Coma, estado vegetativo e sedação são desordens da consciência com diferenças clínicas em que ocorrem redução generalizada ou alteração no conteúdo da consciência, somadas a deficiências no despertar. Objetivo: analisar as relações entre as respostas vitais, faciais e de tônus muscular frente ao estímulo música ou mensagem em pacientes em coma, estado vegetativo ou sedado. Método: Ensaio Clínico Controlado Transversal Unicego para o pesquisador. Local da coleta: duas Unidades de Terapia Intensiva e uma Enfermaria de um Hospital Público de Ensino e Pesquisa. Procedimento de coleta de dados: pacientes com Escala Coma de Glasgow entre 3 e 8 ou Escala de Sedação de Ramsay de 5 ou 6 foram alocados aleatoriamente em um dos três grupos (experimental música, experimental mensagem ou controle). Os familiares gravaram uma mensagem de voz e escolheram uma música de acordo com a preferência do paciente. Foram coletados os sinais vitais, eletroneurografia e expressão facial dos pacientes nos períodos basal e durante a intervenção. Duas sessões de intervenção foram realizadas no mesmo dia. Após 30-40 dias da intervenção inicial foi aplicada a Escala de Resultado de Glasgow. Resultados: a maioria dos 76 pacientes em coma, 9 estado vegetativo ou sedados eram do sexo masculino, tinham entre 18 e 36 anos e foram internados por trauma. Encontrou-se alterações estatisticamente significantes nas variáveis temperatura, expressão facial, eletroneurografia e Escala de Resultado de Glasgow nas análises realizadas nesse estudo, além de alterações mais freqüentes na sessão 2, nos pacientes em coma e estado vegetativo, no canal 1 da eletroneurografia (músculo frontal) e no grupo experimental mensagem com valores médios e porcentagem maiores do que no grupo experimental música. Conclusões: Os resultados em relação aos sinais vitais são limitados e inconclusivos, o que dificulta qualquer inferência em relação a sua influência nas respostas dos pacientes com desordens de consciência em relação aos estímulos apresentados. A expressão facial e a eletroneurografia parecem ser variáveis mais confiáveis para avaliação das respostas desses pacientes, no entanto, mais estudos são sugeridos. / Coma, vegetative state and sedation are disorders of consciousness with clinical differences where a generalized reduction or alteration occurs in the consciousness content, coupled with deficiencies in waking. Objective: to analyze the relations between the vital signs, facial expressions and muscular tonus to the music or message stimuli in coma, vegetative state or sedated patients. Method: This study was a single-blinded transversal controlled clinical trial. Data collection: two Intensive Care Units and one ward of a Public Hospital of Education and Research. Procedure: patients with Glasgow Coma Scale between 3 and 8 or Ramsay Sedation Scale of 5 or 6 being randomly placed into one of the three groups (experimental music, experimental message or control). Their relatives recorded a voice message and chose a song according to the patients preference. The vital signs, eletroneurography and facial expressions of the patients were collected both in the baseline and also during the intervention. Two intervention sessions were performed on the same day. The Glasgow Outcome Scale was applied 30-40 days after the initial intervention. Results: the majority of the 76 coma, vegetative state or 11 sedated patients were masculine, between the ages of 18 and 36 and had been interned for trauma. Statistically significant alterations were noted in the variables of temperature, facial expression, eletroneurography and Glasgow Outcome Scale in the analyses performed in this study, in addition to more frequent alterations in session 2, in the coma and vegetative state patients, in channel 1 of the eletroneurography (frontal muscle) and in the message experimental group with mean values and higher percentages than in the music experimental group. Conclusions: The results, in relation to the vital signs, are limited and inconclusive, which complicates any inference regarding their influence on the responses of patients with disorders of consciousness in relation to stimuli. Facial expressions and eletroneurography, seem to be the more reliable variables for evaluation of the responses of these patients; however, additional studies are suggested.

