A simulation model for analysing patient activity in dermatology

We developed a general model to assess patient activity within the primary and secondary health-care sectors following a dermatology outpatient consultation. Based on observed variables from the UK teledermatology trial, the model showed that up to 11 doctor-patient interactions occurred before a patient was ultimately discharged from care. In a cohort of 1000 patients, the average number of health-care visits was 2.4 (range 1-11). Simulation analysis suggested that the most important parameter affecting the total number of doctor-patient Interactions is patient discharge from care following the initial consultation. This implies that resources should be concentrated in this area. The introduction of teledermatology (either realtime or store and forward) changes the values of the model parameters. The model provides a quantitative tool for planning the future provision of dermatology health-care.

Cenozoic continental weathering and its implications for the palaeoclimate: evidence from Ar-40/Ar-39 geochronology of supergene K-Mn oxides in Mt Tabor, central Queensland, Australia

One hundred and twenty-five mineral grains from 45 visually pure K-bearing Mn oxide (hollandite group) samples collected from weathering profiles in the Mt Tabor region of central Queensland, Australia, were analysed by the Ar-40/Ar-39 laser probe technique. These K-Mn oxides precipitated mainly through a process of cavity filling (direct precipitation from weathering solution), with botryoidal texture formed by micrometric mineral bands. Well-defined and reproducible plateau ages have been obtained for most samples, ranging from 27.2 +/- 0.8 to 6.8 +/- 0.5 Ma (2 sigma). Statistical analysis of the geochronological results by mixture modelling suggests an episodic mineral precipitation history, with two major peaks at 20.2 +/- 0.22 Ma and 16.5 +/- 0.17 Ma. The geochronological results, when combined with information on paragenetic relationships and mineralogical textures obtained from petrographic, scanning electron microscopy, and electron microprobe investigations, indicate that warm and humid palaeoclimatic conditions favourable to intense chemical weathering prevailed in central Queensland from late Oligocene to middle Miocene, particularly in the early Miocene. These results, in conjunction with previous and ongoing investigations in NW and eastern Queensland, suggest that most of Queensland was dominated by humid climates during the Miocene. (C) 2002 Elsevier Science BN. All rights reserved.

Rhythmic variations in pain, stiffness, and manual dexterity in hand osteoarthritis

Objective: To explore circadian variation in pain, stiffness, and manual dexterity inpatients with hand osteoarthritis (OA). Methods: Twenty one patients with hand OA, as defined by ACR criteria (17 women, four men, mean age 62.2 years, range 52-74 years) self rated pain and stiffness on separate 10 cm horizontal visual analogue scales and performed bead intubation coordinometry (BIC) six times each day (on waking up, at bedtime, and every four hours in between) for 10 consecutive days. Each series (using data with the trend removed if there was a significant trend) was analysed for circadian rhythmicity by a cosine. vector technique (single cosinor). With individual data expressed as the percentage of the mean, group rhythm characteristics at period 24 hours were summarised for each variable by population mean cosinor analysis. Results: Individual analyses identified significant circadian rhythms at pless than or equal to0.05 for pain (n=15/21), stiffness (n=16/20), and dexterity (n=18/21), and a significant circadian rhythm on a group basis was identified for pain (p=0.013), stiffness (p

Total Daily Energy Expenditure and Incidence of Upper Respiratory Tract Infection Symptoms in Young Females

A group of 31 young females, tennis players and non-athletes, aged 16 2 years (range: 14 - 21 years), with a wide range of physical activity levels was used to investigate the relationship between total daily energy expenditure and the incidence of upper respiratory tract infection symptoms. Methods: During a 12 week winter period, habitual daily activity (excluding training) was evaluated using a 3-day physical activity record. Tennis training was quantified using a validated method of estimating energy expenditure during play. Total daily energy expenditure was calculated from the sum of daily training plus mean habitual daily activity energy expenditures. The total group of subjects was divided in quartiles for total daily energy expenditure. A validated symptom checklist was used to assess the incidence and severity of upper respiratory tract infections, on a daily basis. Results: The girls in the highest quartile of total daily energy expenditure (greater than or equal to 17322 kJ/day) and in the lowest quartile (less than or equal to 10 047 kJ/day) had the greatest incidence of URTI symptomatology, although the moderately active girls in quartile three (12290-16410 kJ/day) presented the lowest incidence. Significant differences in number of upper respiratory tract infection episodes, sickness days and symptomatology index were found between quartiles three and one (p < 0.05) and quartiles three and four (p < 0.01). Peak severity of symptoms was significantly lower in quartile three compared with all other quartiles (p < 0.05).

