Otimização da anisotropia fronto-calosa e ressonância magnética [1,5T] no idoso normal e com risco cérebro-vascular

RESUMO: Os mais recentes métodos de neuro imagem tal como a Ressonância Magnética (RM) permitiram obter imagens detalhadas do cérebro humano in vivo. Essas imagens revelam, muitas vezes, achados imprevistos face ao padrão normal, com elevada propensão para os indivíduos idosos e franca coexistência com fatores de risco vascular, como característica dum processo de envelhecimento normal. Embora na última década tenham surgido várias publicações sobre este assunto, ele continua ainda pouco explicado. Um pouco por todo o mundo têm emergido os programas de prevenção da doença e promoção da saúde desenvolvidos pela Saúde Pública suportadas sobretudo pelo avanço das tecnologias médicas que resultaram, entre outros impactos, num crescimento da população idosa. Estima-se, em 2030, uma composição demográfica com 20% de indivíduos acima dos 65 anos. Neste contexto, a doença microvascular cerebral é a causa mais frequente de comprometimento cognitivo vascular no idoso sendo as características senescentes na imagem por RM do tipo lesões isquémicas da Substância Branca (Leukoaraiosis) e enfartes lacunares (Status lacunar), atrofia cerebral, gliose e acumulação excessiva de ferro nos núcleos da base. Esta tese, considerando a linha de investigação de que deriva – Ciências da Vida - especialização em Medicina Clinica - Biotecnologia, reúne e reflete sobre três vertentes ligadas à RM e interdependentes em relação a uma problemática comum. A primeira trata da caracterização da Tecnologia por Ressonância Magnética existente em Portugal, a qual inclui uma avaliação exploratória da aplicação da técnica de Difusão Anisotrópica nos estudos cerebrais. As dimensões analíticas estudadas foram a Tecnológica, Sociodemográfica e Económica. Na recolha de dados recorreu-se a várias fontes de informação e a uma metodologia exploratória faseada, validada pela triangulação dos resultados. A sua análise obedeceu a critérios de estratificação e agrupamento segundo as mesmas dimensões analíticas. Otimização da anisotropia fronto-calosa e [RM 1,5T] no idoso normal e com risco cérebro-vascular A segunda descreve o estudo anátomo – radiológico que recaiu sobre parâmetros de quantificação assente na temática do cérebro do idoso em cadáver segundo uma metodologia experimental aplicada às métricas da difusão por RM. Na terceira, e última, é apresentado o estudo técnico - radiológico para avaliação e otimização da imagem ponderada em difusão em estudos clínicos associados ao cérebro do idoso “The Usual Brain Aging” ou Envelhecimento Cerebral Normal, com base metodológica assente nos critérios e indicadores estabelecidos pelo Estudo de Imagem de Roterdão (Rotterdam Scan Study - RSS). Como principais resultados obteve-se que não existem em Portugal estruturas para avaliação dos equipamentos pesados ou Agência de Avaliação das Tecnologias da Saúde para desenvolver o importante papel da produção de estudos comparativos entre os equipamentos disponíveis no mercado, a relação preço-qualidade e a sua afetação às necessidades clínico-epidemiológicas. Constatou-se que a implementação de equipamentos de RM está fortemente assente em critérios económicos carecendo de recomendações e diretivas para o uso racionalizado destas tecnologias. Quanto a dados quantitativos concluímos que a maioria dos equipamentos está instalada em instituições privadas (80,2%); a intensidade de campo magnético mais frequente é [1,5T] com 119 equipamentos; os equipamentos estão instalados maioritariamente nos distritos de Lisboa (55 unidades) e do Porto (39 unidades); o rácio médio de equipamentos por habitante em Portugal é de 1 para 65 195 habitantes; a amplitude de gradientes com maior expressão na amostra é 30-39mT/m; a maioria dos equipamentos foi instalada no intervalo temporal [2009-2012] com 59 equipamentos; apenas 6 instituições desenvolvem investigação clinica e a maioria das bobinas para estudos de crânio são do tipo Array. O estudo de otimização da técnica da difusão revelou, quanto à avaliação dos valoresb, que os mais baixos (b=500 s/mm2 e b=1000 s/mm2), apresentam maior IS e SNR sendo esta uma boa medida referente à qualidade de imagem, no entanto, os valores-b mais elevados (b=2000 s/mm2) apresentam maior CNR e CR, face aos anteriores, o Otimização da anisotropia fronto-calosa e [RM 1,5T] no idoso normal e com risco cérebro-vascular que apesar de proporcionar inferior detalhe anatómico e consequentemente inferior qualidade de imagem, num encéfalo normal, pode auxiliar na interpretação e apresentar vantagens na identificação de lesões microvasculares sempre que persistirem dúvidas em relação ao diagnóstico diferencial de doença microvascular do tipo status lacunar ou Hiperintensidades da Substância Branca. As alterações deste parâmetro são particularmente refletidas nas diferenças da avaliação da qualidade de imagem na região fronto-calos Concluímos da avaliação quantitativa da concentração média de ferro (26Fe) em todas as faixas etárias que os núcleos da base que apresentam maior concentração são, por ordem decrescente: Substância Nigra, Globus Pallidus, Putamen, Tálamo, Núcleo Rubro e Núcleo Caudado; que existe uma predominância na concentração de ferro (26Fe) no hemisfério esquerdo e que os indivíduos do género masculino apresentam mais ferro (26Fe) que os do género feminino nas faixas etárias [30-40[, [40-50[ e [50-60[. Como principal conclusão do estudo da concentração média de ferro em relação à idade destacamos que a concentração média de ferro (26Fe) é superior nos grupos etários superiores, logo aumenta com a idade, sobretudo