As práticas de reconciliação consistem na comparação entre as quantidades e teores de minério estimados pelos modelos da jazida e as quantidades e teores de minério produzidos na usina de beneficiamento. O resultado dessas comparações é geralmente um grupo de fatores que são aplicados a estimativas futuras, na tentativa de melhorar a previsão do desempenho de uma operação. Atualmente, a prática comum de reconciliação baseia-se na definição do mine call factor (MCF) e sua aplicação às estimativas dos modelos de recursos e de controle de teor. O MCF expressa a diferença entre a produção prevista pelos modelos e a produção registrada na usina e, portanto, sua aplicação permite uma correção nas estimativas dos modelos. Esta é uma prática de reconciliação reativa. Entretanto, a aplicação desses fatores às estimativas dos modelos pode mascarar as causas dos erros responsáveis pelas discrepâncias observadas. As causas reais de qualquer variância só podem ser identificadas analisando-se as informações referentes a cada variância e, em seguida, modificando metodologias e processos. Este é o conceito de prognosticação, ou reconciliação pró-ativa, um processo iterativo de recalibração constante das entradas de dados e dos cálculos. Portanto, a prognosticação permite uma correção das metodologias de coleta de dados, e não simplesmente uma correção das estimativas dos modelos. O presente trabalho analisa as práticas de reconciliação realizadas em uma mina de ouro do Brasil e sugere um novo protocolo de amostragem, com base nos conceitos de prognosticação. / Reconciliation is the practice of comparing the tonnage and average grade of ore predicted from resource and grade control models with the tonnage and grade generated by the processing plant. The result is usually a group of factors, which are applied to future estimates in an attempt to better predict how the operation may perform. The common practice of reconciliation is based on definition of the mine call factor (MCF) and its application to resource or grade control estimates. The MCF expresses the difference, a ratio or percentage, between the predicted grade and the grade reported by the plant. Therefore, its application allows to correct model estimates. This practice is named reactive reconciliation. However, the use of generic factors that are applied across differing time scales and material types often disguises the causes of the error responsible for the discrepancy. The root causes of any given variance can only be identified by analyzing the information behind any variance and, then, making changes to methodologies and processes. This practice is named prognostication, or proactive reconciliation, an iterative process resulting in constant recalibration of the inputs and the calculations. The prognostication allows personnel to adjust processes so that results align within acceptable tolerance ranges, and not only to correct model estimates. This study analyses the reconciliation practices performed at a gold mine in Brazil and suggests a new sampling protocol, based on prognostication concepts.

In the present work there was analysed analysis of financial condition of the enterprise, engaged in a very specific activity – sale of property of enterprises undergoing the process of bankruptcy and re-buying of debit indebtednesses. There were used three main types of analysis – vertical, horizontal and analysis of comparative indicators. There were identified the main problems, among them are to be mentioned to high indebtedness of the enterprise, ineffective management of reserves, freeze of means. It was determined that the profit rates of the enterprise were good and they were improving further. Upon comprehensive diagnosing of bankruptcy, assessing changes of separate articles and using various systems of comparative indicators, there was detected that the threat of bankruptcy is very little. In the constructive part, there were evaluated perspectives of the enterprise. Calculated prognosticated values of sales of KB “Fabiola” for the years 2006 and 2007, using the faction of hyperbola of second type. Considering specifics of the activities of the enterprise, there was evaluated dependence of sales on started procedures of bankruptcy, using correlative and regressive analysis. It was determined, that these indicators are closely coherent. Therefore, upon completion of prognostication of started bankruptcy procedures, there were evaluated perspectives of changes of sales of the enterprise.