Guitar solo tracker

A motivação para este trabalho vem da necessidade que o autor tem em poder registar as notas tocadas na guitarra durante o processo de improviso. Quando o músico está a improvisar na guitarra, muitas vezes não se recorda das notas tocadas no momento, este trabalho trata o desenvolvimento de uma aplicação para guitarristas, que permita registar as notas tocadas na guitarra eléctrica ou clássica. O sinal é adquirido a partir da guitarra e processado com requisitos de tempo real na captura do sinal. As notas produzidas pela guitarra eléctrica, ligada ao computador, são representadas no formato de tablatura e/ou partitura. Para este efeito a aplicação capta o sinal proveniente da guitarra eléctrica a partir da placa de som do computador e utiliza algoritmos de detecção de frequência e algoritmos de estimação de duração de cada sinal para construir o registo das notas tocadas. A aplicação é desenvolvida numa perspectiva multi-plataforma, podendo ser executada em diferentes sistemas operativos Windows e Linux, usando ferramentas e bibliotecas de domínio público. Os resultados obtidos mostram a possibilidade de afinar a guitarra com valores de erro na ordem de 2 Hz em relação às frequências de afinação standard. A escrita da tablatura apresenta resultados satisfatórios, mas que podem ser melhorados. Para tal será necessário melhorar a implementação de técnicas de processamento do sinal bem como a comunicação entre processos para resolver os problemas encontrados nos testes efectuados.

Relatório de estágio. Terapia manual ortopédica

Objectivo: Descrever a intervenção em fisioterapia aplicada num paciente com o diagnóstico de entorse da Tíbio-társica de grau III. Participantes e Métodos: Paciente que em 1 de Dezembro de 2009 na sequência de uma disputa de bola, sofreu uma entorse da tíbio-társica. Iniciou fisioterapia a 4 de Janeiro de 2010, tendo sido utilizadas para o tratamento técnicas de Mulligan, nomeadamente MWM, mobilização articular, reforço muscular e treino proprioceptivo. O tratamento foi realizado diariamente durante 6 semanas. Resultados: Após a aplicação das técnicas de Mulligan MWM na 1ªsemana, o perónio encontra-se devidamente reposicionado, no entanto o calcâneo ainda se encontra posteriorizado. No fim da 2ªsemana, a amplitude articular aumentou significativamente, aproximando-se dos valores do membro contralateral, verificouse um ganho de força muscular progressivo. Na 3ª e 4ª semana progrediu-se o tratamento em termos de fortalecimento muscular e treino proprioceptivo. Na 5ª semana apresentava amplitudes de movimento de 17º de dorsiflexão, 43º de flexãoplantar, 15º de eversão e 18º de inversão. Relativamente à força, o músculo tibial anterior apresentava um grau 5 de força, longo e curto peronial e flexores plantares grau 4+. No fim de 6 semanas, terminada a sua recuperação encontrava-se sem qualquer limitação funcional, igual força muscular bilateral e proprioceptividade normal. Conclusão: Foi salientado o processo de raciocínio clínico desenvolvido pelo fisioterapeuta ao longo das 6 semanas de intervenção: a recolha e interpretação dos dados da história, levantamento das primeiras hipóteses, testes dessas hipóteses no exame objectivo, estabelecimento de um diagnóstico funcional e construção e implementação de um plano de intervenção com a colaboração do utente que permitiram uma recuperação funcional que foi de encontro aos objectivos traçados.

Robôs quadrúpedes: geração de trajectórias em tempo real usando sistemas dinâmicos não-lineares

