Relação entre desempenho funcional e indicadores de doença arterial obstrutiva periférica em idosas

The presence of peripheral arterial disease (PAD) increases the risk and vulnerability to adverse clinical outcomes in the elderly. Like this, we investigated the relationship between functional performance and indicators of PAD in elderly women. METHODS: Cross-sectional study in which 54 elderly were assessed by questionnaire mini mental state examination, Short Phisical Performance Battery (SPPB), ankle-brachial index (ABI), human activity profile (HAP) and Edinburgh questionnaire. Statistical analysis was performed using ANOVA, t test and Pearson correlation. We considered p <0.05 as significance level. RESULTS: The mean age SPPB and ABI were 69.2 (± 6.9) years, SPPB 9.42 (± 2.55) and ABI 1.04 (± 0.14). The prevalence of PAD was 16.3%. There was a significant correlation between ABI and gait speed (r = 0.75, p = 0.001) and between PAH with SPPB (p = 0.001). CONCLUSIONS: It is suggested that the decline in functional performance in older, expressed in gait velocity component of the SPPB, is related to the presence of PAD

Contribuições de modelagem de equações estruturais na análise de dados em modelos comportamentais de destino turístico

A fragilidade brasileira quanto à competitividade turística é um fato observável nos dados da Organização Mundial do Turismo. O Brasil caiu em 2011, da 45ª para a 52ª posição, apesar de liderar no atributo recursos naturais e estar colocado na 23° em recursos culturais. Assim, grandes interesses e esforços têm sido direcionados para o estudo da competitividade dos produtos e destinos turísticos. O destino turístico é caracterizado por um conjunto complexo e articulado de fatores tangíveis e intangíveis, apresentando alta complexidade, dados de elevada dimensionalidade, não linearidade e comportamento dinâmico, tornando-se difícil a modelagem desses processos por meio de abordagens baseadas em técnicas estatísticas clássicas. Esta tese investigou modelos de equações estruturais e seus algoritmos, aplicados nesta área, analisando o ciclo completo de análise de dados, em um processo confirmatório no desenvolvimento e avaliação de um modelo holístico da satisfação do turista; na validação da estrutura do modelo de medida e do modelo estrutural, por meio de testes de invariância de múltiplos grupos; na análise comparativa dos métodos de estimação MLE, GLS e ULS para a modelagem da satisfação e na realização de segmentação de mercado no setor de destino turístico utilizando mapas auto-organizáveis de Kohonen e sua validação com modelagem de equações estruturais. Aplicações foram feitas em análises de dados no setor de turismo, principal indústria de serviços do Estado do Rio Grande do Norte, tendo sido, teoricamente desenvolvidos e testados empiricamente, modelos de equações estruturais em padrões comportamentais de destino turístico. Os resultados do estudo empírico se basearam em pesquisas com a técnica de amostragem aleatória sistemática, efetuadas em Natal-RN, entre Janeiro e Março de 2013 e forneceram evidências sustentáveis de que o modelo teórico proposto é satisfatório, com elevada capacidade explicativa e preditiva, sendo a satisfação o antecedente mais importante da lealdade no destino. Além disso, a satisfação é mediadora entre a geração da motivação da viagem e a lealdade do destino e que os turistas buscam primeiro à satisfação com a qualidade dos serviços de turismo e, posteriormente, com os aspectos que influenciam a lealdade. Contribuições acadêmicas e gerenciais são mostradas e sugestões de estudo são dadas para trabalhos futuros.

Padronização de testes para avaliação do estado de mania e potencial anti-maníaco de um agonista do receptor NOP

