INTRODUÇÃO: apesar da identificação de mais de 1500 mutações para o gene CFTR (cystic fibrosis transmembrane conductance regulator), o teste do suor ainda é o teste diagnóstico para Fibrose Cística (FC). O teste quantitativo de iontoforese por pilocarpina (TQIP) é o padrão-ouro para coleta do suor e análise do cloro, mas está sujeito a erros se não for realizado por técnicos qualificados. Embora a técnica de coleta do suor pelo sistema macroduct® e análise pela condutividade seja simples e tenha boa correlação com os níveis de cloro em estudos prévios, a mesma ainda é considerada como um teste de triagem para FC. O melhor ponto de corte para confirmar ou afastar a FC pelo método da condutividade deve ser ainda estabelecido. OBJETIVOS: comparar os valores de cloro no suor obtidos pelo teste quantitativo da iontoforese pela pilocarpina (teste clássico) com os valores de condutividade do suor obtido pelo sistema de coleta por macroduct® (teste simplificado) em pacientes com e sem FC e em uma amostra aleatória de pacientes em investigação para FC. O custo e o tempo despendidos na execução de cada teste foram também analisados na fase inicial do estudo. MÉTODOS: o teste do suor, pelas duas técnicas, foi realizado simultaneamente em pacientes com e sem FC e posteriormente em pacientes em investigação diagnóstica da doença no período de fevereiro/2006 a outubro/2008. Os pontos de corte para a condutividade para excluir ou diagnosticar FC foram < 75 e ? 90 mmol/L, respectivamente, e para o teste clássico cloro ? 60 e > 60 mmol/L. Na fase inicial da pesquisa (casos com e sem FC) foram utilizadas tabelas de contingência para os cálculos de sensibilidade (S), especificidade (E), valor preditivo positivo (VPP) e negativo (VPN), além do teste exato de Fisher para avaliar a associação entre os testes e a presença ou ausência de FC. Na amostra aleatória de pacientes usou-se a curva ROC também para os cálculos de S, E, VPP e VPN e também para calcular a área sob a curva entre os testes, e, em ambas as fases da pesquisa, para avaliar sua acurácia. Os respectivos intervalos de confiança de 95% (IC95%) também foram analisados. Para avaliação da concordância entre os testes, na amostra aleatória de pacientes, utilizou-se o coeficiente de kappa e o teste de McNemar. Aplicou-se o teste de Wilcoxon para se comparar os tempos na execução de cada teste, sendo considerados significativos quando p<0,05. RESULTADOS: 52 pacientes com FC (29M/23F; 1,5 a 18,2 anos) realizaram o teste do suor pelas duas técnicas, apresentando valores medianos de cloro e condutividade no suor de 114 e 122 mmol/L, respectivamente. A condutividade foi ? 95 mmol/L em todos os pacientes, conferindo ao teste 100% de sensibilidade (IC95%: 93,1 a 100%). Cinquenta pacientes sem FC (24M/26F; 0,5 a 12,5 anos) apresentaram valores medianos de cloro e condutividade no suor de 15,5 e 30 mmol/L, respectivamente. Em todos os casos a condutividade foi < 70 mmol/L, conferindo ao teste 100% de especificidade (IC95%: 92,9 a 100%). Foram então realizados 918 testes nos pacientes em investigação para FC, mas, em 180, as amostras foram inadequadas. Dos 738 testes realizados pelas duas técnicas, em 714 pacientes se afastou a FC, encontrando-se mediana de cloro de 11 mmol/L (variação: 3 a 137 mmol/L) e de condutividade de 25 mmol/L (variação: 14 a 138 mmol/L). Foram confirmados 24 pacientes com FC, encontrando-se uma mediana de cloro de 87 mmol/L (variação: 54 a 132 mmol/L) e de condutividade de 103 mmol/L (variação: 50 a 126 mmol/L). Pela curva ROC, com valores de condutividade > 90 mmol/L, obteve-se S= 83,3%, E= 99,7%, VPP= 90,9% e VPN= 99,4% para o diagnóstico de FC. Com valores de condutividade < 75 mmol/L praticamente se pôde excluir o diagnóstico de FC (VPN=99,7%; IC95%:99,0-100%). Houve excelente concordância entre o teste clássico e o simplificado, tanto pelo valor de kappa (0,934; IC95% 0,86 a 1,009), quanto pelo teste de McNemar (p=1,0000). O tempo despendido na execução dos testes foi significativamente menor com o teste simplificado (p<0,0001) e o custo do método simplificado foi discretamente inferior. CONCLUSÕES: o teste da condutividade do suor, seja em pacientes com diagnóstico previamente conhecido (com ou sem FC) ou quando realizado aleatoriamente, mostrou resultados superponíveis ao teste clássico e foi capaz de diferenciar pacientes com e sem FC. O teste simplificado apresentou alta sensibilidade e especificidade e houve excelente