We examined the validity of the Serbian version of the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King and Henderson-King 2005). A total of 622 Serbian adults completed the ACSS, along with Serbian translations of measures for the discrepancy between actual body weight and ideal body weight, body appreciation, sociocultural attitudes toward appearance, and demographics. Confirmatory factor analyses were conducted to compare how different ACSS models fitted the collected data. A three-factor model provided the best fit to the data relative to two- and one-factor models. The three-factor model had good internal consistency, convergent and discriminant validity, and nomological validity. The ACSS seems to be a valid instrument for use in Serbian populations. Our study will contribute towards better understanding of the acceptance of cosmetic surgery from a cross-cultural perspective.
Background The access to healthcare and treatment by rheumatoid arthritis (RA) patients, particularly to biologics, differs significantly among European countries. We aimed to explore the views and experiences of Portuguese healthcare stakeholders on key barriers which limit the access to treatment, and ultimately to biologics, by RA patients and to find potential solutions (leverage points) to overcome the identified barriers. Methods This was a qualitative research consisting of semi-structured face-to-face interviews with key stakeholders in RA framework. Thirty four individuals from eight groups of stakeholders were interviewed: rural and urban general practitioners (GPs), rheumatologists, hospital managers, hospital pharmacists, budget holders, representatives from the Portuguese Rheumatology Society and the RA Patient Association. Interviews were conducted between May and June 2011. Conventional content analysis with research triangulation was used. Results The key barriers identified were related to the accessibility to primary healthcare services, difficulties in RA diagnosis among GPs, inefficient referral to secondary healthcare and controlled process of biologics prescription in public hospitals. The leverage points identified included the improvement of epidemiological and clinical knowledge about RA in Portugal, a better understanding of the disease among patients and GPs, the clarification of biologics benefits among budget holders and a raised awareness of the current treatment guidelines. In order to further address the leverage points, the following key initiatives were proposed: optimization of RA national registry; dissemination of information on rheumatic symptoms in primary care facilities and among the general public; increase interaction between rheumatologists and GPs through clinical discussions of successfully treated patients or workshops; broader utilization of disease diagnosis and monitoring tools, such as DAS28, and implementation of hospital–based research to collect real-world data. Conclusions Most of the key barriers limiting the access to treatment, including biologics, in RA in Portugal are upstream of rheumatology practice. Our findings suggest that future actions should be focused on the primary care level to improve referral to rheumatologists. In addition, the collection of real-world data seems essential to characterise the RA population, to improve disease management and to increase compliance with current treatment guidelines.
Background The number of HIV-related hospitalizations has decreased worldwide in recent years owing to the availability of highly active antiretroviral therapy. However, the change in HIV-related hospitalizations in Portugal has not been studied. Using comprehensive hospital discharge data from mainland Portuguese hospitals, we examined trends in HIV-related inpatient admissions, length of stay (LOS), Elixhauser comorbidity measures, in-hospital mortality, and mean cost from 2000 to 2010. Methods The hospital administrative data from inpatient admissions and discharges at 75 public acute care hospitals in the Portuguese National Health Service from 2000 to 2010 were included. HIV-related admissions were identified using the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes 042.x–044.x. The effect of Elixhauser comorbidity measures on extending the LOS was assessed by comparing admissions in HIV patients with and without comorbidities using the Mann–Whitney U test. Multivariate logistic regression was performed to estimate the odds of having a decreased discharge. Results A total of 57,027 hospital admissions were analyzed; 73% of patients were male, and the mean age was 39 years. The median LOS was 11 days, and the in-hospital mortality was 14%. The mean cost per hospitalization was 5,148.7€. A total of 83% of admissions were through the emergency room. During the period, inpatient HIV admissions decreased by 22%, LOS decreased by 9%, and in-hospital mortality dropped by 12%. Elixhauser comorbidities increased the median LOS in nearly all admissions. Conclusions Despite small regional variations, a strong, consistent decrease was observed in the hospital admission rate, mean cost, length of stay, and mortality rate for HIV-related admissions in Portugal during 2000–2010.
Background Cell-based therapy is a treatment method in tendon injuries. Bone morphogenic protein 12 (BMP-12) possesses tenogenic activity and was proposed as a differentiating factor for stem cells directed to transplantation. However, BMPs belong to pleiotropic TGF-β superfamily and have diverse effect on cells. Therefore, the aim of this study was to determine if BMP-12 induces tenogenic differentiation of human adipose stem cells (hASCs) and how it affects other features of this population. Results Human ASCs from 6 healthy donors were treated or not with BMP-12 (50 or 100 ng/ml, 7 days) and tested for gene expression (COLL1, SCX, MKH, DCN, TNC, RUNX2), protein expression (COLL1, COLL3, MKH), proliferation, migration, secretory activity, immunomodulatory properties and susceptibility to oxidative stress. RT-PCR revealed up-regulation of SCX, MKH and RUNX2 genes in BMP-12 treated cells (2.05, 2.65 and 1.87 fold in comparison to control, respectively, p < 0.05) and Western Blot revealed significant increase of COLL1 and MHK expression after BMP-12 treatment. Addition of BMP-12 significantly enhanced secretion of VEGF, IL-6, MMP-1 and MPP-8 by hASCs while had no effect on TGF-β, IL-10, EGF and MMP-13. Moreover, BMP-12 presence in medium attenuated inhibitory effect of hASCs on allo-activated lymphocytes proliferation. At the same time BMP-12 displayed no influence on hASCs proliferation, migration and susceptibility to oxidative stress. Conclusion BMP-12 activates tenogenic pathway in hASCs but also affects secretory activity and impairs immunomodulatory potential of this population that can influence the clinical outcome after cell transplantation.
