Avaliação das Funções Executivas em Dependentes Químicos

The aim of this study was to investigate possible alterations in attentive functions and mental flexibility in individuals diagnosed with Addiction. The sample (n=40) was located for convenience, and included 20 individuals with addiction behaviors (G1), and 20 individuals who do not use harmfully psychoactive substances (G2). Assessment instruments used were: Experimental and Computerized Test of Continuous Performance, and the Wisconsin Card Sorting Test. It was concluded that individuals in the G1 group had a poorer performance in all categories analyzed on the Wisconsin Card Sorting Test and in reaction time on the Experimental and Computerized Test (p<0,05), showing a deficit in mental flexibility and attentive functions, which may have direct implications on addictive behaviors and treatment.

Estratégias de trabalho com blogs no ensino de geometria em turmas de 5° ano do ensino fundamental

This paper presents a survey conducted through collaborative work, which took place in a suburb school in the city of Uberlandia-MG. The research is characterized as case study and has a qualitative approach. Had the objective to look for different strategies of teaching and learning through the use of technology in pedagogical practice. Regarding the methodology in this research, we analyzed the work with the support of blogs, whose pages were used for student records and discussions directed to the geometry content. The students who were attending the fifth (5th) year of elementary school were invited to participate in this project. However, the research subjects were only those students who accepted the invitation to participate in the study through statement signed by parents. The project was developed with 30 students in the second half of 2014 and another 30 in the first half of 2015. The physical space at school, where most of the project activities were done was at the computer lab. In the process of compiling the data, at school, the following instruments were used: field notes produced by the entire project team, photographs and footage of the activities produced in the computer lab and in classroom (recorded by the research team) questionnaires, interviews, virtual space records: the blogs. The results of this research mainly focused on the analysis of the fifth year student‟s productions records in blogs. Regarding the conclusion, the research has shown that blogs, software and differentiated dynamic studies attracted the student‟s attention, leaving them mostly instigated by the unknown. Gradually, students built their own knowledge from their mistakes and successes. The entire work process enabled the computer lab to be an environment that is used not just to solving computerized and tedious drills. The blogs production work in groups, developed in students the reading and writing of both the mother language as symbols and mathematical nomenclature. The interaction between students became noticeable throughout the project, since it provided the student‟s personal growth, respect, tolerance and mutual cooperation. In this sense, we concluded that the project greatly contributed to the students' literacy process in the mother language, mathematics and computer literacy.

Tradução e adaptação transcultural do domínio função física do Patient-Reported Outcomes Measurement Information System – PROMIS® - versão para a língua portuguesa

In 2004, the National Institutes of Health made available the Patient-Reported Outcomes Measurement Information System – PROMIS®, which is constituted of innovative item banks for health assessment. It is based on classical, reliable Patient-Reported Outcomes (PROs) and includes advanced statistical methods, such as Item Response Theory and Computerized Adaptive Test. One of PROMIS® Domain Frameworks is the Physical Function, whose item bank need to be translated and culturally adapted so it can be used in Portuguese speaking countries. This work aimed to translate and culturally adapt the PROMIS® Physical Function item bank into Portuguese. FACIT (Functional Assessment of Chronic Illness Therapy) translation methodology, which is constituted of eight stages for translation and cultural adaptation, was used. Fifty subjects above the age of 18 years participated in the pre-test (seventh stage). The questionnaire was answered by the participants (self-reported questionnaires) by using think aloud protocol, and cognitive and retrospective interviews. In FACIT methodology, adaptations can be done since the beginning of the translation and cultural adaption process, ensuring semantic, conceptual, cultural, and operational equivalences of the Physical Function Domain. During the pre-test, 24% of the subjects had difficulties understanding the items, 22% of the subjects suggested changes to improve understanding. The terms and concepts of the items were totally understood (100%) in 87% of the items. Only four items had less than 80% of understanding; for this reason, it was necessary to chance them so they could have correspondence with the original item and be understood by the subjects, after retesting. The process of translation and cultural adaptation of the PROMIS® Physical Function item bank into Portuguese was successful. This version of the assessment tool must have its psychometric properties validated before being made available for clinical use.

