

  1. Os benefícios da hipoterapia nos ajustes posturais em crianças portadoras de paralisia cerebral

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    Daniela Carrogi Vianna

    2017-05-01

    Full Text Available Paralisia Cerebral é uma afecção encefálica que ocorre na fase maturacional, apresentando seqüelas variáveis, envolvendo desordens de postura e movimentos. Examinaram-se alterações posturais de pacientes portadores de Paralisia Cerebral durante e após a realização de Hipoterapia, observando ajustes posturais. Participaram oito crianças, entre 6 e 12 anos, com tetraparesia espástica, apresentando déficics das reações básicas de endireitamento, proteção e equilíbrio. Utilizou-se a Hipoterapia como terapêutica complementar, exigindo respostas posturais automáticas. As crianças foram submetidas a duas sessões semanais, durante doze meses. Constatou-se melhora das variáveis estudadas, concluindo-se que a Hipoterapia auxilia na ativação dos ajustes posturais em crianças com Paralisia Cerebral.

  2. Historia Funcional de Morfologías Lingüísticas y su Efecto en un Ajuste Convencional

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    Nataly Yáñez Ramírez

    2011-01-01

    Full Text Available Se observó si diferentes historias funcionales construidas durante la adquisición de un conjunto de morfologías lingüísticas facilitaban un ajuste convencional. Participaron 24 estudiantes universitarios distribuidos en tres grupos, expuestos a entrenamientos construidos bajo la lógica de diferentes niveles de interacción: contextual, suplementario o selector (Ribes y López, 1985; y posteriormente se evaluó su ejecución en una tarea convencional. El entrenamiento cuyo criterio de ajuste era de tipo selector fue la que más facilitó tanto la adquisición de las morfologías lingüísticas como su uso en la tarea, efecto que pareció más evidente en los hablantes que en los escuchas. No se encontraron diferencias entre los entrenamientos contextual y suplementario. Los resultados se discuten en términos de sus implicaciones teóricas y metodológicas.

  3. El ajuste estratégico: las relaciones entre la estrategia competitiva, la estrategia de recursos humanos y la estrategia de producción

    OpenAIRE

    González Sánchez, Daniel

    2017-01-01

    [ES] Este trabajo se centra en el estudio del ajuste estratégico que se produce en la empresa entre distintos niveles de estrategia y entre diferentes funciones de la misma. En concreto, analizamos el ajuste entre la estrategia competitiva, la estrategia de recursos humanos y la estrategia de producción, prestando especial atención al área de recursos humanos. Para ello concebimos la estrategia competitiva de acuerdo al paradigma propuesto por Porter (1980), nos basamos en la teoría de la ...

  4. Análisis de los factores de ajuste por utilización de carril en intersecciones semaforizadas de bogotá d. c.

    OpenAIRE

    Peña Lindarte, Ricardo José

    2010-01-01

    Este artículo está basado en el planteamiento metodológico desarrollado en el Manual de Capacidad de Carreteras de Estados Unidos (HCM - Highway Capacity Manual), de la Transportation Research Board (TRB), para el análisis de capacidad y niveles de servicio en intersecciones semaforizadas, asociado al factor de ajuste por utilización de carril (fLU), que corresponde a uno de los once factores de ajuste propuestos en la metodología de cálculo, en el módulo de intensidades de saturación. La est...

  5. Comércio intra-industrial e custos de ajuste para a indústria do Valle del Cauca (1975-2014)

    OpenAIRE

    Hernández García, Edwin Arbey; Universidad del Valle; Raffo López, Leonardo; Universidad del Valle

    2016-01-01

    RESUMEN El objetivo del artículo es analizar los costos de ajuste para la industria vallecaucana durante el período 1975-2014, considerando el patrón de comercio exterior del Departamento. Para ello, se calcula el índice de Brülhart para analizar el comercio intra-industrial marginal. También se examina la naturaleza vertical y horizontal del comercio intra-industrial, y su relación con los costos de ajuste en la industria del Departamento. Como principal resultado, se obtiene que las relacio...

  6. Algoritmos Evolutivos y su empleo en el ajuste de controladores del tipo PID: Estado Actual y Perspectivas

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    Gilberto Reynoso-Meza

    2013-07-01

    Full Text Available Resumen: Los controladores PID continúan siendo una solución fiable, robusta, práctica y sencilla para el control de procesos. Actualmente constituyen la primera capa de control de la gran mayoría de las aplicaciones industriales. De ahí que un número importante de trabajos de investigación se han orientado a mejorar su rendimiento y prestaciones. Las líneas de investigación en este campo van desde nuevos métodos de ajuste, pasando por nuevos tipos de estructura hasta metodologías de diseño integrales. Particularizando en el ajuste de parámetros, una de las formas de obtener una solución novedosa consiste en plantear un problema de optimización, el cual puede llegar a ser no-lineal, no-convexo y con restricciones. Dado que los algoritmos evolutivos han mostrado un buen desempeño para solucionar problemas complejos de optimización, han sido utilizados en diversas propuestas relacionadas con el ajuste de controladores PID. Este trabajo muestra un revisión de estas propuestas y las prestaciones obtenidas en cada caso. Así mismo, se identifican algunas tendencias y posibles líneas de trabajo futuras. Abstract: PID controllers are a reliable, robust, practical and easy to implement control solution for industrial processes. They provide the first control layer for a vast majority of industrial applications. Owing to this, several researches invest time and resources to improve their performance. The research lines in this field scope with new tuning methods, new types of structures and integral design methods. For tuning methods, improvements could be fulfilled stating an optimization problem, which could be non-linear, non-convex and highly constrained. In such instances, evolutionary algorithms have shown a good performance and have been used in various proposals related with PID controllers tuning. This work shows a review of these proposals and the benefits obtained in each case. Some

  7. O ajuste urbano: as políticas do Banco Mundial e do BID para as cidades

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    Pedro Fiori Arantes

    2006-12-01

    Full Text Available Ao ajuste estrutural que se seguiu à crise da dívida no Terceiro Mundo, no início dos anos 80 - e ainda persiste como um ajuste permanente -, parece ter ocorrido um correspondente" ajuste urbano". Em ambos os casos, o Banco Mundial e, na América Latina, o BID, tiveram ação decisiva, em parceria com as elites e tecnocracias locais. As estratégias de ação dessas duas instituições financeiras, apesar de sua forte interferência nas políticas públicas dos países em desenvolvimento, constituem um tema novo e ainda pouco abordado pela pesquisa acadêmica. Em nosso caso, o objetivo foi desvendar o modelo de cidade que tem sido por elas defendido e qual seu significado. Na dissertação que realizei pela FAUUSP, constatei que os empréstimos do Banco Mundial e do BID - que aparecem aos gestores públicos como" tábuas de salvação" em tempos de crise -, não são" neutros" e carregam consigo uma agenda afirmativa: pretendem modelar um determinado padrão de uso do recurso público e de organização do Estado. As duas instituições difundem políticas públicas que seguem critérios empresariais de rentabilidade e um modelo de gestão estatal terceirizada, à mercê de um corpo técnico privado - formado por gerenciadoras de projeto, fundações privadas, ONGs e inúmeros consultores. Seu objetivo é transformar uma parcela dos governos locais nos países em desenvolvimento, especialmente os que administram os territórios que dão suporte aos negócios transnacionais, em estruturas administrativas treinadas para responder aos grandes interesses privados, ao mesmo tempo em que se desembaraçam de qualquer compromisso com a democracia real.

  8. Les particules illocutoires, variable d’ajustement de la traduction sous-titrante au cinéma

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    Ève Vayssière

    2010-12-01

    Full Text Available Die illokutiven Partikel fungieren als Anpassungsvariable, die beim Übersetzungsakt zur Untertitelung von Filmen entweder weggelassen werden oder erscheinen. Wenn sie einfach gelöscht werden, ergeben sich weder grammatikalische Störungen noch Informationsverlust. Das Auftauchen dieser Partikel in den deutschen Untertiteln zeigt jedoch, wie wichtig sie sind: Als Partikel der Oralität tragen sie zur Idiomatizität bei.Les particules illocutoires sont des variables d’ajustement lors de l’acte de traduction sous-titrante au cinéma, elles peuvent être supprimées sans que cela occasionne de dysfonctionnement grammatical et elles disparaissent lors de la traduction en français sans que cela occasionne une perte d’informations. Leur apparition dans les sous-titres allemands montre néanmoins leur importance : particules de l’oralité, elles sont vecteur d’« idiomaticité ».

  9. Cirurgia de estrabismo ajustável no peroperatório com anestesia tópica em pacientes com orbitopatia de Graves Intraoperative adjustable strabismus surgery under drop anesthesia in patients with Graves' orbitopathy

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    Patrícia Grativol Costa

    2008-06-01

    Full Text Available OBJETIVO: Descrever as características clínicas pré-operatórias dos pacientes com estrabismo secundário à orbitopatia de Graves e os resultados da cirurgia com anestesia tópica e sutura ajustável. MÉTODOS: Estudo retrospectivo realizado no Hospital das Clínicas da Universidade de São Paulo. Foram pesquisados os prontuários de todos os pacientes atendidos no ambulatório de estrabismo no período de março de 1994 a maio de 2004. Destes, foram separados aqueles com estrabismo associado à orbitopatia de Graves submetidos à cirurgia ajustável com anestesia tópica. As características clínicas pré-operatórias e os resultados cirúrgicos foram levantados a partir desta análise. RESULTADOS: Foram incluídos 13 pacientes. O tipo de desvio mais freqüentemente encontrado foi esotropia com hipotropia. Em 9 pacientes modificou-se o retrocesso programado no pré-operatório. Três casos necessitaram de uma segunda cirurgia. Após 6 meses de seguimento, 8 dos 13 pacientes estavam ortotrópicos ou com foria pequena e com algum grau de estereopsia. CONCLUSÃO: Neste estudo observou-se que 62% (8/13 dos pacientes apresentavam hipotropia com esotropia, provavelmente por causa do comprometimento associado do reto inferior e reto medial. Nove dos 13 pacientes necessitaram de ajuste no peroperatório e apenas 3 foram reoperados, indicando a importância da técnica ajustável para melhor alinhamento ocular no pós-operatório, possibilitando obter resultados mais satisfatórios.PURPOSE: To report the clinical features of strabismus associated with Graves' orbitopathy, and the results of surgery with adjustable suture under drop anesthesia. METHODS: The charts of 13 patients who had surgical treatment for strabismus related to Graves' orbitopathy at Hospital das Clínicas of University of São Paulo were retrospectively reviewed. Ocular motility, sensorial examination and the follow-up after strabismus correction were studied. RESULTS

  10. Ajustement de la courbe de lactation de la chèvre locale dans les zones arides Tunisiennes

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    Ilyes Mekki

    2011-10-01

    Full Text Available Les performances laitières de la chèvre locale dans les zones arides tunisiennes dépendent des capacités génétiques de l’effet des conditions du milieu et du mode de conduite des troupeaux. L’objectif de cette étude est d’analyser les performances laitières de la chèvre locale en fonction de ces facteurs à travers l’ajustement de la courbe de lactation. De telles connaissances sont indispensables pour planifier la gestion raisonnable de cette ressource animale rustique dans des conditions naturelles difficiles. Les données utilisées pour cette étude sont issues de 10 campagnes de contrôle laitier réalisé au niveau d’un troupeau caprin expérimental conduit dans les régions arides. Suite à l’élaboration des données, l’application des procédures de régression non linéaire a identifié le modèle de Wood comme le plus adaptée pour l’ajustement de la courbe de lactation de la chèvre locale. Ce modèle a été appliqué pour estimer les paramètres de la lactation individuelle et l’étude des facteurs de variation. Les résultats d’ajustements des données montrent que la lactation de la chèvre locale évolue après la mise bas selon une trajectoire assez aplatie. Les performances de la chèvre locale sont assez réduites et similaires à celles observées pour des populations élevées dans des zones difficiles tunisiennes de point de vue climatique et pastorale. La moyenne de production initiale observée est de 720 g/j, le pic de lactation est observé au 17ème jour lorsqu’une chèvre produit en moyenne 980g/j. La réduction des potentialités laitières de la chèvre locale illustre les effets du processus de sélection naturelle qui a favorisé l’adaptation aux conditions difficiles des régions arides. Les résultats contribuent à la caractérisation de la chèvre locale et à la planification de son amélioration comme étant une ressource génétique locale et rustique.

  11. Ajuste oclusal na Ortodontia: por que, quando e como? Occlusal adjustment in Orthodontics: why, when and how?

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    Roberto Carlos Bodart Brandão

    2008-06-01

    Full Text Available INTRODUÇÃO: o conhecimento sobre oclusão dentária deve ser considerado condição fundamental para a prática de uma Ortodontia de qualidade. O diagnóstico feito sem a manipulação do paciente em Relação Cêntrica pode levar à surpresa desagradável de se planejar o tratamento de uma má oclusão e se deparar com outra, depois dos primeiros arcos de nivelamento. Ao usar arcos retangulares, é importante a checagem dos contatos oclusais para se definir o tipo de movimento dentário necessário para o alcance do equilíbrio oclusal e, principalmente, verificar se este movimento é exeqüível. Durante o tratamento ortodôntico, devido à complexidade das superfícies oclusais, o ajuste oclusal por desgaste deve ser realizado para viabilizar movimentos dentários verticais, reduzindo o tempo de tratamento. Interferências oclusais são responsáveis tanto por efeitos adversos na biomecânica, quanto por aplicação de forças excessivas, que podem causar reabsorções radiculares. Após a Ortodontia, o ajuste oclusal é um dos determinantes da estabilização dentária, devendo-se obter, para cada dente posterior, contatos oclusais "A" e "B", ou "B" e "C" no sentido vestibulolingual, além dos contatos de "parada" e "equilíbrio" no sentido mesiodistal. Os dentes anteriores passam a funcionar em movimentos mandibulares, desocluindo de imediato os dentes posteriores, o que é denominado de guia anterior, visando equilíbrio muscular e proteção do sistema estomatognático. O desgaste seletivo não deve ser utilizado como substituto da movimentação ortodôntica. OBJETIVO: apresentar os princípios relacionados ao ajuste oclusal em Ortodontia.INTRODUCTION: The knowledge of dental occlusion should be considered the basic foundation to an excellent orthodontic practice. The patient’s diagnose without the centric relation assessment can take the orthodontist to an unpleasant surprises. The use of rectangular archwires requires occlusal

  12. Efectividad del ajuste oclusal en pacientes de alta de ortodoncia Effectiveness of occlusal adjustment in patients with orthodontic discharge

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    Amitis Ruiseco Palomares

    2006-12-01

    Full Text Available El tratamiento ortodóncico tiene como objetivo llegar a un punto óptimo oclusal, estético y funcional. Con frecuencia son introducidas interferencias que a largo plazo pueden provocar disturbios del sistema estomatognático; una técnica de ajuste oclusal puede ser útil para estabilizar la función y garantizar la salud de este. Se seleccionó una muestra constituida por 14 pacientes con más de 6 meses de alta ortodóncica, diagnosticados con interferencias oclusales en una investigación previa. A cada uno de ellos se les realizó un ajuste oclusal por tallado selectivo, y pasados 6 meses, se procedió a la evaluación de la oclusión para la detección de posibles interferencias, analizándolas durante los diferentes movimientos mandibulares, tanto en las áreas de trabajo como de no trabajo, así como por grupos dentarios. Para ello se les realizó el análisis funcional de la oclusión en boca, completándose el estudio con el montaje de los modelos en el articulador semiajustable Dentatus ARL mediante el uso del arco facial. El estudio reveló que a la mayoría de los pacientes se les reestableció una oclusión funcional, lo que demuestra la efectividad del tratamiento, que el mayor porcentaje de interferencias después del ajuste fueron en el área de no trabajo y durante los movimientos de lateralidad, además de que el grupo molar fue el de mayor cantidad de interferencias, tanto antes como después del tratamiento oclusal.The orthodontic treatment is aimed at reaching an occlusal, aesthetic, and functional optimal point. The frequently introduced interferences may cause disorders of the stomathognatic system, and an occlusal adjustment technique may be useful to stabilize the function and to gurantee its health. A sample of 14 patients with more than 6 months of orthodontic discharge that were diagnosed occlusal interferences in a previous research was selected. Each of them underwent occlusal adjustment by selective grinding, and

  13. Cronograma de amostragem de alface cultivada em hidroponia para ajuste de curvas de crescimento vegetativo Sampling chronology of hydroponics lettuce plants for adjusting vegetative growth curves

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    Sidinei José Lopes

    2007-10-01

    Full Text Available O objetivo deste trabalho foi determinar o cronograma de amostragem de plantas de alface hidropônica, para ajuste de curvas de crescimento durante o período vegetativo. Foram realizados dois cultivos de alface, variedade Regina, de 8/9/2004 a 19/11/2004 (primavera/verão e 22/2/2005 a 24/5/2005 (verão/outono, em estufas de plástico do Dep. de Fitotecnia, da UFSM, Santa Maria, RS. A partir do ajuste do modelo co-seno com amostragem diária, registrada como padrão, diferentes intervalos entre as amostragens foram simulados para o ajuste do mesmo modelo. A fim de se encontrar o intervalo adequado, foi comparada a variância de falta de ajuste do modelo de amostragem diária com as variâncias de falta de ajuste dos modelos com diferentes intervalos de amostragens pelo teste F. Os cronogramas de amostragens para ajuste de curvas de crescimento de plantas de alface sob hidroponia, para experimentos de primavera/verão e verão/outono, possuem intervalos iguais a dois dias, para fitomassa seca total da planta e da folha; intervalos de quatro dias, para fitomassa de raiz; e, diariamente, para área foliar.The objective of this work was to determinate a sampling chronology to adjust lettuce hidroponic growth curves during its vegetative development. The variety Regina was grown from September 8, 2004 until November 19, 2004 (spring/summer and February 22, 2005 until May 24, 2005 (summer/fall. Plants were placed inside a plastic covered greenhouse in Santa Maria, RS, Brazil. Based on the adjusted cosine model, daily samples were taken as standard and different sampling intervals were simulated in order to better adjust the same model. To estimate de adequate sampling interval a comparison was conducted between the variance of lack of adjustment of the daily sampling with the variance of lack of adjustment of different samplings intervals using an F test. Sampling chronograms for adjusting crop growth curves of hydroponics lettuce plants for both

  14. La norma L1 como alternativa a la norma L2 en el ajuste de la regresión

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    Carlos N. Bouza

    2002-01-01

    Full Text Available En este trabajo analizamos el desarrollo y los conceptos de las normas L1 y L2 y se comparan con algunos ejemplos. Por una parte la norma L1 es óptima bajo los supuestos de que los errores tienen la distribución de Laplace. Esta fue propuesta mucho antes que el MC, pero las facilidades de cómputo de éstos últimos le dieron primacía. Actualmente va adquiriendo gran importancia para las aplicaciones económicas, dado que en general los problemas de finanzas y de series temporales incumplen con las hipótesis usadas en el teorema de Gauss-Markoff. El uso de la norma L2, es el método de universal aceptación en el ajuste de la regresión. Sin embargo su optimalidad solo es válida bajo una serie de supuestos que no se cumplen en general (Teorema de Gaus- Markoff. Por lo tanto, norma L1 aparece como una alternativa mejor que la L2 en muchas aplicaciones dada su robustez ante las observaciones atípicas.

  15. EL AJUSTE CONDUCTUAL, EMOCIONAL Y SOCIAL EN HERMANOS DE NIÑOS CON UN TRASTORNO DEL ESPECTRO AUTISTA. UNA REVISIÓN TEÓRICA

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    Raquel Ruiz Aparicio

    2015-09-01

    Full Text Available Las personas con Trastorno del Espectro Autista (TEA tienen características únicas y hay una falta de conocimiento sobre cómo estas características podrían influir en sus familias y en el ajuste conductual, emocional y social de sus hermanos. El presente estudio tiene el objetivo de centrarse en los hermanos de estas personas con TEA y realizar una revisión teórica relacionada con el ajuste conductual, emocional y social de hermanos de niños con TEA. Un total de 24 artículos han sido incluidos y analizados con el fin de encontrar resultados relevantes que puedan ayudar a entender las necesidades de estos hermanos. El estudio sugiere, en ocasiones, resultados diferentes pero identifica aquellos factores de riesgo que podrían impactar en el núcleo familiar y, principalmente, en los hermanos de niños con TEA.

  16. Estableciendo nexos entre Políticas de Ajuste Estructural y su impacto ambiental: una discusión metodológica

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    Rosalba Ortiz

    2011-09-01

    Full Text Available Las políticas de Ajuste Estructural han sido la base de la política económica costarricense en los últimos 10 años, por lo cual, han tenido gran incidencia en el análisis de los procesos y relaciones de cualquier sector productivo. En este contexto, los efectos ambientales de los últimos años, están decididamente influenciados por estas políticas, pues aunque, los programas de Ajuste no tienen como propósito direccionar aspectos ambientales, al modificar algunos precios relativos, pueden propiciar un cambio en el patrón de uso de un recurso, y es así como, tienen un efecto directo o indirecto sobre el ambiente

  17. Apego y Ajuste Socio Emocional: Un Estudio en Embarazadas Primigestas Attachment and Socio-Emotional Adjustment: A Study in First Pregnant Women

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    Chamarrita Farkas

    2008-05-01

    Full Text Available Este artículo se centra en el estudio del apego adulto y su relación con el ajuste socioemocional durante el primer embarazo. Se utiliza una investigación descriptiva correlacional de carácter transversal. La muestra se compone de 139 embarazadas primigestas de 19 a 40 años y nivel socio-económico medio, medio bajo y bajo. El estilo de apego fue evaluado con el Cuestionario de Apego en Adultos, CaMir, y el ajuste socioemocional con el Cuestionario de Salud Mental, OQ-45.2. Se realizan análisis descriptivos de la muestra y correlaciones entre estilos de apego y las dimensiones del Cuestionario de Ajuste Socioemocional con el Coeficiente Producto Momento de Pearson. Los resultados muestran una relación significativa entre los estilos de apego y los indicadores de ajuste.This article focuses on the study of adult attachment and its relationship with socio-emotional adjustment during the first pregnacy. A correlational descriptive study using a cross-sectional design was conducted. The sample included 139 primípara females between 19 and 40 years of age, from medium, medium-low and low socioeconomic status. The attachment style was evaluated using the Attachment Questionnaire for Adults, CaMir, and the socio-emotional adjustment with the Mental Health Questionnaire, OQ-45.2. Descriptive analyses of the sample were conducted, and the bivariate correlations between attachment styles and adjustment was estimated. The results show a significant relation between attachment styles and adjustment indexes.

  18. Autonomía y ajuste académico: un estudio con estudiantes portugueses de primer año

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    Ana Paula Soares

    2007-01-01

    Full Text Available Los niveles de autonomía psicológica de los alumnos desempeñan un papel importante en su ajuste a las presiones y desafíos de la vida universitaria. En este sentido, el presente estudio descriptivo analiza las relaciones entre los niveles de autonomía de los estudiantes en su entrada en la Enseñanza Superior y la calidad de su ajuste académico al final del primer año. Se aplicó el Iowa Developing Autonomy Inventory (IDAI en el inicio del año lectivo y el Questionário de Vivências Académicas (QVA al final de ese año a una muestra de 420 alumnos de primer año de la Universidade do Minho. Los resultados revelan que los alumnos poseen percepciones bastante positivas en cuanto a sus niveles de autonomía en las áreas de Gestión del tiempo, Movilidad e Interdependencia, y niveles más bajos en la Gestión del dinero, observándose algunas oscilaciones en función del género. Por otro lado, los alumnos cuya entrada en la Enseñanza Superior no implicó su abandono del hogar familiar, especialmente los de sexo masculino, presentan niveles más elevados de ajuste académico. Finalmente, los resultados sugieren que el ajuste académico se encuentra asociado a los niveles de autonomía de los alumnos, en particular en lo que concierne a la Gestión del tiempo, Independencia emocional de sus compañeros e Interdependencia.

  19. Los Programas de Desarrollo Rural en la Argentina (en el contexto del ajuste macroeconómico neoliberal

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    Mabel Manzanal

    2000-09-01

    Full Text Available Este trabajo expone las estrategias de los principales programas de desarrollo rural en la Argentina, y sus alcances y posibilidades en el contexto del ajuste macroeconómico neoliberal. Discute si se están dando, o no, los cursos de acción adecuados, y si es viable la asistencia a los pobres rurales, promovida por los organismos internacionales de financiamiento, frente al impacto negativo de las políticas neoliberales sobre los pequeños y medianos productores agropecuarios.El desarrollo rural se inicia en la Argentina junto con la recuperación democrática de la década del 80, pero las primeras acciones recién comienzan a ejecutarse a principios de los 90. Desde entonces se sucedieron y se superpusieron diferentes programas, que son el objeto de este artículoThis paper discusses the strategies of Argentina’s main rural development programs, and their accomplishments and possibilities in the context of neoliberal macroeconomic adjustment. It analyzes whether the actions being carried out are suitable and whether assistance to the rural poor (promoted by international financing organizations is feasible in the face of the neoliberal policies’ negative impact on small and intermediate farmers and ranchers. Although rural development programs began in Argentina with the restoration of democracy in the 1980s, the first significant actions were not taken until the 1990s. The different programs that have followed, often overlapping, are the object of our study

  20. DO INCENTIVO À CRIMINALIZAÇÃO: OS TERMOS DE AJUSTE DE CONDUTA NA ORIZICULTURA EM SANTA CATARINA - BRASIL

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    Alfredo Celso Fantini

    2014-03-01

    Full Text Available Em Santa Catarina os Termos de Ajuste de Conduta (TACs vêm ganhando espaço como estratégia para garantir, na zona rural, a recuperação de áreas de preservação permanente, principalmente as matas ciliares. No caso dos plantadores de arroz a situação é, no mínimo, discutível: agricultores antes incentivados pelo Estado a usarem para a produção toda a área de várzea, até o limite dos rios, são obrigados agora a recuperarem a vegetação ciliar “que nunca deveria ter sido suprimida”. Ignorando a complexidade da questão, o Ministério Público adotou o comando e controle para resolver “o problema”. Passados três anos, quase nada aconteceu na prática. Neste artigo, usamos uma abordagem sistêmica para compreender a situação-problema e apontar encaminhamentos para a sua melhoria. Em um estudo de caso realizado em Jacinto Machado-SC, foram utilizados métodos qualitativos e quantitativos (análise documental, entrevistas, inventários e oficinas e principalmente a Soft System Methodology (SSM. Os resultados revelaram que a mata ciliar é só mais um elemento de um complexo sistema de interesses, onde fatores sociais, culturais, ambientais e econômicos interagem dinamicamente. Apontam, também, a necessidade de uma aproximação entre os interessados na situação-problema para tornar possível uma acomodação entre as diferentes visões de mundo dos envolvidos

  1. La industria manufacturera en Centroamérica: Perspectivas del Ajuste a la nueva política comercial regional

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    Fernando RUEDA-JUNQUERA

    2009-11-01

    Full Text Available RESUMEN: La nueva política comercial del Mercado Común Centroamericano está dando lugar a cambios en los flujos comerciales, que inducirán un ajuste inter-/intraindustrial en el sector manufacturero regional. Este artículo presenta y analiza los principales resultados de un estudio empírico que evaluó el impacto del nuevo programa de integración regional en el patrón de especialización y comercio de manufacturas de cada país miembro. El enfoque empírico empleado conllevó la construcción de hojas de balance que integraron en una base comparable los datos de producción y comercio para el sector manufacturero de cada país. Asimismo, se obtuvieron dos grupos de ratios que midieron respectivamente, la importancia relativa de los mercados regional y mundial para los subsectores manufactureros de cada país, y el potencial de éstos para una especialización inter-/intraindustrial en los dos mercados.ABSTRACT: The new trade policy in the Central American Common Market is given rise to changes in trade flows that will induce an inter-/intraindustry adjustment in the regional manufacturing sector. This article presents and analyses the main results of an empirical study which assessed the impact of the new integration scheme on each member country's pattern of trade and specialisation in manufactures. The empirical approach used in the study involved the construction of balance sheets integrating production and trade data on a comparable basis for each country's manufacturing sector. Likewise, two groups of ratios were obtained. They measured respectively, the relative importance of the regional and world market for the manufacturing subsectors of each country and the subsectoral potential for an inter-/intraindustry specialisation in the two markets.

  2. Ajuste social em pacientes com transtorno afetivo bipolar, unipolar, distimia e depressão dupla Social disability in patients with bipolar and unipolar affective disorders, dysthymia and double depression

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    Adriana M Tucci

    2001-06-01

    Full Text Available OBJETIVOS: Dados internacionais mostram que os transtornos afetivos têm uma prevalência de, aproximadamente, 11,3% da população. Além disso, são uma das doenças que mais geram perdas sociais e nos relacionamentos familiares. O objetivo deste trabalho foi avaliar o ajuste social e familiar de pacientes com transtornos afetivos (bipolar, unipolar, distimia e com depressão dupla, comparando o resultado entre as categorias diagnósticas, além de verificar quais variáveis estão associadas e conduzem ao pior ajuste. MÉTODOS: Foram feitos a caracterização socioeconômica e demográfica e um levantamento dos dados de evolução e de história da doença por meio de um questionário elaborado para essa finalidade. Para a avaliação de ajuste social, utilizou-se a Escala de Avaliação da Incapacitação Psiquiátrica (DAS/OMS, 1998. O relacionamento familiar foi avaliado pelo Global Assessment of Relational Functioning Scale (GARF/APA, 1994. Foram estudados 100 pacientes em tratamento, por pelo menos seis meses, no Ambulatório de Psiquiatria da Faculdade de Medicina Unesp, Botucatu, SP. RESULTADOS/CONCLUSÕES: Com predomínio de mulheres, a maioria dos pacientes tinha no mínimo dois anos de seguimento, idade acima de 50 anos, baixa escolaridade e nível socioeconômico baixo. Não houve diferença estatística significativa quanto aos dados socioeconômicos e demográficos. Na análise de regressão logística, o diagnóstico e o relacionamento familiar tiveram papel significativo no resultado de ajustamento social. Os pacientes unipolares e os distímicos tiveram melhores resultados no ajustamento social e no relacionamento familiar do que os bipolares e aqueles com depressão dupla.OBJECTIVES: International data show that affective disorders have a prevalence of 11.3% in the general population. Besides that, they are responsible for social dysfunctioning and family relationship distress. The aim of this study was to assess social and

  3. El ajuste o desajuste de las prácticas normativas en Ignacio Ellacuría: hacia una nueva dimensión de lo normativo /

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    Senent, Juan Antonio

    2011-08-01

    Full Text Available Abstract: This work provides an analysis of adjustment or disadjustment of human rights from Ignacio Ellacuría thesis. We must first place this analysis in the critical context that animatesit, the horizon of historical praxis. From there, a rationale for its adjustment in relation to human praxis is proposed, as well as a critical study of the role such adjustment or maladjustment of regulatory schemes currently plays in the overall regulatory process within the social practices in the contemporary civilization stage.In turn, we conduct an analysis of the struggle to articulate other regulatory schemes that respond more tightly to the demands of justiceagainst others and nature.Resumo: Este trabajo realiza un análisis sobre el ajuste o desajuste de los derechos humanos a partir de la tesis de Ignacio Ellacuría. Se trata primero de ubicar este análisis en el contexto crítico que lo anima, el horizonte de la praxis histórica. Desde ahí se propone una fundamentación del ajuste en su relación con la praxis humana, así como el estudio crítico del papel que ese ajuste o desajuste de los esquemas normativos juega actualmente en el conjunto del procesonormativo en el seno de las prácticas sociales en la presente fase civilizatoria. A su vez, se aborda un análisis de la lucha por articular otros esquemas normativos que respondan más ajustadamentea las exigencias de la justicia frente a los otros y a la naturaleza.

  4. Análisis de los factores de ajuste por utilización de carril en intersecciones semaforizadas de Bogotá D. C.

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    Ricardo José Peña Lindarte

    2010-01-01

    Full Text Available Este artículo está basado en el planteamiento metodológico desarrollado en el Manual de Capacidad de Carreteras de Estados Unidos (HCM - Highway Capacity Manual, de la Transportation Research Board (TRB, para el análisis de capacidad y niveles de servicio en intersecciones semaforizadas, asociado al factor de ajuste por utilización de carril (fLU, que corresponde a uno de los once factores de ajuste propuestos en la metodología de cálculo, en el módulo de intensidades de saturación. La estimación del factor fLU plantea la definición de una metodología teniendo en cuenta las condiciones operacionales de intersecciones se- maforizadas en Bogotá D. C. a partir del análisis de las corrientes vehiculares, que incluye caracterización vial y del tránsito, con base en muestreos estadísticos, toma y procesamiento de información de campo y análisis de datos. El estudio establece, entre otros aspectos, ecuaciones que permiten obtener datos referenciales para la determinación de factores de ajuste por utilización de carril en vías de Bogotá en función de las tipologías de los accesos y el volumen vehicular prevaleciente para el análisis de intersecciones semaforizadas; por ejemplo, para el caso específico de vías con accesos de dos carriles directos (2CCD la ecuación básica determinada fue y=-3,03E-08X2+3,44E-05X+0,888988, con coeficiente de correlación igual a 1,0, donde la variable dependiente y corresponde al factor fLU y la variable independiente X es el volumen en vehículos mixtos/hora, ecuación considerada estadísticamente significativa. Finalmente, se presenta el análisis comparativo de los factores de ajuste por utilización de carril estimados en el estudio, comparando los valores recomendados por el HCM, sustentándose así las conclusiones y recomendaciones, de las cuales se extracta la validación de los factores recomendados por el HCM, y se propone utilizar para los proyectos de diseño y planeamiento semaf

  5. Creencias y ajuste psicológico de la persona que acompaña al drogodependiente y creencias de éste durante el tratamiento

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    José Miguel Martínez González; Humberto Manuel Trujillo Mendoza

    2005-01-01

    El objetivo de esta investigación fue estudiar si las creencias relacionadas con la vivencia del acompañamiento de un familiar en el tratamiento de un drogodependiente, y las del mismo paciente, varían en función de aspectos como el tiempo de abstinencia, el tiempo dedicado al tratamiento, la presencia de patología dual en el drogodependiente, la gravedad de ajuste psicológico del acompañante, los años de evolución de la drogodependencia y el tiempo transcurrido desde que se co...

  6. Aplicación de dos pruebas estadísticas de bondad de ajuste en muestras complejas: un caso práctico en el campo forestal

    OpenAIRE

    Quintero-Méndez, María A.; Durán-Núñez, Mariano J.

    2008-01-01

    En esta investigación se comparan dos pruebas de bondad de ajuste en términos de su error tipo I: ji-cuadrada de Pearson y Rao-Scott con corrección de segundo orden, aplicadas a datos recolectados mediante técnicas de muestreo que no cumplen los supuestos de independencia e igual probabilidad de inclusión de las observaciones, llamadas muestras complejas. Ambas pruebas se usaron para ajustar categorías diamétricas en una plantación de gmelina (Gmelina arborea), aplicando muestreo sistemático ...

  7. Acontecimientos vitales estresantes, estilo de afrontamiento y ajuste adolescente: un análisis longitudinal de los efectos de moderación

    OpenAIRE

    Rosa María Estévez Campos; Alfredo Oliva Delgado; Águeda Parra Jiménez

    2012-01-01

    El objetivo principal de este estudio fue analizar la relación entre la vivencia de los acontecimientos vitales estresantes y los problemas de ajuste emocional y comportamental durante la adolescencia, prestando atención al posible efecto moderador del estilo de afrontamiento. La muestra estuvo compuesta por 90 adolescentes que fueron seguidos durante seis años, desde su adolescencia media (15-16 años) hasta la adultez emergente (21-22 años). Completaron cuestionarios sobre su vivencia de aco...

  8. UNA APROXIMACIÓN TEÓRICA A LA VALORACIÓN DEL DOBLE AJUSTE EN EL DISEÑO DE LA ESTRATEGIA DE RECURSOS HUMANOS

    Directory of Open Access Journals (Sweden)

    García Carbonell, Natalia

    2013-05-01

    Full Text Available Tradicionalmente la literatura ha considerado la necesidad del doble ajuste, vertical y horizontal, de la estrategia de recursos humanos en las organizaciones. Su importancia estratégica ha sido demostrada en buena parte de los estudios empíricos planteados. Sin embargo, la complejidad de este proceso requiere de un análisis más profundo que permita identificar los elementos que lo hacen posible. En el presente trabajo, partiendo de la revisión de la literatura de las perspectivas de investigación en dirección estratégica de recursos humanos y del concepto «fortaleza del sistema de recursos humanos» propuesto por Bowen y Ostroff (2004, discutimos los 3 factores que integran dicho concepto y su relación con el ajuste del sistema. Como consecuencia de ello, definimos 3 proposiciones teóricas que explican la vinculación entre ambas dimensiones y la fortaleza del sistema.

  9. Ajuste fiscal nos estados: uma análise do período 1998-2006 Fiscal adjustment in brazilian states

    Directory of Open Access Journals (Sweden)

    Sérgio Wulff Gobetti

    2010-01-01

    Full Text Available O objetivo deste artigo é analisar a forma de enquadramento dos estados ao Programa de Ajuste Fiscal (PAF e à Lei de Responsabilidade Fiscal (LRF, destacando seus impactos nas escolhas de alocação dos recursos públicos e na taxa de investimento. Os resultados obtidos após minucioso trabalho de depuração das bases de dados confirmam a melhoria da situação financeira de estados no período posterior à LRF, mas sugerem que existe um trade-off entre os indicadores fiscais, de um lado, e os investimentos e gastos em infraestrutura, de outro, exigindo uma reflexão sobre a qualidade e sustentabilidade do ajuste fiscal. Os dados orçamentários analisados também apontam evidências de contabilidade criativa.The objective of this article is to offer an analysis of the accommodation by Brazilian states with Fiscal Adjustment Program and with Fiscal Responsibility Act (FRA, showing their impacts on the choices of public resources allocation and on the investment rate. The results obtained after detailed work of data depuration confirm the improvement of financial situation of the states in the period post FRA, but also suggest the existence of a trade-off between fiscal indicators and infrastructure investment, demanding a reflection about the quality and the sustainability of the fiscal adjustment. The budget data analyzed also indicate evidences of creative accountability.

  10. Afectividad inducida e impacto en la creatividad, crecimiento personal después del cambio y ajuste percibido al narrar una experiencia emocional intensa

    Directory of Open Access Journals (Sweden)

    Silvia da Costa

    2015-05-01

    Full Text Available Se examinan en un estudio experimental los efectos de la inducción de afectividad positiva en la creatividad y la importancia de las emociones como variables mediadoras. Se indujo alta y baja afectividad positiva pidiendo a las personas participantes que redactaran tres poemas haikus sobre dos estímulos de connotación positiva, alta (N = 28 y baja (N = 28. Las personas escribieron sobre su experiencia de enamoramiento más intenso y contestaron una escala sobre las emociones sentidas al redactar el texto, una medida de crecimiento personal y una tercera referida a la obtención de metas adaptativas después del episodio. En la condición de alta afectividad positiva se informó de más emociones positivas y menos negativas al narrar la experiencia, un mayor crecimiento personal y un mayor ajuste. Jueces independientes evaluaron como más originales el último poema y la narración de la experiencia en la condición de alta afectividad positiva. Un análisis mediacional mostró que las emociones positivas explicaban la influencia de la manipulación sobre el crecimiento personal y el ajuste percibido.

  11. Ajuste teórico de las curvas PTCR de BaTiO3 dopado con niobio

    Directory of Open Access Journals (Sweden)

    Castro, M. S.

    2002-02-01

    Full Text Available In this work, a theoretical fitting to the experimental PTCR effect in slightly Nb-doped BaTiO3 from the Heywang-Jonker model is simulated. Besides, a qualitative approach was used to evaluate the GBBL characteristics of strongly Nb - doped BaTiO3. In both cases, a link between the electrical properties and the defect profile developed in these based - BaTiO3 ceramics was established. From the results, good agreement between experimental and calculated results was obtained for the PTCR ceramics. Asmall increment in Nb2O5 concentration leads to an increasing in the concentration of occupied acceptor states, the energy of the surface state and also the barrier height. In these cases, microstructural observations shown an important grain growth with average grain size between 10 and 100μm. EPR results clearly indicate low concentration of cationic vacancies for these materials. This phenomenon is associated to a charge-compensation mechanism in slightly-doped BaTiO3, that result in a semiconducting behaviour. On the other hand, the electrical behaviour of strongly–doped BaTiO3 moves away from the PTCR effect, and the material becomes insulating with noticeable GBBL characteristics. In this case, microstructural observations along defect structure analysis encourage the hypothesis in which barium vacancies act as acceptor at grain boundaries and play and important role in restricting grain growth of Nb2O5-BaTiO3 ceramics.En este trabajo se determinó la influencia de la concentración de Nb2O5 sobre el comportamiento PTCR de cerámicos basados en BaTiO3. Por otra parte, se estudió el impacto de una gran concentración del dopante sobre el comportamiento GBBL del BaTiO3. En ambos casos, se estableció una relación entre las propiedades eléctricas observadas y la estructura de defectos iónicos desarrollada. La aplicación del modelo de Heywang-Jonker permite el ajuste teórico de las curvas de resistividad – temperatura de los cerámicos PTCR

  12. El ajuste estructural neoliberal en el sector agrario latinoamericano en la era de la globalización

    Directory of Open Access Journals (Sweden)

    Francisco García Pascual

    2003-10-01

    productividad,  balanza comercial, precios implícitos en la producción y en la exportación o nivel de ingresos de  los agricultores – podemos comprobar fehacientemente que la brecha que ha separado históricamente a la agricultura latinoamericana de  los sectores agrarios de los Estados Unidos o de la  Unión Europea es cada vez mayor. Es más, los  grandes problemas que atenazaban al mundo  agrario en América Latina a principios de los  ochenta (baja productividad, distribución desigual  de los recursos productivos, exclusión social, desequilibrios territoriales, amén de la dependencia tecnológica y de la dependencia financiera del  sector siguen siendo la realidad mayoritaria  después de dos décadas de ajuste estructural.

