Modelo de planeamento – GDH de ambulatório

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia Biomédica

Modelo de previsão para identificar fatores de risco dos reinternamentos hospitalares em 30 dias : um estudo ao GDH 127 - insuficiência cardíaca ou choque

A representatividade do número de reinternamento hospitalares, no quadro dos custos hospitalares, deverá ser encarada como um indicador de qualidade nos serviços prestados e um objeto de estudo no que diz respeito à forma como estão a ser geridos esses serviços. Caracterizar os utentes com maior propensão a um reinternamento e identificar os fatores de risco que lhe estão associados torna-se, pois, pertinente, pois só assim, se poderá, no futuro, desenvolver uma atuação proativa com o objetivo primeiro de uma redução de custos sem colocar, no entanto, em causa a qualidade dos serviços que as entidades hospitalares prestam aos seus utentes. O objetivo deste estudo consiste em criar um modelo preditivo, com base em árvores de decisão, que auxilie a identificar os fatores de risco dos reinternamentos em 30 dias relativos ao Grupos de Diagnóstico Homogéneo (GDH) 127 - Insuficiência cardíaca e/ou choque, de forma a auxiliar as entidades prestadoras de cuidados de saúde a tomar decisões e atuar atempadamente sobre situações críticas. O estudo é suportado pela base de dados dos Grupos de Diagnóstico Homogéneos, a qual, possui informação sobre o utente e sobre o seu processo de internamento, nomeadamente, o diagnóstico principal, os diagnósticos secundários, os procedimentos realizados, a idade e sexo do utente e o destino após a alta. Pode concluir-se após estudo, que as taxas de reinternamentos têm vindo a aumentar nos últimos anos, que a população idosa insere-se no universo sujeito ao maior risco de reinternamento e que além do diagnóstico principal, a existência de comorbidades representa um papel importante no incremento do risco, nomeadamente, quando são diagnosticadas em simultâneo doenças renais, diabetes mellitus ou doenças isquémicas crónicas do coração (NCOP).

GDH activity and ammonium excretion in the marine mysid, "Leptomysis lingvura": effects of age and starvation

[EN] Ammonium (NH4+) release by bacterial remineralization and heterotrophic grazers determines the regenerated fraction of phytoplankton productivity, so the measurement of NH4+ excretion in marine organisms is necessary to characterize both the magnitude and the efficiency of the nitrogen cycle. Glutamate dehydrogenase (GDH) is largely responsible for NH4+ formation in crustaceans and consequently should be useful in estimating NH4+ excretion by marine zooplankton.
Here, we address body size and starvation as sources of variability on the GDH to NH4+ excretion ratio (GDH/RNH4+). We found a strong correlation between the RNH4+ and the GDH activity (r2 = 0.87, n = 41) during growth. Since GDH activity maintained a linear relation (b = 0.93) and RNH4+ scaled exponentially (b =0.55) in well fed mysids, the GDH/RNH4+ ratio increased with size. However, the magnitude of its variation increased even more when adult mysids were starved. In this case, the GDH/RNH4+ ratio ranged from 11.23 to 102.41.

GDH activity and ammonium excretion in the marine mysid "Leptomysis lingvura": effects of age and starvation

Máster Universitario en Oceanografía

GDH activity and ammonium excretion during growth in the marine mysid, "Leptomysis lingvura"

[EN] Ammonium (NH4+) and nitrate (NO3-) are the main constituents of the inorganic nitrogen pool that supports primary production in marine systems. NH4+ release via glutamate deamination in heterotrophic organisms represents the largest recycled nitrogen source in the euphotic zone, supporting around the 80 % of the primary producers requirements (Harrison, 1992). Glutamate dehydrogenase (GDH) is the enzyme that catalyzes this process. This fact has lead to the use of GDH activity as an index, a proxy, for physiological NH4+ formation. The result is a measure of potential excretion that avoids incubation artefacts due to manipulation of the organisms. The relationship between GDH activity and NH4+ excretion in cultures of the marine mysid Leptomysis lingvura is analyzed here. With interspecific and environmental interferences minimized, the study shows that the relationship between GDH activity and NH4+ excretion in L. lingvura is similar to equivalent results measured on mixed assemblages of zooplankton.

Is the GDH/RNH4+ ratio in the mesozooplankton constant through different oceanic systems?

