INTRODUÇÃO: O Lúpus Eritematoso Sistêmico (LES) é uma doença inflamatória crônica que pode acometer qualquer órgão ou sistema. O acometimento do coração pode ocorrer em até 50% dos casos e não existem estudos de prevalência de eventos arrítmicos (EA) em pacientes com LES, nem de correlações laboratoriais preditoras de sua ocorrência. OBJETIVOS: Estabelecer a taxa de ocorrência de EA e identificar variáveis laboratoriais preditoras de sua ocorrência em pacientes com LES em seguimento em ambulatório de hospital terciário; estabelecer a associação entre o uso de cloroquina com a ocorrência de EA e óbitos (tipo, número e tempo de seguimento). MÉTODOS: Foi realizado um estudo clínico descritivo, observacional e aberto com pacientes em seguimento ambulatorial no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo que foram submetidos a avaliação clínica, exames laboratoriais, ECG de repouso e Holter de 24h. A associação entre as variáveis e os EA foi avaliada por meio dos testes qui-quadrado, razão de verossimilhança, teste exato de Fisher, teste t-Student, teste não-paramétrico de Mann-Whitney, regressão logística múltipla e curva ROC. RESULTADOS: Entre agosto/2005 e agosto/2006 foram estudados 325 pacientes consecutivos, sendo 8 excluídos. A idade média foi de 40,25 anos, 91% mulheres. O tempo médio do diagnóstico de LES foi de 11,36 anos e apenas 6 pacientes apresentaram critérios para atividade do LES (escore SLEDAI). Duzentos e vinte e um pacientes estavam em uso de cloroquina. Alterações ao ECG ocorreram em 66 pacientes (20,82%): 5 bloqueios atrioventriculares de 1º grau; 4 bradicardias sinusais; 4 taquicardias sinusais e 1 supraventricular; 6 bloqueios do ramo direito (BRD); 2 bloqueios do ramo esquerdo (BRE); 45 QT prolongados. Ao Holter foram identificados 4 pacientes com pausas > 2,0 segundos; 45 com FC mínima < 50bpm; 90 com extrassístoles supraventriculares (ESV); 26 com taquiarritmias supraventriculares (FA/TA); 65 com extrassístoles ventriculares (EV). Foram registrados 7 óbitos (2,47%). Idade acima de 40 anos foi preditora da ocorrência de EA (p=0,002; OR=2,523; IC 95%= 1,389-5,583). A presença do anticorpo anticardiolipina foi preditora da ocorrência de BRD/BRE (p = 0,005; OR 3,989; IC 95% = 1,615-9,852). Títulos de C3 abaixo de 105mg% foram preditores de menor probabilidade de ocorrência de FC mínima < 50bpm (p=0,016; OR=1,018; IC 95%=1,003-1,033). Os preditores para a ocorrência de EV foram a idade (p=0,002; OR=1,051; IC95%=1,018-1,085) e a duração do QRS (p=0,005; OR=1,061; IC95%=1,018-1,106); quanto mais avançada a idade e quanto mais largo o QRS, maior a probabilidade de ocorrência de EV. Para a ocorrência de TA/FA, os preditores foram a idade (p<0,001; OR=1,100; IC95%=1,050-1,154) e o tempo de uso cloroquina (p=0,035; OR=0,921; IC95%=0,853-0,994); quanto mais avançada a idade e quanto menor o tempo de uso de cloroquina, maior a probabilidade de ocorrência de TA/FA. Pacientes com mais de 50 anos e tempo de uso de cloroquina inferior a 8 anos tiveram mais TA/FA. CONCLUSÕES: Neste estudo, que avaliou pacientes com LES em seguimento ambulatorial em hospital terciário, a taxa de ocorrência de EA foi elevada; a sua correlação com variáveis laboratoriais identificou como preditores de maior ocorrência: idade acima de 40 anos, título de C3 abaixo de 105mg% e presença de anticorpo anticardiolipina. A cloroquina demonstrou efeito protetor cardíaco sobre a evolução da doença. / INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a chronic inflammatory illness that can affect any organ and system. Up to 50% of patients have their heart affected and there are no prevalence studies of arrhythmic events (AE) in SLE patients and