  13. Comparación entre Factores de Ajuste Multiplicativos y Aditivos para Producción por Lactancia en un Hato Holstein

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    Arboleda Zapata Elkin Mauricio

    1995-09-01

    Full Text Available La presente investigación se efectuó a partir de 558 registros de lactancia tomados del hato Holstein Paysandú el cual está situado en el corregimiento Santa Elena de Medellín en una zona ecológica de bosque húmedo montano bajo (bh-MB y pertenece a la Facultad de Ciencias Agropecuarias de la Universidad Nacional de Colombia, Sede Medellín. El objetivo propuesto fué determinar las ventajas comparativas entre factores de ajuste multiplicativos y aditivos para producción por lactancia. Para ello se trabajó con datos ajustados a 305 días, en vista de la muy alta significancia observada para el efecto duración de la lactancia. Después de confirmar por medio del programa de mínimos cuadrados de Harvey, 1988, que los factores medio-ambientales más influyentes sobre la producción ajustada a 305 días son el año de parto, los días abiertos previos y el número de partos (P£0.01, así como la edad y la época de parto (P£0.05, se procedió a ajustar por estos efectos mediante factores de corrección multiplicativos y aditivos. Inicialmente se utilizó como base la subclase de máxima producción para cada efecto y a ellas fueron llevados los demás registros; luego se obtuvieron factores aditivos mediante el uso de constantes estimadas por el programa Harvey y multiplicativos a partir de la media de mínimos cuadrados. Una vez ajustados los datos se corrió nuevamente el modelo inicial, con el fin de cuantificar la varianza residual presente tanto para factores de ajuste multiplicativos como aditivos, a los dos niveles propuestos. La comparación se realizó mirando las relaciones de la tabla F y las varianzas residuales entre grupos y dentro de ellos. Aunque no se presentaron diferencias marcadas, se observa que, en general los factores de ajuste aditivos tuvieron un mejor comportamiento que los multiplicativos, pues con el empleo de estos últimos queda una pequeña variación sin remover; en tanto que con factores de ajuste

  14. Influencia de los cementos y de los diseños protésicos en el ajuste interno de estructuras de zirconia confeccionadas mediante tecnología Cad-Cam para prótesis fija

    OpenAIRE

    Sánchez Monescillo, Andrés

    2015-01-01

    1. INTRODUCCIÓN Y JUSTIFICACIÓN Aún quedan gran cantidad de elementos y variables que pueden influir en el ajuste interno de las restauraciones y cuyo desconocimiento obliga a seguir investigando. Este estudio permite conocer si existe una influencia real en el ajuste interno de estructuras de zirconia fabricadas mediante tecnología CAD-CAM en función del tipo de cemento utilizado y del tipo de convergencia oclusal de la preparación realizada. 2. OBJETIVOS - Evaluar la influencia de disti...

  15. Propuesta de un método de ordenador para resolver el ajuste a la ecuación de Zener-Hollomon (Garofalo

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    Rieiro, I.

    1996-10-01

    Full Text Available An integrated computational method to solve the Zener-Hollomon equation has been developed by the authors. This method solves the fitting problem of the equation of Zener-Hollomon for wide ranges of applied stress, strain rate and work temperature by means of the progressive application of three kinds of algorithms. In the first place a program, by means of a reiterated linear regression by planes, allows to get some values that will be later the initial values of a second block of algorithms. It permits also to purify the experimental data set. The second block of algorithms carries out a fitting by nonlinear least squares using a variation of the modified Gauss-Newton method. In the third place a group of programs is chained that permit iterate starting by the solution of the previous program approaching (if it is necessary line by line in R2 until the optimum value is reached. All this with a support of statistical analysis for they determine the accuracy of each step, of the data, of the residuals and of the last fitting reached.

    Se presenta un método de ordenador integrado, desarrollado por los autores, para resolver la ecuación de Zener-Hollomon. Este método resuelve el problema del ajuste de la ecuación de Zener-Hollomon para amplios rangos de tensión aplicada, velocidad de deformación y temperatura de trabajo, mediante la aplicación progresiva de tres tipos de algoritmos. En primer lugar, una regresión reiterada multivariante por planos, para obtener unos valores que serán considerados como iniciales para un segundo bloque de algoritmos, además de depurar la base experimental de datos. El segundo bloque de algoritmos realiza un ajuste por mínimos cuadrados no lineales usando una modificación del método de Gauss-Newton modificado. En tercer lugar se encadena un grupo de programas que permiten iterar a partir de la solución del programa no lineal acercándose (si es preciso por líneas en R2

  16. Curvas de Lactação em Rebanhos da Raça Holandesa no Estado de Minas Gerais: Escolha do Modelo de Melhor Ajuste

    Directory of Open Access Journals (Sweden)

    Gonçalves Tarcísio de Moraes

    2002-01-01

    Full Text Available Para selecionar o modelo de curva de lactação de melhor ajuste aos dados de produção de leite no dia de controle de animais da raça Holandesa no Estado de Minas Gerais, utilizaram-se 157.932 controles de 17.150 lactações, de 1990 a 1996, do arquivo inicial com 305.506 controles de 56.422 lactações, do Serviço de Controle Leiteiro da ACGHMG. Ajustaram-se os dados para os fatores: região, nível de produção, ano-estação de parto, classes de ordem e idade ao parto (COPI, grupo genético, número de controles e interações, além dos efeitos linear e quadrático da duração da lactação. Para verificar o melhor ajuste aos modelos Quadrático logarítmico, Gamma Incompleta, Regressão Múltipla e Multifásico (Monofásico e difásico, foram usados menor desvio padrão residual, R² ajustado ao número de parâmetros das equações, autocorrelação de primeira ordem e teste de Durbin-Watson. O uso de uma função difásica para predizer a produção de leite em programas de seleção é recomendado, sendo também possível estimar, com base nessa função, a produção de leite em 305 dias.

  17. Comparison of single-incision mini-slings (Ajust) and standard transobturator midurethral slings (Align) in the management of female stress urinary incontinence: A 1-year follow-up.

    Science.gov (United States)

    Chang, Chia-Pei; Chang, Wen-Hsun; Hsu, Yen-Mei; Chen, Yi-Jen; Wen, Kuo-Chang; Chao, Kuan-Chong; Yen, Ming-Shyen; Horng, Huann-Cheng; Wang, Peng-Hui

    2015-12-01

    To investigate the effectiveness and safety of a new single-incision mini-sling (SIMS)-Ajust-compared with the standard transobturator midurethral sling (SMUS)-Align-for the treatment of female stress urinary incontinence (SUI). A retrospective cohort study was conducted between January 1, 2010 and August 31, 2012. Women with SUI who underwent either SMUS-Align or SIMS-Ajust were recruited. The primary outcomes included operation time, estimated operative blood loss, postoperative pain, and complications. The secondary outcomes included subjective and objective success, defined as an International Consultation on Incontinence Questionnaire (ICIQ) score of 0 or improvement as felt by the patient and a long-term complication, such as dyspareunia and mesh erosion after 6 months and 12 months of follow-up. A total of 136 patients were enrolled, including 76 receiving SMUS-Align and 60 receiving SIMS-Ajust. Baseline characteristics of the patients in both groups were similar, without a statistically significant difference. Primary outcomes between both groups were similar, except that women treated with SIMS-Ajust had statistically significantly shorter operation time (p = 0.003), less intent to treat (p < 0.05), and earlier postoperative discharge (p = 0.001) than women treated with SMUS-Align. Secondary outcomes were similar without a significant difference between the two groups (93% vs. 88% success rate in each group). Our results showed that SIMS-Ajust was not inferior to SMUS-Align with respect to success rate, and might have a slight advantage in early discharge. A long-term follow-up or prospective study is needed to confirm the above findings. Copyright © 2015. Published by Elsevier B.V.

  18. HISTORIA FUNCIONAL DE MORFOLOGÍAS LINGÜÍSTICAS Y SU EFECTO EN UN AJUSTE CONVENCIONAL/ FUNCTIONAL HISTORY OF LINGUISTIC MORPHOLOGIES AND THEIR EFFECT ON A CONVENTIONAL ADJUSTMENT/ HISTÓRIA FUNCIONAL DE MORFOLOGIAS LINGÜÍSTICAS E SEU EFEITO EM UM AJUSTE CONVENCIONAL

    Directory of Open Access Journals (Sweden)

    Nataly Yáñez Ramírez

    2011-12-01

    Full Text Available Se observó si diferentes historias funcionales construidas durante la adquisición de un conjunto de morfologías lingüísticas facilitaban un ajuste convencional. Participaron 24 estudiantes universitarios distribuidos en tres grupos, expuestos a entrenamientos construidos bajo la lógica de diferentes niveles de interacción: contextual, suplementario o selector (Ribes y López, 1985; y posteriormente se evaluó su ejecución en una tarea convencional. El entrenamiento cuyo criterio de ajuste era de tipo selector fue la que más facilitó tanto la adquisición de las morfologías lingüísticas como su uso en la tarea, efecto que pareció más evidente en los hablantes que en los escuchas. No se encontraron diferencias entre los entrenamientos contextual y suplementario. Los resultados se discuten en términos de sus implicaciones teóricas y metodológicas.

  19. Linear study and bundle adjustment data fusion; Application to vision localization; Recherche lineaire et fusion de donnees par ajustement de faisceaux; Application a la localisation par vision

    Energy Technology Data Exchange (ETDEWEB)

    Michot, J.

    2010-12-09

    integrate this additional information directly into an extended bundle adjustment, by adding a constraint term in the weighted cost function. We evaluate three methods (based on machine learning or regularization) that dynamically select the weight associated to the constraint and show that these methods can be used in a real time multi-sensor SLAM, and validate them with different types of constraint on the orientation or on the scale. Experiments conducted on real video sequences show that this technique of constrained bundle adjustment reduces the drifts observed with the classical vision algorithms and improves the global accuracy of the positioning system. (author) [French] Les travaux presentes dans ce manuscrit concernent le domaine de la localisation et la reconstruction 3D par vision artificielle. Dans ce contexte, la trajectoire d'une camera et la structure 3D de la scene filmee sont initialement estimees par des algorithmes lineaires puis optimisees par un algorithme non-lineaire, l'ajustement de faisceaux. Cette these presente tout d'abord une technique de recherche de l'amplitude de deplacement (recherche lineaire), ou line search pour les algorithmes de minimisation iterative. La technique proposee est non iterative et peut etre rapidement implantee dans un ajustement de faisceaux traditionnel. Cette technique appelee recherche lineaire algebrique globale (G-ALS), ainsi que sa variante a deux dimensions (Two way-ALS), accelerent la convergence de l'algorithme d'ajustement de faisceaux. L'approximation de l'erreur de reprojection par une distance algebrique rend possible le calcul analytique d'une amplitude de deplacement efficace (ou de deux pour la variante Two way-ALS), par la resolution d'un polynome de degre 3 (G-ALS) ou 5 (Two way-ALS). Nos experimentations sur des donnees simulees et reelles montrent que cette amplitude, optimale en distance algebrique, est performante en distance euclidienne, et permet

  20. Ajuste de modelos de platô de resposta via regressão isotônica Response plateau models fitting via isotonic regression

    Directory of Open Access Journals (Sweden)

    Renata Pires Gonçalves

    2012-02-01

    Full Text Available Dentro do contexto nutricional, a suplementação de microminerais em rações para aves frequentemente é feita em quantidades superiores às exigidas na tentativa de assegurar o bom desempenho dos animais. Os experimentos do tipo dose resposta são muito comuns na determinação de níveis ótimos dos nutrientes na ração e contemplam a utilização de modelos de regressão para atingir tal objetivo. Porém, na análise de regressão usual, geralmente, não se usa uma informação a priori sobre uma possível relação de ordem na variável resposta. A regressão isotônica é um método de estimação por mínimos quadrados que gera estimativas que satisfazem a mesma ordenação dos dados. Na teoria da regressão isotônica, essa informação é utilizada de forma essencial e espera-se que a eficiência do ajuste seja aumentada quando se faz uso dela. Diante do exposto, o presente trabalho tem como objetivo utilizar uma metodologia de regressão isotônica, como uma forma alternativa para analisar dados de deposição de zinco (Zn na tíbia de aves machos da linhagem Hubbard. No estudo, foram considerados os modelos de platô de resposta polinomial quadrático e não linear exponencial. Além desses modelos, também foi proposto o ajuste de um modelo logarítmico para os dados e a eficiência da metodologia foi avaliada por meio de um estudo de simulação Monte Carlo, considerando diferentes cenários para os valores paramétricos. A isotonização dos dados propiciou uma melhora em todos os avaliadores de qualidade de ajuste considerados no trabalho. Dentre os modelos utilizados, o logarítmico apresentou estimativas dos parâmetros mais coerentes com os valores relatados na literatura, para os dados de deposição de Zn na tíbia de aves machos.Within the nutritional context, the supplementation of microminerals in bird food is often made in quantities exceeding those required in the attempt to ensure the proper performance of the animals

  1. Ajuste do rendimento para a variação do estande em experimentos de melhoramento genético do feijão Adjustment of the yield for the stand variation in common bean genetic breeding experiments

    Directory of Open Access Journals (Sweden)

    Clause Fátima de Brum Piana

    2007-12-01

    Full Text Available O objetivo deste trabalho foi avaliar o ajuste do rendimento pela variação do estande em experimentos de feijão e propor procedimento para ajustamento por análise de co-variação. Utilizaram-se dados de 33 ambientes do Ensaio Estadual de Feijão do Rio Grande do Sul. Realizaram-se as análises de variação e de co-variação de rendimento e de estande em cada ambiente. Foram considerados quatro modelos de ajustamento alternativos: sem ajuste para a variação do estande; com ajuste para o estande médio geral; com ajuste para os estandes médios dos genótipos; e com ajuste para os estandes médios dos grupos de genótipos. Em 70% dos ambientes, ocorreu efeito linear ou quadrático significativo de estande sobre rendimento e em 85% efeito significativo de genótipo sobre estande. O efeito compensatório manifestou-se com diferentes intensidades nos ambientes. O ajuste do rendimento para a variação do estande, considerando o efeito de genótipos sobre o estande, é importante em ensaios de melhoramento do feijão. É necessário o registro de informações que permitam discriminar a origem da variação do estande.The objective of this work was to evaluate the adjustment of the yield for the stand in common bean experiments and to propose a procedure for the adjustment through covariance analysis. Data from 33 environments of the Common Bean Assay of Rio Grande do Sul State, Brazil, were used. Variance and covariance analyses of yield and stand were proceeded for each environment. Four alternative models were considered: without adjustment for stand; with adjustment for the average stand; with adjustment for the genotypes average stand; and with adjustment for the groups of genotypes average stand. Significant linear or quadratic effects of stand on yield occurred in 70% of the environments and of genotype on stand in 85%. The compensatory effect was manifested with different intensities in the environments. The adjustment of the yield

  2. Cálculo, mediante la aplicación del algoritmo de ajuste por mínimos cuadrados, de los componentes de velocidad para estaciones GNSS continuas

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    Jorge Moya Zamora

    2014-07-01

    Full Text Available El cálculo de la velocidad de una estación de observación continua GNSS representa un insumo fundamental en la geodesia moderna. El hecho de determinar la posición de las estaciones GNSS de forma diaria implica que se puedan establecer las series temporales de las estaciones, con base en las cuales se puede obtener información de la influencia de fenómenos que afecten el comportamiento de estas. En este artículo se plantea una descripción del algoritmo de ajuste por mínimos cuadrados adaptado y aplicado a la determinación de los componentes de velocidad de estaciones de observación continua. Además, se aplica este algoritmo para la calcular la velocidad de la estación ETCG, perteneciente al Sistema Geocéntrico para las Américas (SIRGAS.

  3. Ajuste produtivo e medidas de flexibilização da legislação trabalhista Productive adjustment and flexibilization in the labor laws

    Directory of Open Access Journals (Sweden)

    Rosana Ribeiro

    2007-05-01

    Full Text Available A partir da década de 90, a introdução de inovações tecnológicas e organizacionais na indústria brasileira se intensificou significativamente. Um dos objetivos deste artigo é analisar os principais obstáculos à negociação de cláusulas referentes a essas inovações entre o sindicato dos trabalhadores da indústria de calçados, da indústria siderúrgica e da indústria têxtil e os respectivos empresários. Outro objetivo é investigar o grau de difusão das recentes medidas de flexibilização da legislação trabalhista e a estratégia desses sindicatos. Palavras-chave: Ajuste produtivo. Negociação coletiva. Flexibilização. Legislação trabalhista. During the 90’s, many new technologies and innovations in organizational structure were introduced to the Brazilian industry. One of the purposes of this article is to analyze the main obstacles to the negotiation of new labor laws in relation to theses changes between labor unions (footwear, metal and textile industry workers and the owners of the factories. The other purpose is to investigate the level of diffusion of the recent flexibilization measures of the labor legislation and the strategy of these unions. Keywords: Productive adjustment. Collective negotiation. Flexibilization. Labor laws.

  4. AJUSTE DE ECUACIONES DE BIOMASA PARA Pinus durangensis (Martínez M. EN LA REGIÓN DE EL SALTO, DURANGO

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    E. Montes de Oca-Cano

    2009-01-01

    Full Text Available El objetivo del presente estudio fue ajustar ecuaciones lineales y no lineales para estimar biomasa por componente de hojas, ramas, fuste y total, para árboles con edades entre tres y diez años, en la región de El Salto, Dgo. Los resultados indican que las ecuaciones se ajustan mejor a nivel individual, el componente total muestra los mejores estadísticos de ajuste, mientras que las mayores variaciones se detectan en las ramas y en el fuste. Adicionalmente se analizan porcentajes de biomasa por componente donde se observa que el fuste aporta 46.9 % de la biomasa, las hojas 35.6 % y las ramas solamente 17.3 % de la biomasa total. Así mismo, dentro del rango de edad analizado, la biomasa en el fuste aumenta anualmente 2.96 %; la biomasa en las hojas disminuye 3.13 % y la biomasa en las ramas aumenta 0.17 %.

  5. Ausentismo y producción: el esquema de ajuste de primas por siniestralidad observada aplicado al seguro de salud en Francia

    Directory of Open Access Journals (Sweden)

    Sébastien Ménard

    2018-01-01

    Full Text Available En este trabajo se analizan los efectos de la introducción de un esquema de ajuste (experience rating en las contribuciones patronales al seguro de salud. Para ello, se desarrolla un modelo de búsqueda y emparejamiento en un mercado de trabajo segmentado. En el segmento donde los empleos son más riesgosos, las ausencias por enfermedad son más frecuentes y la producción media es más baja. El modelo es calibrado para Francia y los resultados de las simulaciones muestran que la introducción de este esquema mejora levemente la producción y el empleo. En términos cuantitativos, una variación del 1 % en la tasa de experience rating induce una reducción de 0,48 % en la duración del desempleo y de 1,07 % en los días de ausencia, así como un aumento de 0,1 % en la producción. Finalmente, se encuentra que esta política conduce también a un desempeño económico ligeramente mejor que la privatización del seguro de salud

  6. Series de días hábiles en Colombia: una aplicación al ajuste del crecimiento industrial

    Directory of Open Access Journals (Sweden)

    Álvaro Montenegro García

    2014-06-01

    Full Text Available Si bien muchos economistas son conscientes del efecto de los días hábiles sobre la medición de la producción, aún es frecuente encontrar que estas cifras se analizan sin el correspondiente ajuste. En general, el número de días hábiles en un mes cambia de un año a otro, lo cual es cierto para todos los meses, no solo para los que contienen la Semana Santa. Este trabajo recopila la serie de días hábiles mensuales tomando en cuenta los festivos actuales y anteriores a la Ley Emiliani, y la utiliza para ajustar la serie de producción manufacturera del DANE. Para algunos meses, la diferencia entre la cifra de crecimiento industrial reportada por el DANE y la cifra ajustada por días hábiles puede acercarse a los 12 puntos porcentuales, en cualquier dirección

  7. Política socioambiental e de entorno do BNDES: dos ajustes espaciais aos corretivos territoriais: os casos das UHEs de Santo Antônio e Jirau (RO e da UHE de Belo Monte (PA

    Directory of Open Access Journals (Sweden)

    Luis Fernando Novoa Garzon

    2015-07-01

    Full Text Available O artigo procura apresentar a posição e o discurso paradoxais de um Banco que é ao mesmo tempo viabilizador de macro-ajustes espaciais e propositor de micro-correções territoriais. A política socioambiental e de entorno do BNDES são avaliadas a partir dos casos dos grandes projetos, especificamente o Complexos Hidrelétricos do Madeira e de Belo Monte.

  8. Dimensiones familiares relevantes en la consecución del conocimiento parental y sus repercusiones sobre el ajuste adolescente. Un análisis internacional, nacional y local sobre la familia en la adolescencia.

    OpenAIRE

    Jiménez Iglesias, Antonia María

    2013-01-01

    La familia constituye el contexto principal y fundamental de socialización, que continua ejerciendo gran influencia durante la adolescencia. La evidencia disponible indica que el predictor más simple y consistente de la salud y el ajuste adolescente es la calidad de las relaciones de los chicos y las chicas con sus progenitores. La importancia de la familia en la adolescencia es bien conocida por el Estudio sobre Conductas de los Escolares Relacionadas con la Salud o Health Beha...

  9. El papel de la categorización social y las diferencias sociodemográficas en la autoestima, el ajuste y el bienestar psicológicos de una muestra de inmigrantes

    Directory of Open Access Journals (Sweden)

    José Andrés Peña-Pinzón

    2014-05-01

    Full Text Available Se explora el efecto de la saliencia de la categorización social inmigrante y su interacción con diferencias sociodemográficas (nivel de estudios, situación laboral, sexo de los sujetos, en ajuste psicológico, bienestar psicológico y autoestima. 210 inmigrantes de origen sudamericano, residentes en las provincias de Granada y Almería, fueron distribuidos en dos condiciones experimentales: "saliencia baja/alta de la categorización social inmigrante". Encontramos efecto de la manipulación sobre las medidas de pertenencia e identidad (autoestima colectiva, autoestima individual, ansiedad (SA-45 y bienestar laboral. Cuando la saliencia de la categorización social es baja (vs. alta, los sujetos presentan mejor autoestima, menos ansiedad y menos bienestar laboral. El sexo se asocia con la manipulación experimental en las escalas privada y pública (autoestima colectiva y en somatización, depresión y ansiedad (SA45. Los hombres para los que es menos saliente su condición de inmigrante presentan resultados más óptimos. El nivel de estudios y la situación laboral se asocian con ajuste psicológico: los sujetos sin trabajo (vs. los que están trabajando y los de estudios básicos o sin estudios (vs. los de estudios medios o superiores presentan peor ajuste.

  10. Incorporação da densidade no ajuste de dois modelos à curva de retenção de água no solo

    Directory of Open Access Journals (Sweden)

    C. A. Tormena

    2002-06-01

    Full Text Available A curva de retenção de água no solo é fundamental para o desenvolvimento de estudos relacionados com a dinâmica da água, com a modelagem de processos físicos do solo e crescimento das plantas. Normalmente, a curva de retenção é obtida por meio de medidas simultâneas do conteúdo de água (θ e do potencial mátrico da água no solo (ψ numa única amostra. Um procedimento alternativo consiste em utilizar várias amostras por ψ para descrever a curva de retenção. A utilização deste procedimento requer a incorporação dos fatores de variação existentes entre as amostras nos parâmetros das funções matemáticas utilizadas para descrever essa curva. O objetivo deste trabalho foi obter a curva de retenção, utilizando esta última sistemática, e ajustar duas diferentes funções não-lineares aos dados de θ(ψ. Amostras indeformadas (0,05 m de diâmetro e 0,05 m de altura foram obtidas num Latossolo Vermelho distroférrico cultivado com milho sob plantio direto e preparo convencional do solo. Foram retiradas 96 amostras por sistema de preparo, na profundidade de 0-0,10 m, na linha e na entrelinha da cultura. A curva de retenção foi obtida utilizando-se 12 ψ, sendo 16 amostras por ψ: oito por sistema de preparo e quatro por posição amostrada. Os modelos de Genuchten (1980 - VG e o de Hutson & Cass (1987 - HC foram ajustados aos dados. Funções relacionando os parâmetros dos modelos com as variáveis independentes preparo, posição de amostragem e densidade do solo (Ds os substituíram no ajuste dos dados. Não houve influência estatisticamente significativa dos sistemas de preparo e posição de amostragem (p > 0,05 no ajuste das funções aos dados . Com a função de VG obtiveram-se efeitos significativos da Ds no parâmetro n, o qual foi descrito por uma função quadrática da Ds. Resultado similar foi obtido com o parâmetro "a" da função de HC. A curva de retenção foi sensível às variações da Ds e o

  11. Ajuste psicosocial en agresores, víctimas puras y víctimas agresivas en la escuela. Psychosocial adjustment in aggressors, pure victims and aggressive

    Directory of Open Access Journals (Sweden)

    Estefanía Estévez

    2008-07-01

    Full Text Available

    En el presente estudio se examinan las diferencias entre cuatro categorías de adolescentes –agresores, víctimas puras, víctimas agresivas y estudiantes no implicados en problemas comportamentales o de victimización en la escuela– en relación con la autoestima, la sintomatología depresiva, el estrés percibido, el sentimiento de soledad, y una medida general de satisfacción con la vida. Los participantes fueron 1.319 adolescentes con edades comprendidas entre los 11 y los 16 años (47% chicos y escolarizados en siete centros públicos de enseñanza secundaria ubicados en Valencia (España. Los análisis de varianza indicaron la existencia de diferencias significativas entre las cuatro categorías de estudiantes. Así, los adolescentes no implicados mostraron un mejor ajuste psicosocial general: niveles más elevados de autoestima y satisfacción con la vida y niveles inferiores de sintomatología depresiva, estrés percibido y sentimiento de soledad. Las puntuaciones en este grupo fueron equivalentes a aquellas obtenidas por los agresores con respecto a la autoestima, la sintomatología depresiva y la soledad. Sin embargo, los agresores percibieron más estrés y expresaron menor satisfacción con sus vidas, como así también hicieron los otros dos grupos, a saber: víctimas puras y víctimas agresivas. Las víctimas mostraron los niveles más elevados de sentimiento de soledad.

    Palabras clave: Agresor, víctima, víctima agresiva, violencia escolar, ajuste psicosocial.

    The present study examined differences among four categories of adolescents –aggressors, pure victims, aggressive victims, and students not involved in behavioural or victimization problems at school– with respect to self-esteem, depressive symptomatology, perceived stress, feeling of loneliness, and a general measure of satisfaction with life. Participants were 1,319 adolescents aged from 11 to 16 years old (47% male and drawn from seven state

  12. Ajuste de parâmetros de transporte de solutos no solo utilizando Matlab 6.5 Adjustment of soil solute transport parameters with Matlab 6.5

    Directory of Open Access Journals (Sweden)

    Anderson L. de Souza

    2011-12-01

    Full Text Available O sucesso na utilização de modelos matemáticos no estudo do transporte de íons no solo está intimamente ligado à precisão com que os parâmetros de transporte envolvidos neste processo são estabelecidos. De maneira geral, tais parâmetros são determinados mediante a resolução de um problema de otimização não linear em que os dados experimentais, obtidos em ensaios de deslocamento miscível, são ajustados a um modelo teórico. Neste sentido, a utilização de softwares de alta performance no ajuste destes parâmetros mostra-se vantajosa, uma vez que, além da consistência e da disponibilidade de ferramentas numéricas preexistentes, possibilita a incorporação de novas rotinas de acordo com o fenômeno que se queira simular. Sendo assim, este trabalho teve como objetivo desenvolver, em ambiente MATLAB 6.5, uma rotina computacional para a otimização dos seguintes parâmetros de transporte: fator de retardamento (R e coeficiente de dispersão (D. A rotina desenvolvida foi aplicada a dados experimentais de três ensaios de deslocamento miscível do íon potássio em colunas preenchidas com um Latossolo Vermelho- -Amarelo, fase arenosa. A qualidade dos ajustes obtidos foi avaliada utilizando-se do coeficiente de exatidão. Concluiu-se que a rotina proposta apresentou ótimo desempenho, o que, além de reforçar a consistência do método numérico utilizado, indica que a rotina proposta neste trabalho pode contribuir com o avanço dos estudos teóricos da dinâmica da água e de solutos em meios porosos não saturados.The successful use of mathematical models in studies of solute transport in soil is dependent on the accuracy to which the transport parameters involved in this process can be specified. In general, these parameters are determined by using nonlinear optimization techniques to fit theoretical models to experimental data obtained in miscible displacement experiments. The use, therefore, of high-performance software to

  13. Modelo experimental de bandagem ajustável do tronco pulmonar para preparo rápido do ventrículo

    Directory of Open Access Journals (Sweden)

    DIAS Carlos A.

    2000-01-01

    Full Text Available OBJETIVO: Um dispositivo de bandagem do tronco pulmonar (TP com ajuste percutâneo foi desenvolvido com o objetivo de induzir a hipertrofia rápida do ventrículo subpulmonar. MATERIAL E MÉTODOS: Consiste de um manguito de silicone insuflável percutaneamente, através de um botão de silicone auto-selante. Os corações de 7 cabritos jovens (peso médio: 8,7 kg foram submetidos à sobrecarga sistólica imposta pelo dispositivo e avaliados sob os aspectos hemodinâmicos, ecocardiográficos e morfológicos. Foram extraídas biópsias basais do miocárdio do ventrículo direito (VD para análise microscópica (perímetro e área do miócito. O dispositivo foi implantado no TP. As pressões do VD, TP e aorta foram monitorizadas. Após convalescença, foi iniciado o protocolo de insuflação do dispositivo de bandagem do TP. Foi injetada água destilada no botão auto-selante (via percutânea, até que a pressão sistólica do VD atingisse 70% da pressão sistólica do VE. As avaliações ecocardiográfica e hemodinâmica foram realizadas a cada 24 horas. A sobrecarga sistólica do VD foi mantida por um período de 96 horas, com insuflações progressivas no limite máximo tolerado, a cada 24 horas. Após esse período, os animais foram sacrificados para análise morfológica dos corações. Outros 9 cabritos (peso médio: 7,7 kg foram utilizados como grupo controle, para análise do peso do VD. RESULTADOS: Após 96 horas de sobrecarga sistólica do VD, foi observado um aumento do gradiente sistólico VD/TP de 10,1±4,3 mmHg para 60,0±11,0 mmHg e da pressão sistólica no VD de 22,4±4,1 mmHg para 71,0±10,0 mmHg (p<0,0001. O ecocardiograma revelou aumento da espessura muscular do VD, de 4,4±0,5 mm para 7,3±1,7 mm (p=0,001. Quando comparado ao grupo controle, houve um ganho de peso de 74% do VD submetido à sobrecarga sistólica (p<0,0001. À microscopia óptica, foi observado aumento de 27% no perímetro e de 69% na área dos miócitos (p=0

  14. Modelos para ajuste da produção de gases em silagens de girassol e milho Models for fit of gas production in sunflower and corn silages

    Directory of Open Access Journals (Sweden)

    Renius Mello

    2008-02-01

    Full Text Available O objetivo deste trabalho foi identificar entre os modelos Brody, Von Bertalanffy, Gompertz, France, Logístico, Logístico modificado e Logístico bicompartimental, aquele que apresenta maior qualidade de ajuste à curva de produção cumulativa de gases em silagens de girassol e milho. Os critérios adotados foram: coeficiente de determinação, quadrado médio do resíduo, análise gráfica das curvas observadas e estimadas, análise gráfica de dispersão dos resíduos estudentizados, erro percentual médio, eficiência relativa e número de iterações para atingir a convergência. Os modelos Brody, France e Logístico bicompartimental apresentaram os maiores valores de coeficiente de determinação em ambos os substratos, e a diferença entre eles pode ser considerada desprezível. Estes modelos apresentaram, também, os menores valores de quadrado médio do resíduo em silagens de girassol, e a diferença entre eles foi considerada desprezível. Os modelos Brody e France apresentaram menor quadrado médio do resíduo em silagens de milho. Todos os modelos apresentaram dispersão positiva dos resíduos em ambos os substratos após 144 horas de incubação. O modelo Brody apresentou menor erro percentual médio e número de iterações em ambos os substratos. Os modelos Logístico bicompartimental e France apresentaram maior eficiência relativa, respectivamente, em silagens de girassol e milho. Assim, o modelo Logístico bicompartimental apresenta maior qualidade de ajuste à curva de produção de gases em silagens de girassol e milho.The aim of this work was to identify among the Brody, Von Bertalanffy, Gompertz, France, Logistic, Modified logistic and Dual-pool logistic models, the one that presents the highest quality of fit for cumulative gas production curve in sunflower and corn silages. The quality of fit was evaluated by coefficient of determination, residual mean square, graphic analysis of the observed and estimated curves

  15. Ajuste social y escolar de jóvenes víctimas de maltrato infantil en situación de acogimiento residencial

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    Alexander Muela

    2013-01-01

    Full Text Available El objetivo del presente trabajo consistió en examinar el ajuste social y escolar de jóvenes que habían sufrido maltrato en la infancia y se encontraban en situación de acogimiento residencial. Además, pretendíamos comprobar si existían diferencias entre los sujetos sometidos a distintas situaciones de desprotección infantil. En el estudio participaron 318 jóvenes residentes en la Comunidad Autónoma del País Vasco de edades comprendidas entre los 13 y los 18 años (M = 15.35, DT = 1.68 pertenecientes a tres colectivos. El primero de ellos estaba constituido por 69 jóvenes (31 mujeres y 38 varones víctimas de maltrato infantil que se hallaban bajo una medida de protección de acogimiento residencial. El segundo grupo estaba formado por 75 jóvenes (29 mujeres y 46 varones víctimas de maltrato infantil que se encontraban en situación de riesgo de desamparo. Por último, el tercer grupo estaba constituido por 174 jóvenes (95 mujeres y 79 varones que no habían sufrido maltrato. Los resultados pusieron de manifiesto que, independientemente de la situación de desprotección infantil en la que se encontrasen, los jóvenes víctimas de maltrato infantil mostraban mayores dificultades de adaptación social y escolar que los jóvenes que no habían sufrido maltrato en la infancia.

  16. COSTA RICA EN LA ENCRUCIJADA: LOS LÍMITES DEL AJUSTE ESTRUCTURAL Y LOS URGENTES DESAFÍOS DE LA REFORMA ECONÓMICA Y SOCIAL

    Directory of Open Access Journals (Sweden)

    Henry Manuel Mora Jiménez

    2011-09-01

    Full Text Available Aunque en Costa Rica no se ha seguido en los últimos quince años una política económica neoliberal a ultranza, sino una “a la tica”; todo el debate económico y el accionar del sector público durante este período ha sido permeable a la lógica del ajuste estructural. Pero la actual encrucijada obliga a “tirios y troyanos”, a críticos y defensores del ajuste, a superar este enfoque aún predominante. Independientemente de los logros y fracasos acumulados desde 1983 hasta la fecha, en el campo económico y social, el país debe, urgentemente, realizar un “viraje estratégico”, pues la sensación de estancamiento o lento crecimiento de los últimos años se ha convertido en cruda realidad, con el agravante de que ya no podemos seguir viviendo del pasado. En el texto se aborda la problemática nacional en las siguientes cinco áreas:Estabilidad macroeconómica: sin ser artificial, continúa siendo frágil, dependiente en alto grado de la entrada de capitales externos y arrastrando una crisis fiscal latente que recurrentemente estalla. Esto en gran parte se explica por los rasgos de inestabilidad estructural que aun persisten.Gobernabilidad y Reforma del Estado: el estilo de gobernabilidad moldeada durante el período 1950-1975 ya no es viable, y la vacilante reforma del Estado está contribuyendo solo de manera precaria a construir nuevas formas de gobernabilidad acordes con las exigencias de las modernas sociedades democráticas. La gran tarea por delante es reconstruir un Estado estratégico y solidario; que facilite la irrupción de la sociedad civil en la vida pública nacional.Transformación productiva y competitividad: avanza, pero sin un rumbo claro y seguro, pues se adolece de una estrategia nacional de desarrollo de la competitividad internacional, que supere prácticas anticuadas de intervención estatal y viejos pero maquillados dogmas antiestatales que conducen a visiones parciales sobre el papel de las empresas y del

  17. Capacidade máxima de adsorção de fósforo e constante de energia em Latossolo Bruno em razão de diferentes ajustes do modelo Langmuir

    Directory of Open Access Journals (Sweden)

    Clovisson Menotti Boeira de Oliveira

    2014-12-01

    Full Text Available A capacidade máxima de adsorção de fósforo (CMAP é um parâmetro bastante útil para caracterizar a capacidade de adsorção de fósforo (P do solo e, por isso, o modelo de Langmuir, que possibilita essa estimativa, é bastante difundido. Porém, se o ajuste da equação for realizado por modelos não lineares ou linearizados, ou se forem escolhidos modelos de região única ou múltiplas, nem sempre os valores estimados da CMAP e da constante de energia de ligação (k são semelhantes. O objetivo deste trabalho foi avaliar o efeito do uso de diferentes métodos de ajuste do modelo de Langmuir sobre os valores estimados de CMAP e k. Para isso, utilizouse um único solo de alta capacidade de adsorção de P, o qual foi misturado a quantidades crescentes de areia lavada, construindo-se sistemas com capacidades de sorção crescentes, mas com a fase sólida constituída da mesma mineralogia. Foi utilizado solo do horizonte B de um Latossolo Bruno com 800 g kg-1 de argila, o qual foi misturado com areia em quantidades para obterem-se solos artificiais com 0, 200, 400, 600 e 800 g kg-1 de argila. Esses solos artificiais foram incubados por 30 dias com calcário para elevar o pH(H2O até 6,0 e, após, foram secos em estufa e peneirados. Foram realizadas as isotermas de adsorção e os dados ajustados pelo modelo de Langmuir, usando os seguintes métodos: NLin - não linear com região única; L-1R - linearização com região única; L-2RG - linearização com duas regiões, ajuste gráfico; L-3RG - linearização com três regiões, ajuste gráfico; L-2RE linerização com duas regiões, ajuste estatístico. Os resultados evidenciaram que todos os métodos utilizados estimaram valores de CMAP proporcionais ao teor de argila dos solos e poderiam ser usados para caracterizar os solos. Contudo, quando utilizados ajustes com mais de uma região de adsorção, os valores da CMAP para a última região foram sensivelmente superiores

  18. Ajustes nos movimentos de alcançar e apreender objetos: impacto da Síndrome de Down Adjustments in the movements of reaching for and grasping objects: the impact of Down Syndrome

    Directory of Open Access Journals (Sweden)

    Mariana Martins dos Santos

    2012-06-01

    Full Text Available OBJETIVOS: verificar a influência das propriedades dos objetos nos ajustes realizados por lactentes típicos e com Síndrome de Down (SD dos quatro aos oito meses de idade ao alcançar e apreender objetos. MÉTODOS: 16 lactentes, avaliados uma vez ao mês dos 4 aos 8 meses, sendo oito típicos e oito com SD. Quatro objetos esféricos (maleável grande, maleável pequeno, rígido grande e rígido pequeno foram apresentados, e os cinco primeiros movimentos válidos foram registrados para análise das variáveis: ajuste proximal (uni e bimanual, ajuste distal (orientação da palma, abertura da mão e apreensão do objeto. RESULTADOS: os lactentes típicos apresentaram mais ajuste bimanual para objetos grandes aos seis e oito meses e os com SD aos sete meses. Quanto aos ajustes distais, os lactentes típicos variaram seu comportamento enquanto os com SD apresentaram uso predominante da posição oblíqua. Em geral, o grupo típico apresentou maior sucesso na apreensão dos objetos rígidos e maleável pequeno quando comparados aos lactentes com SD. CONCLUSÕES: Os lactentes com SD apresentaram menor variedade de ajustes o que levou a um menor sucesso na apreensão, possivelmente devido a restrições intrínsecas da SD.OBJECTIVES: to verify the influence that properties of objects have on the reaching and grasping adjustments made by infants with and without Down syndrome (DS between four to eight months of age. METHODS: 16 infants, eight typical and eight with DS, were evaluated once a month from months 4 to 8. Four spherical objects (large soft, small soft, large hard and small hard were offered and the first five valid movements were recorded for analysis of the variables: proximal adjustment (uni- and bimanual, distal adjustments (palm orientation, hand opening and grasping of the object. RESULTS: the typical infants displayed greater bimanual adjustment for large objects at six and eight months and those with DS at seven months. As for distal

  19. El ajuste entre la estrategia competitiva y la estrategia de innovación tecnológica: Su implicación en el resultado de la empresa

    OpenAIRE

    González Moreno, Ángela

    2011-01-01

    A pesar de la importancia de la innovación tecnológica en la obtención de la ventaja competitiva, las relaciones entre la estrategia competitiva y la estrategia de innovación no han sido tratadas en profundidad. Esta tesis pone de manifiesto la necesidad del buen acoplamiento entre estos dos tipos de estrategia, proporcionando evidencia empírica acerca de como el ajuste entre ambas repercute positivamente en el resultado. El análisis aplicado a empresas del sector industrial de la electrón...

  20. Estudio de las primeras consultas en un Centro de Salud Mental (II). Características clínicas, sucesos vitales, ajuste y apoyo social, motivación y expectativas.

    OpenAIRE

    Oscar Martínez Azumendi; Miriam Beitia; Karmelo J Araluce; José M Ayerra; Carlos Cela; Jorge Grijalvo; José Ignacio Mendezona; Dolores Azkunaga; Patricia Insúa

    1997-01-01

    Proyecto de evaluación de 749 consultas consecutivas durante año y medio en un Centro de Salud Mental Comunitario. Se presentan las características y diferencias por sexos en relación con la sintomatolog��a diagnóstico, valoración global de la gravedad del caso, ajuste social, autoestima y apoyo social percibido. Además se describe el número y tipo de sucesos vitales referidos en los 6 meses anteriores, así como motivación y expectativas que traen al servicio.

  1. El papel de la categorización social y las diferencias sociodemográficas en la autoestima, el ajuste y el bienestar psicológicos de una muestra de inmigrantes

    OpenAIRE

    José Andrés Peña-Pinzón; Carmen Gómez-Berrocal; Antonio Fernández-Parra

    2014-01-01

    Se explora el efecto de la saliencia de la categorización social inmigrante y su interacción con diferencias sociodemográficas (nivel de estudios, situación laboral, sexo) de los sujetos, en ajuste psicológico, bienestar psicológico y autoestima. 210 inmigrantes de origen sudamericano, residentes en las provincias de Granada y Almería, fueron distribuidos en dos condiciones experimentales: "saliencia baja/alta de la categorización social inmigrante". Encontramos efecto de la manipulación sobr...

  2. Validez del modelo bidimensional de socialización parental en diferentes entornos sociales de la cultura española : implicaciones para el ajuste psicosocial de los adolescentes

    OpenAIRE

    Fuentes Durán, María del Castillo

    2014-01-01

    Durante las últimas décadas, la literatura empírica ha demostrado en repetidas ocasiones la influencia que tienen las diferentes formas de actuación de los padres en el proceso de socialización en el ajuste psicológico y social de los hijos. La investigación en torno a la socialización familiar se ha basado tradicionalmente en el modelo teórico de dos grandes dimensiones teóricamente independientes (aceptación/implicación y severidad/imposición, Darling y Steinberg, 1993; Maccoby y Martin...

