Introdução: Transplantes de órgãos ocorrem principalmente devido a doações provenientes de pacientes que apresentam morte encefálica (ME). Algumas situações limitam o diagnóstico de ME baseado apenas no exame neurológico, sendo necessário utilizar um exame de imagem ou gráfico para esta confirmação. No Brasil, o exame complementar é obrigatório por lei para todos os casos suspeitos. A maioria dos métodos complementares utilizados para confirmação de ME não está disponível em muitos locais do Brasil. Neste contexto, a angiografia por tomografia computadorizada (ATC) representaria uma alternativa, devido à presença de equipamentos de tomografia em diversos hospitais brasileiros. Porém, a capacidade de este exame reconhecer a interrupção da circulação intracraniana é desconhecida. Métodos: Realizou-se revisão sistemática para verificar evidência na literatura sobre o uso de ATC como teste avaliador de ME. Foram seguidas diretrizes de busca e extração de dados, sendo o QUADAS 2 utilizado para verificar risco de vieses e qualidade dos estudos. Os dados foram sumarizados para produzir metanálise. Resultados: Dez estudos com alto risco de vieses foram encontrados. Devido à falta de estudos controlados, não se obteve dados de especificidade. Trezentos e vinte e dois pacientes foram elegíveis para metanálise, a qual revelou 84,7% de sensibilidade. Houve variação de protocolos de avaliação das imagens de ATC entre os estudos, sobre a definição de resultados positivos ou negativos. Conclusão: ATC apresenta alta sensibilidade para detectar interrupção de circulação intracraniana entre pacientes com avaliação clínica compatível com ME. Este nível de evidência é similar ao de outros métodos utilizados no mundo. Há falta de estudos bem desenhados neste tema / Background: Organ transplantation depends more often of donation from brain dead (BD) individuals. Several complications make the diagnosis of BD medically challenging and a complimentary method is needed for confirmation. Additionally, in Brazil, the complimentary diagnosis is mandatory by law, despite there are still many areas where these methods are not available. In this context, computed tomography angiography (CTA) could represent a valuable alternative, because of its widespread presence. However, the reliability of CTA for confirming brain circulatory arrest remains unclear. Methods: A systematic review was performed to identify relevant studies regarding the use of CTA as ancillary test for BD confirmation. Guidelines for online search were followed, and the QUADAS 2 tool was used to verify study quality. Data from the studies retrieved were extracted aiming to perform the meta-analysis. Results: Ten low quality studies were found. Due to the absence of controls in all studies, specificity could not be calculated. Three hundred twenty-two patients were eligible for the meta-analysis, which exhibited 84,7% sensitivity. CTA image evaluation protocol exhibited variations between medical institutions regarding which intracranial vessels should be considered to determine positive or negative test results. Conclusions: For patients who were previously diagnosed with BD according to clinical criteria, CTA demonstrated high sensitivity to verify intracranial circulatory arrest. The current evidence that supports the use of CTA in BD diagnosis is comparable to other methods applied worldwide. Considering the importance of this subject, high quality studies are currently missing and needed

INTRODUÇÃO: A Addenbrookes Cognitive Examination Revised (ACE-R) avalia cinco domínios cognitivos em conjunto e também oferece notas parciais para cada um deles, a saber: Atenção e Orientação, Memória, Fluência, Linguagem e Habilidades VisuaisEspaciais. Essa bateria tem se mostrado útil na diferenciação entre a doença de Alzheimer (DA) e a demência frontotemporal (DFT) em outros países. O instrumento foi submetido à adaptação para o português e sua versão brasileira foi previamente publicada pelos autores. OBJETIVO: Investigar o desempenho de indivíduos idosos cognitivamente saudáveis e de outros com DA provável leve na versão brasileira da ACE-R. MÉTODOS: O teste foi administrado a um grupo de 31 pacientes com DA provável leve e a 114 idosos cognitivamente saudáveis. Destes, 62 foram equiparados aos pacientes por idade e escolaridade. Todos os participantes incluídos tinham idade 60 anos e 4 anos de