The influence of the day of the week of hospital admission on the prognosis of stroke patients

This study aimed to evaluate the weekday and weekend distribution of stroke case hospital admissions and their respective prognosis based on a sample from the Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral (EMMA), a cohort of stroke patients admitted to a community hospital in the city of São Paulo, Brazil. We ascertained all consecutive cases of first-time strokes between April 2006 and December 2008 and performed a subsequent one-year follow-up. No association was found between frequency of hospital admissions due to ischemic and hemorrhagic strokes and the specific day of the week on which the admission occurred. However, ten-day and twelve-month case-fatality was higher in hemorrhagic stroke patients admitted at the weekend. We also found that intracerebral hemorrhage patients admitted on weekends had a worse survival rate (50%) compared with those admitted during weekdays (25.6%, P log-rank = 0.03). We found a multivariate hazard ratio of 2.49 (95%CI: 1.10-5.81, P trend = 0.03) for risk of death at the weekend compared to weekdays for intracerebral hemorrhage cases. No difference in survival was observed with respect to the overall sample of stroke or ischemic stroke patients

How doctors diagnose diseases and prescribe treatments: an fMRI study of diagnostic salience

Understanding the brain mechanisms involved in diagnostic reasoning may contribute to the development of methods that reduce errors in medical practice. In this study we identified similar brain systems for diagnosing diseases, prescribing treatments, and naming animals and objects using written information as stimuli. Employing time resolved modeling of blood oxygen level dependent (BOLD) responses enabled time resolved (400 milliseconds epochs) analyses. With this approach it was possible to study neural processes during successive stages of decision making. Our results showed that highly diagnostic information, reducing uncertainty about the diagnosis, decreased monitoring activity in the frontoparietal attentional network and may contribute to premature diagnostic closure, an important cause of diagnostic errors. We observed an unexpected and remarkable switch of BOLD activity within a right lateralized set of brain regions related to awareness and auditory monitoring at the point of responding. We propose that this neurophysiological response is the neural substrate of awareness of one’s own (verbal) response. Our results highlight the intimate relation between attentional mechanisms, uncertainty, and decision making and may assist the advance of approaches to prevent premature diagnostic closure

Nível de escolaridade e dependência funcional em sobreviventes de acidente vascular cerebral isquêmico

We evaluated the functional dependence of stroke survivors from the Study of Stroke Mortality and Morbidity, using the Rankin Scale. Out of 355 ischemic stroke survivors (with a mean age of 67.9 years), 40% had some functional dependence at 28 days and 34.4% had some functional dependence at 6 months. Most predictors of physical dependence were identified at 28 days. These predictors were: low levels of education [illiterate vs. >= 8 years of education, multivariate odds ratio (OR) = 3.7; 95% confidence interval (95%CI): 1.60-8.54] and anatomical stroke location (total anterior circulation infarct, OR = 16.9; 95%CI: 2.93-97.49). Low levels of education and ischemic brain injury influenced functional dependence in these stroke survivors. Our findings reinforce the necessity of developing strategies for the rehabilitation of stroke patients, more especially in formulating specific strategies for care and treatment of stroke survivors with low socioeconomic status.Foi avaliada a dependência funcional em sobreviventes de acidente vascular cerebral (AVC) do Estudo da Mortalidade e Morbidade do Acidente Vascular Cerebral, utilizando a Escala de Rankin. De 355 sobreviventes com AVC isquêmico (idade média de 67,9 anos), 40% tinham dependência funcional em 28 dias e 34,4% em 6 meses. Os principais indicadores de dependência física foram identificados em 28 dias, e eram: baixa escolaridade (analfabetos vs. > 8 anos de educação, RC = 3,7; IC95%: 1,60-8,54) e localização do AVC (infarto circulação total anterior, RC = 16,9; IC95%: 2,93-97,49). Baixo nível educacional e insulto cerebral isquêmico influenciaram o grau de dependência funcional nesses sobreviventes de AVC. Nossos achados reforçam a necessidade de desenvolvimento de estratégias para reabilitação de pacientes com AVC e formulação de estratégias específicas de atenção e tratamento para essas pessoas, especialmente na população com baixo nível socioeconômico.CNPqFAPES

Dermatan sulfate in tunicate phylogeny: Order-specific sulfation pattern and the effect of [→4IdoA(2-Sulfate)β-1→3GalNAc(4-Sulfate)β-1→] motifs in dermatan sulfate on heparin cofactor II activity