  3. Adaptive capacity of the Adjusted Clinical Groups Case-Mix System to the cost of primary healthcare in Catalonia (Spain): a observational study.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Velasco-Velasco, Soledad; Navarro-Artieda, Ruth; Prados-Torres, Alexandra; Bolibar-Ribas, Buenaventura; Violan-Fors, Concepción

    2012-01-01

    To describe the adaptive capacity of the Adjusted Clinical Groups (ACG) system to the cost of care in primary healthcare centres in Catalonia (Spain). Retrospective study (multicentres) conducted using computerised medical records. 13 primary care teams in 2008 were included. All patients registered in the study centres who required care between 1 January and 31 December 2008 were finally studied. Patients not registered in the study centres during the study period were excluded. Demographic (age and sex), dependent (cost of care) and case-mix variables were studied. The cost model for each patient was established by differentiating the fixed and variable costs. To evaluate the adaptive capacity of the ACG system, Pearson's coefficient of variation and the percentage of outliers were calculated. To evaluate the explanatory power of the ACG system, the authors used the coefficient of determination (R(2)). The number of patients studied was 227 235 (frequency: 5.9 visits per person per year), with a mean of 4.5 (3.2) episodes and 8.1 (8.2) visits per patient per year. The mean total cost was €654.2. The explanatory power of the ACG system was 36.9% for costs (56.5% without outliers). 10 ACG categories accounted for 60.1% of all cases and 19 for 80.9%. 5 categories represented 71% of poor performance (N=78 887, 34.7%), particularly category 0300-Acute Minor, Age 6+ (N=26 909, 11.8%), which had a coefficient of variation =139% and 6.6% of outliers. The ACG system is an appropriate manner of classifying patients in routine clinical practice in primary healthcare centres in Catalonia, although improvements to the adaptive capacity through disaggregation of some categories according to age groups and, especially, the number of acute episodes in paediatric patients would be necessary to reduce intra-group variation.

  4. Avaliação de marcapasso unicameral de ajuste automático de freqüência de pulso mediado por movimentação corporal Evaluation of the activity mode rate variable pulse generator

    Directory of Open Access Journals (Sweden)

    Paulo R Brofman

    1987-12-01

    Full Text Available Quarenta e oito pacientes com marcapasso unicameral de ajuste automático de freqüência de pulso mediado por movimentação corporal (AAI-R/VVI-R foram avaliados através da eletrocardiografia dinâmica, para correlacionar a atividade física com a variação da freqüência de estímulos e teste ergométrico em esteira (pareados e randomizados em modo AAI/VVI e modo AAI-R/VVI-R, para quantificar a capacidade de realizar esforço físico, um mês após o implante do gerador de pulso Activitrax 8400. A idade média dos pacientes era de 46 anos e a etiologia predominante da arritmia que motivou o implante era a miocardiopatia chagásica. O eletrocardiograma ambulatorial mostrou modificações apropriadas na freqüência cardíaca (exceto em 1 paciente, que permaneceu em ritmo sinusal. Teste ergométrico no modo AAI-R/VVI-R mostrou elevação significativa na freqüência cardíaca com relação ao valor médio controle: de 66,9+0,8 ppm para 84,6+2,1 ppm aos 14 minutos 90,5*2,8 ppm aos 6 minutos e 95,7+2,9 ppm aos 8 minutos (P To evaluate the physiologic benefits of the rate response estimulation, 48 patients were submited to a 24 hours Holter recording and paired tolerance treadmill test (AAI VVI and AAI-R/VVI-R modes, selected in random order one month after implantation of an activity sensing pacemaker Activitrax 8400. Mean age of the patients was 46 years and indications for pacing included atrial arrhythmias (16 patients or A-V conduction disturbances (32 patients, including 25 with complete A-V block. The underlying disease was Chagas cardiomiopathy, in 32 patients. Initial pacemaker setting was: basic rate: 60 or 70 ppm; maximum activity rate: 125 ppm; activity threshold: medium, rate response: 5. The 24 hours Holter recording documented appropriate changes in heart during daily activities. Oversensing, which resulted in pacing interval fluctuations, was diagnosed in two patients and required pacemaker reprograming. Treadmill test showed a

  5. Avaliação estrutural da escala de ajustamento diádico Evaluacíon de la escala de ajuste conyugal Structural assessment of the dyadic adjustment scale

    Directory of Open Access Journals (Sweden)

    José Augusto Evangelho Hernandez

    2008-09-01

    Full Text Available O objetivo deste estudo foi avaliar a Escala de Ajustamento Diádico respondida por uma amostra não-probabilística de homens e mulheres brasileiros que estavam em relacionamento amoroso de diversos tipos. Os 542 sujeitos foram recrutados em diversos locais de Porto Alegre/RS e região metropolitana. Através da técnica estatística Análise Fatorial, este estudo realizou um exame da estrutura da escala. Os resultados obtidos foram comparados com o estudo original de construção do instrumento e outras confirmações subseqüentes. Através da comparação dos escores médios dos diferentes tipos de casais da amostra atual se pôde verificar o poder discriminativo do instrumento e, além disso, foi examinada sua fidedignidade. Apareceram evidências que dão razoável suporte à versão brasileira do instrumento para sua utilização na pesquisa e na clínica psicológica.El propósito del estudio presente fue evaluar la Escala de Ajuste Conyugal contestada por una muestra non-probabilistic de hombres y mujeres brasileños que estuvieron implicados con relaciones de amor de varias clases. Los 542 sujetos fueron reclutados en varios sitios en Porto Alegre/RS y su área metropolitana. Con la técnica de estadística del análisis factorial, este estudio examinó la estructura de la escala. Los resultados fueron comparados a la construcción original del instrumento y de otras confirmaciones subsecuentes. Comparando las puntuaciones promedio de las clases diferentes de parejas de la muestra presente, podemos verificar el poder discriminatorio del instrumento, además de esto, su fiabilidad fue examinada también. Pruebas mostradas, del apoyo razonable a la versión brasileña del instrumento para su uso en la investigación y en clínica de psicología.The Dyadic Adjustment Scale answered by a non-probabilistic sample of Brazilian males and females involved in different types of love relationships is assessed. The 542 subjects were recruited in

  6. Teorías e hipótesis de régimen aplicadas al estudio de ajuste dinámico de los cauces aluviales

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    Conesa García, Carmelo

    2003-06-01

    Full Text Available Geomorphic approaches to describe and explain the equilibrium alluvial river channel form, and another approache porpuses to stable «regime» channel design, have relied on simple equations relating channel dimensions to sediment grain-size, gradient and discharge. These equations are either empirical «hydraulic geometry» equations, obtained from regression analysis of the main variables sampled in natural rivers, or «rational» regime equations derived from physical theory of hydraulics and sediment transport. In this work several theories and hypothesis on the river regime are shown in order to explain the dynamic adjustments of channels in connection with environmental changes: i theory of unit stream power, ii minimum energy dissipation rate , iii dispersive-force model, iv concepts of boundary shear stress and critical bank shear, v other regime relationships. Finally, the last part is devoted to the application of the regime theories in arid and semi-arid environments, by considering it a complex aspect, of great interest in the hydro-morphologic context and until the moment little studied.

    Las aproximaciones geomórficas para describir y explicar la forma de equilibrio de un cauce fluvial y los métodos propuestos para el diseño de cauces de «régimen » estable han contado siempre con ecuaciones simples que relacionan las dimensiones del cauce con el tipo de sedimento, pendiente y caudal. Estas ecuaciones son ecuaciones empíricas de «geometría hidráulica», obtenidas a partir del análisis de regresión de variables relevantes muestreadas en cursos de agua naturales o ecuaciones «racionales » de régimen derivadas a partir de la teoría física sobre hidráulica y transporte de sedimentos. En este trabajo se muestran diferentes teorías e hipótesis de régimen para explicar el ajuste dinámico de los cauces aluviales en relación con los cambios ambientales: i teoría de energía por unidad de corriente, ii tasa m

  7. Explaining prescription drug use and expenditures using the adjusted clinical groups case-mix system in the population of British Columbia, Canada.

    Science.gov (United States)

    Hanley, Gillian E; Morgan, Steve; Reid, Robert J

    2010-05-01

    Given that prescription drugs have become a major financial component of health care, there is an increased need to explain variations in the use of and expenditure on medicines. Case-mix systems built from existing administrative datasets may prove very useful for such prediction. We estimated the concurrent and prospective predictive validity of the adjusted clinical groups (ACG) system in pharmaceutical research and compared the ACG system with the Charlson index of comorbidity. We ran a generalized linear models to examine the predictive validity of the ACG system and the Charlson index and report the correlation between the predicted and observed expenditures. We reported mean predictive ratios across medical condition and cost-defined groups. When predicting use of medicines, we used C-statistics to summarize the area under the receiver operating characteristic curve. The 3,908,533 British Columbia residents who were registered for the universal health care plan for 275+ days in the calendar years 2004 and 2005. Outcomes were total pharmaceutical expenditures, use of any medicines, and use of medicines from 4+ different therapeutic categories. The ACG case mix system predicted drug expenditures better than the Charlson index. The mean predictive ratios for the ACG system models were all within 4% of the actual costs when examining medical condition group and the C-stats for the 2 dichotomous outcomes were between 0.82 and 0.89. ACG case-mix adjusters are a valuable predictor of pharmaceutical use and expenditures with much higher predictive power than age, sex, and the Charlson index of comorbidity.

  8. Modifier le cadre participatif pour résoudre un problème client : exemples d’ajustement opéré par les professionnels dans les interactions en centre d’appels

    Directory of Open Access Journals (Sweden)

    Colón De Carvajal Isabel

    2012-07-01

    Full Text Available Si, dans les interactions de service en centre d’appels, la conversation principale est celle engagée entre l’appelant et l’appelé, une multitude d’autres interactions caractérise le travail des opérateurs. Cet article présente une étude linguistique sur les interactions entre les opérateurs du centre d’appels LocBike, qui propose l’accès à des vélos en libre service dans une grande ville française, et les clients, qui empruntent ces vélos et appellent le centre en cas de problèmes. Ces interactions ont la particularité d’être menées autour d’objets technologiques, afin d’interagir avec le client et traiter son dossier. L’accès à cet environnement d’interactions téléphoniques médiées par ordinateur permet d’analyser la résolution du problème client du point de vue de l’opérateur, et d’observer que ce travail se réalise parfois en collaboration avec son collègue co-présent dans son environnement immédiat. Les professionnels opèrent alors des ajustements par rapport au dispositif de communication, ou s’ajustent eux-mêmes à ce dispositif, pendant l’interaction principale avec le client, ce qui tend à modifier le cadre participatif. L’objectif de notre travail est d’analyser les pratiques des professionnels lors de modifications du cadre participatif, et ce, dans le but de résoudre un problème client. A travers des exemples de collaboration, nous étudierons les formes d’ajustement que les professionnels mettent en place par rapport au dispositif de communication, modifiant ainsi temporairement le cadre participatif.

  9. Ajuste de modelos estocásticos lineares e não-lineares para a descrição do perfil longitudinal de árvores Fitting linear and nonlinear stochastic models to describe longitudinal tree profile

    Directory of Open Access Journals (Sweden)

    Leonardo Machado Pires

    2007-10-01

    Full Text Available Os modelos polinomiais são mais difundidos no meio florestal brasileiro na descrição do perfil de árvores devido à sua facilidade de ajuste e precisão. O mesmo não ocorre com os modelos não-lineares, os quais possuem maior dificuldade de ajuste. Dentre os modelos não-lineares clássicos, na descrição do perfil, podem-se citar o de Gompertz, o Logístico e o de Weibull. Portanto, este estudo visou comparar os modelos lineares e não lineares para a descrição do perfil de árvores. As medidas de comparação foram o coeficiente de determinação (R², o erro-padrão residual (s yx, o coeficiente de determinação corrigido (R²ajustado, o gráfico dos resíduos e a facilidade de ajuste. Os resultados ressaltaram que, dentre os modelos não-lineares, o que obteve melhor desempenho, de forma geral, foi o modelo Logístico, apesar de o modelo de Gompertz ser melhor em termos de erro-padrão residual. Nos modelos lineares, o polinômio proposto por Pires & Calegario foi superior aos demais. Ao comparar os modelos não-lineares com os lineares, o modelo Logístico foi melhor em razão, principalmente, do fato de o comportamento dos dados ser não-linear, à baixa correlação entre os parâmetros e à fácil interpretação deles, facilitando a convergência e o ajuste.Polynomial models are most commonly used in Brazilian forestry for taper modeling due to its straightforwardly fitting and precision. The use of nonlinear regression classic models, like Gompertz, Logistic and Weibull, is not very common in Brazil. Therefore, this study aimed to verify the best nonlinear and linear models, and among these the best model to describe the longitudinal tree profile. The comparison measures were: R², syx, R²adjusted, residual graphics and fitting convergence. The results pointed out that among the non-linear models the best behavior, in general, was given by the Logistic model, although the Gompertz model was superior compared with the Weibull

  10. Avaliação de marcapasso unicameral de ajuste automático de freqüência de pulso mediado por movimentação corporal

    OpenAIRE

    Brofman,Paulo R; Loures,Danton R. da Rocha; Rossi,Paulo R. F; Ardito,Roberto V; Greco,Osvaldo T; Braile,Domingo M; Sant'Anna,João R; Lucchese,Fernando A; Kalil,Renato A. K; Eloy,Ricardo; Barros,Rubens T; Andrade,José Carlos S; Pesarini,Aldo; Gauch,Paulo R. A

    1987-01-01

    Quarenta e oito pacientes com marcapasso unicameral de ajuste automático de freqüência de pulso mediado por movimentação corporal (AAI-R/VVI-R) foram avaliados através da eletrocardiografia dinâmica, para correlacionar a atividade física com a variação da freqüência de estímulos e teste ergométrico em esteira (pareados e randomizados em modo AAI/VVI e modo AAI-R/VVI-R), para quantificar a capacidade de realizar esforço físico, um mês após o implante do gerador de pulso Activitrax 8400. A idad...

  11. Influência do tamanho e da rigidez dos objetos nos ajustes proximais e distais do alcance de lactentes Influence of object size and rigidity on proximal and distal adjustments to infant reaching

    Directory of Open Access Journals (Sweden)

    NACF Rocha

    2006-09-01

    Full Text Available CONTEXTUALIZAÇÃO: Estudos têm identificado que as propriedades dos objetos induzem os ajustes no alcance; no entanto, poucos investigaram a influência específica do tamanho e rigidez dos objetos em lactentes jovens. OBJETIVO: Verificar se lactentes de 4 a 6 meses realizam ajustes proximais e distais ao alcançarem objetos de diferentes tamanhos e rigidez. MÉTODOS: Nove lactentes saudáveis foram posicionados em uma cadeira inclinada a 50º. Quatro objetos foram apresentados, um rígido grande (RG, um rígido pequeno (RP, um maleável grande (MG e um maleável pequeno (MP, por um período de 1 minuto cada. Em um total de 384 alcances, foram analisados os ajustes proximais (alcance uni e bimanual e distais (orientação da mão horizontal, vertical e oblíqua; mão aberta, fechada e semi-aberta e o sucesso do alcance dos objetos. RESULTADOS: Constatou-se ajuste bimanual para o objeto RG e unimanual para os demais. A orientação da mão oblíqua foi predominante no toque dos objetos, enquanto para a preensão dos mesmos, a predominância foi a vertical, principalmente para o objeto RG. A orientação horizontal não foi observada na preensão do objeto RG. A mão semi-aberta foi mais freqüente no início do alcance para todos os objetos, enquanto no toque do objeto RG a mão aberta foi predominante. O sucesso do alcance foi maior para os objetos maleáveis (MG, MP do que para os rígidos (RG e RP. CONCLUSÃO: Lactentes jovens estudados são capazes de planejar e ajustar seus movimentos baseados na percepção das propriedades físicas dos objetos, o que sugere interação percepção-ação.BACKGROUND: Studies have identified that object properties lead to adjustments to reaching. However, few have investigated the specific influence of object size and rigidity among young infants. OBJECTIVE: To verify whether four to six-month-old infants make proximal and distal adjustments when reaching for objects of different sizes and rigidity. METHOD

  12. Um Estudo sobre a Governança Corporativa e o Nível de Atendimento aos Critérios de Evidenciação do Ajuste a Valor Presente em Empresas de Construção e Transporte

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    Juliana Gonçalves de Araújo

    2015-08-01

    Full Text Available Esta pesquisa tem como objetivo verificar a relação do nível de governança com o atendimento aos critérios de evidenciação dispostos no CPC 12, referente às práticas do Ajuste a Valor Presente, nas empresas do setor de Construção e Transporte listadas na BM&FBovespa entre os anos de 2008 a 2012. No entanto, foram excluídas algumas empresas, por estas não apresentarem indícios, em quaisquer dos anos, da realização do Ajuste a Valor Presente. Assim, a amostra deste estudo foi composta por 72 companhias, as quais evidenciaram, seja em Nota Explicativa ou em conta de Balanço Patrimonial, indício da prática de Ajuste a Valor Presente. Foi possível verificar que as divulgações realizadas estão aquém das propostas pelo CPC 12, e que as mudanças ocorridas no processo de ajuste são pouco divulgadas, constituindo um cenário que pouco se modifica. O único item que sofreu uma grande elevação de atendimento foi o da divulgação das práticas gerais de Ajuste a Valor Presente em Notas Explicativas, principalmente no ano de 2010, devido à compulsoriedade da aplicação das normas contábeis nas entidades de capital aberto. O item que menos foi atendido referiu-se à evidenciação dos modelos de cálculos para aplicação do Ajuste a Valor Presente. Apesar da descrição do item objeto do Ajuste a Valor Presente ter grande representatividade, as entidades ainda necessitam divulgar melhor as premissas, montante e horizonte temporal destes. Também foi possível observar, através do uso do teste Exato de Fisher, uma relação entre o nível de governança e o nível de atendimento, onde aquelas que pertencem ao Novo Mercado se apresentam mais propensas a evidenciar melhor suas informações, enquanto as que não estão enquadradas nos níveis de governança apresentam um nível de atendimento insatisfatório.

  13. RETIRO LABORAL Y AJUSTE A LA JUBILACIÓN DE HOMBRES Y MUJERES EN LA MEDIANA EDAD (WORK RETIREMENT AND ADJUSTMENT TO RETIREMENT OF MEN AND WOMEN IN THE MIDDLE-AGED

    Directory of Open Access Journals (Sweden)

    Cruz Meléndez Roxana

    2011-04-01

    Full Text Available Resumen:En este artículo se presentan los resultados de una investigación aplicada cuyo objeto de estudio fue un grupo de hombres exfuncionarios y mujeres exfuncionarias del área administrativa de la Universidad de Costa Rica (UCR que se encuentran en la etapa de vida denominada “la mediana edad” y que enfrentan el proceso trabajo-retiro laboral. El estudio consistió en identificar los principales factores que inciden en el retiro laboral a una edad más temprana; la viviencia del proceso, el ajuste a la jubilación y sus implicaciones a nivel personal y social. La información recopilada se obtuvo a partir de la técnica “la entrevista fenomenológica” concebida como una exploración profunda que proporciona datos de gran valor conceptual y humana; en ella, tanto la persona que entrevista como la entrevistada mantienen un compromiso para que la búsqueda de la información sea dentro de una relación empática. Partiendo de lo subjetivo por su historia de vida al mandato social por lo roles asignados y asumidos por la población en estudio. Los resultados obtenidos indican que pareciera que la valoración que cada uno de los participantes hace de su rol laboral y el significado del trabajo en sus vidas es determinante en el proceso de retiro laboral y su ajuste al rol de persona jubilada.Abstract: This article presents the results of applied research study that was aimed at a group of men and women, former administrative staff of the University of Costa Rica that are in the stage of life called middle age and facing work-retirement process work. The study consist in identify the main factors affecting the removal from work at a younger age, the experiencing process, adjustment to retirement and its implications for personal and social level. Information collected was obtained from the technique "the phenomenological interview “conceived as a deep exploration that provides valuable data conceptual and human, in her interview both

  14. Programa de ajuste multiparamétrico de curvas de titulação potenciométricas de ácidos húmicos Multiparametric adjustment program of potentiometric titration curves of humic acids

    Directory of Open Access Journals (Sweden)

    Clausius Duque Gonçalves Reis

    2010-04-01

    Full Text Available Tendo em vista a dificuldade de determinação dos pontos de inflexão na curva de titulação potenciométrica de ácidos húmicos, por metodologias tradicionais, foi desenvolvido foi desenvolvido um programa na linguagem Delphi para ajuste multiparamétrico de dados de titulação potenciométrica. Para isso um processo iterativo para estimar as raízes de um polinômio, com base no método de Newton-Raphson, foi utilizado. Os dados das titulações potenciométricas de ácidos húmicos usados nas regressões foram obtidos em um sistema automatizado de titulação potenciométrica. O programa desenvolvido na linguagem Delphi permite maior versatilidade e facilidade de operação, com uma interação mais amigável com o usuário. As curvas de titulação potenciométricas ajustadas sobrepuseram-se quase que totalmente às curvas experimentais. Os valores de pKa e as percentagens de grupos tituláveis dos ácidos húmicos, parâmetros ajustáveis na regressão multiparamétrica, apresentaram valores comparáveis com dados da literatura.Regarding the difficulty of determining the inflection points in the potentiometric titration curve of humic acids by means of traditional methodologies, a Delphi program a Delphi program was developed for the multiparametric data adjustment in potentiometric titration. For this purpose, an iterative process was used, based on the Newton-Raphson method to estimate the roots of a polynomial. The humic acid potentiometric titration data, used in regressions, were obtained in an automated system of potentiometric titration. The program developed in Delphi language features greater versatility, ease of operation and better interaction with the user. The adjusted potentiometric titration curves overlap the experimental curves almost entirely. The pKa values and percentages of titrable groups of humic acids extracted from soil, adjustable parameters in the multiparametric regression, were comparable with those reported

  15. A tecnologia da informação como suporte ao ajuste da previsão da demanda: um estudo de caso em uma empresa de bebidas carbonatadas

    Directory of Open Access Journals (Sweden)

    Alexandre Pereira Salgado Junior

    2010-08-01

    Full Text Available A gestão da cadeia de suprimentos é um problema que sempre instigou gestores por todo o mundo, ademais os modelos de previsão da demanda tradicionais não mais satisfazem os novos desafios da gestão dos estoques e da ruptura. Assim, novas soluções foram desenvolvidas, buscando-se melhorar os níveis de serviço prestados ao consumidor final. Dentre elas, destaca-se a utilização da TI que, por disponibilizar a informação em tempo real, pode contribuir para o ajuste dos modelos tradicionais de previsão da demanda. Desta forma, o objetivo desta pesquisa é analisar como a TI pode ajudar o segmento de bebidas a ajustar sua previsão de demanda. O método de pesquisa utilizado foi o estudo de caso, analisando uma empresa de bebidas carbonatadas, escolhida por conveniência. Para análise dos dados, utilizou-se a técnica de análise de conteúdo. Como principais resultados destacam-se melhorias no nível dos estoques, na ruptura e no nível de serviço.

  16. Ajuste empírico da curva de calibração do termopar Chromel-Alumel através de calçuladoras programáveis

    Directory of Open Access Journals (Sweden)

    Klemensas Rimgaudas Juraitis

    1982-11-01

    Full Text Available Computation of polynomial regression with precision is possible with some programmable calculators. In this paper, a program of a polynomial regression, using a Texas 77-59 pocket calculator, is presented in a didactic manner. The method is exemplified by means of fitting data of a curve of calibration for Chromel-Alumel thermocouple in the temperature range between CR c and J. 2009 C.Uma regressão polonomial pode ser utilizada com precisão, utilizando-se certas calculadoras programáveis. No presente trabalho apresenta-se, da maneira didática, um programa de regressão polinomial, usando-se uma calculadora programável Texas Tl-59, exemplificando-se o método através do ajuste de uma curva de calibração de um termopar Chromel-Alumel na faixa de temperatura de 0 a 1200 graus centígrados.

  17. Sistemas homogéneos de ecuaciones diofánticas. Resolución y aplicación al ajuste automático de reacciones químicas

    Directory of Open Access Journals (Sweden)

    Recuero, Alfonso

    1984-06-01

    Full Text Available An algorithm to solve systems of linear homogeneous diophantine equations is given here. Subsequently, as an example of application, a method of heuristic search for the best solution is described; this fulfils certain conditions within an infinite space of solutions of various dimensions. Finally, an application of the algorithm and of the process of heuristic search for the best solution in adjusting chemical reactions is described. The listing in BASIC of the program of application mentioned is included, for the HP-75 portable computer.

    Se presenta un algoritmo de resolución de sistemas de ecuaciones diofánticas lineales y homogéneas. Seguidamente y como ejemplo de aplicación se describe un método de búsqueda heurística de una solución óptima que cumpla unas ciertas condiciones dentro de un espacio infinito de soluciones de varias dimensiones. Por último se describe la aplicación del algoritmo y del procedimiento de búsqueda heurística para el caso de ajuste de reacciones químicas. Se incluye el listado en BASIC del programa para el ordenador HP-75.

  18. Obtaining the mean relative weights of the cost of care in Catalonia (Spain): retrospective application of the adjusted clinical groups case-mix system in primary health care.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Velasco-Velasco, Soledad; Navarro-Artieda, Ruth; Aguado Jodar, Alba; Plana-Ripoll, Oleguer; Hermosilla-Pérez, Eduardo; Bolibar-Ribas, Bonaventura; Prados-Torres, Alejandra; Violan-Fors, Concepción

    2013-04-01

    The study aims to obtain the mean relative weights (MRWs) of the cost of care through the retrospective application of the adjusted clinical groups (ACGs) in several primary health care (PHC) centres in Catalonia (Spain) in routine clinical practice. This is a retrospective study based on computerized medical records. All patients attended by 13 PHC teams in 2008 were included. The principle measurements were: demographic variables (age and sex), dependent variables (number of diagnoses and total costs), and case-mix or co-morbidity variables (International Classification of Primary Care). The costs model for each patient was established by differentiating the fix costs from the variable costs. In the bivariate analysis, the Student's t, analysis of variance, chi-squared, Pearson's linear correlation and Mann-Whitney-Wilcoxon tests were used. In order to compare the MRW of the present study with those of the United States (US), the concordance [intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC)] and the correlation (coefficient of determination: R²) were measured. The total number of patients studied was 227,235, and the frequentation was 5.9 visits/habitant/year) and with a mean diagnoses number of 4.5 (3.2). The distribution of costs was €148.7 million, of which 29.1% were fixed costs. The mean total cost per patient/year was €654.2 (851.7), which was considered to be the reference MRW. Relationship between study-MRW and US-MRW: ICC was 0.40 [confidential interval (CI) 95%: 0.21-0.60] and the CCC was 0.42 (CI 95%: 0.35-0.49). The correlation between the US MRW and the MRW of the present study can be seen; the adjusted R² value is 0.691. The explanatory power of the ACG classification was 36.9% for the total costs. The R² of the total cost without considering outliers was 56.9%. The methodology has been shown appropriate for promoting the calculation of the MRW for each category of the classification. The results provide

  19. A multicentre prospective randomised study of single-incision mini-sling (Ajust®) versus tension-free vaginal tape-obturator (TVT-O™) in the management of female stress urinary incontinence: pain profile and short-term outcomes.

    Science.gov (United States)

    Mostafa, Alyaa; Agur, Wael; Abdel-All, Mohamed; Guerrero, Karen; Lim, Chi; Allam, Mohamed; Yousef, Mohamed; N'Dow, James; Abdel-fattah, Mohamed

    2012-11-01

    To compare the postoperative pain profile, peri-operative details, and short-term patient-reported and objective success rates of single-incision mini-slings (SIMS) versus standard mid-urethral slings (SMUS). In a multicentre prospective randomised trial in six UK centres in the period between October 2009 and October 2010, 137 women were randomised to either adjustable SIMS (Ajust®, C. R. Bard Inc., NJ, USA), performed under local anaesthesia as an opt-out policy (n=69), or SMUS (TVT-O™, Ethicon Inc., Somerville, USA) performed under general anaesthesia (n=68). Randomisation was done through number-allocation software and using telephone randomisation. Postoperative pain profile (primary outcome) was assessed on a ten-point visual analogue scale at fixed time-points. Pre- and post operatively (4-6 months) women completed symptom severity, urgency perception scale (UPS), quality of life and sexual function questionnaires. In addition, women completed a Patient Global Impression of Improvement Questionnaire and underwent a cough stress test at 4-6 months follow up. Sample size calculation was performed and data were analysed using SPSS 18. Descriptive analyses are given and between-group comparisons were performed using chi-square, Fischer exact test and Mann-Whitney test as appropriate. Significance level was set at 5%. Women in the SIMS Ajust® group had a significantly lower postoperative pain profile up to 4 weeks (p=TVT-O™ groups respectively. There was a trend towards higher rates of de novo urgency or worsening of pre-existing urgency in the SIMS Ajust® group (21.7% versus 8.8%) but this did not reach statistical significance (p=0.063). Women in the SIMS Ajust® group had shorter hospital stay (median (IQR) 3.65 (2.49, 4.96)) compared to (4.42 (3.16, 5.56)) the TVT-O™ group 95% CI (-0.026, 1.326), with significantly earlier return to normal activities (p=0.025) and to work (p=0.006). The adjustable single-incision mini-sling (Ajust®) is associated

  20. Ajuste do modelo fototérmico de estimativa do desenvolvimento e do índice de área foliar de soja Adjustment of the photothermic model to estimate soybean development and leaf area index

    Directory of Open Access Journals (Sweden)

    Neila T. Toledo

    2010-03-01

    Full Text Available Visou-se neste estudo, realizar o ajuste do modelo de estimativa do desenvolvimento de populações de soja e da variação do índice de área foliar para a variedade IAS 5. Como fonte de variação na velocidade de desenvolvimento, diferentes épocas de plantio foram utilizadas em experimentos nos anos agrícolas de 2004/2005 (três datas e 2005/2006 (quatro datas no IRDeR (Instituto Regional de Desenvolvimento Rural localizado em Augusto Pestana, RS (28º 27' 17" S e 53º 54' 50" W, nos quais foram identificadas as datas em que ocorreram as principais fases do desenvolvimento da cultura da soja, seguindo a Escala Fenológica de Fehr & Caviness e estimados o índice de área foliar em quatro momentos: no final do período de instalação da população vegetal (V6; no início do florescimento (R1; início do enchimento de grãos (R5; e no início da maturação (R7. As variáveis meteorológicas temperaturas mínima e máxima diárias foram coletadas. Após o ajuste dos coeficientes genéticos, o modelo foi formatado no programa Stella 5.0. O modelo de estimativa do desenvolvimento da soja teve desempenho satisfatório, apresentando estimativas precisas para os dados que o determinaram. O modelo de estimativa do índice de área foliar apresentou estimativas satisfatórias.The present study was carried out to adjust the soy population development model and the leaf area index model for the IAS 5 cultivar. Different sowing dates were used in two experiments as source of development variation during 2004/2005 (three dates and 2005/2006 (four dates in the IRDeR (Instituto Regional de Desenvolvimento Rural located in Augusto Pestana, in the State of Rio Grande do Sul (28º 27' 17" S and 53º 54' 50" W. The main crop development phases were identified according to the Feher & Caviness phenological scale, and the leaf area index was determined in four occasions: at the final period of plant population installation (V6; at the beginning of flowering

  1. Ajuste de metodologia da eletroforese de proteínas para obtenção de fenótipos isoenzimáticos de moranga Adjustment of the methodology of protein electrophoresis to obtain isozymatic phenotypes of pumpkin

    Directory of Open Access Journals (Sweden)

    Antonio Teixeira do Amaral Júnior

    1994-01-01

    Full Text Available Modificações no procedimento eletroforético foram introduzidas para uma satisfatória obtenção de fenótipos isoenzimáticos de moranga (Cucurbita maxima Duchesne. Extratos de folhas definitivas de oito acessos de moranga foram submetidos à análise eletroforética para revelação dos seguintes sistemas: esterase (EST; fosfatase ácida (ACP; transaminase do glutamato oxaloacetato (GOT, desidrogenase do malato (MDH e peroxidase (PO. Os resultados apontaram a ineficiência do tampão extrator utilizado e satisfatória qualidade do gel de amido de milho nas resoluções dos sistemas EST, ACP, GOT e MDH. Para o sistema PO, adequado efeito de peneiramento molecular só foi possível com a utilização do amido hidrolisado de batata (Sigma. Ajustes no tempo de cozimento do gel, manuseio da corrente elétrica, preparo de soluções corantes e tempo de revelação indicaram os melhores protocolos ao pro-cedimento eletroforético.Changes in the electrophoresis procedures were introduced to obtain a better isozymatic phenotypes of pumpkin (Cucurbita maxima Duchesne. Extracts of eight access of pumpkin's leaves were subjected to electrophoresis analysis in order to reveal the following systems: esterase (EST, acid phosphatase (ACP, glutamate oxaloacetate transaminase (GOT, malato dehydrogenase (MDH and peroxidase (PO. The results pointed out the inefficiency of the extractor buffer used, and the satisfactory quality of maize starch gel electrophoresis in the resolution of EST, ACP, GOT and MDH systems. For PO system a better effect of "molecular sieving" was only possible when potato starch gel (Sigma was used. Adjusting the starch cooking time, handling the electric current, preparing the staining solutions and revealing time indicated the best protocol to the electrophoresis process.

  2. Resultados de tres años de ensayo en el ajuste de la tecnología de “Tree Row Volume” (TRV para el control de mancha negra en naranja Valencia

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    HABERLE, T.J.

    2011-08-01

    Full Text Available Actualmente, los consumidores de fruta son altamente exigentes tanto en la calidad externa como interna de la fruta. En el aspecto externo, exigen ausencia de daños causados por plagas y/o enfermedades con énfasis en aquellas consideradas cuarentenarias como es Mancha Negra (MN causada por el hongo Guignardia citricarpa Kiely. Con respecto a los aspectos internos, se considera que debe tener alta calidad organoléptica y, sobre todo, tener mínimos residuos de plaguicidas. Para contribuir con ambos objetivos, se están realizando desde hace varios años tratamientos para optimizar la dosis de fungicidas y volúmenes aplicados a lotes con frutas con destino de exportación. A tal efecto se han realizado ensayos por tres años para el ajuste del volumen de caldo a aplicar por hectárea en función del tamaño de los árboles aplicando la fórmula del TRV (“Tree Row Volume” en un lote de naranja Valencia (Citrus sinensis L. Osb. con alta incidencia de (MN. Los ensayos consistieron en la utilización de picos inyectores de aire ID instalados en turbinas de alto volumen con el fin de reducir el volumen total de caldo de modo similar al logrado con la tecnología de bajo volumen. Los resultadosobtenidos en diferentes campañas con picos ID en tratamientos reducidos al 50% en volumen ejercieron un muy buen control de la enfermedad sin diferencias significativas con respecto a los tratamientos de alto volumen convencionales. Esta estrategia permite optimizar la utilización de equipos existentes con el beneficiodel ahorro de agua, insumos y, además, sustentable con el ambiente.

  3. Calibración de cámaras de tiempo de vuelo: Ajuste adaptativo del tiempo de integración y análisis de la frecuencia de modulación

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    P. Gil

    2013-10-01

    Full Text Available Resumen: La percepción de profundidad se hace imprescindible en muchas tareas de manipulación, control visual y navegación de robots. Las cámaras de tiempo de vuelo (ToF: Time of Flight generan imágenes de rango que proporcionan medidas de profundidad en tiempo real. No obstante, el parámetro distancia que calculan estas cámaras es fuertemente dependiente del tiempo de integración que se configura en el sensor y de la frecuencia de modulación empleada por el sistema de iluminación que integran. En este artículo, se presenta una metodología para el ajuste adaptativo del tiempo de integración y un análisis experimental del comportamiento de una cámara ToF cuando se modifica la frecuencia de modulación. Este método ha sido probado con éxito en algoritmos de control visual con arquitectura ‘eye-in-hand’ donde el sistema sensorial está compuesto por una cámara ToF. Además, la misma metodología puede ser aplicada en otros escenarios de trabajo. Abstract: The depth perception is essential in many manipulation tasks, visual inspection and robot navigation. The cameras of Time of Flight (TOF generate range images which provide depth measurements in real time. However, the distance parameter computed from these cameras is strongly dependent on the integration time set for the sensor and the frequency of modulation used by the integrated lighting system. In this paper, a methodology for automatic setting of integration time and an experimental analysis of ToF camera behavior adjusting its modulation frequency is presented. This method has been successfully tested on visual servoing algorithms with architecture ‘eye-in-hand’ in which the sensory system consists of a ToF camera, in addition this methodology can be applied to other workspaces and scenarios. Palabras clave: Tiempo de vuelo, calibración, imagen de rango, percepción robótica, cámaras 3D, Keywords

  4. LA REFORMA ECONÓMICA Y SU IMPACTO SOCIAL EN COSTA RICA DURANTE EL PERÍODO DE AJUSTE ESTRUCTURAL: apuntes críticos para el análisis

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    Rafael Arias Ramírez

    2007-12-01

    Full Text Available Resumen El objetivo de este artículo es analizar la reforma económica implementada en Costa Rica en los últimos veinticinco años como resultado de la aplicación de los programas y políticas de ajuste estructural. Para tal efecto se analiza el debate que acompañó el proceso de aprobación e implementación de los mencionados programas, el discurso de los mismos, su desempeño y algunos de sus principales efectos sociales. Esta reforma económica representó un cambio importante en el estilo de desarrollo y en las funciones del estado social vigentes desde la década de los 1950s. De ahí que resulte de gran interés analizar cuál fue el nuevo enfoque de desarrollo que se implementó a partir de la década de los años ochenta y los resultados del mismo en materia de crecimiento económico y equidad social. Esta publicación pretende servir de insumo para promover la tarea académica de repensar la política de desarrollo que la sociedad costarricense debe definir dentro del nuevo contexto de la globalización.   Abstract The objective of this article is to analyze the economic reform implemented in Costa Rica in the last twenty-five years as result of the application of the structural adjustment programs and policies. For such effect we analyze the debate that accompanied the process of approval and implementation of the mentioned programs, the speech of such, its performance and some of its main social effects. This economic reform represented an important change in the style of development and in the current functions of the social state from the decade of 1950s. Hence it results of big interest to analyze which was the new approach of development that was implemented from the decade of the eighties and the results of the same one on the subject of economic growth and social equity.This publication tries to serve as input to promote the academic task of rethinking the politics of development that the Costa Rican society must define

  5. Disputas, ajustes e acomodações na produção da agenda eleitoral: a cobertura jornalística ao Programa Bolsa Família e as eleições de 2006

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    Flávia Biroli

    2010-06-01

    Full Text Available Resumo: Este artigo apresenta uma análise da cobertura jornalística ao Programa Bolsa Família durante as eleições presidenciais de 2006. A pesquisa abrange um total de 166 textos que mencionaram o Programa, publicados pelos jornais O Globo, O Estado de São Paulo, Folha de São Paulo e Valor Econômico entre os dias 1º de setembro e 31 de outubro de 2006. Discutimos a dinâmica de produção da agenda eleitoral, observando as disputas, ajustes e acomodações que constituem a cobertura. A análise conjunta das vozes e dos enquadramentos presentes no material permite observar aspectos relevantes das interações entre os campos da mídia e da política no contexto em que a cobertura foi realizada. As conclusões ressaltam a baixa pluralidade do noticiário, associada a representações das eleições de 2006 e da democracia brasileira que têm como aspectos centrais a estigmatização dos eleitores de baixa renda e dos beneficiários de programas sociais.Abstract: This article presents an analysis of the news about an important social program maintained by the federal government, Programa Bolsa Família, in the period of brazilian major elections of 2006. The study is based in 166 texts published in the newspapers O Globo, O Estado de São Paulo, Folha de São Paulo e Valor Econômico between September 1st and October 31st. We discuss the production of electoral agenda, observing disputes, adjustments and acommodations that constitute news coverage. The analysis of voices and framings in the texts leads to the observation of relevant aspects of the relations between media and politics at that moment. Conclusions underline the low plurality in press coverage, connected to representations of the elections of 2006 and Brazilian democracy that include stigmatization of low income voters and beneficiaries of social programs.

  6. Ajustes de funções de distribuição de probabilidade à radiação solar global no Estado do Rio Grande do Sul Adjustments of probability distribution functions to global solar radiation in Rio Grande do Sul State

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    Alberto Cargnelutti Filho

    2004-12-01

    Full Text Available O objetivo deste trabalho foi verificar o ajuste das séries de dados de radiação solar global média decendial, de 22 municípios do Estado do Rio Grande do Sul, às funções de distribuições de probabilidade normal, log-normal, gama, gumbel e weibull. Aplicou-se o teste de aderência de Kolmogorov-Smirnov, nas 792 séries de dados (22 municípios x 36 decêndios de radiação solar global média decendial, para verificar o ajuste dos dados às distribuições normal, log-normal, gama, gumbel e weibull, totalizando 3.960 testes. Os dados decendiais de radiação solar global média se ajustam às funções de distribuições de probabilidade normal, log-normal, gama, gumbel e weibull, e apresentam melhor ajuste à função de distribuição de probabilidade normal.The objective of this work was to verify the adjustment of data series for average global solar radiation to the normal, log-normal, gamma, gumbel and weibull probability distribution functions. Data were collected from 22 cities in Rio Grande do Sul State, Brazil. The Kolmogorov-Smirnov test was applied in the 792 series of data (22 localities x 36 periods of ten days of average global solar radiation to verify the adjustment of the data to the normal, log-normal, gamma, gumbel and weibull probability distribution functions, totalizing 3,960 tests. The data of average global solar radiation adjust to the normal, log-normal, gamma, gumbel and weibull probability distribution functions, and present a better adjustment to the normal probability function.

