999 resultados para tilt-table testing


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Dissertation submitted in partial fulfilment of the requirements for the Degree of Master of Science in Geospatial Technologies

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Second International Workshop on Analog and Mixed Signal Integrated Circuits for Space Applications (AMICSA 2008), Sintra, Portugal, Setembro de 2008

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No decorrer dos últimos anos tem-se verificado um acréscimo do número de sistemas de videovigilância presentes nos mais diversos ambientes, sendo que estes se encontram cada vez mais sofisticados. Os casinos são um exemplo bastante popular da utilização destes sistemas sofisticados, sendo que vários casinos, hoje em dia, utilizam câmeras para controlo automático das suas operações de jogo. No entanto, atualmente existem vários tipos de jogos em que o controlo automático ainda não se encontra disponível, sendo um destes, o jogo Banca Francesa. A presente dissertação tem como objetivo propor um conjunto de algoritmos idealizados para um sistema de controlo e gestão do jogo de casino Banca Francesa através do auxílio de componentes pertencentes à área da computação visual, tendo em conta os contributos mais relevantes e existentes na área, elaborados por investigadores e entidades relacionadas. No decorrer desta dissertação são apresentados quatro módulos distintos, os quais têm como objetivo auxiliar os casinos a prevenir o acontecimento de fraudes durante o decorrer das suas operações, assim como auxiliar na recolha automática de resultados de jogo. Os quatro módulos apresentados são os seguintes: Dice Sample Generator – Módulo proposto para criação de casos de teste em grande escala; Dice Sample Analyzer – Módulo proposto para a deteção de resultados de jogo; Dice Calibration – Módulo proposto para calibração automática do sistema; Motion Detection – Módulo proposto para a deteção de fraude no jogo. Por fim, para cada um dos módulos, é apresentado um conjunto de testes e análises de modo a verificar se é possível provar o conceito para cada uma das propostas apresentadas.

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A candidin, which is a suspension of killed yeast cells, is commonly used for intradermal tests of delayed hypersensitivity, to evaluate the immunological cellular competence of the patient, when the test is applied along with other similar tests. When working with a cellular antigen, the histopathology of positive skin tests reveals a cellular infiltrate which not only presents a characteristic hypersensitivity reaction but also a neutrophilic abscess in the central part. This research presents the results of a comparison between the yeast cell suspension and the polysaccharide antigens, both obtained from the same strains of Candida albicans. The results obtained by skin tests in one hundred individuals were 61.0% with the polysaccharide antigen and 69.0% with the yeast cell suspension antigen. Concordant results concerning the two antigens were observed in 82.0% of the individuals. The discussion section presents an assumption to explain the differences of positivity obtained with the two antigens. We conclude that the polysaccharide antigen can be utilized in the intradermal test of delayed hypersensitivity to Candida albicans.

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Based on the difficulties experienced in the treatment of chromoblastomycosis, 12 primary human isolates of F. pedrosoi, were tested for their in vitro susceptibility to various antimycotics. We adapted the recommendations of the NCCLS for yeasts and followed the indications for mold testing from other authors in order to determine their MIC’s and the MLC’s. It was found that a significant proportion of the isolates were resistant to 3 of the 4 antimycotics tested, as revealed by high MIC values, as follows: 33% were resistant to amphotericin B (AMB), 58.3% to 5 fluocytosine (5 FC) and 66.7% to fluconazole (FLU). Contrarywise, none of the isolates proved resistant to itraconazole (ITZ). Determination of the MLC’s revealed that a larger proportion of the isolates were not killed by AMB, 5 FC (91.7%), FLU (100%) or even, ITZ (41.7%). These data indicate that it would be desirable to determine the susceptibility of F. pedrosoi before initiating therapy, in order to choose the more effective antifungal and avoid clinical failure

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Dissertation presented to obtain the PhD degree in Biology/Molecular Biology by Universidade Nova de Lisboa, Instituto de Tecnologia Química e Biológica

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A comparison of the Etest and the reference broth macrodilution susceptibility test for fluconazole, ketoconazole, itraconazole and amphotericin B was performed with 59 of Candida species isolated from the oral cavities of AIDS patients. The Etest method was performed according to the manufacturer's instructions, and the reference method was performed according to National Committee for Clinical Laboratory Standards document M27-A guidelines. Our data showed that there was a good correlation between the MICs obtained by the Etest and broth dilution methods. When only the MIC results at ± 2 dilutions for both methods were considered, the agreement rates were 90.4% for itraconazole, ketoconazole and amphotericin B and 84.6% for fluconazole of the C. albicans tested. In contrast, to the reference method, the Etest method classified as susceptible three fluconazole-resistant isolates and one itraconazole-resistant isolate, representing four very major errors. These results indicate that Etest could be considered useful for antifungal sensitivity evaluation of yeasts in clinical laboratories.

