Initial experience in Brazil with the Helex septal occluder for percutaneous occlusion of atrial septal defects

OBJECTIVE: To evaluate the initial clinical experience with the Helex septal occluder for percutaneous closure of atrial septal defects. METHODS: Ten patients underwent the procedure, 7 patients with ostium secundum atrial septal defects (ASD) with hemodynamic repercussions and 3 patients with pervious foramen ovale (PFO) and a history of stroke. Mean age was 33.8 years and mean weight was 55.4 kg. Mean diameter by transesophageal echocardiography and mean stretched ASD diameter were 11.33 ± 3.3mm, and 15.2 ± 3.8mm, respectively. The Qp/Qs ratio was 1.9 ± 0.3 in patients with ASD. RESULTS: Eleven occluders were placed because a patient with 2 holes needed 2 devices. It was necessary to retrieve and replace 4 devices in 3 patients. We observed immediate residual shunt (< 2mm) in 4 patients with ASD, and in those with patent foramen ovale total occlusion of the defect occurred. No complications were noted, and all patients were discharged on the following day. After 1 month, 2 patients with ASD experienced trivial residual shunts (1mm). In 1 patient, we observed mild prolapse in the proximal disk in the right atrium, without consequences. CONCLUSION: The Helex septal occluder was safe and effective for occluding small to moderate atrial septal defects. Because the implantation technique is demanding, it requires specific training of the operator. Even so, small technical failures may occur in the beginning of the learning curve, but they do not involve patient safety.

Jogo de atividade física e aprendizagens escolares : um estudo sobre a relação entre recess, estatuto sociométrico e o desempenho escolar das crianças do 1º ciclo

A presente investigação examina a importância do recess enquanto parte integrante do quotidiano escolar, deslindando o seu contributo ao nível da aprendizagem, da capacidade de trabalho e do sucesso académico. A premissa de que a aprendizagem dos alunos sai beneficiada pela introdução de pausas no seio de longos períodos de trabalho intelectual, é comum a um sem número de teorias gizadas na literatura que, no entanto, deixam por esclarecer se o benefício provém do conteúdo da pausa, ou meramente da sua existência. De forma a contribuir para este debate, centra-se a presente investigação numa abordagem alternativa: partindo do pressuposto de que as características individuais dos alunos, nomeadamente o estatuto sociométrico, a idade e o género, condicionam a forma como ocupam o tempo que passam no recreio, constituiu-se uma amostra, seleccionada mediante a aplicação de um questionário sociométrico, e levou-se a cabo a observação das actividades por ela desenvolvidas no recreio e da performance por ela conseguida na sala de aula, antes e depois do intervalo. Concluiu-se que a forma como as crianças vivem o recess é fortemente influenciada pelas três variáveis chave (status sociométrico, género e nível de ensino), e que o conteúdo do intervalo, mais do que a sua simples existência, é determinante para a subsequente atitude na sala de aula. Ressalve-se, em particular, que os alunos cuja actividade no recreio se revela fisicamente intensa e socialmente Cooperativa e Associativa, por excelência os alunos Populares, experimentam maiores dificuldades de atenção e concentração no regresso à aula do que aqueles que vivem um recess marcado por níveis moderados de actividade física e por um comportamento social menos expansivo. Mais, constatou-se que a dimensão social do comportamento durante o recess monopoliza o seu conteúdo influenciando, como tal, o desempenho na sala de aula.

Procesos de cambio en la cultura jurídica: análisis desde la experiencia del juicio por jurados. Processes of change in the Legal Culture: Analysis from the Experience of Jury Trials.