  7. A mortalidade materna nas capitais brasileiras: algumas características e estimativa de um fator de ajuste Maternal mortality in Brazilian State Capitals: some characteristics and estimates for an adjustment factor

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    Ruy Laurenti

    2004-12-01

    Full Text Available A mortalidade materna pode ser considerada um excelente indicador de saúde, não só da mulher, mas da população geral; mostra, também, iniqüidades. A redução da mortalidade materna é uma das principais metas, estando também incluída nas Metas do Desenvolvimento do Milênio da ONU. OBJETIVO: Conhecer a qualidade da informação da mortalidade de mulheres de 10 a 49 anos, e estimar a razão de mortalidade materna (RMM e os fatores de ajuste para os dados oficiais, no conjunto das capitais de estados brasileiros e Distrito Federal. METODOLOGIA: Adotou-se a metodologia RAMOS (a partir da declaração de óbito, entrevista no domicílio da mulher falecida, com preenchimento de questionário, sobre variáveis demográficas, epidemiológicas, clínicas e de acesso a serviços; seguiam-se consultas a prontuários médicos hospitalares e a laudos de autópsia. Após o resgate da informação, pôde ser feita análise das reais causas básicas, terminais e associadas. A população de estudo foi estimada em 7.332 mortes de mulheres de 10 a 49 anos, ocorridas no primeiro semestre de 2002, sendo 239 óbitos por causas maternas. A RMM foi de 54,3 por cem mil nascidos vivos (n.v., no conjunto de capitais, variando entre 42 por cem mil n.v. no Sul, e 73,2 por cem mil n.v. no Nordeste. O fator de ajuste para o conjunto das capitais brasileiras foi igual a 1,4; para as regiões (considerando apenas as capitais, variaram entre 1,08 na Região Norte e 1,83 na Região Sul. As mortes obstétricas diretas corresponderam a 67,1%, mostrando que assistência ao pré-natal, ao parto e ao puerpério deve ser aprimorada.INTRODUCTION: There is criticism as to the heterogeneity and reliability of mortality data in Brazilian Regions. However, official mortality statistics of State Capitals are more accurate and have adequate coverage. Reduction of maternal mortality is one of the world's major goals and it is measured by the Maternal Mortality Ratio. International

  8. Medida de los pesos relativos del coste de la asistencia como efecto de la aplicación retrospectiva de los adjusted clinical groups en atención primaria Measurement of relative cost weights as an effect of the retrospective application of adjusted clinical groups in primary care

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    Antoni Sicras-Mainar

    2006-03-01

    Full Text Available Objetivo: El objeto del estudio es obtener los pesos relativos medios de los costes de la asistencia con la aplicación retrospectiva de los adjusted clinical groups (ACG en población atendida por equipos de atención primaria en situación de práctica clínica habitual. Métodos: Estudio descriptivo de carácter retrospectivo. Fueron incluidos en el estudio todos los pacientes atendidos por 4 equipos de atención primaria durante el año 2003. Las principales mediciones fueron: variables universales (edad y sexo, dependientes (visitas y costes y de casuística o comorbilidad. El modelo de costes para cada paciente se estableció diferenciando los costes fijos y los variables. Se efectuó un análisis de regresión lineal múltiple para la predicción de los modelos. El coste relativo de cada ACG se obtuvo dividiendo el coste medio de cada categoría entre el coste medio de toda la población de referencia. Resultados: El número total de pacientes estudiados fue de 62.311 (intensidad de uso del 76,7%, con una media de 4,8 ± 3,2 episodios y 7,8 ± 7,5 visitas/paciente/año. La distribución de los costes fue de 24.135.236,41 €, el 28,9% fijos. El coste unitario total por visita/año fue de 49,62 ± 24,71 € y el promedio paciente/año de 387,34 ± 145,87 € (pesos relativos de referencia. El poder explicativo de la clasificación ACG fue del 50,1% en las visitas y del 54,9% para los costes totales. Conclusiones: Los ACG se muestran como un aceptable sistema de clasificación de pacientes en situación de práctica clínica habitual. De confirmarse los resultados posibilitarían una mejora en la aplicación práctica de los ACG como una posible herramienta para la gestión clínica en los centros de atención primaria.Objective: The objective of the study is to obtain the cost's relative average weights of the assistance with the retrospective application of the Adjusted Clinical Groups (ACG's in four teams of Primary Care with an attended

  9. L’exposition contrôlée à la lumière et à l’obscurité ajuste le rythme du cortisol salivaire chez les travailleurs de nuit

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    Anny Casademont

    2005-05-01

    Full Text Available Dans cette étude réalisée sur le terrain et en laboratoire, nous avons testé l’efficacité d’une intervention consistant à contrôler l’exposition à la lumière/obscurité de façon à favoriser l’adaptation circadienne au travail de nuit. Six travailleurs permanents de nuit (moyenne d’âge 37,1 ± σ : 8,1 ans avaient comme consigne de s’exposer de façon intermittente à une lumière blanche vive plein spectre (~2 000 lux au cours des 6 premières heures de leur quart de travail de 8 heures. Il leur était demandé de se protéger de la lumière solaire du matin avec des verres teintés (densité gris neutre, transmission visuelle de la lumière 15 % et de maintenir des épisodes réguliers de sommeil/obscurité dans une pièce très sombre. Ces épisodes devaient commencer 2 heures après la fin de chaque quart de travail de nuit. Cinq travailleurs du groupe contrôle (41,1 ± σ : 9,9 ans ont été étudiés alors qu’ils devaient uniquement maintenir un horaire régulier de sommeil/obscurité. Des procédures de routine constante, réalisées avant et après une série d’environ 12 quarts de travail de nuit s’échelonnant sur 3 semaines, ont montré chez les travailleurs du groupe traitement une variation significative dans l’heure d’apparition du pic de cortisol ainsi qu’un ajustement de ce rythme à un horaire de travail de nuit. Un plus petit changement de phase a été observé dans le groupe contrôle, ce qui suggère une adaptation partielle à l’horaire de travail de nuit. Nos résultats démontrent l’efficacité d’une exposition judicieuse à la lumière et à l’obscurité pour favoriser l’adaptation des rythmes physiologiques au travail de nuit.The efficacy of a light/darkness intervention designed to promote circadian adaptation to night shift work was tested in this combined field and laboratory study. Six permanent night shift workers (mean age: 37.1 / s: 8.1 years were instructed to

  10. Ajustamento psicológico e perspectiva de velhice pessoal em adultos com deficiência física Ajuste psicológico e la perspectiva percibida del envejecimiento personal en adulto y adultos moyores con discapacidad física Psychological adjustment and personal aging perspective in adults and older adults with physical disability

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    Marineia Crosara de Resende

    2009-12-01

    Full Text Available Foram investigadas relações entre senso de ajustamento psicológico e perspectiva de velhice em adultos e idosos com deficiência física. Participaram 90 pessoas, de ambos os sexos, com idade entre 25 e 84 anos, que responderam aos instrumentos: questionários sociodemografico e sobre a deficiência física; Inventário Sheppard de Atitudes em Relação à Velhice Pessoal; Escala de Desenvolvimento Pessoal (ajustamento psicológico. Os índices de ajustamento pessoal foram de moderados a altos, mas as mulheres pontuaram mais baixo. Para toda a amostra, quanto maior o senso de ajustamento, mais positiva a perspectiva de velhice pessoal. Os com deficiência congênita e os mais ajustados psicologicamente mostraram perspectivas mais positivas de velhice pessoal. Concluiu-se que envelhecer com uma deficiência física é um processo que exige competência adaptativa e resiliência aos eventos de vida e aos desafios acarretados pela deficiência.Realizamos una investigación para analizar las relaciones entre el ajuste psicológico y la perspectiva percibida del envejecimiento personal en adulto y adultos mayores con discapacidad física. Materiales y método: 90 participantes, ambos géneros, adultos con 25 a 84 respondieron a cuestionarios contestados pidiendo la información sobre características socio demográficas y discapacidad; el inventario de Sheppard de actitudes acerca del propio envejecimiento; y una escala que determina el ajuste psicológico percibido. Resultados: Los índices del ajuste personal eran moderados y altos. Las mujeres tenían las cuentas más bajas. Había correlaciones positivas observadas entre el ajuste psicológico positivo y las actitudes positivas acerca del propio envejecimiento. Los que tenían discapacidad congénita y el ajuste psicológico más alto divulgado demostraron perspectivas más positivas del envejecimiento personal. Conclusión: El envejecer con discapacidad física es un proceso complejo que

  11. The value of episodic, intensive blood glucose monitoring in non-insulin treated persons with Type 2 Diabetes: design of the Structured Testing Program (STeP) study, a cluster-randomised, clinical trial [NCT00674986].

    Science.gov (United States)

    Polonsky, William; Fisher, Lawrence; Schikman, Charles; Hinnen, Deborah; Parkin, Christopher; Jelsovsky, Zhihong; Amstutz, Linda; Schweitzer, Matthias; Wagner, Robin

    2010-05-18

    The value and utility of self-monitoring of blood glucose (SMBG) in non-insulin treated T2DM has yet to be clearly determined. Findings from studies in this population have been inconsistent, due mainly to design differences and limitations, including the prescribed frequency and timing of SMBG, role of the patient and physician in responding to SMBG results, inclusion criteria that may contribute to untoward floor effects, subject compliance, and cross-arm contamination. We have designed an SMBG intervention study that attempts to address these issues. The Structured Testing Program (STeP) study is a 12-month, cluster-randomised, multi-centre clinical trial to evaluate whether poorly controlled (HbA1c >or= 7.5%), non-insulin treated T2DM patients will benefit from a comprehensive, integrated physician/patient intervention using structured SMBG in US primary care practices. Thirty-four practices will be recruited and randomly assigned to an active control group (ACG) that receives enhanced usual care or to an enhanced usual care group plus structured SMBG (STG). A total of 504 patients will be enrolled; eligible patients at each site will be randomly selected using a defined protocol. Anticipated attrition of 20% will yield a sample size of at least 204 per arm, which will provide a 90% power to detect a difference of at least 0.5% in change from baseline in HbA1c values, assuming a common standard deviation of 1.5%. Differences in timing and degree of treatment intensification, cost effectiveness, and changes in patient self-management behaviours, mood, and quality of life (QOL) over time will also be assessed. Analysis of change in HbA1c and other dependent variables over time will be performed using both intent-to-treat and per protocol analyses. Trial results will be available in 2010. The intervention and trial design builds upon previous research by emphasizing appropriate and collaborative use of SMBG by both patients and physicians. Utilization of per

  12. The value of episodic, intensive blood glucose monitoring in non-insulin treated persons with type 2 diabetes: Design of the Structured Testing Program (STeP Study, a cluster-randomised, clinical trial [NCT00674986

    Directory of Open Access Journals (Sweden)

    Jelsovsky Zhihong

    2010-05-01

    Full Text Available Abstract Background The value and utility of self-monitoring of blood glucose (SMBG in non-insulin treated T2DM has yet to be clearly determined. Findings from studies in this population have been inconsistent, due mainly to design differences and limitations, including the prescribed frequency and timing of SMBG, role of the patient and physician in responding to SMBG results, inclusion criteria that may contribute to untoward floor effects, subject compliance, and cross-arm contamination. We have designed an SMBG intervention study that attempts to address these issues. Methods/design The Structured Testing Program (STeP study is a 12-month, cluster-randomised, multi-centre clinical trial to evaluate whether poorly controlled (HbA1c ≥ 7.5%, non-insulin treated T2DM patients will benefit from a comprehensive, integrated physician/patient intervention using structured SMBG in US primary care practices. Thirty-four practices will be recruited and randomly assigned to an active control group (ACG that receives enhanced usual care or to an enhanced usual care group plus structured SMBG (STG. A total of 504 patients will be enrolled; eligible patients at each site will be randomly selected using a defined protocol. Anticipated attrition of 20% will yield a sample size of at least 204 per arm, which will provide a 90% power to detect a difference of at least 0.5% in change from baseline in HbA1c values, assuming a common standard deviation of 1.5%. Differences in timing and degree of treatment intensification, cost effectiveness, and changes in patient self-management behaviours, mood, and quality of life (QOL over time will also be assessed. Analysis of change in HbA1c and other dependent variables over time will be performed using both intent-to-treat and per protocol analyses. Trial results will be available in 2010. Discussion The intervention and trial design builds upon previous research by emphasizing appropriate and collaborative use of

  13. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan

    Directory of Open Access Journals (Sweden)

    Weiner Jonathan P

    2010-01-01

    Full Text Available Abstract Background Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. Methods A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234, while those in both 2002 and 2003 were included for prospective analyses (n = 164,562. Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. Results The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster. When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Conclusions Given the

  14. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

    Science.gov (United States)

    Chang, Hsien-Yen; Weiner, Jonathan P

    2010-01-18

    Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory

  15. Comorbidity adjustment index for the international classification of diseases, 10 Índice de ajuste de co-morbilidad para la 10a revisión de la clasificación internacional de enfermedades Índice de ajuste de comorbidade para a 10a revisão da classificação internacional de doenças

    Directory of Open Access Journals (Sweden)

    Robert Antonio Ramiarina

    2008-08-01

    Full Text Available OBJECTIVE: To develop a Charlson-like comorbidity index based on clinical conditions and weights of the original Charlson comorbidity index. METHODS: Clinical conditions and weights were adapted from the International Classification of Diseases, 10th revision and applied to a single hospital admission diagnosis. The study included 3,733 patients over 18 years of age who were admitted to a public general hospital in the city of Rio de Janeiro, southeast Brazil, between Jan 2001 and Jan 2003. The index distribution was analyzed by gender, type of admission, blood transfusion, intensive care unit admission, age and length of hospital stay. Two logistic regression models were developed to predict in-hospital mortality including: a the aforementioned variables and the risk-adjustment index (full model; and b the risk-adjustment index and patient's age (reduced model. RESULTS: Of all patients analyzed, 22.3% had risk scores >1, and their mortality rate was 4.5% (66.0% of them had scores >1. Except for gender and type of admission, all variables were retained in the logistic regression. The models including the developed risk index had an area under the receiver operating characteristic curve of 0.86 (full model, and 0.76 (reduced model. Each unit increase in the risk score was associated with nearly 50% increase in the odds of in-hospital death. CONCLUSIONS: The risk index developed was able to effectively discriminate the odds of in-hospital death which can be useful when limited information is available from hospital databases.OBJETIVO: Desarrollar un índice de co-morbilidad a partir de las condiciones clínicas y de los pesos de índice original de co-morbilidad de Charlson. MÉTODOS: Las condiciones clínicas y pesos del índice de Charlson fueron adaptados según la Clasificación Internacional de Enfermedades - 10a Revisión, y aplicados al diagnóstico principal de internación hospitalaria. Fueron estudiados 3.733 pacientes arriba de 18 a

  16. Clinical Trials

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  19. Ajuste do modelo de Schumacher e Hall e aplicação de redes neurais artificiais para estimar volume de árvores de eucalipto Adjustment of the Schumacher and Hall model and application of artificial neural networks to estimate volume of eucalypt trees

    Directory of Open Access Journals (Sweden)

    Mayra Luiza Marques da Silva

    2009-12-01

    Full Text Available Objetivou-se, neste trabalho, avaliar o ajuste do modelo volumétrico de Schumacher e Hall por diferentes algoritmos, bem como a aplicação de redes neurais artificiais para estimação do volume de madeira de eucalipto em função do diâmetro a 1,30 m do solo (DAP, da altura total (Ht e do clone. Foram utilizadas 21 cubagens de povoamentos de clones de eucalipto com DAP variando de 4,5 a 28,3 cm e altura total de 6,6 a 33,8 m, num total de 862 árvores. O modelo volumétrico de Schumacher e Hall foi ajustado nas formas linear e não linear, com os seguintes algoritmos: Gauss-Newton, Quasi-Newton, Levenberg-Marquardt, Simplex, Hooke-Jeeves Pattern, Rosenbrock Pattern, Simplex, Hooke-Jeeves e Rosenbrock, utilizado simultaneamente com o método Quasi-Newton e com o princípio da Máxima Verossimilhança. Diferentes arquiteturas e modelos (Multilayer Perceptron MLP e Radial Basis Function RBF de redes neurais artificiais foram testados, sendo selecionadas as redes que melhor representaram os dados. As estimativas dos volumes foram avaliadas por gráficos de volume estimado em função do volume observado e pelo teste estatístico L&O. Assim, conclui-se que o ajuste do modelo de Schumacher e Hall pode ser usado na sua forma linear, com boa representatividade e sem apresentar tendenciosidade; os algoritmos Gauss-Newton, Quasi-Newton e Levenberg-Marquardt mostraram-se eficientes para o ajuste do modelo volumétrico de Schumacher e Hall, e as redes neurais artificiais apresentaram boa adequação ao problema, sendo elas altamente recomendadas para realizar prognose da produção de florestas plantadas.This research aimed at evaluating the adjustment of Schumacher and Hall volumetric model by different algorithms and the application of artificial neural networks to estimate the volume of wood of eucalyptus according to the diameter at breast height (DBH, total height (Ht of the clone. For such, 21 scalings of stands of eucalyptus clones were used with

  20. Clinical Trials

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    Full Text Available ... the NHLBI's Children and Clinical Studies Web page. Children and Clinical Studies Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to ...

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    Full Text Available ... medical strategy, treatment, or device is safe and effective for humans. What Are Clinical Trials? Clinical trials ... and Centers sponsor clinical trials. Many other groups, companies, and organizations also sponsor clinical trials. Examples include ...

  4. Elasto-plastic hardening models adjustment to ferritic, austenitic and austenoferritic Rebar; Ajuste de los aceros corrugados ferríticos, austeníticos y austenoferríticos a los modelos de endurecimiento elastoplástico por deformación

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    Hortigóna, B.; Gallardo, J.M.; Nieto-García, E.J.; López, J.A.

    2017-09-01

    de Rasmussen presentando un exponente de valor 6 realizando un ajuste libre de la función correspondiente. Para los aceros inoxidables Dúplex se obtienen muy bajos ajustes para los dos modelos citados.

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    Full Text Available ... clinical trials are vital to the process of improving medical care. Many people volunteer because they want ... care costs for clinical trials. If you're thinking about taking part in a clinical trial, find ...

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    Full Text Available ... Working at the NHLBI Contact and FAQs Accessible Search Form Search the NHLBI, use the drop down list to ... to learn more about clinical research and to search for clinical trials: NHLBI Clinical Trials Browse a ...

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    Full Text Available ... take part in a clinical trial. When researchers think that a trial's potential risks are greater than ... care costs for clinical trials. If you're thinking about taking part in a clinical trial, find ...

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    Full Text Available ... the same scientific safeguards as clinical trials for adults. For more information, go to "How Do Clinical ... based on what is known to work in adults. To improve clinical care of children, more studies ...

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    Full Text Available ... comparison groups by chance, rather than choice. This method helps ensure that any differences observed during a ... to learn more about clinical research and to search for clinical trials: NHLBI Clinical Trials Browse a ...

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    Full Text Available ... Health Topics / About Clinical Trials About Clinical Trials Clinical trials are research studies that explore whether a medical strategy, treatment, ... tool for advancing medical knowledge and patient care. Clinical research is done only if doctors don't know ...

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    Full Text Available ... about your health or fill out forms about how you feel. Some people will need to travel or stay in hospitals to take part in clinical trials. For example, the National Institutes of Health Clinical Center in Bethesda, Maryland, runs clinical trials. Many other clinical trials take place ...

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    Full Text Available ... of clinical trials contribute to medical knowledge and practice. Why Clinical Trials Are Important Clinical trials are a key ... Enterprise NHLBI has a strong tradition of supporting clinical trials that have not only shaped medical practice around the world, but have improved the health ...

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    Full Text Available ... child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials. Clinical trials for children have the same scientific safeguards as clinical trials for adults. For more information, go to "How Do Clinical ...

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    Full Text Available ... part in a clinical trial is your decision. Talk with your doctor about all of your treatment options. Together, you can make the ... more about, or taking part in, clinical trials, talk with your doctor. He or she may know about ... clinical trials. NIH Clinical Research Studies ...

  3. Comparação de alguns modelos matemáticos para ajuste à curva de lactação média de um rebanho da raça Caracu Comparison of some mathematical models for the adjustment of the average milking curve of caracu breed herd

    Directory of Open Access Journals (Sweden)

    Lenira El Faro

    1999-01-01

    Full Text Available No presente estudo foi estimada a curva de lactação média de 7239 lactações de vacas da raça Caracu, com base em 299.949 controles semanais. As funções ajustadas aos dados médios da curva de lactação foram Linear Hiperbólica e Quadrática Logarítmica, como lineares, e Gama Incompleta e Polinomial Inversa, como não-lineares. Os parâmetros foram estimados por meio de processos iterativos, método de Gauss-Newton. O Coeficiente de Determinação ajustado (R²A, o Teste de Durbin-Watson (DW e os desvios (% entre as produções totais (PTL observadas e estimadas foram usados como medida da qualidade do ajuste. Os resíduos estimados, apesar de pequenos, apresentaram correlação serial positiva, pois o teste DW foi significativo para as quatro funções estudadas, indicando violação da pressuposição de independência entre estes resíduos. Os R²A foram superiores a 97% e os desvios entre as PTL observadas e estimadas, mínimos, indicando que, de acordo com estes critérios, qualquer função poderia ser usada para ajustar a curva de lactação média desse rebanho. Quanto aos componentes da curva, a melhor aproximação foi obtida pela função Polinomial Inversa, para produção inicial, tempo e produção no pico. As funções Gama Incompleta e Quadrática Logarítmica apresentaram ajustes semelhantes, porém a primeira apresentou melhor definição dos parâmetros e componentes da curva de lactação.The present study was carried out to estimate the average lactation curve of 7239 lactations of Caracu cows based on 299,949 weekly records. The functions fitted to the mean data of the lactation curve were: Linear Hyperbolic and Logarithmic Quadratic as linear and Incomplete Gamma and Inverse Polynomial function as non-linear. The parameters were estimated by iterative methods, Gauss-Newton method. The adjusted Coefficient of Determination (R²A, the Durbin-Watson test (DW and the deviations (% from actual and predicted total milk

  4. Efecto del ajuste estructural sobre la situación de salud en América Latina y el Caribe, 1980-2000 The effect of structural adjustment on health conditions in Latin America and the Caribbean, 1980-2000

    Directory of Open Access Journals (Sweden)

    Álvaro Franco-Giraldo

    2006-05-01

    Full Text Available OBJETIVO: Evaluar el impacto del ajuste estructural sobre los indicadores de salud en América Latina y el Caribe durante el período de 1980-2000. MÉTODOS: Se trata de un estudio ecológico. Los datos del gasto público y del producto interno bruto per cápita (PIBpc se tomaron del Banco Mundial y los de la esperanza de vida (EV y mortalidad infantil (MI, de la Organización Mundial de la Salud. El ajuste estructural (adelgazamiento del Estado se evaluó mediante el cambio en el consumo de gobierno (la reducción del gasto público en los países de América Latina y el Caribe en la década de 1980-1990. El cambio en los indicadores de salud se midió por la variación porcentual de la EV y la MI. Se compararon estas variaciones en América Latina y el Caribe con las observadas en diferentes grupos de países de otras regiones del mundo durante el período de 1980-2000. Se determinaron las asociaciones entre la reducción del gasto público y los indicadores de salud mediante la prueba de Pearson. Para estimar el efecto de los cambios sobre la salud se construyó un modelo de regresión lineal multifactorial ajustado según el PIBpc. RESULTADOS: Se observó una ralentización del incremento de la EV y del descenso de la MI en América Latina y el Caribe, especialmente en la década de 1980-1990. Se encontraron asociaciones significativas entre la variación de los indicadores de salud y el cambio del gasto público en todos los grupos de países analizados. Al ajustar el modelo de regresión múltiple, las asociaciones solo se mantuvieron en América Latina y el Caribe. CONCLUSIONES: En la década de 1980, el ajuste de las políticas macroeconómicas tuvo un efecto negativo sobre los indicadores sociales, específicamente sobre los relacionados con la situación de salud en América Latina y el Caribe. Estos efectos se siguieron observando durante la década siguiente.OBJECTIVE: To assess the impact of structural adjustment on health

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    Full Text Available ... Entire Site NHLBI Entire Site Health Topics News & Resources Intramural Research ... or device is safe and effective for humans. What Are Clinical Trials? Clinical trials are research ...

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    Full Text Available ... sponsor clinical trials. Many other groups, companies, and organizations also sponsor clinical trials. Examples include Government Agencies, ... and Veterans Affairs; private companies; universities; and nonprofit organizations. NIH Institutes and Centers (including the NHLBI) usually ...

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    Full Text Available ... decisionmaking. The purpose of clinical trials is research, so the studies follow strict scientific standards. These standards ... otherwise. The purpose of clinical trials is research, so the studies follow strict scientific standards. These standards ...

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    Full Text Available ... Diseases Heart and Vascular Diseases Precision Medicine Activities Obesity, Nutrition, and Physical Activity Population and Epidemiology Studies ... the NHLBI's Children and Clinical Studies Web page. Children and Clinical Studies Learn more about Children and ...

  11. Clinical Pharmacopsychology

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    Fava, Giovanni A.; Tomba, Elena; Bech, Per

    2017-01-01

    of its most representative expressions and reference to current challenges of clinical research, with particular reference to clinimetrics. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment...... effects, (b) treatment-induced unwanted side effects, and (c) the patient's own personal experience of a change in terms of well-being and/or quality of life. Clinical pharmacopsychology offers a unifying framework for the understanding of clinical phenomena in medical and psychiatric settings. Research......The aim of this critical review was to outline emerging trends and perspectives of clinical pharmacopsychology, an area of clinical psychology that is concerned with the psychological effects of medications. The historical development of clinical pharmacopsychology is outlined, with discussion...

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    Full Text Available ... risks that outweigh any possible benefits. Clinical Trial Phases Clinical trials of new medicines or medical devices are done in phases. These phases have different purposes and help researchers ...

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    Full Text Available ... and treatments that work best. How Clinical Trials Work If you take part in a clinical trial, ... Customer Service/Center for Health Information Email Alerts Jobs and Careers Site Index About NHLBI National Institute ...

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    Full Text Available ... Some companies and groups sponsor clinical trials that test the safety of products, such as medicines, and how well they work. The U.S. Food and Drug Administration (FDA) oversees these clinical trials. ...

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    Full Text Available ... What to Expect During a clinical trial, doctors, nurses, social workers, and other health care providers might ... enroll in a clinical trial, a doctor or nurse will give you an informed consent form that ...

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    Full Text Available ... and doctors' offices around the country. Benefits and Risks Possible Benefits Taking part in a clinical trial ... volunteer because they want to help others. Possible Risks Clinical trials do have risks and some downsides, ...

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    Full Text Available ... and treatments that work best. How Clinical Trials Work If you take part in a clinical trial, ... Learn More Connect With Us Contact Us Directly Policies Privacy Policy Freedom of Information Act (FOIA) Accessibility ...

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    Full Text Available ... a Clinical Trial If you're interested in learning more about, or taking part in, clinical trials, ... Customer Service/Center for Health Information Email Alerts Jobs and Careers Site Index About NHLBI National Institute ...

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    Full Text Available ... and treatments that work best. How Clinical Trials Work If you take part in a clinical trial, ... kol). This plan explains how the trial will work. The trial is led by a principal investigator ( ...

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    Full Text Available ... Trial Protocol Each clinical trial has a master plan called a protocol (PRO-to-kol). This plan explains how the trial will work. The trial ... clinical trial; and detailed information about the treatment plan. Eligibility Criteria A clinical trial's protocol describes what ...

  8. Clinical Trials

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    Full Text Available ... benefits of lowering high blood pressure in the elderly outweighed the risks. Other examples of clinical trials ... child to enroll. Also, children aged 7 and older often must agree (assent) to ... as clinical trials for adults. For more information, go to "How Do Clinical ...

  9. Clinical Trials

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    Full Text Available ... give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials. Find a Clinical Trial If you're interested in learning more about, or taking part in, clinical trials, ...

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    Full Text Available ... clinical trials. If you're thinking about taking part in a clinical trial, find out ahead of time about costs and coverage. You should learn about the risks and benefits of any clinical trial before you agree to take part in the trial. Talk with your doctor about ...

  11. Utilización de los grupos clínicos ajustados en un centro de atención primaria español: estudio retrospectivo de base poblacional Adjusted clinical groups use at a Spanish primary care center: a retrospective, population-based study

    Directory of Open Access Journals (Sweden)

    Antoni Sicras-Mainar

    2010-01-01

    Full Text Available OBJETIVOS: Evaluar los resultados de la aplicación del sistema de clasificación mediante grupos clínicos ajustados (GCA en un centro de atención primaria de salud (APS de una población española. MÉTODOS: Estudio transversal retrospectivo a partir de los registros médicos informatizados de los pacientes atendidos ambulatoriamente durante 2007 en el centro de salud La Roca, administrado por una empresa de gestión de servicios de salud en La Roca del Vallès, Barcelona, España. Los GCA se conformaron según la Clasificación Internacional de Enfermedades, 9.ª revisión, modificación clínica. Se calcularon los pesos relativos medios en dólares estadounidenses de cada GCA respecto al costo medio total y, a partir de ellos, se crearon las bandas de utilización de recursos. Se determinaron los índices de riesgo (IR y eficiencia (IE con respecto a 2006 y se estimó el poder explicativo de la clasificación empleada. RESULTADOS: Se estudiaron 8 294 pacientes, para una cobertura de 82,7%, con una media de 4,1 episodios por paciente, 6,9 visitas por paciente y 5,7 visitas por habitante al año. A siete GCA correspondió 51,0% de los pacientes atendidos. El IR fue de 1,015, el IE en las visitas de 0,975 y el poder explicativo de la clasificación en GCA fue de 53,4% para las visitas y de 74,8% para los episodios. CONCLUSIONES: El sistema de GCA permitió agrupar a los pacientes de una población según su estado clínico y puede ayudar, entre otros aspectos, en la asignación de recursos y la evaluación de la eficiencia de los equipos de APS.OBJECTIVES: To evaluate the results of implementing a classification system based on adjusted clinical groups (ACG at a primary health care (PHC in a Spanish population. METHODS: A retrospective, cross-sectional study based on the computerized medical records of outpatients seen in 2007 by the La Roca clinic, administered by a health services management company in La Roca del Vallès, Barcelona, Spain

  12. Incertidumbre y ajuste por las cantidades en the General Theory

    OpenAIRE

    Rodríguez Herrera, Adolfo

    2009-01-01

    Robert Clower desarrolla una interpretación de la crítica de Keynes al funcionamiento de la economía capitalista en la cual la incertidumbre explica la incapacidad del sistema para alcanzar un equilibrio en todos los mercados, y en particular en el mercado de trabajo. El incumplimiento del principal supuesto de la economía neoclásica, la información perfecta, hace que la tasa de interés pierda su papel regulador y el sistema la capacidad de ajustarse instantáneamente a través de movimientos d...

  13. Gasto y servicios públicos: Efectos del ajuste presupuestal

    Directory of Open Access Journals (Sweden)

    Eugenia Correa

    2008-09-01

    Full Text Available Entre la crisis de la deuda de 1982 y el presente, las políticas económicas del Consenso de Washington (CW, han sido obedecidas de forma continua e ininterrumpida en México. Las tres generaciones de estas políticas recomendadas-impuestas, que han buscado recuperar la capacidad de pago de la deuda, privatizar las empresas estatales, y abrir y desregular la economía nacional, han seguido los intereses de los acreedores privados y las empresas en expansión en la región, que a la vez han debilitado la empresa local, las instituciones públicas y a la clase política en general. El principio fundamental del CW mas dañino ha sido el mantenimiento del equilibrio fiscal. Sin embargo, la creencia en la necesidad del equilibrio fiscal también es el elemento del CW que más ha penetrado las ideologías, tanto de izquierda como de derecha en América Latina. Después de presentar los orígenes y la trayectoria de las políticas de Washington, se destaca cómo las privatizaciones y el servicio de la deuda pública han disminuido los ingresos y gastos fiscales, dejando el Estado dependiente de los excedentes petroleros y de los servicios públicos básicos. Se analizan como tales sectores enfrentan una mayor participación de la empresa extranjera, mayor descapitalización y privatización.

  14. Ajuste psicosocial en adolescentes víctimas de cyberbullying

    OpenAIRE

    Iranzo Ejarque, Begoña

    2017-01-01

    1. INTRODUCCIÓN Los enormes y continuos avances de las nuevas tecnologías de la información y comunicación (TICs) han contribuido al desarrollo de nuevas formas de comunicación e interrelación social en la sociedad actual (Buelga y Chóliz, 2013). Pese a estas ventajas, han surgido nuevos problemas en la red como consecuencia del mal uso que algunos niños y adolescentes hacen de la TICs (Durán y Martínez, 2015; Ortega-Barón, Buelga y Cava, 2016; Rice et al., 2015). En este sentido, dest...

  15. Ajuste macro, política monetaria y empleo

    Directory of Open Access Journals (Sweden)

    Jorge Iván González

    2000-04-01

    Full Text Available El artículo muestra que la política monetaria restrictiva ha sido uno de los factores que más ha incidido en el crecimiento del desempleo en Colombia durante la segunda mitad de los años noventa. La tasa de sacrificio de la política monetaria no ha sido cero, porque el costo de reducir la inflación ha sido muy elevado. La responsabilidad que tiene el manejo de la política monetaria en la crisis del sector real se hace más visible si se tiene en cuenta que no hay evidencia de que la menor demanda de trabajo esté asociada a los costos laborales y a las inflexibilidades del mercado laboral.

  16. Ajuste de particiones planas mediante diagramas de Voronoi discretos

    OpenAIRE

    García Bernal, Daniel

    2017-01-01

    La geometría computacional se centra en el diseño y análisis de algoritmos para problemas geométricos. En la última decada, esta disciplina ha atraído un enorme interés. Pero ha sido en los últimos a~nos cuando se ha incrementado el interés en una estructura geométrica, concretamente los diagramas de Voronoi. No solo por sus características y propiedades matemáticas, sino también por aparecer ampliamente relacionados con fenómenos y procesos físicos que se dan en la naturale...

  17. Clinical Trials

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    Full Text Available ... part. Randomization Most clinical trials that have comparison groups use randomization. This involves assigning patients to different comparison groups by chance, rather than choice. This ...

  18. Clinical review

    DEFF Research Database (Denmark)

    Groth, Kristian; Skakkebæk, Anne; Høst, Christian

    2013-01-01

    Recently, new clinically important information regarding Klinefelter syndrome (KS) has been published. We review aspects of epidemiology, endocrinology, metabolism, body composition, and neuropsychology with reference to recent genetic discoveries.......Recently, new clinically important information regarding Klinefelter syndrome (KS) has been published. We review aspects of epidemiology, endocrinology, metabolism, body composition, and neuropsychology with reference to recent genetic discoveries....

  19. Clinical Trials

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    Full Text Available ... the clinical trial you take part in, the information gathered can help others and add to scientific knowledge. People who take part in clinical trials are vital to the process of improving medical care. Many people volunteer because ...

  20. Clinical Trials

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    Full Text Available ... from other clinical trials show what doesn't work or may cause harm. For example, the NHLBI Women's Health Initiative ... safe a treatment is or how well it works. Children (aged 18 and younger) get ... legal consent for their child to take part in a clinical trial. When ...

  1. Clinical Trials

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    Full Text Available ... to Expect During a clinical trial, doctors, nurses, social workers, and other health care providers might be part of your treatment ... clinical trials are vital to the process of improving medical care. Many people ... participants, it may not work for you. A new treatment may have side ...

  2. Clinical Trials

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    Full Text Available ... Expect During a clinical trial, doctors, nurses, social workers, and other health care providers might be part of your treatment ... phase II clinical trials. The risk of side effects might be even greater for ... treatments. Health insurance and health care providers don't always ...

  3. Clinical Trials

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    Full Text Available ... a Clinical Trial If you're interested in learning more about, or taking part in, clinical trials, talk with your doctor. He or she may know about studies going on in your area. You can visit the following website to learn more about ...

  4. Clinical Trials

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    Full Text Available ... more screening tests to see which test produces the best results. Some companies and groups sponsor clinical trials that test the ... and Drug Administration (FDA) oversees these clinical trials. The NIH may partner with these companies or groups to help sponsor some trials. All ...

  5. Clinical Trials

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    Full Text Available ... products, such as medicines, and how well they work. The U.S. Food and Drug Administration (FDA) oversees these clinical trials. ... cancer also increased. As a result, the U.S. Food and Drug Administration now recommends never using HT ... Clinical Trials Work If you take ...

  6. Clinical Trials

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    Full Text Available ... Wide Range of Audiences The Children and Clinical Studies Program has been successfully developed and evaluated to fill an important gap in information and education for parents, clinicians, researchers, children, and the general public. What to Expect During a clinical trial, doctors, ...

  7. Clinical Studies

    DEFF Research Database (Denmark)

    Pallesen, Ulla

    universities and practicing dentists restore millions of teeth throughout the World with composite resin materials. Do we know enough about the clinical performance of these restorations over time? Numerous in vitro studies are being published on resin materials and adhesion, some of them attempting to imitate...... in vivo conditions. But real life is different and in vitro studies cannot include all variables. Only clinical studies can provide valid information on the clinical performance of restorations over time. What do we know about longevity of posterior resin restorations? What are the reasons for replacement...... and results from own up to 30-year prospective clinical university studies and practice based studies from Public Dental Health Service on the clinical performance of posterior composite resin restorations....

  8. Clinical Research

    DEFF Research Database (Denmark)

    Christensen, Irene

    2016-01-01

    This paper is about the logic of problem solving and the production of scientific knowledge through the utilisation of clinical research perspective. Ramp-up effectiveness, productivity, efficiency and organizational excellence are topics that continue to engage research and will continue doing so...... for years to come. This paper seeks to provide insights into ramp-up management studies through providing an agenda for conducting collaborative clinical research and extend this area by proposing how clinical research could be designed and executed in the Ramp- up management setting....

  9. Clinical Trials

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    Full Text Available ... strict scientific standards. These standards protect patients and help produce reliable study results. Clinical trials are one ... are important because they advance medical knowledge and help improve patient care. Sponsorship and Funding The National ...

  10. Clinical Trials

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    Full Text Available ... groups, companies, and organizations also sponsor clinical trials. Examples include Government Agencies, such as the U.S. Departments ... sponsor trials that test principles or strategies. For example, one NHLBI study explored whether the benefits of ...

  11. Clinical Trials

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    Full Text Available ... patients to find out whether a new approach causes any harm. In later phases of clinical trials, ... device improves patient outcomes; offers no benefit; or causes unexpected harm All of these results are important ...

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    Full Text Available ... Departments of Defense and Veterans Affairs; private companies; universities; and nonprofit organizations. NIH Institutes and Centers (including ... our campus or trials NIH has sponsored at universities, medical centers, and hospitals. ClinicalTrials.gov View a ...

  13. Clinical Trials

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    Full Text Available ... and compare new treatments with other available treatments. Steps To Avoid Bias The researchers doing clinical trials take steps to avoid bias. "Bias" means that human choices ...

  14. Clinical Trials

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    Full Text Available ... gathered can help others and add to scientific knowledge. People who take part in clinical trials are vital to the process of improving medical care. Many people volunteer because they want to help others. ...

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    Full Text Available ... materials, and offer advice on research-related issues. Data Safety Monitoring Board Every National Institutes of Health ( ... III clinical trial is required to have a Data and Safety Monitoring Board (DSMB). This board consists ...

  16. Clinical Trials

    Science.gov (United States)

    ... of Personal Stories Peers Celebrating Art Peers Celebrating Music Be Vocal Support Locator DBSA In-Person Support ... by participating in a clinical trial is to science first and to the patient second. More About ...

  17. Clinical Trials

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    Full Text Available ... to Expect During a clinical trial, doctors, nurses, social workers, and other health care providers might be ... the new approach. You also will have the support of a team of health care providers, who ...

  18. Clinical Trials

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    Full Text Available ... final stages of a long and careful research process. The process often begins in a laboratory (lab), where scientists ... part in clinical trials are vital to the process of improving medical care. Many people volunteer because ...

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    Full Text Available ... as gene therapy) or vulnerable patients (such as children). A DSMB's role is to review data from a clinical trial for safety problems or differences in results among different groups. The DSMB also reviews research results ...

  20. Clinical Trials

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    Full Text Available ... identified earlier than they would be in general medical practice. This is because late-phase trials have large ... supporting clinical trials that have not only shaped medical practice around the world, but have improved the health ...

  1. Clinical Trials

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    Full Text Available ... medical centers and doctors' offices around the country. Benefits and Risks Possible Benefits Taking part in a clinical trial can have many benefits. For example, you may gain access to new ...

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    Full Text Available ... or treatment is having harmful effects. Food and Drug Administration In the United States, the Food and Drug Administration (FDA) provides oversight for clinical trials that ...

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    Full Text Available ... Usually, a computer program makes the group assignments. Masking The term "masking" refers to not telling the clinical trial participants which treatment they're getting. Masking, or "blinding," helps avoid bias. For this reason, ...

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    Full Text Available ... organizations also sponsor clinical trials. Examples include Government Agencies, such as the U.S. Departments of Defense and ... how you feel. Some people will need to travel or stay in hospitals to take part in ...

  5. Clinical Trials

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    Full Text Available ... clinical trials are required to have an IRB. Office for Human Research Protections The U.S. Department of Health and Human Services’ (HHS’) Office for Human Research Protections (OHRP) oversees all research ...

  6. Clinical Trials

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    Full Text Available ... clinical trial. IRB members are doctors, statisticians, and community members. The IRB's purpose is to ensure that ... lung, and blood disorders. By engaging the research community and a broad group of stakeholders and advisory ...

  7. Clinical Trials

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    Full Text Available ... successfully developed and evaluated to fill an important gap in information and education for parents, clinicians, researchers, ... gathered can help others and add to scientific knowledge. People who take part in clinical trials are ...

  8. Clinical proteomics

    DEFF Research Database (Denmark)

    Albrethsen, Jakob; Frederiksen, Hanne; Johannsen, Trine Holm

    2018-01-01

    Clinical proteomics aims to deliver cost-effective multiplexing of potentially hundreds of diagnostic proteins, including distinct protein isoforms. The analytical strategy known as targeted proteomics is particularly promising because it is compatible with robust mass spectrometry (MS)-platforms...... standards and calibrants. The present challenge is to examine if targeted proteomics of IGF-I can truly measure up to the routine performance that must be expected from a clinical testing platform.......Clinical proteomics aims to deliver cost-effective multiplexing of potentially hundreds of diagnostic proteins, including distinct protein isoforms. The analytical strategy known as targeted proteomics is particularly promising because it is compatible with robust mass spectrometry (MS......)-platforms already implemented in many clinical laboratories for routine quantitation of small molecules (i.e. uHPLC coupled to triple-quadrupole MS). Progress in targeted proteomics of circulating insulin-like growth factor 1 (IGF-I) have provided valuable insights about tryptic peptides, transitions, internal...

  9. Clinical Trials

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    Full Text Available ... you agree to take part in the trial. Talk with your doctor about specific trials you're ... part in a clinical trial is your decision. Talk with your doctor about all of your treatment ...

  10. Clinical Trials

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    Full Text Available ... studies. View funding information for clinical trials optimization . Building 31 31 Center Drive Bethesda, MD 20892 Learn ... and Usage No FEAR Act Grants and Funding Building 31 31 Center Drive Bethesda, MD 20892 Learn ...

  11. Clinical Trials

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    Full Text Available Skip to main content U.S. Department of Health & Human Services Health Topics Health Topics A-Z Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders and ...

  12. Clinical Trials

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    Full Text Available ... the past, clinical trial participants often were White men. Researchers assumed that trial results were valid for ... different ethnic groups sometimes respond differently than White men to the same medical approach. As a result, ...

  13. Clinical Trials

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    Full Text Available ... results. Clinical trials are one of the final stages of a long and careful research process. The ... a patient's age and gender, the type and stage of disease, and whether the patient has had ...

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    Full Text Available ... Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders and Blood ... of estrogen and progestin, the risk of breast cancer also increased. As a result, the U.S. Food ...

