Arrhythmogenic cardiomyopathy of the right ventricle. Predictive value of QT interval dispersion to assess arrhythmogenic risk and sudden death

OBJECTIVE: To determine in arrhythmogenic right ventricular cardiomyopathy the value of QT interval dispersion for identifying the induction of sustained ventricular tachycardia in the electrophysiological study or the risk of sudden cardiac death. METHODS: We assessed QT interval dispersion in the 12-lead electrocardiogram of 26 patients with arrhythmogenic right ventricular cardiomyopathy. We analyzed its association with sustained ventricular tachycardia and sudden cardiac death, and in 16 controls similar in age and sex. RESULTS: (mean ± SD). QT interval dispersion: patients = 53.8±14.1ms; control group = 35.0±10.6ms, p=0.001. Patients with induction of ventricular tachycardia: 52.5±13.8ms; without induction of ventricular tachycardia: 57.5±12.8ms, p=0.420. In a mean follow-up period of 41±11 months, five sudden cardiac deaths occurred. QT interval dispersion in this group was 62.0±17.8, and in the others it was 51.9±12.8ms, p=0.852. Using a cutoff > or = 60ms to define an increase in the degree of the QT interval dispersion, we were able to identify patients at risk of sudden cardiac death with a sensitivity of 60%, a specificity of 57%, and positive and negative predictive values of 25% and 85%, respectively. CONCLUSION: Patients with arrhythmogenic right ventricular cardiomyopathy have a significant increase in the degree of QT interval dispersion when compared with the healthy population. However it, did not identify patients with induction of ventricular tachycardia in the electrophysiological study, showing a very low predictive value for defining the risk of sudden cardiac death in the population studied.

Diagnostic value of the tilt-table test for the assessment of syncope in children and adolescents

OBJECTIVE - To assess the diagnostic value, the characteristics, and feasibility of tilt-table testing in children and adolescents. METHODS - From August 1991 to June 1997, we retrospectively assessed 94 patients under the age of 18 years who had a history of recurring syncope and presyncope of unknown origin and who were referred for tilt-table testing. These patients were divided into 2 groups: group I (children) - 36 patients with ages ranging from 3 to 12 (mean of 9.19±2.31) years; group II (adolescents) - 58 patients with ages ranging from 13 to 18 (mean of 16.05±1.40) years. We compared the positivity rate, the type of hemodynamic response, and the time period required for the test to become positive in the 2 groups. RESULTS - The positivity rates were 41.6 % and 50% for groups I and II, respectively. The pattern of positive hemodynamic response that predominated in both groups was the mixed response. The mean time period required for the test to become positive was shorter in group I (11.0±7.23 min) than in group II (18.44±7.83 min). No patient experienced technical difficulty or complications. CONCLUSION - No difference was observed in regard to feasibility, positivity rate, and pattern of positive response for the tilt-table test in children and adolescents. Pediatric patients had earlier positive responses.

Lipid metabolism in rats fed diets containing different types of lipids

OBJECTIVE: To assess the effect of different types of lipid diets on the lipid metabolism of aging rats. METHODS: Fifty male Wistar rats were studied from the time of weaning to 12 and 18 months of age. Their diets were supplemented as follows: with soybean oil (S), canola oil (CA), lard and egg yolk (LE), and canola oil + lard and egg yolk (CA + LE). Blood pressure (BP) was measured every month, and the heart/body ratio (H/BR) was determined. The rats were euthanized at the age of 12 and 18 months, and blood samples were collected for lipid analysis as follows: total cholesterol (TC), LDL-C, VLDL-C, HDL-C, triglycerides (TG), and glucose. RESULTS: The type of oil ingested by the animals significantly altered BP, H/BR, and serum lipid levels in rats at 12 and 18 months. No difference was observed in the survival curve of the animals in the different groups. The LE group had the highest BP, and the CA group was the only one in which BP did not change with aging. A reduction in the H/BR was observed in the LE and CA+LE animals. At the age of 12 months, differences in TC, HDL-C, LDL-C, VLDL-C, TG, and glucose were observed. At the age of 18 months, a significant difference in TC, HDL-C, and glucose was observed. The highest TC value was found in the CA group and the lowest in the S group. CONCLUSION: No increase in BP occurred, and an improvement was evident in the lipid profile of rats fed a diet supplemented with CA, in which an elevation in HDL-C levels was observed, as compared with levels with the other types of diet.

