Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients

Abstract Background Decreased heart rate variability (HRV) is related to higher morbidity and mortality. In this study we evaluated the linear and nonlinear indices of the HRV in stable angina patients submitted to coronary angiography. Methods We studied 77 unselected patients for elective coronary angiography, which were divided into two groups: coronary artery disease (CAD) and non-CAD groups. For analysis of HRV indices, HRV was recorded beat by beat with the volunteers in the supine position for 40 minutes. We analyzed the linear indices in the time (SDNN [standard deviation of normal to normal], NN50 [total number of adjacent RR intervals with a difference of duration greater than 50ms] and RMSSD [root-mean square of differences]) and frequency domains ultra-low frequency (ULF) ≤ 0,003 Hz, very low frequency (VLF) 0,003 – 0,04 Hz, low frequency (LF) (0.04–0.15 Hz), and high frequency (HF) (0.15–0.40 Hz) as well as the ratio between LF and HF components (LF/HF). In relation to the nonlinear indices we evaluated SD1, SD2, SD1/SD2, approximate entropy (−ApEn), α1, α2, Lyapunov Exponent, Hurst Exponent, autocorrelation and dimension correlation. The definition of the cutoff point of the variables for predictive tests was obtained by the Receiver Operating Characteristic curve (ROC). The area under the ROC curve was calculated by the extended trapezoidal rule, assuming as relevant areas under the curve ≥ 0.650. Results Coronary arterial disease patients presented reduced values of SDNN, RMSSD, NN50, HF, SD1, SD2 and -ApEn. HF ≤ 66 ms2, RMSSD ≤ 23.9 ms, ApEn ≤−0.296 and NN50 ≤ 16 presented the best discriminatory power for the presence of significant coronary obstruction. Conclusion We suggest the use of Heart Rate Variability Analysis in linear and nonlinear domains, for prognostic purposes in patients with stable angina pectoris, in view of their overall impairment.

Adaptação cultural e validação da Underwood's Daily Spiritual Experience Scale - versão brasileira

Este estudo objetivou adaptar culturalmente e analisar as propriedades psicométricas da versão brasileira da Underwood's Daily Spiritual Experience Scale (DSES). A adaptação seguiu as etapas internacionalmente recomendadas e a versão adaptada manteve equivalência com a original, após ajustes na redação de cinco itens. Na aplicação a 179 pacientes médico-cirúrgicos mostrou evidências de consistência interna (alfa de Cronbach=0,91), estabilidade temporal (ICC=0,94 no teste e reteste) e validade de construto convergente, na correlação com a subescala Religiosidade Intrínseca do instrumento DUREL (r=0,56; p<0,001). A análise fatorial exploratória extraiu três componentes, explicando 60,5% da variância do total. A versão brasileira da DSES apresenta evidências de confiabilidade e validade junto a pacientes hospitalizados. São necessários mais estudos para confirmar a sua composição fatorial e testar a sua aplicabilidade em diferentes populações.

Spiritual dimension of children and adolescents with cancer: an integrative review

OBJECTIVE: To review scientific literature relating to the spiritual dimension of children and adolescents with cancer. METHODS: We conducted an integrative literature review in the LILACS, SciELO, PsycINFO and MEDLINE databases in the period between 1990 to 2011. RESULTS: Twenty-one studies were analyzed and grouped into thematic categories: quality of life and elements of spirituality; alternative and complementary therapies: spirituality as a therapeutic resource; spirituality as a coping strategy and spirituality as an attribute of existential transformations. It was found that spirituality is present at different stages of the disease experience and that its forms of expression may vary, according to age and cognitive development. CONCLUSION: There is a scarcity of specific scales for this age range and a need for scientific production relating to the spiritual dimension of children and adolescents with cancer. Descriptors: Neoplasms; Children; Adolescents; Spirituality

One-repetition maximum test and isokinetic leg extension and flexion: correlations and predicted values

