Clinical and economic impact of exercise electrocardiography and exercise echocardiography in clinical practice

Background Patients with known or suspected coronary disease are often investigated to facilitate risk assessment. We sought to examine the cost-effectiveness of strategies based on exercise echocardiography and exercise electrocardiography. Methods and results We studied 7656 patients undergoing exercise testing; of whom half underwent exercise echocardiography. Risk was defined with the Duke treadmill score for those undergoing exercise electrocardiography alone, and by the extent of ischaemia by exercise echocardiography. Cox proportional hazards models, risk adjusted for pretest likelihood of coronary artery disease, were used to estimate time to cardiac death or myocardial infarction. Costs (including diagnostic and revascularisation procedures, hospitalisations, and events) were calculated, inflation-corrected to year 2000 using Medicare trust fund rates and discounted at a rate of 5%. A decision model was employed to assess the marginal cost effectiveness (cost/life year saved) of exercise echo compared with exercise electrocardiography. Exercise echocardiography identified more patients as low-risk (51% vs 24%, p<0.001), and fewer as intermediate- (27% vs 51%, p<0.001) and high-risk (22% vs 4%); survival was greater in low- and intermediate- risk and less in high-risk patients. Although initial procedural costs and revascularisation costs (in intermediate- high risk patients) were greater, exercise echocardiography was associated with a greater incremental life expectancy (0.2 years) and a lower use of additional diagnostic procedures when compared with exercise electrocardiography (especially in lower risk patients). Using decision analysis, exercise echocardiography (Euro 2615/life year saved) was more cost effective than exercise electrocardiography. Conclusion Exercise echocardiography may enhance cost-effectiveness for the detection and management of at risk patients with known or suspected coronary disease. (C) 2003 Published by Elsevier Science Ltd on behalf of The European Society of Cardiology.

Learning the dynamics of embedded clauses

Recent work by Siegelmann has shown that the computational power of recurrent neural networks matches that of Turing Machines. One important implication is that complex language classes (infinite languages with embedded clauses) can be represented in neural networks. Proofs are based on a fractal encoding of states to simulate the memory and operations of stacks. In the present work, it is shown that similar stack-like dynamics can be learned in recurrent neural networks from simple sequence prediction tasks. Two main types of network solutions are found and described qualitatively as dynamical systems: damped oscillation and entangled spiraling around fixed points. The potential and limitations of each solution type are established in terms of generalization on two different context-free languages. Both solution types constitute novel stack implementations - generally in line with Siegelmann's theoretical work - which supply insights into how embedded structures of languages can be handled in analog hardware.

Large amplitude vibration of thermo-electro-mechanically stressed FGM laminated plates

This paper presents a large amplitude vibration analysis of pre-stressed functionally graded material (FGM) laminated plates that are composed of a shear deformable functionally graded layer and two surface-mounted piezoelectric actuator layers. Nonlinear governing equations of motion are derived within the context of Reddy's higher-order shear deformation plate theory to account for transverse shear strain and rotary inertia. Due to the bending and stretching coupling effect, a nonlinear static problem is solved first to determine the initial stress state and pre-vibration deformations of the plate that is subjected to uniform temperature change, in-plane forces and applied actuator voltage. By adding an incremental dynamic state to the pre-vibration state, the differential equations that govern the nonlinear vibration behavior of pre-stressed FGM laminated plates are derived. A semi-analytical method that is based on one-dimensional differential quadrature and Galerkin technique is proposed to predict the large amplitude vibration behavior of the laminated rectangular plates with two opposite clamped edges. Linear vibration frequencies and nonlinear normalized frequencies are presented in both tabular and graphical forms, showing that the normalized frequency of the FGM laminated plate is very sensitive to vibration amplitude, out-of-plane boundary support, temperature change, in-plane compression and the side-to-thickness ratio. The CSCF and CFCF plates even change the inherent hard-spring characteristic to soft-spring behavior at large vibration amplitudes. (C) 2003 Elsevier B.V. All rights reserved.

