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Dissertations / Theses on the topic 'Adversary system'
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1
Fulchino, Matthew T. "An assessment of uncertainty due to adversary mobility." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/100373.
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Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2015..Cataloged from PDF version of thesis.
Includes bibliographical references (pages 47-50).
Uncertainty related to an adversary's tactics, techniques, and procedures is often difficult to characterize, particularly during the period immediately before a conflict, when planning for a face-to-face confrontation with a combatant. Adversarial freedom of maneuver and the fixed nature of asset defense leaves limited room for error or half-assessments, yet past analysis of regional defendability presumes a static, symmetric adversary, rather than a nimble, cunning one. This thesis examines historical events to identify the source of uncertainty with respect to defensive operations, and proposes that an alternative measure of performance be evaluated to fully characterize the effectiveness and limitations of defensive elements in the face of a determined peer.
by Matthew T. Fulchino.
S.M. in Engineering and Management
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Crispin, K. J., and n/a. "Ethics and the advocate." University of Canberra. Law, 1995. http://erl.canberra.edu.au./public/adt-AUC20060630.172938.
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This thesis examines the ethical implications of legal professional advocacy in an
adversary system of justice. It identifies a standard conception of the advocate's duty
which is encapsulated in the various professional codes and its fundamental principles of
partisanship and zealous advocacy. It acknowledges that the standard conception
involves a duty to pursue the interests of clients without regard for the interests of others
and explores the inevitable moral ambivalence which such an absolute loyalty entails. The
concept of role morality upon which this conception is based is explored. This involves
an examination of the adversary system of justice and the extent to which it serves the
public interest. It is concluded that the adversary system is of considerable utility in
maintaining individual rights, eliciting the truth, providing an important element of ritual
and sublimating conflict. Consequently, its value provides ethical justification for lawyers
to fulfil the adversarial roles upon which it depends. However, it is contended that it
neither requires nor justifies the absolutism inherent in the standard conception of the
advocate's duty. A number of alternative paradigms are considered but rejected as
inadequate. It is argued that the existing norms of partisanship and zealous advocacy
should be retained but relegated to prima facie duties which may have to be balanced
against competing ethical demands such as the need to avoid causing undue harm to
others.
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Fukasaka, M. "The adversary system of the International Court of Justice : an analytical study." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1526961/.
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This dissertation analyses the role of the International Court of Justice in dealing with technical facts, including those of a scientific nature. Specifically, it examines (1) how the ICJ has traditionally adopted a passive approach in dealing with technical evidence, but that this has been changing in recent years; (2) the factors that have contributed both to this traditional passive approach and the recent transformation, analysing different legal and non-legal factors, some of which limit its active approach in fact-finding, while others encourage the ICJ to adopt progressive methods; (3) how the ICJ may balance these different factors, with a view to examining how the ICJ can balance its responsibility to effectively settle international disputes against its fundamental consensual character. The dissertation proposes how to strike this balance by examining the historical background of the ICJ Statute and Rules, the historical development of Court’s practice, as well as related procedural principles and the function of the Expert Opinion.
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Gaines, Phil. "Cross purposes : a critical analysis of the representational force of questions in adversarial legal examination /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/9431.
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Ascensi, Lionel. "Du principe de la contradiction /." Paris : L.G.D.J, 2006. http://www.gbv.de/dms/spk/sbb/recht/toc/51222952X.pdf.
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Timmerbeil, Sven. "Witness coaching und adversary system : der Einfluss der Parteien und ihrer Prozessbevollmächtigten auf Zeugen und Sachverständige im deutschen und U.S.-amerikanischen Zivilprozess /." Tübingen : Mohr Siebeck, 2004. http://www.gbv.de/dms/ilmenau/toc/376083883.PDF.
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Rubio, Hernan Jose Manuel. "Detection of attacks against cyber-physical industrial systems." Thesis, Evry, Institut national des télécommunications, 2017. http://www.theses.fr/2017TELE0015/document.
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Nous abordons des problèmes de sécurité dans des systèmes cyber-physiques industriels. Les attaques contre ces systèmes doivent être traitées à la fois en matière de sûreté et de sécurité. Les technologies de contrôles imposés par les normes industrielles, couvrent déjà la sûreté. Cependant, du point de vue de la sécurité, la littérature a prouvé que l’utilisation de techniques cyber pour traiter la sécurité de ces systèmes n’est pas suffisante, car les actions physiques malveillantes seront ignorées. Pour cette raison, on a besoin de mécanismes pour protéger les deux couches à la fois. Certains auteurs ont traité des attaques de rejeu et d’intégrité en utilisant une attestation physique, p. ex., le tatouage des paramètres physiques du système. Néanmoins, ces détecteurs fonctionnent correctement uniquement si les adversaires n’ont pas assez de connaissances pour tromper les deux couches. Cette thèse porte sur les limites mentionnées ci-dessus. Nous commençons en testant l’efficacité d’un détecteur qui utilise une signature stationnaire afin de détecter des actions malveillantes. Nous montrons que ce détecteur est incapable d’identifier les adversaires cyber-physiques qui tentent de connaître la dynamique du système. Nous analysons son ratio de détection sous la présence de nouveaux adversaires capables de déduire la dynamique du système. Nous revisitons le design original, en utilisant une signature non stationnaire, afin de gérer les adversaires visant à échapper à la détection. Nous proposons également une nouvelle approche qui combine des stratégies de contrôle et de communication. Toutes les solutions son validées à l’aide de simulations et maquettes d’entraînementWe address security issues in cyber-physical industrial systems. Attacks against these systems shall be handled both in terms of safety and security. Control technologies imposed by industrial standards already cover the safety dimension. From a security standpoint, the literature has shown that using only cyber information to handle the security of cyber-physical systems is not enough, since physical malicious actions are ignored. For this reason, cyber-physical systems have to be protected from threats to their cyber and physical layers. Some authors handle the attacks by using physical attestations of the underlying processes, f.i., physical watermarking to ensure the truthfulness of the process. However, these detectors work properly only if the adversaries do not have enough knowledge to mislead crosslayer data. This thesis focuses on the aforementioned limitations. It starts by testing the effectiveness of a stationary watermark-based fault detector, to detect, as well, malicious actions produced by adversaries. We show that the stationary watermark-based detector is unable to identify cyber-physical adversaries. We show that the approach only detects adversaries that do not attempt to get any knowledge about the system dynamics. We analyze the detection performance of the original design under the presence of adversaries that infer the system dynamics to evade detection. We revisit the original design, using a non-stationary watermark-based design, to handle those adversaries. We also propose a novel approach that combines control and communication strategies. We validate our solutions using numeric simulations and training cyber-physical testbeds
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Barreto, Carolina Pereira. "O princípio do contraditório e da ampla defesa no processo administrativo disciplinar." Pós-Graduação em Direito, 2013. https://ri.ufs.br/handle/riufs/4357.
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The research aims to study the adversarial principle and legal defense in administrative disciplinary proceedings, examined not only in its formal aspect, but also the material. For this, we start from the vision neoconstitucionalista law, especially characterized by the transformations that the rule of law and its influence on the administrative performance, highlighting the constitutionalization of administrative law as a result of this movement. At the time that will discuss the true meaning of democracy and the approximation of the relationship between state and citizen, was launched as a result of the shift in focus to administrative act administrative process. The approach will bring extensive administrative processuality sedimented as a new paradigm in consensual, citizen participation and democratic legitimacy of state activity, with the administrative process as a true instrument of positive role of government in the implementation of fundamental rights and the effective democratization of the State of Right. In this context, the research aims to deepen the study of the adversarial principle and wide defense in administrative disciplinary proceedings as a fundamental right of the citizen, serving as a tool for democratization of the state, and is in line with the new interpretation and application of the principles and values constitutional. With the effectiveness of this principle procedural constitutional guarantees to the citizen the full defense before the Disciplinary Committees, and to be effective, the defense should be performed technical point of influencing the decision of the judge in the administrative process. Thus, the discussion of the controversy will give around the analysis of the new vision of the right neoconstitucionalista, more focused on achievement of constitutional values and the effectiveness of fundamental rights, as opposed to the judicial practice of the Supreme Court, on the grounds that motivated Binding Precedent n. 05.A pesquisa se propõe a estudar o princípio do contraditório e da ampla defesa no processo administrativo disciplinar, analisado não apenas sob seu aspecto formal, mas também material. Para isso, parte-se da visão neoconstitucionalista do direito, caracterizado especialmente pelas transformações verificadas no Estado de Direito e sua influência na atuação administrativa, destacando a constitucionalização do direito administrativo como decorrência deste movimento. Ao tempo que discorrerá sobre o verdadeiro sentido de democracia e a aproximação das relações entre o Estado e o cidadão, lançando como consequência a mudança de enfoque do ato administrativo para processo administrativo. A abordagem trará a ampla processualidade administrativa como novo paradigma sedimentado na consensualidade, participação do cidadão e na legitimidade democrática da atividade estatal, apresentando o processo administrativo como verdadeiro instrumento de atuação positiva do poder público na concretização dos direitos fundamentais e da efetiva democratização do Estado de direito. Nesse contexto, a pesquisa tem como objetivo aprofundar o estudo do princípio do contraditório e da ampla defesa no processo administrativo disciplinar como direito fundamental do cidadão, servindo de instrumento de democratização do Estado, coadunando-se com a nova interpretação e aplicação dos princípios e valores constitucionais. Com a efetividade deste princípio processual constitucional, garante-se ao cidadão a ampla defesa perante as Comissões de Processo Disciplinar, e para que seja efetiva, a defesa deve ser realizada de forma técnica a ponto de influenciar a decisão do julgador no processo administrativo. Dessa forma, a discussão da controvérsia dar-se-á em torno da análise da nova visão do direito neoconstitucionalista, mais voltada para concretização dos valores constitucionais e na efetividade dos direitos fundamentais, em contraposição à prática jurisprudencial da Corte Suprema, diante das razões que motivaram a Súmula Vinculante n. 05.
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Queiroz, Pedro Gomes de. "O princípio da cooperação e a exibição de documento ou coisa no Processo Civil." Universidade do Estado do Rio de Janeiro, 2014. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=7474.
