Qualidade de vida e indicadores clínicos na insuficiência cardíaca: análise multivariada

FUNDAMENTO: Na Insuficiência Cardíaca (IC), a atenção especial é necessária não somente em relação à aspectos objetivos ou isolados, mas também às percepções de saúde do paciente. Os aspectos subjetivos podem ajudar os profissionais da saúde a entender e a melhor tratar a IC. OBJETIVO: O objetivo desse estudo foi avaliar simultaneamente os efeitos dos indicadores clínicos da IC na qualidade de vida (QDV). MÉTODOS: Investigamos, através de análise multivariada, a QDV de 101 pacientes ambulatoriais brasileiros, utilizando o questionário de Minnesota (Minnesota Living with Heart Failure Questionnaire), incluindo suas sub-escalas, e sua correlação com as variáveis clínicas e psicológicas, tais como idade, etnia, gênero, parâmetros ecocardiográficos, índice de massa corporal, pressão arterial média de repouso, tempo de diagnóstico, Classificação Funcional de acordo com a NYHA, capacidade funcional através de uma Escala de Atividade Específica, comorbidades, Escore de Risco de Framingham (ERF), teste de função pulmonar (espirometria) e composição corporal. RESULTADOS: A QDV mostrou correlações univariadas significantes com o ecocardiograma: fração de ejeção (p=0,0415), diâmetro diastólico do ventrículo esquerdo (DDVE) (p=0,004), diâmetro sistólico do ventrículo esquerdo (DSVE) (p=0,0001); comorbidades (p=0,002) e teste de função pulmonar: Capacidade Vital Forçada (CVF) (p<0,0001), Volume Expiratório Forçado no 1º segundo (FEV1) (p<0,0001) e Ventilação Voluntária Máxima (VVM) (p=0,001). Na análise multivariada, o protocolo Backward Stepwise detectou importantes variáveis influentes simultâneas (r²=0.60): gênero (0,000178), etnia (p<0,00001), DSVE (p<0,00001), ERF (p=0,000002), CVF (p=0,002027), FEV1 (p<0,00001) e VVM (p=0,00001). CONCLUSÃO: Gênero, etnia, DSVE, ERF, CVF, FEV1 e VVM são preditores independentes de QDV em pacientes com IC. Simultaneamente, eles são responsáveis por cerca de 60% da variância da QDV. Os aspectos biopsicossociais podem contribuir para as expectativas dos pacientes e profissionais de saúde e resultado do tratamento.

Associação do índice tornozelo-braço com inflamação e alterações minerais ósseas em pacientes em hemodiálise

FUNDAMENTO: O índice tornozelo-braço (ITB) reduzido, inflamação e distúrbio mineral ósseo (DMO) estão associados com aumento no risco de morte e complicações cardiovasculares em pacientes em hemodiálise (HD), mas a relação entre esses fatores necessita ser elucidada. OBJETIVO: Avaliar a associação entre ITB anormal e DMO com inflamação em pacientes em HD. MÉTODOS: Esta análise transversal avaliou 478 pacientes em HD por pelo menos 1 ano. O ITB foi avaliado através de um Doppler portátil e manômetro de coluna de mercúrio. Os pacientes foram divididos em três grupos, de acordo com o ITB (baixo: <0,9, normal: 0,9 a 1,3, e alto: >1,3). As medidas de proteína C-reativa foram utilizadas como marcador inflamatório, enquanto a DMO foi avaliada através dos níveis de cálcio, fósforo e hormônio paratireoidiano intacto (iPTH). RESULTADOS: Os participantes tinham 54 (18 a 75) anos, 56% eram do sexo masculino, 17% eram diabéticos e estavam em HM por 5 (1 a 35) anos. A prevalência de ITB baixo, normal e alto AAI foi 26,8%, 64,6% e 8,6%, respectivamente. Usando um modelo de regressão logística condicional com procedimento backward, idade (p<0,001), diabetes (p= 0,001), e níveis de proteína C-reativa >6 mg/L (p= 0,006) estavam associados com a presença de ITB baixo, enquanto o sexo masculino (p<0,001), diabetes (p= 0,001) e produto cálcio x fósforo elevado (p= 0,026) estavam associados com ITB alto. CONCLUSÃO: Em pacientes em HD, a presença de diabetes estava associada com ITB alto e baixo. O risco de ter ITB baixo parece aumentar com a idade e inflamação, enquanto a DMO estava associada com ITB alto.

