Segurança do paciente na utilização de heparina sódica intravenosa: cuidados de enfermagem baseados na análise dos fatores de risco para eventos hemorrágicos

O objeto deste estudo são os eventos hemorrágicos em pacientes críticos que utilizam infusão contínua de heparina sódica. Tem como objetivo geral propor cuidados de enfermagem para pacientes que recebem infusão contínua de heparina, a fim de aumentar a segurança do paciente e reduzir a ocorrência de hemorragia, com base nos fatores de risco. Esta pesquisa procura contribuir com a farmacovigilância da heparina e com a qualidade da assistência de enfermagem. Trata-se de um estudo de coorte retrospectivo, com análise em prontuário, desenvolvido em unidade intensiva e semi-intensiva de um hospital público do Rio de Janeiro. Foram investigados 867 prontuários de 2010 a 2011, encontrando-se uma população de 79 pacientes que fizeram uso de heparina sódica em infusão contínua. As variáveis do estudo foram submetidas a tratamentos estatísticos não paramétricos e a medidas de associação. Os resultados apontam entre os pacientes três diagnósticos: fibrilação atrial, trombose venosa profunda e síndrome coronariana; percebe-se ainda predomínio do sexo feminino (58,23%) e de idosos (md=65 anos). A taxa de eventos hemorrágicos foi de 21,52% e se mostrou mais elevada quando comparada a outros estudos. Evidencia-se que pacientes com TTPa maior do que 100s tem um risco 9,29 vezes maior de apresentar eventos hemorrágicos. Todos os fatores de risco idade maior do que sessenta anos, hipertensão arterial sistêmica, TTPa maior do que 100s, uso prévio de anticoagulante e insuficiência renal apresentam associação positiva com a presença de evento hemorrágico. Entre os pacientes com eventos hemorrágicos, 94,16% apresentam um ou mais fatores de risco para sangramento. Os eventos hemorrágicos foram identificados na pele (47,37%), em sítio de punção, nas vias aéreas, no sistema geniturinário (15,79%) e no sistema gastrointestinal (10,53%). A maioria (55%) dos eventos hemorrágicos foi classificada com tipo 2 de BARC. Na associação entre o dispositivo invasivo utilizado e o tipo de sangramento, 100% dos pacientes com sangramento de via aérea ou do sistema gastrointestinal utilizavam sonda nasoentérica. Paciente com cateter vesical de demora (CVD) tem sete vezes mais risco de hematúria quando comparados com pacientes sem CVD; já pacientes com acesso venoso periférico tem menos risco de sangramento de sítio de punção quando comparados ao pacientes com acesso venoso central (RR= 0,74; 1,29). Essas associações norteiam a assistência de enfermagem e sugerem que o enfermeiro seja cauteloso ao realizar esses procedimentos nos pacientes com heparina sódica. Frente às variações no TTPa dosado, analisou-se o seguimento do protocolo e detectou-se que, nos pacientes com eventos hemorrágicos, a taxa de erro no ajuste da infusão foi maior (76,24%) quando comparada com os pacientes sem eventos hemorrágicos (39,05%). Ao se associar a taxa de erro da infusão com a presença de evento hemorrágico, evidencia-se que, quando a heparina não é ajustada segundo o protocolo, aumenta-se em 3,3 vezes o risco de evento hemorrágico. Portanto, para garantir o uso seguro na infusão de heparina, descrevem-se alguns cuidados específicos de enfermagem baseados nos fatores de risco e na indicação clínica de cada paciente.

Continuous F0 in the source-excitation generation for HMM-based TTS: Do we need voiced/unvoiced classification?

Most HMM-based TTS systems use a hard voiced/unvoiced classification to produce a discontinuous F0 signal which is used for the generation of the source-excitation. When a mixed source excitation is used, this decision can be based on two different sources of information: the state-specific MSD-prior of the F0 models, and/or the frame-specific features generated by the aperiodicity model. This paper examines the meaning of these variables in the synthesis process, their interaction, and how they affect the perceived quality of the generated speech The results of several perceptual experiments show that when using mixed excitation, subjects consistently prefer samples with very few or no false unvoiced errors, whereas a reduction in the rate of false voiced errors does not produce any perceptual improvement. This suggests that rather than using any form of hard voiced/unvoiced classification, e.g., the MSD-prior, it is better for synthesis to use a continuous F0 signal and rely on the frame-level soft voiced/unvoiced decision of the aperiodicity model. © 2011 IEEE.

Continuous asr for flexible incremental dialogue

Spoken dialogue systems provide a convenient way for users to interact with a machine using only speech. However, they often rely on a rigid turn taking regime in which a voice activity detection (VAD) module is used to determine when the user is speaking and decide when is an appropriate time for the system to respond. This paper investigates replacing the VAD and discrete utterance recogniser of a conventional turn-taking system with a continuously operating recogniser that is always listening, and using the recogniser 1-best path to guide turn taking. In this way, a flexible framework for incremental dialogue management is possible. Experimental results show that it is possible to remove the VAD component and successfully use the recogniser best path to identify user speech, with more robustness to noise, potentially smaller latency times, and a reduction in overall recognition error rate compared to using the conventional approach. © 2013 IEEE.

