Transcatheter Closure of Atrial Septal Defects in a Center With Limited Resources: Outcomes and Short Term Follow-Up

Background: Transcatheter closure of atrial septal defects (ASD) has been accepted world-wide as an alternative to surgical closure with excellent results. This interventional, non-surgical technique plays an important role in the treatment of ASD mostly in the developing world where resources are limited. Objectives: To report the outcomes and short term follow-up of transcatheter closure of ASD over a 12-year period at our institution with limited resources. Patients and Methods: This retrospective study included all patients with the diagnosis of secundum ASD and significant shunting (Qp/Qs > 1.5:1) as well as dilated right atrium and right ventricle who had transcatheter closure at Integrated Cardiovascular Center (PJT), Dr. Cipto Mangunkusumo Hospital between October 2002 and October 2014. One hundred fifty-two patients enrolled in this study were candidates for device closure. Right and left heart cardiac catheterization was performed before the procedure. All patients underwent physical examination, ECG, chest X-ray and transthoracal echocardiography (TTE) prior to device implantation. Results: A total of 152 patients with significant ASD underwent device implantation. Subjects’ age ranged from 0.63 to 69.6 years, with median 9.36 years and mean 16.30 years. They consisted of 33 (21.7%) males and 119 (78.3%) females, with mean body weight of 29.9 kg (range 8 to 75; SD 18.2). The device was successfully implanted in 150 patients where the majority of cases received the Amplatzer septal occluder (147/150; 98%) and the others received the Heart Lifetech ASD occluder (3/150, 2%), whereas two other cases were not suitable for device closure and we decided for surgical closure. The mean ASD size was 19.75 (range 14 - 25) mm. During the procedure, 5 (4.9%) patients had bradycardia and 3 (2.9%) patients had supraventricular tachycardia (SVT), all of which resolved. Conclusions: In our center with limited facilities and manpower, transcatheter closure of atrial septal defect was effective and safe as an alternative treatment to surgery. The outcome and short-term follow-up revealed excellent results, but long-term follow-up is needed.

Using Kofax Solutions for Process Improvement

One of the ways the South Carolina State Housing Finance and Development Authority fulfills this mission is through the purchase and servicing of mortgage loans. The 2007 Recession resulted in decreased revenues for the department while higher default, foreclosure and bankruptcy rates increased the department's manpower cost. The agency has since acquired different servicing software which complies with current industry regulations and is once again servicing the loans that it purchases. This project is to see if the department could improve any of their overall processes by using existing technologies and software to better utilize the new servicing system while minimizing manual tasks. This paper explores whether the existing Kofax Document Recognition system could improve this process and reduce overall employee time and effort?