na Substância Nigra e no Núcleo Lenticular. No estudo técnico-radiológico encontrámos evidências do aumento da difusibilidade da água na substância branca subcortical dos sujeitos idosos comparativamente aos mais jovens. Uma relação idêntica foi avaliada nos tálamos. O aumento relacionado com a idade parece ser predominantemente observado em doentes com mais de 65 anos de idade o que pode refletir alterações estruturais ligeiras associados ao envelhecimento normal. Os resultados indicam que a análise quantitativa das imagens ponderadas em difusão fornece informações, sobre a estrutura do cérebro, as quai s não estão disponíveis apenas por inspeção visual, tanto nas imagens ponderadas em difusão como em outras sequências de aplicação clínica de rotina. Para fazer face às desvantagens dos sistemas de quantificação das HSB os quais são dispendiosos, complexos, requererem tecnologia e formação específicas, recomendamos que a aplicação automatizada GUIAL, desenvolvida ao longo do nosso trabalho é de utilização elementar e prática para que seja introduzida nos sistemas de aquisição de imagem por RM com o fim de integrar o processamento de imagem nos indivíduos portadores de fatores de risco vascular. A avaliação do ADC, nesta amostra, permitiu concluir que a variação desta variável é explicada estatisticamente pela existência da condição clínica de status lacunar em ambos os hemisférios ou por outras palavras, o status lacunar influencia o valor de ADC. Embora uma pequena percentagem da variação do ADC seja explicada pelo género, o ADC nos homens foi superior ao das mulheres o que não nos surpreende, pois são também os homens onde a frequência de doença microvascular se revelou mais expressiva. Os valores do ADC, globalmente, entre os hemisférios cerebrais não mostraram alterações exceto na SB entre os idosos e não idosos. A SB da região frontal mostrou valores diminuídos na anisotropia e isotropia face às restantes áreas anatómicas. Os estudos indicam que na idade avançada existe uma maior predisposição para suscetibilidades de estrutura com status de desconexão. A classificação das HSB foi superior em indivíduos mais velhos e com status lacunar, e em menor quantidade (inferior rating de classificação) nos indivíduos idosos sem status lacunar. As alterações volumétricas foram mais frequentes no homem do que na mulher, presumivelmente devido à associação com a elevada classificação de status lacunar. Um aumento do índice de Evan correspondeu, neste estudo, ao aumento das HSB, à diminuição do volume cerebral total, à expansão ventrículo-sulcal frontal e ao aumento da medida do ângulo caloso. Estes resultados foram agravados pela classificação elevada de status lacunar nos indivíduos que apresentaram indícios de doença de pequenos vasos, com manifesto aumento dos espaços de Virchow-Robin,enfartes lacunares ou HSB. Esses resultados foram mais expressivos no género masculino do que no feminino revelando uma maior vulnerabilidade sobretudo na atrofia frontal nos homens. Por sua vez as dimensões do Corpo Caloso tornaram-se reduzidas devido à compressão dos ventrículos laterais e terceiro ventrículo. Estes indicadores tiveram expressão particularmente nos indivíduos com mais de 65 anos. ---------------------------------------------------------------------------------------------ABSTRACT: The latest neuroimaging methods, such as Magnetic Resonance Imaging (MRI), have enabled detailed images of in vivo human brain. These images reveal often unexpected findings related to the normal pattern, with high predisposition for the elderly people with forthright coexistence with vascular risk factors such as characteristics of a normal aging process. Although it has been, in the last decade, several publications on this subject, it is still little explained. All over the world have emerged disease prevention programs and health promotion developed by the Public Health sector, supported mainly by the advancement of medical technologies that have resulted, among other impacts, in a growing of the elderly population. It is estimated, in 2030, a demographic composition with 20% o people over 65 years. In this context, microvascular disease is the most common cause of cognitive vascular impairment in the elderly and senescent characteristics in the MRI trough ischemic lesions of the white matter (Leukoaraiosis) and lacunar infarcts (lacunar status), cerebral atrophy, gliosis and iron accumulation in the basal ganglia in excess.This thesis, considering the research line that stems - Life Sciences - specialization in Clinical Medicine, Biotechnology, gathers and reflects on three aspects linked to MR, interdependent and related to a common problem. The first deals with the Magnetic Resonance Technology characterization in Portugal, which includes an exploratory evaluation of the implementation of Anisotropic Diffusion technique in brain studies. The analytical dimensions studied were the Technologic, Socio-demographic and Economics. Collecting data was supported by different sources of information and was applied an exploratory methodology whose results were validated by triangulation. The research method was grouped and stratified criteria under the same analytical dimensions. The second describes the anatomical study - which was focused on radiological measurement parameters, based on the brain’s specimen under an experimental methodology applied to MRI diffusion metrics. Radiological evaluation and optimization of the weighted image diffusion in clinical studies were associated with the brain of the elderly "The Usual Brain Aging" with methodological basis based on established criteria and indicators by