999 resultados para Atraso da gratificação


Relevância:

10.00% 10.00%

Publicador:

Resumo:

Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Januário Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiency

Relevância:

10.00% 10.00%

Publicador:

Resumo:

As mucopolissacaridoses (MPS) são doenças genéticas raras decorrente da deficiência de enzimas lisossomais envolvidas no catabolismo de glicosaminoglicanos, resultando em um amplo espectro de manifestações clínicas, progressivas e multissistêmicas, exigindo tratamento por uma equipe multidisciplinar. Embora o Nordeste brasileiro seja uma região com grande taxa de consangüinidade e um efeito fundador envolvendo MPS, não há estudos caracterizando os pacientes dessa região. Nosso objetivo foi determinar o perfil epidemiológico, clínico e genético de casos não publicados com MPS provenientes do Ceará, identificando as diferenças entre outros estudos com MPS e possíveis problemas a serem enfrentados para a realização do diagnóstico precoce. O estudo foi seccional, descritivo, com amostra de pacientes com MPS em acompanhamento no Hospital Infantil Albert Sabin e Hospital Geral Cesar Cals no período de 2006-2013. Os dados foram obtidos a partir da avaliação clínica, revisão de prontuários médicos e entrevista com os pacientes e/ou familiares realizadas pelo investigador principal. Cinquenta e três pacientes foram incluídos no estudo (36 do sexo masculino), sendo 6 MPS I, 17 MPS II, 7 MPS III (3 MPSIII-A, 3 MPS III-B, 1 MPS III-C), 7 MPS IV-A, 16 de MPS VI. O óbito ocorreu em 16 casos (3 MPS I, MPS II 6, 1 MPS IIIA , IIIB 1MPS , 1 MPS IV , 4 MPS VI). A amostra foi composta principalmente por crianças. Houve elevada taxa de consangüinidade e recorrência familiar. Os tipos mais comuns foram MPS II e MPS VI. Exceto para macrossomia em MPS II, os dados de nascimento indicam que não houve risco para desenvolvimento de viii complicações perinatais. Os sintomas iniciaram em crianças com menos de 2 anos. As manifestações clínicas foram heterogêneas exceto para atraso no desenvolvimento neurológico em MPS III e manifestações esqueléticas em MPS IV. As principais características clínicas foram macrocefalia, baixa estatura, alterações odontológicas, respiratórias, cardíacas, hepatoesplenomegalia, hérnia umbilical, rigidez articular e anormalidades esqueléticas. A terapia de reposição enzimática foi instituída em 26 casos (4 MPS I, 10 MPS II, 12 MPS VI). Os problemas sócio-econômicos das famílias, o amplo espectro de sintomas e a gravidade da doença foram causas das dificuldades em realizar a avaliação periódica pela equipe multidisciplinar, além de exames complementares de maior custo para determinar as complicações da doença. Este foi o maior estudo transversal sobre MPS no Nordeste do Brasil. Em contraste com a maior incidência de MPS I na maioria das populações ocidentais, houve maior incidência de MPS II e VI. As alterações respiratórias foram um dos principais contribuintes para a mortalidade precoce, exceto nos casos de MPS I, em que a cardiomiopatia foi prevalente. A menor expectativa de vida ocorreu em MPS I. O envolvimento cognitivo foi comum em casos graves e o maior número de órgãos envolvidos representou maior risco de morrer. Para o diagnóstico precoce, deve-se buscar indivíduos afetados em famílias em que há parentes com MPS, além do maior reconhecimento de sinais e sintomas de MPS por profissionais de saúde

Relevância:

10.00% 10.00%

Publicador:

Resumo:

In the first half of the twentieth century different groups of intellectuals were engaged in the pursuit of an ideal of Brazility. Thereon, two currents are perceived. The first was marked by a nostalgic bias about the past, being formulated by intellectuals from the region that was turning as Northeast. This group of intellectuals emphasized values and traditions of the agrarian aristocracy of the region that was losing visibility in the political and economic Brazil scene. Already the other current has a more modern and industrial feature, was formed by intellectuals from the Southeast that in detriment of the first, was rising. This group, on the other hand, was intended to give a new face to Brazil and break with the "roots" of our delay that in their view were linked to our agrarian past. This resulted in different perceptions and interpretations of our historical past, and the construction of different profiles to the Brazilian. Accordingly, our work seeks to understand how was produced the writing that silenced the mixed ancestry of Auta de Souza (1876-1901) considering the position that she should occupy in the intellectuals projects who were in charge of forming a memory for our state. Auta as a relevant historical character in this project of potiguares intellectuals, she was raised to the condition of a model woman and elected in the pantheon of the most beloved poets of Rio Grande do Norte, however, to occupy such prestigious position she had her racial ancestry concealed in the writings that these same intellectuals had written about her, what is still spreaded in memory and rituals places of religious and civic features

