Indiana University-Purdue University Indianapolis (IUPUI) / The present thesis is an analysis of longitudinal data collected through the years 2011-2013, from a complex of four hospitals located in Indiana, USA. The aim of the analysis was the detection of changes (especially a decline) in the disease related group (DRG) weights (and thus, the case mix index (CMI)), and the determination of the predictors that significantly affect these changes. The document is divided in four major parts. In the first part it is described the statistical theory required for the the analysis, in the second part the reimbursement strategies for the hospitals in the USA, are briefly described and the concept of the DRG and CMI are explained. In the third part the actual analysis is presented while the last part contains a summary of the findings and some conclusions. The correlation between the observations was taken into account by modeling the data using linearmixed models (LMM). Three major factors were studied for their effect on the DRG weight of thehospitals: the changes in the type of cases (i.e. the product lines), the changes in the number of the Surgical cases, and also the changes of the length of stay (LOS). The analysis did not indicate any significant DRG change in any of the hospitals except from the H4. The H4 hospital has a significant decline over time regarding the Cardio-vascular (CV) DRG weights. For the hospitals H1, H2 and H3 the only decline observed in the product lines was that for the Medical-Surgical DRG. Finally, no significant change was observed for the LOS, or the number of Surgical cases. In addition to the three predictors studied, changes in the coding system, the documentation etc. may also affect the DRG and CMI. However, these changes are not possible to be detected through this analysis, since no available information was given in the present data.

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Made available in DSpace on 2014-06-12T16:29:03Z (GMT). No. of bitstreams: 2 arquivo2104_1.pdf: 1986412 bytes, checksum: 5e5c9aa31c89058b5dd56e7d4f88eab8 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2008 / Microrganismos endofíticos atualmente se apresentam como uma fonte importante para a produção de metabólitos secundários com ação antibacteriana, antifúngica, antitumoral, antimalária, entre outras. Para produção de metabólitos bioativos de Streptomyces sp. UFPEDA 3347, endófito de Momordica charantia L, diferentes meios de fermentação foram testados e a atividade antifúngica foi avaliada através do método de difusão em ágar. O líquido fermentado e a massa celular foram tratados respectivamente com solventes orgânicos apolares e polares em diferentes pHs, para extração de metabólitos antifúngicos. Após a seleção do solvente orgânico, os extratos obtidos foram submetidos à cromatografia em camada delgada (CCD) realizada em placas de sílica gel GF254. O extrato etanólico bruto foi cromatografado em coluna de sílica gel e as 65 frações obtidas foram reunidas em sete grupos (F1, F2,....F7). Tanto o extrato etanólico como as sete frações foram submetidos à CCD seguido da revelação bioautográfica. A avaliação da atividade antifúngica do extrato etanólico e das frações F1 e F7 foi realizada pelo teste de difusão em ágar, enquanto que a concentração mínima inibitória (CMI) e concentração mínima fungicida (CMF) foram determinadas pelo método de diluição em caldo. O meio MA (MPE modificado) favoreceu a maior produção de metabólitos bioativos por 48h, com pH entre 7,8 a 8,0. O ensaio bioautográfico mostrou a presença de metabólitos antifúngicos com Rfs diferentes nos extratos acetato e etanólico.O extrato etanólico e as frações F1 e F7 apresentaram halos de inibição acima de 14 mm de diâmetro para as diferentes cepas de Candida, enquanto que a CMI verificada para o extrato etanólico e para as frações F1 e F7 variou entre 200 a 400 μg/mL. A anfotericina B foi utilizada como padrão. A análise espectroscópica na região UV-VIS das frações, mostrou bandas de absorção características de um antibiótico macrolídeo poliênico para F7 e não-poliênico para F1