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A dissertação procura estabelecer os fundamentos constitucionais e legais do princípio da cooperação no processo civil, descrevendo-o como um princípio constitucional implícito, decorrente do princípio da solidariedade (art. 3, I, CF/1988), da isonomia (art. 5., caput, CF/1988), do acesso à ordem jurídica justa (art. 5., XXXV, CF/1988), do devido processo legal (art. 5., LIV, CF/1988), do contraditório, da ampla defesa (art. 5., LV, CF/1988) e da duração razoável do processo (art. 5., LXXVIII, CF/1988). O trabalho procura demonstrar que o princípio da cooperação é a ideia base de vários dispositivos do Código de Processo Civil (CPC) de 1973 e do Projeto do Novo CPC, entre eles o art. 339 do CPC/1973 e aqueles que disciplinam a exibição de documento ou coisa. A dissertação procura estabelecer os limites do princípio da cooperação existentes no ordenamento jurídico brasileiro, em especial o direito à privacidade (art. 5., X, CF/1988) e o direito ao silêncio (art. 5., LXIII, CF/1988). Enfim, a dissertação procura estabelecer o conteúdo do princípio da cooperação e a forma como este opera no processo civil.The dissertation seeks to establish the constitutional and legal foundations of the principle of cooperation in civil procedure, describing it as an implicit constitutional principle deriving from the principle of solidarity (art. 3., I, Constitution of the Federative Republic of Brazil - CFRB), access to justice (art. 5., XXXV , CFRB), due process of law (art. 5, LIV , CFRB), adversary system (art. 5., LV , CF/1988) and reasonable duration of proceedings ( art. 5. , LXXVIII , CF/1988) . The essay seeks to demonstrate that the principle of cooperation is the basic idea of various provisions of the Code of Civil Procedure (CPC) of 1973 and of the Project of the New CPC, including the art. 339 of CPC/1973 and those that discipline the disclosure of documents and things. The dissertation seeks to establish the limits to the principle of cooperation in the Brazilian legal system, in particular the right to privacy (art. 5. , X, CF/1988) and the right to remain silent (art. 5. , LXIII , CF / 1988). At last, the dissertation seeks to establish the essence of the principle of cooperation and the way it operates in civil procedure.
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Cambazoglu, Volkan. "Protocol, mobility and adversary models for the verification of security." Licentiate thesis, Uppsala universitet, Avdelningen för datorteknik, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-202017.
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The increasing heterogeneity of communicating devices, ranging from resource constrained battery driven sensor nodes to multi-core processor computers, challenges protocol design. We examine security and privacy protocols with respect to exterior factors such as users, adversaries, and computing and communication resources; and also interior factors such as the operations, the interactions and the parameters of a protocol. Users and adversaries interact with security and privacy protocols, and even affect the outcome of the protocols. We propose user mobility and adversary models to examine how the location privacy of users is affected when they move relative to each other in specific patterns while adversaries with varying strengths try to identify the users based on their historical locations. The location privacy of the users are simulated with the support of the K-Anonymity protection mechanism, the Distortion-based metric, and our models of users' mobility patterns and adversaries' knowledge about users. Security and privacy protocols need to operate on various computing and communication resources. Some of these protocols can be adjusted for different situations by changing parameters. A common example is to use longer secret keys in encryption for stronger security. We experiment with the trade-off between the security and the performance of the Fiat–Shamir identification protocol. We pipeline the protocol to increase its utilisation as the communication delay outweighs the computation. A mathematical specification based on a formal method leads to a strong proof of security. We use three formal languages with their tool supports in order to model and verify the Secure Hierarchical In-Network Aggregation (SHIA) protocol for Wireless Sensor Networks (WSNs). The three formal languages specialise on cryptographic operations, distributed systems and mobile processes. Finding an appropriate level of abstraction to represent the essential features of the protocol in three formal languages was central.QC 20170217
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Vale, Silvia Isabelle Ribeiro Teixeira do. "Devido processo legal na relação de emprego: contraditório e motivação - poder disciplinar e cessação do contrato de trabalho." Pontifícia Universidade Católica de São Paulo, 2018. https://tede2.pucsp.br/handle/handle/21518.
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Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-10-22T12:32:43Z
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Silvia Isabelle Ribeiro Teixeira do Vale.pdf: 1379797 bytes, checksum: 3f582bb333035dabd730c3ea7c44065b (MD5)Made available in DSpace on 2018-10-22T12:32:43Z (GMT). No. of bitstreams: 1 Silvia Isabelle Ribeiro Teixeira do Vale.pdf: 1379797 bytes, checksum: 3f582bb333035dabd730c3ea7c44065b (MD5) Previous issue date: 2018-09-10
The main objective of this study is to analyze the principle of due process in its greatest potentiality, investigating how and to what extent this ancestral clause has effectiveness in the employment relationship, limiting the disciplinary labor power, by imposing a procedure for fair dismissals motive, in honor of the principles of the adversary and the ample defense. The Federal Constitution of 1988 is expressed by prohibiting arbitrary dismissal, considering it an unlawful act. However, in addition to the aforementioned protection, the principle of due process requires the employer to motivate the act of resignation, be it individual or collective, hence the new rule brought by Article 477-A of the Consolidation of Labor Laws is unconstitutional
O presente trabalho visa primordialmente analisar o princípio do devido processo legal em sua maior potencialidade, averiguando como e em que medida essa cláusula ancestral possui eficácia na relação de emprego, limitando o poder disciplinar laboral, ao impor uma procedimentalização para as despedidas por justo motivo, em homenagem aos princípios do contraditório e à ampla defesa. A Constituição Federal de 1988 é expressa ao proibir a despedida arbitrária, considerando-a ato antijurídico. Todavia, para além da proteção aludida, o princípio do devido processo legal impõe o dever de o empregador motivar o ato demissional, seja ele individual ou coletivo, razão pela qual a nova regra trazida pelo artigo 477-A da Consolidação das Leis do Trabalho é inconstitucional
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Carnes, Tara Barker. "Hartley Wood Day: Inventor of Numeral Notation and Adversary of Lowell Mason." Thesis, University of North Texas, 1991. https://digital.library.unt.edu/ark:/67531/metadc500655/.
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Ignorance of the basic principles of music reading was one of the primary obstacles to the improvement of congregational singing in nineteenth-century America. Six separate numeral notation systems arose to provide a simple way for the common man to learn the basic principles of music. Hartley Day developed his own numeral notation system and published six tune-books that enjoyed modest success in the New England area. This thesis examines Day's numeral notation system as it appeared in the Boston Numeral Harmony (1845), and the One-Line Psalmist (1849). It also studies Day's periodical, The Musical Visitor, in which he continually attacked Lowell Mason, possibly leading to Mason's dismissal as Superintendent of Music of Boston's public schools.
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Passarelli, Maria Cristina Guerra. ""Reações adversas a medicamentos em uma população idosa hospitalizada"." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5144/tde-02092005-111313/.
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Nesta pesquisa foram avaliados 186 idosos hospitalizados quanto ao aparecimento de reações adversas a medicamentos (RAM). Encontrou-se 199 RAM (1,07 por paciente). Para 11,3% dos idosos a RAM constituiu a causa da internação, para 17,2% estava presente à internação mas não como causa e 46,2% apresentaram RAM durante a hospitalização. As RAM sérias mais comuns foram a insuficiência renal aguda, a hipercalemia e a hipotensão postural. Concluiu-se que houve uma prevalência importante de RAM nesses pacientes, encontrando-se como fatores de risco significativos o número de diagnósticos, o número de medicamentos e o uso de medicamento inapropriado para idososThe present study evaluated the prevalence of adverse drug reactions (ADR) among 186 hospitalized elderly. A total of 199 ADR were founded (1.07 per patient). For 11.3% of the patients the ADR was the cause of hospitalization, for 17.2% the ADR was present at hospitalization but not as the cause and for 46.2% it was presented during hospitalization. The most common serious ADR were acute renal insufficiency, hyperkalemia and postural hypotension. We concluded that a significant prevalence of ADR was found among that patients, with the number of diagnosis, the number of drugs and the use of a drug considered to be inappropriate as risk factors
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Twigg, Jennifer. "A qualitative exploration of the dimensions of family resilience in a rural community on the West Coast." University of the Western Cape, 2017. http://hdl.handle.net/11394/6283.
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Magister Artium - MA (Psychology)Historically, families living in disenfranchised communities were viewed as being dysfunctional. This view led to the perpetuation of the challenges and adverse situations faced by these families. It is important to view the family holistically rather than just to focus on the risk factors and/or the dysfunctional nature of the family. This study endeavoured to explore how the family functions and copes with the challenges they face. The aim of the study was to qualitatively explore the dimensions of family resilience as perceived by families in a rural community on the West Coast, South Africa. Family resilience theory was used as the theoretical framework for the research study. Three family resilience dimensions were explored. These dimensions are family belief systems, family organisation and resources, and family communication patterns. Participants were selected by means of nonprobability sampling. The local NGO in collaboration with the researcher identified the participants. The participants were homogenous in terms of being parents who participated in a parent support programme and were from the same community. Six semi-structured, oneon- one interviews were conducted as the data collection method. The interviews were transcribed and analysed using thematic analysis. Three main themes emerged, in congruence with the theoretical framework. These themes were the family's belief system, their organisational patterns when faced with adversity, as well as the communication patterns of the family. The participants all reported that their strong sense of faith was used as coping mechanisms through their adversities. They had varying reports on how their family organised themselves and how they communicated. Some participants reported that living in a small community could at times be challenging, especially when sharing adversities as they feared community gossip, which then acted as a barrier to seeking help. The researcher adhered to the ethics requirements of the study in terms of confidentiality, provided the participants with informed consent forms and informed them of their rights as participants. Participants were free to discontinue the research process at any point without prejudice.
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Subbiah, Arun. "Efficient Proactive Security for Sensitive Data Storage." Diss., Georgia Institute of Technology, 2007. http://hdl.handle.net/1853/19719.
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Fault tolerant and secure distributed data storage systems typically require that only up to a threshold of storage nodes can ever be compromised or fail. In proactively-secure systems, this
requirement is modified to hold only in a time interval (also called epoch), resulting in increased security. An attacker or adversary
could compromise distinct sets of nodes in any two time intervals. This attack model is also called the mobile adversary model. Proactively-secure systems require all nodes to "refresh" themselves periodically to a clean state to maintain the availability, integrity, and confidentiality properties of the data storage service.
This dissertation investigates the design of a proactively-secure distributed data storage system. Data can be stored at storage servers using encoding schemes called secret sharing, or encryption-with-replication. The primary challenge is that the protocols that the servers run periodically to maintain integrity and confidentiality must scale with large amounts of stored data. Determining how much data can be proactively-secured in practical settings is an important objective of this dissertation.
The protocol for maintain the confidentiality of stored data is developed in the context of data storage using secret sharing. We propose a new technique called the GridSharing framework that uses a combination of XOR secret sharing and replication for storing data efficiently. We experimentally show that the algorithm can secure several hundred GBs of data.
We give distributed protocols run periodically by the servers for maintaining the integrity of replicated data under the mobile adversary model.
This protocol is integrated into a document repository to make it proactively-secure. The proactively-secure document repository is implemented and evaluated on the Emulab cluster (http://www.emulab.net). The experimental evaluation shows that several 100 GBs of data
can be proactively-secured.
This dissertation also includes work on fault and intrusion detection - a necessary component in any secure system. We give a novel Byzantine-fault detection algorithm for quorum systems, and experimentally evaluate its performance using simulations and by deploying it in the AgileFS distributed file system.
