Transtorno do Estresse Pós-Traumático e alterações lipídicas

O transtorno do estresse pós-traumático (TEPT) e alterações lipídicas são as temáticas principais dessa Dissertação. Seu objetivo principal foi investigar a associação entre o TEPT e as concentrações séricas de colesterol total (CT), lipoproteína de baixa densidade (LDL), lipoproteína de alta densidade (HDL) e triglicerídeos (TG) através de uma revisão sistemática da literatura seguida de metanálise. Adicionalmente, a relação entre essas variáveis lipídicas e os grupos de sintomas do TEPT revivescência, esquiva/entorpecimento emocional e hiperestimulação autonômica foi avaliada em um segundo estudo com dados primários. A metanálise incluiu 18 artigos, totalizando 2.110 indivíduos com TEPT e 17.550 indivíduos sem TEPT. As diferenças de médias ponderadas (DMP) mg/dL dos parâmetros lipídicos foram calculadas por modelos de efeitos aleatórios e modelos de meta-regressão foram ajustados para investigar possíveis fontes de heterogeneidade. O estudo encontrou que o TEPT foi associado a um pior perfil lipídico quando comparados a controles sem o transtorno (DMPCT= 20,57, IC 95% 12,21 28,93; DMPLDL= 12,11, IC 95% 5,89 18,32; DMPHDL= -3,73, IC 95% -5,97 -1,49; DMPTG= 35,87, IC 95% 21,12 50,61). A heterogeneidade estatística entre os resultados dos estudos foi alta para todos os parâmetros lipídicos e a variável que mais pareceu explicar essas inconsistências foi idade. O segundo artigo faz parte de um estudo maior conduzido em 2004 com 157 policiais do sexo masculino do Batalhão de Choque da Polícia Militar do Estado de Goiás (BPMCHOQUE). Somente oficiais de férias ou em dispensa inclusive dispensa médica não foram avaliados. O instrumento utilizado para o rastreio do TEPT foi a versão em português para civis da Post-Traumatic Stress Disorder Checklist (PCL-C). Trinta e nove participantes (25%) foram excluídos do estudo: dois porque falharam no preenchimento dos questionários e 37 cujas amostras de sangue não foram coletadas por vários motivos. Neste trabalho, encontrou-se uma forte correlação positiva entre as concentrações séricas de CT e LDL com o grupo de sintomas de hiperestimulação autonômica, somente no grupo TEPT: ρ= 0,89 (p<0,01) e ρ =0,92 (p<0,01), respectivamente. Em suma, espera-se que os resultados dessa Dissertação possam colaborar para o estabelecimento de um melhor acompanhamento clínico de pacientes com TEPT, particularmente porque estes parecem estar sob um maior risco de doenças cardiovasculares devido a um pior perfil lipídico.

Saúde do trabalhador e atenção ao servidor público: estudo exploratório de afastamentos por doença em universidade pública no Rio de Janeiro

A investigação realizada, cujos resultados são expostos nessa dissertação, é voltada para os afastamentos por doença entre servidores de uma universidade pública federal sediada no Rio de Janeiro. Sua contribuição consiste em subsidiar o processo de produção de conhecimento acadêmico-científico quanto ao perfil sócio-ocupacional e de adoecimento de trabalhadores afastados por doença nesta universidade, nos anos de 2010 e 2011, e nos marcos de implementação do Subsistema Integrado de Atenção à Saúde do Servidor (SIASS). Contempla o tema a partir da perspectiva de integração das diferentes dimensões previstas pelo SIASS, a saber: perícia, assistência, promoção e vigilância à saúde. Tem como concepção a diretriz de investigação / intervenção, própria ao campo da Saúde do Trabalhador, podendo contribuir, com o conhecimento gerado, para a identificação de alternativas de intervenção nas ações do SIASS. A pesquisa se caracteriza como de natureza exploratória, apoiada em revisão teórico-bibliográfica e pesquisa documental de dados secundários.

