Early major worsening in ischemic stroke: predictors and outcome.

INTRODUCTION: We aimed to investigate the characteristics and outcome of patients suffering early major worsening (EMW) after acute ischemic stroke (AIS) and assess the parameters associated with it. METHODS: All consecutive patients with AIS in the ASTRAL registry until 10/2010 were included. EMW was defined as an NIHSS increase of ≥8 points within the first 24 h after admission. The Bootstrap version of the Kolmogorov-Smirnov test and the χ(2)-test were used for the comparison of continuous and categorical covariates, respectively, between patients with and without EMW. Multiple logistic regression analysis was performed to identify independent predictors of EMW. RESULTS: Among 2155 patients, 43 (2.0 %) had an EMW. EMW was independently associated with hemorrhagic transformation (OR 22.6, 95 % CI 9.4-54.2), cervical artery dissection (OR 9.5, 95 % CI 4.4-20.6), initial dysarthria (OR 3.7, 95 % CI 1.7-8.0), and intravenous thrombolysis (OR 2.1, 95 % CI 1.1-4.3), whereas a negative association was identified with initial eye deviation (OR 0.4, 95 % CI 0.2-0.9). Favorable outcome at 3 and 12 months was less frequent in patients with EMW compared to patients without (11.6 vs. 55.3 % and 16.3 vs. 50.7 %, respectively), and case fatality was higher (53.5 vs. 12.9 % and 55.8 vs. 16.8 %, respectively). Stroke recurrence within 3 months in surviving patients was similar between patients with and without EMW (9.3 vs. 9.0 %, respectively). CONCLUSIONS: Worsening of ≥8 points in the NIHSS score during the first 24 h in AIS patients is related to cervical artery dissection and hemorrhagic transformation. It justifies urgent repeat parenchymal and arterial imaging. Both conditions may be influenced by targeted interventions in the acute phase of stroke.

Estomizado adulto no município de São Paulo: um estudo sobre o custo de equipamentos especializados

O estudo objetivou analisar o custo mensal do uso de dispositivos e adjuvantes por estomizados. Trata-se de uma pesquisa retrospectiva, realizada em dois Ambulatórios de Especialidades, em São Paulo. Os dados foram coletados em 635 prontuários de pacientes estomizados adultos, atendidos em junho de 2005. Os valores dos dispositivos e adjuvantes foram obtidos em registros eletrônicos e publicações oficiais da Secretaria de Estado da Saúde de São Paulo e seus resultados foram submetidos aos testes de Kolmogorov-Smirnov, Mann-Whitney, Kruskal-Wallis, Bonferroni e Spearman. A maioria dos indivíduos era do sexo feminino (51%), idade > 60anos, com colostomia provisória (64,5%). O custo individual mensal médio foi R$ 137,72, maior para os urostomizados, com estomas definitivos, com neoplasias de vias urinárias e atendidos no serviço que possui enfermeiro especialista. Houve correlação estatisticamente significativa e positiva entre o custo mensal e o tempo de estomia. Este estudo contribuiu para a avaliação do custo do estomizado no Estado de São Paulo.

Identification of molecular apocrine breast tumours by microarray analysis.

Previous microarray studies on breast cancer identified multiple tumour classes, of which the most prominent, named luminal and basal, differ in expression of the oestrogen receptor alpha gene (ER). We report here the identification of a group of breast tumours with increased androgen signalling and a 'molecular apocrine' gene expression profile. Tumour samples from 49 patients with large operable or locally advanced breast cancers were tested on Affymetrix U133A gene expression microarrays. Principal components analysis and hierarchical clustering split the tumours into three groups: basal, luminal and a group we call molecular apocrine. All of the molecular apocrine tumours have strong apocrine features on histological examination (P=0.0002). The molecular apocrine group is androgen receptor (AR) positive and contains all of the ER-negative tumours outside the basal group. Kolmogorov-Smirnov testing indicates that oestrogen signalling is most active in the luminal group, and androgen signalling is most active in the molecular apocrine group. ERBB2 amplification is commoner in the molecular apocrine than the other groups. Genes that best split the three groups were identified by Wilcoxon test. Correlation of the average expression profile of these genes in our data with the expression profile of individual tumours in four published breast cancer studies suggest that molecular apocrine tumours represent 8-14% of tumours in these studies. Our data show that it is possible with microarray data to divide mammary tumour cells into three groups based on steroid receptor activity: luminal (ER+ AR+), basal (ER- AR-) and molecular apocrine (ER- AR+).

