Use of stress echocardiography to predict mortality in patients with diabetes and known or suspected coronary artery disease

OBJECTIVE - This study sought to determine whether stress echocardiography using exercise (when feasible) or dobutamine echo could be used to predict mortality in patients with diabetes. RESEARCH DESIGN AND METHODS - Stress echo was performed in 937 patients with diabetes (aged 59 +/- 13 years, 529 men) for symptom evaluation (42%) and follow-up of known coronary artery disease (CAD) (58%). Stress echocardiography using exercise was performed in 333 patients able to exercise maximally, and dobutamine echo using a standard dobutamine stress was used in 604 patients. Patients were followed for less than or equal to9 years (mean 3.9 +/- 2.3) for all-cause mortality. RESULTS - Normal studies were obtained in 567 (60%) patients; 29% had resting left ventricular (LV) dysfunction, and 25% had ischemia. Abnormalities were confined to one territory in 183 (20%) patients and to multiple territories in 187 (20%) patients. Death (in 275 [29%] patients) was predicted by referral for pharmacologic stress (hazard ratio [HR] 3.94, P < 0.0001), ischemia (1.77, P <0.0001), age (1.02, P = 0.002), and heart failure (1.54, P = 0.01). The risk of death in patients With a normal scan was 4% per year, and this was associated with age and selection for pharmacologic stress testing. In stepwise models replicating the sequence of clinical evaluation, the predictive power of independent clinical predictors (age, selection for pharmacologic stress, previous infarction, and heart failure; model chi(2) = 104.8) was significantly enhanced by addition of stress echo data (model chi(2) = 122.9). CONCLUSIONS - The results of stress echo are independent predictors of death in diabetic patients with known or suspected CAD.. Ischemia adds risk that is incremental to clinical risks and LV dysfunction.

Transducer for direct measurement of skin friction in hypervelocity impulse facilities

An acceleration compensated transducer was developed to enable the direct measurement of skin friction in hypervelocity impulse facilities. The gauge incorporated a measurement and acceleration element that employed direct shear of a piezoelectric ceramic. The design integrated techniques to maximize rise time and shear response while minimizing the affects of acceleration, pressure, heat transfer, and electrical interference. The arrangement resulted in a transducer natural frequency near 40 kHz. The transducer was calibrated for shear and acceleration in separate bench tests and was calibrated for pressure within an impulse facility. Uncertainty analyses identified only small experimental errors in the shear and acceleration calibration techniques. Although significant errors were revealed in the method of pressure calibration, total skin-friction measurement errors as low as +/-7-12% were established. The transducer was successfully utilized in a shock tunnel, and sample measurements are presented for flow conditions that simulate a flight Mach number near 8.

Robust model-order reduction of complex biological processes

This paper addresses robust model-order reduction of a high dimensional nonlinear partial differential equation (PDE) model of a complex biological process. Based on a nonlinear, distributed parameter model of the same process which was validated against experimental data of an existing, pilot-scale BNR activated sludge plant, we developed a state-space model with 154 state variables in this work. A general algorithm for robustly reducing the nonlinear PDE model is presented and based on an investigation of five state-of-the-art model-order reduction techniques, we are able to reduce the original model to a model with only 30 states without incurring pronounced modelling errors. The Singular perturbation approximation balanced truncating technique is found to give the lowest modelling errors in low frequency ranges and hence is deemed most suitable for controller design and other real-time applications. (C) 2002 Elsevier Science Ltd. All rights reserved.

Tide-induced water table fluctuations in coastal aquifers bounded by rhythmic shorelines

Previous studies on tidal water table dynamics in unconfined coastal aquifers have focused on the inland propagation of oceanic tides in the cross-shore direction based on the assumption of a straight coastline. Here, two-dimensional analytical solutions are derived to study the effects of rhythmic coastlines on tidal water table fluctuations. The computational results demonstrate that the alongshore variations of the coastline can affect the water table behavior significantly, especially in areas near the centers of the headland and embayment. With the coastline shape effects ignored, traditional analytical solutions may lead to large errors in predicting coastal water table fluctuations or in estimating the aquifer's properties based on these signals. The conditions under which the coastline shape needs to be considered are derived from the new analytical solution.

