The use of expert systems on the differential diagnosis of urinary incontinence

The differential diagnosis of urinary incontinence classes is sometimes difficult to establish. As a rule, only the results of urodynamic testing allow an accurate diagnosis. However, this exam is not always feasible, because it requires special equipment, and also trained personnel to lead and interpret the exam. Some expert systems have been developed to assist health professionals in this field. Therefore, the aims of this paper are to present the definition of Artificial Intelligence; to explain what Expert System and System for Decision Support are and its application in the field of health and to discuss some expert systems for differential diagnosis of urinary incontinence. It is concluded that expert systems may be useful not only for teaching purposes, but also as decision support in daily clinical practice. Despite this, for several reasons, health professionals usually hesitate to use the computer expert system to support their decision making process.

The relationship between monocarboxylate transporters 1 and 4 expression in skeletal muscle and endurance performance in athletes

The purpose of this study was to examine the relationship between skeletal muscle monocarboxylate transporters 1 and 4 (MCT1 and MCT4) expression, skeletal muscle oxidative capacity and endurance performance in trained cyclists. Ten well-trained cyclists (mean +/- SD; age 24.4 +/- 2.8 years, body mass 73.2 +/- 8.3 kg, VO(2max) 58 +/- 7 ml kg(-1) min(-1)) completed three endurance performance tasks [incremental exercise test to exhaustion, 2 and 10 min time trial (TT)]. In addition, a muscle biopsy sample from the vastus lateralis muscle was analysed for MCT1 and MCT4 expression levels together with the activity of citrate synthase (CS) and 3-hydroxyacyl-CoA dehydrogenase (HAD). There was a tendency for VO(2max) and peak power output obtained in the incremental exercise test to be correlated with MCT1 (r = -0.71 to -0.74; P < 0.06), but not MCT4. The average power output (P (average)) in the 2 min TT was significantly correlated with MCT4 (r = -0.74; P < 0.05) and HAD (r = -0.92; P < 0.01). The P (average) in the 10 min TT was only correlated with CS activity (r = 0.68; P < 0.05). These results indicate the relationship between MCT1 and MCT4 as well as cycle TT performance may be influenced by the length and intensity of the task.

Medicine and Science in a New Medical-surgical Context: The Royal College of Surgery of Barcelona (1760–1843)

Taking the Royal College of Barcelona (1760 -1843) as a case study this paper shows the development of modern surgery in Spain initiated by Bourbon Monarchy founding new kinds of institutions through their academic activities of spreading scientific knowledge. Antoni Gimbernat was the most famousinternationally recognised Spanish surgeon. He was trained as a surgeon at the Royal College of Surgery in Cadiz and was later appointed as professor of theAnatomy in the College of Barcelona. He then became Royal Surgeon of King Carlos IV and with that esteemed position in Madrid he worked resiliently to improve the quality of the Royal colleges in Spain. Learning human bodystructure by performing hands-on dissections in the anatomical theatre has become a fundamental element of modern medical education. Gimbernat favoured the study of natural sciences, the new chemistry of Lavoisier and experimental physics in the academic programs of surgery. According to the study of a very relevant set of documents preserved in the library, the so-called “juntas literarias”, among the main subjects debated in the clinical sessions was the concept of human beings and diseases in relation to the development of the new experimental sciences. These documents showed that chemistry andexperimental physics were considered crucial tools to understand the unexplained processes that occurred in the diseased and healthy human bodyand in a medico-surgical context. It is important to stress that through these manuscripts we can examine the role and the reception of the new sciences applied to healing arts.

