Made available in DSpace on 2014-06-12T23:15:06Z (GMT). No. of bitstreams: 2 arquivo8384_1.pdf: 858386 bytes, checksum: 45afa0b6538ac2d93d340d518636a1ef (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2006 / Objetivos: Através de revisão da literatura, avaliar as características gerais da manobra expiratória forçada (MEF) em crianças pré-escolares e a aplicação dos critérios de aceitação e reprodutibilidade testados nestes estudos. Por pesquisa original, avaliar a aceitação da MEF em crianças pré-escolares saudáveis em relação aos atuais critérios padronizados pela American Thoracic Society e European Respiratory Society (ATS/ERS, atualização 2005) e verificar o efeito de modificações nestes critérios, aceitando-se curvas com expiração incompleta; avaliar a reprodutibilidade da capacidade vital forçada (CVF), do volume expiratório forçado no primeiro segundo da CVF (VEF1) e do volume expiratório forçado na metade do primeiro segundo da CVF (VEF0,5), aos critérios já avaliados em outros estudos, de diferença ≤ 10% e ≤ 0,1 L, e, a um novo critério sugerido por estes autores, de diferença ≤ 8%. Métodos: Revisão da literatura nas bases de dados Medline, Scielo, Lilacs e Biblioteca Cockrane, de 1996 a março de 2006. Descritores: espirometria, testes de função pulmonar, capacidade vital forçada, valores de referência. Pesquisa por palavra: manobra, expiratória, forçada, espirometria. Estudo transversal com dados coletados prospectivamente e amostra calculada de 225 crianças. Realizado MEF em 240 crianças pré-escolares (três a cinco anos) de escolas e creches da cidade do Recife, Brasil, por amostragem aleatória simples. Os critérios de aceitação das manobras foram divididos em três grupos: ATS/ERS de acordo com os atuais critérios padronizados. Parcial Tipo I grupo com expiração incompleta, com término da expiração quando o fluxo era ≤ 0,3 L/s ou ≤ 10% do pico de fluxo expiratório (PFE), o que for maior. Parcial Tipo II grupo com expiração incompleta, com término da expiração quando o fluxo era > 0,3 L/s ou > 10% do PFE, o que for maior; neste, foram consideradas apenas medidas do PFE e do VEF0,5. Utilizado o teste de Duncan para comparação entre os grupos e os testes kappa para avaliar a concordância entre os diversos critérios testados. Resultados: A aceitabilidade da MEF variou, nos diversos estudos, de 40-92%, diretamente proporcional com a faixa etária e, inversamente com o rigor dos critérios de aceitação adotados. O critério de reprodutibilidade para CVF e VEF1, de ≤ 0,1 L, foi considerado o mais adequado. Foi demonstrada a reprodutibilidade do VEF0,5 e do VEF0,75 e comprovada a utilidade do VEF0,5 na avaliação de resposta ao broncodilatador. Na pesquisa original com 240 pré-escolares, a distribuição por grupos foi: ATS/ERS (37,1%), Parcial Tipo I (13,7%) e Parcial Tipo II (30,8%). As modificações aplicadas ao grupo Parcial Tipo I foram válidas para medidas de PFE, VEF1, VEF0,5 e fluxo expiratório forçado médio entre 25-75% da CVF (FEF25-75), mas não para medidas de CVF. A reprodutibilidade da CVF, VEF1 e VEF0,5 aos critérios ≤ 0,1 L, ≤ 10% e ≤ 8%, foi maior que 89%, dentre as crianças que realizaram três ou mais curvas aceitáveis, nos três grupos. Não houve diferença estatística significante entre os grupos, em relação à aceitabilidade e reprodutibilidade. Conclusão: A revisão evidenciou a necessidade de modificações nos atuais critérios de aceitação em relação ao volume retro-extrapolado e aos critérios de final de teste, assim como de uma definição de critérios de reprodutibilidade para o pré-escolar. A pesquisa original demonstrou a necessidade de adequações nos critérios de aceitação (aceitando curvas parcialmente expiradas) e reprodutibilidade dos programas de espirometria e dos programas de incentivo visual dirigidos ao pré-escolar. De acordo com o teste kappa, recomendamos o critério de diferença ≤ 0,1 L ou 8%, o que for maior para CVF e VEF1, e o critério de diferença ≤ 10% para o VEF0,5

