Association of hypertension and hypokalemia with Cushing's syndrome caused by ectopic ACTH secretion: a series of 58 cases.

Cushing's syndrome is associated with hypertension in approximately 80% of cases. Hypertension contributes to the marked increased mortality risk of past or current Cushing's syndrome, largely because of increased cardiovascular risk. Observation of the pathophysiological effect of chronically elevated ACTH and cortisol values in patients with ectopic ACTH secretion complements the available data from acute studies of the effects of ACTH and glucocorticoid infusions in normal volunteers. In a retrospective case review, we identified 58 patients with Cushing's syndrome caused by ectopic ACTH secretion, who were treated at the National Institutes of Health between 1983-1997. The diagnosis of an ectopic ACTH cause was confirmed by inferior petrosal sinus sampling and/or pathologic examination of tumor. The commonest causes were bronchial carcinoid (40%) and thymic carcinoid (10%), but 18 of 58 (31%) patients had an unknown source of ectopic ACTH. Hypertension (systolic blood pressure >140 mmHg and/or diastolic blood pressure >90 mmHg in adults) was noted in 45 of 58 (78%) ectopic Cushing's patients, a prevalence similar to that noted in other endogenous Cushing's syndrome etiologies. Hypertension was severe, deemed to require 3 or more drugs by the treating physicians, in 26 of 58 (45%) patients. Hypokalemia was much more prevalent than in patients with other causes of Cushing's syndrome, affecting 33 of 58 (57%) patients. The range of plasma ACTH (17-1557 pg/mL, normal

Historical and dialectical perspectives on the teaching of Aboriginal and Torres Strait Islander musics in the Australian education system

Indigenous studies (also referred to as Aboriginal and Torres Strait Islander studies) has a double identity in the Australian education system, consisting of the education of Indigenous students and education of all students about Aboriginal and Torres Strait Islander cultures and histories. Through explanations of the history of the inclusion of Aboriginal and Torres Strait Islander musics in Australian music education, this article critiques ways in which these musics have been positioned in relation to a number of agendas. These include definitions of Aboriginal and Torres Strait Islander musics as types of Australian music, as ethnomusicological objects, as examples of postcolonial discourse, and as empowerment for Indigenous students. The site of discussion is the work of the Australian Society for Music Education, as representative of trends in Australian school-based music education, and the Centre for Aboriginal Studies in Music at the University of Adelaide, as an example of a tertiary music program for Indigenous students.

Speleothem U-series dating of semi-synchronous climate oscillations during the last deglaciation

Evidence for nearly synchronous climate oscillations during the last deglaciation has been found throughout the Northern Hemisphere but few records are based on independent time scales of calendar years. We present a rare uranium-series dated oxygen-carbon isotope record for a speleothem from Tangshan Cave, China, which demonstrates that abrupt deglacial climatic oscillations from 16 800 to 10 500 yr BP are semi-synchronous with those found in Greenland ice core records. Relatively rapid shifts in speleothem oxygen isotope ratios demonstrate that the intensity of the East Asian monsoon switched in parallel with the abrupt transitions separating the Bolling-Allerod, Younger Dryas, and pre-Boreal climatic reversals. However, the dated isotopic transitions appear to have lasted longer. Our results demonstrate the dominant role of atmospheric teleconnections in the rapid propagation of deglacial climatic signals on a hemispheric scale, and highlight the importance of U-series dated speleothems in the timing and characterization of abrupt climate change. (C) 2003 Elsevier B.V. All rights reserved.

Historical and conceptual landscape of the character

This paper was developed with the intention of broadly demonstrating the complexity of the area known recently as character development, as a creative process methods and implementation. It searches the understanding of the character itself, its place in the narrative and its reception by the reader or target audience. It is a multidisciplinary tool that faces a multitude of challenges from an increasingly demanding public and with specific goals in mind, and yet it also gives us valuable insight over how we interact with one another and the world around us, teaching us how to transfer such knowledge into fiction promoting empathic bonds between the reader and the characters. The human tendency to create is limitless and as old as mankind itself, we create, recreate and reinterpret and then populate such tales with believable characters from who we learn, and experience events and tales that shape our very lives.

