The absence of gold standard criteria for mild cognitive impairment (MCI) impedes the comparison of research findings and the development of primary and secondary prevention strategies addressing the possible conversion to dementia. The objective of Study 1 was to compare the predictive ability of different MCI models as markers for incipient dementia in a longitudinal population-based Canadian sample. The utility of well-documented MCI criteria using data from persons who underwent a clinical examination in the second wave of the Canadian Study of Health and Aging (CSHA) was examined. Demographic characteristics, average neuropsychological test performance, and prevalence and conversion rates were calculated for each classification. Receiver operating characteristic (ROC) analyses were employed to assess the predictive power of each cognitive classification. The highest prevalence and conversion rates were associated with case definitions of multiple-domain MCI. The only diagnostic criteria to significantly predict dementia five years later was the Cognitive Impairment, No Dementia (CIND) Type 2 case definition. It is estimated that more restrictive MCI case definitions fail to address the varying temporal increases in decline across different cognitive domains in the progression from normal cognitive functioning to dementia. Using data from the CSHA, the objective of Study 2 was to elucidate the clinical correlates that best differentiate between cognitive classifications. A machine learning algorithm was used to identify the symptoms that best discriminated between: 1) not cognitively impaired (NCI) and CIND; 2) CIND & demented; and 3) converting and non-converting CIND participants. Poor retrieval was consistently a significant predictor of greater cognitive impairment across all three questions. While interactions with other predictors were noted when differentiating CIND from NCI and demented from non-demented participants, retrieval was the sole predictor of conversion to dementia over five years. Importantly, the limited specificity and predictive values of the respective algorithms caution against their use as clinical markers of CIND, dementia, or conversion. Rather, it is recommended that the predictors serve as markers for ongoing monitoring and assessment. Overall, the results of both studies suggest that the architecture of pathological cognitive decline to dementia may not be captured by a single set of diagnostic criteria.