Integration of olfactory information in a spatial representation enabling accurate arm choice in the radial arm maze

The aim of the present study was to determine whether and how rats can use local olfactory cues for spatial orientation. Rats were trained in an eight-arm radial maze under different conditions as defined by the presence or absence of supplementary olfactory cues marking each arm, the availability of distant visuospatial information, and the illumination of the maze (light or darkness). The different visual conditions were designed to dissociate among the effects of light per se and those of visuospatial cues, on the use of olfactory cues for accurate arm choice. Different procedures with modifications of the arrangement of olfactory cues were used to determine if rats formed a representation of the spatial configuration of the olfactory cues and if they could rely on such a representation for accurate arm choice in the radial maze. The present study demonstrated that the use of olfactory cues to direct arm choice in the radial arm maze was critically dependent on the illumination conditions and implied two different modes of processing of olfactory information according to the presence or the absence of light. Olfactory cues were used in an explicit manner and enabled accurate arm choice only in the absence of light. Rats, however, had an implicit memory of the location of the olfactory cues and formed a representation of the spatial position of these cues, whatever the lighting conditions. They did not memorize the spatial configuration of the olfactory cues per se but needed these cues to be linked to the external spatial frame of reference.

Anti-Nogo-A Antibody Treatment Promotes Recovery of Manual Dexterity after Unilateral Cervical Lesion in Adult Primates--re-examination and Extension of Behavioral Data.

In rodents and nonhuman primates subjected to spinal cord lesion, neutralizing the neurite growth inhibitor Nogo-A has been shown to promote regenerative axonal sprouting and functional recovery. The goal of the present report was to re-examine the data on the recovery of the primate manual dexterity using refined behavioral analyses and further statistical assessments, representing secondary outcome measures from the same manual dexterity test. Thirteen adult monkeys were studied; seven received an anti-Nogo-A antibody whereas a control antibody was infused into the other monkeys. Monkeys were trained to perform the modified Brinkman board task requiring opposition of index finger and thumb to grasp food pellets placed in vertically and horizontally oriented slots. Two parameters were quantified before and following spinal cord injury: (i) the standard 'score' as defined by the number of pellets retrieved within 30 s from the two types of slots; (ii) the newly introduced 'contact time' as defined by the duration of digit contact with the food pellet before successful retrieval. After lesion the hand was severely impaired in all monkeys; this was followed by progressive functional recovery. Remarkably, anti-Nogo-A antibody-treated monkeys recovered faster and significantly better than control antibody-treated monkeys, considering both the score for vertical and horizontal slots (Mann-Whitney test: P = 0.05 and 0.035, respectively) and the contact time (P = 0.008 and 0.005, respectively). Detailed analysis of the lesions excluded the possibility that this conclusion may have been caused by differences in lesion properties between the two groups of monkeys.

Status of eye lens radiation dose monitoring in European hospitals.

A questionnaire was developed by the members of WG12 of EURADOS in order to establish an overview of the current status of eye lens radiation dose monitoring in hospitals. The questionnaire was sent to medical physicists and radiation protection officers in hospitals across Europe. Specific topics were addressed in the questionnaire such as: knowledge of the proposed eye lens dose limit; monitoring and dosimetry issues; training and radiation protection measures. The results of the survey highlighted that the new eye lens dose limit can be exceeded in interventional radiology procedures and that eye lens protection is crucial. Personnel should be properly trained in how to use protective equipment in order to keep eye lens doses as low as reasonably achievable. Finally, the results also highlighted the need to improve the design of eye dosemeters in order to ensure satisfactory use by workers.

Oxygen uptake kinetics and middle distance swimming performance.

OBJECTIVE: The aim of this study was to determine whether V˙O(2) kinetics and specifically, the time constant of transitions from rest to heavy (τ(p)H) and severe (τ(p)S) exercise intensities, are related to middle distance swimming performance. DESIGN: Fourteen highly trained male swimmers (mean ± SD: 20.5 ± 3.0 yr; 75.4 ± 12.4 kg; 1.80 ± 0.07 m) performed an discontinuous incremental test, as well as square wave transitions for heavy and severe swimming intensities, to determine V˙O(2) kinetics parameters using two exponential functions. METHODS: All the tests involved front-crawl swimming with breath-by-breath analysis using the Aquatrainer swimming snorkel. Endurance performance was recorded as the time taken to complete a 400 m freestyle swim within an official competition (T400), one month from the date of the other tests. RESULTS: T400 (Mean ± SD) (251.4 ± 12.4 s) was significantly correlated with τ(p)H (15.8 ± 4.8s; r=0.62; p=0.02) and τ(p)S (15.8 ± 4.7s; r=0.61; p=0.02). The best single predictor of 400 m freestyle time, out of the variables that were assessed, was the velocity at V˙O(2max)vV˙O(2max), which accounted for 80% of the variation in performance between swimmers. However, τ(p)H and V˙O(2max) were also found to influence the prediction of T400 when they were included in a regression model that involved respiratory parameters only. CONCLUSIONS: Faster kinetics during the primary phase of the V˙O(2) response is associated with better performance during middle-distance swimming. However, vV˙O(2max) appears to be a better predictor of T400.

