Orientador: Donizeti Cesar Honorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T19:15:40Z (GMT). No. of bitstreams: 1 Leite_JulianaValeria_M.pdf: 641050 bytes, checksum: b62398f140661279efb6ea212dc9afcf (MD5) Previous issue date: 2013 / Resumo: A avaliação do nível de consciência faz parte da rotina da equipe multiprofissional que conduz pacientes em coma. Sinais que possam representar a melhora do nível de consciência destes pacientes são constantemente buscados. Atualmente sabe-se que alguns fatores, como por exemplo, a resposta motora na escala de coma de Glasgow (ECG) e a apresentação do reflexo fotomotor apresentam valor prognóstico, porém nenhum deles é relacionado diretamente ao despertar destes pacientes. O objetivo deste estudo foi o de relacionar a presença do reflexo de piscar à ameaça visual (RPAV), com o despertar de pacientes comatosos e evidenciar o seu valor prognóstico. Para tanto foi feito um estudo retrospectivo com os dados obtidos em prontuários do serviço de arquivos médicos do Hospital das Clínicas da Universidade Estadual de Campinas (HC-UNICAMP) de pacientes internados nas enfermarias de neurologia clinica e neurocirurgia entre os períodos de abril de 2005 a abril de 2010. Foram selecionados 975 prontuários correspondentes ao diagnóstico de traumatismo cranioencefálico e acidente vascular encefálico. Destes, foram selecionados 119 prontuários de pacientes que se enquadraram nos critérios de inclusão representados pela resposta motora menor ou igual a quatro na ECG na admissão hospitalar e a descrição do RPAV durante o período de internação sendo excluídos os pacientes com resposta motora na admissão hospitalar superior a quatro, que não apresentassem a descrição da avaliação do RPAV ou que tivessem patologias neurológicas associadas às mencionadas como fator de seleção para os prontuários. Foram analisados os dados relativos ao sexo, diagnóstico clínico, resposta motora isolada e ao Glasgow total na admissão e alta hospitalar, a apresentação do RPAV durante o período de internação e a evolução clínica do paciente que foi representada pelo despertar, traduzido pela resposta motora seis ou cinco na ECG, evolução ao estado vegetativo persistente e óbito. A análise estatística demonstrou através da análise de regressão logística univariada e multivariada com critério Stepwise de seleção de variáveis uma associação entre a apresentação positiva do RPAV durante o período de internação e o despertar dos pacientes estudados (p<0.001). Todos os 51 pacientes que apresentaram o reflexo despertaram enquanto os pacientes que não apresentaram o reflexo não despertaram, evoluindo ao estado vegetativo persistente (24 pacientes) ou ao óbito (44 pacientes). Os pacientes que apresentaram o reflexo positivo durante o período de internação apresentaram uma maior possibilidade de despertar (11.685.00 vezes maior) dos que não o apresentaram adotando-se o nível de significância para os testes estatísticos de 5%, ou seja, p<0.05. O presente estudo demonstrou que o RPAV apresenta valor prognostico, estando sua apresentação positiva diretamente associada ao despertar destes pacientes / Abstract: The level of consciousness assessment is part of the hospital routine in comatose patients. Signs that may indicate cognitive improvement in these patients are constantly searched. Nowadays it is kwon that some features represent prognostic value, however, none relates directly with awakening in coma patients. The main purpose of this study was to associate the presence of the blinking reflex as a response to a visual threat with awakening in coma patients. We reviewed medical records from University of Campinas Clinical Hospital from patients diagnosed with stroke and traumatic brain injury (TBI) who stayed in the hospital neurological ward from April 2005 to April 2010. We reviewed 975 medical records. 119 patients were included; on admission they presented a score four or less for motor response in Glasgow Coma Scale (GCS) and description RPVA during hospitalization, being excluded patients with diagnoses other than those cited and motor response at admission more than four, which did not present the description of the assessment the blinking reflex or had neurological pathologies associated with those mentioned as selection factor for records. We gathered information from the charts regarding sex, disease, GCS total score, GCS motor score on admission and discharge, the presence or absence of the blinking reflex and level of consciousness on discharge, characterized as awakening, persistent vegetative state or death. Statistical analysis demonstrated through the analysis of univariate and multivariate logistic regression with stepwise selection criterion variables of a direct association between a positive blinking reflex of to visual threat during the period of hospitalization awakening in our cohort (p<0.001) . All the 51 patients with a positive reflex awoke, while patients with a negative reflex don't awakening evolved to persistent vegetative state (24) or death (44). A positive blinking reflex to visual threat during hospitalization increases the chance of awakening by 11.685.00 times when compared with patients with a negative reflex. The blinking reflex as a response to a threat has great prognostic value while its positivity is directly associated with awakening in coma patients / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Proefschrift Universiteit van Amsterdam. / Met samenvatting in het Nederlands.

