Objective: To evaluate patient post-intensive care syndrome (PICS-P) and caregiver burden 3 months after discharge from the Intensive Care Unit (ICU) and determine the impact of different components of PICS-P upon caregiver burden. Design: A prospective observational study was conducted over 26 months (January 2013-February 2015). Setting: Medical-surgical ICU and follow-up consultation in Portugal. Patients or participants: Patients discharged after a minimum of 2 days in the ICU. Caregiver inclusion criteria: not paid, written and spoken Portuguese, and agreement to participate in the study. Main variables of interest: In ICU: Patient gender, age, severity of illness (SAPS II) and length of ICU stay. At 3 months caregiver burden, physical (reduced mobility, weakness acquired in the ICU) and psychological components of PICS (anxiety, depression, post-traumatic stress disorder). Results: A total of 168 caregivers completed the survey (response rate of 69%). A low degree of overburden was reported by 34.5% of caregivers, while 15.5% showed moderate to high levels of overburden. Patient anxiety and depression 3 months after ICU discharge significantly influenced the presence of caregiver burden (p = 0.030 vs p = 0.008). When physical components of PICS-P were evaluated, no influence on caregiver burden was observed. Patient demographics, severity of illness and length of stay also failed to influence caregiver burden. Conclusions: The presence of psychological components of PICS-P 3 months after ICU seems to have a negative impact upon caregiver burden. On the other hand, physical problems showed no important impact upon caregiver overburden. (C) 2017 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.

Objective: To assess the validity of the estimation of 24-h urinary sodium (UNa) and potassium (UK) excretion obtained through 4 formulae based on occasional urine samples. Design and method: We analyzed 2460 individuals (50.2% females) aged 18–96 years representatives of Portuguese population (PP). Tanaka, Kawasaki, INTERSALT and NHANES formulae were used to predict 24-h UNa and UK excretions from occasional urinary samples (OUrS) and we compared it with validated real 24-h urine samples (VUrS) (average 24 h UNa = 4073 mg/d). We also derive formulas specific to the PP using Tanaka and Kawasaki's formulae with adjusted parameters, obtained through the method of least squares. All formulas were then used on data collected from 24-h urine samples to compute predictions. We compared observed vs estimated measurements by examining bias (observed minus predicted UNa/UK), the intra-class correlation (ICC) coefficients between measurements, and Bland-Altman plots categorized by hypertension and normotension diagnosis. Results: The degree of bias of estimations based on OUrS relative to VUrS measurements ranged from -31 mg/day of sodium in Tanaka, to 1969 mg/day of UNa in Kawasaki and from -259 mg/day to 736 mg/day of UK in Tanaka. The only formula for which bias was not significant was Tanaka's for UNa prediction. All ICC were lower than 0,470 for both UNa and UK excretion estimations. The Bland-Altman plots indicated a high dispersion of the estimates biases regardless of the formulae used and the diagnosis of normotension/hypertension. Most formulas’ estimations showed a positive relationship between bias and the magnitude of the average between observed and predicted measurements. All formulas lead to a wide range of overestimation and underestimation of both 24 h UNa and UK excretion even when applied to the 24-h real samples. Conclusions: We found a poor agreement between estimated and observed measurements of UNa and UK in our large population exhibiting a high salt intake. That suggests that any of these formulas may incur in over- or under-estimations of UNa and UK excretion that may be unreliable for clinical evaluation of individual's daily UNa and UK+ excretion.

BACKGROUND:Patients with liver cirrhosis may develop cirrhotic cardiomyopathy (CC), characterized by blunted contractile responsiveness to stress, diastolic dysfunction (DD), and electrophysiological abnormalities. It may adversely affect the long-term prognosis of these patients.METHODS:We conducted a retrospective analysis of patients undergoing liver transplantation (LT) for cirrhosis from January 2012 to June 2015. We analyzed demographic characteristics, the etiology of cirrhosis, Child-Pugh and Model for End-Stage Liver Disease (MELD) scores, the corrected QT (QTc) interval in the preoperative period, diastolic and systolic dysfunction, mortality and survival, and duration of mechanical ventilation and vasopressor support in the post-LT period. These variables were compared with diastolic dysfunction and prolongation of QTc, with the use of chi-square, Fisher, and Mann-Whitney U tests.RESULTS:The study included 106 patients, 80.2% male and overall average age 54.83 years. The median MELD score was 16, and Child-Pugh class C in 55.4%. Prolonged QTc interval before LT was present in 19% and DD in 35.8% of patients. QTc before LT or DD did not vary significantly with MELD or Child-Pugh score.CONCLUSIONS:The patients in the pre-LT period presented with a significant incidence of DD, which can predispose them to adverse cardiac events. The presence of DD correlates with mortality after LT in patients with hepatic cirrhosis.

