Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2000. / Vita. Includes bibliographical references (leaves 62-67).

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2013. / Made available in DSpace on 2014-08-06T17:37:33Z (GMT). No. of bitstreams: 1 325089.pdf: 2828355 bytes, checksum: 6d32020d466708407af202cc8f71b377 (MD5) Previous issue date: 2013 / Justificativa: No Brasil, a incidência anual de traumatismo crânio-encefálico (TCE) é de aproximadamente 341 casos por 100.000 habitantes. A faixa etária mais afetada é aquela que se encontra na "idade produtiva" e varia entre 25 a 45 anos de idade em média. Aproximadamente 50% dos sobreviventes de TCE grave apresentam sequelas de longo prazo, que comprometem sua funcionalidade e reintegração social. Devido à sua importância, tanto do ponto de vista do paciente e de sua família, quanto em relação ao custo social, o retorno ao trabalho tem sido um dos principais desfechos a ser avaliado em sobreviventes de TCE grave.Objetivos: O objetivo deste estudo é identificar preditores de retorno ao trabalho em pacientes vítimas de TCE grave.Desenho do estudo: Estudo prospectivo, observacional. Foram avaliadas 43 vítimas de TCE grave cerca de 18 meses após o trauma. A coleta de dados incluiu variáveis demográficas, clínicas, radiológicas e laboratoriais da hospitalização.Métodos: Transtornos psiquiátricos foram avaliados pela Entrevista Diagnóstica Estruturada para o Manual Diagnóstico e Estatístico dos Transtornos Mentais, 4ª edição, e os sintomas psiquiátricos por meio da Escala Hospitalar de Ansiedade e Depressão (HADS). A qualidade de vida foi mensurada pelo Questionário Genérico de Avaliação de Qualidade de Vida SF-36 (Brasil SF-36).Resultados: Acidentes de trânsito foram as principais causas de TCE (62,7%). Indivíduos do sexo masculino constituíam 83,7% da amostra e a idade média foi de 31 anos de idade. Dentre as variáveis sócio-demográficas, psiquiátricas e de hospitalização analisadas, apenas o diagnóstico de alterações de personalidade esteve associado significativa e independentemente ao não retorno ao trabalho com um OR de 10,92 (p = 0,02; IC 95%: 1,41 ? 84,28). Tempo de amnésia pós traumática (PTA) esteve associado significativa e independentemente ao diagnóstico de alterações de personalidade 18 meses após o TCE grave com um OR de 9,26 (p = 0,001; IC 95%: 1,56 ? 54,92).Conclusões e implicações: Nesse estudo, diagnóstico de alterações de personalidade pós TCE grave esteve associado significativa e independentemente ao não retorno ao trabalho cerca de 18 meses após o trauma. Tempo de amnésia pós traumática pode ser um dado clínico útil para identificar indivíduos sob risco de desenvolverem alterações de personalidade pós TCE grave. Estudos mostram que tais alterações podem estar associadas a prejuízo cognitivo. Prejuízo cognitivo ealterações de personalidade poderiam ser na verdade ?duas faces da mesma moeda?. Assim, pacientes vítimas de TCE grave que apresentem tempo de amnésia pós traumática prolongado poderiam ser beneficiados com a intervenção precoce de procedimentos associados à recuperação e prevenção de prejuízos cognitivos, permitindo que o paciente tenha maiores condições de retornar à sua vida produtiva e reintegração social.<br> / Abstract : Justification: In Brazil, the annual incidence of traumatic brain injury (TBI) is approximately 341 cases per 100,000 inhabitants. The most affected age group is the "productive age", which ranges from around 25 to 45 years old. Approximately 50% of severe TBI survivors have long-term sequelae that impair their functionality and social reintegration. Given its importance from the point of view of both the patient and their family, when compared to the social cost, return to work has been one of the main outcomes assessed for survivors of severe TBI.Objectives: The objective of this study was to identify predictors of return to work in patients suffering from severe TBI.Study design: Prospective observational study, in which 43 victims of severe TBI were evaluated approximately 18 months after the trauma. Data on demographic, clinical, radiological and laboratory factors related to hospitalization were collected.Methods: Psychiatric disorders were assessed by the Structured Diagnostic Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and psychiatric symptoms were determined by means of the Hospital Anxiety and Depression Scale (HADS). Quality of life was measured by SF-36 Generic Assessment Questionnaire of Quality of Life (SF-36 Brazil).Results: Traffic accidents (automobile and motorcycle) were the main causes of TBI (62.7%). The sample was comprised primarily for male gender (83.7%) and the mean age of the victims was 31 years old. Among all the socio demographics, psychiatric and hospitalization variables, only the diagnosis of personality disorders was associated significantly and independently with not