Bipolar disorder is characterized by mood impairment, alternating between mania/hypomania and depression, and its exact pathophysiology is already unknown. The treatment of bipolar disorder is based on prevention of the manic and depressive episodes using mood stabilizers. Nociceptin/orfanin FQ (N/OFQ) is an endogenous heptadecapeptide which binds as an agonist to NOP receptor, which is a G-coupled inhibitory receptor. N/OFQ and its receptor modulate a lot of functions in the organism, including emotional processes. It is known that the plasmatic concentration of N/OFQ is altered in patients in both phases depressive and manic of bipolar disorder and it is assumed that this system has a role on the etiology of this disorder. Concerning mania, the animal models used in research tend to focus in an unique aspect of the manic behavior, as hyperactivity or agressivity. In the 60’s, the hole board test was proposed, and it consists of an apparatus with holes where a behavior known as head-dippings is measured. High levels of head-dippings are suggestive of neophilia, while low levels can be characteristic of an anxious-like behavior. As the increase of exploratory and goal-directed behavior are characteristics of manic behavior, this test could help in mania research. Thus, this work was organized in 3 steps and aims to: (1) investigate the induction of a manic-like state promoted by ouabain, a Na+/K+-ATPase inhibitor, in the mouse open field test; (2) set up the hole board as a test to measure manic-like behaviors; and (3) investigate the N/OFQ effects in prevention of this kind of behavior on hole board. Male Swiss mice were used in this study, and they take part of only one of the described steps. Depending on the step performed, mice received one or more of the following treatments: (1) ouabain 10-6 , 10-5 , 10-4 , 10-3 or 10-2 M, intracerebroventricular (icv); (2) sodium valproate 300 mg/kg, intraperitoneal (ip); (3) sodium valproate 400 mg/kg, ip; (4) diazepam 1 mg/kg, ip; (5) methylphenidate 10 mg/kg, ip; and (6) N/OFQ 0,1 or 1 nmol, icv. The results suggest that hole board can be used to evaluate a manic state, through analysis of different animal behaviors. However, it was not possible to standard the model of Na+ /K+ -ATPase dysfunction through ouabain administration in mice. Moreover, the data suggest that N/OFQ, at the doses tested, has not affected the methylphenidate-induced mania-like behavior. Taken together, the results point to a new approach of manic research, through the hole board using. However, more studies are necessary in order to verify the role of N/OFQ system on bipolar disorder.

Avaliação dos efeitos da retirada do etanol em curto e longo prazo sobre respostas comportamentais relacionadas à ansiedade e sobre células imunorreativas para a serotonina no núcleo dorsal da Rafe em ratas

Ethanol withdrawn individuals present a wealth of signs and symptoms, some of them related with anxiety. To better understand brain areas involved in anxiety caused by ethanol abstinence, preclinical studies have been employing models of ethanol consumption followed by withdrawal in rodents submitted to behavioral tests of anxiety, such as the elevated plus-maze. The aim of this study was to investigate if short- or long-term ethanol withdrawal could alter both anxiety-related behaviors in the elevated plus-maze (EPM) and open field tests and the number of serotonin immunorreactive cels in the dorsal raphe nucleus, a midbrain area associated with anxiety. Female Wistar rats (90 days old) were submitted to increasing concentrations of ethanol (2% for 3 days, 4% for 3 days and 6% for 15 days) as the only source of liquid diet and the control group received water ad libitum. Both groups received food ad libitum. In the behavioral experiments, on 21st day of consumption, ethanol was substituted by water (withdrawal) and 72 h or 21 days after withdrawal animals were submitted to the EPM, where it was evaluated the percentage of time and entries in the open arms and the entries in the enclosed arms during 5 minutes. Twenty and four hours after testing in the EPM, animals were submitted to the open field test for 15 minutes, where the distance traveled by the animals was observed along this period. During the first 5 minutes, the distance traveled, entries and time spent in the center of the test were analyzed. In the immunohistochemistry study, animals were submitted to 21 days of consumption of ethanol followed or not by 72 hours and 21 days of withdrawal previously perfusion, brain tissue preparation and quantification of serotonin dyed cells in the dorsal and caudal portions in the dorsal raphe nucleus. Behavioral data showed that both short- and long-term ethanol withdrawals reduced the open arms exploration in the EPM. In the open field test there were no locomotor activity changes during the total 15 minutes; however, longterm ethanol withdrawal reduced the exploration in the center of the open field during the first 5 minutes. In the immunohistochemistry step, there were no differences, when short- and long-term withdrawn groups were compared with control group; nevertheless, the chronic consumption of ethanol decreased the number of serotonergic immunorreactive cells in the dorsal part of dorsal raphe nucleus. Taken together, results here obtained suggest that both short- and long-term ethanol withdrawals promoted an anxiogenic-like effect that was not related with changes in the serotonin immunorreactivity in the dorsal and caudal parts of the dorsal raphe nucleus.

