Determinants of frailty: the added value of assessing medication

This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0–4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.

Revisão, aplicação e avaliação dos mercados eletrónicos - emarket

Os mercados eletrónicos são sistemas de informação (SI) utilizados por várias entidades organizacionais distintas dentro de um ou vários níveis em termos das cadeias de valor económico (Journal Electronic Markets, 2012). Segundo (Bakos, 1998) têm um papel central na economia, facilitando a troca de informações, produtos, serviços e pagamentos. Durante o processo, é criado valor económico para o comprador, fornecedor, intermediários do mercado e para a sociedade em geral. O comércio eletrónico é o ato de realizar um qualquer tipo de negócio através de uma via eletrónica e é constituído por modelos diversificados onde se destacam o Business to Business (B2B) e o Business to Consumer (B2C). O modelo B2B possui uma quota de 90 % de todo o comércio, sendo esse sucesso intrinsecamente relacionado em grande parte às vantagens que as suas plataformas oferecem às empresas que inseridas nelas (Anacom, 2004). O âmbito principal deste trabalho é o estudo dos B2B, tendo sido para tal definidos os seguintes objetivos: Realizar a identificação do estado atual bem como a evolução dos mercados B2B em Portugal; Caraterização das funcionalidades das plataformas que atuam no tecido nacional e por fim fazer a criação de um conjunto de orientações de apoio a empresas que desejam fazer a inserção nestes mercados. Para serem alcançados os objetivos propostos na dissertação, foram inquiridas várias organizações ao mesmo tempo que foi realizada uma pesquisa de temas e artigos relacionados com os mercados eletrónicos e plataformas B2B, recorrendo a sites como a B-On.pt, e utilizando o motor de busca Google. Este relatório apresenta a seguinte estrutura: No capítulo 1 é apresentada a introdução teórica das matérias apresentadas nos capítulos seguintes; O capítulo 2 é centrado no comércio eletrónico, definições mais comuns e são demonstrados os modelos mais preponderantes do comércio eletrónico; No capítulo 3 são expostas todas as vertentes do modelo B2B, as principais plataformas B2B a atuar no tecido nacional, as suas funcionalidades e modo de operação bem como uma apresentação das principais plataformas a nível mundial; No capítulo 4 são apresentados um conjunto de tópicos de auxílio a empresas que desejem fazer a sua inserção neste tipo de mercados; Por último são descritas as principais conclusões retiradas na realização da dissertação. Em suma, este trabalho reúne um conjunto de dados e orientações úteis, decorrentes do estudo realizado de auxílio a empresas a aderirem aos mercados eletrónicos, visto ser uma abordagem promissora para as organizações.

Models and tools for value systems analysis in collaborative environments

Dissertation to obtain the degree of Doctor in Electrical and Computer Engineering, specialization of Collaborative Networks

Módulo de realidade aumentada para uma aplicação LBS

As aplicações móveis de serviços baseados na localização, denominados LBS (Location-based services), disponibilizam serviços ao utilizador baseadas na sua localização geográfica. Este tipo de serviços começou a surgir ainda na década de 90 e, à medida que o número de dispositivos móveis cresceu de forma exponencial, a sua oferta disparou consideravelmente. Existem várias áreas com aplicabilidade prática, mas o foco desta tese é a pesquisa e localização de pontos de interesse (POI’s). Através dos sensores que os dispositivos móveis atualmente disponibilizam, torna-se possível localizar a posição do utilizador e apresentar-lhe os pontos de interesse que estão situados em seu redor. No entanto essa informação isolada revela-se por vezes insuficiente, uma vez que esses pontos de interesse são à partida desconhecidos para o utilizador. Através do serviço coolplaces, um projeto que pretende dedicar-se à pesquisa e partilha de POI’s, podemos criar a nossa rede de amigos e de locais, beneficiando assim da respetiva informação de contexto de um determinado POI. As inovações tecnológicas permitiram também o aparecimento de aplicações de Realidade Aumentada nos dispositivos móveis, isto é, aplicações capazes de sobrepor imagens virtuais a visualizações do mundo real. Considerando a visualização de POI’s num dado ambiente, se encararmos a Realidade Aumentada como um potenciador da interação do utilizador com o mundo real, rapidamente identificamos as potencialidades da junção destes conceitos numa só aplicação. Sendo assim, o trabalho desenvolvido nesta tese pretende constituir um estudo sobre a implementação e desenvolvimento de um módulo de Realidade Aumentada para a aplicação móvel do serviço coolplaces, fazendo uso da tecnologia disponível no mercado de forma a proporcionar uma experiência inovadora e acrescentar valor à referida aplicação.

