Social learning has given us insight into how children learn actions from others across different domains (e.g., actions on objects, pretend play, and tool use). However, little research exists to confirm whether young children can generate their own novel actions. Three different settings were chosen to offer a varied investigation of children’s ability to generate novel actions: generating multiple actions with novel objects; generating iconic gestures in order to communicate; and generating pretend actions using object substitution. Generating multiple actions with novel objects: The Unusual Box test was developed to investigate children’s ability to generate multiple actions with novel objects (Chapter 2). The Unusual Box test involves children playing with a wooden box that contains many different features (e.g., rings, stairs, strings), and five novel objects. The number of different actions performed on the box and with the objects (i.e., fluency) was used as a measure of their individual learning. Positive correlations between the fluency scores of 24 3- and 4-year-olds on the Unusual Box test and two existing measures of divergent thinking were found. Divergent thinking relates to the ability to think of multiple answers based on one premise. Furthermore, a large range of fluency scores indicated individual differences in children’s ability to generate multiple actions with novel objects. In addition, 16 2-year-olds were assessed on the Unusual Box test, twice two weeks apart, to investigate test-retest reliability and the possibility that the Unusual Box test could be used with children younger than 3 years. A strong positive correlation between the scores on the two assessments showed high test-retest reliability, while individual differences in fluency scores and the absence of a floor effect indicated that the Unusual Box test was usable in children from 2 years of age. Generating iconic gestures in order to communicate: Children’s ability to generate iconic gestures in order to communicate was assessed using a game to request stickers from an experimenter (N = 20, Chapter 3). In order to get a sticker children had to communicate to the experimenter which out of two objects they wanted (only one object had a sticker attached to it). Children’s use of speech or pointing was ineffective; therefore only generating an iconic gesture was sufficient to retrieve the sticker. Children generated a correct iconic gesture on 71% of the trials. These findings indicate that children generate their own iconic gestures in order to communicate; and that they understand the representational nature of iconic gestures, and use this in their own generation of iconic gestures. Generating pretend actions using object substitution: In order to determine whether children are able to generate their own object substitution actions and understand the representational nature of these actions, 45 3- and 4-year-olds were familiarized with the goal of a task through modelling actions. Children distinguished between the intentions of an experimenter to pretend, or try and perform a correct action. Children mainly imitated the pretend actions, while correcting the trying actions. Next, children were presented with objects for which they had to generate their own object substitution actions without being shown a model. When children had previously been shown pretend actions, children generated their own object substitution actions. This indicates that children generate their own object substitution actions, and that they understand the representational nature of these actions. An additional study with 34 3-year-olds, revealed no significant correlations between divergent thinking, inhibitory control, or children’s object substitution in a free play setting, and children’s ability to generate object substitution actions in the experimental setting.

This thesis primarily uses submillimetre molecular line data from HARP, a heterodyne array on the James Clerk Maxwell Telescope (JCMT), to further investigate star formation in the Ophiuchus L1688 cloud. HARP was used to observe CO J = 3-2 isotopologues: 12CO, 13CO and C18O; and the dense gas tracer HCO+ J = 4-3. A method for calculating molecular line contamination in the SCUBA-2 450 and 850 μm dust continuum data was developed, which can be used to convert 12CO J =6-5and J =3-2 maps of integrated intensity (K km s−1) to molecular line flux (mJy beam−1) contaminating the continuum emission. Using HARP maps of 12CO J = 3-2, I quantified the amount of molecular line contamination found in the SCUBA-2 850 μm maps of three different regions, including NGC 1333 of Perseus and NGC 2071 and NGC 2024 of Orion B. Regions with ‘significant’ (i.e. > 20%) molecular line contamination correspond to molecular outflows. This method is now being used to remove molecular line contamination from regions with both SCUBA-2 dust continuum and HARP 12CO map coverage in the Gould Belt Legacy Survey (GBS). The Ophiuchus L1688 cloud was observed in all three CO J = 3-2 isotopologues. I carried out a molecular outflow analysis in the region on a list of 30 sources from the Spitzer ‘c2d’ survey [Evans et al., 2009]. Out of the 30 sources, 8 had confirmed bipolar outflows, 20 sources had ‘confused’ outflow detections and 2 sources did not have outflow detections. The Ophiuchus cloud was found to be gravitationally bound with the turbulent kinetic energy a factor of 7 lower than the gravitational binding energy. The high-velocity outflowing gas was found to be only 21% of the turbulence in the cloud, suggesting outflows are significant but not the dominant source of turbulence in the region. Other factors were found to influence the global high-velocity outflowing gas in addition to molecular outflows, including hot dust from nearby B-type stars, outflow remnants from less embedded sources and stellar winds from the Upper Scorpius OB association. To trace high density gas in the Ophiuchus L1688 cloud, HCO+ J = 4-3 was observed to further investigate the relationship between high column density and high density in the molecular cloud. Non-LTE codes RADEX and TORUS were used to develop density models corresponding to the HCO+ emission. The models involved both constant density and peaked density profiles. RADEX [van der Tak et al., 2007] models used a constant density model along the line-of-sight and indicated the HCO+ traced densities that were predominantly subthermally excited with den- sities ranging from 10^3–10^5 cm^−3. Line-of-sight estimates ranged from several parsecs to 90 pc, which was unrealistic for the Ophiuchus cloud. This lead to the implementation of peaked density profiles using the TORUS non-LTE radiative transfer code. Initial models used a ‘triangle’ density profile and a more complicated log-normal density probability density function (PDF) profile was subsequently implemented. Peaked density models were relatively successful at fitting the HCO+ data. Triangle models had density fits ranging