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Made available in DSpace on 2016-06-02T20:06:06Z (GMT). No. of bitstreams: 1 4338.pdf: 1335557 bytes, checksum: 8e0bef5711ff8c398be194e335deecec (MD5) Previous issue date: 2012-02-28 / Universidade Federal de Sao Carlos / Classification consists in the discovery of rules of prediction to assist with planning and decision-making, being a continuously indispensable tool and a highly discussed subject in literature. As a special case in classification, we have the process of credit risk rating, within which there is interest in identifying good and bad paying customers through binary classification methods. Therefore, in many application backgrounds, as in financial, several techniques can be utilized, such as discriminating analysis, probit analysis, logistic regression and neural nets. However, the Probabilistic Nets technique, also known as Bayesian Networks, have showed itself as a practical convenient classification method with successful applications in several areas. In this paper, we aim to display the appliance of Probabilistic Nets in the classification scenario, specifically, the technique named K-dependence Bayesian Networks also known as KDB nets, as well as compared its performance with conventional techniques applied within context of the Credit Scoring and Medical diagnosis. Applications of the technique based in real and artificial datasets and its performance assisted by the bagging procedure will be displayed as results. / A classificação consiste na descoberta de regras de previsão para auxílio no planejamento e tomada de decisões, sendo uma ferramenta indispensável e um tema bastante discutido na literatura. Como caso especial de classificação, temos o processo de avaliação de risco de crédito, no qual temos o interesse de identificar clientes bons e maus pagadores através de métodos de classificação binária. Assim, em diversos enredos de aplicação, como nas financeiras, diversas técnicas podem ser utilizadas, tais como análise discriminante, análise probito, regressão logística e redes neurais. Porém, a técnica de Redes Probabilísticas, também conhecida como Redes Bayesianas, tem se mostrado um método prático de classificação e com aplicações bem sucedidas em diversos campos. Neste trabalho, visamos exibir a aplicação das Redes Probabilísticas no contexto de classificação, em específico, a técnica denominada Redes Probabilísticas com K-dependência, também conhecidas como redes KDB, bem como comparar seu desempenho com as técnicas convencionais aplicadas no contexto de Credit Scoring e Diagnose Médica. Exibiremos como resultado aplicações da técnica baseadas em conjuntos de dados reais e artificiais e seu desempenho auxiliado pelo procedimento de bagging.

Orientadores: Viviane Hermann, Cássio Luiz Zanettini Riccetto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T22:47:40Z (GMT). No. of bitstreams: 1 Manente_FernandaDalphorno_M.pdf: 1640371 bytes, checksum: bb7045d453650447e32f75b7c7322b55 (MD5) Previous issue date: 2011 / Resumo: Introdução: Os slings sintéticos marcaram a transição do tratamento invasivo para o tratamento minimamente invasivo da incontinência urinária de esforço feminina. Técnicas igualmente eficazes, porém com menores riscos de complicações têm sido pesquisadas. Os mini-slings, utilizando incisão única e de acesso exclusivamente vaginal podem representar uma alternativa à técnica de sling tradicional. Objetivo: Avaliar a eficácia do mini sling Ophira para o tratamento da incontinência urinária de esforço feminina. Material e Método: Foram avaliadas 49 mulheres que compareceram ao Ambulatório de Uroginecologia do HC da UNICAMP no período de abril de 2008 a maio de 2009 com queixa clínica de incontinência urinária de esforço. Todas as pacientes foram submetidas a Estudo Urodinâmico pré-operatório e avaliadas através de história clínica, exame físico, urina I e urocultura, teste de esforço, Pad test de uma hora e aplicação do questionário de qualidade de vida UDI-6. A colocação de mini sling Ophira foi realizada sob anestesia local em regime ambulatorial com alta após micção espontânea. As avaliações subsequentes foram realizadas após seis dias e um, três, seis e 12 meses após o procedimento, compreendendo exame físico, Pad test de uma hora e aplicação