Racjonalność i skuteczność planowania na przykładzie gminnego programu profilaktyki i rozwiązywania problemów alkoholowych

In the system of legal sources, apart from typical acts of local law created in accordance with the provisions of the Constitution, there are also acts that do not fall within the constitutional standards of law, although they concern, among other things, important social and economic issues. Such documents (planning acts, programmes, or strategies), although enacted by resolutions, often fail to contain generally binding regulations. Although this does not prevent them from having a binding force, they should nevertheless be made in compliance with the generally recognised rules of lawmaking, including the principles of proportionality, rationality, communicativeness and brevity. The generally applicable provisions often impose on local self-governments an obligation to create acts regulating important social issues, such as for instance programmes preventing and solving alcohol-related problems and determining the way of dealing with alcohol addiction in local conditions. However, these programmes are often developed in violation of the rules of a rational law-making process, and are frequently detached from the local reality, which makes them ineffective. Therefor it may be worth considering another way of responding to the problem of alcoholism, not necessarily by means of resolutions adopted annually. The obligation to develop a prevention and resolution programme addressing alcohol-related problems could be replaced, for example, by certain specific organisational measures, an educational programme, or the implementation of other measures. The law is not always the right way to achieve the goals set, but the above recommendation will requires statutory changes first, anyway.W systemie źródeł prawa wyróżnić można, obok typowych aktów prawa miejscowego stanowionych zgodnie z przepisami Konstytucji, także takie akty, które nie mieszczą się w standardach konstytucyjnych źródeł prawa, choć dotyczą istotnych kwestii społecznych, gospodarczych itp. Tego rodzaju dokumenty (np. akty planowania, programy, strategie itp.), mimo że są uchwalane w drodze uchwał, nie zawsze zawierają przepisy powszechnie obowiązujące. Bez względu jednak na moc wiążącą aktu normatywnego prawodawca powinien przestrzegać powszechnie uznawanych reguł stanowienia prawa, w tym zasady proporcjonalności, racjonalności, komunikatywności i zwięzłości. Przepisy powszechnie obowiązujące często nakładają na samorządy lokalne obowiązek tworzenia aktów regulujących ważne kwestie społeczne, np. program profilaktyki i rozwiązywania problemów alkoholowych dotyczący zagadnienia sposobu postępowania ze zjawiskiem nałogu alkoholowego w warunkach lokalnych. Programy te często opracowywane są z naruszeniem reguł racjonalnego tworzenia prawa, a ponadto oderwane są od lokalnej rzeczywistości, co powoduje, że są one nieskuteczne. Warto zatem rozważyć możliwość innego sposobu reagowania na zjawisko alkoholizmu, nie za pomocą corocznie uchwalanych uchwał. Obowiązek sporządzania programu profilaktyki i rozwiązywania problemów alkoholowych mógłby zostać zastąpiony np. odpowiednimi działaniami organizacyjnymi, edukacyjnymi itp. Prawo nie zawsze jest właściwym sposobem osiągania zakładanych celów. Wymaga to jednak zmian ustawowych

Community Service Learning Packet

This learning packet contains a set of exercises designed to stimulate the student\u27s thinking about their community and the value of community service. It begins with a personal definition of the word community. From this definition, the student then gathers information about the school community. Hopefully, by attending school club meetings students will increase their sense of belonging and learn about options for volunteering at their campus. The notion that young people are selfish and hedonistic is examined in a section about stereotypes and biased news reporting. To break up the worksheet sequence two movie assignment guides are provided, where students view stories of compassion or caring and documentaries about youth performing volunteer service

Probabilistic and semi-probabilistic analysis of slender columns frequently used in structural engineering