We demonstrate the schema and ontology matching tool COMA++. It extends our previous prototype COMA utilizing a composite approach to combine different match algorithms [3]. COMA++ implements significant improvements and offers a comprehensive infrastructure to solve large real-world match problems. It comes with a graphical interface enabling a variety of user interactions. Using a generic data representation, COMA++ uniformly supports schemas and ontologies, e.g. the powerful standard languages W3C XML Schema and OWL. COMA++ includes new approaches for ontology matching, in particular the utilization of shared taxonomies. Furthermore, different match strategies can be applied including various forms of reusing previously determined match results and a so-called fragmentbased match approach which decomposes a large match problem into smaller problems. Finally, COMA++ cannot only be used to solve match problems but also to comparatively evaluate the effectiveness of different match algorithms and strategies.

This chapter presents the generic schema match system, COmbination MAtch (COMA), which provides an extensible library of simple and hybrid match algorithms and supports a powerful framework for combining match results. The user can tailor match strategies by selecting the marchers and their combination for a given match problem. Hybrid matchers can also be configured easily by combining existing matchers using the provided combination strategies. Schema matching is the task of finding semantic correspondences between elements of two schemas. It is needed in many database applications, such as integration of web data sources, data warehouse loading, and XML message mapping. To reduce the amount of user effort as much as possible, automatic approaches combining several match techniques are required. While such match approaches have found considerable interest recently, the problem of how to best combine different match algorithms still requires further work.

Measures routinely used to assess the severity and outcome of closed head injury, that is the Glasgow Coma Scale (GCS) and the duration of post-traumatic amnesia (PTA), are of limited use in the case of mild closed head injury (MCHI). The present study investigated the sensitivity of a proposed alternative measure, the Glasgow Coma Scale-Extended (GCS-E), which is a combination of GCS and PTA measures. Twenty subjects who sustai1ed MCHI were assessed with a brief battery of neuropsychological tesrs, six months after the injury. Correlations between the neuropsych1 logical measures and GCS, duration of PTA and the GCS-E were not significant, possibly because of methodological limitations. Although statistical methods do not support the notion that the GCS-E is mere sensitive than currently used measures in detecting the consequem es of MCHI, some support is obtained from qualitative observations. / Psychology / M.A. (Psychology)

Measures routinely used to assess the severity and outcome of closed head injury, that is the Glasgow Coma Scale (GCS) and the duration of post-traumatic amnesia (PTA), are of limited use in the case of mild closed head injury (MCHI). The present study investigated the sensitivity of a proposed alternative measure, the Glasgow Coma Scale-Extended (GCS-E), which is a combination of GCS and PTA measures. Twenty subjects who sustai1ed MCHI were assessed with a brief battery of neuropsychological tesrs, six months after the injury. Correlations between the neuropsych1 logical measures and GCS, duration of PTA and the GCS-E were not significant, possibly because of methodological limitations. Although statistical methods do not support the notion that the GCS-E is mere sensitive than currently used measures in detecting the consequem es of MCHI, some support is obtained from qualitative observations. / Psychology / M.A. (Psychology)

No description available.

The Comet Interceptor is a joint mission by European Space Agency (ESA) and Japan Aerospace Exploration Agency (JAXA) which seeks to perform a flyby over a Long Period Comet using a multi-element spacecraft. The Comet Interceptor comprises three spacecrafts- A, B1 and B2. All three spacecrafts will observe and map the comet at three different points on the coma of the comet, thereby making this mission the first ever multipoint mission dedicated to study a Long Period Comet. Out of the eleven instruments aboard the Comet Interceptor, the work done for this thesis aims to help the team designing the instrument-Optical Periscope Imager forComets (OPIC). The team designing OPIC uses the imaging simulation software Space Imaging Simulator for Proximity Operations (SISPO) to render images of theoretically modelled dust and gas densities of the coma of a comet to obtain prerequisite knowledge of the images which is to be taken by OPIC during its flyby. Using the theoretical model of the coma, a 3D model was created as part of the thesis which shall be later implemented in SISPO. The structure of the coma was made with the help of a sparse volumetric data manipulation tool OpenVDB, which was coded and run in Python. The generated data was imported in Blender to visualise the volumetric data with the help of Blender’s rendering engine-Cycles. To visualise the 3D model with utmost physical realism as the software Blender allows, a study on the scattering properties of the dust and gas model was done. Also, a motion blur was implemented in Blender to simulate the high relative velocity between the instrument and comet. Multiple approaches of varying complexities and time consumption were considered for importing and visualising the volumetric data. The final render images were brightness-matched with reference to images from previous cometary missions. Finally, a qualitative analysis was done by visually comparing the render images to the images from previous missions. With the help of this qualitative analysis, several features and characteristics were identified which were analogous to the real life images, thus establishing the correctness of the renders produced.