Asymmetries in the capacity-inflation trade-off

This paper analyzes the joint dynamics of two key macroeconomic variables for the conduct of monetary policy: inflation and the aggregate capacity utilization rate. An econometric procedure useful for estimating dynamic rational expectation models with unobserved components is developed and applied in this context. The method combines the flexibility of the unobserved components approach, based on the Kalman recursion, with the power of the general method of moments estimation procedure. A 'hyb id' Phillips curve relating inflation to the capacity utilization gap and incorporating forward and backward looking components is estimated. The results show that such a relationship in non-linear: the slope of the Phillips curve depends significantly on the magnitude of the capacity gap. These findings provide support for studying the implications of asymmetricmonetary policy rules.

Lp-solutions to BSDEs with super-linear growth coefficient. Application to degenerate semilinear PDEs.

We consider multidimensional backward stochastic differential equations (BSDEs). We prove the existence and uniqueness of solutions when the coefficient grow super-linearly, and moreover, can be neither locally Lipschitz in the variable y nor in the variable z. This is done with super-linear growth coefficient and a p-integrable terminal condition (p & 1). As application, we establish the existence and uniqueness of solutions to degenerate semilinear PDEs with superlinear growth generator and an Lp-terminal data, p & 1. Our result cover, for instance, the case of PDEs with logarithmic nonlinearities.

Large deviation for BSDE with subdifferential operator

In this paper we prove that the solution of a backward stochastic differential equation, which involves a subdifferential operator and associated to a family of reflecting diffusion processes, converges to the solution of a deterministic backward equation and satisfes a large deviation principle.

Molecular estimation of dispersal for ecology and population genetics

The dispersal process, by which individuals or other dispersing agents such as gametes or seeds move from birthplace to a new settlement locality, has important consequences for the dynamics of genes, individuals, and species. Many of the questions addressed by ecology and evolutionary biology require a good understanding of species' dispersal patterns. Much effort has thus been devoted to overcoming the difficulties associated with dispersal measurement. In this context, genetic tools have long been the focus of intensive research, providing a great variety of potential solutions to measuring dispersal. This methodological diversity is reviewed here to help (molecular) ecologists find their way toward dispersal inference and interpretation and to stimulate further developments.

When is Monetary Policy All we Need?

We consider optimal monetary and scal policies in a New Keynesian model of a small open economy with sticky prices and wages. In this benchmark setting monetary policy is all we need - analytical results demonstrate that variations in government spending should play no role in the stabilization of shocks. In extensions we show, rstly, that this is even when true when allowing for in ation inertia through backward-looking rule-of-thumb price and wage-setting, as long as there is no discrepancy between the private and social evaluation of the marginal rate of substitution between consumption and leisure. Secondly, the optimal neutrality of government spending is robust to the issuance of public debt. In the presence of debt government spending will deviate from the optimal steady-state but only to the extent required to cover the deficit, not to provide any additional macroeconomic stabilization. However, unlike government spending variations in tax rates can play a complementary role to monetary policy, as they change relative prices rather than demand.

Estimating Phillips Curves in Turbulent Times using the ECB’s Survey of Professional Forecasters

This paper uses forecasts from the European Central Bank's Survey of Professional Forecasters to investigate the relationship between inflation and inflation expectations in the euro area. We use theoretical structures based on the New Keynesian and Neoclassical Phillips curves to inform our empirical work. Given the relatively short data span of the Survey of Professional Forecasters and the need to control for many explanatory variables, we use dynamic model averaging in order to ensure a parsimonious econometric speci cation. We use both regression-based and VAR-based methods. We find no support for the backward looking behavior embedded in the Neo-classical Phillips curve. Much more support is found for the forward looking behavior of the New Keynesian Phillips curve, but most of this support is found after the beginning of the financial crisis.

The Monetary policy rules and the inflation process in open emerging

This paper has three objectives. First, it aims at revealing the logic of interest rate setting pursued by monetary authorities of 12 new EU members. Using estimation of an augmented Taylor rule, we find that this setting was not always consistent with the official monetary policy. Second, we seek to shed light on the inflation process of these countries. To this end, we carry out an estimation of an open economy Philips curve (PC). Our main finding is that inflation rates were not only driven by backward persistency but also held a forward-looking component. Finally, we assess the viability of existing monetary arrangements for price stability. The analysis of the conditional inflation variance obtained from GARCH estimation of PC is used for this purpose. We conclude that inflation targeting is preferable to an exchange rate peg because it allowed decreasing the inflation rate and anchored its volatility.

