Evaluación de la Saturación Venosa de Oxígeno (SvO2) desde la teoría de los sistemas dinámicos / Evaluation of SvO2 from the Theory of Dynamic Systems

Introducción: La evolución de un sistema dinámico se puede caracterizar a partir de la construcción de atractores caóticos. Objetivo: Desarrollar una metodología de evaluación de la saturación venosa de oxígeno, fundamentada en los sistemas dinámicos, para pacientes en Unidad de Cuidados Intensivos. Metodología: Se seleccionaron 10 pacientes con diferentes patologías de la Unidad de Cuidados Intensivos Postquirúrgicos, y registró la saturación venosa de oxígeno durante su tiempo de estancia. Con base en estos valores se construyeron atractores caóticos en el mapa de retardo y se evaluaron los valores mínimos y máximos ocupados por el atractor. Resultados: Se halló que la saturación venosa de oxígeno tiene un comportamiento caótico; los valores máximos y mínimos de los atractores en el mapa de retardo variaron entre 22,10 mmHg y 93,70 mmHg. Conclusiones: Se plantea una nueva metodología capaz de caracterizar el comportamiento de la variable monitorizada para la evaluación del paciente crítico(AU)

Introduction: The evolution of a dynamic system can be characterized from the construction of chaotic attractors. Objective: To develop a methodology based on dynamic systems, for the evaluation of venous oxygen saturation of patients in the Intensive Care Unit. Methodology: 10 patients with different pathologies of the Post-surgical Intensive Care Unit were selected, and recorded venous oxygen saturation during their time of stay. Based on these values, chaotic attractors were constructed on the delay map and the minimum and maximum values occupied by the attractor were evaluated. Results: It was found that venous oxygen saturation has a chaotic behavior; the maximum and minimum values of the attractors on the delay map varied between 22.10 mmHg and 93.70 mmHg. Conclusions: A new methodology is proposed capable of characterizing the behavior of this monitored variable for the evaluation of the critical patient(AU)

Educação de qualidade na Enfermagem: fenômeno complexo e multidimensional / Educación de calidad en la Enfermería: fenómeno complejo y multidimensional / Quality Nursing education: a complex and multidimensional phenomenon

RESUMO Objetivo: refletir sobre a educação de qualidade na Enfermagem como fenômeno complexo e multidimensional. Método: trata-se de um estudo teórico-reflexivo desenvolvido e sistematizado em cinco unidades de reflexão: ambientes de aprendizagem significativa; metodologias ativas; convivência em realidades distintas; Redes colaborativas; e, Abordagens complexas de intervenção. Resultados: a análise das unidades de reflexão, à luz do pensamento complexo, demonstraram que a aprendizagem, na contemporaneidade, não pode mais ser concebida como processo pontual e linear. A educação de qualidade está relacionada à ampliação das interações e associações sistêmicas e à capacidade de fortalecer a interlocução com a realidade complexa e em constante mudança. Conclusão: necessita-se transcender o paradigma da simplificação e considerar a complexidade intrínseca que se encontra no cerne da ciência.

RESUMEN Objetivo: reflexionar sobre la educación de calidad en la Enfermería como fenómeno complejo y multidimensional. Método: se trata de un estudio teórico-reflexivo desarrollado y sistematizado en cinco unidades de reflexión: ambientes de aprendizaje significativo, metodologías activas, convivencia en realidades distintas, redes colaborativas y abordajes complejos de intervención. Resultados: el análisis de las unidades de reflexión a la luz del pensamiento complejo demostró que el aprendizaje, en la contemporaneidad, no puede ser concebido como un proceso puntual y lineal. La educación de calidad está relacionada con la ampliación de las interacciones, las asociaciones sistémicas y con la capacidad de fortalecer la interlocución con la realidad compleja y en constante cambio. Conclusión: se necesita transcender el paradigma de la simplificación y considerar a la complejidad intrínseca que se encuentra en el cerne de la ciencia.