from 0.2–2.0×10^6 cm^−3 and 0.1–0.3×10^6 cm^−3 for the 0.2 and 0.3 pc cloud length models re- spectively. Log-normal density models with constant-σ had peak density ranges from 0.2–1.0 ×10^5 cm^−3 and 0.6–2.0×10^5 cm^−3 for 0.2 and 0.3 pc models respectively. Similarly, log-normal models with varying-σ had lower and upper density limits corresponding to the range of FWHM velocities. Densities (lower and upper limits) ranged from 0.1–1.0 ×10^6 and 0.5–3.0 ×10^5 cm^-3 for the 0.2 and 0.3 pc models respectively. The result of the HCO+ density modelling indicated the distributions of starless, prestellar and protostellar cores do not have a preference for higher densities with respect to the rest of the cloud. This is contrary to past research suggesting the probability of finding a submillimetre core steeply rises as a function of column density (i.e. density; Belloche et al. 2011; Hatchell et al. 2005). Since the majority of sources are less embedded (i.e Class II/III), it is possible the evolutionary state of Ophiuchus is the main reason the small sample of Class 0/I protostars do not appear to have a preference for higher densities in the cloud.

Theories of how galaxies form and evolve depend greatly on constraints provided by observations. However, when those observations come from different datasets, systematic offsets may occur. This causes difficulties measuring variations in parameters between filters. In this thesis I present the variation in total luminosity density with wavelength in the nearby Universe (z<0.1), produced from a consistent reanalysis of NIR and optical observations, taken from the MGC, UKIDSS and SDSS surveys. I derive luminosity distributions, best-fitting Schechter function parameterisations and total luminosity densities in ugrizYJHK, and compare the variation in luminosity density with cosmic star formation history (CSFH) and initial mass function (IMF) models. I examine the r band luminosity distribution produced using different aperture definitions, the joint luminosity- surface brightness (bivariate brightness) distribution in ugrizYJHK, comparing them to previously derived distributions, and how the total luminosity density varies with wavelength when surface brightness incompleteness is accounted for. I find the following results. (1) The total luminosity density calculated using a non-Sersic (e.g. Kron or Petrosian) aperture is underestimated by at least 15%, (2) Changing the detection threshold has a minor effect on the best-fitting Schecter parameters, but the choice of Kron or Petrosian apertures causes an offset between datasets, regardless of the filter used to define the source list, (3) The decision to use circular or elliptical apertures causes an offset in M* of 0.20 mag, and best-fitting Schechter parameters from total magnitude photometric systems have a flatter faint-end slope than Kron or Petrosian photometry, (4) There is no surface brightness distribution evolution with luminosity for luminous galaxies, but at fainter magnitudes the distribution broadens and the peak surface brightness dims. A Choloniewski function that is modified to account for this surface brightness evolution fits the bivariate-brightness distribution better than an unmodified Choloniewski function, (5) The energy density per unit interval, vf(v) derived using MGC and GAMA samples agrees within 90% confidence intervals, but does not agree with predictions using standard CSFH and IMF models. Possible improvements to the data and alterations to the theory are suggested.

Problématique. La Fondation Canadienne du rein soutient qu’en 2013, la prévalence de l’insuffisance rénale chronique (IRC) avoisinait les 10% et qu’elle touchait une proportion considérable de gens souffrant d’obésité. Il semble raisonnable de viser une perte pondérale modérée chez les gens atteints du duo obésité – IRC. Malgré cela, aucune recommandation nutritionnelle n’est spécifiquement bâtie afin de respecter les restrictions alimentaires liées à l’IRC et aux autres co-morbiditées, tout en permettant un déficit énergétique. Objectifs. Ce projet de recherche vise à étudier les facteurs associés avec la réussite d’une perte de poids dans le contexte restreint de ces patients. Méthodologie. 45 patients en évaluation ou en attente d’une transplantation rénale seront recrutés à la clinique de greffe rénale de l’Hôpital Maisonneuve-Rosemont. Une entrevue sera menée afin de compléter deux questionnaires (valeurs biochimiques, anthropométrie, historique médical, habitudes de vie, contexte sociodémographique, comportement alimentaire) suivie de la remise d’un journal alimentaire de quatre jours. Les apports nutritionnels obtenues seront analysés et comparés aux lignes directrices actuelles. Résultats. La perte de poids est difficile et limitée, chez les gens obèses souffrant d’IRC, malgré l’atteinte des cibles caloriques estimées et le niveau de motivation élevé de ceux-ci. Discussion. La sédentarité (46,7%, actif ˂ 1 hr/ jr) et le peu de suivi en nutrition pourraient entraver l’atteinte du poids ciblé. Conclusion. L’échec observé dans la perte pondérale semble principalement lié à la sédentarité alors qu’il n’y aurait aucune influence directe de l’apport calorique, du manque de motivation ou des comportements alimentaires. / Problematic. The Kidney Foundation of Canada argues that in 2013, the prevalence of chronic kidney disease (CKD) was around 10% and it touched a considerable proportion of people suffering from obesity. It should be reasonable to consider moderate weight loss in these patients. Despite this, no nutritional recommendation is specifically built to meet the dietary restrictions related to CKD, while allowing an energy deficit. Objectives. The objective of this project is to establish the nutritional profile of the population of obese renal failure patients, while identifying the risk factors associated with weight loss before renal transplantation. Methodology. 45 patients identified during the evaluation process or who were awaiting a kidney transplant and recruited from the kidney transplant clinic of the Maisonneuve-Rosemont hospital. Their medical and nutritional profiles were evaluated by questionnaires filled during a short interview (biochemical profile, vital signs, medical history, socio-demograpic data, anthropometry, food habits). Finally, a four-day food diary, accompanied with pictures if feasible, were used to compare to the nutritional guidelines, depending on the stage of renal disease and ongoing treatment. Results. Weight loss is difficult and limited in obese people with CKD, despite achieving targets estimated calorie and their high level of motivation. Discussion. A sedentary lifestyle (46,7%, actives ˂ 1 hr/ jr) and inadequate nutritional follow-up could hinder the achievement of the target weight. Conclusion. The failure observed in weight loss seems mainly related to a sedentary lifestyle then there would be no direct impact of caloric intake, lack of motivation or eating behaviors.