Tillering in grain sorghum over a wide range of population densities: Identification of a common hierarchy for tiller emergence, leaf area development and fertility

Most studies of tiller development have not related the physiological and morphological features of each calm to its subsequent fertility. This introduced problems when trying to account for the effects of tillering on yield in crop models. The objective of this study was to detect the most likely early determinants of tiller fertility in sorghum by identifying hierarchies for emergence, fertility and grain number of tillers over a wide range of assimilate availabilities. Emergence, phenology, leaf area development and dry weight partitioning were quantified weekly for individual tillers and main culms of tillering and uniculm plants grown at one of four densities, from two to 16 plants m(-2). For a given plant in any given density, the same tiller hierarchy applied for emergence of tillers, fertility of the emerged tillers and their subsequent grain number. These results were observed over a range of tiller fertility rates (from 7 to 91%), fertile tiller number per plant at maturity (from 0.2 to 4.7), and tiller contribution to grain yield (from 5 to 78%). Tiller emergence was most probably related to assimilate supply and light quality. Development, fertility and contribution to yield of a specific tiller were highly dependent on growing conditions at the time of tiller emergence, particularly via early leaf area development of the tiller, which affected its subsequent leaf area accumulation. Assimilate availability in the main culm at the time of tiller emergence was the most likely early determinant of subsequent tiller fertility in this study. (C) 2002 Annals of Botany Company.

Repeated three-dimensional magnetic resonance imaging of atherosclerosis development in innominate arteries of low-density lipoprotein receptor-knockout mice

Background-In vivo methods to evaluate the size and composition of atherosclerotic lesions in animal models of atherosclerosis would assist in the testing of antiatherosclerotic drugs. We have developed an MRI method of detecting atherosclerotic plaque in the major vessels at the base of the heart in low-density lipoprotein (LDL) receptor-knockout (LDLR-/-) mice on a high-fat diet. Methods and Results-Three-dimensional fast spin-echo magnetic resonance images were acquired at 7 T by use of cardiac and respiratory triggering, with approximate to140-mum isotropic resolution, over 30 minutes. Comparison of normal and fat-suppressed images from female LDLR-/- mice I week before and 8 and 12 weeks after the transfer to a high-fat diet allowed visualization and quantification of plaque development in the innominate artery in vivo. Plaque mean cross-sectional area was significantly greater at week 12 in the LDLR-/- mice (0.14+/-0.086 mm(2) [mean+/-SD]) than in wild-type control mice on a normal diet (0.017+/-0.031 mm(2), p

Correlação entre a depuração plasmática de creatinina utilizando urina coletada durante 24 horas e 12 horas

Introdução: A concentração da creatinina no plasma é usada para avaliar a função renal, mas a depuração da creatinina plasmática (DCP) constitui método mais sensível para essa finalidade. Objetivo: Correlacionar a DCP em coleta urinária de 12 horas noturna com a de 24 horas. Métodos: Noventa e cinco voluntários (34-64 anos) coletaram urina durante 24 horas em dois frascos: diurno (das 7h às 19h) e noturno (das 19h às 7h do dia seguinte). A coleta de sangue se deu em jejum para medidas bioquímicas. A correlação entre as variáveis foi feita pelo teste Pearson (r) e a concordância de medidas, pelo teste de Bland-Altman. Resultados: Urinas de quatro indivíduos foram recusadas por erro de coleta. Na amostra final (n = 91; 42 homens), havia 23 hipertensos e cinco diabéticos. A DCP (mL/min/1,73 m2) foi menor no período noturno em mulheres (77,8 ± 22,7 versus 88,4 ± 23,6; p < 0,05) e similar em homens (91,2 ± 22,9 versus 97,3 ± 30,9; p > 0,05). As correlações entre a DCP na urina de 12 horas noturna ou diurna e a de 24 horas foram fortes (r = 0,85 e 0,83, respectivamente). Em 85 e 83 dos 91 indivíduos, a medida da DCP noturna e diurna, respectivamente, foi concordante com a de 24 horas. Conclusão: A urina de 12 horas, sobretudo quando coletada à noite, fornece valores de DCP similares àqueles obtidos em coleta de 24 horas. Como essa coleta é mais fácil de ser feita em pacientes ambulatoriais à noite, esse período deveria ser preferido para a medida da filtração glomerular.