El presente proyecto de investigación se orienta a analizar la institución del juicio por jurados, considerada como un punto estratégico para la observación de los procesos de cambio que recorren la cultura jurídica en Argentina. Frente a las múltiples transformaciones y a los intensos procesos de reestructuración de las relaciones sociales observados en el contexto latinoamericano y especialmente en Argentina, la necesidad de reconstruir la legitimidad de los jueces ante la opinión pública se ha vuelto impostergable, y el recurso a la participación popular en el campo judicial aparece como un instrumento útil para ello. Analizar la efectividad de esta estrategia para la legitimación del poder judicial es uno de los objetivos del presente proyecto de investigación. Abordar dicho objetivo implica, indagar en la relación entre la administración de justicia y diferentes actores sociales, especialmente los miembros de la profesión jurídica y la opinión pública.Se explora igualmente la contradicción entre el hecho de que esta institución, nacida para atenuar la dureza de los castigos, se ha implementado recientemente en la provincia de Córdoba en la situación inversa. El modo en que la tensión entre el espíritu garantista de los jueces y la demanda de castigos de los ciudadanos comunes se manejará en la práctica de los juicios por jurado, y su incidencia en el éxito de las estrategias legitimadoras del poder judicial, aparece como una cuestión relevante para el análisis que se propone. Con la utilización de diferentes fuentes de información cuantitativas y cualitativas, se espera que el análisis de la implementación del juicio penal con jurados populares en la provincia de Córdoba propuesto en el presente proyecto, contribuya a documentar los niveles de articulación entre la cultura jurídica interna y externa.

Experience of ECMO in Primary Graft Dysfunction after Orthotopic Heart Transplantation

Background:Primary graft dysfunction is the main cause of early mortality after heart transplantation. Mechanical circulatory support has been used to treat this syndrome.Objective:Describe the experience with extracorporeal membrane oxygenation to treat post-transplant primary cardiac graft dysfunction.Methods:Between January 2007 and December 2013, a total of 71 orthotopic heart transplantations were performed in patients with advanced heart failure. Eleven (15.5%) of these patients who presented primary graft dysfunction constituted the population of this study. Primary graft dysfunction manifested in our population as failure to wean from cardiopulmonary bypass in six (54.5%) patients, severe hemodynamic instability in the immediate postoperative period with severe cardiac dysfunction in three (27.3%), and cardiac arrest (18.2%). The average ischemia time was 151 ± 82 minutes. Once the diagnosis of primary graft dysfunction was established, we installed a mechanical circulatory support to stabilize the severe hemodynamic condition of the patients and followed their progression longitudinally.Results:The average duration of extracorporeal membrane oxygenation support was 76 ± 47.4 hours (range 32 to 144 hours). Weaning with cardiac recovery was successful in nine (81.8%) patients. However, two patients who presented cardiac recovery did not survive to hospital discharge.Conclusion:Mechanical circulatory support with central extracorporeal membrane oxygenation promoted cardiac recovery within a few days in most patients.

Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

Abstract Background: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

Recent brazilian experience on farmer reaction and crop response to fertilizer use

(1) In the period 1965/77 fertilizer consumption in Brazil increased nearly fifteen foild from circa 200,000 tons of N + P2O5 + K2O to 3 million tons. During the fifteen years extending from 1950 to 1964 usage of the primary macronutrients was raised by a factor of 2 only. (2) Several explanations are given for the remarkable increase, namely: an experimental background which supplied data for recommendations of rates, time and type of application; a convenient governmental policy for minimum prices and rural credit; capacity of the industry to meet the demand of the fertilizer market; an adequate mechanism for the diffusion of the practice of fertilizer use to the farmer. (3) The extension work, which has caused a permanent change in the aptitude towards fertilization, was carried out in the traditional way by salesmen supported by a technical staff, as well as by agronomists of the official services. (4) Two new programs were started and conducted in a rather short time, both putting emphasis on the relatively new technology of fertilizer use. (5) The first program, conducted in the Southern part of the country, extended lab and green house work supplemented by a few field trials to small land owners - the so called "operação tatú" (operation armadillo). (6) The seconde program, covering a larger problem area in the Northeast and in Central Brazil, began directly in field as thousands of demonstrations and simple experiments with the participation of local people whose involvement was essential for the success of the initiative; in this case the official extension services, both foreign and national sources of funds, and universities did participate under the leadership of the Brazilian Association for the Diffusion of Fertilizers (ANDA). (7) It is felt that the Brazilian experience gained thereof could be useful to other countries under similar conditions.

