Prevalence of internet addiction and psychological factors in adolescents during the covid-19 pandemic / Prevalência de dependência da internet e fatores psicológicos em adolescentes durante a pandemia de covid-19 / Prevalencia de la adicción a internet y factores psicológicos en adolescentes durante la pandemia de la covid-19

Addictive behaviors related to Internet are becoming more common and this tool has been essential once it enables home office, entertainment, homeschooling, and easy access to information. Despite the easiness brought by technology, the exaggerated use has affected users in different ways, including in the development of psychiatric disorders. This study aimed to assess internet addiction, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), attention, impulsivity, and stress in 48 adolescents (26 young women and 22 young men), aged from 15 to 18 years, with a mean age of 16.74 (0.61), mostly students of public schools, during COVID-19, to investigate correlations between these variables according to sex and sociodemographic aspects. To assess the factors, the Internet Addiction Test (IAT); the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) Questionnaire ; the Depression, Anxiety, and Stress scale for brazilian adolescents (EDAE-A); the Barratt Impulsiveness Scale (BIS-11); and a sociodemographic questionnaire were applied. The data collection was performed in schools located in southern Brazil. The results indicated that 12 out of 48 adolescents were considered addicted to the Internet. Moreover, Internet addiction was a predictor of depression in regression analysis (p<0.001). In addition, participants classified as more addicted to the Internet scored lower averages in general attention (p<0.035) and higher averages in behavioral symptoms of inattention and ADHD (p<0.050), stress (p<0.003), anxiety (p<0.016), and depression (p<0.015), with effect sizes ranging from moderate to high. Therefore, the intense internet use by adolescents might cause psychological consequences such as depression in adolescents. Family support and professional intervention might help in the reduction of symptoms and consequences of internet addiction as well as in its prevention.(AU)

A dependência de internet é cada vez mais comum, pois essa ferramenta tem se tornado imprescindível, uma vez que possibilita home office, entretenimento, educação domiciliar e fácil acesso às informações. No entanto, o uso exagerado da tecnologia afeta os usuários de diversas formas, inclusive no desenvolvimento de transtornos psiquiátricos. Este estudo visou avaliar a dependência de internet, depressão, ansiedade, hiperatividade, atenção, impulsividade e estresse em 48 adolescentes (26 meninas e 22 meninos) de 15 a 18 anos, com idade média de 16,74 (0,61), estudantes de escolas públicas do Sul do Brasil durante a covid-19, para investigar correlações entre as variáveis anteriores de acordo com gênero e aspectos sociodemográficos. Para avaliar, aplicou-se o Internet Addiction Test (IAT), um teste de atenção, escala SNAP IV, escala de depressão, ansiedade e estresse para adolescentes (EDAE-A), escala de impulsividade de Barratt e um questionário sociodemográfico. Os resultados indicaram que 12 adolescentes foram considerados viciados em internet, e que a dependência desta foi preditora da depressão na análise de regressão (p < 0,001). Ainda, os participantes classificados como adictos tiveram médias mais baixas em atenção geral (p < 0,035) e mais altas em sintomas comportamentais de desatenção e hiperatividade (p < 0,050), estresse (p < 0,003), ansiedade (p < 0,016) e depressão (p < 0,015), com efeitos que variaram de moderado a alto. Portanto, o uso intenso da internet por adolescentes pode ter consequências psicológicas, como a depressão. Bom apoio familiar e intervenção profissional podem ajudar na redução dos sintomas e consequências, bem como na prevenção da dependência.(AU)