do UDI-6. A cura objetiva foi avaliada através do Pad test e do teste de esforço. A cura subjetiva foi avaliada pela queixa clínica e pelo questionário de qualidade de vida. Resultados: A análise da percepção subjetiva dos resultados demonstrou que, após 12 meses de seguimento, 37 pacientes (76%) referiram cura da IUE e sete (14%) melhora. O escore do questionário UDI-6, inicialmente com média de 41,29, caiu para 7,24 após 12 meses de seguimento. O Pad test de uma hora apresentou queda de 6,2g no préoperatório para 1g após o término do acompanhamento. Apenas seis pacientes apresentavam teste de esforço positivo no seguimento de 12 meses. Não houve complicações intra-operatórias. Apenas um caso de dor pós-operatória foi observado. Obteve-se taxa de extrusão do sling de 12,2%. Conclusão: O mini sling Ophira representa uma alternativa cirúrgica segura e eficaz para o tratamento da incontinência urinária de esforço feminina, no período de tempo avaliado / Abstract: Introduction: The synthetic slings marked the transition from invasive treatment to minimally invasive treatment of stress urinary incontinence. Techniques equally effective but with fewer risks of complications have been proposed. The minislings, with single incision and accessing exclusively the vaginal route represents an alternative to tradicional sling technique. Objective: To evaluate the efficacy of mini sling Ophira for the treatment of stress urinary incontinence in women. Methods: We evaluated 49 women attending the outpatient clinic of Urogynecology at the HC/UNICAMP from April 2008 to May 2009 with clinical complaints of stress urinary incontinence. All patients were initially submitted to urodynamic investigation, clinical and physical evaluation, urine analysis, stress test, 1-hour pad test and UDI- 6 Quality of life questionnaire. Mini sling Ophira was placed under local anesthesia and patients were dismissed after spontaneous voiding. Evaluation was undertaken 6 days after surgery and 1, 3, 6 and 12 months follow-up. Objective cure was assessed by Pad test and stress test. Subjective cure was assessed by QoL questionnaire. Results: Subjective analysis demonstrated that, after 12 months, 37 (76%) of patients referred themselves as cured and 7 (14%) as improved. UDI score significantly dropped from 41.29 to 7.24 and 1 hour Pad-test significantly decreased from 6.2 g to 1.0 g. Only 6 patients had persistent positive stress test. No intra operative complications occurred and only one patient complained of pain. Mesh erosion rate was 12.2%. Conclusion: Mini sling Ophira represents a safe and effective alternative to female stress urinary incontinence treatment, should the results proved to be long lasting / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

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Abstract The purpose of this work was to determine on the basis of the national hospital discharge register and cause-of-death statistics the extent of the hospital treatment required for chronic obstructive pulmonary disease (COPD) in Finland over the period 1972–2001, i.e. the use made of hospital services, factors affecting the length of stay in hospital and the correlation of length of stay with the prognosis. Different intervals within this period were taken for study according to the themes of the individual papers. The results suggest that the length of stay in hospital varies both geographically and seasonally in Finland, the shortest times being recorded in Northern Finland in summer. The main explanations for this would appear to lie in regional differences in health care resources and treatment practises and in climatic variations. The mean length of stay in hospital in the total material in 1987–1998 was nine days. The longest periods applied to cases with concurrent pneumonia or a cerebrovascular disorder. The duration of treatment for the exacerbation stage of COPD decreased by two days between 1993 and 2001, with the longest periods of treatment observed in the case of elderly women. One week of treatment with current modalities may be regarded as optimal, as this was associated with the longest interval before the next exacerbation, just over six months. About 3% of all emergency admissions ended in death, most commonly on a Friday in winter or