concordância entre os testes. O tempo de execução foi mais rápido e o custo inferior ao teste clássico. / INTRODUCTION: despite the identification of over 1500 CFTR (cystic fibrosis transmembrane conductance regulator) gene mutations, the sweat test is still the diagnostic test for cystic fibrosis (CF). The quantitative pilocarpine iontophoresis test (QPIT) is the gold-standard method for collection of sweat and chloride analyses, but is subjected to errors if not performed by qualified technicians. Although the technique using the macroduct system for sweat collection and the conductivity analysis is simpler and has good correlation with chloride levels in previous studies, it is still considered a screening test for CF. The best cut-off point of sweat conductivity to confirm or rule out CF must yet be established. OBJECTIVES: to compare the sweat chloride values obtained by the quantitative pilocarpine iontophoresis test (classic test) with sweat conductivity analysis obtained by the macroduct (simplified test) in patients with a confirmed CF diagnosis, in patients without CF and in a random sample of patients being investigated for CF. The cost and time spent to perform each test were also analysed in the initial phase of the study. METHODS: both techniques of sweat test were simultaneously performed initially in patients with CF, afterwards in patients in whom CF had been ruled out and finally in patients referred for a sweat test between February 2006 and October 2008. The cut-off values for sweat conductivity to exclude or diagnose CF were = 90 mmol/L and for the QPIT were sweat chloride ? 60 e > 60 mmol/L, respectively. Contingency tables were used in the initial phase of the study (cases with or without CF) for calculation of sensitivity (Se), specificity (Sp), positive (PPV) and negative predictive value (NPV) and Fisher\'s exact test was used to assess the association between the tests and the presence or absence of CF. ROC curve was used in the random sample of patients also for calculation of Se, Sp, PPV and NPV and also to calculate the area under the curve between both tests in both phases of the study to assess their accuracy. The respective 95% confidence intervals (95%CI) were also analysed. Kappa coefficient and McNemar tests were used for evaluation of agreement between the tests in the random sample of patients. Wilcoxon test was used to compare the time spent to perform each test, with the significant difference set at p < 0.05. RESULTS: in 52 CF patients (29M/23F, age range 1.5 to 18.2y) the median value of sweat Cl and conductivity were 114 and 122 mmol/L, respectively. All patients had sweat conductivity values above 95 mmol/L (100% sensitivity; 95%CI: 93.1 to 100%). In 50 patients without CF (24M/26F, age range 6m to 12.5y) the median value of sweat Cl and conductivity were 15.5 and 30 mmol/L, respectively. All patients had conductivity values bellow 70 mmol/L (100% specificity; 95%CI: 92.9 to 100%). Nine hundred and eighteen tests were then performed in patients being investigated for CF but 180 had inadequate samples. Of the 738 tests performed with both techniques in 714 CF was ruled out, with median values of sweat Cl of 11 mmol/L (range: 3 to 137 mmol/L) and of conductivity of 25 mmol/L (range: 14 to 138 mmol/L). Twenty four patients had a diagnosis of CF presenting a median sweat Cl of 87 mmol/L (range: 54 to 132 mmol/L) and a median conductivity value of 103 mmol/L (range: 50 to 126 mmol/L). The ROC curve showed that with a conductivity value > 90 mmol/L sensitivity of 83.3%, specificity of 99.7%, PPV of 90.9% and NPV of 99.4% was obtained to diagnose CF. The best conductivity cut-off value to exclude CF was < 75 mmol/L (NPV=99.7%; IC95%:99.0-100%). Good agreement were observed between the tests (kappa: 0.934; IC95% 0.86 a 1.009; McNemar test: p=1.0000). The time spent to perform the tests was significantly lower with the simplified test (p<0.0001) and the cost was slightly lower with the conductivity test. CONCLUSIONS: sweat conductivity performed in patients with a known CF or non-CF diagnosis or randomly applied in subjects referred for a sweat test showed similar results as the classic test and could differentiate patients with or without CF. Conductivity test had a high sensitivity and specificity and good agreement was observed between the techniques. The time spent to perform the tests was lower with the simplified test, as well as the cost.