ABSTRACT Objective: to reflect on quality Nursing education as a complex and multidimensional phenomenon. Method: this is a theoretical-reflexive study developed and systematized into five units of reflection: significant learning environments; active methodologies; Interactions in different realities; collaborative networks; and complex intervention approaches. Results: based on complex thinking, an analysis of the units of reflection has shown that learning in the contemporaneity can no longer be conceived as a specific and linear process. Quality education is related to expanding systemic interactions and associations, and to the ability to strengthen its relation with a constantly changing complex reality. Conclusion: it is necessary to transcend the simplification paradigm, taking into account the intrinsic complexity that lies at the heart of science.

Risk appraisal by novel chaotic globals to HRV in subjects with malnutrition

The aim of this study is to assess the risk of dynamical diseases in malnourished children. This is achieved by the application of novel chaotic global techniques to the RR-intervals of the electrocardiogram (ECG) in the cohort. Heart Rate Variability (HRV) is an inexpensive and non-invasive tool to measure the autonomic impulses. Here there has been a decrease in chaotic response of HRV. Seventy children were divided into equal groups and the HRV monitored for 20-25 minutes. The Chaos Forward Parameter (CFP) which applies all three chaotic global parameters is suggested to be the most robust algorithm. These three parameters are high spectral entropy (hsEntropy), high spectral detrended fluctuation analysis (hsDFA) and spectral multi-taper method (sMTM)...

O objetivo deste estudo é avaliar o risco de doenças dinâmicas em crianças desnutridas. Isto é feito por meio da aplicação de novas técnicas caóticas globais para os intervalos R-R do ECG. A variabilidade da frequência cardíaca (VFC) é uma ferramenta de baixo custo e não-invasiva que mensura os impulsos autonômicos. Na desnutrição ocorreu uma diminuição na resposta caótica da VFC. Setenta crianças foram divididas em grupos iguais e a VFC foi monitorada por 20 a 25 minutos. O parâmetro caótico avançado (CFP), que utiliza os três parâmetros caóticos globais é o algoritmo mais robusto. Estes três parâmetros são: alta entropia espectral (hsEntropia), análise da alta flutuação depurada espectral (hsDFA) e método espectral multi-taper (sMTM)...

La dinámica de la transmisión de la enfermedad según la teoría de la complejidad / Disease transmission dynamics according to complexity theory

RESUMEN Objetivo Se ilustra el proceso de transmisión de una enfermedad, entendido como un sistema complejo a la luz de la teoría de la complejidad. Métodos Se simula el comportamiento de un modelo matemático SEIR que refleja el proceso de transmisión de una enfermedad a partir de la conexión de los estados de susceptibilidad, infección, enfermedad y recuperación y no linealidad en la interacción de susceptibles e infectados. Se asume una tasa de infección con oscilaciones en el tiempo, descrito por un mapeo logístico. Resultados La transmisión transcurre en el tiempo con la reducción de los susceptibles en la medida que estos se infectan y enferman y el aumento de la recuperación tras el diagnóstico y tratamiento. Con pequeños aumentos en el valor de la tasa de infección, se observan oscilaciones en el número de susceptibles y expuestos y aleatoriedad en la relación entre los susceptibles e infectados, hasta confluir a un patrón regular. Conclusión El modelo refleja la conexión entre los estados, la no linealidad y el comportamiento caótico tras pequeños aumentos del valor de la tasa de infección. Una perspectiva histórica y transdisciplinaria ayudaría a comprender la complejidad de la transmisión y a concertar opciones de control.

ABSTRACT Objective Illustrating disease transmission as a complex system according to complexity theory. Methods A SIR mathematical model (S=number susceptible, I=number infectious, and R=number recovered or immune) reflecting disease transmission from the connection between states of susceptibility, infection, disease, recovery and nonlinearity in the interaction between susceptible and infected was simulated. Infection rate temporal fluctuations were described by logistic mapping. Results Transmission occurs with the reduction of susceptible states as people become infected and sick, followed by an increase in individuals' recovery following diagnosis and treatment. Small increases in infection rate value led to fluctuations in the number of susceptible and exposed people and randomness in the relationship between being susceptible and infected, until converging towards a regular pattern. Conclusion The model reflected the connection between states of susceptibility, nonlinearity and chaotic behavior following small increases in infection rate. A historical and trans-disciplinary perspective could help in understanding transmission complexity and coordinating control options.