escolaridade. Não apresentavam sintomatologia depressiva associada, definida como pontuação > 7 na Escala Cornell para Depressão em Demência. O comprometimento cognitivo dos pacientes foi evidenciado por pontuação < 123 na Escala Mattis de Avaliação de Demência (DRS). Os controles apresentaram escore total na DRS 123. Dados normativos foram extraídos da amostra total de indivíduos sadios. Foi analisada a correlação entre a ACE-R e o Teste de Memória de Figuras (BCB-Edu), os de Fluência Verbal (Frutas e F.A.S.) e a Bateria de Avaliação Frontal. Os grupos/variáveis foram analisados pelos testes Qui-quadrado, Teste t de Student e Teste de Mann-Whitney. Analisou-se a influência da idade/escolaridade pelo ANOVA e Bonferroni (dados com distribuição normal) e pelo Teste de Kruskal- Wallis e Método Diferença Mínima Significativa (dados sem distribuição normal). Os índices de correlação de Pearson e Spearman foram utilizados para aferir a relação entre o desempenho na ACE-R e nos demais testes cognitivos. A acurácia da bateria foi investigada pela análise das áreas das curvas ROC. RESULTADOS: As médias (DP) de idade e escolaridade dos 62 controles foram de 77,82 (6,58) e 10,05 (4,98), e dos pacientes, 78,03 (6,74) e 9,97 (5,19), respectivamente. A amostra sadia foi subdividida em três faixas etárias (60-69, 70-79 e 80) e em três grupos de escolaridade (4-7, 8-11 e 12). As subescalas da ACE-R se correlacionaram significativamente com os demais testes. Os escores gerais da bateria e da DRS mostraram forte correlação A escolaridade influenciou em todos os escores da ACER. Já a idade interferiu nas subescalas Memória, Fluência e na pontuação total. A nota de corte < 78 na ACE-R demonstrou sensibilidade de 100% e especificidade de 82,26% para o diagnóstico de DA leve (ASC = 0,947). A nota de corte para DA determinada pela razão VLOM foi de > 3,22 (ASC = 0,836; sens. 67,74%; espec. 96,77% e VPP 91,73%). CONCLUSÕES: A versão brasileira da ACE-R provou ser um instrumento de boa acurácia e de propriedades diagnósticas satisfatórias para a avaliação cognitiva em nosso meio, tendo sido capaz de discriminar pacientes com DA leve de indivíduos controles, além de avaliar com eficiência vários domínios cognitivos comumente afetados em estágios iniciais da doença. Os dados normativos apresentados representam parâmetros úteis de normalidade em idosos brasileiros. / INTRODUCTION: The Addenbrooke\'s Cognitive Examination Revised (ACE-R) allows evaluation of five cognitive domains, namely: Attention and Orientation, Memory, Fluency, Language and Visuospatial. It is particularly useful in differentiating Alzheimer\'s disease (AD) from frontotemporal dementia (FTD). The instrument was adapted to the Brazilian population and this version has already been published by the authors. OBJECTIVES: To investigate the performance of healthy individuals and patients with mild probable AD in the ACE-R Brazilian version. METHODS: The test was administered to 31 AD patients and to 114 cognitively preserved elderly. Sixty two subjects of this healthy group were adequately matched to the patients for age and education. The participants included were aged 60 years, had 4 years of schooling and did not show depressive symptoms, defined by a score > 7 in the Cornell Scale for Depression in Dementia. Cognitive impairment was defined by a score < 123 in the Mattis Dementia Rating Scale (DRS), while control scores were 123 in the DRS. Normative data were extracted from the whole sample of healthy subjects. We correlated scores in the ACE-R with those in Memory tests from the BCB-Edu, with Verbal Fluency Tests (Fruits and F.A.S.) and with the Frontal Assessment Battery. Data were analyzed with Chi-square test, Students t test and Mann-Whitney test. The influence of age/educational level in ACE-R scores was investigated by ANOVA and Bonferroni Multiple test (normal distribution data) as well as by Kruskal-Wallis test and the Minimum Significant Difference test (non-normal distribution data). Pearsons and Spearmans correlation indexes were used to assess the relationship between performance in the ACE-R and other cognitive tests. The accuracy of the battery was investigated by ROC curve analysis. RESULTS: Mean (SD) age / schooling found in the groups were 77.82 (6.58) / 10.05 (4.98) for the 62 controls and 78.03 (6.74) / 9.97 (5.19) for the patients, respectively. The healthy