A systems approach to cardiovascular health and disease with a focus on aortic wave dynamics

Cardiovascular diseases (CVDs) have reached an epidemic proportion in the US and worldwide with serious consequences in terms of human suffering and economic impact. More than one third of American adults are suffering from CVDs. The total direct and indirect costs of CVDs are more than $500 billion per year. Therefore, there is an urgent need to develop noninvasive diagnostics methods, to design minimally invasive assist devices, and to develop economical and easy-to-use monitoring systems for cardiovascular diseases. In order to achieve these goals, it is necessary to gain a better understanding of the subsystems that constitute the cardiovascular system. The aorta is one of these subsystems whose role in cardiovascular functioning has been underestimated. Traditionally, the aorta and its branches have been viewed as resistive conduits connected to an active pump (left ventricle of the heart). However, this perception fails to explain many observed physiological results. My goal in this thesis is to demonstrate the subtle but important role of the aorta as a system, with focus on the wave dynamics in the aorta.

The operation of a healthy heart is based on an optimized balance between its pumping characteristics and the hemodynamics of the aorta and vascular branches. The delicate balance between the aorta and heart can be impaired due to aging, smoking, or disease. The heart generates pulsatile flow that produces pressure and flow waves as it enters into the compliant aorta. These aortic waves propagate and reflect from reflection sites (bifurcations and tapering). They can act constructively and assist the blood circulation. However, they may act destructively, promoting diseases or initiating sudden cardiac death. These waves also carry information about the diseases of the heart, vascular disease, and coupling of heart and aorta. In order to elucidate the role of the aorta as a dynamic system, the interplay between the dominant wave dynamic parameters is investigated in this study. These parameters are heart rate, aortic compliance (wave speed), and locations of reflection sites. Both computational and experimental approaches have been used in this research. In some cases, the results are further explained using theoretical models.

The main findings of this study are as follows: (i) developing a physiologically realistic outflow boundary condition for blood flow modeling in a compliant vasculature; (ii) demonstrating that pulse pressure as a single index cannot predict the true level of pulsatile workload on the left ventricle; (iii) proving that there is an optimum heart rate in which the pulsatile workload of the heart is minimized and that the optimum heart rate shifts to a higher value as aortic rigidity increases; (iv) introducing a simple bio-inspired device for correction and optimization of aortic wave reflection that reduces the workload on the heart; (v) deriving a non-dimensional number that can predict the optimum wave dynamic state in a mammalian cardiovascular system; (vi) demonstrating that waves can create a pumping effect in the aorta; (vii) introducing a system parameter and a new medical index, Intrinsic Frequency, that can be used for noninvasive diagnosis of heart and vascular diseases; and (viii) proposing a new medical hypothesis for sudden cardiac death in young athletes.

INFLUENCE OF A NATIVE INSECTARY PLANT, CHAMAECRISTA FASCICULATA (MICHX.) ON ORGANIC FIELD CORN AND ARTHROPOD COMMUNITIES

Increasing plant diversity in conventionally monoculture agrosystems has been promoted as a method to enhance beneficial arthropod density and efficacy, suppress herbivory and provide a range of ecosystem services. I investigated the pest suppressive potential and economic impact of plant diversification in organic field corn. The experiment consisted of two treatments, corn grown in monoculture (C) and bordered by strips of partridge pea (PP). Pest and natural enemy populations, corn damage, yield, and profits were compared among treatments. Natural enemy and herbivore arthropod populations were affected by treatment and distance from plot border. Corn damage due to pests was also affected by treatment and location, but did not significantly affect yield. Yield in monoculture plots was generally greater than in PP but did not result in greater profit. Pest and natural enemy arthropod abundances were elevated in partridge pea treatment borders, but these populations did not consistently diffuse into plot interiors. The potential causes and implications of findings are discussed.