Dans le milieu clinique des soins intensifs, l’induction du coma médicamenteux (i.e. iatrogénique) par les sédatifs et les analgésiques est souvent associée à une augmentation significative du délirium. De plus, l’utilisation de sédatifs et d’analgésiques comme le fentanyl et le midazolam sans interruption et sans ajustement aux besoins du patient augmentent la durée de séjour, les coûts et la mortalité. Le but de cette étude était d’explorer les facteurs de variabilité pouvant influencer la survenue du coma iatrogénique et du délirium tel que : les facteurs génétiques/sociodémographiques et la co-administration de médicaments substrats ou inhibiteurs de CYP3A4/3A5 ou de la glycoproteine P. L’étude prospective à visée observationnelle a été effectuée à l’unité de soins intensifs de l’hôpital Maisonneuve-Rosemont avec 53 patients perfusés avec fentanyl ou midazolam. La faisabilité du modèle pharmacocinétique du fentanyl a été mise en évidence à partir des échantillons sanguins des patients et était compatible avec les données cliniques. Cette étude montre donc que contrairement au profil génomique de CYP3A5 (p value = 0,521) et MDR1 (p value = 0,828), les effets des interactions médicamenteuses entre les inhibiteurs CYP3A4/CYP3A5 et fentanyl/midazolam représentent un facteur de risque pour le coma iatrogénique (p value = 0,014). Ces effets peuvent être facilement identifiés et sont prévisibles; résultats qui seront utiles aux praticiens – intensivistes dans le choix d’une thérapie pharmacologique appropriée pour prévenir les complications morbides comme le coma iatrogénique et le délirium. / When sedatives such as midazolam or opiate analgesics such as fentanyl administered to critically ill patients and medication-induced coma occurs, increased delirium is observed. In addition, there is an increase in the length of stay in ICU, in costs and mortality. The purpose of this study was to explore the factors of variability affecting the incidence of iatrogenic coma and delirium: genetics/socio demographics factors, co-administration of substrates/inhibitors of CYP3A4/3A5 or P-gp. We performed a prospective cohort observational study of 53 hospitalized patients treated with fentanyl or/and midazolam in the intensive care unit of the Maisonneuve-Rosemont hospital The feasibility of pharmacokinetics modeling using blood samples from critically ill patients was demonstrated and was compatible with clinical data. This study suggests that contrary to genomic variants in the CYP3A5 (p value = 0,521) and MDR1 (p value = 0,828) genes, the effect of drugs and drugs interactions between inhibitors of CYP3A4/3A5 and fentanyl/ midazolam constitutes the main risk factor for iatrogenic coma (p value - 0,014). These effects are easily identifiable and predictable, and are very important for intensive care workers to make the appropriate choice of medication in order to prevent morbid complications such as iatrogenic coma and delirium.

Photometric techniques are often used to observe stars and it can be demonstrated that fundamental stellar properties can be observationally determined using calibrated sets of photometric data. Many of the most powerful techniques utilized to calibrate stellar photometry employ the use of stars in clusters since the individual stars are believed to have many common properties such as age, composition, and approximate distance. Broadband photometric Johnson/Cousins BVRI observations are presented for several nearby open clusters. The new photometry has been tested for consistency relative to archival work and shown to be both accurate and precise. The careful use of a regular routine when making photometric observations, along with the monitoring of instrumental systems and the use of various quality control techniques when making observations or performing data reductions, will enhance an observer's ability to produce high-quality photometric measurements. This work contains a condensed review of the history of photometry, along with a brief description of several popular photometric systems that are often utilized in the field of stellar astrophysics. Publications written by Taylor or produced during the early Taylor and Joner collaboration are deemed especially relevant to the current work. A synopsis of seven archival publications is offered, along with a review of notable reports of VRI photometric observations for the nearby Hyades open star cluster. The body of this present work consists of four publications that appeared between the years 2005 and 2008, along with a soon to be submitted manuscript for a fifth publication. Each of these papers deals specifically with high-quality broadband photometry of open clusters with new data being presented for the Hyades, Coma, NGC 752, Praesepe, and M67. It is concluded that the VRI photometry produced during the Taylor and Joner collaborative investigations forms a high-quality data set that has been: 1) stable for a period of more than 25 years; 2) monitored and tested several times for consistency relative to the broadband Cousins system, and 3) shown to have well-understood transformations to other versions of broadband photometric systems. Further work is suggested for: 1) the transformation relationships for the reddest stars available for use as standards; 2) the standardization of more fields for use with CCD detectors; 3) a further investigation of transformations of blue color indices for observations done using CCD detectors with enhanced UV sensitivity, and 4) a continuation of work on methods to produce high-quality observations of assorted star clusters (both open and globular) with CCD-based instrumentation and intermediate-band photometric systems.

