Forced oscillation assessment of respiratory mechanics in ventilated patients

The forced oscillation technique (FOT) is a method for non-invasively assessing respiratory mechanics that is applicable both in paralysed and non-paralysed patients. As the FOT requires a minimal modification of the conventional ventilation setting and does not interfere with the ventilation protocol, the technique is potentially useful to monitor patient mechanics during invasive and noninvasive ventilation. FOT allows the assessment of the respiratory system linearity by measuring resistance and reactance at different lung volumes or end-expiratory pressures. Moreover, FOT allows the physician to track the changes in patient mechanics along the ventilation cycle. Applying FOT at different frequencies may allow the physician to interpret patient mechanics in terms of models with pathophysiological interest. The current methodological and technical experience make possible the implementation of portable and compact computerised FOT systems specifically addressed to its application in the mechanical ventilation setting.

A Qualitative Exploration of the Psychological Contents and Dynamics of Momentum in Sport

While studies on triggers and outcomes of Psychological Momentum (PM) exist, little is known about the dynamics by which PM emerges and develops over time. Based on video-assisted recalls of PM experiences in table tennis and swimming competitions, this research qualitatively explored the triggering processes, contents, and the development of PM over time. PM was found to be triggered by mechanisms of dissonance, consonance, or fear of not winning. During the PM experience, participants reported a variety of perceptions, affects and emotions, cognitions, and behaviors, and PM was found to develop through processes of amplification that sometimes ended with a reduction of efforts when the victory or defeat was perceived as certain. These findings are discussed in light of theories on self-regulation and reactance-helplessness. From a practical standpoint, achievement goal-based strategies are suggested, since mastery-approach goals were found to be endorsed to maintain positive PM and overcome negative PM

Correlations between forced oscillation technique parameters and pulmonary densitovolumetry values in patients with acromegaly

The aims of this study were to evaluate the forced oscillation technique (FOT) and pulmonary densitovolumetry in acromegalic patients and to examine the correlations between these findings. In this cross-sectional study, 29 non-smoking acromegalic patients and 17 paired controls were subjected to the FOT and quantification of lung volume using multidetector computed tomography (Q-MDCT). Compared with the controls, the acromegalic patients had a higher value for resonance frequency [15.3 (10.9-19.7) vs 11.4 (9.05-17.6) Hz, P=0.023] and a lower value for mean reactance [0.32 (0.21-0.64) vs 0.49 (0.34-0.96) cm H2O/L/s2, P=0.005]. In inspiratory Q-MDCT, the acromegalic patients had higher percentages of total lung volume (TLV) for nonaerated and poorly aerated areas [0.42% (0.30-0.51%) vs 0.25% (0.20-0.32%), P=0.039 and 3.25% (2.48-3.46%) vs 1.70% (1.45-2.15%), P=0.001, respectively]. Furthermore, the acromegalic patients had higher values for total lung mass in both inspiratory and expiratory Q-MDCT [821 (635-923) vs 696 (599-769) g, P=0.021 and 844 (650-945) vs 637 (536-736) g, P=0.009, respectively]. In inspiratory Q-MDCT, TLV showed significant correlations with all FOT parameters. The TLV of hyperaerated areas showed significant correlations with intercept resistance (rs=−0.602, P<0.001) and mean resistance (rs=−0.580, P<0.001). These data showed that acromegalic patients have increased amounts of lung tissue as well as nonaerated and poorly aerated areas. Functionally, there was a loss of homogeneity of the respiratory system. Moreover, there were correlations between the structural and functional findings of the respiratory system, consistent with the pathophysiology of the disease.

