908 resultados para probability and reinforcement proportion
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Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica
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INTRODUCTION: Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001). CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.
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RESUMO: Tivemos como objectivo do presente trabalho avaliar a capacidade funcional, e factores eventualmente a ela associados, numa amostra de 152 idosos ambulatórios, sem doenças agudas ou graves, utentes de um centro de saúde urbano. Cada avaliação consistiu numa entrevista, mediante um inquérito sobre capacidade funcional, morbilidade, estado mental e aspectos sociais, e no estudo da composição corporal. As perguntas referentes às variáveis estudadas foram por nós desenvolvidas e estruturadas com base em escalas internacionais validadas e de utilização comum na avaliação de idosos, excepto para as variáveis em que não encontrámos escalas com essas características. Os seus quesitos foram incluídos como perguntas e respostas estruturadas e pré-codificadas, permitindo a atribuição de uma pontuação a cada variável e a sua posterior divisão dicotómica. Aplicámos as escalas de Katz e de Lawton para a avaliação das actividades de autonomia física e instrumental da vida diária, a escala de Grimby para a avaliação da actividade física, a escala de Hamilton e o teste de Folstein para a avaliação do estado mental nas vertentes afectiva e cognitiva e a escala de Graffar para caracterizar a classe social, e perguntas sobre locomoção, autoavaliação da saúde, queixas de saúde presentes e rede social. Fizemos o registo da morbilidade segundo a International Classification of Primary Care - ICPC. A avaliação antropométrica constou da medição do peso, da altura, dos perímetros do braço, da cintura, da anca e proximal da coxa, e das pregas bicipital, tricipital, sub-escapular e supra-ilíaca. Foi também feita a estimativa da composição corporal por cálculos derivados de índices antropométricos e de bioimpedância eléctrica corporal total, o doseamento de algumas proteínas plasmáticas e a quantificação da força de preensão. Analisámos os resultados obtidos por grupos quanto ao sexo e à idade, dividida nos escalões etários 65 a 74 anos e mais do que 74 anos. Por regressão linear múltipla, foi testado o efeito do sexo e da idade sobre os valores medidos, para cada uma das variáveis e cada uma das suas pontuações parciais, sendo considerado como evidência de um efeito estaticamente significativo um valor “p” inferior a 0,05.Resumimos do seguinte modo os dados obtidos e a sua comparação com os dos estudos que seleccionámos como referência: A média de idades da amostra foi de 74 anos, sendo um terço destes do sexo masculino. Na sua maioria eram independentes em locomoção e funcionalidade, praticavam alguma actividade física, classificavam a sua saúde como razoável ou boa, apresentavam sintomatologia activa, não tinham depressão ou demência, tinham quem os acompanhasse embora cerca de metade apresentasse algum grau de isolamento, eram de baixa classe social, tinham excesso de peso, valores elevados de massa gorda, parâmetros plasmáticos proteicos compatíveis com ausência de doenças agudas ou graves e considerável força muscular de preensão. Na análise descritiva por grupos quanto ao sexo e/ou à idade, verificou-se que as mulheres e os mais idosos apresentavam maior isolamento social e os valores mais baixos de massa magra, hemoglobina e força de preensão. As mulheres tinham maior prevalência de dependência em autonomia física, depressão e valores mais baixos de transferrina. Os mais idosos apresentavam maior dependência em funcionalidade, menor actividade física, maior prevalência de demência, índice de massa corporal menos elevado, e valores mais baixos de albumina. Não se verificou prevalência de piores resultados dicotómicos nos homens nem no escalão etário menos idoso. Não teve relação com o sexo ou a idade o compromisso em autonomia instrumental, a presença de morbilidade ou a baixa classe social, assim como a não perturbação da locomoção e dos níveis de somatomedina-C. A análise comparativa com estudos multidimensionais em idosos portugueses e europeus ambulatórios revelou que a nossa amostra apresentava muitas características semelhantes às desses idosos. Assim, tinham elevada independência em locomoção, considerável independência em autonomia física e menor independência em autonomia instrumental; prática de actividade física ligeira, as mulheres dentro e os homens fora de