INTRODUÇÃO: A busca do entendimento das causas da mortalidade humana está relacionada diretamente ao conhecimento das condições de vida de uma população. Reduzir a mortalidade de crianças é uma das principais metas das políticas de saúde para a infância em todos os países. No Brasil, apesar da redução da mortalidade infantil (MI) observada nos últimos anos, existem, porém, grandes diferenciais do CMI entre algumas populações. OBJETIVO: Estudar a evolução da mortalidade infantil no Estado de Santa Catarina e a tendência de queda dos óbitos infantis evitáveis nas nove Macrorregiões Estaduais de Saúde do Estado, no período de 1997- 2008. METODOLOGIA: Estudo ecológico de séries temporais com cálculo e análise do CMI, segundo componentes e critérios de evitabilidade para óbitos ocorridos nas nove Macrorregiões catarinenses, no período entre 1997-2008. Foram analisadas, por regressão linear simples, as médias trianuais dos óbitos evitáveis, segundo Macrorregiões, no mesmo período. RESULTADOS: analisados 15.146 óbitos ocorridos no primeiro ano de vida, observou-se que 51por cento , aconteceu entre 0 e 6 dias,13,8por cento entre 7 e 27 dias e 35,8por cento , de 28 a 364 dias de vida. O Estado de Santa Catarina registra um dos menores CMIs do país e apresentou queda de 27,2por cento , principalmente às custas do componente pós-neonatal, mostrando, no entanto, preocupantes taxas de mortalidade infantil por óbitos evitáveis (58,6por cento ) e importantes diferenças no CMI entre as Macrorregiões catarinenses. O CMI por óbitos evitáveis do Planalto Serrano (11,90/00NV) foi o dobro da Macrorregião Nordeste (5,70/00NV). CONCLUSÕES: apesar do declínio do CMI, o Estado de Santa Catarina apresentou estabilização das taxas da MI para o componente neonatal e elevado índice de óbitos evitáveis, com diferenças substanciais das suas taxas entre as Macrorregiões, no período estudado. Essa realidade aponta para a necessidade urgente de estudos sequenciais que elucidem esses fatos, a fim de que intervenções ajustadas ás populações estudadas possam vir a acontecer, diminuindo as mortes infantis no território catarinense / INTRODUCTION: The pursuit for understanding the causes of human mortality is related straight to the knowledge of a living society conditions. The reduction of child mortality is the major goal of children health policies in all countries. In Brazil, despite of the infant mortality reduction observed in recent years, there are, however, huge differences of Infant mortality rate between populations. OBJECTIVE:In order to study the infant mortality evolution in the Santa Catarina State and the downward trend of avoidable child deaths in nine Health Macro-regions in the State, in each triennium from 1997 to 2008. METHODS: An ecological time series studies with calculation and analysis of Infant mortality rate second components of the infant mortality, in the nine Santa Catarina Macro-regions (Brazil) for avoidability deaths in a period between 1997 and 2008, the triennial averages of avoidable deaths, by regions in the same period, were analyzed by simple linear regression. RESULTS: Was analyzed 15,146 deaths in the first year of life between1997- 2008, the data showed that 51per cent of the total occurred from 0 to 6 of life days, 13.8per cent between 7 and 27 days and 35.8per cent of 28 to 364 days of life, the state of Santa Catarina showed a decline of CMI (27.2per cent), mainly due to a postneonatal fees period, showing, however alarming rates of infant mortality from preventable deaths (58.6per cent) and important differences among SC regions of the CMI. CONCLUSIONS: Despite the decline of CMI, the state of Santa Catarina showed stabilization of the neonatal ID and high rate of avoidable deaths, with significant differences in their rates among regions, in the study period. This reality leads to the urgent need for sequential studies that will elucidate these facts, so that interventions set to a studied of a specific populations may happen, reducing child deaths in the territory of Santa Catarina

INTRODUÇÃO: A busca do entendimento das causas da mortalidade humana está relacionada diretamente ao conhecimento das condições de vida de uma população. Reduzir a mortalidade de crianças é uma das principais metas das políticas de saúde para a infância em todos os países. No Brasil, apesar da redução da mortalidade infantil (MI) observada nos últimos anos, existem, porém, grandes diferenciais do CMI entre algumas populações. OBJETIVO: Estudar a evolução da mortalidade infantil no Estado de Santa Catarina e a tendência de queda dos óbitos infantis evitáveis nas nove Macrorregiões Estaduais de Saúde do Estado, no período de 1997- 2008. METODOLOGIA: Estudo ecológico de séries temporais com cálculo e análise do CMI, segundo componentes e critérios de evitabilidade para óbitos ocorridos nas nove Macrorregiões catarinenses, no período entre 1997-2008. Foram analisadas, por regressão linear simples, as médias trianuais dos óbitos evitáveis, segundo Macrorregiões, no mesmo período. RESULTADOS: analisados 15.146 óbitos ocorridos