Dinámica de la bio-acumulación de las ciguatoxinas en una cadena alimentaria / Dynamics of the bioaccumulation of ciguatoxins in a food chain

Introducción: frecuentemente en las regiones insulares de países tropicales se reportan casos de intoxicación por ciguatera, los cuales se asocian al consumo de ciertos tipos de peces que se alimentan de algas tóxicas. Debido a que la aparición de la intoxicación es impredecible, y que los peces portadores de la ciguatoxinas presentan sabor y olor como los peces no contaminados, existen grandes dificultades en la prevención de esta enfermedad, ocacionando serios problemas socio-económicos en las comunidades que habitan estas regiones. Objetivo: con el propósito de entender la bio-acumulación de las ciguatoxinas en la cadena alimentaria marina, se propone un sistema no lineal de ecuaciones diferenciales que puede ser utilizado como herramienta en la determinación de tiempos de veda en el consumo de peces y mitigar los riesgos de intoxicación. Métodos: se analiza la estabilidad de la solución de equilibrio del sistema que tienen sentido ecológico y se presentan y discuten simulaciones numéricas para diferentes escenarios de brotes de las ciguatoxinas. Resultados: los resultados indican que la evolución del sistema de transporte y bio-acumulación de toxina depende de la dinámica del sistema poblacional. Conclusiones: El modelo puede convertirse en una orientación para los ecólogos que investigan en actividades de campo relacionadas con la enfermedad, ya que sugiere algunas medidas importantes que son necesarias para calibrar el modelo y hacer de él una herramienta valiosa en la toma de decisiones por las autoridades encargadas del tema de salud pública en zonas costeras caribeñas donde la enfermedad sea endémica.

Introduction: Island regions in tropical countries often report cases of ciguatera fish poisoning associated with consumption of certain types of fish feeding on toxic algae. The emergence of intoxication is unpredictable, and fish carrying ciguatoxins taste and smell just like uncontaminated fish. Therefore, it is very difficult to prevent this disease, which causes serious socio-economic problems in the communities inhabiting these regions. Objective: with the purpose of understanding the bioaccumulation of ciguatoxins in the marine food chain, a proposal is made of a non-linear system of differential equations which may be used as a tool to lay down closed seasons in fish consumption and thus mitigate poisoning risks. Methods: an analysis is conducted of the stability of the equilibrium solution of the system which makes ecological sense, and a presentation and discussion are provided of numerical simulations for various scenarios of ciguatoxin outbreaks. Results: results show that evolution of the toxin transport and bioaccumulation system depends on the dynamics of the population system. Conclusions: the model may be used as a guideline for ecologists carrying out field research into the disease, since important measures are suggested which are required to calibrate the model and turn it into a valuable tool for the taking of decisions by public health authorities in Caribbean coastal areas where the disease is endemic.

Between the processes of strengthening and weakening of the Family Health Strategy / Entre os processos de fortalecimento e de fragilização da Estratégia Saúde da Família / Entre los procesos de fortalecimiento e de debilitamiento de la Estrategia Salud de la Familia

This was a qualitative study with the purpose of designing a meta-model for the work process of the Family Health Strategy (FHS) team. It was based on the experience of six sample groups, composed of their members (physicians, professional nurses, dentists, dental assistants, licensed technical nurses and community health agents) in a city in São Paulo state, Brazil, totaling 54 subjects. Six theoretical models emerged from non-directive interviews. These were analyzed according to Grounded Theory and submitted to the meta-synthesis strategy, which produced the meta-model "between the processes of strengthening and weakening of the FHS model: professional-team-community reciprocity as an intervening component". When analyzed in light of the Theory of Complexity (TC), it showed to be a work with a vertical and authoritarian tendency, which is largely hegemonic in the tradition of public health care policies.