[EN] Nitrogen (N) is essential for life, but its availability is frequently limited in ocean ecosystems. Among all the compounds which influence the N pool, ammonium (NH4+) represents the major source of N for autotrophs. This NH4+ is provided by bacterial remineralization and heterotrophic grazers, with the mesozooplankton responsible for 12% to 33% of the total NH4+ recycled.  Quantifying the excretion physiology of zooplankton is then, necessary to understand the basis of an aquatic ecosystem’s productivity.
The measurement of glutamate dehydrogenase (GDH) activity has been widely used to assess the NH4+ excretion rates in planktonic communities. However, its relationship with the physiology varies with temperature and the nutritional status of the organisms, among other variables. Here we compare the GDH/RNH4+ ratio between oceanic regions with different trophic conditions.  Strengthening our knowledge of the relationship between GDH activities and the NH4+ excretion rates will lead to more meaningful interpretations of the mesoscale variations in planktonic NH4+ excretion.

Is the GDH/RNH4+ ratio in the mesozooplankton constant through different oceanic systems?

[EN]Nitrogen (N) is essential for life, but its availability is frequently limited in ocean ecosystems. Among all the compounds which influence the N pool, ammonium (NH4+) represents the major source of N for autotrophs. This NH4+ is provided by bacterial remineralization and heterotrophic grazers, with the mesozooplankton responsible for 12% to 33% of the total NH4+ recycled. Quantifying the excretion physiology of zooplankton is then, necessary to understand the basis of an aquatic ecosystem?s productivity. The measurement of glutamate dehydrogenase (GDH) activity has been widely used to assess the NH4+ excretion rates in planktonic communities. However, its relationship with the physiology varies with temperature and the nutritional status of the organisms, among other variables. Here we compare the GDH/RNH4+ ratio between oceanic regions with different trophic conditions. Strengthening our knowledge of the relationship between GDH activities and the NH4+ excretion rates will lead to more meaningful interpretations of the mesoscale variations in planktonic NH4+ excretion.

Erste Untersuchungen zur Messung helizitätsabhängiger (gamma N)-Wirkungsquerschnitte für das GDH-Experiment am MAMI

Das experimentelle Studium der 1966 von Gerasimov, Drell undHearn unabhängig voneinander aufgestellten und als GDH-SummenregelbezeichnetenRelation macht die Vermessung totalerPhotoabsorptionswirkungsquerschnitte von zirkular polarisierten Photonen an longitudinalpolarisierten Nukleonen über einen weiten Energiebereich notwendig. Die im Sommer1998 erfolgte Messung am Mainzer Mikrotron stellt das erste derartigeExperiment mit reellen Photonen zur Messung des GDH-Integrals am Protondar. Die Verwendung eines Frozen-Spin-Butanoltargets, das eingesetzt wurde, umeinen möglichst hohen Proton-Polarisationsgrad zu erreichen, hat diezusätzliche experimentelle Schwierigkeit zur Folge, daß die imButanoltarget enthaltenen Kohlenstoffkerne ebenfalls Reaktionsprodukte liefern, diezusammen mit den am Proton erzeugten nachgewiesen werden.Ziel der Arbeit war die Bestimmung von Wirkungsquerschnittenam freien Proton aus Messungen an einem komplexen Target (CH2) wie esbeim polarisiertenTarget vorliegt. Die hierzu durchgeführten Pilotexperimentedienten neben der Entwicklung von Methoden zur Reaktionsidentifikation auchder Eichung des Detektorsystems. Durch die Reproduktion der schon bekanntenund vermessenen unpolarisierten differentiellen und totalenEin-Pion-Wirkungsquerschnitte am Proton (gamma p -> p pi0 und gamma p -> n pi+), die bis zueiner Photonenergievon etwa 400 MeV den Hauptbeitrag zum GDH-Integralausmachen, konnte gezeigt werden, daß eine Separation der Wasserstoff- vonKohlenstoffereignissen möglich ist. Die notwendigen Techniken hierzu wurden imRahmen dieser Arbeit zu einem allgemein nutzbaren Werkzeug entwickelt.Weiterhin konnte gezeigt werden, daß der vom Kohlenstoffstammende Anteil der Reaktionen keine Helizitätsabhängigkeit besitzt. Unterdieser Voraussetzung reduziert sich die Bestimmung der helizitätsabhängigenWirkungsquerschnittsdifferenz auf eine einfacheDifferenzbildung. Aus den erhaltenen Ergebnissen der intensiven Analyse von Daten, diemit einem unpolarisierten Target erhalten wurden, konnten so schnellerste Resultate für Messungen, die mit dem polarisierten Frozen-Spin-Targetaufgenommen wurden, geliefert werden. Es zeigt sich, daß sich dieseersten Resultate für polarisierte differentielle und totale (gammaN)-Wirkungsquerschnitte im Delta-Bereich in guter Übereinstimmung mit theoretischenAnalysen befinden.