casa; maior prevalência de morbilidade a nível dos aparelhos locomotor e cardiocirculatório, nos nossos idosos com pouca flutuação na autoavaliação de saúde; pequena prevalência de depressão e de demência; maior isolamento social nas mulheres e nas mais idosas; factores de classe social de baixo nível, diferindo apenas em relação aos idosos do norte da Europa que apresentavam elevada escolaridade e profissões mais diferenciadas; características biométricas sobreponíveis às dos idosos portugueses e às dos do sul da Europa, com tendência para o excesso de peso e proporção elevada de massa gorda; e doseamentos plasmáticos proteicos e força muscular de preensão compatíveis com ausência de doenças agudas ou crónicas graves. A comparação com os referidos estudos em relação ao risco de dependência, revelou semelhanças na associação entre dependência funcional e idade avançada, morbilidade, alteração do estado mental e isolamento social. Na amostra que estudámos não obtivemos associação entre dependência e o sexo feminino, facto que se verificou no estudo nacional de Almeida et al. e nos estudos multicêntricos europeus, ou o grau de escolaridade, como no estudo francês. Podemos concluir que, com o instrumento de avaliação que utilizámos, foi possível detectar e caracterizar perturbações numa amostra de idosos ambulatórios, a maioria funcionalmente independentes, sem alterações do estado mental, mas apresentando morbilidade activa, tendência para a obesidade, e actividade física ligeira. Nos que apresentaram alterações, estas foram mais frequentes no sexo feminino e nos indivíduos com mais de 74 anos. A escala de funcionalidade desenvolvida foi sensível aos efeitos da idade e permitiu o cálculo do risco de dependência em relação às outras variáveis estudadas, sendo mais marcante a associação com baixa actividade física, presença de queixas de saúde, demência e índice de massa corporal elevado. Consideramos que a metodologia que empregámos poderá contribuir para a avaliação de capacidades, cujo conhecimento sistemático nos idosos se impõe. ------------- ABSTRACT: The main objective of the present work was to evaluate functional capacity and related factors, in a sample of 152 ambulatory elderly, free from acute or serious disease, attending an urban health centre. Each evaluation included an interview, with a questionnaire about functional capacity, morbidity, mental health and social aspects, and the study of body composition. The questions were developed and structured in accordance with international validated scales usually applied in the evaluation of the elderly, whenever there were scales for that purpose. Their items were included as structured pre-coded questions and answers, so that each variable could have its own quotation and be dichotomised. We employed Katz and Lawton scales for basic and instrumental activities of daily living, Grimby scale for physical activity, Hamilton scale for depression, Folstein’s Mini Mental State Examination for cognitive ability and Graffar scale for social class, and questions about walking, health perception, active complaints and social network. The symptoms register was done according to the International Classification of Primary Care - ICPC. The anthropometric exam involved the determination of height and weight, arm, waist, hip and proximal thigh circumferences, and biceps, triceps, subscapular and suprailiac skinfolds. For the body composition calculation we employed equations derived from anthropometric indices, and from measurement of total body bioelectric impedance. We also measured some plasma proteins and handgrip strength. The analysis of results was done by sex and age groups, separating those with 65 to 74 years from those older than 74 years. The effects of sex and age were tested by linear multiple regression, for each variable and its components. Presented "p" values being considered statistically significative if less than 0,05. The results we obtained and their comparison with the studies we choose as reference can be summarised as follows: Mean age of the sample was 74 years and about one third were men. Most of them were independent in gait and functionality, practised some physical activity, rate their health as fair or good, had physical complaints, had not depression or dementia, had some companionship although almost half of them with stigmas of isolation, belonged to low social class, were in the range of overweight, had raised values of fat mass, plasma proteins in accordance with no acute or serious disease, and considerable handgrip strength. The analysis of groups by sex and age revealed that