The stability of slender columns is a topic that has been dealt with in research and practice for many years. The importance of this topic also increases with the possibility of using non-linear modeling approaches to determine the stability and with the increasingly complex safety formats. In order to show the complexity and the variability associated with the non-linear models, two previous contributions discussed and compared (a) the results of the Round Robin Non-Linear Modeling, and (b) the existing international associated standard specifications and safety concepts with respect to experimental results. The aim herein is to determine the reliability level (safety index) on the basis of these investigations and findings and to examine the existing safety formats of classical and extended probabilistic analyses and to derive any necessary adjustments. In addition, the method of the safety format Estimation of Coefficient of Variance of resistance (ECOV) is used for the determination of the global safety resistance factors based on the non-linear analyses’ findings of the Round Robin modeling partners.This paper describes work mainly carried out during IABSE activities. The authors would like to acknowledge IABSE Commission 1 for supporting this project, the authors acknowledge the financial support provided by the Interreg project ATCZ190 SAFEBRIDGE. The authors also gratefully acknowledge Scientific Grant Agency of the Ministry of Education. This work was supported by the Slovak Research and Development Agency under the contract No. APVV-150658. The authors also would like to express their thanks for the support provided from the Czech Science Foundation project MUFRAS No. 19-09491S. In addition, this work was partly financed by: (1) national funds through the Foundation for Science and Technology (FCT) under Grant No. PD/BD/143003/2018 attributed to the seventh author; and (2) FCT/MCTES through national funds (PIDDAC) under the R&D Unit Institute for Sustainability and Innovation in Structural Engineering (ISISE), under Reference UIDB/04029/2020

Educación a distancia para mejorar la calidad del tratamiento del asma en la atención primaria de salud : ensayo clínico aleatorizado grupal - RESPIRANET