La adicción a Internet es cada vez más habitual, puesto que esta herramienta es esencial para el trabajo remoto, el entretenimiento, la educación domiciliar y el fácil acceso a la información. Sin embargo, su uso exagerado afecta a la vida de las personas de diferentes maneras, incluso en el desarrollo de trastornos psiquiátricos. El objetivo de este estudio fue evaluar la adicción a Internet, depresión, ansiedad, hiperactividad, atención, impulsividad y estrés en 48 adolescentes (26 muchachas y 22 muchachos), de entre 15 y 18 años, con una edad promedio de 16,74 (0,61), en su mayoría estudiantes de escuelas públicas del Sur de Brasil, durante la pandemia de la COVID-19, para investigar las correlaciones entre las variables mencionadas según género y aspectos sociodemográficos. Para evaluar los factores, se aplicaron el Test de Adicción a Internet (TAI), un test de atención, la escala SNAP IV, la Escala de Depresión, Ansiedad y Estrés para adolescentes (EDAE-A), la escala de impulsividad de Barratt y un cuestionario sociodemográfico. Los resultados indicaron que 12 adolescentes fueron considerados adictos a Internet, además, la adicción a Internet fue un predictor de la depresión en el análisis de regresión (p<0,001). Igualmente, los participantes clasificados como más adictos a Internet tuvieron promedios más bajos en atención general (p<0,035), y más altos en síntomas conductuales de falta de atención e hiperactividad (p<0,050), estrés (p<0,003), ansiedad (p<0,016) y depresión (p<0,015), con efectos que varían de moderado a alto. Por lo tanto, el uso intenso podría producir consecuencias psicológicas como la depresión en los adolescentes. Tener un buen apoyo familiar e intervención profesional puede ayudar a reducir los síntomas y las consecuencias de la adicción a Internet, así como prevenirla.(AU)

Simplified Assessment of the Index of Microvascular Resistance.

BACKGROUND: To validate a simplified invasive method for the calculation of the index of microvascular resistance (IMR). METHODS: This is a prospective, single-center study of patients with chronic coronary syndromes presenting with nonobstructive coronary artery disease. IMR was obtained using both intravenous (IV) adenosine and intracoronary (IC) papaverine. Each IMR measurement was obtained in duplicate. The primary objective was the agreement between IMR acquired using adenosine and papaverine. Secondary objectives include reproducibility of IMR and time required for the IMR measurement. RESULTS: One hundred and sixteen IMR measurements were performed in 29 patients. The mean age was 68.8 ± 7.24 years, and 27.6% was diabetics. IMR values were similar between papaverine and adenosine (17.7 ± 7.26 and 20.1 ± 8.6, p=0.25; Passing-Bablok coefficient A 0.58, 95% CI -2.42 to 3.53; coefficient B 0.90, 95% CI -0.74 to 1.07). The reproducibility of IMR was excellent with both adenosine and papaverine (ICC 0.78, 95% CI 0.63 to 0.88 and ICC 0.93, 95% CI 0.87 to 0.97). The time needed for microvascular assessment was significantly shortened by the use of IC papaverine (3.23 (2.84, 3.78) mins vs. 5.48 (4.94, 7.09) mins, p < 0.0001). CONCLUSION: IMR can be reliably measured using IC papaverine with similar results compared to intravenous infusion of adenosine with increased reproducibility and reduced procedural time. This approach simplifies the invasive assessment of the coronary microcirculation in the catheterization laboratory.

A Novel Method Enables General Pathologists to Create Web Dynamic Forms for Synoptic Tumor Reporting.

CONTEXT.­: Tumor reporting constitutes a significant daily task of pathologists. An efficient tumor-reporting methodology is thus vitally important. The Web dynamic form (WbDF) method offers a multitude of advantages over the prevailing transcription-mediated reporting method based on static-text checklists. However, its adaptation has been severely hampered for 2 decades by its costly needs to maintain a complex back-end system and to change the system for frequent updates of reporting content. OBJECTIVE.­: To overcome these 2 obstacles with a serverless Web platform that enables users to create, customize, use, and download WbDFs as synoptic templates for structured tumor reporting. DESIGN.­: Deploy ReactJS as a Web platform. Create form components in JavaScript Object Notation files. Use JavaScript Object Notation files to make WbDFs on the Web platform. Use the WbDFs to generate final pathology reports. RESULTS.­: Ordinary users (pathologists) can create/customize reporting templates as WbDFs on the Web platform. The WbDF can be used to make a pathology report and stored/shared like ordinary document files. There is no back-end system to change, nor a requirement for computer programming skills. CONCLUSIONS.­: This strategy eliminates the need for a complex back-end system and the associated cost when updating tumor-reporting standards, making it possible to adopt the WbDF method without the technological drawbacks associated with content updates. It also opens a new field of how the tumor-reporting system should be organized, updated, and implemented.

