Introdução: Apesar de não ser puramente disabsortiva, o Bypass Gástrico em Y de Roux pode provocar alteração da absorção de muitas vitaminas e minerais. Considerando ainda o fato de existirem poucos estudos que relatem o estado geral destes indivíduos, sobretudo com relação aos parâmetros nutricionais em longo prazo, observou-se à necessidade do desenvolvimento de um estudo que verifique a prevalência das carências nutricionais e a efetividade da técnica empregada, bem como o estado geral destes pacientes e suas inter-relações com outros fatores, para especialmente direcionar com maior efetividade as condutas a serem empregadas no pós-operatório pela equipe multidisciplinar. Métodos: 8 homens e 67 mulheres de uma amostra inicial de 130 pacientes compareceram a entrevista. Estes pacientes foram operados pela técnica de Bypass Gástrico em Y de Roux, possuíam entre 18-65 anos e tinham mais que 5 anos de pós-operatório. Foram coletados os seguintes dados: IMC pré e pós-operatório, perda do excesso de peso, queixa de sintomas gastrointestinais, além de dados referente a deficiências nutricionais através da análise de sangue pelos métodos padrões. Resultados: O IMC inicial foi de 56,5 +/- 10 Kg/m2. Após 2 anos, o IMC médio havia caído para 29,4 +/-6 e após 87 meses após a cirurgia, este era de 34,3 +/-10 Kg/m². Uma associação inversa entre perda do excesso de peso (PEP) e tempo de pósoperatório foi observada (P= 0,27; p=0,0183). Após 2 anos apenas 1,33 % (n=1) não atingiu a PEP esperada de 50% do excesso de peso e no momento da entrevista, 30,6% (n=23) não haviam conseguido mantê-la. As deficiências mais comumente verificadas foram as deficiências de vitamina B12 (61,82%) e D (60,53%). Baixos níveis de hemoglobina também foram verificados (50,82%). Vômitos e Síndrome de Dumping foram às queixas gastrointestinais mais observadas 66,19% e 56,76%. Verificou-se correlações significantes entre baixos níveis de hemoglobina e o sexo feminino (p=0,011), % de PEP e ocorrência de vômito com deficiência de vitamina B12 (p=0,028) e (p=0,022). Conclusão: O BGYR é eficiente na promoção e manutenção de perda de peso em longo prazo. Especial atenção deve ser dada aos grupos de maior risco para desenvolvimento de deficiências nutricionais, mulheres em idade fértil, perda de peso excessiva e naqueles que apresentam vômitos freqüentes. / Background: The goal of this study is determining both the efficacy of the surgery and the prevalence of nutritional deficiencies in the long term after the Roux-en Y Gastric Bypass and search for relations of theses deficiencies with other factors. Methods: 8 men and 67 women consecutives patients, who had 5 years or more after the surgery were assessed during regular visits. Pre and Post-operative BMI, excess weight loss and gastrointestinal symptoms were registered. Nutritional deficiencies were accessed by standard laboratory assays. Result: The initial BMI was 56,5 +/- 10 Kg/m2. After 2 years, the mean BMI had dropped to 29,4 +/-6 and by and average of 87 months it was 34,3 +/-10 Kg/m². A inverse association beetwen Excess Weight Loss (EWL) and time of postoperative was verified (P= 0,27; p=0,0183). After 2 years only 1,33 % (n=1) had not achieve a EWL of at least 50%. At the end, 30,6% (n=23) could not maintain this EWL. The more commom nutricional deficiencies are vitamin B12 (61,82%) and D (60,53%). Low levels of hemoglobin (50,82%) was also verified. Vomiting and dumping syndrome was reffered in 66,19% and 56,76%. Significant correlation and with clinical signify was observed between low hemoglobin levels and femine sex (p=0,011), % of weight loss and the B12 deficiency (p=0,028) and vomiting and deficiency of B12 (p=0,022). Conclusion: The RYGB is efficient to promotes and maintain the weight. Special attention should be given to patients with massive weight loss, frequent vomiting and women in reprodutive age.

