Pacientes com epilepsia farmacorresistente, frequentemente, possuem lesões extrahipocampais como etiologia. Muitas vezes, estes pacientes se beneficiam de lesionectomias para redução da ocorrência de crises epilépticas. Para que possam se submeter a este procedimento, atualmente é necessário o uso tanto da videoeletroencefalografia prolongada (VEEG) quanto da imagem de ressonância magnética do encéfalo (IRM) para delimitação apurada da zona epileptogênica, local que deve ser ressecado para controle das crises. No presente trabalho, foi estudada a acurácia diagnóstica da VEEG e da IRM na determinação da zona epileptogênica de pacientes com displasia cortical focal. Comparou-se os locais de ocorrência da zona de início ictal (VEEG) e da lesão epileptogênica (IRM) se concordantes ou discordantes com o local da cirurgia. Foram revisados os prontuários médicos de 209 pacientes, sendo o padrão de referência (local da cirurgia) e tempo de acompanhamento pós-operatório superior a 12 meses disponíveis em 43 pacientes. A VEEG apresentou sensibilidade de 85,7% (IC 95% 62,6-96,2) e especificidade de 41,1% (IC 95% 19,4-66,5), com valor preditivo positivo de 64,2% (IC 95% 44,1-80,6) e valor preditivo negativo de 70% (IC 95% 35,3-91,9). A IRM apresentou sensibilidade de 91,6% (IC 95% 71,5-98,5) e especificidade de 36,8% (IC 95% 17,2-61,3), com valor preditivo positivo de 64,7% (IC 95% 46,4-79,6) e valor preditivo negativo de 77,7% (IC 95% 40,1-96). As diferenças de sensibilidade e especificidade, áreas sob as curvas ROC e os índices de Youden não foram significativas. A concordância dos resultados da VEEG e da IRM foi moderada (k=0,599; p<0,01; IC 95% 0,468-0,730). / Patients with drug-resistant epilepsy frequently have extrahippocampal lesions as etiology. A large proportion of these patients might benefit from lesionectomy for the reduction of seizures. For surgery to be undertaken, it is usually performed both long-term videoelectroencephalography monitoring (VEEG) and magnetic resonance imaging of the brain (MRI) for the precise delimitation of the epileptogenic zone, the region that must be resected for seizure control. In the present study, the diagnostic accuracy of VEEG and MRI were studied in the localization of the epileptogenic zone in patients with focal cortical dysplasia. The seizure-onset zone (VEEG) and the region of epileptogenic lesion (MRI) were compared whereas concordant or discordant regarding surgery region. Medical charts of 209 patients were reviewed, being the reference standard (surgery region) and post-surgical follow-up longer than 12 months available in 43 patients. Videoelectroencephalography has a sensitivity of 85.7% (95% CI 62.6-96.2) and specificity of 41.1% (95% CI 19.4-66.5), with positive predictive value of 64.2% (95% CI 44.1-80.6) and negative predictive value of 70% (95% CI 35.3-91.9). Magnetic resonance imaging has a sensitivity of 91.6% (95% CI 71.5-98.5) and specificity of 36.8% (95% CI 17.2-61.3), with positive predictive value of 64.7% (95% CI 46.4-79.6) and negative predictive value of 77.7% (95% CI 40.1-96). The differences of sensitivity and specificity, areas under the ROC curves and Youden\'s indexes were not significant. The concordance between the results of VEEG and MRI was moderate (k=0.599; p<0.01; 95% CI 0.468-0.730).

