Survival of freeze dried Lactobacillus plantarum in instant fruit powders and reconstituted fruit juices

The aim of this study was to investigate the survival of freeze dried Lactobacillus plantarum cells mixed with several freeze dried instant fruit powders (strawberry, pomegranate, blackcurrant and cranberry) during storage for 12 months as well as after reconstitution with water each month. Inulin and gum arabic were also added to the instant fruit powders at two levels (10% and 20% w/w of dry weight) to improve the cell survival and functional properties of the product. The best cell survival over the 12 months of storage was observed for the blackcurrant powder (almost no decrease) followed by strawberry (~ 0.3 log decrease), pomegranate (~ 0.9 log decrease), whereas the worst survival was obtained in cranberry powder (~ 4.5 logs). To explain these results multiple regression analysis was conducted with the log decrease [log10N0 month − log10N12 months] as the dependent variable and water activity, pH, citric acid, dietary fibre and total phenol as the independent variables. The results indicated that among all the examined factors, the [log10N0 month − log10N12 months] depended only on the water activity (P < 0.05). Inulin and gum arabic demonstrated a substantial protective effect on cell survival (1–1.5 log) in the case of cranberry, which was likely due to a physical interaction between the cells and the carbohydrates. After reconstituting the dried fruit powders at room temperature and measuring cell viability for up to 4 h, it was shown that in the case of strawberry juice there was no decrease, and very little in the case of pomegranate and blackcurrant juices (< 0.5 log). On the other hand, a significant decrease was observed for cranberry juice (P < 0.05), which increased as the storage time of the dried cranberry powder increased, indicating that the cells became more susceptible with prolonged storage. Multiple regression analysis indicated that the main factors influencing cell survival were water activity and pH, while citric acid, dietary fibre and total phenol did not have an effect. Furthermore, inulin and gum arabic addition did not have a significant (P > 0.05) effect upon reconstitution of the dried fruit powder. This study showed that instant juice powders are very good carriers of probiotic cells and constitute good alternatives to highly acidic fruit juices.

Individual differences in mental control predict involuntary musical imagery

The experience of earworms, a type of involuntary musical imagery, may reflect a systematic failure in mental control. This study focused on how individual differences in each of two factors, schizotypy, or “openness to experience”, and thought suppression might relate to the appearance of the involuntary musical image (earworm). Schizotypy, was measured by Raine’s schizotypal personality questionnaire (SPQ; Raine, 1991) and thought suppression was measured by the White Bear Suppression Inventory (WBSI; Wegner & Zanakos, 1994). Each was found to contribute independently to the overall experience of involuntary musical imagery. Schizotypy was correlated with the length and disruptiveness of earworms, the difficulty with which they were dismissed and the worry they caused, but was not correlated with the frequency of such intrusive imagery. In turn, schizotypy was predicted by suppression and intrusion components of WBSI. The WBSI is associated with the length, disruptiveness, difficulty dismissing and interference but not with the worry caused or the frequency of earworms. The assumption of “ownership” of earworms was also found to affect the extent to which the earworms were considered worrying. Multiple regression analysis showed that both schizotypy and the WBSI predicted the difficulty with which unwanted musical images were dismissed, but that the WBSI accounted for additional variance on top of that accounted for by schizotypy. Finally we consider how earworm management might relate to wider cognitive processes.

Sustainable urban metabolism as a link between bio-physical sciences and urban planning: the BRIDGE project

Urban metabolism considers a city as a system with flows of energy and material between it and the environment. Recent advances in bio-physical sciences provide methods and models to estimate local scale energy, water, carbon and pollutant fluxes. However, good communication is required to provide this new knowledge and its implications to endusers (such as urban planners, architects and engineers). The FP7 project BRIDGE (sustainaBle uRban plannIng Decision support accountinG for urban mEtabolism) aimed to address this gap by illustrating the advantages of considering these issues in urban planning. The BRIDGE Decision Support System (DSS) aids the evaluation of the sustainability of urban planning interventions. The Multi Criteria Analysis approach adopted provides a method to cope with the complexity of urban metabolism. In consultation with targeted end-users, objectives were defined in relation to the interactions between the environmental elements (fluxes of energy, water, carbon and pollutants) and socioeconomic components (investment costs, housing, employment, etc.) of urban sustainability. The tool was tested in five case study cities: Helsinki, Athens, London, Florence and Gliwice; and sub-models were evaluated using flux data selected. This overview of the BRIDGE project covers the methods and tools used to measure and model the physical flows, the selected set of sustainability indicators, the methodological framework for evaluating urban planning alternatives and the resulting DSS prototype.

