Question: Can Respiratory therapy alter the lung mechanics in patients with invasive mechanical ventilation? The data available in the literature remain controversial. This study aims to assess the changes of pulmonary mechanics in patients with invasive mechanical ventilation, comparing hemodynamic and ventilatory parameters one hour prior to application of the service, immediately after and one hour after the service. Design: Participants: Patients on mechanical ventilation for at least 48 hours with oro-tracheal tube. Intervention: Patients underwent a protocol of respiratory therapy and hemodynamic variables were recorded at different times. Outcome measures: The following variables were measured one hour before, immediately after and one hour after application of the protocol of respiratory therapy. Dynamic lung compliance (Cdyn), respiratory system resistance (Rsr), Tidal Volume (Vt), Positive End Expiratory Pressure (PEEP), Peak inspiratory pressure (PIP), Heart Rate (HR), Respiratory frequency (RF), and Saturation peripheral oxygen (SpO2). Results: The variables obtained the following mean and standard deviation: HR 88.9 ± 18.7 an hour before the service, presented an increase to 93.7 ± 19.2 immediately after the service, which fell one hour after the service, 88.5 ± 17.1. So we can conclude that heart rate showed an increase after treatment of respiratory therapy and one hour after this variable had a value less than the obtained in the beginning. SpO2 96.5 ± 2.29 one hour before the service, with an increase to 98.2 ± 1.62 immediately after the service, and a slight decrease to 97.8 ± 1.79 one hour after the service. We can conclude that the oxygen saturation showed a significant improvement one hour after the service, not returning to the value obtained one hour before the service. RF 20.8 ± 5.40 one hour before the service, increasing to 21.9 ± 5.89 immediately after the service and presenting a decrease of 19.4 ± 1.79 one hour after the service, when compared to one hour before the service. Rsr 14.2 ± 4.63 one hour before the service, down immediately after the service 11.0 ± 3.43 and a small increase one hour after the service, but did not return to baseline. Vt 550± 134 one hour before the service, increasing significantly to 698 ± 155 and presenting a decrease 672 ± 146, although it remained higher than the value obtained one hour before the service. PIP 22.2 ± 5.54 one hour before the service, with a slowdown that does not differ from the Bonferroni test with the value immediately after the service, and decreased to 21.5 ± 5.24, when compared with the previous two times . Cdyn 52.3 ± 16.1 one hour before the service, increased significantly immediately after the service 65.1 ± 19.1 and decreased to 64.7 ± 20.2 one hour after the service, with no significant difference if compared to the second time, and significant difference if compared with the first time. Peep 5.93 ± 1.80 one hour before the service, 5.89 ± 1.71 immediately after the service and 5.91 ± 1.70 one hour after the service. This was the only variable that showed no significant difference in any of the times compared. In Conclusion: The variables HR, SpO2, RF, Rsr, Vt and Cdyn obtained significance p < 0,01.Variable PIP gained significance with p <0, 013.

Question: Can Respiratory therapy alter the lung mechanics in patients with invasive mechanical ventilation? The data available in the literature remain controversial. This study aims to assess the changes of pulmonary mechanics in patients with invasive mechanical ventilation, comparing hemodynamic and ventilatory parameters one hour prior to application of the service, immediately after and one hour after the service. Design: Participants: Patients on mechanical ventilation for at least 48 hours with oro-tracheal tube. Intervention: Patients underwent a protocol of respiratory therapy and hemodynamic variables were recorded at different times. Outcome measures: The following variables were measured one hour before, immediately after and one hour after application of the protocol of respiratory therapy. Dynamic lung compliance (Cdyn), respiratory system resistance (Rsr), Tidal Volume (Vt), Positive End Expiratory Pressure (PEEP), Peak inspiratory pressure (PIP), Heart Rate (HR), Respiratory frequency (RF), and Saturation peripheral oxygen (SpO2). Results: The variables obtained the following mean and standard deviation: HR 88.9 ± 18.7 an hour before the service, presented an increase to 93.7 ± 19.2 immediately after the service, which fell one hour after the service, 88.5 ± 17.1. So we can conclude that heart rate showed an increase after treatment of respiratory therapy and one hour after this variable had a value less than the obtained in the beginning. SpO2 96.5 ± 2.29 one hour before the service, with an increase to 98.2 ± 1.62 immediately after the service, and a slight decrease to 97.8 ± 1.79 one hour after the service. We can conclude that the oxygen saturation showed a significant improvement one hour after the service, not returning to the value obtained one hour before the service. RF 20.8 ± 5.40 one hour before the service, increasing to 21.9 ± 5.89 immediately after the service and presenting a decrease of 19.4 ± 1.79 one hour after the service, when compared to one hour before the service. Rsr 14.2 ± 4.63 one hour before the service, down immediately after the service 11.0 ± 3.43 and a small increase one hour after the service, but did not return to baseline. Vt 550± 134 one hour before the service, increasing significantly to 698 ± 155 and presenting a decrease 672 ± 146, although it remained higher than the value obtained one hour before the service. PIP 22.2 ± 5.54 one hour before the service, with a slowdown that does not differ from the Bonferroni test with the value immediately after the service, and decreased to 21.5 ± 5.24, when compared with the previous two times . Cdyn 52.3 ± 16.1 one hour before the service, increased significantly immediately after the service 65.1 ± 19.1 and decreased to 64.7 ± 20.2 one hour after the service, with no significant difference if compared to the second time, and significant difference if compared with the first time. Peep 5.93 ± 1.80 one hour before the service, 5.89 ± 1.71 immediately after the service and 5.91 ± 1.70 one hour after the service. This was the only variable that showed no significant difference in any of the times compared. In Conclusion: The variables HR, SpO2, RF, Rsr, Vt and Cdyn obtained significance p < 0,01.Variable PIP gained significance with p <0, 013.