A geração de trajectórias de robôs em tempo real é uma tarefa muito complexa, não existindo ainda um algoritmo que a permita resolver de forma eficaz. De facto, há controladores eficientes para trajectórias previamente definidas, todavia, a adaptação a variações imprevisíveis, como sendo terrenos irregulares ou obstáculos, constitui ainda um problema em aberto na geração de trajectórias em tempo real de robôs. Neste trabalho apresentam-se modelos de geradores centrais de padrões de locomoção (CPGs), inspirados na biologia, que geram os ritmos locomotores num robô quadrúpede. Os CPGs são modelados matematicamente por sistemas acoplados de células (ou neurónios), sendo a dinâmica de cada célula dada por um sistema de equações diferenciais ordinárias não lineares. Assume-se que as trajectórias dos robôs são constituídas por esta parte rítmica e por uma parte discreta. A parte discreta pode ser embebida na parte rítmica, (a.1) como um offset ou (a.2) adicionada às expressões rítmicas, ou (b) pode ser calculada independentemente e adicionada exactamente antes do envio dos sinais para as articulações do robô. A parte discreta permite inserir no passo locomotor uma perturbação, que poderá estar associada à locomoção em terrenos irregulares ou à existência de obstáculos na trajectória do robô. Para se proceder á análise do sistema com parte discreta, será variado o parâmetro g. O parâmetro g, presente nas equações da parte discreta, representa o offset do sinal após a inclusão da parte discreta. Revê-se a teoria de bifurcação e simetria que permite a classificação das soluções periódicas produzidas pelos modelos de CPGs com passos locomotores quadrúpedes. Nas simulações numéricas, usam-se as equações de Morris-Lecar e o oscilador de Hopf como modelos da dinâmica interna de cada célula para a parte rítmica. A parte discreta é modelada por um sistema inspirado no modelo VITE. Medem-se a amplitude e a frequência de dois passos locomotores para variação do parâmetro g, no intervalo [-5;5]. Consideram-se duas formas distintas de incluir a parte discreta na parte rítmica: (a) como um (a.1) offset ou (a.2) somada nas expressões que modelam a parte rítmica, e (b) somada ao sinal da parte rítmica antes de ser enviado às articulações do robô. No caso (a.1), considerando o oscilador de Hopf como dinâmica interna das células, verifica-se que a amplitude e frequência se mantêm constantes para -52), usando novamente o oscilador de Hopf, a amplitude e a frequência têm o mesmo comportamento, crescendo e diminuindo nos intervalos de g [-0.5,0.34] e [0.4,1.83], sendo nos restantes valores de g nulas. Isto traduz-se em variações na extensão do movimento e na velocidade do robô, proporcionais à amplitude e à frequência, respectivamente. Ainda com o oscilador Hopf, no caso (b), a frequência mantêm-se constante enquanto a amplitude diminui para g<0.2 e aumenta para g>0.2. A extensão do movimento varia de forma directamente proporcional à amplitude. No caso das equações de Morris-Lecar, quando a componente discreta é embebida (a.2), a amplitude e a frequência aumentam e depois diminuem para - 0.170.5 Pode concluir-se que: (1) a melhor forma de inserção da parte discreta que menos perturbação insere no robô é a inserção como offset; (2) a inserção da parte discreta parece ser independente do sistema de equações diferenciais ordinárias que modelam a dinâmica interna de cada célula. Como trabalho futuro, é importante prosseguir o estudo das diferentes formas de inserção da parte discreta na parte rítmica do movimento, para que se possa gerar uma locomoção quadrúpede, robusta, flexível, com objectivos, em terrenos irregulares, modelada por correcções discretas aos padrões rítmicos.

Isokinetic assessment of the flexor-extensor balance of the knee in athletes with total rupture of the anterior cruciate ligament

The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average interval between occurrence of the injury and assessment was 10.2 months (range 2 - 48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60°/sec and 240°/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60°/sec was greater than that at 240°/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60°/sec or at 240°/sec. The average value for the flexor-extensor relationship at 60°/sec on the injured was 60% (( 6), compared to 57% (( 10) on the contra-lateral side. At 240°/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60°/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor muscle group to approach that of the extensor muscle group, and this tendency was more pronounced on the side of the injury.

Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study).

BACKGROUND To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. METHODS The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. RESULTS Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. CONCLUSIONS WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.

Rapid high-performance liquid chromatographic determination with fluorescence detection of furosemide in human body fluids and its confirmation by gas chromatography-mass spectrometry.

Furosemide (FD: Lasix) is a loop diuretic which strongly increases both urine flow and electrolyte urinary excretion. Healthy volunteers were administered 40 mg orally (dissolved in water) and concentrations of FD were determined in serum and urine for up to 6 h for eight subjects, who absorbed water at a rate of 400 ml/h. Quantification was performed by HPLC with fluorescence detection (excitation at 233 nm, emission at 389 nm) with a limit of detection of 5 ng/ml for a 300-microliters sample. The elution of FD was completed within 4 min using a gradient of acetonitrile concentration rising from 30 to 50% in 0.08 M phosphoric acid. The delay to the peak serum concentration ranged from 60 to 120 min. FD was still easily measurable in the sera from all subjects 6 h after administration. In urine, the excretion rates reached their maximum between 1 and 3 h. The total amount of FD excreted in the urine averaged 11.2 mg (range 7.6-14.0 mg), with a mean urine volume of 3024 ml (range 2620-3596 ml). Moreover, the urine density was lower than 1.010 (recommended as an upper limit in doping analysis to screen diuretics) only for 2 h. An additional volunteer was administered 40 mg of FD and his urine was collected over a longer period. FD was still detectable 48 h after intake. Gas chromatography-mass spectrometry with different types of ionization was used to confirm the occurrence of FD after permethylation of the extract. Negative-ion chemical ionization, with ammonia as reactant gas, was found to be the most sensitive method of detection.