The housing pathways of young people in the UK

The authors examine the housing pathways of young people in the UK in the years 1999 to 2008, and consider the changing nature of these pathways in the run up to 2020. They employ a highly innovative methodology, which begins with the identification and description of key drivers likely to affect young people’s housing circumstances in the future. The empirical identification and analysis of housing pathways is then achieved using multiple-sequence analysis and cluster analysis of the British Household Panel Survey, contextualised by qualitative interviews with a large sample of young people. The authors describe how the interactions between the meanings, perceptions, and aspirations of young people, and the opportunities and constraints imposed by the drivers, are having a major impact on young people’s housing pathways, resulting in considerable housing policy challenges, particularly in relation to the private rented sector

Robust future changes in temperature variability under greenhouse gas forcing and the relationship with thermal advection

Recent temperature extremes have highlighted the importance of assessing projected changes in the variability of temperature as well as the mean. A large fraction of present day temperature variance is associated with thermal advection, as anomalous winds blow across the land-sea temperature contrast for instance. Models project robust heterogeneity in the 21st century warming pattern under greenhouse gas forcing, resulting in land-sea temperature contrasts increasing in summer and decreasing in winter, and the pole-to-equator temperature gradient weakening in winter. In this study, future monthly variability changes in the 17 member ensemble ESSENCE are assessed. In winter, variability in midlatitudes decreases while in very high latitudes and the tropics it increases. In summer, variability increases over most land areas and in the tropics, with decreasing variability in high latitude oceans. Multiple regression analysis is used to determine the contributions to variability changes from changing temperature gradients and circulation patterns. Thermal advection is found to be of particular importance in the northern hemisphere winter midlatitudes, where the change in mean state temperature gradients alone could account for over half the projected changes. Changes in thermal advection are also found to be important in summer in Europe and coastal areas, although less so than in winter. Comparison with CMIP5 data shows that the midlatitude changes in variability are robust across large regions, particularly high northern latitudes in winter and mid northern latitudes in summer.

Influence of Abusive Vocal Habits, Hydration, Mastication, and Sleep in the Occurrence of Vocal Symptoms in Teachers

Some vocal disorders in teachers are associated with occupational factors, but there are few studies that analyze the influence of vocal habits, fluid intake, mastication, and sleep on these disorders. The objective was to analyze the Occurrence of vocal fatigue, hoarseness, and dry throat in elementary and high school teachers and their association with vocal habits, fluid intake, mastication, and sleep. A sample of 422 elementary and secondary school teachers was Studied using a specific questionnaire. The multiple regression analysis showed that hoarseness was associated with absence of water intake (odds ratio (OR) = 1.7; P = 0.047), yelling/speaking loudly (OR = 1.6; P = 0.058), jaw-opening limitations (OR = 3.8; P = 0.003). average of: 6 hours of sleep/light (OR = 1.7; P = 0.039), and waking-up feeling replenished (OR = 2.0; P = 0.020). The presence of vocal fatigue was significantly associated with yelling/speaking loudly (OR = 2.2: P = 0.013), speaking excessively (OR = 2.4; P = 0.023), difficulty to open the mouth to masticate (OR = 6.6; P = 0.003), less than 6 hours of sleep (OR = 4.0; P = 0.008), and waking-up feeling replenished (sometimes OR = 2.8: P = 0.003; or never OR = 3.3 P = 0.002). The presence of dry throat was associated with being a former smoker (OR = 3.3; P = 0.011) and having jaw-opening limitations (OR = 3.9; P = 0.021). In recent years, speech and hearing interventions with teachers have focused on health-care promotion actions and prevention of vocal disorders, prioritizing issues related with hydration and healthy vocal use habits. However, the findings in the present study show the need to further focus on lifestyle habits related to sleep and eating habits.

