HIV risk assessment models use multiple risk factors to build composite index scores to evaluate population level HIV risk. In this report, four risk assessment models were applied to a dataset with demographic, biological, and behavioral risk factors from 927 individuals in high and low HIV burden zip code groups in metro Atlanta, GA. Predictive ability of the risk assessment models were evaluated by comparing their sensitivity and specificity, area under the ROC curve, and mean score difference between high-burden and low-burden zip code area. The results show that the proportion of study participants who scored high in the risk assessment method are significantly greater in high-HIV burden zip code area than in low-HIV burden zip code area in all four risk assessment models. The Clinical Decision Rule risk-scoring model showed the best predictive ability of HIV risk and Binary Risk Indicator model showed the best predictive ability in predicting the residence zip code area.

Hälso- och sjukvårdens utveckling har lett fram till ett marknadsstyrt system. För att kunna jämföra olika vårdgivare och utveckla kvalitén har ett flertal kvalitetsindikatorer och uppföljningsområden införts. Fallrisk är ett av dessa uppföljningsområden. I Sverige är Downton Fall Risk Index förstahandsval som fallriskbedömningsinstrument. Hälso- och sjukvård ska utformas och genomföras i samråd med patienterna. Den traditionella rollfördelningen mellan patienterna och sjuksköterskorna håller på att förändras till att patienternas rätt till delaktighet uppmärksammas. Syftet med denna uppsats var att belysa sjuksköterskornas erfarenhet av och syn på patienternas delaktighet i fallriskbedömningen. Det här är en intervjustudie med kvalitativ ansats. Åtta sjuksköterskor som arbetar på ett akutsjukhus i mellersta Sverige och använder sig av Downton Fall Risk Index vid fallriskbedömningen har intervjuats. Kvalitativ innehållsanalys som inspirerats av Graneheim och Lundman har använts. Den teoretiska utgångspunkten är Peplaus syn på relationen mellan sjuksköterskorna och patienterna som en av de viktigaste grundstenarna inom omvårdnaden. Studien kom fram till följande fem teman: fallrisk är sjuksköterskornas bedömning, standardmall har ett eget liv, fallrisk - skrämselpropaganda eller verklighet, sjuksköterskornas svårigheter med att involvera patienterna och sjuksköterskornas syn på patienternas delaktighet. Det standardiserade arbetssättet uppmuntrar inte till utvecklingen av reflektionsförmågan och kliniska blicken bland nyutbildade sjuksköterskor därför behövs det en kompetensstege för sjuksköterskor. Sjuksköterskor hittar inte plats varken för sin egen eller för patienternas delaktighet i Downton Fall Risk Index. Frågan som kan ställas är om rätt instrument har valts för fallriskbedömningen i akutsjukvården.

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Orientadores: Antonio Carlos Pereira, Glaucia Maria Bovi Ambrosano / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-15T02:54:21Z (GMT). No. of bitstreams: 1 Cortellazzi_KarineLaura_D.pdf: 2197396 bytes, checksum: 7feb66c05a5cfd3b911677b435684e93 (MD5) Previous issue date: 2010 / Resumo: Esta tese, composta por dois estudos, teve como objetivos: a) Identificar os indicadores de risco de cárie dentária utilizando dados coletados no exame inicial e os preditores do incremento da doença após 18 meses de acompanhamento em crianças de 5 anos de idade (Capítulo 1); e b) Determinar a incidência de cárie dentária e avaliar a influência de variáveis socioeconômicas, clínicas e demográficas no tempo para o surgimento da doença em dentes permanentes numa coorte de crianças de 5 anos de idade, após 3 anos de acompanhamento (Capítulo 2). A amostra foi composta por 427 pré-escolares de 22 pré-escolas públicas de Piracicaba, SP, examinados em 2005 (baseline), após 18 meses (2006) e 36 meses (2008) pelo mesmo cirurgião-dentista previamente calibrado, sob luz natural, com espelho e sonda IPC. No exame inicial, o examinador coletou dados sobre variáveis clínicas (cárie dentária, lesão inicial de cárie - LI, gengivite, fluorose, apinhamento e espaçamento) socioeconômicas (renda familiar, número de pessoas na casa, escolaridade dos pais, habitação e posse de automóvel) e de hábitos orais deletérios (uso de chupeta e mamadeira). Após 18 e 36 meses, realizou-se o reexame para verificar a incidência de cárie. No primeiro estudo, para testar a associação entre as variáveis dependentes (experiência de cárie no baseline - ceos e incremento da doença - CPOS) e independentes (gênero, LI, experiência passada de cárie em dentes decíduos, gengivite, fluorose, apinhamento, espaçamento, renda familiar, número de pessoas na casa, escolaridade dos pais, habitação, posse de automóvel, uso de chupeta e mamadeira), uma análise bivariada foi conduzida