Análise espacial do padrão de introdução e disseminação da dengue nos municípios do Espírito Santo

O número de municípios infestados pelo Aedes aegypti no Estado do Espírito Santo vem aumentando gradativamente, levando a altas taxas de incidência de dengue ao longo dos anos. Apesar das tentativas de combate à doença, esta se tornou uma das maiores preocupações na saúde pública do Estado. Este estudo se propõe a descrever a dinâmica da expansão da doença no Estado a partir da associação entre variáveis ambientais e populacionais, utilizando dados operacionalizados por meio de técnicas de geoprocessamento. O estudo utilizou como fonte de dados a infestação pelo mosquito vetor e o coeficiente de incidência da doença, as distâncias rodoviárias intermunicipais do Estado, a altitude dos municípios e as variáveis geoclimáticas (temperatura e suficiência de água), incorporadas a uma ferramenta operacional, as Unidades Naturais do Espírito Santo (UNES), representadas em um único mapa operacionalizado em Sistema de Informação Geográfica (SIG), obtido a partir do Sistema Integrado de Bases Georreferenciadas do Estado do Espírito Santo. Para análise dos dados, foi realizada a Regressão de Poisson para os dados de incidência de dengue e Regressão Logística para os de infestação pelo vetor. Em seguida, os dados de infestação pelo mosquito e incidência de dengue foram georreferenciados, utilizando como ferramenta operacional o SIG ArcGIS versão 9.2. Observou-se que a pluviosidade é um fator que contribui para o surgimento de mosquito em áreas não infestadas. Altas temperaturas contribuem para um alto coeficiente de incidência de dengue nos municípios capixabas. A variável distância em relação a municípios populosos é um fator de proteção para a incidência da doença. A grande variabilidade encontrada nos dados, que não é explicada pelas variáveis utilizadas no modelo para incidência da doença, reforça a premissa de que a dengue é condicionada pela interação dinâmica entre muitas variáveis que o estudo não abordou. A espacialização dos dados de infestação pelo mosquito e incidência de dengue e as Zonas Naturais do ES permitiu a visualização da influência das variáveis estatisticamente significantes nos modelos utilizados no padrão da introdução e disseminação da doença no Estado.

Crescimento, teores e acúmulo de nutrientes em plantas de milho fertirrigadas com água residuária do beneficiamento de frutos de café

A cultura do cafeeiro sempre ocupou lugar de destaque na economia do país, dada sua importância na área econômica e social, buscando cada vez mais, um mercado diferenciado, com novas tecnologias para a melhoria da qualidade da bebida. A atividade de lavagem e despolpa de frutos do cafeeiro, necessária para a redução do custo de secagem e a melhoria da qualidade de bebida, é geradora de grandes volumes de resíduos sólidos e líquidos, ricos em material orgânico e inorgânico. A água residuária da atividade de beneficiamento do café (ARC) é gerada anualmente em grande volume no Espírito Santo, e aliado aos nutrientes existentes nesse efluente indica a sua viabilidade de reaproveitamento na fertirrigação de culturas agrícolas. O objetivo do presente trabalho foi avaliar o efeito de diferentes doses de água residuária de café no crescimento, na absorção e interação entre nutrientes e no estado nutricional do milho. Para tanto, foi conduzido um experimento em casa de vegetação utilizando-se o delineamento experimental inteiramente casualizado, onde foram aplicadas 7 doses de ARC, com 3 repetições, em unidades experimentais constituídas por vasos com 2 dm³ de solo. As doses foram equivalentes a 0,00, 15,17, 30,35, 45,52, 60,70, 75,87 e 91,05 litros de ARC por m² de solo. Realizou-se a semeadura de cinco sementes de milho híbrido BR 206 por vaso e cinco dias após a germinação das plantas foi feito o desbaste, mantendo-se três plantas por vaso. Aos trinta dias após a germinação determinou-se o diâmetro do caule (DC), área foliar (AF), matéria seca da parte aérea (MSPA), matéria seca do sistema radicular (MSR), relação parte aérea/raiz (MSPA/MSR), razão massa radicular (matéria seca raiz/matéria seca total) e razão área foliar (área foliar/matéria seca total). Na parte aérea das plantas foi determinado os teores dos macronutrientes (N, P, K, Ca, Mg e S). Os dados foram submetidos a análise de variância e as variáveis em função das doses de ARC submetidas a análise de regressão. Para as variáveis dependentes foi calculado o coeficiente de correlação linear de Pearson. A ARC serviu como fonte de nutrientes para as plantas de milho, aumentou o rendimento da maioria das variáveis de crescimento e os teores de N, K e S. Porém diminuiu o teor de Ca, Mg e P da parte aérea das plantas além de indicar que altas doses promovem desbalanceamento na relação entre nutrientes.

