Preditores de fibrilação atrial de novo em unidade de cuidados intensivos não cardíaca

OBJECTIVE: To assess the predictors of de novo atrial fibrillation in patients in a non-cardiac intensive care unit. METHODS: A total of 418 hospitalized patients were analyzed between January and September 2016 in a non-cardiac intensive care unit. Clinical characteristics, interventions, and biochemical markers were recorded during hospitalization. In-hospital mortality and length of hospital stay in the intensive care unit were also evaluated. RESULTS: A total of 310 patients were included. The mean age of the patients was 61.0 ± 18.3 years, 49.4% were male, and 23.5% presented de novo atrial fibrillation. The multivariate model identified previous stroke (OR = 10.09; p = 0.016) and elevated levels of pro-B type natriuretic peptide (proBNP, OR = 1.28 for each 1,000pg/mL increment; p = 0.004) as independent predictors of de novo atrial fibrillation. Analysis of the proBNP receiver operating characteristic curve for prediction of de novo atrial fibrillation revealed an area under the curve of 0.816 (p 5,666pg/mL. There were no differences in mortality (p = 0.370), but the lengths of hospital stay (p = 0.002) and stay in the intensive care unit (p = 0.031) were higher in patients with de novo atrial fibrillation. CONCLUSIONS: A history of previous stroke and elevated proBNP during hospitalization were independent predictors of de novo atrial fibrillation in the polyvalent intensive care unit. The proBNP is a useful and easy- and quick-access tool in the stratification of atrial fibrillation risk.Objetivo: Avaliar quais os preditores de fibrilação atrial de novo em doentes de uma unidade de cuidados intensivos não cardíaca. Métodos: Foram analisados 418 doentes internados entre janeiro e setembro de 2016 em uma unidade de cuidados intensivos não cardíaca. Registaram-se as características clínicas, as intervenções efetuadas e os marcadores bioquímicos durante a internação. Avaliaram-se ainda a mortalidade hospitalar e o tempo de internação hospitalar e na unidade de cuidados intensivos. Resultados: Foram incluídos 310 doentes, com média de idades de 61,0 ± 18,3 anos, 49,4% do sexo masculino, 23,5% com fibrilação atrial de novo. O modelo multivariável identificou acidente vascular cerebral prévio (OR de 10,09; p = 0,016) e valores aumentados de proBNP (OR de 1,28 por cada aumento em 1.000pg/mL; p = 0,004) como preditores independentes de fibrilação atrial de novo. A análise por curva Característica de Operação do Receptor do proBNP para predição de fibrilação atrial de novo revelou área sob a curva de 0,816 (p 5.666pg/mL. Não se verificaram diferenças na mortalidade (p = 0,370), porém a duração da internação hospitalar (p = 0,002) e na unidade de cuidados intensivos (p = 0,031) foi superior nos doentes com fibrilação atrial de novo. Conclusões: História de acidente vascular cerebral prévio e proBNP elevado em internação constituíram preditores independentes de fibrilação atrial de novo na unidade de cuidados intensivos polivalente. O proBNP pode constituir ferramenta útil, de fácil e rápido acesso na estratificação do risco de fibrilação atrial.info:eu-repo/semantics/publishedVersio

Finite-momentum Bose-Einstein condensates in shaken 2D square optical lattices

We consider ultracold bosons in a 2D square optical lattice described by the Bose-Hubbard model. In addition, an external time-dependent sinusoidal force is applied to the system, which shakes the lattice along one of the diagonals. The effect of the shaking is to renormalize the nearest-neighbor hopping coefficients, which can be arbitrarily reduced, can vanish, or can even change sign, depending on the shaking parameter. It is therefore necessary to account for higher-order hopping terms, which are renormalized differently by the shaking, and introduce anisotropy into the problem. We show that the competition between these different hopping terms leads to finite-momentum condensates, with a momentum that may be tuned via the strength of the shaking. We calculate the boundaries between the Mott-insulator and the different superfluid phases, and present the time-of-flight images expected to be observed experimentally. Our results open up new possibilities for the realization of bosonic analogs of the FFLO phase describing inhomogeneous superconductivity.Comment: 7 pages, 7 figure

Dynamics of topological defects in a spiral: a scenario for the spin-glass phase of cuprates

We propose that the dissipative dynamics of topological defects in a spiral state is responsible for the transport properties in the spin-glass phase of cuprates. Using the collective-coordinate method, we show that topological defects are coupled to a bath of magnetic excitations. By integrating out the bath degrees of freedom, we find that the dynamical properties of the topological defects are dissipative. The calculated damping matrix is related to the in-plane resistivity, which exhibits an anisotropy and linear temperature dependence in agreement with experimental data.Comment: 4 pages, as publishe