Transplantes de córneas no estado do Rio Grande do Norte: aspectos epidemiológicos e clínicos

This study aimed to characterize in a clinical and epidemiological way the patients who are on a waiting list for transplantation and the patients transplanted with corneal tissue in a corneal transplants reference service in the state of Rio Grande do Norte. It is an epidemiological study of a quantitative approach, with cross-sectional, descriptive and analytical cut including all patients on the waiting list for transplantation (population A) and the patients already transplanted with a corneal tissue (population B) in a reference service. In population A, there was a census conducted of patients on the waiting list for corneal transplantation (n=62 patients). In population B, the sample was non-probabilistic and corresponded to all corneal transplants performed in the service in the period from 2010 to 2014 (n=258). This study is approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, in Opinion 876 177 and CAAE 37533014.8.0000.5537. Data were collected in full in the period from January to April 2015, by two instruments built to systematize the necessary data collection. After being coded and tabulated, data were analyzed using the Statistical Package for Social Sciences software, version 20.0. The definition of variables and their distribution patterns were presented as frequencies and measures of central tendency while, for multivariate analysis, the effect of magnitude measures were applied (prevalence ratio) and measures of association (chi-square test or Fisher's exact test) for a 0.05 significance level. The results are shown in two scientific articles coming from the field survey data. It was found that the epidemiological profile of patients on the waiting list (n=62) showed a prevalence of individuals aged over 50 years old, female (54.84%) and residents of the middle region of East Rio Grande do Norte (66.13%). The clinical profile of patients with corneal transplantation (n=258) was characterized by being male (51.16%) with an average age of 49.33 years old and 57.75% were coming from East Rio Grande do Norte. The average time on the waiting list was 172.63 days in elective transplants and 9.03 days in urgent transplants. Keratoconus was the main indicator condition to perform the transplant. For patients on the waiting list, the variable “type of disorder of the cornea” showed statistically significant association with gender and age. For patients with corneal transplants, the variable "type of disorder of the cornea" was associated with the variables gender, age, previous surgery, failure of previous graft, classification of the eye and glaucoma. By characterizing the clinical and epidemiological profile of corneal transplants, it is possible to question the reality, pointing about the care that should be offered and develop targeted interventions to collective and individual needs intrinsic to patients who need this surgery as a treatment option.

Efeitos do Kinesio Taping® sobre os marcadores clínicos indiretos de dano muscular induzido pelo exercício excêntrico: ensaio clínico randomizado

Objective: analyze the effect of Kinesio Taping (KT) on the indirect clinical markers of muscle damage induced by eccentric exercises in the elbow flexors in healthy individuals. Materials and methods: It is a randomized controlled trial involving sixty volunteers at age group between 18 and 28 years randomly selected. The sample into three groups with twenty participants: control group (CG) – eccentric protocol without KT, KT group – eccentric with tensioned KT, placebo group – eccentric protocol KT with no tension. The evaluations took place at four moments; the first one was the basis line (AV1), after the second protocol (AV2) and the following two groups 24 (AV3) and 48 hours (AV4) after the intervention protocol. The muscle damage was induced by sixteen maximum eccentric contractions of the elbow flexors from the non-dominant limb, divided in two sets of eight repetitions, at 60º/s, with two minutes interval. The variables analyzed were: the joint amplitude in rest, the level of pain, the joint position sense (JPS) followed of isokinetic checking with electromyographic sign capitation. These data were analyzed in software SPSS 20.0. The normality was identified by Kolmogorov-Smimov examination and then, being used the ANOVA mixed model with significance of 5%. Outcomes: a decrease was observed at joint amplitude moreover, an immediate increase of pain wich increased after 24 and remained until 48 hours at all groups searched. There was not difference at the JPS. The variables peak torque, average peak torque, total work and mean power mean reduced until 48 hours after muscle lesion in all groups. Among the groups, there was no difference in EMG values and for any of the variables. Conclusion: The KT did not influence at the indirect clinical markers of muscle lesion induced by eccentric exercises in the elbow flexors in healthy people.