no primeiro ano de vida, observou-se que 51por cento , aconteceu entre 0 e 6 dias,13,8por cento entre 7 e 27 dias e 35,8por cento , de 28 a 364 dias de vida. O Estado de Santa Catarina registra um dos menores CMIs do país e apresentou queda de 27,2por cento , principalmente às custas do componente pós-neonatal, mostrando, no entanto, preocupantes taxas de mortalidade infantil por óbitos evitáveis (58,6por cento ) e importantes diferenças no CMI entre as Macrorregiões catarinenses. O CMI por óbitos evitáveis do Planalto Serrano (11,90/00NV) foi o dobro da Macrorregião Nordeste (5,70/00NV). CONCLUSÕES: apesar do declínio do CMI, o Estado de Santa Catarina apresentou estabilização das taxas da MI para o componente neonatal e elevado índice de óbitos evitáveis, com diferenças substanciais das suas taxas entre as Macrorregiões, no período estudado. Essa realidade aponta para a necessidade urgente de estudos sequenciais que elucidem esses fatos, a fim de que intervenções ajustadas ás populações estudadas possam vir a acontecer, diminuindo as mortes infantis no território catarinense / INTRODUCTION: The pursuit for understanding the causes of human mortality is related straight to the knowledge of a living society conditions. The reduction of child mortality is the major goal of children health policies in all countries. In Brazil, despite of the infant mortality reduction observed in recent years, there are, however, huge differences of Infant mortality rate between populations. OBJECTIVE:In order to study the infant mortality evolution in the Santa Catarina State and the downward trend of avoidable child deaths in nine Health Macro-regions in the State, in each triennium from 1997 to 2008. METHODS: An ecological time series studies with calculation and analysis of Infant mortality rate second components of the infant mortality, in the nine Santa Catarina Macro-regions (Brazil) for avoidability deaths in a period between 1997 and 2008, the triennial averages of avoidable deaths, by regions in the same period, were analyzed by simple linear regression. RESULTS: Was analyzed 15,146 deaths in the first year of life between1997- 2008, the data showed that 51per cent of the total occurred from 0 to 6 of life days, 13.8per cent between 7 and 27 days and 35.8per cent of 28 to 364 days of life, the state of Santa Catarina showed a decline of CMI (27.2per cent), mainly due to a postneonatal fees period, showing, however alarming rates of infant mortality from preventable deaths (58.6per cent) and important differences among SC regions of the CMI. CONCLUSIONS: Despite the decline of CMI, the state of Santa Catarina showed stabilization of the neonatal ID and high rate of avoidable deaths, with significant differences in their rates among regions, in the study period. This reality leads to the urgent need for sequential studies that will elucidate these facts, so that interventions set to a studied of a specific populations may happen, reducing child deaths in the territory of Santa Catarina

Cold-adapted (ca) live attenuated influenza vaccines (LAIVs) have been introduced as alternatives to existing inactivated influenza vaccines. The influenza A components of the FDA-approved ca LAIVs (Flumist®; Medimmune) have common internal genes derived from the donor strain A/Ann Arbor/6/60 ca and surface genes derived from current wild-type (wt) epidemic strains. The aim of this thesis was to investigate determinants of immunogenicity for reassortants of A/Ann Arbor/6/60 ca, using a range of immunological assays, including recently developed MHC tetramer techniques. From the study, the extent of viral replication in the respiratory tract of mice, the primary site of inoculation, was a key factor in determining ca vaccine immunogenicity. Replication was shown to be influenced by both viral surface Ags and the host MHC. The H3 ca reassortants CR6, CR18, CR29 and CR6-35* exhibited greater replication efficiency (as determined by their PFU:HAU ratios) than the H1 ca reassortants CR35 and CR6-35. The H3 ca reassortant CR6 caused a 3.79% loss in body weight but no losses were observed for the H1 ca reassortant CR35 and the ca H2N2 donor strain A/Ann Arbor/6/60 ca. Higher HI responses were detected after 3 weeks in groups infected with the H3 ca reassortant CR6 (GMT 80) than with the H1 reassortant CR35 (GMT 10) and the H2 ca donor strain A/Ann Arbor/6/60 ca (GMT 13). Recently developed techniques were used to evaluate specific T-cell response to ca LAIVs. Fluorescent-labelled tetramer is the key reagent for use in tetramer-based flow cytometry assays. The NP366-374 