Delay in the Diagnosis of Cerebral Vein and Dural Sinus Thrombosis Influence on Outcome

Background and Purpose-Diagnostic delay of cerebral vein and dural sinus thrombosis may have an impact on outcome. Methods-In the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) cohort (624 patients with cerebral vein and dural sinus thrombosis), we analyzed the predictors and the impact on outcome of diagnostic delay. Primary outcome was a modified Rankin Scale score > 2 at the end of follow-up. Secondary outcomes were modified Rankin Scale score 0 to 1 at the end of follow-up, death, and visual deficits (visual acuity or visual field). Results-Median delay was 7 days (interquartile range, 3 to 16). Patients with disturbance of consciousness (P < 0.001) and of mental status (P = 0.042), seizure (< 0.001), and with parenchymal lesions on admission CT/MR (P < 0.001) were diagnosed earlier, whereas men (P = 0.01) and those with isolated intracranial hypertension syndrome (P = 0.04) were diagnosed later. Between patients diagnosed earlier and later than the median delay, no statistically significant differences were found in the primary (P = 0.33) and in secondary outcomes: modified Rankin Scale score 0 to 1 (P = 0.86) or deaths (P = 0.53). Persistent visual deficits were more frequent in patients diagnosed later (P = 0.05). In patients with isolated intracranial hypertension syndrome, modified Rankin Scale score > 2 at the end of follow-up was more frequent in patients diagnosed later (P = 0.02). Conclusions-Diagnostic delay was considerable in this cohort and was associated with an increased risk of visual deficit. In patients with isolated intracranial hypertension syndrome, diagnostic delay was also associated with death or dependency. (Stroke. 2009; 40: 3133-3138.)

Risk Score to Predict the Outcome of Patients with Cerebral Vein and Dural Sinus Thrombosis

Background: Around 15% of patients die or become dependent after cerebral vein and dural sinus thrombosis (CVT). Method: We used the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) sample (624 patients, with a median follow-up time of 478 days) to develop a Cox proportional hazards regression model to predict outcome, dichotomised by a modified Rankin Scale score > 2. From the model hazard ratios, a risk score was derived and a cut-off point selected. The model and the score were tested in 2 validation samples: (1) the prospective Cerebral Venous Thrombosis Portuguese Collaborative Study Group (VENO-PORT) sample with 91 patients; (2) a sample of 169 consecutive CVT patients admitted to 5 ISCVT centres after the end of the ISCVT recruitment period. Sensitivity, specificity, c statistics and overall efficiency to predict outcome at 6 months were calculated. Results: The model (hazard ratios: malignancy 4.53; coma 4.19; thrombosis of the deep venous system 3.03; mental status disturbance 2.18; male gender 1.60; intracranial haemorrhage 1.42) had overall efficiencies of 85.1, 84.4 and 90.0%, in the derivation sample and validation samples 1 and 2, respectively. Using the risk score (range from 0 to 9) with a cut-off of 6 3 points, overall efficiency was 85.4, 84.4 and 90.1% in the derivation sample and validation samples 1 and 2, respectively. Sensitivity and specificity in the combined samples were 96.1 and 13.6%, respectively. Conclusions: The CVT risk score has a good estimated overall rate of correct classifications in both validation samples, but its specificity is low. It can be used to avoid unnecessary or dangerous interventions in low-risk patients, and may help to identify high-risk CVT patients. Copyright (C) 2009 S. Karger AG, Basel

Toxoplasma gondii: The severity of toxoplasmic encephalitis in C57BL/6 mice is associated with increased ALCAM and VCAM-1 expression in the central nervous system and higher blood-brain barrier permeability

In order to investigate the differential ALCAM, ICAM-1 and VCAM-1 adhesion molecules mRNA expression and the blood-brain barrier (BBB) permeability in C57BL/6 and BALB/c mice in Toxoplasma gondii infection, animals were infected with ME-49 strain. It was observed higher ALCAM on day 9 and VCAM-1 expression on days 9 and 14 of infection in the central nervous system (CNS) of C57BL/6 compared to BALB/c mice. The expression of ICAM-1 was high and similar in the CNS of both lineages of infected mice. In addition, C57BL/6 presented higher BBB permeability and higher IFN-gamma and iNOS expression in the CNS compared to BALB/c mice. The CNS of C578L/6 mice presented elevated tissue pathology and parasitism. In conclusion, our data suggest that the higher adhesion molecules expression and higher BBB permeability contributed to the major inflammatory cell infiltration into the CNS of C57BL/6 mice that was not efficient to control the parasite. (C) 2010 Elsevier Inc. All rights reserved.

