Novel Cellular Luminescence Probes for Immunological and Toxicological Assessments

Escherichia coli K-12 (pEGFPluxABCDEAmp) (E. coli-lux), constitutively emitting bioluminescence (BL), was constructed and its BL emitting properties tested in different growth and killing conditions. The BL emission directly correlated with the number of viable E. coli-lux cells, and when subjected to the antimicrobial agent, the diminishment of the BL signal was linked directly to the number of killed bacterial cells. The method provided a very convenient application, especially when compared to conventional plate counting assays. This novel real-time based method was utilized in both immunological and toxicological assessments. The parameters such as the activation phase, the lytic phase and the capacity of the killing of the serum complement system were specified not only in humans but also in other species. E. coli-lux was also successfully used to study the antimicrobial activities of insect haemolymph. The mechanisms of neutrophil activity, like that of a myeloperoxidase (MPO)-H2O2-halide system, were studied using the E. coli-lux approach. The fundamental role of MPO was challenged, since during the actual killing in described circumstances in phagolysosome the MPO system was inactivated and chlorination halted. The toxicological test system, assessing indoor air total toxicity, particularly suitable for suspected mold damages, was designed based on the E. coli-lux method. Susceptibility to the vast number of various toxins, both pure chemicals and dust samples from the buildings and extracts from molds, were investigated. The E. coli-lux application was found to possess high sensitivity and specificity attributes. Alongside the analysis system, the sampling kit for indoor dust was engineered based on the swipe stick and the container. The combination of practical specimen collector and convenient analysis system provided accurate toxic data from the dust sample within hours. Neutrophils are good indicators of the pathophysiological state of the individual, and they can be utilized as a toxicological probe due to their ability to emit chemiluminescence (CL). Neutrophils can either be used as probe cells, directly exposed to the agent studied, or they can act as indicators of the whole biological system exposed to the agent. Human neutrophils were exposed to the same toxins as tested with the E. coli-lux system and measured as luminol amplified CL emission. The influence of the toxins on the individuals was investigated by exposing rats with moniliniformin, the mycotoxin commonly present in Finnish grains. The activity of the rat neutrophils was found to decrease significantly during the 28 days of exposure.

The role of Ca2+/calmodulin-dependent protein kinase II and calcineurin in TNF-α-induced myocardial hypertrophy

We investigated whether Ca2+/calmodulin-dependent kinase II (CaMKII) and calcineurin (CaN) are involved in myocardial hypertrophy induced by tumor necrosis factor α (TNF-α). The cardiomyocytes of neonatal Wistar rats (1-2 days old) were cultured and stimulated by TNF-α (100 μg/L), and Ca2+ signal transduction was blocked by several antagonists, including BAPTA (4 µM), KN-93 (0.2 µM) and cyclosporin A (CsA, 0.2 µM). Protein content, protein synthesis, cardiomyocyte volumes, [Ca2+]i transients, CaMKIIδB and CaN were evaluated by the Lowry method, [³H]-leucine incorporation, a computerized image analysis system, a Till imaging system, and Western blot analysis, respectively. TNF-α induced a significant increase in protein content in a dose-dependent manner from 10 µg/L (53.56 µg protein/well) to 100 μg/L (72.18 µg protein/well), and in a time-dependent manner from 12 h (37.42 µg protein/well) to 72 h (42.81 µg protein/well). TNF-α (100 μg/L) significantly increased the amplitude of spontaneous [Ca2+]i transients, the total protein content, cell size, and [³H]-leucine incorporation in cultured cardiomyocytes, which was abolished by 4 µM BAPTA, an intracellular Ca2+ chelator. The increases in protein content, cell size and [³H]-leucine incorporation were abolished by 0.2 µM KN-93 or 0.2 µM CsA. TNF-α increased the expression of CaMKIIδB by 35.21% and that of CaN by 22.22% compared to control. These effects were abolished by 4 µM BAPTA, which itself had no effect. These results suggest that TNF-α induces increases in [Ca2+]i, CaMKIIδB and CaN and promotes cardiac hypertrophy. Therefore, we hypothesize that the Ca2+/CaMKII- and CaN-dependent signaling pathways are involved in myocardial hypertrophy induced by TNF-α.