Objective: The mere dissemination of standard care recommendations has been insufficient to improve clinical results in patients with asthma. The objective of the present study was to evaluate the clinical effectiveness of a multifaceted asthma distance education for primary care providers. Methods: Cluster randomized controlled trial. Full primary care teams were included if they had access to telehealth support and free basic asthma treatment. Before randomization, selected teams indicated asthma patients between 5-45 years old for inclusion. The intervention group received three interactive online sessions, printed educational material, reminders, booklet for patients, and frequent stimulus to use consulting services. The control group received no intervention. Symptomfree days per two weeks was the primary result. Controlled asthma, unscheduled asthma doctor visits, and preventive inhaled corticosteroid use were the secondary results. Six months after intervention, the results were compared with baseline data using generalized estimating equations for repeated measures and clustering effect. Results: Were enrolled 71 primary care teams and 443 individuals. Most patients (60.3%) were female, and 44% were younger than 12 years old. The attendance of interactive sessions by the teams was 50%. The odds ratio (OR) for additional symptom-free day was 1.31 (95%CI 0.61-2.82; p=0.49). For the secondary results, the results were: controlled asthma OR 1.29 (95%CI 0.89-1.87; p=0.18); unscheduled asthma doctor visits OR 0.81 (95%CI 0.60-1.10; p=0.17); and preventive inhaled corticosteroid use OR 1.02 (95%CI 0.71-1.47; p=0.91). Conclusions: Multifaceted distance education in asthma care for primary care providers was not effective to improve patients’ results. Telemedicine needs to deal with significant obstacles in professional education.Objetivo: A mera disseminação de recomendações de cuidados padronizados tem sido insuficiente para melhorar os desfechos clínicos em pacientes com asma. O objetivo do presente estudo foi avaliar a eficácia clínica de uma intervenção educativa multifacetada a distância sobre asma para profissionais da atenção primária à saúde. Métodos: Ensaio clínico randomizado por cluster. Equipes completas de atenção primária foram incluídas se tinham acesso a suporte de telessaúde e tratamento básico gratuito para asma. Antes da randomização, as equipes selecionadas indicaram pacientes asmáticos entre 5-45 anos para inclusão. O grupo de intervenção recebeu três sessões online interativas, material educativo impresso, lembretes, folheto para pacientes e estímulos frequentes para o uso de serviços de consultoria. O grupo controle não recebeu intervenção. O desfecho primário foi dias sem sintomas por duas semanas. Asma controlada, consultas médicas não programadas para asma e uso preventivo de corticosteroides inalatórios foram os desfechos secundários. Seis meses após a intervenção, os resultados foram comparados com a linha de base, usando equações de estimativas generalizadas para medidas repetidas e efeito de agrupamento. Resultados: Foram inscritas 71 equipes de atenção primária e 443 indivíduos. A maioria dos pacientes (60,3%) era do sexo feminino e 44% tinha menos de 12 anos de idade. A frequência das equipes nas sessões interativas foi de 50%. O odds ratio (OR) para dias sem sintomas adicionais foi de 1,31 (IC 95% 0,61-2,82; p=0,49). Para os desfechos secundários, os resultados foram: asma controlada 1,29 (IC 95% 0,89-1,87; p=0,18); visitas não programadas de asma ao médico OR 0,81 (IC 95% 0,60-1,10; p=0,17); e uso preventivo de corticosteroides inalatórios OR 1,02 (IC 95% 0,71-1,47; p=0,91). Conclusões: Ações multifacetadas de educação a distância em cuidados de asma para profissionais de saúde da atenção primária não foram eficazes para melhorar os resultados nos pacientes. A telemedicina precisa lidar com obstáculos significativos na educação profissional.Objetivo: La mera difusión de las recomendaciones de atención estándar ha sido insuficiente para mejorar los resultados clínicos en pacientes con asma. El objetivo del presente estudio fue evaluar la efectividad clínica de una educación multifacética a distancia sobre el asma para los proveedores de atención primaria. Métodos: Ensayo controlado aleatorizado por grupos. Se incluyeron equipos completos de atención primaria si tenían acceso a apoyo de telesalud y tratamiento básico gratuito para el asma. Antes de la aleatorización, los equipos seleccionados indicaron pacientes con asma entre 5-45 años de edad para inclusión. El grupo de intervención recibió tres sesiones interactivas en línea, material educativo impreso, recordatorios, folleto para los pacientes y estímulos frecuentes para utilizar los servicios de consultoría. El grupo control no recibió ninguna intervención. El resultado primario fue días sin síntomas por dos semanas. Los resultados secundarios fueron asma controlada, visitas médicas no programadas para el asma y el uso preventivo de corticosteroides inhalados. Seis meses después de la intervención, los resultados se compararon con los datos de referencia utilizando ecuaciones de estimación generalizadas para medidas repetidas y efecto de agrupación. Resultados: Se inscribieron 71 equipos de atención primaria y 443 personas. La mayoría de los pacientes (60,3%) eran mujeres y el 44% eran menores de 12 años. La asistencia a sesiones interactivas por parte de los equipos fue del 50%. La razón de probabilidades (OR) para un día sin síntomas adicional fue de 1.31 (IC del 95%: 0.61 a 2.82; p=0.49). Para los resultados secundarios, los resultados fueron: asma controlada O 1.29 (IC del 95%: 0.89 a 1.87; p=0.18); visitas al médico para el asma no programadas O 0,81 (IC del 95%: 0,60 a 1,10; p=0,17); y el uso preventivo de corticosteroides inhalados OR 1.02 (IC del 95%: 0.71 a 1.47; p=0.91). Conclusiones: La educación a distancia multifacética en el cuidado del asma para los proveedores de atención primaria no fue efectiva para mejorar los resultados de los pacientes. La telemedicina debe enfrentar obstáculos significativos en la educación profesional.Teleducaçã

