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Valor prognóstico dos padrões eletrocardiográficos em pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST: Estudo ERICO-ECG / Prognostic value of electrocardiographic patterns in patients with non ST-elevation acute coronary syndromeBrandão, Rodrigo Martins 30 September 2015 (has links)
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
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"Det känns som att man har en stämpel i pannan" : Upplevelser av bemötande på psykiatriska akutmottagningar enligt personer med emotionellt instabil personlighetsstörning / "It feels like having a stamp in the forehead" : Experiences of treatment in psychiatric emergency rooms according to persons with borderline personality disorderKargar, Mazdak, Samuelsson, Anna Viktoria January 2019 (has links)
Personer med diagnosen emotionell instabil personlighetsstörning är högkonsumenter av psykiatrisk akutvård. Diagnosen kännetecknas av ett ihållande mönster av instabilitet vad gäller självbild, känslor och relationer med andra, samt en hög grad av impulsivitet. Vidare förekommer ofta självskadebeteende och suicidala handlingar som ett sätt att reglera affekter. Symtombilden kan göra mötet mellan patient och vårdpersonal svårt. Syftet med denna studie var att utifrån lidandeperspektiv belysa hur personer med diagnosen Emotionellt instabilt personlighetssyndrom upplever och erfar personalens bemötande när de söker akut vård. Metoden som användes var en kvalitativ intervjustudie med fenomenologisk ansats. Huvudresultatet visade att fenomenets centrala teman är att respekteras som människa med symtom, att inte bli tagen på allvar och att bli stigmatiserad. Varje tema kunde kopplas till ett lidandeperspektiv; sjukdomslidande lindras av att respekteras som människa med symtom, men att inte bli tagen på allvar orsakade vårdlidande och att bli stigmatiserad orsakade ett livslidande. Samtidigt gick lidandeformerna in i varandra, på så vis att vårdlidande lades till den levda erfarenhet som är livslidandet, och livslidandet hade betydelse för hur sjukdomslidandet hanterades och upplevdes. Slutsatsen är att personer med EIPS som söker akut psykiatrisk vård upplever vårdpersonalens bemötande som att de antingen respekteras som människa med symtom och får sitt sjukdomslidande lindrat, eller inte tas på allvar och stigmatiseras med vård- respektive livslidande, som ökar på symtombördan, som följd. / People with Borderline Personality Disorder [BPD] are among the consumers of psychiatric emergency care. BPD is characterized by a persistent pattern of impulsivity and instability with regard to self-image, emotions and relationships with others. Furthermore, self-harm and suicidal behaviour often occur as a way to regulate emotions. The symptoms can make interaction between patients and healthcare professionals difficult. The aim of this study was to gain insight into how, from a perspective of suffering, people with BPD who seek psychiatric emergency care experience and sense the approach. The method used was a qualitative interview study with a descriptive phenomenological approach. The main results consisted of three central themes: to be respected as a human being with symptoms, to not be taken seriously, and to be stigmatized. Each theme was linked to a perspective of suffering; being respected as a human being with symptoms alleviated suffering from symptoms, while not being taken seriously caused suffering related to care, and getting stigmatized added to the existential suffering. The different dimensions of suffering interacted; suffering related to care was added to the existential suffering, which in turn had implications for the ability to deal with suffering from symptoms. The conclusion is that individuals with BPD experience either a treatment with respect for being a human being with symptoms, and thus having those symptoms alleviated, or experience not being taken seriously and being stigmatized, with the consequences of suffering related to care and existential suffering, both which add on to the symptom burden.
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Periodic solutions and bistability in a model for cytotoxic T-lymphocyte (CTL) response to human T-cell lymphotropic virus type I (HTLV-I)Lang, John Cameron 11 1900 (has links)
HTLV-I is the first discovered human retrovirus and a causative agent of both adult T-cell leukemia (ATL) and HTLV-I-associated myelopathy (or tropical spastic paraparesis) (HAM/TSP). Previous models have been successful in providing insight into the progression of HTLV-I infection. The relative simplicity of HTLV as well as its similarities to HIV and other diseases allow HTLV-I research to have diverse applications.