Influence of body composition on bone mass in postmenopausal osteoporotic women

We aimed at evaluating the relationship of lean and fat mass to bone mass in osteoporotic postmenopausal women. We invited 65 women who were being treated at the Sao Paulo Hospital osteoporosis outpatients` clinic to participate. Body composition and bone mineral density (BMD) measurements were performed using Dual-energy X-ray absorptiometry methodology (DXA). The mean age and weight were 69.7 +/- 6.4 years and 56.3 +/- 7.6 kg, respectively. Accordingly to the body mass index (BMI), 52.8% were of normal weight and 47.1% of the patients were overweight. Overweight women had significantly higher bone mass. Similarly, skeletal muscle index (SMI) showed a positive effect on BMD measurements and women with sarcopenia had significantly lower BMD measurements in total femur and femoral neck. In multiple regression analysis only lean mass and age, after adjustments to fat mass and BMI, were able to predict total body bone mineral content (BMC) (R(2) = 28%). Also lean mass adjusted to age and BMI were able to predict femoral neck BMD (R(2) = 14%). On the other hand, none of the components of the body composition (lean mass or fat mass) contributed significantly to explaining total femur BMD and neither body composition measurements were associated with spine BMD. These findings suggest that lean mass has a relevant role in BMC and BMD measurements. In addition, lower BMI and lean mass loss (sarcopenia) is associated to lower BMC and BMD of femoral neck and total femur and possible higher risk of osteoporotic fracture. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Annual profile of fecal androgen and glucocorticoid levels in free-living male American kestrels from southern mid-latitude areas

Fecal samples and behavioral data were collected at a fortnightly basis during 11 months period from free-living male American kestrels living in southeast Brazil (22 degrees S latitude). The aim was to investigate the seasonal changes in testicular and adrenal steroidogenic activity and their correlation to reproductive behaviors and environmental factors. The results revealed that monthly mean of fecal glucocorticoid metabolites in May and June were higher than those estimated in November. in parallel, monthly mean of androgen metabolites in September was higher than those from January to April and from October to November. Molt took place from January to March, whereas copulation was observed from June to October but peaked in September. Nest activity and food transfer to females occurred predominantly in October, and parental behavior was noticed only in November. Territorial aggressions were rare and scattered throughout the year. Multiple regression analysis revealed that fecal androgen levels are predicted by photoperiod and copulation, while fecal glucocorticoid levels are only predicted by photoperiod. Bivariate correlations showed that fecal androgen metabolites were positively correlated with fecal glucocorticoid metabolites and copulation, but negatively correlated with molt. Additionally, copulation was positively correlated with food transfer to females and nest activity, but negatively correlated with molt. These findings suggest that male American kestrels living in southeast Brazil exhibit significant seasonal changes in fecal androgen and glucocorticoid concentrations, which seem to be stimulated by decreasing daylength but not by rainfall or temperature. (C) 2009 Elsevier Inc. All rights reserved.

Determinants of Accelerated Small Intestinal Transit in Alcohol-Related Chronic Pancreatitis

Patients with chronic pancreatitis may have abnormal gastrointestinal transit, but the factors underlying these abnormalities are poorly understood. Gastrointestinal transit was assessed, in 40 male outpatients with alcohol-related chronic pancreatitis and 18 controls, by scintigraphy after a liquid meal labeled with (99m)technetium-phytate. Blood and urinary glucose, fecal fat excretion, nutritional status, and cardiovascular autonomic function were determined in all patients. The influence of diabetes mellitus, malabsorption, malnutrition, and autonomic neuropathy on abnormal gastrointestinal transit was assessed by univariate analysis and Bayesian multiple regression analysis. Accelerated gastrointestinal transit was found in 11 patients who showed abnormally rapid arrival of the meal marker to the cecum. Univariate and Bayesian analysis showed that diabetes mellitus and autonomic neuropathy had significant influences on rapid transit, which was not associated with either malabsorption or malnutrition. In conclusion, rapid gastrointestinal transit in patients with alcohol-related chronic pancreatitis is related to diabetes mellitus and autonomic neuropathy.

Matproblem och personlighet

The purpose of this study was to examine by means of Eysenck Personality Inventory (EPI), the relationship between Neuroticism, and self-rated eating problems. Altogether 105 respondents, mean aged 42,3 years, including 11 men and 94 women, participated by answering an Internet-based questionnaire comprising three different sections. Neuroticism correlated with self-rated eating problems (r=,468, p<0,01). By means of multiple regression analysis it was indicated that both Neuroticism (p<.001) and Body Mass Index (BMI) (p<.001) contributed significantly to the prediction of self-rated eating problems (multiple correlation (ß=.594). The study indicated that the personality only partly explained the variation of eating problems. The result was discussed in terms of significance of biological factors stressing changes in 5-HT levels triggering eating problems.