laboratory predictors are also unknown. OBJECTIVES: To establish the rate of occurrence of AE and to identify laboratory predictors in outpatients with SLE; to establish the association between chloroquine use and the occurrence of AE and death (type, number and time of follow-up). METHODS: A descriptive, observational and opened clinical study was carried out with SLE oupatients selected from the Rheumatology clinic of São Paulo University Medical School, Brazil. They were submitted to clinical evaluation, laboratory exams, resting-ECG and 24-hour Holter monitoring. Statistics: The association between the variables and the occurrence of AE was assessed by chi-square, likelihood ratio, Fishers test, t-Student, Mann-Whitney, ROC curve and logistic regressions. RESULTS: Between august/05-august/06, 325 consecutive patients were studied. Resting-ECG abnormalities were found in 66 patients, rate of 20.82%. The average age was 40.25yo, 91% female. The average time of SLE diagnosis was of 11.36y and only 6 presented criteria for diseases activity (SLEDAI score). There were 221 patients using chloroquine. ECG disturbances found: 5 1st degree AV-block; 4 sinus bradycardia; 4 sinus tachycardia and 1 supraventricular tachycardia; 6 RBBB; 2 LBBB; 45 long QT. At Holter monitoring: 4 pauses>2.0s; 45 HR<50bpm; 90 atrial ectopies; 26 atrial tachyarrhythmia; 65 ventricular ectopies. Seven death were registered (2.47%). Age above 40yo was predictor of AE (p=0.002; OR=2.5; 95%IC=1.4-5.6). Presence of anticardiolipine antibody was predictor of QRS>120ms occurrence (p = 0.005; OR 3.989; IC 95% = 1.615-9.852). C3 level bellow 105mg% was predictor of non-occurrence of HR<50bpm (p=0.02; OR=1.02;95% IC=1.003-1.03). The predictor for ventricular ectopies (VE) occurrence were age (p=0,002; OR=1,051; IC95%=1,018-1,085) and QRS duration (p=0,005; OR=1,061; IC95%=1,018-1,106); advanced age and longer QRS predicted greater probability of VE. For supraventricular tachyarrhythmia (AT/AF) the predictors were age (p<0,001; OR=1,100; IC95%=1,050-1,154) and time of Chloroquine use (p=0,035; OR=0,921; IC95%=0,853-0,994); advanced age and short time of Chloroquine use are related to greater probability of AT/AF. Patients older than 50y and using chloroquine for less than 8y had more AT/AF. CONCLUSIONS: The rate of AE occurrence was high (20%) and the correlation with laboratory variables identified predictors of occurrence of AE: age above 40 years, C3 level below 105mg% and anticardiolipin antibody. Chloroquine demonstrated cardiac protection effect.

Master thesis is focused on the philosophy of design adaptive controller. In the theoretic part are described parts of the adaptive controller, which belongs parts as online identification by recursive least-squares method and PSD controller, which can set its parameters according to identified system (use Z-N method). The part of control system with transport delay is situated at the conclusion of the theoretic part, there are focused on Smith predictor. Practical part is focused on verification of all algorithms, which was performed on models and real systems.

Master thesis is focused on the philosophy of design adaptive controller. In the theoretic part are described parts of the adaptive controller, which belongs parts as online identification by recursive least-squares method and PSD controller, which can set its parameters according to identified system (use Z-N method). The part of control system with transport delay is situated at the conclusion of the theoretic part, there are focused on Smith predictor. Practical part is focused on verification of all algorithms, which was performed on models and real systems.