return to work with an OR of 10.92 (p = 0:02, 95% CI: 1.41 to 84.28). Time of post traumatic amnesia (PTA) was significantly and independently associated with the diagnosis of personality disorders 18 months after severe TBI with an OR of 9.26 (p = 0.001, 95% CI: 1.56 to 54.92).Conclusions and implications: In this study, diagnosis of personality changes was significantly and independently associated with not return to work about 18 months after the trauma. Duration of PTA could be useful for identifying patients under risk of developing personality changes after severe TBI. Studies show that cognitive impairment after TBI is associated with both personality changes as well as return to work. Cognitive impairment and personality changes could actually be "two sides of the same coin." Thus, victims of severe TBI with longer duration of PTA could benefit from early intervention proceduresassociated with the recovery and prevention of cognitive impairments, allowing the patient to have a better position to return to their productive life and social reintegration.

The nonrecurring-items delayed nonmatching-to-sample (DNMS) task is an integral part of contemporary monkey models of brain-damage-produced amnesia. This thesis began the development of a comparable rat model of brain-damage-produced amnesia. First, a DNMS task for rats was designed by adapting key features of the monkey task. Then, the rat DNMS task was studied in three experiments; each assessed the comparability of the rat DNMS task to the monkey DNMS task. Experiment 1 determined the rate at which the rat DNMS task is learned and the asymptotic level at which it is performed, Experiment 2 assessed the memory abilities that it taps, and Experiment 3 investigated the brain structures that are involved i n its performance. In Experiment 1, rats were trained on the DNMS task and their performance was assessed at retention delays of 4, 15, 60, 120, and 600 s. All of the rats learned the DNMS task, and their performance was comparable to that commonly reported for monkeys in terms of both the rate at which they acquired the nonmatching rule at a brief retention delay and their asymptotic accuracy at delays of up to 120 s. These results establish that rats can perform a DNMS task that closely resembles the monkey DNMS task and that they can approximate the level of performance that is achieved by monkeys. Experiment 2 examined the effects of distraction during the retention delay on the DNMS performance of rats. Rats were tested at retention delays of 60 s. On half of the trials, the rats performed a distraction task during the retention delay; on the other half, they did not. Consistent with findings from monkeys and humans, distraction during the retention delay disrupted the DNMS performance of rats. This suggests that similar memory abilities are involved in the DNMS performance of rats, monkeys, and humans. Experiment 3 investigated the effects of separate and combined bilateral lesions of the hippocampus and the amygdala on DNMS performance in pretrained rats. Rats were tested both before and after surgery at retention delays of 4, 15, 60, 120, and 600 s. Each experimental rat received bilateral lesions of the hippocampus, amygdala, or both. There were no significant differences among the three experimental groups, and the rats in each of the three experimental groups were significantly impaired, in comparison to no-surgery control rats, only at the 600-s delay. In contrast, rats that had sustained inadvertent entorhinal and perirhinal cortex damage during surgery displayed profound D N M S deficits. These results parallel the results of recent studies of the neural basis of DNMS in monkeys. They suggest that, in contrast to one previously popular view, neither the hippocampus nor the amygdala play a critical role in the DNMS of pretrained animals and that the entorhinal and perirhinal cortex are critically involved. On the basis of these findings, it appears that the rat DNMS task may prove to be a useful component of rat models of brain-damage-produced amnesia. This conclusion is supported by the preliminary results of several experiments that are currently employing the task. / Arts, Faculty of / Psychology, Department of / Graduate