Analysis of Intracellular Substrates and Products of Thimet Oligopeptidase in Human Embryonic Kidney 293 Cells

Thimet oligopeptidase (EC 3.4.24.15; EP24.15) is an intracellular enzyme that has been proposed to metabolize peptides within cells, thereby affecting antigen presentation and G protein-coupled receptor signal transduction. However, only a small number of intracellular substrates of EP24.15 have been reported previously. Here we have identified over 100 peptides in human embryonic kidney 293 (HEK293) cells that are derived from intracellular proteins; many but not all of these peptides are substrates or products of EP24.15. First, cellular peptides were extracted from HEK293 cells and incubated in vitro with purified EP24.15. Then the peptides were labeled with isotopic tags and analyzed by mass spectrometry to obtain quantitative data on the extent of cleavage. A related series of experiments tested the effect of overexpression of EP24.15 on the cellular levels of peptides in HEK293 cells. Finally, synthetic peptides that corresponded to 10 of the cellular peptides were incubated with purified EP24.15 in vitro, and the cleavage was monitored by high pressure liquid chromatography and mass spectrometry. Many of the EP24.15 substrates identified by these approaches are 9-11 amino acids in length, supporting the proposal that EP24.15 can function in the degradation of peptides that could be used for antigen presentation. However, EP24.15 also converts some peptides into products that are 8-10 amino acids, thus contributing to the formation of peptides for antigen presentation. In addition, the intracellular peptides described here are potential candidates to regulate protein interactions within cells.

HOME RANGE AND SPATIAL ORGANIZATION OF MANED WOLVES IN THE BRAZILIAN GRASSLANDS

The maned wolf (Chrysocyon brachyurus) is the largest canid in South America, weighing up to 30 kg, and exhibits an omnivorous diet based on fruits and small vertebrates. Maned wolves are considered to live in monogamous pairs defending a common territory, with mates living a largely solitary life, but these conclusions come from few studies with small samples. We captured maned wolves in Emas National Park, central Brazil, and monitored their use of space using radiotelemetry. Home-range size and overlap of 45 adults, and interactions between members of 5 pairs, were investigated. Home-range sizes of resident adults averaged 80.18 km(2) using the fixed kernel with 95% of the locations, and averaged 13.78 km(2) with 50% of the locations. Overlap of 95% ranges between male-male, female-female, or mixed dyads was similar, approximately 0.20, whereas 50% ranges of maned wolves showed less overlap overall but more tolerance for overlap with the opposite sex. Members of a pair were located alone more often than together, and even when located simultaneously maintained a mean distance of >0.5 km apart, independent of time of day. Results are in agreement with a spatial organization based on monogamous mating pairs with little intrapair sociality, but the latter needs to be investigated in more detail.

Bispectral index in dogs at three intravenous infusion rates of propofol

Objective To establish the correlation between the bispectral index (BIS) and different rates of infusion of propofol in dogs. Study design Prospective experimental trial. Animals Eight adult dogs weighing 6-20 kg. Methods Eight animals underwent three treatments at intervals of 20 days. Propofol was used for induction of anesthesia (10 mg kg(-1) IV), followed by a continuous rate infusion (CRI) at 0.2 mg kg(-1) minute(-1) (P2), 0.4 mg kg(-1) minute(-1) (P4) or 0.8 mg kg(-1) minute(-1) (P8) for 55 minutes. The BIS values were measured at 10, 20, 30, 40, and 50 minutes (T10, T20, T30, T40, and T50, respectively) after the CRI of propofol was started. Numeric data were submitted to analysis of variance followed by Tukey test (p < 0.05). Results The BIS differed significantly among groups at T40, when P8 was lower than P2 and P4. At T50, P8 was lower than P2. The electromyographic activity (EMG) in P2 and P4 was higher than P8 at T40 and T50. Conclusion An increase in propofol infusion rates decreases the BIS values and EMG.