sample of 114 subjects was divided into three age groups (60-69, 70-79 and 80 years) and into three groups according to education (4-7, 8-11 and 12 years). The performance in the ACE-R subscales significantly correlated with that in the other cognitive instruments. The total scores from both ACE-R and DRS were strongly correlated between themselves. The educational status influenced the ACE-R sub-scores. Age interfered in the Memory, Fluency and in the ACE-R composite score. The cut-off point < 78 of ACE-R demonstrated 100% of sensitivity and 82.26% of specificity for the diagnosis of mild AD (AUC = 0,947). The VLOM cut-off point to determinate AD was > 3.22 (AUC = 0.836; sens. 67.74%; spec. 96.77% and PPV 91.73%). CONCLUSIONS: The Brazilian version of the ACE-R displayed high accuracy and great diagnostic properties for cognitive assessment in our milieu; also it was able to discriminate patients with mild AD from cognitively healthy individuals. In addition, the ACE-R efficiently assesses multiple cognitive domains that are commonly affected in the early stages of dementia. Normative data presented here represent useful parameters for the clinical use of the ACE-R in Brazilian elderly.

Orientador: Márcia Regina Ferreira de Brito / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-26T07:30:33Z (GMT). No. of bitstreams: 1 Machado_MileneCarneiro_D.pdf: 1743601 bytes, checksum: 888800a2901654c38a2ab99b60499e9a (MD5) Previous issue date: 2014 / Resumo: O estudo teve como objetivo principal identificar se existem e descrever as possíveis relações entre as crenças de autoeficácia matemática, as atitudes em relação à Matemática, o gênero e o desempenho dos estudantes do ensino médio usando itens da prova de Matemática do ENEM. Esta pesquisa foi realizada em duas escolas, uma privada e outra pública, de uma cidade localizada no interior do estado de São Paulo e teve como participantes 119 estudantes do terceiro ano do ensino médio. Os dados foram coletados através de um questionário informativo; uma escala de atitudes em relação à Matemática; uma escala de autoconceito matemático; um instrumento de autoeficácia matemática; uma prova de Matemática e entrevistas semiestruturadas com o objetivo de obter mais informações sobre as variáveis de interesse desse estudo. As entrevistas foram conduzidas individualmente, e os outros instrumentos foram aplicados coletivamente pela pesquisadora, em período normal de aula sem a presença do professor. Os dados coletados foram analisados de forma qualitativa e quantitativa e possibilitaram concluir a existência de relações entre as atitudes, autoconceito, autoeficácia matemática e o desempenho escolar dos estudantes em alguns itens de Matemática do ENEM. Foram encontradas também relações significativas entre as atitudes, autoconceito, autoeficácia matemática e o desempenho escolar quanto ao gênero e tipo de escola / Abstract: The study aimed to identify whether there are and describe the possible relationship between mathematics self-efficacy beliefs, attitudes toward Mathematics, gender and performance of high school students using test items of Mathematics ENEM. This research was conducted in two schools, in a private school and in a public school, in a city located in the state of São Paulo and there were 119 students of the third year of high school. Data were collected through an information questionnaire, a scale of attitudes towards mathematics, mathematics self-concept of a scale, an instrument of mathematics self-efficacy, a Mathematics test and semi-structured interviews in order to get more information about the variables of interest this study. The interviews were conducted individually, and the other instruments were administered collectively by the researcher during normal periods of class without the teacher's presence. The collected data were analyzed qualitatively and quantitatively and conclude enabled the existence of relationships between attitudes, self-concept, self-efficacy and mathematics academic performance of students in some items of Mathematics ENEM. Significant relationships between attitudes, self-concept, self-efficacy and mathematics school performance according to gender and type of school were also found / Doutorado / Psicologia Educacional / Doutora em Educação