The basic function of an electric power system is to supply its customers with electric energy as economically as possible and with a reasonable degree of continuity and quality. Power system reliability evaluation techniques are now highly developed through the work of many researchers and engineers. It is expected that the application of power system reliability evaluation in bulk power systems will continue to increase in the future especially in the newly deregulated power industry. This thesis presents research conducted on the three areas of incorporating multi-state generating unit models, evaluating system performance indices and identifying transmission deficiencies in composite system adequacy assessment. The research was done using a previously developed software package designated as MECORE. Many generating companies in both the traditionally regulated and newly deregulated electrical power industry have large generating units that can operate in one or more derated states. In this research work, load point and system reliability indices are evaluated using two-state and multi-state generating unit models to examine the impact of incorporating multi-state generating unit models in composite system adequacy assessment. The intention behind deregulation in the power industry is to increase competition in order to obtain better service quality and lower production costs. This research illustrates how Canadian power systems have performed in the past using data compiled by the Canadian Electricity Association. A procedure to predict similar indices is presented and used to estimate future performance and the effects of system modifications. The incentives for market participants to invest in new generation and transmission facilities are highly influenced by the market risk in a deregulation environment. An adequate transmission system is a key element in a dynamic competitive market. This thesis presents a procedure to identify transmission deficiencies in composite generation and transmission system. The research work illustrated in this thesis is focused on the application of probabilistic techniques in composite system adequacy assessment and particularly in the newly deregulated electric power industry. The conclusions and the techniques presented should prove valuable to those responsible for power system planning.

The basic function of an electric power system is to supply its customers with electric energy as economically as possible and with a reasonable degree of continuity and quality. Power system reliability evaluation techniques are now highly developed through the work of many researchers and engineers. It is expected that the application of power system reliability evaluation in bulk power systems will continue to increase in the future especially in the newly deregulated power industry. This thesis presents research conducted on the three areas of incorporating multi-state generating unit models, evaluating system performance indices and identifying transmission deficiencies in composite system adequacy assessment. The research was done using a previously developed software package designated as MECORE. Many generating companies in both the traditionally regulated and newly deregulated electrical power industry have large generating units that can operate in one or more derated states. In this research work, load point and system reliability indices are evaluated using two-state and multi-state generating unit models to examine the impact of incorporating multi-state generating unit models in composite system adequacy assessment. The intention behind deregulation in the power industry is to increase competition in order to obtain better service quality and lower production costs. This research illustrates how Canadian power systems have performed in the past using data compiled by the Canadian Electricity Association. A procedure to predict similar indices is presented and used to estimate future performance and the effects of system modifications. The incentives for market participants to invest in new generation and transmission facilities are highly influenced by the market risk in a deregulation environment. An adequate transmission system is a key element in a dynamic competitive market. This thesis presents a procedure to identify transmission deficiencies in composite generation and transmission system. The research work illustrated in this thesis is focused on the application of probabilistic techniques in composite system adequacy assessment and particularly in the newly deregulated electric power industry. The conclusions and the techniques presented should prove valuable to those responsible for power system planning.

assessed and strengthened. Performance evaluation of deficient buildings has become a major concern due to devastating earthquakes in the past. In order to justify new provisions in design and assessment codes, experiments and analyses are inherently necessary. In this thesis study, investigations into the behaviour of two deficient reinforced concrete frames built at Middle East Technical University&rsquo / s Structural and Earthquake Laboratory and tested via pseudo-dynamic tests were made. These frames were modelled on the OpenSees platform by following methods of analyses outlined in the Turkish Earthquake Code of 2007 (TEC 2007) and ASCE/SEI-41-06. Both deficient frames were essentially the same, with the only difference being the presence of insufficient lap splices, which was the focus of the study. Time history performance assessments were conducted in accordance to TEC 2007&rsquo / s damage state limits and ASCE/SEI 41-06&rsquo / s performance limits. The damages observed matched the performance levels estimated through the procedure outlined in TEC 2007 rather well. Specific to the specimen with lap splice deficiencies, ASCE/SEI 41-06 was overly conservative in its assessments. TEC 2007&rsquo / s requirements for lap splice lengths were found to be conservative in the laboratory and are able to tolerate deficiencies up to 25% of the required length. With respect to mathematical models, accounting for materials in deficient systems by using nominal but reduced strength properties is not very efficient and unless joint deformations are explicitly accounted for, local deformations cannot be captured.