RsfA (YbeB) Proteins Are Conserved Ribosomal Silencing Factors

The YbeB (DUF143) family of uncharacterized proteins is encoded by almost all bacterial and eukaryotic genomes but not archaea. While they have been shown to be associated with ribosomes, their molecular function remains unclear. Here we show that YbeB is a ribosomal silencing factor (RsfA) in the stationary growth phase and during the transition from rich to poor media. A knock-out of the rsfA gene shows two strong phenotypes: (i) the viability of the mutant cells are sharply impaired during stationary phase (as shown by viability competition assays), and (ii) during transition from rich to poor media the mutant cells adapt slowly and show a growth block of more than 10 hours (as shown by growth competition assays). RsfA silences translation by binding to the L14 protein of the large ribosomal subunit and, as a consequence, impairs subunit joining (as shown by molecular modeling, reporter gene analysis, in vitro translation assays, and sucrose gradient analysis). This particular interaction is conserved in all species tested, including Escherichia coli, Treponema pallidum, Streptococcus pneumoniae, Synechocystis PCC 6803, as well as human mitochondria and maize chloroplasts (as demonstrated by yeast two-hybrid tests, pull-downs, and mutagenesis). RsfA is unrelated to the eukaryotic ribosomal anti-association/60S-assembly factor eIF6, which also binds to L14, and is the first such factor in bacteria and organelles. RsfA helps cells to adapt to slow-growth/stationary phase conditions by down-regulating protein synthesis, one of the most energy-consuming processes in both bacterial and eukaryotic cells

Cross-cultural adaptation of the PatientDoctor Relationship Questionnaire (PDRQ-9) in Brazil

OBJETIVO: Descrever o processo de adaptação transcultural do Patient-Doctor Relationship Questionnaire (PDRQ-9), além de comparar a concordância entre duas diferentes formas de aplicação. MÉTODOS: Estudo transversal, com 133 usuários adultos de uma Unidade Básica de Saúde de Porto Alegre, RS. O PDRQ-9 foi respondido pelos participantes de maneira autoaplicada e por meio de entrevista. O instrumento também foi validado por entrevista, utilizando os dados de 628 participantes da Pesquisa de Avaliação do Programa Mais Médicos, um estudo transversal com amostra sistemática de Unidades Básicas de Saúde em todas as regiões do Brasil. Foram realizadas avaliações de equivalência semântica, conceitual e de itens, análise fatorial e avaliação da fidedignidade. RESULTADOS: Todos os itens apresentaram carga fatorial > 0,5 nos diferentes métodos de aplicação e populações na análise fatorial. Foi encontrado alfa de Cronbach de 0,94 no método autoaplicado. A aplicação por meio de entrevista encontrou alfa de Cronbach de 0,95 e 0,94 nas duas amostras diferentes. A utilização do PDRQ-9 por meio de entrevista ou de maneira autoaplicada foi considerada equivalente. CONCLUSÕES: A adaptação transcultural do PDRQ-9 no Brasil replicou a estrutura fatorial encontrada no estudo original, com alta consistência interna. O instrumento poderá ser utilizado como uma nova dimensão na avaliação da qualidade do cuidado em saúde em pesquisas clínicas, na avaliação de serviços e em saúde pública, na gestão em saúde e na formação profissional. Novos estudos poderão ampliar a avaliação de outras propriedades do instrumento, bem como seu comportamento em diferentes populações e contextos.OBJECTIVE: To describe the process of cross-cultural adaptation of the Patient-Doctor Relationship Questionnaire (PDRQ-9), as well as compare the agreement between two different types of application. METHODS: This is a cross-sectional study with 133 adult users of a Primary Health Service in Porto Alegre, State of Rio Grande do Sul, Brazil. The PDRQ-9 was answered by the participants as a self-administered questionnaire and in an interview. The instrument was also validated by interview, using data from 628 participants of the Mais Médicos Program Evaluation Research, which is a cross-sectional study with a systematic sample of Primary Care Services in all regions of Brazil. We evaluated the semantic, conceptual, and item equivalence, as well as factor analysis and reliability. RESULTS: All items presented factor loading > 0.5 in the different methods of application and populations in the factor analysis. We found Cronbach’s alpha of 0.94 in the self-administered method. We found Cronbach’s alpha of 0.95 and 0.94 in the two different samples in the interview application. The use of PDRQ-9 with an interview or self-administered was considered equivalent. CONCLUSIONS: The cross-cultural adaptation of the PDRQ-9 in Brazil replicated the factorial structure found in the original study, with high internal consistency. The instrument can be used as a new dimension in the evaluation of the quality of health care in clinical research, in the evaluation of services and public health, in health management, and in professional training. Further studies can evaluate other properties of the instrument, as well as its behavior in different populations and contexts

