Glycosylated haemoglobin (HbA1c) and cortisol levels on admission to intensive care as predictors of outcome

Objective: To evaluate the predictive value of glycosylated haemoglobin and cortisol on admission, in critical care patients. Design: Prospective, observational, single centre study. Setting: 14 bedded Intensive care unit of a tertiary-level university hospital. Patients: 124 consecutive emergency medical and surgical patients. Methods: Data collected on admission included patient demographics, medical history, medication, diagnosis, type of nutrition, TISS28 score, serum blood glucose, Glycosylated haemoglobin (HbA1c), cortisol, mean arterial blood pressure, and the use of inotropes in the first 24hrs. Daily baseline tests included complete blood count, urea and electrolytes, creatinine, twice weekly liver function tests. The primary outcome measure was intensive care unit mortality. Secondary outcome measures were ITU stay, days of ventilation, peak urea, peak creatinine, lowest platelet count, peak bilirubin, lowest Pa/FiO2, and the number of transfusions. Measurements and results: 124 patients (mean age 56.2 years SD 23.2) were included. Regression analysis was used to identify any potential predictors of outcome: HbA1c levels on admission were not found to be significantly associated with mortality (p=0.51), or any other secondary endpoints listed above. However, subgroup analysis revealed a predictive role of HbA1c with regards to length of ITU stay (p= 0.01) and number of days of ventilation (p=0.007) in those patients with a history of diabetes. Glucose level on admission emerged as an independent marker of mortality (p=0.009). Conclusions: This study suggests that HbA1c may not be a predictor of outcome in the general ITU population but may be of predictive value in diabetic ITU patients. On the other hand, blood glucose levels on admission emerged as a predictor of mortality, whilst no association was found between HbA1c and cortisol levels on admission.peer-reviewe

Excavations at Tas-Silg, Malta : a preliminary report on the 1996-1998 campaigns conducted by the Department of Classics and Archaeology of the University of Malta

The area known as Tas-Silg is situated in the south-eastern part of the island of Malta, close to Marsaxlokk harbour. In reality the place name refers to the small church dedicated to Our Lady of the Snows (hence Tas-Silg) situated at the point where the narrow · road from Zejtun forks out in two directions: to Delimara and Xrobb il-Ghagin due south-east and to Marsaxlokk village due south-west. A British-period fort occupying the highest point of the elongated hill further south along· the first road also carries the same place name. The lower and more compact hill on which the excavations have been conducted is called 'Ta' Berikka' , but since it is so close to the above-mentioned church (only 50 m to the north) the tradition of calling it Tas-Silg is now well established and there is no sense in changing it. The site has a commanding view of the Marsaxlokk harbour to the south and overlooks two other bays, Marsascala and St Thomas's bay, to the north-east. On all sides the slope is broken up by man-made terraced fields There is no doubt that the topography of the site must have been a determining factor in its choice for the establishment of a religious centre in the Temple period of Maltese pehistory (3000--2500 BC), though one must keep in mind that close to Tas-Silg there are three other prehistoric temple sites. each one with a completely different topography. The Temple people were quite introverted in their cultural isolation and do not seem to have been much interested in seafaring and in the outside world. The situation changed radically in the following age, the Bronze Age. when the island was occupied by people who set up villages on naturally defensible hilltops, occasionally fortifying them with artificial ramparts. The Tas-Silg hill with its temple ruins was occupied by these people, but it is not as yet clear for what purpose. The scenario changed again in historical times when the central and western Mediterranean started to be parcelled out among the commercial powers originating in the eastern Mediterranean. The Greeks do not seem to have even tried 10 colonize Malta as they did in neighbouring Sicily. The Phoenicians, however, did occupy the island, apparently through a slow process of peaceful penetration and eventual political and cultural assimi lation. It was in this period that the ruins of the megalithic temple were transformed into a Phoenician extraurban shrine dedicated to Astarte, which in time expanded into a full y-fledged sanctuary with an international reputation. The last chapter in the millennia- long history of the site was written when the colonnaded courtyard in front of the old temple was transformed into an early Christian church. Any use made of the site in the following Arab period is, once again, poorly understood.peer-reviewe

A mobile agent strategy for grid interoperable virtual organisations

During the last few years much effort has been put into developing grid computing and proposing an open and interoperable framework for grid resources capable of defining a decentralized control setting. Such environments may define new rules and actions relating to internal Virtual Organisation (VO) members and therefore posing new challenges towards to an extended cooperation model of grids. More specifically, VO policies from the viewpoint of internal knowledge and capabilities may be expressed in the form of intelligent agents thus providing a more autonomous solution of inter-communicating members. In this paper we propose an interoperable mobility agent model that performs migration to any interacting VO member and by traveling within each domain allows the discovery of resources dynamically. The originality of our approach is the mobility mechanism based on traveling and migration which stores useful information during the route to each visited individual. The method is considered under the Foundation for Intelligent Physical Agents (FIPA) standard which provides an on demand resource provisioning model for autonomous mobile agents. Finally the decentralization of the proposed model is achieved by providing each member with a public profile of personal information which is available upon request from any interconnected member during the resource discovery process

Formar melhor para um melhor cuidar

A formação surge como uma ajuda ao desenvolvimento humano, adoptando uma posição abrangente que inclui o aluno e o próprio professor (Kohlberg e Mayer, 1972), em que o resultado obtido é menos importante do que a disponibilidade gerada durante o percurso, para que o aluno possa continuar a evoluir ao longo da vida. Esta perspectiva desenvolvimentalista, antecipava já, a tendência actual que defende que a educação deve constituir para cada indivíduo uma forma de promover o máximo desenvolvimento das suas potencialidades, através de experiências de aprendizagem de complexidade crescente. A formação não é apenas uma instância de mediação das relações formador/formando ou equipa de formadores/grupo de formandos, mas uma instância de auto-mediação do formando com o seu mundo subjectivo, mediador do grupo de formação com as suas subjectividades, mediador do grupo com um projecto de acção através do qual ele se exterioriza (Correia, 1997: 25)

From grids to clouds: a collective intelligence study for inter-cooperated infrastructures

Recently, more effort has been put into developing interoperable and distributed environments that offer users exceptional opportunities for utilizing resources over the internet. By utilising grids and clouds, resource consumers and providers, they gain significant benefits by either using or purchasing the computer processing capacities and the information provided by data centres. On the other hand, the collective intelligence paradigm is characterized as group based intelligence that emerges from the collaboration of many individuals, who in turn, define a coordinated knowledge model. It is envisaged that such a knowledge model could be of significant advantage if it is incorporated within the grid and cloud community. The dynamic load and access balancing of the grid and cloud data centres and the collective intelligence provides multiple opportunities, involving resource provisioning and development of scalable and heterogeneous applications. The contribution of this paper is that by utilizing grid and cloud resources, internal information stored within a public profile of each participant, resource providers as well as consumers, can lead to an effective mobilization of improved skills of members. We aim to unify the grid and cloud functionality as consumable computational power, for a) discussing the supreme advantages of such on-line resource utilization and provisioning models and b) analyzing the impact of the collective intelligence in the future trends of the aforementioned technologies

Rendimento e eficiência da fermentação alcoólica na produção de hidromel.

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