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-02T17:55:08Z No. of bitstreams: 1 Carlos Magno Carvalho da Silva.pdf: 2078256 bytes, checksum: 767e90ad0a455f94af947d3b9d7e1278 (MD5) / Made available in DSpace on 2015-12-02T17:55:08Z (GMT). No. of bitstreams: 1 Carlos Magno Carvalho da Silva.pdf: 2078256 bytes, checksum: 767e90ad0a455f94af947d3b9d7e1278 (MD5) Previous issue date: 2010 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Trata-se de uma investigação sobre o exame físico de enfermagem e suas implicações no cuidado com o corpo na perspectiva da complexidade, referencial que surge para auxiliar a compreensão do cliente como um ser uno e múltiplo, dotado de características que vão além da patologia, mas a todo momento se relacionam com esta, devendo ser contempladas do processo de atenção à saúde. Traçam-se como objetivos: descrever a realização do exame físico por enfermeiros do Programa de Saúde da Família (PSF); analisar o(s) saber(es) articulado(s) ao exame físico que norteia(m) o cuidado, e orienta(m) a prática assistencial destes enfermeiros; e discutir o exame físico na perspectiva da Complexidade tendo em vista a atitude transdisciplinar no cuidado de enfermagem. O método empregado foi a pesquisa qualitativa, de cunho descritivo e exploratório, que se utilizou da observação e da entrevista semiestruturada como instrumentos para a coleta de dados, dirigidos a enfermeiros do Programa de Saúde da Família do município de Itaboraí (RJ). As entrevistas produziram o Discurso do Sujeito Coletivo, técnica analítica proposta por Lefevrè e Lefevrè, cujas ideias centrais deram origem a três eixos temáticos: “Para a reflexão sobre a ação: a descrição da realização do exame físico pelos enfermeiros do PSF”; “Do disciplinar ao transdisciplinar: o revelar de saberes norteadores do exame físico e das práticas de cuidado no Programa de Saúde da Família”; e “Um caminho para a Complexidade: aspectos apontados pela realização do exame físico de enfermagem”. Concluiu-se que o exame físico pode contemplar características do ser humano que possibilitem a instituição do cuidado integral. No entanto, é necessário ao enfermeiro realizar a investigação corporal integrando conhecimento, crítica e reflexão, mantendo uma atitude ética e profissional, atento ao caráter complexo do processo que exerce. Além disto, é necessário que durante a formação sejam fortalecidas as competências intelectuais, cognitivas, reflexivas e críticas dos futuros enfermeiros, visando a uma mudança na prática mecanizada do cuidado. / The primary purpose of this document is to provide an investigation of physical examination in nursing and its implications concerning body care under a complex perspective, a view that emerges to help understand the client as being one and manifold, endowed with features that go beyond the pathology, which are always related and should be addressed in the process of health care. Outlined as objectives are: the description of physical examination by nurses from the Family Health Program (PSF); analysis of articulated knowhow underlying physical exam care which guides the practice of nursing care; and the discussion of physical examination in its complexity in the light of a transdisciplinary approach in nursing care. The method adopted was the qualitative research, being descriptive and exploratory, which used observation and semistructured interviews as instruments for data collection, aimed at nurses from the Family Health Program of Itaboraí (RJ). The interviews produced the Collective Subject Discourse, an analytic technique proposed by Lefèvre and Lefèvre, whose ideas gave rise to three central themes: "Towards a reflection on the action: the Description of the Physical Examination by Nurses of the PSF," "From Disciplinary to Transdisciplinary: Scientific Guides to Unfold the Physical Examination and Care Practices in the Family Health Program " and "A path to Complexity: Mentioned Aspects of Physical Examination in Nursing." It was concluded that physical examination can contemplate human features which may enable comprehensive care. However, it is necessary that the nurse carry out body investigation, integrating knowledge, critical thinking and maintaining a professional attitude and ethics, given the complex nature of the process he performs. Moreover, intellectual, cognitive, reflective and critical competences of future nurses must be strengthened during their formation, seeking a change in mechanized practice care.

