Automated monitoring of mouse feeding and body weight for continuous health assessment.

Routine health assessment of laboratory rodents can be improved using automated home cage monitoring. Continuous, non-stressful, objective assessment of rodents unaware that they are being watched, including during their active dark period, reveals behavioural and physiological changes otherwise invisible to human caretakers. We developed an automated feeder that tracks feed intake, body weight, and physical appearance of individual radio frequency identification-tagged mice in social home cages. Here, we experimentally induce illness via lipopolysaccharide challenge and show that this automated tracking apparatus reveals sickness behaviour (reduced food intake) as early as 2-4 hours after lipopolysaccharide injection, whereas human observers conducting routine health checks fail to detect a significant difference between sick mice and saline-injected controls. Continuous automated monitoring additionally reveals pronounced circadian rhythms in both feed intake and body weight. Automated home cage monitoring is a non-invasive, reliable mode of health surveillance allowing caretakers to more efficiently detect and respond to early signs of illness in laboratory rodent populations.

Estimating disease burden using Internet data.

Data on disease burden are often used for assessing population health, evaluating the effectiveness of interventions, formulating health policies, and planning future resource allocation. We investigated whether Internet usage and social media data, specifically the search volume on Google, page view count on Wikipedia, and disease mentioning frequency on Twitter, correlated with the disease burden, measured by prevalence and treatment cost, for 1633 diseases over an 11-year period. We also applied least absolute shrinkage and selection operator to predict the burden of diseases. We found that Google search volume is relatively strongly correlated with the burdens for 39 of 1633 diseases, including viral hepatitis, diabetes mellitus, multiple sclerosis, and hemorrhoids. Wikipedia and Twitter data strongly correlated with the burdens of 15 and 7 diseases, respectively. However, an accurate analysis must consider each condition's characteristics, including acute/chronic nature, severity, familiarity to the public, and the presence of stigma.

Improving radiopharmaceutical supply chain safety by implementing bar code technology.

The aim of this study was to describe and evaluate an approach for improving radiopharmaceutical supply chain safety by implementing bar code technology. We first evaluated the current situation of our radiopharmaceutical supply chain and, by means of the ALARM protocol, analysed two dispensing errors that occurred in our department. Thereafter, we implemented a bar code system to secure selected key stages of the radiopharmaceutical supply chain. Finally, we evaluated the cost of this implementation, from overtime, to overheads, to additional radiation exposure to workers. An analysis of the events that occurred revealed a lack of identification of prepared or dispensed drugs. Moreover, the evaluation of the current radiopharmaceutical supply chain showed that the dispensation and injection steps needed to be further secured. The bar code system was used to reinforce product identification at three selected key stages: at usable stock entry; at preparation-dispensation; and during administration, allowing to check conformity between the labelling of the delivered product (identity and activity) and the prescription. The extra time needed for all these steps had no impact on the number and successful conduct of examinations. The investment cost was reduced (2600 euros for new material and 30 euros a year for additional supplies) because of pre-existing computing equipment. With regard to the radiation exposure to workers there was an insignificant overexposure for hands with this new organization because of the labelling and scanning processes of radiolabelled preparation vials. Implementation of bar code technology is now an essential part of a global securing approach towards optimum patient management.

Low-cost wearable data acquisition for stroke rehabilitation: a proof-of-concept study on accelerometry for functional task assessment.

BACKGROUND: An increasingly aging society and consequently rising number of patients with poststroke-related neurological dysfunctions are forcing the rehabilitation field to adapt to ever-growing demands. Although clinical reasoning within rehabilitation is dependent on patient movement performance analysis, current strategies for monitoring rehabilitation progress are based on subjective time-consuming assessment scales, not often applied. Therefore, a need exists for efficient nonsubjective monitoring methods. Wearable monitoring devices are rapidly becoming a recognized option in rehabilitation for quantitative measures. Developments in sensors, embedded technology, and smart textile are driving rehabilitation to adopt an objective, seamless, efficient, and cost-effective delivery system. This study aims to assist physiotherapists' clinical reasoning process through the incorporation of accelerometers as part of an electronic data acquisition system. METHODS: A simple, low-cost, wearable device for poststroke rehabilitation progress monitoring was developed based on commercially available inertial sensors. Accelerometry data acquisition was performed for 4 first-time poststroke patients during a reach-press-return task. RESULTS: Preliminary studies revealed acceleration profiles of stroke patients through which it is possible to quantitatively assess the functional movement, identify compensatory strategies, and help define proper movement. CONCLUSION: An inertial data acquisition system was designed and developed as a low-cost option for monitoring rehabilitation. The device seeks to ease the data-gathering process by physiotherapists to complement current practices with accelerometry profiles and aid the development of quantifiable methodologies and protocols.