Made available in DSpace on 2016-08-03T16:34:35Z (GMT). No. of bitstreams: 1 ElaineSantos.pdf: 342463 bytes, checksum: ea279dc649a7459b9e27ce53f87c0382 (MD5) Previous issue date: 2014-09-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Subjective well-being (SWB) involvesa setof categories withcognitive andemotional componentsthat people useto evaluateyour own life. This is notan objectiveevaluation byobservers related to thequality of lifeof a person, but thesubjectiveevaluation of eachindividual onthe qualityof your own life, about thesatisfaction experiencedin everyday life. Thus, BESisa personalassessment ofhow happya personfeelsregardlessof the context andsocioeconomic status, health, success and other variablesthat could allowan objective assessmentofquality of life. It is assumed thatparents ofproblemsareassociated with lowerreports ofBES. The objectiveof this studywas to investigaterelationships betweensubjective well-being of parentsandpsychiatric diagnosesof children. Forthis studyquestionnairesto70parentswithchildreninpsychological careat the Health UnitofChildandAdolescentbeen applied. Resultsof analyzesof variance, t tests andchi-square revealednorelationship betweensubjective well-being of parents andpresence ofdisorderin their children. There wereevendifferences betweenmothers and fathersBESorBESbetweentheparentsof boys andgirls. Furthermore, theseparents havereasonable levels ofBES, composed ofgood levels ofgenerallife satisfactionandlowemotionalbalance, which reveals almostemotionalneutrality.Discussionspoint to theneed for studiesthat complementthese findings / Bem-estar subjetivo (BES) envolve um conjunto de categorias com componentes cognitivos e emocionais utilizados pelas pessoas para avaliar sua própria vida. Não se trata de uma avaliação objetiva feita por observadores com relação à qualidade de vida de uma pessoa, mas da avaliação subjetiva de cada indivíduo sobre a qualidade de sua própria vida, sobre a satisfação experimentada no quotidiano. Assim, BES representa uma avaliação pessoal sobre quão feliz o indivíduo se sente, independentemente do contexto e das condições socioeconômicas, da saúde, do sucesso e de outras variáveis que poderiam permitir uma avaliação objetiva de qualidade de vida. Supõe-se que pais de crianças com problemas avaliem-se como menos felizes do que outros e que o diagnóstico de problemas esteja associado a um menor relato de BES. Assim, o objetivo deste estudo foi verificar relações entre bem-estar subjetivo de genitores e diagnósticos psiquiátricos de crianças. Para a realização deste estudo foram aplicados questionários para 70 genitores com filhos em atendimento psicológico na Unidade de Saúde da Criança e Adolescente. Resultados de análises de variância, testes t e de qui-quadrados revelaram não haver relações entre bem-estar subjetivo dos pais e presença de transtorno em seus filhos. Sequer houve diferenças entre BES de pais e mães ou entre BES de genitores de meninos e meninas. Além disso, esses genitores possuíam níveis razoáveis de BES, composto por bons índices de satisfação geral com a vida e balanço emocional baixo, o que revela uma quase neutralidade afetiva. Discussões apontam para a necessidade de estudos que complementem esses achados.