Bakgrund:Sjuksköterskors huvudsakliga mål är att respektera patientens integritet och självbestämmande i vården samt att ge omvårdnad så att patienten känner sig trygg. Inom psykiatrisk omvårdnad ska sjuksköterskor dessutom ha fördjupade kunskaper för att främja hälsoresurser hos patienter samt tillgodose patientens omvårdnadsbehov. Sjuksköterskor betonar behovet att förtydliga målen inom psykiatrisk omvårdnad och enligt Socialstyrelsen behöver den psykiatriska vården förbättras. Syfte:Syftet med studien är att beskriva brister relaterat till sjuksköterskans utförande av omvårdnad inom psykiatrisk vård för att förebygga uppkomsten av vårdlidande hos patienten. Metod:En litteraturöversikt bestående av tio vetenskapliga artiklar hämtade från databaserna Cinahl och Pubmed. Artiklarna lästes igenom, analyserades, bearbetades och flera kategorier bildades. Den teoretiska utgångspunkten är begreppet vårdlidande som tagits upp av Katie Eriksson. Resultat:Två huvudkategorier av brister med respektiva subkategorier framkom. Brister som direkt relateras till omvårdnaden av patienter med subkategorier: brister i vårdrelationen, brister i kommunikationen och brister i bemötandet samt brister som indirekt relateras till omvårdnaden av patienter med subkategorier:brister i resurser, brister i gemensam vårdfilosofi och brist på kunskap. Diskussion:Litteraturöversikten visar på att det finns brister i sjuksköterskors utförande av omvårdnad. Bristerna har sin grund i att sjuksköterskor har svårigheter att skapa vårdrelationer med patienter, bristande kunskaper och ointresse samt oklarheter kring sin yrkesroll. Sammantaget ger detta patienten ett lidande i stället för hälsobefrämjande omvårdnad. / Background:Nurses' primary goal is to respect patient integrity and autonomy in health care and provide nursing care so the patient feels safe. Nurses within psychiatric care should also have more knowledge to promote health resources for patients and meet patient needs of care. Nurses need to clarify their goals within psychiatric nursing and according to Socialstyrelsen the psychiatric care needs to be improved. Aim:The aim of the studie is to describe the deficiencies in the nurse’s performance of nursing within psychiatric care to prevent the rising of the patient´s care suffering. Method:A literature review based on ten peer-reviewed scientific articles gathered from the databases Cinahl and Pubmed describing deficiencies in nursing care based on patients' and nurses' experiences. Katie Eriksson’s concept of care suffering was used as a theoretical basis. Results:Two main categories of deficiencies with respective subcategories emerged. For the first, deficiencies directly related to the nursing care of patients with subcategories: deficiencies in relationship in care, deficiencies in communication and deficiencies in hospitality and for the second, deficiencies indirectly related to the nursing care of patients with subcategories: deficiencies in resources, deficiencies in common care philosophy and deficiency in knowledge. Discussion:The lliterature review shows that there are deficiencies in nurses' performance of nursing. These deficiencies are based on nurses’ difficulties in creating care relationships with patients, lack of knowledge and disinterest and confusion about their professional role. Overall, it gives the patient care suffering instead of health care promoting.

Objectives: The goal of this project was to determine the nutritional needs of preschool age children to help guide intervention development. The research aims were 1) to examine and describe young child (ages one to five) nutritional status as it relates to key nutrients associated with stunting and wasting; 2) to determine what key macro- and micro-nutrient deficiencies (primarily iron and zinc) are associated with wasting and stunting. Methodology: Study sample: Sixty-seven families with children ages one to five who participating in routine health care clinic visits during the UK Shoulder to Shoulder Global health brigade visits. Study design: A cross-sectional survey was conducted collecting demographic data, medical history, and dietary intake. Objective measures of height/length and weight were completed; and blood samples were drawn to measure serum micronutrient levels. Nutrition Data System for Research (NDSR) identified nutrient intakes for analytical comparison based on growth parameters. Nutritional and health status were compared to food security and World Health Organization growth reference points of standard deviations on Z-scores of height-for-age and weight-for-age. Analyses: Chi Square, ANOVA, and binary logistic regression tests were run using Statistical Analysis System (SAS) Results: Low serum levels of zinc and iron corresponded to low levels of dietary intake of zinc and iron, limited food security and moderate stunting z = -0 to 1.99 Standard Deviation. Conclusion: This study will inform a comprehensive nutritional intervention for this population. The evidence that specific nutrients are limiting will focus the health promotion objectives.

Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [108]-114).

The main purpose of this study was to investigate and implement a repair design for corrosion damaged bridge bents in order to resist lateral loading, such as wind loads or ship impact. Using the results from a one-third scale bridge bent constructed and tested for a previous study, non-linear modeling was used to simulate the same corrosion damage and load response. The principle variable considered was damage, represented as a percent of effective area loss of prestressing steel within a designated damage zone along the length of piles. Other influencing variables included: prestress transfer length, localized loss in prestress due to corrosion damage, prestress force, and concrete modulus of elasticity. Upon successful convergence of measured and modeled results, carbon fiber repair schemes were then modeled to restore bents to their full capacity. Suitable repairs were judged on the basis of restoration of capacity of the entire pile bent and the interaction diagrams of the individual piles. Results of the modeled repairs suggested that a single layer of a commercially available unidirectional carbon fiber would be sufficient when aligned longitudinally. No benefit from accompanying transverse fibers were considered although such a repair was suggested by the study findings. Analysis indicated that longitudinally bonded carbon fiber reinforced polymer (CFRP) to bridge piles increases a bent’s ability to resist bending moment due to lateral loading at the cap. However, additional capacity to plastic region of the response curve indicated larger capacity gains than by gains to elastic regions.

A presente dissertação visa, ao mapear e analisar as concepções elaboradas pelos alunos na aquisição do sistema de escrita no contexto da escola especial, oferecer uma versão das possibilidades de aprendizagem dos alunos “com deficiência mental”. As produções e interpretações escritas (escrita do nome, palavras, frases, textos) realizadas na dinâmica da sala de aula de uma turma coordenada pela pesquisadora apresentaram nove alunos na condição de “leitores e de escritores em processo”, construtores de variadas e particulares reflexões em interação com este objeto de conhecimento. A intervenção efetiva da professora e do contexto escolar enquanto intérpretes e informantes deste conhecimento culturalmente organizado tornou-se fundamental no sentido de oferecer uma série de vivências significativas com atos de leitura e escrita, possibilitando aos alunos um questionar-se e o desejo de apropriar-se da cultura escrita. Observou-se uma rede (não linear) de concepções que oscilavam entre diferentes níveis de conceitualização. O olhar teórico foi determinante no sentido de possibilitar visualizar o processo de alfabetização, dando a compreender o que poderia ser entendido como “erro, imaturidade ou deficiência” como formas de pensar diferenciadas da convencional, pertinentes ao processo de desenvolvimento e de aprendizagem em geral, como nos mostram os autores Emilia Ferreiro, Ana Teberosky e David Olson. Reconheceu-se o sujeito inventivo da teoria piagetiana. Este entendimento marca possibilidades de se viver novas formas de ser, diferenciadas do padrão “deficiente mental”: o de um aluno que também pode vir a ser letrado, independentemente de dominar ou não a forma oficial do sistema de escrita. Uma pessoa que assina seu nome e suas aprendizagens. / The present dissertation presents the concepts students with mental deficiencies are able to build when acquiring the written code, and discusses a version of these students´ learning possibilities. Their written productions and interpretations (spelling of names and words, writing of full statements and texts) emerge as a result of a classroom dynamic work coordenated by the present researcher. The study finds out nine students as readers-and-writers-in-process – able of producing varied and private reflections in interaction with the target object. The effective intervention of the teacher and the whole school context, as interpreters and communicators of this culturally-organized-knowledge, became crucial factors to offer students a series of meagninful experiences of life along to the reading and writing tasks, so the students behaved like questioning themselves and had the wish to acquire the written code. It was possible to observe a growing network of concepts (not in a linear basis), which floated among different levels of nominalization. The theoretical choice, making it clear what we should consider or should not consider as an “error”, “imaturity” or a “deficiency”. It also was decisive to best visualize the literacy process in a different approach from the ones used by convencional learning and development practices, as Emilia Ferreiro, Ana Teberosky and David Olson have pointed out. It made possible to recognize the inventive subject according to the piagetian theory. The understanding that underlines this work sets new possibilities of living new ways of being, which differ from the mental deficient standard. We talk about a student that is also able to become lectured, and that despite acquiring or not the official writen code, is a person who is able to sign his/her name and his/her productions.