Polymorphism in the flanking regions of the PbGP43 gene from the human pathogen Paracoccidioides brasiliensis: search for protein binding sequences and poly(A) cleavage sites

<p>Abstract</p> <p>Background</p> <p><it>Paracoccidioides brasiliensis </it>is a thermo-dimorphic fungus that causes paracoccidiodomycosis (PCM). Glycoprotein gp43 is the fungal main diagnostic antigen, which can also protect against murine PCM and interact with extracellular matrix proteins. It is structurally related to glucanases, however not active, and whose expression varies considerably. We have presently studied polymorphisms in the Pb<it>GP43 </it>flanking regions to help understand such variations.</p> <p>Results</p> <p>we tested the protein-binding capacity of oligonucleotides covering the Pb<it>GP43 </it>proximal 5' flanking region, including overlap and mutated probes. We used electrophoretic mobility shift assays and found DNA binding regions between positions -134 to -103 and -255 to -215. Only mutation at -230, characteristic of <it>P. brasiliensis </it>phylogenetic species PS2, altered binding affinity. Next, we cloned and sequenced the 5' intergenic region up to position -2,047 from <it>P. brasiliensis </it>Pb339 and observed that it is composed of three tandem repetitive regions of about 500 bp preceded upstream by 442 bp. Correspondent PCR fragments of about 2,000 bp were found in eight out of fourteen isolates; in PS2 samples they were 1,500-bp long due to the absence of one repetitive region, as detected in Pb3. We also compared fifty-six Pb<it>GP43 </it>3' UTR sequences from ten isolates and have not observed polymorphisms; however we detected two main poly(A) clusters (1,420 to 1,441 and 1,451 to 1,457) of multiple cleavage sites. In a single isolate we found one to seven sites.</p> <p>Conclusions</p> <p>We observed that the amount of Pb<it>GP43 </it>transcripts accumulated in <it>P. brasiliensis </it>Pb339 grown in defined medium was about 1,000-fold higher than in Pb18 and 120-fold higher than in Pb3. We have described a series of features in the gene flanking regions and differences among isolates, including DNA-binding sequences, which might impact gene regulation. Little is known about regulatory sequences in thermo-dimorphic fungi. The peculiar structure of tandem repetitive fragments in the 5' intergenic region of Pb<it>GP43</it>, their characteristic sequences, besides the presence of multiple poly(A) cleavage sites in the 3' UTR will certainly guide future studies.</p

Quality of board members’ training and bank financial performance : evidence from Portugal

This study examines the impact of the quality of board members’ training on the financial performance of Portuguese banks. The study employs a sample of 276 board members. Financial ratios such as return on average assets (ROAA) and return on average equity (ROAE) are used as measures for gauging banks’ financial performance. Three indexes are used as proxies for board members’ educational qualifications, specifically: Eduindex, for all academic qualifications obtained in areas such as business or economics; EduindexDP, for all qualifications obtained in prestigious domestic business schools; and EduindexFP, for all qualifications obtained in prestigious foreign business schools. The study findings have important policy implications, specifically a positive and significant impact on the bank’s financial performance from having board members holding degrees from prestigious foreign business schools. In particular, the findings suggest that the prudential supervision developed by Banco de Portugal in cooperation with the European Central Bank should include a more rigorous process in the selection of board members. The present study is one of the first attempts in the literature emphasizing all these aspects simultaneously, that is, the banking sector, quality of board members’ training, and Eduniversal Rankings, in the context in which all the banks of a specific country are analysed.peer-reviewe

Calibration of parameters in Dynamic Energy Budget models using Direct-Search methods

Dynamic Energy Budget (DEB) theory aims to capture the quantitative aspects of metabolism at the individual level, for all species. The parametrization of a DEB model is based on information obtained through the observation of natural populations and experimental research. Currently the DEB toolbox estimates these parameters using the Nelder–Mead Simplex method, a derivative-free direct-search method. However, this procedure presents some limitations regarding convergence and how to address constraints. Framed in the calibration of parameters in DEB theory, this work presents a numerical comparison between the Nelder–Mead Simplex method and the SID-PSM algorithm, a Directional Direct-Search method for which convergence can be established both for unconstrained and constrained problems. A hybrid version of the two methods, named as Simplex Directional Direct-Search, provides a robust and efficient algorithm, able to solve the constrained optimization problems resulting from the parametrization of the biological models.authorsversionpublishe

Comparison of 120Sn(6He,6He)120Sn and 120Sn(alpha,alpha)120Sn elastic scattering and signatures of the 6He neutron halo in the optical potential

