Correlação da Variação dos Níveis de NT-ProBNP com a Modificação da Capacidade Funcional em Doentes com Insuficiência Cardíaca Crónica

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.

An efficient numerical scheme for solving multi-dimensional fractional optimal control problems with a quadratic performance index

The shifted Legendre orthogonal polynomials are used for the numerical solution of a new formulation for the multi-dimensional fractional optimal control problem (M-DFOCP) with a quadratic performance index. The fractional derivatives are described in the Caputo sense. The Lagrange multiplier method for the constrained extremum and the operational matrix of fractional integrals are used together with the help of the properties of the shifted Legendre orthonormal polynomials. The method reduces the M-DFOCP to a simpler problem that consists of solving a system of algebraic equations. For confirming the efficiency and accuracy of the proposed scheme, some test problems are implemented with their approximate solutions.

Importância da Avaliação Funcional Respiratória em Idade Precoce

As provas de função respiratória são instrumentos de quantificação objectiva do compromisso pulmonar utilizadas na confirmação diagnóstica, monitorização após terapêutica e avaliação do prognóstico de diversas patologias. Tem sido possível nos últimos anos a sua aplicação em crianças mais jovens, com benefícios evidentes, pela possibilidade de atempadamente monitorizar e alterar o curso natural de certas doenças. As provas de função respiratória no lactente e em idade pré-escolar revestem-se de particularidades metodológicas, tendo ocorrido recentemente um grande interesse da comunidade científica neste âmbito, com grandes progressos nesta área. Pretende-se no presente artigo enumerar as técnicas de função respiratória disponíveis em idade precoce, explicitando a sua fundamentação teórica, metodologia e aplicabilidade. Será dado particular destaque às técnicas mais inovadoras aplicadas no lactente – técnicas de compressão torácica rápida em volume corrente e volume aumentado, bem como em idade pré-escolar – pletismografia sem oclusão e espirometria animada. Embora as provas funcionais do lactente permaneçam no domínio da investigação, pela sua controversa aplicabilidade individual, as provas de função respiratória em idade pré-escolar são muito promissoras para o futuro.

PCR - based diagnosis to evaluate the performance of malaria reference centers

Although the Giemsa-stained thick blood smear (GTS) remains the gold standard for the diagnosis of malaria, molecular methods are more sensitive and specific to detect parasites and can be used at reference centers to evaluate the performance of microscopy. The description of the Plasmodium falciparum, P. vivax, P. malariae and P. ovale ssrRNA gene sequences allowed the development of a polymerase chain reaction (PCR) that had been used to differentiate the four species. The objective of this study was to determine Plasmodium species through PCR in 190 positive smears from patients in order to verify the quality of diagnosis at SUCEN's Malaria Laboratory. Considering only the 131 positive results in both techniques, GTS detected 4.6% of mixed and 3.1% of P. malariae infections whereas PCR identified 19.1% and 13.8%, respectively.

Performance Model for MRC Receivers with Adaptive Modulation and Coding in Rayleigh Fading Correlated Channels with Imperfect CSIT

RTUWO Advances in Wireless and Optical Communications 2015 (RTUWO 2015). 5-6 Nov Riga, Latvia.

A competing values framework approach on growth and performance in micro firms

This study aims to analyze and compare four micro-firms' organizational culture, evaluated through the Competing Values Framework (Quinn & Rohbaugh, 1983). Data was collected in 2011 and 2013 in firms selling the same type of software and providing the same kind of services, focusing on the years between 2008-2011. Findings point to somewhat different results of micro-firms, when comparing to other samples in the literature. Suggestions for future research are given.

Influence of entrepreneurial orientation in export performance

This study aims at investigating the influence that entrepreneurial orientation has on export performance of Portuguese footwear small and mediumenterprises (SMEs). Therefore, a quantitative methodological approach was used, conducting a descriptive, exploratory and transversal empirical study, having applied a questionnaire to a sample of Portuguese companies exporting footwear. The research results suggest that entrepreneurial orientation enhances export performance in the analysed SMEs, particularly innovation and proactiveness, through the amount of funds invested, human resources dedicated to this activity, number of new products or services introduced in the market and frequent change in product lines or services and materialization of a long-term perspective, which is accompanied by innovative activities or new businesses. Therefore, the findings sustain the necessity to invest in entrepreneurial orientation as a strategic determinant, which contributes to the growth of small firms in foreignmarkets. Finally, the main limitation of this study is related to the sample size, since it was difficult to find companies willing to collaborate with this kind of research.

