Guidelines for the clinical management of atrial fibrillation: a practical perspective.

Since the management of atrial fibrillation may be difficult in the individual patient, our purpose was to develop simple clinical recommendations to help the general internist manage this common clinical problem. Systematic review of the literature with evaluation of data-related evidence and framing of graded recommendations. Atrial fibrillation affects some 1% of the population in Western countries and is linked to a significant increase in morbidity and mortality. The management of atrial fibrillation requires individualised evaluation of the risks and benefits of therapeutic modalities, relying whenever possible on simple and validated tools. The two main points requiring a decision in clinical management are 1) whether or not to implement thromboembolic prevention therapy, and 2) whether preference should be given to a "rate control" or "rhythm control" strategy. Thromboembolic prophylaxis should be prescribed after individualised risk assessment: for patients at risk, oral anticoagulation with warfarin decreases the rate of embolic complications by 60% and aspirin by 20%, at the expense of an increased incidence of haemorrhagic complications. "Rate control" and "rhythm control" strategies are probably equivalent, and the choice should also be made on an individualised basis. To assist the physician in making his choices for the care of an atrial fibrillation patient we propose specific tables and algorithms, with graded recommendations. On the evidence of data from the literature we propose simple algorithms and tables for the clinical management of atrial fibrillation in the individual patient.

Cross National Contact Strategies

Using paradata gathered from the 11-nation Survey of Health, Ageing and Retirement in Europe (SHARE), this paper examines the impact of the first contact attempt and the first contact properties, respectively, on contact and response efficiency using logistic multilevel models. We find that despite the different sample frames and interviewer compensation structure between countries, there are no considerable country effects with respect to making contact, once interviewer effects are controlled. Moreover, results point to an increased efficiency associated with evenings especially on Sundays, at least on the very first contact attempt. For attempts that result in initial contact, Saturday afternoons are most likely to eventually lead to completed interviews, followed by initial contact on weekdays during the daytime. We hypothesize that this may be due to the SHARE sample being composed of people aged 50 and over.

O CONCEITO DE IMPARIDADE E SUA EVOLUÇÃO HISTÓRICA – A APLICABILIDADE DA NRF 17

O presente trabalho, pretende como objectivo geral, contribuir para o conhecimento e aplicação prática do conceito de imparidade de activos, visando aproximar os valores das demonstrações financeiras de uma empresa ao respectivo valor económico. A abordagem é direccionada para o meio empresarial cabo-verdiano onde se pretende chamar a atenção para as mudanças que irão ocorrer a nível contabilístico e fiscal, e em particular no que diz respeito à imparidade de activos. O trabalho foi preparado com base em consulta de bibliografia especializada, de normativos estabelecidos no país e ainda recolha de opinião de profissionais da área. The present work has as general purpose, contribute for the knowledge and practical application of the concept of Impairment of assets, seeking to approximate the values of the financial demonstrations of the companies to the respective economic value. The approach comes to the capeverdian business way, where we intend to alert for what will pass to be accounting practical, the legal and framing in the one that concerns the theme in analysis. The work was prepared with base in consultation of specialized bibliography, of normative established in Cape Verde and still collects of professionals of this area opinion.

Security analysts as frame-makers

In this paper we explore the mechanisms that allow securities analysts to value companies in contexts of Knightian uncertainty, that is, in the face of information that is unclear, subject to unforeseeable contingencies or to multiple interpretations. We address this question with a grounded-theory analysis of the reports written on Amazon.com by securities analyst Henry Blodget and rival analysts during the years 1998-2000. Our core finding is that analysts' reports are structured by internally consistent associations that includecategorizations, key metrics and analogies. We refer to these representations as calculative frames, and propose that analysts function as frame-makers - that is, asspecialized intermediaries that help investors value uncertain stocks. We conclude by considering the implications of frame-making for the rise of new industry categories, analysts' accuracy, and the regulatory debate on analysts'independence.

Ojos aniquilados: ceguera reveladora y apagamiento de las imágenes en el cine de Angelopoulos, Bresson, Kiarostami, Majidi, Sokurov