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Francelino, Eudiana Vale. "Centro de FarmacovigilÃncia do CearÃ: anÃlise do perfil de reaÃÃo adversa a medicamento e queixa tÃcnica." Universidade Federal do CearÃ, 2007. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=580.
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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorOs medicamentos sÃo a principal ferramenta terapÃutica para a recuperaÃÃo ou manutenÃÃo das condiÃÃes de saÃde da populaÃÃo. Dentre os problemas mais comuns relacionados aos mesmos estÃo a ReaÃÃo Adversa a Medicamentos (RAM) e Queixas TÃcnicas (QT), sendo necessÃria sua vigilÃncia atravÃs do gerenciamento, direcionamento e desenvolvimento de atividades de farmacovigilÃncia mediante a formaÃÃo de centros colaboradores/notificadores. Avaliar as notificaÃÃes de RAM e QT enviadas e analisadas pelo Centro de FarmacovigilÃncia do Cearà (CEFACE) durante os seus nove anos de funcionamento voltados para o contexto da saÃde pÃblica e do uso racional de medicamentos. Foram coletadas todas as notificaÃÃes de RAM e QT do banco de dados do CEFACE, durante o perÃodo de janeiro/97 a dezembro/05, sendo as seguintes variÃveis analisadas: sexo e idade, origem da notificaÃÃo, notificador, medicamento envolvido, RAM referida, e classificaÃÃo desta quanto à causalidade e severidade e tipo de RAM segundo Rawlins e Thompson. Quanto à QT, as variÃveis foram: origem da notificaÃÃo, tipo de QT, notificador e medicamento ou material mÃdico envolvido. Foi tambÃm realizado um levantamento para identificaÃÃo na literatura da possibilidade dos excipientes farmacÃuticos serem fatores de risco para RAM, utilizando-se como base inicial os 11 medicamentos mais vendidos no mercado brasileiro, no perÃodo de novembro/02 a novembro/03 e suas respectivas formulaÃÃes. Posteriormente foi feita a retirada de casos com envolvimento desses excipientes em estudos de casos clÃnicos suspeitos. No perÃodo de janeiro/97 a dezembro/05, o CEFACE registrou 1.293 notificaÃÃes. Destas, 1.172 (90,6%) foram casos de RAM e 121 (9,4%) de QT. Houve uma reduÃÃo significante do envio dessas notificaÃÃes durante os anos. A maioria das RAM foi referente ao sexo feminino (62,7%) e a faixa etÃria de 21-30 anos (17,7%). A busca ativa foi o mÃtodo de notificaÃÃo com maior percentual (59,3%). 85,6% (RAM) foram de origem hospitalar com percentual de pÃblicos de 81,6%. O grupo terapÃutico com maior envolvimento foi o dos antiinfecciosos de uso sistÃmico (40%). O sistema da pele (48,5%) destacou-se dentro das RAM referidas. Quanto à causalidade, o maior nÃmero de RAM foi do tipo provÃvel (44,1%) e para a severidade destacaram-se as moderadas (52,2%). A maioria foi RAM do tipo A. As RAM graves e fatais tambÃm ocorreram. As QT foram de origem hospitalar (n=120), com Ãnfase para a mudanÃa de coloraÃÃo (47,1%) e falta de eficÃcia (22,3%). Foram identificados na literatura 10 excipientes farmacÃuticos de risco, sendo 03 responsÃveis por RAM coletadas no banco de dados do CEFACE. O estudo de RAM e QT, bem como o estabelecimento de seus fatores condicionantes por um centro de farmacovigilÃncia tÃm grande importÃncia no contexto da saÃde pÃblica e do uso racional de medicamentos. Tanto o profissional notificador, como a populaÃÃo em geral, deve ser incentivado a notificar toda suspeita de RAM e QT aos ÃrgÃos responsÃveis para que sejam estabelecidas medidas administrativas, dentre elas: a) Retirada de produtos inadequados do mercado; b) MudanÃas nas suas bulas e c) RestriÃÃo de uso na populaÃÃo. O levantamento na literatura cientÃfica demonstra de forma clara que, o envolvimento dos excipientes à um fator de risco para a ocorrÃncia de RAM, possibilitando sua inserÃÃo no estudo de causalidade de casos suspeitos.
Drugs are the mainly therapeutical tool to the recoverying or maintenance of the population health condiction. Among the most common problems related for it are Adverse Drug Reactions (ADR) and Technical Complains (TC), being need this survey through the management, and development of activities of pharmacovigillance with the creation of helperâs and notifiers centers. Evaluate the ADR and TC sended to and analized by the pharmacovigillance center of ceara during its nine years of function toward to public health and rational use of drugs. Were collected All the ADR and TC notifications in the database of CEFACE, during the period of January 1997 to December 2005, being analized the following variables: gender and age, origin of the notification, notifier, drug involved, ADR, causality and severity classification of these ones and the kind of ADR according to Rawlins and Thompson. About the TC, the variables being: origin of notification, kind of TC, notifier, and drug or medical material involved. Also A research was made to identify in literature the possibility of pharmaceutical excipients being risks factors to cause ADR, using as initial data the 11 drugs most sold in the brazilian market in the period of November/02 to November/03 and their respective compositions. Lately was made the retrieve of cases with the involvement of these excipients in studies of suspects clinical cases. In the analized period, January 1997 to December 2005, the CEFACE registered 1.293 notifications. Of these ones, 1.172 (90,6%) ADR cases and 121 (9,4%) TC. There was a significant reduction of the number of notification during the years. Most of the ADR were registered in females (62,7%) and age of 21-30 anos (17,7%). Active search was the greatest notification method (59,3%). 85,6% (ADR) came from in hospitals with a percentual of publics in 81,6%. The therapeutical group with greatest involvement most was antibiotics for systemic use (40,0%). %). The skin system (48,5%) to be detached inside of the reported ADR. For causality, the higher number of ADR were classified as probably (44,1%) and for severity the highest percentual were considered as moderate (52,2%). Most were ADR A type. The severe and fatal ADR also occurred. The TC came from in hospitals (n=120), with emphasis to changing of color (47,1%) and lack of effectiveness (22,3%). In the literature were identified 10 risk pharmaceutical excipients, being 03 responsible for ADR collected in CEFACE database. The study of ADR and TC, as well as the establishment of their conditioners factors by a pharmacovigillance center, has large importance in public health and rational use of drugs context. Both the professional notifier and the population must be encouraged to notify all the suspects of ADR and TC to the responsable groups to be taken administrative measures among them: a) retrieve of inapropriated products from market; b) change in the labels and c) restriction in the use by population. The research in scientific literature shows in a clear way that, the involvment of excipients is a risk factor to ADR occurrence, enabling your insertion in the causality study of suspects cases.
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Nilsen, Loren. "Reações adversas durante condicionamento para transplante autólogo de células tronco hematopoéticas em vigência do uso de globulina antitimocitária." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-05112012-200934/.
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A esclerose múltipla (EM) é uma doença autoimune desmielinizante progressiva imunomediada por linfócitos T auto-reativos, que provocam uma cascata imunológica, amplificando a inflamação local. No Diabetes mellitus tipo 1 (DM1), existem linfócitos T auto reativos destroem as células beta do pâncreas, causando deficiência na produção de insulina. O desenvolvimento de terapêuticas específicas fica limitado pela etiologia indefinida destas doenças, apesar de avanços na terapêutica antiinflamatória e imunossupressora. Uma alternativa de tratamento atual para tais doenças é o transplante autólogo de células tronco hematopoéticas (TACTH). O presente estudo, observacional do tipo transversal, com a coleta de dados de caráter retrospectivo, tem como objetivo identificar as reações adversas manifestadas pelos pacientes diabéticos ou de esclerose múltipla, submetidos ao TACTH no período de 2004 a dezembro de 2010. Para a coleta de dados elaborou-se dois instrumentos que foram submetidos à validação aparente e de conteúdo por três juízes. A amostra final do estudo foi constituída pela obtenção dos dados de 72 prontuários, sendo 23 de pacientes diabéticos e 49 de pacientes com EM. Em relação aos pacientes diabéticos 16 pertenciam ao sexo masculino e a idade média foi 18,26 anos. Todos possuíam positividade para o anticorpo anti-carboxilase do ácido glutâmico (antiGAD65). Quanto aos pacientes com EM, trinta e três pertenciam ao sexo feminino e idade média foi de 37,2 anos. O subtipo da doença mais frequente foi o surto-remissivo em 21 (42,9%) pacientes. A escala expandida do estado de incapacidade (EDSS) variou entre 3,0 e 6,5. Em relação às reações adversas manifestadas pelos pacientes diabéticos foram mais frequentes os calafrios, febre, cefaléia, náusea e vômito e nos pacientes com esclerose múltipla foram retenção hídrica e cefaléia. As principais intervenções de enfermagem identificadas para os pacientes diabéticos e com EM foram monitorização dos sinais vitais, coleta de hemocultura, otimização da administração de medicamentos antieméticos, controle da infusão da globulina antitimocitária, orientações sobre alimentação e para reduzir o risco de queda. Os pacientes com DM1 apresentam reações mais agudas e necessitam de monitorização contínua. Já os pacientes com EM são mais dependentes dos cuidados de enfermagem, exigindo maior tempo de cuidados prestados pelo profissional. Embora o DM1 e a EM sejam doenças distintas, percebe-se que na prática clínica, exigem do enfermeiro uma excelência no cuidado, quer pelas particularidades do tratamento realizado ou pelas singularidades de cada uma delas.Multiple sclerosis (MS) is a progressive demyelinating autoimmune disease, immune- mediated by auto-reactive T lymphocytes, which provoke an immunological cascade, enhancing the local inflammation. In type 1 diabetes mellitus (DM1), self-reactive T lymphocytes exist that destroy ? cells in the pancreas, causing insulin production deficiency. The development of specific therapeutics is limited by these diseases\' undefined etiology, despite advances in anti-inflammatory and immunosuppressive therapy. A current treatment alternative for these diseases is autologous hematopoietic stem cell transplantations (AHSCT). The aim of this observational and cross-sectional study with retrospective data collection is to identify the adverse reactions manifested by diabetic or MS patients who were submitted to AHSCT between 2004 and December 2010. For data collection, two instruments were elaborated, submitted to face and content validation with the help of three experts. The final study sample comprised data from 72 patient files, 23 from diabetic and 49 from MS patients. As for the diabetic patients, 16 were male and the mean age was 18.26 years. All were positive for the anti-glutamic acid decarboxylase (antiGAD65) antibody. Concerning MS patients, 33 were female and the mean age was 37.2 years. The most frequent disease subtype was relapsing-remitting in 21 (42.9%) patients. The expanded disability status scale (EDSS) score ranged between 3.0 and 6.5. As for the adverse reactions the diabetic patients manifested, shivers, fever, migraine, nausea and vomiting were the most frequent, while fluid retention and migraine were the most frequent among multiple sclerosis patients. The main nursing interventions identified for the diabetic and MS patients were vital sign monitoring, blood culture collection, optimization of anti-emetic drug administration, control of anti- thymocyte globulin infusion, dietary orientations and advice to reduce the risk of falls. DM1 patients present more acute reactions and need continuous monitoring. MS patients are more dependent on nursing care, demanding lower professional care time. Although DM1 and MS are distinct conditions, in clinical practice, they demand excellent care from nurses, whether due to the particularities of the treatment or the singularities of each disease.