A comparison of two methods for the calculation of accumulated oxygen deficit

The aim of this study was to compare accumulated oxygen deficit data derived using two different exercise protocols with the aim of producing a less time-consuming test specifically for use with athletes. Six road and four track male endurance cyclists performed two series of cycle ergometer tests. The first series involved five 10 min sub-maximal cycle exercise bouts, a (V) over dotO(2peak) test and a 115% (V) over dotO(2peak) test. Data from these tests were used to estimate the accumulated oxygen deficit according to the calculations of Medbo et al. (1988). In the second series of tests, participants performed a 15 min incremental cycle ergometer test followed, 2 min later, by a 2 min variable resistance test in which they completed as much work as possible while pedalling at a constant rate. Analysis revealed that the accumulated oxygen deficit calculated from the first series of tests was higher (P< 0.02) than that calculated from the second series: 52.3 +/- 11.7 and 43.9 +/- 6.4 ml . kg(-1), respectively (mean +/- s). Other significant differences between the two protocols were observed for (V) over dot O-2peak, total work and maximal heart rate; all were higher during the modified protocol (P

A comparison of the cycling performance of cyclists and triathletes

The aim of this study was to compare the cycling performance of cyclists and triathletes. Each week for 3 weeks, and on different days, 25 highly trained male cyclists and 18 highly trained male triathletes performed: (1) an incremental exercise test on a cycle ergometer for the determination of peak oxygen consumption ((V) over dot O-2peak), peak power output and the first and second ventilatory thresholds, followed 15 min later by a sprint to volitional fatigue at 150% of peak power output; (2) a cycle to exhaustion test at the (V) over dot O-2peak power output; and (3) a 40-km cycle time-trial. There were no differences in (V) over dot O-2peak, peak power output, time to volitional fatigue at 150% of peak power output or time to exhaustion at (V) over dot O-2peak power output between the two groups. However, the cyclists had a significantly faster time to complete the 40-km time-trial (56:18 +/- 2:31 min:s; mean +/- s) than the triathletes (58:57 +/- 3:06 min:s; P < 0.01), which could be partially explained (r = 0.34-0.51; P < 0.05) by a significantly higher first (3.32 +/- 0.36 vs 3.08 +/- 0.36 l . min(-1)) and second ventilatory threshold (4.05 +/- 0.36 vs 3.81 +/- 0.29 l . min(-1); both P < 0.05) in the cyclists compared with the triathletes. In conclusion, cyclists may be able to perform better than triathletes in cycling time-trial events because they have higher first and second ventilatory thresholds.

Photon-added detection

The production of conditional quantum states and quantum operations based on the result of measurement is now seen as a key tool in quantum information and metrology. We propose a different type of photon number detector. It functions nondeterministically, but when successful, it has high fidelity. The detector, which makes use of an n-photon auxiliary Fock state and high efficiency homodyne detection, allows a tunable trade-off between fidelity and probability. By sacrificing probability of operation, an excellent approximation to a photon-number detector is achieved.

Biased EPR entanglement and its application to teleportation

We consider pure continuous variable entanglement with non-equal correlations between orthogonal quadratures. We introduce a simple protocol which equates these correlations and in the process transforms the entanglement onto a state with the minimum allowed number of photons. As an example we show that our protocol transforms, through unitary local operations, a single squeezed beam split on a beam splitter into the same entanglement that is produced when two squeezed beams are mixed orthogonally. We demonstrate that this technique can in principle facilitate perfect teleportation utilizing only one squeezed beam.

Tailoring teleportation to the quantum alphabet

We introduce a refinement of the standard continuous variable teleportation measurement and displacement strategies. This refinement makes use of prior knowledge about the target state and the partial information carried by the classical channel when entanglement is nonmaximal. This gives an improvement in the output quality of the protocol. The strategies we introduce could be used in current continuous variable teleportation experiments.

