Evaluation of the heart rate and arrhythmias following the Maze procedure for chronic atrial fibrillation

PURPOSE: To assess the presence and the prevalence of arrhythmias and the variability of the heart rate in the medium-term postoperative period following the maze procedure for chronic atrial fibrillation (AF). METHODS: Seventeen patients with a mean age of 51.7±12.9 years, who previously underwent the maze procedure without cryoablation for chronic atrial fibrillation, were evaluated with the 24 hour electrocardiogram (ECG) - Holter monitoring from the 6th month after the operation. Valvular and coronary procedures were concomitantly performed. RESULTS: The mean heart rate during Holter monitoring was 82±8bpm; the maximal heart rate was 126 ± 23bpm and the minimal heart rate 57±7bpm. Sinus rhythm was found in 10 (59%) patients and atrial rhythm was found in 7 (41%). Supraventricular extrasystoles had a rate of 2.3±5.5% of the total number of heartbeats and occurred in 16 (94%) patients. Six (35%) patients showed nonsustained atrial tachycardia. Ventricular extrasystoles, with a rate of 0.8±0.5% of the total heartbeats, occurred in 14 (82%) patients. The chronotropic competence was normal in 9 (53%) patients and attenuated in 8 (47%). The atrioventricular conduction (AV) was unchanged in 13 (76%) patients and there were 4 (24%) cases of first degree atrioventricular block (AVB). CONCLUSION: After the maze procedure, the values for the mean heart rate, AV conduction and chronotropic competence approach the normal range, although some cases show attenuation of the chronotropic response, first degree AV block or benign arrhythmias.

China and India’s Maritime Geostrategies:: Implications for International Maritime Security and Scenarios for 2030

Dissertação de Mestrado em Estratégia

BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit

Background:Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events.Objectives:To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS).Methods:This study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%.Results:The mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia.Conclusions:BNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome.

Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

Background: Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation. Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year. Results: Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019) emerged as predictors of a secondary outcome. Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

Predictors of Arrhythmic Events Detected by Implantable Loop Recorders in Renal Transplant Candidates

AbstractBackground:The recording of arrhythmic events (AE) in renal transplant candidates (RTCs) undergoing dialysis is limited by conventional electrocardiography. However, continuous cardiac rhythm monitoring seems to be more appropriate due to automatic detection of arrhythmia, but this method has not been used.Objective:We aimed to investigate the incidence and predictors of AE in RTCs using an implantable loop recorder (ILR).Methods:A prospective observational study conducted from June 2009 to January 2011 included 100 consecutive ambulatory RTCs who underwent ILR and were followed-up for at least 1 year. Multivariate logistic regression was applied to define predictors of AE.Results:During a mean follow-up of 424 ± 127 days, AE could be detected in 98% of patients, and 92% had more than one type of arrhythmia, with most considered potentially not serious. Sustained atrial tachycardia and atrial fibrillation occurred in 7% and 13% of patients, respectively, and bradyarrhythmia and non-sustained or sustained ventricular tachycardia (VT) occurred in 25% and 57%, respectively. There were 18 deaths, of which 7 were sudden cardiac events: 3 bradyarrhythmias, 1 ventricular fibrillation, 1 myocardial infarction, and 2 undetermined. The presence of a long QTc (odds ratio [OR] = 7.28; 95% confidence interval [CI], 2.01–26.35; p = 0.002), and the duration of the PR interval (OR = 1.05; 95% CI, 1.02–1.08; p < 0.001) were independently associated with bradyarrhythmias. Left ventricular dilatation (LVD) was independently associated with non-sustained VT (OR = 2.83; 95% CI, 1.01–7.96; p = 0.041).Conclusions:In medium-term follow-up of RTCs, ILR helped detect a high incidence of AE, most of which did not have clinical relevance. The PR interval and presence of long QTc were predictive of bradyarrhythmias, whereas LVD was predictive of non-sustained VT.

New business formation and employment growth: some evidence for the Spanish manufacturing industry

This paper explores the effects of new business formation on employment growth in Spanish manufacturing industries. New firms are believed to make an important contribution to economic growth but the extent of this contribution is unclear. We consider time lags of new firm formation as explanatory variables of employment change and identify how long the effect of new firm entries on employment lasts. Our main results show that the effects of new business formation are positive in the short term, negative in the medium term and positive in the long term, thus confirming the existence of indirect supply-side effects found in similar studies for other countries. Key words: regional growth, firm entry, time lags and Spanish economy. JEL classifications: L00, L60, R11, R12

Anàlisi de la situació actual del llop (Canis lupus) a Catalunya i valoració socioambiental de la seva presència