Complications associated with closing wedge ostectomy procedure for treatment of cranial cruciate ligament rupture in dogs : a retrospective study of 145 cases

Dissertação de Mestrado Integrado em Medicina Veterinária

To eat or not to eat meat: that is the question

Meat is a well accepted food with appreciable appealing. Due to its high nutritional value it plays a central role in human development. Meat/meat derivates are important sources of proteins, minerals and vitamins. Their nutritional importance is paralleled to their economic impact. Paying attention to the social alarm originated by a recent publication of WHO about the relationship between red and/or processed meat consumption and cancer, this paper reviews the following aspects: a) the present consumption of meat/meat products in Spain; b) the contribution of their macro/micronutrients to the recommended dietary allowances; c) the obliged use of additives (e.g. nitrites and nitrates) to warrant the food safety, and their daily intake. In addition health risks derived from a high consumption, as well as the most appropriate culinary uses in order to reduce the formation of toxic products (e.g. N-nitrosocompounds) are commented. Due to the huge variety of available meat products, this paper concludes that any generalization should be avoided. We also emphasize about the advantages of consuming meat/meat products in the frame of a Mediterranean diet, rich in vegetables, fruits, and bioactive compounds.

Life cycle assessment of residual forestry biomass chips at a power plant: a Portuguese case study

The residual forest biomass (RFB) sector has been experiencing strong development at European level and particularly in Portugal mainly due to the increase of energy production from renewable sources. The aim of this study is to assess the environmental impacts of eucalyptus RFB chips production chain in Portugal. The environmental and economic impact comparison of the processes included in the production chain is presented as well. The environmental impacts were calculated by the life cycle assessment approach described in the ISO 14040 series of standards. The production chain assessed included all processes from eucalyptus forest until the delivery of RFB chips at the power plant. The main conclusion of this study is that eucalyptus wood production is the process that presents the greatest environmental impact through the product life cycle.

Climate variability of the last 1000 years in the NW Pacific: high resolution, multi-biomarker records from Lake Toyoni

The East Asian Monsoon (EAM) is an active component of the global climate system and has a profound social and economic impact in East Asia and its surrounding countries. Its impact on regional hydrological processes may influence society through industrial water supplies, food productivity and energy use. In order to predict future rates of climate change, reliable and accurate reconstructions of regional temperature and rainfall are required from all over the world to test climate models and better predict future climate variability. Hokkaido is a region which has limited palaeo-climate data and is sensitive to climate change. Instrumental data show that the climate in Hokkaido is influenced by the East Asian Monsoon (EAM), however, instrumental data is limited to the past ~150 years. Therefore down-core climate reconstructions, prior to instrumental records, are required to provide a better understanding of the long-term behaviour of the climate drivers (e.g. the EAM, Westerlies, and teleconnections) in this region. The present study develops multi-proxy reconstructions to determine past climatic and hydrologic variability in Japan over the past 1000 years and aid in understanding the effects of the EAM and the Westerlies independently and interactively. A 250-cm long sediment core from Lake Toyoni, Hokkaido was retrieved to investigate terrestrial and aquatic input, lake temperature and hydrological changes over the past 1000-years within Lake Toyoni and its catchment using X-Ray Fluorescence (XRF) data, alkenone palaeothermometry, the molecular and hydrogen isotopic composition of higher plant waxes (δD(HPW)). Here, we conducted the first survey for alkenone biomarkers in eight lakes in the Hokkaido, Japan. We detected the occurrence of alkenones within the sediments of Lake Toyoni. We present the first lacustrine alkenone record from Japan, including genetic analysis of the alkenone producer. C37 alkenone concentrations in surface sediments are 18µg C37 g−1 of dry sediment and the dominant alkenone is C37:4. 18S rDNA analysis revealed the presence of a single alkenone producer in Lake Toyoni and thus a single calibration is used for reconstructing lake temperature based on alkenone unsaturation patterns. Temperature reconstructions over the past 1000 years suggest that lake water temperatures varies between 8 and 19°C which is in line with water temperature changes observed in the modern Lake Toyoni. The alkenone-based temperature reconstruction provides evidence for the variability of the EAM over the past 1000 years. The δD(HPW) suggest that the large fluctuations (∼40‰) represent changes in temperature and source precipitation in this region, which is ultimately controlled by the EAM system and therefore a proxy for the EAM system. In order to complement the biomarker reconstructions, the XRF data strengthen the lake temperature and hydrological reconstructions by providing information on past productivity, which is controlled by the East Asian Summer monsoon (EASM) and wind input into Lake Toyoni, which is controlled by the East Asian Winter Monsoon (EAWM) and the Westerlies. By combining the data generated from XRF, alkenone palaeothermometry and the δD(HPW) reconstructions, we provide valuable information on the EAM and the Westerlies, including; the timing of intensification and weakening, the teleconnections influencing them and the relationship between them. During the Medieval Warm Period (MWP), we find that the EASM dominated and the EAWM was suppressed, whereas, during the Little Ice Age (LIA), the influence of the EAWM dominated with time periods of increased EASM and Westerlies intensification. The El Niño Southern Oscillation (ENSO) significantly influenced the EAM; a strong EASM occurred during El Niño conditions and a strong EAWM occurred during La Niña. The North Atlantic Oscillation, on the other hand, was a key driver of the Westerlies intensification; strengthening of the Westerlies during a positive NAO phase and weakening of the Westerlies during a negative NAO phase. A key finding from this study is that our data support an anti-phase relationship between the EASM and the EAWM (e.g. the intensification of the EASM and weakening of the EAWM and vice versa) and that the EAWM and the Westerlies vary independently from each other, rather than coincide as previously suggested in other studies.