Vaccine-preventable infectious diseases are still prevalent today. Hence, accurate data and techniques such as mathematical modelling are required to better understand their impact on a population level. This is especially the case for measles, as it has been identified to cause immune amnesia (IA): the loss of pre-existing immunological memory for other diseases after a measles infection. First, spectral analysis was used to describe the recurrent patterns of measles and whooping cough (WC) using weekly London mortality data between 1750–1900. Then, stochastic simulations of a model incorporating IA were performed to understand the effect of IA on the recurrent patterns of WC. The periodograms of the simulated model revealed that increasing IA strength and duration caused the longer periodicities of WC to resemble those of measles. This shift was seen for different population sizes, seasonal forcing amplitudes, and mean transmission rates, suggesting this trend can be observed in different ecological or social contexts. When the birth and death rates of London were used in the model with IA duration of less than a year, the WC periodogram of the simulations resembled that of the London mortality data between 1842–1900. Overall, the simulations demonstrate that IA may have contributed to the longer period spectral structure of WC that was found in the real data. Additionally, the mortality, birth rate, and death rate data presented in this thesis provide new tools for future studies in mathematical epidemiology. / Thesis / Master of Science (MSc) / This thesis presents the weekly mortality time series of measles and whooping cough between 1750 and 1900, and describes their epidemic patterns over time. We also model the phenomenon of measles-induced immune amnesia (reduced pre-existing immunity after a measles infection), and examine how it alters the recurrent patterns of whooping cough at a population level. Additionally, we construct a plausible time series of the birth and all-cause mortality rate over the same 150 years. Overall, our analysis suggests immune amnesia alters the longer periodicities of whooping cough to resemble that of measles. Furthermore, we show that this longer periodic structure is similar to that of whooping cough in the late 19th century. Finally, the given mortality, birth rate, and all-cause mortality rate time series can serve as tools for other epidemiological studies, such as predicting long-term epidemic patterns of other diseases.

Introduction Transient global amnesia (TGA) is a condition associated with temporary anterograde amnesia with or without retrograde amnesia, often resolving within 24 hours. It is mostly prevalent in elderly women with a mean age of 60-65 years and may be triggered by acute stressors like emotional trauma, strenuous exercise, Valsalva maneuver, sudden change in body temperature, intense pain, medical procedures, and sexual intercourse. We present a case of 62-year-old female who presented with transient global amnesia while having sexual intercourse. Case presentation 62-year-old female with no significant past medical history presented after having an acute mental status change during sexual intercourse. The episode began with the patient turning her head, and having a staring spell that lasted for few seconds following which she was disoriented to place and was asking same questions repeatedly. The patient was repeatedly asking where she was and where her handbag was during the episode which lasted almost 2 hours during which she was brought to the hospital. Review of systems was negative for any focal weakness, sensory loss, headache, seizures. She denied having any prior episodes of memory loss, migraines, syncope, stroke like symptoms or psychiatric conditions. Social history was only significant for occasional alcohol use but denied tobacco or recreational drug use. On the physical exam, the patient was alert, awake and oriented. Her cognition was intact. No focal neurological or cranial nerve deficits were noted. Lab workup was unremarkable except for slight hypokalemia. CT head without contrast and CT angiogram of head were unremarkable. The patient was diagnosed with TGA and was observed overnight with supportive care. MRI brain with and without contrast next day after the event only revealed tiny punctate area of susceptibility artifact within the right posterior parietal lobe. Patient and family were reassured and was discharged home. Discussion TGA is a condition accompanied by temporary anterograde amnesia with repetitive questioning. TGA has an incidence of 5.2 to 10 per 100,00 per year. Common risk factors include older age, migraines, and rarely familial causes. Most possibly related to neurological damage in median temporal lobe or hippocampus as these areas are strongly associated with memory formation. Potential etiologies include arterial ischemia, venous congestion and cortical spreading depression seen in migraine. TGA is a diagnosis of exclusion, only after ruling out other differential diagnosis like hypoglycemia, acute intoxication, transient ischemic attack, drug withdrawal and Wernicke's encephalopathy. Patients need to be admitted for observation until the amnesia resolves. Neuroimaging helps rule out serious pathologies and EEG may be considered in patients with high clinical suspicion for seizure. No specific intervention is required, and the patient and their families must be reassured that the condition is benign and usually does not recur.