We have received a mission from a surgical ward at a hospital in northern Sweden; they want a solution that can be used on portable devices. On these devices the healthcare professionals should be able to document the measured vital signs and the results should automatically be documented in the patient record. In the context of a Participatory Design project we conducted design sessions which focused on the user interface of the solution but also deliberated possible functionalities that were not mentioned in the original mission description. The purpose of this study is to describe the situation surrounding the measurement of vital signs of patients. It is currently done manually on a paper form and then registered in the digital patient record. Our aim was to find a design and formulate the functional requirement of a tablet application together with the staff at a hospital in Sweden.

Abstract The main objective of this thesis project is to implement a wireless vital signs monitoring system for measuring the ECG of a patient in the home environment. The research focuses on two specific research objectives: 1) the development of a distributed healthcare system for vital signs monitoring using wireless sensor network devices and 2) a practical test and performance evaluation for the reliability for such low-rate wireless technology in ubiquitous health monitoring applications. The first section of the thesis describes the design and implementation of a ubiquitous healthcare system constructed from tiny components for the home healthcare of elderly persons. The system comprises a smart shirt with ECG electrodes and acceleration sensors, a wireless sensor network node, a base station and a server computer for the continuous monitoring of ECG signals. ECG data is a commonly used vital sign in clinical and trauma care. The ECG data is displayed on a graphical user interface (GUI) by transferring it to a PDA or a terminal PC. The smart shirt is a wearable T-shirt designed to collect ECG and acceleration signals from the human body in the course of daily life. In the second section, a performance evaluation of the reliability of IEEE 802.15.4 low-rate wireless ubiquitous health monitoring is presented. Three scenarios of performance studies are applied through practical tests: 1) the effects of the distance between sensor nodes and base-station, 2) the deployment of the number of sensor nodes in a network and 3) data transmission using different time intervals. These factors were measured to analyse the reliability of the developed technology in low-rate wireless ubiquitous health monitoring applications. The results showed how the relationship between the bit-error-rate (BER) and signal-to-noise ratio (SNR) was affected when varying the distance between sensor node and base-station, through the deployment of the number of sensor nodes in a network and through data transmission using different time intervals.

Crossing the Sahara to reach Libya for the purpose of onward migration across the Mediterranean to Italy is what in Gambia is called “The Back Way”. The aim of this study is to examine the ambitions and reasons behind a migratory project from The Gambia to Europe. By identifying the key constituents of a migration culture, I can get a broader insight into why the celebration of migration is evident, and how the ‘story of Europe’ is shaped. I have interviewed Gambians who are geographically in different places and who all find themselves in different life trajectories, most of them connected to migration. My conversations about migration, “The Back Way” and Europe stretches from interviews with repatriates, aspiring migrants and non-migrants. I have also interviewed Gambians in the Diaspora. In this study, I found a strong societal expectation and hope towards both migration and the diaspora which in return caused certain diasporic behavior that painted a misleading picture of Europe. I also found a strong hope and resilient aspirations in terms of social status and recognition believed to be attained easier as a migrant coming back from Europe.

Tick proteins functioning in vital physiological processes such as blood meal uptake, digestion and reproduction are potential targets for anti-tick vaccines, since vaccination could disrupt these essential functions and ultimately affect tick survival. In this study we identified metzincin metalloproteases from R. microplus, the world’s most economically important external ectoparasite of cattle, as potential vaccine candidates since they are implicated to be essential to blood-cavity formation, bloodmeal digestion and reproduction in ixodid ticks. A vaccine derived from a single member of such a large family pose the obstacle of redundancy within the family, that may allow the function of the targeted family member to be taken up by other family members. Therefore the aim of this study was not only to focus on the physiological importance of each metzincin transcript, but also to investigate the differential gene expression network between the different metzincin family members. Eight transcripts encoding proteins containing the characteristic metzincin zinc-binding motif HEXXHXXG/NXXH/D and a unique methionine-turn were identified from native and in-house assembled R. microplus Expressed Sequence Tag databases. These were representative of five reprolysin-like and three astacin-like metzincin metalloproteases. Reverse transcription-PCR indicated that the reprolysins were most abundantly expressed in the salivary glands, whereas the astacins were most abundant in the midgut and ovaries. In vivo gene silencing utilizing RNA interference, was performed to assess a possible phenotype in silenced adult female R. microplus ticks during blood feeding and reproduction. RNAi against two reprolysins and one astacin significantly affected average egg weight as well as the oviposition rate. Moreover, integrated real time-PCR studies revealed an extensive cross organ network between the R. microplus metzincin transcripts, supporting the use of a combinatorial metzincinbased anti- R. microplus vaccine targeting multiple members of the large metzincin clan simultaneous. To conclusively evaluate the vaccination potential of the three identified metzincin candidates, the immunogenicity and protective properties of the recombinant proteins needs to be determined. Due to metalloproteases destructive activity and characteristics such as cysteine rich domains, only selected domains of the three candidates were expressed, using a cost effective Eshericia coli based expression system. Finally, the ability of each successfully expressed domain to elicit an immune response and serve as a protective antigen against R. microplus will be screened during vaccination trials in cattle. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Biochemistry / unrestricted