Increasing access to farmers markets for beneficiaries of nutrition assistance: evaluation of the farmers market access project.

INTRODUCTION: Increased acceptance of nutrition benefits at farmers markets could improve access to nutritious foods for low-income shoppers. The objective of this study was to evaluate a pilot project to increase participation by farmers markets and their vendors in the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: The intervention targeted 9 markets in lower-income regions of King County, Washington. Markets and vendors were offered subsidized electronic benefits transfer (EBT) terminals for processing SNAP, and vendors could apply to accept WIC cash value vouchers. WIC staff received information on using SNAP and vouchers at farmers markets. We used mixed methods post-implementation to measure participation, describe factors in acceptance of benefits, and assess information needs for WIC staff to conduct effective outreach. RESULTS: Of approximately 88 WIC-eligible vendors, 38 agreed to accept vouchers. Ten of 125 vendors installed an EBT terminal, and 6 markets installed a central market terminal. The number of market stalls accepting SNAP increased from 80 to 143, an increase of 79%. Participating vendors wanted to provide access to SNAP and WIC shoppers, although redemption rates were low. Some WIC staff members were unfamiliar with markets, which hindered outreach. CONCLUSION: Vendors and markets value low-income shoppers and, when offered support, will take on some inconvenience to serve them. To improve participation and sustainability, we recommend ongoing subsidies and streamlined procedures better suited to meet markets' capabilities. Low EBT redemption rates at farmers markets suggest a need for more outreach to low-income shoppers and relationship building with WIC staff.

Electronic access to food and cash benefits.

The authors' purpose was to examine access to Family Independence Program and Food benefits in relation to customer service and an automated helpline. In addition, participants identified impediments and limitations to the receipt of services. Two hundred forty-four surveys were mailed to recipients of over-the-counter electronic benefit transfer cards; 58 were returned. The findings indicate that when customers (age 21-92) received assistance navigating the electronic benefits transfer system from local office staff, they were able to obtain benefits successfully. Negative credit/debit card history and touchtone phones were related to difficulty using the system. The results suggest that the local office and the contracted service provider (automatic helpline) need to provide assistance that promotes greater autonomy for the customer to make successful transitions to benefits that are delivered electronically.

Increasing supplemental nutrition assistance program/electronic benefits transfer sales at farmers' markets with vendor-operated wireless point-of-sale terminals.

BACKGROUND: Supplemental Nutrition Assistance Program (SNAP) (formerly Food Stamp Program) participants can use their benefits at many farmers' markets. However, most markets have only one market-operated wireless point-of-sale (POS) card swipe terminal for electronic benefits transfer (EBT) transactions. It is not known whether providing each farmer/vendor with individual wireless POS terminals and subsidizing EBT fees will increase SNAP/EBT purchases at farmers' markets. OBJECTIVE: To evaluate the effects of multiple vendor-operated wireless POS terminals (vs a single market-operated terminal) on use of SNAP benefits at an urban farmers' market. DESIGN: Time-series analyses of SNAP/EBT sales. SETTING: The Clark Park farmers' market in West Philadelphia, PA, which accounts for one quarter of all SNAP/EBT sales at farmers' markets in Pennsylvania. INTERVENTION: Vendors were provided with individual wireless POS terminals for 9 months (June 2008-February 2009.) The pilot program covered all equipment and wireless service costs and transaction fees associated with SNAP/EBT, credit, and debit sales. MAIN OUTCOME MEASURE: Monthly SNAP/EBT sales at the Clark Park farmers' market. STATISTICAL ANALYSES: SNAP/EBT sales data were collected for 48 months (January 2007-December 2010). Time-series regression analysis was used to estimate the effect of the intervention period (June 2008-February 2009) on SNAP/EBT sales, controlling for seasonal effects and total SNAP benefits issued in Philadelphia. RESULTS: The intervention was associated with a 38% increase in monthly SNAP/EBT sales. Effects were greatest during the busy fall market seasons. SNAP/EBT sales did not remain significantly higher after the intervention period. CONCLUSIONS: Providing individual wireless POS terminals to farmers' market vendors leads to increased sales. However, market vendors indicated that subsidies for equipment costs and fees would be needed to break even. Currently, SNAP provides some support for these services for supermarket and other SNAP retailers with landline access, but not for farmers' markets.