This study examined the prevalence of undiagnosed dissociative disorders in a sample of 201 adult patients admitted to a private psychiatric hospital in a major metropolitan city in the south-central United States, over an eight-month period. A screening measure, two blind structured interviews, and a blind clinical interview were employed. The lifetime prevalence of dissociate disorders among the interviewed subjects was 40.8%. More specifically, 7.5% were diagnosed with dissociative identity disorder, 15.4% with dissociative disorder not otherwise specified, 13.4% with dissociative amnesia, and 4.5% with depersonalization disorder. Dissociative fugue was not found in this sample. Cohen's kappa reliability coefficients were computed between the three interview measures, resulting in significant findings for the presence of dissociative identity disorder and dissociative disorder not otherwise specified versus no dissociative disorder. The Cohen's kappa reliability coefficients were as follows: DDIS-DES-T = 0.81; SCID-D-DES-T = 0.76; Clinician-DES-T = 0.74, DDIS-SCID-D = 0.74; DDIS-Clinician = 0.71, and SCID-D-Clinician = 0.56. A meeting was conducted at the end of all subject interviews to discuss discrepant findings between measures. Four additional sub-analyses were performed between dissociative and non-dissociative subjects on DSM-IV variables. Patients diagnosed with a dissociative disorder had higher rates of comorbid major depressive disorder, borderline personality disorder, somatization disorder, and childhood history of physical and/or sexual abuse. Theoretical and methodological issues were discussed as they relate to these findings.

Thesis (Ph. D.)--State University of New York at Binghamton, Department of Psychology, Behavioral Neuroscience, 2008. / Includes bibliographical references.

O ensino de computação envolve muitos assuntos que formam a base para uma aprendizagem eficaz. A falta de recursos apropriados torna difícil a apresentação de tais assuntos de forma clara, devido à dinâmica e à complexidade dos mesmos. O ensino de assuntos referentes ao conteúdo de hierarquia de memória e memória virtual é desafiador, porque ambos consideram diferentes aspectos estruturais, funcionais e de desempenho. Muitas abordagens vêm sendo estudadas para tornar o ensino desses assuntos mais atrativo. Uma dessas abordagens considera o desenvolvimento e aplicação de Recursos Educacionais Abertos (REA). Os REA têm sido aplicados com sucesso para ajudar o ensino e a aprendizagem de assuntos desafiadores. Mesmo com conhecimento da possibilidade do uso de REA, muito conteúdos ainda são desprovidos desses recursos. Tendo isso em mente, este trabalho apresenta a transformação do simulador Amnesia em um REA para facilitar o ensino e o aprendizado de memória virtual, simulando aspectos estruturais, funcionais e de desempenho. O foco deste trabalho é melhorar o ensino de Memória Virtual com o auxílio do REA Amnesia. Foram desenvolvidos materiais didáticos para auxiliar os professores e alunos com planos de aula, tutorial de utilização e texto com conteúdo teórico, os quais são disponibilizados juntamente com o REA Amnesia. Para verificar a melhora no ensino e aprendizado foram realizados três experimentos com alunos de graduação e pós-graduação, aplicando avaliações quantitativas e qualitativas. Os experimentos seguiram uma base experimental similar, mas cada experimento teve sua particularidade na aplicação e na análise dos resultados. Os experimentos realizados mostram uma considerável evolução no aprendizado do assunto memória virtual. No primeiro experimento foi possível observar uma melhora 28,8% na quantidade de acertos. No segundo experimento foi possível comparar resultados de alunos que utilizaram o REA Amnesia com alunos que não tiveram nenhuma aula entre as avaliações. Os resultados do terceiro experimento mostram melhorias de até 180% na quantidade de acertos com a utilização do REA Amnesia, para alunos com dificuldades (demonstradas em suas notas), onde o uso do Amnesia se mostrou mais importante. / The teaching of computer science involves many subjects that form the basis for an effective learning. The lack of adequate educational resources makes difficult to present such subjects clearly, due to the dynamics and complexity of them. The teaching of subjects related to the content of memory hierarchy and virtual memory