Efeitos do Kinesio Taping® sobre os marcadores clínicos indiretos de dano muscular induzido pelo exercício excêntrico: ensaio clínico randomizado

Objective: analyze the effect of Kinesio Taping (KT) on the indirect clinical markers of muscle damage induced by eccentric exercises in the elbow flexors in healthy individuals. Materials and methods: It is a randomized controlled trial involving sixty volunteers at age group between 18 and 28 years randomly selected. The sample into three groups with twenty participants: control group (CG) – eccentric protocol without KT, KT group – eccentric with tensioned KT, placebo group – eccentric protocol KT with no tension. The evaluations took place at four moments; the first one was the basis line (AV1), after the second protocol (AV2) and the following two groups 24 (AV3) and 48 hours (AV4) after the intervention protocol. The muscle damage was induced by sixteen maximum eccentric contractions of the elbow flexors from the non-dominant limb, divided in two sets of eight repetitions, at 60º/s, with two minutes interval. The variables analyzed were: the joint amplitude in rest, the level of pain, the joint position sense (JPS) followed of isokinetic checking with electromyographic sign capitation. These data were analyzed in software SPSS 20.0. The normality was identified by Kolmogorov-Smimov examination and then, being used the ANOVA mixed model with significance of 5%. Outcomes: a decrease was observed at joint amplitude moreover, an immediate increase of pain wich increased after 24 and remained until 48 hours at all groups searched. There was not difference at the JPS. The variables peak torque, average peak torque, total work and mean power mean reduced until 48 hours after muscle lesion in all groups. Among the groups, there was no difference in EMG values and for any of the variables. Conclusion: The KT did not influence at the indirect clinical markers of muscle lesion induced by eccentric exercises in the elbow flexors in healthy people.

Imunoexpressão das proteínas APE-1 e XRCC-1 em carcinoma epidermoide de língua oral

DNA repair systems play a critical role in protecting the human genome from damage caused by carcinogens present in the environment. Mutations in DNA repair genes may be responsible for tumor development and resistance of malignant cells to chemotherapeutic agents. The major pathway for oxidative DNA damage repair is the base excision repair pathway. The objective of this study was to investigate the immunoexpression of APE-1 and XRCC-1, which are proteins involved in DNA base excision repair and its association with clinical and histopathological parameters in oral tongue squamous cell carcinoma (OTSCC), in order to investigate a possible prognostic value for those proteins. The expression of APE-1 and XRCC-1 was evaluated semi-quantitatively by immunohistochemistry in 50 OTSCC cases. Clinical data was collected from patients’ medical charts and histopathological grading was performed for each case. Statistical analysis (Chi-square and Fisher’s exact tests; significance of 5%) was performed to determine the association between protein expressions and clinico-pathological characteristics. APE-1 was highly expressed in nucleus and cytoplasm in 56% of cases. XRCC-1 showed overexpression only in nucleus in 60% of cases. High expression of XRCC-1 was significantly associated to clinical stages I and II (P=0.02). Both proteins were not associated to other clinical parameters or histopathological grading. Our findings demonstrate that DNA base excision repair proteins APE-1 and XRCC-1 are upregulated in OTSCC, however, they are not related to clinical and histologic parameters, except for XRCC-1 association to better clinical staging. Our results indicate that the immunohistochemical expression of these proteins has no association with prognostic parameters in this tumor.

Imunoexpressão das proteínas APE-1 e XRCC-1 em carcinoma epidermoide de língua oral