Orientador: Célio F.B. Haddad / Resumo: Na última década houve um grande desenvolvimento nos Modelos de Distribuição de Espécies (MDE), com diversas aplicações na conservação da biodiversidade. No entanto, apesar dos avanços recentes, a seleção de variáveis preditoras tem sido relativamente negligenciada na construção dos MDE. Este procedimento deveria ser um dos passos cruciais do processo de modelagem, já que as variáveis preditoras estão relacionadas diretamente à capacidade dos modelos de capturar os requisitos ambientais das espécies. Neste contexto, os anfíbios são excelentes organismos modelo para avaliar a importância da seleção de variáveis preditoras ecologicamente significativas no MDE. Isto pode trazer avanços para a biogeografia e biologia da conservação, uma vez que os anfíbios são usados como bioindicadores da qualidade ambiental e da integridade de hábitat. A presente tese de doutorado teve como objetivo principal verificar o efeito da utilização de variáveis preditoras ecologicamente significativas no processo de modelagem dos anfíbios e posteriormente aplicar parte deste conhecimento na comunidade de anfíbios do Estado de São Paulo, visando verificar o potencial desta metodologia para identificar áreas de alto valor de riqueza de anfíbios e verificar também o potencial de invasão de Eleutherodactylus jonhstonei, uma espécie de anfíbio invasora registrada para o Estado de São Paulo. No primeiro capítulo avaliamos a importância da seleção de variáveis essenciais ao MDE usando os anfíbios como estudo... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In the last decade there has been a great development in the Species Distribution Models (SDM), with several applications in conservation planning. However, despite recent advances, the selection of predictor variables has been relatively neglected in the construction of SDM. This methodological approach should be one of the critical steps of the modeling process, as the predictor variables are directly related to the ability of models to capture the environmental requirements of the species. In this context, amphibians are excellent model for assessing the importance of selecting ecologically meaningful variables in the SDM. This methodology may lead to advances in biogeography and conservation biology, since amphibians are used as bioindicators of environmental quality and habitat integrity. The aim of the work was to verify the effect of the use of ecologically meaningful variables in the amphibian modeling process and to apply part of this knowledge to the amphibian community of São Paulo state, checking the potential of this methodology to identify areas of high amphibian richness value and to verify the potential invasion of Eleutherodactylus jonhstonei, an invasive amphibian species registered in São Paulo state. In the first chapter we evaluated the importance of selecting essential variables in SDM using amphibians as a case study. The second chapter deals specifically with the amphibian modeling protocol of São Paulo state. The central focus of this chapter has been... (Complete abstract click electronic access below) / Doutor

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This experiment was designed to determine which assessment method: continuous assessment (in the form of daily in-class quizzes), cumulative assessment (in the form of online homework), or project-based learning, best predicts student learning (dependent upon posttest grades) in an undergraduate mathematics course. Participants included 117 university-level undergraduate freshmen enrolled in a course titled "Mathematics for Calculus". Initially, a multiple regression model was formulated to model the relationship between the predictor variables (the continuous assessment, cumulative assessment, and project scores) versus the outcome variable (the posttest scores). However, due to the possibility of multicollinearity present between the cumulative assessment predictor variable and the continuous assessment predictor variable, a stepwise regression model was implemented and caused the cumulative assessment predictor variable to be forced out of the resulting model, based on the results of statistical significance and hypothesis testing. The finalized stepwise regression model included continuous assessment scores and project scores as predictor variables of students' posttest scores with a 99% confidence level. Results indicated that ultimately the continuous assessment scores best predicted students' posttest scores.

ITC/USA 2015 Conference Proceedings / The Fifty-First Annual International Telemetering Conference and Technical Exhibition / October 26-29, 2015 / Bally's Hotel & Convention Center, Las Vegas, NV / Over the past several years DoD imposed constraints on test deliverables, requiring objective measures of test results, i.e., statistically defensible test and evaluation (SDT&E) methods and results. These constraints force testers to employ statistical hypotheses, analyses and modeling to assess test results objectively, i.e., based on statistical metrics, analytical methods, probability of confidence complemented by, rather than solely on expertise, which is too subjective. In this and companion papers we discuss methods of objectifying testing. We employ an earth coordinate model and statistical modeling of telemetry (TM) tracking antenna employing time-space position information (TSPI) and derived statistical measures for tracking-error and auto-tracking mode. Test data were statistically analyzed via analysis of covariance (ANCOVA) which revealed that the antenna control unit (ACU) under test (AUT) does not track statistically identically, nor as practically or efficiently in C-band while receiving data carriers in both S- and C-bands. The conclusions of this paper add support to that hypothesis. In this third of three papers we use data from a range test, but make no reference to the systems under test as the purpose of this paper is to present an example of tools useful for employing a SDT&E methodology.