Usefulness of methadone plasma concentration measurement in patients receiving nevirapine or efavirenz.

Objective: To determine methadone plasma trough and peak concentrations in patients presenting opiate withdrawal symptoms after introduction of nevirapine or efavirenz. To describe the disappearance of these symptoms after methadone titration based on plasma concentrations rather than on the symptoms. Methods: Nine patients undergoing highly active antiretroviral therapy (HAART) and either nevirapine or efavirenz treatment were monitored daily for opiate withdrawal in a specialized drug addiction center. Methadone dose was titrated daily, and plasma concentrations were measured. The data are retrospective (case series). Results: Several patients complained of symptoms such as nausea, vomiting, accelerated intestinal transit, or insomnia. Even after methadone titration based on clinical symptoms, patients and health-care providers trained in infectious disease did not classify these as withdrawal symptoms and considered them as the side effects of HAART or anxiety. Methadone plasma trough concentration showed low levels of (R)- and (R,S)-methadone. Further methadone dose adjustment according to plasma level resulted in the disappearance of these withdrawal symptoms. The daily methadone dose was split when the peak/trough (R)-methadone ratio was more than 2. Conclusions: When introducing efavirenz or nevirapine to patients undergoing methadone treatment, withdrawal symptoms should be monitored, especially those such as insomnia, vomiting, or nausea. Methadone plasma trough and peak measurements can be of value in preventing unnecessary side effects of HAART.

Multisensory facilitation of behavior in monkeys: effects of stimulus intensity.

Multisensory stimuli can improve performance, facilitating RTs on sensorimotor tasks. This benefit is referred to as the redundant signals effect (RSE) and can exceed predictions on the basis of probability summation, indicative of integrative processes. Although an RSE exceeding probability summation has been repeatedly observed in humans and nonprimate animals, there are scant and inconsistent data from nonhuman primates performing similar protocols. Rather, existing paradigms have instead focused on saccadic eye movements. Moreover, the extant results in monkeys leave unresolved how stimulus synchronicity and intensity impact performance. Two trained monkeys performed a simple detection task involving arm movements to auditory, visual, or synchronous auditory-visual multisensory pairs. RSEs in excess of predictions on the basis of probability summation were observed and thus forcibly follow from neural response interactions. Parametric variation of auditory stimulus intensity revealed that in both animals, RT facilitation was limited to situations where the auditory stimulus intensity was below or up to 20 dB above perceptual threshold, despite the visual stimulus always being suprathreshold. No RT facilitation or even behavioral costs were obtained with auditory intensities 30-40 dB above threshold. The present study demonstrates the feasibility and the suitability of behaving monkeys for investigating links between psychophysical and neurophysiologic instantiations of multisensory interactions.