La « langue du coma » peut être une locution surprenante, si l’on considère que le coma est le silence de la parole du patient réanimé. Les mots « coma »et « réanimation » affectent également la parole de l’autre, le laissant souvent sans voix face à la violence d’un effondrement somatique qui ne dit pas son nom. Dans un espace où la pulsion de mort est à l’œuvre, remettant en question les divisions du temps, une langue surgit de ces interstices et vient dire quelque chose du sujet réanimé, dans sa temporalisation et sa spatialisation. En tant que langue circonstancielle, elle est composée de figures de style pour pallier d’impossibles représentations: elle place les proches et les soignants dans un véritable bilinguisme et le patient dans un statut phénoménologique d’être-au-monde. La langue, à la fois outil et objet de la psychanalyse nous permet de penser les conditions d’une réanimation psychique qui accompagnerait la réanimation médicale. / The “coma’s language” can be a surprising expression, if we regard the coma as the silence of the resuscitated patient’s speech. The words “coma” and “resuscitation” affect also the speech of the other one, often making him speechless in front of the violence of a somatic collapse that does not say its name. In a space where the death pulsion is at work, calling into question the time divisions, a language appears suddenly of its interstice and come and say something to the resuscitated subject, in its temporization and spatialization. As a circumstantial language, it is composed of figure of speech to compensate for impossible representations: it put the close relatives and the medical in a real bilingualism and the patient in a phenomenological representation “d’être-au-monde”. The language, at the same time tool and subject of the psychoanalysis allow us to think the conditions of a psychological resuscitation that would go with the medical resuscitation.

La compréhension actuelle de l'état comateux est très limitée. La technique des potentiels évoqués s'est démontrée des plus prometteuses en vue de l'élaboration du pronostic des patients en coma. La MMN, une onde cognitive auditive, est perçue comme reflétant un processus automatique de sélection dans le cortex auditif primaire, pouvant être enregistrée sans que le sujet porte attention au stimulus. Quelques études ont rapportées que la présence d'une MMN chez les patients comateux est un facteur de pronostic favorable. Ce mémoire vise à répliquer les résultats des études antérieures, avec un contrôle optimal des paramètres d'enregistrements, sur un échantillon composé de 16 enregistrements provenant de patients ayant subi un traumatisme craniocérébral (TCC) modéré à sévère à différents niveaux de conscience. Les conclusions soulèvent l'intérêt de la MMN pour la validation du niveau conscience des patients et l'évaluation du traitement cognitif dans le cortex auditif durant les différents états de conscience.

The study aimed at giving a thick description of African families' experiences, views, cultural beliefs and interpretations of traumatic brain injury (TBI), and making recommendations for rehabilitation. It was conducted from the qualitative research paradigm, adopting a phenomenological research method. Twenty-two pairs of participants (patients and their caregivers )were interviewed about their perception of TBI. The semi-structured interviews were conducted at the participants' homes in Sesotho, and where necessary in their home languages. The consequences of TBI were found to follow universal trends (Oddy, 1984). However, participants' perceptions, as shaped by their experiences, views and cultural beliefs, were found to be unique. On analysing the gathered data, using inductive data analysis, it was found that African families' interpretations of TBI were based on beliefs about witchcraft, thwasa, Satanism, ancestral anger and God's wish. Based on these findings, rehabilitation services in the form of education, advocacy, networking and family therapy are recommended. / Psychology / M.A.(Clinical Psychology)

On observe des anomalies d'abondances en surface de nombreuses étoiles A (d'amas et du champ). Ces anomalies d'abondances sont générées par la diffusion microscopique et peuvent etre modulées par l'action d'autres processus de m´elange, incluant la convection, le méange rotationnel, la perte de masse, etc. Ces étoiles désignées chimiquement particulières montrent typiquement des sous-abondances en calcium et/ou en scandium ainsi que des surabondances en éléments du pic du fer et en éléments plus lourds. Les étoiles A non magnétiques de ce type sont classifiées Am.<br />En observant en particulier des étoiles A et F dans des amas ouverts, on peut obtenir des informations additionnelles qui facilitent la comparaison aux mod`eles, soient la composition chimique initiale et l'age de ces étoiles. Ainsi en déterminant la composition chimique des étoiles A/F dans plusieurs amas ouverts d'ages différents, on peut suivre l'évolution de la composition chimique de surface et contraindre les modèles évolutifs au niveau des processus de transport.<br />Dans cette thèse, j'expose l'analyse de la composition chimique d'échantillons d'étoiles A et F dans deux amas ouverts d'ages différents: les Pléiades (100 Myrs) et Coma Berenices (450 Myrs). Ce travail repose sur des observations que j'ai menées avec les trois spectrographes AURELIE, ELODIE et SOPHIE a l'Observatoire de Haute-Provence (OHP). La méthode des spectres synthétiques, basée sur des modèles d'atmosphères d'ATLAS9-12, a été utilisée afin de déterminer les abondances de 22 éléments. Ces observations sont ensuite comparées aux prédictions des modèles évolutifs de Montréal. Les résultats démontrent l'existence de processus hydrodynamiques dans les zones radiatives de ces étoiles et qui contrebalancent les effets de la diffusion microscopique.