Mapping the royal road and other hierarchical functions

In this paper we present a technique for visualising hierarchical and symmetric, multimodal fitness functions that have been investigated in the evolutionary computation literature. The focus of this technique is on landscapes in moderate-dimensional, binary spaces (i.e., fitness functions defined over {0, 1}(n), for n less than or equal to 16). The visualisation approach involves an unfolding of the hyperspace into a two-dimensional graph, whose layout represents the topology of the space using a recursive relationship, and whose shading defines the shape of the cost surface defined on the space. Using this technique we present case-study explorations of three fitness functions: royal road, hierarchical-if-and-only-if (H-IFF), and hierarchically decomposable functions (HDF). The visualisation approach provides an insight into the properties of these functions, particularly with respect to the size and shape of the basins of attraction around each of the local optima.

Avan??os desiguais e inten????es indefinidas: a reforma do estado do M??xico e a estrat??gia de gerenciamento

Este paper defende duas id??ias. A primeira, ?? apresentar os diferentes processos da reforma do Estado mexicano, analisados sob as prioridades diversas no decorrer do tempo. As reformas econ??mica, pol??tica, social e administrativa tiveram prioridades e objetivos divergentes. A reforma econ??mica foi sistem??tica e congruente, a pol??tica foi defensiva e pouco abrangente, e a social foi problem??tica e confusa. A reforma administrativa foi, comparativamente, limitada. Uma proposta para desenvolver um sistema administrativo respons??vel pelo servi??o p??blico foi postergada nos ??ltimos 12 anos at?? que, em maio de 1997, finalmente a atual administra????o prop??s um programa de moderniza????o. A segunda id??ia ?? que, mesmo que a atual administra????o tenha a inten????o de desenvolver um novo sistema de accountability e um plano de carreira para o servi??o p??blico, parece plaus??vel que a tradicional pol??tica de controle, atrav??s da estrutura administrativa, possa ser prejudicada se essas propostas realmente reduzirem o poder discricion??rio dos altos cargos p??blicos e submeterem reservas p??blicas a um esquema de controle social mais aberto e formal. Logo, ?? poss??vel dizer que a alternativa escolhida pelos reformistas foi usar uma abordagem gerenciadora, onde a melhoria dos procedimentos e a implementa????o de algumas t??cnicas administrativas avan??adas substituem, pelo menos at?? agora, uma transforma????o mais profunda da estrutura administrativa. Uma estrat??gia de gerenciamento permite, pelo menos at?? o momento, a melhoria dos servi??os atrav??s do aumento da participa????o de servidores p??blicos, sem prejudicar a atual administra????o, como um instrumento para implementar diferentes agendas pol??ticas usando recursos p??blicos. Nosso argumento ?? que, como o programa de moderniza????o est?? sendo implantado, ?? importante estudar minuciosamente as possibilidades de se implementar a reforma do servi??o p??blico e melhorar a responsabilidade do sistema, dada a particular rela????o que existe entre a administra????o p??blica e o sistema pol??tico no M??xico.

Ocupa????o no setor p??blico: tend??ncias recentes e quest??es em aberto

Com base neste trabalho, poder-se-ia hoje afirmar com maior seguran??a que: i) o movimento de recomposi????o de pessoal no setor p??blico brasileiro, observado durante toda a primeira d??cada de 2000, mostrou-se apenas suficiente para repor praticamente o mesmo estoque de servidores ativos existentes em meados da d??cada de 1990; ii) tampouco se deduz dos dados analisados que os gastos com pessoal tenham sa??do do controle do governo federal, pois, em termos percentuais, essa rubrica permaneceu praticamente constante ao longo da primeira d??cada de 2000, em um contexto de retomada relativa do crescimento econ??mico e tamb??m da arrecada????o tribut??ria; e iii) do ponto de vista qualitativo, evid??ncias da pesquisa indicam que esse movimento atual deve trazer melhorias gradativas ao desempenho institucional, pois vem sendo promovido a partir de crit??rios meritocr??ticos de sele????o (concursos p??blicos), e diante disso as atividades-fim, que exigem n??vel superior de escolariza????o, s??o mais contempladas do que as atividades-meio, indicando a possibilidade de maiores impactos sobre a produtividade agregada do setor p??blico; e tem assumido a forma de vincula????o estatut??ria, em detrimento do padr??o celetista ou de v??rias formas de contrata????o prec??rias, o que coloca o novo contingente sob direitos e deveres comuns e est??veis, podendo com isso gerar maior coes??o e homogeneidade no interior da categoria como um todo, aspecto considerado essencial para um desempenho satisfat??rio do Estado a longo prazo.