peptide of influenza A viruses comprises an immunodominant epitope that is highly conserved between subtypes. Tetramers developed for A/PR/8/34 (H1N1) were able to detect NP-specific cytotoxic T lymphocytes (CTLs) induced by A/Ann Arbor /6/60 ca (H2N2). An attempt to prepare the A/Ann Arbor/6/60 ca-specific-NP-tetramer is described. H-2Db monomers were successfully refolded with the peptide, but only 20% were able to form tetramers through biotin-streptavidin linkage, resulting in a poor capacity to stain. By contrast, an IFN-γ ICC assay developed in parallel demonstrated that peptide NP366-374 was able to restimulate A/Ann Arbor/6/60 NP ca-specific CTLs and secrete IFN-γ when tested in vitro. Specific-B and T cell responses induced in the lungs in response to infection by ca reassortants exhibited great variability that was determined by the growth characteristics of different viruses. Type I (CTL) responses were induced by low yielding ca reassortants, such as CR35 (H1N1). Viruses with enhanced growth characteristics, such as CR6 (H3N2), produced higher Type II (HA-specific Ab) responses. In addition, host factors, such as MHC type, were found to play an important role in responses to the same viruses. Susceptible mouse strains, such as C57BL/6, showed higher CTL but lower serum Ab responses than more resistant strains, such as BALB/c. Throughout this PhD project, a fine balance between the humoral and CMI, local and systemic immune responses induced by ca LAIVs was demonstrated. The need to assess local immune responses, in addition to serum antibody levels, for the evaluation of vaccine efficacy was an important conclusion of the thesis.

The main purpose of the present study is to examine the predictive validity of the Youth Level of Service/Case Management Inventory (YLS/CMI) to Japanese juvenile offender population. Three hundred and eighty-nine juveniles who were released from the five Juvenile Classification Homes (JCHs) were followed for more than one year on average. Results demonstrate that those who show higher score on the YLS/CMI are more likely to recidivate than those who are not. A total score of the YLS/CMI also significantly contributes to predict faster time to recidivate. Furthermore, the superiority of actuarial risk measures over clinical risk judgment is confirmed. The overall findings support the applicability of the YLS/CMI among Japanese juvenile offenders. Practical implications and limitations to the current study are also discussed.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-06-30T16:59:18Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação- Raphael Santana.pdf: 1198352 bytes, checksum: 2ddd13ab9df70bdaf76d80dd5d481f49 (MD5) / Made available in DSpace on 2016-06-30T16:59:19Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação- Raphael Santana.pdf: 1198352 bytes, checksum: 2ddd13ab9df70bdaf76d80dd5d481f49 (MD5) Previous issue date: 2015-02-24 / FACEPE / Actinobactérias são bactérias Gram-positivas formadoras de filamentos ramificados que se destacam pela produção de metabólitos secundários, como antimicrobianos, antitumorais, fitohormônios e corantes naturais. Diante disso, este trabalho teve o objetivo de determinar o potencial biotecnológico de actinobactérias da coleção UFPEDA contra Candida spp. Para avaliação da atividade biotecnológica, 32 actinobactérias foram testadas contra sete isolados clínicos de Candida spp. utilizando diferentes meios de cultura para o crescimento (ALA, ISP-4, AY, ISP-3) e temperaturas (37 ºC ou 45 ºC). No ensaio primário, foi evidenciada atividade apenas quando as actinobactérias foram cultivadas em meio ISP-3 a temperatura de 37 ºC. Dessas, apenas 2 linhagens (6,25 %) apresentaram atividade antifúngica com halo de inibição variando entre 11 mm e 18 mm. As duas linhagens produtoras de metabólitos secundários com atividades antifúngicas não apresentaram diferença estatística, por isso foi selecionada a linhagem G24 por apresentar um pigmento na cor vermelha para dar seguimento às análises. A fermentação da linhagem (G24) foi realizada para avaliar atividade antifúngica, biomassa e pH, durante 5 dias, utilizando diferentes meios (MPE, M1 e ISP-3),sendo tais parâmetros monitorados a cada 24 horas. O melhor meio para produção de metabólitos secundários foi ISP-3 fermentado durante 48 h em pH 7.0, sendo evidenciados halos de inibição de 13 a 18 mm e biomassa de 0,1 g/mL de meio. Estabelecidas às condições, foi realizada a extração do princípio bioativo, sendo evidenciada atividade apenas para biomassa quando extraído em acetato de etila. A concentração mínima