Η συχνότητα εμφάνισης του μεταδιασεισικού συνδρόμου μετά από ελαφρές κρανιοεγκεφαλικές κακώσεις στις ανεπτυγμένες χώρες κυμαίνεται από 40% έως 80% κατά τις πρώτες εβδομάδες μετά τον τραυματισμό. Ωστόσο, σχεδόν το 50% των ασθενών αναφέρουν συμπτώματα έως και 3 μήνες μετά και το 10-15% από αυτούς για περισσότερο από ένα χρόνο. Οι ελαφρές κρανιοεγκεφαλικές κακώσεις και το μεταδιασεισικό σύνδρομο αποτελούν σοβαρό πρόβλημα δημόσιας υγείας, μιας και το ποσοστό επαγγελματικής ανικανότητας που οφείλεται σε αυτά εκτιμάται από 12% για 2 μήνες έως και 20% για 1 χρόνο, με τον αντίστοιχο οικονομικό και κοινωνικό αντίκτυπο. Σκοπός της παρούσας μελέτης είναι να προσδιοριστούν τα χαρακτηριστικά και να εκτιμηθεί η συχνότητα εμφάνισης του μεταδιασεισικού συνδρόμου σε έναν ενήλικο ελληνικό πληθυσμό, ταυτόχρονα με την καταγραφή των δημογραφικών στοιχείων και των παραμέτρων που αφορούν αποκλειστικά στις ελαφρές κρανιοεγκεφαλικές κακώσεις στην ίδια πληθυσμιακή ομάδα. Υλικό-Μέθοδοι: Η προοπτική αυτή μελέτη πραγματοποιήθηκε στο Πανεπιστημιακό Γενικό Νοσοκομείο Πατρών, στη Δυτική Ελλάδα. Η συλλογή των ασθενών με ελαφρά κρανιοεγκεφαλική κάκωση ξεκίνησε τον Μάιο του 2006 και ολοκληρώθηκε τον Μάιο του 2008. Πεντακόσιοι τριάντα εννέα ασθενείς με ελαφρές κρανιοεγκεφαλικές κεφαλής συμπεριλήφθηκαν με τυχαία διαλογή στην μελέτη. Συνολικά, 223 ασθενείς (223/539: 41,5%) (άνδρες 63% και γυναίκες 37%) πληρούσαν τα κριτήρια του "Colorado Medical Society Guidelines" για τον καθορισμό της διάσεισης, με μέση ηλικία τα 30 έτη (εύρος: 18.5-57.5). Η παρακολούθηση των ασθενών συνεχίστηκε μέσω τηλεφωνικών συνεντεύξεων στους 1, 3 και 6 μήνες μετα-τραυματικά, οπότε ρωτήθηκαν εάν εμφάνισαν οποιοδήποτε από τα κοινά μεταδιασεισικά συμπτώματα (ICD-10 κριτήρια). Αποτελέσματα: Το ποσοστό του μεταδιασεισικού συνδρόμου στο τέλος του πρώτου, του τρίτου και του έκτου μήνα μετά τον τραυματισμό υπολογίστηκε σε 10,3%, 6%, και 0,9%, αντίστοιχα, δηλαδή 4-8 φορές μικρότερο σε σχέση με τις άλλες μελέτες. Το μεταδιασεισικό σύνδρομο βρέθηκε να είναι συχνότερο μεταξύ των γυναικών (17%) και μεταξύ των ατόμων με αιμορραγική διάθεση (26%), σε σύγκριση με τους άνδρες και τους ασθενείς χωρίς διαταραχές πήξεως, αντίστοιχα. Επιπλέον, το μεταδιασεισικό σύνδρομο παρατηρήθηκε σε υψηλότερα ποσοστά σε ανθρώπους που υπέστησαν επίθεση ή κακοποίηση, σε σύγκριση με άλλου είδους ατυχήματα καθώς και σε ασθενείς με μετατραυματική ανοσμία. . Συμπεράσματα: Τα αποτελέσματά μας βρίσκονται σε αντίθεση με προηγούμενες μελέτες άλλων ανεπτυγμένων χωρών, όπου η συχνότητα εμφάνισης του μεταδιασεισικού συνδρόμου ήταν αξιοσημείωτα υψηλή. Οι πολιτιστικές διαφορές όσον αφορά στα προσδοκώμενα συμπτώματα μετά την κάκωση, οι διαφορές στο νομικό πλαίσιο και το ασφαλιστικό καθεστώς μεταξύ των χωρών και η έλλειψη αξίωσης αποζημίωσης, θα μπορούσαν να εξηγήσουν το χαμηλό ποσοστό των χρόνιων συμπτωμάτων στους Έλληνες. Από όσο είμαστε σε θέση να γνωρίζουμε, αυτή είναι η πρώτη προοπτική μελέτη για τον καθορισμό της επίπτωσης του μεταδιασεισικού συνδρόμου σε Έλληνες ενήλικες και η πρώτη που καταγράφει δημογραφικά στοιχεία και παραμέτρους που να αφορούν αποκλειστικά στις ελαφρές κρανιοεγκεφαλικές κακώσεις. Τα συμπεράσματα αυτά , εάν επιβεβαιωθούν από μεγαλύτερες σειρές, θα μπορούσαν να εγείρουν ερωτήματα , όπως π.χ. ποιοι ασθενείς πάσχουν πραγματικά και εάν θα μπορούσε να αποφευχθεί η απουσία τους από την εργασία, μιας και το κόστος της χαμένης παραγωγικότητας λόγω του μεταδιασεισικού συνδρόμου στις ανεπτυγμένες χώρες φαίνεται να είναι ιδιαίτερα υψηλό. / The prevalence of postconcussion syndrome following mild traumatic brain injury in developed countries varies from 40% to 80% during the first weeks after injury. However, as many as 50% of patients report symptoms for up to 3 months and 10-15% of them for more than a year. Mild head injuries and postconcussion syndrome represent a very serious public health issue, as estimates of occupational disability range from 12% at 2 months to 20% at 1 year, with severe concomitant social and financial impact. The objective of this study is to determine the characteristics and estimate the prevalence of postconcussion syndrome in an adult Greek population and to reveal demographics and injury characteristics concerning exclusively mild head injuries in the same cohort. Material-Methods: This prospective study was undertaken in the University Hospital of Patras in Western Greece. Recruitment of patients with mild traumatic brain injury began on May 2006 and finished on May 2008. Five hundred and thirty nine patients (539) with mild head injury were randomly recruited. Overall, 223 patients (223/539: 41,5%) (male 63% and female 37%) met the inclusion criteria of the ΄΄Colorado Medical Society Guidelines΄΄ for concussion, with median age 30 years (range: 18.5-57.5). The patients had a follow-up through telephone interviews at 1, 3 and 6 months post-injury and were asked about having any of the common postconcussion symptoms (ICD-10 criteria). Results: The rate of postconcussion syndrome at the end of the first, third and sixth month post-injury, was estimated at 10.3%, 6%, and 0.9%, respectively, which was 4-8 time less than other studies. Postconcussion syndrome was found to be more frequent among women (17%) and among individuals with bleeding diathesis (26%), compared with men and patients without clotting disorders, respectively. In addition, postconcussion syndrome affected in higher rates people who sustained assaults in comparison with other types of accident and was also more frequent among patients with posttraumatic anosmia. Conclusions: Our results are in contrast with previous studies in other developed countries, where the prevalence of the postconcussion syndrome was remarkably higher. The cultural differences regarding symptom expectation and the lack of compensation might explain the low rate of chronic symptoms in Greeks. To our knowledge, this is the first prospective study to estimate the prevalence of postconcussion syndrome among Greek adults and also the first trial in recording demographics and injury characteristics concerning exclusively mild head injuries in the same cohort. If further studies confirm our results in the future, reasonable queries could emerge, such as which patients really do suffer and whether their absence from work could have been avoided, as the cost of the lost productive work time after mild head injuries is extremely high.