Update of the simplified criteria for autoimmune hepatitis: Evaluation of the methodology for immunoserological testing.

BACKGROUND & AIMS: The simplified criteria for the diagnosis of autoimmune hepatitis (AIH) include immunofluorescence testing (IFT) of antinuclear and smooth muscle autoantibodies (ANA and SMA) on rodent tissue sections. We aimed to establish scoring criteria for the implementation of ANA IFT on human epithelioma-2 (HEp-2) cells and ELISA-based testing. METHODS: ANA and SMA reactivity of 61 AIH sera and 72 non-alcoholic fatty liver disease controls were separately assessed on tissue sections and HEp-2 cells to compare the diagnostic value at increasing titers. A total of 113 patients with AIH at diagnosis and 202 controls from 3 European centers were assessed by IFT as well as 3 different commercially available ANA ELISA and 1 anti-F-actin ELISA. RESULTS: ANA assessment by IFT on liver sections had 83.6% sensitivity and 69.4% specificity for AIH at a titer of 1:40. On HEp-2 cells, sensitivity and specificity were 75.4% and 73.6%, respectively, at an adjusted titer of 1:160. Area under the curve (AUC) values of ANA ELISA ranged from 0.70-0.87, with ELISA coated with HEp-2 extracts in addition to selected antigens performing significantly better. SMA assessment by IFT had the highest specificity for the SMA-VG/T pattern and anti-microfilament reactivity on HEp-2 cells. ELISA-based anti-F-actin evaluation was a strong predictor of AIH (AUC 0.88) and performed better than SMA assessment by IFT (AUC 0.77-0.87). CONCLUSION: At adjusted cut-offs, both ANA IFT using HEp-2 cells and ELISA-based autoantibody evaluation for ANA and SMA are potential alternatives to tissue-based IFT for the diagnosis of AIH. LAY SUMMARY: Autoantibodies are a hallmark of autoimmune hepatitis and are traditionally tested for by immunofluorescence assays on rodent tissue sections. Herein, we demonstrate that human epithelioma cells can be used as a reliable substrate for immunofluorescence testing. ELISA-based testing is also a potentially reliable alternative for autoantibody assessment in autoimmune hepatitis. We propose the implementation of these testing methods into the simplified criteria for the diagnosis of autoimmune hepatitis.

A New Simplified Biplanar (0-90°) Fluoroscopic Puncture Technique for Percutaneous Nephrolithotomy. Reducing Fluoroscopy Without Ultrasound. Initial Experience and Outcomes.

OBJECTIVE: To present our simplified biplanar fluoroscopic puncture technique, its reduction in the fluoroscopic screening time as well as outcomes and the initial experience for percutaneous nephrolithotomy. METHODS: We performed a retrospective review of 136 patients operated with our simplified 0-90° puncture technique for percutaneous nephrolithotomy between 2015 and 2018. All patients were classified by stone complexity with Guy´s nephrolithometric stone score. The stone-free rate was evaluated by nonenhanced computerized tomography, and residual stones were defined as fragments ≥2 mm. Complications were divided according to the Clavien-Dindo classification. RESULTS: One hundred and thirty-six patients were operated with our puncture technique; 121 patients were performed in supine and 15 in the prone position. Fifty-one were men, and 85 were women with an overall mean age of 44.36 ± 13.23 years. The overall stone-free rate was 62.5%, and 83.8 % after an ancillary procedure. The mean fluoroscopy screening time was 69.47 ± 7.1 and 6 ± 4.1 seconds for the total surgical procedure and the percutaneous puncture, respectively. Complications were present in 25.7%, and no grade IV and V complications were present. CONCLUSION: Our first case series with the 0-90° simplified fluoroscopic puncture technique shows a similar stone-free rate and safety profile but a low fluoroscopic screening time compared to the most common previously reported fluoroscopic puncture techniques non-focused on low radiation protocols. Further studies are required to evaluate the reproducibility, external validation, and the learning curve of our simplified 0-90° technique.