Question: Can Respiratory therapy alter the lung mechanics in patients with invasive mechanical ventilation? The data available in the literature remain controversial. This study aims to assess the changes of pulmonary mechanics in patients with invasive mechanical ventilation, comparing hemodynamic and ventilatory parameters one hour prior to application of the service, immediately after and one hour after the service. Design: Participants: Patients on mechanical ventilation for at least 48 hours with oro-tracheal tube. Intervention: Patients underwent a protocol of respiratory therapy and hemodynamic variables were recorded at different times. Outcome measures: The following variables were measured one hour before, immediately after and one hour after application of the protocol of respiratory therapy. Dynamic lung compliance (Cdyn), respiratory system resistance (Rsr), Tidal Volume (Vt), Positive End Expiratory Pressure (PEEP), Peak inspiratory pressure (PIP), Heart Rate (HR), Respiratory frequency (RF), and Saturation peripheral oxygen (SpO2). Results: The variables obtained the following mean and standard deviation: HR 88.9 ± 18.7 an hour before the service, presented an increase to 93.7 ± 19.2 immediately after the service, which fell one hour after the service, 88.5 ± 17.1. So we can conclude that heart rate showed an increase after treatment of respiratory therapy and one hour after this variable had a value less than the obtained in the beginning. SpO2 96.5 ± 2.29 one hour before the service, with an increase to 98.2 ± 1.62 immediately after the service, and a slight decrease to 97.8 ± 1.79 one hour after the service. We can conclude that the oxygen saturation showed a significant improvement one hour after the service, not returning to the value obtained one hour before the service. RF 20.8 ± 5.40 one hour before the service, increasing to 21.9 ± 5.89 immediately after the service and presenting a decrease of 19.4 ± 1.79 one hour after the service, when compared to one hour before the service. Rsr 14.2 ± 4.63 one hour before the service, down immediately after the service 11.0 ± 3.43 and a small increase one hour after the service, but did not return to baseline. Vt 550± 134 one hour before the service, increasing significantly to 698 ± 155 and presenting a decrease 672 ± 146, although it remained higher than the value obtained one hour before the service. PIP 22.2 ± 5.54 one hour before the service, with a slowdown that does not differ from the Bonferroni test with the value immediately after the service, and decreased to 21.5 ± 5.24, when compared with the previous two times . Cdyn 52.3 ± 16.1 one hour before the service, increased significantly immediately after the service 65.1 ± 19.1 and decreased to 64.7 ± 20.2 one hour after the service, with no significant difference if compared to the second time, and significant difference if compared with the first time. Peep 5.93 ± 1.80 one hour before the service, 5.89 ± 1.71 immediately after the service and 5.91 ± 1.70 one hour after the service. This was the only variable that showed no significant difference in any of the times compared. In Conclusion: The variables HR, SpO2, RF, Rsr, Vt and Cdyn obtained significance p < 0,01.Variable PIP gained significance with p <0, 013.

La tesis aborda como problema de investigación si existen diferencias académicamente significativas en el rendimiento académico en los cursos de formación humanística de los ingresantes a una Escuela Superior de Formación Superior del Sector Público bajo dos modalidades de admisión interna y externa. Para responder a esta interrogante se ha efectuado una investigación de tipo descriptivo-comparativo, con diseño ex post facto. La presente investigación efectuó una recopilación de información de los registros académicos existente en la Escuela de Formación Superior del sector público, en particular del Cuadro de Notas Promedio Final de todas las asignaturas que cursan los ingresantes por semestre académico así como de las actas de promedio final de los cursos de formación humanística. La población de estudio estuvo constituida por 148 ingresantes por admisión interna y externa y la muestra de estudio fue censal abarcando a toda la población señalada. El estudio encontró que el rendimiento académico de los ingresantes a una Escuela de Formación Superior del Sector Público indica que se presentan diferencias académicamente significativas bajo diferentes modalidades del proceso de admisión tanto en el rendimiento académico integral como en el de los cursos de formación humanística. El rendimiento académico de los ingresantes es mayor en los que ingresaron por la modalidad interna de admisión que en aquellos que ingresaron por la modalidad externa.