The scale development process is critical to building knowledge in human and social sciences. The present paper aimed (a) to provide a systematic review of the published literature regarding current practices of the scale development process, (b) to assess the main limitations reported by the authors in these processes, and (c) to provide a set of recommendations for best practices in future scale development research. Papers were selected in September 2015, with the search terms “scale development” and “limitations” from three databases: Scopus, PsycINFO, and Web of Science, with no time restriction. We evaluated 105 studies published between 1976 and 2015. The analysis considered the three basic steps in scale development: item generation, theoretical analysis, and psychometric analysis. The study identified ten main types of limitation in these practices reported in the literature: sample characteristic limitations, methodological limitations, psychometric limitations, qualitative research limitations, missing data, social desirability bias, item limitations, brevity of the scale, difficulty controlling all variables, and lack of manual instructions. Considering these results, various studies analyzed in this review clearly identified methodological weaknesses in the scale development process (e.g., smaller sample sizes in psychometric analysis), but only a few researchers recognized and recorded these limitations. We hope that a systematic knowledge of the difficulties usually reported in scale development will help future researchers to recognize their own limitations and especially to make the most appropriate choices among different conceptions and methodological strategies.
Organizational and technical approaches have proven successful in increasing the performance and preventing risks at socio-technical systems at all scales. Nevertheless, damaging events are often unavoidable due to a wide and dynamic threat landscape and enabled by the increasing complexity of modern systems. For overall performance and risk control at the system level, resilience can be a versatile option, in particular for reducing resources needed for system development, maintenance, reuse, or disposal. This paper presents a framework for a resilience assessment and management process that builds on existing risk management practice before, during, and after potential and real events. It leverages tabular and matrix correlation methods similar as standardized in the field of risk analysis to fulfill the step-wise resilience assessment and management for critical functions of complex systems. We present data needs for the method implementation and output generation, in particular regarding the assessment of threats and the effects of counter measures. Also included is a discussion of how the results contribute to the advancement of functional risk control and resilience enhancement at system level as well as related practical implications for its efficient implementation. The approach is applied in the domains telecommunication, gas networks, and indoor localization systems. Results and implications are further discussed.
Often because of limitations in generation capacity of power stations, many developing countries frequently resort to disconnecting large parts of the power grid from supply, a process termed load shedding. This leaves households in disconnected parts without electricity, causing them inconvenience and discomfort. Without fairness being taken into due consideration during load shedding, some households may suffer more than others. In this paper, we solve the fair load shedding problem (FLSP) by creating solutions which connect households to supply based on some fairness criteria (i.e., to fairly connect homes to supply in terms of duration, their electricity needs, and their demand), which we model as their utilities. First, we briefly describe some state-of-art household-level load shedding heuristics which meet the first criteria. Second, we model the FLSP as a resource allocation problem, which we formulate into two Mixed Integer Programming (MIP) problems based on the Multiple Knapsack Problem. In so doing, we use the utilitarian, egalitarian and envy-freeness social welfare metrics to develop objectives and constraints that ensure our FLSP solutions results in fair allocations that consider the utilities of agents. Then, we solve the FLSP and show that our MIP models maximize the groupwise and individual utilities of agents, and minimize the differences between their pairwise utilities under a number of experiments. When taken together, our endeavour establishes a set of benchmarks for fair load shedding schemes, and provide insights for designing fair allocation solutions for other scarce resources.
Dysregulation of metabolism allows tumor cells to generate needed building blocks as well as to modulate epigenetic marks to support cancer initiation and progression. Cancer-induced metabolic changes alter the epigenetic landscape, especially modifications on histones and DNA, thereby promoting malignant transformation, adaptation to inadequate nutrition, and metastasis. Recent advances in cancer metabolism shed light on how aberrations in metabolites and metabolic enzymes modify epigenetic programs. The metabolism-induced recoding of epigenetics in cancer depends strongly on nutrient availability for tumor cells. In this review, we focus on metabolic remodeling of epigenetics in cancer and examine potential mechanisms by which cancer cells integrate nutritional inputs into epigenetic modification.