spring. Patients admitted at a weekend died within the first 24 hours more frequently than did those admitted on a weekday. The mean duration of treatment and frequency of hospitalization increased towards the terminal stage. About one fourth of the patients had died within a year of the first admission for COPD and about a half within five years. Hospital treatment for COPD intensified in Finland during the 1990s as the numbers of hospital beds decreased. Treatment times became shorter and deaths in hospital during exacerbation became less frequent. It will be necessary from now onwards, however, to anticipate the ageing of the population and to develop treatment modalities to replace hospitalization, in order to reduce the costs accruing from this disease. Early diagnosis and outpatient rehabilitation should be developed, and special attention should be paid to appropriate treatment at the terminal stage. / Tiivistelmä Tutkimuksen tarkoituksena oli selvittää valtakunnallisen hoitoilmoitusrekisterin ja kuolemansyytilaston avulla keuhkoahtaumataudista (KAT) aiheutunutta sairaalahoitoa Suomessa 1972–2001: sairaalapalvelujen käyttöä, hoitojakson pituuteen vaikuttavia tekijöitä sekä hoitoajan yhteyttä ennusteeseen. Lähdeaineistosta valittiin erilaisia ajanjaksoja tutkimusasetelman mukaan. Tulokset viittaavat siihen, että hoitoajan pituus vaihtelee Suomessa maantieteellisesti ja vuodenaikojen mukaan: lyhyin hoitoaika on Pohjois-Suomessa kesällä. Ilmiötä selittänevät pääosin terveydenhuollon resurssien ja hoitokäytäntöjen alueelliset erot sekä ilmasto-olosuhteiden vaihtelu. Vuosina 1987–1998 keskimääräinen hoitoaika koko aineistossa oli yhdeksän vuorokautta. Jos potilaalla oli samanaikaisina sairauksina keuhkokuume tai aivoverenkiertohäiriö, nämä johtivat pisimpiin hoitoaikoihin. KAT:n pahenemisvaiheen hoitoaika lyheni kaksi vuorokautta vuodesta 1993 vuoteen 2001. Iäkkäitten naisten hoitoajat olivat pisimmät. Viikon pituinen hoitoaika nykyisillä hoitomuodoilla oli optimaalinen, sillä tällöin aika seuraavan pahenemisvaiheen hoitojakson alkuun oli pisin: vähän yli puoli vuotta. Kaikista päivystyshoitojaksoista potilaan kuolemaan päättyi kolmisen prosenttia. Yleisimmin tällainen hoitojakso päättyi potilaan kuolemaan perjantaisin ja todennäköisimmin talvella tai keväällä. Viikonloppuna sairaalaan tulleista potilaista kuoli ensimmäisen vuorokauden aikana enemmän kuin arkipäivinä tulleista. Keskimääräinen hoitoaika oli pisin ja sairaalahoito runsainta sairauden loppuvaiheessa kuoleman lähestyessä. Ensimmäisen KAT:n aiheuttaman hoitojakson jälkeen noin neljännes potilaista oli kuollut vuoden sisällä ja viiden vuoden kuluessa noin puolet. Keuhkoahtaumataudin sairaalahoito on tehostunut Suomessa 1990-luvulla sairaansijojen vähentyessä. Hoitoajat ovat lyhentyneet ja pahenemisvaiheiden sairaalakuolleisuus on vähäistä. Väestön ikääntyminen on kuitenkin ennakoitava ja sairaalaa korvaavia hoitomuotoja kehitettävä taudista aiheutuneiden kustannusten hillitsemiseksi. Varhaisdiagnostiikkaa ja avokuntoutusta on kehitettävä ja erityinen huomio kiinnitettävä sairauden loppuvaiheen asianmukaiseen hoitoon.

Les méthodes osseuses de diagnose sexuelle donnent d’excellents résultats, avec des taux de bonnes prédictions du sexe supérieurs à 90%. Néanmoins, les éléments osseux ne sont pas toujours disponibles et, lorsqu’ils le sont, selon les causes de la mort et/ou les conditions de conservation du corps, ils peuvent avoir été lourdement dégradés. Pour parvenir à déterminer le sexe d’un individu dans ces situations là, des techniques dentaires de diagnose sexuelle sont nécessaires.Contrairement à la détermination du sexe, la problématique de la détermination de l’âge a fait l’objet de nombreuses études et d’autant de propositions de techniques différentes, signe d’une insuffisance de l’ensemble de ces méthodes, que la littérature n’a pas manqué de mettre en exergue.Le premier objectif de ce travail est de proposer une technique dentaire de détermination du sexe simple et précise, de façon à pouvoir répondre à cette problématique anthropologique de façon fiable en l’absence d’autres éléments du squelette.Le second est de développer une méthode d’estimation de l’âge de mise en œuvre facile, rapide et ne nécessitant ni un plateau technique lourd, ni la détérioration du