Aufbau des GDH-Experiments und Messung der Helizitätsabhängigkeit von gamma p p pi + pi- von der Schwelle bis 800 MeV

Das Experiment zur Überprüfung der Gerasimov-Drell-Hearn(GDH)-Summenregel am Mainzer Mikrotron diente zur Messunghelizitätsabhängiger Eigenschaften der Photoproduktion amProton. Hierbei konnten neben den totalen Photoabsorptionswirkungsquerschnitten auch Querschnitte partieller Kanäle der Einpion-, Zweipion- und Eta-Produktion bestimmt werden. Für die möglichen Doppel-Pion-Reaktionen sind zur Zeit nur wenig Information vorhanden. Daher sind die Reaktionsmechanismen der Doppel-Pion-Photoproduktion weitgehend noch unverstanden. Aus diesem Grund ist die Untersuchung weiterer Observablenerforderlich. Die Helizitätsabhängigkeit stellt eine solcheneue Observable dar und kann dadurch gemessen werden, daßein zirkular polarisiertes Photon mit einem longitudinalpolarisierten Nukleon wechselwirkt. Der Photonspin beträgt1 und der Fermionenspin des Nukleons beträgt 1/2.Die Spins koppeln zu 3/2 und 1/2. Dies liefert diehelizitätsabhängigen Wirkungsquerschnitte.Diese Dissertation beschreibt den Aufbau des Mainzer GDH-Experiments und die technische Realisation der Messung helizitätsabhängiger Photoabsorptionswirkungsquerschnitte. Die Helizitätsabhängigkeit der doppelt geladenen Doppel-Pion-Photoproduktion am Proton wurde anhand der gemessenen Daten untersucht. Diese Reaktion ist ein Zweistufenprozeß, wobei das angeregte Nukleon resonant oder nicht-resonant in die Endzustandsteilchen zerfällt. Durch die helizitätsabhängigen Daten wurden Freiheitsgradein der Doppel-Pion-Photoproduktion eingeschränkt, wodurch eine Verbesserung der Modelle der Gent-Mainz- und der Valencia-Gruppe ermöglicht wurde. Die im Rahmen dieser Arbeit ermittelten Daten haben zusätzlich eine Motivation für weitere Interpretationsansätze durch die genanntenTheoriegruppen geschaffen.

Measurement of the doubly-polarized He3→(γ→,n)pp reaction at 16.5 MeV and its implications for the GDH sum rule

We report new measurements of the double-polarized photodisintegration of 3He at an incident photon energy of 16.5 MeV, carried out at the High Intensity γ-ray Source (HIγS) facility located at Triangle Universities Nuclear Laboratory (TUNL). The spin-dependent double-differential cross sections and the contribution from the three-body channel to the Gerasimov–Drell–Hearn (GDH) integrand were extracted and compared with the state-of-the-art three-body calculations. The calculations, which include the Coulomb interaction and are in good agreement with the results of previous measurements at 12.8 and 14.7 MeV, deviate from the new cross section results at 16.5 MeV. The GDH integrand was found to be about one standard deviation larger than the maximum value predicted by the theories.

Disparity between Multilocus Enzyme Electrophoresis, Microsatellite Markers and Pulsed-Field Gel Electrophoresis in epidemiological tracking of Candida albicans