Precipitation hardening of Cu-Fe-Cr alloys - Part II - Microstructural characterisation

This research is part of a project whose scope was to investigate the engineering properties of new non-commercial alloy formulations based on the Cu rich corner of the Cu-Fe-Cr ternary system with the primary aim of exploring the development of a new cost-effective high-strength, high-conductivity copper alloy. Promising properties have been measured for the following alloys: Cu-0.7wt%Cr-0.3wt%Fe and Cu-0.7wt%Cr-2.0wt%Fe. This paper reports on the microstructural characterisation of these alloys and discusses the mechanical and electrical properties of these alloys in terms of their microstructure, particularly the formation of precipitates. These alloys have evinced properties that warrant further investigation. Cost modelling has shown that Cu-0.7wt%Cr-0.3wt%Fe is approximately 25% cheaper to produce than commercial Cu-1%Cr. It has also been shown to be more cost efficient on a yield stress and % IACS per dollar basis. The reason for the cost saving is that the Cu-0.7%Cr-0.3%Fe alloy can be made with low carbon ferro-chrome additions as the source of chromium rather than the more expensive Cu-Cr master-alloy. For applications in which cost is one of the primary materials selection criteria, it is envisaged that there would be numerous applications in both cast and wrought form, where the Cu-0.7%Cr-0.3%Fe alloy would be more suitable than Cu-1%Cr. (C) 2001 Kluwer Academic Publishers.

Boletim eletr??nico de bibliografias especializadas:comunica????o e lideran??a

A 4a edi????o do Boletim Eletr??nico de Bibliografias Especializadas apresenta publica????es do acervo da Biblioteca Graciliano Ramos e do Portal de Peri??dicos da ENAP. Este n??mero tem como foco o Programa de Comunica????o e Lideran??a (Comlide). Trata-se de uma iniciativa da ENAP, sob a responsabilidade da Diretoria de Desenvolvimento Gerencial (DDG), envolvendo todas as ??reas da Escola. As obras reunidas neste Boletim d??o ??nfase a t??cnicas de comunica????o e lideran??a dentro de organiza????es. O objetivo dessas estrat??gias ?? viabilizar o melhor desempenho em rela????o aos trabalhos em grupo. Com a crescente import??ncia de l??deres nas institui????es, estudos e projetos prop??em caminhos para que esses gestores motivem suas equipes a alcan??ar cada vez mais qualidade, produtividade e crescimento. Enfim, a colet??nea presente neste Boletim permite que se desenvolva uma melhor compreens??o quanto a conceitos e m??todos sugeridos por diversos autores, al??m de apresentar estudos de caso voltados para negocia????es e gest??o de equipes

Programa agentes de desenvolvimento

No seu processo de moderniza????o, o Banco do Nordeste realizou reflex??es sobre a sua atua????o na Regi??o, concebendo o Programa Agentes de Desenvolvimento como uma estrat??gia de ampliar sua a????o atrav??s da presen??a dos agentes de desenvolvimento nos 1.873 munic??pios do Nordeste e Norte de Minas. O agente de desenvolvimento age como facilitador do processo de transforma????o das comunidades, articulando parcerias para viabiliza????o das a????es de desenvolvimento local e interagindo com os agentes produtivos na busca de alternativas econ??micas e empresariais dentro de crit??rios de sustentabilidade. Todo o seu esfor??o est?? voltado para a comunidade assumir o papel de sujeito no processo de desenvolvimento, tra??ando seus pr??prios caminhos na busca da melhoria da qualidade de vida de seus habitantes. Munido de informa????o e tecnologia, esse profissional trabalha junto ??s comunidades de uma forma bem diferente de um banco tradicional, conscientizando os agentes produtivos sobre o real papel do cr??dito e sobre o valor que lhe agrega a capacita????o na viabiliza????o dos projetos econ??micos

C??rculo de controle de qualidade

Criada na d??cada de 40 para extrair min??rio de ferro dos dep??sitos do interior do Estado de Minas Gerais, aos poucos a Companhia Vale do Rio Doce (CVRD) expandiu suas atividades e ??reas de atua????o, de forma que hoje ?? a maior companhia exportadora de ferro, al??m de atuar na extra????o e beneficiamento de bauxita, ouro e outros minerais abundantes no Brasil. Com o prop??sito de elevar o rendimento das minas e a economicidade global do sistema, a CVRD adotou o processo de aglomera????o de min??rio por pelotiza????o e implantou seis usinas de pelotiza????o na ??rea de Tubar??o, no Estado do Esp??rito Santo. As usinas de pelotiza????o produzem pelotas de min??rio de ferro de alta qualidade. A pelotiza????o ?? um processo de aglomera????o da parcela ultrafina de min??rio ??? com o recurso de um processamento t??rmico ??? em esferas de di??metro adequado, com caracter??sticas de qualidade que permitam a sua aplica????o direta nos fornos sider??rgicos. A moagem ?? parte desse processo. Quando os moinhos est??o em opera????o normal, s??o programadas paradas para inspe????o do revestimento. Se h?? desgaste, programam-se paradas para trocar as barras de revestimento desgastadas