Oviposition preference hierarchy in Ceratitis capitata (Diptera, Tephritidae): influence of female age and experience

The influence of two factors, age and previous experience, on the oviposition hierarchy preference of Ceratitis capitata (Wiedemann, 1824) females was studied. Two populations were analyzed: one reared in laboratory during 17 years and the other captured in nature. In the first experiment the oviposition preference for four fruits, papaya, orange, banana and apple was tested at the beginning of oviposition period and 20 days past. The results showed that the wild females as much the laboratory ones had an oviposition preference hierarchy at the beginning of peak period of oviposition. However this hierarchic preference disappeared in a later phase of life. In the second experiment the females were previously exposed to fruits of different hierarchic positions and afterwards their choice was tested in respect to the oviposition preference for those fruits. The results showed that there was an influence of the previous experience on the posterior choice of fruits to oviposition when the females were exposed to fruits of lower hierarchic position.

The influence of prior experience with artificial fruits on the ovipositioning behavior of Anastrepha fraterculus (Diptera, Tephritidae)

The South American fruit fly, Anastrepha fraterculus (Wiedemann, 1830) (Diptera, Tephritidae), is a leading pest of Brazilian fruit crops. This study evaluated how prior experience with artificial fruits containing peach and/or guabiroba pulp influenced the ovipositing behavior of A. fraterculus. Insects 15-21 days old were exposed to four treatments: 1) experience with guabiroba, Campomanesia xanthocarpa O. Berg (Myrtaceae); 2) experience with peach, Prunus persica (L.) Batsch (Chimarrita cultivar; Rosaceae); 3) experience with both fruits; and 4) no experience (naive). Naive females and females experienced with guabiroba pulp and with both fruits (peach and guabiroba) oviposited and showed dragging and puncturing behavior on substrates containing guabiroba, but females that were only exposed to peach pulp did not show a preference for any substrate. The study shows that prior experience with substrate influences ovipositing behavior in A. fraterculus.

The Experience of European Integration and the Potential for Integration in South America

The experience of the European Union is the most significant and far-reaching among all attempts at regional integration. It is, therefore, the most likely to provide some lessons for those world regions that are just beginning this complex process. In turn, the Common Market of the South (MERCOSUR) and the Andean Community (CAN) are among the regional integration projects that have reached the greatest level of formal accomplishment after the EU. MERCOSUR is a customs union that aspires to become a common market, while avowing the commitment to advance towards political integration. For its part, CAN is a customs union that has already developed supranational institutions such as a Commission, a Parliament and a Court of Justice. In both cases, however, words have progressively tended to wander far from deeds. One reason underlying this phenomenon may be a misunderstanding of the European experience with integration. In this article, we discuss the theories that have been developed to account for integration in Europe and may prove useful to understand integration elsewhere and put forward a set of lessons that could be drawn from the European experience. Subsequently, we introduce a description of the experience of integration in South America and reflect (critically) on how the theories and lessons drawn from the EU could be applied to this region –and beyond.

Reivindicación de la Independencia Intelectual en la primera época de Cuadernos del Congreso por la Libertad de la Cultura: I (marzo-mayo de 1953)- XXVII (noviembre-diciembre de 1957)

La “retórica de la libertad” ocupó una posición dominante durante la primera época de la revista Cuadernos, publicación en castellano del Congreso por la Libertad de la Cultura, donde colaboraron numerosos intelectuales republicanos exiliados. El Congreso por la Libertad de la Cultura, fundado durante la guerra fría cultural por el gobierno de los EEUU, y organizado y financiado por sus servicios secretos (CIA), utilizó grandes ideales, como la lucha antitotalitaria y la independencia intelectual, con el fin de promover determinadas actitudes en la intelectualidad occidental, con el fin de “vacunarla” a la influencia del comunismo. --------- La “retòrica de la llibertat” va ocupar una posició dominant durant la primera època de la revista Cuadernos, publicació en castellà del Congrés per la Llibertat de la Cultura, on van col•laborar nombrosos intel•lectuals republicans exiliats. El Congrés per la Llibertat de la Cultura, fundat durant la guerra freda cultural pel govern dels EEUU, i organitzat i finançat pels seus serveis secrets (CIA), va utilitzar grans ideals, com la lluita antitotalitaria i la independència intel•lectual, amb la finalitat de promoure determinades actituds en la intel•lectualitat occidental, amb la finalitat de “vacunar-la” a la influència del comunisme.

Communication, cultural identities and the Olympic Games: the Barcelona’92 experience

This document includes the results of the research undertaken by the author on the media planning and coverage of the Barcelona'92 and its cultural implications.