Emerging adulthood is often-overlooked in current gastrointestinal (GI) health research; however, epidemiological evidence suggests that GI disorders are increasing in this population. The purpose of this study was to first define common GI symptom subgroups within emerging adults and then to characterize these group differences with key biopsychosocial factors encompassing diet, depression and anxiety symptoms, as well as physical and social functioning related to quality of life. A total of 956 emerging adults from a southeastern US university were surveyed on GI symptoms, psychosocial factors, and demographics. Latent class analysis uncovered three statistically significant GI symptom patterns within the sample identified by the degree of severity: Normal (n=649), Mild (n=257), and Moderate (n=50). This study demonstrated that significant impairment in GI functioning emerges at much earlier ages that are commonly assumed. In addition, these GI symptom levels were associated with important biopsychosocial factors. Assessing GI functioning in emerging adults may provide important insights into understanding the development of FGIDs.

Cognitive impairment related to treatment for breast cancer, affects as many as 75% of patients in study samples (Jansen, Cooper, Dodd & Miaskowski, 2011). Deficits in the cognitive domains of short-term memory, attention, speed of information processing, judgment, reasoning, spatial attention, and verbal memory have been documented. The extent to which these deficits impact functional performance within this population has not yet been quantified. The purpose of this study was to investigate the impact of breast cancer on self-reported cognition and functional performance in the six months post-completion in two groups of breast cancer survivors, a chemotherapy group and chemotherapy and radiotherapy group. Cognition and functional performance were measured with the Patient Reported Outcomes Measurement Information System (PROMIS®). Cognition was measured in terms of abilities and concerns. Functional performance measures addressed the constructs of physical function, ability to participate in social roles and activities, and satisfaction with participation in social roles and activities. Sixteen female participants (ages 28-45) completed online surveys three weeks following the conclusion of chemotherapy or radiotherapy and three and six months later. Linear mixed-effects models were used to analyze changes over time within groups and compare differences between groups. Over the six months post-treatment the chemotherapy group had a significant improvement in physical function (p=.0178), and the chemotherapy + radiotherapy group showed significant gains in the ability to participate in social roles and activities (p=.0447). Fatigue was a significant factor in the chemotherapy + radiotherapy group (p=.015). No significant differences between groups were noted for changes in cognition, functional performance or psychosocial factors. This research provides insight into self-reported changes in cognition and functional performance in the six months following breast cancer treatment. Cognition and functional performance appear to be interrelated and impacted by a constellation of factors that occupational therapists and oncology providers need to be aware of in order to best support cancer survivors in the resumption of occupations after treatment. A comprehensive approach to assessment and intervention that considers the complexity of cognitive performance as it relates to physical capacity and concurrent symptoms is recommended.

Η γλώσσα Java έχει πλέον εδραιωθεί σαν μια από τις πιο συχνά χρησιμοποιούμενες γλώσσες όχι μόνο λόγω της εξαιρετικής υποστήριξης σύγχρονων παραδειγμάτων προγραμματισμού, όπως ο αντικειμενοστραφής και ο γενικευμένος προγραμματισμός, αλλά κυρίως λόγω της εύκολης μεταφερσιμότητας του κώδικα και της ανεξαρτησίας που παρέχει στα προγράμματά της από κάποια συγκεκριμένη πλατφόρμα υλικού-λειτουργικού συστήματος. Η δυνατότητα αυτή συνοψίζεται στο σύνθημα “Write once, run anywhere” που καθιέρωσε η Sun, η εταιρία η οποία σχεδίασε αρχικά την γλώσσα. Κάτι τέτοιο, επιτυγχάνεται με την μετάφραση ενός προγράμματος από πηγαίο κώδικα Java σε μια ενδιάμεση αναπαράσταση object κώδικα (bytecode), η οποία στη συνέχεια εκτελείται στα πλαίσια μιας εικονικής μηχανής. Η πατροπαράδοτη μέθοδος εκτέλεσης των προγραμμάτων από την εικονική μηχανή ακολουθεί το μοντέλο της διερμήνευσης (interpretation), το οποίο στην πράξη δεν είναι καθόλου αποδοτικό, σε ότι αφορά το χρόνο εκτέλεσης. Μια διαφορετική προσέγγιση στην εκτέλεση Java bytecode είναι αυτή της δυναμικής μετάφρασης (Just In Time compilation – JIT compilation). Εδώ, την πρώτη φορά που εμφανίζεται η ανάγκη να εκτελεστεί ένα συγκεκριμένο τμήμα κώδικα, η εικονική μηχανή το επεξεργάζεται, εφαρμόζοντας προαιρετικά μετασχηματισμούς βελτιστοποίησης και παράγει τον αντίστοιχο κώδικα για το συγκεκριμένο σύστημα-οικοδεσπότη στο οποίο εκτελείται και η ίδια. Ο κώδικας αυτός στη συνέχεια μπορεί να επαναχρησιμοποιηθεί, εξαλείφοντας το κόστος της επαναληπτικής μετάφρασης του ίδιου τμήματος bytecode και μειώνοντας το συνολικό χρόνο εκτέλεσης. Στο πλαίσιο της συγκεκριμένης μεταπτυχιακής εργασίας κατασκευάζουμε ένα JIT μεταφραστή για μια εικονική μηχανή ειδικού σκοπού, το DSJOS (Distributed Scalable Java Operating System). Όπως φανερώνει και το όνομα του, το DSJOS είναι ουσιαστικά ένα κατανεμημένο σύστημα που προσφέρει στα προγράμματα που εκτελούνται εντός αυτού την αφαίρεση μιας Java εικονικής μηχανής. Ο JIT που δημιουργούμε χρησιμοποιεί ως εσωτερική αναπαράσταση το Ιεραρχικό Γράφημα Εργασιών (Hierarchical Task Graph – HTG) και στηρίζεται στη βιβλιοθήκη μετασχηματισμών και βελτιστοποιήσεων (compilation framework) PROMIS. Η υλοποίηση μας διαρθρώνεται σε τρία κυρίως στάδια: το frontend το οποίο είναι υπεύθυνο για την μετατροπή Java bytecode στην ενδιάμεση αναπαράσταση, το backend που μετατρέπει την ενδιάμεση αναπαράσταση σε κώδικα μηχανής για συστήματα x86 και, τέλος, το επίπεδο χρόνου εκτέλεσης που παρέχει στα εκτελούμενα προγράμματα διάφορες υπηρεσίες απαραίτητες για την εκτέλεση του (π.χ. διαχείριση εξαιρέσεων). Παράλληλα με το σχεδιασμό του βασικού μεταφραστή και την ενσωμάτωση του στο DSJOS, σχεδιάζουμε και υλοποιούμε και ένα σύνολο μετασχηματισμών, τόσο στο frontend όσο και στο backend, οι οποίοι έχουν ως σκοπό να βελτιώσουν την ποιότητα του παραγόμενου κώδικα και να μειώσουν το χρόνο εκτέλεσης των προγραμμάτων. / -