Rotterdam Scan Study (RSS). The main results obtained reveal the inexistence frameworks in Portugal for evaluation of equipments or Agency of Health Technology to produce studies comparing the equipment available on the market, the value for money and its allocation to clinical and epidemiological needs. It was found that the implementation of MRI equipment is strongly based on economic criteria lacking recommendations and guidelines for the rationalized use of these technologies. As the quantitative data we conclude that most of the scanners are located in private clinical institutions (80,2%); the most frequent magnetic field intensity is [1.5T] with 119 scanners; the scanners are mainly installed in Lisbon (55 units) and Porto (39 units) districts; the average ratio of equipment per capita in Portugal is 1 to 65 195 people; the gradient power with higher expression in the sample is 30-39mT / m;most of the scanners were installed in the years range [2009-2012 years] with 59 equipment; only 6 clinical placements develop clinical research and the most coils for brain studies are of Array type. The optimization study of diffusion technique revealed, as the assessment of the bvalues, the lower (b = 500 s / mm2 and b = 1000 s / mm 2), promotes an increase in the SI and SNR being this measure related to a higher image quality, however the highest b values (b = 2000 s / mm 2) have a higher CNR (Contrast to Noise-Ratio) and CR (Contrast Ratio), compared to the previous ones. This may provide less anatomical details and, thus, ower image quality, of a normal brain, however can help the interpretation and have advantages in identifying microvascular injuries when doubts persist regarding the differential diagnosis of microvascular disease of lacunar or WMH (White Matter Hyperintensities) status type. Changes on this parameter are Otimização da anisotropia fronto-calosa e [RM 1,5T] no idoso normal e com risco cérebro-vascular particularly reflected in the differences of image quality evaluation in the frontocallosum anatomical area. We conclude from the quantitative assessment of the average concentration of iron (26Fe), in all age groups to the basal ganglia, that the higher concentrations are, in descending order: Nigral Substantia, Globus pallidus, Putamen, Thalamus, Rubio nucleus and Caudate nucleus; that there is a predominance in the concentration of iron (26Fe) in the left hemisphere and that male gender show higher iron (26Fe) level tha females, in the age groups [30-40 [[40-50 [and [50- 60 [. Regarding a main conclusion of the mean concentration study of iron, in terms of age we point out that the average concentration of iron (26Fe) is higher among older groups and increases with age, especially in Nigral Substantia and Lenticular Nucleus. On the technical and radiological study we found evidence of an increased in water /diffusivity in the ubcortical white matter of the elderly compared with younger subjects. A similar relationship was assessed in the Thalamus. The increase agerelated seems to be predominantly observed in patients over 65 years which may reflect minor structural changes associated with normal aging. The results indicate that quantitative analysis of diffusion weighted imaging can provide information about the structure of the brain which is not reached only by visual inspection or standard sequences applied in clinical routine. To address the disadvantages the systems of quantification of WMH which the authors state that are costly, complex, require specific technology and training, we recommend that the automated application GUIAL, developed over our work is basic and practical to use and to be introduced in MR image systems acquisition in order to integrate image processing in patients with vascular risk factors. The evaluation of the ADC showed that its variation is statistically explained by the existence of the medical condition of lacunar status, in both hemispheres, or in other words, the lacunar status influences the ADC value. Although a small percentage of the ADC variation is explained by gender, the ADC in men was higher than women which Otimização da anisotropia fronto-calosa e [RM 1,5T] no idoso normal e com risco cérebro-vascular do not surprise us, since they are also men where the frequency of microvasculardisease has proved more significant. The values of ADC, overall, between the cerebral hemispheres showed no changes but were different in WM among the elderly and non-elderly subjects.The WM's forehead showed decreased values in anisotropy and isotropy face the other anatomical areas. The studies indicate that in old age there is a greater tendency to higher susceptibility to disconnection- status framework. The classification of WMH was higher in elderly people and lacunar status, and fewer (lower classification rating) in the elderly without lacunar status. volumetric changes were more frequent in men than in women, most probably because of its association with high lacunar status rating. An increase of Evan index corresponded, in this study, to an increase in WMH, to a decreased of total brain volume, to a ventricle sulcal frontal and callous angle expansion. These results were wound up by high ranking of lacunar status in subjects who had small vessel disease, clear increase in spaces of Virchow-Robin, lacunar infarctions or WMH. These results were more significant in males than in females revealing vulnerability particularly in the frontal atrophy in men. In turn the size of Corpus Callosum because reduced due to the compression of the lateral and third ventricles. These indicators had expression particularly in individuals over 65 years.