En el present treball, en primer lloc, s’ha analitzat l’escenari actual en referència a la tornada del llop (Canis lupus) a Catalunya i s’han avaluat les mesures gestió que s’estan duent a terme al respecte, tot identificant els seus punts forts i els seus punts dèbils. D’aquesta manera, s’ha pogut saber que la població de llops actual és petita i poc estable, i es mou per la zona del Parc Natural del Cadí-Moixeró i els seus voltants, on s’estan efectuant les tasques de control i seguiment de l’espècie. No obstant, la seva evolució ha anat a l’alça durant els darrers anys, i es preveu que pugui colonitzar noves àrees a curt-mig termini, pel que aviat s’hauria d’ampliar l’àmbit d’aplicació d’aquesta gestió. Posteriorment, s’ha realitzat una valoració de la seva presència a Catalunya -encabida dins d’un marc hipotètic- per determinar l’ampli ventall d’aspectes socials i ambientals que envolten aquest fet. Mitjançant aquesta valoració s’han pogut detectar les principals mancances que presenta el país per fer front a aquesta situació, però també s’han identificat les fortaleses i les oportunitats que es presenten de cara al futur.

Perspective for the reproduction of antimalarial drugs in Brazil

The appears to be no chemical manufacture of antimalarial drugs is Brazil. Technology at laboratory process level has been developed for chloroquine, mefloquine, pyrimethamine and cycloquanil, but not perfected nor scaled-up, largely for economic reasons and market uncertainty. Development of primaquine has been contracted but it will run into the same difficulty. Manufacturing capacity for sulfadoxine was registred in the SDI by Roche. A project to produce artemisinine and its derivates is under way at UNICAMP-CPQBA but is hampered by low content in the plant. Proguanil could be produced easily, but apparently no attempt has been made to do so. Quinine is imported on a large scale mostly for softdrink production. Since malarial treatment falls largely within responsability of the Government health authorities, manufacture of drugs in Brazil will depend on an assured medium-term purchase order made to a potential local manufacturer, since competition in the world market is scarcelyviable at the present moment.

Avaluació de la capacitat de segrest de carboni d'un sòl restaurat amb fangs de depuradora: paper de les propietats físiques del sòl

S’ha estudiat el grau de protecció física del carboni dins d’agregats de diferents mides en un sòl d’una pedrera restaurada fa 17 anys amb terres adobades amb fangs de depuradora, i s’ha interpretat el seu paper en el context del segrest de carboni en el sòl. La metodologia aplicada es basa en la d’humitejament ràpid dels agregats del sòl per immersió en aigua (Le Bissonnais, 1996), que simula l’estabilitat d'un sòl sec que es veu sotmès a processos tals com la inundació local o saturació ràpida. També s’ha determinat la quantitat de carboni oxidable present en els agregats del sòl amb el mètode de Nelson i Sommers (1982). Els resultats han mostrat que l’adobat amb fangs de depuradora contribueix a augmentar el contingut de carboni orgànic en els agregats del sòl i n’estimula el segrest a mitjà termini (unes 10 tones ha-1 en 17 anys), aportant estabilitat al sòl i protegint físicament el carboni orgànic dins dels agregats de mida major (5-2 mm). A més s’ha constatat que per determinar l’estabilitat del carboni segrestat en el sòl cal conèixer com es distribueix entre les diferents mides d’agregats. Finalment, l’augment del segrest de carboni en el sòl propiciat per l’aplicació dels fangs de depuradora li dóna més capacitat per fixar CO2 atmosfèric.

Determination and control of schistosomiasis

The subject of this conference reflects the scientific community's interest in seeking to understand the complex causal web whose various social, economic, and biological components interact in the production and reproduction of schistosomiasis and its control in relation to community participation. From the onset, the author stresses the impossibility of dealing separately with community participation, as if social components were just one more "weapon" in the arsenal for schistosomiasis control. This study begins with a brief historical review of the 71 years of control activities with this endemic disease, stressing the enormous efforts and huge expenditures in this field vis-à-vis the limited results, despite the extraordinary technological development of specific, classical control inputs such as new treatment drugs and molluscicides. The article then discusses the various strategies used in control programs, emphasizing ideological consistencies and contradictions. Interactions at the macro and micro levels are discussed, as are the determinants and risk factors involved in producing the disease's endemicity. Unequal occupation of space leaves the segregated portion of the population exposed to extremely favorable conditions for transmission of the disease. This raises the issue of how to control an endemic disease which is so closely linked to the way of life imposed on the population. The study challenges the classical control model and suggests an alternative model now undergoing medium-term investigation in the States of Espirito Santo, and Pernambuco, Brazil. The author concludes that we do not need new strategies, but a new control model, contrary to the prevailing classical model in both concept and practice. From the conceptual point of view, the new model mentioned above is different from others in that schistosomiasis control is seen from a social perspective stressing the population's accumulated knowledge in addition to the building of shared knowledge. The model's praxis has the following characteristics: (1) it is integrated with and financed by research agencies and health services; (2) it operates at the local health services level; (3) use of molluscicides has been eliminated; (4) emphasis is given to individual medical treatment and improvement of sanitary conditions.