A investigação do romance Girlfriend in a Coma permitiu perceber alguns elementos centrais que estruturam a obra como mito e paródia. O mundo ficcional é caracterizado por uma sociedade à beira de um colapso devido a sua incapacidade de mudar seu comportamento e sequer consegue perceber o que está errado. Na narrativa são utilizados recursos estéticos identificados com o realismo maravilhoso, pois, juntamente com a descrição de eventos coerentes com a racionalidade humana, há eventos sobrenaturais realizados pelo divino. Nesta narrativa, a ideologia do trabalho árduo como estruturador da vida em uma sociedade democrática e capitalista é esfacelado em vista dos terríveis efeitos sentidos pelos personagens: trabalho extenuante, drogadição, anorexia e individualismo. Com o uso de teoria da narrativa e pós-modernista, argumenta-se que este romance é um ‗mito do novo mundo‘ ao fazer uso da paródia como forma de contestar meta-narrativas, e ao propor novas cosmogonias baseadas na experiência pós-colonial Canadense. / The investigation of the novel Girlfriend in a Coma revealed some central elements that structure this work as myth and parody. The fictional world is characterized by a society incapable of changing its behavior or even realizing what is wrong with it. In the narrative some aesthetic resources are used which are related to magic realism because, along with the description of events coherent with human rationality, there are supernatural events performed by the divine. In this narrative, the ideology of hard work as the main structure of life in a democratic capitalist society is unveiled, taking into account some terrible effects felt by the characters, such as: overworking, drug addiction, anorexia and individualism. With the use of narrative theory and postmodernist theory, it is argued that this novel is a ‗new world myth‘ because it makes use of parody as a way to refute masternarratives and to suggest new cosmogonies based on the Canadian post-colonial experience.

A investigação do romance Girlfriend in a Coma permitiu perceber alguns elementos centrais que estruturam a obra como mito e paródia. O mundo ficcional é caracterizado por uma sociedade à beira de um colapso devido a sua incapacidade de mudar seu comportamento e sequer consegue perceber o que está errado. Na narrativa são utilizados recursos estéticos identificados com o realismo maravilhoso, pois, juntamente com a descrição de eventos coerentes com a racionalidade humana, há eventos sobrenaturais realizados pelo divino. Nesta narrativa, a ideologia do trabalho árduo como estruturador da vida em uma sociedade democrática e capitalista é esfacelado em vista dos terríveis efeitos sentidos pelos personagens: trabalho extenuante, drogadição, anorexia e individualismo. Com o uso de teoria da narrativa e pós-modernista, argumenta-se que este romance é um ‗mito do novo mundo‘ ao fazer uso da paródia como forma de contestar meta-narrativas, e ao propor novas cosmogonias baseadas na experiência pós-colonial Canadense. / The investigation of the novel Girlfriend in a Coma revealed some central elements that structure this work as myth and parody. The fictional world is characterized by a society incapable of changing its behavior or even realizing what is wrong with it. In the narrative some aesthetic resources are used which are related to magic realism because, along with the description of events coherent with human rationality, there are supernatural events performed by the divine. In this narrative, the ideology of hard work as the main structure of life in a democratic capitalist society is unveiled, taking into account some terrible effects felt by the characters, such as: overworking, drug addiction, anorexia and individualism. With the use of narrative theory and postmodernist theory, it is argued that this novel is a ‗new world myth‘ because it makes use of parody as a way to refute masternarratives and to suggest new cosmogonies based on the Canadian post-colonial experience.