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Almeida, Filho Agostinho Teixeira de. "Decisão monocrática e agravo interno: lesão ao devido processo legal?" reponame:Repositório Institucional do FGV, 2010. http://hdl.handle.net/10438/8570.
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Esta dissertação tem por objetivo analisar os institutos da decisão monocrática e do agravo interno, sob o prisma de metodologia empírica que busca priorizar a realidade pragmática da aplicação do artigo 557 do Código de Processo Civil. Enfocou-se o instituto da decisão monocrática no contexto das minirreformas processuais brasileiras, que tiveram como alicerce o princípio da efetividade processual. Esse princípio pressupõe a duração razoável do processo, garantida na Constituição Federal Brasileira. A partir da constitucionalidade desse princípio, defendeu-se a constitucionalidade do artigo 557 do Código de Processo Civil, que não pode ser considerado abstratamente inconstitucional. Demonstrou-se que a aplicabilidade do artigo 557 pode ser inconstitucional se não atender à técnica da ponderação de valores, que garante a interpretação conforme a Constituição. Analisou-se o agravo interno, sob a premissa do valor da celeridade em cotejo com o devido processo legal, que permeou a subsequente análise do procedimento desta espécie de agravo. Após uma reflexão sobre os institutos da decisão monocrática e do agravo interno, aliada ao exame dos princípios do devido processo legal, ampla defesa, contraditório e motivação das decisões judiciais, passou-se ao exame empírico desses institutos jurídicos. Nessa análise, foram coletados e examinados dados estatísticos, que confirmaram – e, assim, possibilitaram a conclusão da dissertação – a constitucionalidade do artigo 557 e a importância de sua interpretação conforme os referidos princípios constitucionais.
This dissertation has the purpose to analise the institutes of the single verdict and the internal appeal, according to empirical methodology that focus the pragmatic reality of the 557 th. dispositive of Code of Civil Procedure`s enforcement. This dissertation focused the institute of the single verdict in the context of the reformation of the Brazilian Code of Civil Procedure, which had as foundation the principle of procedure efectiveness. This principle presupposes a reasonable duration of the suit, secured by the Brazilian Federal Constitution. From the constitutionality of this principal, this dissertation defended the constitutionality of the 557 th. dispositive of Code of Civil Procedure, which can`t be considered abstractedly unconstitutional. This dissertation proved that the enforcement of the 557 th. dispositive could be unconstitutional if doesn`t suit the technique of the weighing of values, which secures the interpretation according to the Brazilian Federal Constitution. This dissertation analised the internal appeal, under the presupposition of the value of the reasonable duration of the suit in comparison with the due process of law, which motivate the following analysis of the internal appeal proceeding. After a reflection of single verdict and the internal appeal institutes, also with the analysis of due process of law, legal defense, adversary system and the motivation of the judgement, this dissertation analised the empirical enforcement of these institutes. In this analysis, estatistic data have been collected, which corroborate – and, therefore, enabled the conclusion of the dissertation – the constitutionality of the 557 th. dispositive of Code of Civil Procedure and the consideration of its interpretation according to the mentioned constitucional principles.
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Horta, Ricardo de Lins e. "Consequences of adversity on the development of attachment-related neuro transmitter systems: integrative review and analysis of Brazilian federal policies for early childhood." Universidade Federal de Minas Gerais, 2012. http://hdl.handle.net/1843/BUOS-94MJMM.
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Decades of research have shown that abuse and neglect in early childhood increase the probability of unhealthy and psychopathological outcomes in adulthood. However, mechanisms concerning mediator and moderator variables are not completely clear. Drawing from Bow|bys Attachment Theory and evolutionary-developmental models, this work aims to uncover the effects of gene-environment interactions in neurotransmitter systems related to attachment styles. It is hypothesized that early adversity affects the development of decision making, emotion regulation and social bonding behaviors in a lifelong perspective, due to phylogenetically and evolutionary causes. Using the integrative review method, literature on gene-environment interplay and attachment behavior is analysed, particularly experiments on genetic polymorphisms linked to dopamine, serotonin, oxytocin/vasopressin and opioid neurotransmitter systems. Results of experiments so far conducted are not straightforward, due mainly to design limitations and to the multilevel complexity between genetic polymorphisms and social behavior. However, research does provide good evidence on the importance and efficacy of early intervention. In an evidence- based policy perspective, it is claimed that Brazilian federal policies toward children have significantly advanced since 1988, but there is still much to be done. Neuroscientific, genetic and epigenetic studies may help to explain why changing early
environments is so important and what are the most effective ways to do it, considering the existing political and institutional constraints and the dynamic reality of policy networks.
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Richards, Kathryn H. "Mutations in the vpu and env Genes of HIV-1 Can Adversely Impact Infectivity: A Dissertation." eScholarship@UMMS, 2008. https://escholarship.umassmed.edu/gsbs_diss/378.
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The Human Immunodeficiency Virus (HIV) is able to infect CD4+ T cells as well as macrophages. Macrophage-tropism has been linked to determinants in the envelope of HIV. These determinants allow envelopes to exploit low levels of CD4 for infection. Macrophages are an important reservoir of virus, especially during chronic infection, and are likely responsible for the bulk of virus produced after CD4+T cells have declined. Viral factors that may impact the ability to infect macrophages are worth studying because this cell type is so important in infection.
It was previously reported that the macrophage-tropic primary isolate AD8 was vpu-independent. The molecular clone YU-2, derived from brain tissue without culture, was also reported to be macrophage-tropic despite having a mutation in the vpu start codon. It was therefore possible that vpu-independent envelopes could evolve in vivo. To examine this possibility, I constructed chimeras containing wild type or defective vpu start codons, and gp160 sequences from AD8, YU-2 or SF162 (a vpu-dependent control). I also used full length AD8 and YU-2 with wild type or defective vpu start codons. I infected macrophages with equal amounts of virus, and measured viral output over two weeks. Viruses with defective vpu start codons were released to lower levels compared to their wild type vpucounterparts. In contrast to previous reports, the AD8 envelope is not vpu-independent for replication in macrophages. The YU-2 envelope is also not vpu-independent.
Macrophage-tropic envelopes from late stages of infection can be sensitive to antibodies that bind the CD4 binding site on gp120, implying that macrophage-tropic envelopes have more exposed CD4 binding sites. Neutralizing antibodies may act as modulators of macrophage-tropism over the course of infection. Using chimeras containing gp120 sequences derived from the PBMC of four HIV+patients, I examined the capacity for envelopes to infect macrophages. Three patients (MM1, 4, and 8) had macrophage-tropic envelopes before and after developing autologous neutralizing antibodies. Three patients (MM1, 4, and 23) developed heterologous antibodies against IIIB, an easily neutralized T-cell line adapted strain of HIV-1. This data indicates that macrophage-tropism in these patients is not modulated by the presence of neutralizing antibodies.
The macrophage-tropism of envelopes tends to segregate depending on the tissue origin of the virus. Envelopes from two separate tissues from the same patient exhibit very different infectivity characteristics. The B33 envelope, from brain tissue, is very infectious and is macrophage-tropic, while the LN40 envelope, from lymph node tissue, is weakly infectious and is not macrophage-tropic. Replacing the entire gp41 of LN40 with that of B33 restores some infectivity to LN40. The cytoplasmic domain of gp41 contains many motifs important for assembly and infectivity. To examine which motifs are responsible for the weak infectivity of LN40, I made chimeras of gp41, as well as point mutations in gp41. The LN40 chimera containing the entire gp41 of B33 restored the most infectivity. Point mutations in the palmitoylation site, Pr55gagbinding region, and dileucine motif at the C-terminus also restored infectivity when combined. Determinants in the gp41 cytoplasmic domain are responsible for the weak infectivity of LN40; however, it is possible that there are contributing determinants in gp120, such as the ability to use low levels of CD4.
Here, I examined how changes in the vpu and env genes of HIV-1 can impact infectivity, especially infectivity of macrophages. Changes that adversely impact the virus’ ability to infect macrophages may also impact the overall course of disease. However, the data here show that retaining the ability to infect, and replicate in, macrophages give HIV an advantage. I speculate that retaining the ability to infect macrophages gives the virus a reservoir for later in disease, when CD4+ T cells have been depleted, as well as way of avoiding neutralizing antibodies. This work further defines the importance of macrophages in HIV-1 infectivity and disease.
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Modesto, Ana Carolina Figueiredo. "Reações adversas a medicamentos e a farmacovigilância: conhecimentos e condutas de profissionais de saúde de um hospital da rede sentinela." Universidade Federal de Goiás, 2014. http://repositorio.bc.ufg.br/tede/handle/tede/4142.
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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
Background: The use of drugs isn’t harmless, and require greater attention by health professionals to assist in identifying and preventing adverse drug reactions. These, and other problems related to drug use are the subject of study of pharmacovigilance. It becomes necessary knowledge by health professionals to improve patient safety. Objective: To measure the knowledge and attitudes among healthcare professionals in a teaching hospital towards adverse drugs reactions and a pharmacovigilance program. Methodology: Cross-sectional study conducted from October 2013 to January 2014 with 54 health professionals in a medical unit and in the pharmacy of a sentinel hospital. Data were collected through a questionnaire divided into three sessions: the first is the profissiographic and demographic characteristics of health professionals, and the subsequent identification of knowledge on adverse drug reactions and Pharmacovigilance hospital program. Results: There was a predominance of technical professionals in nursing (35.2%), female (79.6%), aged between 26 and 30 years (33.4%). Almost half of the participants (46.2%) had knowledge about adverse drug reactions, likewise 35.8% did towards pharmacovigilance. The probability of having knowledge about adverse drug reactions increases with longer professional training and activities at the institution, and the same does not occur with the knowledge of pharmacovigilance. Regarding the institutional knowledge, only 11.1% of participants stated that they know the site that has operations across the suspected adverse drug reactions and 38.9% reported the knowledge about the inclusion of the institution on a pharmacovigilance program. Conclusion: There was a predominance of female professionals, the technical area in nursing and training time and work at less than or equal to five years institution. It was observed that doctors have more knowledge about the concept of adverse drug reaction, and nurse technician, the lowest. Health professionals had little knowledge about the location of the institution that has operations across the adverse drug reactions and inserting the same in any program pharmacovigilance.