DNA repair systems play a critical role in protecting the human genome from damage caused by carcinogens present in the environment. Mutations in DNA repair genes may be responsible for tumor development and resistance of malignant cells to chemotherapeutic agents. The major pathway for oxidative DNA damage repair is the base excision repair pathway. The objective of this study was to investigate the immunoexpression of APE-1 and XRCC-1, which are proteins involved in DNA base excision repair and its association with clinical and histopathological parameters in oral tongue squamous cell carcinoma (OTSCC), in order to investigate a possible prognostic value for those proteins. The expression of APE-1 and XRCC-1 was evaluated semi-quantitatively by immunohistochemistry in 50 OTSCC cases. Clinical data was collected from patients’ medical charts and histopathological grading was performed for each case. Statistical analysis (Chi-square and Fisher’s exact tests; significance of 5%) was performed to determine the association between protein expressions and clinico-pathological characteristics. APE-1 was highly expressed in nucleus and cytoplasm in 56% of cases. XRCC-1 showed overexpression only in nucleus in 60% of cases. High expression of XRCC-1 was significantly associated to clinical stages I and II (P=0.02). Both proteins were not associated to other clinical parameters or histopathological grading. Our findings demonstrate that DNA base excision repair proteins APE-1 and XRCC-1 are upregulated in OTSCC, however, they are not related to clinical and histologic parameters, except for XRCC-1 association to better clinical staging. Our results indicate that the immunohistochemical expression of these proteins has no association with prognostic parameters in this tumor.

Testes cosmológicos aplicados a modelos de energia escura

A significant observational effort has been directed to investigate the nature of the so-called dark energy. In this dissertation we derive constraints on dark energy models using three different observable: measurements of the Hubble rate H(z) (compiled by Meng et al. in 2015.); distance modulus of 580 Supernovae Type Ia (Union catalog Compilation 2.1, 2011); and the observations of baryon acoustic oscilations (BAO) and the cosmic microwave background (CMB) by using the so-called CMB/BAO of six peaks of BAO (a peak determined through the Survey 6dFGS data, two through the SDSS and three through WiggleZ). The statistical analysis used was the method of the χ2 minimum (marginalized or minimized over h whenever possible) to link the cosmological parameter: m, ω and δω0. These tests were applied in two parameterization of the parameter ω of the equation of state of dark energy, p = ωρ (here, p is the pressure and ρ is the component of energy density). In one, ω is considered constant and less than -1/3, known as XCDM model; in the other the parameter of state equantion varies with the redshift, where we the call model GS. This last model is based on arguments that arise from the theory of cosmological inflation. For comparison it was also made the analysis of model CDM. Comparison of cosmological models with different observations lead to different optimal settings. Thus, to classify the observational viability of different theoretical models we use two criteria information, the Bayesian information criterion (BIC) and the Akaike information criteria (AIC). The Fisher matrix tool was incorporated into our testing to provide us with the uncertainty of the parameters of each theoretical model. We found that the complementarity of tests is necessary inorder we do not have degenerate parametric spaces. Making the minimization process we found (68%), for the Model XCDM the best fit parameters are m = 0.28 ± 0, 012 and ωX = −1.01 ± 0, 052. While for Model GS the best settings are m = 0.28 ± 0, 011 and δω0 = 0.00 ± 0, 059. Performing a marginalization we found (68%), for the Model XCDM the best fit parameters are m = 0.28 ± 0, 012 and ωX = −1.01 ± 0, 052. While for Model GS the best settings are M = 0.28 ± 0, 011 and δω0 = 0.00 ± 0, 059.