Positive effects of continuous low nitrate levels on growth and photosynthesis of Alexandrium tamarense (Gonyaulacales, Dinophyceae)

The growth and photosynthesis of Alexandrium tamarense (Lebour) Balech in different nutrient conditions were investigated. Low nitrate level (0.0882 mmol/L) resulted in the highest average growth rate from day 0 to day 10 (4.58 x 10(2) cells mL(-1) d(-1)), but the lowest cell yield (5420 cells mL(-1)) in three nitrate level cultures. High nitrate-grown cells showed lower levels of chlorophyll a-specific and cell-specific light-saturated photosynthetic rate (P-m(chl a) and P-m(cell)), dark respiration rate (R-d(chl a) and R-d(cell)) and chlorophyll a-specific apparent photosynthetic efficiency (alpha(chl a)) than was seen for low nitrate-grown cells; whereas the cells became light saturated at higher irradiance at low nitrate condition. When cultures at low nitrate were supplemented with nitrate at 0.7938 mmol/L in late exponential growth phase, or with nitrate at 0.7938 mmol/L and phosphate at 0.072 mmol/L in stationary growth phase, the cell yield was drastically enhanced, a 7-9 times increase compared with non-supplemented control culture, achieving 43 540 cells mL(-1) and 52 300 cells mL(-1), respectively; however, supplementation with nitrate in the stationary growth phase or with nitrate and phosphate in the late exponential growth phase increased the cell yield by no more than 2 times. The results suggested that continuous low level of nitrate with sufficient supply of phosphate may facilitate the growth of A. tamarense.

Investigation of gain recovery for InAs/GaAs quantum dot semiconductor optical amplifiers by rate equation simulation

The gain recoveries in quantum dot semiconductor optical amplifiers (QD SOAs) are numerically studied by rate equation simulation. Similar to the optical pump-probe experiment, the injection of double 150 fs optical pulses is used to simulate the gain recovery of a weak continuous signal under different injection levels, inhomogeneous broadenings, detuning wavelengths, and pulse signal energies for the QD SOAs. The obtained gain recoveries are then fitted by a response function with multiple exponential terms to determine the response times. The gain recovery can be described by three exponential terms with the time constants, which can be explained as carrier relaxation from the excited state to the ground state, carrier captured by the excited state from the wetting layer, and the supply of the wetting layer carriers. The fitted lifetimes decrease with the increase of the injection currents under gain unsaturation, slightly decrease with the decrease of inhomogeneous broadening of QDs, and increase with the increase of detuning wavelength between continuous signal and pulse signal and the increase of the pulse energy.

GaAs-based room-temperature continuous-wave 1.59 mu m GaInNAsSb single-quantum-well laser diode grown by molecular-beam epitaxy

Starting from the growth of high-quality 1.3 mu m GaInNAs/GaAs quantum well (QW), the QW emission wavelength has been extended up to 1.55 mu m by a combination of lowering growth rate, using GaNAs barriers and incorporating some amount of Sb. The photoluminescence properties of 1.5 mu m range GaInNAsSb/GaNAs QWs are quite comparable to the 1.3 mu m QWs, revealing positive effect of Sb on improving the optical quality of the QWs. A 1.59 mu m lasing of a GaInNAsSb/GaNAs single-QW laser diode is obtained under continuous current injection at room temperature. The threshold current density is 2.6 kA/cm(2) with as-cleaved facet mirrors. (c) 2005 American Institute of Physics.

High average power and short pulse duration continuous wave mode-locked Nd : GdVO4 laser with a semiconductor absorber mirror

Passive mode locking of a solid-state Nd:GdVO4 laser is demonstrated. The laser is mode locked by use of a semiconductor absorber mirror (SAM). A low Nd3+ doped Nd:GdVO4 crystal is used to mitigate the thermal lens effect of the laser crystal at a high pump power. The maximum average output power is up to 6.5 W, and the pulse duration is as short as 6.2 ps. The optic-to-optic conversion efficiency is 32.5% and the repetition rate is about 110 MHz.

High-average-power and high-conversion-efficiency continuous wave mode-locked Nd : YVO4 laser with a semiconductor absorber mirror

A high-power continuous wave (cw) mode-locked Nd:YVO4 solid-state laser was demonstrated by use of a semiconductor absorber mirror (SAM). The maximum average output power was 8.1 W and the optic-to-optic conversion efficiency was about 41 %. At the maximum incident pump power, the pulse width was about 8.6 ps and the repetition rate was 130 MHz. Experimental results indicated that this absorber was suitable for high power mode-locked solid-state lasers. (C) 2006 Elsevier Ltd. All rights reserved.