INTRODUÇÃO: O instrumento escolhido para coleta de informações em uma investigação científica tem de ser capaz de traduzir, com boa precisão, a realidade estudada. Neste estudo, foi analisado o desempenho de um questionário para avaliar o consumo de drogas na prisão confrontando o relato dos entrevistados com a análise toxicológica de urina. METODOLOGIA: Foi realizado um estudo observacional transversal em setembro de 2007, numa unidade prisional masculina, localizada no estado de São Paulo. Os detentos foram entrevistados e submetidos à coleta de urina para detecção qualitativa de canabinóides e de cocaína, utilizando análise por imunoensaio enzimático. Foram selecionadas duas questões; a primeira sobre uso de drogas e, a segunda, mais específica, que identifica o padrão de uso da maconha e da cocaína na prisão. Para avaliar a capacidade destas questões em identificar corretamente os indivíduos que usam drogas na prisão, foram comparadas as respostas com os resultados de exame de urina (padrão ouro) e calculadas a sensibilidade e a especificidade. Entrevistador, período em que foi realizada a entrevista, faixa etária dos entrevistados, tempo de presídio, situação prisional, relação existente entre o delito cometido e as drogas, duração da pena atual e o resultado das análises toxicológicas da urina foram escolhidos como fatores com potencial para interferir nos resultados. RESULTADOS: Participaram da pesquisa 337 detentos, com idade média de 30,4 anos, cumprindo pena média de 10,1 anos, que estão em média há 16,7 meses no presídio e que, em sua maioria não cometeram delitos relacionados a drogas (73,3%). A prevalência obtida pela análise toxicológica da urina foi de 61,4% para maconha e 7,7% para cocaína. Combinar as questões melhorou o desempenho do questionário. Dos 260 entrevistados identificados, pelo questionário, como usuários de drogas na prisão, 191 tiveram resultado positivo na análise toxicológica da urina e 69, resultado negativo. Dos 76 entrevistados identificados como não usuários de droga na prisão, 21 tiveram resultado positivo na análise toxicológica da urina e 55, resultado negativo (Sensibilidade=90,1% e Especificidade=44,1%). A prevalência para o uso de maconha na prisão, obtida a partir das entrevistas, foi de 77,4% e, para o de cocaína, de 8,8%. Os detentos que não cometeram crimes relacionados a drogas (p=0,011) e os com resultado positivo para a análise da urina para canabinóides (p=0,028) tiveram um desempenho melhor ao responder as questões relacionadas ao uso de cocaína. Os detentos mais novos consomem mais maconha na prisão (80,6%, p=0,000). Já os reincidentes (11,4%, p=0,017) e os que estão há mais tempo no presídio (17,3%, p=0,038) destacaram-se como os que consumem mais cocaína. Os detentos primários (11,3%, p=0,028) e os com resultado positivo na análise da urina para canabinóides (10,2%, p=0,009) apresentaram frequência maior de respostas dissociadas. Apresentaram frequência menor, os que cumprem pena entre 6,33 e 14,62 anos (3,4%, p=0,025). CONCLUSÕES: A concordância entre o relato de consumo de maconha e cocaína na prisão obtida pelo questionário e o resultado do exame toxicológico foi boa para as duas drogas. Combinar as respostas apareceu como uma forma de melhorar a sensibilidade do questionário. / INTRODUCTION: The instrument used for collection of information in scientific research must be able to translate with accuracy the reality under investigation. In this study, we investigated the performance of a questionnaire in assessing drug use in prison compared with toxicological analysis of urine. METHODS: A cross sectional observational study was conducted in September 2007, in a male inmate placed in the state of Sao Paulo. The prisoners were interviewed and underwent urine collection for the detection of cannabinoids and cocaine metabolites trough toxicological analysis (enzyme immunoassay). Two questions were selected, one about drug use in general, and a second one, which was more specific and used to identify the drug consumption pattern in prison. To assess the ability of these questions to correctly identify individuals who currently use drugs in prison, the responses were compared with the urine test (gold standard) and sensitivity and specificity rates were calculated. Interviewer characteristics, total period of interview, age of respondents, time in jail, penalties conditions, relationship between the offense and drug use, total penalty time and urinalysis were considered factors with the potential to affect the results. RESULTS: 337 prisoners completed the questionnaire and provided urine samples for the study. These subjects presented a mean age of 30.4 years, an average time spent in prison of 1 year and 16.7 months, 10.1 years of total penalty time and the majority of them have not committed crimes related to drugs (73.3%). The prevalence based on urine toxicological analysis was 61.4% for marijuana and 7.7% for cocaine. When the answers to the questions were combined to the toxicological results, the assessment for drug consumption trough the questionnaire was improved. Of the 260 respondents identified by the questionnaire as a drug user in prison, 191 presented positive results for toxicological analysis and 69 negative results. Of the 76 respondents identified as non-drug user in prison, 21 presented positive results for toxicological analysis and 55 negative (sensitivity=90.1% and specificity =44.1%). The prevalence of cannabis use in prison taking into account only the interviews was 77.4% and 8.8%, for marijuana and cocaine, respectively. Prisoners who have committed crimes related to drugs (p=0,011) and those with positive urinalysis for cannabinoids (p=0,028) performed better in answering questions related to cocaine use. The younger prisoners consumed more marijuana in prison (80.6%, p=0,000) than their older counterparts. Repeat offenders (11.4%, p=0,017) and those who are in prison for longer (17.3%, p=0,038) time stood out as those who consume more cocaine. First offenders (11.3%, p=0,028) and those with positive urinalysis for cannabinoids (10,2%, p=0,009) showed higher frequency of misleading answers and, less often, those who were serving time between 6.33 and 14.62 years (3.4%, p=0.025). CONCLUSIONS: The agreement between the reporting of marijuana and cocaine consumption in prison obtained by questionnaire with toxicological essay was adequate for both use in general and recent use. Combining responses appeared as a way to improve the sensitivity of the questionnaire.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-04-13T12:41:57Z No. of bitstreams: 1 vanessacastroabreu.pdf: 2365875 bytes, checksum: f04aeafd7fe1f0509c66cbb52f8e7b4e (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-04-24T03:27:22Z (GMT) No. of bitstreams: 1 vanessacastroabreu.pdf: 2365875 bytes, checksum: f04aeafd7fe1f0509c66cbb52f8e7b4e (MD5) / Made available in DSpace on 2016-04-24T03:27:22Z (GMT). No. of bitstreams: 1 vanessacastroabreu.pdf: 2365875 bytes, checksum: f04aeafd7fe1f0509c66cbb52f8e7b4e (MD5) Previous issue date: 2015-04-08 / O presente estudo busca avaliar se a adoção do regime de metas de inflação no Brasil, em 1999, tem sido capaz de reduzir os erros de previsões de inflação geradas pelos modelos Naïve, ARIMA, GARCH, UC-SV, VAR e Curva de Phillips, e como a acurácia das previsões geradas por esses modelos tem se comportadoao longo do período pós-adoção do regime. Adicionalmente, busca-se verificar a ocorrência de encompassing das previsões geradas pelos modelos citados. O período analisado compreende janeiro de 1996 à dezembro de 2013 e o horizonte de previsão é igual a doze meses. Utilizando a estatística Raiz do Erro Quadrado Médio (REQM) e o teste Diebold-Mariano modificado (mDM), os resultados mostram que os erros de previsão têm se reduzido ao longo do tempo, de modo que o processo inflacionário parece ser mais fácil de ser previsto. Por outro lado, o modelo Naïve apresenta-se mais acurado do que os outros modelos analisados, de modo que a inflação está mais difícil de ser prevista. O teste HLN modificado (mHLN) mostra que as previsões de inflação geradas pelo modelo Naïve contêm, na maior parte do tempo, todas as informações necessárias para realizar previsões acuradas, não necessitando incorporar informações disponíveis nas previsões geradas por outros modelos. Entretanto, essa situação parece estar se modificando com o decorrer do tempo. / This study seeks to determine if the adoption of inflation targeting regime in Brazil in 1999, has been able to reduce inflation forecasts errors generated by Naïve models, ARIMA, GARCH, UC-SV, VAR and Phillips Curve, and how the accuracy of the forecasts generated by these models has behaved throughout the post-adoption period of the regime. In addition, we seek to verify the occurrence of predictions encompassing generated by the models mentioned. The reporting period comprises January 1996 to December 2013 and the horizon of the forecast is twelve months. Using statistical Root Mean Square Error (RMSE) and Diebold-Mariano modified test (mDM), the results show that the prediction errors have been reduced over time, so that inflation appears to be easier to be predicted. On the other hand, the Naive model is more accurate than other models examined, so that inflation is more difficult to predict. The HLN modified test (mHLN) shows that inflation forecasts generated by the Naive model contains in most of the time, all the necessary information to make accurate predictions, not requiring to incorporate information available on predictions generated by other models. However, this situation appears to be changing over time.