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    Full Text Available ... issues arise. Participation and Eligibility Each clinical trial defines who is eligible to take part in the ... the strategy or treatment is having harmful effects. Food and Drug Administration In the United States, the ...

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    Full Text Available Skip to main content U.S. Department of Health & Human Services Health Topics Health Topics A-Z Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders ...

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    Full Text Available ... A-Z Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders ... to fill an important gap in information and education for parents, clinicians, researchers, children, and the general ...

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    Full Text Available ... clinical care of children, more studies are needed focusing on children's health with the goal to develop ... study? How might this trial affect my daily life? Will I have to be in the hospital? ...

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    Full Text Available ... work best for certain illnesses or groups of people. Clinical trials produce the best data available for ... or animals doesn't always work well in people. Thus, research in humans is needed. For safety ...

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    Full Text Available ... sponsor clinical trials. Examples include Government Agencies, such as the U.S. Departments of Defense and Veterans Affairs; ... age and frequency for doing screening tests, such as mammography; and compare two or more screening tests ...

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    Full Text Available ... or strategies work best for certain illnesses or groups of people. Some clinical trials show a positive result. For example, the National Heart, Lung, and Blood Institute (NHLBI) sponsored a trial of two different ...

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    Full Text Available ... harm. In later phases of clinical trials, researchers learn more about the new approach's risks and benefits. ... explore whether surgery or other medical treatments produce better results for certain illnesses or groups of people; ...

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    Full Text Available ... any clinical trial before you agree to take part in the trial. Talk with your doctor about specific trials you're interested in. For a list of questions to ask your doctor and the ...

  4. Clinical Trials

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    Full Text Available ... offer a variety of funding mechanisms tailored to planning and conducting clinical trials at all phases, including ... Center for Health Information Email Alerts Jobs and Careers Site Index About NHLBI National Institute of Health ...

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    Full Text Available ... patients. Usually, a computer program makes the group assignments. Masking The term "masking" refers to not telling ... questions to ask your doctor and the research staff, go to "How Do Clinical Trials Protect Participants?" ...

  6. Clinical Trials

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    Full Text Available ... healthy people to test new approaches to prevention, diagnosis, or screening. In the past, clinical trial participants ... DSMBs for large trials comparing alternative strategies for diagnosis or treatment. In addition, the NIH requires DSMBs ...

  7. Clinical Trials

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    Full Text Available ... study explored whether the benefits of lowering high blood pressure in the elderly outweighed the risks. Other examples of clinical trials that test principles or strategies include studies that explore whether ...

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    Full Text Available ... treatment is having harmful effects. Food and Drug Administration In the United States, the Food and Drug Administration (FDA) provides oversight for clinical trials that are ...

  9. Clinical Trials

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    Full Text Available ... well they work. The U.S. Food and Drug Administration (FDA) oversees these clinical trials. The NIH may partner with these companies or groups to help sponsor some trials. All ...

  10. Clinical Trials

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    Full Text Available ... trials produce the best data available for health care decisionmaking. The purpose of clinical trials is research, ... they advance medical knowledge and help improve patient care. Sponsorship and Funding The National Heart, Lung, and ...

  11. Clinical Trials

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    Full Text Available ... questions to ask your doctor and the research staff, go to "How Do Clinical Trials Protect Participants?" ... in Bethesda, Maryland. The physicians, nurses, scientists and staff of the NHLBI encourage you to explore NIH ...

  12. Clinical Trials

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    Full Text Available ... Science Science Home Blood Disorders and Blood Safety Sleep Science and Sleep Disorders Lung Diseases Heart and Vascular Diseases Precision ... women and that are ethnically diverse. Children also need clinical trials that focus on them, as medical ...

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    Full Text Available ... and evaluated to fill an important gap in information and education for parents, clinicians, researchers, children, and the general public. What to Expect During a clinical trial, ...

  14. Clinical Trials

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    Full Text Available ... and useful results, which in turn will improve public health. We offer a variety of funding mechanisms tailored to planning and conducting clinical ... Privacy Policy Freedom of Information Act (FOIA) Accessibility ...

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    Full Text Available ... small groups of people for safety and side effects. Phase II clinical trials look at how well ... confirm how well treatments work, further examine side effects, and compare new treatments with other available treatments. ...

  16. Clinical Trials

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    Full Text Available ... and devices specific to children. Resources for a Wide Range of Audiences The Children and Clinical Studies ... have not only shaped medical practice around the world, but have improved the health of millions of ...

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    Full Text Available ... the strategy or treatment is having harmful effects. Food and Drug Administration In the United States, the Food and Drug Administration (FDA) provides oversight for clinical ...

  18. Clinical Trials

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    Full Text Available ... Events About NHLBI About NHLBI Home Mission and Strategic Vision Leadership Scientific Divisions Operations and Administration Advisory ... offer a variety of funding mechanisms tailored to planning and conducting clinical trials at all phases, including ...

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    Full Text Available ... NHLBI About NHLBI Home Mission and Strategic Vision Leadership Scientific Divisions Operations and Administration Advisory Committees Budget ... always, parents must give legal consent for their child to take part in a clinical trial. When ...

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    Full Text Available ... and organizations also sponsor clinical trials. Examples include Government Agencies, such as the U.S. Departments of Defense and Veterans Affairs; private companies; universities; and nonprofit organizations. NIH Institutes and ...

  1. Clinical Trials

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    Full Text Available ... records can quickly show this information if safety issues arise. Participation and Eligibility Each clinical trial defines ... and materials, and offer advice on research-related issues. Data Safety Monitoring Board Every National Institutes of ...

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    Full Text Available ... women and that are ethnically diverse. Children also need clinical trials that focus on them, as medical ... often differ for children. For example, children may need lower doses of certain medicines or smaller medical ...

  3. Clinical Trials

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    Full Text Available ... care providers might be part of your treatment team. They will monitor your health closely. You may ... taking part in a clinical trial. Your treatment team also may ask you to do other tasks. ...

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    Full Text Available ... including the NHLBI) usually sponsor trials that test principles or strategies. For example, one NHLBI study explored ... risks. Other examples of clinical trials that test principles or strategies include studies that explore whether surgery ...

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    Full Text Available ... harmful effects. Food and Drug Administration In the United States, the Food and Drug Administration (FDA) provides oversight ... of research studies at the NIH Clinical Center, America's research hospital, located on the NIH campus in ...

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    Full Text Available ... new treatments in small groups of people for safety and side effects. Phase II clinical trials look at how well treatments work and further review these treatments for safety. Phase ...

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    Full Text Available ... Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders and Blood ... these results are important because they advance medical knowledge and help improve patient care. Sponsorship and Funding ...

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    Full Text Available ... and organizations also sponsor clinical trials. Examples include Government Agencies, such as the U.S. Departments of Defense ... FOIA) Accessibility Copyright and Usage No FEAR Act Grants and Funding Building 31 31 Center Drive Bethesda, ...

  9. Clinical Trials

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    Full Text Available ... as the U.S. Departments of Defense and Veterans Affairs; private companies; universities; and nonprofit organizations. NIH Institutes ... for parents, clinicians, researchers, children, and the general public. What to Expect During a clinical trial, doctors, ...

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    Full Text Available ... combination of estrogen and progestin, the risk of breast cancer also increased. As a result, the U.S. Food ... to test new approaches to prevention, diagnosis, or screening. In the past, clinical trial participants often were ...

  11. Clinical Trials

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    Full Text Available ... from other clinical trials show what doesn't work or may cause harm. For example, the NHLBI Women's Health Initiative tested whether hormone therapy (HT) reduced the risk of heart disease in postmenopausal women. ( ...

  12. Clinical Trials

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    Full Text Available ... always, parents must give legal consent for their child to take part in a clinical trial. When ... minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older ...

  13. Clinical epidemiology.

    Science.gov (United States)

    Martin, S W; Bonnett, B

    1987-06-01

    Rational clinical practice requires deductive particularization of diagnostic findings, prognoses, and therapeutic responses from groups of animals (herds) to the individual animal (herd) under consideration This process utilizes concepts, skills, and methods of epidemiology, as they relate to the study of the distribution and determinants of health and disease in populations, and casts them in a clinical perspective.We briefly outline diagnostic strategies and introduce a measure of agreement, called kappa, between clinical diagnoses. This statistic is useful not only as a measure of diagnostic accuracy, but also as a means of quantifying and understanding disagreement between diagnosticians. It is disconcerting to many, clinicians included, that given a general deficit of data on sensitivity and specificity, the level of agreement between many clinical diagnoses is only moderate at best with kappa values of 0.3 to 0.6.Sensitivity, specificity, pretest odds, and posttest probability of disease are defined and related to the interpretation of clinical findings and ancillary diagnostic test results. An understanding of these features and how they relate to ruling-in or ruling-out a diagnosis, or minimizzing diagnostic errors will greatly enhance the diagnostic accuracy of the practitioner, and reduce the frequency of clinical disagreement. The approach of running multiple tests on every patient is not only wasteful and expensive, it is unlikely to improve the ability of the clinician to establish the correct diagnosis.We conclude with a discussion of how to decide on the best therapy, a discussion which centers on, and outlines the key features of, the well designed clinical trial. Like a diagnosis, the results from a clinical trial may not always be definitive, nonetheless it is the best available method of gleaning information about treatment efficacy.

  14. Clinical dosimetry

    International Nuclear Information System (INIS)

    Rassow, J.

    1973-01-01

    The main point of this paper on clinical dosimetry which is to be understood here as application of physical dosimetry on accelerators in medical practice, is based on dosimetric methodics. Following an explanation of the dose parameters and description of the dose distribution important for clinical practice as well as geometric irradiation parameters, the significance of a series of physical parameters such as accelerator energy, surface energy of average stopping power etc. is dealt with in detail. Following a section on field homogenization with bremsstrahlung and electron radiation, details on dosimetry in clinical practice are given. Finally, a few problems of dosemeter or monitor calibration on accelerators are described. The explanations are supplemented by a series of diagrams and tables. (ORU/LH) [de

  15. Modelos de ajuste e métodos para a determinação da curva de retenção de água de um Latossolo-vermelho-amarelo Adjustment models and methods for determining the soil water retention curve of a red-yellow Latosol

    Directory of Open Access Journals (Sweden)

    Wanderley Andrade Costa

    2008-04-01

    Full Text Available A caracterização da capacidade de retenção de água de um solo é fundamental para a descrição do fluxo de água através dele e para o adequado manejo da irrigação. São apresentadas comparações entre curvas de retenção de água do solo: ajustadas pelos modelos propostos por van Genuchten e por Hutson & Cass; obtidas pelo método do WP4 usando processo de umedecimento e de secagem; obtidas pelo método da centrífuga utilizando amostras deformadas e indeformadas; e obtidas pelo WP4 e centrífuga, usando um processo de secagem e amostra deformada. Amostras deformadas e indeformadas foram coletadas com trados específicos em um Latossolo Vermelho-Amarelo (LVA, textura argilosa. Foram determinadas as propriedades hídricas do solo necessárias à elaboração das curvas de retenção de água obtidas por análise de regressão. O modelo de van Genuchten possibilitou o melhor ajuste nas diversas situações estudadas. Considerando o processo de secagem, o teor de água útil obtido superou em 13 % o resultado do processo de umedecimento e evidenciou reduzido efeito de histerese. A amostra deformada apresentou-se com um teor de água útil superior 61,7 % ao valor obtido para a amostra indeformada. Entre os métodos estudados, verificou-se que aquele que usa o WP4 subestimou os dados obtidos pela centrífuga. Verificou-se que há diferenças entre amostra deformada e indeformada e os métodos utilizados na obtenção da curva de retenção.The characterization of the soil water retention capacity is fundamental for an adequate irrigation management and water flow description. We present comparisons of soil water retention curves adjusted in distinct ways: by the models proposed by van Genuchten and by Hutson & Cass; by the WP4 method in a wetting and drying process; by the centrifuge method using disturbed as well as undisturbed soil samples; and by the WP4 and centrifuge using a drying process and disturbed soil samples. Disturbed and

  16. Clinical Trials

    Medline Plus

    Full Text Available ... seems promising, the next step may involve animal testing. This shows how the approach affects a living body and whether it's harmful. However, an approach that works well in the lab or animals doesn't always work well in people. Thus, research in humans is needed. For safety purposes, clinical ...

  17. Clinical Trials

    Medline Plus

    Full Text Available ... an important gap in information and education for parents, clinicians, researchers, children, and the general public. What to Expect During a clinical trial, doctors, nurses, social workers, and other health care providers might be part of your treatment team. ...

  18. Clinical Trials

    Medline Plus

    Full Text Available Skip to main content U.S. Department of Health & Human Services Health Topics Health Topics A-Z Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders and Blood Safety Sleep ...

  19. Clinical Trials

    Medline Plus

    Full Text Available ... treatments produce better results for certain illnesses or groups of people; look at the best age and frequency for doing screening tests, such as mammography; and compare two or more screening tests to see which test ... Some companies and groups sponsor clinical trials that test the safety of ...

  20. clinical: dementia

    African Journals Online (AJOL)

    have impairment on multiple cognitive domains, including attention, concentration, memory, executive function, motor functioning and speed of information processing, and sensory perceptual/motor skills deficits. The milder forms of HAND are easily missed. Diagnosis can be made on clinical grounds in the most severe ...

  1. Clinical Trials

    Medline Plus

    Full Text Available ... trial found that one of the combinations worked much better than the other for moderate persistent asthma. The results provided important treatment information for doctors and patients. The results from other clinical trials show what doesn't work or may cause harm. For example, the NHLBI ...

  2. Clinical Trials

    Medline Plus

    Full Text Available ... patient has had certain treatments or has other health problems. Eligibility criteria ensure that new approaches are tested ... public. What to Expect During a clinical trial, doctors, nurses, social workers, and other health care providers might be part of your treatment ...

  3. Clinical Trials

    Medline Plus

    Full Text Available ... other expenses (for example, travel and child care)? Who will be in charge of my care? What will happen after the trial? Taking part in a clinical trial is your decision. Talk with your doctor about all of your treatment ...

  4. Clinical Trials

    Medline Plus

    Full Text Available ... This shows how the approach affects a living body and whether it's harmful. However, an approach that works well in the lab or animals doesn't always work well in people. Thus, research in humans is needed. For safety purposes, clinical trials start ...

  5. Clinical Trials

    Medline Plus

    Full Text Available ... the final stages of a long and careful research process. The process often begins in a laboratory (lab), where scientists first develop and test new ideas. If an approach seems ... Thus, research in humans is needed. For safety purposes, clinical ...

  6. Clinical Trials

    Medline Plus

    Full Text Available ... to main content U.S. Department of Health & Human Services Health Topics Health Topics A-Z Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders and Blood Safety Sleep Science and ...

  7. Clinical Trials

    Medline Plus

    Full Text Available ... protect patients and help produce reliable study results. Clinical trials are one of the final stages of a long and careful research process. The process often begins in a laboratory (lab), where scientists first develop and test new ...

  8. Clinical Trials

    Medline Plus

    Full Text Available ... benefits of lowering high blood pressure in the elderly outweighed the risks. Other examples of clinical trials ... child to enroll. Also, children aged 7 and older often must agree (assent) to take part ... about how you feel. Some people will need to travel or stay in hospitals ...

  9. Clinical Trials

    Medline Plus

    Full Text Available ... safe a treatment is or how well it works. Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial. When ...

  10. Clinical Trials

    Medline Plus

    Full Text Available ... As a result, the U.S. Food and Drug Administration now recommends never using HT to prevent heart disease. When HT is used for menopausal symptoms, it should be taken only at the smallest dose and for the shortest time possible. Clinical trials, like the two described above, ...

  11. Clinical cases

    International Nuclear Information System (INIS)

    Servente, L.

    2012-01-01

    This presentation is about clinical cases and the contribution of the PET - CT Fag application in the diagnosis and treatment of different types of cancer. The cases presented were: neck diseases, epidermoid carcinoma, liver damage and metastasize, lymphoma, thrombosis, colonic cancer and lung disease

  12. Clinical Trials

    Medline Plus

    Full Text Available ... approach that works well in the lab or animals doesn't always work well in people. Thus, research in humans is needed. For safety purposes, clinical trials start with small groups of patients to find out whether a ...

  13. Clinical biochemistry

    Science.gov (United States)

    Alexander, W. C.; Leach, C. S.; Fischer, C. L.

    1975-01-01

    The objectives of the biochemical studies conducted for the Apollo program were (1) to provide routine laboratory data for assessment of preflight crew physical status and for postflight comparisons; (2) to detect clinical or pathological abnormalities which might have required remedial action preflight; (3) to discover as early as possible any infectious disease process during the postflight quarantine periods following certain missions; and (4) to obtain fundamental medical knowledge relative to man's adjustment to and return from the space flight environment. The accumulated data presented suggest that these requirements were met by the program described. All changes ascribed to the space flight environment were subtle, whereas clinically significant changes were consistent with infrequent illnesses unrelated to the space flight exposure.

  14. Clinical Investigations

    Science.gov (United States)

    1977-09-30

    conducted at WBAV’S is categorized as t basic experimental medicine or trials and testing of clinical medicine pro- cedures using the indigenous population...Unit No. 77/20 (FY77, 0) An Analysis of Ameloblastic Fibro-odontoma ....................... 27 Department of Medicine Nork Unit No, 69/338 (FY69, T...Unit No. 71/38 (FY71, T) Injected Marihuana : Effects of Cannabinol ....................... 71 Department of Pediatrics Wfork Unit No. 74/23 (FY74, T

  15. Clinical arthrography

    International Nuclear Information System (INIS)

    Arndt, R.; Horns, J.W.; Gold, R.H.; Blaschke, D.D.

    1985-01-01

    This book deals with the method and interpretation of arthrography of the shoulder, knee, ankle, elbow, hip, wrist, and metacarpophalangeal, interphalangeal, and temporomandibular joints. The emphasis is on orthopaedic disorders, usually of traumatic origin, which is in keeping with the application of arthrography in clinical practice. Other conditions, such as inflammatory and degenerative diseases, congenital disorders and, in the case of the hip, arthrography of reconstructive joint surgery, are included. Each chapter is devoted to one joint and provides a comprehensive discussion on the method of arthrography, including single and double contrast techniques where applicable, normal radiographic anatomy, and finally, the interpretation of the normal and the abnormal arthrogram

  16. Can casemix-systems be applied in Danish primary care?

    DEFF Research Database (Denmark)

    Halling, Anders; Kristensen, Troels

    -sectional study uses individual data on gender, age and diagnoses for the year 2013 from the Danish General Practice Database (DAMD) to make ACG groupings of a sample of 700,443 citizens of Zealand in Denmark. The Johns Hopkins Adjusted Clinical Groups ACG software, Version 10 December 2011 was applied to make...... that the corresponding ACG / RUB-grouping provide useful estimates of morbidity burden (casemix) and related resource need. Before a casemix system is implemented in Denmark, however, further research should be undertaken of the applicability of the DAMD data and the corresponding ACG groupings....

  17. Portrait de la compression et de l'expansion de la morbidité au Canada : évolution de l'espérance de vie et de l'espérance de vie ajustée en fonction de la santé, 1994-2010

    Directory of Open Access Journals (Sweden)

    Colin Steensma

    2017-01-01

    Full Text Available Introduction : Notre étude visait à examiner s'il y a eu une expansion ou une compression de la morbidité au Canada, à l'échelle tant nationale que provinciale, en suivant l'évolution de l'espérance de vie (EV et de l'espérance de vie ajustée en fonction de la santé (EVAS entre 1994 et 2010. Une « compression », qui correspond à une diminution de la proportion de la vie marquée par des problèmes de santé, survient lorsque l'EVAS augmente plus rapidement que l'EV. Inversement, une « expansion », qui désigne une augmentation de la proportion de la vie marquée par des problèmes de santé, survient lorsque l'EVAS est stable ou augmente plus lentement que l'EV. Méthodologie : Nous avons estimé l'EV à l'aide des données de Statistique Canada sur la mortalité et sur la population. Nous avons utilisé les données sur la qualité de vie liée à la santé (c.-à-d. morbidité de l'Enquête nationale sur la santé de la population (1994-1999 et de l'Enquête sur la santé dans les collectivités canadiennes (2000-2010 pour calculer l'EVAS. Nous avons établi des tables de mortalité abrégées pour sept intervalles de temps correspondant aux cycles d'enquête disponibles durant la période de 1994 à 2010, ainsi que pour les deux sexes et les dix provinces canadiennes. Les tendances nationales et provinciales ont été examinées à la naissance, à 20 ans et à 65 ans. Résultats : Dans l'ensemble, nous avons constaté une hausse annuelle moyenne statistiquement significative de l'EVAS chez les deux sexes aux trois âges évalués, sauf chez les nouveau-nés de sexe féminin. L'EVAS à la naissance a augmenté en moyenne par année, entre 1994 et 2010, de 0,2 % (p = 0,08 chez les sujets de sexe féminin et de 0,3% (p < 0,001 chez ceux de sexe masculin. À l'échelle nationale, les trois groupes d'âge ont présenté une augmentation annuelle moyenne non statistiquement significative de la proportion de la vie marquée par des

  18. Clinical trial methodology

    National Research Council Canada - National Science Library

    Peace, Karl E; Chen, Ding-Geng

    2011-01-01

    ... in the pharmaceutical industry, Clinical trial methodology emphasizes the importance of statistical thinking in clinical research and presents the methodology as a key component of clinical research...

  19. Textbook of clinical trials

    National Research Council Canada - National Science Library

    Day, Simon; Machin, David; Green, Sylvan B

    2006-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 The Development of Clinical Trials Simon...

  20. Hypothyroidism in clinical practice

    Directory of Open Access Journals (Sweden)

    Faiza Qari

    2014-01-01

    Full Text Available Background: Hypothyroidism is the most common endocrine disease that was seen in the clinical practice especially for family physicians. Methods: This review article covered the important practical clinical issues for managing overt hypothyroidism, subclinical hypothyroidism and hypothyroidism during pregnancy. Conclusions: The clinical issues were addressed by clinical scenario followed by questions and stressed on the important clinical points.

  1. Clinical professional governance for detailed clinical models.

    Science.gov (United States)

    Goossen, William; Goossen-Baremans, Anneke

    2013-01-01

    This chapter describes the need for Detailed Clinical Models for contemporary Electronic Health Systems, data exchange and data reuse. It starts with an explanation of the components related to Detailed Clinical Models with a brief summary of knowledge representation, including terminologies representing clinic relevant "things" in the real world, and information models that abstract these in order to let computers process data about these things. Next, Detailed Clinical Models are defined and their purpose is described. It builds on existing developments around the world and accumulates in current work to create a technical specification at the level of the International Standards Organization. The core components of properly expressed Detailed Clinical Models are illustrated, including clinical knowledge and context, data element specification, code bindings to terminologies and meta-information about authors, versioning among others. Detailed Clinical Models to date are heavily based on user requirements and specify the conceptual and logical levels of modelling. It is not precise enough for specific implementations, which requires an additional step. However, this allows Detailed Clinical Models to serve as specifications for many different kinds of implementations. Examples of Detailed Clinical Models are presented both in text and in Unified Modelling Language. Detailed Clinical Models can be positioned in health information architectures, where they serve at the most detailed granular level. The chapter ends with examples of projects that create and deploy Detailed Clinical Models. All have in common that they can often reuse materials from earlier projects, and that strict governance of these models is essential to use them safely in health care information and communication technology. Clinical validation is one point of such governance, and model testing another. The Plan Do Check Act cycle can be applied for governance of Detailed Clinical Models

  2. Understanding Clinical Trials

    Science.gov (United States)

    Watch these videos to learn about some basic aspects of cancer clinical trials such as the different phases of clinical trials, methods used to protect patient safety, and how the costs of clinical trials are covered.

  3. Fertility Clinic Success Rates

    Science.gov (United States)

    ... Defects ART and Autism 2013 Assisted Reproductive Technology Fertility Clinic Success Rates Report Recommend on Facebook Tweet ... Additional Information About ART in the United States. Fertility Clinic Tables Introduction to Fertility Clinic Tables [PDF - ...

  4. Future requirements. Clinical investigations

    DEFF Research Database (Denmark)

    Qvist, V.

    2002-01-01

    Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics......Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics...

  5. Treatment of clinical mastitis.

    Science.gov (United States)

    Roberson, Jerry R

    2012-07-01

    In summary, culture-based therapy and severity levels are key to management of clinical mastitis. Antibiotic therapy should be strongly considered for gram-positive clinical mastitis. Antibiotic therapy is not necessary for mild-to-moderate gram-negative clinical mastitis. Antibiotic therapy is warranted for practically all severe clinical mastitis as well as fluids and anti-inflammatory drugs. Clinical mastitis cases due to yeast and fungal pathogens or no growth isolates do not warrant antibiotic therapy.

  6. Implementing a clinical pharmacy service in hematology.

    Science.gov (United States)

    Farias, Tatiane Fernandes; Aguiar, Karina da Silva; Rotta, Inajara; Belletti, Klezia Morais da Silva; Carlotto, Juliane

    2016-01-01

    To implement a clinical pharmacy service focused on the comprehensive review of antineoplastic drugs used in therapy of hematological diseases. An interventional study was conducted in a Brazilian tertiary teaching hospital in two different periods, with and without a clinical pharmacy service, respectively. This service consisted of an antineoplastic prescription validation (analysis of patients' characteristics, laboratory tests, compliance with the therapeutic protocol and with pharmacotechnical parameters). When problems were detected, the pharmacist intervened with the physician or another health professional responsible for the patient. Inpatients and outpatients with hematological diseases were included. We found an increased detection of drug-related problem by 106.5% after implementing the service. Comparing the two periods, an increase in patients' age (26.7 years versus 17.6 years), a predominance of outpatients (54% versus 38%), and an increase in multiple myeloma (13% versus 4%) and non-Hodgkin lymphoma (16% versus 3%) was noted. The most commonly found problems were related to dose (33% versus 25%) and cycle day (14% versus 30%). With regard to clinical impact, the majority had a significant impact (71% versus 58%), and in one patient from the second period could have been fatal. The main pharmaceutical interventions were dose adjustment (35% versus 25%) and drug withdrawal (33% versus 40%). The pharmacy service contributed to increase the detection and resolution of drug-related problems, and it was an effective method to promote the safe and rational use of antineoplastic drugs. Implementar um serviço farmacêutico clínico centrado na revisão completa dos antineoplásicos utilizados no tratamento de doenças hematológicas. Estudo intervencional conduzido em um hospital universitário terciário brasileiro em dois períodos distintos, com base na ausência e na presença do serviço farmacêutico clínico, respectivamente. O referido servi

  7. Clinical Laboratory Fee Schedule

    Data.gov (United States)

    U.S. Department of Health & Human Services — Outpatient clinical laboratory services are paid based on a fee schedule in accordance with Section 1833(h) of the Social Security Act. The clinical laboratory fee...

  8. Research Areas - Clinical Trials

    Science.gov (United States)

    Information about NCI programs and initiatives that sponsor, conduct, develop, or support clinical trials, including NCI’s Clinical Trial Network (NCTN) and NCI Community Oncology Research Program (NCORP) initiatives.

  9. Radioimmunoassay in clinical practice

    Energy Technology Data Exchange (ETDEWEB)

    Ametov, A S

    1982-01-01

    A wide application of radioimmunoassay in clinical practice is shown. The main theoretical aspects of radioimmunoassay and the fields of application in clinical practice - endocrinology, oncology, allergology, cardiology, pharmacology, pediatrics, hematology, obstetrics and gynecology, are presented.

  10. Clinical trial methodology

    National Research Council Canada - National Science Library

    Peace, Karl E; Chen, Ding-Geng

    2011-01-01

    "Now viewed as its own scientific discipline, clinical trial methodology encompasses the methods required for the protection of participants in a clinical trial and the methods necessary to provide...

  11. NIH Clinical Centers

    Data.gov (United States)

    Federal Laboratory Consortium — The NIH Clinical Center consists of two main facilities: The Mark O. Hatfield Clinical Research Center, which opened in 2005, houses inpatient units, day hospitals,...

  12. HISTIOCYTOSIS X: CLINICAL OBSERVATIONS

    Directory of Open Access Journals (Sweden)

    E. Y. Ponomareva

    2012-01-01

    Full Text Available Two clinical cases of pulmonary Langerhans cell histiocytosis X have been analyzed demonstrating lung and other inner organ pathology, common clinical and X-ray features but different life prognosis.

  13. Learning clinical reasoning.

    Science.gov (United States)

    Pinnock, Ralph; Welch, Paul

    2014-04-01

    Errors in clinical reasoning continue to account for significant morbidity and mortality, despite evidence-based guidelines and improved technology. Experts in clinical reasoning often use unconscious cognitive processes that they are not aware of unless they explain how they are thinking. Understanding the intuitive and analytical thinking processes provides a guide for instruction. How knowledge is stored is critical to expertise in clinical reasoning. Curricula should be designed so that trainees store knowledge in a way that is clinically relevant. Competence in clinical reasoning is acquired by supervised practice with effective feedback. Clinicians must recognise the common errors in clinical reasoning and how to avoid them. Trainees can learn clinical reasoning effectively in everyday practice if teachers provide guidance on the cognitive processes involved in making diagnostic decisions. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  14. Decision analysis. Clinical art or Clinical Science

    Science.gov (United States)

    1977-05-01

    having helped some clients. Over the past half century, psychotherapy has faced a series of crises concerned with its transformation from an art to a...clinical science . These include validation of the effectiveness of various forms of therapy, validating elements of treatment programs and

  15. Clinical reasoning: concept analysis.

    Science.gov (United States)

    Simmons, Barbara

    2010-05-01

    This paper is a report of a concept analysis of clinical reasoning in nursing. Clinical reasoning is an ambiguous term that is often used synonymously with decision-making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning. Data sources. Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008. Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision-making. Our concept analysis defines one of these terms, 'clinical reasoning,' as a complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions. This concept analysis provides a middle-range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations.

  16. Introduction to clinical nutrition

    National Research Council Canada - National Science Library

    Sardesai, Vishwanath M

    2012-01-01

    .... Introduction to Clinical Nutrition, Third edition discusses the physiologic and metabolic interrelationships of all nutrients and their roles in health maintenance and the prevention of various...

  17. Clinical research informatics

    CERN Document Server

    Richesson, Rachel L

    2012-01-01

    This book provides foundational coverage of key areas, concepts, constructs, and approaches of medical informatics as it applies to clinical research activities, in both current settings and in light of emerging policies. The field of clinical research is fully characterized (in terms of study design and overarching business processes), and there is emphasis on information management aspects and informatics implications (including needed activities) within various clinical research environments. The purpose of the book is to provide an overview of clinical research (types), activities, and are

  18. Clinical review: Riedel's thyroiditis: a clinical review.

    Science.gov (United States)

    Hennessey, James V

    2011-10-01

    Riedel's thyroiditis is a rare inflammatory process involving the thyroid and surrounding cervical tissues and is associated with various forms of systemic fibrosis. Riedel's presentation is complex, including a thyroid mass associated with local symptoms, characteristic biochemical abnormalities such as hypocalcemia and hypothyroidism, as well as the involvement of a wide range of other organ systems. Diagnosis of Riedel's thyroiditis requires histopathological confirmation, but due to high complication rates, the role of surgical intervention is limited to airway decompression and diagnostic tissue retrieval. Unique among processes of the thyroid, Riedel's is commonly treated with long-term antiinflammatory medications to arrest progression and maintain a symptom-free course. Due to its rarity, Riedel's may not be immediately diagnosed, so clinicians benefit from recognizing the constellation of findings that should make prompt diagnosis possible. A review of print and electronic reviews was conducted. Source references were identified, and available literature was reviewed. A search of the PubMed database using the search term "Riedel's thyroiditis" was cross-referenced with associated clinical findings, systemic fibrosis diagnoses, and therapeutic search terms. Because most of the literature consisted of case reports and very small series, inclusion of identified articles was based on clinical descriptions of the subjects included and the criteria for diagnosis reported. More weight was attributed to series, using contemporary criteria for diagnosis. Case reports were included if the diagnosis was clear and clinical presentation was unique to illustrate the spectrum of disease. Because the majority of therapeutic intervention data were based upon case reports and very small series, an evidence-based approach was problematic, but information is presented as objectively and with as much balance as the limited quality of the data allows. Clinical awareness of the

  19. Clinical Case. Visceral Leishmaniasis

    Directory of Open Access Journals (Sweden)

    I.V. Bogadelnikov

    2014-04-01

    Full Text Available This article presents a clinical case of visceral leishmaniasis in 9-month-old girl. There is described in detail the change of clinical symptoms, as well as laboratory and instrumental diagnostic technique in this child. Attention was paid to epidemiological history, which made it possible to make a definitive diagnosis (posthumously.

  20. CLINICAL PHARMACOLOGY OF DIURETICS

    Directory of Open Access Journals (Sweden)

    I. V. Soldatenko

    2014-06-01

    Full Text Available Clinical pharmacology of diuretics in the international system of ATC (anatomic-therapeutic-chemical is presented. Classification of this group by the action mechanism and caused effects is provided. Pharmacokinetics and pharmacodynamics features, indications and principles of diuretics usage in clinics are considered. Contraindications, side effects and interaction with other drugs of this group are discussed in detail.

  1. ACCP Clinical Pharmacist Competencies.

    Science.gov (United States)

    Saseen, Joseph J; Ripley, Toni L; Bondi, Deborah; Burke, John M; Cohen, Lawrence J; McBane, Sarah; McConnell, Karen J; Sackey, Bryan; Sanoski, Cynthia; Simonyan, Anahit; Taylor, Jodi; Vande Griend, Joseph P

    2017-05-01

    The purpose of the American College of Clinical Pharmacy (ACCP) is to advance human health by extending the frontiers of clinical pharmacy. Consistent with this mission and its core values, ACCP is committed to ensuring that clinical pharmacists possess the knowledge, skills, attitudes, and behaviors necessary to deliver comprehensive medication management (CMM) in team-based, direct patient care environments. These components form the basis for the core competencies of a clinical pharmacist and reflect the competencies of other direct patient care providers. This paper is an update to a previous ACCP document and includes the expectation that clinical pharmacists be competent in six essential domains: direct patient care, pharmacotherapy knowledge, systems-based care and population health, communication, professionalism, and continuing professional development. Although these domains align with the competencies of physician providers, they are specifically designed to better reflect the clinical pharmacy expertise required to provide CMM in patient-centered, team-based settings. Clinical pharmacists must be prepared to complete the education and training needed to achieve these competencies and must commit to ongoing efforts to maintain competence through ongoing professional development. Collaboration among stakeholders will be needed to ensure that these competencies guide clinical pharmacists' professional development and evaluation by educational institutions, postgraduate training programs, professional societies, and employers. © 2017 Pharmacotherapy Publications, Inc.

  2. Clinical diagnostic ultrasound

    International Nuclear Information System (INIS)

    Barnett, E.; Morley, P.

    1986-01-01

    This textbook on diagnostic ultrasound covers the main systems, with emphasis being placed on the clinical application of diagnostic ultrasound in everyday practice. It provides not only a textbook for postgraduates (particularly FRCR candidates), but also a reference work for practitioners of clinical ultrasound and clinicians generally

  3. Developing Clinical Competence

    NARCIS (Netherlands)

    P.F. Wimmers (Paul)

    2006-01-01

    textabstractThe development of clinical competence is the main purpose of medical education. The long road to become clinically competent starts on the first day of medical school, and every institution strives to select the best students. The responsibility of medical schools is to train

  4. Clinical implementation of pharmacogenetics.

    Science.gov (United States)

    García-González, Xandra; Cabaleiro, Teresa; Herrero, María José; McLeod, Howard; López-Fernández, Luis A

    2016-03-01

    In the last decade, pharmacogenetic research has been performed in different fields. However, the application of pharmacogenetic findings to clinical practice has not been as fast as desirable. The current situation of clinical implementation of pharmacogenetics is discussed. This review focuses on the advances of pharmacogenomics to individualize cancer treatments, the relationship between pharmacogenetics and pharmacodynamics in the clinical course of transplant patients receiving a combination of immunosuppressive therapy, the needs and barriers facing pharmacogenetic clinical application, and the situation of pharmacogenetic testing in Spain. It is based on lectures presented by speakers of the Clinical Implementation of Pharmacogenetics Symposium at the VII Conference of the Spanish Pharmacogenetics and Pharmacogenomics Society, held in April 20, 2015.

  5. American Association for Clinical Chemistry

    Science.gov (United States)

    ... Find the answer to your question IN CLINICAL CHEMISTRY Hs-cTnI as a Gatekeeper for Further Cardiac ... Online Harmonization.net Commission on Accreditation in Clinical Chemistry American Board of Clinical Chemistry Clinical Chemistry Trainee ...

  6. Clinical microbiology informatics.

    Science.gov (United States)

    Rhoads, Daniel D; Sintchenko, Vitali; Rauch, Carol A; Pantanowitz, Liron

    2014-10-01

    The clinical microbiology laboratory has responsibilities ranging from characterizing the causative agent in a patient's infection to helping detect global disease outbreaks. All of these processes are increasingly becoming partnered more intimately with informatics. Effective application of informatics tools can increase the accuracy, timeliness, and completeness of microbiology testing while decreasing the laboratory workload, which can lead to optimized laboratory workflow and decreased costs. Informatics is poised to be increasingly relevant in clinical microbiology, with the advent of total laboratory automation, complex instrument interfaces, electronic health records, clinical decision support tools, and the clinical implementation of microbial genome sequencing. This review discusses the diverse informatics aspects that are relevant to the clinical microbiology laboratory, including the following: the microbiology laboratory information system, decision support tools, expert systems, instrument interfaces, total laboratory automation, telemicrobiology, automated image analysis, nucleic acid sequence databases, electronic reporting of infectious agents to public health agencies, and disease outbreak surveillance. The breadth and utility of informatics tools used in clinical microbiology have made them indispensable to contemporary clinical and laboratory practice. Continued advances in technology and development of these informatics tools will further improve patient and public health care in the future. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  7. Learning for clinical leadership.

    Science.gov (United States)

    Cook, Michael J; Leathard, Helen L

    2004-11-01

    Clinical leadership has been acclaimed widely as a major factor influencing the quality of patient care but research has revealed a paucity of preparation for this significant role. Leadership literature has rarely addressed clinical leadership specifically or referred to the difficulties in characterizing effective clinical leaders. The research informing this paper focused on clinical leadership and identified five attributes of effective clinical leaders: creativity, highlighting, influencing, respecting, and supporting. Effective clinical leaders adopted a transformational leadership style and improved care, through others, by including transformational (soft) knowledge as an integral part of their effective practice repertoire. Phronesis is introduced as practical wisdom that is gained through immersion in relevant experience, and as an essential element of preparation for clinical nursing leadership practice. It is argued, that learning to transform care requires opportunities to work within an environment that engenders and supports aspiring leaders. The paper describes the research process, elucidates the attributes through illustrative examples from the research data, and discusses an emergent educational strategy for the development of these attributes by clinicians in their practice environments. The paper also describes the application of this research through an interdisciplinary programme for staff leading teams in both health and social services sectors.

  8. Clinical PET application

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Sang Moo; Hong, Song W.; Choi, Chang W.; Yang, Seong Dae [Korea Cancer Center Hospital, Seoul (Korea)

    1997-12-01

    PET gives various methabolic images, and is very important, new diagnostic modality in clinical oncology. In Korea Cancer Center Hospital, PET is installed as a research tool of long-mid-term atomic research project. For the efficient use of PET for clinical and research projects, income from the patients should be managed to get the raw material, equipment, manpower, and also for the clinical PET research. 1. Support the clinical application of PET in oncology. 2. Budgetary management of income, costs for raw material, equipment, manpower, and the clinical PET research project. In this year, 250 cases of PET images were obtained, which resulted total income of 180,000,000 won. 50,000,000 won was deposited for the 1998 PET clinical research. Second year PET clinical research should be managed under unified project. Increased demand for {sup 18}FDG in and outside KCCH need more than 2 times production of {sup 18}FDG in a day purchase of HPLC pump and {sup 68}Ga pin source which was delayed due to economic crisis, should be done early in 1998. (author). 2 figs., 3 tabs.

  9. Varieties of clinical reasoning.

    Science.gov (United States)

    Bolton, Jonathan W

    2015-06-01

    Clinical reasoning comprises a variety of different modes of inference. The modes that are practiced will be influenced by the sociological characteristics of the clinical settings and the tasks to be performed by the clinician. This article presents C.S. Peirce's typology of modes of inference: deduction, induction and abduction. It describes their differences and their roles as stages in scientific argument. The article applies the typology to reasoning in clinical settings. The article describes their differences, and their roles as stages in scientific argument. It then applies the typology to reasoning in typical clinical settings. Abduction is less commonly taught or discussed than induction and deduction. However, it is a common mode of inference in clinical settings, especially when the clinician must try to make sense of a surprising phenomenon. Whether abduction is followed up with deductive and inductive verification is strongly influenced by situational constraints and the cognitive and psychological stamina of the clinician. Recognizing the inevitability of abduction in clinical practice and its value to discovery is important to an accurate understanding of clinical reasoning. © 2015 John Wiley & Sons, Ltd.

  10. Clinical physiology grand rounds.

    Science.gov (United States)

    Richards, Jeremy; Schwartzstein, Richard; Irish, Julie; Almeida, Jacqueline; Roberts, David

    2013-04-01

    Clinical Physiology Grand Rounds (CPGR) is an interactive, case-based conference for medical students designed to: (1) integrate preclinical and clinical learning; (2) promote inductive clinical reasoning; and (3) emphasise students as peer teachers. CPGR specifically encourages mixed learning level student interactions and emphasises the use of concept mapping. We describe the theoretical basis and logistical considerations for an interactive, integrative, mixed-learner environment such as CPGR. In addition, we report qualitative data regarding students' attitudes towards and perceptions of CPGR. Medical students from first to fourth year participate in a monthly, interactive conference. The CPGR was designed to bridge gaps and reinforce linkages between basic science and clinical concepts, and to incorporate interactive vertical integration between preclinical and clinical students. Medical education and content experts use Socratic, interactive teaching methods to develop real-time concept maps to emphasise the presence and importance of linkages across curricula. Student focus groups were held to assess attitudes towards and perceptions of the mixed-learner environment and concept maps in CPGR. Qualitative analyses of focus group transcripts were performed to develop themes and codes describing the students' impressions of CPGR. CPGR is a case-based, interactive conference designed to help students gain an increased appreciation of linkages between basic science and clinical medicine concepts, and an increased awareness of clinical reasoning thought processes. Success is dependent upon explicit attention being given to goals for students' integrated learning. © Blackwell Publishing Ltd 2013.

  11. Automation in Clinical Microbiology

    Science.gov (United States)

    Ledeboer, Nathan A.

