Cost-effectiveness analysis of cardiac resynchronization therapy in patients with NYHA I and NYHA II heart failure in Spain

Objectives: The aim of the study was to combine clinical results from the European Cohort of the REVERSE study and costs associated with the addition of cardiac resynchronization therapy (CRT) to optimal medical therapy (OMT) in patients with mild symptomatic (NYHA I-II) or asymptomatic left ventricular dysfunction and markers of cardiac dyssynchrony in Spain. Methods: A Markov model was developed with CRT + OMT (CRT-ON) versus OMT only (CRT-OFF) based on a retrospective cost-effectiveness analysis. Raw data was derived from literature and expert opinion, reflecting clinical and economic consequences of patient"s management in Spain. Time horizon was 10 years. Both costs (euro 2010) and effects were discounted at 3 percent per annum. Results: CRT-ON showed higher total costs than CRT-OFF; however, CRT reduced the length of hospitalization in ICU by 94 percent (0.006 versus 0.091 days) and general ward in by 34 percent (0.705 versus 1.076 days). Surviving CRT-ON patients (88.2 percent versus 77.5 percent) remained in better functional class longer, and they achieved an improvement of 0.9 life years (LYGs) and 0.77 years quality-adjusted life years (QALYs). CRT-ON proved to be cost-effective after 6 years, except for the 7th year due to battery depletion. At 10 years, the results were 18,431 per LYG and 21,500 per QALY gained. Probabilistic sensitivity analysis showed CRT-ON was cost-effective in 75.4 percent of the cases at 10 years. Conclusions: The use of CRT added to OMT represents an efficient use of resources in patients suffering from heart failure in NYHA functional classes I and II.

Metais pesados em águas superficiais como estratégia de caracterização de bacias hidrográficas

The input of heavy metals concentrations determinated by ICP-AES, in samples of the Cambé river basin, was evaluated by using the Principal Component Analysis. The results distinguishes clearly one site, which is strongly influenced by almost all elements studied. Special attention was given to Pb, because of the presence of one battery industry in this area. Some downstream samples were associated with the same characteristics of this site, showing residual action of contaminants along the basin. Other sites presented influence of soil elements, plus Cr near a tannery industry. This study allowed to distinguish different sites in the upper basin of the Cambé (Londrina-PR-BR), in accordance to elements input.

Fontes, reatividade e quantificação de metanol e etanol na atmosfera

In the last two decades, the use of oxygenated fuels, like methanol and ethanol, pure or in mixture with gasoline, has been growing due to benefits introduced into the air quality. In Brasil, the fraction of light duty vehicles powered by pure hydrated ethanol is estimated at about 4 million, while the remaining vehicles actually utilize a mixture (22:78 v/v) of ethanol:gasoline. As a consequence, there's a need for the availability of methods that can provide the evaluation of possible impacts of alcohol emissions in the formation of chemical species in the atmosphere, as ozone, aldehydes, carboxylic acids and so on. In this paper, methanol and ethanol are discussed in their general aspects, as well as their atmospheric sources, chemical reactivity and available methods of analysis.

Radio continuum and near-ingrared study of the MGRO J2019+37 region

Context. MGRO J2019+37 is an unidentified extended source of very high energy gamma-rays originally reported by the Milagro Collaboration as the brightest TeV source in the Cygnus region. Its extended emission could be powered by either a single or several sources. The GeV pulsar AGL J2020.5+3653, discovered by AGILE and associated with PSR J2021+3651, could contribute to the emission from MGRO J2019+37. Our aim is to identify radio and near-infrared sources in the field of the extended TeV source MGRO J2019+37, and study potential counterparts to explain its emission. Methods: We surveyed a region of about 6 square degrees with the Giant Metrewave Radio Telescope (GMRT) at the frequency 610 MHz. We also observed the central square degree of this survey in the near-infrared Ks-band using the 3.5 m telescope in Calar Alto. Archival X-ray observations of some specific fields are included. VLBI observations of an interesting radio source were performed. We explored possible scenarios to produce the multi-TeV emission from MGRO J2019+37 and studied which of the sources could be the main particle accelerator. Results: We present a catalogue of 362 radio sources detected with the GMRT in the field of MGRO J2019+37, and the results of a cross-correlation of this catalog with one obtained at near-infrared wavelengths, which contains ∼3 × 105 sources, as well as with available X-ray observations of the region. Some peculiar sources inside the ∼1◦ uncertainty region of the TeV emission from MGRO J2019+37 are discussed in detail, including the pulsar PSR J2021+3651 and its pulsar wind nebula PWN G75.2+0.1, two new radio-jet sources, the Hii region Sh 2-104 containing two star clusters, and the radio source NVSS J202032+363158. We also find that the hadronic scenario is the most likely in case of a single accelerator, and discuss the possible contribution from the sources mentioned above. Conclusions: Although the radio and GeV pulsar PSR J2021+3651 / AGL J2020.5+3653 and its associated pulsar wind nebula PWN G75.2+0.1 can contribute to the emission from MGRO J2019+37, extrapolation of the GeV spectrum does not explain the detected multi-TeV flux. Other sources discussed here could contribute to the emission of the Milagro source