The most typical maximum tests for measuring leg muscle performance are the one-repetition maximum leg press test (1RMleg) and the isokinetic knee extension/flexion (IKEF) test. Nevertheless, their inter-correlations have not been well documented, mainly the predicted values of these evaluations. This correlational and regression analysis study involved 30 healthy young males aged 18-24y, who have performed both tests. Pearson's product moment correlation between 1RMleg and IKEF varied from 0.20 to 0.69 and the more exact predicted test was to 1RMleg (R2 = 0.71). The study showed correlations between 1RMleg and IKEF although these tests are different (isotonic vs. isokinetic) and provided further support for cross determination of 1RMleg and IKEF by linear and multiple linear regression analysis.

Rafael Moneo: la complessità del vuoto. Dalle matrici formali dell'opera di Oteiza e Chillida

The experience of void, essential to the production of forms and to make use them, can be considered as the base of the activities that attend to the formative processes. If void and matter constitutes the basic substances of architecture. Their role in the definition of form, the symbolic value and the constructive methods of it defines the quality of the space. This job inquires the character of space in the architecture of Moneo interpreting the meaning of the void in the Basque culture through the reading of the form matrices in the work of Jorge Oteiza and Eduardo Chillida. In the tie with the Basque culture a reading key is characterized by concurring to put in relation some of the theoretical principles expressed by Moneo on the relationship between place and time, in an unique and specific vision of the space. In the analysis of the process that determines the genesis of the architecture of Moneo emerges a trajectory whose direction is constructed on two pivos: on the one hand architecture like instrument of appropriation of the place, gushed from an acquaintance process who leans itself to the reading of the relations that define the place and of the resonances through which measuring it, on the other hand the architecture whose character is able to represent and to extend the time in which he is conceived, through the autonomy that is conferred to them from values. Following the trace characterized from this hypothesis, that is supported on the theories elaborated from Moneo, surveying deepens the reading of the principles that construct the sculptural work of Oteiza and Chillida, features from a search around the topic of the void and to its expression through the form. It is instrumental to the definition of a specific area that concurs to interpret the character of the space subtended to a vision of the place and the time, affine to the sensibility of Moneo and in some way not stranger to its cultural formation. The years of the academic formation, during which Moneo enters in contact with the Basque artistic culture, seem to be an important period in the birth of that knowledge that will leads him to the formulation of theories tied to the relationship between time, place and architecture. The values expressed through the experimental work of Oteiza and Chillida during years '50 are valid bases to the understanding of such relationships. In tracing a profile of the figures of Oteiza and Chillida, without the pretension that it is exhaustive for the reading of the complex historical period in which they are placed, but with the needs to put the work in a context, I want to be evidenced the important role carried out from the two artists from the Basque cultural area within which Moneo moves its first steps. The tie that approaches Moneo to the Basque culture following the personal trajectory of the formative experience interlaces to that one of important figures of the art and the Spanish architecture. One of the more meaningful relationships is born just during the years of his academic formation, from 1958 to the 1961, when he works like student in the professional office of the architect Francisco Sáenz de Oiza, who was teaching architectural design at the ETSAM. In these years many figures of Basque artists alternated at the professional office of Oiza that enjoys the important support of the manufacturer and maecenas Juan Huarte Beaumont, introduced to he from Oteiza. The tie between Huarte and Oteiza is solid and continuous in the years and it realizes in a contribution to many of the initiatives that makes of Oteiza a forwarder of the Basque culture. In the four years of collaboration with Oiza, Moneo has the opportunity to keep in contact with an atmosphere permeated by a constant search in the field of the plastic art and with figures directly connected to such atmosphere. It’s of a period of great intensity as in the production like in the promotion of the Basque art. The collective “Blanco y Negro”, than is held in 1959 at the Galería Darro to Madrid, is only one of the many times of an exhibition of the work of Oteiza and Chillida. The end of the Fifties is a period of international acknowledgment for Chillida that for Oteiza. The decade of the Fifties consecrates the hypotheses of a mythical past of the Basque people through the spread of the studies carried out in the antecedent years. The archaeological discoveries that join to a context already rich of signs of the prehistoric era, consolidate the knowledge of a strong cultural identity. Oteiza, like Chillida and other contemporary artists, believe in a cosmogonist conception belonging to the Basques, connected to their matriarchal mythological past. The void in its meaning of absence, in the Basque culture, thus as in various archaic and oriental religions, is equivalent to the spiritual fullness as essential condition to the revealing of essence. Retracing the archaic origins of the Basque culture emerges the deep meaning that the void assumes as key element in the religious interpretation of the passage from the life to the death. The symbology becomes rich of meaningful characters who derive from the fact that it is a chthonic cult. A representation of earth like place in which divine manifest itself but also like connection between divine and human, and this manipulation of the matter of which the earth it is composed is the tangible projection of the continuous search of the man towards God. The search of equilibrium between empty and full, that characterizes also the development of the form in architecture, in the Basque culture assumes therefore a peculiar value that returns like constant in great part of the plastic expressions, than in this context seem to be privileged regarding the other expressive forms. Oteiza and Chillida develop two original points of view in the representation of the void through the form. Both use of rigorous systems of rules sensitive to the physics principles and the characters of the matter. The last aim of the Oteiza’s construction is the void like limit of the knowledge, like border between known and unknown. It doesn’t means to reduce the sculptural object to an only allusive dimension because the void as physical and spiritual power is an active void, that possesses that value able to reveal the being through the trace of un-being. The void in its transcendental manifestation acts at the same time from universal and from particular, like in the atomic structure of the matter, in which on one