Arsenic speciation by ion-exchange chromatography with on- line determination by hydride generation: electronic modification of the D.C. plasma by photon counting

A method using L-cysteine for the determination of arsenous acid (As(III)), arsenic acid (As(V)), monomethylarsonic acid (MMAA), and dimethylarsinic acid (DMAA) by hydride generation was demonstrated. The instrument used was a d.c. plasma atomic emission spectrometer (OCP-AES). Complete recovery was reported for As(III), As(V), and DMAA while 86% recovery was reported for MMAA. Detection limits were determined, as arsenic for the species listed previously, to be 1.2, 0.8, 1.1, and 1.0 ngemL-l, respectively. Precision values, at 50 ngemL-1 arsenic concentration, were f.80/0, 2.50/0, 2.6% and 2.6% relative standard deviation, respectively. The L-cysteine reagent was compared directly with the conventional hydride generation technique which uses a potassium iodide-hydrochloric acid medium. Recoveries using L-cysteine when compared with the conventional method provided the following results: similar recoveries were obtained for As(III), slightly better recoveries were obtained for As(V) and MMAA, and significantly better recoveries for DMAA. In addition, tall and sharp peak shapes were observed for all four species when using L-cysteine. The arsenic speciation method involved separation by ion exchange .. high perfonnance liquid chromatography (HPLC) with on-line hydride generation using the L.. cysteine reagent and measurement byOCP-AES. Total analysis time per sample was 12 min while the time between the start of subsequent runs was approximately 20 min. A binary . gradient elution program, which incorporated the following two eluents: 0.01 and 0.5 mM tri.. sodium citrate both containing 5% methanol (v/v) and both at a pH of approximately 9, was used during the separation by HPLC. Recoveries of the four species which were measured as peak area, and were normalized against As(III), were 880/0, 290/0, and 40% for DMAA, MMAA and As(V), respectively. Resolution factors between adjacent analyte peaks of As(III) and DMAA was 1.1; DMAA and MMAA was 1.3; and MMAA and As(V) was 8.6. During the arsenic speciation study, signals from the d.c. plasma optical system were measured using a new photon-signal integrating device. The_new photon integrator developed and built in this laboratory was based on a previously published design which was further modified to reflect current available hardware. This photon integrator was interfaced to a personal computer through an AID convertor. The .photon integrator has adjustable threshold settings and an adjustable post-gain device.

The development of a Flanders Interaction Analysis style instrument for use in educational computer mediated communication research

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 E38 D56 1992

Les théories de la complexité et la systémique en gouvernance clinique: le cas des soins intensifs chirurgicaux

Deux thématiques importantes des technologies de la santé: la pratique médicale fondée sur des preuves probantes et l’évaluation des interventions en médecine sont fondées sur une approche positiviste et une conception mécaniste des organisations en santé. Dans ce mémoire, nous soulevons l’hypothèse selon laquelle les théories de la complexité et la systémique permettent une conceptualisation différente de ces deux aspects de la gouvernance clinique d’une unité de Soins Intensifs Chirurgicaux (SIC), qui est considérée comme un système adaptatif dynamique non linéaire qui nécessite une approche systémique de la cognition. L’étude de cas d’une unité de SIC, permet de démontrer par de nombreux exemples et des analyses de micro-situations, toutes les caractéristiques de la complexité des patients critiques et instables et de la structure organisationnelle des SIC. Après une critique épistémologique de l’Evidence-Based Medicine nous proposons une pratique fondée sur des raisonnements cliniques alliant l’abduction, l’herméneutique et la systémique aux SIC. En nous inspirant des travaux de Karl Weick, nous suggérons aussi de repenser l’évaluation des modes d’interventions cliniques en s’inspirant de la notion d’organisation de haute fiabilité pour mettre en place les conditions nécessaires à l’amélioration des pratiques aux SIC.