Relevância:

10.00% 10.00%

Publicador:

Resumo:

This work analyses the ability of National States and regions have to formulations development strategies. Redeeming the initial development concept as a conflictual process, the hypothesis is that it presents internal and external constraints, as the latter have a higher preponderance, revealed the role played by money. In this case, one can point to as sub-hypothesis that the growth models with external constraint, mainly through the balance of payments, may illustrate the fact that countries are subject to international economic interactions that limit the possibility of bringing acylating strategies well successful in overcoming backwardness. For the specific case of regions, indicates that the external constraint remains an element of embarrassment for regional development, but redeems itself the center-periphery relations in this context to discuss the role of monetary and financial system as an explanation for the disparities regional income. On the domestic front, we highlight the importance of social structures of accumulation as an element of internal cohesion necessary to achieve successful development trajectories. It points also to the importance of the State in the process rescuing some of the main theoretical contributions of the political economy of development, incorporating the concept of globalization on theoretical frameworks presented. This construction where development depends on the actions of external and internal conditions, where money plays a key role as a guideline for reflections on regional development. The attempt was to transplant our considerations on the general development to address the case of regions. Finally, we conclude by greater confidence in the hypothesis and sub-hypotheses of departure, which led to propositions of economic policies

Relevância:

10.00% 10.00%

Publicador:

Resumo:

Simultanément à l' expulsion des jésuites du contrôles de l' éducaton formeI du royaume portugais, l'Ordre du 28 juin 1759 a décrété une reforme générale aux études, comme une des partie d'un ensemble de mesures modernisatoires qui ont été établisent dans le Royaume et dans ses domaines à la période comprise entre 1750 et 1777, pendant le royaume de D. José I et sous la direction de son principal ministre, Sebastião José Carvalho e MeIo, plus connu par le titre de noblesse de Marquis de Pombal. Notre thèse, locaIisée notament à la Capitanie de Bahia (Capitanie - division politique administrative du Brésil Colonie) entre les années de 1759 à 1827, a comme objet d'études les singularités du magistère bahianais et comme objectif, à partir de Ia référence théorique de l'histoire sociale des idées, comprendre comment les membres de cette nouvelle catégorie professionelle, crée pour préparés des cadres professionels mais bien qualifiés pour exercer leurs fonctions de burocratie de l'État, ont pris contact avec la pensée reforniste ilustré portugais du siècle XVIII, ont été véhiculé autant par des étrangérisés, comme par la législation pombalina (du Marquis de Pombal) et comme cet ensembIe théorique rapporté à la pensée, la vie et le travail d'enseignant de ces premiers représentants du magistère bahianais. L' analyse de la documentation (des lettres, et des ordres royals, des licences officielles pour exercer la fonction, et des serments des professeurs royal pour les plusieurs villages et capitanies; registres de correspondence reçues et envoyées par les chambres des villages; registres et correspondences expédiées par plusieurs autorités; provisions; tous les types de licences et autorisations; désignation; testament et inventaires) montre que les professeurs royals, malgré la quantité pas très nombreuses de membres, ont été extremement actifs sur les décisions les plus importantes de la période de celle qui est connue comme la crise du système colonial, qui, en Bahia, a eu ses particularités dans un mouvement d' émancipation politique seulement au mois de juillet 1823. Finallement, on a le but, dans le contenu de cette thèse de doctorat, d'offrir une connaissance sur l'histoire de l'éducation brésilienne et bahianaise qu' on retrouve encore entouré de doutes, préjugements et imterpretations équivoques qui insistent d'anaIyser le Brésil sous un stigmate du retard du royaume portugais, malgré sa production récente dans l'historiographie

Relevância:

10.00% 10.00%

Publicador:

Resumo:

O experimento foi instalado em área de plantio comercial de soja Roundup Ready®, na região do Pontal do Paranapanema, no município de Euclides da Cunha Paulista-SP, localizada a 20º 43' 11'' S e 50º 10' 20'' W, com uma altitude de 270 m. A fase experimental foi conduzida de dezembro de 2006 a abril de 2007, sob sistema plantio direto, com uma temperatura média de 25 ºC e índice pluviométrico de 800 mm. O solo da área experimental apresenta classe textural franco-argilo arenosa. Objetivou-se com este trabalho avaliar a eficácia e seletividade de glyphosate na formulação Roundup Transorb®, associado aos herbicidas diclosulam, cloransulam-methyl, flumioxazina e S-metolachlor em duas modalidades de aplicação: única, com associação do glyphosate aos herbicidas; e uma sequencial apenas com glyphosate aos 15 DAA, no manejo das plantas daninhas trapoeraba (Commelina benghalensis) e corda-de-viola (Ipomoea triloba) durante o cultivo da soja. O experimento foi instalado no delineamento de blocos ao acaso, com 12 tratamentos e quatro repetições. Os tratamentos foram distribuídos em arranjo fatorial acrescido de duas testemunhas: sem capina manual e com capina manual. O arranjo fatorial 2 x 5 contemplou duas condições de aplicação dos herbicidas (única e sequencial) e cinco herbicidas (glyphosate, glyphosate + diclosulam, glyphosate + cloransulam-methyl, glyphosate + flumioxazin e glyphosate + S-metolachlor). Nas condições de produtos, épocas de aplicação e doses, os resultados mostraram que o herbicida glyphosate aplicado em dose única ou sequencial e suas combinações com diclosulam e cloransulam-methyl na primeira aplicação não promovem fitointoxicação nas plantas de soja. A combinação com flumioxazin e S-metolachlor promoveu atraso no crescimento das plantas e no fechamento da cultura, em razão do efeito na altura dos indivíduos e comprimento dos ramos. No tratamento com o S-metolachlor, isso pode ser explicado pelo fato de o herbicida ser registrado para controle em pré-emergência e ter sido aplicado em pós-emergência. Nenhum dos tratamentos influenciou significativamente a produção de grãos da cultura da soja. A aplicação única ou a complementação com aplicação sequencial de glyphosate promoveram excelente controle de Commelina benghalensis e Ipomoea triloba.

Relevância:

10.00% 10.00%

Publicador:

Resumo:

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Relevância:

10.00% 10.00%

Publicador:

Resumo:

Cancer of the cervix (cervical cancer) is the second most prevalent cancer among Brazilian women. The high rates of cervical cancer in Brazil justify the implementation of effective strategies to control this, which include actions to promote health, primary prevention, early detection, screening, treatment and palliative care. Despite the existence of the National Programme for Control of the CCU there was no reduction in the incidence and mortality of this disease in Brazil. The Family Health Strategy (FHS) has the potential to facilitate such control and, in this context, one should consider that nurses play a central role. The study aimed to know the general intervention strategies used by nurses FHS of Natal / RN in CCU control, and how specific: analyzing the knowledge of these nurses on the CCU, the actions developed in the ESF for the control of CCU and identify the difficulties faced by them to perform it. This is a descriptive exploratory quantitative developed through a structured interview guide with 106 nurses who have experience in controlling the CCU in FHS teams of Natal / RN. Data analysis was performed using descriptive statistic s. The results pointed to actions taken in the FHS to control the CCU, collection of cervical cancer screening, health education activities, nursing consultation, referral of suspected cases for medical monitoring and active women with abnormal test result . The actions that were not mentioned by the nurses included: forming groups of prevention and health promotion; expand coverage of exams and office hours of consultations, establishment of alternatives to end the pent-up demand in the health units, participation in treatment or rehabilitation process users with the CCU; interventions for pain management, alliances and partnerships with schools, in dustry and the use of protocols. This study can be seen that the practice nurses partially shares to the CCU in Natal / RN. The participants of this study, when asked about the CCU, specifically for signs and symptoms of disease and risk factors in general showed important gaps. Difficulties such as lack of materials for collection of Pap smear; inadequate physical space in the Health Units; pent-up demand in the service, delay in arrival of the test results; obstacles in the actions of referral and counter-referral and cultural factors make the CCU control is compromised. It is believed in this research contributed to a reflection on the importance of the role of nurses in the development of the ESF control actions CCU, pointing out the factors that affect these. It is important to involve all nurses who comprise the ESF as knowledgeable of the risk factors, signs and symptoms, and existing tools for the early detection of cervical cancer in the pursuit of quality improvement actions to promote women`s health, contributing in planning future interventions that may reduce mortality from this disease in Natal / RN.

Relevância:

10.00% 10.00%

Publicador:

Resumo:

This thesis proposes the specification and performance analysis of a real-time communication mechanism for IEEE 802.11/11e standard. This approach is called Group Sequential Communication (GSC). The GSC has a better performance for dealing with small data packets when compared to the HCCA mechanism by adopting a decentralized medium access control using a publish/subscribe communication scheme. The main objective of the thesis is the HCCA overhead reduction of the Polling, ACK and QoS Null frames exchanged between the Hybrid Coordinator and the polled stations. The GSC eliminates the polling scheme used by HCCA scheduling algorithm by using a Virtual Token Passing procedure among members of the real-time group to whom a high-priority and sequential access to communication medium is granted. In order to improve the reliability of the mechanism proposed into a noisy channel, it is presented an error recovery scheme called second chance algorithm. This scheme is based on block acknowledgment strategy where there is a possibility of retransmitting when missing real-time messages. Thus, the GSC mechanism maintains the real-time traffic across many IEEE 802.11/11e devices, optimized bandwidth usage and minimal delay variation for data packets in the wireless network. For validation purpose of the communication scheme, the GSC and HCCA mechanisms have been implemented in network simulation software developed in C/C++ and their performance results were compared. The experiments show the efficiency of the GSC mechanism, especially in industrial communication scenarios.