A Comparison of Anchor-Item Designs for the Concurrent Calibration of Large Banks of Likert-Type Items

Current interest in measuring quality of life is generating interest in the construction of computerized adaptive tests (CATs) with Likert-type items. Calibration of an item bank for use in CAT requires collecting responses to a large number of candidate items. However, the number is usually too large to administer to each subject in the calibration sample. The concurrent anchor-item design solves this problem by splitting the items into separate subtests, with some common items across subtests; then administering each subtest to a different sample; and finally running estimation algorithms once on the aggregated data array, from which a substantial number of responses are then missing. Although the use of anchor-item designs is widespread, the consequences of several configuration decisions on the accuracy of parameter estimates have never been studied in the polytomous case. The present study addresses this question by simulation, comparing the outcomes of several alternatives on the configuration of the anchor-item design. The factors defining variants of the anchor-item design are (a) subtest size, (b) balance of common and unique items per subtest, (c) characteristics of the common items, and (d) criteria for the distribution of unique items across subtests. The results of this study indicate that maximizing accuracy in item parameter recovery requires subtests of the largest possible number of items and the smallest possible number of common items; the characteristics of the common items and the criterion for distribution of unique items do not affect accuracy.

Are stress and mixed urinary incontinence associated with impaired executive control in community-dwelling older women?

Objectives: To assess whether stress or mixed urinary incontinence (UI) is associated with deficits in executive functioning among community-dwelling women. Design: An observational study comparing the performance, using multivariate analyses of variance (MANOVAs) and Bonferroni post hoc test, of continent women and women with stress or mixed UI during executive control tasks. Setting: The research center of the Institut universitaire de gériatrie de Montréal. Participants: One hundred and fifty-five community-dwelling women aged 60 and older participated in the study. Measurements: Based on the Urogenital Distress Inventory (UDI), participants were split into three groups: 35 continent women, 43 women with stress UI, and 78 women with mixed UI. Participants completed a battery of neuropsychological tests and a computerized dual-task test. Results: Women with mixed UI showed poorer performances than continent and stress UI women in executive control functions. Deficits were specific to tests involving switching and sharing/dividing attention between two tasks. Conclusion: Results of this study suggest that mixed UI can be associated with executive control deficits in community-dwelling older women. Future intervention studies in the treatment of UI should take the higher risk of an executive control deficit in women with UI under consideration.

Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency.

BACKGROUND: Guidance for appropriate utilisation of transthoracic echocardiograms (TTEs) can be incorporated into ordering prompts, potentially affecting the number of requests. METHODS: We incorporated data from the 2011 Appropriate Use Criteria for Echocardiography, the 2010 National Institute for Clinical Excellence Guideline on Chronic Heart Failure, and American College of Cardiology Choosing Wisely list on TTE use for dyspnoea, oedema and valvular disease into electronic ordering systems at Durham Veterans Affairs Medical Center. Our primary outcome was TTE orders per month. Secondary outcomes included rates of outpatient TTE ordering per 100 visits and frequency of brain natriuretic peptide (BNP) ordering prior to TTE. Outcomes were measured for 20 months before and 12 months after the intervention. RESULTS: The number of TTEs ordered did not decrease (338±32 TTEs/month prior vs 320±33 afterwards, p=0.12). Rates of outpatient TTE ordering decreased minimally post intervention (2.28 per 100 primary care/cardiology visits prior vs 1.99 afterwards, p<0.01). Effects on TTE ordering and ordering rate significantly interacted with time from intervention (p<0.02 for both), as the small initial effects waned after 6 months. The percentage of TTE orders with preceding BNP increased (36.5% prior vs 42.2% after for inpatients, p=0.01; 10.8% prior vs 14.5% after for outpatients, p<0.01). CONCLUSIONS: Ordering prompts for TTEs initially minimally reduced the number of TTEs ordered and increased BNP measurement at a single institution, but the effect on TTEs ordered was likely insignificant from a utilisation standpoint and decayed over time.

Latent Space and Social Psychological Models of Diffusion

The problem of social diffusion has animated sociological thinking on topics ranging from the spread of an idea, an innovation or a disease, to the foundations of collective behavior and political polarization. While network diffusion has been a productive metaphor, the reality of diffusion processes is often muddier. Ideas and innovations diffuse differently from diseases, but, with a few exceptions, the diffusion of ideas and innovations has been modeled under the same assumptions as the diffusion of disease. In this dissertation, I develop two new diffusion models for "socially meaningful" contagions that address two of the most significant problems with current diffusion models: (1) that contagions can only spread along observed ties, and (2) that contagions do not change as they spread between people. I augment insights from these statistical and simulation models with an analysis of an empirical case of diffusion - the use of enterprise collaboration software in a large technology company. I focus the empirical study on when people abandon innovations, a crucial, and understudied aspect of the diffusion of innovations. Using timestamped posts, I analyze when people abandon software to a high degree of detail.