side it constitutes the inner structure of every atom and on the other one it is necessary condition to the interaction between all the atoms. The void can be seen therefore as the action field that concurs the relations between the forms but is also the necessary condition to the same existence of the form. In the construction of Chillida the void represents that counterpart structuring the matter, inborn in it, the element in absence of which wouldn’t be variations neither distinctive characters to define the phenomenal variety of the world. The physics laws become the subject of the sculptural representation, the void are the instrument that concurs to catch up the equilibrium. Chillida dedicate himself to experience the space through the senses, to perceive of the qualities, to tell the physics laws which forge the matter in the form and the form arranges the places. From the artistic experience of the two sculptors they can be transposed, to the architectonic work of Moneo, those matrices on which they have constructed their original lyric expressions, where the void is absolute protagonist. An ambit is defined thus within which the matrices form them drafts from the work of Oteiza and Chillida can be traced in the definition of the process of birth and construction of the architecture of Moneo, but also in the relation that the architecture establishes with the place and in the time. The void becomes instrument to read the space constructed in its relationships that determine the proportions, rhythms, and relations. In this way the void concurs to interpret the architectonic space and to read the value of it, the quality of the spaces constructing it. This because it’s like an instrument of the composition, whose role is to maintain to the separation between the elements putting in evidence the field of relations. The void is that instrument that serves to characterize the elements that are with in the composition, related between each other, but distinguished. The meaning of the void therefore pushes the interpretation of the architectonic composition on the game of the relations between the elements that, independent and distinguished, strengthen themselves in their identity. On the one hand if void, as measurable reality, concurs all the dimensional changes quantifying the relationships between the parts, on the other hand its dialectic connotation concurs to search the equilibrium that regulated such variations. Equilibrium that therefore does not represent an obtained state applying criteria setting up from arbitrary rules but that depends from the intimate nature of the matter and its embodiment in the form. The production of a form, or a formal system that can be finalized to the construction of a building, is indissolubly tied to the technique that is based on the acquaintance of the formal vocation of the matter, and what it also can representing, meaning, expresses itself in characterizing the site. For Moneo, in fact, the space defined from the architecture is above all a site, because the essence of the site is based on the construction. When Moneo speaks about “birth of the idea of plan” like essential moment in the construction process of the architecture, it refers to a process whose complexity cannot be born other than from a deepened acquaintance of the site that leads to the comprehension of its specificity. Specificity arise from the infinite sum of relations, than for Moneo is the story of the oneness of a site, of its history, of the cultural identity and of the dimensional characters that that they are tied to it beyond that to the physical characteristics of the site. This vision is leaned to a solid made physical structure of perceptions, of distances, guideline and references that then make that the process is first of all acquaintance, appropriation. Appropriation that however does not happen for directed consequence because does not exist a relationship of cause and effect between place and architecture, thus as an univocal and exclusive way does not exist to arrive to a representation of an idea. An approach that, through the construction of the place where the architecture acquires its being, searches an expression of its sense of the truth. The proposal of a distinction for areas like space, matter, spirit and time, answering to the issues that scan the topics of the planning search of Moneo, concurs a more immediate reading of the systems subtended to the composition principles, through which is related the recurrent architectonic elements in its planning dictionary. From the dialectic between the opposites that is expressed in the duality of the form, through the definition of a complex element that can mediate between inside and outside as a real system of exchange, Moneo experiences the form development of the building deepening the relations that the volume establishes in the site. From time to time the invention of a system used to answer to the needs of the program and to resolve the dual character of the construction in an only gesture, involves a deep acquaintance of the professional practice. The technical aspect is the essential support to which the construction of the system is indissolubly tied. What therefore arouses interest is the search of the criteria and the way to construct that can reveal essential aspects of the being of the things. The constructive process demands, in fact, the acquaintance of the formative properties of the matter. Property from which the reflections gush on the relations that can be born around the architecture through the resonance produced from the forms. The void, in fact, through the form is in a position to constructing the site establishing a reciprocity relation. A reciprocity that is determined in the game between empty and full and of the forms between each other, regarding around, but also with regard to the subjective experience. The construction of a background used to amplify what is arranged on it and to clearly show the relations between the parts and at the same time able to tie itself with around opening the space of the vision, is a system that in the architecture of Moneo has one of its more effective applications in the use of the platform used like architectonic element. The spiritual force of this architectonic gesture is in the ability to define a place whose projecting intention is perceived and shared with who experience and has lived like some instrument to contact the cosmic forces, in a delicate process that lead to the equilibrium with them, but in completely physical way. The principles subtended to the construction of the form taken from the study of the void and the relations that it concurs, lead to express human values in the construction of the site. The validity of these principles however is tested from the time. The time is what Moneo considers as filter that every architecture is subordinate to and the survival of architecture, or any of its formal characters, reveals them the validity of the principles that have determined it. It manifests thus, in the tie between the spatial and spiritual dimension, between the material and the worldly dimension, the state of necessity that leads, in the construction of the architecture, to establish a contact with the forces of the universe and the intimate world, through a process that translate that necessity in elaboration of a formal system.