    2013-01-01

    Historically, the trend toward automation in clinical pathology laboratories has largely bypassed the clinical microbiology laboratory. In this article, we review the historical impediments to automation in the microbiology laboratory and offer insight into the reasons why we believe that we are on the cusp of a dramatic change that will sweep a wave of automation into clinical microbiology laboratories. We review the currently available specimen-processing instruments as well as the total laboratory automation solutions. Lastly, we outline the types of studies that will need to be performed to fully assess the benefits of automation in microbiology laboratories. PMID:23515547

  12. Clinical Case Registries (CCR)

    Data.gov (United States)

    Department of Veterans Affairs — The Clinical Case Registries (CCR) replaced the former Immunology Case Registry and the Hepatitis C Case Registry with local and national databases. The CCR:HIV and...

  13. ClinicalTrials.gov

    Data.gov (United States)

    U.S. Department of Health & Human Services — Provides patients, family members, health care professionals, and members of the public easy access to information on clinical trials for a wide range of diseases...

  14. Health Clinic Cost Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Independent Rural Health Clinic and Freestanding Federally Qualified Health Center (HCLINIC).This data...

  15. Celiac disease: clinical observations

    Directory of Open Access Journals (Sweden)

    Yu. A. Emel’yanova

    2016-01-01

    Full Text Available Presented clinical cases of patients with a diagnosis of gluten enteropathy in treatment in the department of gastroenterology Regional Clinical Hospital. The case is of interest to doctors of different specialties for the differential diagnosis of anemia and malabsorption syndrome, demonstrate both the classic version, and atypical forms of the disease course. Diagnosis of celiac disease is based on three key positions: clinical findings, histology and serological markers. The clinical picture of celiac disease is characterized by pronounced polymorphism, by going beyond the a gastroenterological pathology. For screening of gluten sensitive celiac typically used an antibody to tissue transglutaminase. Morphological research of the mucous membrane of the small intestine is the determining criterion in the diagnosis of celiac disease. The use of specific gluten-free diet leads to the positive dynamics of the disease and improve the quality of life of patients.

  16. Clinical approach to dyslipidaemia

    African Journals Online (AJOL)

    Repro

    ment and management right can pro- foundly influence ... Depending on the clinical context, a lipid value that .... tree, to which as much information as possible is .... Further useful laboratory investiga- tions at the ... on the system. If triglyceride ...

  17. Fidelity in clinical simulation

    DEFF Research Database (Denmark)

    Jensen, Sanne; Nøhr, Christian; Rasmussen, Stine Loft

    2013-01-01

    Clinical simulation may be used to identify user needs for context sensitive functionalities in e-Health. The objective with this paper is to describe how user requirements and use cases in a large EHR-platform procurement may be validated by clinical simulation using a very low-fidelity prototype...... without any existing test data. Instead of using test scenarios and use cases, the healthcare professionals who are participating in the clinical simulation are generating both scenario and patient data themselves. We found that this approach allows for an imaginative discussion, not restricted by known...... functionalities and limitations, of the ideal EHR-platform. Subsequently, we discuss benefits and challenges of using an extremely low fidelity environment and discuss the degree of fidelity necessary for conducting clinical simulation....

  18. Hepatitis C: Clinical Trials

    Science.gov (United States)

    ... and Public Home » Hepatitis C » Treatment Decisions Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For ... can I find out about participating in a hepatitis C clinical trial? Many trials are being conducted ...

  19. CliniCal

    African Journals Online (AJOL)

    2009-12-01

    Dec 1, 2009 ... tion choices, available data from clinical studies and expert paediatric pharmacology ... large volumes required or palatability, solid dosage formulations are ... crushed and added to food or liquid, it is important that the entire ...

  20. Cancer clinical trials

    International Nuclear Information System (INIS)

    Scheurlen, A.; Kay, R.; Baum, M.

    1988-01-01

    This book contains the proceedings on Cancer clinical trials: A critical appraisal. Topics covered include: Scientific fundamentals; Heterogeneous treatment effects; On combining information: Historical controls, overviews, and comprehensive cohort studies; and assessment of quality of life

  1. Clinical leadership project.

    Science.gov (United States)

    Kling, Vera G

    2010-11-01

    Nurse educators seek innovative strategies to maximize student learning in the classroom and clinical settings. Students enrolled in a nursing leadership and management course often find they spend more clinical time observing leaders than practicing the necessary skills to lead others in the provision of nursing care. In addition, opportunities to explore the nurse educator role often do not exist in baccalaureate nursing education, despite the shortage of nurse educators. An experience was developed in a baccalaureate nursing program to give senior students, under supervision of faculty, the opportunity to lead and evaluate lower-level students providing patient care in the clinical setting and to experience the role of nursing faculty. Feedback from senior students was positive, and students noted increased proficiency in leadership ability and critical thinking. Student interest in the nurse educator role was also enhanced. Program expansion and evaluation with faculty, clinical staff, and patients are planned. Copyright 2010, SLACK Incorporated.

  2. The clinical nanomedicine handbook

    CERN Document Server

    Brenner, Sara

    2013-01-01

    Designed to foster a stronger awareness and exploration of the subject by practicing clinicians, medical researchers and scientists, The Clinical Nanomedicine Handbook discusses the integration of nanotechnology, biology, and medicine from a clinical point of view. The book highlights relevant research and applications by specialty; it examines nanotechnology in depth, and the potential to solve medical problems. It also increases literacy in nanotechnology, and allows for more effective communication and collaboration between disciplines. Details worldwide developments in nanomedicine Provide

  3. Falsificationism and clinical trials.

    Science.gov (United States)

    Senn, S J

    1991-11-01

    The relevance of the philosophy of Sir Karl Popper to the planning, conduct and analysis of clinical trials is examined. It is shown that blinding and randomization can only be regarded as valuable for the purpose of refuting universal hypotheses. The purpose of inclusion criteria is also examined. It is concluded that a misplaced belief in induction is responsible for many false notions regarding clinical trials.

  4. Beninese vaccination clinic

    OpenAIRE

    Linda Sun

    2017-01-01

    This photo was taken in the village of Ladji, which is on the outskirts of Cotonou, the capital of Benin. At the time, I was a second year medical student volunteering at a local medical clinic. On every Wednesday morning, many Beninese babies, like this one, cry out of discomfort while receiving their monthly vaccinations. The photo shows a local clinic nurse administering the vaccination.

  5. Beninese vaccination clinic

    Directory of Open Access Journals (Sweden)

    Linda Sun

    2017-04-01

    Full Text Available This photo was taken in the village of Ladji, which is on the outskirts of Cotonou, the capital of Benin. At the time, I was a second year medical student volunteering at a local medical clinic. On every Wednesday morning, many Beninese babies, like this one, cry out of discomfort while receiving their monthly vaccinations. The photo shows a local clinic nurse administering the vaccination.

  6. Fundamentals of clinical trials

    CERN Document Server

    Friedman, Lawrence M; DeMets, David L; Reboussin, David M; Granger, Christopher B

    2015-01-01

    This is the fifth edition of a very successful textbook on clinical trials methodology, written by recognized leaders who have long and extensive experience in all areas of clinical trials. The three authors of the first four editions have been joined by two others who add great expertise.  Most chapters have been revised considerably from the fourth edition.  A chapter on regulatory issues has been included and the chapter on data monitoring has been split into two and expanded.  Many contemporary clinical trial examples have been added.  There is much new material on adverse events, adherence, issues in analysis, electronic data, data sharing, and international trials.  This book is intended for the clinical researcher who is interested in designing a clinical trial and developing a protocol. It is also of value to researchers and practitioners who must critically evaluate the literature of published clinical trials and assess the merits of each trial and the implications for the care and treatment of ...

  7. [Outlook for clinical hemorheology].

    Science.gov (United States)

    Stoltz, J F

    1996-01-01

    Harvey may be considered to be the precursor of modern hemorheology, but it was not until the pioneering work of Loewenhoeck, Poiseuille, Fahraeus and Copley that the essential role of the hemorheological properties of blood and its cellular components was recognized. Before the advent of modern hemorheology in the 70s, studies were mainly focussed on microcirculation and validation of global hemorheological equations applied to blood circulation. Parallel studies on the microrheological properties (erythrocyte deformability and aggregation) explained analytically the non-Newtonian behavior of blood, and the essential contribution of these parameters to the understanding hyperviscosity syndromes. The development of clinical hemorheology in fact started at the international conferences held in Reykjavik (1966) and Heidelberg (1969), and with the initiation of the periodical European Microcirculation (since Nancy in 1960) and Clinical Hemorheology (since Nancy in 1979) Conferences. The current main avenues of research involve flow modelling, studies of cell-cell interaction mechanisms (aggregation and adhesion), in relation to the associated pathophysiological phenomena, such as cellular activation (platelets and leukocytes in particular), gene expression linked to blood flow (e.g. endothelial cells)... Clinically and therapeutically, it is crucial that pathophysiological studies be undertaken on the relationship existing between rheological parameters and objective clinical data (local flow rates, ischemic markers, hemostatic parameters, tissue oxygen, clinical symptoms,...). The main clinical application fields are cardiovascular diseases, thrombosis, diabetes, hypercholesterolemia... Also, studies on new therapeutics or on biomaterials should also be given priority.

  8. Clinical dosimetry using mosfets

    International Nuclear Information System (INIS)

    Ramani, Ramaseshan; Russell, Stephen; O'Brien, Peter

    1997-01-01

    Purpose: The use of metal oxide-silicon field effect transistors (MOSFETs) as clinical dosimeters is demonstrated for a number of patients with targets at different clinical sites. Methods and Materials: Commercially available MOSFETs were characterized for energy response, angular dependency of response, and effect of accumulated dose on sensitivity and some inherent properties of MOSFETs. The doses determined both by thermoluminescence dosimetry (TLD) and MOSFETs in clinical situation were evaluated and compared to expected doses determined by calculation. Results: It was observed that a standard calibration of 0.01 Gy/mV gave MOSFET determined doses which agreed with expected doses to within 5% at the 95% confidence limit for photon beams from 6 to 25 MV and electron beams from 5 to 14 MeV. An energy-dependent variation in response of up to 28% was observed between two orientations of a MOSFET. The MOSFET doses compared very well with the doses estimated by TLDs, and the patients tolerated MOSFETs very well. A standard deviation of 3.9% between expected dose and MOSFET determined dose was observed, while for TLDs the standard deviation was 5.1%. The advantages and disadvantages of using MOSFETs for clinical dosimetry are discussed in detail. Conclusion: It was concluded that MOSFETs can be used as clinical dosimeters and can be a good alternative to TLDs. However, they have limitations under certain clinical situations

  9. Balancing mechanism status: January 2010; Bilan du mecanisme d'ajustement: janvier 2010

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-07-01

    RTE ensures the real-time balance between production and consumption and deals with congestion on the French electricity system. The Balancing Mechanism assists in the accomplishment of this task. As in many countries, and after extensive dialogue with representatives from the market's various players, RTE proposes a Balancing Mechanism in the form of a permanent and transparent system of calls for tender. The system is open to everyone and provides a real-time reserve of power that can be used for balancing either upward or downward. RTE takes advantage of these offers according to economic precedence, taking into account the system's operating conditions. It pays for them at the offer price. There are two types of offer: - Upward offer: increase in production, decrease in consumption, imports, - Downward offer: decrease in production, increase in consumption, exports. For a Balancing Entity, an offer systematically consists of: a balancing direction (upward/downward), a time period, a price that may vary according to six time slots. RTE publishes each month a Balancing Mechanism Report. which includes the following information: - energy volumes activated to ensure the balance of the system and to resolve congestion; - minimum and maximum prices of offers activated to balance the system; - daily trends calculated according to the predominant value of the overall upward or downward trend; - balancing shares by technology (nuclear, thermal, hydraulic); - characteristics of the five most activated balancing entities; - balances/imbalances accounts and production/consumption overcharge; - congestion curbing costs on the French electricity system; - energy volumes activated to ensure the balance of the system according to contracts between RTE and other Balance Responsible entities (UK, Belgium, Italy, Germany, Switzerland); - reliability of the provisional data supplied by RTE about the balancing trend; - availability of RTE's information services (planning, balancing mechanism, block exchange notification, market indicators). This report presents the above information for January 2010. (J.S.)

  10. La crisis y el ajuste cubano en los noventa: apuntes en torno a lo social

    Directory of Open Access Journals (Sweden)

    María Teresa Valdés Fernández

    1996-01-01

    Full Text Available This paper outlines the role played by the social sector within development strategies designed in Cuba, as well as the effects that the recent economic situation and the adjustment derived therefrom have had on the social sector’s role. This constitutes a necessary antecedent for an understanding of the conditions in which a new model of social policies ought to be formulated in the future, in tune with the transformations already under way in the economy and which will doubtless continue.

  11. AJUSTE A LA CRISIS Y MERCADO LABORAL (PERÚ 2008-2010

    Directory of Open Access Journals (Sweden)

    Norberto E. García

    2011-06-01

    Full Text Available The present paper analyses the adjustment of the Peruvian economy to the external shock caused by the global crisis in 2008-2010, with particular attention to: i the macroeconomic policies adopted to face the external shock; ii the consequences of the adjustment for the labor market; iii the importance of the high rates of economic growth recorded by Peru before the crisis in obtaining a soft adjustment to the external shock; iv the reasons that explained why the Peruvian economy does not suffer a recession and only decelerates growth, which allow us to understand why the adjustment to the external shock does not have a negative effect on the labor market – as a matter of fact there is a reduction of the unemployment rate during the crisis.

  12. Mondialisation, ajustement et défi de la croissance partagée ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Far East Asia, Indonesia, Philippines, Viet Nam, Central Asia, South Asia ... productivity, and workers' welfare under globalization : case studies, insights, and policy recommendations ... Industry churning, the labor market and workers' welfare.

  13. Reseña del libro: Ajuste Cultural de la persona con Discapacidad Intelectual

    Directory of Open Access Journals (Sweden)

    Maira Fernanda Hurtado Abril

    2013-06-01

    Full Text Available El presente trabajo realiza una breve exploración crítica del libro de Verdugo y Gutiérrez (2009, el cual tiene como eje central el análisis de la evolución del término “discapacidad” en los principales sistemas de acción, y la explicación de propuestas de intervención para la adaptabilidad de la persona con discapacidad intelectual. La lectura del libro transcurre de una manera armoniosa, clara y funcional para aquellos interesados en el tema (psicólogos, investigadores, terapeutas, educadores, familiares, buscando así la aplicación conjunta del modelo de una manera práctica y eficaz en la vida cotidiana de estas personas.

  14. Ajustement automatique des parametres de coupe pour l'obtention de stabilite dynamique en usinage

    Science.gov (United States)

    Tabet, Ricardo

    High speed machining has as principal limitation the dynamic stability of the cutting action which can generate premature wear of the machine spindle and the cutting tool, tool breakage and dimensional errors on the machined part. This phenomenon is known in the literature as chatter and is defined as being self-excited vibrations. This master thesis presents an approach applicable to manufacturing environments that allows eliminating chatter in real time during machining of aerospace aluminum alloys before the damaging effect can occur. A control algorithm is developed in order to detect chatter using a microphone and by analyzing the audio signal in the frequency domain. The analysis allows determining precisely the frequency at which the chatter occurs and therefore, the spindle speed is adjusted in order to make the tooth passing frequency equal to the detected chatter frequency. Also, a new feedrate is determined by keeping a constant chip load and within the physical limits of the cutting tool. The new cutting parameters are then sent out to the machine controller as a command using a communication interface between an external computer and the controller. Multiples experimental tests were conducted to validate the effectiveness to detect and suppress chatter. High speed machining tests, between 15 000 and 33 000 RPM, were performed in order to reflect real conditions for aerospace components manufacturing.

  15. Ajustes al framework de evaluación de productos de software MyFEPS

    OpenAIRE

    Angeleri, Paula; Titiosky, Rolando; Sorgen, Amos; Wuille Bille, Jaquelina; Oliveros, Alejandro

    2014-01-01

    El objetivo de este artículo es presentar la situación actual del proyecto de investigación MyFEPS Metodologías y Framework para la Evaluación de Productos de Software, basados en normas internacionales, en desarrollo en la Facultad de Ingeniería y Tecnología Informática de la Universidad de Belgrano, cuyo propósito es diseñar e implementar un framework que de apoyo al proceso de evaluación de software completo: desde la determinación de los objetivos de la evaluación, su planificación, ejecu...

  16. RECURSOS PARA A EDUCAÇÃO E LIMITES DO AJUSTE FISCAL

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Ferreira Alves de Brito

    Full Text Available Resumo: Este artigo analisa o financiamento da rede pública estadual de Minas Gerais e a remuneração dos professores da rede entre 2003 e 2014. Focaliza a modernização da administração governamental e os efeitos do programa denominado "Choque de gestão" na aplicação dos recursos para a função educação e para a remuneração do magistério assim como analisa a limitação imposta pela Lei de Responsabilidade Fiscal para os gastos com pessoal. Para isso, foram analisados dados orçamentários e relatórios do Tribunal de Contas do Estado de Minas Gerais. O trabalho é parte da pesquisa "Remuneração de professores da educação básica pública: configurações, impactos, impasses e perspectivas", realizada para o Observatório da Educação. A pesquisa constatou a diminuição de recursos financeiros para a função educação em Minas Gerais e a não implantação do piso salarial profissional nacional para os professores da rede estadual de educação básica.

  17. AJUSTE, ESTRUCTURA Y AMBIENTE COMO FACTORES CLAVES EN LA TEORÍA DE CONTINGENCIAS

    Directory of Open Access Journals (Sweden)

    Juan De J. Pinto

    2003-01-01

    Full Text Available Este artículo desarrolla la teoría de contingencias dentro del marco de la evolución de las teorías de la administración, basados en los estudios realizados por Burns y Stalker, Lawrence y Lorsh, Pradip Khandwall quienes hicieron grandes investigaciones en la década de los años 60 y 70 sobre el tema. También se hace un análisis de los aportes hechos por Henry Mintzberg, Van de Ven y Drazin y Stephen Robbins autores contemporáneos que han enriquecido el entendimiento de la teoría de contingencias, determinando la influencia de esta teoría sobre la estrategia, la estructura y el ambiente.

  18. Ajuste de un modelo directo de amortiguador MR mediante algoritmos genéticos

    OpenAIRE

    Pacheco Martín, Manuel

    2015-01-01

    This Bachelor Degree Project seeks to model a direct magneto-rheological damper aided by genetic algorithms. The main function of the suspension system of a vehicle is to ensure that all tires are in contact with the pavement, that all vibrations created by the contact of the tires are absorbed and that the suspensions assures safety and comfort to the vehicle’s passengers. There are three different set ups for the suspension system of a vehicle, based in its control system. Passive sus...

  19. Experiencias con un nuevo índice de falta de ajuste en Tablas de Contingencia

    Directory of Open Access Journals (Sweden)

    Adalberto González Debén

    2012-04-01

    Full Text Available Rudas, Clogg and Lindsay, en 1994, proposed a new index of lack of fit for contingency table analysis. For a contingency table P with N cells, and a model H, the new index is defined as the smallest \\pi that satisfies the equation P_h=(1-\\pi\\Pi_{1h}+\\pi\\Pi_{2h},     h=1,...,N with 0 \\leq \\pi \\leq 1, and \\Pi_1 and \\Pi_2 the tables of probabilities for each latent class. The model H applies to \\Pi_1 but not impose any restrictions on \\Pi_2. The interpretation of the index of lack of fit is the proportion of individuals of the population intrinsically outside model H. In this work we propose the analysis of the second latent class to the study of the causes of lack of fit of a model and to detect outlying cells. At the same time, we propose the new index of lack of fit as a concepto of non-independence in the two simple configural frequency analysis

  20. El ajuste en Cuba: ¿Medidas de sobrevivencia o nuevo modelo de desarrollo?

    Directory of Open Access Journals (Sweden)

    Hugo Fazio Vengoa

    1997-06-01

    Full Text Available El propósito del trabajo consiste en analizar la actual etapa por la que atraviesa Cuba y precisar la esencia de las reformas en curso. En una primera parte se señalan las características del modelo cubano de socialismo y los factores internos e internacionales que lo condujeron a una gran crisis. Después de pasar revista sobre la naturaleza del periodo especial, los autores señalan los límites que existen para que los sectores dinámicos en la actual economía cubana puedan convertirse en un nuevo modelo de desarrollo en la isla que le permita preservar su sistema socialista.

  1. Controlador Borroso Multivariable para el Ajuste de Tratamientos en Agricultura de Precisión

    Directory of Open Access Journals (Sweden)

    Xavier P. Burgos-Artizzu

    2007-04-01

    Full Text Available Resumen: Se presenta un control borroso MIMO sobre una barra multisección de aplicación de tratamientos incorporada a un tractor, que controla la apertura y cierre de cada una de las secciones de la barra y la dosis de herbicida a aplicar en cada instante, actuando sobre el caudal de la barra y la velocidad del vehículo. La dosificación se determina a partir de los resultados suministrados por un sistema de procesamiento de imágenes que genera, para el campo a tratar, los mapas de distribución de mala hierba y estado de crecimiento de cultivo, a partir de un muestreo fotográfico. El controlador se ha desarrollado y simulado en Matlab con resultados muy satisfactorios que indican un ahorro significativo en la cantidad de herbicida a utilizar, manteniendo un alto nivel de eficacia en el tratamiento de las infestaciones. Palabras clave: Control Borroso, Control multivariable, Agricultura de Precisión, Conocimiento experto

  2. Distribution transformer with automatic voltage adjustment - performance; Transformador de distribucion con ajuste automatico de tension - desempeno

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez Ruiz, Gustavo A.; Delgadillo Bocanegra, Alfonso; Betancourt Ramirez, Enrique [PROLEC-GE, Apodaca, Nuevo Leon (Mexico)]. E-mail: gustavo1.hernandez@ge.com; alfonso.delgadillobocanegra@ge.com; enrique.betancourt@ge.com; Ramirez Arredondo, Juan M. [CINVESTAV-Guadalajara, Zapopan, Jalisco (Mexico)]. E-mail: jramirez@gdl.cinvestav.mx

    2010-11-15

    In the electric power distribution systems, the power quality is strongly linked with the service stability voltage. In the radial kind systems, it is virtually impossible to achieve a flat voltage along the lines, so it is desirable to count with transformers that can adjust automatically the turns ratio. In this work, it is described the development and the performance of a transformer with an integrated electronic tap changer, that allows to change the turns ratio along the standard range of +/-5%, and it was identified the application limits of the technology. [Spanish] En los sistemas de distribucion de energia electrica, la calidad del suministro de energia esta fuertemente ligada con la estabilidad del voltaje de servicio. En sistemas de tipo radial, es virtualmente imposible mantener uniforme la tension a lo largo de las lineas, por lo que se hace deseable contar con transformadores que puedan ajustar automaticamente la relacion de transformacion. En este trabajo, se describe el desarrollo y desempeno de un transformador con switch electronico integrado, que permite variar la relacion de transformacion dentro del rango estandarizado de +/-5%, y se identifican los limites de aplicacion de la tecnologia.

  3. Teaching Cases in Management - RIPASA: Venda e Ajuste com Minoritários

    Directory of Open Access Journals (Sweden)

    Roberto Borges Kerr

    2009-04-01

    Full Text Available In 2004, the Zogbi, Derani and Zarzur [ZDZ] holding began negotiations to sell control of Ripasa, an attractive growth opportunity for its competitors which would not alter the market equilibrium. National and international competitors will dispute this crown jewel, the smallest of the big cellulose and paper companies. The Ripasa Case is a detailed description of a real business situation, the acquisition of the control of Ripasa by Votorantim Celulose e Papel [VCP] and Suzano Bahia Sul, two competing companies that joined forces in a strategic alliance designed as a consortium to acquire the control of Ripasa. The Case analyzes the acquisition process and the complex agreement with minority stockholders. The main question under discussion is the price to be paid to the minority stockholders. The situation became more complex due to the ambiguity of Ripasa´s Social Statute, which allowed for more than one interpretation on the tag along rights and caused a conflict between agencies. The acquiring companies decided not to take into consideration the best practices of Corporate Governance, aggravating the problem and delaying a final agreement for eighteen months.

  4. Determination of methodology of automatic history matching; Determinacao de metodologia de ajuste automatizado de historico

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Jose Pedro Moura dos

    2000-01-01

    In management of hydrocarbon reservoirs the numeric simulation is a fundamental tool. The validation of a field model with production report is made through history matching which, many times, is done by trial and errors procedures consuming excessive computational time and human efforts. The objective of this work is to present a methodology for automation of the history matching using the program UNIPAR with the modules of parallel computing, sensibility analysis and optimization. Based on an example of an offshore field, analyses of the objective function (water production, oil production and average pressure of the reservoir) behavior were accomplished as function of the variations of reservoir parameters. It was verified that this behavior is very regular. After that, several adjustment situations were tested to define a procedure to be used for a history matching. (author) Ate aqui estao scanned.

  5. Ecuador 1980-1990: crisis, ajuste y cambio de régimen de desarrollo

    Directory of Open Access Journals (Sweden)

    Julio Oleas-Montalvo

    2017-01-01

    Full Text Available En la década de 1980 terminó la industrialización dirigida por el Estado, comenzaron las reformas de mercado y cambió la forma de gestionar la política económica. En Ecuador los gobiernos de los presidentes Osvaldo Hurtado (1981-1984, León Febres Cordero (1984-1988, Rodrigo Borja (1988-1992 y la influencia del FMI promovieron este cambio adaptativo al régimen económico alentado por las emergentes doctrinas neoconservadoras de la época. Se estudian las cartas de intención remitidas al FMI y las memorias anuales del Banco Central del Ecuador, además de otras fuentes primarias. El PIB creció en promedio 2.4% anual, mientras la población lo hizo al 2.6%; la gestión de la crisis se desplazó desde la Junta Nacional de Planificación hacia el Banco Central, entidad que hizo de la devaluación monetaria su principal herramienta de política económica.

  6. Ecuador 1980-1990: crisis, ajuste y cambio de régimen de desarrollo

    OpenAIRE

    Julio Oleas-Montalvo

    2017-01-01

    En la década de 1980 terminó la industrialización dirigida por el Estado, comenzaron las reformas de mercado y cambió la forma de gestionar la política económica. En Ecuador los gobiernos de los presidentes Osvaldo Hurtado (1981-1984), León Febres Cordero (1984-1988), Rodrigo Borja (1988-1992) y la influencia del FMI promovieron este cambio adaptativo al régimen económico alentado por las emergentes doctrinas neoconservadoras de la época. Se estudian las cartas de intención remitidas al FMI y...

  7. Venezuela: del ajuste neoliberal a la promesa de “Socialismo del siglo XXI”

    Directory of Open Access Journals (Sweden)

    Luis Miguel Uharte Pozas

    2009-12-01

    Full Text Available El presente artículo, partiendo de un marco conceptual en torno a la democracia, pretende identificar los rasgos fundamentales del proyecto de gobierno que actualmente rige en Venezuela, y que está liderado por el presidente Hugo Chávez. Se analizan los cambios en el sistema político, en el ámbito económico, en el área social, en participación ciudadana, y en política exterior, realizando una comparación con los dos gobiernos precedentes, el de Carlos Andrés Pérez y el de Rafael Caldera.___________________ABSTRACT:The article takes as its starting point the conceptual framework around democracy and attempts to identify the fundamental characteristics of the project of the government currently in power in Venezuela, led by the president Hugo Chávez. It analyses the changes in the political system, in the field of economy, in the social area, in the citizen participation and the foreign policy, making a comparison with two preceding governments, headed by Carlos Andrés Pérez and Rafael Caldera.  

  8. Ajustes a la arquitectura del sistema general de salud de Colombia: una propuesta

    Directory of Open Access Journals (Sweden)

    Dov Chernichovsky

    2015-04-01

    Full Text Available El modelo de competencia regulada establecido por la Ley 100 de 1993 para el funcionamiento del sistema de salud en Colombia presenta fallas de mercado y fallas de gobierno. A la luz del modelo conceptual del «Paradigma Emergente», este artículo presenta una propuesta de adaptación de la arquitectura del sistema de salud de Colombia a la arquitectura de sistemas internacionales considerados exitosos, identificando instituciones, roles y competencias. Dado lo anterior, las recomendaciones más importantes son: impulsar el sistema dual de competencia regulada en zonas densamente pobladas y monopolios en zonas sin densidad geográfica y regionalizar el sistema. También se sugiere la adopción de instrumentos de regulación de la oferta como el certificado de necesidad.

  9. Ajustes a la arquitectura del sistema general de salud de Colombia: una propuesta

    Directory of Open Access Journals (Sweden)

    Dov Chernichovsky

    2015-01-01

    Full Text Available El modelo de competencia regulada establecido por la Ley 100 de 1993 para el funcionamiento del sis- tema de salud en Colombia presenta fallas de mercado y fallas de gobierno. A la luz del modelo conceptual del « Paradigma Emergente » , este artículo presenta una propuesta de adaptación de la arquitectura del sistema de salud de Colombia a la arquitectura de sistemas internacionales considerados exitosos, identificando instituciones, roles y competencias. Dado lo anterior, las recomendaciones más importantes son: impulsar el sistema dual de competencia regulada en zonas densamente pobladas y monopolios en zonas sin densidad geográfica y regionalizar el sistema. También se sugiere la adopción de instrumentos de regulación de la oferta como el certificado de necesidad.

  10. Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena

    OpenAIRE

    Mannix, Judy; Wilkes, Lesley; Jackson, Debra

    2013-01-01

    Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30?years but no research has captured nurses? clinicians? views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses? understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-struct...

  11. Clinical simulation practise framework.

    Science.gov (United States)

    Khalili, Hossein

    2015-02-01

    Historically, simulation has mainly been used to teach students hands-on skills in a relatively safe environment. With changes in the patient population, professional regulations and clinical environments, clinical simulation practise (CSP) must assist students to integrate and apply their theoretical knowledge and skills with their critical thinking, clinical judgement, prioritisation, problem solving, decision making, and teamwork skills to provide holistic care and treatment to their patients. CSP holds great potential to derive a positive transformation in students' transition into the workplace, by associating and consolidating learning from classrooms to clinical settings, and creating bridges between theory and practice. For CSP to be successful in filling the gap, the design and management of the simulation is crucial. In this article a new framework called 'Clinical simulation practise framework: A knowledge to action strategy in health professional education' is being introduced that aims to assist educators and curriculum developers in designing and managing their simulations. This CSP framework theorises that simulation as an experiential educational tool could improve students' competence, confidence and collaboration in performing professional practice in real settings if the CSP provides the following three dimensions: (1) a safe, positive, reflective and fun simulated learning environment; (2) challenging, but realistic, and integrated simulated scenarios; and (3) interactive, inclusive, interprofessional patient-centred simulated practise. © 2015 John Wiley & Sons Ltd.

  12. Hypertrophic Cardiomyopathy: Clinical Update.

    Science.gov (United States)

    Geske, Jeffrey B; Ommen, Steve R; Gersh, Bernard J

    2018-05-01

    Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy, manifesting as left ventricular hypertrophy in the absence of a secondary cause. The genetic underpinnings of HCM arise largely from mutations of sarcomeric proteins; however, the specific underlying mutation often remains undetermined. Patient presentation is phenotypically diverse, ranging from asymptomatic to heart failure or sudden cardiac death. Left ventricular hypertrophy and abnormal ventricular configuration result in dynamic left ventricular outflow obstruction in most patients. The goal of therapeutic interventions is largely to reduce dynamic obstruction, with treatment modalities spanning lifestyle modifications, pharmacotherapies, and septal reduction therapies. A small subset of patients with HCM will experience sudden cardiac death, and risk stratification remains a clinical challenge. This paper presents a clinical update for diagnosis, family screening, clinical imaging, risk stratification, and management of symptoms in patients with HCM. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Clinics of ocular tuberculosis.

    Science.gov (United States)

    Gupta, Vishali; Shoughy, Samir S; Mahajan, Sarakshi; Khairallah, Moncef; Rosenbaum, James T; Curi, Andre; Tabbara, Khalid F

    2015-02-01

    Ocular tuberculosis is an extrapulmonary tuberculous condition and has variable manifestations. The purpose of this review is to describe the clinical manifestations of ocular tuberculosis affecting the anterior and posterior segments of the eye in both immunocompetent and immunocompromised patients. Review of literature using Pubmed database. Mycobacterium tuberculosis may lead to formation of conjunctival granuloma, nodular scleritis, and interstitial keratitis. Lacrimal gland and orbital caseating granulomas are rare but may occur. The intraocular structures are also a target of insult by M. tuberculosis and may cause anterior granulomatous uveitis, anterior and posterior synechiae, secondary glaucoma, and cataract. The bacillus may involve the ciliary body, resulting in the formation of a localized caseating granuloma. Posterior segment manifestations include vitritis, retinal vasculitis, optic neuritis, serpiginous-like choroiditis, choroidal tubercules, subretinal neovascularization, and, rarely, endophthalmitis. The recognition of clinical signs of ocular tuberculosis is of utmost importance as it can provide clinical pathway toward tailored investigations and decision making for initiating anti-tuberculosis therapy.

  14. Ethics of clinical trials.

    Science.gov (United States)

    Palter, S F

    1996-05-01

    The modern clinical trial is a form of human experimentation. There is a long history of disregard for individual rights of the patient in this context, and special attention must be paid to ethical guidelines for these studies. Clinical trials differ in basic ways from clinical practice. Foremost is the introduction of outside interests, beyond those of the patient's health, into the doctor-patient therapeutic alliance. Steps must be taken to protect the interests of the patient when such outside influence exists. Kantian moral theory and the Hippocratic oath dictate that the physician must respect the individual patient's rights and hold such interests paramount. These principles are the basis for informed consent. Randomization of patients is justified when a condition of equipoise exists. The changing nature of health care delivery in the United States introduces new outside interests into the doctor-patient relationship.

  15. Clinical pancreatic islet transplantation.

    Science.gov (United States)

    Shapiro, A M James; Pokrywczynska, Marta; Ricordi, Camillo

    2017-05-01

    Clinical pancreatic islet transplantation can be considered one of the safest and least invasive transplant procedures. Remarkable progress has occurred in both the technical aspects of islet cell processing and the outcomes of clinical islet transplantation. With >1,500 patients treated since 2000, this therapeutic strategy has moved from a curiosity to a realistic treatment option for selected patients with type 1 diabetes mellitus (that is, those with hypoglycaemia unawareness, severe hypoglycaemic episodes and glycaemic lability). This Review outlines the techniques required for human islet isolation, in vitro culture before the transplant and clinical islet transplantation, and discusses indications, optimization of recipient immunosuppression and management of adjunctive immunomodulatory and anti-inflammatory strategies. The potential risks, long-term outcomes and advances in treatment after the transplant are also discussed to further move this treatment towards becoming a more widely available option for patients with type 1 diabetes mellitus and eventually a potential cure.

  16. Consolidated clinical microbiology laboratories.

    Science.gov (United States)

    Sautter, Robert L; Thomson, Richard B

    2015-05-01

    The manner in which medical care is reimbursed in the United States has resulted in significant consolidation in the U.S. health care system. One of the consequences of this has been the development of centralized clinical microbiology laboratories that provide services to patients receiving care in multiple off-site, often remote, locations. Microbiology specimens are unique among clinical specimens in that optimal analysis may require the maintenance of viable organisms. Centralized laboratories may be located hours from patient care settings, and transport conditions need to be such that organism viability can be maintained under a variety of transport conditions. Further, since the provision of rapid results has been shown to enhance patient care, effective and timely means for generating and then reporting the results of clinical microbiology analyses must be in place. In addition, today, increasing numbers of patients are found to have infection caused by pathogens that were either very uncommon in the past or even completely unrecognized. As a result, infectious disease specialists, in particular, are more dependent than ever on access to high-quality diagnostic information from clinical microbiology laboratories. In this point-counterpoint discussion, Robert Sautter, who directs a Charlotte, NC, clinical microbiology laboratory that provides services for a 40-hospital system spread over 3 states in the southeastern United States explains how an integrated clinical microbiology laboratory service has been established in a multihospital system. Richard (Tom) Thomson of the NorthShore University HealthSystem in Evanston, IL, discusses some of the problems and pitfalls associated with large-scale laboratory consolidation. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  17. Clinical dictionary of MRT

    International Nuclear Information System (INIS)

    Herborn, C.U.; Zink, C.

    2007-01-01

    MRT is the method of choice in many clinical problems. It is also one of the most complex imaging procedures, requiring much technical and physical knowledge and also detailed knowledge of the signal response of physiological and pathological tissues in the many variants of contrast enhancement, image reconstruction and image processing. In 2006, the pocket dictionary of MRT was published by the same publisher. It met with much positive response, which induced the publication of this new dictionary. With more than 3000 terms and definitions elaborated in cooperation with an excellent practician, the clinical applications of MRT are illustrated by typical findings and examples. (orig.)

  18. Mycobacteria of clinical interest

    International Nuclear Information System (INIS)

    Casal, M.

    1986-01-01

    This book is based upon a symposium on mycobacteria of clinical interest. Due to the multidisciplinary participation of, among others, microbiologists, clinicians, immunologists and epidemiologists, a very wide and thorough presentation of the present state of clinical research in this field is ensured. Topics of particular interest included in this volume were the new antimicrobial agents active against mycobacteria; new therapeutic possibilities; a system of rapid diagnosis of tuberculosis and mycobacteriosis; mycobacteriosis in AIDS; progress in immunopathology of tuberculosis and leprosy; progress in bacteriology and vaccination in leprosy; progress in immunological diagnosis and new epidemiological biovars of M. tuberculosis. (Auth.)

  19. Managing clinical trials

    Directory of Open Access Journals (Sweden)

    Kenyon Sara

    2010-07-01

    Full Text Available Abstract Managing clinical trials, of whatever size and complexity, requires efficient trial management. Trials fail because tried and tested systems handed down through apprenticeships have not been documented, evaluated or published to guide new trialists starting out in this important field. For the past three decades, trialists have invented and reinvented the trial management wheel. We suggest that to improve the successful, timely delivery of important clinical trials for patient benefit, it is time to produce standard trial management guidelines and develop robust methods of evaluation.

  20. Pursuing Improvement in Clinical Reasoning: The Integrated Clinical Education Theory.

    Science.gov (United States)

    Jessee, Mary Ann

    2018-01-01

    The link between clinical education and development of clinical reasoning is not well supported by one theoretical perspective. Learning to reason during clinical education may be best achieved in a supportive sociocultural context of nursing practice that maximizes reasoning opportunities and facilitates discourse and meaningful feedback. Prelicensure clinical education seldom incorporates these critical components and thus may fail to directly promote clinical reasoning skill. Theoretical frameworks supporting the development of clinical reasoning during clinical education were evaluated. Analysis of strengths and gaps in each framework's support of clinical reasoning development was conducted. Commensurability of philosophical underpinnings was confirmed, and complex relationships among key concepts were elucidated. Six key concepts and three tenets comprise an explanatory predictive theory-the integrated clinical education theory (ICET). ICET provides critical theoretical support for inquiry and action to promote clinical education that improves development of clinical reasoning skill. [J Nurs Educ. 2018;57(1):7-13.]. Copyright 2018, SLACK Incorporated.

  1. Clinical Validation of the Nursing Outcome "Swallowing Status" in People with Stroke: Analysis According to the Classical and Item Response Theories.

    Science.gov (United States)

    Oliveira-Kumakura, Ana Railka de Souza; de Araujo, Thelma Leite; Costa, Alice Gabrielle de Sousa; Cavalcante, Tahissa Frota; Lopes, Marcos Venícios de Oliveira; Carvalho, Emilia Campos

    2017-09-19

    To validate clinically the nursing outcome "Swallowing status". The adjustment of the nursing outcome was investigated according to the Classical and Item Response Theories. The models were compared regarding information loss, goodness-of-fit, and differential item functioning. Stability and internal consistency were examined. The nursing outcome has the best fit in the generalized partial credit model with different discrimination parameters. Strong correlations among the scores of each indicator were observed. There was no differential item functioning of the outcome indicators. The scale presented high internal consistency (Cronbach's α = .954) and stability (and > .800). This study presents a valid nursing outcome. Most accurate monitoring of sensitivity to an intervention. Validar clinicamente o resultado de enefermagem "Estado da Deglutição". MÉTODOS: O ajustamento do resultado foi investigado de acordo com as teorias Clássica e de Resposta ao Item. Os modelos foram comparados assumindo parâmetros de itens cruzados de igual discriminação. Investigaram-se as propriedades de bondade do ajuste, funcionamento diferencial dos itens, estabilidade e consistência interna. O resultado se ajustou melhor a partir do Modelo de crédito parcial generalizado, o qual demonstrou unidimensionalidade do resultado e forte correlação entre os escores de cada indicador. Não houve funcionamento diferencial dos indicadores. A consistência interna para a escala global (Cronbach's α = .954) e a estabilidade (>.800) mantiveram-se elevadas. CONCLUSÃO: O estudo apresenta um resultado de enfermagem válido. RELEVÂNCIA PARA A PRÁTICA CLÍNICA: Maior acurácia para monitorar a sensibilidade da intervenção. © 2017 NANDA International, Inc.

  2. The Burden and Clinical Presentation of Pulmonary Tuberculosis in Adults With Severe Respiratory Illness in a High Human Immunodeficiency Virus Prevalence Setting, 2012–2014

    Science.gov (United States)

    Tempia, Stefano; Dreyer, Andries; Dawood, Halima; Variava, Ebrahim; Martinson, Neil A.; Moyes, Jocelyn; Cohen, Adam L.; Wolter, Nicole; von Mollendorf, Claire; von Gottberg, Anne; Haffejee, Sumayya; Treurnicht, Florette; Hellferscee, Orienka; Ismail, Nazir; Cohen, Cheryl

    2017-01-01

    Abstract Background Understanding the burden and clinical presentation of tuberculosis in patients with severe respiratory illness (SRI) has important implications for anticipating treatment requirements. Methods Hospitalized patients aged ≥15 years with SRI at 2 public teaching hospitals in periurban areas in 2 provinces (Edendale Hospital in Pietermaritzburg, KwaZulu-Natal Province and Tshepong Hospital in Klerksdorp, North West Province) were enrolled prospectively from 2012 to 2014. Tuberculosis testing included smear microscopy, culture, or Xpert MTB/Rif. Results We enrolled 2486 individuals with SRI. Of these, 2097 (84%) were tested for tuberculosis, 593 (28%) were positive. Tuberculosis detection rate was 18% (133 of 729) in individuals with acute (≤14 days) presentation and 34% (460 of 1368) in those with chronic (>14 days) presentation. Among laboratory-confirmed tuberculosis cases, those with acute presentation were less likely to present with cough (88% [117 of 133] vs 97% [447 of 460]; ajusted odds ratio [aOR] = 0.2, 95% confidence interval [CI] = 0.1–0.5), night sweats (57% [75 of 132] vs 73% [337 of 459]; aOR = 0.4, 95% CI = 0.3–0.7), or be started on tuberculosis treatment on admission (63% [78 of 124] vs 81% [344 of 423]; aOR = 0.4, 95% CI = 0.3–0.7), but they were more likely to be coinfected with pneumococcus (13% [16 of 124] vs 6% [26 of 411]; aOR 2.3, 95% CI 1.3–5.3) than patients with chronic presentation. Annual incidence of acute and chronic tuberculosis-associated SRI per 100000 population was 28 (95% CI = 22–39) and 116 (95% CI = 104–128), respectively. Conclusions In this setting, tuberculosis, including acute presentation, is common in patients hospitalized with SRI. PMID:28852676

  3. The Burden and Clinical Presentation of Pulmonary Tuberculosis in Adults With Severe Respiratory Illness in a High Human Immunodeficiency Virus Prevalence Setting, 2012-2014.