A Responsabilidade social empresarial na indústria de elevadores

Dissertação de Mestrado Apresentado ao Instituto Superior de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Empreendedorismo e Internacionalização, sob orientação da Mestre Anabela Ribeiro

Prognostic Value of a New Cardiopulmonary Exercise Testing Parameter in Chronic Heart Failure: Oxygen Uptake Efficiency at Peak Exercise - Comparison with Oxygen Uptake Efficiency Slope

INTRODUCTION: A growing body of evidence shows the prognostic value of oxygen uptake efficiency slope (OUES), a cardiopulmonary exercise test (CPET) parameter derived from the logarithmic relationship between O(2) consumption (VO(2)) and minute ventilation (VE) in patients with chronic heart failure (CHF). OBJECTIVE: To evaluate the prognostic value of a new CPET parameter - peak oxygen uptake efficiency (POUE) - and to compare it with OUES in patients with CHF. METHODS: We prospectively studied 206 consecutive patients with stable CHF due to dilated cardiomyopathy - 153 male, aged 53.3±13.0 years, 35.4% of ischemic etiology, left ventricular ejection fraction 27.7±8.0%, 81.1% in sinus rhythm, 97.1% receiving ACE-Is or ARBs, 78.2% beta-blockers and 60.2% spironolactone - who performed a first maximal symptom-limited treadmill CPET, using the modified Bruce protocol. In 33% of patients an cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT-D) was implanted during follow-up. Peak VO(2), percentage of predicted peak VO(2), VE/VCO(2) slope, OUES and POUE were analyzed. OUES was calculated using the formula VO(2) (l/min) = OUES (log(10)VE) + b. POUE was calculated as pVO(2) (l/min) / log(10)peakVE (l/min). Correlation coefficients between the studied parameters were obtained. The prognosis of each variable adjusted for age was evaluated through Cox proportional hazard models and R2 percent (R2%) and V index (V6) were used as measures of the predictive accuracy of events of each of these variables. Receiver operating characteristic (ROC) curves from logistic regression models were used to determine the cut-offs for OUES and POUE. RESULTS: pVO(2): 20.5±5.9; percentage of predicted peak VO(2): 68.6±18.2; VE/VCO(2) slope: 30.6±8.3; OUES: 1.85±0.61; POUE: 0.88±0.27. During a mean follow-up of 33.1±14.8 months, 45 (21.8%) patients died, 10 (4.9%) underwent urgent heart transplantation and in three patients (1.5%) a left ventricular assist device was implanted. All variables proved to be independent predictors of this combined event; however, VE/VCO2 slope was most strongly associated with events (HR 11.14). In this population, POUE was associated with a higher risk of events than OUES (HR 9.61 vs. 7.01), and was also a better predictor of events (R2: 28.91 vs. 22.37). CONCLUSION: POUE was more strongly associated with death, urgent heart transplantation and implantation of a left ventricular assist device and proved to be a better predictor of events than OUES. These results suggest that this new parameter can increase the prognostic value of CPET in patients with CHF.