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No. of bitstreams: 1 GARCIA_Uanderson_2017.pdf: 25453924 bytes, checksum: 4c34f46362e91f9eb2f88106f805d7f3 (MD5) Previous issue date: 2017-03-14 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / This work covers the investigation and synthesis of nanometric structures of Porous Anodic Alumina PAA, produced from low purity substrates, in aim to obtain selfsustained membranes. The Hard Anodization (HA) and Mild Anodization (MA) processes were used under special conditions through those found in literature. The analyses of results were based in comparing the AAP produced under the same conditions except the applied potential that was different depending on the MA or HA. HA process had its time halved in order to investigate the oxide growth rate and to calibrate the conditions of anodized membrane synthesis over the glass samples. This work also covers the construction of a resistive thermal evaporation PVD system capable of evaporating metals with melting points below 800°C. Through the deposition of successive layers it was possible to obtain metallic films of aluminum with thicknesses above 10 µm, enabling conditions of synthesis of porous anodic alumina on substrates produced by thermal resistive evaporation. The result of membrane synthesis on low purity aluminum substrates was complement to the synthesis of membranes obtained in aluminum evaporated in glass substrates, since the thickness of each deposited film is low if compared to the thickness of the AAP layer. Therefore, it was necessary to make several Al depositions on the same samples, to obtain an aluminum film that was able to support an oxide layer of anodic alumina and with the same characteristics of those obtained by the process of MA. All anodized samples were characterized by scanning electron microscopy, including samples made from metalized aluminum. The micrography obtained from the low purity aluminum membranes were treated by ImageJ software allowing the morphological analysis. AAP membranes obtained from technical Al substrate depicted the formation of branched pore channels, a result of instabilities in applied electric field during Anodization and presence of different alloying elements in the Al substrate. The metalized aluminum film had a larger thickness in the samples positioned in the middle of the sample holder possibly due to different temperature gradients of filament depending on the position of Al pellets. / Este trabalho aborda a síntese e investigação de estruturas nanométricas de Alumina Anódica Porosa AAP produzidas a partir de substratos de baixa pureza, com a finalidade da obtenção de membranas auto-suportadas. Foram utilizados os processos de Hard Anodization (HA) e Mild Anodization (MA). Para efeito comparativo entre os processos foram mantidas todas as condições variando apenas o potencial aplicado. Posteriormente para HA o tempo experimental foi reduzido pela metade a fim de investigar a velocidade no crescimento do óxido e condições de anodização de membranas sobre as amostras de vidro. Este trabalho também abrange a construção de um sistema Phisical Vapor Deposition (PVD) por evaporação térmica resistiva, capaz de evaporar metais com pontos de fusão abaixo de 800°C. Através da deposição de sucessivas camadas foi possível a obtenção de filmes metálicos de Alumínio com espessuras acima de 10 µm, possibilitando condições de síntese de alumina anódica porosa sobre substratos produzidos por evaporação térmica resistiva. O resultado da síntese de membranas em substratos de Al de baixa pureza foi complementar à síntese das membranas obtidas em alumínio evaporado em substratos de vidro, pois a espessura de cada filme depositado é baixa se comparados a espessura da camada de AAP. Portanto, houve a necessidade de várias deposições sobre as mesmas amostras, para se obter o filme de alumínio que fosse capaz de suportar uma camada de alumina anódica porosa resistente e que se aproximasse das características das obtidas pelo processo de MA. Todas as amostras anodizadas foram caracterizadas por microscopia eletrônica de varredura, inclusive as amostras produzidas a partir do alumínio metalizado. As micrografias obtidas a partir das membranas de alumínio de baixa pureza foram tratadas pelo software ImageJ, possibilitando a análise morfológica das mesmas. As membranas de AAP de baixa pureza possuem poros com ramificações transversais, são provocadas pelos desvios do campo elétrico aplicado, além da possibilidade de formação de outros tipos de óxidos. O filme de alumínio metalizado teve maior espessura nas amostras posicionadas na parte central do porta amostra, isso pode estar relacionado com o aquecimento do filamento que ocorre da região central para as extremidades. / 2010/10813-0