utilizando-se o teste de Qui-quadrado ou o Exato de Fisher. Análise de regressão logística múltipla foi realizada, estimando os Odds Ratio (OR), os respectivos intervalos de 95% de confiança (IC) e os valores de p. A presença de LI (OR=10,69; IC=4,86-23,50) ou de gengivite (OR=1,54; IC=0,99-2,38), a ausência de espaçamento (OR=3,41; IC=1,39-8,40) ou de fluorose (OR=2,28; IC=1,17-4,44) foram considerados indicadores de risco de cárie no baseline (p<0,05). Os pré-escolares com experiência de cárie em dentes decíduos (OR=4,25; IC=1,95-9,27) ou de famílias com posse de automóvel (OR=2,27; IC=1,06-4,88) tiveram maior chance de desenvolver incremento da doença (p<0,05). Variáveis clínicas foram identificadas como indicadores e preditores de risco de cárie, e dentre as variáveis socioeconómicas avaliadas, somente posse de automóvel permaneceu como preditor de risco. No segundo estudo, utilizou-se o método de Kaplan-Meier para estudar o efeito isolado das variáveis socioeconómicas (renda familiar, número de pessoas na casa, escolaridade dos pais, habitação, posse de automóvel), clínicas (experiência passada de cárie em dentes decíduos, gengivite e fluorose) e demográfica (gênero) na incidência de cárie após 3 anos de acompanhamento. Um modelo de riscos proporcionais de Cox foi realizado para testar a influência das variáveis coletadas no exame inicial no tempo para o surgimento de incremento de CPOD. A análise de sobrevivência mostrou que crianças com experiência passada de cárie em dentes decíduos tiveram maior risco de desenvolver incremento de CPOD. Os resultados desta tese demonstraram que variáveis clínicas puderam identificar os pré-escolares com risco de apresentar ou desenvolver a doença e que a experiência passada de cárie continua sendo o principal e mais forte preditor de risco / Abstract: This thesis, composed of two papers aimed to: a) Identify the risk indicators of dental caries with data collected at initial examination and the predictors of disease increment based on the 18-months-follow-up examination in 5-year-old children (Chapter 1); e b) Determine the incidence of dental caries and evaluate the influence of socioeconomic, clinical and demographic variables on the time for disease to appear in the permanent teeth of a cohort of 5-year-old children after 3 years of follow-up (Chapter 2). The sample was composed by 427 preschool children from 22 public preschools in Piracicaba, SP, examined in 2005 (baseline), after 18 months (2006) and 36 months (2008) by the same calibrated dentist in an outdoor setting, under natural light, using a dental mirror and CPI probe. At initial examination, the dentist collected data on the clinical (dental caries, initial caries lesion - IL, gingivitis, fluorosis, crowding and spacing) and socioeconomic variables (family income, number of people living in the household, parents' educational level, home ownership and car ownership) and about deleterious oral habits (pacifier use and nursing bottle). Reexaminations were performed after 18 and 36 months to verify dental caries incidence. In the first paper, for testing the association between dependent variables (caries experience at baseline - dmfs and caries increment - DMFS) and independent variables (gender, IL, past caries experience in primary teeth, gingivitis, fluorosis, crowding, spacing, family income, number of people living in the household, parents' educational level, home ownership, car ownership, pacifier use and nursing bottle), a bivariate analysis was performed using the Chi-square or Fisher Exact tests. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals (CI) and p-values. Presence of IL (OR=10.69; CI=4.86-23.50) or gingivitis (OR=1.54; CI=0.99-2.38), absence of spacing (OR=3.41; CI=1.39-8.40) or fluorosis (OR=2.28; CI=1.17-4.44) were risk indicators for caries at baseline (p<0.05). The preschool children with caries experience in primary teeth (OR=4.25; CI=1.95-9.27) or from families with car ownership (OR=2.27; CI=1.06-4.88) were more prone to developing caries increment (p<0.05). Clinical variables were identified as risk indicators and risk predictors of dental caries and among socioeconomic variables tested only car ownership remained as risk predictor. In the second paper, the Kaplan-Meier survival analysis method was used to study the isolated effect of socioeconomic (family income, number of people living in the household, parents' educational level, home ownership and car ownership), clinical (past caries experience in primary teeth, gingivitis and fluorosis) and demographic (gender) variables on caries incidence after 3 years of follow-up. A Cox proportional hazards regression model was built to test the influence of the variables collected at initial examination on time to develop DMFT increment. Survival analysis showed that children with past caries experience in primary teeth would be at greater risk to developing DMFT increment. The results of this thesis demonstrated that clinical variables could identify the preschool children at risk to presented or developing the disease and the past caries experience continue to be the main and strongest risk predictor / Doutorado / Saude Coletiva / Doutor em Odontologia