Pesquisa qualitativa, em que se elaborou um metamodelo do processo de trabalho da Estratégia Saúde da Família (ESF), a partir da experiência de seis grupos amostrais: médicos, enfermeiros, cirurgiões dentistas, auxiliares de cirurgião dentista, auxiliares de enfermagem e agentes comunitários de saúde, de um município do interior paulista, perfazendo 54 atores. Das entrevistas não diretivas, analisadas segundo a Teoria Fundamentada nos Dados, emergiram seis modelos teóricos, os quais foram submetidos à estratégia de metassíntese, produzindo o metamodelo "entre os processos de fortalecimento e de fragilização do modelo ESF: reciprocidade profissional - equipe - comunidade como componente interveniente". Analisado à luz da Teoria da Complexidade (TC), revelou-se um trabalho de tendência verticalizada e autoritária, largamente hegemônico na tradição das políticas públicas de saúde.

En esta investigación cualitativa se elaboró un metamodelo del proceso de trabajo de la Estrategia Salud de la Familia (ESF) con base en la experiencia de seis grupos de muestras: médicos, enfermeros, cirujanos dentistas, auxiliares de cirujano dentista, auxiliares de enfermería y agentes comunitarios de salud de un municipio del interior de São Paulo, con un total de 54 actores. De las entrevistas no directivas, analizadas según el Muestreo Teórico, emergieron seis modelos teóricos que se sometieron a la estrategia de meta síntesis y produjeron el metamodelo "entre los procesos de fortalecimiento y de debilitamiento del modelo ESF: reciprocidad profesional - equipo - comunidad como componente interviniente". Analizado a la luz de la Teoría de la Complejidad (TC) se reveló un trabajo de tendencia vertical y autoritaria, largamente hegemónico en la tradición de las políticas públicas de salud.

Assistência em saúde: revisão integrativa do conhecimento produzido à luz da complexidade / Health care: integrative review of knowledge produced in light of complexity / Asistencia en salud: revisión integrativa del conocimiento producido a la luz de la complejidad

Trata-se de um recorte a partir de uma revisão integrativa, cujo objeto de estudo foi a produção do conhecimento em periódicos acerca de pesquisas na área da Enfermagem que se utilizaram da teoria da complexidade como referencial teórico. Este estudo reúne sete artigos a partir de pesquisa bibliográfica que localizou 18 publicações nas bases de dados Medical Literature Analysis and Retrieval Sistem on-line (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Cumulative Index to Nursing and Allied Health Literature (CINAHL), no período de 1998 a 2008. Nas duas primeiras foi utilizada a seguinte combinação de palavras-chave: "complexitytheory" e "health" e "nursing", e na terceira: "complexidade" e "saúde" e "enfermagem". A análise de conteúdo foi o referencial metodológico que permitiu organizar o conhecimento, agregado no tema: assistência em saúde. Percebeu-se que a Teoria da Complexidade tem embasado a compreensão do processo do cuidado em saúde, destacando o cuidador com suas práticas e o meio ambiente.

This is part of an integrative review whose object of study was the production of knowledge in journals concerning nursing studies that have used the Theory of complexity as a theoretical framework. This study gathers seven articles collected from a literature review of 18 publications found on the databases: Medical Literature Analysis and Retrieval Sistem on-line (MEDLINE), Literatura Latino-Americana e do Caribe emCiências da Saúde (LILACS) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1998 to 2008. In the two former databases, the following combination of key words was used: "complexity theory" and "health" and "nursing", and in the third: "complexidade" and "saúde" and "enfermagem. Content analysis was the methodological framework that allowed for organizing the knowledge aggregated in the theme: Health Care. It was observed that the Complexity Theory has based the comprehension of the health care process, pointing out the care provider with his practices and the environment.