Semin??rio gest??o do conhecimento no setor p??blico

Semin??rio gest??o do conhecimento no setor p??blico sob o tema "caminhos e perspectivas para gest??o do conhecimento em organiza????es p??blicas" .

A imagem dos tribunais de contas subnacionais

O presente artigo exp??e a vis??o que as elites sociais e institucionais t??m sobre os Tribunais de Contas (TCs) subnacionais brasileiros. Realizada no bojo do processo de diagn??stico e reforma dos TCs, o Programa de Moderniza????o do Sistema de Controle Externo dos Estados e do Distrito Federal (Promoex), esta pesquisa revela quais s??o os problemas que afetam o desempenho administrativo e a legitimidade institucional desses ??rg??os fiscalizadores, bem como as suas qualidades, as quais podem ser utilizadas como motor de sua reformula????o. A partir da interpreta????o das opini??es dos atores entrevistados, a an??lise final procura revelar quais caminhos podem ser trilhados para se modernizarem os Tribunais de Contas subnacionais.

Machado de Assis funcion??rio p??blico

Joaquim Maria Machado de Assis, uma das maiores figuras do mundo liter??rio brasileiro do s??culo passado e do in??cio deste s??culo, teve duas carreiras paralelas, a de homem de letras e a de burocrata. Na primeira iniciou-se mais cedo, quando, apenas um adolescente de pouco mais de 15 anos, publicou um soneto ??? por sinal bem ruinzinho ??? no Peri??dico dos Pobres, a 3 de outubro de 1854. Nascido no morro do Livramento, perto da Gamboa e do Saco do Alferes, a 21 de junho de 1839, deu mostras de impressionante precocidade, ao assinar um Soneto, no mesmo jornalzinho. Nota-se que, nessa ??poca, o Rio de Janeiro ainda n??o tinha sequer ilumina????o a g??s ??? s?? contratada pelo governo imperial em 1859 ??? nem sabia ainda o que fossem estradas de ferro. Seu ingresso no servi??o p??blico s?? se daria quase treze anos depois dessa estreia liter??ria, que em nada fazia prever o grande escritor que viria a ser. E isto se deu a 8 de abril de 1867, com a sua nomea????o para ???ajudante do diretor de publica????o do Di??rio Oficial???, ent??o subordinado ao Minist??rio da Fazenda, durante o 22?? gabinete ministerial da monarquia, chefiado pelo ent??o deputado-geral Zacarias de G??is e Vasconcelos.

Los desaf??os de las pol??ticas y la gesti??n social en Am??rica Latina

La pobreza est?? aumentando en t??rminos absolutos de manera sistem??tica desde 1990 y, desde comienzos del nuevo siglo, tambi??n en valores relativos. Hay, sin embargo, una buena nueva: el gasto p??blico social ha aumentado tambi??n de manera sistem??tica desde entonces. ??Qu?? se ha hecho con la enorme magnitud de recursos destinada a financiar las pol??ticas sociales? Hay, por un lado, limitaciones que surgen de la forma en que ellas se dise??an e implementan. La gesti??n social tradicional asume que el impacto perseguido se producir?? autom??ticamente como resultado de la mera entrega de los bienes o servicios a la poblaci??n destinataria. Aparece, adem??s, la masiva introducci??n de mecanismos de mercado en las pol??ticas sociales, bajo el supuesto que permitir??an mejorar su eficiencia e impacto. Teniendo en cuenta las limitaciones precedentes, se sugieren en este art??culo tres senderos, estos son: la superaci??n del estilo tradicional de gestionar los programas y proyectos sociales; el aprendizaje por medio de la experiencia de la evaluaci??n de impacto y del monitoreo; y la generaci??n de un estilo m??s participativo en el proceso de dise??o, gesti??n y evaluaci??n de las pol??ticas sociales.