Marges i biodiversitat a Vandellòs i l'Hospitalet de l'Infant

Els marges de pedra seca són un dels ambients socioecològics més singulars del país i, al mateix temps, un dels hàbitats menys estudiats. La nostra recerca ha analitzat la biodiversitat de les margenades de Vandellòs i l’Hospitalet de l’Infant; mitjançant mostrejos de flora i de la fauna hem constatat l’elevada complexitat de la xarxa tròfica que s’estableix en aquest nínxol ecològic. En la vessant socioambiental, hem realitzat entrevistes a diferents entesos en la cultura de la pedra seca, les quals han permès determinar la importància dels marges per entendre una part de la història ambiental del país. Amb la recerca s’ha observat un clar retrocés del patrimoni de pedra seca a causa de la recessió del sector agrícola. L’aprofitament turístic de la cultura de la pedra seca i la implicació de les Administracions Públiques en la difusió d’aquest patrimoni, són claus per garantir-ne la pervivència en el futur.

Measurement of parent satisfaction in french-speaking PICUs: a need for translation and cultural adaptation of the empathic questionnaire

Background and aims: Family-centred care is an expected standard in PICU and parent reported outcomes are rarely measured. The Dutch validated EMPATHIC questionnaire provides accurate measures of parental perceptions of family-centred care in PICU. A French version would provide an important resource for quality control and benchmarking with other PICUs. The study aimed to translate and to assess the French cultural adaptation of the EMPATHIC questionnaire. Methods: In September 2012, following approval from the developer, translation and cultural adaptation were performed using a structured method (Wild et al. 2005). This included forward-backward translation and reconciliation by an official translator, harmonization assessed by the research team, and cognitive debriefing with the target users' population. In this last step, a convenience sample of parents with PICU experience assessed the comprehensibility and cultural relevance of the 65-item French EMPATHIC questionnaire. The PICUs in Lausanne, Switzerland and Lille, France participated. Results: Seventeen parents, including 13 French native and 4 French as second language speakers, tested the cognitive equivalence and cultural relevance of the French EMPATHIC questionnaire. The mean agreement for comprehensibility of all 65 items reached 90.2%. Three items fell below the cut-off 80% agreement and were revised for inclusion in the final French version. Conclusions: The translation and the cultural adaptation permitted to highlight a few cultural differences that did not interfere with the main construct of the EMPATHIC questionnaire. Reliability and validity testing with a new sample of parents is needed to strengthen the psychometric properties of the French EMPATHIC questionnaire.

Is there a common factor for vision?

In cognition, common factors play a crucial role. For example, different types of intelligence are highly correlated, pointing to a common factor, which is often called g. One might expect that a similar common factor would also exist for vision. Surprisingly, no one in the field has addressed this issue. Here, we provide the first evidence that there is no common factor for vision. We tested 40 healthy students' performance in six basic visual paradigms: visual acuity, vernier discrimination, two visual backward masking paradigms, Gabor detection, and bisection discrimination. One might expect that performance levels on these tasks would be highly correlated because some individuals generally have better vision than others due to superior optics, better retinal or cortical processing, or enriched visual experience. However, only four out of 15 correlations were significant, two of which were nontrivial. These results cannot be explained by high intraobserver variability or ceiling effects because test-retest reliability was high and the variance in our student population is commensurate with that from other studies with well-sighted populations. Using a variety of tests (e.g., principal components analysis, Bayes theorem, test-retest reliability), we show the robustness of our null results. We suggest that neuroplasticity operates during everyday experience to generate marked individual differences. Our results apply only to the normally sighted population (i.e., restricted range sampling). For the entire population, including those with degenerate vision, we expect different results.

