Preditores de injúria renal aguda e de mortalidade em uma Unidade de Terapia Intensiva

Introdução e Objetivos: Comparar características clínicas e evolução dos pacientes com e sem injúria renal aguda (IRA), avaliar a incidência, mortalidade da IRA e fatores de risco de IRA e de óbito em pacientes em uma Unidade de Terapia Intensiva (UTI). Métodos: Estudo retrospectivo que analisou 152 pacientes em uma única UTI. Avaliamos a idade, o sexo, o motivo do internamento, fatores de risco para IRA, dados laboratoriais, a necessidade de terapia renal substitutiva e a mortalidade. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) e RIFLE foram registrados no dia de admissão na UTI. Determinamos a incidência da IRA, mortalidade e os preditores independentes de IRA e de óbito utilizando o modelo de regressão logística. Resultados: A idade média foi de 57,1 ± 20 anos e 60,1% eram masculinos. IRA não dialítica ocorreu em 81 pacientes (53,2%) e a IRA dialítica ocorreu em 19 pacientes (12,4%). A mortalidade global foi de 35,9%, enquanto que a taxa de mortalidade nos pacientes com IRA não dialítica foi de 43,2% e a dos com IRA dialítica de 84,2%. Na análise multivariada, a ventilação mecânica invasiva, a creatinina e a ureia elevadas na admissão foram fatores de risco independentes para IRA, enquanto que diagnóstico clínico, uso de ventilação mecânica invasiva, ureia e lactato aumentados e hipernatremia foram fatores de risco independentes para mortalidade na UTI. Conclusão: A incidência e a mortalidade de IRA na UTI foram elevadas neste estudo, apesar dos avanços que vêm surgindo no seu manejo.

Avaliação do conhecimento sobre terapia renal substitutiva dos profissionais de saúde nas regiões de Juiz de Fora, São João Nepomuceno e Santos Dumont

ResumoEm consonância com o Editorial "Como explicar a baixa penetração da diálise peritoneal no Brasil" publicado em 2014 no Jornal Brasileiro de Nefrologia, escrito pelo Professor Hugo Abensur,1 mostramos os resultados de um estudo denominado "Avaliação do conhecimento sobre terapia renal substitutiva dos profissionais de saúde nas microrregiões de Juiz de Fora, São João Nepomuceno e Santos Dumont" (Aprovado pelo Comitê de Ética da UFJF CAAE: 23659213.8.0000.5147 e financiado pela FAPEMIG sob número APQ 03626-12).Objetivo:Avaliar o conhecimento sobre TRS dos profissionais de saúde das microrregiões de Juiz de Fora, São João Nepomuceno e Santos Dumont.Métodos:Estudo transversal no período de abril de 2014 a abril de 2015. A população estudada foi de profissionais de saúde (médicos, enfermeiros e técnicos de enfermagem) que trabalhavam nas unidades de pronto atendimento (UPA) e atenção primária à saúde (UAPS). Os profissionais de saúde foram entrevistados com o uso de um questionário semiestruturado, baseado em um caso clínico de uma paciente com diagnóstico de Diabetes Mellitus, Hipertensão Arterial e Doença Renal Crônica que evoluiu com piora da função renal, de uma creatinina de 1,8 mg/dL para 12 mg/dL e com diferentes perguntas conforme trabalhasse na UAPS ou UPA e categoria profissional e nele continha uma questão qualitativa.Resultados:Foram entrevistados 75 profissionais de 8 municípios, sendo 26,7% médicos, 32% enfermeiros e 41,3% técnicos de enfermagem. A idade média foi de 38 anos. Destes, 70,7% trabalhavam em UAPS e 29,3% em UPA. Tanto na UPA quanto na UAPS a frequência referida de atendimento de casos semelhantes ficou entre uma vez por mês e uma vez a cada três meses. A maioria encaminharia o paciente para unidade hospitalar e indicaria TRS. A TRS mais indicada pelos médicos é a HD (> 90% dos casos) e menos de 10% indicariam DP como primeira escolha. A associação de "creatinina" e função renal" é adequada em mais de 90% das respostas, a despeito de não haver associação da mesma com nível de filtração glomerular, quando esta pergunta é feita. Mais de 90% dos profissionais não médicos desejam realizar treinamento/capacitação em nefrologia/TRS.Conclusão:Observamos que a maioria dos profissionais não indicam diálise peritoneal, principalmente profissionais médicos, tanto das UAPS quanto das UPAs; 90% destes indicaram HD. Sobre enfermeiros e técnicos de enfermagem das UAPS, 52,1% indicaram HD e 9,4% DP. Aqueles da UPA 41,6% indicaram HD e 26,6% DP. Concluímos que uma minoria dos profissionais de saúde indicaria DP como primeira escolha e, na questão qualitativa referem frequente déficit de "conhecimento na área", estão interessados em realizar treinamento/capacitação.