Stress, coping and presenteeism in nurses assisting critical and potentially critical patients

Objective to verify the associations between stress, Coping and Presenteeism in nurses operating on direct assistance to critical and potentially critical patients. Method this is a descriptive, cross-sectional and quantitative study, conducted between March and April 2010 with 129 hospital nurses. The Inventory of stress in nurses, Occupational and Coping Questionnaire Range of Limitations at Work were used. For the analysis, the Kolmogorov-Smirnov test, correlation coefficient of Pearson and Spearman, Chi-square and T-test were applied. Results it was observed that 66.7% of the nurses showed low stress, 87.6% use control strategies for coping stress and 4.84% had decrease in productivity. Direct and meaningful relationships between stress and lost productivity were found. Conclusion stress interferes with the daily life of nurses and impacts on productivity. Although the inability to test associations, the control strategy can minimize the stress, which consequently contributes to better productivity of nurses in the care of critical patients and potentially critical.


Macrozoobentos de dos Áreas de la plataforma continental del Norte Peruano en el verano de 1987

Se estudiaron muestras de Macrozoobentos (> 1 mm) tomadas a diferentes profundidades en enero de 1987 por el BIC Humboldt de la plataforma continental de dos áreas del norte del litoral peruano, una frente a zorritos (3º35.5`- 3º51.3`) y otra entre Isla Lobos de Tierra y Pimentel (6º32.0`- 6º55.5`), de distinto tipo de sedimento en el fondo. Las muestras estudiadas, así como los datos de Temperatura, Oxigeno disuelto y Salinidad en el fondo, fueron proporcionadas por el Programa Cooperativo Peruano-Alemán de Investigación Pesquera (PROCOPA) y el Instituto del Mar del Perú (IMARPE). El trabajo consiste en identificar, cuantificar y comparar las taxa presentes en las muestras de ambas áreas, determinar la Biomasa, Densidad, Diversidad, Equidad y Riqueza, y analizar el tipo y característica del sedimento de las estaciones. Para el estudio del aspecto comunitario se emplearon el análisis de agrupamiento por racimos (“cluster análisis”; Legendre y Legendre, 1983) y la técnica de los Índices Biológicos (Guille, 1970). En el análisis estadístico se usaron preferentemente la prueba no paramétrica de dos grupos de Kolmogorov-Smirnov y correlaciones lineales entre los factores abiòticos, características del sedimento y parámetros biológicos hallados.

Heavy rainfall equations for Santa Catarina, Brazil

Knowledge of intensity-duration-frequency (IDF) relationships of rainfall events is extremely important to determine the dimensions of surface drainage structures and soil erosion control. The purpose of this study was to obtain IDF equations of 13 rain gauge stations in the state of Santa Catarina in Brazil: Chapecó, Urussanga, Campos Novos, Florianópolis, Lages, Caçador, Itajaí, Itá, Ponte Serrada, Porto União, Videira, Laguna and São Joaquim. The daily rainfall data charts of each station were digitized and then the annual maximum rainfall series were determined for durations ranging from 5 to 1440 min. Based on these, with the Gumbel-Chow distribution, the maximum rainfall was estimated for durations ranging from 5 min to 24 h, considering return periods of 2, 5, 10, 20, 25, 50, and 100 years,. Data agreement with the Gumbel-Chow model was verified by the Kolmogorov-Smirnov test, at 5 % significance level. For each rain gauge station, two IDF equations of rainfall events were adjusted, one for durations from 5 to 120 min and the other from 120 to 1440 min. The results show a high variability in maximum intensity of rainfall events among the studied stations. Highest values of coefficients of variation in the annual maximum series of rainfall were observed for durations of over 600 min at the stations of the coastal region of Santa Catarina.

Seasonal dependence in the solar neutrino flux

Mikheyev-Smirnov-Wolfenstein (MSW) solutions of the solar neutrino problem predict a seasonal dependence of the zenith angle distribution of the event rates, due to the nonzero latitude at the Super-Kamiokande site. We calculate this seasonal dependence and compare it with the expectations in the no-oscillation case as well as just-so scenario, in the light of the latest Super-Kamiokande 708-day data. The seasonal dependence can be sizable in the large mixing angle MSW solution and would be correlated with the day-night effect. This may be used to discriminate between MSW and just-so scenarios and should be taken into account in refined fits of the data.

Zenith angle distributions at Super-Kamiokande and SNO and the solution of the solar neutrino problem

We have performed a detailed study of the zenith angle dependence of the regeneration factor and distributions of events at SNO and SK for different solutions of the solar neutrino problem. In particular, we discuss the oscillatory behavior and the synchronization effect in the distribution for the LMA solution, the parametric peak for the LOW solution, etc. A physical interpretation of the effects is given. We suggest a new binning of events which emphasizes the distinctive features of the zenith angle distributions for the different solutions. We also find the correlations between the integrated day-night asymmetry and the rates of events in different zenith angle bins. The study of these correlations strengthens the identification power of the analysis.