Objective: The long-term cognitive effects of mild traumatic brain injury (MTBI) and sport-related concussion (SRC) are not always clear. Higher-level longer-term cognitive difficulties can indicate enduring neurological damage, as part of a post-concussion syndrome (PCS). This study aimed to investigate whether cognitive performance and self-reported PCS symptoms of athletes (rugby players) relate to SRC and whether gender moderates these effects. Method: Eighty-six participants completed a questionnaire detailing SRC history (frequency and severity) and rated long-term symptoms using the Sport Concussion Assessment Tool 3 (SCAT3) symptom evaluation scales, before completing the CogState Brief Battery and STOP-IT (stop-signal response inhibition task). Results: No significant relationships between SRC dosage (frequency/severity), self-reported PCS symptoms, and cognitive test performance were identified. A greater proportion of males reported SRC compared to females, but no effect of gender was found on any of the cognitive outcome measures or self-reports of PCS symptoms. Conclusions: The results show that SRC has no observable long-term effects on cognitive test performance or PCS symptom self-reports. The analysis may have lacked power to detect effects. Analysis of individual performance over time against baseline scores may be more relevant for accurate diagnosis than relying on normative test scores. Recommendations for future research were made.

This research focuses on the experiences of primary school teachers in providing learning support for learners with mild intellectual disabilities. In South Africa, most learners attend in mainstream schools. Mainstream schools are expected to support learners inclusively. However, most teachers seem challenged to address the learning needs such as those experienced by learners with mild intellectual disabilities. The research was conducted by means of interviews with selected participants over a period of approximately four months. Data was also obtained through the analysis of records such as learners‘ workbooks, test books, support forms used by teachers to record their observation and field notes which were reflected in a journal. Interviews and transcriptions were typed out verbatim. The research produced a number of key findings and concluded that many teachers lack sufficient training to identify and address barriers to learning, especially those with mild intellectual disabilities. Furthermore, the study revealed that support structures at participating research schools seem to be non-functional, and guidance and assistance from the Department of Education is minimal. The findings were used to propose recommendations that could be used by primary school teachers to support learners with mild intellectual disabilities in mainstream schools. / Inclusive Education / M. Ed. (Inclusive Education)

No description available.

No description available.

Retinal nerve fiber layer measurement in patients with Alzheimer's disease The current ophthalmologist's possibilities in diagnostics of Alzheimer's disease Alzheimer disease (AD) is the most common cause of dementia syndrome and mild cognitive impairment. To enroll the disease most securely there are used so called biomarkers using evidence of changed brain metabolism by pozitron emission tomography (PET) and in cerebrospinal fluid or the brain's structure magnetic resonance imaging (MRI). These methods are expensive, organisationally and temporally challenging and burdening for the patients. According to that reasons we are still seeking for alternative attitudes suitable for early diagnosis. The evaluation of thickness of retinal nerve fiber layer (RNFL) which is well accessible to examination through optical aparatus of the eye could be one of the options. The aim of our work was to present current knowledges about Alzheimer's disease targeting relations of Alzheimer's disease and an ophthalmological finding. In the next part of this paper we introduce the retinal nerve fiber layer measurement by optical coherence tomography (OCT) as a potential diagnostics method by screening of patients with Alzheimer's disease and to present our results measured in our cohort of patients. The studied cohort...

The thesis focuses on dynamic evaluation of younger pupils with mild mental retardation by application of a Visual Perception Test, which evaluates certain areas of sight perception. It is an alternative diagnostic method focused on rational intervention, which applies diagnostically obtained findings and results in search for adequate assistance and support of the particular pupil. In the theoretical section, the text focuses on pupils with mild mental retardation, their specific features and education. It introduces basic findings on dynamic diagnostics and dynamic approach and its application in support of pupils with reduced intellect. In the empirical section, the research seeks to verify whether the test, which evaluates selected aspects of sight perception, is a suitable tool for dynamic examination of children with mild mental disabilities and whether and in what form of intervention, the pupils who have been included in the research project experience different results in the pre-test and post-test. Based on the detected results, the Visual Perception Test appears to be a very effective tool in dynamic diagnostics for individuals with mild mental retardation. In the conclusion and the recommendations, the work presents the detected suitable forms of intervention for each particular pupil.