Information geometry theory of high-dimension space and application for speaker independent continuous digit speech recognition

In the light of descriptive geometry and notions in set theory, this paper re-defines the basic elements in space such as curve and surface and so on, presents some fundamental notions with respect to the point cover based on the High-dimension space (HDS) point covering theory, finally takes points from mapping part of speech signals to HDS, so as to analyze distribution information of these speech points in HDS, and various geometric covering objects for speech points and their relationship. Besides, this paper also proposes a new algorithm for speaker independent continuous digit speech recognition based on the HDS point dynamic searching theory without end-points detection and segmentation. First from the different digit syllables in real continuous digit speech, we establish the covering area in feature space for continuous speech. During recognition, we make use of the point covering dynamic searching theory in HDS to do recognition, and then get the satisfying recognized results. At last, compared to HMM (Hidden Markov models)-based method, from the development trend of the comparing results, as sample amount increasing, the difference of recognition rate between two methods will decrease slowly, while sample amount approaching to be very large, two recognition rates all close to 100% little by little. As seen from the results, the recognition rate of HDS point covering method is higher than that of in HMM (Hidden Markov models) based method, because, the point covering describes the morphological distribution for speech in HDS, whereas HMM-based method is only a probability distribution, whose accuracy is certainly inferior to point covering.

Research on continuous speech recognition with small vocabulary based on biomimetic pattern recognition

Based on biomimetic pattern recognition theory, we proposed a novel speaker-independent continuous speech keyword-spotting algorithm. Without endpoint detection and division, we can get the minimum distance curve between continuous speech samples and every keyword-training net through the dynamic searching to the feature-extracted continuous speech. Then we can count the number of the keywords by investigating the vale-value and the numbers of the vales in the curve. Experiments of small vocabulary continuous speech with various speaking rate have got good recognition results and proved the validity of the algorithm.

A speaker-independent continuous speech recognition system using biomimetic pattern recognition

In speaker-independent speech recognition, the disadvantage of the most diffused technology (HMMs, or Hidden Markov models) is not only the need of many more training samples, but also long train time requirement. This paper describes the use of Biomimetic pattern recognition (BPR) in recognizing some mandarin continuous speech in a speaker-independent manner. A speech database was developed for the course of study. The vocabulary of the database consists of 15 Chinese dish's names, the length of each name is 4 Chinese words. Neural networks (NNs) based on Multi-weight neuron (MWN) model are used to train and recognize the speech sounds. The number of MWN was investigated to achieve the optimal performance of the NNs-based BPR. This system, which is based on BPR and can carry out real time recognition reaches a recognition rate of 98.14% for the first option and 99.81% for the first two options to the persons from different provinces of China speaking common Chinese speech. Experiments were also carried on to evaluate Continuous density hidden Markov models (CDHMM), Dynamic time warping (DTW) and BPR for speech recognition. The Experiment results show that BPR outperforms CDHMM and DTW especially in the cases of samples of a finite size.

Continuous speech research based on HyperSausage Neuron

In this paper, we presents HyperSausage Neuron based on the High-Dimension Space(HDS), and proposes a new algorithm for speaker independent continuous digit speech recognition. At last, compared to HMM-based method, the recognition rate of HyperSausage Neuron method is higher than that of in HMM-based method.

Continuous speech research based on HyperSausage Neuron

In this paper, we presents HyperSausage Neuron based on the High-Dimension Space(HDS), and proposes a new algorithm for speaker independent continuous digit speech recognition. At last, compared to HMM-based method, the recognition rate of HyperSausage Neuron method is higher than that of in HMM-based method.

Simulation on Gain Recovery of Quantum Dot Semiconductor Optical Amplifiers by Rate Equation

The gain recoveries in quantum dot semiconductor optical amplifiers are numerically studied by rate equation models. Similar to the optical pump-probe experiment, the injection of double optical pulses is used to simulate the gain recovery of a weak continuous signal for the QD SOAs. The gain recoveries are fitted by a response function with multiple exponential terms. For the pulses duration of 10 ps, the gain recovery can be described by three exponential terms with the time constants, and for the pulse with the width of 150 fs, the gain recovery can be described by two exponential terms, the reason is that the short pulse does not consume lot of carriers.

Period Continuous Tuning of an Efficient Mid-Infrared Optical Parametric Oscillator Based on a Fan-out Periodically Poled MgO-Doped Lithium Niobate

We report a period continuously tunable, efficient, mid-infrared optical parametric oscillator (OPO) based on a fan-out periodically poled MgO-doped congruent lithium niobate (PPMgLN). The OPO is pumped by a Nd:YAG laser and a maximum idler output average power of 1.65 W at 3.93 mu m is obtained with a pump average power of 10.5 W, corresponding to the conversion efficiency of about 16% from the pump to the idler. The output spectral properties of the OPO with the fan-out crystal are analyzed. The OPO is continuously tuned over 3.78-4.58 mu m (idler) when fan-out periods are changed from 27.0 to 29.4 mu m. Compared with temperature tuning, fan-out period continuous tuning has faster tuning rate and wider tuning range.