The subject of this thesis are the models of the school-leaving exams changing over time due to the educational policy of the state and sometimes tumultuous political developments. The theoretical part contains historical analysis of the graduation exam and its models, creating the basis for the empirical part. Based on the study of legislation and rules governing conditions and holding the graduation exams and further study of the relevant literature, on a precise description of the current model and indicating the current efforts to modify the existing model of the graduation exam the vivid picture of this phenomenon in the whole range of educational issues is created. The attention is also paid to the issue of holding the graduation exam. The leaving examination since its inception in our country in 1849 has been defined by the law, its implementation has been modified the closer decrees. It has always been a significant "politicians", not only purely "educational theme." Changes in model of the school-leaving examination always reflect the changes in the system of our educational policy. The aim of the work in the empirical part is to analyze the current evolution, current status, to identify neuralgic points of the graduation exams and to suggest possible trends of the graduation exam in the...

Doctor Educationis / The study aims to investigate the fundamental validity issues that can affect the DR Congo English state examination, a national exit test administered to high school final year students for certification. The study aspires to generate an understanding of the potential issues that affect the construct validity of a test within the epistemological stance that supports a strong relationship between test construct and test context. The study draws its theoretical underpinning from three theories: the validity theory that provides a theoretical ground necessary for understanding the quality of tests needed for assessing students’ reading abilities; the construction-integration theory that provides an understanding of how texts used in reading assessments are processed and understood by the examinees; and the strategic competence theory that explains how examinees deploy strategies to complete test tasks, and the extent to which these strategies tap into the reading construct. Furthermore, the study proposes a reading model that signposts the social context of testing; therefore, conceptualizing reading as both a cognitive and a social process. As research design, the study adopts an exploratory design using both qualitative and quantitative data. Besides, the study uses protocol analysis and content analysis methodologies. While the former provides an understanding of the cognitive processes that mediate the reading construct and test performance so as to explore the different strategies examinees use to answer the English state examination (henceforth termed ESE) test questions, the latter examines the content of the different ESE papers so as to identify the different textual and item features that potentially impact on examinees’ performance on the ESE tasks. As instruments, the study uses a concurrent strategies questionnaire administered to 496 student-participants, a contextual questionnaire administered to 26 student-participants, a contextual questionnaire administered to 27 teacher-participants, and eight tests administered to 496 student-participants. The findings indicate that, the ESE appears to be less appropriate to the ESE context as the majority of ESE test items target careful reading than expeditious reading; on the one hand, and reading at global level than to reading at local level; on the other hand. The findings also indicate that the ESE tasks hardly take account of the text structure and the underlined cognitive demands appropriate to the text types. Besides, the ESE fails to include other critical aspects of the reading construct. Finally, the findings also indicate that the ESE constructors may not be capable to construct an ESE with five functioning distractors as expected. Moreover, the inclusion of the implicit option 6 overlaps with the conceptual meaning of this option. The entire process of the present study has generated some insights that can advance our understanding of the construct validity of reading tests. These insights are: (a) the concept of validity is an evolving and context-dependent concept, (b) reading construct cannot be examined outside the actual context of reading activity, (c) elimination of distractors can sometimes be a construct-relevant strategy, (d) construct underrepresentation is a context-dependent concept, and (e) a reading test cannot be valid in all contexts. The suggested proposal for the improvement of the ESE requires the Congolese government through its Department of Education to (a) always conduct validation studies to justify the use of the ESE, (b) always consider the actual context of reading activity while developing the ESE, (c) revisit the meanings and interpretations of the ESE scores, (d) ensure the appropriateness of tasks to be included in the ESE, (e) ensure the construct representativeness of the ESE tasks, (f) revisit the number of questions to be included in the ESE, (g) avoid bias in the ESE texts in order to ensure fairness, (h) diversify the genres of ESE texts, (i) ensure the coherence of ESE texts through the use of transitions and cohesive devices, (j) ensure that the order of test questions is in alignment with the order of text information, (k) revisit the structure and length of the texts to be included in the ESE, (l) revisit the number of alternatives to be included in the ESE, and (m) reconsider the use of the implicit alternative 6.