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Está demonstrado o papel do teste de inclinação na avaliação de doentes com síncope de causa não esclarecida, sendo utilizado como a técnica gold standard para o diagnóstico da síncope neurocardiogénica, em particular com o recurso a agentes provocativos farmacológicos de modo a melhorar a acuidade diagnóstica. A estimulação com nitroglicerina sub-lingual é, regra geral, bem tolerada e permite aumentar a sensibilidade do teste reduzindo a sua duração. Neste sentido, tem-se verificado também o alargamento da sua aplicação em doentes idosos. Objectivos: Avaliar, numa população referenciada por síncope de etiologia desconhecida, a utilidade do teste de inclinação com recurso a nitroglicerina sub-lingual e comparar o tipo de respostas obtidas nos doentes idosos com o dos restantes doentes. Métodos: Estudámos 158 doentes submetidos a teste de inclinação com utilização de nitroglicerina como agente provocativo. Foram considerados doentes com idade <65 anos (Grupo A, n=74) e ≥65 anos (Grupo B, n=84). O teste de inclinação foi efectuado segundo o protocolo “italiano”, sob monitorização contínua do electrocardiograma e da tensão arterial (Task Force Monitor; CNSystems). Foram incluídos somente doentes assintomáticos na fase passiva do teste. O teste foi considerado positivo para resposta neurocardiogénica quando houve reprodução da sintomatologia acompanhada de bradicardia e/ou hipotensão arterial e as respostas foram definidas como cardio-inibitória, vasodepressora ou mista. Uma descida gradual e paralela da tensão arterial após administração de nitroglicerina seguida de síncope foi considerada como resposta exagerada aos nitratos. Resultados: Não se verificam diferenças na distribuição por sexos entre os grupos. O teste de inclinação foi positivo em 57% do Grupo A e 51% do Grupo B (p=NS), tendo ocorrido resposta exagerada aos nitratos em 11% e 16%, respectivamente (p=NS). Relativamente ao tipo de respostas neurocardiogénicas, as vasodepressoras foram mais frequentes no Grupo B (53% versus 24%; p=0,001) e as mistas tendencialmente mais frequentes no Grupo A (59% versus 40%; p=0,07), sem diferenças significativas no que se refere à resposta do tipo cardio-inibitória (17% nos Grupo A versus 7% no Grupo B; p=NS). Conclusões: Numa população com síncope de etiologia não conhecida, o teste de inclinação potenciado pela nitroglicerina: a) contribui de modo significativo para o esclarecimento diagnóstico com utilidade idêntica em idosos e nos restantes doentes. B) associa-se a maior incidência de resposta neurocardiogénica vasodepressora nos idosos embora com uma taxa semelhante de respostas exageradas aos nitratos.

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OBJECTIVE: We set out to evaluate whether changes in N-terminal pro-brain natriuretic peptide (proBNP) can predict changes in functional capacity, as determined by cardiopulmonary exercise testing (CPET), in patients with chronic heart failure (CHF) due to dilated cardiomyopathy (DCM). METHODS: We studied 37 patients with CHF due to DCM, 81% non-ischemic, 28 male, who performed symptom-limited treadmill CPET, with the modified Bruce protocol, in two consecutive evaluations, with determination of proBNP after 10 minutes rest prior to CPET. The time between evaluations was 9.6+/-5.5 months, and age at first evaluation was 41.1+/-13.9 years (21 to 67). RESULTS IN THE FIRST AND SECOND EVALUATIONS RESPECTIVELY WERE: NYHA functional class >II 51% and 16% (p<0.001), sinus rhythm 89% and 86.5% (NS), left ventricular ejection fraction 24.9+/-8.9% and 26.6+/-8.6% (NS), creatinine 1.03+/-0.25 and 1.09+/-0.42 mg/dl (NS), taking ACE inhibitors or ARBs 94.5% and 100% (NS), beta-blockers 73% and 97.3% (p<0.001), and spironolactone 89% and 89% (NS). We analyzed the absolute and percentage variation (AV and PV) in peak oxygen uptake (pVO2--ml/kg/min) and proBNP (pg/ml) between the two evaluations. RESULTS: (1) pVO2 AV: -17.4 to 15.2 (1.9+/-5.7); pVO2 PV: -56.1 to 84% (11.0+/-25.2); proBNP AV: -12850 to 5983 (-778.4+/-3332.5); proBNP PV: -99.0 to 379.5% (-8.8+/-86.3); (2) The correlations obtained--r value and p value [r (p)]--are shown in the table below; (3) We considered that a coefficient of variation of pVO2 PV of >10% represented a significant change in functional capacity. On ROC curve analysis, a proBNP PV value of 28% showed 80% sensitivity and 79% specificity for pVO2 PV of >10% (AUC=0.876, p=0.01, 95% CI 0.75 to 0.99). CONCLUSIONS: In patients with CHF due to DCM, changes in proBNP values correlate with variations in pVO2, as assessed by CPET. However, our results suggest that only a proBNP PV of >28% predicts a significant change in functional capacity.