Diferença entre características na formação do preço de venda e locação de imóveis na cidade de Vitória/ES

Essa dissertação estuda as características relevantes na formação do preço de venda e aluguel, analisando também as diferenças entre esses atributos para apartamentos na cidade de Vitória/ES, preenchendo uma lacuna ainda não desenvolvida, tendo em vista a possibilidade de comparação entre preços de aluguel e venda. O constructo teórico teve como fundamento abordagem de preços hedônicos, aplicada em estudos de Waugh (1928) e Court (1939), mas formalmente desenvolvida teoricamente por Lancaster (1966) e Rosen (1974), e aplicadas e discutidas por Palmquist (1984) e Sheppard (1999). A revisão de literatura mostra que existe impactos tanto em relação aos aspectos físicos dos imóveis, como características externas, como violência, facilidade de acesso, ou presença de estações de trens ou mercados no entorno, dentre outras. A amostra partiu de uma listagem de oferta de imóveis no site da Netimóveis durante os meses de maio e junho de 2014, contando com um número de 563 observações para venda e 185 para locação. Além dessas duas amostras, foram elaboradas análises com relação a subamostras que possuíam a variável valor do condomínio, buscando ampliar as variáveis explicativas coletadas. A análise dos resultados foi feita com utilização da estatística descritiva, correlação entre variáveis e regressão múltipla, sendo essa última aplicada nos 6 modelos propostos para cada amostra, posteriormente propondo um modelo final para venda e aluguel. No que tange as hipóteses utilizadas e aplicadas nos modelos, parte delas foram utilizadas tendo em base estudos prévios, e outras, como o sol da manhã, por exemplo, foram apresentadas como propostas. Dos resultados encontrados, muitos corroboraram com estudos anteriores, confirmando que variáveis como área, vagas na garagem, varanda, anda e posição de frente da unidade, piscina e localização em bairros nobres impactam positivamente no preço dos imóveis, independente se venda ou aluguel. Como diferenças, foi possível identificar que as variáveis presença de elevador, playground e valor do condomínio participam positivamente da explicação do preço de venda, enquanto, presença de quadra, mobília e sol da manhã explicam positivamente o valor do aluguel na amostra.

Variations of the soft tissue thicknesses external to the ribs in Pectus Excavatum patients

Background: Surgical repair of pectus excavatum (PE) has become more popular due to improvements in the minimally invasive Nuss procedure. The pre-surgical assessment of PE patients requires Computerized Tomography (CT), as the malformation characteristics vary from patient to patient. Objective: This work aims to characterize soft tissue thickness (STT) external to the ribs among PE patients. It also presents a comparative analysis between the anterior chest wall surface before and after surgical correction. Methods: Through surrounding tissue segmentation in CT data, STT values were calculated at different lines along the thoracic wall, with a reference point in the intersection of coronal and median planes. The comparative analysis between the two 3D anterior chest surfaces sets a surgical correction influence area (SCIA) and a volume of interest (VOI) based on image processing algorithms, 3D surface algorithms, and registration methods. Results: There are always variations between left and right side STTs (2.54±2.05 mm and 2.95±2.97 mm for female and male patients, respectively). STTs are dependent on age, sex, and body mass index of each patient. On female patients, breast tissue induces additional errors in bar manual