Profiling visitors to Dalarna Museum : What are the motivational factors that influence visitors' frequency of visits

Prior studies on museum visitors are extensively centred on national museums, the studies on regional museums are scarce. To fill in the academic gap, a research is proposed concerning the visitors of Dalarna Museum, a regional museum in Sweden. With an aim to profile visitors’ demographic characteristics and investigate the motivational factors that influence visitors’ frequency of visits, a face-to-face questionnaire survey was implemented at Dalarna Museum. To get visitors’ demographic characteristics, a few closed and open questions are devised to profile visitors’ gender, age, occupation, income, education, number of children and residence place. To investigate the motivational factors that influence visitors’ frequency of visits, a seven-point Likert questionnaire is employed with 17 motivational factors included. During a 12-day data collection, 372 visitors were invited to participate in the questionnaire survey, whereof 357 had filled in the questionnaire, generating a response rate that is as high as 96 percent. After data cleansing, there are 355 completed and valid responses in total. According to the results, some of visitors’ demographic characteristics are similar including gender, age, occupation, income, and number of children. However, the characteristics regarding visitors’ residence places and educational attainments are different comparing the frequent visitors to occasional visitors. Through running a multiple regression analysis, 13 out of the 17 motivational factors are detected having significant influences on visitors’ frequency of visits to Dalarna Museum, of which the most influential one is visitors’ day-outs with their friends and relatives.

Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

Tha contribution of home-based technology to older people's quality of life in extra care housing

Background: British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH).  Methods: A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used.  Results: Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19].  Conclusions: The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies.

Contribuição ao estudo das hepatectomias parciais com oclusão do fluxo sanguíneo aferente

O tratamento cirúrgico dos tumores hepáticos tem sido um grande desafio na história evolutiva da cirurgia. No passado, as altas taxas de morbidade e mortalidade limitavam sua aplicação como opção terapêutica. O refinamento da técnica de ressecção hepática está associado a menores índices de mortalidade e morbidade peri-operatória e, embora, a mortalidade tenha sido reduzida a menos de 10% nos serviços especializados, a morbidade ainda é bastante significativa, sendo que a hemorragia grave e a embolia aérea permanecem como complicações graves das hepatectomias. O controle da perda sanguínea é o objetivo primordial durante este tipo de cirurgia. As técnicas descritas, com a finalidade de conter a hemorragia transoperatória, são aquelas associadas à redução do fluxo sanguíneo ao fígado, seja através da oclusão vascular aferente ou manobra de Pringle por clampeamento do pedículo hepático, seja por exclusão vascular total do órgão. Hepatectomias parciais podem ser realizadas com pequeno sangramento e, mesmo quando associadas a períodos prolongados de isquemia tecidual, não foram identificadas lesões parenquimatosas ou falência hepática persistente. A redução na necessidade de reposição de sangue, no período peri-operatório, está associada a menor morbidade e à diminuição significativa na incidência de sepse abdominal. O objetivo deste estudo foi o de avaliar uma série de hepatectomias parciais com oclusão do fluxo sanguíneo aferente, em pacientes portadores de patologias benignas e neoplasias malignas. Foram analisadas 60 hepatectomias em 59 pacientes com oclusão do fluxo sanguíneo aferente quanto a possíveis fatores de risco para morbidade e mortalidade, bem como a relação entre o tempo de isquemia hepática e a variação das transaminases, tempo de protrombina e bilirrubinas, e destes, com a evolução pós-operatória. A prevalência de complicações pós-operatórias foi de 43,3% e a mortalidade de 6,7%. O fator de risco significativo para mortalidade foi tempo cirúrgico mais prolongado, quando comparado com os pacientes que não foram a óbito. Para a morbidade pós-operatória, foram identificados como fatores de risco a idade acima de 60 anos, cirurgia por neoplasia maligna, parênquima hepático anormal, ou seja, presença de cirrose, esteatose ou colestase, perda sanguínea necessitando reposição de mais de uma unidade de sangue e outros procedimentos cirúrgicos concomitantes. Na análise multivariada por regressão logística, estes fatores de risco foram reduzidos, apenas, para presença de cirrose, esteatose ou colestase. O tempo de isquemia não apresentou relação com a morbi-mortalidade pós-operatória. A variação das transaminases foram mais acentuadas nos casos com maior tempo de isquemia, porém, retornaram aos níveis pré-operatórios em, aproximadamente, uma semana. Não houve variação de tempo de protrombina e bilirrubinas quanto ao tempo de isquemia. A variação de AST e ALT não foram diferentes entre os pacientes com e sem morbidade pós-operatória.

