1000 resultados para second harmonic
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v. 1 1834
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v. 2 1840
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v. 3 1841
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v. 4 1842
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A pesar de que en los últimos años los estudios sobre historia y sociología de la Salud y la Enfermedad han experimentado un salto cualitativo, se ha soslayado sistemáticamente el análisis del paludismo y los complejos entramados de poder que subyacen a su presencia en los Departamentos del Noroeste y -en menor medida- en los del Oeste de la provincia de Córdoba. Nos referimos específicamente a la presencia de la endemia en los departamentos de Cruz del Eje, San Javier, San Alberto, Minas y Pocho. Con el propósito de redimensionar un comportamiento endemoepidémico que en esas localidades de Córdoba se remontó -según exploraciones provisionales- a mediados del siglo XIX, se construyen problemáticas que cobran sentido al ingresar en el terreno de los proyectos político-estatales nacionales, provinciales y de las mismas localidades afectadas, y, en lo que refiere a la articulación de las respuestas sanitarias frente a una enfermedad de profundas connotaciones ligadas al desarrollo socioeconómico y político de las regiones en estudio. En ese sentido en una primera instancia se articulará un análisis demográfico de la presencia y distribucion de la enfermedad a partir del trabajo con datos de corte estadistíco, elaborando mapas, cuadros y gráficos de morbimortalidad. Convergentemente se realizará un análisis hermenéutico de fuentes históricas del período en estudio. A grandes rasgos se considera que en relación al impacto del paludismo en bastas zonas del interior de la provincia de Córdoba y en cuanto a la acción sanitaria de los aparatos de poder estatal, desde mediados del siglo XIX, hasta la importante reducción de casos nuevos de paludismo a mediados del XX, pueden determinarse dos etapas sucesivas: Una primera se podría datar desde mediados del siglo XIX hasta mediados de la década de 1930, en la que actúa un Estado Nacional liberal que se desentendía de los problemas sanitarios de la regiones dejando esa función en manos de las provincias afectadas. Un segundo momento, aunque delimitado provisionalmente entre mediados de la década del 30' y mediados de la década del 50', se halla complejizado en su definición al combinarse en él procesos políticos particulares de la esfera nacional y de la provincial. Por un lado, en el plano nacional se ha observado desde la historiografía del período que, a partir de la década del 40' comienza a manifestarse una acción estatal nacional progresivamente centralizada y dispuesta a combatir la enfermedad con instituciones que podían llegar a todos los sectores sociales y a todas las regiones geográficas, aunque en menor medida a las zonas extra-pampeanas.Paralelamente, al considerar esos años en la esfera provincial se debe analizar el impacto de las formulaciones e intervenciones del radicalismo sabattinista como matriz política contraria al gobierno conservador nacional y promotor de un nuevo modelo de Estado en el que ocuparían un lugar privilegiado las políticas orientadas a la "cuestión social" y a la Salud en particular. Por otro lado, cobra significación una cuestión poco reconocida en los estudios en materia de politica sanitaria: los planes del peronismo combinaron una política centralizada en materia de dirección con una descentralización en el área de la ejecución.Finalmente dentro de este complejo marco político sanitario, se debe atender a lo largo de las dos etapas delimitadas, al universo de las iniciativas articuladas desde las autoridades de las localidades afectadas por el paludismo, así como, a las iniciativas civiles ya sea de vecinos, Sociedades de Beneficencia y asociadas a la Iglesia Católica.De acuerdo a la perspectiva asumida se propone recuperar una significativa problemática de marginalidad socioeconómica de las regiones, procurando reconstruir el impacto sociodemográfico del paludismo en el Noroeste y Oeste de la provincia de Córdoba ingresando al analisis histórico de las construcciones del poder público y privado en ese contexto local.
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Quality Management is a well-developed and widely used approach within industry to gain competitive edge and increased market share. It is a new management approach for schools who are now applying it without having the culture or experience of its evolution. Industrially based Quality management systems and excellence models have been developed. These excellence models and frameworks are based on the principles and concepts of TQM which are recognised as essential elements of high performing organisations. Schools are complex social institutions that provide a service. Like any other service industry, the customers of education are expecting and demanding a better service or else they will go elsewhere. Schools are beginning to reform and change to adapt to such demands. This has been reflected in Ireland in the Education Act, 1998. It is now the right time to develop a quality management system specifically for schools. The existing industrial excellence models have been modified for use in the private and public sector and some have been specifically tailored for education. The problem with such models is that they are still too sophisticated and the language still too industrial for schools. This Thesis develops and Excellence Model for Second Level Schools and provides guidance and school specific tools for its implementation.
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Background: Physiological reflexes modulated primarily by the vagus nerve allow the heart to decelerate and accelerate rapidly after a deep inspiration followed by rapid movement of the limbs. This is the physiological and pharmacologically validated basis for the 4-s exercise test (4sET) used to assess the vagal modulation of cardiac chronotropism. Objective: To present reference data for 4sET in healthy adults. Methods: After applying strict clinical inclusion/exclusion criteria, 1,605 healthy adults (61% men) aged between 18 and 81 years subjected to 4sET were evaluated between 1994 and 2014. Using 4sET, the cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two RR intervals in the electrocardiogram: 1) after a 4-s rapid and deep breath and immediately before pedaling and 2) at the end of a rapid and resistance-free 4-s pedaling exercise. Results: CVI varied inversely with age (r = -0.33, p < 0.01), and the intercepts and slopes of the linear regressions between CVI and age were similar for men and women (p > 0.05). Considering the heteroscedasticity and the asymmetry of the distribution of the CVI values according to age, we chose to express the reference values in percentiles for eight age groups (years): 18–30, 31–40, 41–45, 46–50, 51–55, 56–60, 61–65, and 66+, obtaining progressively lower median CVI values ranging from 1.63 to 1.24. Conclusion: The availability of CVI percentiles for different age groups should promote the clinical use of 4sET, which is a simple and safe procedure for the evaluation of vagal modulation of cardiac chronotropism.
When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome?
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Abstract Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.
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Abstract Background: There are sparse data on the performance of different types of drug-eluting stents (DES) in acute and real-life setting. Objective: The aim of the study was to compare the safety and efficacy of first- versus second-generation DES in patients with acute coronary syndromes (ACS). Methods: This all-comer registry enrolled consecutive patients diagnosed with ACS and treated with percutaneous coronary intervention with the implantation of first- or second-generation DES in one-year follow-up. The primary efficacy endpoint was defined as major adverse cardiac and cerebrovascular event (MACCE), a composite of all-cause death, nonfatal myocardial infarction, target-vessel revascularization and stroke. The primary safety outcome was definite stent thrombosis (ST) at one year. Results: From the total of 1916 patients enrolled into the registry, 1328 patients were diagnosed with ACS. Of them, 426 were treated with first- and 902 with second-generation DES. There was no significant difference in the incidence of MACCE between two types of DES at one year. The rate of acute and subacute ST was higher in first- vs. second-generation DES (1.6% vs. 0.1%, p < 0.001, and 1.2% vs. 0.2%, p = 0.025, respectively), but there was no difference regarding late ST (0.7% vs. 0.2%, respectively, p = 0.18) and gastrointestinal bleeding (2.1% vs. 1.1%, p = 0.21). In Cox regression, first-generation DES was an independent predictor for cumulative ST (HR 3.29 [1.30-8.31], p = 0.01). Conclusions: In an all-comer registry of ACS, the one-year rate of MACCE was comparable in groups treated with first- and second-generation DES. The use of first-generation DES was associated with higher rates of acute and subacute ST and was an independent predictor of cumulative ST.
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v.62:no.3(1973)