Introdução: A utilização de medicamentos não está isenta de riscos, maior atenção por parte dos profissionais de saúde pode auxiliar na identificação e prevenção das Reações Adversas a Medicamentos (RAM). Estas, e demais problemas relacionados ao seu uso são objeto de estudo da Farmacovigilância (FV). Faz-se necessário seu conhecimento, por parte dos profissionais de saúde, como forma de contribuir para a segurança do paciente. Objetivo: Identificar os conhecimentos e condutas de profissionais de saúde de um hospital de ensino frente às Reações Adversas a Medicamentos e ao programa de Farmacovigilância hospitalar. Metodologia: Estudo transversal, com coleta de dados realizada no período de outubro de 2013 a janeiro de 2014 com 54 profissionais de saúde em uma unidade de clínica médica e no serviço de farmácia de um hospital da rede sentinela. Os dados foram coletados por meio de um questionário dividido em três sessões: a primeira consiste na caracterização demográfica e profissiográfica dos participantes, e as subsequentes, na identificação dos conhecimentos e condutas sobre as Reações Adversas a Medicamentos e ao programa de Farmacovigilância hospitalar. Resultados: Quase metade dos participantes (46,2%) mostraram conhecimentos sobre RAM, destes, os médicos foram os que detém maior conhecimento em relação aos demais profissionais (p=0,00). Em contrapartida, os técnicos em enfermagem mostraram menos conhecimento (p=0,00). Um total de 35,8% dos participantes do estudo mostraram conhecimentos em relação à FV, destes, os farmacêuticos demonstraram maior conhecimento em relação aos demais profissionais (p=0,00), em oposição, os médicos apresentaram menores conhecimentos sobre este conceito (p=0,01). A probabilidade de apresentar conhecimentos sobre as RAM aumenta em profissionais com maior tempo de formação e atuação na instituição, e o mesmo não ocorre com os conhecimentos sobre a farmacovigilância. Somente 11,1% dos participantes declararam conhecer o local que tenha atuação frente às suspeitas de RAM e 38,9% mencionaram o conhecimento acerca da inserção da instituição em um programa de FV. Conclusão: Houve predominância de profissionais do sexo feminino, da área técnica em enfermagem e tempo de formação e de trabalho na instituição inferior ou igual à cinco anos. Observou-se, dentre os profissionais participantes do estudo, que os médicos possuem maior conhecimento sobre o conceito de RAM, e o técnico em enfermagem, o menor. Os profissionais de saúde apresentaram poucos conhecimentos quanto ao local da instituição que tenha atuação frente às RAM, bem como a inserção da mesma em algum programa de FV.
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Silva, Isabel Galdino da. "SIHSUS como fonte para o estudo de morbi-mortalidade por medicamentos no Estado do Rio de Janeiro." Universidade do Estado do Rio de Janeiro, 2009. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=3200.
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A despeito de suas limitações, os dados do SIHSUS são os mais sistemáticos e abrangentes sobre as Reações Adversas e Intoxicações a medicamentos que provocam hospitalização. Eles demonstram a importância das ações de educação e investigação de casos do Programa Nacional de Farmacovigilância para possibilitar o diagnóstico mais acurado e superação do quadro atual de ocorrência desses agravos, além da possibilidade de o SIH/SUS ser utilizado sistematicamente como fonte de dados na detecção e análise dos problemas relacionados a medicamentos. No período de 1999 a 2007, foram emitidas 6.670.609 AIH (tipo 1), entre as quais 3.611 foram classificadas como internações devidas a RAM e 4.675 como Intoxicações, correspondendo, respectivamente, às taxas médias de 5,41 casos por 104 AIH e 7,2 casos por 104 AIH. Ocorreram 137 óbitos (3,79% das AIH) por RAM e 207 (4,43% das AIH) por Intoxicações na população internada. Tanto as RAM como as Intoxicações tiveram menor chance de levar ao óbito quando comparados às outras causas. Uma característica da distribuição dos RAM foi concentrar 62% das AIH nas faixas etárias de 20 a 59 anos de idade (grupo adulto). Nas Intoxicações merece destaque a elevada proporção de AIH na faixa etária de 0-4 anos (14,29%). As AIH registradas com causas básicas relacionados a RAM foram principalmente de pacientes do sexo masculino, já as Intoxicações foram principalmente de pacientes do sexo feminino. Em ambos tipos de agravos estes pacientes foram internados em hospitais que não faziam parte da Rede de Hospitais Sentinelas do Programa Nacional de Farmacovigilância. No entanto, a probabilidade destes hospitais registrarem as AIH com códigos CID-10 referentes às RAM é maior, o que ocorre provavelmente por estarem mais capacitados em diagnosticar este tipo de agravo. Porém este fato não foi observado para as Intoxicações. Os fármacos que causaram os agravos estudados são psicoativos. Este estudo apresentou algumas evidências sobre a distribuição da morbi-mortalidade provocada por medicamentos entre pacientes internados em hospitais conveniados ao SUS no período de 1999-2007, baseadas nas informações das AIH, que podem ser úteis ao Programa de Farmacovigilância no Estado do Rio de Janeiro.Despite its limitations, the data SIHSUS are the most systematic and comprehensive on Adverse Reactions and Drug Poisonings causing hospitalization. They demonstrate the importance of these actions and investigation of cases of National Pharmacovigilance Programme to enable the most accurate and overcoming the current frame of event occurrences diagnosis, beyond the possibility of SIH / SUS be systematically used as a data source in the detection and analysis of drug-related problems. In the period 1999-2007, were issued 6,670,609 AIH (type 1), among which 3,611 were classified as hospitalizations due to poisoning as RAM and 4675, corresponding, respectively, at average rates of 5.41 cases per 104 AIH and 7.2 cases per 104 AIH. There were 137 deaths (3.79% of AIH) by RAM and 207 (4.43% of AIH) by poisoning in hospitalized population. Both the RAM as poisoning were less likely to cause death when compared to other causes. A characteristic distribution of RAM was concentrating 62% of AIH in the age groups 20-59 years of age (adult group). In Poisoning deserves the high proportion of AIH aged 0-4 years (14.29%). The AIH registered root causes related ADRs were mostly male patients, since the poisoning were mainly female patients. In both types of injuries these patients were admitted to hospitals that were not part of the Network of Sentinel Hospitals of the National Pharmacovigilance Programme. However, the likelihood of these hospitals register the AIH with ICD-10 codes related to RAM is higher, which is probably because they are better able to diagnose this type of offense. However this was not observed for the poisoning. The drugs that caused the diseases studied are psychoactive. This study presented some evidence on the distribution of morbidity and mortality caused by drugs among patients admitted to the SUS hospitals during the period 1999-2007, based on the information of AIH, which may be useful to Pharmacovigilance Programme in the State of Rio de Janeiro .
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Nascimento, Paulo Pedro do. "Toxicidade medicamentosa relacionada ao uso de desoxicolato de anfotericina B." reponame:Repositório Institucional da UFC, 2010. http://www.repositorio.ufc.br/handle/riufc/2611.
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NASCIMENTO, Paulo Pedro do. Toxicidade medicamentosa relacionada ao uso de desoxicolato de anfotericina B. 2010. 79 f. Dissertação (Mestrado em Farmacologia) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza, 2010.Submitted by denise santos (denise.santos@ufc.br) on 2012-05-09T13:47:40Z No. of bitstreams: 1 2010_dis_ppnascimento.pdf: 8789647 bytes, checksum: 8de42b49884e1e557b1b3f5251a04a91 (MD5)
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Amphotericin B Desoxicolate (AmB-D) is a drug that possesses the capacity to produce many adverse effects. It is a fungicide substance of choice in the treatment of the majority of the systemic mycosis and an important alternative for the treatment of visceral leishmaniosis. The institute of tropical diseases Natan Portela is the only hospital of reference for the treatment of parasite and infectious diseases in the state of Piauí. Participate of the sentinel web ANVISA, and through the farmacovigilance system, monitors the use of drugs notifying any adverse reaction to drugs. This observing, retrospective and quantitative study, was carried out in which the records of all the patients Who used the drug between january and march 2009, a total of 60 patients were analyzed, considering at all times adverse reactions to drugs, the technical complaints and the interactions of the drug with other drugs present in the medical prescription. The statistic analysis was carried out by the program Stata/SE® 10.0 for Windows (College Station, Texas, USA). Among the patients analyzed in the present study, 63,3% were male. The age group with greater number of patients was “41 or over” with 36%.The presnet pathology in most patients using AmB-D was visceral Leishmaniosis with 75,0%. 93,3% of the patients analyzed presented RAMs and 11,7% of the patients passed away. These patients presented an average of 5,6 RAMs/pacient. It was evident the greater number of RAMs in the age group from “21 to 40 years”. 6,0 RAMs/pacient was the average number observed in the patients Who did not receive pre-medication. Among the RAMs with greater frequence were: fever (76,7%), chills (45,0%), vomit (40,0%), cough (27,0%) and headache (25,0%). It was observed that in a total of 221 RAMs, there was the predominance of RAMs of moderate seriousness (57%). It was observed that there was no drug interaction of the prescribed drugs when administered in association with AmB-D. Thegreater lethality happened in patients with age between 21 and 40 years. Patients with AIDS were aged between 21 and 40 years, mainly. It was concluded, therefore, that there are many RAMs caused by AmB-D. Incomplete or absent Information about RAMs registered in the records have shown that there may exist sub-notifications of these reactions. Among the age groups, the ones who suffers most with the appearing of these reactions are Young adults (between 21 and 40 years). It is believed that, the greater frequency of RAMs in the patients who passed away could have contributed for the worsening the clinical picture of these patients. Patients with AIDS were aged between 21 and 40 years mainly, this could have been the reason of greater lethality.
A Anfotericina B Desoxicolato (ANB-D) é uma droga que possui a capacidade de produzir muitos efeitos adversos. É uma substância fungicida de escolha no tratamento da maioria das micoses sistêmicas e uma alternativa importante para o tratamento da leishmaniose visceral. O Instituto de Doenças Tropicais Natan Portela é o único hospital de referência para o tratamento de doenças infecciosas e parasitárias no Estado do Piauí. Participa da Rede Sentinela da ANVISA, e através do Sistema de Farmacovigilância, monitora o uso dos fármacos notificando qualquer reação adversa a medicamentos (RAM). Partindo desse pressuposto, realizou-se este estudo, observacional, retrospectivo e quantitativo, a partir do qual foram analisados os prontuários de todos os pacientes que utilizaram o fármaco no período de janeiro a março de 2009, um total de 60 pacientes, considerando sempre as reações adversas a medicamentos, as queixas técnicas e as interações medicamentosas do fármaco com outros medicamentos presentes nas prescrições médicas. A análise estatística for realizadapelo programa Stata/SE® 10.0 for Windows (CollegeStation, Texas, USA). Entre os pacientes analisados no presente estudo, 63,3% eram do sexo masculino. A faixa etária com maior número de pacientes foi a de “41 ou mais anos” com 36%. A patologia presente na grande parte dos pacientes em uso de ANB-D foi a Leishmaniose visceral com 75,0%. 93,3% dos pacientes analisados apresentaram RAMs e 11,7% dos pacientes foram a óbitos, os quais apresentaram uma média de 5,6 RAMs/paciente. Evidenciou-se o maior numero de RAMs no grupo etário de “21 à 40 anos”. 6,0 RAMs/paciente foi o número médio observado nos pacientes que não receberam a pré-medicação. Dentre as RAMs com maior freqüência estiveram: febre (76,7%), calafrios (45,0%), vômitos (40,0%), tosse (27,0%) e cefaléia (25,0%). Observou-se que em um total de 221 RAMs, houve predominância de RAMs de gravidade moderada (57%). Visualizou-se que não houve interação medicamentosa dos medicamentos prescritos quando utilizados em associação à ANB-D. A maior letalidade ocorreu em pacientes com idade de 21 a 40 anos. Pacientes com AIDS tinham idade entre 21 e 40 anos principalmente. Conclui-se, portanto, que são muitas as RAMs provocadas pela ANB-D. Informações incompletas/ou ausentes sobre RAMs registradas nos prontuários mostrou que pode existir subnotificação dessas reações. Dentre os grupos etários, os que mais sofrem com o aparecimento dessas reações são adultos jovens (entre 21 e 40 anos).Acredita-se que, a maior freqüência de RAMs nos pacientes que vieram a óbito pode ter contribuído para o agravamento do quadro clínico dos mesmos. Pacientes com AIDS tinham idade entre 21 e 40 anos principalmente, esta doença pode ter sido a razão da maior letalidade.