Background: Fall injuries are a costly problem for society, with costs ranging up to 14 billion a year. In addition to economic loss accidental falls also creates human value losses and reduced quality of life for its victims. In order to prevent the occurrence of injury related to accidental falls healthcare providers utilize various scientifically developed risk assessment tools, one of them being Downton Fall Risk Index. Method: Empirical, quantitative cross-sectional study. Objective: The purpose of the extended essay was to describe the categories in Downton Fall Risk Index that have a bearing on patients' risk of falling while in hospital and in municipal care, and to illustrate how nurses can use the fall risk assessment tool. Results: Of the 708 participants a total of 73% had a high risk of falling according to Downton Fall Risk Index, of the patients being treated at a hospital 66% had high risk of falling and of the patients being treated in municipal care 87% had high risk of falling. Downton Fall Risk Index indicates that the medication was by far the largest category and included 576 patients (81%), followed by sensory impairment in 474 patients (67%). 335 patients (47%) had fallen previously. Discussion: Previous studies show that among patients being treated in hospitals, between 1.3 to 2.1% will fall. Downton Fall Risk Index indicates that 66% of the group of patients are at high risk of falling. This may be due to the fact that Downton Fall Risk Index focuses too much on medication. It is the nurse’s responsibility to coordinate work around the patient in order to minimize the risk of falling. For example, contact an occupational therapist or an ophthalmologist who can undertake specific actions to reduce patients' risk of falling. Nurses should also use appropriate risk assessment tools to identify risk factors in the patient and then use these to formulate a nursing diagnosis. Conclusion: Downton Fall Risk Index is too sensitive to be used on hospitalized patients, the instrument works better in patients being treated in municipal care. It is important that the nurse can use scientifically designed tool for ensuring good health care for the patient, tools such as the fall risk assessment tool. / Bakgrund: Fallskador är ett dyrt problem för samhället med kostnader som sträcker sig upp mot 14 miljarder kronor om året i Sverige. Förutom ekonomiska förluster skapar fall även humanvärdesförluster och försämrad livskvalitet för den drabbade. För att förhindra uppkomsten av fallskador används inom sjukvården olika vetenskapligt framtagna fallriskbedömningsinstrument, ett av dessa är Downton Fall Risk Index. Metod: Empirisk, kvantitativ tvärsnittsstudie. Syfte: Syftet med fördjupningsarbetet är att beskriva vilka kategorier i Downton Fall Risk Index som har betydelse för patienters fallrisk vid vistelse på sjukhus och vid kommunal vård, samt att belysa hur sjuksköterskan kan använda Fallriskbedömningsinstrument. Resultat: Av de 708 medverkande hade totalt 73% hög risk att falla enligt Downton Fall Risk Index, på sjukhus hade 66% av patienterna hög risk att falla och i kommunal vård hade 87% av patienterna hög risk att falla. Downton Fall Risk Index anger att medicinering var den klart största kategorin och inkluderade 576 av patienterna (81%), därefter kom sensorisk funktionsnedsättning med 474 patienter (67%). 335 patienter (47%) hade fallit tidigare. Diskussion: Tidigare studier visar att på sjukhus faller mellan 1,3-2,1% av patienterna. Downton Fall Risk Index anger att 66% av samma patientgrupp har hög risk för fall. Detta kan bero på att Downton Fall Risk Index fokuserar för mycket på medicinering. Det är sjuksköterskans uppgift att samordna arbetet runt patienten så att fallrisken minimeras. Till exempel ska sjuksköterskan kontakta arbetsterapeuter eller ögonläkare som kan utföra punktinsatser för att minska patientens fallrisk. Sjuksköterskan ska även använda fallriskbedömningsinstrument för att identifiera riskfaktorer hos patienten och sedan använda dessa för att utforma en omvårdnadsdiagnos. Slutsats: Downton Fall Risk Index är alldeles för känsligt för att kunna användas på patienter inneliggande på sjukhus, instrumentet fungerar bättre på patienter inneliggande i kommunal vård. Det är viktigt att sjuksköterskan kan använda vetenskapligt utformade verktyg för att säkerställa en god omvårdnad för patienten, verktyg såsom Fallriskbedömningsinstrument.