Introdução: Alguns autores estudaram o valor prognóstico do eletrocardiograma inicial na sobrevida em longo prazo dos pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST. O valor prognóstico de outros traçados eletrocardiográficos na fase intra-hospitalar do tratamento foi menos estudado. Objetivos: Avaliar o papel no prognóstico clínico dos registros eletrocardiográficos obtidos durante o evento índice dos participantes do estudo Estratégia de Registro de Insuficiência Coronariana (ERICO) com síndrome coronariana aguda sem supradesnivelamento do segmento ST. Métodos: Foram analisados e classificados, de acordo com o Código de Minnesota, os traçados eletrocardiográficos intra-hospitalares de 634 participantes do estudo ERICO com síndrome coronariana aguda sem supradesnivelamento do segmento ST, no período de fevereiro de 2009 a dezembro de 2013. Foram classificados como alterados os traçados eletrocardiográficos com infradesnivelamento do segmento ST > 1mm e/ou com onda T negativa > 1mm. Foram construídos modelos de regressão de Cox brutos e ajustados, para estudar se o padrão eletrocardiográfico foi um preditor independente de desfechos clínicos (morte por qualquer causa, morte por causa cardiovascular, morte por infarto agudo do miocárdio, e desfecho combinado de morte por infarto do miocárdio ou novo infarto do miocárdio não fatal). Resultados: A mediana de seguimento foi de 3 anos. Encontramos uma tendência não significativa para a associação entre a presença de alteração de segmento ST no eletrocardiograma inicial com o desfecho combinado de morte por infarto do miocárdio ou novo infarto do miocárdio não fatal [Hazard Ratio (HR) ajustado: 1,64, intervalo de confiança de 95% (IC 95%): 1,00-2,70, p = 0,052]. Encontramos um risco significativamente maior de morte por infarto do miocárdio em indivíduos com alterações do segmento ST no eletrocardiograma final (HR ajustado: 2,04; IC 95%: 1,06-3,92). Os indivíduos com alterações do segmento ST em qualquer traçado durante o evento índice apresentaram risco significativamente maior para desfecho combinado de morte por infarto do miocárdio ou novo infarto do miocárdio não fatal (HR ajustado: 1,71; IC 95%: 1,04-2,79). Quando as alterações de onda T foram incluídas na classificação dos traçados, não houve associação significativa com o prognóstico a longo prazo. Conclusões: Encontramos associações significativas entre as alterações de segmento ST e pior prognóstico em longo prazo. A avaliação sequencial dos traçados eletrocardiográficos durante o evento índice parece adicionar informação prognóstica ao ECG inicial / Introduction: Some authors have studied the prognostic value of initial electrocardiogram in long-term survival of patients with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The prognostic value of other in-hospital electrocardiographic tracings has been less studied. Objectives: To describe the association between electrocardiogram abnormalities (in ST-segment and T wave) during the index event and outcomes in patients with NSTE ACS in the Strategy of Registry of Acute Coronary Syndrome (ERICO) cohort. Methods: We analyzed and classified, according to the Minnesota Code, in-hospital ECG tracings of 634 ERICO participants with NSTE-ACS, from February 2009 to December 2013. We considered as altered electrocardiographic tracings with ST-segment depression > 1 mm and / or negative T wave > 1 mm. We built crude and adjusted Cox regression models to study if ECG pattern was an independent predictor for clinical outcomes (death from any cause, death from cardiovascular causes, death from acute myocardial infarction, and combined outcome of fatal or new nonfatal myocardial infarction). Results: Median follow-up was 3 years. We found a trend for the association between initial ECG tracing and the combined outcome of fatal or new nonfatal myocardial infarction [Hazard Ratio (HR) adjusted: 1,64, confidence interval 95% (95% CI): 1,00-2,70, p = 0,052]. We found a significantly higher risk of death due myocardial infarction in patients with ST-segment abnormalities in the final ECG tracing (adjusted HR: 2,04; 95% CI: 1,06 to 3,92). Individuals with ST-segment abnormalities in any tracing had significant higher risk for fatal or new nonfatal myocardial infarction (adjusted HR: 1,71; 95% CI: 1,04 2,79). When the T wave changes were included in the classification, there was no significant association with long-term prognosis. Conclusions: We found significant associations between ECG patterns and worse long-term prognosis. Sequential evaluation of electrocardiographic tracings during the index event seems to add prognostic information to the initial ECG