Factores asociados a transfusión sanguínea en el manejo quirúrgico del canal lumbar estrecho en la Fundación Santa Fe de Bogotá 2003 - 2013

Introduccion: El canal lumbar estrecho es un motivo de consulta frecuente en el servicio de columna de la Fundación Santa Fe de Bogotá. Derivado del tratamiento quirurgico se pueden generar múltiples complicaciones, entre las que se encuentra la transfusión sanguínea. Objetivo: Identificar los factores sociodemográficos, antecedentes personales y factores quirúrgicos asociados a transfusión sanguínea en cirugía canal lumbar estrecho en la Fundación Santa Fe de Bogotá 2003- 2013. Materiales y métodos: Se aplicó en diseño de estudio observacional analítico transversal. Se incluyeron 367 pacientes sometidos a cirugía de canal lumbar estrecho a quienes se les analizaron variables de antecedentes personales, características sociodemograficas y factores quirúrgicos. Resultados: La mediana de la edad fue de 57 años y la mayoría de pacientes fueron mujeres (55,6%). La mediana del Índice de Masa Corporal (IMC) fue de 24,9 clasificado como normal. Entre los antecedentes patológicos, la hipertensión arterial fue el más común (37,3%). La mayoría de pacientes (59,1%) presentaron clasificación ASA de II. El tipo de cirugía más prevalente fue el de descompresión (55,6%). En el 79,8% de los pacientes se intervinieron 2 niveles. Se realizó transfusión de glóbulos rojos en 26 pacientes correspondiente a 7,1% del total. En la mayoría de procedimientos quirúrgicos (42,5%) el sangrado fue clasificado como moderado (50-500 ml). En el modelo explicativo transfusión sanguínea en cirugía de canal lumbar estrecho se incluyen: antecedente de cardiopatía (OR 4,68, P 0,034, IC 1,12 – 19,44), Sangrado intraoperatorio >500ml (OR 6,74, p 0,001, 2,09 – 21,74) y >2 niveles intervenidos (OR 3,97, p 0,023, IC 1,20 – 13,09). Conclusión: Como factores asociados a la transfusión sanguínea en el manejo quirúrgico del canal lumbar estrecho a partir de la experiencia de 10 años en la Fundación Santa Fe de Bogotá se encontraron: enfermedad cardiaca, sangrado intraoperatorio mayor de 500ml y más de dos niveles intervenidos.