Made available in DSpace on 2014-06-11T19:22:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-15Bitstream added on 2014-06-13T19:48:21Z : No. of bitstreams: 1 ambrozin_arp_dr_botfm.pdf: 169682 bytes, checksum: e35521aad39da34ec6c55a5da6cd12ad (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Algumas variáveis propostas para predizer o risco de complicação pósoperatória (CPO) são a altura no teste da escada (TE) e a distância do teste de caminhada de seis minutos (TC6) e acreditamos que o tempo no teste da escada (tTE) também pode ser utilizado para este fim. Além disso, são utilizados a prova de função pulmonar e os índices pré-operatórios. Objetivo: Determinar se os índices de Torrington e Henderson, American Society of Anesthesiologists, Goldman, Detsky e Charlson, a variável VEF1 da espirometria e as variáveis obtidas nos testes de esforço (TC6 e TE) podem ser preditivos das complicações pós-toracotomia e qual deles seria o melhor preditor dessas complicações. Método: Foram avaliados pacientes com indicação de toracotomia para ressecção pulmonar ou não, maiores de 18 anos. As comorbidades foram obtidas e traçados os índices de Comorbidade de Charlson, de risco de Torrington e Henderson, de Goldman, de Detsky e o ASA. A espirometria foi realizada de acordo com a ATS, em espirômetro Medgraphics Pulmonary Function System 1070. O TC6 foi realizado segundo os critérios da ATS e a distância prevista calculada. O TE foi realizado numa escada à sombra, composta por seis lances, num total de 12,16m de altura. O tTE em segundos percorrido na subida da altura total foi obtido e a partir deste a Potência (P) foi calculada utilizando a fórmula clássica. Também foi estimado o VO2 a partir do tTE (VO2 t) e da P (VO2 P). No intra-operatório foram registradas as complicações e o tempo cirúrgico. E no pós-operatório foram registradas as CPOs. Para análise estatística os pacientes foram divididos em grupos sem e com CPO. Foi aplicado o teste de acurácia para obtenção dos valores preditivos para o TC6 e para o tTE, a curva ROC e dessa o ponto de corte. As variáveis foram testadas para uma possível associação com as CPO pelo teste t de... / Some varieties purposed to predict the postoperative complication (POC) risk are the height in the stair-climbing test (SCT) and the distance in the six minute walk test (6MWT), we also believe that the time on the stair-climbing test can also be used for this purpose. Besides, the pulmonary function test and the preoperative index are also used. Objectives: We aim to determine if the Charlson, Torrington and Henderson, Goldman, Detsky and American Society of Anesthesiologists indexes, the variable FEV1 obtained on the Spirometry and on the Cardiopulmonary Exercise Testing (6MWT, SCT) can be predictive of the complication after thoracic surgery and which one of them would be the best. Method: Patients with indication to thoracic surgery, for resection or not, and older than 18 years old were evaluated. The comorbidities were obtained and the Comorbidity Charlson, Torrington and Henderson risk, Goldman, the Detsky and ASA indexes were calculated. The spirometry was performed according to ATS in Medgraphics Pulmonary Function System 1070. The 6MWT was performed according to the ATS criteria and the predicted distance was calculated. The SCT was performed indoor, on six flights of stairs, which results as a 12,16m climb. The time on the SCT was obtained after finished the stair height total in seconds and the Power (P) was calculated using the class formula. The maximum oxygen uptake (VO2) was estimated from the time of SCT (VO2 t) and the P (VO2 P). In the intraoperative was registered the complication and the surgery time. And in the postoperative was registered the POC. In the statistics analysis, the patients were divided in groups with and without POC. It was applied the accuracy test for the distance 6MWT and for the time in the SCT. We have found the cutoff from the ROC curve. The correlation between the variables and POC were tested using the t test for independent population ... (Complete abstract click electronic access below)