Ausgangspunkt dieser Dissertation ist, dass mit stabilen Präferenzen unvereinbares Verhalten für die Standardökonomik eine Herausforderung darstellt. Eines der sich stellenden Probleme ist, dass sich wandelnde Präferenzen der normativen Analyse abträglich sind: Wenn nicht vorhersagbar ist, ob und wie Präferenzen abhängig von der Situation und von institutionellen Arrangements variieren, lässt sich keine optimale Wirtschaftspolitik bestimmen. Es wird argumentiert, dass die Ökonomik daher auch in Betracht ziehen muss, wie Präferenzen evolvieren und wie ökonomische Akteure Informationen - z. B. Wahrscheinlichkeiten und Auszahlungen -verarbeiten. In den folgenden Kapiteln werden zwei Studien vorgestellt, die dieses Ziel verfolgen, indem sie den Prozess der Entscheidungsfindung experimentell untersuchen. Die erste Studie, "Kognitive Last erhöht Risikoaversion", zeigt, dass eine spezifische Änderung des Entscheidungsumfelds - nämlich eine Erhöhung der kognitiven Last - einen messbaren Einfluss auf die Risikoeinstellungen der Versuchspersonen hatte. Zudem werden die beobachteten Verhaltensänderungen in Verbindung zu existierenden Mehr-System-Modellen der Entscheidungsfindung gesetzt. Die ebenfalls gemessenen Reaktionszeiten bestätigt die Interpretation, dass die Entscheidungsfindung unter Risiko das Produkt interagierender Systeme im menschlichen Hirn ist. Die zweite Studie, "Soziales Lernen auf Finanzmärkten", verfolgt das Ziel, die normalerweise verborgenen Komponenten Präferenzen und Überzeugungen beobachtbar zu machen. Zu diesem Zweck absolvierten Versuchspersonen ein Experiment, während ihre Hirnaktivierung per funktioneller Magnetresonanztomografie gemessen wurde. Dies erweitert den analysierbaren Datensatz über die getroffenen Entscheidungen hinaus um Maße der Hirnaktivierung. Dadurch trägt diese Studie zur Identifizierung der Faktoren bei, die bestimmen, in welchem Umfang wir aus der Beobachtung der Entscheidungen anderer lernen. / The point of departure of this dissertation is that behavior which is inconsistent with stable preferences poses a challenge for mainstream economics. One of the issues that arise is that changing preferences are detrimental to the objective of normative economics: If one cannot predict whether and how people’s preferences vary across situations or institutions, one cannot determine which economic policy would be optimal. Based on this, it is argued that economics has to take into account how preferences evolve and how information - e.g., probabilities and payoffs - is processed by economic agents. In the following two chapters, two experimental studies are presented that pursue this goal by investigating the process by which people make decisions. The first study, "Cognitive load increases risk aversion," shows that a specific change in the environment - in this case, an increase in cognitive load - had a measurable impact on subjects’ risk attitudes. Importantly, it also relates the observed changes to existing dual-system models of decision making. The response times which were recorded in addition to subjects’ choices contribute to the interpretation of the study’s findings, since they support the view that decision making under risk is the product of interacting systems in the human brain. The second study, "Social learning in asset markets," has the objective of making the latent components preferences and beliefs observable. To this end, subjects participated in a social-learning experiment while their brain activation was recorded via functional magnetic-resonance imaging. This enlarges the analyzable dataset through measures of subjects’ brain activation in addition to subjects’ choices. In doing so, the study contributes to identifying the factors that shape to what extent we learn from observing the choices of other human beings.