Patient-controlled analgesic infusion pumps. Making a painless purchase.

Patient-controlled analgesic infusion pumps give patients the ability to self-administer pain-relieving medication as needed within the limits set by a physician. The most significant risk associated with these pumps is the possibility of oversedation, potentially leading to life-threatening narcotic-induced respiratory depression. We examine nine pumps, basing our ratings on safety and ease of use.

Development and characterization of food-grade tracers for the global grain tracing and recall system.

Tracing grain from the farm to its final processing destination as it moves through multiple grain-handling systems, storage bins, and bulk carriers presents numerous challenges to existing record-keeping systems. This study examines the suitability of coded caplets to trace grain, in particular, to evaluate methodology to test tracers' ability to withstand the rigors of a commercial grain handling and storage systems as defined by physical properties using measurement technology commonly applied to assess grain hardness and end-use properties. Three types of tracers to dispense into bulk grains for tracing the grain back to its field of origin were developed using three food-grade substances [processed sugar, pregelatinized starch, and silicified microcrystalline cellulose (SMCC)] as a major component in formulations. Due to a different functionality of formulations, the manufacturing process conditions varied for each tracer type, resulting in unique variations in surface roughness, weight, dimensions, and physical and spectroscopic properties before and after coating. The applied two types of coating [pregelatinized starch and hydroxypropylmethylcellulose (HPMC)] using an aqueous coating system containing appropriate plasticizers showed uniform coverage and clear coating. Coating appeared to act as a barrier against moisture penetration, to protect against mechanical damage of the surface of the tracers, and to improve the mechanical strength of tracers. The results of analysis of variance (ANOVA) tests showed the type of tracer, coating material, conditioning time, and a theoretical weight gain significantly influenced the morphological and physical properties of tracers. Optimization of these factors needs to be pursued to produce desirable tracers with consistent quality and performance when they flow with bulk grains throughout the grain marketing channels.

Técnicas de secretariado / Curso de Capacitação a Distância

CD-ROM contém vídeo de apresentação do em formato de vídeo juntamente com vídeos aulas do curso de capacitação em técnicas de secretariado. Contém o livro do curso e orientações aos estudantes em formato PDF e aplicativo da disciplina. Objetiva apresentar conceitos sobre a profissão de secretariado e técnicas para desenvolver, atualizar ou otimizar atividades, processos e procedimentos realizados pelo profissional de secretariado, no contexto da gestão pública, sem deixar de focar também o exercício da profissão no âmbito corporativo, em um mercado de trabalho altamente competitivo e globalizado

Embedding and retrieving private metadata in electrocardiograms.

Due to the recent explosion of 'identity theft' cases, the safeguarding of private data has been the focus of many scientific efforts. Medical data contain a number of sensitive attributes, whose access the rightful owner would ideally like to disclose only to authorized personnel. One way of providing limited access to sensitive data is through means of encryption. In this work we follow a different path, by proposing the fusion of the sensitive metadata within the medical data. Our work is focused on medical time-series signals and in particular on Electrocardiograms (ECG). We present techniques that allow the embedding and retrieval of sensitive numerical data, such as the patient's social security number or birth date, within the medical signal. The proposed technique not only allows the effective hiding of the sensitive metadata within the signal itself, but it additionally provides a way of authenticating the data ownership or providing assurances about the origin of the data. Our methodology builds upon watermarking notions, and presents the following desirable characteristics: (a) it does not distort important ECG characteristics, which are essential for proper medical diagnosis, (b) it allows not only the embedding but also the efficient retrieval of the embedded data, (c) it provides resilience and fault tolerance by employing multistage watermarks (both robust and fragile). Our experiments on real ECG data indicate the viability of the proposed scheme.

C-CAT: a computer software used to analyze and select Chinese characters and character components for psychological research.