matériel, pour une application aussi bien anthropologique que médico-légale. L’échantillon d’apprentissage était composé de 210 scanners d’individus présentant chacun 4 canines saines. L’échantillon d’application était composé de 55 scanners d’individus, présentant chacun au moins 1 canine saine. Les volumes pulpaire et total de chaque dent ont été modélisés et calculés à l’aide du logiciel Mimics. Une régression logistique binaire a été utilisée pour déterminer sept modèles de prédiction du sexe, en fonction du nombre et du type de canines exploitables. La comparaison des aires sous la courbe ROC a mis en évidence une plus grande performance du modèle utilisant les volumes des 4 canines. La méthode des moindres carrés pondérés a été utilisée pour déterminer les équations d’estimation de l’âge pour les sept mêmes modèles. Une plus grande performance du modèle utilisant les volumes des 2 canines maxillaires a été mise en évidence. Toutes ces régressions ont été testées sur l’échantillon d’application pour procéder à leur validation externe.Il s’avère que dans un contexte scientifique historique où les canines mandibulaires constituaient l’outil dentaire de référence dans la diagnose sexuelle, la modélisation tridimensionnelle souligne l’intérêt potentiel de leurs homologues maxillaires. Par ailleurs, il semblerait que l’évaluation de la réduction pulpaire physiologique, imputable à l’apposition naturelle de dentine secondaire sur les canines uniquement, soit un critère performant dans la détermination de l’âge.A défaut d’être parfaits, les modèles proposés à l’issue cette étude permettent donc toutefois de disposer d’éléments fiables, qui ont toute leur place dans l’indispensable faisceau de preuves, nécessaire à la détermination de l’âge et du sexe dans le cadre d’une identification estimative. / The bone methods of sexual diagnosis give excellent results, with rates of good predictions over 90%. Nonetheless, bones are not always available and, when they are, according to the causes of death and/or storage conditions of the body, they may have been severely degraded. To be able to determine the sex of an individual in these situations, dental techniques of sexual diagnosis are needed.In contrast to sex determination, the problem of age estimation has been the topic of many studies and so many different techniques, evidence of failure of all these methods, which the literature did not fail to highlight.The first aim of this work was to propose a simple and accurate dental technique for determining sex, in order to resolve this anthropological issue, reliably in the absence of other elements of the skeleton.The second was to develop a method for estimating the age of easy and fast implémentation, neither requiring a heavy technical support nor damage to material, for an application as well in forensics as in anthropology.The training sample consisted of 210 subjects’ CT-scans, each with four canines healthy. The validation sample was composed of 55 CT-scans, each with at least one healthy canine. Pulp and total volumes of each tooth were modeled and calculated using the software Mimics . A binary logistic regression was used to determine seven prediction models of sex, according to the number and type of canine available in practice. The comparison of the areas under the ROC curve showed a greater performance of the model using the volumes of the four canines. The weighted least squares method was used to determine the equations for estimating the age for the same seven models. Greater performance of the model using the volumes of maxillary canines has been demonstrated. All these regressions were tested on the validation sample to perform their external validation.It turns out that in a scientific context where historical mandibular canines were the reference tool in the sex diagnosis, three-dimensional modeling emphasizes the potential value of maxillary counterparts. Moreover, it appears that the evaluation of the physiological pulp reduction, due to the natural apposition of secondary dentine on canines only, is a performance criterion in determining age.The models proposed in this study can therefore have reliable evidence, which all have all their place in the necessary body of evidence for determining age and sex, in estimating identification.