Efeito da simplificação sintática sobre a compreensão de leitura de crianças do ensino fundamental / Effects of syntactic simplification on reading comprehension of Elementary School students

RESUMO Objetivo Investigar o efeito da estratégia de simplificação sintática de textos sobre o desempenho em compreensão leitora de escolares de 20 a 40 ano do ensino fundamental. Métodos Estudo transversal, analítico, caso controle. Participaram 112 escolares do ensino público, do 20 ao 40 ano escolar. Os participantes foram distribuídos em Grupo TO - expostos ao texto expositivo original e Grupo TS - expostos ao texto simplificado. Os grupos foram pareados segundo acurácia e não diferiram quanto à capacidade de compreensão leitora. O texto original foi submetido às seguintes modificações sintáticas: divisão de sentenças complexas, simplificação de marcadores discursivos, supressão de voz ativa e anáforas, inversão na ordem de cláusulas, com deslocamento da sentença principal para o início e utilização exclusiva da ordenação sujeito-verbo-objeto. Para atestar a simplificação, utilizou-se a ferramenta computadorizada CohMetrix-Port. A análise da compreensão por meio dos recontos dos textos lidos computou o total de ideias (centrais, detalhes) e de enlaces recontados. Resultados A análise comparativa dos grupos identificou diferenças quanto ao total de ideias centrais (U=1029,5, p=0,001), de detalhe (U=599,5, p=0,000) e total de ideias recontadas (U=1247,5, p=0,041), com melhor desempenho para o Grupo TS. A análise da escolaridade mostrou que o 30 e o 40 ano mais se beneficiaram da simplificação sintática. Conclusão A simplificação dos textos, atestada pelos parâmetros do CohMetrix-Port, produziu efeitos de facilitação sobre o processamento microestrutural do texto de escolares do 30 e 40 anos do ensino fundamental, promovendo maior retenção das ideias.

ABSTRACT Purpose To investigate the effects of Syntactic text simplification on the reading comprehension performance of Elementary School students. Methods Cross-sectional, analytical, case-control study. Study participants were 112 students regularly enrolled in the 2nd-4th grades of public Elementary Schools. Participants were divided into two groups: Group OT - students exposed to the original expository text and Group ST - students exposed to the simplified expository text. The groups were matched for accuracy and did not differ with respect to reading comprehension capacity. The simplified text was obtained by submitting the original text to the following syntactic modifications: separation of complex sentences, simplification of discursive markers, suppression of active voice and anaphora, inversion of clause order with displacement of the main clause to the beginning of the sentence, and exclusive use of the subject-verb-object order. Text simplification was verified using the Coh-Metrix-Port computational tool. Comprehension analysis through retell of the texts read determined the total of ideas (central and detailed) and retold links. Results Comparative analysis of the groups identified differences between the total of central, detailed and retold ideas, with the best performance observed in the Group ST. Students from 3rd and 4th grades benefitted the most from syntactic simplification. Conclusion Text syntactic simplification, verified by the Coh-Metrix-Port parameters, facilitated the micro-structural text processing of 3rd and 4th grade students, promoting greater retention of ideas.

Workarounds Are Routinely Used by Nurses-But Are They Ethical?

: Nurses regularly circumvent work systems they perceive to be flawed to provide more efficient or better care. If kept secret, however, such workarounds become ethically questionable, even when the nurse is trying to do the right thing. In this article, the author discusses how nurses can be creative problem solvers without resorting to practices that may be ethical in intent yet potentially harmful in their consequences.

[The synergy of radiology and CAD/CAM]. / De synergie van radiologie en CAD/CAM.

For treatment planning purposes, data acquired with cone-beam computer tomography and data from other three-dimensional imaging techniques can be combined in a single dataset. With the aid of this combined dataset extensive treatment planning and prosthetic solutions can be realised. The planning and production of the definitive prosthetic solution can then be accomplished using computer-aided design and computer-aided manufacturing technologies. These technological developments are expected to play an increasingly significant role for chair-side solutions.

The Effect of an Electronic Checklist on Critical Care Provider Workload, Errors, and Performance.