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Marques, Cátia Filipa Saraiva. "Frequência do antigénio eritrocitário DEA 1.1 em canídeos e dos antigénios eritrocitários A, B e AB em felídeos de Lisboa, Portugal." Bachelor's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2010. http://hdl.handle.net/10400.5/2176.
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Dissertação de Mestrado Integrado em Medicina VeterináriaO sistema sanguíneo AB dos felídeos, caracterizado por Auer e Bell, é considerado como o clinicamente mais relevante. O antigénio eritrocitário canino (DEA) 1.1 é o mais antigénico e consequentemente responsável pelas reacções transfusionais adversas mais severas. Este estudo teve como objectivo determinar a frequência dos antigénios eritrocitários do sistema sanguíneo AB e do DEA 1.1 na área da Grande Lisboa, em Portugal. As amostras foram obtidas no Hospital Escolar e no Banco de Sangue Veterinário da Faculdade de Medicina Veterinária da Universidade Técnica de Lisboa e em algumas Clínicas Veterinárias. Foram testados 538 gatos e 54 cães. Os antigénios eritrocitários dos felídeos foram determinados pela prova de aglutinação clássica usando lectina de Triticum vulgaris (Sigma ref. L9640) ou pelo teste rápido DME VET A+B®. A presença/ausência do DEA 1.1 foi determinada pelo teste rápido DME DEA 1.1®. A frequência dos antigénios eritrocitários felinos A, B e AB foi de 97,40% (n=524), 2,23% (n=12) e 0,37% (n=2), respectivamente. Dos canídeos testados, 50,00% (n=27) eram DEA 1.1 positivo. Estes resultados enfatizam a importância da realização da tipificação sanguínea e da prova de compatibilidade eritrocitária para minimizar a ocorrência de reacções transfusionais adversas.
ABSTRACT - FREQUENCY OF THE CANINE ERYTHROCYTE ANTIGEN 1.1 AND OF THE FELINE ERYTHROCYTE ANTIGENS A, B AND AB IN LISBON, PORTUGAL - The feline AB blood group system, characterized by Auer and Bell, is considered the clinically most relevant system. The dog erythrocyte antigen (DEA) 1.1 is the most antigenic and therefore responsible for the severest transfusion adverse reactions. This study was undertaken to determine the frequency of the erythrocyte antigens of the AB blood group system and the DEA 1.1 in the Lisbon area of Portugal. Samples were obtained at the Teaching Hospital and Veterinary Blood Bank of the Veterinary Medicine Faculty of the Technical University of Lisbon, and at several Veterinary Clinics. 538 cats and 54 dogs were tested. The feline erythrocyte antigens were determined by the classical agglutination assay using lectin from Triticum vulgaris (Sigma ref. L9640) or by the DME VET A+B® quick test. The presence/absence of DEA 1.1 was determined by the DME DEA 1.1® quick test. The frequency of feline erythrocyte antigens A, B and AB was 97,40% (n=524), 2,23% (n=12) and 0,37% (n=2), respectively. Of the dogs tested 50,00% (n=27) were DEA 1.1 positive. These results emphasize the importance of blood typing and blood crossmatching to minimize the occurrence of transfusion adverse reactions.
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Amaral, Renata Teixeira do. "Avaliação dos níveis plasmáticos e possíveis alterações clínico-laboratoriais em pacientes portadores de hipertensão arterial sistêmica na terapia com nifedipina." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/9/9141/tde-29012018-101149/.
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A nifedipina atua como bloqueador de canais de cálcio inibindo o fluxo transmembrânico de ions Ca2+ no interior das células do músculo cardíaco e células do músculo liso vascular, o qual induz ao relaxamento do músculo liso e diminuição da resistência vascular periférica. É utilizado no Brasil no tratamento de hipertensão arterial sistêmica (HAS), faz parte da Relação Nacional de Medicamentos Essenciais do Ministério da Saúde e vem sendo distribuída pela Secretaria da Saúde do Estado de São Paulo. Uma vez que a determinação plasmática do fármaco contribui para maior segurança de seu uso, o objetivo deste trabalho se prendeu em padronizar e validar um método analítico em cromatografia em fase gasosa com detecção por captura de elétrons, sensível, específico e reprodutível para a quantificação das concentrações plasmáticas com a finalidade de avaliar a relação entre a dose diária de 60mg e a concentração plasmática versus a resposta da pressão arterial sistêmica, observando a ocorrência de possíveis reações adversas, alterações bioquímicas e hematológicas, em pacientes portadores de HAS, submetidos à farmacoterapia. O método apresentou linearidade na faixa de 10 a 200 ng.mL-1 , com coeficiente de correlação (r) igual a 0,9977. Coeficientes de variação de precisão intra e interensaio menor que 10% e recuperação absoluta da nifedipina de 74,47 a 75,97%. Os limites de detecção e quantificação do método foram de 1,0 e 2,0 ng.mL-1, respectivamente e o fármaco demonstrou ser estável por 90 dias quando armazenado a -70°C ao abrigo da luz. Os dados observados no presente estudo permitiram evidenciar que os pacientes apresentaram concentrações plasmáticas no intervalo terapêutico preconizado, as quais foram efetivas na redução da pressão arterial sistólica e diastólica. Estas concentrações não acarretaram efeitos adversos em nível do sistema hematológico e bioquímico estatisticamente significativos e em relação às reações adversas relacionadas ao medicamento, tais como: cefaléia, edema periférico vascular, tontura, hipotensão arterial, rubor, tosse e cãibras, apesar de relatadas de forma significativa pelos pacientes no inicio do tratamento, foram ao longo do mesmo minimizadas e pouco relatadas.Nifedipine, a compound of dihydropyridine class, is a calcium-channel antagonists drug that inhibits the transmembrane influx of Ca+2 into cardiac muscle cells and vasculas smooth muscle cells throught specific ion channels. It induces smooth muscle relaxation and decreases peripheral vascular resistance. It is widely used for the treatment of high blood pressure, and is considered as a essencial medicine by the Brazilian government. In Sao Paulo state, this drug has been distributed to hypertensive patients in treatment. Since the drug quantification in plasma contributes for a drug safety use, the objective of the present study was to develop and validate a accurate, specific and reproducible method for the determination of nifedipine in plasma by gas chromatography with eletron capture detection. The validated method was applied in samples of hipertensive patients on 60 mg daily dose of nifedipine with the purpose to evaluate the relation between drug plasma concentration and it\'s daily dose versus the hemodymamic effects, possible side effects and biochemical and hematologic alterations. The method was linear over a concentration range of 10 -200 ng.mL-1 (r2>0,99). The coefficient of variation of intra- and inter-assay precision less than 10% and the recovery was higher than 74%. The limit of detection and quantification were 1,0 and 2,0 ng.mL-1, respectively. Nifedipine was found to be stable in samples stored at -70ºC for 90 days and protect from light. The result showed that patients with drug plasma concentration within therapeutics levels also showed systolic and diastolic blood pressure succesfully controled. Therefore, these patients do not manifested any adverse effects specially in biochemical and hematologic systems. Other adverse efects of nifedipine such as headache, peripheral edema, hypotension, redness, cramp and cough reported by the patients at the beggining of thetreatment, were gradually diminishing and rarely related.
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Mota, Daniel Marques. "Evolução e resultados do sistema de farmacovigilância do brasil." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/159285.