Nos últimos anos o mundo tem vivenciado uma avalanche de novas tecnologias para auxílio ao diagnóstico médico. Esses esforços buscam um diagnóstico rápido e preciso através de exames e informações sobre a condição física do paciente. Através do uso de imagens médicas, a radiologia busca a visualização de órgãos ou estruturas internas do corpo humano para encontrar respostas às suspeitas de problemas físicos expressos por sinais e sintomas relatados pelo paciente. Nessa área, os Sistemas de Comunicação e Armazenamento de Imagens (PACS) têm ajudado no armazenamento e organização do crescente número de imagens geradas pelos exames realizados nos hospitais. Trabalhos de pesquisa médica têm evidenciado o potencial de uso dessas imagens como auxílio à prática da Medicina Baseada em Casos Similares (MBCS). Por esse motivo, há na literatura um esforço contínuo em desenvolver técnicas computacionais para recuperação de imagens baseada em conteúdos similares (CBIR) em grandes conjuntos de dados. As consultas por similaridade são essenciais para apoiar a prática da MBCS e a descoberta de comportamentos de lesões causadas por diversas doenças. A evolução e intensificação das pesquisas em CBIR têm encontrado vários desafios. Um desses é a divergência entre os resultados obtidos automaticamente e aqueles esperados pelos radiologistas (descontinuidade semântica). Outro desafio é a falta de estudos sobre a viabilidade clínica dessas ferramentas como forma de auxílio ao diagnóstico. Esses obstáculos são dois dos principais responsáveis pela não efetivação dessa tecnologia no ambiente médico-hospitalar. Mediante o exposto acima, este trabalho de pesquisa propõe um mecanismo para contornar essa descontinuidade semântica e ao mesmo tempo aproximar o CBIR do ambiente real de aplicação. A contribuição principal deste trabalho foi o desenvolvimento de uma metodologia baseada em parâmetros perceptuais que aproximam o sistema ao nível de percepção do usuário médico. Em seguida, foi realizado um estudo sobre a viabilidade clínica do sistema CBIR no Hospital das Clínicas de Ribeirão Preto. A metodologia proposta foi aplicada e os resultados comprovaram a aplicabilidade de Sistemas CBIR como ferramenta de auxílio ao diagnóstico em um ambiente clínico real / In recent years the world has experienced an avalanche of new technologies to aid medical diagnosis. These efforts seek a quick and accurate diagnosis through exams and information about the patient\'s physical condition. The radiology studies the visualization of the organs or structures through the use of images. In this area, the Picture Archiving and Communication Systems (PACS) have helped in the storage and organization of the growing number of images generated by exams performed in hospitals. Medical research papers have shown the potential use of these images as an aid to the Similar Case-Based Reasoning (SCBR) practice in Medicine. For this reason, there is an ongoing effort in the literature to develop computational techniques for Content-Based Image Retrieval (CBIR) in large data sets. Similarity queries are essential to support the practice of SCBR. The evolution and intensification of research in CBIR have encountered several challenges. One of these is the discrepancy between the results obtained automatically and those expected by radiologists (semantic gap). Another challenge is the lack of studies on the clinical viability of these tools as a way to assist in diagnosis. These obstacles are the two main responsible for reservation in using this technology in the medical hospital environment. Considering this scenario, this research proposes a mechanism to overcome this semantic gap and bring the real environment to the CBIR application. The main contribution for this research was the development of a methodology based on Perceptual Parameters to approximate the system to the level of user perception. Then we conducted a study on the clinical viability of a CBIR system at the Clinical Hospital of the University of São Paulo at Ribeirão Preto. The proposed methodology was applied and the results showed the applicability of CBIR systems as a computer aided diagnosis tool in a real clinical environment

Background: In Parkinson’s disease (PD), alpha-synuclein accumulation in cutaneous autonomic pilomotor and sudomotor nerve fibers has been linked to autonomic nervous system disturbances even in the early stages of the disease. This study aims to assess the association between alpha-synuclein-mediated structural autonomic nerve fiber damage and function in PD, elucidate the role of neuropathy progression during the early disease stages, and test reproducibility and external validity of pilomotor function assessment using quantitative pilomotor axon-reflex test and sudomotor function via quantitative direct and indirect test of sudomotor function. Methods/design: A prospective controlled study will be conducted at four study sites in Europe and the USA. Fifty-two male and female patients with idiopathic PD (Hoehn and Yahr 1–2) and 52 age- and sex-matched healthy controls will be recruited. Axon-reflex-mediated pilomotor erection will be induced by iontophoresis of phenylephrine on the dorsal forearm. Silicone impressions of the response will be obtained, scanned, and quantified for pilomotor muscle impressions by number, impression size, and area of axon-reflex spread. Axon-reflex-mediated sweating following acetylcholine iontophoresis will be quantified for number and size of droplets and axon-reflex spread. Sympathetic skin responses, autonomic and motor symptoms will be evaluated. Tests will be performed at baseline, after 2 weeks, 1, 2, and 3 years. Skin biopsies will be obtained at baseline and after 3 years and will be analyzed for nerve fiber density and alpha-synuclein accumulation. Discussion: We anticipate that progression of autonomic nerve dysfunction assessed via pilomotor and sudomotor axon-reflex tests is related to progression of autonomic symptom severity and alpha-synuclein deposition. Potential applications of the techniques include interventional studies evaluating disease-modifying approaches and clinical assessment of autonomic dysfunction in patients with PD.