Latim e sabélico são línguas que possuem muitos paralelos entre si, pois pertencem ao mesmo ramo do proto-indo-europeu, o ramo itálico. Uma semelhança interessante e intrigante entre essas línguas é a síncope vocálica, porque se trata de um processo fonológico recorrente. Até algumas décadas atrás, os estudiosos não acreditavam ser possível analisar devidamente as condições nas quais a síncope ocorre em latim, por serem muito complexas. No entanto, pesquisas mais recentes mostram que isso é possível de alguma forma, apesar de a análise ser difícil. A ocorrência da síncope vocálica em sabélico parece menos complexa que em latim. Em sabélico, os ambientes fonológicos nos quais a síncope ocorre são mais limitados, mas a dificuldade em entender o significado e a etimologia de algumas palavras sabélicas também torna a análise complicada. O objetivo desta pesquisa foi delimitar o máximo possível os ambientes fonológicos da síncope em latim e em sabélico e entender quais correlações podem ser feitas entre os exemplos listados. Ainda que seja interessante analisar todos os casos com base nas mesmas premissas, isso é muito difícil, uma vez que os dados encontrados são muito variados. As correlações que podem ser feitas entre casos de línguas diferentes são basicamente apenas de ordem etimológica, pois a ação e resultado da síncope agem de maneiras diferentes dependendo da língua e do período. / Latin and Sabellic are languages that have many parallels, for they belong to the same Indo-European branch, the Italic branch. An interesting and intriguing phonological similarity between these languages is vowel syncope, because is a recurring phonological process. Until a few decades ago, scholars believed not to be possible to analyze properly the conditions under which syncope occurs in Latin, because they are very complex. However, more recent researches show that this is somehow possible, though the analysis is difficult. The occurrence of vowel syncope in Sabellic seems to be less complex than in Latin. In Sabellic, the phonological environments in which syncope occurs are more limited, but the difficulty to understand the meaning and etimology of some Sabellic words make this analysis also tough. The aim of this research was to limit as much as possible the phonological environments of syncope in Latin and in Sabellic and to understand the correlations that can be made among the examples of the corpora. Although it would be interesting to analyze all cases based on the same premises, this is very difficult, for the data do not allow it. The correlations that can be made are basically just etymological, because the way it works and the results are different according to each language and each time they existed.

La syncope, dont l'origine peut ne pas être clairement définie, est considérée comme une pathologie fréquente. Dans ce cas et lorsque les épisodes sont répétés, le patient peut être amené à réaliser le test de la table d'inclinaison. Cet examen appelé tilt-test, est une méthode reconnue pour recréer les conditions dans lesquelles le patient ressent les symptômes de la syncope. Cependant, le principal problème de ce test est sa durée, qui peut atteindre une heure. Dès lors, pour des raisons de coût et de bien-être des patients, il paraît important de pouvoir réduire sa durée. C'est dans cet objectif que s'inscrivent les travaux réalisés dans le cadre de cette thèse, qui tentent de prédire l'apparition des symptômes liés à la syncope, et ce, le plus tôt possible. Durant nos recherches, deux axes sont ressortis naturellement : la fouille de données et le dé- veloppement de modèles capables de prédire le résultat du tilt-test. Ces deux axes partagent des méthodes issues de l'apprentissage articiel, qui permettent d'acquérir et d'extraire des connaissances à partir d'un ensemble d'observations signicatif. La littérature propose tout un ensemble de méthodes, qui nous ont permis de mettre en évidence certaines caractéristiques pertinentes, de manière à construire des modèles parcimonieux et robustes. Ces derniers ont permis d'obtenir des résultats intéressants pour la prédiction du résultat du tilt-test au terme notamment, des dix premières minutes de l'examen. Ces performances ont pu être considérablement améliorées par le développement de nouvelles techniques de fouille de données, permettant d'extraire très e- cacement de la connaissance. Les méthodes mises en place s'articulent autour de la sélection de variables et de l'interprétation de projections non linéaires. Ces méthodes, bien que développées autour de notre thématique, se sont montrées reproductibles lors de tests sur d'autres ensembles de données.

Diss.--Berlin, 2003--Freie Univ. / Glossaire p. 251-254. Bibliogr. et discogr. p. 255-266.