    Science.gov (United States)

    Walaza, Sibongile; Tempia, Stefano; Dreyer, Andries; Dawood, Halima; Variava, Ebrahim; Martinson, Neil A; Moyes, Jocelyn; Cohen, Adam L; Wolter, Nicole; von Mollendorf, Claire; von Gottberg, Anne; Haffejee, Sumayya; Treurnicht, Florette; Hellferscee, Orienka; Ismail, Nazir; Cohen, Cheryl

    2017-01-01

    Understanding the burden and clinical presentation of tuberculosis in patients with severe respiratory illness (SRI) has important implications for anticipating treatment requirements. Hospitalized patients aged ≥15 years with SRI at 2 public teaching hospitals in periurban areas in 2 provinces (Edendale Hospital in Pietermaritzburg, KwaZulu-Natal Province and Tshepong Hospital in Klerksdorp, North West Province) were enrolled prospectively from 2012 to 2014. Tuberculosis testing included smear microscopy, culture, or Xpert MTB/Rif. We enrolled 2486 individuals with SRI. Of these, 2097 (84%) were tested for tuberculosis, 593 (28%) were positive. Tuberculosis detection rate was 18% (133 of 729) in individuals with acute (≤14 days) presentation and 34% (460 of 1368) in those with chronic (>14 days) presentation. Among laboratory-confirmed tuberculosis cases, those with acute presentation were less likely to present with cough (88% [117 of 133] vs 97% [447 of 460]; ajusted odds ratio [aOR] = 0.2, 95% confidence interval [CI] = 0.1-0.5), night sweats (57% [75 of 132] vs 73% [337 of 459]; aOR = 0.4, 95% CI = 0.3-0.7), or be started on tuberculosis treatment on admission (63% [78 of 124] vs 81% [344 of 423]; aOR = 0.4, 95% CI = 0.3-0.7), but they were more likely to be coinfected with pneumococcus (13% [16 of 124] vs 6% [26 of 411]; aOR 2.3, 95% CI 1.3-5.3) than patients with chronic presentation. Annual incidence of acute and chronic tuberculosis-associated SRI per 100000 population was 28 (95% CI = 22-39) and 116 (95% CI = 104-128), respectively. In this setting, tuberculosis, including acute presentation, is common in patients hospitalized with SRI.

  4. Clinical spectrum of onchodermatitis

    International Nuclear Information System (INIS)

    Bari, A.U.

    2007-01-01

    To describe the frequency and to see various dermatological presentations of onchocerciasis in black Africans of Sierra Leone. Local black patients of all age groups, attending dermatology outpatient department of Pak Field Hospital (established as a part of UN peacekeeping mission in Sierra Leone) with clinical diagnosis of onchodermatitis, based on symptomatology and morphological features of the disease, were included. UN troops were excluded. Laboratory investigations including blood complete picture and skin snips were carried out in all patients. Skin biopsy and nodule biopsy was performed in selected cases. Skin manifestations were recorded and categorized into various clinical patterns, i.e. acute, chronic, lichenified, onchocercoma, etc. Data was analyzed by using descriptive statistics in Instat. A total of 3011 patients, belonging to different local tribes, having a variety of skin disorders, were seen during the study period. One hundred and eighty-seven (6.2%) patients were found to have onchodermatitis. Patients were of all ages and both sexes, their ages ranging from 1 month to 73 years. Gender ratio was almost equal. A whole clinical spectrum of onchodermatitis was observed, chronic papular onchodermatitis being the most common pattern. Onchodermatitis with a large spectrum of clinical manifestations was seen in black Africans of the eastern part of Sierra Leone. (author)

  5. Clinical Mastery of Hypnosis.

    Science.gov (United States)

    Horevitz, Richard P.

    Hypnosis is an increasingly popular clinical intervention. The number of training courses in hypnosis is growing each year. Research on hypnosis training appears to show that limited exposure to training, as is typical in the common 3 to 5 day format of mass training, produces limited results. Only when training is extended over time do the…

  6. Radioimmunoimaging in clinical oncology

    International Nuclear Information System (INIS)

    Kairemo, K.J.A.

    1993-01-01

    In the thesis radiolabeled antibodies were tested for screening of cancer in patients without previous knowledge of tumour histopathology. They were tested as well targeting known cancer, sometimes in unknown clinical stage. Methods for detection enhancement utilizing double-tracer techniques and alternative routes of administration were also investigated. (385 refs., 11 tabs.)

  7. Prolactinomas : clinical studies

    NARCIS (Netherlands)

    Kars, Marleen

    2008-01-01

    Prolactinoma are treated with dopamine agonists, which are effective in reducing prolactin and tumor size. Studies reporting clinical and radiological outcome are scarce. The study described in chapter 2, assesses long-term outcome in patients treated with dopamine agonists for macroprolactinoma. An

  8. Clinical Process Intelligence

    DEFF Research Database (Denmark)

    Vilstrup Pedersen, Klaus

    2006-01-01

    .e. local guidelines. From a knowledge management point of view, this externalization of generalized processes, gives the opportunity to learn from, evaluate and optimize the processes. "Clinical Process Intelligence" (CPI), will denote the goal of getting generalized insight into patient centered health...

  9. OARSI Clinical Trials Recommendations

    DEFF Research Database (Denmark)

    Kraus, V B; Blanco, F J; Englund, M

    2015-01-01

    The objective of this work was to describe requirements for inclusion of soluble biomarkers in osteoarthritis (OA) clinical trials and progress toward OA-related biomarker qualification. The Guidelines for Biomarkers Working Group, representing experts in the field of OA biomarker research from...

  10. OARSI Clinical Trials Recommendations

    DEFF Research Database (Denmark)

    McAlindon, T. E.; Driban, J. B.; Henrotin, Y.

    2015-01-01

    The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct...

  11. The Unstructured Clinical Interview

    Science.gov (United States)

    Jones, Karyn Dayle

    2010-01-01

    In mental health, family, and community counseling settings, master's-level counselors engage in unstructured clinical interviewing to develop diagnoses based on the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed., text rev.; "DSM-IV-TR"; American Psychiatric Association, 2000). Although counselors receive education about…

  12. Electrogastroenterography in clinical practice

    Directory of Open Access Journals (Sweden)

    Pavel M. Kosenko

    2013-05-01

    Full Text Available The review contains the information on the basics of electrophysiological evaluation of motor-evacuator function of stomach. It describes the main methods for registration of electric activity of stomach and intestine, characterizes the registered parameters, and gives modern data on its clinical application.

  13. Clinical status of carboplatin.

    Science.gov (United States)

    Canetta, R; Franks, C; Smaldone, L; Bragman, K; Rozencweig, M

    1987-07-01

    Carboplatin, a cisplatin derivative, shows promise of being an effective weapon against ovarian, cervical, and small-cell lung cancer, as well as epidermoid cancer of the head and neck, with fewer toxic effects than cisplatin. It has successfully completed phase III investigation and clinical trials continue.

  14. Clinical phenotypes of asthma

    NARCIS (Netherlands)

    Bel, Elisabeth H.

    2004-01-01

    PURPOSE OF REVIEW: Asthma is a phenotypically heterogeneous disorder and, over the years, many different clinical subtypes of asthma have been described. A precise definition of asthma phenotypes is now becoming more and more important, not only for a better understanding of pathophysiologic

  15. Computerized Clinical Simulations.

    Science.gov (United States)

    Reinecker, Lynn

    1985-01-01

    Describes technique involved in designing a clinical simulation problem for the allied health field of respiratory therapy; discusses the structure, content, and scoring categories of the simulation; and provides a sample program which illustrates a programming technique in BASIC, including a program listing and a sample flowchart. (MBR)

  16. Clinical application of ghrelin.

    Science.gov (United States)

    Strasser, Florian

    2012-01-01

    Ghrelin as a human natural hormone is involved in fundamental regulatory processes of eating and energy balance. Ghrelin signals the nutrient availability from the gastrointestinal tract to the central nervous system, up-regulates food intake and lowers energy expenditure mainly through hypothalamic mediators acting both centrally and peripherally including the gastrointestinal tract (motility, epithelium), promotes both neuro-endocrine and inflammatory signals to increase skeletal muscle growth and decrease protein breakdown, and increases lipolysis while body fat utilization is reduced. Ghrelin does more to exert its probably sentinel role around "human energy": it influences through mainly extra-hypothalamic actions the hedonic and incentive value of food, mood and anxiety, sleep-wake regulation, learning and memory, and neurogenesis. Recently numerous ghrelin gene-derived peptides were discovered, demonstrating the complexity within the ghrelin/ghrelin receptor axis. For clinical applications, not only the natural ghrelin and its slice variants, but also several modified or artificial molecules acting at ghrelin-associated receptors were and are developed. Current clinical applications are limited to clinical studies, focusing mainly on cachexia in chronic heart failure, COPD, cancer, endstage- renal-disease or cystic fibrosis, but also on frailty in elderly, gastrointestinal motility (e.g., gastroparesis, functional dyspepsia, postoperative ileus), after curative gastrectomy, anorexia nervosa, growth hormone deficient patients, alcohol craving, sleep-wake regulation (e.g. major depression), or sympathetic nervous activity in obesity. The results of completed, preliminary studies support the clinical potential of ghrelin, ghrelin gene-derived peptides, and artificial analogues, suggesting that larger clinical trials are demanded to move ghrelin towards an available and reimbursed pharmaceutical intervention.

  17. Computers and clinical arrhythmias.

    Science.gov (United States)

    Knoebel, S B; Lovelace, D E

    1983-02-01

    Cardiac arrhythmias are ubiquitous in normal and abnormal hearts. These disorders may be life-threatening or benign, symptomatic or unrecognized. Arrhythmias may be the precursor of sudden death, a cause or effect of cardiac failure, a clinical reflection of acute or chronic disorders, or a manifestation of extracardiac conditions. Progress is being made toward unraveling the diagnostic and therapeutic problems involved in arrhythmogenesis. Many of the advances would not be possible, however, without the availability of computer technology. To preserve the proper balance and purposeful progression of computer usage, engineers and physicians have been exhorted not to work independently in this field. Both should learn some of the other's trade. The two disciplines need to come together to solve important problems with computers in cardiology. The intent of this article was to acquaint the practicing cardiologist with some of the extant and envisioned computer applications and some of the problems with both. We conclude that computer-based database management systems are necessary for sorting out the clinical factors of relevance for arrhythmogenesis, but computer database management systems are beset with problems that will require sophisticated solutions. The technology for detecting arrhythmias on routine electrocardiograms is quite good but human over-reading is still required, and the rationale for computer application in this setting is questionable. Systems for qualitative, continuous monitoring and review of extended time ECG recordings are adequate with proper noise rejection algorithms and editing capabilities. The systems are limited presently for clinical application to the recognition of ectopic rhythms and significant pauses. Attention should now be turned to the clinical goals for detection and quantification of arrhythmias. We should be asking the following questions: How quantitative do systems need to be? Are computers required for the detection of

  18. Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena

    Science.gov (United States)

    2013-01-01

    Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses’ clinicians’ views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses’ understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Results Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. Conclusion There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An ‘ideal nurse’ may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community. PMID:23587282

  19. Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena.

    Science.gov (United States)

    Mannix, Judy; Wilkes, Lesley; Jackson, Debra

    2013-01-01

    Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses' clinicians' views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses' understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An 'ideal nurse' may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community.

  20. Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions.

    Science.gov (United States)

    Hunter, Sharyn; Arthur, Carol

    2016-05-01

    Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements. Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Danish clinical databases: An overview

    DEFF Research Database (Denmark)

    Green, Anders

    2011-01-01

    Clinical databases contain data related to diagnostic procedures, treatments and outcomes. In 2001, a scheme was introduced for the approval, supervision and support to clinical databases in Denmark.......Clinical databases contain data related to diagnostic procedures, treatments and outcomes. In 2001, a scheme was introduced for the approval, supervision and support to clinical databases in Denmark....

  2. 4 pitfalls to clinical integration.

    Science.gov (United States)

    Redding, John

    2012-11-01

    Four common mistakes can easily thwart clinical integration: Assuming that EHR adoption is the cornerstone of successful integration; Delaying the development of ambulatory services that support clinical integration; Believing that knowledge of clinical integration initiatives will passively diffuse through the ranks; Attaching too much weight to Federal Trade Commission/Department of Justice approval of a clinical integration model.

  3. Clinical Data Warehousing - A Survey

    DEFF Research Database (Denmark)

    Pedersen, Torben Bach; Jensen, Christian Søndergaard

    1998-01-01

    In this article we present the concept of data warehousing, and its use in the clinical area. Clinical data warehousing will become very important in the near future, as healthcare enterprises need to gain more information from their clinical, administrative, and financial data, in order to impro...... in the area, and providing criteria for comparing clinical data warehouse systems....

  4. Pet in Clinical oncology

    International Nuclear Information System (INIS)

    Hunsche, A.; Grossman, G.; Santana, M.; Santana, C.; Halkar, R.; Garcia, E.

    2003-01-01

    The utility of the PET (positron emission tomography in clinical oncology has been recognized for more than two decades, locating it as a sensible technique for the diagnosis and the prognosis stratification of the oncology patients. The sensitivity and specificity of the PET in comparation to other image studies have demonstrated to be greater. For some years, there was a restriction of PET because of the high cost of the equipment and the cyclotrons. Nevertheless, the relation of cost/benefits is considered as a priority as this technique offers important clinical information. In this article the results observed when using it in diverse types of cancer, as well as the effectiveness shown in the pre-operating evaluation, the evaluation of residual disease, diagnosis of recurrences, pursuit and prognosis stratification of the patients with cancer. (The author)

  5. Clinical Relevance of Adipokines

    Directory of Open Access Journals (Sweden)

    Matthias Blüher

    2012-10-01

    Full Text Available The incidence of obesity has increased dramatically during recent decades. Obesity increases the risk for metabolic and cardiovascular diseases and may therefore contribute to premature death. With increasing fat mass, secretion of adipose tissue derived bioactive molecules (adipokines changes towards a pro-inflammatory, diabetogenic and atherogenic pattern. Adipokines are involved in the regulation of appetite and satiety, energy expenditure, activity, endothelial function, hemostasis, blood pressure, insulin sensitivity, energy metabolism in insulin sensitive tissues, adipogenesis, fat distribution and insulin secretion in pancreatic β-cells. Therefore, adipokines are clinically relevant as biomarkers for fat distribution, adipose tissue function, liver fat content, insulin sensitivity, chronic inflammation and have the potential for future pharmacological treatment strategies for obesity and its related diseases. This review focuses on the clinical relevance of selected adipokines as markers or predictors of obesity related diseases and as potential therapeutic tools or targets in metabolic and cardiovascular diseases.

  6. Clinical ethics and happiness.

    Science.gov (United States)

    Devettere, R J

    1993-02-01

    Most contemporary accounts of clinical ethics do not explain why clinicians should be ethical. Those few that do attempt an explanation usually claim that clinicians should be ethical because ethical behavior provides an important good for the patient--better care. Both these approaches ignore the customary traditional reason for being ethical, namely, the good of the moral agent. This good was commonly called 'happiness'. The following article shows how the personal happiness of the moral agent provided a major reason for being ethical in the ancient philosophical and biblical traditions and how it continues to play a role in the more modern rights-based, Kantian and utilitarian theories. This history suggests that the personal happiness of the clinician, rightly understood, is a legitimate and important goal of clinical ethics.

  7. Transgressive first clinical experiences

    DEFF Research Database (Denmark)

    Jensen, Carsten Juul; Jeppesen, Lise Kofoed; Drachmann, Merete

    2014-01-01

    . The nursing students’ learning seems to be oriented towards socialization in the clinic as a workplace. This means that the nursing students seek to deal with overwhelming experiences concerning the naked bodies of patients and death, useful application of theoretical knowledge, the path from novice...... to advanced beginner, and adjusting to the workplace community. The conclusion is that the learning of nursing students during their first clinical in-service placement appears informal and not founded on evident best practice....... graduation as a Nurse. The Study has a qualitative methodology, inspired by Michael Eraut’s thoughts on learning in the workplace. When the workplace perspective is applied, learning seems to be concentrated on actual situations which the Learner is in, in contrast to employing constructed concepts...

  8. [Clinical diagnosis of dyslexia].

    Science.gov (United States)

    Martínez Hermosillo, A; Balderas Gil, A

    1980-01-01

    In 5 years of experience at the Instituto Nacional de la Comunicacion Humana, 302 clinical histories showed the diagnosis of dyslexia. The following parameters were studied: age, sex, heredofamilial history, gestation, psychomotor development, clinical picture, examination of the language (type, reading, spontaneous writing, dictation, mathematic concepts), laterality, scholarship, scholar failures, psychological study. The following results were obtained: Dyslexia was more important or frequent between 5 to 8.9 years of age. Males predominated 3:1. The heredofamilial history was important. Dyslexia prevailed in products of the first gestations. A high disturbance was found in the psychomotor development of a large percent of dyslexic patients. Examination of language was also important. Dyslexia was more frequent in right-handed patients. Scholar failures in one or more instances were found. The psychological study must be done. If dyslexia is diagnosed on time, it may be prevented and all unwanted sequelae may be avoided.

  9. Clinical physiopathology of hypernatremia

    Directory of Open Access Journals (Sweden)

    F. Sgambato

    2013-05-01

    Full Text Available BACKGROUND The maintenance of sodium levels at normal ranges has to be considered one of the most important and crucial physiological balance in order to preserve life. The increase of natremia determines the leakage of H2O from the inside of cells and the consequent brain cells withering, that causes encephalopathy at different stages and in some cases it can even lead to death. AIM OF THE STUDY The fundamentals of general physiopathology are analysed together with systems of compensation and brain adaptation in the three different aetiopathogenetic forms: primary increase of sodium (hypervolemic and haedematose form; missed introduction of pure water (mainly euvolemic form, with no aedema; loss of hypotonic fluids (hypovolemic form with dehydration. The three different clinical entities with their relative clinical approaches have been described.

  10. Horizons in clinical nanomedicine

    CERN Document Server

    Karagkiozaki, Varvara

    2014-01-01

    Nanomedicine-the application of nanotechnology to health sciences-has the potential to address many important medical problems by exploiting the advanced physicochemical characteristics of nanostructured materials and devices. It can revolutionize conventional medicine by offering cutting-edge developments in the processes of diagnosing, treating, and preventing diseases, injuries, or genetic disorders. Thus, clinical nanomedicine holds promise to preserve and improve human health.This book provides a comprehensive overview on the forefront developments of nanotechnology in various domains of

  11. Horner syndrome: clinical perspectives

    Science.gov (United States)

    Kanagalingam, Sivashakthi; Miller, Neil R

    2015-01-01

    Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis, all resulting from damage to the ipsilateral oculosympathetic pathway. Herein, we review the clinical signs and symptoms that can aid in the diagnosis and localization of a Horner syndrome as well as the causes of the condition. We emphasize that pharmacologic testing can confirm its presence and direct further testing and management. PMID:28539793

  12. Managing clinical improvement projects.

    Science.gov (United States)

    Phillips, Joanna; Simmonds, Lorraine

    This paper, the second of a three-part series looking at change management tools, provides a practical guide on how to use common project management principles in practice. Much of the literature on project management focuses on the business arena, with little reference to clinical settings. Identifying this literature and understanding its relevance to managing projects in healthcare can be difficult. This article provides a practical guide to identifying the key principles of good project management and applying these in health settings.

  13. Clinical versus actuarial judgment.

    Science.gov (United States)

    Dawes, R M; Faust, D; Meehl, P E

    1989-03-31

    Professionals are frequently consulted to diagnose and predict human behavior; optimal treatment and planning often hinge on the consultant's judgmental accuracy. The consultant may rely on one of two contrasting approaches to decision-making--the clinical and actuarial methods. Research comparing these two approaches shows the actuarial method to be superior. Factors underlying the greater accuracy of actuarial methods, sources of resistance to the scientific findings, and the benefits of increased reliance on actuarial approaches are discussed.

  14. Clinical highlights from Amsterdam

    Directory of Open Access Journals (Sweden)

    Jouke T. Annema

    2016-07-01

    Full Text Available This article contains highlights and a selection of the scientific advances from the Clinical Assembly that were presented at the 2015 European Respiratory Society International Congress in Amsterdam, the Netherlands. The most relevant topics for clinicians will be discussed, covering a wide range of areas including interventional pulmonology, rehabilitation and chronic care, thoracic imaging, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, exciting novel data will be discussed and put into perspective.

  15. Clinical practice of radiotherapy

    International Nuclear Information System (INIS)

    Horiuchi, Junichi; Masaki, Norie; Onoyama, Yasuto

    1987-01-01

    This chapter presents in greater detail radiotherapy used in each clinical setting. The descriptions are given under the following sections: the tongue and oral cavity; the maxilla, larynx, and pharynx; brain tumors; the eyes and orbit; pediatric tumors; lung cancer; the esophagus; breast cancer; the abdominal digestive system; the urogenital system; the uterine cervix; the ovaries and vulva; bone and soft tissues; the skin; hematopoietic tumors; lymph node metastases; and radiotherapy as palliative treatment. (Namekawa, K.)

  16. Rural health clinics infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Olson, K.

    1997-12-01

    The author discusses programs which were directed at the installation of photovoltaic power systems in rural health clinics. The objectives included: vaccine refrigeration; ice pack freezing; lighting; communications; medical appliances; sterilization; water purification; and income generation. The paper discusses two case histories, one in the Dominican Republic and one in Colombia. The author summarizes the results of the programs, both successes and failures, and offers an array of conclusions with regard to the implementation of future programs of this general nature.

  17. Clinical multiphoton FLIM tomography

    Science.gov (United States)

    König, Karsten

    2012-03-01

    This paper gives an overview on current clinical high resolution multiphoton fluorescence lifetime imaging in volunteers and patients. Fluorescence lifetime imaging (FLIM) in Life Sciences was introduced in Jena/Germany in 1988/89 based on a ZEISS confocal picosecond dye laser scanning microscope equipped with a single photon counting unit. The porphyrin distribution in living cells and living tumor-bearing mice was studied with high spatial, temporal, and spectral resolution. Ten years later, time-gated cameras were employed to detect dental caries in volunteers based on one-photon excitation of autofluorescent bacteria with long fluorescence lifetimes. Nowadays, one-photon FLIM based on picosecond VIS laser diodes are used to study ocular diseases in humans. Already one decade ago, first clinical twophoton FLIM images in humans were taken with the certified clinical multiphoton femtosecond laser tomograph DermaInspectTM. Multiphoton tomographs with FLIM modules are now operating in hospitals at Brisbane, Tokyo, Berlin, Paris, London, Modena and other European cities. Multiple FLIM detectors allow spectral FLIM with a temporal resolution down to 20 ps (MCP) / 250 ps (PMT) and a spectral resolution of 10 nm. Major FLIM applications include the detection of intradermal sunscreen and tattoo nanoparticles, the detection of different melanin types, the early diagnosis of dermatitis and malignant melanoma, as well as the measurement of therapeutic effects in pateints suffering from dermatitis. So far, more than 1,000 patients and volunteers have been investigated with the clinical multiphoton FLIM tomographs DermaInspectTM and MPTflexTM.

  18. Applied clinical engineering

    International Nuclear Information System (INIS)

    Feinberg, B.

    1986-01-01

    This book demonstrates how clinical engineering has applied engineering principles to the development and use of complex medical devices for the diagnosis and treatment of the sick and injured. It discusses the proper utilization of medical devices and equipment in the health-care industry and provides understanding of complex engineering systems, and their uses in the modern hospital or other health-care facility

  19. Athlete's Foot: Clinical Update.

    Science.gov (United States)

    Ramsey, M L

    1989-10-01

    In brief: Athletes are particularly prone to athlete's foot because they are generally more exposed than others to conditions that encourage fungal growth, eg, communal showers and locker rooms. Diagnosis of athlete's foot rests on clinical suspicion and laboratory testing. Treatment may consist of topical antifungal agents and, for more resistant cases, oral griseofulvin. Preventive measures include keeping the feet dry, wearing nonocclusive leather shoes or sandals and absorbent cotton socks, and applying talcum or antifungal powder at least twice daily.

  20. Comfrey: A Clinical Overview

    OpenAIRE

    Staiger, Christiane

    2012-01-01

    Comfrey has a centuries-old tradition as a medicinal plant. Today, multiple randomized controlled trials have demonstrated the efficacy and safety of comfrey preparations for the topical treatment of pain, inflammation and swelling of muscles and joints in degenerative arthritis, acute myalgia in the back, sprains, contusions and strains after sports injuries and accidents, also in children aged 3 or 4 and over. This paper provides information on clinical trials and non-interventional studies...

  1. Clinical approach to diarrhea.

    Science.gov (United States)

    Corinaldesi, Roberto; Stanghellini, Vincenzo; Barbara, Giovanni; Tomassetti, Paola; De Giorgio, Roberto

    2012-10-01

    Diarrhea is defined as reduced stool consistency, increased water content and number of evacuations per day. A wide array of causes and pathophysiological mechanisms underlie acute and chronic forms of diarrhea. This review focuses on the major clinical aspects which should aid clinicians to diagnose chronic diarrhea. Clinical history, physical examination and stool evaluation and the predominant stool characteristic, i.e., bloody, watery, and fatty diarrhea, may narrow the differential diagnosis. Although mainly involved in acute diarrhea, many different infectious agents, including bacteria, viruses and protozoa, can be identified in chronic bloody/inflammatory diarrhea by appropriate microbiological tests and colonoscopic biopsy analysis. Osmotic diarrhea can be the result of malabsorption or maldigestion, with a subsequent passage of fat in the stool leading to steatorrhea. Secretory diarrhea is due to an increase of fluid secretion in the small bowel lumen, a mechanism often identified in gastroenteropancreatic neuroendocrine tumors. The evaluation of the fecal osmotic gap may help to characterize whether a chronic diarrhea is osmotic or secretory. Fatty diarrhea (steatorrhea) occurs if fecal fat output exceeds the absorptive/digestive capacity of the intestine. Steatorrhea results from malabsorption or maldigestion states and tests should differentiate between these two conditions. Individualized diagnostic work ups tailored on pathophysiological and clinical features are expected to reduce costs for patients with chronic diarrhea.

  2. STRUCTURED CLINICAL EVALUATION

    Directory of Open Access Journals (Sweden)

    Arabela Maria Barbosa Sampaio

    2014-05-01

    Full Text Available In a world experiencing profound technological and socio-political changes in areas of knowledge and capacity, healthcare can not remain static. A new kind of professional is required, whose practice is based on ethics, scientific standards, integrity, citizenship, and health promotion, who develops skills beyond healthcare, such as decision making, communication,leadership, management, and continuing education. No single method can assess all of these elements (knowledge, skills, and attitudes, and only a combination of methods is able to produce a valid evaluation. An alternative method exists: structured clinical assessments based on observation of "to do, or how to do" that aim to complete this evaluation by focusing attention on the performance of specific skills. In order to broaden the scope of evaluation methods that have been used in health education, this article, a literature review, intends to offer readers an overview of the diverse types of structured clinical evaluation, emphasizing Objective Structured Clinical Examination, the most widely used in Brazil, with a goal of advancing opportunities for health professionals to make use of this evaluative tool.

  3. Basic and clinical immunology

    Science.gov (United States)

    Chinen, Javier; Shearer, William T.

    2003-01-01

    Progress in immunology continues to grow exponentially every year. New applications of this knowledge are being developed for a broad range of clinical conditions. Conversely, the study of primary and secondary immunodeficiencies is helping to elucidate the intricate mechanisms of the immune system. We have selected a few of the most significant contributions to the fields of basic and clinical immunology published between October 2001 and October 2002. Our choice of topics in basic immunology included the description of T-bet as a determinant factor for T(H)1 differentiation, the role of the activation-induced cytosine deaminase gene in B-cell development, the characterization of CD4(+)CD25(+) regulatory T cells, and the use of dynamic imaging to study MHC class II transport and T-cell and dendritic cell membrane interactions. Articles related to clinical immunology that were selected for review include the description of immunodeficiency caused by caspase 8 deficiency; a case series report on X-linked agammaglobulinemia; the mechanism of action, efficacy, and complications of intravenous immunoglobulin; mechanisms of autoimmunity diseases; and advances in HIV pathogenesis and vaccine development. We also reviewed two articles that explore the possible alterations of the immune system caused by spaceflights, a new field with increasing importance as human space expeditions become a reality in the 21st century.

  4. Transforming practice into clinical scholarship.

    Science.gov (United States)

    Limoges, Jacqueline; Acorn, Sonia

    2016-04-01

    The aims of this paper were to explicate clinical scholarship as synonymous with the scholarship of application and to explore the evolution of scholarly practice to clinical scholarship. Boyer contributed an expanded view of scholarship that recognized various approaches to knowledge production beyond pure research (discovery) to include the scholarship of integration, application and teaching. There is growing interest in using Boyer's framework to advance knowledge production in nursing but the discussion of clinical scholarship in relation to Boyer's framework is sparse. Discussion paper. Literature from 1983-2015 and Boyer's framework. When clinical scholarship is viewed as a synonym for Boyer's scholarship of application, it can be aligned to this well established framework to support knowledge generated in clinical practice. For instance, applying the three criteria for scholarship (documentation, peer review and dissemination) can ensure that the knowledge produced is rigorous, available for critique and used by others to advance nursing practice and patient care. Understanding the differences between scholarly practice and clinical scholarship can promote the development of clinical scholarship. Supporting clinical leaders to identify issues confronting nursing practice can enable scholarly practice to be transformed into clinical scholarship. Expanding the understanding of clinical scholarship and linking it to Boyer's scholarship of application can assist nurses to generate knowledge that addresses clinical concerns. Further dialogue about how clinical scholarship can address the theory-practice gap and how publication of clinical scholarship could be expanded given the goals of clinical scholarship is warranted. © 2016 John Wiley & Sons Ltd.

  5. Classification and clinical assessment

    Directory of Open Access Journals (Sweden)

    F. Cantini

    2012-06-01

    Full Text Available There are at least nine classification criteria for psoriatic arthritis (PsA that have been proposed and used in clinical studies. With the exception of the ESSG and Bennett rules, all of the other criteria sets have a good performance in identifying PsA patients. As the CASPAR criteria are based on a robust study methodology, they are considered the current reference standard. However, if there seems to be no doubt that they are very good to classify PsA patients (very high specificity, they might be not sensitive enough to diagnose patients with unknown early PsA. The vast clinical heterogeneity of PsA makes its assessment very challenging. Peripheral joint involvement is measured by 78/76 joint counts, spine involvement by the instruments used for ankylosing spondylitis (AS, dactylitis by involved digit count or by the Leeds dactylitis index, enthesitis by the number of affected entheses (several indices available and psoriasis by the Psoriasis Area and Severity Index (PASI. Peripheral joint damage can be assessed by a modified van der Heijde-Sharp scoring system and axial damage by the methods used for AS or by the Psoriatic Arthritis Spondylitis Radiology Index (PASRI. As in other arthritides, global evaluation of disease activity and severity by patient and physician and assessment of disability and quality of life are widely used. Finally, composite indices that capture several clinical manifestations of PsA have been proposed and a new instrument, the Psoriatic ARthritis Disease Activity Score (PASDAS, is currently being developed.

  6. BALANOPOSTHITIS: A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Raju

    2015-01-01

    Full Text Available INTRODUCTION: The inflammation of the non - keratinized epithelium of the glans penis (i.e., Balanities and that of prepuce (i.e., posthitis together comprise the term Balanoposthitis. AIMS AND OBJECTIVES: To determine the aetiological and p redisposing factors for the development of Balanoposthitis, and to know its relation with venereal and non - venereal disease, local and systemic precipitatin g factors. To know the prevalence of Balanoposthitis in STD clinic. Study design - retrospective study . MATERIALS AND METHODS: The study material consists of 75 cases of balanoposthitis attending out - patient department Skin & STD clinic during a period exten din g from Feb, 1998 to Feb, 1999 . CRITERIA FOR SELECTION OF A CASE: Only those cases which have a history of redness of glans or mucous surface of prepuce, with or without genital discharge or ulcer on glans or mucosal surface of prepuce with or without discharge or growth on the penis or fissuring of fore skin were selected for the study. RESULTS: Incidence of balanoposthitis during the period from Feb. 98 to Feb.99 was – 11.53%, out of 650 new STD cases. It was observed that maximum number of pat i ents w as in the 21 - 30 age group (33.34%. The next predominant groups affected were 17 - 20 & 31 - 40 age group (20% each. The third most common age group affected was 41 - 50 (16%. In this study 69 patients (92% who presented with balanoposthitis of whatever cause were found to be uncircumcised, only 6 cases (8% were found to be circumcised. Most cases who presented with balanoposthitis gave a history of exposure to STD risk. CONCLUSIONS: Balanoposthitis is very commonly encountered condition in the STD clinics wi th a multi factorial aetiology. Infective causes dominated over the other possible causes, and 30% of the candidial infection had diabetes mellitus as a predisposing factor.

  7. Gateways to clinical trials.

    Science.gov (United States)

    Bayés, M; Rabasseda, X; Prous, J R

    2007-12-01

    Gateways to Clinical Trials are a guide to the most recent clinical trials in current literature and congresses. The data in the following tables has been retrieved from the Clinical Trials Knowledge Area of Prous Science Intergrity, the drug discovery and development portal, http://integrity.prous.com. This issue focuses on the following selection of drugs: 249553, 2-Methoxyestradiol; Abatacept, Adalimumab, Adefovir dipivoxil, Agalsidase beta, Albinterferon alfa-2b, Aliskiren fumarate, Alovudine, Amdoxovir, Amlodipine besylate/atorvastatin calcium, Amrubicin hydrochloride, Anakinra, AQ-13, Aripiprazole, AS-1404, Asoprisnil, Atacicept, Atrasentan; Belimumab, Bevacizumab, Bortezomib, Bosentan, Botulinum toxin type B, Brivaracetam; Catumaxomab, Cediranib, Cetuximab, cG250, Ciclesonide, Cinacalcet hydrochloride, Curcumin, Cypher; Darbepoetin alfa, Denosumab, Dihydrexidine; Eicosapentaenoic acid/docosahexaenoic acid, Entecavir, Erlotinib hydrochloride, Escitalopram oxalate, Etoricoxib, Everolimus, Ezetimibe; Febuxostat, Fenspiride hydrochloride, Fondaparinux sodium; Gefitinib, Ghrelin (human), GSK-1562902A; HSV-tk/GCV; Iclaprim, Imatinib mesylate, Imexon, Indacaterol, Insulinotropin, ISIS-112989; L-Alanosine, Lapatinib ditosylate, Laropiprant; Methoxy polyethylene glycol-epoetin-beta, Mipomersen sodium, Motexafin gadolinium; Natalizumab, Nimotuzumab; OSC, Ozarelix; PACAP-38, Paclitaxel nanoparticles, Parathyroid Hormone-Related Protein-(1-36), Pasireotide, Pegfilgrastim, Peginterferon alfa-2a, Peginterferon alfa-2b, Pemetrexed disodium, Pertuzumab, Picoplatin, Pimecrolimus, Pitavastatin calcium, Plitidepsin; Ranelic acid distrontium salt, Ranolazine, Recombinant human relaxin H2, Regadenoson, RFB4(dsFv)-PE38, RO-3300074, Rosuvastatin calcium; SIR-Spheres, Solifenacin succinate, Sorafenib, Sunitinib malate; Tadalafil, Talabostat, Taribavirin hydrochloride, Taxus, Temsirolimus, Teriparatide, Tiotropium bromide, Tipifarnib, Tirapazamine, Tocilizumab; UCN-01, Ularitide

  8. Gateways to clinical trials.

    Science.gov (United States)

    Bayés, M; Rabasseda, X; Prous, J R

    2005-04-01

    Gateways to Clinical Trials is a guide to the most recent clinical trials in current literature and congresses. The data in the following tables has been retrieved from the Clinical Trials Knowledge Area of Prous Science Integrity, the drug discovery and development portal, http://integrity. prous.com. This issue focuses on the following selection of drugs: ABX-IL-8, Acclaim, adalimumab, AGI-1067, alagebrium chloride, alemtuzumab, Alequel, Androgel, anti-IL-12 MAb, AOD-9604, aripiprazole, atomoxetine hydrochloride; Biphasic insulin aspart, bosentan, botulinum toxin type B, bovine lactoferrin, brivudine; Cantuzumab mertansine, CB-1954, CDB-4124, CEA-TRICOM, choriogonadotropin alfa, cilansetron, CpG-10101, CpG-7909, CTL-102, CTL-102/CB-1954; DAC:GRF, darbepoetin alfa, davanat-1, decitabine, del-1 Genemedicine, dexanabinol, dextofisopam, dnaJP1, dronedarone hydrochloride, dutasteride; Ecogramostim, eletriptan, emtricitabine, EPI-hNE-4, eplerenone, eplivanserin fumarate, erlotinib hydrochloride, ertapenem sodium, escitalopram oxalate, esomeprazole magnesium, etoricoxib, ezetimibe; Falecalcitriol, fingolimod hydrochloride; Gepirone hydrochloride; HBV-ISS, HSV-2 theracine, human insulin; Imatinib mesylate, Indiplon, insulin glargine, ISAtx-247; L612 HuMAb, levodopa/carbidopa/entacapone, lidocaine/prilocaine, LL-2113AD, lucinactant, LY-156735; Meclinertant, metelimumab, morphine hydrochloride, morphine-6-glucuronide; Natalizumab, nimotuzumab, NX-1207, NYVAC-HIV C; Omalizumab, onercept, osanetant; PABA, palosuran sulfate, parathyroid hormone (human recombinant), parecoxib sodium, PBI-1402, PCK-3145, peginterferon alfa-2a, peginterferon alfa-2b, peginterferon alfa-2b/ribavirin, pemetrexed disodium, pimecrolimus, PINC, pregabalin; Ramelteon, rasagiline mesilate, rasburicase, rimonabant hydrochloride, RO-0098557, rofecoxib, rosiglitazone maleate/metformin hydrochloride; Safinamide mesilate, SHL-749, sitaxsentan sodium, sparfosic acid, SprayGel, squalamine, St. John's Wort

  9. Understanding Oracle Clinical

    CERN Document Server

    Johnson, Joan

    2007-01-01

    This Short Cut is written to assist you, an Oracle Clinical Developer, with many of the tasks and decisions you may encounter on an occasional basis. These tasks involve study setup and maintenance, account maintenance, handling discrepancies, preparing data sets for analysis, batch-loading data, altering system-level settings and defining standard processes. A working knowledge of screen setup and procedure coding is assumed. Remote Data Capture (RDC), which moves data entry from the CRO or pharmaceutical company to the sites, is fast becoming the preferred way to gather and clean data for

  10. Clinical cognition and embodiment.

    Science.gov (United States)

    Paley, John

    2004-01-01

    I first identify two different distinctions: between Cartesian cognition and embodied cognition, and between calculative rationality and intuitive know-how. I then suggest that, in the nursing literature, these two distinctions are run together, to create an opposition between 'Cartesian rationality' and 'embodied know-how'. However, it is vital to keep the two distinctions apart, because 'embodied knowing' is very frequently rational. In separating the idea of embodied cognition from non-rational intuition, I show how 'embodiment' leads to the concepts of distributed cognition and distributed expertise. This has extensive and important implications for how we understand clinical cognition in nursing.

  11. Tianeptine - A Clinical Review.

    Directory of Open Access Journals (Sweden)

    More Patil Vidita

    2016-06-01

    Full Text Available Depression is a wide spread disorder. The development of effective pharmacotherapy for major depression is important because it is such a widespread and debilitating mental disorder. The following review is based on the preclinical and clinical studies carried out on Tianeptine, an atypical antidepressant that lowers the adverse effects of stress on brain and memory. It is one of the many drugs being tested these days in the market as nootropics; it is presented as a “Smart Drug”. These are believed to be of low-risk and work to improve, enhance, or repair damage done to the brain via injury or disease.

  12. Clinical thinking in psychiatry.

    Science.gov (United States)

    Wells, Lloyd A

    2015-06-01

    I discuss the lack of precision in the term 'clinical reasoning' and its relationship to evidence-based medicine and critical thinking. I examine critical thinking skills, their underemphasis in medical education and successful attempts to remediate them. Evidence-based medicine (and evidence-based psychiatry) offer much but are hampered by the ubiquity and flaws of meta-analysis. I explore views of evidence-based medicine among psychiatry residents, as well as capacity for critical thinking in residents before and after a course in philosophy. I discuss decision making by experienced doctors and suggest possible futures of this issue. © 2015 John Wiley & Sons, Ltd.

  13. Clinical trials in India.

    Science.gov (United States)

    Maiti, Rituparna; M, Raghavendra

    2007-07-01

    The concept of outsourcing for the development and global studies on new drugs has become widely accepted in the pharmaceutical industry due to its cost and uncertainty. India is going to be the most preferred location for contract pharma research and development due to its huge treatment naïve population, human resources, technical skills, adoption/amendment/implementation of rules/laws by regulatory authorities, and changing economic environment. But still 'miles to go' to fulfill the pre-requisites to ensure India's success. In spite of all the pitfalls, the country is ambitious and optimist to attract multinational pharmaceutical companies to conduct their clinical trials in India.

  14. Clinical neurogenetics: friedreich ataxia.

    Science.gov (United States)

    Collins, Abigail

    2013-11-01

    Friedreich ataxia is the most common autosomal recessive ataxia. It is a progressive neurodegenerative disorder, typically with onset before 20 years of age. Signs and symptoms include progressive ataxia, ascending weakness and ascending loss of vibration and joint position senses, pes cavus, scoliosis, cardiomyopathy, and arrhythmias. There are no disease-modifying medications to either slow or halt the progression of the disease, but research investigating therapies to increase endogenous frataxin production and decrease the downstream consequences of disrupted iron homeostasis is ongoing. Clinical trials of promising medications are underway, and the treatment era of Friedreich ataxia is beginning. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Clinical neurogenetics: stroke.