A partir de tres ideas -la "impercepción" (el "punctum caecum") en el pensamiento de Maurice Merleau-Ponty, la "ceguera" en Jacques Derrida, y la teoría del "no ver" en Maurice Blanchot y Michel de Certeau-, se analizan algunos ejemplos del cine contemporáneo que constituyen imágenes representativas de la confluencia entreexperiencia-límite y representación-límite, del apagamiento místico de los sentidos y del estrecho intervalo entre lo visible y lo invisible: "teología cero" de lo "siempre ausente" (Derrida), "éxtasis blanco" (Certeau). Algunos escritores hablan de cerrar los ojos, de ojos vacíos de mirada, de cegarse para ver (A. Breton, P. Celan, J. Joyce, R. M. Rilke): la visión coincide con el desvanecimiento de las cosas vistas para hacer de esta"ausencia de visión el punto culminante de la mirada" (M. Blanchot). En el cine de Theo Angelopoulos, Robert Bresson, Abbas Kiarostami, Majid Majidi y Aleksandr Sokurov se emplean diversos recursos -el fuera de campo, los fundidos en blanco o en negro, la pantalla a oscuras¿- orientados a expresar -por medio de este espacio vacío- aquello de otro modo inexpresable. Estos recursos reflejan la dialéctica visible-invisible, la contraimagen de la mirada, la "mirada sin mirada" (Angelopoulos) hasta "perder por completo la noción de imagen" (Bresson). Se trata, en definitiva, de "la retirada de lo divino al fondo de una presencia-ausencia" (Jean-Luc Nancy) expresada por medio del eclipse o la extinción de las imágenes.

Web decoration of Micrathena sexpinosa (Araneae: Araneidae): a frame-web-choice experiment with stingless bees

The function of silk web decorations in orb weaving spiders has been debated for decades. The most accepted hypothesized functions are that web decorations I) provide camouflage against predators, 2) are an advertisement for vertebrates to avoid web damage, or 3) increase the attraction of prey to the web. Most studies have focused on only a few genera, Argiope being the most common. In this study, I evaluated the prey attraction hypothesis of silk decorations for a species of a poorly studied genus in this topic, Micrathena sexpinosa Hahn 1822. I used a web-choice experiment in which I presented empty or web-bearing frames at the end of a tunnel to stingless bees (Tetragonisca angustula). This frame-choice experiment consisted of the following comparisons: decorated web vs. empty frame, decorated web vs. undecorated web, and undecorated web vs. empty frame. Webs with decoration intercepted significantly more bees than empty frames and undecorated webs. Therefore, the decorations of Micrathena sexpinosa might play a role in increasing foraging success.

Cardiac motion estimation by joint alignment of tagged MRI sequences

Image registration has been proposed as an automatic method for recovering cardiac displacement fields from Tagged Magnetic Resonance Imaging (tMRI) sequences. Initially performed as a set of pairwise registrations, these techniques have evolved to the use of 3D+t deformation models, requiring metrics of joint image alignment (JA). However, only linear combinations of cost functions defined with respect to the first frame have been used. In this paper, we have applied k-Nearest Neighbors Graphs (kNNG) estimators of the -entropy (H ) to measure the joint similarity between frames, and to combine the information provided by different cardiac views in an unified metric. Experiments performed on six subjects showed a significantly higher accuracy (p < 0.05) with respect to a standard pairwise alignment (PA) approach in terms of mean positional error and variance with respect to manually placed landmarks. The developed method was used to study strains in patients with myocardial infarction, showing a consistency between strain, infarction location, and coronary occlusion. This paper also presentsan interesting clinical application of graph-based metric estimators, showing their value for solving practical problems found in medical imaging.

Pneumocystis-carinii-Pneumonie bei Säuglingen mit vertikaler HIV-Infektion in der Schweiz [Pneumocystis carinii pneumonia in infants with vertically acquired HIV infection in Switzerland]

OBJECTIVE: Review of incidence, clinical picture, therapy, and outcome of Pneumocystis carinii pneumonia (PCP) in infants with vertically-acquired HIV infection in Switzerland. METHODS: Inquiry among members of the Swiss Pediatrics AIDS Group, review of the data base of the Swiss Neonatal HIV Study and retrospective analysis of the charts from infants with PCP. RESULTS: Since 1986 PCP has been diagnosed in 10 out of 107 infants with vertically-acquired HIV infection. PCP occurred in 7 infants at the age of 3-6 months and in 3 at the age of 9-11 months. 4 infants showed symptoms related to HIV infection before developing PCP. Before the development of PCP, infection with HIV had been ascertained in 6 infants. In 2 the diagnosis was still unclear and in the 2 remaining the risk of HIV infection was not known. None of the infants was on primary prophylaxis against PCP. Signs and symptoms of PCP included cough and tachypnea (100%) as well as high fever up to 40 degrees C (90%). Transcutaneous oxygen saturation was 70-95%. Chest X-rays revealed interstitial infiltrates in 6 infants, localized infiltrates in 2 and interstitial as well as localized infiltrates in 2. The CD4+ cell count was, with one exception, < 1500/microliters, i.e. below the normal value for age. Side effects of high dose cotrimoxazole were noted in 6 patients. 5 infants required intubation and mechanical ventilation. 4 infants died due to PCP, including 3 of those who required intubation and mechanical ventilation. CONCLUSIONS: PCP in infants with vertically-acquired HIV infection preferentially occurs at the age of 3 to 6 months and is often lethal, especially in patients requiring intubation. Evaluation for HIV infection should be done as early as possible in order to introduce primary PCP prophylaxis in infants at risk for this opportunistic infection.