Latim e sabélico são línguas que possuem muitos paralelos entre si, pois pertencem ao mesmo ramo do proto-indo-europeu, o ramo itálico. Uma semelhança interessante e intrigante entre essas línguas é a síncope vocálica, porque se trata de um processo fonológico recorrente. Até algumas décadas atrás, os estudiosos não acreditavam ser possível analisar devidamente as condições nas quais a síncope ocorre em latim, por serem muito complexas. No entanto, pesquisas mais recentes mostram que isso é possível de alguma forma, apesar de a análise ser difícil. A ocorrência da síncope vocálica em sabélico parece menos complexa que em latim. Em sabélico, os ambientes fonológicos nos quais a síncope ocorre são mais limitados, mas a dificuldade em entender o significado e a etimologia de algumas palavras sabélicas também torna a análise complicada. O objetivo desta pesquisa foi delimitar o máximo possível os ambientes fonológicos da síncope em latim e em sabélico e entender quais correlações podem ser feitas entre os exemplos listados. Ainda que seja interessante analisar todos os casos com base nas mesmas premissas, isso é muito difícil, uma vez que os dados encontrados são muito variados. As correlações que podem ser feitas entre casos de línguas diferentes são basicamente apenas de ordem etimológica, pois a ação e resultado da síncope agem de maneiras diferentes dependendo da língua e do período. / Latin and Sabellic are languages that have many parallels, for they belong to the same Indo-European branch, the Italic branch. An interesting and intriguing phonological similarity between these languages is vowel syncope, because is a recurring phonological process. Until a few decades ago, scholars believed not to be possible to analyze properly the conditions under which syncope occurs in Latin, because they are very complex. However, more recent researches show that this is somehow possible, though the analysis is difficult. The occurrence of vowel syncope in Sabellic seems to be less complex than in Latin. In Sabellic, the phonological environments in which syncope occurs are more limited, but the difficulty to understand the meaning and etimology of some Sabellic words make this analysis also tough. The aim of this research was to limit as much as possible the phonological environments of syncope in Latin and in Sabellic and to understand the correlations that can be made among the examples of the corpora. Although it would be interesting to analyze all cases based on the same premises, this is very difficult, for the data do not allow it. The correlations that can be made are basically just etymological, because the way it works and the results are different according to each language and each time they existed.

Patients presenting with an abrupt loss of postural control are commonly said to have had ‘collapse?cause’. This is a common presentation, accounting for up to 6% of emergency department cases, and 3% of hospital admissions. However, collapse?cause is a ‘catch-all’ term and there are many different causes which include falls, transient ischemic attacks, cerebrovascular accidents, road traffic accidents, metabolic abnormalities, intoxication, and transient loss of consciousness, (TLOC or ‘blackout’). A majority of patients fall into the latter category. Where TLOC has occurred, the causes are syncope, epilepsy and psychogenic blackouts. The clinical features of these three conditions can often be similar, albeit with subtle differences. A wide variation exists in the way such patients are assessed, investigated and managed, who manages them and where. There is an absence of simple clinical tools for assessment, poor risk stratification, inappropriate and overuse of investigations. Hospitalisation is often unnecessary and misdiagnoses are common. In this thesis, the problem of TLOC has been addressed in four projects. Section 1 (Chapter II): reports a simple new risk stratification scheme for patients presenting with TLOC, assessed in a specialist nurse lead, cardiologist supervised (SP), Rapid Access Blackouts Triage Clinic - RABTC. Frequently, after triage, a patient may be deemed to be at low risk, but blackouts continue, the cause remains unclear, and conventional tests, have been unhelpful. In Chapter III, we describe the option of investigating such patients by long term (up to 3 years) ECG monitoring using an implantable loop recorder (ILR). In order to address the specific question of misdiagnosis of epilepsy where convulsive syncope might be the true diagnosis, the REVISE Study- REVeal in the Investigation of Syncope and Epilepsy was undertaken, which is described in Chapter IV. Lastly, convulsive syncope is the likely explanation for a misdiagnosis in patients diagnosed with epilepsy, but the incidence of cardiac disease in patients with brain injury and epilepsy is unknown. Therefore a cohort of patients in a residential epilepsy centre was studied. In this setting, residents typically had a history of brain injury and suffered from recurrent epileptic seizures. The findings of cardiology assessment are presented in Section 4 (Chapter V).

Symptomatic sinus bradycardia, due to either sick sinus syndrome or vagotonia, can be familial, affecting several members of a family. We report an 18-year-old male patient with palpitations and limited exercise capacity who was noted to have severe sinus bradycardia. His resting heart rate was 40/min, with normal PR and corrected QT intervals, and sinus pauses up to 6 seconds during sleep. Exercise treadmill test and pharmacologic autonomic blockade during electrophysiologic studies abolished the bradycardia, suggestive of vagotonia rather than intrinsic sinus node dysfunction. This patient's father and a female cousin had a similar clinical history but associated with syncope and severe sinus bradycardia. The mode of transmission appeared to be autosomal dominant. All three have permanent demand pacemakers implanted and are asymptomatic.