The transfer of copies of vital event records into a government archives repository is necessary not only to ensure their ongoing preservation, but also to provide access and accessibility to them for all researchers in an appropriate setting. At present all vital event records gatekeepers in Canada, except two, do not have in place a system providing for such regular transferral. The central reason for this lack of process is the assumption that vital event records are somehow different in kind, and not just in type, from other public records that contain personal information. This thesis evaluates that assumption through an analysis of the history of vital statistics legislation and a comparative study of the privacy regime of that legislation with the legislative regime of access to information and privacy. Having done these two studies, the thesis then recommends a way in which legal transfer from the gatekeepers to the repository can be achieved. That recommendation is, first, that all discussion regarding access must be accomplished before their acquisition. Secondly, their acquisition and accessibility must be based upon the expiration of time—limits. / Arts, Faculty of / Library, Archival and Information Studies (SLAIS), School of / Graduate

La nouvelle étant un récit bref, elle est à même de représenter le tragique de l'existence : elle attrape sur le vif tous les événements de la vie et les présente dans une économie restreinte. Theodor Storm et Guy de Maupassant ne manquent pas à cette règle et proposent des récits marqués par l'empire de la fatalité. Celle-ci est la manifestation du destin et/ ou du hasard qui transparaissent à travers la description de paysages réalistes et à travers la mise en avant d'objets clé qui entraînent avec eux la décrépitude des personnages. La technique narrative est également au service de la mise en scène de ce déterminisme, ainsi, l'un et l'autre auteur se permettent d'enchâsser les histoires, de revenir en arrière dans la narration pour mieux faire peser le poids du destin et/ ou du hasard afin de souligner que chacun fonctionne comme un mécanisme à ressort se déroulant tragiquement. Pourtant, même si tout laisse supposer le contraire, ces nouvelles ne sont pas qu'imprégnées de pessimisme. En effet, de cette fatalité empreinte de destin et/ ou de hasard se dégage un élan vital caractéristique de la pensée philosophique et sociale du XIXe siècle. Le destin et/ ou le hasard est en fait l'expression aveugle d'une volonté qui détermine le choix des personnages. Aussi ces nouvelles mettent-elles l'accent sur l'illusion du libre arbitre des personnages qui pensent pouvoir se déterminer eux-mêmes. De là, l'élan créatif issu de l'écriture permet une suspension de ce déterminisme. Ainsi, ce sont ces mécanismes de la fatalité qui sont démontés dans ce travail afin de repérer cet élan vital, salvateur et libérateur propre à la conception philosophique et littéraire du XIXe siècle. / A short story is a brief narrative and therefore can represent the tragic of existence : it catches on the spot all the events of life and presents them in a restricted economy. Theodor Storm and Guy de Maupassant obey the rule and offer narratives marked by fatality, which is the demonstration of fate and/ or chance shown through the description of realistic landscapes and through the emphasis of key objects which pull with them the decline of the characters. The narrative technique also serves the fabrication of this determinism. So, both authors allow themselves to intersperse stories, to go back into the narration, so that the weigh of fate and/ or chance is heavier and works as a spring mechanism taking place tragically. Nevertheless, even if everything suggests the opposite, these short stories are not so pessimistic. Indeed, a life force typical of the philosophical and social thinking of the 19th century arises from this fatality marked with fate and/ or chance. Fate and/ or chance is in fact the blind expression of a will which determines the choice of characters. So these short stories emphasize the illusion of characters' free will who think they can decide of their life. From there, the creative impulse stemming from the writing allows a interruption of this determinism. So, it is those mechanisms of fate that are defused in this work to observe this saving and liberatoring life force, inherent to the philosophic and literary concept of the XIXth century.