Video-based analysis of Gait pathologies

L’analyse de la marche a émergé comme l’un des domaines médicaux le plus im- portants récemment. Les systèmes à base de marqueurs sont les méthodes les plus fa- vorisées par l’évaluation du mouvement humain et l’analyse de la marche, cependant, ces systèmes nécessitent des équipements et de l’expertise spécifiques et sont lourds, coûteux et difficiles à utiliser. De nombreuses approches récentes basées sur la vision par ordinateur ont été développées pour réduire le coût des systèmes de capture de mou- vement tout en assurant un résultat de haute précision. Dans cette thèse, nous présentons notre nouveau système d’analyse de la démarche à faible coût, qui est composé de deux caméras vidéo monoculaire placées sur le côté gauche et droit d’un tapis roulant. Chaque modèle 2D de la moitié du squelette humain est reconstruit à partir de chaque vue sur la base de la segmentation dynamique de la couleur, l’analyse de la marche est alors effectuée sur ces deux modèles. La validation avec l’état de l’art basée sur la vision du système de capture de mouvement (en utilisant le Microsoft Kinect) et la réalité du ter- rain (avec des marqueurs) a été faite pour démontrer la robustesse et l’efficacité de notre système. L’erreur moyenne de l’estimation du modèle de squelette humain par rapport à la réalité du terrain entre notre méthode vs Kinect est très prometteur: les joints des angles de cuisses (6,29◦ contre 9,68◦), jambes (7,68◦ contre 11,47◦), pieds (6,14◦ contre 13,63◦), la longueur de la foulée (6.14cm rapport de 13.63cm) sont meilleurs et plus stables que ceux de la Kinect, alors que le système peut maintenir une précision assez proche de la Kinect pour les bras (7,29◦ contre 6,12◦), les bras inférieurs (8,33◦ contre 8,04◦), et le torse (8,69◦contre 6,47◦). Basé sur le modèle de squelette obtenu par chaque méthode, nous avons réalisé une étude de symétrie sur différentes articulations (coude, genou et cheville) en utilisant chaque méthode sur trois sujets différents pour voir quelle méthode permet de distinguer plus efficacement la caractéristique symétrie / asymétrie de la marche. Dans notre test, notre système a un angle de genou au maximum de 8,97◦ et 13,86◦ pour des promenades normale et asymétrique respectivement, tandis que la Kinect a donné 10,58◦et 11,94◦. Par rapport à la réalité de terrain, 7,64◦et 14,34◦, notre système a montré une plus grande précision et pouvoir discriminant entre les deux cas.

Effets de l’utilisation d’un chien d’assistance sur les efforts aux membres supérieurs lors de la montée d’une pente en fauteuil roulant chez les individus ayant une lésion médullaire

Problématique. L'utilisation d'un chien d'assistance à la mobilité (CAM) représente une option novatrice pour préserver l’intégrité des membres supérieurs (MSs) chez les utilisateurs de fauteuil roulant manuel (FRM). Aucune étude biomécanique n’a quantifié les effets du CAM sur les efforts aux MSs lors de la montée d’un plan incliné. Objectif. Cette étude quasi-expérimentale vise à comparer les efforts aux MSs lors de la montée d’un plan incliné avec et sans l’assistance d’un CAM. Méthodologie. Dix participants avec une lésion de la moelle épinière (LME) qui utilisent un FRM et possèdent un CAM ont monté un plan incliné à trois reprises avec et sans l’assistance du CAM. Les forces appliquées sur les cerceaux, mesurées avec des roues instrumentées, et les mouvements du FRM et des MSs, enregistrés avec un système d'analyse du mouvement, ont permis de mesurer les efforts mécaniques aux MSs. Simultanément, l'activité électromyographique (EMG) des muscles grand pectoral, deltoïde antérieur, biceps et triceps a été enregistrée et normalisée avec sa valeur maximale pour mesurer les efforts musculaires aux MSs. Résultats. En général, le CAM réduit significativement les valeurs moyennes et maximales de la force totale appliquée aux cerceaux et de sa composante tangentielle, des moments nets de flexion, de rotation interne et d’adduction aux épaules et des taux d’utilisation musculaire du deltoïde antérieur, du biceps et du triceps. Conclusion. L’assistance d’un CAM réduit les efforts aux MSs lors de la montée d’un plan incliné chez les utilisateurs d’un FRM ayant une LME.

Brain Tissue Classification from Multispectral MRI by Wavelet based Principal Component Analysis

In this paper, we propose a multispectral analysis system using wavelet based Principal Component Analysis (PCA), to improve the brain tissue classification from MRI images. Global transforms like PCA often neglects significant small abnormality details, while dealing with a massive amount of multispectral data. In order to resolve this issue, input dataset is expanded by detail coefficients from multisignal wavelet analysis. Then, PCA is applied on the new dataset to perform feature analysis. Finally, an unsupervised classification with Fuzzy C-Means clustering algorithm is used to measure the improvement in reproducibility and accuracy of the results. A detailed comparative analysis of classified tissues with those from conventional PCA is also carried out. Proposed method yielded good improvement in classification of small abnormalities with high sensitivity/accuracy values, 98.9/98.3, for clinical analysis. Experimental results from synthetic and clinical data recommend the new method as a promising approach in brain tissue analysis.