Contextualização: As complicações agudas do diabetes, embora em grande parte evitáveis, apresentavam considerável mortalidade em diversas localidades do mundo no século passado. No Brasil, a organização do Sistema Único de Saúde pode ter resultado em importante queda na mortalidade por esta causa. Objetivos: Descrever a mortalidade por complicações agudas do diabetes no Brasil entre 1991 e 2010. Métodos: Os óbitos declarados no Sistema de Informações sobre Mortalidade por complicações agudas do diabetes (CID-9 249 e 250, seguidos pelos dígitos 1, 2 ou 3, e CID-10 E10 a E14, seguidos pelos dígitos 0 ou 1) foram corrigidos para causas mal definidas e sub-registro. A partir da população obtida do Instituto Brasileiro de Geografia e Estatística, foram calculadas taxas de mortalidade padronizadas de acordo com a população mundial. Correlações lineares foram realizadas para descrever a relação entre mortalidade e idade, e regressões Joinpoint foram utilizadas para descrever tendências. Resultados: Houve queda de 70,9% na mortalidade por complicações agudas do diabetes no Brasil entre 1991 e 2010, de 8,42 para 2,45 óbitos por 100.000 habitantes. A redução ocorreu em ambos os sexos, todas as faixas etárias, todas as regiões e quase todas as unidades federativas. O declínio foi menor nos últimos anos, quando as taxas já estavam bem mais baixas. A mortalidade aumentou exponencialmente com a idade e foi maior nas regiões Norte e Nordeste. Conclusões: A marcante redução na mortalidade por complicações agudas do diabetes no Brasil nas últimas duas décadas indica que a cobertura ampla e gratuita adotada pelo sistema nacional de saúde do Brasil, com disponibilização de insulina e organização do cuidado, foi capaz de reduzir substancialmente as complicações agudas dessa doença. Entretanto, considerando especialmente as iniquidades regionais existentes, ainda há espaço para redução na mortalidade por essas complicações no Brasil. / Background: Acute complications of diabetes, though largely preventable, presented considerable mortality in various locations around the world in the 20th Century. In Brazil, the organization of the national health system may have resulted in an important decline in this cause of mortality. Objectives: To describe mortality rates from acute complications of diabetes in Brazil from 1991 to 2010. Methods: The deaths reported in the Mortality Information System for acute complications of diabetes (ICD-9 249 and 250, followed by the digits 1, 2 or 3, and ICD-10 E10 to E14, followed by the digits 0 or 1) were corrected for ill-defined and under-reporting. Using the population obtained from national censuses, we calculated mortality rates standardized to the world population. Linear correlations were performed to describe the relationship between mortality and age, and Joinpoint regressions were used to characterize trends. Results: Mortality from acute complications of diabetes decreased 70.9%, from 8.42 to 2.45 deaths / 100000 inhabitants, in Brazil from 1991 to 2010. The reduction occurred in both sexes, all ages, all regions and almost all states. The decline was less marked in recent years. Mortality rates increased exponentially with age and were higher in the North and Northeast regions. Conclusions: The marked reduction in mortality from acute complications of diabetes in Brazil over the last two decades suggests that the universal coverage adopted by the national health system of Brazil, provided without charge and in an increasingly organized fashion, coupled with greater availability of insulin, was able to substantially reduce deaths due to the acute complications of diabetes. However, especially considering regional inequities, much room still exists for further reduction in mortality from these complications in Brazil.