Localización de faltas en sistemas de distribución de energía eléctrica usando métodos basados en el modelo y métodos basados en el conocimiento

La calidad de energía eléctrica incluye la calidad del suministro y la calidad de la atención al cliente. La calidad del suministro a su vez se considera que la conforman dos partes, la forma de onda y la continuidad. En esta tesis se aborda la continuidad del suministro a través de la localización de faltas. Este problema se encuentra relativamente resuelto en los sistemas de transmisión, donde por las características homogéneas de la línea, la medición en ambos terminales y la disponibilidad de diversos equipos, se puede localizar el sitio de falta con una precisión relativamente alta. En sistemas de distribución, sin embargo, la localización de faltas es un problema complejo y aún no resuelto. La complejidad es debida principalmente a la presencia de conductores no homogéneos, cargas intermedias, derivaciones laterales y desbalances en el sistema y la carga. Además, normalmente, en estos sistemas sólo se cuenta con medidas en la subestación, y un modelo simplificado del circuito. Los principales esfuerzos en la localización han estado orientados al desarrollo de métodos que utilicen el fundamental de la tensión y de la corriente en la subestación, para estimar la reactancia hasta la falta. Como la obtención de la reactancia permite cuantificar la distancia al sitio de falta a partir del uso del modelo, el Método se considera Basado en el Modelo (MBM). Sin embargo, algunas de sus desventajas están asociadas a la necesidad de un buen modelo del sistema y a la posibilidad de localizar varios sitios donde puede haber ocurrido la falta, esto es, se puede presentar múltiple estimación del sitio de falta. Como aporte, en esta tesis se presenta un análisis y prueba comparativa entre varios de los MBM frecuentemente referenciados. Adicionalmente se complementa la solución con métodos que utilizan otro tipo de información, como la obtenida de las bases históricas de faltas con registros de tensión y corriente medidos en la subestación (no se limita solamente al fundamental). Como herramienta de extracción de información de estos registros, se utilizan y prueban dos técnicas de clasificación (LAMDA y SVM). Éstas relacionan las características obtenidas de la señal, con la zona bajo falta y se denominan en este documento como Métodos de Clasificación Basados en el Conocimiento (MCBC). La información que usan los MCBC se obtiene de los registros de tensión y de corriente medidos en la subestación de distribución, antes, durante y después de la falta. Los registros se procesan para obtener los siguientes descriptores: a) la magnitud de la variación de tensión ( dV ), b) la variación de la magnitud de corriente ( dI ), c) la variación de la potencia ( dS ), d) la reactancia de falta ( Xf ), e) la frecuencia del transitorio ( f ), y f) el valor propio máximo de la matriz de correlación de corrientes (Sv), cada uno de los cuales ha sido seleccionado por facilitar la localización de la falta. A partir de estos descriptores, se proponen diferentes conjuntos de entrenamiento y validación de los MCBC, y mediante una metodología que muestra la posibilidad de hallar relaciones entre estos conjuntos y las zonas en las cuales se presenta la falta, se seleccionan los de mejor comportamiento. Los resultados de aplicación, demuestran que con la combinación de los MCBC con los MBM, se puede reducir el problema de la múltiple estimación del sitio de falta. El MCBC determina la zona de falta, mientras que el MBM encuentra la distancia desde el punto de medida hasta la falta, la integración en un esquema híbrido toma las mejores características de cada método. En este documento, lo que se conoce como híbrido es la combinación de los MBM y los MCBC, de una forma complementaria. Finalmente y para comprobar los aportes de esta tesis, se propone y prueba un esquema de integración híbrida para localización de faltas en dos sistemas de distribución diferentes. Tanto los métodos que usan los parámetros del sistema y se fundamentan en la estimación de la impedancia (MBM), como aquellos que usan como información los descriptores y se fundamentan en técnicas de clasificación (MCBC), muestran su validez para resolver el problema de localización de faltas. Ambas metodologías propuestas tienen ventajas y desventajas, pero según la teoría de integración de métodos presentada, se alcanza una alta complementariedad, que permite la formulación de híbridos que mejoran los resultados, reduciendo o evitando el problema de la múltiple estimación de la falta.