Contrasts in the basins of attraction of structurally identical iterative root finding methods

A numerical comparison is performed between three methods of third order with the same structure, namely BSC, Halley’s and Euler–Chebyshev’s methods. As the behavior of an iterative method applied to a nonlinear equation can be highly sensitive to the starting points, the numerical comparison is carried out, allowing for complex starting points and for complex roots, on the basins of attraction in the complex plane. Several examples of algebraic and transcendental equations are presented.

O impacto da internacionalização nos esquemas interpretativos dos dirigentes do banco Bamerindus

O objetivo do presente estudo de caso foi verificar o impacto do processo de internacionalização do Banco Bamerindus sobre os esquemas interpretativos dos seus dirigentes no período compreendido entre 1989 e 1995. O estudo de caso, realizado com base em análise longitudinal dos dados e em uso de diferentes fontes de evidência com o apoio da técnica de triangulação, revela que o impacto da internacionalização foi de natureza incremental, o que não confirma estudos anteriores sobre o tema. Algumas hipóteses foram levantadas para explicar tal resultado: o pouco tempo de envolvimento internacional do Bamerindus; a evolução incremental da internacionalização; a existência prévia de alguns valores coerentes com valores compartilhados no exterior; e as peculiaridades do contexto institucional brasileiro após longa história de alta inflação que dificultaram a assimilação de valores e crenças disponibilizados pela experiência internacional.

Busca da informação em marketing: a perspectiva da ciência da informação

Com base nas perspectivas do marketing a da ciência da informação, o artigo relata os resultados de uma pesquisa sobre o processo de inovação em três indústrias brasileiras. Os objetivos do estudo foram: a) descrever os processos internos associados à concepção e ao desenvolvimento de inovações incrementais de produtos; b) identificar os atores envolvidos em cada etapa desses processos; c) descrever os contextos nos quais esses atores interagem; d) identificar e descrever as interfaces existentes entre esses atores; e) identificar e descrever os comportamentos de busca e uso da informação em cada etapa dos processos de inovação incremental de produto; e f) descrever as fontes de informação utilizadas em cada etapa. Os resultados demonstraram, dentre outros aspectos, a influência de aspectos relativos à tarefa sobre a extensão e o número de ciclos de busca, bem como o tipo de informação procurada.

Democratização e reforma do Estado: o desenvolvimento institucional dos tribunais de contas no Brasil recente

Este artigo analisa as transformações das últimas décadas nos tribunais de contas no Brasil, à luz da discussão da temática do desenvolvimento institucional. Essa perspectiva analítica permite olhar os processos de mudanças nas arenas políticas, no longo prazo, enfatizando não só a resistência dos atores institucionais ou sociais com poder de veto e os mecanismos de path dependence, mas igualmente as conjunturas críticas que permitem levar adiante as transformações, mesmo que de forma incremental. No caso em estudo, a conjuntura crítica da democratização e da Constituição de 1988 trouxe mudanças, mas estas foram neutralizadas pela capacidade de veto da elite dirigente especialmente em alguns tribunais. Por outro lado, a nova conjuntura crítica representada pela Lei de Responsabilidade Fiscal, de 2000, alterou a dinâmica política e institucional, permitindo que, até muito recentemente, as mudanças que permaneciam bloqueadas começassem, a partir de então, a ser efetivadas diante da menor capacidade de exercício de tais vetos.