L’utilisation des mesures d’isolement et de contentions en milieu psychiatrique intrahospitalier se produit fréquemment en réponse à des comportements agressifs et continue de soulever la controverse. À cet égard, de plus en plus d’études tendent à démontrer que le personnel soignant travaillant sur ces unités est influencé par plusieurs facteurs de nature différente, notamment la perception de l’agressivité, quand vient le temps de prendre une décision quant à l’utilisation (ou non) de ces mesures coercitives. Méthodologie : Plus de trois cents membres du personnel soignant travaillant en milieu psychiatrique intrahospitalier ont été recrutés dans huit établissements psychiatriques du Québec. Dans un premier temps, un questionnaire leur a été distribué afin de mettre en relief les différents facteurs (individuels et organisationnels) ayant un impact sur l’utilisation des mesures coercitives. Simultanément, l’analyse factorielle de la version française de deux échelles permettant de mesurer la perception de l’agressivité en milieu hospitalier (le MOAS et le POAS) a été faite. Résultats : Un modèle final multivarié a démontré que le type d’unité psychiatrique, l’expression de la colère et de l’agressivité parmi les membres de l’équipe de soins, la perception de la fréquence de gestes autoagressifs et la perception de mesures de sécurité insuffisantes dans le milieu de travail étaient des prédicteurs indépendants de l’utilisation de procédures d’isolement et de contentions. L’analyse factorielle a pour sa part mis en évidence une structure à 4 facteurs pour le MOAS et à 3 facteurs pour le POAS, conformément à ce que l’on retrouvait dans la littérature scientifique. Conclusion : Ces résultats soulignent l’importance des facteurs organisationnels par rapport aux facteurs individuels dans l’utilisation des mesures coercitives en psychiatrie et la nécessité d’évaluer les perceptions quant à l’agressivité et à la sécurité chez le personnel soignant. En comprenant mieux les phénomènes qui amènent leur utilisation, il sera possible de trouver des alternatives aux mesures d’isolement et de contentions et ainsi réduire le recours à ces dernières. / Psychiatric staff can have both positive and negative attitudes towards inpatient aggression. Different attitudes towards aggression can have a substantial influence on how such behaviour is dealt with on psychiatric wards. In this manner, seclusion and restraint are frequently used measures for managing violent behaviour. However, their use raises several concerns. Method: Over three hundred staff members were recruited from eight psychiatric hospitals in the province of Quebec. First of all, an examination was conducted from the staff perspective of the organizational and staff factors that may be associated with increased recourse to seclusion and restraint in psychiatric wards. Simultaneously, factorial analysis of the French version of two scales used to measure staff attitude towards institutional violence and aggression (MOAS and POAS) was completed. Results: The final multivariate model showed that the following factors independently predict to greater use of seclusion and restraint: the type of hospital ward; greater expression of anger and aggression among staff members; perceptions of the frequency of incidents of physical aggression against the self; and the perception of insufficient protection measures in the workplace. Factor analyses revealed a four factor structure for the MOAS and a three factor structure for the 12-item POAS, which is similar to what is found in recent scientific literature in North American and European countries. Conclusion: These findings underscore the importance of evaluating a variety of factors, including perceptions of safety and violence, when exploring the management of aggression and violence on psychiatric wards and the reasons seclusion and restraint measures are used. These findings represent the first stage of a research program of the multidisciplinary group to whom the author is associated, aimed at reducing recourse to seclusion and restraint in Quebec psychiatric services.