The Character-Component Analysis Toolkit (C-CAT) software was designed to assist researchers in constructing experimental materials using traditional Chinese characters. The software package contains two sets of character stocks: one suitable for research using literate adults as subjects and one suitable for research using schoolchildren as subjects. The software can identify linguistic properties, such as the number of strokes contained, the character-component pronunciation regularity, and the arrangement of character components within a character. Moreover, it can compute a character's linguistic frequency, neighborhood size, and phonetic validity with respect to a user-selected character stock. It can also search the selected character stock for similar characters or for character components with user-specified linguistic properties.

[Objectives, tools and methods for an epidemiological use of electronic health archives in various areas of Italy]. / Obiettivi, strumenti e metodi per un utilizzo epidemiologico di archivi sanitari elettronici correnti in diverse aree italiane.

The availability of Electronic Health Archives (EHA) has increased remarkably over the last twenty years. As part of a joint project of the Italian Association of Epidemiology (AIE) and the Italian Association of Medical Statistics and Clinical Epidemiology (SISMEC), a workgroup of experts was set up in 2005 with the aim of comparing various experiences and of standardizing the procedures by which electronic sources can be integrated. In particular, the workgroup's aim was to estimate the frequency of certain major diseases using standard algorithms applied to EHA. This volume is published with the purpose of making available in a common publication the methods and the results obtained. The results from a multicentre study using a standard approach to probabilistic record-linkage procedures are also included in a specific chapter. Eleven Italian centres from five Italian regions with an overall population of 11,932,026 collected and treated more than 21,374,426 records (year 2003) from five electronic information sources: death certificates, hospital discharge records (including outpatient discharges), drug prescriptions, tax- exemptions, and pathology records in order to estimate the frequency of the following diseases: diabetes, ischemic heart diseases, acute myocardial infarction, stroke, asthma, chronic obstructive pulmonary disease, obstructive lung diseases. For each pathology a specific algorithm was developed and used by all centres for the identification of the prevalent/incident cases of the selected diseases. Standardized methods were used to estimate the rates. The results confirm the need for a common standard approach to produce estimates based on EHA, considering the variability of the quality and of the completeness of the archives, and the difficulties of standardizing record-linkage operations in the various centres. The main achievement of this work was the elimination of the variability due to the use of different algorithms to identify cases using EHA.

[Ischemic heart disease prevalence estimated using a standard algorithm based on electronic health data in various areas of Italy]. / Stima della prevalenza della cardiopatia ischemica basata su dati sanitari correnti mediante un algoritmo comune in differenti aree italiane.

AIM: to define an algorithm to estimate prevalence of ischemic heart disease from health administrative datasets. SETTING: four Italian areas: Venezia, Treviso, Torino, Firenze. PARTICIPANTS: resident population in the four areas in the period 2002-2004 (only 2003 for Firenze) for a total of 2,350,000 inhabitants in 2003. MAIN OUTCOMES: annual crude and standardized prevalence rate (x100 inhabitants), 95% confidence intervals by area. Quality (comparability and coherence) indicators are also reported METHODS: the algorithm is based on record linkage of hospital discharges (SDO), pharmacological prescriptions (PF), exemptions from health-tax exemptions (ET) and causes of mortality (CM). From SDO we extracted discharges for ICD9-CM codes 410*-414* in all diagnoses in the estimation year and during the four years immediately preceding. We selected from PF subjects with at least two prescriptions of organic nitrates (ATC = C01DA*) in the estimation year. From ET subjects with a new exemption for ischemic heart disease (002.414) or who obtained exemption in the three years preceding, were selected. We also considered all deaths in the year for ischemic heart disease (ICD9 CM 410-414). Cases were defined as ischemic heart disease prevalent cases if they were extracted at least once from one of the datasets and if they were alive on January 1 of the estimation year. RESULTS: estimated crude prevalence ranges from 2.5 to 4%. The standardized prevalence led to a narrower range of values (2.8-3.3%). Venezia and Firenze show a higher standardized prevalence in both sexes (men 4.7% and 4.4%; women 2.3% and 2.2% respectively); Treviso and Torino present a lower standardized prevalence (men: 3.9%; women: 1.9%). The hospital discharges are the main source to identify prevalent subjects (34-48% of subjects are solely identified by SDO), pharmacological prescriptions are a relevant source in Firenze and Torino (27-28%), while they are less relevant in Venezia and Treviso (13-15%). ET shows a different contribution to prevalent case identification in the four areas: Venezia (8%), Treviso (3.2%), Firenze (1.3%), whereas in Torino this source was not available at all. Subjects classified as prevalent cases only through causes of death are less than 2%. The percentage of subjects simultaneously identified by multiple sources is high in Venezia (43%) and low in Torino (30%). CONCLUSIONS: patterns in use of pharmaceuticals and exemptions from prescription charges appear to be heterogeneous in the different areas under study. These two aspects make a proper comparison between areas difficult. The algorithm could be applied only in areas with a similar use of organic nitrates and with a good comparability of the exemptions dataset.