Introdução: As avaliações econômicas completas do tipo custo-utilidade, suportadas por dados de efetividade do mundo real, permitem uma perspectiva diferenciada da avaliação de tecnologia em saúde. Objetivo: Realizar uma análise de custo-utilidade do uso de estatinas para a prevenção secundária de eventos cardiovasculares em portadores de doença cardiovascular isquêmica, e avaliar a variabilidade da efetividade e da razão de custo-efetividade incremental com diferentes classificações de usuários de estatina (incidentes e prevalentes). Método: Um modelo de microssimulação de Markov com 5 estados, ciclos anuais e horizonte temporal de 20 anos, com taxas de desconto de 5% foi desenvolvido. As probabilidades de transição para mortalidade por todas as causas foram extraídas após pareamento por escore de propensão dos dados e tratamento de dados ausentes de uma base secundária de registro assistencial com linkage determinístico com a base de mortalidade do Ministério da Saúde. As probabilidades dos desfechos não-fatais foram obtidas na literatura. As medidas de efetividade (QALY) foram calculadas com dados publicados dos domínios do SF-36 de um estudo realizado com a população do mesmo hospital, no mesmo período e com as mesmas condições clínicas e transformados em medidas de utilidade por modelo validado. Somente custos diretos na perspectiva do reembolso do SUS foram considerados. Resultados: 3.150 pacientes foram pareados após o escore de propensão, 1.050 não usuários de estatina, 1.050 usuários de estatinas classificados como prevalentes e 1.050 usuários de estatinas classificados como incidentes, com diagnóstico de doença cardiovascular isquêmica prévia, com seguimento médio de 5,1 anos. A efetividade das estatinas quando considerados todos os usuários em relação aos não usuários resultou em um HR para mortalidade de 0,992 (IC 95% 0,85; 0,96) e de 0,90 (IC 95% 0,85; 0,96) para os usuários incidentes. A RCEI comparando todos os usuários de estatinas versus não usuários foi de R$5.846,10/QALY e de R$7.275,61/QALY para os usuários incidentes. Conclusão: As estatinas diminuíram a mortalidade por todas as causas, e a análise incluindo usuários prevalentes diminui o tamanho do efeito. O tratamento possui custo-efetividade favorável dentro do limiar de disponibilidade a pagar definido, sendo modificado pela forma de extração do dado de efetividade / Background: The complete economic evaluations, such as cost-utility analysis, supported by real world data of effectiveness lead to a more realistic perspective of a health technology assessment. Objective: Perform a cost-utility analysis of statins for secondary prevention in ischemic cardiovascular disease patients based on effectiveness from real world data and evaluate the variability of effectiveness and incremental cost-effectiveness ratio (ICER) considering prevalent and incident users. Methods: A Markov microssimulation model with five states, annual cycle and time horizon (TH) of 20 years, with discount rate of 5% was developed. Transition probabilities for all cause mortality was derived from a secondary database of a teaching hospital after record linkage with national registry of mortality database and an analysis of propensity score matching and multiple imputation analysis for missing data. Non-fatal endpoints were derived from a published meta-analysis. Utility measures was calculated with a validated model to derive values from published domains of SF-36 QoL questionnaire, domains was measured for a published RCT in the same teaching hospital, over the same period, with similar age and diagnostic characteristics. Only direct costs were analyzed from the Brazilian public health reimbursement perspective. Results: 3150 patients were matched, 1050 non-statins users (CG), 1050 prevalent statins users (PSU) and 1050 incident statins users (ISU) with previous cardiovascular disease, with mean follow-up of 5,1 years. Treatment effects on the treatment group considering all statins users for all cause mortality had a hazard ratio of HR:0,992 (IC 95% 0,85 - 0,96) and HR: 0,90 (IC 95% 0,85 - 0,96) only for ISU. The ICER comparing all users with non-users was R$5.846,10 per QALY and for ISU was R$7.275,61 per QALY. Conclusion: Real world evidence demonstrated that statins are an effective treatment to reduce all cause mortality in secondary prevention and are a cost-effective strategy considering the willingness to pay established, but the prevalent users resulted in less effectiveness of the drug when included in the analysis and influenced the ICER

Introdução: A ocorrência de episódios depressivos e abuso ou dependência de álcool após um evento agudo de insuficiência coronariana pode representar um marcador independente de mau prognóstico. Portanto, investigamos a presença de sintomas depressivos, transtorno depressivo maior (TDM) e abuso ou dependência de álcool em uma subamostra de uma coorte prospectiva de Síndrome Coronariana Aguda (SCA), Estratégia de Registro de Insuficiência Coronariana Aguda (ERICO) em andamento no pronto-socorro do Hospital Universitário. Métodos: Foi realizado um estudo observacional em 146 participantes do estudo ERICO. A gravidade dos sintomas depressivos foi avaliada em três momentos: 1ª) na admissão hospitalar pelo Patient Health Questionnaire (PHQ-9 itens); 2º) 30 dias pós-SCA pelo PHQ-9, Inventário de Depressão de Beck (BDI) e Escala de Depressão