Les hydrogénases ont été identifiées comme des protéines clé de la corrosion induite par les microorganismes (CIM) mais leur réel impact est encore sujet à controverses. Bien qu’elles soient présentes dans la plupart des microorganismes impliqués dans la biocorrosion anaérobie, leur participation dans un transfert électronique direct a rarement été démontrée. L’objectif de ce travail est d’étudier l’influence de l’hydrogénase sur la corrosion anaérobie de l’acier en approfondissant la compréhension des phénomènes interfaciaux qui régissent son action. Il s’agit en particulier d’étudier l’incidence des centres Fe-S présents dans la protéine et qui s’étaient révélés être des acteurs majeurs lors de précédents travaux au LGC. Pour cela, différents types d’hydrogénases ont été conçus, élaborés en collaboration avec l’équipe EAD3 du LISBP, INSA Toulouse, et étudiés : la native et des mutants possédant un nombre plus ou moins important de centres Fe-S. Dans un premier temps, le choix des matériaux a été réalisé sur la base des résultats de caractérisation et d’étude du comportement électrochimique dans le milieu Tris-HCl. L’acier doux S235JR a été choisi car c’est le matériau le plus réactif pour mettre en évidence l’influence de l’hydrogénase. Par la suite, les premières études en présence de divers types d’hydrogénases (native et mutants) ont révélé que la présence de certaines molécules additionnelles dans le milieu de purification ne permet pas d’obtenir un saut du potentiel d’abandon et une vitesse de corrosion exclusivement liés aux enzymes. Le protocole de purification des enzymes a donc été optimisé pour permettre un meilleur rendement de purification avec une activité enzymatique haute, tout en ayant le moins possible d’impact sur les signaux électrochimiques. Enfin, l’utilisation d’un sac de dialyse pour concentrer l’hydrogénase au voisinage de l’électrode de travail a permis d’exacerber l’effet de l’enzyme : une augmentation du potentiel d’abandon ainsi que de la vitesse de corrosion a été observée. La spectroscopie d’impédance couplée à des analyses de surface a également confirmé le fort pouvoir corrosif de l’hydrogénase. En outre, les électrolyses réalisées à potentiel cathodique ont mis en évidence la catalyse de la réaction de réduction par transfert électronique direct entre l’hydrogénase et la surface de l’acier. Le moteur responsable de la prise d’électrons est le centre catalytique de l’enzyme, les centres Fe-S jouant seulement un rôle de transfert des électrons au sein de la protéine. / Hydrogenases have been identified as key proteins in microbially induced corrosion (MIC) phenomena but their real impact is still a controversial issue. Even though they are present in most of the microorganisms involved in anaerobic biocorrosion, their participation in a direct electron transfer mechanism has rarely been demonstrated. The purpose of the present work is to study the influence of hydrogenase on the anaerobic corrosion of steel by deepening the understanding of interfacial phenomena governing its action. The study is particularly focusing on the effect of Fe-S clusters, which had proved to be major players in earlier work at LGC. To achieve this, different types of hydrogenases were designed, developed in collaboration with the EAD3 team of LIBP, INSA Toulouse, and studied: the native and mutants, containing a higher or lower number of Fe-S. First, the material choice was carried out on the base of the characterization results and electrochemical behavior study in TrisHCl medium. The S235JR mild steel was chosen since it is the more reactive material to highlight the influence of hydrogenase. Thereafter, the first studies in presence of various types of hydrogenases (native and mutants) have revealed that the presence of additional molecules in the purification medium does not permit to get an open-circuit potential jump and a corrosion rate that could be attributed solely to enzymes. The enzyme purification protocol has been then optimized to simultaneously allow a better purification performance with a high enzymatic activity and a lower impact on electrochemical signals. Finally, the use of a dialysis bag to concentrate hydrogenase in the close vicinity of the working electrode led to the exacerbation of the enzyme effect: an open-circuit potential ennoblement as well as a corrosion rate increase were observed. Impedance spectroscopy coupled with surface analysis also confirmed the strong corrosiveness of hydrogenase. Electrolysis performed at a cathodic potential brought to light the catalysis of the reduction reaction that occurred by direct electronic transfer between the hydrogenase and the steel surface. The driving force of the electron uptake is the catalytic center of the enzyme, the Fe-S clusters only acting in the electron transfer within the protein.