[Acute stroke incidence estimated using a standard algorithm based on electronic health data in various areas of Italy]. / Stima dell'incidenza di ictus acuto basata su dati sanitari correnti mediante un algoritmo comune in differenti aree italiane.

AIM: to define an algorithm and implement it in various areas of Italy, in order to evaluate acute stroke incidence through current databases. SETTING: Lazio, Tuscana , Venezia AULSS 12, Torino ASL 5. PARTICIPANTS: resident-based population in the above mentioned 4 areas during 2002-2004. MAIN OUTCOME: Annual and triennal incidence rate (crude and standardized per 100,000 inhabitants with 95% CI) by sex and age classes (0-14, 15-34, 35-54, 55-64, 65-74, 75-84, 85+), standardized rate of mortality by sex and areas. METHODS: acute stroke incident cases during 2002-2004 in the 4 Italian areas were identified through hospitalization databases (SDO) and death causes (CM). The selection was made including hospitalization cases (no outpatients) and deceased people with a discharge or death code ICD9-CM 430*, 431*, 434*, 436* with no hospitalization for stroke diagnosis in the previous 60 months. Moreover, patients with 438* codes in secondary diagnoses and patients with hospital discharge from rehabilitation or long-hospital units were excluded. RESULTS: men have a higher crude incidence rate than women (+30%). The age-specific rates show a large variability among the areas for elderly people (65+ for men and 75+ for women), with higher rates in Toscana in both genders (cases per 100,000 inhabitants: 260.1 men; 193.1 women). Intermediate values were found in Torino and in Lazio; the lowest values are reported in Venezia (men: 182.5; women: 1368). Standardized mortality rates also present higher mortality levels in the two regional areas (Lazio and Toscana) and lower levels in the two urban areas (Torino and Venezia). CONCLUSIONS: It is not easy to evaluate the algorithm. Results seem compatible enough with other studies and show a certain consistency with current mortality data. Different socio-economical characteristics could account for differences in the estimated incidence among areas. However, diferences in the quality indicators suggest that a validation study with standardized diagnostic criteria will make quality evaluation of the algorithm possible.

A gestão em saúde e as ferramentas gerenciais: a experiência com o SISPLAN do Instituto Nacional do Câncer

A gestão na área de saúde vem sofrendo modificações ao longo do tempo. As últimas duas décadas foram voltadas para o crescimento e implementação da gestão profissional neste setor, com o suporte do uso de sistemas de planejamento informatizados como apoio à gestão. Assim, este estudo tem como principal fio condutor as premissas da Gestão e do uso de ferramentas gerenciais. Embora não seja um estudo de caso, apóia-se em uma experiência concreta de gestão no Instituto Nacional de Câncer do Rio de Janeiro. Nesta pesquisa é observado que as organizações de saúde sempre estiveram voltadas para a assistência sem preocupação com a gestão em si, mas que a partir da crise econômica mundial dos anos 80 houve mudanças neste cenário. Estas alterações ocorreram não somente na gestão da saúde, como também na profissionalização do gestor. O uso de ferramentas gerenciais também é contemplado nesta pesquisa, porquanto hoje se debate a sua importância no auxílio do planejamento e da estratégia a ser orientada para estas organizações. Paralelamente à discussão sobre os sistemas mais usados nas empresas e organizações de saúde, é discutida como ferramenta gerencial principal nesta tese o Sistema de Planejamento (SISPLAN) do Instituto Nacional de Câncer do Rio de Janeiro, um instrumento desenvolvido na Instituição e que vem redesenhando os espaços institucionais de decisão e de discussão de políticas. Este estudo demonstra que a aplicação desta ferramenta gerencial possibilitou a implementação dos projetos prioritários e mais relevantes. Como ferramenta gerencial, o SISPLAN facilitou o desenvolvimento de uma gestão participativa e compartilhada em todos os níveis. Apesar das melhorias que ainda são necessárias para o aperfeiçoamento deste instrumento, são inegáveis as conquistas obtidas no transcorrer deste processo...