Efeito da terapia de indução em pacientes sensibilizados: análise dos riscos e benefícios

Resumo Introdução: A sensibilização está associada a piores desfechos clínicos após o transplante renal (TxR), incluindo maior incidência de função tardia, rejeição aguda e perda do enxerto. Objetivos: Avaliar os desfechos de eficácia e segurança de 1 ano de receptores de TxR com doador falecido sensibilizados induzidos com globulina antitimócito (ATG) e compará-las aos de pacientes não sensibilizados. Métodos: Receptores de TxR com doador falecido entre janeiro de 1998 e dezembro de 2009 foram divididos em 5 grupos: grupo controle 1 - n = 89, PRA negativo, sem indução; grupo controle 2 - n = 94, PRA negativo, indução com basiliximabe; grupo controle 3 - n = 81, PRA negativo, indução com ATG; grupo teste 4 - n = 64, PRA 1-49%, indução com ATG; grupo teste 5 - n = 118, PRA ≥ 50%, indução com ATG. Resultados: Não houve diferença na incidência de rejeição entre pacientes sensibilizados e não sensibilizados, exceto pelo grupo 1, que apresentou a maior incidência de rejeição aguda comprovada por biópsia (20,2%, p = 0,006 vs. grupo 4 ep = 0,001 vs. grupo 5). Os pacientes sensibilizados induzidos com ATG apresentaram maior incidência de infecção por citomegalovírus quando comparados aos pacientes do grupo 2 (26,6% e 14,4% vs. 2,1%). Não houve diferença nas sobrevidas do enxerto e do paciente. Na análise multivariada, PRA > 50% e uso de ATG não foram associados à perda, perda com óbito censorado ou óbito. Conclusão: Os pacientes sensibilizados induzidos com ATG apresentaram incidência de rejeição semelhante ou inferior à de pacientes não sensibilizados não induzidos. Estes pacientes apresentaram sobrevidas do enxerto e do paciente semelhantes em 1 ano e comparável perfil de segurança.

Use of airborne laser scanner data in demanding forest conditions

Most of the applications of airborne laser scanner data to forestry require that the point cloud be normalized, i.e., each point represents height from the ground instead of elevation. To normalize the point cloud, a digital terrain model (DTM), which is derived from the ground returns in the point cloud, is employed. Unfortunately, extracting accurate DTMs from airborne laser scanner data is a challenging task, especially in tropical forests where the canopy is normally very thick (partially closed), leading to a situation in which only a limited number of laser pulses reach the ground. Therefore, robust algorithms for extracting accurate DTMs in low-ground-point-densitysituations are needed in order to realize the full potential of airborne laser scanner data to forestry. The objective of this thesis is to develop algorithms for processing airborne laser scanner data in order to: (1) extract DTMs in demanding forest conditions (complex terrain and low number of ground points) for applications in forestry; (2) estimate canopy base height (CBH) for forest fire behavior modeling; and (3) assess the robustness of LiDAR-based high-resolution biomass estimation models against different field plot designs. Here, the aim is to find out if field plot data gathered by professional foresters can be combined with field plot data gathered by professionally trained community foresters and used in LiDAR-based high-resolution biomass estimation modeling without affecting prediction performance. The question of interest in this case is whether or not the local forest communities can achieve the level technical proficiency required for accurate forest monitoring. The algorithms for extracting DTMs from LiDAR point clouds presented in this thesis address the challenges of extracting DTMs in low-ground-point situations and in complex terrain while the algorithm for CBH estimation addresses the challenge of variations in the distribution of points in the LiDAR point cloud caused by things like variations in tree species and season of data acquisition. These algorithms are adaptive (with respect to point cloud characteristics) and exhibit a high degree of tolerance to variations in the density and distribution of points in the LiDAR point cloud. Results of comparison with existing DTM extraction algorithms showed that DTM extraction algorithms proposed in this thesis performed better with respect to accuracy of estimating tree heights from airborne laser scanner data. On the other hand, the proposed DTM extraction algorithms, being mostly based on trend surface interpolation, can not retain small artifacts in the terrain (e.g., bumps, small hills and depressions). Therefore, the DTMs generated by these algorithms are only suitable for forestry applications where the primary objective is to estimate tree heights from normalized airborne laser scanner data. On the other hand, the algorithm for estimating CBH proposed in this thesis is based on the idea of moving voxel in which gaps (openings in the canopy) which act as fuel breaks are located and their height is estimated. Test results showed a slight improvement in CBH estimation accuracy over existing CBH estimation methods which are based on height percentiles in the airborne laser scanner data. However, being based on the idea of moving voxel, this algorithm has one main advantage over existing CBH estimation methods in the context of forest fire modeling: it has great potential in providing information about vertical fuel continuity. This information can be used to create vertical fuel continuity maps which can provide more realistic information on the risk of crown fires compared to CBH.