Assessment of Energy Conservation in Indian Cement Industry and Forecasting of Co2 Emissions

Cement industry ranks 2nd in energy consumption among the industries in India. It is one of the major emitter of CO2, due to combustion of fossil fuel and calcination process. As the huge amount of CO2 emissions cause severe environment problems, the efficient and effective utilization of energy is a major concern in Indian cement industry. The main objective of the research work is to assess the energy cosumption and energy conservation of the Indian cement industry and to predict future trends in cement production and reduction of CO2 emissions. In order to achieve this objective, a detailed energy and exergy analysis of a typical cement plant in Kerala was carried out. The data on fuel usage, electricity consumption, amount of clinker and cement production were also collected from a few selected cement industries in India for the period 2001 - 2010 and the CO2 emissions were estimated. A complete decomposition method was used for the analysis of change in CO2 emissions during the period 2001 - 2010 by categorising the cement industries according to the specific thermal energy consumption. A basic forecasting model for the cement production trend was developed by using the system dynamic approach and the model was validated with the data collected from the selected cement industries. The cement production and CO2 emissions from the industries were also predicted with the base year as 2010. The sensitivity analysis of the forecasting model was conducted and found satisfactory. The model was then modified for the total cement production in India to predict the cement production and CO2 emissions for the next 21 years under three different scenarios. The parmeters that influence CO2 emissions like population and GDP growth rate, demand of cement and its production, clinker consumption and energy utilization are incorporated in these scenarios. The existing growth rate of the population and cement production in the year 2010 were used in the baseline scenario. In the scenario-1 (S1) the growth rate of population was assumed to be gradually decreasing and finally reach zero by the year 2030, while in scenario-2 (S2) a faster decline in the growth rate was assumed such that zero growth rate is achieved in the year 2020. The mitigation strategiesfor the reduction of CO2 emissions from the cement production were identified and analyzed in the energy management scenarioThe energy and exergy analysis of the raw mill of the cement plant revealed that the exergy utilization was worse than energy utilization. The energy analysis of the kiln system showed that around 38% of heat energy is wasted through exhaust gases of the preheater and cooler of the kiln sysetm. This could be recovered by the waste heat recovery system. A secondary insulation shell was also recommended for the kiln in the plant in order to prevent heat loss and enhance the efficiency of the plant. The decomposition analysis of the change in CO2 emissions during 2001- 2010 showed that the activity effect was the main factor for CO2 emissions for the cement industries since it is directly dependent on economic growth of the country. The forecasting model showed that 15.22% and 29.44% of CO2 emissions reduction can be achieved by the year 2030 in scenario- (S1) and scenario-2 (S2) respectively. In analysing the energy management scenario, it was assumed that 25% of electrical energy supply to the cement plants is replaced by renewable energy. The analysis revealed that the recovery of waste heat and the use of renewable energy could lead to decline in CO2 emissions 7.1% for baseline scenario, 10.9 % in scenario-1 (S1) and 11.16% in scenario-2 (S2) in 2030. The combined scenario considering population stabilization by the year 2020, 25% of contribution from renewable energy sources of the cement industry and 38% thermal energy from the waste heat streams shows that CO2 emissions from Indian cement industry could be reduced by nearly 37% in the year 2030. This would reduce a substantial level of greenhouse gas load to the environment. The cement industry will remain one of the critical sectors for India to meet its CO2 emissions reduction target. India’s cement production will continue to grow in the near future due to its GDP growth. The control of population, improvement in plant efficiency and use of renewable energy are the important options for the mitigation of CO2 emissions from Indian cement industries

Optimierung der laserinduzierten Plasmaspektroskopie an Metallen durch Femtosekunden-Doppelpulse für die Entwicklung eines hochauflösenden 3D-Rasterabbildungsverfahrens