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Este trabalho aborda o intercâmbio comercial do Brasil na América do Sul por meio dos seus aspectos de qualidade, intensidade e das modalidades de transportes utilizadas. Emprega uma metodologia de avaliação da competitividade do comércio, valendo-se dos conceitos de valor agregado, dinâmica e intensidade tecnológica dos produtos comercializados. Com os resultados desta aplicação, observa o caráter da participação do Brasil no intercâmbio comercial do subcontinente. Em seguida, a dissertação avalia alternativas logísticas para a superação das limitações de transporte internacional de cargas na região amazônica, como forma de incrementar a competitividade, o comércio e a integração regionais. / Este trabajo aborda las características del intercambio comercial de Brasil en la América del Sur, por medio de sus aspectos de calidad, intensidad y de las modalidades de transporte utilizadas. Aplica una metodología de evaluación de competitividad del comercio; valiendo-se de los conceptos de valor agregado, dinámica y intensidad de los productos comercializados. Como resultados de esta aplicación, observa el carácter de la participación de Brasil en el intercambio comercial del subcontinente. En seguida la disertación evalúa alternativas logísticas para la superación de las limitaciones de transporte internacional de cargas en la región Amazónica, como forma de promover la competitividad, el comercio y la integración regionales.

Las investigaciones arqueológicas realizadas en el marco de esta tesis, estuvieron orientadas a comprender las actividades y procesos vinculados con la extracción de rocas por parte de los grupos cazadores y recolectores pampeanos durante épocas pasadas. Para ello los focos de análisis más específicos fueron los sitios de obtención de materias primas líticas (canteras y talleres), en especial aquellos en que se explotaron unas de las rocas más ampliamente utilizadas en el contexto regional pampeano: las ortocuarcitas del grupo Sierras Bayas. El área de estudio para llevar adelante dichas tareas arqueológicas fue el sector central de Tandilia, delimitado por las poblaciones de Barker y San Manuel. En esta investigación el problema de estudio fue abordado desde distintas perspectivas complementarias. Asi, en el capítulo 3 se desarrolló un análisis detallado de la bibliografía específica sobre diversos contextos de extracción de rocas en distintos lugares del mundo, con especial énfasis en los casos arqueológicos de canteras y talleres y los estudios etnoarqueológicos sobre el tema. Finalmente se realizó un análisis comparativo de las publicaciones existentes en el ámbito nacional sobre el aprovisionamiento de materias primas líticas. En base a las conclusiones obtenidas en dicho análisis, en el capítulo 4 se formuló una propuesta de clasificación y definición de ciertos conceptos teóricos de interés, los que remiten al proceso de obtención de rocas (por ejemplo aprovisionamiento, extracción, recolección, suministro y reserva) y a los lugares donde esto ocurre (tales como los afloramientos, canteras, canteras potenciales y minas). Por otra parte, en el capitulo 5 se presenta el diseño metodológico elaborado para llevar adelante las tareas de campo. Este permitió organizar las actividades en función de la gran extensión del área de estudio. Asimismo en dicho diseño se contempló la aplicación de métodos y técnicas especiales tanto para las etapas de prospección como de excavación, en función de las características particulares de los sitios (por ejemplo gran extensión y volumen de desechos líticos, tanto en superficie como en estratigrafía). El resultado fue una metodología de campo que posibilitó abordar las actividades en tres etapas de crecientes detalle sobre el terreno, las que incluyeron dos momentos de prospecciones y uno de trabajos específicos sobre sitios particulares. En el capitulo 6 y 7 se detallan los resultados las tareas de campo realizadas, las que constituyen el cuerpo principal de información de esta tesis. Entre ellas se destacan las prospecciones en vehículo y a pie a lo largo de amplios sectores del área de estudio, así como también las excavaciones realizadas en contextos específicos de obtención de rocas. A partir de estos trabajos se caracterizaron una gran cantidad de sitios arqueológicos, se registraron distintas modalidades de obtención de rocas, se recolectaron y excavaron diversos artefactos diagnósticos y se obtuvieron fechados radiocarbónicos para algunos de dichos sitios. Los materiales arqueológicos obtenidos durante las tareas de campo son analizados en el capitulo 8. En este apartado se describen e interpretan los artefactos líticos recolectados en superficie en los sitios de obtención de materias primas relevados, así como en otros contextos de superficie dispuestos sobre la llanura inmediatamente aledaña a las elevaciones serranas. Finalmente se analizan los materiales óseos y líticos obtenidos mediante excavación en los sitios La Esperanza y El Picadero, ambos ubicados en la zona de la Numancia (Pdo. de Tandil). La última vía de análisis se llevó a cabo a partir del abordaje experimental, descripto en el capitulo 9. Para ello se realizaron dos experiencias, una de reducción de clastos y otra de fragmentación de grandes bloques de piedra. En ambos casos se testearon técnicas, gestos y herramientas posibles para llevar a la práctica tales actividades, en función de las observaciones hechas sobre las fuentes etnoarqueológicas y los registros tomados en los trabajos de campo y el análisis de los materiales. Finalmente en el capitulo 10 se integran los datos obtenidos durante esta investigación con las propuestas existentes para explicar la organización social de los cazadores y recolectores pampeanos en relación a los recursos líticos, los territorios que los contienen y las redes de interacción social planteadas a lo largo del Holoceno.