As práticas de reconciliação consistem na comparação entre as quantidades e teores de minério estimados pelos modelos da jazida e as quantidades e teores de minério produzidos na usina de beneficiamento. O resultado dessas comparações é geralmente um grupo de fatores que são aplicados a estimativas futuras, na tentativa de melhorar a previsão do desempenho de uma operação. Atualmente, a prática comum de reconciliação baseia-se na definição do mine call factor (MCF) e sua aplicação às estimativas dos modelos de recursos e de controle de teor. O MCF expressa a diferença entre a produção prevista pelos modelos e a produção registrada na usina e, portanto, sua aplicação permite uma correção nas estimativas dos modelos. Esta é uma prática de reconciliação reativa. Entretanto, a aplicação desses fatores às estimativas dos modelos pode mascarar as causas dos erros responsáveis pelas discrepâncias observadas. As causas reais de qualquer variância só podem ser identificadas analisando-se as informações referentes a cada variância e, em seguida, modificando metodologias e processos. Este é o conceito de prognosticação, ou reconciliação pró-ativa, um processo iterativo de recalibração constante das entradas de dados e dos cálculos. Portanto, a prognosticação permite uma correção das metodologias de coleta de dados, e não simplesmente uma correção das estimativas dos modelos. O presente trabalho analisa as práticas de reconciliação realizadas em uma mina de ouro do Brasil e sugere um novo protocolo de amostragem, com base nos conceitos de prognosticação. / Reconciliation is the practice of comparing the tonnage and average grade of ore predicted from resource and grade control models with the tonnage and grade generated by the processing plant. The result is usually a group of factors, which are applied to future estimates in an attempt to better predict how the operation may perform. The common practice of reconciliation is based on definition of the mine call factor (MCF) and its application to resource or grade control estimates. The MCF expresses the difference, a ratio or percentage, between the predicted grade and the grade reported by the plant. Therefore, its application allows to correct model estimates. This practice is named reactive reconciliation. However, the use of generic factors that are applied across differing time scales and material types often disguises the causes of the error responsible for the discrepancy. The root causes of any given variance can only be identified by analyzing the information behind any variance and, then, making changes to methodologies and processes. This practice is named prognostication, or proactive reconciliation, an iterative process resulting in constant recalibration of the inputs and the calculations. The prognostication allows personnel to adjust processes so that results align within acceptable tolerance ranges, and not only to correct model estimates. This study analyses the reconciliation practices performed at a gold mine in Brazil and suggests a new sampling protocol, based on prognostication concepts.

Cardiac arrest is a common cause of coma with frequent poor outcomes. Palliative medicine teams are often called upon to discuss the scope of treatment and future care in cases of anoxic brain injury. Understanding prognostic tools in this setting would help medical teams communicate more effectively with patients’ families and caregivers and may promote improved quality of life overall. This article reviews multiple tools that are useful in determining outcomes in the setting of postarrest anoxic brain injury.

The overall aim of the thesis was to study post-resuscitation care of cardiac arrest (CA) patients with a focus on therapeutic hypothermia treatment, outcomes up to six months post-CA and relatives’ experiences during the hospital stay. In Paper I, the aim was to asses effectiveness of hypothermia treatment with cold, 4°C, intravenous crystalloid infusion combined with ice packs. In conclusion, the described cooling method was found to be useful for inducing and maintaining hypothermia, allowed good temperature control during rewarming and to be feasible in clinical practice. The aim in Paper II was to investigate biomarkers and the association of serum glial fibrillary acidic protein (GFAP) levels with outcome, and to compare GFAP with neuron-specific enolas (NSE) and S100B. The result showed increased GFAP levels in the poor outcome group, but did not show sufficient sensitivity to predict neurological outcome. Both NSE and S100B were shown to be better predictors. A combination of the investigated biomarkers did not increase the ability to predict neurological outcome. In Paper III, the aim was to investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months post-CA. There was improvement over time in HRQoL, but changes over time in anxiety and depression were not found. Physical problems seemed to affect HRQoL more than psychological problems. The results also indicate that the less anxiety and depression patients perceive, the better their HRQoL. In the fourth paper, the aim was to describe relatives’ experiences during the next of kin’s hospital stay after surviving a CA. The analysis resulted in three themes: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence. In conclusion, the results of the thesis have helped to improve knowledge within the areas studied and reveal aspects that should be taken into account in the overall treatment of this group of patients. The thesis have also shown the importance of developing an overall view and establishing a chain of care from an individual’s CA until follow-up for both the patient and his/her relatives.

no / Dear Editor In undertaking studies of palliative care in heart failure and chronic obstructive pulmonary disease (COPD) in the UK, we identified procedural, conceptual and ethical challenges that may arise from one feature of The End of Life Care Strategy for England.1 The strategy presents the question, ‘Would I be surprised if the person in front of me was to die in the next six months or one year?’ as a prompt to initiate discussion of endof-life care needs and preferences (paragraph 3.23). We believe this question is inappropriate in heart failure and COPD and its use will inhibit the initiation of a palliative care approach with these patients.