To address the first problem, I suggest a latent space diffusion model. Rather than treating ties as stable conduits for information, the latent space diffusion model treats ties as random draws from an underlying social space, and simulates diffusion over the social space. Theoretically, the social space model integrates both actor ties and attributes simultaneously in a single social plane, while incorporating schemas into diffusion processes gives an explicit form to the reciprocal influences that cognition and social environment have on each other. Practically, the latent space diffusion model produces statistically consistent diffusion estimates where using the network alone does not, and the diffusion with schemas model shows that introducing some cognitive processing into diffusion processes changes the rate and ultimate distribution of the spreading information. To address the second problem, I suggest a diffusion model with schemas. Rather than treating information as though it is spread without changes, the schema diffusion model allows people to modify information they receive to fit an underlying mental model of the information before they pass the information to others. Combining the latent space models with a schema notion for actors improves our models for social diffusion both theoretically and practically.

The empirical case study focuses on how the changing value of an innovation, introduced by the innovations' network externalities, influences when people abandon the innovation. In it, I find that people are least likely to abandon an innovation when other people in their neighborhood currently use the software as well. The effect is particularly pronounced for supervisors' current use and number of supervisory team members who currently use the software. This case study not only points to an important process in the diffusion of innovation, but also suggests a new approach -- computerized collaboration systems -- to collecting and analyzing data on organizational processes.

Simplified Predictive Instrument to Rule Out Acute Coronary Syndromes in a High-Risk Population.

BACKGROUND: It is unclear whether diagnostic protocols based on cardiac markers to identify low-risk chest pain patients suitable for early release from the emergency department can be applied to patients older than 65 years or with traditional cardiac risk factors. METHODS AND RESULTS: In a single-center retrospective study of 231 consecutive patients with high-risk factor burden in which a first cardiac troponin (cTn) level was measured in the emergency department and a second cTn sample was drawn 4 to 14 hours later, we compared the performance of a modified 2-Hour Accelerated Diagnostic Protocol to Assess Patients with Chest Pain Using Contemporary Troponins as the Only Biomarker (ADAPT) rule to a new risk classification scheme that identifies patients as low risk if they have no known coronary artery disease, a nonischemic electrocardiogram, and 2 cTn levels below the assay's limit of detection. Demographic and outcome data were abstracted through chart review. The median age of our population was 64 years, and 75% had Thrombosis In Myocardial Infarction risk score ≥2. Using our risk classification rule, 53 (23%) patients were low risk with a negative predictive value for 30-day cardiac events of 98%. Applying a modified ADAPT rule to our cohort, 18 (8%) patients were identified as low risk with a negative predictive value of 100%. In a sensitivity analysis, the negative predictive value of our risk algorithm did not change when we relied only on undetectable baseline cTn and eliminated the second cTn assessment. CONCLUSIONS: If confirmed in prospective studies, this less-restrictive risk classification strategy could be used to safely identify chest pain patients with more traditional cardiac risk factors for early emergency department release.

Influence of Increased Human Presence in the Mills River Basin on Water Availability and Drought

Periods of drought and low streamflow can have profound impacts on both human and natural systems. People depend on a reliable source of water for numerous reasons including potable water supply and to produce economic value through agriculture or energy production. Aquatic ecosystems depend on water in addition to the economic benefits they provide to society through ecosystem services. Given that periods of low streamflow may become more extreme and frequent in the future, it is important to study the factors that control water availability during these times. In the absence of precipitation the slower hydrological response of groundwater systems will play an amplified role in water supply. Understanding the variability of the fraction of streamflow contribution from baseflow or groundwater during periods of drought provides insight into what future water availability may look like and how it can best be managed. The Mills River Basin in North Carolina is chosen as a case-study to test this understanding. First, obtaining a physically meaningful estimation of baseflow from USGS streamflow data via computerized hydrograph analysis techniques is carried out. Then applying a method of time series analysis including wavelet analysis can highlight signals of non-stationarity and evaluate the changes in variance required to better understand the natural variability of baseflow and low flows. In addition to natural variability, human influence must be taken into account in order to accurately assess how the combined system reacts to periods of low flow. Defining a combined demand that consists of both natural and human demand allows us to be more rigorous in assessing the level of sustainable use of a shared resource, in this case water. The analysis of baseflow variability can differ based on regional location and local hydrogeology, but it was found that baseflow varies from multiyear scales such as those associated with ENSO (3.5, 7 years) up to multi decadal time scales, but with most of the contributing variance coming from decadal or multiyear scales. It was also found that the behavior of baseflow and subsequently water availability depends a great deal on overall precipitation, the tracks of hurricanes or tropical storms and associated climate indices, as well as physiography and hydrogeology. Evaluating and utilizing the Duke Combined Hydrology Model (DCHM), reasonably accurate estimates of streamflow during periods of low flow were obtained in part due to the model’s ability to capture subsurface processes. Being able to accurately simulate streamflow levels and subsurface interactions during periods of drought can be very valuable to water suppliers, decision makers, and ultimately impact citizens. Knowledge of future droughts and periods of low flow in addition to tracking customer demand will allow for better management practices on the part of water suppliers such as knowing when they should withdraw more water during a surplus so that the level of stress on the system is minimized when there is not ample water supply.