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Os sistemas de farmacovigilância fundamentam as decisões sobre segurança no uso de medicamentos regulamentados por autoridades de saúde. Estudá-los e propor estratégias de melhorias contribuem para fortalecer os sistemas de saúde, aperfeiçoando a qualidade da assistência à saúde e assegurando a segurança do paciente e coletividade. A Tese objetivou analisar a evolução e desempenho do sistema brasileiro de farmacovigilância, denominado de SINAF, e as notificações dos pacientes com suspeitas de reações adversas a medicamentos (RAMs) registradas no Notivisa-medicamento no período de 2008 a 2013 e propor uma lista-referência de códigos da CID-10 para vigilância de RAMs e intoxicações medicamentosas (IMs). A Tese compreende seis artigos científicos organizados para publicação. No primeiro, uma revisão de escopo apresentou uma perspectiva histórica para caracterizar a evolução do SINAF e lacunas identificadas no processo, como a ausência de comissão de farmacovigilância que atenda aos requisitos mínimos de um sistema de farmacovigilância propostos pela Organização Mundial da Saúde. Os artigos 2, 3 e 4 analisaram características relacionadas com o desempenho do SINAF. O artigo 2 revelou que não há preferência digital da idade na base de dados das notificações de eventos adversos a medicamentos (EAMs) do Notivisa-medicamento. Mediante uma análise comparativa, o artigo 3 mostrou diferenças entre o formulário para notificação de EAMs utilizado no SINAF e de outros doze países latinoamericanos (Argentina, Bolívia, Chile, Colômbia, Costa Rica, Cuba, Guatemala, México, Panamá, Peru, Uruguai e Venezuela), sobretudo na quantidade de variáveis para preenchimento, podendo contribuir com a subnotificação de casos. No artigo 4 – um estudo de avaliação de sistemas de vigilância de saúde pública –, revelou que o desempenho do Notivisa-medicamento foi considerado satisfatório para três atributos (flexibilidade, validade e erro preditivo positivo) e deficitário para a maioria deles (simplicidade, aceitabilidade, representatividade, completude, consistência, oportunidade e clareza metodológica). O artigo 5, mediante estudo descritivo e retrospectivo, encontrou uma taxa de notificação de RAMs de 22,8/ 1 milhão de habitantes/ano. Trata-se de taxa bastante inferior a países de alta renda como Nova Zelândia, Suécia, Austrália e Suíça que possuem mais de 300 notificações por milhão, como em relação a países de média renda, como a África do Sul, com taxa de 77 por milhão de habitantes. A população feminina (60,5%) prevaleceu no total de pacientes (26.554), assim como, a raça/cor branca (58,1%). A idade variou de 0 a 112 anos (mediana = 46 anos). Quase 1/3 (32,5%) das suspeitas de RAMs ocorreram em populações vulneráveis (idosos e crianças). Foram avaliados 54.288 pares de medicamento-reação adversa, onde prevaleceram as reações adversas graves (59,2%), com destaque para as que resultaram em efeito clinicamente importante (83,1%). O estudo 6 propôs uma lista-referência com 691 códigos da CID-10, sendo 360 (52,1%) relacionados com RAMs e 331 (47,9%) com IMs. Um total de 511 (73,9%) códigos estão relacionados com casos de admissão hospitalar e/ou óbito. Os achados da Tese evidenciam a necessidade de mudanças em diferentes aspectos estudados do SINAF, como forma de contribuir na produção de informações completas, fidedignas e mais representativas sobre danos ocasionados por medicamentos comercializados no país.The pharmacovigilance systems support the decisions on safety when using medications regulated by health authorities. Analyzing them and proposing improvement strategies are ways to make healthcare systems stronger, improving the quality of healthcare assistance, making sure the patient is safe and that the population is ensured. The dissertation was aimed at analyzing the evolution and performance of the Brazilian pharmacovigilance system, SINAF, and the notification of patients with suspected adverse drug reactions (ADRs) registered with the notification system NOTIVISA/medication from 2008 through 2013, as well as proposing a reference list of ICD-10 codes for surveillance of ADRs and intoxication due to medication (IDM). The dissertation is comprised of six scientific articles ready to be published. The first one, a scoping review, presents a historical perspective to demonstrate the development process of SINAF and the gaps identified during the process, such as the absence of a pharmacovigilance commission that complies with the minimum requirements of a pharmacovigilance system as proposed by World Health Organization. Articles 2, 3 and 4 presents an analysis of the performance-related characteristics of SINAF. Article 2 reveals that there is no digital age preference in the adverse drug events (ADEs) database belonging to NOTIVISA/medication. Using a comparative analysis, article 3 shows differences between the form for ADEs notification using SINAF and in other twelve Latin-American countries (Bolivia, Chile, Colombia, Costa Rica, Cuba, Guatemala, Mexico, Panama, Peru, Uruguay and Venezuela), highlighting the number of variables to complete, and it may collaborate with the sub-notification of cases. Article 4 – a study on the evaluation of public health surveillance systems over time – reveal that the performance of NOTIVISA/medication was considered satisfactory regarding three attributes (flexibility, validity and positive predictive error) and deficient regarding most of the others (simplicity, acceptability, representability, integrality, consistency, opportunity and methodological clarity). Article 5, by means of a descriptive and retrospective study, found an ADR notification rate of 22.8/million inhabitants/year. This is a much lower rate than in high income countries, such as New Zealand, Sweden, Australia and Switzerland, which have over 300 notifications per million, when compared against average income, such as South Africa, with a rate of 77/million inhabitants. Female population (60.5%) prevailed in the total number of patients (26,554), as well as white race/color (58.1%). Age was between 0 - 112 years old (median = 46 years). Almost 1/3 (32.5%) of the suspected ADRs occurred in vulnerable populations (elderly and children). 54,288 pairs of medication/adverse reactions were assessed. Severe adverse reactions prevailed (59.2%), and attention is drawn to those resulting in clinically important effect (83.1%). Study 6 proposes a reference list with 691 ICD-10 codes; 360 (52.1%) out of them are ADRs-related and 331 (47.9%) out of them are IDM. A total of 511 (73.9%) codes are related to cases of hospital admission and/or death. The dissertation findings prove the need of changes across different aspects in SINAF as a way to contribute to production of complete, reliable and representative information on damages caused by commercially available drugs in Brazil.
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Shih, Mu-Chin, and 石木欽. "Rules of Evidence in the Modified Adversary System ─ With Focus on the Practice of Trial." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/10655408170664816503.
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碩士臺灣大學
國家發展研究所
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In September 2003, Taiwan began to adopt the modified adversary system for the criminal litigation system, and in the process, the Exclusionary Rule of Evidence, Hearsay Rule and the cross-examination system are introduced. Because the scope of this reform is broad, and the revised articles are yet too simple, judges remain befuddled by the application of the new law even after 3 years and 6 months of practice, resulting in a discrepancy in interpretation. The situation has yet to be improved. This paper briefly introduces the Rules of Evidence in the modified adversary system, and compares the Rules against that adopted in the U.S. and Japan, respectively. It discusses the procedures adopted by Taiwan, including the rejection of the jury system, Principle of Unitary Indictment and cause of action system, which are then compared against their American and Japanese counterparts. In addition, the different interpretations provided by the supreme courts are analyzed according to the issues addressed, such as the admissibility of illegally obtained evidence, the admissibility of hearsay evidence and the general investigative procedures involved in obtaining evidence. The purpose of the paper is to first discuss the issues in general terms, identify the core problems, analyze the problems through academic, theoretic, and practical aspects, and finally offer some legal basis for interpretations. Furthermore, it is worth discussing the discrepancy between Judicial Yuan Interpretation No. 592, on the one hand, and No. 384 and No. 582, on the other, in determining whether hearsay evidence should be the sole ground for an acquittal. Finally, legal precedents should also be unified: After the implementation of the new Code of Criminal Procedure, some courts still cite legal precedents that are no longer cited by the Supreme Court. This paper also reviews several current precedents based on the outcome of the trials, and proposes that the Supreme Court should refrain from using those precedents in the future. Because the new Code of Criminal Procedure is still in its infancy and remains primitive, there is uncertainty in the application of the law in areas such as determining the admissibility of illegally obtained evidence and how to properly handle the evidence: Should the admissibility of such evidence be excluded entirely, and if so, should it be excluded based on Article 158-4 of the Code of Criminal Procedure? Are statements made before a judge or prosecutors admissible? Is the defendant required to be cross-examined? Is there a different interpretation before and after the announcement of J.Y. Interpretation No. 582, the proviso of Article 7-3 of the Criminal Procedure with respect to contents of special documents? Is the Rule of Consent still consistent with Article 159-1~4 of the Code of Criminal Procedure? Should new evidence be admitted and investigated during trial? These issues have led to inconsistent interpretations issued by the Supreme Court, some are perhaps due to incomplete laws, while others are due to different interpretations of legal terms. The Supreme Court has not reached a consensus on these issues, which will only result in confusion and contradictions among the lower courts. Therefore, it is necessary to hold criminal division meetings to reach, by resolution, a uniformed interpretation. Items 1 and 2 of Article 159-1, Item 4 of Article 159-4, and Item 2 of Article 165-1 should also be revised to make the procedures more complete and to meet practical application.
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(11186139), Benjamin D. Harsha. "Modeling Rational Adversaries: Predicting Behavior and Developing Deterrents." Thesis, 2021.
Find full textAbstract:
In the field of cybersecurity, it is often not possible to construct systems that are resistant to all attacks. For example, even a well-designed password authentication system will be vulnerable to password cracking attacks because users tend to select low-entropy passwords. In the field of cryptography, we often model attackers as powerful and malicious and say that a system is broken if any such attacker can violate the desired security properties. While this approach is useful in some settings, such a high bar is unachievable in many security applications e.g., password authentication. However, even when the system is imperfectly secure, it may be possible to deter a rational attacker who seeks to maximize their utility. In particular, if a rational adversary finds that the cost of running an attack is higher than their expected rewards, they will not run that particular attack. In this dissertation we argue in support of the following statement: Modeling adversaries as rational actors can be used to better model the security of imperfect systems and develop stronger defenses. We present several results in support of this thesis. First, we develop models for the behavior of rational adversaries in the context of password cracking and quantum key-recovery attacks. These models allow us to quantify the damage caused by password breaches, quantify the damage caused by (widespread) password length leakage, and identify imperfectly secure settings where a rational adversary is unlikely to run any attacks i.e. quantum key-recovery attacks. Second, we develop several tools to deter rational attackers by ensuring the utility-optimizing attack is either less severe or nonexistent. Specifically, we develop tools that increase the cost of offline password cracking attacks by strengthening password hashing algorithms, strategically signaling user password strength, and using dedicated Application-Specific Integrated Circuits (ASICs) to store passwords.
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VanTieghem, Michelle R. "Longitudinal changes in amygdala, hippocampus and cortisol development following early caregiving adversity." Thesis, 2020. https://doi.org/10.7916/d8-p797-p545.
Full textAbstract:
Decades of research have shown long-term effects of early caregiving adversity on stress physiology and limbic brain regions, two key biological systems that are implicated in risk for internalizing disorders. Although stress physiology and limbic brain structure undergo significant maturational change during childhood and adolescence, and reciprocally influence each other, the effects of early caregiving adversity on these developmental processes is not well understood. In the current study, we used an accelerated longitudinal design to assess the development of stress physiology, amygdala, and hippocampal volume following early institutional care. Previously Institutionalized (PI; N = 93) and comparison (COMP; N = 161) youth (ages 4-20 years old) completed 1-3 waves of data collection, each spaced approximately 2 years apart, for diurnal cortisol (N = 239, providing a total of 380 diurnal datasets), structural MRI (N = 156, providing a total of 306 scans) and parent-reported internalizing symptoms (N = 133, providing a total of 227 time points). We observed a developmental shift in morning cortisol in the PI group, with blunted levels in childhood and heightened levels in late adolescence. PI history was associated with reduced hippocampal volume and reduced growth of the amygdala, resulting in smaller volumes by adolescence. Results also suggested feed-forward brain-to-hormone mechanisms, such that both amygdala and hippocampal volumes were prospectively associated with morning cortisol levels two years later. Finally, amygdala and hippocampal volumes were independently associated with internalizing scores across the entire sample. These results indicate that adversity-related physiological and neural phenotypes are not stationary during development but instead exhibit dynamic and interdependent changes from early childhood to early adulthood.
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Matos, Cristiano Filipe Romão 1989. "Are patients ready to take part in pharmacovigilance system : a Portuguese preliminary study concerning ADR reporting." Master's thesis, 2014. http://hdl.handle.net/10400.26/17035.
Full textAbstract:
Background: New Pharmacovigilance legislation allows patients to report adverse drug reactions
(ADRs) directly to competent authorities in all European Union (EU) member states. Patient
reporting is available in Portugal since July 2012. In 2013, the National Pharmacovigilance System
(SNF) had received 3461 spontaneous ADR reports, of which only 1.4% (n=50) were reported by
patients. Underreporting remains a reality in Portugal, although patient reporting could be one of
the measures to reduce the rate of underreporting by healthcare professionals (HCP).