Stratégies des entreprises chinoises dans le secteur extractif dans l’Arctique

Poussée par une croissance économique rapide ces trente dernières années, la demande chinoise en matières premières a considérablement augmenté au cours de cette période. Premier importateur mondial de nombreux minerais depuis le début du XXIe siècle, la Chine, qui n’est pas un État côtier de l’Arctique, semble attentive au potentiel économique de la région, et notamment en ce qui a trait à l’exploitation des gisements miniers. Avec l’ouverture relative des accès maritimes à travers les passages arctiques, les entreprises chinoises seraient en mesure d’effectuer des économies sur les coûts de transport et pourraient plus aisément accéder aux gisements miniers du Groenland et de l’Arctique canadien. La montée en puissance de l’économie chinoise, qui s’est concrétisée depuis le début du siècle, son affirmation politique sur la scène mondiale, et sa diplomatie des ressources perçue comme agressive a contribué à développer une perception négative de la Chine au sein des opinions publiques canadiennes, danoises, groenlandaises, et islandaises. Dans un contexte de débats et d’inquiétudes sur les questions de souveraineté dans l’Arctique, les presses canadiennes, groenlandaises et danoises ont contribué à construire, dans leurs opinions publiques respectives ces dernières années, une certaine sinophobie face aux investissements directs à l’étranger chinois, qui débutent réellement en 2005. Par exemple, un sondage mené en 2015 par l’Asia Pacific Foundation of Canada faisait ressortir que près de 76% de la population canadienne était hostile à l’acquisition d’entreprises canadiennes par des entreprises chinoises, tous secteurs confondus. Au Groenland, la perspective d’opérations minières dirigées par des entreprises chinoises a provoqué l’ire des médias danois et groenlandais. Alors que certains dénoncent une stratégie géopolitique chinoise plus large dans cette région du monde, d’autres mettent l’accent sur les implications de la venue de nombreux travailleurs chinois, de même que sur les questions d’une Chine cherchant à assurer un accès à long terme aux ressources de la région, prétextant que le Groenland serait une région d’investissement majeur pour les entreprises chinoises. La Chine, par l’entremise de ses entreprises, chercherait-elle à faire main basse sur les ressources minières de l’Arctique ? L’Arctique canadien, le Groenland et le Grand Nord québécois sont-ils des territoires d’investissements majeurs pour les entreprises chinoises ? Comment les facteurs qui déterminent les choix des entreprises chinoises se sont-ils traduits dans l’Arctique ? Dans le cadre de cette recherche, trente-six entreprises et organes du gouvernement ont été consultés. Les résultats de l’enquête soulignent que ces territoires ne sont pas des régions où les entreprises chinoises investissent d’importantes sommes, mais demeurent attractifs en raison de la stabilité politique et du climat compétitif des affaires qui y règnent, ainsi que pour la qualité des ressources physiques qu’on y retrouve. Cependant, les acteurs chinois soulignent d’importants défis tels que le déficit en matière d’infrastructures maritimes et de communication dans l’Arctique, le manque d’informations sur les opportunités d’affaires, c’est le cas des projets disponibles au Groenland notamment, et les acteurs chinois soulignent également leur manque d’expérience à l’international, de même que le coût et la disponibilité de la main-d’oeuvre comme des défis importants pour les entreprises chinoises. En somme, les investissements des entreprises chinoises dans des projets miniers dans l’Arctique canadien et au Groenland s’insèrent, certes, dans les stratégies globales des entreprises chinoises qui visent à diversifier et sécuriser leurs sources d’approvisionnements. En revanche, s’il apparaît que les territoires arctiques ne sont pas des régions d’investissements majeurs pour les entreprises chinoises dans le secteur extractif, les acteurs chinois sondés raisonnent, de manière générale, selon une logique de marché et recherchent donc, pour la plupart, à assurer la rentabilité de leur entreprise par la réalisation de gains. Outre les fluctuations des prix des matières premières sur les marchés mondiaux qui affectent grandement les opérations minières globales, de nombreux facteurs dans l’Arctique tels que l’éloignement, les conditions météorologiques extrêmes, et le manque d’infrastructures augmentent considérablement le coût de faire des affaires dans le secteur minier dans l’Arctique, qui demeure un marché niche.

Modelo de gestión para la atención integral de pacientes con enfermedades huérfanas o raras en Colombia

Las enfermedades raras o huérfanas corresponden a aquellas con baja prevalencia en la población, y en varios países tienen una definición distinta de acuerdo con el número de pacientes que afectan en la población. La Organización Mundial de la Salud (OMS), las define como un trastorno que afecta de 650 a 1.000 personas por millón de habitantes, de las que se han identificado alrededor de 7.000. En Colombia su prevalencia es menor de 1 por cada 5.000 personas y comprenden: las enfermedades raras, las ultra-huérfanas y las olvidadas. Los pacientes con este tipo de enfermedades imponen retos a los sistemas sanitarios, pues si bien afectan a un bajo porcentaje de la población, su atención implica una alta carga económica por los costos que involucra su atención, la complejidad en su diagnóstico, tratamiento, seguimiento y rehabilitación. El abordaje de las enfermedades raras requiere un manejo interdisciplinar e intersectorial, lo que implica la organización de cada actor del sistema sanitario para su manejo a través de un modelo que abraque las dinámicas posibles entre ellos y las competencias de cada uno. Por lo anterior, y teniendo en cuenta la necesidad de formular políticas sanitarias específicas para la gestión de estas enfermedades, el presente trabajo presenta una aproximación a la formulación de un modelo de gestión para la atención integral de pacientes con enfermedades raras en Colombia. Esta investigación describe los distintos elementos y características de los modelos de gestión clínica y de las enfermedades raras a través de una revisión de literatura, en la que se incluye la descripción de los distintos actores del Sistema de Salud Colombiano, relacionados con la atención integral de estos pacientes para la documentación de un modelo de gestión integral.

Simplificação do processo de multiplicação in vitro da oliveira "Olea europaea L."