室外自主移动机器人AMOR的导航技术

在非结构化环境,移动机器人行驶运动规划和自主导航是非常挑战性的问题。基于实时的动态栅格地图,提出了一个快速的而又实效的轨迹规划算法,实现机器人在室外环境的无碰撞运动导航。AMOR是自主研发的室外运动移动机器人,它在2007年欧洲C-ELROB大赛中赢得了野外自主侦察比赛的冠军。它装备了SICK的激光雷达,用来获取机器人运动前方的障碍物体信息,建立实时动态的环境地图。以A*框架为基础的改造算法,能够在众多的路径中快速地找到最佳的安全行驶路径,实现可靠的自主导航。所有的测试和比赛结果表明所提方案是可行的、有效的。

移动机器人激光测距仪性能综述

对当前移动机器人上常用的激光测距仪的性能研究进行了全面的总结。分析了检测SICK、Perceptron、Explorer等常用激光测距仪各方面特性的各种实验结果。根据影响激光测距仪测量性能的方式,把激光测距仪的时变特性、角度偏移、数据传输影响、混合象素现象、色度亮度干扰现象、辐射干扰现象等,分为内因和外因两大类进行了分类讨论。

Gestão construtiva de conflitos em contexto de saúde

Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para a obtenção do grau de Mestre em Psicologia, ramo de Psicologia Clínica e da Saúde

St. Columba, Silnán, and the 'Male Bovine' (VC 2.17)

At Vita Columbae VC 2.17, Adomnán has severely misunderstood a written source which originally described how Columba ordered one party to a dispute, an alleged maleficus ‘evil-doer’ called Silnán, to milk a sick cow in order to settle the dispute by demonstrating that its contaminated milk was the real, hidden cause of the harm which had occasioned the dispute. Adomnán misread a description of a bos maculosus ‘pock-marked bovine’ to refer to a bos masculus ‘male bovine’, and proceeded to misunderstand the story as the description of some form of contest between Columba and a maleficus ‘sorcerer’.

The Barretstown experience

The thesis was prompted by a simple clinical observation. Seriously ill children returning from Barretstown Holiday Camp appeared changed. Barretstown ‘magic’ confuses the issue but indicates real and clinically evident transformations. The project sought to understand the experience and place it in a recognisable framework. The data was collected by interviews, observations as camp Paediatrician, memberships of the Child Advisory Committee and the Association’s criteria assessment team, participation in volunteer training and visits to international camps. The research presents evidence that the concepts of rite of passage, graceful mimesis and salutogenesis clarify operative social processes. The passage stages of separation, transition and reaggregation can be identified. Passage rites reorder personal and social upsets to fresh arrangements that facilitate change. Interviews confirm the reordering impact of achievements in play activities. These are challenging experiences closely guided by their Masters of Ceremonies – the Caras. The Cara/camper relationship is crucial and compatible with Girard’s theory of external mimesis. Visits to four camps confirm an inspirational process in contrast to a reported camp with a predetermined formative influence. Charismatic Caras/Councillors inspire playful mimesis and salutogenic transformations. Health is more than correction of pathogenic deficits and restoration of homeostasis. Salutogenic health promotes heterostasis – a desire for optimal experiences underpinned by a sense of coherence and adequate resources. Some evidence is presented that children have an improved sense of coherence after camp, which enables them to cope better with the demands of ill health. The camps enable sick children to up regulate risk taking towards more heterostatic experiences rather than down regulate their expectations. The heterostatic impulse can explain the disability paradox of good quality of life in the presence of severe disability. The salutogenic power of Barretstown can trump the pathogenic effects of childhood cancer and other serious illnesses.