What makes articles highly cited?

We examined drivers of article citations using 776 articles that were published from 1990-2012 in a broad-based and high-impact social sciences journal, The Leadership Quarterly. These articles had 1,191 unique authors having published and received in total (at the time of their most recent article published in our dataset) 16,817 articles and 284,777 citations, respectively. Our models explained 66.6% of the variance in citations and showed that quantitative, review, method, and theory articles were significantly more cited than were qualitative articles or agent-based simulations. As concerns quantitative articles, which constituted the majority of the sample, our model explained 80.3% of the variance in citations; some methods (e.g., use of SEM) and designs (e.g., meta-analysis), as well as theoretical approaches (e.g., use of transformational, charismatic, or visionary type-leadership theories) predicted higher article citations. Regarding the statistical conclusion validity of quantitative articles, articles having endogeneity threats received significantly fewer citations than did those using a more robust design or an estimation procedure that ensured correct causal estimation. We make several general recommendations on how to improve research practice and article citations.

Desafios da gestão e liderança feminina em Cabo Verde: como exercer a liderança em espaços de identidade masculina

O objectivo do presente estudo é identificar, caracterizar e entender os factores que contribuem para a eficácia da gestão e liderança da mulher cabo-verdiana num cenário de chefia de topo, em espaços caracterizados pela predominância masculina, transformando-se assim num desafio constante para as mulheres a nível mundial e em particular, para as mulheres cabo-verdianas. Foi realizada uma pesquisa bibliográfica sobre liderança e sobre género, mais especificamente, sobre o papel da mulher no contexto do trabalho. Trata-se de uma pesquisa de natureza exploratória, utilizando uma abordagem qualitativa e quantitativa. Neste sentido, foi analisado o processo da liderança feminina no contexto mundial e nacional, a evolução da sua participação nas chefias de topo, os factores que contribuem para o seu desempenho, e o que fazer para vencer os desafios e atingir a eficácia. O método de pesquisa utilizado foi a pesquisa quantitativa e qualitativa, através de aplicação de um questionário a trinta gestores de primeira linha, com o objectivo de avaliar a forma como o líder se auto percepciona, bem assim como ele é percepcionado pelo seu superior hierárquico, pelos colegas e pelos subordinados directos. As conclusões do estudo apontam para a existência de divergências entre as percepções dos líderes e dos outros membros da organização em relação à liderança exercida. Por outro lado, a questão do género parece ter pouca influência na eficácia da liderança. The aim of this paper is to identify, characterize and understand the factors that contribute to effective management and leadership of the Cape Verdean women in male dominated areas characterized by a background of top management. This scenario is characterized by a high male predominance, which represents a constant challenge for women worldwide and in particular for the Cape Verdean women. A literature search on the topics of leadership and on gender, specifically on the role of women in the work context was carried out. It is an exploratory research, using a qualitative and quantitative approach. In this sense the process of women's leadership in global and national context, the evolution of their participation in top leadership, the factors that contribute to their performance as well as how to overcome challenges and achieve efficiency were considered. The research method used was a qualitative and quantitative research through application of a questionnaire to 30 first line managers, in order to assess how the leader perceives itself, as well as, how he is perceived by his superior, colleagues and direct reports. The conclusions indicate that there are important differences between the perception of the leaders and other members of the organization in relation to the leadership exercise. On the other hand, gender seems to have little influence on leadership effectiveness.

Risk factors associated with mental health issues in adolescents: a integrative review

Objective: To identify the risk factors associated with mental health issues in adolescents. Method: An integrative review was conducted in four databases with publications from 2007 to 2013. The terms Adolescent and Mental Health were used to search adequate articles as DeCs/MeSH bases. Results: Publications were found in different journals in different fields of knowledge and the quantitative research was the most frequent. The mental health issues were categorized as individual factors; drug related factors, school factors, family factors, social factors and STDs/Aids related factors. The most addressed category was individual factors, with 23 publications. Conclusion: The integrative review allowed to point important questions to be addressed in preventive actions by the health professional, including the nurse, to create a space that works with risk conditioning factors in adolescents for mental health aggravation.


Procedures’ costs related to outpatient chemotherapy treatment of women suffering from breast cancer

To identify the direct cost of procedures related to an outpatient chemotherapy treatment for women with breast cancer. Method: This is a quantitative research, using the case study methodology, performed in an outpatient chemotherapy of a private hospital. The total cost was calculated by multiplying the time spent by professionals involved in therapeutic procedures, the unit cost of direct labor, adding to the cost of materials, drugs and solutions. For performing the calculations, we used the Brazilian currency (R$). Results: The average total cost per chemotherapy session corresponded to R$ 1,783.01 (100%), being R$ 1,671.66 (93,75%) spent with drugs, R$ 74,98 (4.21%) with materials, R$ 28.49 (1.60%) with labor and R$ 7.88 (0.44%) with solutions. Conclusion: The results may support discussions and decision making for the management of costs related to chemotherapy aimed at reducing expenses and eliminating waste without harm to the care provided. 


Narrative interviews: an important resource in qualitative research

Objetives This methodological study explain and emphasize the extent and fertility of the narrative interview in qualitative research. Methods To describe the narrative method within the qualitative research. Results The qualitative research method is characterized by addressing issues related to the singularities of the field and individuals investigated, being the narrative interviews a powerful method for use by researchers who aggregate it. They allow the deepening of research, the combination of life stories with socio-historical contexts, making the understanding of the senses that produce changes in the beliefs and values that motivate and justify the actions of possible informants. Conclusion The use of narrative is an advantageous investigative resource in qualitative research, in which the narrative is a traditional form of communication whose purpose is to serve content from which the subjective experiences can be transmitted.

Pleasure-suffering indicators of nursing work in a hemodialysis nursing service

OBJECTIVE To measure the pleasure and suffering indicators at work and relate them to the socio-demographic and employment characteristics of the nursing staff in a hemodialysis center in southern Brazil. METHOD Quantitative research, with 46 workers. We used a self-completed form with demographic and labor data and the Pleasure and Suffering Indicators at Work Scale (PSIWS). We conducted a bivariate and correlation descriptive analysis with significance levels of 5% using the Epi-Info® and PredictiveAnalytics Software programs. RESULTS Freedom of Speech was considered critical; other factors were evaluated as satisfactory. The results revealed a possible association between sociodemographic characteristics and work, and pleasure and suffering indicators. There was a correlation between the factors evaluated. CONCLUSION Despite the satisfactory evaluation, suffering is present in the studied context, expressed mainly by a lack of Freedom of Speech, with the need for interventions to prevent injury to the health of workers.