Laser- plasma- hybridihitsauksen käytettävyys teollisuudessa

Hybridihitsaukseksi nimitetään yleensä hitsausprosesseja, joissa yhdistetään kaari- ja laserhitsauksen vahvuudet. Laser- MIG/MAG- prosessit ovat näistä selvästi yleisimpiä, mutta muillekin prosesseille on sovelluksia. Tässä kandidaatintyössä on arvioitu laser- plasma- hybridihitsausprosessin käytettävyyttä teollisuuden prosesseissa. Arviointi on tehty vertailevana kirjallisuustutkimuksena laser- plasma- hybridiprosessin, laserhitsauksen, sekä muiden laser- hybridihitsausprosessien kesken. Prosessien vertailun lisäksi työssä on käsitelty hybridihitsausprosessien parametrien valintaa ja laser- plasma- hybridiprosessin erityispiirteitä.

Real-time adaptive control of ultra-fast laser scribing process with spectrometer online monitoring

There exist several researches and applications about laser welding monitoring and parameter control but not a single one have been created for controlling of laser scribing processes. Laser scribing is considered to be very fast and accurate process and thus it would be necessary to develop accurate turning and monitoring system for such a process. This research focuses on finding out whether it would be possible to develop real-time adaptive control for ultra-fast laser scribing processes utilizing spectrometer online monitoring. The thesis accurately presents how control code for laser parameter tuning is developed using National Instrument's LabVIEW and how spectrometer is being utilized in online monitoring. Results are based on behavior of the control code and accuracy of the spectrometer monitoring when scribing different steel materials. Finally control code success is being evaluated and possible development ideas for future are presented.

Real-time monitoring of laser scribing process utilizing high-speed camera

Currently, laser scribing is growing material processing method in the industry. Benefits of laser scribing technology are studied for example for improving an efficiency of solar cells. Due high-quality requirement of the fast scribing process, it is important to monitor the process in real time for detecting possible defects during the process. However, there is a lack of studies of laser scribing real time monitoring. Commonly used monitoring methods developed for other laser processes such a laser welding, are sufficient slow and existed applications cannot be implemented in fast laser scribing monitoring. The aim of this thesis is to find a method for laser scribing monitoring with a high-speed camera and evaluate reliability and performance of the developed monitoring system with experiments. The laser used in experiments is an IPG ytterbium pulsed fiber laser with 20 W maximum average power and Scan head optics used in the laser is Scanlab’s Hurryscan 14 II with an f100 tele-centric lens. The camera was connected to laser scanner using camera adapter to follow the laser process. A powerful fully programmable industrial computer was chosen for executing image processing and analysis. Algorithms for defect analysis, which are based on particle analysis, were developed using LabVIEW system design software. The performance of the algorithms was analyzed by analyzing a non-moving image from the scribing line with resolution 960x20 pixel. As a result, the maximum analysis speed was 560 frames per second. Reliability of the algorithm was evaluated by imaging scribing path with a variable number of defects 2000 mm/s when the laser was turned off and image analysis speed was 430 frames per second. The experiment was successful and as a result, the algorithms detected all defects from the scribing path. The final monitoring experiment was performed during a laser process. However, it was challenging to get active laser illumination work with the laser scanner due physical dimensions of the laser lens and the scanner. For reliable error detection, the illumination system is needed to be replaced.