Residents’ perception of the benefits of cultural tourism: the case of Guimarães

In many cities throughout Europe and the rest of the world, cultural tourism plays a major role in local economic development. Tourism also acts to preserve cultural heritage, as it provides a way to acquire the revenue needed to restore and preserve historical buildings, and encourages local people to value their traditions and festivals. However, tourism success can be a double-edged sword with tourist flows having a strong impact on the quality of life of residents when certain tourist thresholds are surpassed. This paper aims to address local residents’ perception of the benefits of cultural tourism. To capture their perception, a survey was implemented, addressed to both the city centre inhabitants and the non-urban residents of the Guimarães municipality.

O planejamento econômico no Brasil: considerações críticas

In the past thirty years, a series of plans have been developed by successive Brazilian governments in a continuing effort to maximize the nation's resources for economic and social growth. This planning history has been quantitatively rich but qualitatively poor. The disjunction has stimulated Professor Mello e Souza to address himself to the problem of national planning and to offer some criticisms of Brazilian planning experience. Though political instability has obviously been a factor promoting discontinuity, his criticisms are aimed at the attitudes and strategic concepts which have sought to link planning to national goals and administration. He criticizes the fascination with techniques and plans to the exclusion of proper diagnosis of the socio-political reality, developing instruments to coordinate and carry out objectives, and creating an administrative structure centralized enough to make national decisions and decentralized enough to perform on the basis of those decisions. Thus, fixed, quantified objectives abound while the problem of functioning mechanisms for the coordinated, rational use of resources has been left unattended. Although his interest and criticism are focused on the process and experience of national planning, he recognized variation in the level and results of Brazilian planning. National plans have failed due to faulty conception of the function of planning. Sectorial plans, save in the sector of the petroleum industry under government responsibility, ha e not succeeded in overcoming the problems of formulation and execution thereby repeating old technical errors. Planning for the private sector has a somewhat brighter history due to the use of Grupos Executivos which has enabled the planning process to transcend the formalism and tradition-bound attitudes of the regular bureaucracy. Regional planning offers two relatively successful experiences, Sudene and the strategy of the regionally oriented autarchy. Thus, planning history in Brazil is not entirely black but a certain shade of grey. The major part of the article, however, is devoted to a descriptive analysis of the national planning experience. The plans included in this analysis are: The Works and Equipment Plan (POE); The Health, Food, Transportation and Energy Plan (Salte); The Program of Goals; The Trienal Plan of Economic and Social Development; and the Plan of Governmental Economic Action (Paeg). Using these five plans for his historical experience the author sets out a series of errors of formulation and execution by which he analyzes that experience. With respect to formulation, he speaks of a lack of elaboration of programs and projects, of coordination among diverse goals, and of provision of qualified staff and techniques. He mentions the absence of the definition of resources necessary to the financing of the plan and the inadequate quantification of sectorial and national goals due to the lack of reliable statistical information. Finally, he notes the failure to coordinate the annual budget with the multi-year plans. He sees the problems of execution as beginning in the absence of coordination between the various sectors of the public administration, the failure to develop an operative system of decentralization, the absence of any system of financial and fiscal control over execution, the difficulties imposed by the system of public accounting, and the absence of an adequate program of allocation for the liberation of resources. He ends by pointing to the failure to develop and use an integrated system of political economic tools in a mode compatible with the objective of the plans. The body of the article analyzes national planning experience in Brazil using these lists of errors as rough model of criticism. Several conclusions emerge from this analysis with regard to planning in Brazil and in developing countries, in general. Plans have generally been of little avail in Brazil because of the lack of a continuous, bureaucratized (in the Weberian sense) planning organization set in an instrumentally suitable administrative structure and based on thorough diagnoses of socio-economic conditions and problems. Plans have become the justification for planning. Planning has come to be conceived as a rational method of orienting the process of decisions through the establishment of a precise and quantified relation between means and ends. But this conception has led to a planning history rimmed with frustration, and failure, because of its rigidity in the face of flexible and changing reality. Rather, he suggests a conception of planning which understands it "as a rational process of formulating decisions about the policy, economy, and society whose only demand is that of managing the instrumentarium in a harmonious and integrated form in order to reach explicit, but not quantified ends". He calls this "planning without plans": the establishment of broad-scale tendencies through diagnosis whose implementation is carried out through an adjustable, coherent instrumentarium of political-economic tools. Administration according to a plan of multiple, integrated goals is a sound procedure if the nation's administrative machinery contains the technical development needed to control the multiple variables linked to any situation of socio-economic change. Brazil does not possess this level of refinement and any strategy of planning relevant to its problems must recognize this. The reforms which have been attempted fail to make this recognition as is true of the conception of planning informing the Brazilian experience. Therefore, unworkable plans, ill-diagnosed with little or no supportive instrumentarium or flexibility have been Brazil's legacy. This legacy seems likely to continue until the conception of planning comes to live in the reality of Brazil.