Calceology : an introduction to North Western European archaeological leather footwear (Neolithic period to c. AD 1600)

Calceology is the study of recovered archaeological leather footwear and is comprised of conservation, documentation and identification of leather shoe components and shoe styles. Recovered leather shoes are complex artefacts that present technical, stylistic and personal information about the culture and people that used them. The current method in calceological research for typology and chronology is by comparison with parallel examples, though its use poses problems by an absence of basic definitions and the lack of a taxonomic hierarchy. The research findings of the primary cutting patterns, used for making all leather footwear, are integrated with the named style method and the Goubitz notation, resulting in a combined methodology as a basis for typological organisation for recovered footwear and a chronology for named shoe styles. The history of calceological research is examined in chapter two and is accompanied by a review of methodological problems as seen in the literature. Through the examination of various documentation and research techniques used during the history of calceological studies, the reasons why a standard typology and methodology failed to develop are investigated. The variety and continual invention of a new research method for each publication of a recovered leather assemblage hindered the development of a single standard methodology. Chapter three covers the initial research with the database through which the primary cutting patterns were identified and the named styles were defined. The chronological span of each named style was established through iterative cross-site sedation and named style comparisons. The technical interpretation of the primary cutting patterns' consistent use is due to constraints imposed by the leather and the forms needed to cover the foot. Basic parts of the shoe patterns and the foot are defined, plus terms provided for identifying the key points for pattern making. Chapter four presents the seventeen primary cutting patterns and their sub-types, these are divided into three main groups: six integral soled patterns, four hybrid soled patterns and seven separately soled patterns. Descriptions of the letter codes, pattern layout, construction principle, closing seam placement and list of sub-types are included in the descriptions of each primary cutting pattern. The named shoe styles and their relative chronology are presented in chapter five. Nomenclature for the named styles is based on the find location of the first published example plus the primary cutting pattern code letter. The named styles are presented in chronological order from Prehistory through to the late 16th century. Short descriptions of the named styles are given and illustrated with examples of recovered archaeological leather footwear, reconstructions of archaeological shoes and iconographical sources. Chapter six presents documentation of recovered archaeological leather using the Goubitz notation, an inventory and description of style elements and fastening methods used for defining named shoe styles, technical information about sole/upper constructions and the consequences created by the use of lasts and sewing forms for style identification and fastening placement in relation to the instep point. The chapter concludes with further technical information about the implications for researchers about shoemaking, pattern making and reconstructive archaeology. The conclusion restates the original research question of why a group of primary cutting patterns appear to have been used consistently throughout the European archaeological record. The quantitative and qualitative results from the database show the use of these patterns but it is the properties of the leather that imposes the use of the primary cutting patterns. The combined methodology of primary pattern identification, named style and artefact registration provides a framework for calceological research.

Method for Estimating the Magnitude and Frequency of Floods at Ungaged Sites on Unregulated Rural Streams in Iowa, HR-268, 1987

This report provides techniques and procedures for estimating the probable magnitude and frequency of floods at ungaged sites on Iowa streams. Physiographic characteristics were used to define the boundaries of five hydrologic regions. Regional regression equations that relate the size of the drainage area to flood magnitude are defined for estimating peak discharges having specified recurrence intervals of 2, 5, 10, 25, 50, and 100 years. Regional regression equations are applicable to sites on streams that have drainage areas ranging from 0.04 to 5,150 square miles provided that the streams are not affected significantly by regulation upstream from the sites and that the drainage areas upstream from the sites are not mostly urban areas. Flood-frequency characteristics for the mainstems of selected rivers are presented in graphs as a function of drainage area.

Exercici terapèutic cognitiu en lesions cerebrals

Estudi experimental basat amb el mètode Perfetti realitzat per avaluar l’eficàcia i l’eficiència del tractament envers a les diferents afectacions cerebrals que pot tenir un pacient quan ha patit un AVC (Accident Vascular Cerebral). Farem un estudi quantitatiu, tenint en compte unes variables específiques que ens indicaran d’una forma molt més acurada l’evolució del pacient des de l’ inici fins a la fi del tractament. Hem de tenir en compte que al ser un estudi experimental ens podem trobar amb certes limitacions, implícites com trobar la idoneïtat de la mostra de pacients o que totes les afectacions cerebrals d’estudi siguin compatibles. Sempre tindrem en compte que no es seguirà un protocol sinó que és un tractament individualitzat i totalment personalitzat. La població en el nostre país cada cop envelleix més, per això millorar la qualitat de vida és imprescindible. El que volem és intentar que el pacient millori la seva qualitat de vida minvant la seva dependència i/o discapacitat, després de l’AVC. En conseqüència i ja que l’actual situació socioeconòmica no és favorable podrem afavorir la reducció de l’actual despesa sanitària,en aquest tipus de patologies en el nostre país.