Interactive Epistemology and Reasoning: On the Foundations of Game Theory

Game theory describes and analyzes strategic interaction. It is usually distinguished between static games, which are strategic situations in which the players choose only once as well as simultaneously, and dynamic games, which are strategic situations involving sequential choices. In addition, dynamic games can be further classified according to perfect and imperfect information. Indeed, a dynamic game is said to exhibit perfect information, whenever at any point of the game every player has full informational access to all choices that have been conducted so far. However, in the case of imperfect information some players are not fully informed about some choices. Game-theoretic analysis proceeds in two steps. Firstly, games are modelled by so-called form structures which extract and formalize the significant parts of the underlying strategic interaction. The basic and most commonly used models of games are the normal form, which rather sparsely describes a game merely in terms of the players' strategy sets and utilities, and the extensive form, which models a game in a more detailed way as a tree. In fact, it is standard to formalize static games with the normal form and dynamic games with the extensive form. Secondly, solution concepts are developed to solve models of games in the sense of identifying the choices that should be taken by rational players. Indeed, the ultimate objective of the classical approach to game theory, which is of normative character, is the development of a solution concept that is capable of identifying a unique choice for every player in an arbitrary game. However, given the large variety of games, it is not at all certain whether it is possible to device a solution concept with such universal capability. Alternatively, interactive epistemology provides an epistemic approach to game theory of descriptive character. This rather recent discipline analyzes the relation between knowledge, belief and choice of game-playing agents in an epistemic framework. The description of the players' choices in a given game relative to various epistemic assumptions constitutes the fundamental problem addressed by an epistemic approach to game theory. In a general sense, the objective of interactive epistemology consists in characterizing existing game-theoretic solution concepts in terms of epistemic assumptions as well as in proposing novel solution concepts by studying the game-theoretic implications of refined or new epistemic hypotheses. Intuitively, an epistemic model of a game can be interpreted as representing the reasoning of the players. Indeed, before making a decision in a game, the players reason about the game and their respective opponents, given their knowledge and beliefs. Precisely these epistemic mental states on which players base their decisions are explicitly expressible in an epistemic framework. In this PhD thesis, we consider an epistemic approach to game theory from a foundational point of view. In Chapter 1, basic game-theoretic notions as well as Aumann's epistemic framework for games are expounded and illustrated. Also, Aumann's sufficient conditions for backward induction are presented and his conceptual views discussed. In Chapter 2, Aumann's interactive epistemology is conceptually analyzed. In Chapter 3, which is based on joint work with Conrad Heilmann, a three-stage account for dynamic games is introduced and a type-based epistemic model is extended with a notion of agent connectedness. Then, sufficient conditions for backward induction are derived. In Chapter 4, which is based on joint work with Jérémie Cabessa, a topological approach to interactive epistemology is initiated. In particular, the epistemic-topological operator limit knowledge is defined and some implications for games considered. In Chapter 5, which is based on joint work with Jérémie Cabessa and Andrés Perea, Aumann's impossibility theorem on agreeing to disagree is revisited and weakened in the sense that possible contexts are provided in which agents can indeed agree to disagree.

Inflation dynamics and the New Keynesian Phillips curve in EU-4

The paper seeks to shed light on inflation dynamics of four new EU member states: the Czech Republic, Hungary, Poland and Slovakia. To this end, the New Keynesian Phillips curve augmented for open economies is estimated and additional statistical tests applied. We find the following. (1) The claim of New Keynesians that the real marginal cost is the main inflation-forcing variable is fragile. (2) Inflation seems to be driven by external factors. (3) Although inflation holds a forward-looking component, the backward-looking component is substantial. An intuitive explanation for higher inflation persistence may be rather adaptive than rational price setting of local firms.

Aproximació a la figura dels Business Angels

Els business angels són persones físiques que inverteixen una part dels seus diners en empreses joves, tot just acabades de crear, en alguns casos fins i tot ajuden a crear-les. El nom d’àngels té el seu origen en els rics filantrops de Nova York que finançaven les obres que s’estrenaven a Broadway. Aquests filantrops invertien els seus diners en una obra de teatre, pel plaer de contribuir a la cultura, molt sovint no arribaven a recuperar mai aquests diners. Els business angels, no són filantrops, inverteixen esperant guanyar diners, però al igual que els àngels de Broadway, els mou alguna cosa més que els diners, ja que està àmpliament documentat que darrera d’aquestes inversions hi ha també raons no financeres, com ara fomentar l’esperit emprenedor o fins i tot la cerca de diversió. Podríem dir que el terme “business angel” es va encunyar a principis dels 80 als EUA, per tant aviat farà 30 anys, no obstant, encara avui, la majoria de catalans no coneixen el significat d’aquest terme. A Catalunya i Espanya anem terriblement retardats en l’estudi i la promoció d’aquesta figura en relació a països com els EUA i el Regne Unit, però també massa enrera en relació a països com Finlàndia, Suècia, Noruega i Alemanya. L’objectiu d’aquest treball és doncs oferir una complerta aproximació a aquesta figura del business angel, una figura que entenem clau en el desenvolupament empresarial i per tant una figura que cal potenciar a tots els nivells. Per tal de contextualitzar aquesta important figura, el treball parteix de l’anàlisi de la relació existent entre emprenedoria i creixement econòmic, s’endinsa després en el capital risc, per presentar finalment qui és i que fa el business angel. El treball intenta també mostrar l’abús d’usos i la inconsistència de les definicions que es donen del terme “business angel” i per tant la gran confusió que tot això genera.