Chaotic Phenomena and Performance Optimization in the Trajectory Control of Redundant Manipulators

Redundant manipulators have some advantages when compared with classical arms because they allow the trajectory optimization, both on the free space and on the presence of abstacles, and the resolution of singularities. For this type of manipulators, several kinetic algorithms adopt generalized inverse matrices. In this line of thought, the generalized inverse control scheme is tested through several experiments that reveal the difficulties that often arise. Motivated by theseproblems this paper presents a new method that ptimizes the manipulability through a least squre polynomialapproximation to determine the joints positions. Moreover, the article studies influence on the dynamics, when controlling redundant and hyper-redundant manipulators. The experiment confirm the superior performance of the proposed algorithm for redundant and hyper-redundant manipulators, revealing several fundamental properties of the chaotic phenomena, and gives a deeper insight towards the future development of superior trajectory control algorithms.

Performance Issues in Biped Walking Robots

This paper presents the dynamic analysis of robotic biped systems. The main goal is to gain insight into the phenomena of walking and to evaluate its performance. In this study, we propose three methods to quantitatively measure the dynamic efficiency of walking: energy analysis, perturbation analysis and lowpass frequency analysis. In order to accomplish this goal, the prescribed motion of the biped is completely characterised in terms of a set of locomotion variables, namely: step lenght, hip height, hip ripple, hip offset, foot clearance and link lenghts. based on these variables and their influence, the performance measures aer discussed and the results compared with those observed in nature.

Avaliação da Performance Cirúrgica: Como Fazer?

Assessment of surgical performance is a must for every surgical practice nowadays and can be done by using scientific methods imported mostly from the Quality control tools that have been in use for long in industry. Surgical performance comprises several dimensions including clinical activity (mortality and morbidity as end points), academic activities, research and, more and more, efficiency. Stable long time results (efficacy), reducing error (safety) and meeting patient expectations (patient satisfaction) are among other performance components. This paper focus on the precise definitions of mortality and morbidity related to surgical activities and on the tools to evaluate patient complexity and assess pre operative risk. Some graphic representations are suggested to compare performance profiles of surgeons and to define individual performance profiles. Strong emphasis is put on pre operative risk assessment and its crucial role to interpret divergent surgical results. Where risk assessment is not possible or is unavailable, observed / expected ratios (O/E) for a given endpoint , be it mortality, length of stay or morbidity, must be established and routinely used to refer results and to identify performance outliers. Morbidity is being pointed out as a most valuable performance indicator in surgery because it is sensitive and comprises efficiency, safety and quality, at large.

A importância da análise económico-financeira na performance empresarial: relatório de estágio na empresa Prime Century, Lda

Com o acentuar da crise financeira (que se traduziu numa situação de recessão económica a nível mundial com efeitos consideráveis na economia portuguesa), cada empresa tem ainda mais em atenção a sua performance, como maximizar o seu valor, e talvez ainda mais importante nos dias que correm, como minimizar o risco de falência. Para tal, os gestores têm de ter em consideração todos os aspetos relevantes e que possam interferir com o sucesso do seu negócio. Nesse sentido, devem ter em seu poder o mais alargado leque de informação possível, para tomarem as decisões corretas tanto a curto como a médio longo prazo. A informação disponibilizada pela análise económico-financeira torna-se então um importante instrumento para a tomada de decisão embora não poderá ser apenas o único instrumento utilizado pelos decisores. Com o presente relatório de estágio pretende-se aferir da importância da análise económico-financeira na performance das empresas, tendo em consideração o estágio realizado na empresa Prime Century, Lda. Para além da já referida análise económico-financeira, iremos abordar, na sequência do trabalho desenvolvido durante o estágio, a criação de planos de negócios e a avaliação de empresas.

Unidade Coordenadora Funcional da Maternidade Dr. Alfredo da Costa. Alguns Números

A Maternidade Dr. Alfredo da Costa mantém uma interacção com os Centros de Saúde da sua área de referência e que constituem a Unidade Coordenadora Funcional. São analisados alguns aspectos do movimento assistencial no ano de 2003, no que diz respeito a alguns dados perinatais, idade materna, tipo de parto, patologia da gravidez e dos recém-nascidos. É também analisada a mortalidade perinatal na componente fetal e neonatal. Conclui-se da importância que esta análise pode ter na definição de estratégias para melhoria da qualidade.