Background: Dengue is a viral infectious disease that is transmitted by mosquitoes. The disease causes a significant health burden in tropical countries, and has been a public health burden in Singapore for several decades. Severe complications such as hemorrhage can develop and lead to fatal outcomes. Before tetravalent vaccine and drugs are available, vector control is the key component to control dengue transmission. Vector control activities need to be guided by surveillance of outbreak and implement timely action to suppress dengue transmission and limit the risk of further spread. This study aims to explore the feasibility of developing a dengue early warning system using temperature and rainfall as main predictors. The objectives were to 1) analyze the relationship between dengue cases and weather predictors, 2) identify the optimal lead time required for a dengue early warning, 3) develop forecasting models, and 4) translate forecasts to dengue risk indices. Methods: Poisson multivariate regression models were established to analyze relative risks of dengue corresponding to each unit change of weekly mean temperature and cumulative rainfall at lag of 1-20 weeks. Duration of vector control for localized outbreaks was analyzed to identify the time required by local authority to respond to an early warning. Then, dengue forecasting models were developed using Poisson multivariate regression. Autoregression, trend, and seasonality were considered in the models to account for risk factors other than temperature and rainfall. Model selection and validation were performed using various statistical methods. Forecast precision was analyzed using cross-validation, Receiver Operating Characteristics curve, and root mean square errors. Finally, forecasts were translated into stratified dengue risk indices in time series formats. Results: Findings showed weekly mean temperature and cumulative rainfall preceded higher relative risk of dengue by 9-16 weeks and that a forecast with at least 3 months would provide sufficient time for mitigation in Singapore. Results showed possibility of predicting dengue cases 1-16 weeks using temperature and rainfall; whereas, consideration of autoregression and trend further enhance forecast precision. Sensitivity analysis showed the forecasting models could detect outbreak and non-outbreak at above 90% with less than 20% false positive. Forecasts were translated into stratified dengue risk indices using color codes and indices ranging from 1-10 in calendar or time sequence formats. Simplified risk indices interpreted forecast according to annual alert and outbreak thresholds; thus, provided uniform interpretation. Significance: A prediction model was developed that forecasted a prognosis of dengue up to 16 weeks in advance with sufficient accuracy. Such a prognosis can be used as an early warning to enhance evidence-based decision making and effective use of public health resources as well as improved effectiveness of dengue surveillance and control. Simple and clear dengue risk indices improve communications to stakeholders.