Conflict prevention and decentralized governance: some remarks about the state of the art in theory and practice

Is there a link between decentralized governance and conflict prevention? This article tries to answer the question by presenting the state of the art of the intersection of both concepts. Provided that social conflict is inevitable and given the appearance of new threats and types of violence, as well as new demands for security based on people (human security), our societies should focus on promoting peaceful changes. Through an extensive analysis of the existing literature and the study of several cases, this paper suggests that decentralized governance can contribute to these efforts by transforming conflicts, bringing about power-sharing and inclusion incentives of minority groups. Albeit the complexity of assessing its impact on conflict prevention, it can be contended that decentralized governance might have very positive effects on the reduction of causes that bring about conflicts due to its ability to foster the creation of war/violence preventors. More specifically, this paper argues that decentralization can have a positive impact on the so-called triggers and accelerators (short- and medium-term causes).

Breastfeeding Strategy for Northern Ireland (PDF 212 KB)

Northern Ireland has one of the lowest breastfeeding rates in the world. Low breastfeeding rates are associated with considerable morbidity, some mortality and increased health service costs for women and children. In Northern Ireland, several factors make the initiation and maintenance of breastfeeding particularly difficult; these include cultural attitudes, commercial promotion of artificial milks and obstacles for the working mother. The aim of the Strategy is to promote and support breastfeeding. Medium-term objectives: - province-wide co-ordination of breastfeeding promotional activities - commissioning of breastfeeding support within the health service - detailed and uniform collection of infant feeding statistics - research into effective means of breastfeeding promotion - improved training in lactation management for health professionals - supporting breast milk feeding for special needs infants - raising of public awareness of the importance of breastfeeding - cessation of artificial milk promotion within the health service åÊ Long-term objectives: - adopt the recommendations following review of the milk token scheme in England - bringing the marketing of infant foods and feeding products into line with the International Code of Marketing of Breast Milk Substitutes åÊ Progress will be monitored by the Northern Ireland Breastfeeding Strategy Group. åÊ åÊ

Fonctions du plancher pelvien: de la phase expulsive à la consultation du post-partum [Pelvic floor functions: from the beginning of the second phase of labor to the postpartum consultation].

Vaginal delivery can cause lesions of the various pelvic structures responsible for the mechanisms of continence. These lesions may perhaps be prevented in the future by measuring pressure generated during childbirth. Tear of the anal sphincter during childbirth is a marker of a global impairment of the urinary, ano-rectal and sexual pelvic functions in the short and medium term. Persistence of a defect of the anal sphincter is frequent in spite of immediate suture. The correlation between these defects and ano-rectal incontinence are not established in our experience. The quality of the contraction of the sphincter complex and pubo-rectal sling seems to play a more important role in ano-rectal continence after a traumatic childbirth.

PhunkyFoods Programme (PFP)

The PhunkyFoods Programme (PFP) aids schools in meeting healthy lifestyles curriculum requirements by delivering key, consistent health messages in-line with current Government recommendations. The aim is to help schools deliver a whole-school approach to healthy lifestyles and to engage with all pupils, and their families, in promoting tangible health behaviour changes in a fun, lively and positive manner. The short-term objectives (6-months) of the PFP are; 1. To improve school staff competence, confidence and in delivering healthy lifestyles messaging in school. 2. To improve the health-related knowledge of pupils taking part in the PFP. The medium-term objectives (12-18 months) of the PFP are; 3. To improve the dietary behaviours of children taking part in the PFP (increase fruit and veg intake, increase breakfast consumption, decrease HFSS foods, decrease fizzy drink consumption). 4. To increase the levels of habitual phsyical activity undertaken by the children participating in the PFP. The longer-term objectives (+18=months) of the PFP are; 5. To reduce the prevalence of childhood overweight and obesity in participating children 6. To develop the schools to become the community hub for healthy eating and physical activity initiatives based on local needs assessment and partnership workin

National Strategy for Higher Education 2030 Progress Report Q1 2012

The National Strategy for Higher Education was launched in January 2011. In order to ensure effective oversight of implementation of the strategy the Department of Education and Skills has established an Implementation Oversight Group. The Oversight Group is co-ordinating, monitoring and reporting on the implementation of recommendations contained in the National Strategy on an ongoing basis in conjunction with other expertise and stakeholders as required. The Oversight Group has agreed a short to medium term Implementation Progress reporting template that details actions under four broad strategic headings together with a number of supporting objectives. The strategic headings are congruent with the aims of the National Strategy. Each action is the responsibility of a designated organisation. It is the intention of the Department of Education and Skills to report regularly on the implementation of the strategy.