Se trata de un recorte hecho con una revisión integrativa, cuyo objeto de estudio fue la producción del conocimiento en periódicos acerca de investigaciones en el área de la Enfermería, que usaron la teoría de la complejidad como referencial teórico. Este estudio reúne siete artículos de investigación bibliográfica escogidos entre 18, ubicados en las bases de datos: Medical LiteratureAnalysis and RetrievalSistem on-line (MEDLINE), Literatura Latino-Americana e do Caribe emCiências da Saúde (LILACS) y CumulativeIndextoNursing and AlliedHealthLiterature (CINAHL), en el período de 1998 a 2008. En las dos primeras se utilizó la siguiente combinación de palavras clave: "complexitytheory" and "health" and "nursing", y en la tercera: "complexidade" and "saúde" and "enfermagem. El análisis de contenido fue el referencial metodológico que permitió organizar el conocimiento agregado al tema: Asistencia en salud. Se percibió que la Teoría de la Complejidad está en la base de la comprensión del proceso del cuidado en salud y destaca al cuidador con sus prácticas y el medio ambiente.

Non-linear dynamics of chromosome condensation induced by colcemid

This study investigated the dynamical process of chromosome condensation after colcemid treatment. Two pairs of human chromosomes, #2 and #3, were highlighted for the accurate identification by fluorescence in situ hybridization (FISH). A computerized image analysis system was used to measure the lengths of the two pairs of chromosomes averaged over 50 metaphases of different cultures with colcemid (0.5 µg/mL) added either at 3 or 48 h of a total 72 h culture period. For determining whether the process of chromosome condensation was chaotic or random, the algorithm of Detrended Fluctuation Analysis (DFA) was used. In order to evaluate the power of the method, the data were shuffled and DFA was performed again. It was found that colcemid prolonged treatment induced a significantly greater chromosome condensation (p<0.05), and the dynamics of this process was determined by the DFA and showed to be chaotic, with scaling exponents with range values 0.5< α<1.0. When the data were shuffled, the scaling exponent αreduced around to 0.5, which was characteristic of random events. These findings reinforced the idea that colcemid could interfere in some manner with the structure of chromosomes and the dynamics of chromosome condensation was non-linear.

El fenómeno de los desastres. Perspectiva transdisciplinar con el enfoque de los Sistemas Complejos / The disaster phenomenon. A transdisciplinary perspective from the Complex Systems approach

En el trabajo se realiza una breve reseña histórica del estudio de los desastres, como fenómenos objeto de estudio, resaltando lo sucedido en el continente latinoamericano. Se deja ver como la percepción del tema en nuestro continente está permeada por los problemas sociales que están vinculados con la ocurrencia de sucesos, mientras que el tratamiento en países industrializados se inclina hacia el estudio del suceso natural desde las ciencias naturales. En el trabajo se introducen conceptos utilizados en el lenguaje de los Sistemas Complejos, así como se plantea la necesidad de tratar transdisciplinariamente la investigación en el tema de desastres y de su introducción al currículo de las carreras biomédicas, utilizando como base epistemológica el pensamiento complejo.

In this paper it’s fulfill a short historical review about the disaster studies theme, emphasizing what happens in Latin-American continent. We show how the theme perception in our countries is conditioned by the social problems, which are in narrow relation with occurring events, while the treatment about disasters in industrialized countries pass through the study of natural phenomenon from basic sciences. In this work we introduced some concepts used in the complex systems language and we talk about the necessity of the transdisciplinary treatment of disasters research and it introduction in curriculum of biomedicine career, using the epistemological foundations of complex thinking.

Study on Point-wise Correlation Dimension of Electroencephalogram Nonlinear Analysis in Patients with Stagnation of Liver-Qi Syndrome / 中国康复理论与实践

@#Objective To investigate the changes of non-linear dynamics characteristics of electroencephalogram(EEG) in patients with the stagnation of Liver-Qi syndrome.Methods 15 Liver-Qi stagnation syndrome patients and 15 normal persons were paired by sex and age.The data of EEG under three states(eyes closed,eyes opened,and mental arithmetic with eyes opened) were analyzed by the parameter of point-wise correlation dimension(PD2).Results PD2 of the stagnation of Liver-Qi syndrome group increased significantly compared with that of the healthy control group and always maintain high level.The difference of PD2 between two groups was gradually reduced along with the increase of stimulated condition.Conclusion Non-linear dynamic analysis is more appropriate for the study of mental functions changes of stagnation of Liver-Qi syndrome and can be used to investigate the brain mechanism of the stagnation of Liver-Qi syndrome.