PURPOSE: The strategy used to improve effective checklist use in intensive care unit (ICU) setting is essential for checklist success. This study aimed to test the hypothesis that an electronic checklist could reduce ICU provider workload, errors, and time to checklist completion, as compared to a paper checklist. METHODS: This was a simulation-based study conducted at an academic tertiary hospital. All participants completed checklists for 6 ICU patients: 3 using an electronic checklist and 3 using an identical paper checklist. In both scenarios, participants had full access to the existing electronic medical record system. The outcomes measured were workload (defined using the National Aeronautics and Space Association task load index [NASA-TLX]), the number of checklist errors, and time to checklist completion. Two independent clinician reviewers, blinded to participant results, served as the reference standard for checklist error calculation. RESULTS: Twenty-one ICU providers participated in this study. This resulted in the generation of 63 simulated electronic checklists and 63 simulated paper checklists. The median NASA-TLX score was 39 for the electronic checklist and 50 for the paper checklist (P = .005). The median number of checklist errors for the electronic checklist was 5, while the median number of checklist errors for the paper checklist was 8 (P = .003). The time to checklist completion was not significantly different between the 2 checklist formats (P = .76). CONCLUSION: The electronic checklist significantly reduced provider workload and errors without any measurable difference in the amount of time required for checklist completion. This demonstrates that electronic checklists are feasible and desirable in the ICU setting.

Risk of infection due to medical interventions via central venous catheters or implantable venous access port systems at the middle port of a three-way cock: luer lock cap vs. luer access split septum system (Q-Syte).

BACKGROUND: Many cancer patients receive a central venous catheter or port system prior to therapy to assure correct drug administration. Even appropriate hygienic intervention maintenance carries the risk of contaminating the middle port (C-port) of a three-way cock (TWC), a risk that increases with the number of medical interventions. Because of the complexity of the cleaning procedure with disconnection and reconnection of the standard luer lock cap (referred as "intervention"), we compared luer lock caps with a "closed access system" consisting of a luer access split septum system with regard to process optimization (work simplification, process time), efficiency (costs) and hygiene (patient safety). METHODS: For determination of process optimization the workflow of an intervention according to the usual practice and risks was depicted in a process diagram. For determining the actual process costs, we analyzed use of material and time parameters per intervention and used the process parameters for programming the process into a simulation run (n = 1000) to determine the process costs as well as their differences (ACTUAL vs. NOMINAL) within the framework of a discrete event simulation.Additionally cultures were carried out at the TWC C-ports to evaluate possible contamination. RESULTS: With the closed access system, the mean working time of 5.5 minutes could be reduced to 2.97 minutes. The results for average process costs (labour and material costs per use) were 3.92 € for luer lock caps and 2.55 € for the closed access system. The hypothesis test (2-sample t-test, CI 0.95, p-value<0.05) confirmed the significance of the result.In 50 reviewed samples (TWC's), the contamination rate for the luer lock cap was 8% (4 out of 50 samples were positive), the contamination rate of the 50 samples with the closed access system was 0%.Possible hygienic risks (related to material, surroundings, staff handling) could be reduced by 65.38%. CONCLUSIONS: In the present research, the closed access system with a divided split septum was superior to conventional luer lock caps. The advantage of the closed access system lies in the simplified handling for staff, which results in a reduced risk of patient infection due to improved clinical hygiene.

Nurses' workarounds in acute healthcare settings: a scoping review.

BACKGROUND: Workarounds circumvent or temporarily 'fix' perceived workflow hindrances to meet a goal or to achieve it more readily. Behaviours fitting the definition of workarounds often include violations, deviations, problem solving, improvisations, procedural failures and shortcuts. Clinicians implement workarounds in response to the complexity of delivering patient care. One imperative to understand workarounds lies in their influence on patient safety. This paper assesses the peer reviewed empirical evidence available on the use, proliferation, conceptualisation, rationalisation and perceived impact of nurses' use of workarounds in acute care settings. METHODS: A literature assessment was undertaken in 2011-2012. Snowballing technique, reference tracking, and a systematic search of twelve academic databases were conducted to identify peer reviewed published studies in acute care settings examining nurses' workarounds. Selection criteria were applied across three phases. 58 studies were included in the final analysis and synthesis. Using an analytic frame, these studies were interrogated for: workarounds implemented in acute care settings by nurses; factors contributing to the development and proliferation of workarounds; the perceived impact of workarounds; and empirical evidence of nurses' conceptualisation and rationalisation of workarounds. RESULTS: The majority of studies examining nurses' workarounds have been published since 2008, predominantly in the United States. Studies conducted across a variety of acute care settings use diverse data collection methods. Nurses' workarounds, primarily perceived negatively, are both individually and collectively enacted. Organisational, work process, patient-related, individual, social and professional factors contribute to the proliferation of workarounds. Group norms, local and organisational culture, 'being competent', and collegiality influence the implementation of workarounds. CONCLUSION: Workarounds enable, yet potentially compromise, the execution of patient care. In some contexts such improvisations may be deemed necessary to the successful implementation of quality care, in others they are counterproductive. Workarounds have individual and cooperative characteristics. Few studies examine nurses' individual and collective conceptualisation and rationalisation of workarounds or measure their impact. The importance of displaying competency (image management), collegiality and organisational and cultural norms play a role in nurses' use of workarounds.