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The autonomic nervous system (ANS) plays a role as a modulator in the pathogenesis of paroxysmal atrial fibrillation (PAF). The clinical pattern of vagally mediated PAF has been observed mainly in young patients. Neurocardiogenic responses during orthostatic stress are related to autonomic reflexes in which the vagal influence predominates. AIM: To evaluate the susceptibility of elderly patients with PAF to activation of vasovagal syncope mechanisms. METHODS: We performed passive head-up tilt testing (HUT) in 34 patients (62% women, aged 72 +/- 7 years), with > or = 1 year of clinical history of PAF--19 without structural heart disease, 11 with hypertensive heart disease and 4 with coronary artery disease (who had no previous myocardial infarction, had undergone myocardial revascularization, and had no documented ischemia) (PAF group), and compared the results with those obtained in a group of 34 age-matched patients (53% women, aged 74 +/- 6 years), who underwent HUT due to recurrent syncope (Sc group). In this group, 21 had no documented heart disease and none had a clinical history of AF. There was no diabetes, congestive heart failure or syncope in the PAF group. After a supine resting period, the subjects were tilted at 70 degrees for 20 minutes while in sinus rhythm. No provocative agents were used to complement the HUT. ECG and blood pressure were continuously monitored (Task Force Monitor, CNSystems). The test was considered positive when syncope or presyncope occurred with bradycardia and/or arterial hypotension. Abnormal responses were classified as cardioinhibitory, vasodepressor or mixed. RESULTS: HUT was positive in seven patients of the PAF group--vasodepressor response in five and mixed in two (20.5% of the total; 26.3% of those without heart disease)--and in eight patients (vasodepressor in six and mixed in two) of the Sc group (p=NS). During HUT, three patients of the PAF group had short periods of self-limited PAF (in one, after vasodepressor syncope). There were no differences in gender distribution, age or heart disease. No cardioinhibitory responses or orthostatic hypotension were observed. CONCLUSION: In elderly patients with PAF, a significant number of false positive results during passive HUT may be expected, suggesting increased vasovagal reactions despite aging. This suggests that ANS imbalances may be observed in this population.