With the growing number of children who receive a diagnosis of Autism Spectrum Disorder (ASD), there is an increasing need to identify risk markers that will allow for earlier diagnosis of this disorder. Since no single atypical behavior has been found that is shared by all 12-month-old infants who are later diagnosed with ASD, it is likely that a constellation of markers combine in a way that is more predictive of outcome at this age. Establishing a Cumulative Risk Index (CRI) is one way to investigate which combination of early risk markers is most predictive of later ASD diagnostic outcome. Temperament is one construct of behavior that could act as an early risk marker for ASD and therefore, could add predictive power to a CRI for this disorder. Temperament is defined as a "behavioral style" that includes individual differences in reactivity and self-regulation and emphasizes emotional, attentional and activity related characteristics. Another important aspect of temperament is that it exerts bidirectional influences upon the social environment. Therefore, the study of temperament could provide a method for understanding how children with ASD influence and are influenced by the environment of a testing session. Though important information has been collected about early temperament in children with ASD, much of the data is limited due to its dependence on retrospective and parent-report measures. One measure that allows for direct assessment of temperament during a controlled testing session is the Infant Behavior Record (IBR). The purpose of this study is to investigate early temperament in ASD by using the IBR as an assessment of temperament behaviors in high-risk 12-month old infants. Through this, we hope to reveal group differences in IBR scores, establish a relationship between temperament scores and cognitive test performance, and increase predictive value of the CRI when IBR scores are included. For this study, a revised version of the IBR was filled out while watching video record of the administration of the Mullen Scales of Early Learning (MSEL) at an infant's 12-month lab visit. Scores for the IBR reflected the examiner's impressions of the infant's orientation to objects and people and emotional state. Through using the IBR to study task orientation (TO), affect/extraversion (AE) and activity level (AL) in high-risk infants, this study found that only decreased AE behaviors distinguished high-risk infants who went on to develop ASD (HRA+ASD) from high-risk infants who did not receive an ASD diagnosis (HRA-ASD) (p=.08). To determine the relationship of temperament and cognitive assessment performance, IBR scores were compared to MSEL scores. This study found that across all participants, TO and AE behaviors were positively correlated with MSEL scores (AE rs=.27, p<.001; TO rs=.37, p<.001). This relationship remained true for both the high-risk (AE rs=.20, p<.001; TO rs=.23, p<.001) and the low risk groups (AE rs=.32, p<.001; TO rs=.54, p<.001), as well as for the HRA-ASD infants (AE, trend, p=.057; rs=.24, p<.001; TO rs=.459, p<.001), and the low-risk infants who did not go on to receive a diagnosis of ASD (AE rs=.35, p<.001; TO rs=.47, p<.001). The only group in this study that was found to have no correlations between temperament scores and MSEL scores was HRA+ASD. Since only AE behaviors distinguished HRA+ASD infants, this was the only IBR factor added to a pilot model of the CRI. This study found that the inclusion of AE to a pilot model of the CRI did not add significant predictive value to the model (p=.15). Through using the IBR to investigate temperament in HRA infants, the findings of this study suggest that there are some important differences in temperament behaviors for HRA+ASD infants. Specifically, reduced AE behaviors seem to distinguish the HRA+ASD infants from the other outcome groups. Also, this study found that increased TO and AE behaviors were associated with better performance on a cognitive assessment for all groups except HRA+ASD. These two findings are important, as they differentiate this outcome group from all others, suggesting that there may be a different set of mechanisms employed during a testing session for HRA+ASD infants. This study also found that AE risk did not contribute predictive value to a CRI for this disorder. Taken together these findings suggest that though temperament profiles appear to differ in HRA+ASD infants during the first year of life, this construct of behavior is not a valuable early behavioral risk marker for identifying ASD.

Orientador: Maria Francisca Colella dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T21:49:05Z (GMT). No. of bitstreams: 1 Martins_PaulaMariaFaria_M.pdf: 1525547 bytes, checksum: a6bb17a80894818a9bb059e65d0bc99d (MD5) Previous issue date: 2012 / Resumo: Introdução: Estudos mostram que há diferenças nos valores de supressão das emissões otoacústicas se comparados os grupos de neonatos sem riscos para perdas auditivas e os que apresentavam algum risco. A função do sistema olivococlear medial, medida pela supressão das emissões otoacústicas transientes, pode indicar uma função inibitória auditiva reduzida nos lactentes com indicadores de risco para perdas auditivas. Objetivo: Verificar a atividade do sistema auditivo eferente em neonatos que apresentam indicadores de risco para perda auditiva retrococlear, por meio da pesquisa da supressão das emissões otoacústicas transientes. Método: Pesquisa da supressão das emissões otoacústicas transientes realizada por meio do analisador de emissões cocleares ILO V6 - OTODYNAMICS -292 USB, acoplado a um computador e a sondas para supressão contralateral. Participaram da pesquisa 109 neonatos que foram reunidos em três grupos. GI, formado