Reversible cerebral vasoconstriction syndrome – A narrative revision of the literature

AbstractReversible Cerebral Vasoconstriction Syndrome (RCVS) is a not very well known clinical-imaging entity; it is characterized by thunderclap headache, which mimics an aneurysmal subarachnoid haemorrhage, and a diffuse and segmental constriction of cerebral arteries, that resolves spontaneously within 3 months. The pathophysiology remains unknown. The female gender is the more affected and more than half of cases occur in the puerperium or after exposure to vasoactive substances. Typically, RCVS is self-limited and has a benign course, although it may have more serious complications with permanent neurologic sequelae and death. Treatment is predominantly supportive and directed to the symptoms

Classifying heart sounds using multiresolution time series motifs : an exploratory study

The aim of this work is to describe an exploratory study on the use of a SAX-based Multiresolution Motif Discovery method for Heart Sound Classification. The idea of our work is to discover relevant frequent motifs in the audio signals and use the discovered motifs and their frequency as characterizing attributes. We also describe different configurations of motif discovery for defining attributes and compare the use of a decision tree based algorithm with random forests on this kind of data. Experiments were performed with a dataset obtained from a clinic trial in hospitals using the digital stethoscope DigiScope. This exploratory study suggests that motifs contain valuable information that can be further exploited for Heart Sound Classification

Classifying heart sounds using SAX motifs, random forests and text mining techniques

In this paper we describe an approach to classifying heart sounds (classes Normal, Murmur and Extra-systole) that is based on the discretization of sound signals using the SAX (Symbolic Aggregate Approximation) representation. The ability of automatically classifying heart sounds or at least support human decision in this task is socially relevant to spread the reach of medical care using simple mobile devices or digital stethoscopes. In our approach, sounds are firrst pre-processed using signal processing techniques (decimate, low-pass filter, normalize, Shannon envelope). Then the pre-processed symbols are transformed into sequences of discrete SAX symbols. These sequences are subject to a process of motif discovery. Frequent sequences of symbols (motifs) are adopted as features. Each sound is then characterized by the frequent motifs that occur in it and their respective frequency. This is similar to the term frequency (TF) model used in text mining. In this paper we compare the TF model with the application of the TFIDF (Term frequency - Inverse Document Frequency) and the use of bi-grams (frequent size two sequences of motifs). Results show the ability of the motifs based TF approach to separate classes and the relative value of the TFIDF and the bi-grams variants. The separation of the Extra-systole class is overly dificult and much better results are obtained for separating the Murmur class. Empirical validation is conducted using real data collected in noisy environments. We have also assessed the cost-reduction potential of the proposed methods by considering a fixed cost model and using a cost sensitive meta algorithm.Portuguese Funds through the FCT - Fundacao para a Ciencia e a Tecnologia (proj. FCOMP-01-0124-FEDER-037281 and FCOMP-01-0124-FEDER-PEst-OE/EEI/UI0760/2014)

Admission and Readmission/Death Patterns in Hospitalized and Non-hospitalized First-Ever-in-a-Lifetime Stroke Patients During the First Year: A Population-Based Incidence Study

Background: Hospitalization and readmission rates after a first-ever-in-a-lifetime stroke (FELS) are considered measures of quality of care and, importantly, may give valuable information to better allocate health-related resources. We aimed to investigate the hospitalization pattern and the unplanned readmissions or death of hospitalized (HospS) and non-hospitalized stroke (NHospS) patients 1 year after a FELS, based on a community register. Methods: Data about hospitalization and unplanned readmissions and case fatality 1 year after a FELS were retrieved from the population-based register undertaken in Northern Portugal (ACIN2), comprising all FELS in 2009-2011. We used the Kaplan-Meier method to estimate 1-year readmission/death-free survival and Cox proportional hazard models to identify independent factors for readmission/death. Results: Of the 720 FELS, 35.7% were not hospitalized. Unplanned readmission/death within 1 year occurred in 33.0 and 24.9% of HospS and NHospS patients, respectively. The leading causes of readmission were infections, recurrent stroke, and cardiovascular events. Stroke-related readmissions were observed in more than half of the patients in both groups. Male sex, age, pre- and post-stroke functional status, and diabetes were independent factors of readmission/death within 1 year. Conclusion: About one-third of stroke patients were not hospitalized, and the readmission/death rate was higher in HospS patients. Still, that readmission/death rate difference was likely due to other factors than hospitalization itself. Our research provides novel information that may help implement targeted health-related policies to reduce the burden of stroke and its complications.info:eu-repo/semantics/publishedVersio

Psychophysical study of manual loads transportation - a comparative study between students and seasoned workers

The psychophysical criteria are important to develop manual material handling guidelines. It is essential that the studies that use a psychophysical approach be carried out as accurately as possible. However, the sample used in these studies can influence the results, if not appropriate. This work intends to analyze the influence of the sample in determining the maximum acceptable weight (MAW) in tasks of manual transport of loads transportation. The study involved 10 students and 10 workers. The participants’ task was to carry a box for 13 minutes and travel six meters. The box had the dimensions of 60 cm length × 40 cm width x 40 cm deep and the handles had 2.7 cm width and 9.0 cm in length. Moreover, subjects were required to carry out the movement of the box with the trunk erect and the forearms perpendicular to the body. In the end, the MAW and the rate of perceived exertion (RPE) were determined. A strength test was applied to each individual. The MAW was higher for students (11.6kg) than for workers (10.8kg), however, it was not verified significant differences between groups. For students, the MAW depended on the selected IW. Students also assigned RPE values higher than workers. These results suggest that the workers' experience may be a determining factor in the MAW. Although the study has not provided conclusive results, it can be argued that samples comprised by students may affect the results, being that these groups of samples should be used with caution. So, whenever possible it should be used experienced workers in real work context for psychophysical studies.info:eu-repo/semantics/publishedVersio