High capacity audio watermarking using the high frequency band of the wavelet domain

This paper proposes a novel high capacity robust audio watermarking algorithm by using the high frequency band of the wavelet decomposition at which the human auditory system (HAS) is not very sensitive to alteration. The main idea is to divide the high frequency band into frames and, for embedding, to change the wavelet samples depending on the average of relevant frame¿s samples. The experimental results show that the method has a very high capacity (about 11,000 bps), without significant perceptual distortion (ODG in [¿1 ,0] and SNR about 30dB), and provides robustness against common audio signal processing such as additive noise, filtering, echo and MPEG compression (MP3).

High capacity FFT-based audio watermarking

Peer-reviewed

Verkko-opetuksenhyödyntäminen uusien työntekijöiden koulutuksen haasteisiin vastaamisessa

Työn tarkoituksena oli kehittää verkko-oppimisympäristö sahatavaran jatkojalostusprosessien uusien ja työtehtävää vaihtavien työntekijöiden perehdytykseen. Työssä tutkittiin myös miten verkko-oppimisympäristöä voidaan käyttää osaamisen siirrossa. Työssä haastateltiin työnjohtajia ja työntekijöiden perehdyttämisestä vastaavia henkilöitä siitä, mitkä ovat ongelmat ja haasteet sahatavaran jatkojalostuksen alueella tietämyksen siirrossa uusille työntekijöille. Työssä tarkasteltiin tiedon syntymistä ja siirtämistä tietojohtamisen, sekä oppivan organisaation teorioiden avulla. Työssä selvitettiin myös mitkä ovat verkko-oppimisympäristöjen vahvuudet ja heikkoudet tiedonsiirrossa, sekä miten verkko-oppimisympäristö voisi toimia osana tiedonsiirtojärjestelmää. Haasteiksi uusien työntekijöiden koulutuksessa nousi esille neljä teemaa. Ne olivat laatutietous, turvallisuus, taloudellisuus jamotivaatio oppimiseen. Verkko-oppimisen vahvuuksia pyrittiin käyttämään mahdollisimman tehokkaasti hyväksi esiin nousseisiin haasteisiin vastaamisessa. Verkko-oppimisen vahvuuksia ovat eri mediaelementtien käyttö kuten kuvat, videot ja animaatiot. Työn tuloksia käytettiin hyväksi verkko-oppimisympäristön teossa. Lopuksi tehtiin myös ehdotus verkko-oppimisympäristön käytöstä osana tiedonsiirtojärjestelmää. Järjestelmän käyttö riippuu sen sisällön hyödyllisyydestä ja jatkuvasta päivityksestä.

Prosessinostureita valmistavan liiketoimintayksikön arvoverkoston kustannusrakenne

Työn tarkoituksena on tutkia prosessinosturiliiketoiminnan rajatun arvoketjun ja - verkoston kustannuksia. Tavoitteena on selvittää valittujen vaihtoehtoisten valmistuspaikkojen toimintojen pohjalta yleinen arvoketju kustannuskertymineen. Lisäksi tavoitteena on kehittää taulukkolaskentaohjelmistoon perustuva laskentamalli tai perustyökalu kustannusten kasautumisen arviointiin. Edelleen pyrkimyksenä on löytää rakennetusta mallin avulla kehitys- ja jatkotoimenpiteiden kohteita. Työssä perehdytään aluksi arvoketju -viitekehykseen ja niihin seikkoihin joista se muodostuu kirjallisuudesta löytyvän tiedon pohjalta. Arvoketjuajattelu on yksinkertaisimmillaan yrityksen toimintojen tarkastelua kilpailukyvyn ja -edun näkökulmasta. Liiketoiminnan kehittyminen verkostomaiseksi vaatii kuitenkin laajemman ¿ arvoverkosto - tarkastelunäkökulman. Toisaalta liiketoiminnan pidemmän aikavälin kilpailukyvyn suunnittelu edellyttää syvällisempää arvoketjujen ja toimintojen tarkastelua ja hallintaa, jolloin tarvitaan kehittyneempiä laskentatoimen menetelmiä ja kustannuslaskentajärjestelmiä. Tutkimuksen empiirisessä osiossa arvoketjuajattelua ja arvoverkostoviitekehystä sekä kustannuslaskentamenetelmiä sovelletaan käytännön tapauksiin. Tulokset osoittavat tutkimukseen valittujen neljän valmistuspaikan kustannuskertymän ja -rakenteen. Kustannuskertymältään alhaisimmaksi osoittautui tuotantolaitos Saudi-Arabiassa, kunloppuasiakkaan sijainti on Qatarissa. Puolalainen tehdas osoittautui puolestaankilpailukykyisimmäksi, kun nosturin toimitusosoite on Italian pohjoisosaan. Tulosten perusteella kustannusrakenteiden suurimmat kustannuserät ovat kuljetus-, teräsrakenteen valmistus- ja suunnittelutoiminnot.