Sistema de Recomendação: Share GFS Games, Films & Series

Esta dissertação incide sobre o estudo e análise de uma solução para a criação de um sistema de recomendação para uma comunidade de consumidores de media e no consequente desenvolvimento da mesma cujo âmbito inicial engloba consumidores de jogos, filmes e/ou séries, com o intuito de lhes proporcionar a oportunidade de partilharem experiências, bem como manterem um registo das mesmas. Com a informação adquirida, o sistema reúne condições para proceder a sugestões direccionadas a cada membro da comunidade. O sistema actualiza a sua informação mediante as acções e os dados fornecidos pelos membros, bem como pelo seu feedback às sugestões. Esta aprendizagem ao longo do tempo permite que as sugestões do sistema evoluam juntamente com a mudança de preferência dos membros ou se autocorrijam. O sistema toma iniciativa de sugerir mediante determinadas acções, mas também pode ser invocada uma sugestão directamente pelo utilizador, na medida em que este não precisa de esperar por sugestões, podendo pedir ao sistema que as forneça num determinado momento. Nos testes realizados foi possível apurar que o sistema de recomendação desenvolvido forneceu sugestões adequadas a cada utilizador específico, tomando em linha de conta as suas acções prévias. Para além deste facto, o sistema não forneceu qualquer sugestão quando o histórico destas tinha provado incomodar o utilizador.

A Quantitative Model for Decomposing & Assessing the Value for the Customer

The research presented in this paper proposes a novel quantitative model for decomposing and assessing the Value for the Customer. The proposed approach builds on the different dimensions of the Value Network analysis proposed by Verna Allee having as background the concept of Value for the Customer proposed by Woodall. In this context, the Value for the Customer is modelled as a relationship established between the exchanged deliverables and a combination of tangible and intangible assets projected into their endogenous or exogenous dimensions. The Value Network Analysis of the deliverables exchange enables an in-depth understanding of this frontier and the implicit modelling of co-creation scenarios. The proposed Conceptual Model for Decomposing Value for the Customer combines several concepts: from the marketing area we have the concept of Value for the Customer; from the area of intellectual capital the concept of Value Network Analysis; from the collaborative networks area we have the perspective of the enterprise life cycle and the endogenous and exogenous perspectives; at last, the proposed model is supported by a mathematical formal description that stems from the area of Multi-Criteria Decision Making. The whole concept is illustrated in the context of a case study of an enterprise in the footwear industry (Pontechem). The merits of this approach seem evident from the contact with Pontechem as it provides a structured approach for the enterprises to assess the adequacy of their value proposition to the client/customer needs and how these relate to their endogenous and/or exogenous tangible or intangible assets. The proposed model, as a tool, may therefore be a useful instrument in supporting the commercialisation of new products and/or services.

Imparidades em inventários

Dissertação de Mestrado apresentada ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Contabilidade e Finanças, sob orientação da Doutora Albertina Paula Monteiro Esta versão contém as críticas e sugestões dos elementos do júri.

Factorization of elliptic boundary value problems by invariant embedding and application to overdetermined problems

Dissertação para obtenção do Grau de Doutor em Matemática

Prognostic Value of VEGF in Patients Submitted to Percutaneous Coronary Intervention

We examined the longitudinal changes of VEGF levels after percutaneous coronary intervention for predicting major adverse cardiac events (MACE) in coronary artery disease (CAD) patients. VEGF was measured in 94 CAD patients' serum before revascularization, 1-month and 1-year after. Independently of clinical presentation, patients had lower VEGF concentration than a cohort of healthy subjects (median, IQ: 15.9, 9.0-264 pg/mL versus 419, 212-758 pg/mL; P < 0.001) at baseline. VEGF increased to 1-month (median, IQ: 276, 167-498 pg/mL; P < 0.001) and remained steady to 1-year (median, IQ: 320, 173-497 pg/mL; P < 0.001) approaching control levels. Drug eluting stent apposition and previous medication intake produced a less steep VEGF evolution after intervention (P < 0.05). Baseline VEGF concentration <40.8 pg/mL conveyed increased risk for MACE in a 5-year follow-up. Results reflect a positive role of VEGF in recovery and support its importance in CAD prognosis.