Pseudoprogression after high-dose busulfan-thiotepa with autologous stem cell transplantation and radiation therapy in children with brain tumor: impact on survival

Objective: To demonstrate the incidence, time course, predisposing factor and reversibility of neurotoxicity in children with brain tumors treated with high dose busulfan-thiotepa with autologous stem cell transplantation (ASCT) and radiation therapy in our institutional experience.Materials and Methods: We performed a retrospective analysis of prospectively collected data. Between May 1988 and May 2007, 110 patients, median age 3.6 years (range, 1 months-15.3 years), with brain tumors were treated with surgical intervention and conventional chemotherapy. All patients received one course of high-dose busulfan-thiotepa with stem cell rescue, followed or preceded by radiotherapy.Results: Twenty-three patients (21%) developed neuroradiological abnormalities on follow-up imaging studies at a median time of 9.2 months (range, 5.6-17.3 months) after day 0 of ASCT. All MRI-lesions appeared in patients receiving radiotherapy after ASCT and were localized inside the 50-55 Gy isodoses. They disappeared in 14 of 23 patients with a median time of 8 months (range, 3-17 months). The presence of MRI-abnormalities was a favorable prognostic factor for overall survival on univariate analysis (hazard ratio: 0.12, 95% confidence interval [0.04, 0.33]), with a 5-year overall survival in patients with MRI-abnormalities of 84% (95% CI, 62-94), comparedto 27% (95% CI, 19-37) in those without lesions. On multivariate analysis, the presence of MRI-abnormalities was an independent prognostic factor for overall survival.Conclusion: MRI-detectable brain abnormalities are common early findings in children treated with high-dose busulfan-thiotepa followed by radiation therapy, and may mimic early tumor recurrence. They are correlated with a better outcome.

Fixed rings and strictures in Eosinophilic Esophagitis develop due to continuing inflammation over time

Background and Aims: Two distinct e ndoscopic phenotypes of E osinophilic Esophagitis (EoE) h ave been identified: t he inflammatory (IP) a nd the stenosing (SP) p henotype. I t is not known whether these EoE-associated phenotypes are reflective of different phases during disease course. We aimed to assess the phenotype a t initial EoE p resentation and d iagnosis and to evaluate if SP increases over time. Methods: R etrospective a nalysis of t he Swiss EoE Database (SEED) extended b y a review of p atients charts, endoscopy and pathology records. Results: F orty-four E oE p atients were a nalyzed (33 males, mean age at index visit 41 ± 14 years, all Caucasians). Median follow-up t ime was 3.1 years (IQR 1-4, r ange 1 -18 years). Median diagnostic delay w as 5 y ears (IQR 2-16, range 0-34 years). A t first diagnosis, 3 2% ( 14/44) o f EoE patients h ad already presented w ith a stenosis. T he mean d iameter o f the stenoses w as 1 0 ± 2 mm, and the mean length was 2 .8 ± 2 .9 cm. Peak e osinophil count d id n ot c hange over t ime (48 ± 39 eos/HPF at index visit vs. 59 ± 41 eos/HPF at end of follow-up, n=44). The risk of the presence of a stenosis at index visit was 0% f or a d isease duration of 0 -4 y ears, 37% f or a d isease duration between 5-10 years and 67% f or a d isease duration >10 years (p = 0.0035, trend test). Conclusions: T he frequency of e sophageal stenoses i s proportional to the disease duration, whereas the inflammatory activity does n ot s ignificantly c hange over t ime. O ur f indings underscore the necessity to reduce diagnostic delay in EoE and to control the underlying inflammatory processes to prevent esophageal remodeling.