Efectividad del tratamiento de lumbalgia con acupuntura

Se realizó un estudio observacional retrospectivo longitudinal en una Institución prestadora de Servicios de Salud de la ciudad de Bogotá, con el objetivo de evaluar la efectividad en el manejo del dolor de la terapia con acupuntura en el tratamiento de lumbalgia. Se tomaron 150 historias clínicas de pacientes con lumbalgia atendidos de enero de 2014 a mayo de 2016, las cuales fueron sometidas a los criterios de inclusión definidos por los autores, arrojando 48 historias sometidas a la prueba de Friedman con el fin de identificar el impacto sobre el dolor del tratamiento con acupuntura en los pacientes seleccionados. Adicionalmente, bajo un muestreo aleatorio simple de distribución normal sobre las 48 historias clínicas evaluadas, se seleccionaron 25 casos a los cuales se les aplicó una encuesta no estructurada, con el fin de obtener información sobre el estado de la patología después de finalizar el tratamiento e identificar las posibles causas de deserción. Con este estudio se concluye que la terapia con acupuntura es efectiva en el manejo del dolor de pacientes con lumbalgia, y que es necesario realizar más estudios que puedan sustentar la inclusión de la terapéutica en el manejo de esta patología.

Clínica e cirurgia de espécies pecuárias

O presente relatório, inerente ao estágio curricular do Mestrado Integrado em Medicina Veterinária da Universidade de Évora, tem como objetivo descrever as atividades desenvolvidas durante o estágio na área da clínica e cirurgia de espécies pecuárias. A primeira parte do relatório consiste na descrição do local de estágio e na distribuição casuística das atividades acompanhadas. A segunda parte consiste numa revisão bibliográfica e no desenvolvimento de dois casos clínicos ocorridos em bovinos, relacionados com o tema, “necrobacilose hepática bovina” (NHB). A NHB é uma doença infecciosa de grande impacto económico, principalmente em explorações de bovinos de engorda intensiva. Carateriza-se pela formação de abcessos hepáticos, cujo agente etiológico primário é Fusobacterium necrophorum. É de difícil diagnóstico em vida, raramente demonstra sinais clínicos e o seu tratamento é pouco eficaz. A prevenção baseia-se na adição de antimicrobianos na alimentação, num correto maneio alimentar e eventualmente vacinação; Abstract: Medical and Surgical Pathology of livestock species The present report, inherent of the master in Veterinary Medicine from the University of Évora, aims to describe the activities carried out during the internship in the field of clinic and surgery of livestock species. The first part of the report is the description of the local of internship and the statistical distribution of activities. The second part consists of a literature review and the development of two clinical cases in cattle, related to the theme, “hepatic bovine necrobacillosis "(HBN). The HBN is an infectious disease of great economic impact, especially in feedlot cattle. It is characterized by the formation of liver abscesses, whose primary etiological agent is Fusobacterium necrophorum. It is difficult to diagnose in life, rarely show clinical signs and their treatment is ineffective. Prevention is based on the addition of antimicrobials in food, a correct feed management and eventually vaccination.