Variations of the soft tissue thicknesses external to the ribs in pectus excavatum patients

Background: Surgical repair of pectus excavatum (PE) has become more popular due to improvements in the minimally invasive Nuss procedure. The pre-surgical assessment of PE patients requires Computerized Tomography (CT), as the malformation characteristics vary from patient to patient. Objective: This work aims to characterize soft tissue thickness (STT) external to the ribs among PE patients. It also presents a comparative analysis between the anterior chest wall surface before and after surgical correction. Methods: Through surrounding tissue segmentation in CT data, STT values were calculated at different lines along the thoracic wall, with a reference point in the intersection of coronal and median planes. The comparative analysis between the two 3D anterior chest surfaces sets a surgical correction influence area (SCIA) and a volume of interest (VOI) based on image processing algorithms, 3D surface algorithms, and registration methods. Results: There are always variations between left and right side STTs (2.54±2.05 mm and 2.95±2.97 mm for female and male patients, respectively). STTs are dependent on age, sex, and body mass index of each patient. On female patients, breast tissue induces additional errors in bar manual

Are air-borne mycotoxins a public health concern in Portugal?

Introduction - Microscopic filamentous fungi, under suitable environmental conditions, can lead to the production of highly toxic chemical substances, commonly known as mycotoxins. The most widespread and studied mycotoxins are metabolites of some genera of moulds such as Aspergillus, Penicillium and Fusarium. Quite peculiar conditions may influence mycotoxin biosynthesis, such as climate, geographical location, cultivation practices, storage and type of substrate. Toxicity has been extensively investigated for the most important mycotoxins, such as aflatoxins, ochratoxin A and Fusarium toxins, and much information derived from toxicokinetics in animal models has also been obtained. The adverse effects are mainly related to genotoxicity, carcinogenicity, mutagenicity, teratogenicity and immunotoxicity. Aim of the study - To identify fungal species able to produce important mycotoxins in different Portuguese settings.

Relevance of physicochemical characterization in nanotoxicology studies

Nanomaterials (NMs) with the same chemistry can greatly differ by size, surface area, shape, stability, rigidness, coating or electrical charge and these characteristics affect nano-bio interactions, leading to different toxic potential. In this communication is shown that closely related NMs can have different genotoxic effects, evidencing the importance of investigating the toxic potential of each NM individually, instead of assuming a common mechanism and equal genotoxic effects for a set of similar NMs. The importance of considering complexity of in vivo systems in nanotoxicology, such as the use of tridimensional cellular models, air-liquid interface exposure or in vivo models that mimic human routes of exposure, is underlined.

Probabilistic linkage in household survey on hospital care usage

OBJECTIVE: To evaluate the potential advantages and limitations of the use of the Brazilian hospital admission authorization forms database and the probabilistic record linkage methodology for the validation of reported utilization of hospital care services in household surveys. METHODS: A total of 2,288 households interviews were conducted in the county of Duque de Caxias, Brazil. Information on the occurrence of at least one hospital admission in the year preceding the interview was obtained from a total of 10,733 household members. The 130 records of household members who reported at least one hospital admission in a public hospital were linked to a hospital database with 801,587 records, using an automatic probabilistic approach combined with an extensive clerical review. RESULTS: Seventy-four (57%) of the 130 household members were identified in the hospital database. Yet only 60 subjects (46%) showed a record of hospitalization in the hospital database in the study period. Hospital admissions due to a surgery procedure were significantly more likely to have been identified in the hospital database. The low level of concordance seen in the study can be explained by the following factors: errors in the linkage process; a telescoping effect; and an incomplete record in the hospital database. CONCLUSIONS: The use of hospital administrative databases and probabilistic linkage methodology may represent a methodological alternative for the validation of reported utilization of health care services, but some strategies should be employed in order to minimize the problems related to the use of this methodology in non-ideal conditions. Ideally, a single identifier, such as a personal health insurance number, and the universal coverage of the database would be desirable.