In nome della comunità. Analisi dei testi della sicurezza e del terrorismo

The focus of this dissertation is the relationship between the necessity for protection and the construction of cultural identities. In particular, by cultural identities I mean the representation and construction of communities: national communities, religious communities or local communities. By protection I mean the need for individuals and groups to be reassured about dangers and risks. From an anthropological point of view, the relationship between the need for protection and the formation and construction of collective identities is driven by the defensive function of culture. This was recognized explicitly by Claude Lévi-Strauss and Jurij Lotman. To explore the “protective hypothesis,” it was especially useful to compare the immunitarian paradigm, proposed by Roberto Esposito, with a semiotic approach to the problem. According to Esposito, immunity traces borders, dividing Community from what should be kept outside: the enemies, dangers and chaos, and, in general, whatever is perceived to be a threat to collective and individual life. I recognized two dimensions in the concept of immunity. The first is the logic dimension: every element of a system makes sense because of the network of differential relations in which it is inscribed; the second dimension is the social praxis of division and definition of who. We are (or what is inside the border), and who They are (or what is, and must be kept, outside the border). I tested my hypothesis by analyzing two subject areas in particular: first, the security practices in London after 9/11 and 7/7; and, second, the Spiritual Guide of 9/11 suicide bombers. In both cases, one observes the construction of two entities: We and They. The difference between the two cases is their “model of the world”: in the London case, one finds the political paradigms of security as Sovereignty, Governamentality and Biopolitics. In the Spiritual Guide, one observes a religious model of the Community of God confronting the Community of Evil. From a semiotic point view, the problem is the origin of respective values, the origin of respective moral universes, and the construction of authority. In both cases, I found that emotional dynamics are crucial in the process of forming collective identities and in the process of motivating the involved subjects: specifically, the role of fear and terror is the primary factor, and represents the principal focus of my research.