Die laserinduzierte Plasmaspektroskopie (LIPS) ist eine spektrochemische Elementanalyse zur Bestimmung der atomaren Zusammensetzung einer beliebigen Probe. Für die Analyse ist keine spezielle Probenpräparation nötig und kann unter atmosphärischen Bedingungen an Proben in jedem Aggregatzustand durchgeführt werden. Femtosekunden Laserpulse bieten die Vorteile einer präzisen Ablation mit geringem thermischen Schaden sowie einer hohen Reproduzierbarkeit. Damit ist fs-LIPS ein vielversprechendes Werkzeug für die Mikroanalyse technischer Proben, insbesondere zur Untersuchung ihres Ermüdungsverhaltens. Dabei ist interessant, wie sich die initiierten Mikrorisse innerhalb der materialspezifschen Struktur ausbreiten. In der vorliegenden Arbeit sollte daher ein schnelles und einfach zu handhabendes 3D-Rasterabbildungsverfahren zur Untersuchung der Rissausbreitung in TiAl, einer neuen Legierungsklasse, entwickelt werden. Dazu wurde fs-LIPS (30 fs, 785 nm) mit einem modifizierten Mikroskopaufbau (Objektiv: 50x/NA 0.5) kombiniert, welcher eine präzise, automatisierte Probenpositionierung ermöglicht. Spektrochemische Sensitivität und räumliches Auflösungsvermögen wurden in energieabhängigen Einzel- und Multipulsexperimenten untersucht. 10 Laserpulse pro Position mit einer Pulsenergie von je 100 nJ führten in TiAl zum bestmöglichen Kompromiss aus hohem S/N-Verhältnis von 10:1 und kleinen Lochstrukturen mit inneren Durchmessern von 1.4 µm. Die für das Verfahren entscheidende laterale Auflösung, dem minimalen Lochabstand bei konstantem LIPS-Signal, beträgt mit den obigen Parametern 2 µm und ist die bislang höchste bekannte Auflösung einer auf fs-LIPS basierenden Mikro-/Mapping-Analyse im Fernfeld. Fs-LIPS Scans von Teststrukturen sowie Mikrorissen in TiAl demonstrieren eine spektrochemische Sensitivität von 3 %. Scans in Tiefenrichtung erzielen mit denselben Parametern eine axiale Auflösung von 1 µm. Um die spektrochemische Sensitivität von fs-LIPS zu erhöhen und ein besseres Verständnis für die physikalischen Prozesse während der Laserablation zu erhalten, wurde in Pump-Probe-Experimenten untersucht, in wieweit fs-Doppelpulse den laserinduzierten Abtrag sowie die Plasmaemission beeinflussen. Dazu wurden in einem Mach-Zehnder-Interferometer Pulsabstände von 100 fs bis 2 ns realisiert, Gesamtenergie und Intensitätsverhältnis beider Pulse variiert sowie der Einfluss der Materialparameter untersucht. Sowohl das LIPS-Signal als auch die Lochstrukturen zeigen eine Abhängigkeit von der Verzögerungszeit. Diese wurden in vier verschiedene Regimes eingeteilt und den physikalischen Prozessen während der Laserablation zugeordnet: Die Thermalisierung des Elektronensystems für Pulsabstände unter 1 ps, Schmelzprozesse zwischen 1 und 10 ps, der Beginn des Abtrags nach mehreren 10 ps und die Expansion der Plasmawolke nach über 100 ps. Dabei wird das LIPS-Signal effizient verstärkt und bei 800 ps maximal. Die Lochdurchmesser ändern sich als Funktion des Pulsabstands wenig im Vergleich zur Tiefe. Die gesamte Abtragsrate variiert um maximal 50 %, während sich das LIPS-Signal vervielfacht: Für Ti und TiAl typischerweise um das Dreifache, für Al um das 10-fache. Die gemessenen Transienten zeigen eine hohe Reproduzierbarkeit, jedoch kaum eine Energie- bzw. materialspezifische Abhängigkeit. Mit diesen Ergebnissen wurde eine gezielte Optimierung der DP-LIPS-Parameter an Al durchgeführt: Bei einem Pulsabstand von 800 ps und einer Gesamtenergie von 65 nJ (vierfach über der Ablationsschwelle) wurde eine 40-fache Signalerhöhung bei geringerem Rauschen erzielt. Die Lochdurchmesser vergrößerten sich dabei um 44 % auf (650±150) nm, die Lochtiefe um das Doppelte auf (100±15) nm. Damit war es möglich, die spektrochemische Sensitivität von fs-LIPS zu erhöhen und gleichzeitig die hohe räumliche Auflösung aufrecht zu erhalten.