Duration-frequency relationships of heavy rainfall in Santa Catarina, Brazil

The purpose of this study was to adjust equations that establish relationships between rainfall events with different duration and data from weather stations in the state of Santa Catarina, Brazil. In this study, the relationships between different duration heavy rainfalls from 13 weather stations of Santa Catarina were analyzed. From series of maximum annual rainfalls, and using the Gumbel-Chow distribution, the maximum rainfall for durations between 5 min and 24 h were estimated considering return periods from 2 to 100 years. The data fit to the Gumbel-Chow model was verified by the Kolmogorov-Smirnov test at 5 % significance. The coefficients of Bell's equation were adjusted to estimate the relationship between rainfall duration t (min) and the return period T (y) in relation to the maximum rainfall with a duration of 1 hour and a 10 year return period. Likewise, the coefficients of Bell's equation were adjusted based on the maximum rainfall with a duration of 1 day and a 10 year return period. The results showed that these relationships are viable to estimate short-duration rainfall events at locations where there are no rainfall records.

Three essays in financial economics: asset pricing, optimal portfolio selection and financial integration

Executive Summary The unifying theme of this thesis is the pursuit of a satisfactory ways to quantify the riskureward trade-off in financial economics. First in the context of a general asset pricing model, then across models and finally across country borders. The guiding principle in that pursuit was to seek innovative solutions by combining ideas from different fields in economics and broad scientific research. For example, in the first part of this thesis we sought a fruitful application of strong existence results in utility theory to topics in asset pricing. In the second part we implement an idea from the field of fuzzy set theory to the optimal portfolio selection problem, while the third part of this thesis is to the best of our knowledge, the first empirical application of some general results in asset pricing in incomplete markets to the important topic of measurement of financial integration. While the first two parts of this thesis effectively combine well-known ways to quantify the risk-reward trade-offs the third one can be viewed as an empirical verification of the usefulness of the so-called "good deal bounds" theory in designing risk-sensitive pricing bounds. Chapter 1 develops a discrete-time asset pricing model, based on a novel ordinally equivalent representation of recursive utility. To the best of our knowledge, we are the first to use a member of a novel class of recursive utility generators to construct a representative agent model to address some long-lasting issues in asset pricing. Applying strong representation results allows us to show that the model features countercyclical risk premia, for both consumption and financial risk, together with low and procyclical risk free rate. As the recursive utility used nests as a special case the well-known time-state separable utility, all results nest the corresponding ones from the standard model and thus shed light on its well-known shortcomings. The empirical investigation to support these theoretical results, however, showed that as long as one resorts to econometric methods based on approximating conditional moments with unconditional ones, it is not possible to distinguish the model we propose from the standard one. Chapter 2 is a join work with Sergei Sontchik. There we provide theoretical and empirical motivation for aggregation of performance measures. The main idea is that as it makes sense to apply several performance measures ex-post, it also makes sense to base optimal portfolio selection on ex-ante maximization of as many possible performance measures as desired. We thus offer a concrete algorithm for optimal portfolio selection via ex-ante optimization over different horizons of several risk-return trade-offs simultaneously. An empirical application of that algorithm, using seven popular performance measures, suggests that realized returns feature better distributional characteristics relative to those of realized returns from portfolio strategies optimal with respect to single performance measures. When comparing the distributions of realized returns we used two partial risk-reward orderings first and second order stochastic dominance. We first used the Kolmogorov Smirnov test to determine if the two distributions are indeed different, which combined with a visual inspection allowed us to demonstrate that the way we propose to aggregate performance measures leads to portfolio realized returns that first order stochastically dominate the ones that result from optimization only with respect to, for example, Treynor ratio and Jensen's alpha. We checked for second order stochastic dominance via point wise comparison of the so-called absolute Lorenz curve, or the sequence of expected shortfalls for a range of quantiles. As soon as the plot of the absolute Lorenz curve for the aggregated performance measures was above the one corresponding to each individual measure, we were tempted to conclude that the algorithm we propose leads to portfolio returns distribution that second order stochastically dominates virtually all performance measures considered. Chapter 3 proposes a measure of financial integration, based on recent advances in asset pricing in incomplete markets. Given a base market (a set of traded assets) and an index of another market, we propose to measure financial integration through time by the size of the spread between the pricing bounds of the market index, relative to the base market. The bigger the spread around country index A, viewed from market B, the less integrated markets A and B are. We investigate the presence of structural breaks in the size of the spread for EMU member country indices before and after the introduction of the Euro. We find evidence that both the level and the volatility of our financial integration measure increased after the introduction of the Euro. That counterintuitive result suggests the presence of an inherent weakness in the attempt to measure financial integration independently of economic fundamentals. Nevertheless, the results about the bounds on the risk free rate appear plausible from the view point of existing economic theory about the impact of integration on interest rates.