por 42 neonatos que apresentam indicador de risco para perda auditiva retrococlear, GII por 17 neonatos que apresentam indicadores de risco não relacionados com acometimentos retrococleares e GIII por 50 neonatos sem indicadores de risco para perda auditiva. O delineamento deste estudo foi o de corte transversal. Resultados: Encontramos valores médios de supressão das emissões otoacústicas transientes maiores no grupo GII, seguido dos grupos GI e GIII. Observamos que os maiores valores encontrados são dos grupos sem indicadores de risco para perdas auditivas retrococleares, porém não houve diferença estatisticamente significante. Conclusões: O ruído branco apresentado contralateralmente reduziu o nível de resposta das emissões otoacústicas transiente, demonstrando a participação do sistema eferente medial no efeito de supressão. O indicador de risco para perda auditiva retrococlear não foi fator relevante na pesquisa da supressão das emissões otoacústicas transientes em neonatos / Abstract: Introduction: Studies show that there are differences in the values of suppression of otoacoustic emissions compared groups of neonates without risk for hearing loss and those with some risk. The olivocochlear system function, as measured by suppression of otoacoustic emissions, may indicate an inhibitory function in infants with hearing reduced risk indicators for hearing loss. Objective: To investigate the activity of the efferent auditory system in neonates who present risk indicators for retrocochlear hearing loss, through research of the suppression of otoacoustic emissions. Method: Research suppression of otoacoustic emissions accomplished through the cochlear emissions analyzer ILO V6 - OTODYNAMICS -292 USB connected to a computer and probes for contralateral suppression. Participants were 109 neonates who were gathered in three groups. GI, consisted of 42 neonates who present a risk indicator for retrocochlear hearing loss, GII for 17 neonates who present risk factors unrelated bouts retrocochlear and GIII for 50 neonates without risk indicators for hearing loss. The study design was cross-sectional. Results: We found average values of suppression of otoacoustic emissions higher in GII, followed by GI and GIII. We observed that the highest values are found in groups without risk factors for retrocochlear hearing loss, but differences were not statistically significant. Conclusions: The white noise presented contralaterally reduced the response level of otoacoustic emissions, demonstrating the involvement of the medial efferent system in the suppression effect. The risk indicator for retrocochlear hearing loss was not a relevant factor in the study of suppression of otoacoustic emissions in neonates / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

The Risk Index is a useful tool which allows quick conclusions regarding the possibility of something going wrong with a specific device or situation. In this work, the devices are high power transformers belonging to a specific company. This company is EDP Renováveis (EDPR) which develops, manages and maintains wind farms with a total installed capacity of 9,036 MW (at the end of 2014), in ten countries located in Europe, North America and Brazil. Each of these wind farms has a substation with, at least, one high power transformer. High power transformers are expensive devices and are crucial to the proper operation of the wind farm. As so, they present great importance to EDPR. In order to maintain them and make sure, as far as possible, that a break-down does not happen, the company performs several tests a year on these pieces of equipment, taking note of any symptom that might cause alarm. These tests use different methods, and are performed by various entities with diverse time schedules. The amount of information to be taken into account for the Risk Index calculation is vast. From the location to the features of the transformer, going through the above mentioned tests, a sizable amount of data must be collected and processed. The Risk Index allows the ranking of the various conditions according to their real seriousness. For instance, if two transformers are in bad state, it should be able to determine which of them brings more negative consequences. The Risk Index is obtained by predicting the possible scenarios resulting from the symptoms that the transformer is displaying. The consequences resulting from each symptom have to be determined with the information that was gathered in solid previous research work, and using the knowledge available from experts in the area. The consequences have also to be estimated, using formulas based on real cases that have occurred, and taking into account all the influencing parameters of that specific equipment. Testing the algorithms in several transformers with different problems and environments (location, rated power, manufacturer, etc.) and comparing the results among them is the ultimate method to improve the reliability of these formulas. In order to complement the idea of the Risk Index, a Fail Index is also developed in this work. It simply pretends to illustrate the likelihood of failure of a given transformer. This index does not allow comparisons among different information, but it might be useful for a more down-to-earth analysis. It basically splits the transformer in its components. The state of each component is then decomposed in percentages, which are attributed to the results of the tests that contribute to evaluate the given component. Coming up with a risk index is not useful just for itself: it must be followed by a structured program that can efficiently process a great deal of information, and display the results in an intuitive way for its users.