Inventário e análise sociológica das políticas públicas de turismo em Angola

As políticas públicas na área do turismo tornaram-se uma prioridade dos governos dos países desenvolvidos e menos desenvolvidos a partir da década de 1970, quando os organismos estatais ligados ao sector do turismo deram início à definição de amplas agendas nacionais para o desenvolvimento da indústria do turismo para períodos de longo prazo, com descrições claras sobre a posição que o turismo ocupa no âmbito do desenvolvimento da economia nacional; sobre as metas que se pretendem alcançar e a forma como elas serão atingidas. O enorme crescimento do turismo, o envolvimento dos governos e os impactos negativos do turismo que foram registados nos países em desenvolvimento ajudou a trazer ao debate académico a análise sobre as políticas públicas do turismo no final dos anos 80 e início de 90 do séc. passado. Neste estudo inventariou-se o quadro legislativo das políticas públicas do turismo em Angola e fez-se o enquadramento sociológico da Política Nacional e do Plano Diretor do turismo em Angola; identificaram-se os atores que intervêm na execução das políticas públicas do turismo em Angola e o seu sentido social, assim como os fatores centrais propiciadores do desenvolvimento social e económico em contexto local (Huíla). Isto permitiu determinar o perfil e tipologias resultantes da contribuição do quadro de Políticas Públicas de turismo para o nível de promoção do desenvolvimento social local em Angola, ajudando-nos a tentar perceber até que ponto as políticas públicas do turismo em Angola se constituem como fator de desenvolvimento social local. Partindo do perfil e tipologias resultantes da contribuição do quadro de Políticas Públicas de turismo e com base nos resultados obtidos através da análise de conteúdo das entrevistas, construiu-se uma proposta de modelo de políticas públicas de turismo propiciadoras do desenvolvimento local sustentável em Angola baseada numa lógica de ação coletiva, capaz de salvaguardar a sustentabilidade económica, política, social e territorial; ABSTRACT: Public policies in tourism became a priority of developed country governments and less developed countries from the 1970s, when the state bodies linked to the tourism sector began the definition of a broad national agenda for the development of the tourism industry for long-term periods, with clear descriptions of the position that tourism occupies in the national economic development; on the goals they want to achieve and how they will be achieved. The tremendous growth of tourism, the involvement of governments and the negative impacts of tourism were registered in developing countries and helped to bring the academic debate analysis on public tourism policies, in the late 80s and early 90s of the past century. In the legislative framework, we inventoried public tourism policies in Angola that later became the sociological framework of the National Policy and Plan for tourism in Angola; we identified the actors involved in the execution of public tourism policies in Angola and its social meaning, as well as the central factors conductive to social and economic development in the local context (Huila). This allowed to determine the profile and types resulting from the tourism Public Policy framework contribution to the level of promotion of local social development in Angola, helping us in this way to try to understand to what extent public tourism policies in Angola work as a local social development factor. From the profile and types resulting from the tourism Public Policy framework contribution and based on the results obtained from the interviews, we constructed a proposed model of public policies which encourage a more sustainable local development kind of tourism in Angola, based on a logic of collective action, able to safeguard the economic, political, social and territorial capitals.

La ocupación del espacio geográfico y el desarrollo de los sistemas de producción agrícola en el distrito de El General, Pérez Zeledón. Costa Rica (1850-1950)

ResumenEste trabajo aborda el proceso de desarrollo del frente de colonización agrícola en El General, Pérez Zeledón, entre la segunda mitad del siglo XIX y la primera mitad del siglo XX. Se analizan las características del espacio, así como los elementos constitutivos y las transformaciones que durante el período experimentaron las unidades y los sistemas de producción ubicados en dichos territorios. Junto a una revaloración de la complejidad agrícola presente en la región durante esta etapa, este artículo pone de manifiesto el papel de las políticas estatales en la ocupación y la vinculación de la zona sur al entorno económico nacional.AbstractThis work addresses the development process of the agricultural front in El General, Pérez Zeledón, that took place during the second half of the nineteenth century and the first half of the twentieth century. Here, spatial characteristics are analyzed, as well as the components of the production units and systems in these territories and the transformations they experienced. Along with a revaluation of the agricultural complexity present in the region during this period, this article highlights the role of governmental policies pertaining to the settlement of the southern region and its connection with the national economic framework

La privatización de los baldíos nacionales en Costa Rica durante el siglo XIX: Legislación y procedimientos utilizados para su adjudicación

ResumenAnaliza los mecanismos creados a partir de la legislación vigente para la apropiación privada de los baldíos nacionales, entre 1821 y 1900. Enfatiza los criterios utilizados para legitimar la propiedad privada y el fomento agrícola, como eje del desarrollo económico nacional. Detecta manifestaciones del pensamiento liberal clásico y positivista desde principios del siglo XIX.AbstractIncludes a discussion of legal means of acquiring private ownership of government lands, from 1821 to 1900. Study stresses criteria used to legitimate property and promote agriculture as the key to national economic development. Identifies manifestations of classical and positivist liberalism since the early 19

The unpatriotism of the economic constitution? Rights to free movement and their impact on national and European identity

Abstract: Instead of the political reading of the EU Constitution adopted by advocates of constitutional patriotism, this article examines the European economic constitution. The four single market freedoms can be used by the Court of Justice to strike down Member State laws which represent deeply held aspects of national cultural identity. The article examines whether the court does in fact act in this way and proceeds to argue that the issue of identity protection does not stop with the court. In those policy areas where the court is more interventionist, and its case-law is perceived as an identity threat, one is likely to find binding Treaty-based derogations. Where, in contrast, the effect of the court's case-law poses less of a threat, one is more likely to see non-binding declarations. The article examines a number of policy areas in which specific cultural derogations and declarations are to be found, including abortion, property acquisition, football and alcohol control.