women and the eldest had the greater social isolation and the lowest values of free fat mass, haemoglobin and handgrip strength. Women had the higher dependence in basic activities of daily living, more depression and lower levels of transferrin. The eldest were more dependent in functionality, had greater prevalence of dementia, less physical activity, less raised body mass index and lower levels of albumin. Men alone and the age range of 65 to 74 did not show any prevalence of the worse dichotomised results. There was no relationship between sex or age and instrumental activities of daily living, morbidity or low social class, and unaffected gait or somatomedin-C levels. The comparison of results with multidimensional studies in portuguese and european ambulatory elderly showed that our sample had many similarities with theirs. They were independent in gait and activities of daily living; practiced light physical activity, women indoors and men outdoors; had greater morbidity at locomotor and cardiovascular systems, with small latitude in health evaluation; low prevalence of depression and dementia; social isolation predominantly in older women; and low social class factors, witch is only different from those of north Europe who had higher education levels and professional carriers; biometric characteristics similar to other portuguese and south Europe elders, with tendency for overweight and high proportion of fat mass; and plasma protein levels and handgrip strength in accordance with no acute or chronic serious disease. The comparison to the referred studies in relation to dependency risk, showed similarities in the association of dependency and age, morbidity,altered mental state and social isolation. We did not find association between dependency and sex, as it was found in the portuguese study of Almeida et al. and the european multicentric studies, or the education level, as in the french study. We conclude that, with the evaluation battery we employed, it was possible to detect and characterise alterations in a sample of ambulatory elderly, most of whom were functionally independent and had no alterations in mental state, but had active morbidity, tendency to obesity, and only light physical activity. Those that had some alteration, were more frequently women and the eldest. The functionality scale we developed showed to be sensitive to age effects and suitable for the calculation of risk of dependency, being more important the association with low physical activity, active complaints, dementia and high body mass index. We consider that the methodology we applied can contribute to the evaluation of capabilities that should be systematically sought for in the elderly.
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Recent durability studies have shown the susceptibility of bond in fiber-reinforced polymer (FRP) strengthened masonry components to hygrothermal exposures. However, it is not clear how this local material degradation affects the global behavior of FRP-strengthened masonry structures. This study addresses this issue by numerically investigating the nonlinear behavior of FRP-masonry walls after aging in two different environmental conditions. A numerical modeling strategy is adopted and validated with existing experimental tests on FRP-strengthened masonry panels. The model, once validated, is used for modeling of four hypothetical FRP-strengthened masonry walls with different boundary conditions, strengthening schemes, and reinforcement ratios. The nonlinear behavior of the walls is then simulated before and after aging in two different environmental conditions. The degradation data are taken from previous accelerated aging tests. The changes in the failure mode and nonlinear response of the walls after aging are presented and discussed.
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CH, Chitosan; HPMC, (Hydroxypropyl)methyl cellulose; FT, Freeze-thaw; SC, Solvent casting; CH:HPMC (X:Y), pH Z, FT/SC, Chitosan and (hydroxypropyl)methyl cellulose hydrogel, at X and Y proportion (0-100), at Z pH (3.0-4.0) and prepared by freeze-thaw or solvent casting techniques; DSC, Differential scanning calorimetry; MDSC, Temperature modulated Differential scanning calorimetry; Tg, glass transition temperature; ΔH, enthalpy change; TGA, Thermogravimetric Analysis; TG, Thermogravimetry; DTG, Derivative or Differential thermogravimetry; σ, Tensile strength; ε, elongation at break; DMA, Dynamic mechanical analysis; X-Ray, X-radiation, FTIR-ATR, Attenuated total reflectance Fourier transform infrared spectroscopy; SEM, Scanning electron microscopy.
