Feasibility of individualised severe traumatic brain injury management using an automated assessment of optimal cerebral perfusion pressure: the COGiTATE phase II study protocol.

INTRODUCTION: Individualising therapy is an important challenge for intensive care of patients with severe traumatic brain injury (TBI). Targeting a cerebral perfusion pressure (CPP) tailored to optimise cerebrovascular autoregulation has been suggested as an attractive strategy on the basis of a large body of retrospective observational data. The objective of this study is to prospectively assess the feasibility and safety of such a strategy compared with fixed thresholds which is the current standard of care from international consensus guidelines. METHODS AND ANALYSIS: CPPOpt Guided Therapy: Assessment of Target Effectiveness (COGiTATE) is a prospective, multicentre, non-blinded randomised, controlled trial coordinated from Maastricht University Medical Center, Maastricht (The Netherlands). The other original participating centres are Cambridge University NHS Foundation Trust, Cambridge (UK), and University Hospitals Leuven, Leuven (Belgium). Adult severe TBI patients requiring intracranial pressure monitoring are randomised within the first 24 hours of admission in neurocritical care unit. For the control arm, the CPP target is the Brain Trauma Foundation guidelines target (60-70 mm Hg); for the intervention group an automated CPP target is provided as the CPP at which the patient's cerebrovascular reactivity is best preserved (CPPopt). For a maximum of 5 days, attending clinicians review the CPP target 4-hourly. The main hypothesis of COGiTATE are: (1) in the intervention group the percentage of the monitored time with measured CPP within a range of 5 mm Hg above or below CPPopt will reach 36%; (2) the difference in between groups in daily therapy intensity level score will be lower or equal to 3. ETHICS AND DISSEMINATION: Ethical approval has been obtained for each participating centre. The results will be presented at international scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02982122

revista de Ciências da Arte

Organizando-se agora no formato de número duplo, de modo a comportar dois números por ano, a revista digital Convocarte – Revista de Ciências da Arte mantém o mesmo propósito de promover o debate e edição de questões artísticas no espaço universitário, mantendo as coordenadas dominantes: convocar um número de especialistas em torno de um tema do mundo das artes, integrar trabalhos relevantes desenvolvidos nas fases curriculares e de projecto em mestrados e doutoramentos, sobretudo da FBAUL, e publicar trabalhos desenvolvidos em linhas de investigação do CIEBA. Assim, embora de funcionamento afecto à área científica de Ciências da Arte e do Património a Convocarte está aberta a outras especialidades interessadas em contribuir para a reflexão sobre as artes em geral, incorporando ensaios de predomínio teórico enraizado nos mais predominantes modos de discurso sobre arte, tais como História da arte, Crítica de Arte, Estética, Teorias da Arte ou Curadoria. (...) O nº2 organizou-se em torno de uma homenagem a uma figura importante das teorias da arte em Portugal, estratégia que Convocarte procurará manter nos próximos números. A intenção será deixar estudos sistematizados, entre o depoimento ou o ensaio, a memória e a reflexão, que estudem figuras marcantes da cultura portuguesa. (...) Neste número essa pasta foi dedicada a Rui Mário Gonçalves. Os textos são o resultado de uma sessão especial alargada a 2 de Maio no âmbito dos 2ºs Encontros com Críticos de Arte, com organização e coordenação de Fernando Rosa Dias, Cristina Tavares e Viviane Soares Silva, e decorridos ao longo das segundas do mês de Maio de 2016 na FBAUL (http://convocarte.belasartes.ulisboa.pt/index.php/2016/04/29/2o-encontros-com-criticos-de-arte/#more-325). A partir destes trabalhos reuniu-se um conjunto de estudos em torno de Rui Mário Gonçalves, com depoimentos e estudos sobre as mais diferentes facetas desta importante figura da cultura portuguesa: crítico de arte, historiador de arte, curador artístico, pedagogo e professor, político e activista, etc. A Convocarte orgulha-se de publicar os textos dessas comunicações, acrescentado de outros estudos, agradecendo a todos os colaboradores deste evento, que consideramos uma pasta que adianta contributos dando continuidade a estudos no catálogo de homenagem e no âmbito de apresentação da colecção do crítico de arte na SNBA, realizada pouco antes na SNBA.info:eu-repo/semantics/publishedVersio

Medical Systems Integration

Dissertação de Mestrado em Engenharia Informática apresentada à Faculdade de Ciências e Tecnologia da Universidade de CoimbraIn this thesis is described a system integration solution that can acquire data from medical devices such as, ventilators, infusion pumps and Bispectral index monitors. The system is also capable of providing a broker capable of sharing medical device data with other applications running in the healthcare unit. The implemented solution intends to tackle the problem of delivering medical data from medical devices to multiple applications with di erent data requirements. By solving this problem we aim to increase the amount of information available in computer applications of intensive care units