Optimal Cut-Off Value for Homeostasis Model Assessment (HOMA) Index of Insulin-Resistance in a Population of Patients Admitted Electively in a Portuguese Cardiology Ward

INTRODUCTION: Insulin resistance is the pathophysiological key to explain metabolic syndrome. Although clearly useful, the Homeostasis Model Assessment index (an insulin resistance measurement) hasn't been systematically applied in clinical practice. One of the main reasons is the discrepancy in cut-off values reported in different populations. We sought to evaluate in a Portuguese population the ideal cut-off for Homeostasis Model Assessment index and assess its relationship with metabolic syndrome. MATERIAL AND METHODS: We selected a cohort of individuals admitted electively in a Cardiology ward with a BMI < 25 Kg/m2 and no abnormalities in glucose metabolism (fasting plasma glucose < 100 mg/dL and no diabetes). The 90th percentile of the Homeostasis Model Assessment index distribution was used to obtain the ideal cut-off for insulin resistance. We also selected a validation cohort of 300 individuals (no exclusion criteria applied). RESULTS: From 7 000 individuals, and after the exclusion criteria, there were left 1 784 individuals. The 90th percentile for Homeostasis Model Assessment index was 2.33. In the validation cohort, applying that cut-off, we have 49.3% of individuals with insulin resistance. However, only 69.9% of the metabolic syndrome patients had insulin resistance according to that cut-off. By ROC curve analysis, the ideal cut-off for metabolic syndrome is 2.41. Homeostasis Model Assessment index correlated with BMI (r = 0.371, p < 0.001) and is an independent predictor of the presence of metabolic syndrome (OR 19.4, 95% CI 6.6 - 57.2, p < 0.001). DISCUSSION: Our study showed that in a Portuguese population of patients admitted electively in a Cardiology ward, 2.33 is the Homeostasis Model Assessment index cut-off for insulin resistance and 2.41 for metabolic syndrome. CONCLUSION: Homeostasis Model Assessment index is directly correlated with BMI and is an independent predictor of metabolic syndrome.

A Prospective Assessment of Renal Transplantation Versus Haemodialysis: Which Therapeutic Modality Is Good Value for Society?

Background: Economic evaluations help health authorities facing budget constraints. This study compares the health-related quality of life (HRQOL) and costs in patient subgroups on haemodialysis (HD) and renal transplantation (KT). Methods: In a prospective study with follow-up of 1-3 years, we performed a costutility analysis of KT vs. HD, adopting a lifetime horizon. A societal perspective was taken. Costs for organ procurement, KT eligibility, transplant surgery and follow-up of living donors were included. Key clinical events were recorded. HRQOL was assessed using the EuroQol instrument. Results: The HRQOL remained stable on HD patients. After KT, mean utility score improved at 3 months while mean EQ-VAS scores showed a sustained improvement. Mean annual cost for HD was 32,567.57€. Mean annual costs for KT in the year-1 and in subsequent years were, 60,210.09€ and 12,956.77€ respectively. Cost for initial hospitalization averaged 18,740.74€. HLA-mismatches increased costs by 75% for initial hospitalization (p < 0.001) and 41% in the year-1 (p < 0.05), and duplicate the risk of readmission in the year-1 (p < 0.05). The incremental costutility ratio was 5,534.46€/QALY, increasing 35% when costs for organ procurement were added. KT costs were 41,541.63€ more but provided additional 7.51 QALY. Conclusions: The KT is cost-effective compared with HD. Public funding should reflect the value created by the intervention and adapt to the organ demand.

Building clusters for CRM strategies by mining airlines customer data

Trabalho de Projeto apresentado como requisito parcial para obtenção do grau de Mestre em Estatística e Gestão de Informação

Metodologia Value-at-risk: aplicação a uma carteira de obrigações de tesouro portuguesas

Dissertação apresentada como requisito parcial para obtenção do grau de Mestre em Estatística e Gestão de Informação