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CH, Chitosan; HPMC, (Hydroxypropyl)methyl cellulose; FT, Freeze-thaw; SC, Solvent casting; CH:HPMC (X:Y), pH Z, FT/SC, Chitosan and (hydroxypropyl)methyl cellulose hydrogel, at X and Y proportion (0-100), at Z pH (3.0-4.0) and prepared by freeze-thaw or solvent casting techniques; DSC, Differential scanning calorimetry; MDSC, Temperature modulated Differential scanning calorimetry; Tg, glass transition temperature; ΔH, enthalpy change; TGA, Thermogravimetric Analysis; TG, Thermogravimetry; DTG, Derivative or Differential thermogravimetry; σ, Tensile strength; ε, elongation at break; DMA, Dynamic mechanical analysis; X-Ray, X-radiation, FTIR-ATR, Attenuated total reflectance Fourier transform infrared spectroscopy; SEM, Scanning electron microscopy.
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Dissertação de mestrado integrado em Engenharia Civil
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Dissertação de mestrado integrado em Engenharia Civil
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Dissertação de mestrado integrado em Engenharia Civil
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OBJECTIVE: To assess the clinical significance of transient ischemic dilation of the left ventricle during myocardial perfusion scintigraphy with stress/rest sestamibi. METHODS: The study retrospectively analyzed 378 patients who underwent myocardial perfusion scintigraphy with stress/rest sestamibi, 340 of whom had a low probability of having ischemia and 38 had significant transient defects. Transient ischemic dilation was automatically calculated using Autoquant software. Sensitivity, specificity, and the positive and negative predictive values were established for each value of transient ischemic dilation. RESULTS: The values of transient ischemic dilation for the groups of low probability and significant transient defects were, respectively, 1.01 ± 0.13 and 1.18 ± 0.17. The values of transient ischemic dilation for the group with significant transient defects were significantly greater than those obtained for the group with a low probability (P<0.001). The greatest positive predictive values, around 50%, were obtained for the values of transient ischemic dilation above 1.25. CONCLUSION: The results suggest that transient ischemic dilation assessed using the stress/rest sestamibi protocol may be useful to separate patients with extensive myocardial ischemia from those without ischemia.
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The main object of the present paper consists in giving formulas and methods which enable us to determine the minimum number of repetitions or of individuals necessary to garantee some extent the success of an experiment. The theoretical basis of all processes consists essentially in the following. Knowing the frequency of the desired p and of the non desired ovents q we may calculate the frequency of all possi- ble combinations, to be expected in n repetitions, by expanding the binomium (p-+q)n. Determining which of these combinations we want to avoid we calculate their total frequency, selecting the value of the exponent n of the binomium in such a way that this total frequency is equal or smaller than the accepted limit of precision n/pª{ 1/n1 (q/p)n + 1/(n-1)| (q/p)n-1 + 1/ 2!(n-2)| (q/p)n-2 + 1/3(n-3) (q/p)n-3... < Plim - -(1b) There does not exist an absolute limit of precision since its value depends not only upon psychological factors in our judgement, but is at the same sime a function of the number of repetitions For this reasen y have proposed (1,56) two relative values, one equal to 1-5n as the lowest value of probability and the other equal to 1-10n as the highest value of improbability, leaving between them what may be called the "region of doubt However these formulas cannot be applied in our case since this number n is just the unknown quantity. Thus we have to use, instead of the more exact values of these two formulas, the conventional limits of P.lim equal to 0,05 (Precision 5%), equal to 0,01 (Precision 1%, and to 0,001 (Precision P, 1%). The binominal formula as explained above (cf. formula 1, pg. 85), however is of rather limited applicability owing to the excessive calculus necessary, and we have thus to procure approximations as substitutes. We may use, without loss of precision, the following approximations: a) The normal or Gaussean distribution when the expected frequency p has any value between 0,1 and 0,9, and when n is at least superior to ten. b) The Poisson distribution when the expected frequecy p is smaller than 0,1. Tables V to VII show for some special cases that these approximations are very satisfactory. The praticai solution of the following problems, stated in the introduction can now be given: A) What is the minimum number of repititions necessary in order to avoid that any one of a treatments, varieties etc. may be accidentally always the best, on the best and second best, or the first, second, and third best or finally one of the n beat treatments, varieties etc. Using the first term of the binomium, we have the following equation for n: n = log Riim / log (m:) = log Riim / log.m - log a --------------(5) B) What is the minimun number of individuals necessary in 01der that a ceratin type, expected with the frequency p, may appaer at least in one, two, three or a=m+1 individuals. 