The traveling salesman problem in surgery: economy of motion for the FLS Peg Transfer task.

BACKGROUND: In the Peg Transfer task in the Fundamentals of Laparoscopic Surgery (FLS) curriculum, six peg objects are sequentially transferred in a bimanual fashion using laparoscopic instruments across a pegboard and back. There are over 268 trillion ways of completing this task. In the setting of many possibilities, the traveling salesman problem is one where the objective is to solve for the shortest distance traveled through a fixed number of points. The goal of this study is to apply the traveling salesman problem to find the shortest two-dimensional path length for this task. METHODS: A database platform was used with permutation application output to generate all of the single-direction solutions of the FLS Peg Transfer task. A brute-force search was performed using nested Boolean operators and database equations to calculate the overall two-dimensional distances for the efficient and inefficient solutions. The solutions were found by evaluating peg object transfer distances and distances between transfers for the nondominant and dominant hands. RESULTS: For the 518,400 unique single-direction permutations, the mean total two-dimensional peg object travel distance was 33.3 ± 1.4 cm. The range in distances was from 30.3 to 36.5 cm. There were 1,440 (0.28 %) of 518,400 efficient solutions with the minimized peg object travel distance of 30.3 cm. There were 8 (0.0015 %) of 518,400 solutions in the final solution set that minimized the distance of peg object transfer and minimized the distance traveled between peg transfers. Peg objects moved 12.7 cm (17.4 %) less in the efficient solutions compared to the inefficient solutions. CONCLUSIONS: The traveling salesman problem can be applied to find efficient solutions for surgical tasks. The eight solutions to the FLS Peg Transfer task are important for any examinee taking the FLS curriculum and for certification by the American Board of Surgery.

[Benchmarking surgical resources--a work sampling analysis at a German university hospital]. / Ärztliche Ressourcennutzung in der Chirurgie auf dem Prüfstand--eine Worksampling-Analyse an einer deutschen Universitätsklinik.

INTRODUCTION: Work densification caused by lack of young surgeons with increased clinical documentation keeps surgeons busy. It is proven by many studies that surgeons work significantly longer hours per week and deal with a larger amount of medical and non-medical documentation than staff members in conservative disciplines. The aim of the study was to investigate surgeons work distribution in a surgical university department and to evaluate by means of a work sampling analysis whether it can be standardised and slimmed down by systematic use of IT-supported, process-managed work-flow. In addition the data obtained are compared wuith those from other studies on similar topics. METHODS: Based on the results of an independent pilot observational study, 21 surgeons (14 residents, 7 staff surgeons) had to document over a 10-day period in a self-observation once in an hour their actual activity in a two dimensional matrix concerning medical activity (13 items) and patient contact (5 items). After the study, each physician had to estimate his/her own work distribution. Real percentages of the self-observation study were compared to the physicians' estimates of work distribution. IT-supported clinical pathways have been implemented since 2004 in our department. RESULTS: Over a ten-day evaluation period (1830 observation points), surgeons spent 30.2% of their activity in the operating theatre or on direct patient care. During 13.9% they were in meetings and they spent 10.8% of their time on documentation. Time needed for studying medical records (9.2%) and ward rounds (9.0%) ranged in a similar way. There was a significant accordance of estimated and real work distribution concerning the 5 most frequent daily activities. In only 14% there was no direct patient relationship. CONCLUSION: Application of work sampling analysis in surgery is a valid procedure for the evaluation of work flows in the course of personal observations. Surgeons working time in a hospital is limited. To achieve a maximum of direct patient care, clinical documentation has to be optimised by process automatisation within the context of IT-supported clinical pathways. Surgeons are able to estimate very exactly the distribution of their daily activities so that data of working time estimations is valuable.