The SAFEE on-board threat detection system

Under the framework of the European Union Funded SAFEE project(1), this paper gives an overview of a novel monitoring and scene analysis system developed for use onboard aircraft in spatially constrained environments. The techniques discussed herein aim to warn on-board crew about pre-determined indicators of threat intent (such as running or shouting in the cabin), as elicited from industry and security experts. The subject matter experts believe that activities such as these are strong indicators of the beginnings of undesirable chains of events or scenarios, which should not be allowed to develop aboard aircraft. This project aimes to detect these scenarios and provide advice to the crew. These events may involve unruly passengers or be indicative of the precursors to terrorist threats. With a state of the art tracking system using homography intersections of motion images, and probability based Petri nets for scene understanding, the SAFEE behavioural analysis system automatically assesses the output from multiple intelligent sensors, and creates. recommendations that are presented to the crew using an integrated airborn user interface. Evaluation of the system is conducted within a full size aircraft mockup, and experimental results are presented, showing that the SAFEE system is well suited to monitoring people in confined environments, and that meaningful and instructive output regarding human actions can be derived from the sensor network within the cabin.

Chagas disease-related mortality trends, state of Sao Paulo, Brazil, 1985 to 2006: a study using multiple causes of death

Objectives. To study mortality trends related to Chagas disease taking into account all mentions of this cause listed on any line or part of the death certificate. Methods. Mortality data for 1985-2006 were obtained from the multiple cause-of-death database maintained by the Sao Paulo State Data Analysis System (SEADE). Chagas disease was classified as the underlying cause-of-death or as an associated cause-of-death (non-underlying). The total number of times Chagas disease was mentioned on the death certificates was also considered. Results. During this 22-year period, there were 40 002 deaths related to Chagas disease: 34 917 (87.29%) classified as the underlying cause-of-death and 5 085 (12.71%) as an associated cause-of-death. The results show a 56.07% decline in the death rate due to Chagas disease as the underlying cause and a stabilized rate as associated cause. The number of deaths was 44.5% higher among men. The fact that 83.5% of the deaths occurred after 45 years of age reflects a cohort effect. The main causes associated with Chagas disease as the underlying cause-of-death were direct complications due to cardiac involvement, such as conduction disorders, arrhythmias and heart failure. Ischemic heart disease, cerebrovascular disorders and neoplasms were the main underlying causes when Chagas was an associated cause-of-death. Conclusions. For the total mentions to Chagas disease, a 51.34% decline in the death rate was observed, whereas the decline in the number of deaths was only 5.91%, being lower among women and showing a shift of deaths to older age brackets. Using the multiple cause-of-death method contributed to the understanding of the natural history of Chagas disease.

Paracoccidioidomycosis-related mortality trend, state of Sao Paulo, Brazil: a study using multiple causes of death

Objective. To investigate mortality in which paracoccidioidomycosis appears on any line or part of the death certificate. Method. Mortality data for 1985-2005 were obtained from the multiple cause-of-death database maintained by the Sao Paulo State Data Analysis System (SEADE). Standardized mortality coefficients were calculated for paracoccidioidomycosis as the underlying cause-of-death and as an associated cause-of-death, as well as for the total number of times paracoccidioidomycosis was mentioned on the death certificates. Results. During this 21-year period, there were 1950 deaths related to paracoccidioidomycosis; the disease was the underlying cause-of-death in 1 164 cases (59.69%) and an associated cause-of-death in 786 (40.31%). Between 1985 and 2005 records show a 59.8% decline in the mortality coefficient due to paracoccidioidomycosis as the underlying cause and a 53.0% decline in the mortality as associated cause. The largest number of deaths occurred among men, in the older age groups, and among rural workers, with an upward trend in winter months. The main causes associated with paracoccidioidomycosis as the underlying cause-of-death were pulmonary fibrosis, chronic lower respiratory tract diseases, and pneumonias. Malignant neoplasms and AIDS were the main underlying causes when paracoccidioidomycosis was an associated cause-of-death. The decision tables had to be adapted for the automated processing of causes of death in death certificates where paracoccidioidomycosis was mentioned. Conclusions. Using the multiple cause-of-death method together with the traditional underlying cause-of-death approach provides a new angle on research aimed at broadening our understanding of the natural history of paracoccidioidomycosis.