Referral patterns and proximity to palliative care inpatient services by level of socio-economic disadvantage : a national study using spatial analysis

Background: A range of health outcomes at a population level are related to differences in levels of social disadvantage. Understanding the impact of any such differences in palliative care is important. The aim of this study was to assess, by level of socio-economic disadvantage, referral patterns to specialist palliative care and proximity to inpatient services. Methods: All inpatient and community palliative care services nationally were geocoded (using postcode) to one nationally standardised measure of socio-economic deprivation – Socio-Economic Index for Areas (SEIFA; 2006 census data). Referral to palliative care services and characteristics of referrals were described through data collected routinely at clinical encounters. Inpatient location was measured from each person’s home postcode, and stratified by socio-economic disadvantage. Results: This study covered July – December 2009 with data from 10,064 patients. People from the highest SEIFA group (least disadvantaged) were significantly less likely to be referred to a specialist palliative care service, likely to be referred closer to death and to have more episodes of inpatient care for longer time. Physical proximity of a person’s home to inpatient care showed a gradient with increasing distance by decreasing levels of socio-economic advantage. Conclusion: These data suggest that a simple relationship of low socioeconomic status and poor access to a referral-based specialty such as palliative care does not exist. Different patterns of referral and hence different patterns of care emerge.

The Rocky Road of Social Sustainability : The Impact of Integrated Biodiversity Conservation and Development on the Local Realities in Ranomafana National Park, Madagascar

The objective of this study is to examine the social impacts of the integrated conservation and development project (ICDP) aimed at biodiversity conservation and local socio-economic development in the Ranomafana National Park (RNP), Madagascar. Furthermore, the study explores social sustainability and justice of the ICDP in Ranomafana. This ethnographically informed impact study uses of various field methods. The research material used consists of observation, interviews (key-person and focus group), school children's writings, official statistics and project documents. Fieldwork was conducted in three phases in 2001, 2002 and 2004 in twelve villages around the park, as well as in neighbouring areas of Ranomafana. However, four of those twelve villages were chosen for closer study. This study consists of five independent articles and a concluding chapter. Social impacts were studied through reproductive health indicators as well as a life security approach. Equity and distribution of benefits and drawbacks of ICDP were analysed and the actors related to the conservation in Ranomafana were identified. The children and adolescents' environmental views were also examined. The reproductive health indicators studied showed a poor state of reproductive health in the park area. Moreover, the existing social capital in the villages seemed to be fragmented due to economic difficulties that were partly caused by the conservation regulations. The ICDP in Ranomafana did not pay attention to the heterogeneity of the affected communities even though the local beneficiaries of the ICDP varied according to their ethnicity, living place, wealth, social position and gender. In addition, various conservation actors (local people in various groups, local authorities, tourist business owners, conservation NGOs and scientists) contest their interests over the forest, conservation and its related activities. This study corroborates the same type of evidence and conclusions discussed in other similar cases elsewhere: so called social conservation programmes still cannot meet the needs of the people living near the protected areas; on the contrary, they even have a reverse impact on the people's lives. A fundamental misunderstood assumption in the conservation process in Ranomafana was to consider the local people as a problem for biodiversity conservation. Major reasons for the failure of the ICDP in Ranomafana include a lack of local institutions that would have been able to communicate as equals with the conservation NGOs as well as to transfer the tradition of the authoritarian governance in conservation management together with the over-appreciation of scientific biodiversity, and lack of will to understand the local people's rights to use the forest for their livelihoods.