Since 2002, the Canadian state has mandatorily tested applicants for permanent residence for HIV (Human immune deficiency virus). The policy and practices associated with this screening have never been critically scrutinized. Authoritative claims about what happens in the conduct of the immigration medical examination are at odds with the experience of immigrant applicants living with HIV. This is the analytic entry point into this inquiry that is organized within the theoretical and methodological frame offered by institutional ethnography and political activist ethnography. Analysis is connected to broader research literatures and the historical record. The goal of this study is to produce detailed, contextualized understandings of the social and ruling relations that organize the lives of immigrants to Canada living with HIV. These are generated from the material conditions of their lives. An assumption about how organization happens is the social and reflexive production of knowledge in people’s day-to-day lives through which connections between local and extra-local settings are empirically investigable. I investigate the organization of the Canadian immigration process. How is this institutional complex ordered and governed? How is immigration mandatory HIV testing organized, and with what consequences to HIV-positive applicants to Canada? This is a text-mediated organization where all the sites are connected by people’s work and the texts they circulate. The positive result of an immigration HIV test catalyzes the state’s collection of medical data about an applicant. These are entered into state decision-making about the person’s in/admissibility to Canada. I focus on a key component of the immigration process, which is medical examination and HIV testing with this, along with the HIV test counselling practices that happen (or not) there. The reported absence of the latter form of care causes problems and contradictions for people. This investigation adopts the standpoint of these persons to investigate their problems associated with HIV testing. The main empirically supported argument I make is that the Canadian state’s ideological work related to the HIV policy and mandatory screening ushers in a set of institutional practices that are highly problematic for immigrants with HIV. This argument relies on data collected in interviews, focus groups, observations, and analysis of texts organized under Canada’s Immigration and Refugee Protection Act (S.C., 2001, c. 27) and textually mediated, discursively organized concepts that shape people’s practice. Canadian immigration medical policy makers should make use of these findings, as should civil society activists acting on behalf of immigrants to Canada living with HIV. I make nine specific recommendations for future action on HIV and immigration in Canada.

The main aim of this study is to describe and compare the process of medical examination in selected divisions of the Foxconn company on the basis of my personal working experience. The goal is to obtain comprehensive knowledge of strengths and weaknesses, opportunities and threats of the medical examination procedure and to present a suitable optimisation of the process. The theoretical part of the study elaborates on the expert knowledge focusing on personnel management development, particular personnel processes, benefits for employees with the emphasis on medical examinations and international employment. The practical part is divided into two parts. The first part describes the company Foxconn and its selected divisions. The second part contains the medical examination outcomes, a research consisting of the medical check-up monitoring and SWOT analysis of the individual processes, a proposal for process optimisation including software installation, costs, staffing and training courses. A description of research methodology is also included. In order to achieve the aim of this study qualitative methods of collecting data were used. Monitoring the whole process of medical examinations was carried out by methods of observation and half-structured dialogues with human resources officers.

The aim of the thesis The role of independent loss adjusters in the insurance market is to analyze various situations and cases, that the independent loss adjusters during their praxis solve, and clarify procedures, including calculations of insurance settlement. The work is divided into theoretical and practical part. The theoretical part focuses on the specifics of the insurance and technical reserves. Thesis also describes job content of the independent loss adjusters including all the aspects, that are associated with it. The practical part deals with real situations with fictitious names and data.

This thesis aims to describe a process framework suitable for conducting digital forensics investigation projects as support for forensic audit. Selection of existing digital forensics investigation framework was a subject of criterial comparison. Described new framework is a result of combination and enhancement of those frameworks, which were suitable for the characteristics of forensic audit. Thesis also discusses digital forensics methods for fraud examination and risk assessment as a part of external audit.