La fibrillation auriculaire (FA) est une arythmie touchant les oreillettes. En FA, la contraction auriculaire est rapide et irrégulière. Le remplissage des ventricules devient incomplet, ce qui réduit le débit cardiaque. La FA peut entraîner des palpitations, des évanouissements, des douleurs thoraciques ou l’insuffisance cardiaque. Elle augmente aussi le risque d'accident vasculaire. Le pontage coronarien est une intervention chirurgicale réalisée pour restaurer le flux sanguin dans les cas de maladie coronarienne sévère. 10% à 65% des patients qui n'ont jamais subi de FA, en sont victime le plus souvent lors du deuxième ou troisième jour postopératoire. La FA est particulièrement fréquente après une chirurgie de la valve mitrale, survenant alors dans environ 64% des patients. L'apparition de la FA postopératoire est associée à une augmentation de la morbidité, de la durée et des coûts d'hospitalisation. Les mécanismes responsables de la FA postopératoire ne sont pas bien compris. L'identification des patients à haut risque de FA après un pontage coronarien serait utile pour sa prévention. Le présent projet est basé sur l'analyse d’électrogrammes cardiaques enregistrées chez les patients après pontage un aorte-coronaire. Le premier objectif de la recherche est d'étudier si les enregistrements affichent des changements typiques avant l'apparition de la FA. Le deuxième objectif est d'identifier des facteurs prédictifs permettant d’identifier les patients qui vont développer une FA. Les enregistrements ont été réalisés par l'équipe du Dr Pierre Pagé sur 137 patients traités par pontage coronarien. Trois électrodes unipolaires ont été suturées sur l'épicarde des oreillettes pour enregistrer en continu pendant les 4 premiers jours postopératoires. La première tâche était de développer un algorithme pour détecter et distinguer les activations auriculaires et ventriculaires sur chaque canal, et pour combiner les activations des trois canaux appartenant à un même événement cardiaque. L'algorithme a été développé et optimisé sur un premier ensemble de marqueurs, et sa performance évaluée sur un second ensemble. Un logiciel de validation a été développé pour préparer ces deux ensembles et pour corriger les détections sur tous les enregistrements qui ont été utilisés plus tard dans les analyses. Il a été complété par des outils pour former, étiqueter et valider les battements sinusaux normaux, les activations auriculaires et ventriculaires prématurées (PAA, PVA), ainsi que les épisodes d'arythmie. Les données cliniques préopératoires ont ensuite été analysées pour établir le risque préopératoire de FA. L’âge, le niveau de créatinine sérique et un diagnostic d'infarctus du myocarde se sont révélés être les plus importants facteurs de prédiction. Bien que le niveau du risque préopératoire puisse dans une certaine mesure prédire qui développera la FA, il n'était pas corrélé avec le temps de l'apparition de la FA postopératoire. Pour l'ensemble des patients ayant eu au moins un épisode de FA d’une durée de 10 minutes ou plus, les deux heures précédant la première FA prolongée ont été analysées. Cette première FA prolongée était toujours déclenchée par un PAA dont l’origine était le plus souvent sur l'oreillette gauche. Cependant, au cours des deux heures pré-FA, la distribution des PAA et de la fraction de ceux-ci provenant de l'oreillette gauche était large et inhomogène parmi les patients. Le nombre de PAA, la durée des arythmies transitoires, le rythme cardiaque sinusal, la portion basse fréquence de la variabilité du rythme cardiaque (LF portion) montraient des changements significatifs dans la dernière heure avant le début de la FA. La dernière étape consistait à comparer les patients avec et sans FA prolongée pour trouver des facteurs permettant de discriminer les deux groupes. Cinq types de modèles de régression logistique ont été comparés. Ils avaient une sensibilité, une spécificité et une courbe opérateur-receveur similaires, et tous avaient un niveau de prédiction des patients sans FA très faible. Une méthode de moyenne glissante a été proposée pour améliorer la discrimination, surtout pour les patients sans FA. Deux modèles ont été retenus, sélectionnés sur les critères de robustesse, de précision, et d’applicabilité. Autour 70% patients sans FA et 75% de patients avec FA ont été correctement identifiés dans la dernière heure avant la FA. Le taux de PAA, la fraction des PAA initiés dans l'oreillette gauche, le pNN50, le temps de conduction auriculo-ventriculaire, et la corrélation entre ce dernier et le rythme cardiaque étaient les variables de prédiction communes à ces deux modèles. / Atrial fibrillation (AF) is an abnormal heart rhythm (cardiac arrhythmia). In AF, the atrial contraction is rapid and irregular, and the filling of the ventricles becomes incomplete, leading to reduce cardiac output. Atrial fibrillation may result in symptoms of palpitations, fainting, chest pain, or even heart failure. AF is an also an important risk factor for stroke. Coronary artery bypass graft surgery (CABG) is a surgical procedure to restore the perfusion of the cardiac tissue in case of severe coronary heart disease. 