Injetor multicanal com válvulas de estrangulamento para análise em fluxo

An important component for the automation of flow injection analysis (FIA) systems is the sample injection valve. A simple and inexpensive commutator with 16 pinch valves (8 normally open and 8 closed) was developed and configured as a multichannel injection valve. It is activated by a single solenoid of 3 Kgf, powered by a pulsed driver circuit, controlled by a microcomputer or a switch. FIA with spectrophometric detection of potassium dichromate solution was used for the evaluation of the new injection valve and its comparison with other valves, for sample loops of 50, 100, 200, 300 and 500 muL. The repeatability was favorable (RSD 1.0% for 15 injections at each loop volume) compared to a manual injector, an electropneumatic injector and an injector configured with three mini solenoid valves (RSD 1.1, 1.3 and 1.0%, respectively, for15 injections at each loop volume).

El papel de la memoria de trabajo en el cálculo mental un cuarto de siglo después de Hitch = The role of working memory in mental arithmetic a quarter of century after Hitch

Desde que Hitch (1978) publicó el primer estudio sobre el rol de la memoria de trabajo en el cálculo han idoaumentando las investigaciones en este campo. Muchos trabajos han estudiado un único subsistema, pero nuestroobjetivo es identificar qué subsistema de la memoria de trabajo (bucle fonológico, agenda viso-espacial o ejecutivocentral) está más implicado en el cálculo mental. Para ello hemos realizado un estudio correlacional en el quehemos administrado dos pruebas aritméticas y nueve pruebas de la “Bateria de Test de Memòria de Treball” dePickering, Baqués y Gathercole (1999) a una muestra de 94 niños españoles de 7-8 años. Nuestros resultadosindican que el bucle fonológico y sobretodo el ejecutivo central inciden de forma estadísticamente significativa enel rendimiento aritmético

Materiais para cátodos de baterias secundárias de lítio

In this work, cathodes employed in secondary lithium batteries are reviewed. These cathodes have great technologic and scientific importance, specifically, materials for cathodes as electronic conductor polymers (ECP), transition metal oxides (TMO) and nanocomposites of ECP/TMO. The use of a specific cathodic material is based in some intrinsic characteristics that improve the performance of the battery. Thus, some vantages and disvantages of these insertion compounds are discussed, as lithium insertion capacity, energy density, and the ciclability of these materials.

Alternative Energy Conversion Systems for a Micro Scale Wind Turbine

This Master's thesis deals with a Micro Scale Wind Wind Turbine application. The thesis consists of nine chapters. The first chapter is an introduction to the philosophy of a small scale wind turbine application. The second defines concepts, and lists the requirements. The third presents the whole application for an On-Grid , and for an Off-Grid arrangement, with main concentration on lighting, heating, and energy storage. The fourth deals with the Inverter's technology, which are used for the conversion of the produced power. The fifth chapter presents the available storage technology and it's possibilities. The sixth deals with the system, and the technological means used for the implementation. The seventh presents the PLC device, which was used as the controller for the management of the whole application. The eighth deals with the concept and the control application philosophy that the PLC involves. And the final chapter presents conclusions and ideas for further considerations.

An energy efficient vertical handover decision algorithm

As wireless communications evolve towards heterogeneousnetworks, mobile terminals have been enabled tohandover seamlessly from one network to another. At the sametime, the continuous increase in the terminal power consumptionhas resulted in an ever-decreasing battery lifetime. To that end,the network selection is expected to play a key role on howto minimize the energy consumption, and thus to extend theterminal lifetime. Hitherto, terminals select the network thatprovides the highest received power. However, it has been provedthat this solution does not provide the highest energy efficiency.Thus, this paper proposes an energy efficient vertical handoveralgorithm that selects the most energy efficient network thatminimizes the uplink power consumption. The performance of theproposed algorithm is evaluated through extensive simulationsand it is shown to achieve high energy efficiency gains comparedto the conventional approach.

The role of executive functions in the control of aggressive behavior

An extensive literature suggests a link between executive functions and aggressive behavior in humans, pointing mostly to an inverse relationship, i.e., increased tendencies toward aggression in individuals scoring low on executive function tests. This literature is limited, though, in terms of the groups studied and the measures of executive functions. In this paper, we present data from two studies addressing these issues. In a first behavioral study, we asked whether high trait aggressiveness is related to reduced executive functions. A sample of over 600 students performed in an extensive behavioral test battery including paradigms addressing executive functions such as the Eriksen Flanker task, Stroop task, n-back task, and Tower of London (TOL). High trait aggressive participants were found to have a significantly reduced latency score in the TOL, indicating more impulsive behavior compared to low trait aggressive participants. No other differences were detected. In an EEG-study, we assessed neural and behavioral correlates of error monitoring and response inhibition in participants who were characterized based on their laboratory-induced aggressive behavior in a competitive reaction time task. Participants who retaliated more in the aggression paradigm and had reduced frontal activity when being provoked did not, however, show any reduction in behavioral or neural correlates of executive control compared to the less aggressive participants. Our results question a strong relationship between aggression and executive functions at least for healthy, high-functioning people.