Multi-scale systems analysis of plant development : beyond cellular signaling and tissue morphodynamics

Les plantes sont essentielles pour les sociétés humaines. Notre alimentation quotidienne, les matériaux de constructions et les sources énergétiques dérivent de la biomasse végétale. En revanche, la compréhension des multiples aspects développementaux des plantes est encore peu exploitée et représente un sujet de recherche majeur pour la science. L'émergence des technologies à haut débit pour le séquençage de génome à grande échelle ou l'imagerie de haute résolution permet à présent de produire des quantités énormes d'information. L'analyse informatique est une façon d'intégrer ces données et de réduire la complexité apparente vers une échelle d'abstraction appropriée, dont la finalité est de fournir des perspectives de recherches ciblées. Ceci représente la raison première de cette thèse. En d'autres termes, nous appliquons des méthodes descriptives et prédictives combinées à des simulations numériques afin d'apporter des solutions originales à des problèmes relatifs à la morphogénèse à l'échelle de la cellule et de l'organe. Nous nous sommes fixés parmi les objectifs principaux de cette thèse d'élucider de quelle manière l'interaction croisée des phytohormones auxine et brassinosteroïdes (BRs) détermine la croissance de la cellule dans la racine du méristème apical d'Arabidopsis thaliana, l'organisme modèle de référence pour les études moléculaires en plantes. Pour reconstruire le réseau de signalement cellulaire, nous avons extrait de la littérature les informations pertinentes concernant les relations entre les protéines impliquées dans la transduction des signaux hormonaux. Le réseau a ensuite été modélisé en utilisant un formalisme logique et qualitatif pour pallier l'absence de données quantitatives. Tout d'abord, Les résultats ont permis de confirmer que l'auxine et les BRs agissent en synergie pour contrôler la croissance de la cellule, puis, d'expliquer des observations phénotypiques paradoxales et au final, de mettre à jour une interaction clef entre deux protéines dans la maintenance du méristème de la racine. Une étude ultérieure chez la plante modèle Brachypodium dystachion (Brachypo- dium) a révélé l'ajustement du réseau d'interaction croisée entre auxine et éthylène par rapport à Arabidopsis. Chez ce dernier, interférer avec la biosynthèse de l'auxine mène à la formation d'une racine courte. Néanmoins, nous avons isolé chez Brachypodium un mutant hypomorphique dans la biosynthèse de l'auxine qui affiche une racine plus longue. Nous avons alors conduit une analyse morphométrique qui a confirmé que des cellules plus anisotropique (plus fines et longues) sont à l'origine de ce phénotype racinaire. Des analyses plus approfondies ont démontré que la différence phénotypique entre Brachypodium et Arabidopsis s'explique par une inversion de la fonction régulatrice dans la relation entre le réseau de signalisation par l'éthylène et la biosynthèse de l'auxine. L'analyse morphométrique utilisée dans l'étude précédente exploite le pipeline de traitement d'image de notre méthode d'histologie quantitative. Pendant la croissance secondaire, la symétrie bilatérale de l'hypocotyle est remplacée par une symétrie radiale et une organisation concentrique des tissus constitutifs. Ces tissus sont initialement composés d'une douzaine de cellules mais peuvent aisément atteindre des dizaines de milliers dans les derniers stades du développement. Cette échelle dépasse largement le seuil d'investigation par les moyens dits 'traditionnels' comme l'imagerie directe de tissus en profondeur. L'étude de ce système pendant cette phase de développement ne peut se faire qu'en réalisant des coupes fines de l'organe, ce qui empêche une compréhension des phénomènes cellulaires dynamiques sous-jacents. Nous y avons remédié en proposant une stratégie originale nommée, histologie quantitative. De fait, nous avons extrait l'information contenue dans des images de très haute résolution de sections transverses d'hypocotyles en utilisant un pipeline d'analyse et de segmentation d'image à grande échelle. Nous l'avons ensuite combiné avec un algorithme de reconnaissance automatique des cellules. Cet outil nous a permis de réaliser une description quantitative de la progression de la croissance secondaire révélant des schémas développementales non-apparents avec une inspection visuelle classique. La formation de pôle de phloèmes en structure répétée et espacée entre eux d'une longueur constante illustre les bénéfices de notre approche. Par ailleurs, l'exploitation approfondie de ces résultats a montré un changement de croissance anisotropique des cellules du cambium et du phloème qui semble en phase avec l'expansion du xylème. Combinant des outils génétiques et de la modélisation biomécanique, nous avons démontré que seule la croissance plus rapide des tissus internes peut produire une réorientation de l'axe de croissance anisotropique des tissus périphériques. Cette prédiction a été confirmée par le calcul du ratio des taux de croissance du xylème et du phloème au cours de développement secondaire ; des ratios élevés sont effectivement observés et concomitant à l'établissement progressif et tangentiel du cambium. Ces résultats suggèrent un mécanisme d'auto-organisation établi par un gradient de division méristématique qui génèrent une distribution de contraintes mécaniques. Ceci réoriente la croissance anisotropique des tissus périphériques pour supporter la croissance secondaire. - Plants are essential for human society, because our daily food, construction materials and sustainable energy are derived from plant biomass. Yet, despite this importance, the multiple developmental aspects of plants are still poorly understood and represent a major challenge for science. With the emergence of high throughput devices for genome sequencing and high-resolution imaging, data has never been so easy to collect, generating huge amounts of information. Computational analysis is one way to integrate those data and to decrease the apparent complexity towards an appropriate scale of abstraction with the aim to eventually provide new answers and direct further research perspectives. This is the motivation behind this thesis work, i.e. the application of descriptive and predictive analytics combined with computational modeling to answer problems that revolve around morphogenesis at the subcellular and organ scale. One of the goals of this thesis is to elucidate how the auxin-brassinosteroid phytohormone interaction determines the cell growth in the root apical meristem of Arabidopsis thaliana (Arabidopsis), the plant model of reference for molecular studies. The pertinent information about signaling protein relationships was obtained through the literature to reconstruct the entire hormonal crosstalk. Due to a lack of quantitative information, we employed a qualitative modeling formalism. This work permitted to confirm the synergistic effect of the hormonal crosstalk on cell elongation, to explain some of our paradoxical mutant phenotypes and to predict a novel interaction between the BREVIS RADIX (BRX) protein and the transcription factor MONOPTEROS (MP),which turned out to be critical for the maintenance of the root meristem. On the same subcellular scale, another study in the monocot model Brachypodium dystachion (Brachypodium) revealed an alternative wiring of auxin-ethylene crosstalk as compared to Arabidopsis. In the latter, increasing interference with auxin biosynthesis results in progressively shorter roots. By contrast, a hypomorphic Brachypodium mutant isolated in this study in an enzyme of the auxin biosynthesis pathway displayed a dramatically longer seminal root. Our morphometric analysis confirmed that more anisotropic cells (thinner and longer) are principally responsible for the mutant root phenotype. Further characterization pointed towards an inverted regulatory logic in the relation between ethylene signaling and auxin biosynthesis in Brachypodium as compared to Arabidopsis, which explains the phenotypic discrepancy. Finally, the morphometric analysis of hypocotyl secondary growth that we applied in this study was performed with the image-processing pipeline of our quantitative histology method. During its secondary growth, the hypocotyl reorganizes its primary bilateral symmetry to a radial symmetry of highly specialized tissues comprising several thousand cells, starting with a few dozens. However, such a scale only permits observations in thin cross-sections, severely hampering a comprehensive analysis of the morphodynamics involved. Our quantitative histology strategy overcomes this limitation. We acquired hypocotyl cross-sections from tiled high-resolution images and extracted their information content using custom high-throughput image processing and segmentation. Coupled with an automated cell type recognition algorithm, it allows precise quantitative characterization of vascular development and reveals developmental patterns that were not evident from visual inspection, for example the steady interspace distance of the phloem poles. Further analyses indicated a change in growth anisotropy of cambial and phloem cells, which appeared in phase with the expansion of xylem. Combining genetic tools and computational modeling, we showed that the reorientation of growth anisotropy axis of peripheral tissue layers only occurs when the growth rate of central tissue is higher than the peripheral one. This was confirmed by the calculation of the ratio of the growth rate xylem to phloem throughout secondary growth. High ratios are indeed observed and concomitant with the homogenization of cambium anisotropy. These results suggest a self-organization mechanism, promoted by a gradient of division in the cambium that generates a pattern of mechanical constraints. This, in turn, reorients the growth anisotropy of peripheral tissues to sustain the secondary growth.