de Hamilton (HDRS-21 itens); e 3º) 180 dias pós-SCA pelo PHQ-9 e BDI. O abuso e uso nocivo de álcool foram avaliados pelo AUDIT e CAGE em 30 e 180 dias pós-SCA. Resultados: Ao longo do estudo as frequências de sintomas depressivos variaram entre 40% e 60% e de TDM entre 28% e 33%. Na admissão hospitalar houve maior predominância de sintomas depressivos entre os homens (58%; p=0,03) e sedentários (72,1%; p=0,02), entretanto, TDM foi mais frequente na população feminina (55,1%; p < 0,001) com uma razão de chances [(RC) 4,5; intervalo de confiança IC 95% 1,85-10,98]. Após 30 dias do evento agudo constatou-se um maior risco de sintomas depressivos entre os tabagistas (RC 5,8; IC 95% 1,81-18,72) e diabéticos (RC 3,6; IC 95% 1,40-9,60). Os diabéticos também apresentaram (RC 3,5; IC 95% 1,39-8,71) para desenvolver TDM. No seguimento de 180 dias verificou-se que indivíduos com angina instável (AI) (RC 4, 46; IC 95% 1,39-14,32) e infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST) (RC 3,40; IC 95% 1,30-8,87) apresentaram maior probabilidade de desenvolverem sintomas depressivos em relação aos indivíduos que apresentaram IAMSST. Os únicos fatores de risco que se mantiveram associados a um maior risco de sintomas depressivos após 180 dias foi o sexo feminino (RC 3,9; IC 95% 1,54-9,73) e o tabagismo (RC 5,34; IC 95% 1,64-17,44). Em relação à TDM, encontramos uma RC de 14 (IC 95% 2,94-67,51) para associação com tabagismo. Quanto ao abuso e uso nocivo de álcool as frequências variaram ao longo do estudo pelo AUDIT e CAGE entre 18,3% e 33,6%. Verificamos na populacão masculina uma frequência de 88,2% (p=0,001) e entre os tabagistas de 55,9% (p=0,003) e foi encontrada uma RC de 51,64 para população mais jovem (35-44 anos) e uma RC de 42,95 para tabagistas. Finalmente, não foi encontrada nenhuma associação entre abuso de álcool e depressão de acordo com os subtipos de SCA nos períodos analisados. Conclusão: A frequência de depressão variou entre 40% e 60% da admissão até 180 dias pós-SCA. Indivíduos que desenvolveram AI ou IAMCST, além de mulheres e tabagistas apresentaram maiores chances de desenvolver depressão ao longo do seguimento de 180 dias e indivíduos entre 35 e 44 anos e tabagistas apresentaram maior possibilidade de abusar do álcool / Introduction: The occurrence of depression and alcohol abuse or dependence after an acute coronary insufficiency may represent an independent marker of poor prognosis. Therefore, we investigated the presence of depressive symptoms, major depressive disorder (MDD) and alcohol abuse or dependence in a subsample of a prospective cohort of Acute Coronary Syndrome (ACS), Strategy of Registry of Acute Coronary Syndrome Study (ERICO study), which is still ongoing in the emergency room of the Hospital Universitário. Methods: We conducted an observational study in 146 participants of the ERICO study. The severity of depressive symptoms was evaluated in 3 moments: 1st) at the hospital admission using The Patient Health Questionnaire (PHQ-9 items); 2nd) 30 days post-ACS using the PHQ-9, the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS -21 items), and 3rd) 180 days post -ACS through PHQ-9 and BDI. The abuse and harmful alcohol consumption were assessed by the AUDIT and the CAGE 30 and 180 days post-ACS. Results: Along the study, the frequencies of depressive symptoms ranged from 40% to 60% and MDD from 28% to 33%. At the hospital admission there was a higher prevalence of depressive symptoms among men (58%, p= 0.03) and sedentary patients (72.1%, p= 0.02), however, MDD was higher among women (55.1%, p < 0.001) with an increased risk of [odds ratio [(OR) 4.5; confidence interval CI 95% 1.85-10.98]. After 30 days of the acute event, we observed an increased risk of depressive symptoms among smokers (OR 5.8; CI 95%, 1.81-18.72) and among diabetics (OR 3.6; CI 95%, 1.40-9.60) the diabetics were also more likely to develop MDD (OR 3.5; IC 95% 1,39-8,71). At 180 days follow-up, individuals with unstable angina (UA) (OR 4.46; CI 95% 1.39-14.32) and ST elevation myocardial infarction (STEMI) (OR 3.40; CI 95% 1.30-8.87) were more likely to develop depressive symptoms compared with patients who had NSTEMI. The only two factors that remained associated with a higher risk of depressive symptoms after 180 days were female gender (OR 3.9; CI 95% 1.54-9.73) and smokers (OR 5.34; CI 95% 1.64-17.44). Regarding MDD we found an OR of 14 (CI 95% 2.9-67.51) for smokers. In relation to abuse and hazardous consumption of alcohol, the frequencies for CAGE and AUDIT ranged from 18.3% to 33.6% along the study. We found among the male population a frequency of 88.2% (p=0.001) and smokers 55.9% (p=0.003). We also found OR of 51.64 among younger (aged 35-44 years) and OR of 42.95 for smokers. Finally, no association between alcohol abuse and depression according to ACS subtypes was observed. Conclusion: The prevalence of depression post-ACS ranged from 40% to 60% during the follow-up (admission hospital to 180 days). Individuals who developed UA or STEMI, besides women and smokers were more likely to develop depression during follow-up of 180 days and individual aged between 35-44 years and smokers were more likely to abuse of alcohol