Enhanced visuospatial memory following intracerebroventricular administration of nerve growth factor

The present work assessed the effects of intracerebroventricular injections of rh recombined human nerve growth factor (rh NGF) (5 micrograms/2.5 microl) at postnatal days 12 and 13 upon the development of spatial learning capacities. The treated rats were trained at the age of 22 days to escape onto an invisible platform at a fixed position in space in a Morris navigation task. For half of the subjects, the training position was also cued, a procedure aimed at facilitating escape and at reducing attention to the distant spatial cues. Later, at the age of 6 months, all the rats were trained in a radial-arm maze task. Treatment effects were found in both immature and adult rats. The injection of NGF improved the performance in the Morris navigation task in both training conditions. There was a significant reduction in the escape latency and an increased bias toward the training platform quadrant during probe trials. The most consistent effect was the precocious development of an adult-like spatial memory. In the radial-arm maze, the NGF-treated rats made significantly fewer reentries than vehicle rats and this effect was particularly marked in the treated female rats. Taken together, these experiments reveal that the development and the maintenance of an accurate spatial representation are tightly related to the development of brain structures facilitated by the action of NGF. Moreover, these experiments demonstrate that an acute pharmacological treatment that leads to a transient modification in the choline acetyltransferase activity can induce a behavioral change long after the treatment.

Patterns of alcohol use and related issues: analysis of nurses' knowledge


Descriptive study that aimed to identify and compare the nurses’ knowledge addressed to patterns of alcohol use and related issues. The study included 185 nurses of which 84 had attended a training course on the subject. Data were collected through a questionnaire of knowledge showing that while the trained group obtained the highest average on correct answers, there was a lack of knowledge in both groups, especially with regard to the identification of complications from alcohol use. Important definitions to nursing practice in the area of addictions are presented, suggesting that future training may consider the various dimensions involved in caring for people with problems related to alcohol.


Lessons learned from developing a national NCD programme in low- and middle-income countries (Seychelles)

This paper identifies selected issues and lessons learned from the implementation of a national program of prevention and control of non-communicable diseases (NCD) during the past 20 years in the Seychelles, a small island state in the African region. As early as in 1989, population-based surveys demonstrated high levels of several cardiovascular risk factors, which prompted an organized response by the government. The early creation of a NCD unit within the Ministry of Health, coupled with cooperation with international partners, enabled incremental capacity building and coherent development of NCD programs and policy. Information campaigns and screening for hypertension and diabetes in work/public places raised awareness and rallied increasingly broad awareness and support to NCD prevention and control. A variety of interventions were organized for tobacco control and comprehensive tobacco control legislation was enacted in 2009 (including total bans on tobacco advertising and on smoking in all enclosed public and work places). A recent School Nutrition Policy prohibits the sale of soft drinks in schools. At primary health care level, guidelines were developed for the management of hypertension and diabetes (these conditions are managed in all health centers within a national health system); regular interactive education sessions were organized for groups of high risk patients ("heart health club"); and specialized "NCD nurses" were trained. Decreasing prevalence of smoking is evidence of success, but the raising "diabesity epidemic" calls for strengthened health care to high-risk patients and broader multisectoral policy to mould an environment conducive to healthy behaviors. Key components of NCD prevention and control in Seychelles include effective surveillance mechanisms supplemented by focused research; generating broad interest and consensus on the need for prevention and control of NCD; mobilizing leadership and commitment at all levels; involving local and international expertise; building on existing efforts; and seeking integrated, multi-disciplinary and multisectoral approaches.

Análise de Crédito e Avaliação de Riscos em Instituições Bancárias

É indubitável que o sistema financeiro é parte integrante de qualquer sociedade. Através da sua função de intermediação, as instituições financeiras recebem recursos dos agentes superavitários e emprestam aos agentes deficitários mediante promessa de pagamento futuro. Num banco, que tem intermediação financeira como sua principal actividade, o crédito consiste em disponibilizar ao cliente recursos em valores sob a forma de financiamento e ou empréstimo mediante uma promessa de pagamento numa data acordada entre as partes. A discussão e implementação dos acordos de BASILEIA, nomeadamente o Basileia II, veio dar uma nova forma a esse relacionamento sector bancário/clientes determinando as regras no que respeita a concessão de crédito e gestão de risco, estabelecendo os limites de crédito associado ao grau de risco das operações. Surge então, por parte das instituições uma maior preocupação em gerir o crédito e os riscos inerentes a cada operação, apostando em ferramentas e metodologias adequadas ao processo creditício. As instituições bancárias passam a criar departamentos de risco, colocando a gestão de crédito e de risco nas mãos de profissionais especializados, agindo sob regras e padrões internacionais uniformizados. There is no doubt that the financial system is an integral part of any society. Through their intermediary role, financial institutions receive funds from surplus agents and lend to deficit agents, with promises of future payment. Banks, with their primary activity being the financial intermediation, the credit is provided to customers in the form of funding or loans and a promise of payment on a date agreed between the parties. The discussion and implementation of the Basel Accord, Basel II in particular, has given a new form to that relationship banking/customer, setting out the rules regarding the granting of credit and risk management, establishing credit limits associated with the degree of risk of operations. Banking institutions got more and more concerned with credit and risk management, in all of their operations, using tools and methodologies that are designed to meet the needs of crediting processes. Banking institutions are creating departments of risk, putting the management of credit risk in the hands of trained professionals, acting under internationally uniform rules and standards