Objectives: The aim of this study was to describe the attitudes and knowledge of the patients
regarding spontaneous reporting and the reasons and opinions that can influence patients ADR
underreporting.
Methods: A descriptive-correlational study was performed looking for patients’ attitudes and
knowledge regarding spontaneous reporting. A 6-months survey was conducted from June to
November 2013 in general adult patients from a community pharmacy in Coimbra, Portugal, that
used prescribed medicines or OTC-drugs. Attitudes and opinions were surveyed in a closedanswer
questionnaire using a Likert scale. Incomplete questionnaires and answers from
healthcare professionals were excluded from data analysis. The data were analyzed using
descriptive statistics, χ2 tests and Spearman’s correlation coefficients.
Results: A total of 1084 questionnaires were collected with a response rate of 81,1% and 948
completed questionnaires were selected for analysis. Of the respondents, 44.1% never heard
about SNF. Younger people and those with a higher education were significantly more likely to be
aware of SNF. Only 1 patient had previously reported an ADR directly to SNF. Reporting ADRs
indirectly through an HCP was preferred by 62.4%. The main reasons for patients reporting
spontaneous ADR would be the severity of the reaction (81,1% agreed or strongly agreed) and
worries about their own situation (73,4% agreed or strongly agreed). Only weak and moderate
correlations were found between studied statements.
Conclusions: Patients are most likely to do a spontaneous report about a severe reaction or if
they are worried about the symptoms. Tailored and proactive information on ADR reporting and
educational interventions on patients could increase the number of reports from patients in
Portugal.
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Khaleghi, Azadeh. "Projective Space Codes for the Injection Metric." Thesis, 2009. http://hdl.handle.net/1807/18790.
Full textAbstract:
In the context of error control in random linear network coding, it is useful to construct codes that comprise well-separated collections of subspaces of a vector space over a finite field.
This thesis concerns the construction of non-constant-dimension projective space codes for adversarial error-correction in random linear network coding. The metric used
is the so-called injection distance introduced by Silva and Kschischang, which perfectly reflects the adversarial nature of the channel.
A Gilbert-Varshamov-type bound for such codes is derived and its asymptotic behaviour is analysed. It is shown that in the limit as the ambient space dimension approaches infinity, the Gilbert-Varshamov bound on the size of non-constant-dimension codes behaves similar to the Gilbert-Varshamov bound on the size of constant-dimension codes contained within the largest Grassmannians in the projective space.
Using the code-construction framework of Etzion and Silberstein, new non-constant-dimension codes are constructed; these codes contain more codewords than comparable codes designed for the subspace metric. To our knowledge this work is the first to address
the construction of non-constant-dimension codes designed for the injection metric.
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Costa, Patricia Jorge Chaves Ferreira da. "Reação Adversa a Fármacos com Eosinofilia e Sintomas Sistémicos - Síndrome de DRESS." Master's thesis, 2018. http://hdl.handle.net/10316/82160.
Full textAbstract:
Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaA Síndrome de DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) constitui uma reação adversa rara a fármacos, potencialmente fatal, com manifestações cutâneas e envolvimento de órgãos internos, que pode afetar tanto adultos como crianças.Clinicamente carateriza-se por uma erupção cutânea morbiliforme generalizada, acompanhada por febre, linfadenopatias, alterações hematológicas e envolvimento multiorgânico (hepático, renal, pulmonar, cardíaco, neurológico, gastrointestinal e/ou endócrino).O início dos sintomas ocorre tipicamente após 2 a 6 semanas da toma do medicamento e tem uma duração prolongada, quando comparada com outras reações adversas medicamentosas. Historicamente era associada à fenitoína, contudo este panorama foi alterado, sendo atualmente a carbamazepina e o alopurinol os fármacos mais frequentemente responsáveis por esta síndrome. A sua patogenia está relacionada com a ativação linfocitária, defeitos enzimáticos associados ao metabolismo dos fármacos e reativação de herpes vírus (herpesvirus-6 e -7, Epstein-Barr, citomegalovírus), no entanto, ainda não é totalmente conhecida. Esta síndrome tem uma elevada taxa de mortalidade (10%), associada a hepatite fulminante com necrose hepática. Torna-se então imperioso um diagnóstico precoce e suspensão imediata do(s) fármaco(s) imputável(is). Contudo, não existem critérios de diagnóstico válidos e aceites pela maioria da comunidade médica, sendo o mesmo baseado em alterações clínicas e laboratoriais. O tratamento passa por descontinuar o fármaco e instituir terapêuticas médicas adequadas. Futuramente, poderá vir a ser possível detetar genes de suscetibilidade para o desenvolvimento de reações adversas medicamentosas e assim prevenir esses indivíduos de virem a desenvolver uma RCAMs. O rastreio da suscetibilidade genética para este tipo de reação constitui um exemplo de medicina personalizada que poderá, no futuro, alterar o panorama atual deste tipo de patologia.
DRESS (Drug Reaction with Eosinopilia and Systemic Symptoms) is a life-threatening adverse reaction with cutaneous manifestations and internal organ involvement, that occurs in both adults and children.It is clinically characterized by a morbiliform cutaneous eruption with fever, lymphadenopathy, hematologic abnormalities and multiorgan involvement (hepatic, renal, pulmonary, cardiac, neurologic, gastrointestinal and/or endocrine abnormalities).The onset of symptoms typically occurs 2 to 6 weeks after drug administration and the duration of the syndrome is longer than other drug reactions.Historically, it was associated with phenytoin, but this picture has changed. Nowadays it is most frequently due to carbamazepine and allopurinol. Its pathogenesis has been linked with drug specific lymphocyte activation, drug metabolism defects and reactivation of herpesviruses (herpesvirus-6 and -7, Epstein-Barr virus and cytomegalovirus). However, its pathomechanisms are still not fully understood.This syndrome has a significant mortality rate (10%), most commonly from fulminant hepatitis. An early diagnosis and immediate suspension of drugs envolved are therefore imperative. However, there are no established diagnostic criteria for DRESS syndrome, which is based on clinical and laboratory changes. Immediate withdrawal of the causative drug and initiation of adequate medical treatment is the mainstay in the management of DRESS syndrome. In the future, it may be possible to detect susceptibility genes for the development of adverse drug reactions and thus prevent such individuals from developing a SCAR. The screening of genetic susceptibility for this type of reaction is an example of personalized medicine that may, in the future, alter the current panorama of this type of pathology.
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Garcia, José Pedro. "Drug reaction with eosinophilia and systemic symptoms: uma toxidermia alarmante e potencialmente fatal." Master's thesis, 2014. http://hdl.handle.net/10316/30499.
Full textAbstract:
Trabalho final de mestrado integrado em Medicina, apresentado à Faculdade de Medicina da Universidade de Coimbra.A DRESS constitui uma reação adversa a medicamentos potencialmente fatal que se caracteriza clinicamente por uma erupção cutânea generalizada, acompanhada por alterações sistémicas e envolvimento multiorgânico, com um período de latência de 2 a 6 semanas. Inicialmente foi associada à Fenitoína, mas atualmente está comprovado o envolvimento de outros fármacos, sendo os mais frequentemente responsáveis a Carbamazepina e o Alopurinol. A sua patogenia não é totalmente compreendida, mas é inegável o envolvimento de ativação linfocitária pelo fármaco ou um seu metabolito, geralmente associada a defeitos no metabolismo de fármacos, reativação de infeções virais, sendo a mais importante a infeção pelo HHV-6, e a predisposição genética associada a alelos HLA específicos já identificados para diversos fármacos. O diagnóstico célere é imperativo, pois a DRESS está associada a elevada morbilidade e mortalidade em 10 a 20% dos casos. O tratamento obriga à descontinuação imediata do fármaco suspeito e instituição de medidas terapêuticas adequadas, apesar de não haver consenso no que respeita ao tratamento mais adequado. É expectável que o melhor conhecimento da patogenia da reação clarifique o tratamento a implementar O acompanhamento dos doentes após a resolução do quadro agudo é imprescindível, tendo em conta os indícios que apontam para uma maior incidência de patologia autoimune neste período.
DRESS is a potentially fatal adverse drug reaction clinically characterized by a generalized rash accompanied by systemic changes and multiorgan involvement that develops after a latency period of 2 to 6 weeks. DRESS was initially associated with Phenytoin, but currently it is proven the involvement of other drugs, being the most frequently responsible Carbamazepine and Allopurinol. Its pathogenesis is not fully understood, but it is undeniable the involvement of lymphocyte activation by the drug or a metabolite, very often associated with defects in drug metabolism, reactivation of viral infections, mostly HHV-6 infection or reactivation, and a genetic predisposition namely specific HLA alleles already identified for several drugs. An early diagnosis is essential, because DRESS is associated with high morbidity and mortality of 10 to 20%. The treatment requires immediate discontinuation of the suspect drug and institution of appropriate management, although there is no consensus on the most adequate treatment. It is expected that in the near future treatment will benefit from a better understanding of the pathogenesis of DRESS. The follow-up of patients after resolution of the acute condition is essential, given the evidence pointing to an increased incidence of autoimmune disease in this period.
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Prado, Mariana Barros de Carvalho. "A inferência da informação assimétrica no sistema bancário norte americano e seus efeitos na crise Subprime: Um estudo de caso." Master's thesis, 2020. http://hdl.handle.net/10071/21315.
Full textAbstract:
Esta Dissertação procura compreender as implicações do problema de informação assimétrica entre as partes em contratos de crédito, e como estas estavam presentes no sistema económico-financeiro norte-americano durante a crise subprime, que teve início no final de 2017. Esta crise teve repercussões não somente dentro do sistema económico-financeiro norte-americano, mas também impactou a economia mundial como um todo.
Para demonstrar esta dinâmica, o presente trabalho de investigação analisa as principais variáveis presente durante a crise e o processo de desestruturação/insolvência dos bancos Norte-americanos Bear Stearns e Lehman Brothers. Recorreu-se a métodos quantitativos e qualitativos e a análise recaiu sobre o período de 2003 a 2010.
Conclui-se que problemas como seleção adversa e risco moral estão fortemente presentes na estrutura bancária norte americana e que fazem parte de um sistema complexo e integrado, no qual vários agentes económicos estão presentes.This dissertation aims to understand the problem of asymmetric information between the parties on any given credit agreements, and how this issue was present in the North American economic-financial system during the subprime crisis, which began in late 2017, in the USA. The crisis not only impacted the North American economic and financial system, but it also ended up impacting the world economy. To demonstrate this dynamics, this research work analyses the main variables present during the crisis, with a special focus on the process of the bankruptcy of Bear Stearns and Lehman Brothers. Quantitative and qualitative methods were chosen, and the analysis is performed for the period between 2003 and 2010. Our main findings suggest that the major economic issues such as adverse selection and moral hazard were strongly present in the North American financial structure, and they are part of a complex and integrated system in which there are others several economic agents present. These elements together were responsible for the subprime mortgage crisis that started in 2007.