Optical measurement of the arterial pulse wave and determination of pulse wave velocity

Actualmente o sedentarismo e maus hábitos alimentares da generalidade da população dos países desenvolvidos promove o aumento de casos de doenças cardiovasculares. A percentagem de mortes causadas por estas doenças aumenta todos os dias e é agora a maior causa de morte nestes países. Por esta razão, a detecção de complicações cardiovasculares adquiriu um papel de relevância e nas últimas décadas tem sido feita uma grande aposta no desenvolvimento de novos métodos de detecção. Como consequência novos parâmetros, como velocidade da onda de pulso (VOP) e índice de aumentação são presentemente usados para avaliar o risco cardiovascular. No decorrer deste projecto, sondas ópticas capazes de gravar a onda de pressão arterial foram desenvolvidas e testadas. Nestas sondas dois fotodíodos, separados 3 cm, foram usados como sensores e devido à sua configuração (das sondas) foi possível medir a VOP local na carótida humana. Os dados recolhidos eram medidas directas da onda de pressão. Os algoritmos desenvolvidos avaliaram satisfatoriamente o desfasamento temporal entre os sinais recebidos por cada fotodíodo e calcularam a VOP correspondente. De forma a validar os algoritmos e as sondas anteriormente mencionados foram montadas três bancadas de teste capazes de simular a referida onda de pressão e a suas propriedades de propagação

Medical Systems Integration

Dissertação de Mestrado em Engenharia Informática apresentada à Faculdade de Ciências e Tecnologia da Universidade de CoimbraIn this thesis is described a system integration solution that can acquire data from medical devices such as, ventilators, infusion pumps and Bispectral index monitors. The system is also capable of providing a broker capable of sharing medical device data with other applications running in the healthcare unit. The implemented solution intends to tackle the problem of delivering medical data from medical devices to multiple applications with di erent data requirements. By solving this problem we aim to increase the amount of information available in computer applications of intensive care units

HDF5 based data format for archiving complex neuro-monitoring data in Traumatic Brain Injury patients

Modern neurocritical care units generate high volumes of data. This data is originates from a multitude of devices in various formats and levels of granularity. We present a new data format intended to store this data in an ordered and homogenous way. The adopted data format was built on the hierarchical model based on the HDF5 format capable of dealing with a mixture of small and very large data sets with equal ease. It is possible to access and manipulate individual data elements directly within a single file and is extensibile and versatile. Excellent compression is possible and comprehensive support exists for platforms including MATLAB, R and Python. The new file format was implemented in ICM+ software and validated as part of the CENTER-TBI project where it has been used to storage all acquired ICU monitoring data from the participating centres across Europe. Keywords: HDF5, Multimodal monitoring, Data storage, Data forma

HDF5 based data format for archiving complex neuro-monitoring data in Traumatic Brain Injury patients

Modern neurocritical care units generate high volumes of data. This data is originates from a multitude of devices in various formats and levels of granularity. We present a new data format intended to store this data in an ordered and homogenous way. The adopted data format was built on the hierarchical model based on the HDF5 format capable of dealing with a mixture of small and very large data sets with equal ease. It is possible to access and manipulate individual data elements directly within a single file and is extensibile and versatile. Excellent compression is possible and comprehensive support exists for platforms including MATLAB, R and Python. The new file format was implemented in ICM+ software and validated as part of the CENTER-TBI project where it has been used to storage all acquired ICU monitoring data from the participating centres across Europe. Keywords: HDF5, Multimodal monitoring, Data storage, Data forma

Occurrence of CPPopt values in uncorrelated ICP and ABP time series

Optimal CPP (CPPopt) is a concept that uses PRx - CPP relationship over a given time period to find a value of CPP at which PRx shows best autoregulation. . It has been proposed that this relationship can be modelled by a U-shaped curve, where the minimum is interpreted as being the CPP value which corresponds to the strongest autoregulation. Due to the nature of the calculation and the signals involved in it, the occurrence of false positives is possible. Such random occurrences would artificially increase the yield of CPPopt values and decrease the reliability of the methodology. In this work we study the probability of the random occurrence of false positives and we will compare the effect of the parameters used for CPPopt calculation on this probability. The percentage of CPPopt curves generated from uncorrelated data was demonstrated to be 11.5%. This value can be minimized by tuning some of the calculation parameters such as increasing the calculation window and increasing the minimum PRx span accepted on the curve. Keywords: Optimal CPP, Pressure reactivity, PRx, ICM+, Brain trauma, Brain monitoring, Neuro-critical car

Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study

International audienceBackground: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221