Improving the care of preterm infants: before, during, and after, stabilisation in the delivery room

Introduction Up to 10% of infants require stabilisation during transition to extrauterine life. Enhanced monitoring of cardiorespiratory parameters during this time may improve stabilisation outcomes. In addition, technology may facilitate improved preparation for delivery room stabilisation as well as NICU procedures, through educational techniques. Aim To improve infant care 1) before birth via improved training, 2) during stabilisation via enhanced physiological monitoring and improved practice, and 3) after delivery, in the neonatal intensive care unit (NICU), via improved procedural care. Methods A multifaceted approach was utilised including; a combination of questionnaire based surveys, mannequin-based investigations, prospective observational investigations, and a randomised controlled trial involving preterm infants less than 32 weeks in the delivery room. Forms of technology utilised included; different types of mannequins including a CO2 producing mannequin, qualitative end tidal CO2 (EtCO2) detectors, a bespoke quantitative EtCO2 detector, and annotated videos of infant stabilisation as well as NICU procedures Results Manual ventilation improved with the use of EtCO2 detection, and was positively assessed by trainees. Quantitative EtCO2 detection in the delivery room is feasible, EtCO2 increased over the first 4 minutes of life in preterm infants, and EtCO2 was higher in preterm infants who were intubated. Current methods of heart rate assessment were found to be unreliable. Electrocardiography (ECG) application warrants further evaluation. Perfusion index (PI) monitoring utilised in the delivery room was feasible. Video recording technology was utilised in several ways. This technology has many potential benefits, including debriefing and coaching in procedural healthcare, and warrants further evaluation. Parents would welcome the introduction of webcams in the NICU. Conclusions I have evaluated new methods of improving infant care before, during, and after stabilisation in the DR. Specifically, I have developed novel educational tools to facilitate training, and evaluated EtCO2, PI, and ECG during infant stabilisation. I have identified barriers in using webcams in the NICU, to now be addressed prior to webcam implementation.

Dynamic classifiers for neonatal brain monitoring

Brain injury due to lack of oxygen or impaired blood flow around the time of birth, may cause long term neurological dysfunction or death in severe cases. The treatments need to be initiated as soon as possible and tailored according to the nature of the injury to achieve best outcomes. The Electroencephalogram (EEG) currently provides the best insight into neurological activities. However, its interpretation presents formidable challenge for the neurophsiologists. Moreover, such expertise is not widely available particularly around the clock in a typical busy Neonatal Intensive Care Unit (NICU). Therefore, an automated computerized system for detecting and grading the severity of brain injuries could be of great help for medical staff to diagnose and then initiate on-time treatments. In this study, automated systems for detection of neonatal seizures and grading the severity of Hypoxic-Ischemic Encephalopathy (HIE) using EEG and Heart Rate (HR) signals are presented. It is well known that there is a lot of contextual and temporal information present in the EEG and HR signals if examined at longer time scale. The systems developed in the past, exploited this information either at very early stage of the system without any intelligent block or at very later stage where presence of such information is much reduced. This work has particularly focused on the development of a system that can incorporate the contextual information at the middle (classifier) level. This is achieved by using dynamic classifiers that are able to process the sequences of feature vectors rather than only one feature vector at a time.

Are stress and mixed urinary incontinence associated with impaired executive control in community-dwelling older women?