Making decisions at the right time and in the right way is vital in dealing with extreme events. However, uncertainties and severe time constraints usually make the tasks hard and stressful. Since catastrophes are not frequent events in our lives, prior practice is essential to increasing preparedness. In accordance with its rapid development and extensive dissemination, information communication technology (ICT) has been recognised as an indispensable instrument, not only to assist onsite activities of professional emergency responders, but also to support collaborative actions of a wide-range of stakeholders for effective preparedness. This research intends to explore the feasibility of workshop-style decision-making exercises on the basis of scenarios of extreme events, and to examine the role of ICT in mediating the interactive processes during a workshop. A comparative approach between the UK and Japan was employed to find similarities and differences in the way of identifying major issues, proceeding to a discussion, and reaching a decision on which course of action to take. Interviews with Japanese and British experts, including researchers and practitioners, were conducted to develop realistic scenarios and to hear their opinions about the use of ICT in the crisis preparedness context. Experimental face-to-face (FTF) workshops and online workshops were respectively organised for Japanese and British research participants to examine the applicability of the scenario method under these two different methods of communication. Complementary online workshops were also conducted for Japanese and British practitioners to obtain practical feedback on the idea of scenario-based online workshops. The main finding of this study was that scenario-based exercises are beneficial regardless of the nationality or the methods of communication in decision problems in which individuals have no prior experience. The most noteworthy finding was that scenario-based online workshops are unlikely to be argumentative and results-oriented under certain conditions, such as complexity of issues and tasks, amount of time spent by participants, degree of facilitation and type of technology used. This finding indicates that online exercises require different strategies from FTF exercises. In theoretical aspects, this study provides a foundation for theory formation regarding scenario methods. In addition, this work contributes to further development of online communications based on the comparison with FTF communications. In practical terms, the examination of the scenario method and use of ICT offers methodological alternatives in order to implement more robust preparedness.