Robottihitsauksen tehokas käyttöönotto

Työn tavoitteena oli selvittää uuden robottihitsaussolun käyttöönotto siten, että se tapahtuu mahdollisimman tehokkaasti ja taloudellisesti. Uudella robotilla on tarkoitus hitsata nykyisin käsinhitsattavia kauhakuormaajien takarunkoja sekä alihankintana tilattavia kauhoja. Tuotannon kotiuttamisella alihankinnasta ja hitsauksen robotisoinnilla pyritään nostamaan omaa tuotantovolyymiä ja pienentämään valmistuskustannuksia. Työn teoriaosuudessa selvitettiin tyypilliset robotiikkaan liittyvät asiat, kuten robotit, niiden ohjaus ja ohjelmointi sekä perusteet hitsauksen robotisoinnista. Lisäksi käsiteltiin hitsattavan tuotteen suunnittelu- ja valmistusnäkökohtia ja hitsauksen kustannuslaskennan perusteet. Työn käytännön osuudessa tehtiin kartoitus kahden valitun takarunkomallin soveltuvuudesta robottihitsaukseen ja muutosehdotuksia, joilla voidaan parantaa runkojen robottihitsattavuutta. Lisäksi käytiin läpi hitsauksen nykytilanne osavalmistuksesta aina hitsauksen jälkeiseen viimeistelyyn. Hitsauksen kustannusten selvittämistä varten tehtiin taulukkolaskentaohjelma, jolla tehtiin esimerkkinä kuvitteellinen kustannussäätölaskelma. Tuottavuusmittari laadittiin niin, että sillä voidaan mitata sekä robotin että kokohitsaustapahtuman tehokkuutta pitkällä ja lyhyellä aikavälillä. Näiden lisäksi laadittiin sisäinen ohje robottihitsattavien kappaleiden silloitukseen sekä suunnittelijoille ohjeistus huomioitavista asioista suunniteltaessa kappaletta robottihitsaukseen.

Ferramentas para visualização de imagens médicas em hospital universitário

OBJETIVO: Apresentar a implementação de "toolkits" para visualização de imagens médicas no padrão DICOM e fazer uma revisão dos fundamentos e características deste padrão. É apresentado o VDTApplication para visualização das imagens locais e remotas, e o VDTApplet, que possibilita a visualização das imagens utilizando um navegador. MATERIAIS E MÉTODOS: Os "toolkits" foram implementados utilizando a linguagem de programação Java. Para seu desenvolvimento foram consideradas as variações do padrão DICOM, tornando-o um sistema genérico, capaz de ler e abrir imagens geradas por diferentes modalidades de diversos fabricantes. As ferramentas foram avaliadas qualitativamente por médicos, considerando a interface do sistema, a qualidade das imagens e o ajuste da imagem. RESULTADOS: A avaliação foi feita com base em conceitos de 1 (muito ruim) a 5 (muito bom) para cada item, sendo os resultados: 5 para interface do sistema, 4 para qualidade das imagens e 3 para ajuste da imagem. Baseando-se nos conceitos obtidos pode-se classificar as ferramentas como boas. CONCLUSÃO: As ferramentas são práticas, amigáveis e deverão ser incorporadas ao projeto PACS ("picture archiving and communication system") do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo.

Integração RIS/PACS no Hospital das Clínicas de Ribeirão Preto: uma solução baseada em "web"

OBJETIVO: Integração dos Sistemas de Informação em Radiologia (RIS - "Radiology Information System") e de Arquivamento e Comunicação de Imagens (PACS - "Picture Archiving and Communication System") no Serviço de Radiodiagnóstico do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, para possibilitar a consulta remota de laudos e imagens associadas. MATERIAIS E MÉTODOS: A integração RIS/PACS implementada é feita em tempo real, no momento da consulta, utilizando tecnologias "web" e técnicas de programação para "intranet/internet". RESULTADOS: A aplicação "web" permite a consulta pela "intranet" do hospital dos laudos de exames e imagens associadas através de nome, sobrenome, número de registro hospitalar dos pacientes ou por modalidade, dentro de um determinado período. O visualizador possibilita que o usuário navegue pelas imagens, podendo realizar algumas funções básicas como "zoom", controle de brilho e contraste e visualização de imagens lado a lado. CONCLUSÃO: A integração RIS/PACS diminui o risco de inconsistências, através da redução do número de interfaces entre bases de dados com grande redundância de informação, proporcionando um ambiente de trabalho rápido e seguro para consulta de laudos radiológicos e visualização de imagens associadas.