Cultural circuits of climate change in U.K. broadsheet newspapers, 1985–2003

This article argues for a cultural perspective to be brought to bear on studies of climate change risk perception. Developing the “circuit of culture” model, the article maintains that the producers and consumers of media texts are jointly engaged in dynamic, meaning-making activities that are context-specific and that change over time. A critical discourse analysis of climate change based on a database of newspaper reports from three U.K. broadsheet papers over the period 1985–2003 is presented. This empirical study identifies three distinct circuits of climate change—1985–1990, 1991–1996, 1997–2003—which are characterized by different framings of risks associated with climate change. The article concludes that there is evidence of social learning as actors build on their experiences in relation to climate change science and policy making. Two important factors in shaping the U.K.’s broadsheet newspapers’ discourse on “dangerous” climate change emerge as the agency of top political figures and the dominant ideological standpoints in different newspapers.

Incorporation of hybrid phase change materials in plastering mortars for increased energy efficiency in buildings

Tese de Doutoramento em Engenharia Civil.

Exploitation of Ashbya gossypii for the production of high-value products from glycerol feedstocks

Dissertação de mestrado em Bioengenharia

Prognostic value of technetium-99m-labeled single-photon emission computerized tomography in the follow-up of patients after their first myocardial revascularization surgery

OBJECTIVE: To assess the prognostic value of Technetium-99m-labeled single-photon emission computerized tomography (SPECT) in the follow-up of patients who had undergone their first myocardial revascularization. METHODS: We carried out a retrospective study of 280 revascularized patients undergoing myocardial scintigraphy under stress (exercise or pharmacological stress with dipyridamole) and at rest according to a 2-day protocol. A set of clinical, stress electrocardiographic and scintigraphic variables was assessed. Cardiac events were classified as "major" (death, infarction, unstable angina) and "any" (major event or coronary angioplasty or new myocardial revascularization surgery). RESULTS: Thirty-six major events occurred as follows: 3 deaths, 11 infarctions, and 22 unstable anginas. In regard to any event, 22 angioplasties and 7 new surgeries occurred in addition to major events, resulting a total of 65 events. The sensitivity of scintigraphy in prognosticating a major event or any event was, respectively, 55% and 58%, showing a negative predictive value of 90% and 83%, respectively. Diabetes mellitus, inconclusive stress electrocardiography, and a scintigraphic visualization of left ventricular enlargement were significant variables for the occurrence of a major event. On multivariate analysis, abnormal myocardial scintigraphy was a predictor of any event. CONCLUSION: Myocardial perfusion tomography with Technetium-99m may be used to identify high-risk patients after their first myocardial revascularization surgery.

Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease

OBJECTIVE: To determine the value of the radiological study of the thorax for diagnosing left ventricular dilation and left ventricular systolic dysfunction in patients with Chagas' disease. METHODS: A cross-sectional study of 166 consecutive patients with Chagas' disease and no other associated diseases. The patients underwent cardiac assessment with chest radiography and Doppler echocardiography. Sensitivity, specificity, and positive and negative predictive values of chest radiography were calculated to detect left ventricular dysfunction and the accuracy of the cardiothoracic ratio in the diagnosis of left ventricular dysfunction with the area below the ROC curve. The cardiothoracic ratio was correlated with the left ventricular ejection fraction and the left ventricular diastolic diameter. RESULTS: The abnormal chest radiogram had a sensitivity of 50%, specificity of 80.5%, and positive and negative predictive values of 51.2% and 79.8%, respectively, in the diagnosis of left ventricular dysfunction. The cardiothoracic ratio showed a weak correlation with left ventricular ejection fraction (r=-0.23) and left ventricular diastolic diameter (r=0.30). The area calculated under the ROC curve was 0.734. CONCLUSION: The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with Chagas' disease should be reevaluated.

A change in the treatment of abdominal aortic aneurysms

OBJECTIVE: One of the most exciting potential applications of percutaneous therapy is the treatment of abdominal aneurysms. METHODS: Of 230 patients treated with a self-expanding polyester-lined stent-graft for different aortic pathologies at our institution, we selected 80 abdominal aneurysm cases undergoing treatment (from May 1997 to December 2002). The stent was introduced through the femoral artery, in the hemodynamic laboratory, with the patient under general anesthesia, with systemic heparinization, and induced hypotension. RESULTS: The procedure was successful in 70 (92.9%) cases; 10 patients with exclusion of abdominal aortic aneurysms were documented immediately within the hemodynamic room and 5 patients persisted with a residual leak. Two surgical conversions were necessary. Additional stent-grafts had to be inserted in 3 (3.7%) cases. In the follow-up, 91.4% of patients were alive at a mean follow-up of 15.8 months. CONCLUSION: We believe that stent-grafts are an important tool in improving the treatment of abdominal aneurysms, and this new policy may change the conventional medical management of these patients.