Role of blood biomarkers in spontaneous intracerebral hemorrhage Background: The study of blood biomarkers can offer new possibilities in diagnostics, prognostication, determination of etiology, and management of spontaneous intracerebral hemorrhage. The aim of our study was to assess the relationship between a panel of selected blood biomarkers and clinical and radiodiagnostic parameters in patients with spontaneous intracerebral hemorrhage. Primarily, the aim was to find a prognostic biomarker which could help in deciding on the optimal categorization of treatment. Patients and methods: A total of 70 patients were prospectively included in this study. The following blood biomarkers were determined: glial fibrillary acidic protein, S100B protein, matrix metalloproteinase 9, interleukin 6, interleukin 10, 25-hydroxyvitamin D, 1,25- dihydroxyvitamin D, total cholesterol, leukocyte counts, blood glucose and C-reactive protein. These were then correlated with selected clinical and radiodiagnostic parameters. Results: Relative to hematoma volume a statistically significant positive correlation was found for S100B, interleukin 10, interleukin 6 and blood glucose (S100B: ρ= 0,54, p< 0,001, IL-10: ρ= 0,43, p< 0,001, IL-6: ρ= 0,26, p= 0,027, blood glucose: ρ= 0,24, p= 0,045). Using multivariate analysis, a...

Le pronostic de l’arrêt cardiaque (AC) reste dramatique. Diagnostiquer sa cause rapidement et prédire précocement son pronostic ("pronostication") de manière fiable permettrait de mieux guider les traitements initiaux, en évitant de traiter futilement les patients avec faible probabilité d’évolution favorable ou à l’inverse de permettre d’intensifier le traitement de patients avec forte probabilité d’évolution favorable. Les biomarqueurs, dont l’utilité diagnostique et pronostique reste débattue, semblent actuellement insuffisamment sensibles et précis, surtout dans les 1ères heures après la reprise de l’activité circulatoire spontanée (RACS). Dans l’algorithme pronostique, seule la Neuron Specific Enolase (NSE) est validée après le 3ème jour post-AC et en 2ème intention. Notre première étude a montré que la valeur diagnostique des biomarqueurs "spécifiques" des lésions cérébrales en post-AC (protéine S100B : S100 et surtout NSE) était insuffisante, à l’admission en réanimation, pour étayer précisément le diagnostic de cause neurologique d’AC. Si la coronarographie précoce est l’outil diagnostique de référence de l’AC de probable cause cardiaque, les biomarqueurs ne peuvent remplacer le scanner cérébral pour diagnostiquer une cause neurologique d’AC. La deuxième étude a évalué, au 1er jour post-AC, S100 et NSE avec 2 témoins d’œdème cérébral proposés comme outils pronostiques : le diamètre de l’enveloppe du nerf optique (DENO) par échographie et le rapport de dédifférenciation substance grise / substance blanche (DSG/B) par scanner cérébral. Même si une relation directe ne peut être affirmée formellement entre ces paramètres, l’élargissement du DENO à J1 post-AC était corrélé aux lésions cérébrales, surtout l’œdème cérébral et les lésions neuronales suspectés sur l’élévation de la NSE (à l’admission et à J1) et la baisse de DSG/B. Si NSE, DSG/B et DENO à J1 étaient liés, S100, plus spécifique de la glie, n’était pas corrélée au DENO ni au DSG/B. NSE et S100 à l’admission, à J1 et J2 post-RACS et DENO à J1 étaient associées à la mortalité hospitalière. La troisième étude évaluait la valeur pronostique des biomarqueurs à la phase précoce de l’AC (NSE et S100 étant prélevées en médiane 220 min après la RASC). S100, réalisée en aveugle des cliniciens, était le biomarqueur le plus précis à l’admission en réanimation pour prédire correctement le pronostic défavorable à la sortie de l’hôpital et à 3 mois après AC, par rapport au lactate, pH et créatininémie, et surtout à la NSE. Les variations de S100 dans le temps permettaient d’affiner cette prédiction. S100 à l’admission était un facteur indépendant du pronostic défavorable à la sortie de l’hôpital, avec la durée sans massage cardiaque, le rythme initial non-choquable, le lactate initial et la présence de convulsion clinique. Selon les recommandations, la pronostication nécessite théoriquement d’être différée et multimodale, les biomarqueurs seuls n’étant pas recommandés, surtout précocement. Les biomarqueurs ne peuvent constituer une alternative, en comparaison à l’imagerie, pour l’aide diagnostique de la cause d’AC. A l’inverse, certains biomarqueurs comme la S100 après admission pourraient facilement