Neonatal EEG classification using atomic decomposition

The electroencephalogram (EEG) is an important noninvasive tool used in the neonatal intensive care unit (NICU) for the neurologic evaluation of the sick newborn infant. It provides an excellent assessment of at-risk newborns and formulates a prognosis for long-term neurologic outcome.The automated analysis of neonatal EEG data in the NICU can provide valuable information to the clinician facilitating medical intervention. The aim of this thesis is to develop a system for automatic classification of neonatal EEG which can be mainly divided into two parts: (1) classification of neonatal EEG seizure from nonseizure, and (2) classifying neonatal background EEG into several grades based on the severity of the injury using atomic decomposition. Atomic decomposition techniques use redundant time-frequency dictionaries for sparse signal representations or approximations. The first novel contribution of this thesis is the development of a novel time-frequency dictionary coherent with the neonatal EEG seizure states. This dictionary was able to track the time-varying nature of the EEG signal. It was shown that by using atomic decomposition and the proposed novel dictionary, the neonatal EEG transition from nonseizure to seizure states could be detected efficiently. The second novel contribution of this thesis is the development of a neonatal seizure detection algorithm using several time-frequency features from the proposed novel dictionary. It was shown that the time-frequency features obtained from the atoms in the novel dictionary improved the seizure detection accuracy when compared to that obtained from the raw EEG signal. With the assistance of a supervised multiclass SVM classifier and several timefrequency features, several methods to automatically grade EEG were explored. In summary, the novel techniques proposed in this thesis contribute to the application of advanced signal processing techniques for automatic assessment of neonatal EEG recordings.

Employment discrimination against transgender people and self-esteem.

The evocation of gender identity in company anti-discrimination policies is still very rare. This observation is also true forscientific studies. Very few researches have focused exclusively on transgender employees. Transgender are neither sick nor lesscompetent, and yet, the feeling of being strongly discriminated is shared by many transgender people. Such discrimination and thetype of causal attribution do not remain without any effect on the well-being of the concerned individuals. According to Crocker &Quinn (1998), the attribution of the discrimination to the existing prejudices may be a way to protect one-self from the negativeimpact on self-esteem. In this theoretical scope, the "rejection-identification" model (Branscombe, Schmitt & Harvey, 1999) has beenhighly mobilized. It emphasizes the importance of ingroup identification in the causal relationship between perceived discriminationsituation and well-being. Previous studies which did test this model show that the identification to a certain group can counteract thenegative effects on well-being. Following this theoretical frame, the presented study examines the impact of different types of causalattributions on self-esteem: internal causes (e.g. lack of skills), external causes (e.g. economic crisis), and gender identity relatedissues. For that purpose, an online survey has been created and fulfilled by 110 transgender people. Different scales were used to testthe model: the Rosenberg self-esteem scale, a causal attribution scale, the perceived discrimination of the transgender population inthe workplace scale and a group identification scale. The results show that transgender people feel still highly stigmatized today andattribute, significantly, the causes of their situation to the prejudices they are victim of. Also, in accordance with the “rejectionidentification”model, three links are observed: (1) a negative link between perceived discrimination and self-esteem; (2) a positivelink between perceived discrimination and ingroup identification; and (3) a positive link between ingroup identification and selfesteem.This situation reflects a lack in diversity considerations. Nevertheless, the attribution made to group stigmatization seems toplay a protective role towards transgender people self-esteem.

Social policy for nurses and the helping professions

The book examines the relationship between welfare and health and includes discussion of key policy issues such as; changes in health care delivery, regulation of professionals, privatisation, welfare pluralism and the tackling of health and social inequalities. The significance of social policy in preventing ill health and disability, as well as supporting the sick and disabled people, is emphasised throughout the book.

Utilization of analgesics, sedatives, and pain scores in infants with a prolonged hospitlaization: A prospective descriptive cohort study

Aim
Describe the utilization of analgesic and sedative medications and documentation of pain scores in a cohort of critically ill infants in a neonatal intensive care unit.

Method
A prospective, longitudinal, cohort study of infants with a predicted length of stay =28 days. Dosages and routes of administration of analgesic and sedative medications and documentation of pain scores were collected on a daily basis.

Results
55 infants were enrolled into the study. Oral sucrose was administered to all 55 infants, 51 infants (93%) were administered enteral acetaminophen and 50 (91%) infants were administered morphine during their hospitalization. Sedatives were administered to 42 infants (76%); 36 (65%) were administered chloral hydrate and 32 (58%) were administered intravenous midazolam. With the exception of the first week of admission, when there was highest utilization of opioids and lower use of sucrose, acetaminophen and sedatives, the pattern of administration of analgesic and sedative agents remained relatively constant throughout the hospitalization. Pain scores were documented for 36 (65%) infants during their hospitalisation, however for these 36 infants, pain scores were infrequently recorded.