Procesos de cambio en la cultura jurídica: análisis desde la experiencia del juicio por jurados. Processes of change in the Legal Culture: Analysis from the Experience of Jury Trials.

El presente proyecto de investigación se orienta a analizar la institución del juicio por jurados, considerada como un punto estratégico para la observación de los procesos de cambio que recorren la cultura jurídica en Argentina. Frente a las múltiples transformaciones y a los intensos procesos de reestructuración de las relaciones sociales observados en el contexto latinoamericano y especialmente en Argentina, la necesidad de reconstruir la legitimidad de los jueces ante la opinión pública se ha vuelto impostergable, y el recurso a la participación popular en el campo judicial aparece como un instrumento útil para ello. Analizar la efectividad de esta estrategia para la legitimación del poder judicial es uno de los objetivos del presente proyecto de investigación. Abordar dicho objetivo implica, indagar en la relación entre la administración de justicia y diferentes actores sociales, especialmente los miembros de la profesión jurídica y la opinión pública.Se explora igualmente la contradicción entre el hecho de que esta institución, nacida para atenuar la dureza de los castigos, se ha implementado recientemente en la provincia de Córdoba en la situación inversa. El modo en que la tensión entre el espíritu garantista de los jueces y la demanda de castigos de los ciudadanos comunes se manejará en la práctica de los juicios por jurado, y su incidencia en el éxito de las estrategias legitimadoras del poder judicial, aparece como una cuestión relevante para el análisis que se propone. Con la utilización de diferentes fuentes de información cuantitativas y cualitativas, se espera que el análisis de la implementación del juicio penal con jurados populares en la provincia de Córdoba propuesto en el presente proyecto, contribuya a documentar los niveles de articulación entre la cultura jurídica interna y externa.

Dispersión agrícola y cambio social en las Sierras de Córdoba (ca. 1000 a C.- 1600 d C.) Agricultural spread and social change in Córdoba Hills (ca. 1000 b C- 1600 a D.)

El proceso cultural en las Sierras de Córdoba fue habitualmente concebido como marginal con respecto al Noroeste Argentino. Tras el establecimiento del esquema básico de la secuencia prehispánica, a mediados del siglo pasado, se definió una etapa agroalfarera de cronología tardía, que continuaba a una extensa etapa precerámica cuyos límites se aproximaban a la transición Pleistoceno-Holoceno. Se hacía referencia, de este modo, al advenimiento de un modo de vida agrícola y aldeano, que reemplazaba a otro basado en la caza y recolección. Dicha transformación, alternativamente atribuida a la población cazadora local o a una migración de grupos agricultores desde regiones vecinas, se habría consumado hacia 1500 AP, fijando uno de los límites de la dispersión de la agricultura andina. Es necesario destacar la extremada escasez y el carácter indirecto de las evidencias arqueológicas utilizadas para sustentar la ocurrencia de tal proceso. Asimismo, la vigencia de supuestos que han comenzado a mostrar inconsistencias con los resultados de las recientes investigaciones. Entre ellos, principalmente, el que asume que la introducción de la agricultura dio paso a una transformación radical de las sociedades prehispánicas, constituyendo un hito fundamental en su devenir histórico, el comienzo de una nueva etapa. Nuestros últimos estudios en el sector central de las Sierras de Córdoba apuntaron, entre otros objetivos, a reconocer indicadores arqueológicos directos de producción agrícola, así como de la manipulación y consumo de plantas cultivadas. Los primeros resultados nos permiten vislumbrar un escenario complejo que desafía los modelos vigentes. El consumo de maíz, por ejemplo, parece haber antecedido por muchos siglos a la adopción de prácticas agrícolas. El acceso a este cultígeno, sumado a otros elementos, indicaría cambios entre los cazadores-recolectores serranos, promovidos por su integración en redes macrorregionales que los vincularon con sociedades agricultoras de la vertiente oriental andina y quizás del Chaco Santiagueño, por lo menos desde 2500 AP. En definitiva, la agricultura no parece haber sido adoptada rápidamente ni provocado transformaciones profundas e inmediatas en la organización de los grupos prehispánicos. Se ha observado, por el contrario, la incorporación gradual de distintas innovaciones que incluso permiten relacionar la manipulación y más tarde el cultivo de plantas domesticadas, con procesos de intensificación productiva de mayor escala temporal. Uno de nuestros objetivos en este proyecto consiste, básicamente, en profundizar las investigaciones en curso a fin de ampliar el cuerpo de datos con el cual analizar y discutir el problema de la dispersión agrícola en la región. Ello implica el tratamiento de diferentes líneas de evidencia, en particular: 1) la distribución regional de sitios arqueológicos y las modalidades de ocupación de las tierras cultivables; 2) la búsqueda de superficies de cultivo en sitios estratificados; y 3) estudios arqueobotánicos, polínicos y de isótopos estables. Se entiende que no le corresponde a la arqueología asumir apriorísticamente el significado histórico de la introducción de la agricultura, sino establecerlo en cada caso puntual a través de la investigación concreta. Nuestro segundo objetivo consiste, por lo tanto, en delinear los cambios (económicos, tecnológicos, políticos, sociales) que acompañaron al proceso de dispersión agrícola. Ello implica el tratamiento de diferentes problemas, entre otros: 1) las prácticas de apropiación de los recursos silvestres; 2) la continuidad y cambio tecnológico; 3) la movilidad y la articulación microambiental; y 4) los aspectos políticos y sociales ligados a prácticas como la molienda grupal y la producción del arte rupestre. The radical chage of societies from hunter-gatherers to farmers in 1500 BP was considered a milestone whitin the cultural process of pre-hispanic societies in Cordoba Hill. But there is a shortage of archaeological remains to support this change and there are weak hypotheses of absolute transformations. During the last years, our studies carried out on the central area of Cordoba Hill have tried to recognize direct archaeological signs of agriculture production as well as the handling and consumption of crops. The first results show a complex set that challenges the current theoretical models. For example, the corn was probably eatten prior to its adoption for farm practices. Our first main consists in increasing a corpus of data about the spread of agriculture in Cordoba region that we have been researching for the last years. These researches involve different lines of evidence: 1-regional location of archaeological sites and kinds of occupation on cultivable lands; 2-the search for plots at archaeological sites; 3-archaeobotanical, pollen and stable isotopes studies. Our second main consists in outlining changes within the spread of agriculture. It implies to considering different problems: 1-the practices to gatherer wild resources; 2-the continuity and changes of technologies; 3-the mobility and the articulation on the micro-environment; 4-political and social aspects in connection with activities such as groupal grinding and rock art productions.