10% to 65% of patients who never had a history of AF develop AF on the second or third post CABG surgery day. The occurrence of postoperative AF is associated with worse morbidity and longer and more expensive intensive-care hospitalization. The fundamental mechanism responsible of AF, especially for post-surgery patients, is not well understood. Identification of patients at high risk of AF after CABG would be helpful in prevention of postoperative AF. The present project is based on the analysis of cardiac electrograms recorded in patients after CABG surgery. The first aim of the research is to investigate whether the recordings display typical changes prior to the onset of AF. A second aim is to identify predictors that can discriminate the patients that will develop AF. Recordings were made by the team of Dr. Pierre Pagé on 137 patients treated with CABG surgery. Three unipolar electrodes were sutured on the epicardium of the atria to record continuously during the first 4 post-surgery days. As a first stage of the research, an automatic and unsupervised algorithm was developed to detect and distinguish atrial and ventricular activations on each channel, and join together the activation of the different channels belonging to the same cardiac event. The algorithm was developed and optimized on a training set, and its performance assessed on a test set. Validation software was developed to prepare these two sets and to correct the detections over all recordings that were later used in the analyses. It was complemented with tools to detect, label and validate normal sinus beats, atrial and ventricular premature activations (PAA, PVC) as well as episodes of arrhythmia. Pre-CABG clinical data were then analyzed to establish the preoperative risk of AF. Age, serum creatinine and prior myocardial infarct were found to be the most important predictors. While the preoperative risk score could to a certain extent predict who will develop AF, it was not correlated with the post-operative time of AF onset. Then the set of AF patients was analyzed, considering the last two hours before the onset of the first AF lasting for more than 10 minutes. This prolonged AF was found to be usually triggered by a premature atrial PAA most often originating from the left atrium. However, along the two pre-AF hours, the distribution of PAA and of the fraction of these coming from the left atrium was wide and inhomogeneous among the patients. PAA rate, duration of transient atrial arrhythmia, sinus heart rate, and low frequency portion of heart rate variability (LF portion) showed significant changes in last hour before the onset of AF. Comparing all other PAA, the triggering PAA were characterized by their prematurity, the small value of the maximum derivative of the electrogram nearest to the site of origin, as well as the presence of transient arrhythmia and increase LF portion of the sinus heart rate variation prior to the onset of the arrhythmia. The final step was to compare AF and Non-AF patients to find predictors to discriminate the two groups. Five types of logistic regression models were compared, achieving similar sensitivity, specificity, and ROC curve area, but very low prediction accuracy for Non-AF patients. A weighted moving average method was proposed to design to improve the accuracy for Non-AF patient. Two models were favoured, selected on the criteria of robustness, accuracy, and practicability. Around 70% Non-AF patients were correctly classified, and around 75% of AF patients in the last hour before AF. The PAA rate, the fraction of PAA initiated in the left atrium, pNN50, the atrio-ventricular conduction time, and the correlation between the latter and the heart rhythm were common predictors of these two models.

Abstract Purpose: The United States has the highest rate of teen pregnancy of any industrialized nation. Adolescents who have their first sexual intercourse at a young age are at increased risk for teen pregnancies and acquiring a sexually transmitted disease. This study examines predictors of early onset sexual intercourse in male and female residents of the United States. Methods: A nationally representative sample of N=7,643 females and N=4.928 males ages 15-44 was procured from the 2002 National Survey of Family Growth (NSFG), Cycle 6. Age at first sexual intercourse was used to define early onset of sexual debut(<18 years). Socio-demographic and behavioral characteristics of the respondents, demographic and selected reproductive characteristics of the respondent's parents were examined using multiple logistic regression modeling. Results: Non-fispanic black, being raised without both parents, having a mother less than 18 years old at the age of first birth and age difference between partners were significant predictors of early onset of sexual intercourse for both males and females. Maternal education less than high school was a significant protective factor for female respondents [OR=0.72 (95%CI=0.58- 0.90)] and paternal education completed high school only [OR=1.4 (95% CI=l. 1-1.7)] was a significant risk factor for male respondents. Conclusions: Racelethnicity, age difference between partners, not being raised by both parents, having a mother who had her first birth before the age of 18 and parental education are important predictor variables. Further study should be conducted to investigate the protective effect of lack of maternal education for female respondents. Intervention programs for teen pregnancy and sexually transmitted infection prevention should target these at risk groups.