The development of HAM/TSP is precipitated by a CTL immune response. Previous models for CTL response to HTLV-I infection have had relatively simple behaviours. A novel sigmoidal CTL response function results in complex behaviours previously unobserved. We establish the existence of bistability between solutions corresponding to carrier and endemic states. In addition, both super- and sub-critical Hopf bifurcations as well as the resulting stable and unstable periodic solutions are observed. Analytical and numerical results are discussed, as well as the biological consequences of the aforementioned behaviours. / Applied Mathematics
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Periodic solutions and bistability in a model for cytotoxic T-lymphocyte (CTL) response to human T-cell lymphotropic virus type I (HTLV-I)Lang, John Cameron Unknown Date
No description available.
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As estratégias de ajuste postural em indivíduos com instabilidade funcional de tornozelo / The strategies of postural adjustment in subjects with functional ankle instabilityRios, Jaqueline Lourdes 24 May 2013 (has links)
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Previous issue date: 2013-05-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Individuals with functional ankle instability (FAI) experience deficits in postural control. Such a postural instability have been demonstrated through increased Center of Pressure displacement or movement velocity when standing in single limb stance. It is unknown, however, the the anticipatory (APA) and compensatory (CPA) postural adjustments in these individuals during postural perturbations that are common during daily living, athletic and therapeutic activities. Therefore, the main objective of this study was to investigate the strategies of postural adjustment in individuals with FAI. The electromyographic (EMG) activity of postural muscles from a group of individuals with FAI and a matching control group were recorded and analyzed during the task of kicking a ball in single limb stance under different conditions of postural instability (even floor, foam and trampoline). The individuals with FAI showed a delay in the latency of the peroneus longus muscle (PL) when compared with the control group. The magnitude of APAs and CPAs were similar between groups, as well as within experimental conditions. However, the background muscle activity of the leg and thigh muscles was different between conditions, especially between even floor and trampoline conditions for both groups. These results suggest that therapeutic activities, functional exercises and balance training should aim in improving the reaction time of the PL muscle. / Indivíduos com instabilidade funcional de tornozelo (IFT) apresentam déficits de equilíbrio. Esses déficits são demonstrados, na maioria dos estudos, através do aumento do deslocamento ou velocidade de movimento do centro de pressão corporal durante apoio unipodal. Entretanto, pouco se conhece sobre os ajustes posturais antecipatórios (APA) e compensatórios (APC) desses indivíduos durante perturbações posturais, que são comuns durante atividades do cotidiano, esportivas ou terapêuticas. O principal objetivo deste estudo foi investigar as estratégias de ajuste postural de indivíduos com IFT. Para tanto, a atividade eletromiográfica (EMG) dos músculos posturais em indivíduos com e sem IFT foram registradas e analisadas durante a tarefa de chutar uma bola em apoio unipodal em diferentes condições de instabilidade postural (superfície plana, espuma e mini trampolim). Os indivíduos com IFT mostraram um atraso na latência do músculo fibular longo (FL) quando comparados ao grupo controle. As magnitudes dos APAs e APCs foram similares entre os grupos, bem como dentre as condições experimentais. No entanto, a atividade EMG basal para os músculos da perna e da coxa diferiram entre as condições, principalmente entre a superfície plana e o mini trampolim, para ambos os grupos. Sendo assim, atividades terapêuticas, exercícios ou treinamentos funcionais e de equilíbrio devem objetivar melhorar o tempo de reação do músculo FL.