A oliveira tem sido multiplicada ao longo dos tempos por métodos convencionais de propagação vegetativa como a enxertia e a estacaria lenhosa e semilenhosa. No entanto, estes métodos revelam-se lentos ou ineficientes para determinadas cultivares. No caso da cv. ‘Galega Vulgar’, ainda com grande expressão no olival português, e de difícil enraizamento por estacaria semilenhosa, tem sido usada a micropropagação de modo a contornar essas limitações e assim obter um elevado número de plantas em curto período de tempo. O custo final de produção por este processo ainda é elevado, podendo comprometer a sua aplicação a nível comercial. Grande parte dos custos estão relacionados com a fase de enraizamento in vitro que carece de ambiente estéril e condições de assépsia para a sua execução. Com vista a uma redução de custos associados a esta fase de produção, pretendeu-se com este trabalho testar a viabilidade do enraizamento ex vitro, na ausência de condições de assépsia. Este método poderá permitir uma significativa redução da mão-de-obra, ao mesmo tempo que facilitará a aclimatização das plantas e a obtenção de um sistema radicular de melhor qualidade. Compararam-se as taxas de enraizamento in vitro (controlo), com as obtidas ex vitro. Foram utilizados explantes provenientes de dois clones da cv. ‘Galega Vulgar’, (cl. 1441 e cl. 2022) cultivados e mantidos in vitro há vários anos no Laboratório de Melhoramento e Biotecnologia da Universidade de Évora. Para além do clone foi avaliada a influência do tipo de estaca (basal e apical), da hormona de enraizamento (AIB e ANA), da sua concentração (540 e 3000 ppm) e ainda de dois substratos, Preformas Jiffy® e pastilhas de fibra coco. Os melhores resultados foram obtidos com o clone 1441 em pastilhas de fibra de coco prensada, com o uso de estacas basais. Quanto à auxina, não se observaram diferenças significativas entre a utilização de ANA na concentração de 540 ppm e AIB na concentração de 3000 ppm. A aclimatização das plantas foi conseguida com taxas elevadas de sucesso, independentemente do tratamento utilizado. Conclui-se que a aplicação do método de enraizamento ex vitro simplifica procedimentos e mantém taxas de enraizamento elevadas, conduzindo assim a uma efetiva redução de tempo e custos associados; Simplifying procedures for in vitro propagation of olive “Olea europaea L.” Abstract: The olive tree has been multiplied throughout the ages by conventional methods of vegetative propagation such as grafting and wood or softwood cuttings. These propagation methods are somehow inefficient for certain cultivars. For the CV. ‘Galega Vulgar‘, still with great expression in Portuguese olive orchards, propagation has been attempted by in vitro culture in order to circumvent these limitations and so obtain a large number of plants in short time period. The final production fees associated to this process are still high which may compromise its application to a commercial level. Most of this process fees are related to the in vitro rooting phase which lacks sterile and aseptic conditions for its implementation. Aiming to reduce the costs associated with this production phase, this work tested the feasibility of the ex vitro rooting in the absence of aseptic conditions, which can allow a significant reduction of the manpower involved and an easier plant acclimatization due to its transplant with a balled-root system. In vitro rooting rates (control) were compared with those obtained with the ex vitro experiments. Explants from two clones of the cv. ‘Galega Vulgar‘ (cl. 1441 and cl. 2022), grown and maintained in vitro for several years in the Laboratory of Biotechnology and Plant Breeding of the University of Évora, were used in the trials. In addition to the clone, the effect of the cutting type (basal and apical), the rooting hormone (AIB and ANA), their concentration (540 and 3000 ppm) and two substrates, Preformas Jiffy ® and pressed coco fiber pellets, were also evaluated. The best results were obtained with the clone 1441, when rooted in pressed coco fiber pellets, using basal cuttings. Under this conditions no significant differences were observed between the use of ANA at 540 ppm or AIB in the 3000 ppm. Acclimatization of plants was achieved with high rates of success, regardless of the treatment used. It can be concluded that the application of the ex vitro rooting method allows to maintain high rooting rates, contributing for an effective reduction of time and fees of the rooting process.

The women role in the agroenvironmental activities of Amazon agroforeststry systems.

This paper presents the results of a research on the way which shows the role of the farmer women to contribute to overcome the life hindrances in the Amazonian agroforest environment, for food safety and familiar income. The sample was the women of the Associação de Produtores Alternativos - APA, Ouro Preto do Oeste, Rondônia, Brazil. Questionnaires were applied to 50 women of this community, in 2004/2005, with additional interviews in 2006, taking into account their role in the farms, and their several invisible activities. The role of APA?s women was compared to that of other Amazonian women, like rubber tappers and riverine people. The APA?s women perform tasks as field manpower - 78.0% of them, making decisions about what to plant - 18.0%, harvest destination - 32.0%, which animals to raise -14.0% and animal products destination -34.0%. Traditionally, in rural zone, the women with their children play a role as non-paid manpower, getting some monetary income with occasional commercialization of on-farm processed products as cheese, pickles, jellies and fruit liqueurs. They are responsible for the cultures practiced around the house. All these Amazonian women edaphoclimatic conditions, greatly contributing to the biodiversity, conservation, and to ecological, social and economic stability.are guardians, perpetuators and disseminators of a rich germplasm adapted to local.