Various molecular systems are available for epidemiological, genetic, evolutionary, taxonomic and systematic studies of innumerable fungal infections, especially those caused by the opportunistic pathogen C. albicans. A total of 75 independent oral isolates were selected in order to compare Multilocus Enzyme Electrophoresis (MLEE), Electrophoretic Karyotyping (EK) and Microsatellite Markers (Simple Sequence Repeats - SSRs), in their abilities to differentiate and group C. albicans isolates (discriminatory power), and also, to evaluate the concordance and similarity of the groups of strains determined by cluster analysis for each fingerprinting method. Isoenzyme typing was performed using eleven enzyme systems: Adh, Sdh, M1p, Mdh, Idh, Gdh, G6pdh, Asd, Cat, Po, and Lap (data previously published). The EK method consisted of chromosomal DNA separation by pulsed-field gel electrophoresis using a CHEF system. The microsatellite markers were investigated by PCR using three polymorphic loci: EF3, CDC3, and HIS3. Dendrograms were generated by the SAHN method and UPGMA algorithm based on similarity matrices (S(SM)). The discriminatory power of the three methods was over 95%, however a paired analysis among them showed a parity of 19.7-22.4% in the identification of strains. Weak correlation was also observed among the genetic similarity matrices (S(SM)(MLEE) x S(SM)(EK) x S(SM)(SSRs)). Clustering analyses showed a mean of 9 +/- 12.4 isolates per cluster (3.8 +/- 8 isolates/taxon) for MLEE, 6.2 +/- 4.9 isolates per cluster (4 +/- 4.5 isolates/taxon) for SSRs, and 4.1 +/- 2.3 isolates per cluster (2.6 +/- 2.3 isolates/taxon) for EK. A total of 45 (13%), 39(11.2%), 5 (1.4%) and 3 (0.9%) clusters pairs from 347 showed similarity (Si) of 0.1-10%, 10.1-20%, 20.1-30% and 30.1-40%, respectively. Clinical and molecular epidemiological correlation involving the opportunistic pathogen C. albicans may be attributed dependently of each method of genotyping (i.e., MLEE, EK, and SSRs) supplemented with similarity and grouping analysis. Therefore, the use of genotyping systems that give results which offer minimum disparity, or the combination of the results of these systems, can provide greater security and consistency in the determination of strains and their genetic relationships. (C) 2010 Elsevier B.V. All rights reserved.

Genotyping of potentially zoonotic Giardia duodenalis from exotic and wild animals kept in captivity in Brazil

We have studied the variability of glutamate dehydrogenase (gdh) and small subunit ribosomal (SSU) rRNA coding genes of Giardia species in fecal samples isolated from wild and exotic animals in Brazil, and compared with homologous sequences of isolates from human and domestic animals characterized in previous studies. Cysts of Giardia duodenalis were obtained from feces of naturally infected monkeys (Alouatta fusca) (n = 20), chinchillas (Chinchilla lanigera) (n = 3), ostriches (Struthio camelus) (n = 2) and jaguar (Panthera onca) (n = 1). Assemblage AI was assigned to the unique isolate of jaguar. All the samples from monkeys, chinchillas, and ostriches were assigned to Assemblage B. There was little evolutionary divergence between the referred isolates and isolates described elsewhere. The Assemblage B isolates identified in this study were closely related to Assemblage BIV isolated from humans. The molecular identification of Assemblages A and B of G. duodenalis isolates from exotic and wild animals demonstrates that such hosts may be a potential reservoir for zoonotic transmission of G. duodenalis. (C) 2011 Elsevier B.V. All rights reserved.

Panmixia in Pocillopora verrucosa from South Africa

The genetic structure of six local collections of Pocillopora verrrucosa from six coral reefs in KwaZulu-Natal, South Africa, was examined using allozyme electrophoresis. The six separate reefs lie within two different reef complexes. Twenty-two enzymes were screened on five buffer systems, but only five polymorphic loci (Gpi-1, Gdh-1, Lgg-2, Lpp-1, Est-1) could be consistently resolved. No significant differences in allelic frequencies were detected among the six sites. All local collections were genotypically diverse, with evidence of only very limited clonal replication at each site. Indeed, the ratio of observed to expected genotypic diversity (mean Go:Ge=0.64 +/-0.05 SD), the ratio of observed number of genotypes to the number of individuals (mean Ng:N = 0.65 +/-0.04 SE), and deviations from the Hardy-Weinberg equilibrium indicate that sexual reproduction plays a major role in the maintenance of the populations. No genetic differentiation was found either within (FSR = 0.026 +/-0.003 SE) or between (FRT = 0.000 +/-0.001 SE) reef complexes. The homogeneity of the gene frequencies across the six reefs strongly supports the assumption that the KwaZulu-Natal reef complexes are highly connected by gene flow (Nem=44). The reefs in the southern and central reef complexes along the northern Maputaland coastline can therefore be considered part of a single population.