et spécifiquement discriminer les AC ayant une certitude de pronostic défavorable. Associée à d’autres outils prédictifs clinico-radiologiques, la S100 pourrait être incorporée dans des algorithmes permettant de guider les thérapeutiques initiales. Une pronostication correcte précoce pourrait éviter des traitements invasifs inutiles, ou au contraire optimiser certaines thérapeutiques agressives. Le choix de méthodes recommandées et automatisées de contrôle ciblé de la température, très efficaces mais invasives et onéreuses, ou l’indication d’utiliser -ou pas- une assistance cardio-circulatoire extra-corporelle pourrait bénéficier d’une telle stratégie précoce de sélection des patients. / Outcome of cardiac arrest (CA) remains dramatic. To quickly diagnose the cause of CA and establish a reliable outcome prediction (prognostication) as early as possible could help to guide initial treatments. It could avoid futile treatments in patients with low chance of survival or of good neurological recovery, or conversely allow treatment optimization in patients expected to have a high likelihood of good neurological outcome. Usefulness of biomarkers to guide clinicians in finding the CA diagnosis and helping prognostication is debated. Biomarkers are considered as not sensitive and accurate enough, especially within the first hours after return of spontaneous circulation (ROSC). Their use is only recommended in prognostication for Neuron Specific Enolase (NSE) as a second line tool and after the third day from CA. Our first study confirmed that biomarkers “specific” of brain injury (S100B protein: S100 and moreover NSE) cannot sufficiently discriminate the neurological cause of CA on ICU admission. If early coronary angiogram is the standard for diagnosing a probable cardiac cause of CA, biomarkers cannot replace brain computed-tomography (CT) in CA from a neurological cause. The second study evaluated, during the 1st day after ROSC, the link between biomarkers (S100 and NSE) and 2 surrogates of brain oedema recently proposed as outcome predictors: echography of the optic nerve sheath diameter (ONSD), and grey to white matter attenuation ratio (GWR) on brain CT-scan. Even though we cannot conclude on a definitive relationship between these parameters, ONSD enlargement at day 1 was associated with specific brain damage after CA, such as brain oedema and mostly axonal injuries, as reflected by increases in NSE (on admission and at day 1) and low GWR measurements. Whereas NSE, GWR and ONSD at day 1 were correlated, S100, which is more specific of glial injuries, did not reach significance. NSE and S100 on admission, at days 1 and 2 after ROSC, as well as ONSD at day 1, were associated with survival at hospital discharge. The third study evaluated the prognostic value of several biomarkers in the early phase after CA (NSE and S100 being sampled at median 220 min after ROSC). S100, blinded to physicians, was the biomarker with the best accuracy after ICU admission to correctly predict unfavourable outcome at hospital discharge and at 3 months after CA, compared with all other biomarkers such as lactate, pH, creatinine, and especially NSE. S100 variations during the first day after admission refined prognostication. Initial S100 was an early independent predictive factor associated with unfavourable outcome at hospital discharge, with the no-flow duration, initial lactate value, initial non-shockable rhythm, and the presence of clinical seizure. According to guidelines, prognostication theoretically needs to be delayed and multimodal, biomarkers alone not being recommended especially in the early phase after CA. Biomarkers cannot seem to be an alternative option compared to imaging to precisely diagnose the CA cause. By contrast, some biomarkers, such as S100 after admission, could easily and specifically discriminate CA patients with certainty of unfavourable outcome. Associated with other predictive tools (clinical or using imaging), biomarkers could interestingly be incorporated in early decisional algorithms to optimally guide initial therapies. This correct patient classification could help to avoid unuseful treatments versus to maximize aggressive therapies. The choice of recommended servo-controlled targeted temperature management devices, very efficient but invasive and expensive, or the indication -or not- of a cardio-circulatory assist device implementation should be guided in the early stage after ROSC using this simple strategy of patient selection.