O poder social

o presente trabalho teve por objetivo investigar o relacionamento entre locus externo de causalidade e aquiescência de detentores de poder e a so1icitações de subordinados. Pesquisas anteriores realizadas nos Estado Unidos demonstraram das condições que afetam os indivíduos em situação de poder levando-os a atender as solicitações de dependentes. Esse estudo constitui uma réplica parcial do experimento de Schopler e Mathew B (1965) para o teste da mesma hipótese - o detentor de poder que percebe a dependência de seu parceiro motivada por fatores externos dar-lhe-á mais ajuda que quando percebe a dependência do parceiro motivada por auto escolha (fatores internos) - com sujeitos brasileiros. O mesmo “design” serviu para o teste de duas hipóteses adicionais: a) o detentor de poder ajuda mais sem parceiro dependente quando o custo da ajuda é baixo (hipótese de Thibaut e Kelly, 1967); b) o detentor de poder ajuda menos o parceiro, percebido como dependente por força de circunstâncias externas, quando conhece antecipadamente qual a sua solicitação (hipótese original deste trabalho). Os resultados confirmaram as hipóteses ao nível de 0,05. A discussão dos resultados obtidos foi desenvolvida em termos das teorias da troca e da reatância. Com base nos resu1tados conclui-se que: (1) as relações de poder não parecem ser influenciadas pela cultura em que os agentes estão inseridos; (2) a oposição à liberdade perdida pode explicar o menor atendimento a solicitações pré-conhecidas.

Marcadores nutricionais e inflamatórios e sua associação com a morbimortalidade em hemodiálise

Background: Malnutrition, inflammation and comorbidities are frequent in patients with chronic renal failure in hemodialysis (HD), contributing for morbidity and mortality. Aims: To evaluate the correlation between anthropometric, laboratory parameters, bioelectrical impedance (BIA) and inflammatory markers with the morbidity and mortality of patients in HD, as well as the impact of its alterations throughout 12 months. Methods: 143 patients of a dialysis facility in Northeast Brazil were evaluated throughout 18 months. Patients with more than 3 months on dialysis, older than 18 years, without amputation of hands and feet, were included in the study. We performed a clinical (subjective global assessment - SGA), anthropometric (BMI, percent of ideal weight, MAC, MAMC, MAMA, percent of fat mass and TSF), laboratory (albumin, creatinine, lymphocyte count as nutritional markers and CRP, IL-6 and TNF- as inflammatory markers) evaluation and BIA (reactance, phase angle and percent of body cell mass) at the beginning of study and after 3, 6 and 12 months of follow-up. The association between study variables and deaths and hospitalizations in 6 and 12 months was investigated. The variable with significance < 10% in the univariate analysis had been enclosed in a multivariate logistic regression analysis. We also investigated the risk of mortality and hospitalization associated with differences in measurements of the variables at baseline and six months later. Results: Patients were aged 52.2 ± 16.6 years on the average, 58% were male, and mean dialysis vintage was 5.27 ± 5.12 years. The prevalence of malnutrition varied from 7.7-63.6%, according to the nutritional marker. The variables associated with morbidity and mortality in 6 and 12 months had been creatinine ≤ 9.45 mg/dl, phase angle ≤ 4.57 degrees, BMI ≤ 23 kg/m2, age ≤ 64.9 years, reactance ≤ 51.7 ohms; Charlson´s index ≥ 4 and socioeconomic status ≤ 7. During six months of follow up, decrease in albumin was associated with significantly higher mortality risk. Conclusions: This study detected that the best predictors of morbidity and mortality between nutritional and inflammatory markers are phase angle, reactance, creatinine and BMI and that changes in albumin values over six 107 months provide additional prognostic information. The authors believe that parameters of BIA may detect early changes in nutritional status and emphasize that longitudinal studies with larger number of patients are necessary to confirm these data and to recommend BIA as a routine nutritional evaluation in HD patients

Bioimpedance in Pregnant Women with Preeclampsia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Proposta de pontos de corte para indicação da obesidade abdominal entre adolescentes

FUNDAMENTO: A ausência de valores críticos para a identificação de risco cardiovascular entre adolescentes brasileiros representa uma importante limitação. OBJETIVOS: Elaborar valores críticos para circunferência de cintura e analisar sua eficiência na indicação de valores elevados de pressão arterial. MÉTODOS: Estudo transversal que avaliou 1.145 adolescentes de 11 a 17 anos (536 do sexo masculino e 609 do feminino), dos quais foram coletados valores de peso corporal, estatura, resistência, reatância, dobra cutânea tricepital, circunferência de cintura e pressão arterial (n= 334). A obesidade abdominal foi indicada por meio de valores de circunferência de cintura. RESULTADOS: Os adolescentes obesos apresentaram valores mais altos de circunferência de cintura e, independentemente de gênero e grupo etário, houve relação significativa entre os valores de circunferência de cintura e todos os indicadores de adiposidade adotados no estudo. Os valores críticos propostos apresentaram maior sensibilidade na indicação de valores elevados de pressão arterial. CONCLUSÕES: Os valores críticos propostos para circunferência de cintura foram mais sensíveis na indicação de valores elevados de pressão arterial. Entretanto, ainda são necessários estudos para averiguar a eficiência dos mesmos na indicação de outros parâmetros clínicos e laboratoriais.