Este estudo teve como objetivo avaliar o perfil comportamental e a competência social de crianças e adolescentes, filhos de mulheres com esquizofrenia, e compará-los com crianças da mesma faixa etária e sexo, filhos de mulheres sem transtorno mental grave. Para a avaliação das crianças e adolescentes foram utilizados o Inventário de Comportamentos para Infância e Adolescência (Child Behavior Checklist- CBCL) e o Inventário de Comportamentos Auto-Referidos para Adolescentes (Youth Self Report- YSR). Os filhos de mulheres com esquizofrenia apresentaram maior proporção de problemas de internalização e de problemas com o pensamento, principalmente para as crianças que moravam com a mãe com esquizofrenia, quando comparados a crianças e adolescentes do grupo comparativo com mães sem transtornos mentais / The objective of this study was to evaluate the behavior profile and social competence of children and adolescents of schizophrenic mothers, and compare it with children of the same age and gender of mothers without any severe mental disorder. To evaluate children and adolescents the Child Behavior Checklist (CBCL) and Youth Self Report (YSR) were used. The children of schizophrenic mothers had a higher proportion of internalizing problems and of thought problems, mostly for children living with their schizophrenic mothers, when compared to children and adolescents of mothers without any psychiatric disorder

This study examined Chinese and US middle-school science teachers' perceptions of autonomy support. Previous research has documented the link between teachers' perceptions of autonomy and the use of student-oriented teaching practices for US teachers. But is not clear how the perception of autonomy may differ for teachers from different cultures or more specifically how motivation factors differ across cultures. The survey measured teachers' motivation, perceptions of constraints at work, perceptions of students' motivation, and level of autonomy support for students. Exploratory factor analysis of responses for the combined teacher sample (n = 201) was carried out for each of the survey assessments. Significance testing for Chinese (n = 107) and US (n = 94) teachers revealed significant differences in teachers' motivation and perceptions of constraints at work and no significant differences for perceptions of students' motivation or their level of autonomy support for students. Chinese teachers' perceptions of constraints at work, work motivation, and perceptions of student motivation were found to significantly predict teachers' autonomy support. For the US teachers, teacher motivation was the only significant predictor of teachers' autonomy support. A sub-sample of teachers (n = 19) was interviewed and results showed that teachers in both countries reported that autonomy was important to their motivation and the quality of science instruction they provided to students. The primary constraints on teaching reported by the US teachers related to materials and laboratory space while the Chinese teachers reported constraints related to the science curriculum and standards.

Group Purchasing Organizations (GPOs) play a significant role in the healthcare industry. The presence of GPOs helps the healthcare centers to offload their responsibilities so that they can focus on more critical areas which require attention like providing quality care. This thesis involves the comparison of three models of procurement operations in terms of cost efficiency. This cost comparison model features a healthcare organization associated with a national GPO, a healthcare organization which procures by self sourcing (not associated with a GPO), and a hybrid procurement model involving a national GPO and a regional GPO. The comparison model highlighted the cost effectiveness of these three different ways of procurement, which threw significant light on the purchasing operations of healthcare organizations. In the second part of this research study, we formulated a method to measure the degree of access to innovative products across the above mentioned procurement models either involving on-contract (from a GPO) purchasing, or off-contract purchasing (from individual manufacturers not affiliated to GPO) or both. We also identified the metrics for innovation and measure the innovativeness of products. Based on the literature study, it was found that purchasing groups may also be an entry barrier to new suppliers (Zweig 1998), with big national GPOs dominating the market and dictating the pricing of commodities. The first hypothesis H1 of this research study was stated as "National GPOs (Group Purchasing Organizations) enable the healthcare establishments to lower the cost of medical services and operations." The second hypothesis H2 of this research study was acknowledged as "National GPOs a barrier to entry of Innovative product manufacturers in the healthcare industry." This thesis will identify the advantages and disadvantages of each type of procurement operation and address the economic issues which affect the relationship between a healthcare center and a GPO. The proposed research would indirectly help to identify whether cost savings are being shared by the links in the downstream supply chain and the savings are being percolated to the patients for the added welfare of the society. It will also identify the importance of innovative products in the society and will raise the bar of specialty treatments without compromising on the level of service being offered to the patients. This thesis will also highlight positive aspects of niche manufacturers of innovative products with smaller volumes which are currently marginalized in the market by the big national players. To the best of the author's knowledge, the research objective of measuring innovation of products has not been addressed yet in academic literature and will have the benefit of comparing three different purchasing models used in healthcare industry.

Equivalent Lateral Force Method (ELF) and Response Spectrum Analysis (RSA) are the two most popular methods of seismic design of structures. This study aims to present a comparative study of the two methods using hand-calculated approach as well as computer analysis according to ASCE 7-10 Standards. The two methods have been compared in terms of base shear and story forces by analyzing various models for different number of stories and different support conditions. It was found that ELF gives conservative results in comparison to RSA. This result was more obvious in case of four-story frames. Hence, for structures of increased elevation, the analysis from ELF may not be sufficient.

<p>The purpose of the study is, through some aspects, to make it visible and compare the education in mathematics in classes 1-3 in Sweden and Turkey. I have also studied the mathematic lessons, textbook and teaching aids, examinations and the use of calculator, on the basis of steering documents in curriculum and syllabi. The method used in this study contains of qualitative interviews and have an unstructured character but also observations noted continuously. The result is a comparison between my own experiences and the observations connected to relevant theories and the questions.</p>