This diplomatic edition of Leonard Digges's 1555 of *A PROGNOSTICATION OF RIGHT GOOD effect fruitfully augmented, containing plain, brief, pleasant, chosen rules, to judge the weather forever, by the Sun, Moon, Stars, Comets, Rainbow, Thunder, Clouds, with other Extraordinary tokens, not omitting the Aspects of Planets, with a brief judgement forever, of Plenty, Lack, Sickness, Death, Wars, etc. Opening also many natural causes, worthy to be known* is intended to make the treatise available in an edited form which preserves the original page layout and wording, while modernizing spelling and providing a complete scholarly apparatus based on the latest scholarship. This apparatus includes historical notes, translations of all Latin text, a glossary of terms unfamiliar to modern audiences, and a catalogue of any conjectural emendations.

Background Aneurysmal subarachnoid hemorrhage can lead to multi-organ disturbances as a result of central and autonomic nervous system injuries. Alterations in the brain-body interface associated with this cerebrovascular disorder have significant impact on patient morbidity and mortality. Knowledge of the most pertinent brain-body associations, as well as demographic, systemic and neurological prognostic factors on hospital admission, along with their progression during hospitalization can assist the clinician and patient family in the process of treatment decision making. Objectives The goals of this dissertation are to: (1) synthesize and critically appraise the methodologic quality of existing studies that derive clinical predictor tools and clinical predictors used to determine outcome prognosis in patients with aneurysmal subarachnoid hemorrhage (SAH), (2) synthesize and critically appraise the methodologic quality of existing studies that derive pathophysiologic mechanisms of brain-body associations in aneurysmal SAH, (3) provide new insights into the significance of brain-body associations that are essential in influencing outcome in aneurysmal SAH, and (4) create a decision making algorithm for aneurysmal SAH patients that is useful in bedside prognostication and clinical treatment decision making. Methods Existing prospective and retrospective cohort studies and randomized controlled trials were included in the systematic review investigating prognostic factors and clinical prediction tools associated with determining the neurologic outcome in adults patients with aneurysmal SAH. Existing prospective and retrospective cohorts were included in the systematic review investigating the pathophysiologic mechanisms of brain-body associations in patients with ruptured brain aneurysms. The multicenter Tirilazad database (3551 patients) was used to create the aneurysmal SAH prognostic model, in order to elucidate significant brain-body associations. Traditional binary logistic regression models were used. The classification and regression tree analysis technique is applied to the multicenter Tirilazad database in order to create a decision making algorithm. Results Systematic review of the literature confirmed the most frequently retained clinical outcome predictors, namely, age, neurological grade, aneurysm size and blood clot thickness. Systematic review of the literature clarified currently known pathophysiologic mechanisms of brain-body associations in aneurysmal SAH, specifically, sympathetic activation of the cardiopulmonary system with subsequent delayed activation of neuro-cardio-endocrinological responses as part of the secondary injury cascade in response to the primary ictus of aneurysmal SAH. Logistic regression models found the significance of hepatic disease and hypertension in development of brain edema, and the negative consequences of seizures in those with history of myocardial infarction and post admission fever worsening neurological outcome. A clinically useful classification and regression tree revealed prognostic subgroups with important explanatory nodes including neurological grade, age, post admission fever and post-admission stroke. Discussion This dissertation clarified existing information on clinical predictors and pathophysiologic mechanisms of brain-body associations in aneurysmal SAH. It also provides novel information on brain-body associations that are essential in influencing outcome in aneurysmal SAH patients despite scarce existing literature on such important relationships. A clinically useful classification and regression tree was generated to guide both bedside prognostication and clinical treatment decision making in aneurysmal SAH patients. / Thesis / Doctor of Philosophy (PhD)