Relevância:

10.00% 10.00%

Publicador:

Resumo:

In this work, the variable structure adaptive pole placement controller (VS-APPC) robustness and performance are evaluated and this algorithm is applied in a motor control system. The controller robustness evaluation will be done through simulations, where will be introduced in the system the following adversities: time delay, actuator response boundeds, disturbances, parametric variation and unmodeled dynamics. The VS-APPC will be compared with PI control, pole placement control (PPC) and adaptive pole placement controller (APPC). The VS-APPC will be simulated to track a step and a sine reference. It will be applied in a three-phase induction motor control system to track a sine signal in the stator reference frame. Simulation and experimental results will prove the efficiency and robustness of this control strategy

Relevância:

10.00% 10.00%

Publicador:

Resumo:

This work develops a robustness analysis with respect to the modeling errors, being applied to the strategies of indirect control using Artificial Neural Networks - ANN s, belong to the multilayer feedforward perceptron class with on-line training based on gradient method (backpropagation). The presented schemes are called Indirect Hybrid Control and Indirect Neural Control. They are presented two Robustness Theorems, being one for each proposed indirect control scheme, which allow the computation of the maximum steady-state control error that will occur due to the modeling error what is caused by the neural identifier, either for the closed loop configuration having a conventional controller - Indirect Hybrid Control, or for the closed loop configuration having a neural controller - Indirect Neural Control. Considering that the robustness analysis is restrict only to the steady-state plant behavior, this work also includes a stability analysis transcription that is suitable for multilayer perceptron class of ANN s trained with backpropagation algorithm, to assure the convergence and stability of the used neural systems. By other side, the boundness of the initial transient behavior is assured by the assumption that the plant is BIBO (Bounded Input, Bounded Output) stable. The Robustness Theorems were tested on the proposed indirect control strategies, while applied to regulation control of simulated examples using nonlinear plants, and its results are presented

Relevância:

10.00% 10.00%

Publicador:

Resumo:

The development of wireless sensor networks for control and monitoring functions has created a vibrant investigation scenario, covering since communication aspects to issues related with energy efficiency. When source sensors are endowed with cameras for visual monitoring, a new scope of challenges is raised, as transmission and monitoring requirements are considerably changed. Particularly, visual sensors collect data following a directional sensing model, altering the meaning of concepts as vicinity and redundancy but allowing the differentiation of source nodes by their sensing relevancies for the application. In such context, we propose the combined use of two differentiation strategies as a novel QoS parameter, exploring the sensing relevancies of source nodes and DWT image coding. This innovative approach supports a new scope of optimizations to improve the performance of visual sensor networks at the cost of a small reduction on the overall monitoring quality of the application. Besides definition of a new concept of relevance and the proposition of mechanisms to support its practical exploitation, we propose five different optimizations in the way images are transmitted in wireless visual sensor networks, aiming at energy saving, transmission with low delay and error recovery. Putting all these together, the proposed innovative differentiation strategies and the related optimizations open a relevant research trend, where the application monitoring requirements are used to guide a more efficient operation of sensor networks

Relevância:

10.00% 10.00%

Publicador:

Resumo:

This work deals with experimental studies about VoIP conections into WiFi 802.11b networks with handoff. Indoor and outdoor network experiments are realised to take measurements for the QoS parameters delay, throughput, jitter and packt loss. The performance parameters are obtained through the use of software tools Ekiga, Iperf and Wimanager that assure, respectvely, VoIP conection simulation, trafic network generator and metric parameters acquisition for, throughput, jitter and packt loss. The avarage delay is obtained from the measured throughput and the concept of packt virtual transmition time. The experimental data are validated based on de QoS level for each metric parameter accepted as adequated by the specialized literature

Relevância:

10.00% 10.00%

Publicador:

Resumo:

The power system stabilizers are used to suppress low-frequency electromechanical oscillations and improve the synchronous generator stability limits. This master thesis proposes a wavelet-based power system stabilizer, composed of a new methodology for extraction and compensation of electromechanical oscillations in electrical power systems based on the scaling coefficient energy of the maximal overlap discrete wavelet transform in order to reduce the effects of delay and attenuation of conventional power system stabilizers. Moreover, the wavelet coefficient energy is used for electric oscillation detection and triggering the power system stabilizer only in fault situations. The performance of the proposed power system stabilizer was assessed with experimental results and comparison with the conventional power system stabilizer. Furthermore, the effects of the mother wavelet were also evaluated in this work

Relevância:

10.00% 10.00%

Publicador:

Resumo:

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)