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Valor prognóstico dos padrões eletrocardiográficos em pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST: Estudo ERICO-ECG / Prognostic value of electrocardiographic patterns in patients with non ST-elevation acute coronary syndromeRodrigo Martins Brandão 30 September 2015 (has links)
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
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Modelo de deslizamento para escoamento gás-líquido em bomba centrífuga submersa operando com líquido de baixa viscosidade / A drift-flux model for gas-liquid flow in electrical submersible pump operating with low viscous liquidBiazussi, Jorge Luiz, 1984- 06 June 2014 (has links)
Orientador: Antonio Carlos Bannwart / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica, Instituto de Geociências / Made available in DSpace on 2018-08-26T04:52:38Z (GMT). No. of bitstreams: 1
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Previous issue date: 2014 / Resumo: A bomba centrífuga submersa (BCS) é uma bomba de múltiplos estágios que tem recebido muita atenção nos últimos anos, devido à sua importância para a elevação artificial de petróleo em altas vazões. Como uma parte do sistema de Elevação Artificial, a BCS é geralmente instalada no interior do poço, a fim de aumentar a vazão ou até mesmo viabilizar a produção. A presença de gás livre no fluido na entrada da bomba provoca uma diminuição do ganho de pressão fornecido pela BCS e pode conduzir a instabilidades na curva de ganho de pressão versus vazão. O objetivo deste trabalho é desenvolver e avaliar o desempenho de um modelo de deslizamento para representar o ganho de pressão em uma ampla faixa de vazão de líquido de uma BCS. Para este propósito foram realizados testes experimentais em laboratório para três BCS diferentes que operam com misturas ar - água. Especificamente, o ganho de pressão e a potência de eixo foram medidos em diferentes vazões de líquido, de gás, de pressões de entrada e rotação. Os resultados dos testes de água monofásicos foram interpretados por ajuste dos dados com um modelo de correlação genérico para o ganho de pressão e potência, tentando descrever todos os fenômenos físicos envolvidos no escoamento nos canais rotativos. Os resultados dos testes bifásicos foram discutidos em termos dos efeitos da fração de vazio, da pressão de admissão, da velocidade de rotação e da geometria da bomba. Um modelo de deslizamento para escoamento em bolhas foi proposto para representar o ganho de pressão e também foi utilizado para expressar a potência de eixo. Os dois parâmetros envolvidos no modelo, ou seja, C0 e kb?, foram ajustados aos dados e mostrou a capacidade desta abordagem em capturar as principais tendências das curvas experimentais. O parâmetro de distribuição C0 foi, em todos os casos, significativamente menor do que um, confirmando os resultados de outros autores, em escoamento bifásico descendente em tubos. Além disso, este resultado indica que os perfis de velocidade e de distribuição de fase são distorcidos pelo campo centrífugo e de Coriolis. O parâmetro kb? foi significativo apenas para a bomba radial de menor vazão, o que confirma a ideia de que para altas vazões de líquido, as bolhas de gás são dispersadas através do líquido e o deslizamento torna-se insignificante / Abstract: The Electrical Submersible Pump (ESP) is a multiple stage pump which has been receiving a lot of attention in recent years in due to its importance for the Artificial Lift of petroleum at high flow rates. As a part of the AL system, the ESP is often installed inside the well in order to either viabilize the production or increase its flow rate. The presence of free gas within the fluid entering the pump causes a decrease in the head provided by the ESP and may lead to instabilities in the head-capacity curve. The aim of this work is to develop and evaluate the performance of a drift flux model to represent the head in the entire liquid flow rate range of an ESP. For this purpose, experimental performance tests to determine the characteristic curves were performed in laboratory for three different ESPs operating with water and water-air mixtures. Specifically, the head and brakehorsepower were measured at different flow liquid and gas flow rates, inlet pressures and rotation speeds. The results from the single-phase water tests were interpreted by fitting generic correlation models for the head and power to the data, trying to describe all basic phenomena involved in the rotating channel flow. The results from the two-phase runs were discussed in terms of the effects of the mixture composition, intake pressure, rotation speed and pump geometry. A drift flux model for bubbly flow was proposed to