After the publication of the work entitled "Dermatan sulfate in tunicate phylogeny: Order-specific sulfation pattern and the effect of [→4IdoA(2-Sulfate)β-1→3GalNAc(4-Sulfate)β-1→] motifs in dermatan sulfate on heparin cofactor II activity", by Kozlowski et al., BMC Biochemistry 2011, 12:29, we found that the legends to Figures 2 to 5 contain serious mistakes that compromise the comprehension of the work. This correction article contains the correct text of the legends to Figures 2 to 5

Consistency Checking for the Evolution of Cardinality-based Feature Models

International audienceFeature models (FMs) are a widely used approach to specify the commonalities and variability in variable systems and software product lines. Various works have addressed edits to FMs for FM evolution and tool support to ensure consistency of FMs. An important extension to FMs are feature cardinalities and related constraints, as extensively used e.g., when modeling variability of cloud computing environments. Since cardinality-based FMs pose additional complexity, additional support for evolution and consistency checking with respect to feature cardinalities would be desirable, but has not been addressed yet. In this paper, we discuss common cardinality-based FM edits and resulting inconsistencies based on experiences with FMs in cloud domain. We introduce tool-support for automated inconsistency detection and explanation based on an off-the-shelf solver. We demonstrate the feasibility of the approach by an empirical evaluation showing the performance of the tool

Feature Model Differences

International audienceFeature models are a widespread means to represent commonality and variability in software product lines. As is the case for other kinds of models, computing and managing feature model differences is useful in various real-world situations. In this paper, we propose a set of novel differencing techniques that combine syntactic and semantic mechanisms, and automatically produce meaningful differences. Practitioners can exploit our results in various ways: to understand, manipulate, visualize and reason about differences. They can also combine them with existing feature model composition and decomposition operators. The proposed automations rely on satisfiability algorithms. They come with a dedicated language and a comprehensive environment. We illustrate and evaluate the practical usage of our techniques through a case study dealing with a configurable component framework

Diabetes mellitus and sensorineural hearing loss: is there an association? Baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

OBJECTIVES: Although several studies have investigated the effects of diabetes on hearing loss, the relationship between these two conditions remains unclear. Some studies have suggested that diabetes may cause sensorineural hearing loss, whereas others have failed to find an association. The biggest challenge in investigating the association between diabetes and hearing loss is the presence of confounding variables and the complexity of the auditory system. Our study investigated the association between diabetes and sensorineural hearing loss. We evaluated the influence of time from diabetes diagnosis on this association after controlling for age, gender, and hypertension diagnosis and excluding those subjects with exposure to noise. METHODS: This cross-sectional study evaluated 901 adult and elderly Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participants from São Paulo, Brazil who underwent audiometry testing as part of ELSA-Brasil’s baseline assessment. RESULTS: Hearing thresholds and speech test results were significantly worse in the group with diabetes than in the group without diabetes. However, no significant differences were found between participants with and without diabetes after adjusting for age, gender, and the presence of hypertension. Hearing thresholds were not affected by occupational noise exposure in the groups with and without diabetes. In addition, no association between the duration of diabetes and hearing thresholds was observed after adjusting for age, gender, and hypertension. CONCLUSION: We found no association between the duration of diabetes and worse hearing thresholds after models were adjusted for age, gender, and the presence of hypertension

Differential metabolic and biological profiles of Lychnophora ericoides mart. (Asteraceae) from different localities in the Brazilian "campos rupestres"

This paper reports HPLC-DAD-MS/MS and HPLC-ECD characterisation of secondary metabolite profiles of Lychnophora ericoides Mart. leaf extracts from different provenances and their cytotoxic and antioxidant properties. Leaf extracts from populations representing seven different locations were evaluated for antioxidant activity by the DPPH radical scavenging system and activity towards cellular growth in three tumor cell lines. The extracts were electrochemically analysed by HPLC-ECD and their main secondary metabolites were identified by HPLC-DAD-MS and HPLC-DAD-MS/MS. An amplified defensive secondary chemistry, together with maximal cytotoxic and antioxidant bioactivities, were found for plants collected at the interface between two types of forest. These findings furnish additional support for the hypothesis that plants occurring at the interface between two forests ecosystems might be stimulated to amplify their own production and storage of defensive secondary metabolites due to the greater number of environmental influences