Analysing the competitive advantage of Internet based marketing research company starting in Finland

The purpose of this master's thesis was to analyse a competitive advantage of an Internet based marketing research company based on a competitive strategy oriented way. First Internet panel was compared to mostly used marketing research method, telephone interview. Secondly fourteen potential clients were interviewed personally. Intention was to find out what the potential clients thinkabout Zapera Finland Ltd and what kind of competitive strategy could be chosen considering costs, product differentiation, competition, research method, segmentation of business line and substitution. Finally the interviews were analysed and some strategic suggestions were made based on the competitive advatage(s). Conclusion was that Zapera Finland Ltd can choose a competitive strategy based on both the cost advantage and the product differentiation in a narrow competition scope.

Laadullisten tekijöiden vaikutus yrityksen luottoluokitukseen -case Nordea Pankki Suomi Oyj

Tutkielman päätavoitteena oli analysoida, mitkä tekijät vaikuttavat pankin luottoluokituksissa laadullisten tekijöiden arviointiin ja mikävaikutus näillä tekijöillä on luottoluokitukseen. Tutkimuksessa myös arvioitiinlaadullisten tekijöiden vaikutusta pankin pääomavaatimukseen. Tutkimuksessa olimu-kana pankin 408 yritysasiakasta. Tutkimuksessa käytettiin tilastollista tut-kimusmenetelmää. Baselin pankkivalvontakomitean asettamat standardit ja rahoitusalan journaaleissa julkaistut tutkimukset muodostivat tutkimuk-sen teoreettisen viitekehyksen. Tutkimusten pohjalta asetettiin tutkimus-hypoteesit. Tutkimustulokset osoittivat, että laadullisten tekijöiden ja taloudellisten te-kijöiden arvioinnin erotukseen eivät vaikuta merkittävästi yrityksen ikä, ko-ko eikä asiakassuhteen kesto. Myöskään toimialalla ei ollut vaikutusta. Konttoreittain laadullisten tekijöiden arvioinnissa oli eroja. Laadullisia teki-jöitäarvioidaan keskimäärin positiivisemmin kuin taloudellisia tekijöitä mut-ta erotolivat koko otantajoukossa hyvin pieniä. Luottoluokitukset nousevat hieman laadullisten tekijöiden vaikutuksesta, jolloin tällä on pääomavaati-musta laskeva vaikutus. Laadullisten ja taloudellisten tekijöiden arvioinnin eroon voi kuitenkinolla olemassa perustellut syyt. Tutkimustulosten perusteellavoidaan todeta, että laadullisten tekijöiden arviointiin eivät vaikuta yksittäiset yrityskohtaiset tekijät. Luokittelijan sub-jektiivisten tekijöiden lisäksi taustalla saattaa vaikuttaa myös monet muut tekijät, joita ei ole tässä tutkimuksessa tutkittu.