INTRODUÇÃO: Dengue é uma doença viral prevalente e potencialmente fatal associada à alteração da permeabilidade capilar e coagulopatia. Entretanto, não há estudos concernentes aos achados tromboelastométricos nesta doença. Realizamos o presente estudo para analisar pacientes com dengue e plaquetopenia por meio de um exame rápido, efetivo e a beira leito comparando com os exames convencionais de coagulação. MÉTODOS: Trata-se de um estudo observacional e transversal conduzido entre os dias 6 de abril a 5 de maio de 2015, em São Paulo, Brasil, durante epidemia de dengue. Foi realizado tromboelastometria ROTEM® em 53 pacientes com dengue e trombocitopenia em associação com exames convencionais de coagulação: tempo de protrombina (TP), international normalized ratio (INR), tempo de tromboplastina parcial ativado (TTPa), tempo de trombina (TT), contagem de plaquetas, fibrinogênio e d-dímero. Um grupo controle de pacientes foi estabelecido para comparação do status tromboelastométrico. RESULTADOS: Um total de 38 pacientes de 53 (71,7%) apresentaram anormalidades no INTEM e 29/53 (57,4%) no EXTEM. Em contrapartida, alterações no FIBTEM foram encontradas apenas em 3/53 (5,7%). Houve significância estatística em pacientes correlacionando alterações tromboelastométricas no EXTEM e INTEM e contagem de plaquetas (p=0,052) e (p=0,005), respectivamente; assim como os valores de fibrinogênio (p=0,006) e (p=0,021), respectivamente. O grupo controle (GC) apresentou status tromboelastométrico normal em 10/10 (100%) na análise do INTEM, EXTEM, FIBTEM. Avaliação do EXTEM demonstrou significância estatística entre o GC e o grupo Dengue: CT (p=0,044); CFT (p<0,001); MCF (p < 0,001) e Alpha (p < 0,001). Foram observados níveis normais de fibrinogênio (mediana: 290) e altos níveis de d-dímero (mediana: 1330) com IQR (800-1840). Todos os pacientes (53/53) apresentavam trombocitopenia abaixo de 100 x 109/L (mediana 77 x 109/L) IQR (63-88). Exames convencionais de coagulação revelaram-se completamente normais: TP (mediana: 100%) IQR (90-100); INR (mediana: 1,0) IQR (1,0-1,1); TTPa (mediana: 28,9 segundos) IQR (26,0-32,5) e TT (mediana: 18,2 segundos) IQR (17,0-19,5). Apenas (7/49) 14,3% pacientes apresentaram sangramento e (3/52) 5,8% necessitou de hospitalização. Não houve associação entre alterações tromboelastométricas com sangramento ou hospitalização. CONCLUSÕES: Dengue representa um processo inflamatório intenso, mantendo níveis normais de fibrinogênio. Portanto, FIBTEM mantém-se normal promovendo boa formação do coágulo sem risco imediato de sangramento. Não houve correlação entre os achados tromboelastométricos com os exames convencionais de coagulação, sugerindo que testes viscoelásticos são exames mais sensíveis para análise de coagulopatia precoce nessa população / INTRODUCTION: Dengue is a prevalent and potentially fatal viral disease associated with plasma leakage and coagulopathy, though no information is available on thromboelastometric profile. We performed this study to analyze dengue fever patients with thrombocytopenia clot changes through point-ofcare thromboelastometry tests and standard coagulation tests. METHODS: This was an observational, transversal and cross sectional study conducted between April 6th and May 5th 2015 in São Paulo, Brazil, during a dengue outbreak. Thromboelastometry ROTEM® was performed in 53 patients with dengue and thrombocytopenia, in association with conventional coagulation tests: prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), thrombin time (TT); platelet count, fibrinogen level, and d-dimer. A control group of 10 patients was established to compare thromboelastometry profiles. RESULTS: A total of 38 patients in 53 (71,7%) had abnormalities in INTEM, 29 in 53 (57,4%) in EXTEM. Conversely, FIBTEM was abnormal in 3/53 (5,7%). Statistical analysis revealed significant relation in those patients with impairment EXTEM and INTEM with lowered platelet (p=0,052) and (p=0,005) respectively and lowered fibrinogen levels (p=0,006) and (p=0,021) respectively. Control group (CG) had normal status in 10/10 (100%) of INTEM, EXTEM, FIBTEM analysis. EXTEM analysis demonstrated statistical differences between CG and dengue group: CT (p=0,044); CFT (p < 0,001); MCF (p < 0,001) and Alpha (p < 0,001). Normal levels of fibrinogen (median: 290) and high levels of ddimer (median: 1330) IQR (800-1840) were found. All patients (53/53) had platelet under 100 x 109/L (median 77 x 109/L) IQR (63-88). Standard coagulation tests were completely normal: PT (median: 100%) IQR (90-100); INR (median: 1,0) IQR (1,0-1,1); aPTT (median: 28,9 seconds) IQR (26.0- 32,5) and TT (median: 18,2 seconds) IQR (17,0-19.5). Only (7/49) 14,3% patients had bleeding manifestations and (3/52) 5,8% needed hospitalization. There was no association between altered thromboelastometry with bleeding manifestations or hospitalization. CONCLUSIONS: Dengue represents an intense inflammatory process, maintaining normal levels of fibrinogen. FIBTEM remains normal providing good clot strength without immediate bleeding risk. There were no correlation between thromboelastometry findings and standard coagulation exams, suggesting that viscoelastic tests are more sensible method to analyze early coagulation impairments in this population