    Science.gov (United States)

    Rost, Natalia S

    2013-11-01

    Understanding the genetic architecture of cerebrovascular disease holds promise of novel stroke prevention strategies and therapeutics that are both safe and effective. Apart from a few single-gene disorders associated with cerebral ischemia or intracerebral hemorrhage, stroke is a complex genetic phenotype that requires careful ascertainment and robust association testing for discovery and validation analyses. The recently uncovered shared genetic contribution between clinically manifest stroke syndromes and closely related intermediate cerebrovascular phenotypes offers effective and efficient approaches to complex trait analysis. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Elastography in clinical practice.

    Science.gov (United States)

    Barr, Richard G

    2014-11-01

    Elastography is a new technique that evaluates tissue stiffness. There are two elastography methods, strain and shear wave elastography. Both techniques are being used to evaluate a wide range of applications in medical imaging. Elastography of breast masses and prostates have been shown to have high accuracy for characterizing masses and can significantly decrease the need for biopsies. Shear wave elastography has been shown to be able to detect and grade liver fibrosis and may decrease the need for liver biopsy. Evaluation of other organs is still preliminary. This article reviews the principles of elastography and its potential clinical applications. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Comfrey: a clinical overview.

    Science.gov (United States)

    Staiger, Christiane

    2012-10-01

    Comfrey has a centuries-old tradition as a medicinal plant. Today, multiple randomized controlled trials have demonstrated the efficacy and safety of comfrey preparations for the topical treatment of pain, inflammation and swelling of muscles and joints in degenerative arthritis, acute myalgia in the back, sprains, contusions and strains after sports injuries and accidents, also in children aged 3 or 4 and over. This paper provides information on clinical trials and non-interventional studies published on comfrey to date and further literature, substantiating the fact that topical comfrey preparations are a valuable therapy option for the treatment of painful muscle and joint complaints. Copyright © 2012 John Wiley & Sons, Ltd.

  18. Communities of clinical practice: the social organization of clinical learning.

    Science.gov (United States)

    Egan, Tony; Jaye, Chrystal

    2009-01-01

    The social organization of clinical learning is under-theorized in the sociological literature on the social organization of health care. Professional scopes of practice and jurisdictions are formally defined by professional principles and standards and reflected in legislation; however, these are mediated through the day-to-day clinical activities of social groupings of clinical teams. The activities of health service providers typically occur within communities of clinical practice. These are also major sites for clinical curriculum delivery, where clinical students learn not only clinical skills but also how to be health professionals. In this article, we apply Wenger's model of social learning within organizations to curriculum delivery within a health service setting. Here, social participation is the basis of learning. We suggest that it offers a powerful framework for recognizing and explaining paradox and incongruence in clinical teaching and learning, and also for recognizing opportunities, and devising means, to add value to students' learning experiences.

  19. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian

    2002-01-01

    , and single clinics. Accordingly, there is an urgent need to improve this situation. Guidelines for Good Clinical (Research) Practice, conduct of more trials as multicentre trials, The Consort Statement, and The Cochrane Collaboration may all help in the application of the best research evidence in clinical......Evidence-based medicine combines the patient's preferences with clinical experience and the best research evidence. Randomized clinical trials are considered the most valid research design for evaluating health-care interventions. However, empirical research shows that intervention effects may...... practice. By investments in education, applied research, and The Cochrane Collaboration, evidence-based medicine may form a stronger basis for clinical practice....

  20. Critical thinking versus clinical reasoning versus clinical judgment: differential diagnosis.

    Science.gov (United States)

    Victor-Chmil, Joyce

    2013-01-01

    Concepts of critical thinking, clinical reasoning, and clinical judgment are often used interchangeably. However, they are not one and the same, and understanding subtle difference among them is important. Following a review of the literature for definitions and uses of the terms, the author provides a summary focused on similarities and differences in the processes of critical thinking, clinical reasoning, and clinical judgment and notes suggested methods of measuring each.

  1. Construction of ethics in clinical research: clinical trials registration

    OpenAIRE

    C. A. Caramori

    2007-01-01

    Scientific development that has been achieved through decades finds in clinical research a great possibility of translating findings to human health application. Evidence given by clinical trials allows everyone to have access to the best health services. However, the millionaire world of pharmaceutical industries has stained clinical research with doubt and improbability. Study results (fruits of controlled clinical trials) and scientific publications (selective, manipulated and with wrong c...

  2. [Maraviroc: clinical trials results].

    Science.gov (United States)

    Chidiac, C; Katlama, C; Yeni, P

    2008-03-01

    Just over a decade after identification of chemokine receptors CCR5 and CXCR4 as coreceptors for HIV, maraviroc (Celsentri), the first CCR5 antagonist, has recently obtained its Marketing Authorization in the United States and Europe, for treatment of treatment-experienced adult patients infected with only CCR5-tropic HIV-1 detectable. CCR5 antagonists, after fusion inhibitor enfuvirtide available since 2003, also belong to entry inhibitors. These molecules, unlike previous antiretrovirals, do not target the virus but its target cell by blocking viral penetration. Maraviroc has shown its clinical efficacy in patients failing other antiretroviral classes. Its safety profile was similar to placebo in two large phase III trials. However, careful assessment of both hepatic and immunologic safety of this new therapeutic class is needed. Viral tropism testing has to be investigated before using maraviroc in the clinic, because CCR5 antagonists are not active against CXCR4 viruses. For the moment indicated for the treatment-experienced patient population, maraviroc could in the future benefit to other types of patients, depending on ongoing trials results.

  3. Computerizing clinical practice guidelines

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application and comp......It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application...... is comprised by fieldwork in three oncology departments and a case study of advanced life support. Although close to all patients within oncology are treated according to a CPG, I found limited application of physical CPGs and web-based CPG portals. However, I found comprehensive application of activity...... of the business strategic aims, and 3) analysis and formalization of CPGs. This will imply orchestration of design teams with competencies from a wide array of disciplines such as health practice, business management, knowledge management and information systems....

  4. Assuring Quality Control of Clinical Education in Multiple Clinical Affiliates.

    Science.gov (United States)

    Davis, Judith A.

    A plan was developed to assure equivalency of clinical education among the medical laboratory technician (MLT) programs affiliated with Sandhills Community College. The plan was designed by faculty to monitor the quality of clinical courses offered by the clinical affiliates. The major strategies were to develop competencies, slide/tape modules, a…

  5. Opioid detoxification : from controlled clinical trial to clinical practice

    NARCIS (Netherlands)

    Dijkstra, Boukje A G; De Jong, Cor A J; Wensing, Michel; Krabbe, Paul F M; van der Staak, Cees P F

    2010-01-01

    Controlled clinical trials have high internal validity but suffer from difficulties in external validity. This study evaluates the generalizability of the results of a controlled clinical trial on rapid detoxification in the everyday clinical practice of two addiction treatment centers. The results

  6. Construction of ethics in clinical research: clinical trials registration

    Directory of Open Access Journals (Sweden)

    C. A. Caramori

    2007-01-01

    Full Text Available Scientific development that has been achieved through decades finds in clinical research a great possibility of translating findings to human health application. Evidence given by clinical trials allows everyone to have access to the best health services. However, the millionaire world of pharmaceutical industries has stained clinical research with doubt and improbability. Study results (fruits of controlled clinical trials and scientific publications (selective, manipulated and with wrong conclusions led to an inappropriate clinical practice, favoring the involved economic aspect. In 2005, the International Committee of Medical Journal Editors (ICMJE, supported by the World Association of Medical Editors, started demanding as a requisite for publication that all clinical trials be registered at the database ClinicalTrials.gov. In 2006, the World Health Organization (WHO created the International Clinical Trial Registry Platform (ICTRP, which gathers several registry centers from all over the world, and required that all researchers and pharmaceutical industries register clinical trials. Such obligatory registration has progressed and will extend to all scientific journals indexed in all worldwide databases. Registration of clinical trials means another step of clinical research towards transparency, ethics and impartiality, resulting in real evidence to the forthcoming changes in clinical practice as well as in the health situation.

  7. Clinical presentation of thyroid cancer

    International Nuclear Information System (INIS)

    Samuel, A.M.; Shah, D.H.

    1999-01-01

    The clinical manifestation of thyroid cancer (TC) as seen at the Nuclear Medicine Department, where the patients investigated prior to diagnosis of disease are clinically suspected to harbor malignancy and mostly referred for scintigraphic investigations are presented

  8. Clinical Investigator Inspector List (CLIIL)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Clinical Investigator Inspection List (CLIIL) contains names, addresses, and other pertinent information gathered from inspections of clinical investigators who...

  9. Clinical Cancer Genetics and Prevention

    Science.gov (United States)

    Olufunmilayo F. Olopade MD, FACP, Professor of Medicine and Human Genetics and Director of the Cancer Risk Clinic Department of Medicine, BSD Section of Hematology/Oncology University of Chicago, presented "Clinical Cancer Genetics and Prevention".

  10. Nigerian Journal of Clinical Practice

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... The Nigerian Journal of Clinical Practice is the official publication of the Medical ... Its purpose is to promote clinical and academic excellence in Medicine and Dentistry and allied sciences.

  11. Gateways to clinical trials.

    Science.gov (United States)

    Bayés, M; Rabasseda, X; Prous, J R

    2006-10-01

    Gateways to Clinical Trials are a guide to the most recent clinical trials in current literature and congresses. The data the following tables have been retrieved from the Clinical Trials Knowledge Area of Prous Science Integrity, the drug discovery and development portal, http://integrity.prous.com. This issues focuses on the following selection of drugs: (-)-Epigallocatechin gallate, (-)-gossypol, 2-deoxyglucose, 3,4-DAP, 7-monohydroxyethylrutoside; Ad5CMV-p53, adalimumab, adefovir dipivoxil, ADH-1, alemtuzumab, aliskiren fumarate, alvocidib hydrochloride, aminolevulinic acid hydrochloride, aminolevulinic acid methyl ester, amrubicin hydrochloride, AN-152, anakinra, anecortave acetate, antiasthma herbal medicine intervention, AP-12009, AP-23573, apaziquone, aprinocarsen sodium, AR-C126532, AR-H065522, aripiprazole, armodafinil, arzoxifene hydrochloride, atazanavir sulfate, atilmotin, atomoxetine hydrochloride, atorvastatin, avanafil, azimilide hydrochloride; Bevacizumab, biphasic insulin aspart, BMS-214662, BN-83495, bortezomib, bosentan, botulinum toxin type B; Caspofungin acetate, cetuximab, chrysin, ciclesonide, clevudine, clofarabine, clopidogrel, CNF-1010, CNTO-328, CP-751871, CX-717, Cypher; Dapoxetine hydrochloride, darifenacin hydrobromide, dasatinib, deferasirox, dextofisopam, dextromethorphan/quinidine sulfate, diclofenac, dronedarone hydrochloride, drotrecogin alfa (activated), duloxetine hydrochloride, dutasteride; Edaravone, efaproxiral sodium, emtricitabine, entecavir, eplerenone, epratuzumab, erlotinib hydrochloride, escitalopram oxalate, etoricoxib, ezetimibe, ezetimibe/simvastatin; Finrozole, fipamezole hydrochloride, fondaparinux sodium, fulvestrant; Gabapentin enacarbil, gaboxadol, gefitinib, gestodene, ghrelin (human); Human insulin, human papillomavirus vaccine; Imatinib mesylate, immunoglobulin intravenous (human), indiplon, insulin detemir, insulin glargine, insulin glulisine, intranasal insulin, istradefylline, i.v. gamma

  12. Is a clinical sociolinguistics possible?

    Science.gov (United States)

    Ball, M J

    1992-01-01

    This paper considers the idea of developing a clinical sociolinguistics. Various areas of the field are examined, and the importance of the 'core' area of the correlation of non-linguistic variables with linguistic variables stressed. Issues concerning language and class, region, sex, age and context of utterance are investigated, together with the implications for clinical linguistics. Finally, the difficulty of integrating such issues into clinical assessment is explored, and a tentative step forward suggested along the lines of a 'clinical sociolinguistic checklist'.

  13. Improvement of Clinical Skills through Pharmaceutical Education and Clinical Research.

    Science.gov (United States)

    Ishizaki, Junko

    2017-01-01

    Professors and teaching staff in the field of pharmaceutical sciences should devote themselves to staying abreast of relevant education and research. Similarly those in clinical pharmacies should contribute to the advancement of pharmaceutical research and the development of next generation pharmacists and pharmaceuticals. It is thought that those who work in clinical pharmacies should improve their own skills and expertise in problem-finding and -solving, i.e., "clinical skills". They should be keen to learn new standard treatments based on the latest drug information, and should try to be in a position where collecting clinical information is readily possible. In the case of pharmacists in hospitals and pharmacies, they are able to aim at improving their clinical skills simply through performing their pharmaceutical duties. On the other hand, when a pharmaceutical educator aims to improve clinical skills at a level comparable to those of clinical pharmacists, it is necessary to devote or set aside considerable time for pharmacist duties, in addition to teaching, which may result in a shortage of time for hands-on clinical practice and/or in a decline in the quality of education and research. This could be a nightmare for teaching staff in clinical pharmacy who aim to take part in such activities. Nonetheless, I believe that teaching staff in the clinical pharmacy area could improve his/her clinical skills through actively engaging in education and research. In this review, I would like to introduce topics on such possibilities from my own experiences.

  14. Physiotherapy clinical educators' perceptions and experiences of clinical prediction rules.

    Science.gov (United States)

    Knox, Grahame M; Snodgrass, Suzanne J; Rivett, Darren A

    2015-12-01

    Clinical prediction rules (CPRs) are widely used in medicine, but their application to physiotherapy practice is more recent and less widespread, and their implementation in physiotherapy clinical education has not been investigated. This study aimed to determine the experiences and perceptions of physiotherapy clinical educators regarding CPRs, and whether they are teaching CPRs to students on clinical placement. Cross-sectional observational survey using a modified Dillman method. Clinical educators (n=211, response rate 81%) supervising physiotherapy students from 10 universities across 5 states and territories in Australia. Half (48%) of respondents had never heard of CPRs, and a further 25% had never used CPRs. Only 27% reported using CPRs, and of these half (51%) were rarely if ever teaching CPRs to students in the clinical setting. However most respondents (81%) believed CPRs assisted in the development of clinical reasoning skills and few (9%) were opposed to teaching CPRs to students. Users of CPRs were more likely to be male (pphysiotherapy (pStudents are unlikely to be learning about CPRs on clinical placement, as few clinical educators use them. Clinical educators will require training in CPRs and assistance in teaching them if students are to better learn about implementing CPRs in physiotherapy clinical practice. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  15. Developing Effective Clinical Trainers

    Directory of Open Access Journals (Sweden)

    Kevin Khamarko

    2012-05-01

    Full Text Available Continuing education and training provides a means to improve performance among health care professionals (HCP. Research shows, however, that continuing professional education activities have inconsistent effects on HCP competence, performance, and patient health outcomes. Furthermore, the trainer’s role as a facilitator of knowledge translation (KT has been understudied. To understand how clinical trainers support their trainees in translating what they learned into practice, we conducted 16 in-depth interviews with expert trainers. These interviews yielded a variety of KT-enhancing strategies, including tailoring training activities to their trainees’ needs. In addition, participants recommended trainers familiarize themselves with their trainees’ work environments, be able to identify their knowledge deficits, and devote time to provide trainees with post-training support. Creating an effective training, one that leads to transfer, requires active planning, communication, and command of the training topic by skilled trainers.

  16. Clinical nihilism in neuroemergencies.

    Science.gov (United States)

    Hemphill, J Claude; White, Douglas B

    2009-02-01

    Mortality and morbidity remain high from neurologic emergencies, such as acute stroke, traumatic brain injury, and hypoxic-ischemic encephalopathy after cardiac arrest. Decisions regarding initial aggressiveness of care must be made at the time of presentation, and perceived prognosis is often used as part of this decision-making process. These decisions are predicated on the accuracy of early outcome prediction, however. Decisions to limit treatment early after neuroemergencies must be balanced with avoidance of self-fulfilling prophecies of poor outcome attributable to clinical nihilism. This article examines the role of prognostication early after neuroemergencies, the potential impact of early treatment limitations, and how these may relate to communication with patients and surrogate decision makers in the context of these acute neurologic events.

  17. The Carle Clinic.

    Science.gov (United States)

    Schraeder, C; Britt, T

    1997-03-01

    Confronting the challenge of effective, efficient health care for the elderly has led to many variations in service delivery modalities. The approach employed by the Community Nursing Organization (CNO) is based on nurse coordinated care. Nurses are integrally involved in the authorization, coordination, evaluation and payment of services. The nursing role encompasses case management, including coordination of non-CNO covered services as well as those provided through the capitated payment schedule. Thus, in addition to authorizing CNO services, the nurse also may coordinate services such as physician visits, home repair, transportation, respite services and home-delivered meals, even though they are not covered financially under the auspices of the CNO. Preliminary findings indicate that this model may be successful clinically and financially by determining and utilizing an appropriate mix, intensity and duration of services.

  18. Morality in clinical space

    DEFF Research Database (Denmark)

    Laursen, Sara Seerup; Dehlholm-Lambertsen, Birgitte; Stenager, Egon

    2018-01-01

    and health permeate the Western health care system and the discourses of ill individuals. The contribution of this article is to portray in ethnographic detail how such a cultural ethics manifests in practice and what implications this have for the treatment of young people with functional symptoms......, and the implications this has for the assessment and management of ill body-selves. Through an exposition of the general practice of the clinic and an investigation of two specific cases of youngsters, it is found that the assessment of symptoms and selves and the goals of treatment are informed by cultural ideals...... of 'the good self' and 'the good life' in which agency and work ethic - both pertaining to the notion of individual responsibility - figure as prevalent virtues. The study underpins the findings of other researchers who have found that ideals of individual autonomy and responsibility for own life...

  19. Asymptomatic proteinuria. Clinical significance.

    Science.gov (United States)

    Papper, S

    1977-09-01

    Patients with asymptomatic proteinuria have varied reasons for the proteinuria and travel diverse courses. In the individual with normal renal function and no systemic cause, ie, idiopathic asymptomatic proteinuria, the outlook is generally favorable. Microscopic hematuria probably raises some degree of question about prognosis. The kidney shows normal glomeruli, subtle changes, or an identifiable lesion. The initial approach includes a clinical and laboratory search for systemic disease, repeated urinalyses, quantitative measurements of proteinuria, determination of creatinine clearance, protein electrophoresis where indicated, and intravenous pyelography. The need for regularly scheduled follow-up evaluation is emphasized. Although the initial approach need not include renal biopsy, a decline in creatinine clearance, an increase in proteinuria, or both are indications for biopsy and consideration of drug therapy.

  20. Clinical Positioning Space

    DEFF Research Database (Denmark)

    Williams, Lars Peter Hedegaard; Christensen, Mette Krogh; Rytter, Carsten

    2014-01-01

    In this article, we present a case study of residents’ clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights...... and duties. Drawing from seven qualitative interviews and six days of observation, we investigate the residents’ social positioning and their conversations with patients or supervisors. Our focus is on how (a) relational shifts in authority depend on each situation and its participants; (b) storylines...... establish acts and positions and narratively frame what participants can expect from a medical consultation viewed as a social episode; and (c) the positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that residents and patients locate themselves in outpatient...

  1. Primary aldosteronism. Clinical management

    International Nuclear Information System (INIS)

    Grant, C.S.; Carpenter, P.; van Heerden, J.A.; Hamberger, B.

    1984-01-01

    We retrospectively reviewed the clinical features, methods of diagnosis and localization, and results of treatment in 105 patients with primary aldosteronism seen between 1969 and 1981. Coincident with the use of computed tomography (CT), 131 I-6-beta-iodomethyl norcholesterol scans (NP-59), and postural response studies, the study group was temporally divided into pre-1976 and post-1976 groups, and subdivided into groups with aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) due to bilateral adrenal hyperplasia. Our results indicate that aldosterone postural response studies and CT differentiate and localize APA and IHA reliably. Adrenalectomy is a safe and effective treatment for APA, whereas medical treatment alone is preferable for IHA

  2. Conducting clinical trials in Singapore.

    Science.gov (United States)

    Woo, K T

    1999-04-01

    All clinical trials in Singapore will now have to conform to the Medicines (Clinical Trials) Amended Regulations 1998 and the Singapore Good Clinical Practice (GCP) Guidelines 1998. The Medical Clinical Research Committee (MCRC) has been established to oversee the conduct of clinical drug trials in Singapore and together with the legislations in place, these will ensure that clinical trials conducted in Singapore are properly controlled and the well-being of trial subjects are safe guarded. All clinical drug trials require a Clinical Trial Certificate from the MCRC before the trial can proceed. The hospital ethics committee (EC) vets the application for a trial certificate before it is sent to MCRC. The drug company sponsoring the trial has to indemnify the trial investigators and the hospital for negligence arising from the trial. The MCRC, apart from ensuring the safety of trial subjects, has to provide continuing review of the clinical trial and monitors adverse events in the course of the trial. The EC will conduct continuing review of clinical trials. When a non-drug clinical trial is carried out, the EC will ensure that the proposed protocol addresses ethical concerns and meets regulatory requirements for such trials. There is great potential for pharmaceutical Research & Development (R&D) in Singapore. We must develop our skills and infrastructure in clinical trials to enable Singapore to be a regional hub for R&D of drugs in Asia.

  3. Maintenance of Clinical Expertise and Clinical Research by the Clinical Professors at Gifu Pharmaceutical University.

    Science.gov (United States)

    Tachi, Tomoya; Noguchi, Yoshihiro; Teramachi, Hitomi

    2017-01-01

    The clinical professors at Gifu Pharmaceutical University (GPU) provide pharmaceutical services at GPU Pharmacy, Gifu University Hospital, and Gifu Municipal Hospital to keep their clinical skills up-to-date; they also perform clinical research in collaboration with many clinical institutes. The Laboratory of Clinical Pharmacy is part of the Department of Pharmacy Practice and Science, to which the clinical professors belong, and is composed of three clinical professors (a professor, an associate professor, and an assistant professor). The professor administers the GPU Pharmacy as its director, while the associate professor and assistant professor provide pharmaceutical services to patients at Gifu Municipal Hospital, and also provide practical training for students in the GPU Pharmacy. Collectively, they have performed research on such topics as medication education for students, clinical communication education, and analysis of clinical big data. They have also conducted research in collaboration with clinical institutes, hospitals, and pharmacies. Here, we introduce the collaborative research between the Laboratory of Clinical Pharmacy and Gifu Municipal Hospital. These studies include "Risk factors contributing to urinary protein expression resulting from bevacizumab combination chemotherapy", "Hyponatremia and hypokalemia as risk factors for falls", "Economic evaluation of adjustments of levofloxacin dosage by dispensing pharmacists for patients with renal dysfunction", and "Effect of patient education upon discharge for use of a medication notebook on purchasing over-the-counter drugs and health foods". In this symposium, we would like to demonstrate one model of the association and collaborative research between these clinical professors and clinical institutes.

  4. Clinical Reasoning Terms Included in Clinical Problem Solving Exercises?

    Science.gov (United States)

    Musgrove, John L; Morris, Jason; Estrada, Carlos A; Kraemer, Ryan R

    2016-05-01

    Background Published clinical problem solving exercises have emerged as a common tool to illustrate aspects of the clinical reasoning process. The specific clinical reasoning terms mentioned in such exercises is unknown. Objective We identified which clinical reasoning terms are mentioned in published clinical problem solving exercises and compared them to clinical reasoning terms given high priority by clinician educators. Methods A convenience sample of clinician educators prioritized a list of clinical reasoning terms (whether to include, weight percentage of top 20 terms). The authors then electronically searched the terms in the text of published reports of 4 internal medicine journals between January 2010 and May 2013. Results The top 5 clinical reasoning terms ranked by educators were dual-process thinking (weight percentage = 24%), problem representation (12%), illness scripts (9%), hypothesis generation (7%), and problem categorization (7%). The top clinical reasoning terms mentioned in the text of 79 published reports were context specificity (n = 20, 25%), bias (n = 13, 17%), dual-process thinking (n = 11, 14%), illness scripts (n = 11, 14%), and problem representation (n = 10, 13%). Context specificity and bias were not ranked highly by educators. Conclusions Some core concepts of modern clinical reasoning theory ranked highly by educators are mentioned explicitly in published clinical problem solving exercises. However, some highly ranked terms were not used, and some terms used were not ranked by the clinician educators. Effort to teach clinical reasoning to trainees may benefit from a common nomenclature of clinical reasoning terms.

  5. Virtual colonoscopy: clinical application

    International Nuclear Information System (INIS)

    Laghi, A.

    2005-01-01

    Virtual colonoscopy (VC), also known as computed tomography Colonography (CTC), is a non-invasive test for the examination of the colon based on volumetric, thin-collimation CT acquisition of a cleansed and air-distended colon. The technique is easy, less labour-intensive than barium enema and conventional colonoscopy, and is inherently safer. Several studies demonstrate the ability of VC in the detection of colonic neoplastic lesions, not only large carcinomas, but also polyps. Currently, the most widely accepted clinical indication is incomplete or unsuccessful colonoscopy, which may be the result of redundant colon, patient intolerance to the procedure, spasm not resolving even with the use of spasmolytics, obstructing colo-rectal cancer. VC is also used to detect cancer in frail and immobile patients to avoid sedation during colonoscopy or the turning required during barium enema. The use of VC in patients under surveillance following colo-rectal cancer surgery is under investigation. Further studies are necessary in order to assess the cost-effectiveness of this approach. For colo-rectal cancer screening, a practical approach is to consider VC as a currently credible alternative screening method and as a reasonable alternative to the other colo-rectal cancer screening tests when a patient is unable or unwilling to undergo conventional colonoscopy. (orig.)

  6. Hyperthermia: clinical results

    International Nuclear Information System (INIS)

    Bicher, H.I.

    1982-01-01

    A large number of patients have now been entered into a phase I/II protocol to examine the effects of fractionated hyperthermia and radiation on tumor response. Included in the study were 11 different histologies with anatomical locations varying between peripheral and superficial metastases to deep-seated, solid tumors. Patients were treated with four fractions of microwave-induced hyperthermia (45.0 +- 0.5 0 C), each separated by intervals of 72 hours. Microwaves at frequencies of 915 MHz or 300 MHz were employed, Patients were given a one week rest following the first four treatments, following which a second series of four fractions were administered, again at 72 hour intervals. Each of these fractions consisted of a 400 rad dose of radiation followed within 20 min by hyperthermia (42.5 +- 5 0 C) for 1.5 hours. To date 121 fields have been treated by 82 patients. Total regression is seen in 65% of all cases, partial regression in 35% and no response is seen in only 5% of treatments. Adverse effects were rare. Site specific trials are currently in progress to study the feasibility of deep-seated heating with intracavitary antennae as well as to assess tumor response. In addition, a randomized trial to examine the clinical relevance of thermotolerance has been started

  7. Carnitine derivatives: clinical usefulness.

    Science.gov (United States)

    Malaguarnera, Mariano

    2012-03-01

    Carnitine and its derivatives are natural substances involved in both carbohydrate and lipid metabolism. This review summarizes the recent progress in the field in relation to the molecular mechanisms. The pool of different carnitine derivatives is formed by acetyl-L-carnitine (ALC), propionyl-L-carnitine (PLC), and isovaleryl-carnitine. ALC may have a preferential effect on the brain tissue. ALC represents a compound of great interest for its wide clinical application in various neurological disorders: it may be of benefit in treating Alzheimer's dementia, depression in the elderly, HIV infection, chronic fatigue syndrome, peripheral neuropathies, ischemia and reperfusion of the brain, and cognitive impairment associated with various conditions. PLC has been demonstrated to replenish the intermediates of the tricarboxylic acid cycle by the propionyl-CoA moiety, a greater affinity for the sarcolemmal carrier, peripheral vasodilator activity, a greater positive inotropism, and more rapid entry into myocytes. Most studies of the therapeutic use of PLC are focused on the prevention and treatment of ischemic heart disease, congestive heart failure, hypertrophic heart disease, and peripheral arterial disease. ALC and PLC are considered well tolerated without significant side-effects. A number of therapeutic effects possibly come from the interaction of carnitine and its derivatives with the elements of cellular membranes.

  8. Virtual colonoscopy: clinical application

    Energy Technology Data Exchange (ETDEWEB)

    Laghi, A. [Univ. of Rome La Sapienza, Polo Didattico Pontino, Latina (Italy)

    2005-11-15

    Virtual colonoscopy (VC), also known as computed tomography Colonography (CTC), is a non-invasive test for the examination of the colon based on volumetric, thin-collimation CT acquisition of a cleansed and air-distended colon. The technique is easy, less labour-intensive than barium enema and conventional colonoscopy, and is inherently safer. Several studies demonstrate the ability of VC in the detection of colonic neoplastic lesions, not only large carcinomas, but also polyps. Currently, the most widely accepted clinical indication is incomplete or unsuccessful colonoscopy, which may be the result of redundant colon, patient intolerance to the procedure, spasm not resolving even with the use of spasmolytics, obstructing colo-rectal cancer. VC is also used to detect cancer in frail and immobile patients to avoid sedation during colonoscopy or the turning required during barium enema. The use of VC in patients under surveillance following colo-rectal cancer surgery is under investigation. Further studies are necessary in order to assess the cost-effectiveness of this approach. For colo-rectal cancer screening, a practical approach is to consider VC as a currently credible alternative screening method and as a reasonable alternative to the other colo-rectal cancer screening tests when a patient is unable or unwilling to undergo conventional colonoscopy. (orig.)

  9. Pediatric DXA: clinical applications

    International Nuclear Information System (INIS)

    Binkovitz, Larry A.; Sparke, Paul; Henwood, Maria J.

    2007-01-01

    Normal bone mineral accrual requires adequate dietary intake of calcium, vitamin D and other nutrients; hepatic and renal activation of vitamin D; normal hormone levels (thyroid, parathyroid, reproductive and growth hormones); and neuromuscular functioning with sufficient stress upon the skeleton to induce bone deposition. The presence of genetic or acquired diseases and the therapies that are used to treat them can also impact bone health. Since the introduction of clinical DXA in pediatrics in the early 1990s, there has been considerable investigation into the causes of low bone mineral density (BMD) in children. Pediatricians have also become aware of the role adequate bone mass accrual in childhood has in preventing osteoporotic fractures in late adulthood. Additionally, the availability of medications to improve BMD has increased with the development of bisphosphonates. These factors have led to the increased utilization of DXA in pediatrics. This review summarizes much of the previous research regarding BMD in children and is meant to assist radiologists and clinicians with DXA utilization and interpretation. (orig.)

  10. Quantitative clinical radiobiology

    International Nuclear Information System (INIS)

    Bentzen, S.M.

    1993-01-01

    Based on a series of recent papers, a status is given of our current ability to quantify the radiobiology of human tumors and normal tissues. Progress has been made in the methods of analysis. This includes the introduction of 'direct' (maximum likelihood) analysis, incorporation of latent-time in the analyses, and statistical approaches to allow for the many factors of importance in predicting tumor-control probability of normal-tissue complications. Quantitative clinical radiobiology of normal tissues is reviewed with emphasis on fractionation sensitivity, repair kinetics, regeneration, latency, and the steepness of dose-response curves. In addition, combined modality treatment, functional endpoints, and the search for a correlation between the occurrence of different endpoints in the same individual are discussed. For tumors, quantitative analyses of fractionation sensitivity, repair kinetics, reoxygenation, and regeneration are reviewed. Other factors influencing local control are: Tumor volume, histopathologic differentiation and hemoglobin concentration. Also, the steepness of the dose-response curve for tumors is discussed. Radiobiological strategies for improving radiotherapy are discussed with emphasis on non-standard fractionation and individualization of treatment schedules. (orig.)

  11. ABDOMINAL TRAUMA- CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Vanaja Ratnakumari Billa

    2017-08-01

    Full Text Available BACKGROUND In the recent times there has been increased incidence of abdominal trauma cases due to several causes. Quick and prompt intervention is needed to decrease the mortality of the patients. So we conducted a study to assess the cause and the management of abdominal trauma cases in our institution. The aim of this study was to know the incidence of blunt and penetrating injuries and their causes, age and sex incidence, importance of various investigations, mode of treatment offered and post-operative complications. To study the cause of death and evolve better management. MATERIALS AND METHODS The present study comprises of patients admitted to and operated in various surgical units in the Department of Surgery at Government General Hospital, attached to Guntur Medical College Guntur, from August 2014 to October 2016. RESULTS Increase incidence seen in age group 20-29 years (30%. Male predominance 77.5%. Mechanism of injury–road traffic accidents 65%. Isolated organ injury–colon and rectum 40%. Other associated injuries–chest injuries with rib fractures 7.5%. Complications–wound infection 17.5%. Duration of hospital stay 8–14 days. Bowel injury management–closure of perforation 84.6%. Resection anastomosis 15.38%. CONCLUSION Thorough clinical examination, diagnostic paracentesis, plain X-ray erect abdomen and ultrasound proved to be very helpful in the diagnosis of intra-abdominal injuries. Spleen is the commonest organ involved in blunt trauma and colon is the commonly injured organ in penetrating abdominal trauma, many patients have associated extremity and axial skeleton injuries. With advances in diagnosis and intensive care technologies, most patients of solid visceral injuries with hemodynamic stability can be managed conservatively. Surgical site infection is the most common complication following surgery. The mortality is high; reason might be patient reaching the hospital late, high incidence of postoperative septic

  12. Justifying Clinical Nudges.

    Science.gov (United States)

    Gorin, Moti; Joffe, Steven; Dickert, Neal; Halpern, Scott

    2017-03-01

    The shift away from paternalistic decision-making and toward patient-centered, shared decision-making has stemmed from the recognition that in order to practice medicine ethically, health care professionals must take seriously the values and preferences of their patients. At the same time, there is growing recognition that minor and seemingly irrelevant features of how choices are presented can substantially influence the decisions people make. Behavioral economists have identified striking ways in which trivial differences in the presentation of options can powerfully and predictably affect people's choices. Choice-affecting features of the decision environment that do not restrict the range of choices or significantly alter the incentives have come to be known as "nudges." Although some have criticized conscious efforts to influence choice, we believe that clinical nudges may often be morally justified. The most straightforward justification for nudge interventions is that they help people bypass their cognitive limitations-for example, the tendency to choose the first option presented even when that option is not the best for them-thereby allowing people to make choices that best align with their rational preferences or deeply held values. However, we argue that this justification is problematic. We argue that, if physicians wish to use nudges to shape their patients' choices, the justification for doing so must appeal to an ethical and professional standard, not to patients' preferences. We demonstrate how a standard with which clinicians and bioethicists already are quite familiar-the best-interest standard-offers a robust justification for the use of nudges. © 2017 The Hastings Center.

  13. Clinical trials of homoeopathy.

    Science.gov (United States)

    Kleijnen, J; Knipschild, P; ter Riet, G

    1991-01-01

    OBJECTIVE--To establish whether there is evidence of the efficacy of homoeopathy from controlled trials in humans. DESIGN--Criteria based meta-analysis. Assessment of the methodological quality of 107 controlled trials in 96 published reports found after an extensive search. Trials were scored using a list of predefined criteria of good methodology, and the outcome of the trials was interpreted in relation to their quality. SETTING--Controlled trials published world wide. MAIN OUTCOME MEASURES--Results of the trials with the best methodological quality. Trials of classical homoeopathy and several modern varieties were considered separately. RESULTS--In 14 trials some form of classical homoeopathy was tested and in 58 trials the same single homoeopathic treatment was given to patients with comparable conventional diagnosis. Combinations of several homoeopathic treatments were tested in 26 trials; isopathy was tested in nine trials. Most trials seemed to be of very low quality, but there were many exceptions. The results showed a positive trend regardless of the quality of the trial or the variety of homeopathy used. Overall, of the 105 trials with interpretable results, 81 trials indicated positive results whereas in 24 trials no positive effects of homoeopathy were found. The results of the review may be complicated by publication bias, especially in such a controversial subject as homoeopathy. CONCLUSIONS--At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials. PMID:1825800

  14. NMR in clinical practice

    International Nuclear Information System (INIS)

    Smith, F.W.

    1987-01-01

    The development of NMR for clinical use has been complicated by a number of controversies, the largest of these being the question of what is the optimum field strength for proton imaging. Many workers believe that diagnostically useful images can only be produced at high field strength (i.e. 0.5 - 2.0 T), where in fact diagnostically useful images are made using field strengths of as low as 0.02 T. Because the method is more complex than X-ray CT, which relies on the measurement of only one parameter, tissue density, many new users have difficulty in selecting the correct imaging pulse sequence to provide the most useful image for diagnosis. NMR imaging pulse sequence may be selected to produce images of the proton density, T/sub 1/ or T/sub 2/ signals, or combinations of them. When this facility is used, images which are T/sub 1/ or T/sub 2/ weighted can be selected. Inversion-recovery sequences are more appropriate for imaging the abdomen where by selecting a short TR interval the signal from subcutaneous fat, which is the major cause of image artefact in abdominal imaging, is suppressed thereby improving image quality. The use of surface receiver coils, which are applied closely to the area of the body being examined is becoming more widespread and is of particular value when examining the orbits, facial structures, neck, breast, spine and limbs. The use of these coils together with a discussion of patient selection for NMR imaging, image interpretation and data storage follow

  15. Clinical pharmacology of homoharringtonine

    International Nuclear Information System (INIS)

    Savaraj, N.; Lu, K.; Dimery, I.; Feun, L.G.; Burgess, M.; Keating, M.; Loo, T.L.

    1986-01-01

    Clinical pharmacokinetics of homoharringtonine (HHT) were studied in eight patients who received uniformly labeled HHT at 3-4 mg/m2 (150 mu Ci) by continuous 6-hour infusion. The drug and metabolites were quantified by radiochemical and high-performance liquid chromatographic techniques. Computerized nonlinear least-square regression and curve stripping were used to characterize HHT and total [ 3 H]HHT equivalent pharmacokinetics. Unchanged HHT in the plasma declined biphasically, with an alpha-half-life of 0.5 +/- 0.1 hours and a beta-half-life of 9.3 +/- 1.4 hours. The total clearance of HHT was 177.4 +/- 27.7 ml X hour-1 X kg-1, and the apparent volume of distribution, estimated from the area under the drug concentration versus time curve, was 2.4 +/- 0.4 L X kg-1. Correspondingly, the total [ 3 H]HHT equivalent disappeared from the plasma in a triphasic manner. Compared with the pharmacokinetic parameters of unchanged HHT, the terminal half-life of total 3 H was 67.5 +/- 7.5 hours, 7.4 times longer; the total clearance was 30.9 +/- 3.1 ml X hour-1 X kg-1, 5.5 times slower; but the volume of distribution by area was 2.7 +/- 0.1 L X kg-1, nearly the same. The 72-hour cumulative urinary excretion of total tritium was 28.2% of the administered dose and only 38.3% of this resided in unchanged HHT. Thus, urinary excretion was not a major route of elimination of HHT. Moreover, HHT underwent extensive metabolism; one major and two minor unidentified products were detected in both plasma and urine

  16. Demystifying the reflective clinical journal

    International Nuclear Information System (INIS)

    Milinkovic, Danielle; Field, Nikki

    2005-01-01

    Student learning on clinical placement is a complex issue and cannot be defined solely by just doing things. Reflection during clinical practice is essential if the student is going to learn from the experience. Therefore it is important for educators to include as part of clinical education programs learning strategies that encourage reflection. The reflective clinical journal is an educational tool that is employed by the School of Medical Radiation Sciences at the University of Sydney to encourage reflection of undergraduate radiation therapy students whilst on clinical placement. This discussion paper explores the key concepts of reflection and the reflective clinical journal. Due to the paucity of information about this issue in radiation therapy the literature reviewed is from across all areas of the health sciences

  17. Clinical biochemistry education in Spain.

    Science.gov (United States)

    Queraltó, J M

    1994-12-31

    Clinical biochemistry in Spain was first established in 1978 as an independent specialty. It is one of several clinical laboratory sciences specialties, together with haematology, microbiology, immunology and general laboratory (Clinical analysis, análisis clinicos). Graduates in Medicine, Pharmacy, Chemistry and Biological Sciences can enter post-graduate training in Clinical Chemistry after a nation-wide examination. Training in an accredited Clinical Chemistry department is 4 years. A national committee for medical and pharmacist specialties advises the government on the number of trainees, program and educational units accreditation criteria. Technical staff includes nurses and specifically trained technologists. Accreditation of laboratories is developed at different regional levels. The Spanish Society for Clinical Biochemistry and Molecular Pathology (SECQ), the national representative in the IFCC, has 1600 members, currently publishes a scientific journal (Química Clinica) and a newsletter. It organizes a continuous education program, a quality control program and an annual Congress.

  18. Clinical governance and external audit.

    Science.gov (United States)

    Glazebrook, S G; Buchanan, J G

    2001-01-01

    This paper describes a model of clinical governance that was developed at South Auckland Health during the period 1995 to 2000. Clinical quality and safety are core objectives. A multidisciplinary Clinical Board is responsible for the development and publicising of sound clinical policies together with monitoring the effects of their implementation on quality and safety. The Clinical Board has several committees, including an organization-wide Continuous Quality Improvement Committee to enhance the explicit nature of the quality system in terms of structure, staff awareness and involvement, and to develop the internal audit system. The second stream stems from the Chief Medical Officer and clinical directors in a clinical management sense. The Audit Committee of the Board of Directors covers both clinical and financial audit. The reporting lines back to that committee are described and the role of the external auditor of clinical standards is explained. The aim has been to create a supportive culture where quality initiatives and innovation can flourish, and where the emphasis is not on censure but improvement.

  19. Clinical reasoning and critical thinking.

    Science.gov (United States)

    da Silva Bastos Cerullo, Josinete Aparecida; de Almeida Lopes Monteiro da Cruz, Diná

    2010-01-01

    This study identifies and analyzes nursing literature on clinical reasoning and critical thinking. A bibliographical search was performed in LILACS, SCIELO, PUBMED and CINAHL databases, followed by selection of abstracts and the reading of full texts. Through the review we verified that clinical reasoning develops from scientific and professional knowledge, is permeated by ethical decisions and nurses values and also that there are different personal and institutional strategies that might improve the critical thinking and clinical reasoning of nurses. Further research and evaluation of educational programs on clinical reasoning that integrate psychosocial responses to physiological responses of people cared by nurses is needed.

  20. LIMS and Clinical Data Management.

    Science.gov (United States)

    Chen, Yalan; Lin, Yuxin; Yuan, Xuye; Shen, Bairong

    2016-01-01

    In order to achieve more accurate disease prevention, diagnosis, and treatment, clinical and genetic data need extensive and systematically associated study. As one way to achieve precision medicine, a laboratory information management system (LIMS) can effectively associate clinical data in a macrocosmic aspect and genomic data in a microcosmic aspect. This chapter summarizes the application of the LIMS in a clinical data management and implementation mode. It also discusses the principles of a LIMS in clinical data management, as well as the opportunities and challenges in the context of medical informatics.