Disfunção autonômica e doença vascular periférica em pacientes com diabete melito tipo 2

A disfunção autonômica está associada com aumento da mortalidade em pacientes diabéticos, especialmente naqueles com doença cardiovascular. Neuropatia periférica, mau controle glicêmico, dislipidemia e hipertensão são alguns dos fatores de risco para o desenvolvimento de doença vascular periférica (DVP) nestes pacientes. O objetivo deste estudo foi avaliar os fatores de risco associados com a presença de DVP em pacientes com DM tipo 2. Um estudo transversal foi realizado em 84 pacientes com DM tipo 2 ( 39 homens, idade média de 64,9 ± 7,5 anos). Os pacientes foram submetidos a uma avaliação clínica e laboratorial. A presença de DVP foi definida, utilizando-se um um aparelho manual de ultrasom com doppler (índice perna-braço < 0,9). A atividade autonômica foi avaliada através da análise da variabilidade da freqüência cardíaca (HRV) por métodos no domínio do tempo e da freqüência (análise espectral), e pelo mapa de retorno tridimensional durante o período do dia e da noite. Para a análise da HRV, um eletrocardiograma de 24 horas foi gravado e as fitas analisadas em um analisador de Holter Mars 8000 (Marquete). A potência espectral foi quantificada pela área em duas bandas de freqüência: 0,04-0,15 Hz – baixa freqüência (BF), 0,015-0,5 Hz – alta freqüência (AF). A razão BF/AF foi calculada em cada paciente. O mapa de retorno tridimensional foi construído através de um modelo matemático onde foram analisados os intervalos RR versus a diferença entre os intervalos RR adjacentes versus o número de contagens verificadas, e quantificado por três índices refletindo a modulação simpática (P1) e vagal (P2 e P3). DVP estava presente em 30 (36%) pacientes. Na análise univariada, pacientes com DVP apresentaram índices que refletem a modulação autonômica (análise espectral) diminuídos quando comparados aos pacientes sem DVP, respectivamente: BF = 0,19 ± 0,07 m/s2 vs. 0,29 ± 0,11 m/s2 P = 0,0001; BF/AF = 1,98 ± 0,9 m/s2 vs. 3,35 ± 1,83 m/s2 p = 0,001. Além disso, o índice que reflete a atividade simpática no mapa de retorno tridimensional (P1), foi mais baixo em pacientes com DVP (61,7 ± 9,4 vs. 66,8 ± 9,7 unidades arbitrárias, P = 0,04) durante a noite, refletindo maior ativação simpática neste período. Estes pacientes também apresentavam uma maior duração do diabetes (20 ± 8,1 vs. 15,3 ± 6,7 anos, P = 0,006), níveis de pressão arterial sistólica (154 ± 20 vs. 145 ± 20 mmHg, P = 0,04), razão cintura-quadril ( 0,98 ± 0,09 vs.0,92 ± 0,08, P = 0,01), e níveis de HbA1c mais elevados (7,7 ± 1,6 vs. 6,9 ± 1,7 %, P = 0,04), bem como valores de triglicerídeos ( 259 ± 94 vs. 230 ± 196 mg/dl, P= 0,03) e de excreção urinária de albumina ( 685,5 ± 1359,9 vs. 188,2 ± 591,1 μ/min, P = 0,02) superiores aos dos pacientes sem DVP.. Nos pacientes com DVP observou-se uma presença aumentada de nefropatia diabética (73,3% vs. 29,6% P = 0,0001), de retinopatia (73,3% vs. 44,4% P = 0,02) e neuropatia periférica (705 vs. 35,1% P = 0,006). Os grupos não diferiram quanto à idade, índice de massa corporal, tabagismo e presença de doença arterial coronariana. Na análise logística multivariada, a DVP permaneceu associada com a disfunção autonômica, mesmo após ter sido controlada pela pressão arterial sistólica, duração do DM, HbA1c, triglicerídeos e excreção urinária de albumina. Concluindo, pacientes com DVP e DM tipo 2 apresentam índices que refletem a modulação autonômica diminuídos, o que pode representar um fator de risco adicional para o aumento da mortalidade nestes pacientes.