Submitted by Ubirajara Cruz (ubirajara.cruz@gmail.com) on 2017-06-29T14:55:18Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Fernanda_Krug.pdf: 1138754 bytes, checksum: 331c1dbcf37a0662cc3b67ccb9eb9872 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2017-06-29T16:37:31Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Fernanda_Krug.pdf: 1138754 bytes, checksum: 331c1dbcf37a0662cc3b67ccb9eb9872 (MD5) / Made available in DSpace on 2017-06-29T16:37:31Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Fernanda_Krug.pdf: 1138754 bytes, checksum: 331c1dbcf37a0662cc3b67ccb9eb9872 (MD5) Previous issue date: 2016-03-18 / Sem bolsa / Com o aumento da expectativa de vida dos cães, enfermidades vinculadas a senilidade tem sido estudada, tais como a síndrome de disfunção cognitiva (SDCC). Devido a importância de conscientização dessa síndrome objetivamos avaliar a os tipos de distúrbios cognitivos em cães adultos/maduros através de questionário observacional e de testes de reatividade. Primeiramente, realizamos uma revisão bibliográfica abordando fisiopatogenia, métodos de avaliação, testes laboratoriais e formas de tratamento. Em seguida, elaboramos um questionário sobre comportamento com 28 perguntas, disponibilizado em rede social e respondido por tutores de cães acima de sete anos de idade. As questões foram dividas nas categorias de desorientação, interação socioambiental, ciclo sono-vigília, casa sujidade e atividade. Cada uma foi avaliada com escores numéricos, e com a soma da pontuação determinou-se que: o cão com disfunção cognitiva canina (DCC) acima de 50 pontos, o cão Borderline (BL) entre 40 a 49 pontos e sem alterações comportamentais (SAC) até 39 pontos. Também se avaliou há interferência na relação tutor/cão em caso de alteração comportamental. Além, do questionário foi realizado o teste de reatividade (open field, curiosidade, interação com humano e do espelho) com dez cães que apresentavam queixa comportamental, os quais seus tutores responderam ao questionário. Para a análise dos dados utilizou-se os testes ANOVA, as médias foram testadas com Tukey e qui-quadrado. Com relação ao questionário verificou-se nos 112 questionários respondidos, que 25,8% (29) dos cães apresentavam DCC, 41,9% (47) eram BL e 32,1% (36) eram SAC. Nas avaliações das categorias foi constatado que o grupo DCC obteve sempre as maiores médias do somatório, diferindo (p ≤ 0,005) do SAC e BL nas categorias a atividade e ciclo sono–vigília. Todos os tutores relataram no questionário que as alterações comportamentais não interferem na rotina do tutor com o seu cão. Entre os dez cães que participaram do teste de reatividade, constatou-se que dois cães tinham DCC, três eram BL, cinco eram SAC através da análise do questionário. Os cães com DCC tiveram alterações em todos testes de reatividade, exceto no de curiosidade. No open field esses animais urinaram durante o teste diferindo dos demais (p ≤ 0,05). No exame de interação com humanos e no do espelho os cães com DCC não realizaram a interação (p≤0,005) nem com a pessoa ou com o objeto, enquanto os demais grupos apresentaram a interação. Com os estudos realizados conclui-se que cães com DCC tem déficit cognitivo nas atividades, ciclo sono vigília, e interação social. / With increasing life expectancy of dog’s diseases related senility, has been studied, such as cognitive dysfunction syndrome (SDCC). Due to the importance of awareness of this syndrome, we aimed to evaluate the types of cognitive disorders in adult / mature dogs through observational questionnaire and reactivity tests. First, we conducted a literature review addressing pathophysiology, evaluation methods, laboratory tests and forms of treatment. Then, we developed a behavior on questionnaire with 28 questions, available on social network and answered by up dog guardians seven years old. The questions were divided in disorientation categories, socio-environmental interaction, sleep-wake cycle, house soiling and activity. Each was evaluated with numerical scores, and the sum of scores was determined that: the dog with canine cognitive dysfunction (DCC) above 50, the dog Borderline (BL) from 40 to 49 points and without behavioral changes (SAC) to 39 points. Also evaluated for interference in the mentor / dog relationship in case of behavioral change. In addition, the survey was conducted the reactivity test (open field, curiosity, with human interaction and mirror) with ten dogs with behavioral complaint, which his tutors answered the questionnaire. For data analysis, we used the ANOVA tests, the averages were tested with Tukey and chi-square. Regarding the questionnaire there was the 112 responses, 25.8% (29) of the dogs had DCC, 41.9% (47) were BL and 32.1% (36) were SAC. In the evaluations of the categories it was found that the DCC group always had the highest average of the sum, differing (p ≤ 0.005) of the SAC and BL in the categories activity and sleep-wake cycle. All tutors reported in the questionnaire that behavioral changes do not interfere with the tutor of the routine with your dog. Among the ten dogs that participated in the reactivity test, it was found that two dogs had DCC, three were BL, and five were SAC by questionnaire analysis. Dogs with CHD had changes in all reactivity tests, except curiosity. In the open field the animals urinated during the test differed significantly (p ≤ 0.05). In the examination of interaction with humans and the mirror dogs with CHD did not perform the interaction (p≤0,005) or with the person or the object, while the other groups presented the interaction. With the studies, it was concluded that dogs with CHD have cognitive impairment in activities, sleep wake cycle, and social interaction.