Em 2004, o Instituto Nacional de Saúde Norte Americano (NIH), propôs a disponibilização de modelos inovadores (banco de itens) para avaliação de saúde, o Patient-Reported Outcomes Measurement Information System – PROMIS®, baseado em instrumentos clássicos e confiáveis de resultados relatados pelos pacientes (Patient-Reported Outcomes – PROs) existentes e inserindo métodos estatísticos avançados como a Teoria de Resposta ao Item e o Teste Adaptativo Computadorizado. Um dos domínios abordados pelo PROMIS® é o Função Física cujo banco de itens necessita, para que seja utilizado em países lusófonos sua tradução e adaptação transcultural. O objetivo do estudo foi traduzir e adaptar culturalmente o Banco de Itens Função Física do PROMIS® para a língua portuguesa. O método utilizado foi um processo de tradução e adaptação transcultural que contém oito fases determinadas pela metodologia universal proposta pelo Functional Assessment of Chronic Illness Therapy (FACIT). A sétima etapa, chamada pré-teste, contou com 50 indivíduos com idade acima de 18 anos. Os participantes responderam os itens por auto-aplicação, utilizando uma técnica do pensamento em voz alta, além de entrevista cognitiva e retrospectiva de esclarecimento. A metodologia FACIT permitiu uma versão com adaptações, desde o início do processo, assegurando equivalência semântica, conceitual, cultural e operacional do Domínio Função Física. Durante o pré-teste, dificuldades na compreensão dos itens foram relatados por 24% dos participantes, 22% deles sugeriram mudanças para melhorar a compreensão. Os itens atingiram 100% de compreensão dos termos e conceitos, em 87% dos itens. Apenas quatro itens tiveram compreensão abaixo de 80%, exigindo alterações para alcançar correspondência com o item original e entendimento pelos entrevistados após retestagem. O processo de tradução e adaptação cultural dos itens Função Física do PROMIS® para a língua portuguesa foi bem sucedido. Esta versão deve ser submetida à validação das propriedades psicométricas antes de ser disponibilizada para utilização clínica. / In 2004, the National Institutes of Health made available the Patient-Reported Outcomes Measurement Information System – PROMIS®, which is constituted of innovative item banks for health assessment. It is based on classical, reliable Patient-Reported Outcomes (PROs) and includes advanced statistical methods, such as Item Response Theory and Computerized Adaptive Test. One of PROMIS® Domain Frameworks is the Physical Function, whose item bank need to be translated and culturally adapted so it can be used in Portuguese speaking countries. This work aimed to translate and culturally adapt the PROMIS® Physical Function item bank into Portuguese. FACIT (Functional Assessment of Chronic Illness Therapy) translation methodology, which is constituted of eight stages for translation and cultural adaptation, was used. Fifty subjects above the age of 18 years participated in the pre-test (seventh stage). The questionnaire was answered by the participants (self-reported questionnaires) by using think aloud protocol, and cognitive and retrospective interviews. In FACIT methodology, adaptations can be done since the beginning of the translation and cultural adaption process, ensuring semantic, conceptual, cultural, and operational equivalences of the Physical Function Domain. During the pre-test, 24% of the subjects had difficulties understanding the items, 22% of the subjects suggested changes to improve understanding. The terms and concepts of the items were totally understood (100%) in 87% of the items. Only four items had less than 80% of understanding; for this reason, it was necessary to chance them so they could have correspondence with the original item and be understood by the subjects, after retesting. The process of translation and cultural adaptation of the PROMIS® Physical Function item bank into Portuguese was successful. This version of the assessment tool must have its psychometric properties validated before being made available for clinical use. / Dissertação (Mestrado)

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