1) For p between 0,1 and 0,9 and using the Gaussean approximation we have: on - ó. p (1-p) n - a -1.m b= δ. 1-p /p e c = m/p } -------------------(7) n = b + b² + 4 c/ 2 n´ = 1/p n cor = n + n' ---------- (8) We have to use the correction n' when p has a value between 0,25 and 0,75. The greek letters delta represents in the present esse the unilateral limits of the Gaussean distribution for the three conventional limits of precision : 1,64; 2,33; and 3,09 respectively. h we are only interested in having at least one individual, and m becomes equal to zero, the formula reduces to : c= m/p o para a = 1 a = { b + b²}² = b² = δ2 1- p /p }-----------------(9) n = 1/p n (cor) = n + n´ 2) If p is smaller than 0,1 we may use table 1 in order to find the mean m of a Poisson distribution and determine. n = m: p C) Which is the minimun number of individuals necessary for distinguishing two frequencies p1 and p2? 1) When pl and p2 are values between 0,1 and 0,9 we have: n = { δ p1 ( 1-pi) + p2) / p2 (1 - p2) n= 1/p1-p2 }------------ (13) n (cor) We have again to use the unilateral limits of the Gaussean distribution. The correction n' should be used if at least one of the valors pl or p2 has a value between 0,25 and 0,75. A more complicated formula may be used in cases where whe want to increase the precision : n (p1 - p2) δ { p1 (1- p2 ) / n= m δ = δ p1 ( 1 - p1) + p2 ( 1 - p2) c= m / p1 - p2 n = { b2 + 4 4 c }2 }--------- (14) n = 1/ p1 - p2 2) When both pl and p2 are smaller than 0,1 we determine the quocient (pl-r-p2) and procure the corresponding number m2 of a Poisson distribution in table 2. The value n is found by the equation : n = mg /p2 ------------- (15) D) What is the minimun number necessary for distinguishing three or more frequencies, p2 p1 p3. If the frequecies pl p2 p3 are values between 0,1 e 0,9 we have to solve the individual equations and sue the higest value of n thus determined : n 1.2 = {δ p1 (1 - p1) / p1 - p2 }² = Fiim n 1.2 = { δ p1 ( 1 - p1) + p1 ( 1 - p1) }² } -- (16) Delta represents now the bilateral limits of the : Gaussean distrioution : 1,96-2,58-3,29. 2) No table was prepared for the relatively rare cases of a comparison of threes or more frequencies below 0,1 and in such cases extremely high numbers would be required. E) A process is given which serves to solve two problemr of informatory nature : a) if a special type appears in n individuals with a frequency p(obs), what may be the corresponding ideal value of p(esp), or; b) if we study samples of n in diviuals and expect a certain type with a frequency p(esp) what may be the extreme limits of p(obs) in individual farmlies ? I.) If we are dealing with values between 0,1 and 0,9 we may use table 3. To solve the first question we select the respective horizontal line for p(obs) and determine which column corresponds to our value of n and find the respective value of p(esp) by interpolating between columns. In order to solve the second problem we start with the respective column for p(esp) and find the horizontal line for the given value of n either diretly or by approximation and by interpolation. 2) For frequencies smaller than 0,1 we have to use table 4 and transform the fractions p(esp) and p(obs) in numbers of Poisson series by multiplication with n. Tn order to solve the first broblem, we verify in which line the lower Poisson limit is equal to m(obs) and transform the corresponding value of m into frequecy p(esp) by dividing through n. The observed frequency may thus be a chance deviate of any value between 0,0... and the values given by dividing the value of m in the table by n. In the second case we transform first the expectation p(esp) into a value of m and procure in the horizontal line, corresponding to m(esp) the extreme values om m which than must be transformed, by dividing through n into values of p(obs). F) Partial and progressive tests may be recomended in all cases where there is lack of material or where the loss of time is less importent than the cost of large scale experiments since in many cases the minimun number necessary to garantee the results within the limits of precision is rather large. One should not forget that the minimun number really represents at the same time a maximun number, necessary only if one takes into consideration essentially the disfavorable variations, but smaller numbers may frequently already satisfactory results. For instance, by definition, we know that a frequecy of p means that we expect one individual in every total o(f1-p). If there were no chance variations, this number (1- p) will be suficient. and if there were favorable variations a smaller number still may yield one individual of the desired type. r.nus trusting to luck, one may start the experiment with numbers, smaller than the minimun calculated according to the formulas given above, and increase the total untill the desired result is obtained and this may well b ebefore the "minimum number" is reached. Some concrete examples of this partial or progressive procedure are given from our genetical experiments with maize.