Pulsed laser deposition of YBa2Cu3O7-[delta]/PrBa2Cu3O7-[delta] /

The process of depositing thin films by the use of pulsed laser deposition (PLD) has become a more widely used technique for the growth of substances in a thin film form. Pulsed laser deposition allows for the stoichiometric film growth of the target which is of great significance in the deposition of High Temperature Superconducting materials. We will describe a system designed using an excimer laser and vaccum chamber in which thin films and superlattices of YBa2Cuj07_i, PrBa2Cu307_i, and YBajCujOr-j/ PrBajCusOr-^ were deposited on SrTiOs. Results of resistivity measurements using the four probe technique will be shown.

Kr-Ar laser Raman spectrometer for low temperature measurements /

A Czerny Mount double monochromator is used to measure Raman scattered radiation near 90" from a crystalline, Silicon sample. Incident light is provided by a mixed gas Kr-Ar laser, operating at 5145 A. The double monochromator is calibrated to true wavelength by comparison of Kr and Ar emission Une positions (A) to grating position (A) display [1]. The relationship was found to be hnear and can be described by, y = 1.219873a; - 1209.32, (1) where y is true wavelength (A) and xis grating position display (A). The Raman emission spectra are collected via C"*""*" encoded software, which displays a mV signal from a Photodetector and allows stepping control of the gratings via an A/D interface. [2] The software collection parameters, detector temperature and optics are optimised to yield the best quality spectra. The inclusion of a cryostat allows for temperatmre dependent capabihty ranging from 4 K to w 350 K. Silicon Stokes temperatm-e dependent Raman spectra, generally show agreement with Uterature results [3] in their frequency haxdening, FWHM reduction and intensity increase as temperature is reduced. Tests reveal that a re-alignment of the double monochromator is necessary before spectral resolution can approach literature standard. This has not yet been carried out due to time constraints.

Preparation of SrMgx-Ru1-xO3 thin films by pulsed laser deposition /

SrMg^Rui-iOa thin films were made by using pulsed laser deposition on SrTiOa (100) substrates in either O2 or Ar atmosphere. The thin films were characterized by x-ray diffraction, energy dispersive x-ray microanalysis, dc resistivity measurement, and dc magnetization measurement. The effect of Mg doping was observed. As soon as the amount of Mg increased in SrMg-cRui-iOa thin films, the magnetization decreased, and the resistivity increased. It had little effect on the Curie temperature (transition temperature). The magnetization states of SrMgiRui-iOa thin films, for x < 0.15, are similar to SrRuOs films. X-ray diffraction results for SrMga-Rui-iOa thin films made in oxygen showed that the films are epitaxial. The thin films could not be well made in Ar atmosphere during laser ablation as there was no clear peak of SrMg^Rui-iOa in x-ray diffraction results. Substrate temperatures had an effect on the resistivity of the films. The residual resistivity ratios were increased by increasing substrate temperature. It was observed that the thickness of thin films are another factor for film quality: Thin films were epitaxial, but thicker films were not epitaxial.

Introducción a los sistemas laser y sus aplicaciones.

Tesis (Maestría en Ciencias en Ingeniería Eléctrica con Especialidad en Potencia) UANL

Presión arterial post-ejercicio y terapia de luz

Tesis (Maestría en Ciencias del Ejercicio con Acentuación en Deporte de Alto Rendimiento) UANL

Competencias profesionales de enfermería en la atención del paciente sometido a terapia transfusional.

Tesis (Maestría en Ciencias de Enfermería con Énfasis en Administración de Servicios) UANL, 2010.

Estudio de caso : el proceso de la terapia breve en el afrontamiento del estrés en un cuidador de paciente diagnosticado con afasia.

Tesis (Maestría en Psicología con Orientación en Terapia Breve) UANL, 2013.

Hipnoterapia y terapia breve centrada en soluciones aplicada a síntomas por abuso sexual infantil: un estudio de caso.

Tesis (Maestría en Psicología con orientación en Terapia Breve) UANL, 2014.