El valor razonable como concepto vinculado a la pertinencia del valor. Fair value as a concept related to value relevance.

IDENTIFICACIÓN Y CARACTERIZACIÓN DEL PROBLEMA - HIPÓTESIS Según la NIC 39, el valor razonable es la cantidad por la que puede ser intercambiado un activo o cancelado un pasivo entre un comprador y un vendedor interesados y debidamente informados, en condiciones de independencia mutua. La definición del FASB (SFAC 7) es muy similar, y define el valor razonable como el monto mediante el que un activo podría ser enajenado en una transacción entre partes independientes, dispuestas a realizar la operación en situaciones diferentes a la de una liquidación o a la de una venta forzada. Puede apreciarse que esta definición de valor razonable es limitada porque, a excepción de escenarios que se correspondan con mercados perfectos y completos, el concepto puede abarcar valores de entrada, valores de salida y valores en uso, los cuales pueden ser muy diferentes (Beaver, 1987). El valor de entrada es el valor de adquisición o de reemplazo, el valor de salida es el precio al cual un activo puede ser vendido o liquidado, y el valor en uso es el valor incremental de una empresa atribuible a un activo (se correspondería con el valor presente mencionado anteriormente). Dado que el IASB y la FASB se ocupan de la valuación de activos que una empresa posee, y no de activos que serán adquiridos en un futuro, su definición de valor razonable debería ser interpretada desde la perspectiva del vendedor. Por lo tanto, el concepto de valor razonable que manejan el IASB y la FASB se asemeja a un valor de salida, tal como lo propusieron Chambers y Stirling hace bastantes años atrás.Planteado esto, lo que tratará de dilucidar este proyecto de investigación es si este concepto de valor razonable es realmente novedoso o es una simple regresión a los valores corrientes de salida defendidos por los autores de la década del setenta. OBJETIVOS GENERALES Y ESPECÍFICOS General Analizar si el concepto “valor razonable” tal como es definido por la normativa actual se corresponde con una definición novedosa o es una adaptación/modificación/regresión de conceptos ya existentes (valores corrientes de salida). Específicos Revisar la literatura específica desde el punto de vista de la teoría contable y las normas de las que dispone la profesión referidas a los siguientes aspectos: a) Valores corrientes b) Valor razonable MATERIALES Y MÉTODOS El análisis que se llevará a cabo comprenderá dos aspectos. El primero consiste en la revisión de la doctrina contable. Para ello se analizará bibliografía significativa y trabajos de eventos académicos relacionados con el valor razonable. En segundo término se revisará la normativa profesional a nivel nacional e internacional. Después de concluido con los pasos anteriores se analizará la novedad del concepto valor razonable y su semejanza con el valor corriente de salida planteado por los autores de la década del setenta. IMPORTANCIA DEL PROYECTO – IMPACTO Se pretende revisar si el concepto valor razonable planteado por la normativa actual resulta realmente novedoso o es una adaptación de viejos conceptos planteados en la década del setenta del siglo pasado. El proyecto resulta importante porque es un tema no desarrollado en la literatura, ni planteado en congresos. Se estima lograr material de publicación y presentación en eventos académicos. According to the NIC 39, fair value is the quantity for the one that can be exchanged an asset or cancelled a liability between a buyer and a seller interested and due informed, in conditions of mutual independence. The definition of the FASB (SFAC 7) is very similar, and defines fair value as the amount by means of which an assets might be alienated in a transaction between independent parts, ready to realize the operation in situations different from that of a liquidation or to that of a forced sale. This definition of reasonable value is limited because, with the exception of scenes that fit with perfect and complete markets, the concept can include values of entry, values of exit and values in use, which can be very different (Beaver, 1987). The value of entry is the value of acquisition or of replacement, the value of exit is the price to which an asset can be sold or liquidated, and the value in use is the incremental value of a company attributable to an asset. Provided that the IASB and the FASB deal with the appraisal of assets that a company possesses, and not of assets that will be acquired in a future, this definition of fair value should be interpreted from the perspective of the seller. Therefore, the concept of reasonable value that they handle the IASB and the FASB is alike a value of exit, as Chambers and Stirling proposed it enough years ago behind. We will review if the concept of "fair value" is really new or if it is an adaptation of old concepts.

