Internal Medicine Consultation

O apoio clínico aos serviços hospitalares representa uma parcela importante da actividade dos serviços de Medicina Interna. Esta actividade não está quantificada e é muitas vezes subvalorizada. Os autores, com a finalidade de caracterizarem a carga de trabalho desenvolvida pela Medicina Interna na área da consulta intra-hospitalar, realizaram um trabalho prospectivo com a duração de 12 meses, quantificando e caracterizando os pedidos de observação recebidos. Foram acolhidos 556 pedidos de consulta. Mais de metade das chamadas foram feitas a partir das 16 horas e 18% requisitadas com carácter de urgência. Atenderam-se no próprio dia 96,9% dos pedidos de observação. A maioria dos pedidos de consulta foram provenientes das áreas de Ortopedia e Traumatologia (33%), Cirurgia Geral (18%) e Unidade de Cuidados Intermédios Cirúrgica (17%). Os principais motivos de chamada foram intercorrências dos foros cardiovascular, infeccioso ou neurológico. Nas chamadas recebidas no horário normal de trabalho não houve contacto com o Médico assistente do doente em 54% dos casos. Esta vertente da actividade assistencial representa uma importante carga de trabalho adicional, com crescente relevância na qualidade dos cuidados médicos prestados. Os nossos resultados realçam a necessidade de formalizar um serviço de consulta intrahospitalar em cada serviço de Medicina e de incluir esta actividade em futuros planos de formação

Tameness of pseudovariety joins involving R

2000 Mathematics Subject Classification: 20M07 (primary); 20M05, 20M35, 68Q70 (secondary).In this paper, we establish several decidability results for pseudovariety joins of the form VvW, where V is a subpseudovariety of J or the pseudovariety R. Here, J (resp. R) denotes the pseudovariety of all J-trivial (resp. R-trivial) semigroups. In particular, we show that the pseudovariety VvW is (completely) kappa-tame when V is a subpseudovariety of J with decidable kappa-word problem and W is (completely) kappa-tame. Moreover, if W is a kappa-tame pseudovariety which satisfies the pseudoidentity x_1...x_ry^{\omega+1}zt^\omega = x_1... x_ryzt^\omega, then we prove that RvW is also kappa-tame. In particular the joins RvAb, RvG, RvOCR, and RvCR are decidable.União Europeia (UE). Fundo Europeu de Desenvolvimento Regional (FEDER) - POCTI/32817/MAT/2000.International Association for the Promotion of Co-operation with Scientists from the New Independent States (NIS) of the Former Soviet Union (INTAS) - project 99-1224.Fundação para a Ciência e a Tecnologia (FCT)

Model specification and the reliability of fMRI results: Implications for longitudinal neuroimaging studies in psychiatry

Functional Magnetic Resonance Imagine (fMRI) is an important assessment tool in longitudinal studies of mental illness and its treatment. Understanding the psychometric properties of fMRI-based metrics, and the factors that influence them, will be critical for properly interpreting the results of these efforts. The current study examined whether the choice among alternative model specifications affects estimates of test-retest reliability in key emotion processing regions across a 6-month interval. Subjects (N = 46) performed an emotional-faces paradigm during fMRI in which neutral faces dynamically morphed into one of four emotional faces. Median voxelwise intraclass correlation coefficients (mvICCs) were calculated to examine stability over time in regions showing task-related activity as well as in bilateral amygdala. Four modeling choices were evaluated: a default model that used the canonical hemodynamic response function (HRF), a flexible HRF model that included additional basis functions, a modified CompCor (mCompCor) model that added corrections for physiological noise in the global signal, and a final model that combined the flexible HRF and mCompCor models. Model residuals were examined to determine the degree to which each pipeline met modeling assumptions. Results indicated that the choice of modeling approaches impacts both the degree to which model assumptions are met and estimates of test-retest reliability. ICC estimates in the visual cortex increased from poor (mvICC = 0.31) in the default pipeline to fair (mvICC = 0.45) in the full alternative pipeline - an increase of 45%. In nearly all tests, the models with the fewest assumption violations generated the highest ICC estimates. Implications for longitudinal treatment studies that utilize fMRI are discussed. © 2014 Fournier et al