Objectives: To assess whether stress or mixed urinary incontinence (UI) is associated with deficits in executive functioning among community-dwelling women. Design: An observational study comparing the performance, using multivariate analyses of variance (MANOVAs) and Bonferroni post hoc test, of continent women and women with stress or mixed UI during executive control tasks. Setting: The research center of the Institut universitaire de gériatrie de Montréal. Participants: One hundred and fifty-five community-dwelling women aged 60 and older participated in the study. Measurements: Based on the Urogenital Distress Inventory (UDI), participants were split into three groups: 35 continent women, 43 women with stress UI, and 78 women with mixed UI. Participants completed a battery of neuropsychological tests and a computerized dual-task test. Results: Women with mixed UI showed poorer performances than continent and stress UI women in executive control functions. Deficits were specific to tests involving switching and sharing/dividing attention between two tasks. Conclusion: Results of this study suggest that mixed UI can be associated with executive control deficits in community-dwelling older women. Future intervention studies in the treatment of UI should take the higher risk of an executive control deficit in women with UI under consideration.

Caracteristicas dos corredores de rua : um mapeamento dos participantes da 41a Prova Rústica Tiradentes

The aim of this study was to map the age profile according to the sex of the runners who participated in the 41a Prova Rústica Tiradentes held in the city of Maringa-PR. This research was descriptive with a mixed approach. For data analysis, descriptive statistics (frequency and relative percentage) using the computerized statistical package SPSS version 20.0 was used. A total of 2609 runners completed the proof, 67.9 por ciento male and 32.0 por ciento female, what could show greater adherence of male runners, if compared with the female group. It is noteworthy that the age group from 30-34 years old was the most representative in both sexes. It was concluded that there was presence of runners in all categories offered in Prova Rústica Tiradentes, in both sexes; thus, the proof fulfills its social role of promotion the sport of participation, and especially enabling that a greater number of people participate.

Caracteristicas dos corredores de rua : um mapeamento dos participantes da 41a Prova Rústica Tiradentes

The aim of this study was to map the age profile according to the sex of the runners who participated in the 41a Prova Rústica Tiradentes held in the city of Maringa-PR. This research was descriptive with a mixed approach. For data analysis, descriptive statistics (frequency and relative percentage) using the computerized statistical package SPSS version 20.0 was used. A total of 2609 runners completed the proof, 67.9 por ciento male and 32.0 por ciento female, what could show greater adherence of male runners, if compared with the female group. It is noteworthy that the age group from 30-34 years old was the most representative in both sexes. It was concluded that there was presence of runners in all categories offered in Prova Rústica Tiradentes, in both sexes; thus, the proof fulfills its social role of promotion the sport of participation, and especially enabling that a greater number of people participate.

Computational Methods for Identifying Hypertrophic Cardiomyopathy using 12-lead ECG

Hypertrophic cardiomyopathy (HCM) is a cardiovascular disease where the heart muscle is partially thickened and blood flow is - potentially fatally - obstructed. It is one of the leading causes of sudden cardiac death in young people. Electrocardiography (ECG) and Echocardiography (Echo) are the standard tests for identifying HCM and other cardiac abnormalities. The American Heart Association has recommended using a pre-participation questionnaire for young athletes instead of ECG or Echo tests due to considerations of cost and time involved in interpreting the results of these tests by an expert cardiologist. Initially we set out to develop a classifier for automated prediction of young athletes’ heart conditions based on the answers to the questionnaire. Classification results and further in-depth analysis using computational and statistical methods indicated significant shortcomings of the questionnaire in predicting cardiac abnormalities. Automated methods for analyzing ECG signals can help reduce cost and save time in the pre-participation screening process by detecting HCM and other cardiac abnormalities. Therefore, the main goal of this dissertation work is to identify HCM through computational analysis of 12-lead ECG. ECG signals recorded on one or two leads have been analyzed in the past for classifying individual heartbeats into different types of arrhythmia as annotated primarily in the MIT-BIH database. In contrast, we classify complete sequences of 12-lead ECGs to assign patients into two groups: HCM vs. non-HCM. The challenges and issues we address include missing ECG waves in one or more leads and the dimensionality of a large feature-set. We address these by proposing imputation and feature-selection methods. We develop heartbeat-classifiers by employing Random Forests and Support Vector Machines, and propose a method to classify full 12-lead ECGs based on the proportion of heartbeats classified as HCM. The results from our experiments show that the classifiers developed using our methods perform well in identifying HCM. Thus the two contributions of this thesis are the utilization of computational and statistical methods for discovering shortcomings in a current screening procedure and the development of methods to identify HCM through computational analysis of 12-lead ECG signals.