In 1995 Furtado et al performed the first domino transplantation using a donor liver with familial amyloid polyneuropathy (FAP), thereby increasing the pool of donors. Our experience showed that the onset of FAP symptoms occurs earlier in some patients. Patients with FAP acquired by transplantation are candidates for liver retransplantation to minimize the progression of symptoms. Liver retransplantation is considered to be a high-risk procedure and has lower survival compared with the first transplantation. We evaluated the risk of liver retransplantation in patients with acquired FAP. We did a retrospective analysis of these patients based on the records of perioperative data. From 1995 to 2004 we carried out 81 domino transplantations, of which 10 were submitted to liver retransplantation because of acquired FAP. The better outcomes in this group lead us to think that the liver retransplantation in patients with acquired FAP is not associated with the same risks of liver retransplantation in candidates with graft failure.

This paper presents usability tests results with real users during the prototype development phase of two applications for seniors care, AALFred and SmartCompanion. To this aim, usability testing was performed considering a Living Lab approach. Seniors were invited to use the applications in an environment that simulates the one they would use the tested technology during their everyday life. Observation methods, thinking aloud and questionnaires were used to collect data related to the systems' effectiveness and users' satisfaction, namely their expectations, frustrations and difficulties. Evaluations were performed during the initial phases of product development and results were used to improve the applications, considering the development cycle of User-Centered Design methodology.

An increasing number of Intensive Care Unit (ICU) survivors develop psychological, cognitive and physical morbidities that may persist for years. The Post Intensive Care Syndrome (PICS) includes these multidimensional impairments and is described both for patients and families.

Familial amyloid polyneuropathy (FAP) is the most common hereditary amyloidosis, characterized by progressive peripheral sensory and motor neuropathy. The livers of patients with FAP are used in domino liver transplantation in selected cases to increase the number of grafts available. In our department 10 patients underwent liver retransplantation (ReLTx) in the absence of liver dysfunction by de novo FAP after domino liver transplantation. Our aim was to compare the differences in the consumption of blood products and intraoperative hemodynamic support among patients with FAP undergoing liver transplantation (LTx) and patients with de novo FAP undergoing ReLTx in the same time frame. The anesthetic records of all patients who underwent LTx for FAP and ReLTx for de novo FAP were analyzed, from January 2009 to May 2014. Patients were divided into 2 groups: group 1 patients with FAP, and group 2 patients with de novo FAP. Statistical differences in the value of preoperative creatinine were found. Hemoglobin levels, preoperative international normalized ratio (INR), use of blood products, aminergic support, and surgical time showed no statistical difference. Major bleeding rates would be expected in patients undergoing ReLTx. Changes in renal function, chronic immunosuppressive therapy, and age may contribute to the increase in intraoperative complications. We did not find statistically significant differences, leading us to the conclusion that de novo FAP does not seem to be a predictor of perioperative risk.

This paper describes the efforts for the construction of Language Resources and NLP tools for Mirandese, a minority language spoken in North-eastern Portugal, now available on a community-led portal, Casa de la Lhengua. The resources were developed in the context of a collaborative citizenship project led by Microsoft, in the context of the creation of the first TTS system for Mirandese. Development efforts encompassed the compilation of a corpus with over 1M tokens, the construction of a GTP system, syllable-division, inflection and a Part-of-Speech (POS) tagger modules, leading to the creation of an inflected lexicon of about 200.000 entries with phonetic transcription, detailed POS tagging, syllable division, and stress mark-up. Alongside these tasks, which were made easier through the adaptation and reuse of existing tools for closely related languages, a casting for voice talents among the speaking community was conducted and the first speech database for speech synthesis was recorded for Mirandese. These resources were combined to fulfil the requirements of a well-tested statistical parameter synthesis model, leading to an intelligible voice font. These language resources are available freely at Casa de la Lhengua, aiming at promoting the development of real-life applications and fostering linguistic research on Mirandese.

Marques, Castanheira S.; Pereira, E.; Pereira, L.; Pinto, F.; Carvalhas, J.; Mártires, E. Author Information

Speech recognisers trained with adults' speech do not work well with children's speech because of the inherent acoustic and linguistic differences in the speech of these two populations. To develop speech-driven applications capable of successfully recognising children's speech, a sufficient amount of children's speech is needed for training acoustic models from scratch or for adapting acoustic models trained with adults' speech. However, the availability of suitable children's speech corpora is still limited, especially in the case of less-spoken languages. This paper describes the design, collection, transcription and annotation of a 21-hour corpus of prompted European Portuguese children's speech collected from 510 children aged 3-10. Before the development of this corpus, European Portuguese children's speech data have not been available at all for parts of this age range.