Uma sistemática para a implementação da qualidade total na indústria de manufatura

Este trabalho tem como principal objetivo detalhar uma sistemática para implementação do modelo gerencial da Qualidade Total em empresas da área de manufatura operando no Brasil. Um objetivo secundário é apresentar as principais ferramentas da qualidade aplicadas em processos de Gestão pela Qualidade Total. Primeiramente é desenvolvida uma revisão conceitual, necessária à homogeneização do entendimento sobre o tema Qualidade Total. A revisão começa com um breve histórico da disciplina qualidade chegando até a conformação do sistema gerencial da Qualidade Total, segue pela discussão das possíveis diferenças entre o entendimento do tema no Japão e nos Estados Unidos da América, e finaliza com a conceituação da Qualidade Total e apresentação das principais ferramentas da qualidade. São desenvolvidos três estudos de casos, orientados por um modelo para avaliação de sistemas de gestão (compatíveis com a Qualidade Total) desenvolvido especificamente para essa tarefa. Destes estudos são destacadas as principais ferramentas da qualidade utilizadas em cada empresa, e é detalhado o processo de implementação do sistema de gestão. Finalizando, é apresentada e discutida uma sistemática para implementação da Qualidade Total na indústria de manufatura, pela descrição de um modelo conceitual de referência, ao qual são propostas melhorias identificadas a partir do estudo de casos.

Estudo da precocidade diagnóstica dos melanomas cutâneos primários em Porto Alegre por análise de imagem computadorizada

Fundamentos: A literatura tem demonstrado que a detecção precoce e a remoção cirúrgica em fases iniciais reduz a mortalidade do melanoma e que, em conseqüência, a identificação do melanoma em fases curáveis deve ser encorajada. Objetivos: O interesse principal do estudo foi conhecer se os melanomas cutâneos, no meio, estão sendo diagnosticados em fases iniciais, através de método reprodutível e armazenável. Metodologia: Foi realizado um estudo transversal com os casos de melanomas cutâneos primários, analisados nos laboratórios de patologia de Porto Alegre, de 1° de janeiro de 1994 a 30 de junho de 1995, a fim de avaliar se os diagnósticos foram realizados em estágios precoces. Os casos foram revisados por três dermatopatologistas, que classificaram quanto ao tipo histológico e quanto ao nível de invasão de Clark. Foi realizado um consenso com pelo menos duas concordâncias. A espessura de Breslow foi considerada fator prognóstico determinante e foi medida através de um sistema de análise de imagem computadorizada, por dois membros da equipe. Resultados: Do total de 279 casos que preencheram os critérios de inclusão, 2,15% eram intraepiteliais. Dos melanomas invasivos, 52% tinham espessura ≤ 1,5 mm. Quando agrupado por sexo e procedência, as mulheres de Porto Alegre, capital do estado do Rio Grande do Sul, tiveram a mais alta taxa de diagnóstico precoce (75% ≤ 1,5 mm). O tronco foi o sítio predominante no homem e freqüente na mulher. O melanoma de espalhamento superficial foi o tipo histológico mais freqüente (80,9%), seguido pelo nodular (10,1%). Para definir os determinantes do diagnóstico precoce, foram realizados cruzamentos simples, dos melanomas intraepiteliais somados aos de espessura <0,76 mm, com o sexo, a idade, a procedência, a situação previdenciária, a região anatômica e o tipo histológico. A análise de variáveis múltiplas demonstrou que apenas o sexo (feminino), o sítio anatômico (outras regiões exceto membros inferiores) e a procedência (Porto Alegre) mostraram-se variáveis independentes para determinar um diagnóstico precoce. A idade ≥ 40 anos apresentou significância próxima ao limite. O tipo histológico foi excluído do modelo, uma vez que gerou instabilidade estatística. Conclusão: Embora o número de casos fosse pequeno, o diagnóstico do melanoma ainda é tardio (52% com até 1,5 mm de espessura). Entretanto, existe um subgrupo de diagnóstico precoce que são mulheres, sobretudo de Porto Alegre, possivelmente por estarem mais atentas e informadas sobre os riscos do melanoma. As mudanças no estilo de vida, nas últimas décadas, provavelmente são responsáveis pela maior incidência no tronco e pela alta freqüência de melanoma de espalhamento superficial encontrada. A análise da espessura tumoral por projeção em tela de computador mostrou-se um recurso auxiliar vantajoso.