Processos de Reconhecimento, Mensuração e Contabilização do Rédito

O reconhecimento e mensuração do rédito tornaram-se cada vez mais complexos devido a factores como a concorrência internacional e a rápida evolução dos modelos empresariais. O rédito é a componente do rendimento proveniente da actividade operacional da empresa, daí ser de suprema importância determinar-se o momento em que o mesmo deve ser reconhecido bem como os critérios adequados para mensurá-lo. Neste trabalho debruçamo-nos sobre os processos de reconhecimento e mensuração do rédito. Este trabalho foi elaborado em duas partes, na primeira, efectuou-se uma revisão às normas de referência ao tratamento do rédito, com o objectivo de esclarecer algumas questões que suscitam grandes dúvidas, quer no meio académico, quer no meio profissional como é o exemplo do tratamento a dar ao rédito proveniente dos contratos de construção de imóveis numa empresa do ramo imobiliário. Na segunda parte do trabalho, elaborou-se um estudo de caso sobre a empresa TECNICIL Imobiliária, precisamente para verificar na prática o tratamento dado ao rédito proveniente dos acordos de construção levados a cabo por esta entidade. E desse estudo podemos concluir que a entidade não observa o tratamento prescrito pelas normas de referência, particularmente a IFRIC 15 – Acordos para Construção de Imóveis e IAS 18 – Rédito. There is no doubt that the financial system is an integral part of any society. Through their intermediary role, financial institutions receive funds from surplus agents and lend to deficit agents, with promises of future payment. Banks, with their primary activity being the financial intermediation, the credit is provided to customers in the form of funding or loans and a promise of payment on a date agreed between the parties. The discussion and implementation of the Basel Accord, Basel II in particular, has given a new form to that relationship banking/customer, setting out the rules regarding the granting of credit and risk management, establishing credit limits associated with the degree of risk of operations. Banking institutions got more and more concerned with credit and risk management, in all of their operations, using tools and methodologies that are designed to meet the needs of crediting processes. Banking institutions are creating departments of risk, putting the management of credit risk in the hands of trained professionals, acting under internationally uniform rules and standards.

Functional independence measure in patients with intermittent claudication

AbstractOBJECTIVEOf this study were to evaluate the functional independence of patients with intermittent claudication and to verify its association with sociodemographic and clinical variables, walking ability and physical activity level.METHODThis was a descriptive, exploratory, cross-sectional study with a quantitative approach. Fifty participants (66.4 years; 68% male) were recruited from Claudication Unit of a tertiary hospital. Functional Independence Measure were used to evaluate functional incapacity; the Baltimore Activity Scale, to estimate the physical activity level and the Walking Impairement Questionnaire, the walking ability.RESULTSParticipants had complete functional independence (124.8 + 2.0), low levels of physical activity (4.2 + 2.0), and impairment of walking ability; the worst performance was found in walking velocity domain (21.2 + 16.4). The functional independence score was associated with physical activity (r=0,402) and walking ability scores (distance, r=0,485; speed, r=0,463; stairs, r=0,337).CONCLUSIONIn conclusion, the level of functionality is associated with functional capacity in these patients.