Isoenzyme profiles of Trypanosoma cruzi stocks from different areas of Paraguay

Twenty one Trypanosoma cruzi stocks from humans, domiciliary triatomines and one sylvatic animal of different areas of Paraguay were subjected to isoenzyme analysis. Thirteen enzyme systems (15 loci in total) were studied. MN cl2 (clonets 39) and SO34 cl4 (clonets 20) were used as references. Relationships between stocks were depicted by an UPGMA dendrogram constructed using the Jaccard´s distances matrix. Among the Paraguayan stocks 14 zymodemes were identified (Par1 to Par14), Par 5 being the most frequent. Polymorphism rate and clonal diversity were 0.73 and 0.93, respectively. Average number of alleles per polymorphic locus was 2.5 (range 2-4). These measurements show a high diversity, which is confirmed by the dendrogram topology. All stocks belong to the same lineage, as MN cl2 reference strain (T. cruzi II). Moreover three distinct subgroups were identified and two of them correspond to Brazilian and Bolivian zymodemes, respectively. The third subgroup, the most common in Paraguay, is related to Tulahuen stock. The large geographical distribution of some zymodemes agrees with the hypothesis of clonality for T. cruzi populations. However sample size was not adequate to detect genetic recombination in any single locality.

The relationship between muscle strength and physiological age: a cross-sectional study in boys aged from 11 to 15.

OBJECTIVE: To investigate the relationships between isokinetic knee flexor and extensor muscle strength and physiological and chronological age in young soccer players. MATERIAL AND METHODS: Seventy-nine young, healthy, male soccer players (mean+/-standard deviation age: 12.78+/-2.88, range: 11 to 15) underwent a clinical examination (age, weight, height, body mass index and Tanner puberty stage) and an evaluation of bilateral knee flexor and extensor muscle strength on an isokinetic dynamometer. Participation in the study was voluntary. RESULTS: The peak torque increased progressively (by 50%) between the ages of 11 and 15 and most significantly between 12 to 14. The knee flexor/extensor ratios only decreased significantly between 14 and 15 years of age. Puberty stage was the most important determinant of the peak torque level (ahead of chronological age, weight and height) for all angular velocities (p<0.0001). Muscle strength increased significantly between Tanner stages 1 and 5, with the greatest increase between stages 2 and 4. CONCLUSION: The present study showed that isokinetic muscle strength increases most between 12 and 13 years of age and between Tanner stages 2 and 3. There was strong correlation between muscle strength and physiological age.

Anatomic and functional outcome after 23-gauge sutureless transconjunctival vitrectomy, peeling and intravitreal triamcinolone for idiopathic macular epiretinal membranes

Purpose:To report the functional, anatomic outcome and safety profile of 23-gauge pars plana vitrectomy (PPV) combined with peeling and intravitreal injection of triamcinolone acetonide (TA) in eyes with idiopathic epiretinal membranes (ERM). Methods:Retrospective, nonrandomized study of consecutive patients who underwent 23-gauge transconjunctival sutureless PPV with subsequent membrane peeling and intravitreal TA injection for an idiopathic ERM. All patients were operated between February 2007 and February 2008 at the Jules Gonin University Eye Hospital. The minimum follow-up was 6-months. Results:Thirty-nine eyes of 39 patients were included. The mean follow-up was 7 months (SD: 2.2, range: 6-15 months). Twenty-two (56%) eyes were pseudophakic and 17 (44%) were phakic at the time of surgery. Mean preoperative intraocular pressure (IOP) was 14 mmHg (SD: 3.5). At the final follow-up mean IOP was 14.5 (SD: 2.7) that did not differ significantly from the IOP at baseline (P: 0.14- 2-tailed t test). Five patients (13%) needed temporary topical anti-glaucoma treatment.Mean preoperative BCVA was 0.28 decimal equivalent (logMAR 0.54, SD: 0.2, range: 1.0 - 0.2). and improved significantly (P <0.0001, 2-tailed t test) to a mean of 0.6 decimal equivalent (logMAR 0.22, SD: 0.16, range: 0.6 - 0) at the final follow-up. The visual acuity improved by a mean of 3.2 lines (SD 2.1, range 0- 8). Twenty-nine patients (74%) demonstrated a gain of 3 or more lines.Mean central macular thickness (CMT) was 456 µm (SD: 77) at the baseline that reduced significantly (P <0.0001, 2-tailed t test) at the final follow-up to 327µm (SD: 79). Average CMT reduction was 131µm (SD: 77, range: 36- 380 µm). A subgroup analysis of 15 selected cases that had CMT measurement 1 week after surgery demonstrated that 84% of the total final reduction in CMT occurred during the first week. Conclusions:23-gauge sutureless transconjunctival vitrectomy with the concomitant administration of intravitreal TA is a safe and effective technique for the treatment of idiopathic ERM and may speed up anatomical recovery.