Speech interfaces have tremendous potential in education.In this paper, we present our work in the Contents for Next Generation Networks project, an ongoing Portuguese industry-academia collaboration developing a multimodal educational game aimed at improving the physical coordination and the basic mathematical and musical skills of 3-10-year-old children.We focus on our work in the area of children's speech recognition: designing, collecting, transcribing and annotating a 21-hour corpus of prompted European Portuguese children's speech, as well as our first experiments with different acoustic modelling approaches.Our speech recognition results suggest that training children's speech models from scratch is a more promising approach than retraining adult speech models using children's speech when a sufficient amount of training data is available from the targeted age group.This finding also holds for adult female speech models retrained using children's speech.As compared with a baseline recogniser comprising gender-dependent adult speech models, the best-performing children's speech models that we have trained so far -genderindependent cross-word triphones trained with 17.5 hours of speech from 3-10-year-old children -resulted in a 45-percent (relative) decrease in word error rate in a task expecting isolated cardinal numbers, sequences of cardinal numbers or musical notes as speech input.

This paper presents a multimodal prototype application that aims to promote the social integration of the elderly.The application enables communication with their social network through conferencing and social media services, using natural interaction modalities, like speech, touch and gestures.We begin by discussing the requirements and design guidelines that were taken into account for the development of the prototype.We also present the key elements of the development stage and the results of a usability study conducted with ten elderly volunteers.The usability study reveals that such a multimodal solution can simplify accessibility to the considered services.Results indicate that this system is simpler, more natural and more enjoyable than the current user interfaces.Furthermore, the natural interaction modalities of the proposed prototype, allow elderly to be more efficient and have a better user experience, thus contributing with an easier and faster way for this population to join the information era.

Technologies for Human-Computer Interaction (HCI) and Communication have evolved tremendously over the past decades. However, citizens such as mobility impaired or elderly or others, still face many difficulties interacting with communication services, either due to HCI issues or intrinsic design problems with the services. In this paper we start by presenting the results of two user studies, the first one conducted with a group of mobility impaired users, comprising paraplegic and quadriplegic individuals; and the second one with elderly. The study participants carried out a set of tasks with a multimodal (speech, touch, gesture, keyboard and mouse) and multi-platform (mobile, desktop) system, offering an integrated access to communication and entertainment services, such as email, agenda, conferencing, instant messaging and social media, referred to as LHC - Living Home Center. The system was designed to take into account the requirements captured from these users, with the objective of evaluating if the adoption of multimodal interfaces for audio-visual communication and social media services, could improve the interaction with such services. Our study revealed that a multimodal prototype system, offering natural interaction modalities, especially supporting speech and touch, can in fact improve access to the presented services, contributing to the reduction of social isolation of mobility impaired, as well as elderly, and improving their digital inclusion.

Although technology for communication has evolved tremendously over the past decades, mobility impaired individuals still face many difficulties interacting with communication services, either due to HCI issues or intrinsic design problems with the services. In this paper we present the results of a usability study, conducted with a group of five mobility impaired users, comprising paraplegic and quadriplegic individuals. The study participants carried out a set of tasks with a multimodal (speech, touch, gesture, keyboard and mouse) and multiplatform (mobile, desktop) prototype, offering an integrated access to communication and entertainment services, such as email, agenda, conferencing and social media. The prototype was designed to take into account the requirements captured from these users, with the objective of evaluating if the use of multimodal interfaces for communication and social media services, could improve the interaction with such services. Our study revealed that a multimodal prototype system, offering natural interaction modalities, especially supporting speech and touch, can in fact improve access to the presented services, contributing to a better social inclusion of mobility impaired individuals.

Purpose To determine the value of multifocal ERG (mfERG) and optical coherence tomography (OCT) in the evaluation of patients with unexplained visual loss. Methods mfERG and macular OCT were obtained from six patients with unexplained visual loss (normal ophthalmoscopy, fluorescein angiography, full-field ERG and brain CT scan) and four age and sex matched controls. Results Patients BCVA ranged from 20/32 to 20/125. When comparing to controls, patients showed significantly depressed mfERG amplitudes in rings R1 (121.7 vs 64.8; p 0.01) and R2 (42.6 vs 19.5; p 0.02). Foveal thickness, as measured by macular OCT, was also reduced, although not significantly (p 0.1). Conclusion Multifocal ERG allowed localization of the visual dysfunction to the central macula, in cases with hitherto unexplained visual loss.