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In a feeding trial cassava root meal was used as a substitute for wheat bran and wheat middling (mixed) in several ranges: 10, 15, 20 and 30% of a ration. Five groups of 32 seven day old Rhode I. Red chicks were used during 6 weeks of the trial. The results are shown in the Tables (Quadros) I, II and III. Table I shows an high mortality in R4, receiving 30% of cassava root meal and no wheat by product. It was observed a depression of the development of the chicks that was so much high as the proportion of the cassava meal increased in the ration consumed. The A. suggests cassava root meal might have an antagonistic factor acting as a "toxic", that he imagine could be corrected by a higher vitaminic and mineral proportion. This hipothesis must be investigated.
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In IP networks, most of packets, that have been dropped, are recovered after the expiration of retransmission timeouts. These can result in unnecessary retransmissions and needless reduction of congestion window. An inappropriate retransmission timeout has a huge impact on TCP performance. In this paper we have proved that CSMA/CA mechanism can cause TCP retransmissions due to CSMA/CA effects. For this we have observed three wireless connections that use CSMA/CA: with good link quality, poor link quality and in presence of cross traffic. The measurements have been performed using real devices. Through tracking of each transmitted packet it is possible to analyze the relation between one-way delay and packet loss probability and the cumulative distribution of distances between peaks of OWDs. The distribution of OWDs and the distances between peaks of OWDs are the most important parameters of tuning TCP retransmission timeout on CSMA/CA networks. A new perspective through investigating the dynamical relation between one-way delay and packet loss ratio depending on the link quality to enhance the TCP performance has been provided.
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It is often alleged that high auction prices inhibit service deployment. We investigate this claim under the extreme case of financially constrained bidders. If demand is just slightly elastic, auctions maximize consumer surplus if consumer surplus is a convex function of quantity (a common assumption), or if consumer surplus is concave and the proportion of expenditure spent on deployment is greater than one over the elasticity of demand. The latter condition appears to be true for most of the large telecom auctions in the US and Europe. Thus, even if high auction prices inhibit service deployment, auctions appear to be optimal from the consumers' point of view.
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Les comunicacions cooperatives estan guanyant un gran interès en les comunicacions modernes degut a que permeten millorar la transmissió dʼinformació entre un emissor i un receptor utilitzant una sèrie de terminals situats entre ells. Aquest projecte és un estudi complet del sistemes cooperatius, analitzant el seu rendiment i comparant lʼús dʼun sol dʼaquests terminals amb lʼús del codi Alamouti, que utilitza dos terminals. Primer hi ha una introducció als sistemes cooperatius i a la teoria de la informació. Després hem estudiat un sistema cooperatiu amb la teoria de la informació com a base, en termes de probabilitat de fallada del sistema, i posteriorment lʼhem adaptat a un sistema cooperatiu real utilitzant una modulació QPSK, estudiant la seva probabilitat dʼerror de paquet. Finalment es proposen diversos protocols que permeten millorar el rendiment del sistema cooperatiu estudiat.