Improving the efficiency of PV low-power processing circuits by selecting an optimal inductor current of the DC/DC converter

In the context of autonomous sensors powered by small-size photovoltaic (PV) panels, this work analyses how the efficiency of DC/DC-converter-based power processing circuits can be improved by an appropriate selection of the inductor current that transfers the energy from the PV panel to a storage unit. Each component of power losses (fixed, conduction and switching losses) involved in the DC/DC converter specifically depends on the average inductor current so that there is an optimal value of this current that causes minimal losses and, hence, maximum efficiency. Such an idea has been tested experimentally using two commercial DC/DC converters whose average inductor current is adjustable. Experimental results show that the efficiency can be improved up to 12% by selecting an optimal value of that current, which is around 300-350 mA for such DC/DC converters.

Music-supported training is more efficient than functional motor training for recovery of fine motor skills in stroke patients

MOTOR IMPAIRMENTS ARE COMMON AFTER STROKE but efficacious therapies for these dysfunctions are scarce. Extending an earlier study on the effects of music-supported training (MST), behavioral indices of motor function were obtained before and after a series of training sessions to assess whether this new treatment leads to improved motor functions. Furthermore, music-supported training was contrasted to functional motor training according to the principles of constraint-induced therapy (CIT). In addition to conventional physiotherapy, 32 stroke patients with moderately impaired motor function and no previous musical experience received 15 sessions of MST over a period of three weeks, using a manualized, step-bystep approach. A control group consisting of 15 patients received 15 sessions of CIT in addition to conventional physiotherapy. A third group of 30 patients received exclusively conventional physiotherapy and served as a control group for the other three groups. Fine as well as gross motor skills were trained by using either a MIDI-piano or electronic drum pads programmed to emit piano tones. Motor functions were assessed by an extensive test battery. MST yielded significant improvement in fine as well as gross motor skills with respect to speed, precision, and smoothness of movements. These improvements were greater than after CIT or conventional physiotherapy. In conclusion, with equal treatment intensity, MST leads to more pronounced improvements of motor functions after stroke than CIT.

The effect of microfibrillated cellulose addition on drying shrinkage and dimensional stability of wood-free paper

Microfibrillated cellulose (MFC) is known to enhance strength properties of paper. Improved strength usually means increased bonding which is strongly connected to dimensional instability of paper. Dimensional instability is due to changes in moisture content of paper; when paper is moistened it expands and when dried, it shrinks. Hygroexpansion is linked to end-use problems and excessive drying shrinkage consumes strength potential. Effective use of materials requires controlling of these phenomena. There isn’t yet data concerning dimensional stability of papers containing MFC which restricts wider use of MFC. Main objective of the work was to evaluate dimensional stability of wood-free paper containing different amounts of MFC. Sheets were dried with different methods to see how drying strains effected on drying shrinkage and hygroexpansion. Also tensile strength was measured to find out the effect of MFC. Results were compared to sheets containing kraft fines and in some test points cationic starch was used alongside with MFC. MFC increased the dimensional instability of freely dried sheets. As the amounts of MFC increased the effects on dimensional stability became more severe. However the fineness of MFC didn’t play any important role. Both hygroexpansion and drying shrinkage were decreased with cationic starch addition. Prevention of drying shrinkage over powered the effects of additives on hygroexpansion. Tensile strength improved up till 7 % addition amount which could be set as the upper limit of MFC addition when paper preparation and tensile strength are concerned.

Comportamento de zinco e manganês de pilhas alcalinas em uma coluna de solo

The aim of this study was to evaluate the behavior of Zn and Mn in a soil column. Two soil columns were sampled, and four opened alkaline batteries were placed at the top of one soil column. An acid-rainwater solution (HNO3 and H2SO4; pH 4) was percolated through the battery contaminated column during one year. The results showed that the leaching of alkaline batteries caused enrichment of 70 and 11 times in the Zn and Mn concentration of the topsoil, respectively. Additionally, leaching of electrolyte (KOH) from the batteries increased the soil pH in the contaminated column.

Recuperação de cobalto e de lítio de baterias íon-lítio usadas

The "active mass" (cathode + anode + electrolyte) of spent Li-ion batteries was submitted to one of the following procedures: (a) it was calcined (500 ºC) and submitted to extraction with water to recover lithium salts. The residual solid was treated with sulfuric acid containing hydrogen peroxide. Cobalt was recovered as sulfate; (b) the "active mass" was treated with potassium hydrogen sulfate (500 ºC) and dissolved in water. Cobalt was precipitated together with copper after addition of sodium hydroxide. Lithium was partially recovered as lithium fluoride. Co-processing of other battery components (aluminum and copper foils) affected negatively the behavior of the recovery procedures. Previous segregation of battery components is essential for an efficient and economical processing of the "active mass".