Made available in DSpace on 2019-04-05T23:08:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-12-16 / The Word equity , in semantic field, is closely to equality , it can be synonym. The equity involves: in health conditions, to reduce the eludable and unfair differences to minimum as possible. Other hand, the health promotion has been defined as a process with improves population to do and increase the control about their health, been this way relative to self and coletive good heath. The coma condition, in special after encephalic-brain traumatism, is one of the complications that the individual is private of the autonomy of your treatment and of your self-care capacity, becoming dependent. The passive exercise is in three levels of attention to health. The integrality principle is the rehabilitate part and also yearn a better attention to real necessity of coma condition patient, prevailing the equity. As principal effect avoid the complications inherent to morbidities caused by coma condition. This research had the objective analyse the equity principle in the physiotherapy praxis in coma condition patients and, it is exerted, to estimate the organics and metabolics effects. The method used was iniatly observe the atituds and actions of the team multiprofessional to the patient in coma condition. Second of all, if was realized physiotherapy procedures, using passive exercise in 20 and 30 minutes, analyzing the organics effects of this procedure. The variables studed happened because of metabolic homeostasis. As results was conformed that there is a higher necessity about the equality and integrity principles to more humane service. And these been respected with realization of adequated physiotherapy procedure. It was observed that 20 minutes of passive exercise did not show significants changes on researched parameters, with to high tendency the systolic arterial pressure (SAP, p = 0,057) and diastolic arterial pressure (DAP, p = 0,057). In 30 minutes of duration appears a significant change on pH (p = 0,011), breath frequency (BF, p = 0,042), base excess (BE, p = 0,020), while phosphoquinase creatine (CPK, p = 0,066) tending to increase and glucose (GLU, p = 0,065) and phosphorus (PO4 = 0,066) tending to reduce. Concluding the attention to health must be increased, paying attention in patients in Intensive Therapy Unit (ITU), because they observe precaution in the equity and integrality principles reacting with Unic Health Sistem laws in Brazil and organics and metabolics disturbs provoked by physiotherapy action in coma condition patients in ITU could exerc a reducing in comorbidity provoked by coma condition and create a better independent functional to patient. / A palavra eqüidade , no aspecto semântico, está bastante próxima à palavra igualdade , podendo até constar como sinônimas. A eqüidade implica: nas condições de saúde, na redução de diferenças evitáveis e injustas até o mínimo possível;  e nos serviços de saúde, no recebimento de atenção em relação à necessidade. Por outro lado, a promoção de saúde tem sido definida como o processo que capacita a população a exercer e a aumentar o controle sobre a sua saúde, sendo dessa forma relativa ao bem-estar individual e coletivo. O estado comatoso, em especial o decorrente do traumatismo crânio-encefálico (TCE), consiste em uma das complicações nas quais o indivíduo é privado da autonomia de seu tratamento e da sua capacidade de autocuidado, passando a um estado de dependência. O exercício passivo está contido nos três níveis de atenção à saúde. No princípio de integralidade é parte da reabilitação e também visa a maior atenção às necessidades reais do paciente comatoso, prevalecendo aí a eqüidade. Como efeito principal evita as complicações inerentes às morbidades provocadas pelo estado de coma. Este estudo teve como objetivo analisar o respeito ao princípio da eqüidade na práxis fisioterapêutica do cliente em estado comatoso e, uma vez este é exercido, avaliar as repercussões orgânicas e metabólicas desencadeadas. O método utilizado consistiu inicialmente na observação das atitudes e ações da equipe multiprofissional para com o paciente comatoso. Em um segundo tempo, foi realizado procedimento fisioterapêutico, com a utilização do exercício passivo em tempo de 20 e 30 minutos, sendo avaliadas as repercussões orgânicas deste atendimento. As variáveis estudadas consistiram da homeostase metabólica. Como resultado evidenciou-se que há uma necessidade maior de respeito aos princípios da eqüidade e da integralidade referendados para um atendimento humanizado. E estes serem respeitados, com a realização de procedimento fisioterapêutico adequado. Evidenciou-se que o exercício passivo de vinte minutos não apresentou alterações significativas nos parâmetros pesquisados, exceto uma tendência a aumentar a pressão arterial sistólica (PAS, p = 0,057) e pressão arterial diastólica (PAD, p = 0,057). Em trinta minutos, mostrou alterações significativas no pH (p = 0,011), freqüência respiratória (FR, p = 0,042), excesso de base (BE, p = 0,020), enquanto que creatino fosfoquinase (CPK, p = 0,066) com tendência a aumentar e glicose (Gli, p = 0,065) e fósforo (PO4, p = 0,066) com tendência a diminuir. Conclui-se então que a atenção à saúde deve ser incrementada, tendo em vista que os pacientes internados em Unidades de Terapia Intensiva (UTI) merecem os cuidados dentro da visão dos princípios de eqüidade e integralidade que regem as leis do Sistema Único de Saúde (SUS) no Brasil e que as alterações orgânicas e metabólicas provocadas pela ação fisioterapêutica em pacientes comatosos em UTI poderão exercer uma diminuição na comorbidade provocada pelo estado de coma e gerar o máximo de independência funcional ao paciente.