are challenging, because both present distinct aspects, such as: structural, functional and performance. Many approaches have been studied to make the teaching of these aspects more attractive. One of these approaches considers the development and application of Open Educational Resources (OER). OER have been successfully applied to help the teaching and learning of challenging issues. Even knowing the possibility of using OER, many contents do not use such resources. This work presents the transformation of the Amnesia simulator in an OER to make easier the teaching and learning of the virtual memory subject, simulating structural, functional and performance aspects. The focus of this work is to improve the Virtual Memory teaching with the help of the OER Amnesia. We developed teaching materials to help teachers and students with class plans, tutorial of utilization and text with theoretical content, which are available along with the OER Amnesia. In order to verify the improvement in teaching and learning were conducted three experiments with undergraduate and graduate students, applying quantitative and qualitative evaluations. The experiments followed a similar experimental basis, but each experiment had its particularity in the application and analysis of results. The experiments show a considerable progress in the subject virtual memory learning among the students. In the first experiment, it was possible to observe a 28.8% of improvement in the quantity of hits by students. In the second experiment it was possible to compare results of students who used the OER Amnesia with students who had no class between the two tests applied. The results of the third experiment show improvements of up to 180% in the amount of hits, when using Amnesia, for those students with difficulties (demonstrated in their notes), where the use of Amnesia was more significant.

O ensino de computação envolve muitos assuntos que formam a base para uma aprendizagem eficaz. A falta de recursos apropriados torna difícil a apresentação de tais assuntos de forma clara, devido à dinâmica e à complexidade dos mesmos. O ensino de assuntos referentes ao conteúdo de hierarquia de memória e memória virtual é desafiador, porque ambos consideram diferentes aspectos estruturais, funcionais e de desempenho. Muitas abordagens vêm sendo estudadas para tornar o ensino desses assuntos mais atrativo. Uma dessas abordagens considera o desenvolvimento e aplicação de Recursos Educacionais Abertos (REA). Os REA têm sido aplicados com sucesso para ajudar o ensino e a aprendizagem de assuntos desafiadores. Mesmo com conhecimento da possibilidade do uso de REA, muito conteúdos ainda são desprovidos desses recursos. Tendo isso em mente, este trabalho apresenta a transformação do simulador Amnesia em um REA para facilitar o ensino e o aprendizado de memória virtual, simulando aspectos estruturais, funcionais e de desempenho. O foco deste trabalho é melhorar o ensino de Memória Virtual com o auxílio do REA Amnesia. Foram desenvolvidos materiais didáticos para auxiliar os professores e alunos com planos de aula, tutorial de utilização e texto com conteúdo teórico, os quais são disponibilizados juntamente com o REA Amnesia. Para verificar a melhora no ensino e aprendizado foram realizados três experimentos com alunos de graduação e pós-graduação, aplicando avaliações quantitativas e qualitativas. Os experimentos seguiram uma base experimental similar, mas cada experimento teve sua particularidade na aplicação e na análise dos resultados. Os experimentos realizados mostram uma considerável evolução no aprendizado do assunto memória virtual. No primeiro experimento foi possível observar uma melhora 28,8% na quantidade de acertos. No segundo experimento foi possível comparar resultados de alunos que utilizaram o REA Amnesia com alunos que não tiveram nenhuma aula entre as avaliações. Os resultados do terceiro experimento mostram melhorias de até 180% na quantidade de acertos com a utilização do REA Amnesia, para alunos com dificuldades (demonstradas em suas notas), onde o uso do Amnesia se mostrou mais importante. / The teaching of computer science involves many subjects that form the basis for an effective learning. The lack of adequate educational resources makes difficult to present such subjects clearly, due to the dynamics and complexity of them. The teaching of subjects