Long QT syndrome (LQTS) can present with syncope and seizure-like activity in the setting of torsades de pointes (TdP) with hemodynamic instability. Electrolyte abnormalities and medications can predispose to TdP in the setting of latent LQTS. An implantable cardioverter defibrillator (ICD) is needed if patients with TdP continue to be symptomatic despite medical treatment. We report a case of a patient who presented with seizures and was found to have prolonged corrected QT interval (QTc). During her admission, she was treated with ondansetron. She went into torsades de pointes and continued to have prolonged QTc. She underwent implantable cardioverter defibrillator (ICD) placement and remains asymptomatic to date.

<p><strong>Background:</strong> Syncope is estimated to account for 1% to 3% of emergency department (ED) annual visits in North America. Although most potential causes of syncope are benign and self-limited, others are associated with serious morbidity and substantial mortality. Recent efforts have focused on prospective identification of ED patients with syncope who are at high risk for early serious adverse outcomes in an attempt to hospitalize them at their first visit to the ED.</p> <p><strong>Objective: </strong>The purpose of this thesis is to describe the methodological issues related to the design of a study to determine whether the Revised Strategy of Syncope Diagnosis in the Emergency Room at the General Hospital Structured Care Pathway (RESASTER-SCP) is superior to usual care in identifying patients at low risk for serious adverse outcomes presenting to the ED who can be safely discharged home. <strong></strong></p> <p><strong>Design and Methods: </strong>A cluster randomized trial will be conducted with EDs (16 teaching and 46 non-teaching general hospitals) as the unit of randomization and patients presenting with syncope (TLOC) as the unit of analysis. Study participants will be followed at 1, 3, 5, and 12 months after the intervention (RESASTER-SCP vs. usual care) has been applied in the ED. Intention to treat analysis will be used. The analysis will be conducted at the individual level using proportions. Alpha level will be set at 0.05 with a power of 0.80 for the primary outcome.<strong></strong></p> <p><strong>Conclusion: </strong>This thesis describes some of the methodological issues concerning the design of a cluster randomized trial to determine whether or not RESASTER-SCP is superior to usual care in identifying patients presenting with syncope to the ED who can be safely discharged home.</p> / Master of Science (MSc)

La syncope est une perte brusque de conscience. Bien qu'elle ne soit pas généralement mortelle, elle présente un impact économique sur le système de soins et sur la vie personnelle de personnes en souffrant. L'objet de la présente étude est de réduire la durée du test clinique (environ 1 heure) et d'éviter aux patients de développer une syncope en la prédisant. L'ensemble de travail s'inscrit dans une démarche de datamining associant l'extraction de paramètres, la sélection des variables et la classification. Trois approches complémentaires sont proposées, la première exploite des méthodes d'analyse non-linéaires de séries temporelles extraites de signaux acquises pendant le test, la seconde s'intéresse aux relations cardiovasculaires en proposant des indices dans le plan temps-fréquence et la troisième, plus originale, prendre en compte leurs dynamiques temporelles. / Syncope is a sudden loss of consciousness. Although it is not usually fatal, it has an economic impact on the health care system and the personal lives of people suffering. The purpose of this study is to reduce the duration of the clinical test (approximately 1 hour) and to avoid patients to develop syncope by early predicting the occurrence of syncope. The entire work fits into a data mining approach involving the feature extraction, feature selection and classification. 3 complementary approaches are proposed, the first one exploits nonlinear analysis methods of time series extracted from signals acquired during the test, the second one focuses on time- frequency (TF) relation between signals and suggests new indexes and the third one, the most original, takes into account their temporal dynamics.

Estudo comparativo entre o tratamento farmacológico, o treinamento físico moderado e o treinamento postural passivo em pacientes portadores de síncope neurocardiogênica. A síncope neurocardiogênica é uma disfunção autonômica que leva a hipotensão e perda de consciência. Setenta pacientes foram randomizados em 4 grupos: controle, treinamento físico, treinamento postural e tratamento farmacológico. Avaliou-se recorrência clínica, índices de ansiedade e a sensibilidade barorreflexa para a freqüência cardíaca e atividade nervosa simpática muscular. Ocorreu diminuição da recorrência nos 4 grupos. Diminuição da ansiedade foi observada em 3 grupos, exceto no grupo controle. O treinamento físico melhorou a sensibilidade barorreflexa / Neurocardiogenic syncope is an autonomic disfunction that leads to hypotension and loss of conciousness. Seventy patients were randomized in 4 groups: control, physical training, tilt training and pharmacological treatment. Clinical outcome, anxiety levels and baroreflex sensitivity for heart rate and muscle sympathetic nervous activity were evaluated. Lower recurrence rates were obtained in all groups. Anxiety levels decrease was achieved in 3 groups, except controls. Physical training improved baroreflex sensitivity