Made available in DSpace on 2015-07-22T20:50:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-31 / Objetivo: Avaliar a efetividade e segurança do treinamento proprioceptivo na melhora da capacidade funcional em pacientes com artrite reumatóide. Métodos: Revisão Sistemática utilizando a metodologia da Colaboração Cochrane. Estratégia de busca: As bases pesquisadas foram: Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE (1966 to 2008) via PubMed, EMBASE (1980 to 2008), LILACS (1982 to 2008), CINAHL (1982 to 2008), PEDro e Scirus. Também realizamos busca manual em anais de congressos, listas de referências de artigos publicados e contatos com especialistas. Não houve restrição de idioma. Critérios de Seleção: ensaios clínicos randomizados ou ensaios clínicos controlados comparando o treinamento proprioceptivo com alguma outra intervenção ou com nenhuma intervenção, em pacientes com artrite reumatóide, de acordo com os critérios do Colégio Americano de Reumatologia (ACR).de 1987 Coleta de dados e análise: Dois revisores independentemente avaliaram títulos e/ou resumos para critérios de inclusão e para risco de viés. Resultados: A pesquisa eletrônica identificou 864 estudos. Para esta busca, 17 estudos descreveram exercícios gerais em pacientes com artrite reumatóide como o principal tópico. Após analisá-los, observamos que o principal desfecho foi a melhora na força muscular, resistência, e exercícios dinâmicos (natação, caminhada, etc). Portanto nós não encontramos nenhum estudo investigando os efeitos do treinamento proprioceptivo isolado em pacientes com artrite reumatóide, não foi possível incluir nenhum dado em relação ao tópico escolhido em nossa revisão sistemática. Conclusão: Não houve nenhum estudo disponível avaliando a eficácia do treinamento proprioceptivo em pacientes com artrite reumatóide. A efetividade e segurança do treinamento proprioceptivo em melhorar a capacidade funcional destes pacientes permanece desconhecido. / Objective: To assess the effectiveness and safety of balance training (proprioceptive training) to improve functional capacity in patients with rheumatoid arthritis. Methods: Systematic review with Cochrane methodology. Search strategy: Databases Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE (1966 to 2008) via PubMed, EMBASE (1980 to 2008), LILACS (1982 to 2008), CINAHL (1982 to 2008), PEDro e Scirus. We also carried out a handsearching and contact professional associates of the eligible studies when necessary. There was no language restriction. Selection criteria: All eligible randomised controlled trials or controlled clinical trials comparing balance training (proprioceptive training) with any other intervention or with no intervention, in patients with rheumatoid arthritis of according to the 1987 American College of Rheumatology (ACR) criteria. Data collection e analysis: Two reviewers independently assessed titles and/or abstracts for inclusion criteria and for risk of bias. Results: The electronic search identified 864 studies. From this search, 17 studies described general exercises in rheumatoid arthritis patients as the main topic. After analysing them, we observed that the main outcomes were improvement in muscle strength, endurance, and dynamic exercises (swimming, walking, etc). As we did not find any studies investigating the effects of proprioceptive training alone in patients with rheumatoid arthritis, it was not possible to include any data regarding the chosen topic in our systematic review. Conclusion: There is no research available examining the efficacy of balance training in patients with rheumatoid arthritis. The effectiveness and safety of balance training to improve functional capacity of these patients remains unclear, however, it is suggested that future research should give more importance to the balance training by either increasing the number and duration of sessions or investigating its efficacy alone. / TEDE / BV UNIFESP: Teses e dissertações