Resumo: Avaliou-se, em casa de vegetação, o desenvolvimento populacional do ácaro Brevipalpus phoenicis e severidade da leprose em plantas de laranja da variedade Pêra, enxertadas sobre limão Cravo e as tangerinas Cleópatra e Sunki, com aproximadamente 9 meses de idade, submetidas a diferentes condições de deficiência hídrica. Os tratamentos foram estabelecidos em função da Capacidade de Campo (CC) e da fração de esgotamento de água (p) do solo, como segue: T1=25%CC (p=0,25); T2=40%CC (p=0,40); T3=55%CC (p=0,55); T4=70%CC (p=0,70). Decorridos 60 dias da indução ao estresse, realizou-se a colonização das mudas com 25 ácaros infectados e não infectados com o vírus da leprose, procedentes de uma criação sobre frutos com e sem lesões da doença. Os ácaros permaneceram colonizando às plantas por 55 dias, findos os quais, avaliou-se, em laboratório, sua população, contando-se o número de ovos, larvas, ninfas e adultos. Durante a colonização do B. phoenicis, avaliaram-se os sintomas da leprose, iniciando-se 21 dias após a colonização das plantas, e a intervalos de 7 dias. Empregou-se uma escala de notas visual para avaliar a severidade da leprose com base no número de lesões de leprose nos ramos, folhas e desfolha. Conclui-se que a disponibilidade de água para a planta influencia no desenvolvimento de B. phoenicis, visto que, em plantas submetidas a 25%CC, o número de ácaros foi maior que nos demais regimes hídricos, decrescendo à medida que a disponibilidade de água foi maior, atingindo seu menor índice populacional aos 70%CC. Em relação à severidade da leprose, as plantas submetidas a 25 e 40%CC obtiveram notas mais altas, evidenciando maior suscetibilidade... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: It was assessed, in greenhouse, the interaction of the leprosis mite Brevipalpus phoenicis with orange plants Pêra grafted on lemon Cravo variety and on tangerines Cleopatra and Sunki, with about 9 months old, submitted on different condition of water deficits and mite infestation. The treatments were determinate in a function of both, Field Capacity (CC) and soil water drain fraction (p), as this: T1=25%CC (p=0,25); T2=40%CC (p=0,40); T3=55%CC (p=0,55); T4=70%CC (p=0,70). After 60 days of stress induction, was made the colonization of plants with 25 mites that were reared on oranges with and without leprosis symptoms. The mites stayed in the plants for 55 days, after what, its population, counting the number of eggs, grub, nymphs and adults were assessed, in laboratory. During the B. phoenicis colonization, were assessed the leprosis symptoms, starting 21 days after the plants colonization, at intervals of 7 days. To this was used a notes ranking basing in the number of leprosies symptoms in the branches, leaves and desfoliate. Was concluded that the water availability had influence in B. phoenicis development, foundation that the plants submitted on 25%CC, had mite population higher than the others treatments, decreasing with the increase water availability, hitting the lowest population index on 70%CC. In relation with leprosis symptoms, plants submitted on 25 and 40%CC had the highest notes, evidencing more susceptibility of this plants to the disease and faster evolution of the symptoms. The rootstock Cravo and Cleopatra were more susceptible to the mite, showing the biggest population, 134,8 and 125,9 mites respectively, while Sunki showed the lowest population... (Complete abstract, click electronic access below) / Orientador: Carlos Amadeu Leite de Oliveira / Coorientador: Mara Cristina Pessoa da Cruz / Banca: Arlindo Leal Boiça Júnior / Banca: Marineide Rosa Vieira / Banca: Renato Beozzo Bassanezi / Banca: Mário Eidi Sato / Doutor