A mobile testing application using Unity was developed to analyse what impact button sizes and button layouts has on the accuracy of touch as well as the time to finish a labyrinth. This was tested on a Nexus 4 phone. 28 users navigated a small object through a labyrinth in which they collect keys to open the door to the exit. Each participant did the test 6 times with different combinations of button size and button layout each time, done in a random order. Hits, misses, completion time, order of button size and order of button layout was collected and then visualized using R. A mixed model analysis was used to analyse the data. The model to estimate what impact button size has on time is found to be poor while the model to estimate accuracy is assumed to be good. Results show that a button size larger than 6.0mm is required for the average user to have satisfactory accuracy. / En testapplikation för mobila enheter utvecklades i Unity för att analysera vilken påverkan knappstorlekar och gränssnitt har på träffsäkerheten och tiden att slutföra en labyrint. Detta testades på en Nexus 4 telefon. 28 användare navigerade ett litet objekt genom en labyrint i vilken de samlar nycklar för att öppna dörren till utgången. Varje deltagare utförde testet 6 gånger med annorlunda kombination av knappstorlek och gränssnittsdesign varje gång, detta i slumpmässig ordning. Träffar, missar, slutföringstid, vilken ordning som knappstorlek och gränssnittsdesign presenterades för användaren samlades in och visualiserades med R. En blandmodell användes för att analysera data. Modellen för vilken påverkan som knappstorlekar har på slutföringstiden ansågs otillräcklig medan modellen för hur träffsäkerheten påverkas av knappstorlekar ansågs god. Resultaten visar att en knappstorlek större än 6,0mm krävs för den genomsnittliga användaren ska ha en tillfredställande träffsäkerhet.

The Swedish National Testing and Research Institute is maintaining the Swedish realization of the world time scale UTC, called UTC(SP). One area of research and development for The Swedish National Laboratory of Time and Frequency is time synchronization and how UTC(SP) can be distributed in Sweden. Dissemination of time information by SP is in Sweden mainly performed via Internet using the Network Time Protocol (NTP) as well as via a modem dial up service and a speaking clock (Fröken Ur). In addition to these services, time information from the Global Positioning System (GPS) and from the long-wave transmitter DCF77 in Germany, is also available in Sweden. This master’s thesis considers how different available commercial communication systems could be used for multicast time distribution. DECT, Bluetooth, Mobile Telecommunication and Radio Broadcasting are different techniques that are investigated. One application of Radio Broadcasting, DARC, was found to be interesting for a more detailed study. A theoretical description of how DARC could be used for national time distribution is accomplished and a practical implementation of a test system is developed to evaluate the possibilities to use DARC for multicast time distribution. The tests of DARC and the radio broadcast system showed that these could be interesting techniques to distribute time with an accuracy of a couple of milliseconds. This quality level is not obtained today but would be possible with some alterations of the system.

The sustainability of Social Responsible Investments (SRI) markets is highly dependent on the accuracy of social and environmental information. Surprisingly, and in contrast to financial information, there exists no methodological standard for gathering social and environmental information in SRI markets. This work is a first contribution to the understanding of how SRI-analysts verify the accuracy of social and environmental information. A second aim of this thesis is to evaluate if SRI-analysts can produce an accurate output with their respective methodologies. To do so, a case study was performed comparing the assessment of social and environmental information at SRI-screening firms to the more regulated financial auditing process, using legal a categorization of evidence strengths as a model. The findings of this study suggest that practices are not standardized amongst SRI-analysts. Therefore, investors are unlikely to receive an equal degree of information accuracy from one analyst to the next. Moreover, when comparing SRI-screening and financial auditing using the legal categorization of evidence, it was found that screening firms tend to produce outputs that are less carefully verified than seen in their financial counterparts. Nevertheless, the findings also reveal that SRI-analysts generally acknowledge the importance of assessing sources of evidence when controlling information accuracy. In conclusion, a standardized methodology should be welcomed by SRI-analysts, and the legal categorization of evidence strengths could be a good starting point to manage information accuracy in their screening process.