Multivariate statistical methods, including recent computing-intensive techniques, are explained and applied in a medical sociology context to study infant death in relation to socioeconomic risk factors of households in Sri Lankan villages. The data analyzed were collected by a team of social scientists who interviewed households in Sri Lanka during 1980-81. Researchers would like to identify characteristics (risk factors) distinguishing those households at relatively high or low risk of experiencing an infant death. Furthermore, they would like to model temporal and structural relationships among important risk factors. Similar statistical issues and analyses are relevant to many sociological and epidemiological studies. Results from such studies may be useful to health promotion or preventive medicine program planning. With respect to an outcome such as infant death, risk groups and discriminating factors or variables can be identified using a variety of statistical discriminant methods, including Fisher's parametric (normal) linear discriminant, logistic linear discrimination, and recursive partitioning (CART). The usefulness of a particular discriminant methodology may depend on distributional properties of the data (whether the variables are dichotomous, ordinal, normal, etc.,) and also on the context and objectives of the analysis. There are at least three conceptual approaches to statistical studies of risk factors. An epidemiological perspective uses the notion of relative risk. A second approach, generally referred to as classification or discriminant analysis, is to predict a dichotomous outcome, or class membership. A third approach is to estimate the probability of each outcome, or of belonging to each class. These three approaches are discussed and compared; and appropriate methods are applied to the Sri Lankan household data. Path analysis is a standard method used to investigate causal relationships among variables in the social sciences. However, the normal multiple regression assumptions under which this method is developed are very restrictive. In this thesis, limitations of path analysis are explored, and alternative loglinear techniques are considered. / Science, Faculty of / Statistics, Department of / Graduate

Health literacy (HL) skills are necessary to understand the context of medical information provided to patients in all settings including the emergency room. People with low health literacy (LHL) have difficulty comprehending and implementing basic tasks such as understanding medication administration. The purpose of this quasi-experimental study guided by Orem’s self-care theory was to determine the effect of using the teach-back method for discharge instructions compared to standard written instructions based on parents’ learning style and HL skills assessed during their visit to the emergency room. The Newest Vital Sign (NVS) tool was reworded to assess the parents’ HL. A panel of experts reviewed the tool independently, judged appropriateness and accuracy of the questions, and suggested minor changes. Interrater reliability was assessed in a pilot study with 14 participants, and the strength of the agreement was classified as good (κ = 0.61–0.80) to very good (κ = 0.81–1.00). The NVS was used to determine the literacy levels of 16 participants. The data were analyzed using the Mann-Whitney U test to compare the median scores in comprehension, adherence, and recall. Results revealed no statistically significant increase in comprehension adherence and recall when using the teach-back method (n = 9) compared to the standard written instructions (n = 7). The small sample size was a limitation. Modifying teaching methods for those with LHL to assure complete understanding of important health information will affect positive social change. Further research addressing low health literacy in parents who speak languages other than English is necessary to assure the results are applicable to the general population.

Tesis (magíster en derecho) / El presente trabajo busca señalar las principales barreras que experimentan las personas con discapacidad intelectual, cognitiva y psicosocial en el ejercicio de su derecho a decidir sobre su propia salud, en virtud de la legislación chilena actual. Adicionalmente, se busca dar cuenta de las manifestaciones de voluntad anticipada como institución que se ha consagrado en ordenamientos jurídicos extranjeros, y que a juicio del autor, podrían constituir una medida de apoyo en el ejercicio de la capacidad jurídica, especialmente relevante para las personas con discapacidad intelectual, cognitiva y psicosocial. Finalmente, el autor sostiene que es posible obtener los principales objetivos que persiguen las manifestaciones de voluntad anticipada en el derecho extranjero, mediante una interpretación amplia de las normas del ordenamiento jurídico nacional que gobiernan la materia, sin perjuicio de reconocer que existen dificultades asociadas a esa interpretación.