Round-Robin modelling of the load-bearing capacity of slender columns by using classical and advanced non-linear numerical and analytical prediction tools

Non-linear finite element analyses have intrinsic model and user factors that influence the results of the analyses. However, non-linear finite element analysis can provide a tool to assess safety using realistic descriptions of material behaviour with actual material properties. A realistic estimation of the existing safety and capacity of slender column elements can be achieved by means of "true" material properties. Nevertheless, it seems that for some structural components, such as slender columns, non-linear finite element analyses can, due to its complexity and its various setting parameters, cause the risk of overestimating the real performance of analysed components or systems. Hence, an invited expert group has carried out an investigation into the experimental testing and the prediction of the bearing capacity of slender columns by performing independent non-linear finite element analyses in order to determine the practical applicability, and its inconsistencies, with respect to the stability failure of slender columns. This work aims the characterization of modelling uncertainties, concerning the prediction of slender columns stability when forecasted by non-linear finite element analysis.This paper was partly carried out during research exchanges at TU Brno (BUT), Lehigh University (LU). The authors acknowledge also the financial support provided by the SAFEBRIDGE ATCZ190 EU Interreg project, the Scientific Grant Agency of the Ministry of Education of Slovak Republic, the Slovak Academy of Sciences VEGA No. 1/0696/14, and Slovak Research and Development Agency under the contract No. APVV-150658. The computational results presented have been achieved [in part] using the Vienna Scientific Cluster (VSC)

Cross-cultural adaptation of the Patient-Doctor Relationship Questionnaire (PDRQ-9) in Brazil

OBJECTIVE: To describe the process of cross-cultural adaptation of the Patient-Doctor Relationship Questionnaire (PDRQ-9), as well as compare the agreement between two different types of application. METHODS: This is a cross-sectional study with 133 adult users of a Primary Health Service in Porto Alegre, State of Rio Grande do Sul, Brazil. The PDRQ-9 was answered by the participants as a self-administered questionnaire and in an interview. The instrument was also validated by interview, using data from 628 participants of the Mais Médicos Program Evaluation Research, which is a cross-sectional study with a systematic sample of Primary Care Services in all regions of Brazil. We evaluated the semantic, conceptual, and item equivalence, as well as factor analysis and reliability. RESULTS: All items presented factor loading > 0.5 in the different methods of application and populations in the factor analysis. We found Cronbach's alpha of 0.94 in the self-administered method. We found Cronbach's alpha of 0.95 and 0.94 in the two different samples in the interview application. The use of PDRQ-9 with an interview or self-administered was considered equivalent. CONCLUSIONS: The cross-cultural adaptation of the PDRQ-9 in Brazil replicated the factorial structure found in the original study, with high internal consistency. The instrument can be used as a new dimension in the evaluation of the quality of health care in clinical research, in the evaluation of services and public health, in health management, and in professional training. Further studies can evaluate other properties of the instrument, as well as its behavior in different populations and contexts

Minding impacting events in a model of stochastic variance

We introduce a generalisation of the well-known ARCH process, widely used for generating uncorrelated stochastic time series with long-term non-Gaussian distributions and long-lasting correlations in the (instantaneous) standard deviation exhibiting a clustering profile. Specifically, inspired by the fact that in a variety of systems impacting events are hardly forgot, we split the process into two different regimes: a first one for regular periods where the average volatility of the fluctuations within a certain period of time is below a certain threshold and another one when the local standard deviation outnumbers it. In the former situation we use standard rules for heteroscedastic processes whereas in the latter case the system starts recalling past values that surpassed the threshold. Our results show that for appropriate parameter values the model is able to provide fat tailed probability density functions and strong persistence of the instantaneous variance characterised by large values of the Hurst exponent is greater than 0.8, which are ubiquitous features in complex systems.Comment: 18 pages, 5 figures, 1 table. To published in PLoS on