Emprego de planilhas eletrônicas, baseadas nas normas ISO e recomendações IUPAC, em curvas analíticas da análise de água / Use of electronic spreadsheets, based on ISO standards and IUPAC guidelines, for assessing the quality of water analytical curves

Microsoft Excel® para avaliar a qualidade analítica de gráficos de calibração de funções lineares ehomoscedásticas, que são usados em análises físico-químicas de águas por espectrofotometria UV-Vis, eobtidos segundo as normas ISO e recomendações IUPAC. Por meio da inserção dos valores de absorbância,as planilhas apresentam os gráficos de calibração e de resíduos e calculam desvio-padrão residual, desviopadrãopara coeficiente angular, desvio-padrão para intercepto e coeficiente de determinação. Em termosde predições, as planilhas calculam, com 95 % de confiança, o intervalo de predição (apresentado coma respectiva curva com limites superior e inferior), o valor crítico da absorbância, o valor crítico daconcentração (xC), o valor mínimo detectável da concentração (xD) ou limite de detecção, o limite dequantificação e os intervalos de confiança para amostras. De uma planilha inicial, simplificações foramintroduzidas e as planilhas resultantes foram usadas nas análises de nitrato, nitrito e ferro. A influência dassimplificações no cálculo dos parâmetros, nas relações entre os parâmetros xC/xD da ISO 11843-1,2 e nosparâmetros da Comissão Europeia CCα (limite de decisão)/CCβ (capacidade de detecção), são discutidas.

A atividade humana, simultaneamente intelectual e vital: esclarecimentos complementares de Pierre Pastré e Yves Schwartz / Human activity, both intellectual and vital: complementary approaches of Pierre Pastré and Yves Schwartz

Toda situação de trabalho se presta a uma dupla abordagem. É o local onde se realiza uma tarefa, pensada anteriormente e provocadora de uma intensa atividade intelectual pelo trabalhador. Mas é igualmente um momento único da vida, com suas arbitragens. Nesse caso, a tarefa não é mais vista como primeira, ela entra no 'debate de normas' que caracteriza a atividade do trabalhador sob o ângulo vital, aquele das escolhas que um ser humano não cessa de fazer. Entendemos que essas duas perspectivas correspondem, respectivamente, à de Pierre Pastré e à de Yves Schwartz. Elas se completam e enriquecem a análise: seu entrecruzamento confere, notadamente, um destaque inédito à questão das competências.

There can be a dual approach to every work situation. It is the place where a task is done, one which has been planned previously and which leads the worker to an intense intellectual activity. But it is also a unique moment in life, with its arbitrations. In this case, the task is no longer seen as the first. In fact, it enters the realms of the debate of rules that characterize the worker's activity from the critical perspective, the one of the choices a human being never ceases making. We believe these two perspectives correspond to Pierre Pastré and Yves Schwartz's views, respectively. They complement and enrich the analysis: the intersection between them gives rise, notably, to an unprecedented emphasis on the issue of skills.

Voice recognition versus transcriptionist: error rates and productivity in MRI reporting.

PURPOSE: Despite the frequent introduction of voice recognition (VR) into radiology departments, little evidence still exists about its impact on workflow, error rates and costs. We designed a study to compare typographical errors, turnaround times (TAT) from reported to verified and productivity for VR-generated reports versus transcriptionist-generated reports in MRI. METHODS: Fifty MRI reports generated by VR and 50 finalized MRI reports generated by the transcriptionist, of two radiologists, were sampled retrospectively. Two hundred reports were scrutinised for typographical errors and the average TAT from dictated to final approval. To assess productivity, the average MRI reports per hour for one of the radiologists was calculated using data from extra weekend reporting sessions. RESULTS: Forty-two % and 30% of the finalized VR reports for each of the radiologists investigated contained errors. Only 6% and 8% of the transcriptionist-generated reports contained errors. The average TAT for VR was 0 h, and for the transcriptionist reports TAT was 89 and 38.9 h. Productivity was calculated at 8.6 MRI reports per hour using VR and 13.3 MRI reports using the transcriptionist, representing a 55% increase in productivity. CONCLUSION: Our results demonstrate that VR is not an effective method of generating reports for MRI. Ideally, we would have the report error rate and productivity of a transcriptionist and the TAT of VR.