The management in the health area has been experiencing changes through time. The last two decades were concerned only to the growth and implementation of the staffing management system, with the use of computerized planning system as a kind of support to the management itself. Thus, this thesis takes the premises of the Management and the use of Managerial Tools as the basis of its research. Although, it is not a study of case, it is supported on a real managerial experience applied at National Cancer Institute of Rio de Janeiro. In this study, we observe that the health organizations used to be concerned only to the assistance, without worrying about the management itself. This thought has changed following the World Economical Crises in the 80’s, and after that, the health industry became concerned not only in the health management, but also in the professionalism of the manager. The usage of managerial tools in the heath system is also discussed in this thesis, due to the importance that is given to this subject. Nowadays, we debate a lot, the importance of a managerial tool in helping the planning and strategy to be presented as a model to the health organizations. In parallel to the discussion about the most used managerial systems in the companies and organizations of health, this study also discusses, as the most important focus, a managerial tool called SISPLAN of National Cancer Institute of Rio de Janeiro, a tool developed by this institution which has been restructuring the institutional spaces of decision and of politics discussion This research also shows that the application of SISPLAN made able the implementation of more relevant and priority projects. As a managerial tool, SISPLAN facilitated the development of a management system which was both participative and shared in all levels. Despite of improvements that are still necessary for the improvement of this tool, they are undeniable the achievements obtained in the course of this process. It can be realized, however, that spite of its features, SISPLAN doesn’t seem to be a managerial tool which express the institution strategy, because it behaves as a planning tool. So, we concluded that according to balanced scorecard features, it must be associated to SISPLAN as a complementary managerial tool which allows the construction of the strategy, based on a chain of cause and effect relations and on booster factors. This thesis aims to demonstrate, how essential is the availability of a managerial tool is essential for the success of the heath management.

A gestão em saúde e as ferramentas gerenciais: a experiência com o SISPLAN do Instituto Nacional do Câncer / Health management and managerial tools: the SISPLAN experience at the Brazilian National Cancer Institute

A gestão na área de saúde vem sofrendo modificações ao longo do tempo. As últimas duas décadas foram voltadas para o crescimento e implementação da gestão profissional neste setor, com o suporte do uso de sistemas de planejamento informatizados como apoio à gestão. Assim, este estudo tem como principal fio condutor as premissas da Gestão e do uso de ferramentas gerenciais. Embora não seja um estudo de caso, apóia-se em uma experiência concreta de gestão no Instituto Nacional de Câncer do Rio de Janeiro. Nesta pesquisa é observado que as organizações de saúde sempre estiveram voltadas para a assistência sem preocupação com a gestão em si, mas que a partir da crise econômica mundial dos anos 80 houve mudanças neste cenário. Estas alterações ocorreram não somente na gestão da saúde, como também na profissionalização do gestor. O uso de ferramentas gerenciais também é contemplado nesta pesquisa, porquanto hoje se debate a sua importância no auxílio do planejamento e da estratégia a ser orientada para estas organizações. Paralelamente à discussão sobre os sistemas mais usados nas empresas e organizações de saúde, é discutida como ferramenta gerencial principal nesta tese o Sistema de Planejamento (SISPLAN) do Instituto Nacional de Câncer do Rio de Janeiro, um instrumento desenvolvido na Instituição e que vem redesenhando os espaços institucionais de decisão e de discussão de políticas. Este estudo demonstra que a aplicação desta ferramenta gerencial possibilitou a implementação dos projetos prioritários e mais relevantes. Como ferramenta gerencial, o SISPLAN facilitou o desenvolvimento de uma gestão participativa e compartilhada em todos os níveis. Apesar das melhorias que ainda são necessárias para o aperfeiçoamento deste instrumento, são inegáveis as conquistas obtidas no transcorrer deste processo...