Conclusion
There was substantial and varied analgesic and sedative use in this cohort of infants, yet infrequent documentation of pain assessment scores. These practices highlight important clinical implications for sick infants requiring careful consideration of pain and distress management.

Pepsin measured in induced sputum - a test for pulmonary aspiration in children?

Purpose The purpose of this study was to investigate if pepsin measured in sputum is a useful marker of pulmonary aspiration secondary to gastroesophageal reflux (GER) in children. It is possible that the induced sputum procedure could cause GER and invalidate the results. The hypothesis stated that healthy children (those without history of respiratory or gastroesophageal symptoms) would not have pepsin detected in induced sputum. Methods Children attending surgical outpatients in the Royal Belfast Hospital for Sick Children (Belfast, Northern Ireland) were recruited. After spirometry, sputum was obtained by induction with hypertonic 3% saline. Spirometry was repeated, and complications were noted. An “in-house” enzyme-linked immunosorbent assay was used to measure pepsin concentration in sputum. The lower limit of detection of pepsin was 1.19 ng/mL. Results Children (n = 21) aged 4 to 16 years were recruited. Twenty children completed the study. No adverse effects were reported. Pepsin was detected in 17 (85%) of 20 sputum samples. Conclusions The act of sputum induction appears to induce physiologic GER in a healthy childhood population. The analysis of pepsin in sputum obtained by sputum induction is therefore not useful in the investigation of reflux-related respiratory disease.

About infamy: the filthiness of Art and its diogenic disease

In this paper, we postulate the direct relationship that exists between waste production and artistic objects; its manufacturing system, consumption, and subsequent waste. What arises in this relationship then, is another character of interest –and that will serve as a reference to compare its modus operandi with the place of artists and the arts–, in this sick world, the Diogenes. The obsessed that lives among the garbage. The absurdity of the conquest of the infinite of the illogical within the logical. The amount clouded and blinded, nothing is enjoyed, nothing is appreciated; the countless abandons its place in the memory –memorable– and there only exists a pathological accumulation, mountains of garbage, desires to hold on to vital faith of the belief of doing Something for themselves. Working just to work and building something that will not last, like a sand castle, accumulation of detritus and dust. A new logic is born, the enjoyment of diseases and emptiness, the destruction of a world without a history. «Artists of the world, abandon! You have nothing to lose but your own professions!» (Kaprow, 2007, p. 37).

The chronic fatigue syndrome: A comparative pathway analysis

In this paper, we introduce a method to detect pathological pathways of a disease. We aim to identify biological processes rather than single genes affected by the chronic fatigue syndrome (CFS). So far, CFS has neither diagnostic clinical signals nor abnormalities that could be diagnosed by laboratory examinations. It is also unclear if the CFS represents one disease or can be subdivided in different categories. We use information from clinical trials, the gene ontology (GO) database as well as gene expression data to identify undirected dependency graphs (UDGs) representing biological processes according to the GO database. The structural comparison of UDGs of sick versus non-sick patients allows us to make predictions about the modification of pathways due to pathogenesis.

From Bogeyman to Bison: a herd-like amnesia of HIV?

Queer theorists from across a broad range of disciplines argue that we are in a ‘normalizing’ or ‘homonormative’ period, in which marginalized subjectivities strive to align themselves with hegemonic norms. In terms of LGBTQ rights and representation, it can be argued that this has resulted in an increased visibility of ‘desirable’ gays (monogamous – ideally civil-partnered, white, financially-independent, able-bodied) and the decreased visibility of ‘undesirable’ gays (the sick, the poor, the non-white, the non gender-conforming). Focusing specifically on the effects of this hierarchy on the contemporary theatrical representation of gay HIV/AIDS subjectivities, this article looks at two performances, Reza Abdoh’s Bogeyman (1991) and Lachlan Philpott’s Bison (2009/10). The essay argues that HIV/AIDS performance is as urgently necessary today as in the early 1990s, and that a queer dramaturgy, unafraid to resist the lure of normativity or the ‘gaystreaming’ of LGBT representation, is a vital intervention strategy in contemporary (LGBT) theatre.