Plasma level of LDL-cholesterol at diagnosis is a predictor factor of breast tumor progression

BACKGROUND: Among women, breast cancer (BC) is the leading cancer and the most common cause of cancer-related death between 30 and 69 years. Although lifestyle and diet are considered to have a role in global BC incidence pattern, the specific influence of dyslipidemia in BC onset and progression is not yet completely understood. METHODS: Fasting lipid profile (total cholesterol, LDL-C, HDL-C, and triglycerides) was prospectively assessed in 244 women with BC who were enrolled according to pre-set inclusion criteria: diagnosis of non-hereditary invasive ductal carcinoma; selection for surgery as first treatment, and no history of treatment with lipid-lowering or anti-diabetic drugs in the previous year. Pathological and clinical follow-up data were recorded for further inclusion in the statistical analysis. RESULTS: Univariate associations show that BC patients with higher levels of LDL-C at diagnosis have tumors that are larger, with higher differentiation grade, higher proliferative rate (assessed by Ki67 immunostaining), are more frequently Her2-neu positive and are diagnosed in more advanced stages. Cox regression model for disease-free survival (DFS), adjusted to tumor T and N stages of TNM classification, and immunohistochemical subtypes, revealed that high LDL-C at diagnosis is associated with poor DFS. At 25 months of follow up, DFS is 12% higher in BC patients within the third LDL-C tertile compared to those in the first tertile. CONCLUSIONS: This is a prospective study where LDL-C levels, at diagnosis, emerge as a prognostic factor; and this parameter can be useful in the identification and follow-up of high-risk groups. Our results further support a possible role for systemic cholesterol in BC progression and show that cholesterol metabolism may be an important therapeutic target in BC patients

Closures of regular languages for profinite topologies

The Pin-Reutenauer algorithm gives a method, that can be viewed as a descriptive procedure, to compute the closure in the free group of a regular language with respect to the Hall topology. A similar descriptive procedure is shown to hold for the pseudovariety A of aperiodic semigroups, where the closure is taken in the free aperiodic omega-semigroup. It is inherited by a subpseudovariety of a given pseudovariety if both of them enjoy the property of being full. The pseudovariety A, as well as some of its subpseudovarieties are shown to be full. The interest in such descriptions stems from the fact that, for each of the main pseudovarieties V in our examples, the closures of two regular languages are disjoint if and only if the languages can be separated by a language whose syntactic semigroup lies in V. In the cases of A and of the pseudovariety DA of semigroups in which all regular elements are idempotents, this is a new result.PESSOA French-Portuguese project Egide-Grices 11113YM, "Automata, profinite semigroups and symbolic dynamics".FCT -- Fundação para a Ciência e a Tecnologia, respectively under the projects PEst-C/MAT/UI0144/2011 and PEst-C/MAT/UI0013/2011.ANR 2010 BLAN 0202 01 FREC.AutoMathA programme of the European Science Foundation.FCT and the project PTDC/MAT/65481/2006 which was partly funded by the European Community Fund FEDER

Mapping of Alternative Oilseeds from the Brazilian Caatinga and Assessment of Catalytic Pathways toward Biofuels Production

Biofuels are increasingly important renewable resources in the world's energy matrix that have challenged the scientific community as well as small and large farmers to develop alternatives to fossil fuels in order to achieve the aims of energy transition. In particular, Brazil's proven competitiveness in agribusiness together with its rich biodiversity put the country in a key position in the biofuels market. The semiarid Caatinga of northeastern Brazil, an exclusive biome rich in many oilseed species suitable for potential energy purposes, is of particular interest in this field. Nowadays, soybeans are the main feedstock used for the production of biodiesel, but, due to the increasing demand for biofuels, the search for alternative sources of oil from tropical flora with high productivity is crucial. Under this premise, this systematic review focuses on mapping Caatinga's vegetable oil crops that could be used as alternative raw materials for biofuels' production in Brazil, in addition to traditional soybeans and sugarcane. To gain more detailed insight into these matrices, their main properties, including oil content, fatty acid profile and physicochemical properties, are discussed. Moreover, an overview is provided of processes to synthesize different types of biofuels, particularly biodiesel and aviation biokerosene, including the routes employing homogeneous, enzymatic and mainly heterogeneous catalysts. Finally, future prospects and challenges for renewable biofuels and the Caatinga biome are addressed