related to the content of memory hierarchy and virtual memory are challenging, because both present distinct aspects, such as: structural, functional and performance. Many approaches have been studied to make the teaching of these aspects more attractive. One of these approaches considers the development and application of Open Educational Resources (OER). OER have been successfully applied to help the teaching and learning of challenging issues. Even knowing the possibility of using OER, many contents do not use such resources. This work presents the transformation of the Amnesia simulator in an OER to make easier the teaching and learning of the virtual memory subject, simulating structural, functional and performance aspects. The focus of this work is to improve the Virtual Memory teaching with the help of the OER Amnesia. We developed teaching materials to help teachers and students with class plans, tutorial of utilization and text with theoretical content, which are available along with the OER Amnesia. In order to verify the improvement in teaching and learning were conducted three experiments with undergraduate and graduate students, applying quantitative and qualitative evaluations. The experiments followed a similar experimental basis, but each experiment had its particularity in the application and analysis of results. The experiments show a considerable progress in the subject virtual memory learning among the students. In the first experiment, it was possible to observe a 28.8% of improvement in the quantity of hits by students. In the second experiment it was possible to compare results of students who used the OER Amnesia with students who had no class between the two tests applied. The results of the third experiment show improvements of up to 180% in the amount of hits, when using Amnesia, for those students with difficulties (demonstrated in their notes), where the use of Amnesia was more significant.

Transient epileptic amnesia (TEA) is a form of epilepsy of which the principle manifestation is recurrent, transient episodes of isolated memory loss. Although the phenomenon has been recognised for over a century, it is scantily documented in the medical literature and is often misdiagnosed by clinicians. Recent work has highlighted a number of apparently consistent clinical features among the published cases. However, to date there has been no large, systematic study of the condition. The aim of the work reported in this thesis was to investigate a substantial number of prospectively recruited patients with TEA, and thus be able to provide a detailed and authoritative description of its clinical, neuropsychological and radiological characteristics. Fifty patients with TEA were recruited from around the United Kingdom using established diagnostic criteria, together with a group of matched healthy control subjects. Participants underwent a clinical interview, comprehensive neuropsychological testing and structural magnetic resonance imaging of the brain. The study demonstrated the following features. TEA typically begins in later life. The amnesic episodes are frequent, brief and often occur upon waking. They are characterised by a mixed anterograde and retrograde amnesia, the anterograde component of which is often incomplete. Attacks are commonly associated with olfactory hallucinations. They respond well to anticonvulsant medication. Nevertheless, many patients complain of persistent difficulties with memory. Despite generally performing well on standard tests of anterograde memory, many patients show i) accelerated forgetting of new information over a three-week delay and ii) temporally extensive deficits in autobiographical memory. TEA is associated with subtle medial temporal lobe atrophy on magnetic resonance imaging. This atrophy correlates with performance on standard memory tests, but not with long-term forgetting rates or autobiographical memory deficits. It is proposed that TEA is a distinctive syndrome of epilepsy, typically misdiagnosed at presentation, caused by medial temporal seizure activity and associated with accelerated long-term forgetting and autobiographical memory loss. These unusual forms of memory impairment have been documented in other forms of epilepsy. They pose challenges to current models of memory. The syndrome of TEA is therefore both clinically and theoretically important.