This thesis aimed to study how different actors perform hydrological observations in Sweden. Target groups for the study were institutions that regularly measure water stage and river discharge, including water councils, water- and wastewater departments in municipalities, water authorities and hydropower companies. After the identification of the different actors, the study investigated how, where and why they perform hydrological observations as well as the way actors perceive the accuracy of these measurements. Information was collected through interviews and the development of a number of questionnaires. A total of 447 actors were contacted and 260 replied. The majority of them, 209, answered that they do not perform any hydrological measurements while the remaining 51 answered that they measure water stage. One of the main reasons for measuring is that many actors are facing water-rights court ruling. There were also several actors that stated that they perform hydrological measurements to make sure that the water body where water from wastewater treatment plants and storm water is emitted has sufficient water stage for environmental concerns. The hydropower companies replied that they, in addition to maintaining a water-rights court ruling, used water stage data to control the functioning of the plant. They also calculate river discharge based on production, floodgate position and stage. There were also seven municipalities, which stated that they had implemented a flood-monitoring model and that water stage data were used as input to the model. These municipalities and two other actors stated that they measure discharge or use a stage-discharge relationship (rating curve) to derive discharge data. However, in some cases, control measurements were lacking. Most actors used pressure sensors to measure stage. Their perceived levels of accuracy varied from ± 1 mm to ± 5 cm. Only five actors stated that they level their instruments regularly, which is a precondition for maintaining a correct data series. The results are useful for SMHI’s continued review of their hydrological network, although continued attempts to receive answers from all contacted actors would provide a more complete overview of hydrological observations. A study that thoroughly investigates how actors perceive the accuracy of their measurements would also give further knowledge in this field. / Examensarbetet syftade till att undersöka hur olika aktörer genomför hydrologiska mätningar i Sverige. Målgrupper för studien var aktörer vars verksamhet innefattar mätningar av vattenföring och vattenstånd. De målgrupper som identifierades var vattenråd, kommunala VA-avdelningar, vattenmyndigheter och vattenkraftbolag. När aktörerna identifierats undersöktes hur, var och varför aktörerna mäter samt hur de uppfattar noggrannheter i sina mätningar. Informationen samlades in genom frågeformulär och intervjuer. Totalt kontaktades 447 aktörer varav 260 svarade på frågorna som ställdes. Majoriteten, 209 aktörer svarade att de inte utför några hydrologiska mätningar medan resterande svarande att de mäter vattenstånd. Den anledning som flest aktörer gav till att de mäter var att de har en vattendom. Det var även flera aktörer som mätte för att försäkra sig om att recipienter för dagvatten och avloppsreningsverk hade tillräckligt högt vattenstånd för utsläpp. Vattenkraftproducenterna svarade att de, utöver att de har vattendomar, använder vattenståndsdata för att reglera kraftverken. De beräknade också vattenföringen utifrån lucköppningsgrad, vattenstånd och producerad effekt. Det var även sju kommuner som svarade att de hade implementerat modeller för översvämningsövervakning och använde vattenståndsmätningar som indata i prognosmodellerna. Dessa kommuner och två ytterligare aktörer svarade att de mäter vattenföring eller använder avbördningskurvor men i flera fall är kontrollmätningar av vattenföringen bristande. De flesta aktörerna använde tryckgivare för att mäta vattenståndet och de gav noggrannhetsintervall mellan ± 1 mm och ± 5 cm. Endast fem aktörer uppgav att de avväger mätinstrumentet vilket är en förutsättning för att upprätthålla en korrekt mätserie. Resultaten är användbar information i SMHIs utvärdering av sitt nätverk av hydrologiska mätstationer, dock skulle fortsatta försök att få svar från samtliga kontaktade aktörer ge en mer heltäckande bild av hydrologiska mätningar utförda av de olika målgrupperna. Det vore även intressant med en studie som går djupare in på hur noggrannhet uppskattas och uppfattas av de olika aktörerna.

Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process. In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country. The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences. The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings. In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.

Magister Public Health - MPH / Objectives: To assess the knowledge and attitudes of doctors in relation to death certification and also assess whether an educational intervention can improve the accuracy of death certificate completion and thereby improve mortality information. / South Africa

Magister Public Health - MPH / HIV/AIDS is the largest and most serious global epidemic in the recent times. To date, the epidemic has affected approximately 40 million people (range 33 - 46 million) of whom 67%, that is, an estimated 27 million people are in the Sub Saharan Africa. The Sub Saharan Africa is also reported to have the highest regional prevalence of 7.2% compared to an average of 2% in other regions. A medical cure for HIV/AIDS remains elusive but use of antiretroviral therapy (ART) has resulted in improvement of quality and quantity of life as evidenced by the reduction of mortality and morbidity associated with the infection, hence longer and good quality life for HIV/AIDS patients on ART. / South Africa