Application of EEG Non-linear Analysis in Vision Memory Study / 中国康复理论与实践

@#ObjectiveTo investigate the changes of non-linear dynamics characteristics of EEG during picture memory masks, and the application of non-linear dynamic analysis for memory research.MethodsEEGs of 30 healthy old volunteers were recorded under the states of opened eyes and picture memory. Correlation dimension (D2) was calculated for all subjects.ResultsD2 increased significantly during memory tasks compared with the rest state with eyes opened (P<0.05). In different memory tasks, the complexity of mental functions and the regions involved in the memory task were different.ConclusionNon-linear analysis is appropriate for the study of functional changes and working mechanism of brain during memory.

Non-linear Dynamics Characteristic of EEG at Acute Phase of Cerebral Infarction / 中国康复理论与实践

@#ObjectiveTo investigate the changes of non-linear dynamics characteristic of EEG in patient with acute cerebral stroke under eyes closed state. MethodsEEG were recorded in 31 patients with acute cerebral infarction and 22 healthy volunteers under eyes closed state. Correlation dimension (D2) and Approximate Entropy (ApEn) were calculated for all subjects. ResultsD2 and ApEn of uninjured forehead cortex (FP1,FP2)reduced significantly in the group of cerebral infarction as compared with the group of normal control at eyes closed state. ConclusionDynamic analysis based on D2 and ApEn topographic maps might be helpful in understand the changes of mental functions after stroke, that can be used in the study of mental function.

Electroencephalogram Non-linear Analysis on Menopause Depression Subjects / 中国康复理论与实践

@#ObjectiveTo investigate the changes of non-linear dynamics characteristics of EEG of the patients with menopause depression under eyes closed state.MethodsEEG were recorded in 18 patients with menopause depression and 18 healthy volunteers under eyes closed state. Approximate entropy (ApEn) was calculated for all subjects.ResultsApEn of the menopause depression group at eyes closed state increased significantly compared with that of the healthy control group.ConclusionDynamic non-linear analysis is more appropriate for the study of mental functions changes of menopause depression.

Application of EEG non-linear analysis in mental arithmetic and orientation / 中国康复理论与实践

@#ObjectiveTo investigate the changes of non-linear dynamics characteristic of electroencephalogram (EEG) under three states (eyes closed, mental arithmetic with eyes closed and orientation test with eyes closed), and the application of non-linear dynamic analysis for cognitive function research.MethodsEEG was recorded in 30 healthy young volunteers at three stages. The correlation dimension (D2) and approximate entropy (ApEn) were calculated for all subjects.ResultsD2 and ApEn increased significantly during mental tasks as compared to the rest state with eyes closed (P<0.01). In different mental tasks, the complexity of mental functions and the regions involved in the cognitive task were different.ConclusionNon-linear analysis methods are appropriate for the study of cognitive functions and can help to understand the working mechanism of brain during mental activities.

Application of EEG non-linear analysis in monitoring depth of anesthesia / 解放军医学杂志

Objective To investigate the changes in non-linear dynamics properties of EEG and the application of real-time monitoring of non-linear indexes during the course of general anesthesia. Methods EEG was recorded in 65 patients undergoing operations. They were randomly divided into five groups: isoflurane, sevoflurane, desflurane (n=15, respectively), propofol 8mg/(kg?h) and propofol 10mg/(kg?h) (n=10, respectively). The EEG derived parameters correlation dimension (D 2 ) and approximate entropy (ApEn) non-linear indexes were calculated simultaneously during the whole operation, including the time of entering the operation room, anesthetic induction, intraoperation, recovery, and regaining consciousness. Results At the time of entering the operation room, their D 2 and ApEn nonlinear indexes appeared to be highest. Both the indexes decreased swiftly during anesthetic induction, and they dropped to lower values and leveled off during the intra-operation period. During recovery period, both of them rose gradually and returned to a high level in the post-operation awaking period. Conclusions Changes in the depth of anesthesia could be real-timely monitored and precisely measured with non-linear indexes of EEG. Non-linear dynamic analysis might provide us with more information on consciousness during general anesthesia