Historical Inevitability

What interests me more here is the so-called Historical Inevitability. It is a concept intimately linked with Human Choice and Freedom. There is a long history of debate around it among the western thinkers. The protestant thinkers, and particularly its Calvinist brand laid much emphasis upon predestination. The modern thinkers, freed from the theological trappings, questioned the Church imposed limitations to the capacity of human reasoning. The progress of science and technologies supported by it through the Industrial Revolution and thereafter seemed to endorse this new self-confidence. However, the miseries brought upon mankind by regional and world wars fuelled by the same technologies have made mankind wary of its faith upon scientific progress. The promises of modernization have left the greater part of mankind without its benefits, and even the rest of mankind is unsure of living in a safe and uncontaminated environment.

Possible consequences of increasing life expectancy in Brazil: the perspective of a European historical demographer

Those over sixty years of age accounted for 6.6% of the total population of Brazil in 1985, in the Federal Republic of Germany this proportion was 20.3% in 1984. As early as 1950 it had been 14.5%. This proportion will not even be reached in Brazil in the year 2000 when persons aged sixty years and older are only projected to make up 8.8% of the total population. Similarly, in 1982/84 life expectancy at birth in the Federal Republic was 70.8 years for men and 77.5 for women; in Brazil the figures for 1980/85 were, by contrast, "only" 61.0 and 66.0. Against this background it is easy to understand why the discussion concerning an ageing society with its many related medical, economic, individual and social problems has been so slow in coming into its own in Brazil. As important as a more intensive consideration of these aspects may be in Brazil at present, they are, nevertheless, only one side of the story. For a European historical demographer with a long-term perspective of three of four hundred years, the other side of the story is just as important. The life expectancy which is almost ten years lower in Brazil is not a result of the fact that no one in Brazil lives to old age. In 1981 people sixty-five years and older accounted for 34.4% of all deaths! At the same time infants accounted for only 22.1% of total mortality. They are responsible, along with the "premature" deaths among youths and adults, for the low, "average" life expectancy figure. In Europe, by contrast, these "premature" deaths no longer play much of a role. In 1982/84 more than half of the women (52.8%) in the Federal Republic of Germany lived to see their eightieth birthdays and almost half of the men (47.3%) lived to see their seventy-fifth. Our biological existence is guaranteed to an extent today that would have been unthinkable a few generations ago. Then, the classic troika of "plague, hunger and war" threatened our forefathers all the time and everywhere. The radical transition from the formerly uncertain to a present-day certain lifetime, which is the result of the repression of "plague, hunger and war", led to unexpected consequences for our living together. Our forefathers were forced to live in closely knit Gemeinschaften in the interest of physical survival and to subordinate their egoistic goals to a common value, but now these pressures have, for the most part, fallen away. Correspondingly, this much more certain EGO has taken center stage. An ever greater number of us chooses to live life as single beings: the number of marriages is lower every year; the number of divorces is on the increase; in Berlin (West) more than half (sic! 52.3%) of all households are already composed on only one person. For the last dozen years the annual number of births in the Federal Republic has been insufficient to ensure population replacement. Not a population explosion but rather the opposite, a population implosion, is our problem. Human beings do not appear to be "social animals", as was axiomatically assumed for so long. They were only forced to behave as such for as long as "plague, hunger and war" forced them to do so. When these life endangering conditions no longer exist and life becomes certain even without their being integrated into a Gemeinschaft then humans suddenly show themselves more and more to be independent single beings. It is not the percentage of the population that is over sixty or sixty-five that is decisive in this context but rather how certain adults perceive their biological lives to be, since they are the ones who organize their lives, who build communities or who are ever more often willing only to enter into means-to-an-end personal unions without lasting or close ties and mutual responsibilities. There are many signs which seem to point to a development in this direction in Brazil as well. More and more adults in Brazil are caught up in the deep-seated transition from an uncertain to a certain lifetime. A third of them die after having reached their sixty-fifth birthday. It therefore seems to me to be high time that one began to give more consideration to the other side of the story in Brazil as well. And who is more suited intensively to consider the long-term perspectives than those engaged in the public health sector in whose competence, after all, such aspects, as "life certainty", "life expectancy" and "age at death" belong?