To give insights into cross national differences in schooling this study analyzed the initial treatment of the concept of function in three curricula: a US standards-based text--Connected Mathematic 2: Variables and Patterns, a US conventional text--Glencoe: Mathematics Applications and Concepts: Course 2, and a Chinese reform text--Shu Xue: Grade 8, first volume. This study examined content organization and problem features in the three textbooks. For content analysis, this study explored how the concept of function was introduced, defined, and developed. The results indicated both of the US textbooks introduce this concept at grade 7 whereas the Chinese text does so at grade 8. Connected Mathematics devotes more lessons than the Chinese text and Glencoe in the initial treatment of the concept of function. Connected Mathematics defines function as rule while Glencoe addresses it as relationship; the Chinese text introduces the concept of function as correspondence. Connected Mathematics pays equal an amount of attention to the four representations including tables, graphs, verbal descriptions, and equations examined in this study. In contrast, Glencoe employs the representations of tables, graphs, and equations and it focuses on the representation of graphs; the Chinese text also employs the representations of tables, graphs, and equations but it focuses on the representation of equation. The Chinese text provides many explanations and illuminations in worked-out examples to tell how the solutions are derived. Problems were then analyzed extensively with respect to three criteria: (1) contextual feature, (2) response type, and (3) cognitive expectation. Analysis results showed that all the three texts emphasize the cognitive expectation of representation. Connected Mathematics provides more real-world problems than other texts; and the problems aim at cultivating students’ mathematical reasoning. Most of the problems in Glencoe are embedded in pure math contexts to help students do procedure practice. The problems in the Chinese text emphasize problem solving. Implications for curriculum developers, teachers, and researchers have been discussed in accordance with the findings.

<p>The subject of this essay in archaeology is the economy at the mining village of Saladuringthe 16th and early 17th century. The silvermine in Sala was once the foremost producer of silver in Sweden, and the mine as well as the mining village had had a long and rich history. This history can be seen in historical documents as well as in archaeological findings. The lure of silver attracted many different people to the mining village. This in turn madetrade an important part of the mining village. The trade made it possible for coins to circulatefreely and this made it possible for a monetary based economy to be established in the miningvillage. The focus of this essay is mainly on coin finds, but also on other archaeological items foundduring excavations of the mining village. These other archaeological finds can shed some light on the type of economy that existed in the mining village. Included is a comparison of coin finds in two other locations, namely the chapel ruins of St. Ursula in Västerås and Vårfrukyrkan in Enköping. Each of the churches is located near Sala and were used contemporary with the mining village. The purpose of including them into this study is to see whether these churches used the same stock of coin as they did in the mining village.</p>

Islamic banking and finance in Pakistan started in 1977-78 with the elimination of interest in compliance with the Principles of Islamic Shari’ah in Islamic banking practices. Since then, amendments in financial system to allow the issuance of new interest-free instrument of corporate financing, promulgation of ordinance to permit the establishment of Mudaraba companies and floatation of Mudaraba Certificates, constitution of Commission for Transformation of Financial System (CTFS), and the establishments of Islamic Banking Department by the State Bank of Pakistan are some of the key steps taken place by the governments.   The aim of this study is to examine and to evaluate the performance of the first Islamic bank in Pakistan, i.e. Meezan Bank Limited (MBL) in comparison with that of a group of 5 Pakistani conventional banks. The study evaluates performance of the Islamic bank (MBL) in profitability, liquidity, risk, and efficiency for the period of 2003-2007. Financial ratios (12 in total) such as Return on Asset (ROA), Return on Equity (ROE), Loan to Deposit ratio (LDR), Loan to Assets ratio (LAR), Debt to Equity ratio (DER), Asset Utilization (AU), and Income to Expense ratio (IER) are used to assess banking performances. T-test and F-test are used in determining the significance of the differential performance of the two groups of banks. The study found that MBL is less profitable, more solvent (less risky), and also less efficient comparing to the average of the 5 conventional banks. However, there was no significant difference in liquidity between the two sets of banks. The reasons are due to the facts that conventional banks in Pakistan have longer history and experience in doing banking business and hold dominating position in the financial sector with its large share in the overall financial assets of Pakistan, as compared to Islamic banks, which in true sense, started only a few years back with all letter and spirit.     Albeit, the study found that MBL is less profitable, more solvent (less risky), and less efficient during 2003-2007, however, it is improving considerably over time indicating convergence with the performance of the conventional banks.