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The autonomic nervous system (ANS) is known to be an important modulator in the pathogenesis of paroxysmal atrial fibrillation (PAF). Changes in ANS control of heart rate variability (HRV) occur during orthostatism to maintain cardiovascular homeostasis. Wavelet transform has emerged as a useful tool that provides time-frequency decomposition of the signal under investigation, enabling intermittent components of transient phenomena to be analyzed. AIM: To study HRV during head-up tilt (HUT) with wavelet transform analysis in PAF patients and healthy individuals (normals). METHODS: Twenty-one patients with PAF (8 men; age 58 +/- 14 yrs) were examined and compared with 21 normals (7 men, age 48 +/- 12 yrs). After a supine resting period, all subjects underwent passive HUT (60 degrees) while in sinus rhythm. Continuous monitoring of ECG and blood pressure was carried out (Task Force Monitor, CNSystems). Acute changes in RR-intervals were assessed by wavelet analysis and low-frequency power (LF: 0.04-0.15 Hz), high-frequency power (HF: 0.15-0.60 Hz) and LF/HF (sympathovagal) were calculated for 1) the last 2 min of the supine period; 2) the 15 sec of tilting movement (TM); and 3) the 1st (TT1) and 2nd (TT2) min of HUT. Data are expressed as means +/- SEM. RESULTS: Baseline and HUT RR-intervals were similar for the two groups. Supine basal blood pressure was also similar for the two groups, with a sustained increase in PAF patients, and a decrease followed by an increase and then recovery in normals. Basal LF, HF and LF/ HF values in PAF patients were 632 +/- 162 ms2, 534 +/- 231 ms2 and 1.95 +/- 0.39 respectively, and 1058 +/- 223 ms2, 789 +/- 244 ms2 and 2.4 +/- 0.36 respectively in normals (p = NS). During TM, LF, HF and LF/HF values for PAF patients were 747 +/- 277 ms2, 387 +/- 94 ms2 and 2.9 +/- 0.6 respectively, and 1316 +/- 315 ms2, 698 +/- 148 ms2 and 2.8 +/- 0.6 respectively in normals (p < 0.05 for LF and HF). During TF1, LF, HF and LF/ HF values for PAF patients were 1243 +/- 432 ms2, 302 +/- 88 ms2 and 7.7 +/- 2.4 respectively, and 1992 +/- 398 ms2, 333 +/- 76 ms2 and 7.8 +/- 0.98 respectively for normals (p < 0.05 for LF). During TF2, LF, HF and LF/HF values for PAF patients were 871 +/- 256 ms2, 242 +/- 51 ms2 and 4.7 +/- 0.9 respectively, and 1263 +/- 335 ms2, 317 +/- 108 ms2 and 8.6 +/- 0.68 respectively for normals (p < 0.05 for LF/HF). The dynamic profile of HRV showed that LF and HF values in PAF patients did not change significantly during TM or TT2, and LF/HF did not change during TM but increased in TT1 and TT2. CONCLUSION: Patients with PAF present alterations in HRV during orthostatism, with decreased LF and HF power during TM, without significant variations during the first minutes of HUT. These findings suggest that wavelet transform analysis may provide new insights when assessing autonomic heart regulation and highlight the presence of ANS disturbances in PAF.

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A síncope neurocardiogénica é uma entidade com prevalência e incidência significativas. Apesar da baixa mortalidade relacionada com esta entidade, são significativas as implicações na qualidade de vida dos doentes. A metodologia para o seu diagnóstico está hoje claramente estabelecida nas recomendações internacionais e o teste de inclinação é um elemento útil na abordagem diagnóstica, em particular na síncope recorrente de causa desconhecida e frequente. Vários protocolos têm vindo a ser descritos nos últimos anos, inicialmente passivos e posteriormente com introdução de agentes provocativos, dos quais os nitratos sub-linguais são os mais largamente aceites, pela simplicidade e bons resultados da sua utilização. O recurso ao teste de inclinação na avaliação da terapêutica está limitado por problemas relacionados com a reprodutibilidade, que contudo estão na base de uma forma de tratamento – o treino de ortostatismo (tilt training) – embora com taxas de sucesso variáveis. Na presente revisão, iremos abordar os vários aspectos relacionados com a aplicação do teste de inclinação na prática clínica.

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An "in-house" RT-PCR method was developed that allows the simultaneous detection of the RNA of the Hepatitis C Virus (HCV) and an artificial RNA employed as an external control. Samples were analyzed in pools of 6-12 donations, each donation included in two pools, one horizontal and one vertical, permitting the immediate identification of a reactive donation, obviating the need for pool dismembering. The whole process took 6-8 hours per day and results were issued in parallel to serology. The method was shown to detect all six HCV genotypes and a sensitivity of 500 IU/mL was achieved (95% hit rate). Until July 2005, 139,678 donations were tested and 315 (0.23%) were found reactive for HCV-RNA. Except for five false-positives, all 310 presented the corresponding antibody as well, so the yield of NAT-only donations was zero, presenting a specificity of 99.83%. Detection of a window period donation, in the population studied, will probably demand testing of a larger number of donations. International experience is showing a rate of 1:200,000 - 1:500,000 of isolated HCV-RNA reactive donations.

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The antifungal activities of itraconazole, ketoconazole, fluconazole, terbinafine and griseofulvin were tested by broth microdilution methods against 71 isolates of dermatophytes isolated from Nigerian children. Most drugs were very active against all the dermatophytes and the MIC 90 ranged from 0.03 to 8.0 µg/mL. This appears to be the first documented data on the antifungal susceptibility testing of isolates of dermatophytes from Nigerian children.