Qualidade física de um cambissolo sob sistemas de manejo

A Chapada do Apodi vem se destacando como um promissor polo de fruticultura irrigada em virtude da potencialidade agrícola dos seus solos, que são submetidos a diferentes tipos de manejo, condicionando mudanças em seus atributos físicos. Este trabalho teve como objetivo avaliar fisicamente um Cambissolo cultivado com mamoeiro (Carica papaya L.), sob dois sistemas de manejo, comparado com um sob vegetação nativa secundária. Foram coletadas amostras de solo com estruturas deformada e indeformada para determinação de: granulometria, argila dispersa em água, densidade do solo e de partículas, estabilidade de agregados, carbono orgânico e resistência à penetração. Foram calculados o grau de floculação das argilas e o teor de matéria orgânica. No campo, foi realizado ensaio de condutividade hidráulica do solo. Os dados experimentais foram analisados considerando o delineamento inteiramente casualizado, adotando-se para todas as análises o esquema em parcela subdividida 3 x 3 x 5 (dois sistemas de manejo do solo - plantio do mamoeiro em sulco e camalhão - e mata nativa secundária; três camadas de solo - 0,0-0,1; 0,1-0,2; e 0,2-0,3 m; e cinco repetições), exceção para a condutividade hidráulica, em que se adotou o esquema fatorial 3 x 2 x 5 (dois sistemas de manejo do solo e mata nativa secundária; duas tensões - 0 e 5 hPa; e cinco repetições). Foram aplicados os testes de Kolmogorov-Smirnov para verificar a normalidade dos dados, o F para a análise de variância e o de Tukey para a comparação de médias, todos a 5 %. Concluiu-se que a hipótese de que os sistemas de cultivo pioram os solos fisicamente foi refutada, indicando que a qualidade dos atributos do solo sob cultivo, em geral, está mantida ou melhorada em relação à condição atual da mata nativa secundária; o decréscimo do teor de matéria orgânica, da porcentagem de agregados estáveis na classe de 4,76-2,00 mm de diâmetro e do diâmetro médio ponderado em solo cultivado, apesar de ainda estarem distantes de limites considerados críticos, é indicador da necessidade de adoção de práticas de manejo que evitem o desencadeamento de um processo de degradação do solo; e os indicadores de qualidade foram sensíveis às alterações provocadas pelos sistemas de manejo do solo e, portanto, podem ser utilizados como fonte para a interpretação da dinâmica de processos físicos do solo no tempo.

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study.

The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.

Método do hipercubo latino condicionado para a amostragem de solos na presença de covariáveis ambientais visando o mapeamento digital de solos

A amostragem é uma das etapas mais importantes dos levantamentos de solos. No entanto, os esquemas de amostragem utilizados nos levantamentos convencionais têm se evidenciado inadequados para o mapeamento digital de solos, pois podem comprometer os resultados e, além disso, não possibilitam a realização de análises estatísticas. Este estudo teve por objetivo avaliar o método de amostragem do hipercubo latino condicionado (cLHS, sigla em inglês), na presença de covariáveis ambientais (elevação, declividade, curvatura e mapa de uso e cobertura do solo), em comparação com a amostragem aleatória, na alocação de 100 pontos amostrais, buscando maior representatividade das características ambientais da bacia do rio Guapi-Macacu. O desempenho dos métodos foi avaliado pela análise qualitativa dos histogramas de frequência e das análises estatísticas pelos testes F, T de Student e Kolmogorov-Smirnov (K-S), para cada covariável. Os resultados apresentaram que os pontos selecionados pelo método cLHS possuíam distribuição geográfica mais adequada do que aqueles obtidos pela amostragem aleatória. Além disso, o método cLHS preservou mais a distribuição de frequência das covariáveis contínuas do que a amostragem aleatória; para covariável categórica uso e cobertura do solo os métodos foram equivalentes. Os testes estatísticos confirmaram o melhor desempenho do método cLHS, cujas amostras não diferiram estatisticamente da bacia. Entretanto, a amostragem aleatória apresentou diferença estatística para com a bacia, para todas as covariáveis contínuas para pelo menos um dos testes utilizados. Assim, o método cLHS pode ser considerado como um método satisfatório para seleção de locais de amostragem em áreas heterogêneas similares as deste estudo, visando a utilização no mapeamento digital de solos.