O balão intragástrico nas formas graves de obesidade

Introduction: In patients with morbid obesity the intragastric balloon (IGB) can be a “bridge” to surgery or a temporary treatment in patients who are not candidates for surgery. Objective: Evaluate IGB efficacy in morbidly obese patients. Patients and Methods: In 2003/2004 seventeen IGB Bioenterics ® filled with normal saline and methylene blue were placed in 17 patients [11 women, median age was 49.2 (27-69 years); median body mass index was 55.6 (40.2-74.2 Kg/m2)], followed by nutritionists and/or endocrinologists. They had previously tried dietetic and/or pharmacological measures with limited results. Co-morbidities were present in 13 (76.5%). Results: Eight (47%) patients presented nausea/vomiting in the first 24-72h that persisted in 4 (23.5%) leading to dehydration and pre-renal insufficiency and forcing premature removal of the balloon (0.5 to 4 months). In the other patients, the device was removed at 6 months treatment (in 1 patient at 10 months). All patients suffered weight loss (5-70 Kg); median loss-19.6 Kg (p<0.001). No cases of spontaneous deflation/displacement occurred. Six (35.3%) underwent bariatric surgery. Conclusions: The IGB is a useful method for weight loss in morbidly obese patients. Nausea and vomiting are the most common complications. Although desirable, subsequent surgery is not always performed

Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.info:eu-repo/semantics/publishedVersio

Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer

FLAURA ClinicalTrials.gov number, NCT02296125BACKGROUND: Osimertinib is an oral, third-generation, irreversible epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that selectively inhibits both EGFR-TKI-sensitizing and EGFR T790M resistance mutations. We compared osimertinib with standard EGFR-TKIs in patients with previously untreated, EGFR mutation-positive advanced non-small-cell lung cancer (NSCLC). METHODS: In this double-blind, phase 3 trial, we randomly assigned 556 patients with previously untreated, EGFR mutation-positive (exon 19 deletion or L858R) advanced NSCLC in a 1:1 ratio to receive either osimertinib (at a dose of 80 mg once daily) or a standard EGFR-TKI (gefitinib at a dose of 250 mg once daily or erlotinib at a dose of 150 mg once daily). The primary end point was investigator-assessed progression-free survival. RESULTS: The median progression-free survival was significantly longer with osimertinib than with standard EGFR-TKIs (18.9 months vs. 10.2 months; hazard ratio for disease progression or death, 0.46; 95% confidence interval [CI], 0.37 to 0.57; P<0.001). The objective response rate was similar in the two groups: 80% with osimertinib and 76% with standard EGFR-TKIs (odds ratio, 1.27; 95% CI, 0.85 to 1.90; P=0.24). The median duration of response was 17.2 months (95% CI, 13.8 to 22.0) with osimertinib versus 8.5 months (95% CI, 7.3 to 9.8) with standard EGFR-TKIs. Data on overall survival were immature at the interim analysis (25% maturity). The survival rate at 18 months was 83% (95% CI, 78 to 87) with osimertinib and 71% (95% CI, 65 to 76) with standard EGFR-TKIs (hazard ratio for death, 0.63; 95% CI, 0.45 to 0.88; P=0.007 [nonsignificant in the interim analysis]). Adverse events of grade 3 or higher were less frequent with osimertinib than with standard EGFR-TKIs (34% vs. 45%). CONCLUSIONS: Osimertinib showed efficacy superior to that of standard EGFR-TKIs in the first-line treatment of EGFR mutation-positive advanced NSCLC, with a similar safety profile and lower rates of serious adverse events. (Funded by AstraZeneca; FLAURA ClinicalTrials.gov number, NCT02296125 .).info:eu-repo/semantics/publishedVersio