Dengue in the South-eastern region of Brazil: historical analysis and epidemiology

The aim of the study is an historical analysis of the work undertaken by the Public Health organizations dedicated to the combat of the Aedes aegypti, as well as an epidemiolocal study of persons with unexplained fever, with a view to evaluating the ocurrence of dengue within the population. The Mac-Elisa, Gac-Elisa, hemaglutination inhibition, isolation and typage tests were used. Organophosphate intoxication in agricultural workers was also assessed by measuring concentrations of serie cholinesterase. A sera samples of 2,094 were collected in 23 towns, and the type 1 dengue virus was detected in 17 towns and autochthony was confirmed in 12 of them. The cholinesterase was measured in 2,391 sera samples of which 53 cases had abnormal levels. Poisoning was confirmed in 3 cases. Results reveal an epidemic the gravity of which was not officially know. The relationshipe between levels of IgM and IgG antibodies indicates the outbreak tendency. The widespread distribution of the vector is troubling because of the possibility of the urbanization of wild yellow fever, whereas the absence of A. aegypti in 2 towns with autochthony suggests the existence of another vector. Since there is no vaccine against dengue, the combat of the vector is the most efficient measure for preventing outbreaks. The eradication of the vector depends on government decisions which depend, for their execution, on the organization of the Health System and the propagation of information concerning the prevention of the disease using all possible means because short and long term results depend on the education and the active participation of the entire population.

Evaluating Tsunami Impact on the Gulf of Cadiz Coast (Northeast Atlantic).

The Gulf of Cadiz coasts are exposed to tsunamis. Emergency planning tools are now taking into account this fact, especially because a series of historical occurrences were strikingly significant, having left strong evidence behind, in the mareographic records, the geological evidence or simply the memory of the populations. The study area is a strip along the Algarve coast, south Portugal, an area known to have been heavily impacted by the 1 November 1755 event. In this study we use two different tsunami scenarios generated by the rupture of two thrust faults identified in the area, corresponding to 8.1-8.3 magnitude earthquakes. Tsunami propagation and inundation computation is performed using a non-linear shallow water code with bottom friction. Numerical modeling results are presented in terms of flow depth and current velocity with maximum values of 7 m and 8 m/s for inundation depth and flow speed, respectively. These results constitute a valuable tool for local authorities, emergency and decision planners to define the priority zones where tsunami mitigation measures must be implemented and to develop tsunami-resilient communities.