Testes cosmológicos aplicados a modelos de energia escura

A significant observational effort has been directed to investigate the nature of the so-called dark energy. In this dissertation we derive constraints on dark energy models using three different observable: measurements of the Hubble rate H(z) (compiled by Meng et al. in 2015.); distance modulus of 580 Supernovae Type Ia (Union catalog Compilation 2.1, 2011); and the observations of baryon acoustic oscilations (BAO) and the cosmic microwave background (CMB) by using the so-called CMB/BAO of six peaks of BAO (a peak determined through the Survey 6dFGS data, two through the SDSS and three through WiggleZ). The statistical analysis used was the method of the χ2 minimum (marginalized or minimized over h whenever possible) to link the cosmological parameter: m, ω and δω0. These tests were applied in two parameterization of the parameter ω of the equation of state of dark energy, p = ωρ (here, p is the pressure and ρ is the component of energy density). In one, ω is considered constant and less than -1/3, known as XCDM model; in the other the parameter of state equantion varies with the redshift, where we the call model GS. This last model is based on arguments that arise from the theory of cosmological inflation. For comparison it was also made the analysis of model CDM. Comparison of cosmological models with different observations lead to different optimal settings. Thus, to classify the observational viability of different theoretical models we use two criteria information, the Bayesian information criterion (BIC) and the Akaike information criteria (AIC). The Fisher matrix tool was incorporated into our testing to provide us with the uncertainty of the parameters of each theoretical model. We found that the complementarity of tests is necessary inorder we do not have degenerate parametric spaces. Making the minimization process we found (68%), for the Model XCDM the best fit parameters are m = 0.28 ± 0, 012 and ωX = −1.01 ± 0, 052. While for Model GS the best settings are m = 0.28 ± 0, 011 and δω0 = 0.00 ± 0, 059. Performing a marginalization we found (68%), for the Model XCDM the best fit parameters are m = 0.28 ± 0, 012 and ωX = −1.01 ± 0, 052. While for Model GS the best settings are M = 0.28 ± 0, 011 and δω0 = 0.00 ± 0, 059.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Avaliação e correções de testes de hipóteses em modelos de sobrevivência com fração de cura

Survival models deals with the modelling of time to event data. In certain situations, a share of the population can no longer be subjected to the event occurrence. In this context, the cure fraction models emerged. Among the models that incorporate a fraction of cured one of the most known is the promotion time model. In the present study we discuss hypothesis testing in the promotion time model with Weibull distribution for the failure times of susceptible individuals. Hypothesis testing in this model may be performed based on likelihood ratio, gradient, score or Wald statistics. The critical values are obtained from asymptotic approximations, which may result in size distortions in nite sample sizes. This study proposes bootstrap corrections to the aforementioned tests and Bartlett bootstrap to the likelihood ratio statistic in Weibull promotion time model. Using Monte Carlo simulations we compared the nite sample performances of the proposed corrections in contrast with the usual tests. The numerical evidence favors the proposed corrected tests. At the end of the work an empirical application is presented.

Protótipo de testes para aprendizagem com classificadores múltiplos

Os classificadores múltiplos são processos que utilizam um conjunto de modelos, cada um deles obtido pela aplicação de um processo de aprendizagem para um problema dado. Combinam vários classificadores individuais, em que para cada um deles são utilizados dados de treino para gerar limites de decisão diferentes. As decisões produzidas pelos classificadores individuais contém erros, que são combinados pelos classificadores múltiplos de forma a reduzir o erro total. Estes têm vindo a ganhar uma crescente importância devido principalmente ao facto de permitirem obter um melhor desempenho quando comparado com o obtido por qualquer um dos modelos que o compõem, principalmente quando as correlações entre os erros cometidos pelos modelos de base são baixos. A investigação nesta área tem crescido, tornando-se uma área de investigação importante. No entanto, para que o desempenho seja melhor do que o desempenho obtido por cada classificador individualmente, é necessário que cada um deles produza uma decisão diferente originando uma diversidade de classificação. Esta diversidade pode ser obtida tanto pela utilização de diferentes conjuntos de dados para o treino individual de cada classificador, como também pela utilização de diferentes parâmetros de formação de diferentes classificadores. Apesar disso, a utilização de classificadores múltiplos para aplicações no mundo real pode apresentar-se como dispendiosa e morosa. Tem-se notado nos dias de hoje que o desenvolvimento web tem vindo a crescer exponencialmente, assim como o uso de bases de dados. Desta forma, combinando a forte utilização da linguagem R para cálculos estatísticos com a crescente utilização das tecnologias web, foi implementado um protótipo que facilitasse a utilização dos classificadores múltiplos, mais precisamente, foi desenvolvida uma aplicação web que permitisse o teste para aprendizagem com classificadores múltiplos, sendo utilizadas as tecnologias PHP, R e MySQL. Com esta aplicação pretende-se que seja possível testar algoritmos independentes do software em que estejam desenvolvidos, não sendo necessariamente escritos em R. Nesta Dissertação foi utilizada a expressão “classificadores múltiplos” por ser a mais comum, apesar de ser redutora e existirem outros termos mais genéricos como por exemplo modelos múltiplos e ensemble learning.