Percieved Organizational Efficacy in Internationalized Companies: Application of Competing Values Approach and Collective Efficacy

This dissertation focuses on “organizational efficacy”, in particular on employees’ beliefs of organizational capacity to be efficacious. Organizational efficacy is considered from two perspectives – competing values approach and collective efficacy, and evaluated in internationalized companies. The dissertation is composed of three studies. The data were collected in thirteen Italian companies on different stages of internationalization for a total number of respondents is 358. In the first study the factorial validity of the competing values instrument (Rohrbaugh, 1981) was investigated and confirmed. Two scales were used to measure collective efficacy: a general collective efficacy scale (Bohn, 2010), and a specific collective efficacy scale, developed following suggestions of Borgogni et al. (2001), it evaluates employees’ beliefs of efficacy of organizations in the international market. The findings suggest that competing values and collective organizational efficacy instruments may provide a multi-faceted measurement of employees’ beliefs of organizational efficacy. The second study examined the relationship between organizational efficacy and collective work engagement. To measure collective work engagement the UWES-9 (Schaufeli & Bakker, 2003) was adapted at the group level; its factor structure and reliability were similar to the standard UWES-9. The findings suggest that organizational efficacy fully predicts collective work engagement. Also we investigated whether leadership moderates the relationship between organizational efficacy and collective work engagement. We operationalized leadership style with MLQ (Bass & Avolio, 1995); the results suggest that intellectual stimulation and idealized influence (transformational leadership) and contingent reward (transactional leadership) enhance the impact of organizational efficacy on collective work engagement. In the third study we investigated organizational efficacy and collective work engagement in internationalized companies. The findings show that beliefs of organizational efficacy vary across companies in different stages of internationalization, while no significant difference was found for collective work engagement. Limitations, practical implications and future studies are discussed in the conclusion.

Il discorso politico culturale del Deutscher Geist in Gefahr di Ernst Robert Curtius

Nel 1932 Ernst Robert Curtius pubblica il pamphlet politico culturale Deutscher Geist in Gefahr nel quale chiarisce il suo pensiero di fronte alla grave crisi in cui versa la Germania. Egli si schiera contro le posizioni di destra del suo tempo, delle quali critica apertamente la boria nazionalista, il rozzo antisemitismo e la creazione di un mito nazionale elaborato come strumento di manipolazione dell’opinione pubblica. Ritiene inoltre inaccettabili le posizioni rivoluzionarie, tanto di destra quanto di sinistra, che vogliono liberarsi della tradizione umanistica europea e disprezzano la Zivilisation francese; allo stesso modo rifiuta l’ideale di un germanesimo eroico avulso dalla storia europea e respinge infine tutte le forme di nichilismo che si risolvono in un atteggiamento di indifferenza nei confronti della realtà, dei valori e della storia. Curtius accetta il sistema democratico come unica soluzione e ritiene che le decisioni politiche debbano mirare al bene di tutti i ceti sociali indipendentemente dagli interessi di partiti e di singoli gruppi. Rifiuta qualunque forma, anche culturale, di supremazia della Germania, aspira a un’Europa cosmopolita, le cui nazioni siano valorizzate nelle loro caratteristiche specifiche, ed è convinto che per la costruzione della pace gli europei debbano vivere, studiare e lavorare insieme imparando gli uni le lingue degli altri. Per Curtius l’Umanesimo della tradizione classica e la letteratura del Medioevo sono parte integrante della vita di ogni europeo e fonte di energie spirituali per affrontare in modo creativo il presente e il futuro.