inibitória (CMI) do extrato bruto variou de 125 μg/mL a 62,5 μg/mL para Candida spp testadas. Análise Cromatográfica do Extrato Bruto as frações semi-purificadas foram analisadas por cromatografia em camada delgada (CCD) sendo evidenciadas duas frações, uma com atividade antifúngica e outra um corante natural. As características morfológicas do isolado G24 foram analisadas por microscopia óptica, sendo observados esporos verticilados pertencente ao gênero Streptomyces. O gene 16S rDNA foi amplificado e enviado para sequenciamento, sendo identificada como Streptomyces sp. Diante destes resultados, podemos concluir que a linhagem (Streptomyces sp), isolado da rizosfera de Caesalpinia pyramidalis tul, do bioma Caatinga, apresenta uma significativa atividade antifúngica e necessita de estudos espectroscópios para caracterização do composto bioativo e do corante. / Actinobacteria are forming Gram-positive bacteria of branched filaments that stand out for the production of secondary metabolites such as antibiotics, antitumor, phytohormones and naturias dyes. Given this, this study aimed to determine the biotechnological potential of actinomycetes of UFPEDA collection against Candida spp. To evaluate the biotechnological activity, 32 actinomycetes were tested against seven clinical isolates of Candida spp., Using different culture media (ALA, ISP-4, AY, ISP-3) and temperatures (37 ° C and 45 ° C). In the primary test, activity was detected only when the actinomycetes were grown in ISP-medium 3 to a temperature of 37 ° C. Of these, only 2 strains (6.25%) showed antifungal activity with inhibition zone ranging between 11 mm and 18 mm. Fermentation of strain (G24) was used to evaluate antifungal activity, biomass and pH for 5 days, using different media (MPE M1 and ISP-3), these parameters being monitored every 24 hours. The best medium for production of secondary metabolites ISP-3 was fermented for 48 h at pH 7.0, being evidenced inhibition zones 13 to 18 mm and biomass of 0.1 g / ml medium. Established conditions, the extraction of bioactive principle has been performed and demonstrated activity only when biomass extracted into ethyl acetate. The minimum inhibitory concentration (MIC) of the crude extract ranged from 125 mg / mL to 62.5 mg / mL for Candida spp tested. In chemical prospecting, semi-purified fractions were analyzed by thin layer chromatography (TLC) was evidenced two fractions, one with antifungal activity and one with a natural dye. The morphological characteristics of isolated G24 were analyzed by optical microscopy, observed verticilados spores belonging to the genus Streptomyces. The 16S rDNA gene was amplified and sent to sequencing, being identified as Streptomyces sp. Given these results, we can conclude that the line (G24) (Streptomyces sp), isolated from the rhizosphere of Caesalpinia pyramidalis tul, the Caatinga biome, presents a significant antifungal activity and requires spectroscopes studies to characterize the bioactive compound and the dye.

Athletes participating in ice hockey are at a high risk of experiencing a concussion which can lead to impairments in cognitive functions. Deciding when a player can be returned to playing ice hockey is part of the concussion management called return to play (RTP). This can bebased on subjective or objective measures. Returning a concussed hockey player too soon can result in devastating consequences. This review aimed to investigate what objective measure could be used to assess a concussed player. It specifically focused on Immediate Post Concussion Assessment and Cognitive Test (ImPACT) and a cognitive motor integration (CMI) performance task. It was hypothesized that by combining the two could contribute to an optimal objective assessment and be used as accurate indicators in the RTP decision. This review involved searches from PubMed, Scopus and Web of Science which resulted in a total of four articles. The amount of articles was a big limitation. Main findings are that concussed participants showed decreased cognitive performance relative to baseline despite subjectively reporting being symptom free. Findings in this review suggest that adding a CMI performance task to the ImPACT test battery could be a way to objectively catch several composites incognitive recovery including tasks that require higher levels of cognitive functioning. Administering an assessment based on two objective measures could add accuracy and contribute to a safe RTP not risking a second impact syndrome or prolonged cognitive impairments.

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