Planning of secondary distribution circuits through evolutionary algorithms

In this work, the planning of secondary distribution circuits is approached as a mixed integer nonlinear programming problem (MINLP). In order to solve this problem, a dedicated evolutionary algorithm (EA) is proposed. This algorithm uses a codification scheme, genetic operators, and control parameters, projected and managed to consider the specific characteristics of the secondary network planning. The codification scheme maps the possible solutions that satisfy the requirements in order to obtain an effective and low-cost projected system-the conductors' adequate dimensioning, load balancing among phases, and the transformer placed at the center of the secondary system loads. An effective algorithm for three-phase power flow is used as an auxiliary methodology of the EA for the calculation of the fitness function proposed for solutions of each topology. Results for two secondary distribution circuits are presented, whereas one presents radial topology and the other a weakly meshed topology. © 2005 IEEE.

Avaliação dos indicadores nutricionais e da composição corporal em hepatopatas crônicos e a relação com a etiologia e gravidade da doença

Pós-graduação em Bases Gerais da Cirurgia - FMB

Impedância bioelétrica na ocorrência da pré-eclâmpsia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparação entre a dopplervelocimetria das artérias uterinas e a impedância bioelétrica na predição de hipertensao na gestação e restrição de crescimento intrauterino

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Bioimpedância na gravidez: resistência e reactância de gestantes com pré-eclampsia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Evaluation of nutritional indicators and body composition in patients with advanced liver disease enrolled for liver transplantation

PURPOSE: Malnutrition is prevalent in patients with advanced liver disease (LD) related to multifactorial causes. Fluid retention can underestimate the nutritional status based on anthropometric measures. We evaluated nutritional indicators and body composition (BC) in patients with liver cirrhosis and correlated them with LD severity. METHODS: Forty three patients with LD enrolled for liver transplantation were evaluated by Anthropometric measures, subjective evaluation (Global Assessment of Nutritional Status - SGA) and biochemical indicators. Single-frequency electrical bioimpedance (SFE-BIA) was used to evaluate body composition (BC). It measured resistance (R), reactance (Xc) and the phase angle (PA). LD severity was estimated by Child-Pugh and Meld criteria (Model for End-Stage Liver Disease). RESULTS: Child-Pugh index between patients was 7.11±1.70 and Meld was 12.23±4.22. Arm Circumference, Arm Muscle Circumference and Arm Muscle Area, SGA, hemoglobin, hematocrit and albumin showed better correlation with disease severity. Xc and PA showed correlation both with Meld and Child-Pugh score when BC were evaluated. PA was depleted in 55.8% of the patients. CONCLUSIONS: Diagnosis of malnutrition varied according to the method. Global assessment of nutritional status showed better correlation with disease severity than with objective methods. Single-frequency electrical bioimpedance for body composition analysis in cirrhotic patients must be cautiously used; however, primary vectors seems to be valid and promising in clinical practice.

Prototype Fault Current Limiter Using Transformer and a Modular Device of YBCO Coated Conductor

A superconducting fault current limiter (SCFL) consisted of a transformer with low reactance connected to the power line and with the secondary winding short-circuited by a modular superconducting limiter device with 16 elements connected in series was constructed and tested. The designed coupling transformer has low dispersion reactance in order to limit the voltage drop in the power line within the range of 5 % to 10 %. The experimental results showed that an insertion of a 0.125 Omega resistance limited the peak current to a factor of 2.5 times of the unlimited current. The power dissipation reached 39 kW during 100 ms, with an energy density of 380 J/cm(3). Based on these results, the SCFL will be further tested in a 3 MVA (15 kV/380 V) generator for currents up to 10 kA.