Integrating three-dimensional digital technologies for comprehensive implant dentistry.

BACKGROUND: The increase in the popularity of and the demand for the use of dental implants to replace teeth has encouraged advancement in clinical technology and materials to improve patients' acceptance and clinical outcomes. Recent advances such as three-dimensional dental radiography with cone-beam computed tomography (CBCT), precision dental implant planning software and clinical execution with guided surgery all play a role in the success of implant dentistry. METHODS: The author illustrates the technique of comprehensive implant dentistry planning through integration of computer-aided design/computer-aided manufacturing (CAD/CAM) and CBCT data. The technique includes clinical treatment with guided surgery, including the creation of a final restoration with a high-strength ceramic (IPS e.max CAD, Ivoclar Vivadent, Amherst, N.Y.). The author also introduces a technique involving CAD/CAM for fabricating custom implant abutments. RESULTS: The release of software integrating CEREC Acquisition Center with Bluecam (Sirona Dental Systems, Charlotte, N.C.) chairside CAD/CAM and Galileos CBCT imaging (Sirona Dental Systems) allows dentists to plan implant placement, perform implant dentistry with increased precision and provide predictable restorative results by using chairside IPS e.max CAD. CONCLUSIONS: The precision of clinical treatment provided by the integration of CAD/CAM and CBCT allows dentists to plan for ideal surgical placement and the appropriate thickness of restorative modalities before placing implants.

A radiologist's perspective on efficiency and economics in a quality breast center.

As a former general radiologist and current full time clinical breast radiologist, I have observed and experienced both good and suboptimal practice patterns, operations, and economics. Proper organization of a high quality, efficient breast center requires basic infrastructure including functional space, quality imaging equipment, data reporting systems, as well as a highly motivated, dedicated, and focused team. People on the breast care team need to share the same passion and commitment to provide superior care for patients and families. Each member of this interdisciplinary team provides an important role that contributes to best practices and patient satisfaction. Efficiency and quality are essential for the long-term survival of clinical breast radiology, a highly regulated and scrutinized medical subspecialty. This paper reflects personal perspectives and perceptions about how to make a good breast care practice great by incorporating strategies such as the simple hedgehog concept used in other successful businesses.

[Complexity of therapeutic regimens prescribed for elderly retirees, Belo Horizonte/MG, Brazil]. / Complexidade do regime terapêutico prescrito para idosos.

OBJECTIVE: To examine factors associated with therapeutic regimen complexity of drug prescriptions for elderly people in Belo Horizonte, Minas Gerais, Brazil. METHODS: A household survey of elderly people selected by simple random sampling from Brazil's social security register. The medication complexity index (MCI), a direct measurement of actions required to administer medication, was derived from information in the latest prescription. Univariate and bivariate analyses were performed to identify factors associated with the MCI. RESULTS: Of the 667 interviewees, 56.5% had prescriptions meeting the inclusion criteria; most (69.2%) were females aged 72.4 years (mean); 35.5% self-rated their health good or very good; and 37.4% reported five or more diseases. In the 15 days prior to interview, 1873 drugs were used (mean=5.1), of which 942 appeared on the prescriptions examined (mean=2.5). Over the same period, 22.3% of interviewees failed to use some prescribed drug. The MCI ranged from 1 to 24 (mean=6.1). Number of drugs prescribed (>2), less schooling, worse perception of health and a lower benefit payment associated positively with greater complexity (p<0.05). An association was observed between regimen complexity and failure to use some drug in the preceding 15 days (p=0.034). CONCLUSION: Elderly people in worse socio-economic and health conditions seem more likely to receive more complex therapeutic regimens, which are associated with non-compliance to the proposed treatment. This is an important consideration in the healthcare of elderly. Simplification of therapy could aid self-care among the elderly.