The nociceptive withdrawal reflex: Normative values of thresholds and reflex receptive fields

Assessments of spinal nociceptive withdrawal reflexes can be used in human research both to evaluate the effect of analgesics and explore pain mechanisms related to sensitization. Before the reflex can be used as a clinical tool, normative values need to be determined in large scale studies. The aim of this study was to determine the reference values of spinal nociceptive reflexes and subjective pain thresholds (to single and repeated stimulation), and of the area of the reflex receptive fields (RRF) in 300 pain-free volunteers. The influences of gender, age, height, weight, body-mass index (BMI), body side of testing, depression, anxiety, catastrophizing and parameters of Short-Form 36 (SF-36) were analyzed by multiple regressions. The 95% confidence intervals were determined for all the tests as normative values. Age had a statistically and quantitatively significant impact on the subjective pain threshold to single stimuli. The reflex threshold to single stimulus was lower on the dominant compared to the non-dominant side. Depression had a negative impact on the subjective pain threshold to single stimuli. All the other analyses either did not reveal statistical significance or displayed quantitatively insignificant correlations. In conclusion, normative values of parameters related to the spinal nociceptive reflex were determined. This allows their clinical application for assessing central hyperexcitability in individual patients. The parameters investigated explore different aspects of sensitization processes that are largely independent of demographic characteristics, cognitive and affective factors.

Relationship between DIAGNOdent values and sealant penetration depth on occlusal fissures

The aim of this in vitro study was to evaluate the relationship between laser fluorescence values and sealant penetration depth on occlusal fissures. One hundred and sixty-six permanent molars were selected and divided into four groups, which were each treated using a different sealant (two clear and two opaque). The teeth were independently measured twice by two experienced dentists using two laser fluorescence devices-DIAGNOdent (LF and LFpen)-before and after sealing, and then thermoclycled. After measuring, the teeth were histologically prepared and assessed for caries extension. Digital photographs of the cut sealed sites were assessed, and the sealant penetration depth was measured. All 166 sites were measured by one of the examiners taking as limits the outer and inner surface of the sealant into the fissure. For each device (LF and LFpen) and each group, the difference between the values at baseline and after sealing was plotted against the sealant penetration depth and scatter plots were provided. It could be observed that most of the points were concentrated around the zero line, for both LF and LFpen in the four groups. In conclusion, there is no relation between changes in DIAGNOdent values and increasing of depth sealant penetration within the occlusal fissures.

Reference values of mechanical and thermal pain tests in a pain-free population

Quantitative sensory tests are widely used in human research to evaluate the effect of analgesics and explore altered pain mechanisms, such as central sensitization. In order to apply these tests in clinical practice, knowledge of reference values is essential. The aim of this study was to determine the reference values of pain thresholds for mechanical and thermal stimuli, as well as withdrawal time for the cold pressor test in 300 pain-free subjects. Pain detection and pain tolerance thresholds to pressure, heat and cold were determined at three body sites: (1) lower back, (2) suprascapular region and (3) second toe (for pressure) or the lateral aspect of the leg (for heat and cold). The influences of gender, age, height, weight, body-mass index (BMI), body side of testing, depression, anxiety, catastrophizing and parameters of Short-Form 36 (SF-36) were analyzed by multiple regressions. Quantile regressions were performed to define the 5th, 10th and 25th percentiles as reference values for pain hypersensitivity and the 75th, 90th and 95th percentiles as reference values for pain hyposensitivity. Gender, age and/or the interaction of age with gender were the only variables that consistently affected the pain measures. Women were more pain sensitive than men. However, the influence of gender decreased with increasing age. In conclusion, normative values of parameters related to pressure, heat and cold pain stimuli were determined. Reference values have to be stratified by body region, gender and age. The determination of these reference values will now allow the clinical application of the tests for detecting abnormal pain reactions in individual patients.