Mobiilipankkipalveluiden omaksuminen ja strateginen kannattavuus: empiirinen tutkimus

Tutkimuksen päätavoitteena oli analysoida, mitkä tekijät vaikuttavat mobiilipankkipalveluiden omaksumiseen ja miten kyseinenpalvelu tuo yritykselle strategista lisäarvoa. Tutkimuksessa käytettiin tilastollista tutkimusmenetelmää. Tutkimusaineisto kerättiin kontrolloidulla kyselynä Etelä-Karjalan ammattikorkeakoulun ja Lappeenrannan teknillisen yliopiston opiskelijoiden keskuudesta. Tutkimushypoteesit ja tutkimusmalli laadittiin aikaisempien tutkimustulosten sekä omaksumiseen ja strategiseen kannattavuuteen pohjautuvien teorioiden perusteella. Nämä teoriat muodostivat tutkimuksen viitekehyksen. Tutkimustulosten perusteella voidaan todeta, että nuoret suhtautuvat mobiilipankkipalveluiden käyttämiseen pääosin myönteisesti. Suurimman esteen mobiilipankkipalveluiden omaksumiselle aiheuttaa Internet - verkkopankin käyttäminen ja sen myötä varsinaisen palvelutarpeen puuttuminen. Mobiilit pankkipalvelut koetaan täydentäviksi palveluiksi, joita käytetään rinnakkain verkkopankin kanssa. Palveluiden lisäarvo perustuu pankkiasioinnin paikasta riippumattomuudelle sekä ajan ja vaivan säästölle. Erilaisten mobiilien pankkipalvelumuotojen osalta, nuorten mielenkiinto kohdistuu eniten mobiiliraha- ja tekstiviestiperusteisiin palveluihin. Mobiilipankkipalvelut ovat vielä elinkaarensa esittelyvaiheessa, mikä näkyy palveluiden vähäisissä käyttäjämäärissä ja heikossa strategisessa kannattavuudessa. Mobiilien pankkipalveluiden strategisen kannattavuuden parantaminen edellyttää myynnin ja markkinoinnin tehostamista sekä nykyisten hinnoittelustrategioiden alentamista.

Monipuolinen tietotyö tilitoimistossa - kiinnostava vaihtoehto valmistuvalle?

Tutkimuksen tarkoitus on tuottaa ajantasaista tietoutta siitä, millainen käsitys laskenta-alan tradenomi- ja maisteriopiskelijoilla on tämän päivän tilitoimistotyöstä ja koetaanko tilitoimisto kiinnostavana työpaikkana. Asiaa tarkasteltiin tietotyön monipuolisuuden ja motivaation näkökulmasta. Tutkimuksen empiirinen osuus toteutettiin nettikyselynä, joka kohdistettiin viimeisen vuoden taloushallinnon tai laskentatoimen pääainetta Suomessa opiskeleville tradenomi- ja maisteriopiskelijoille. Vastauksia saatiin 182, joista 162 oli tradenomi- ja 20 kauppatieteiden maisteriopiskelijoilta. Tutkimus toteutettiin kvantitatiivisena. Vastaajista 55 prosenttia pititilitoimistoa kiinnostavana ja 25 prosenttia melko kiinnostavana työpaikkana. Tulokset osoittavat, että tilitoimistotyö on kiinnostava vaihtoehto henkilöille, jotka kokevat työn itseään sisäisesti motivoivaksi. Sisäistä motivaatiota voidaan parantaa ulkoiseen motivaatioon vaikuttavia, kuten rahallisia ja sosiaalisia palkkioita, lisäämällä. Myös asiakaslähtöiset työtehtävät ja verkostomainen toimintatapa vaikuttavat sisäiseen motivaatioon. Työntekijän vaikutusmahdollisuudet omaan työhönsä lisäävät puolestaan ulkoista motivaatiota. Tieto- ja viestintätekniikan monipuolinen hyödyntäminen selittää ulkoisesta motivaatiosta pienen osan. Tietotyön ulottuvuuksista ainoastaan koulutus- ja kehittämismahdollisuudet eivätvaikuta motivaatioon eivätkä tilitoimiston kiinnostavuuteen työpaikkana. Tulokset osoittavat tilitoimistotyön olevan tulevien tietotyöntekijöiden näkemyksen mukaan monipuolista tietotyötä. Tilitoimistotyössä hyödynnetääntieto- ja viestintätekniikkaa monipuolisesti, ja se sisältää omaa suunnittelua vaativia työtehtäviä. Työ vaatii tekijältään korkeaa ja laaja-alaista osaamista sekä jatkuvaa itsensä kehittämistä. Tilitoimistot toimivat sekä sisäisissä että ulkoisissa verkostoissa, joten työntekijät tarvitsevat myös sosiaalisia taitoja.Tilitoimistot tarjoavat työntekijöille melko hyvät vaikutusmahdollisuudet omaantyöhönsä. Tilitoimistotyön arvioitiin tarjoavan muuta tietotyötä paremmat koulutus- ja itsensä kehittämismahdollisuudet. Huolimatta monipuolisuudesta tietotyönnäkökulmasta, tilitoimistotyötä pidettiin yleensä liian säännöllisenä rutiinityönä.