represent the head and also used to express the power. The two parameters involved in the model, namely C0 and kb? , were fitted to the data and showed good capability of this approach to capture the main trends of the experimental curves. The distribution parameter C0 was in all cases significantly lower than one, confirming the findings by other authors in two-phase downward pipe flow. Also, this result indicates that the velocity and phase distribution profiles are distorted by both the centripetal and Coriolis fields. The drift parameter kb? was significant for the smallest capacity radial pump only, confirming the idea that at sufficiently high liquid flow rates, the gas bubbles are dispersed through the liquid and drift becomes negligible / Doutorado / Explotação / Doutor em Ciências e Engenharia de Petróleo
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Complexes de type Morse et leurs équivalencesMorin, Audrey 04 1900 (has links)
L'obtention de ce mémoire a été rendue possible par le soutien financier du FRQNT et du CRSNG. / Ce mémoire est une étude détaillée de certains aspects de la théorie de Morse
et des complexes de chaînes qui en découlent : le complexe de Morse, le complexe
de Milnor et le complexe de Barraud-Cornea. À l’aide de différentes techniques
de la topologie différentielle et de la théorie de Morse, dont les bases forment les
premiers chapitres de ce texte, nous ferons la construction détaillée de ces trois
complexes avant de démontrer leurs équivalences deux à deux. Ce mémoire synthétise
et met en parallèle trois branches de la théorie de Morse en ne supposant
que des connaissances du niveau d’un étudiant de début maîtrise. / In this thesis, we study aspects of Morse theory and the chain complexes that
derive from it : the Morse complex, the Milnor complex and the Barraud-Cornea
complex. Using different techniques from differential topology and Morse theory,
which will be presented in the first chapters, we carefully build these complexes before
proving their equivalence. This thesis synthesises and compares three points
of view in Morse theory in a document accessible to beginning graduate students.
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KONCEPT A METODY ODHADU NAIRU A HOSPODÁŘSKÉHO CYKLU NA TRHU PRÁCE V ZEMÍCH VISEGRÁDSKÉ SKUPINY / A CONCEPT AND METHODS OF ESTIMATION OF THE NAIRU AND THE BUSINESS CYCLE AT THE LABOR MARKET IN THE VISEGRAD COUNTRIESJašová, Emilie January 2017 (has links)
This dissertation describes the relationship between inflation and unemployment with the concept of the natural rate of unemployment at which inflation remains unchanged. By comparing NAIRU, as defined in this manner, with the actual unemployment rate, we obtain the gap in unemployment. In connection with the analysed substitution between inflation and unemployment, there can be found a decrease in the importance of the PC in the 1970s, a very popular New Keynesian PC in the 1990s, and doubts over the robustness of the estimates. On the other hand, the concept of the PC and the NAIRU had previously been developed in accordance with the real data. There is a broad consensus on the impact of monetary policy on nominal variables (inflation) and real variables (unemployment). Methods are also being combined and continuously improved This dissertation is seeking to prove or disprove the hypothesis of the NAIRU concept's usability in estimating the economic cycle on the labor market. This hypothesis has helped in the acceptance of: the support for the concept and estimating PC and NAIRU in the literature; the application of measures to refine the estimate of the NAIRU and PC in the empirical analysis of the dissertation; the dissertation conclusion's compliance with the latest international research, with the local authors and with the own research. The contribution of the dissertation can be identified thusly: distribution methods depend upon the different time periods, their treatment and the best methods for the conditions of the countries in the Visegrad Group; the specification of an unstable environment and its impact upon the estimation of the NAIRU and the economic cycle; the calculation of the unemployment rate of the sectors, age categories and their use in estimating the NAIRU and cycle on the meso-level; to determine the effect of different pricing structure indicators in order to estimate the NAIRU and the economic cycle on the labor market and the topicality of their estimates.
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FUNCTIONAL BIOMECHANICAL EVALUATION OF MULTIPLE DESIGN PROGRESSIONS OF DISTAL RADIUS VOLAR PLATESAddula, Venkateshwar Reddy January 2007 (has links)
No description available.
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