Cross sections of $^{120}$Sn($\alpha$,$\alpha$)$^{120}$Sn elastic scattering have been extracted from the $\alpha$ particle beam contamination of a recent $^{120}$Sn($^6$He,$^6$He)$^{120}$Sn experiment. Both reactions are analyzed using systematic double folding potentials in the real part and smoothly varying Woods-Saxon potentials in the imaginary part. The potential extracted from the $^{120}$Sn($^6$He,$^6$He)$^{120}$Sn data may be used as the basis for the construction of a simple global $^6$He optical potential. The comparison of the $^6$He and $\alpha$ data shows that the halo nature of the $^6$He nucleus leads to a clear signature in the reflexion coefficients $\eta_L$: the relevant angular momenta $L$ with $\eta_L \gg 0$ and $\eta_L \ll 1$ are shifted to larger $L$ with a broader distribution. This signature is not present in the $\alpha$ scattering data and can thus be used as a new criterion for the definition of a halo nucleus.Comment: 13 pages, 7 figures, accepted for publication in Phys. Rev.

Clinical manifestations of pandemic (H1N1) 2009 in the ambulatory setting

INTRODUCTION: In June 2009, the World Health Organization declared an influenza pandemic associated with the pandemic (H1N1) 2009 strain. It was summer in the northern hemisphere, and therefore travelling and vacation time, which also provided an increased opportunity for the dissemination of respiratory diseases. METHODOLOGY: We reviewed the paper case report forms from all the patients with influenza-like illnesses with nasopharyngeal samples submitted for laboratory diagnosis of pandemic (H1N1) 2009 infection during the first wave of pandemic influenza that occurred between June and August 2009, in the central region of Portugal. RESULTS: From all the patients with influenza-like illnesses, one third was found positive for pandemic (H1N1) 2009. Individuals under the age of 29 (75%) were the most affected. Most of the patients (91%) presented with fever. A group of symptoms were positively correlated with the probability of pandemic (H1N1) 2009 infection: cough, epistaxis, lack of dyspnea or vomiting, fever, headache and myalgia. CONCLUSIONS: During the first wave of the pandemic influenza, young individuals were the most affected, and in the ambulatory setting, presentation was of a mild febrile illness without complications

Qualidade nos cuidados de enfermagem: que realidade?

Este trabalho de revisão bibliográfica foi realizado no âmbito do IX Programa de Doutoramento em Enfermagem, do Instituto de Ciências da Saúde da Universidade Católica Portuguesa do Porto. A existência de sistemas de saúde que garantam a prestação efectiva de cuidados de qualidade é, actualmente uma das prioridades de variadas organizações, entre elas constam: a ODCE, OMS, SNS e OE. A qualidade dos cuidados de enfermagem para além da importância que tem para a instituição e doente, deve ter uma importância máxima para o prestador de cuidados. O enfermeiro deve almejar a qualidade em cada gesto realizado, deve procurar que o desempenho da sua função seja mais do que uma simples execução de tarefas (Ascensão, 2010). Objectivos: Conhecer o estado da arte em língua portuguesa em termos da qualidade dos cuidados de enfermagem. Conhecer as metodologias usadas no estudo da qualidade dos cuidados de enfermagem. Material e Tratou-se de uma revisão de literatura tendo por finalidade identificar o conhecimento existente sobre esta temática. Foi realizada uma pesquisa na base de dados B-On, tendo em conta Dissertações de Licenciatura, de Mestrado, de Doutoramento e artigos, disponíveis em texto integral, que tivessem como palavras-chave no título: Cuidados, Qualidade e Enfermagem. A pesquisa foi efectuada para documentos em português entre os anos de 2000 e 2013. Resultados: A pesquisa encontrou, na B-on dezoito documentos, artigos de periódicos da área da saúde. Destes dezoito um artigo encontrava-se em quadruplicado e outro em duplicado. Quatro deles não foram incluídos por não dizerem respeito à área em questão. No final, após aplicação dos critérios de pesquisa, reunimos um conjunto de dez documentos (cinco teses, três artigos e duas comunicações em conferências) que se constituíram como o nosso corpus de análise. Os documentos estão disponíveis em texto integral. Discussão e Conclusão: Depois de analisados os documentos encontrados concluímos que os enfermeiros proporcionam um importante contributo na melhoria da qualidade das organizações (Aleixo, 2010). Conclui-se também que existe uma urgência na execução de ações de educação continuada, uma vez que a formação é considerada instrumento de reflexão e mudança, sendo esta um dos pilares para a prestação de cuidados de enfermagem de excelência (Padilha, 2010; Castro, 2007). Paralelamente, conclui-se que os principais resultados da qualidade dos cuidados de enfermagem envolvem mais trabalho e decisão em equipa multidisciplinar, mais recursos materiais e humanos e melhores condições físicas (Carvalhais, 2010)