Efficacy of Cerebral Autoregulation in Early Ischemic Stroke Predicts Smaller Infarcts and Better Outcome

© 2017 Castro, Serrador, Rocha, Sorond and Azevedo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background and purpose: Effective cerebral autoregulation (CA) may protect the vulnerable ischemic penumbra from blood pressure fluctuations and minimize neurological injury. We aimed to measure dynamic CA within 6 h of ischemic stroke (IS) symptoms onset and to evaluate the relationship between CA, stroke volume, and neurological outcome. Methods: We enrolled 30 patients with acute middle cerebral artery IS. Within 6 h of IS, we measured for 10 min arterial blood pressure (Finometer), cerebral blood flow velocity (transcranial Doppler), and end-tidal-CO2. Transfer function analysis (coherence, phase, and gain) assessed dynamic CA, and receiver-operating curves calculated relevant cut-off values. National Institute of Health Stroke Scale was measured at baseline. Computed tomography at 24 h evaluated infarct volume. Modified Rankin Scale (MRS) at 3 months evaluated the outcome. Results: The odds of being independent at 3 months (MRS 0–2) was 14-fold higher when 6 h CA was intact (Phase > 37°) (adjusted OR = 14.0 (IC 95% 1.7–74.0), p = 0.013). Similarly, infarct volume was significantly smaller with intact CA [median (range) 1.1 (0.2–7.0) vs 13.1 (1.3–110.5) ml, p = 0.002]. Conclusion: In this pilot study, early effective CA was associated with better neurological outcome in patients with IS. Dynamic CA may carry significant prognostic implications.This study was part of Ph.D. thesis of PC and received publiC national grant from Fundação para a Ciência e a Tecnologia (FCT), Portugal, PTDC/SAU-ORG/113329/2009. FS is supported by R01 NS085002 (NINDS).info:eu-repo/semantics/publishedVersio

Predictors for cerebral edema in acute ischemic stroke treated with intravenous thrombolysis

Cerebral edema (CED) is a severe complication of acute ischemic stroke. There is uncertainty regarding the predictors for the development of CED after cerebral infarction. We aimed to determine which baseline clinical and radiological parameters predict development of CED in patients treated with intravenous thrombolysis. We used an image-based classification of CED with 3 degrees of severity (less severe CED 1 and most severe CED 3) on postintravenous thrombolysis imaging scans. We extracted data from 42 187 patients recorded in the SITS International Register (Safe Implementation of Treatments in Stroke) during 2002 to 2011. We did univariate comparisons of baseline data between patients with or without CED. We used backward logistic regression to select a set of predictors for each CED severity. CED was detected in 9579/42 187 patients (22.7%: 12.5% CED 1, 4.9% CED 2, 5.3% CED 3). In patients with CED versus no CED, the baseline National Institutes of Health Stroke Scale score was higher (17 versus 10; P<0.001), signs of acute infarct was more common (27.9% versus 19.2%; P<0.001), hyperdense artery sign was more common (37.6% versus 14.6%; P<0.001), and blood glucose was higher (6.8 versus 6.4 mmol/L; P<0.001). Baseline National Institutes of Health Stroke Scale, hyperdense artery sign, blood glucose, impaired consciousness, and signs of acute infarct on imaging were independent predictors for all edema types. The most important baseline predictors for early CED are National Institutes of Health Stroke Scale, hyperdense artery sign, higher blood glucose, decreased level of consciousness, and signs of infarct at baseline. The findings can be used to improve selection and monitoring of patients for drug or surgical treatment

O balanced scorecard e a administração local:aplicação à divisão financeira do município de Vila Franca de Xira

Dissertação, Mestrado, Contabilidade e Finanças, Instituto Politécnico de Santarém, Escola Superior de Gestão e Tecnologia, 2014A restruturação da administração pública é, hoje, um aspeto primordial no desenvolvimento do País. A necessidade de melhorar os índices de eficiência, eficácia e economia são objetivos que se têm colocado aos organismos da Administração Pública, em função do “Value for citizens”, sendo necessário fomentar a racionalização das suas estruturas, bem como a descentralização de funções e a modernização e automatização de processos. Neste contexto, a aplicabilidade do Balanced Scorecard (BSC) às organizações públicas, surge como um sistema de gestão estratégica que interliga a estratégia organizacional com os objetivos definidos e, consequentemente, melhora o desempenho organizacional. Há um novo paradigma da gestão das organizações públicas, uma nova postura comportamental dos dirigentes/funcionários, no seu “saber estar” (atitudes e valores), “saber fazer” (habilidades) e de um “saber mais” (conhecimento e formação), que articulada com um novo processo de gestão estratégica, permite assegurar que a missão, visão e objetivos estratégicos da organização sejam atingidos. A principal intenção deste trabalho assenta em perceber qual a evidência empírica que a aplicação do BSC têm em organizações como autarquias locais, nomeadamente no Departamento de Gestão Administrativa, Financeira e Jurídica, na Divisão Financeira, Patrimonial e do Controlo Orçamental, doravante apenas designada por Divisão Financeira do Município de Vila Franca de Xira. O estudo teve como base o sistema contabilístico adotado pelos organismos públicos e a sua interligação com o BSC como sistema de gestão estratégica, em que as ligações efetuadas pelas relações de causa-efeito, mostram como os ativos intangíveis se transformam em resultados tangíveis. A utilização de indicadores quantitativos, mas não-financeiros, possibilitam a descrição e medição do processo de criação de valo