What value can be attached to a concept of mystery and has it a place in contemporary Western culture?

The idea for this thesis arose from a chain of reactions first set in motion by a particular experience. In keeping with the contemporary need to deconstruct every phenomenon it seemed important to analyse this experience in the hope of a satisfactory explanation. The experience referred to is the aesthetic experience provoked by works of art. The plan for the thesis involved trying to establish whether the aesthetic experience is unique and individual, or whether it is one that is experienced universally. Each question that arises in the course of this exploration promotes a dialectical reaction. I rely on the history of aesthetics as a philosophical discipline to supply the answers. This study concentrates on the efforts by philosophers and critical theorists to understand the tensions between the empirical and the emotional, the individual and the universal responses to the sociological, political and material conditions that prevail and are expressed through the medium of art. What I found is that the history of aesthetics is full of contradictory evidence and cannot provide a dogmatic solution to the questions posed. In fact what is indicated is that the mystery that attaches to the aesthetic experience is one that can also apply to the spiritual or transcendent experience. The aim of this thesis is to support the contribution of visual art in the spiritual well being of human development and supports the uniqueness of the evaluation and aesthetic judgement by the individual of a work of art. I suggest that mystery will continue to be of value in the holistic development of human beings and this mystery can be expressed through visual art. Furthermore, this thesis might suggest that what could be looked at is whether a work of art may be redemptive in its affect and offset the current decline in affective religious practice.

Investigating the long term planning framework for the Galway Bay community from climate change.

This research looked at the scientific evidence available on climate change and in particular, projections on sea level rise which ranged from 0.5m to 2m by the end of the century. These projections were then considered in an Irish context. A review of current policy in Ireland revealed that there was no dedicated Government policy on climate change or coastal zone management. In terms of spatial planning policy, it became apparent that there was little or no guidance on climate change either at a national, regional or local level. Therefore, to determine the likely impacts of sea level rise in Ireland based on current spatial planning practice and policy, a scenario-building exercise was carried out for two case study areas in Galway Bay. The two case study areas were: Oranmore, a densely populated town located to the east of Inner Galway Bay; and Tawin Island, a rural dispersed community, located to the south east of Inner Galway Bay. A ‘best’ and ‘worse’ case scenario was envisaged for both areas in terms of sea level rise. In the absence of specific climate change policies it was projected that in the ‘best’ case scenario of 0.5m sea level rise, Tawin Island would suffer serious and adverse impacts while Oranmore was likely to experience slight to moderate impacts. However, in the ‘worse’ case scenario of a 2m sea level rise, it was likely that Tawin Island would be abandoned while many houses, businesses and infrastructure built within the floodplain of Oranmore Bay would be inundated and permanently flooded. In this regard, it was the author’s opinion that a strategic and integrated climate change policy and adaptation plan is vital for the island of Ireland that recognises the importance of integrated land use and spatial planning in terms of mitigation and adaptation to climate change.