Resistant hypertension: what the cardiologist needs to know.

Treatment-resistant hypertension (TRH) affects between 3 and 30% of hypertensive patients, and its presence is associated with increased cardiovascular morbidity and mortality. Until recently, the interest on these patients has been limited, because providing care for them is difficult and often frustrating. However, the arrival of new treatment options [i.e. catheter-based renal denervation (RDN) and baroreceptor stimulation] has revitalized the interest in this topic. The very promising results of the initial uncontrolled studies on the blood pressure (BP)-lowering effect of RDN in TRH seemed to suggest that this intervention might represent an easy solution for a complex problem. However, subsequently, data from controlled studies have tempered the enthusiasm of the medical community (and the industry). Conversely, these new studies emphasized some seminal aspects on this topic: (i) the key role of 24 h ambulatory BP and arterial stiffness measurement to identify 'true' resistant patients; (ii) the high prevalence of secondary hypertension among this population; and (iii) the difficulty to identify those patients who may profit from device-based interventions. Accordingly, for those patients with documented TRH, the guidelines suggest to refer them to a hypertension specialist/centre in order to perform adequate work-up and treatment strategies. The aim of this review is to provide guidance for the cardiologist on how to identify patients with TRH and elucidate the prevailing underlying pathophysiological mechanism(s), to define a strategy for the identification of patients with TRH who may benefit from device-based interventions and discuss results and limitations of these interventions, and finally to briefly summarize the different drug-based treatment strategies.

Acute and Chronic Altitude-Induced Cognitive Dysfunction in Children and Adolescents.

OBJECTIVE To assess whether exposure to high altitude induces cognitive dysfunction in young healthy European children and adolescents during acute, short-term exposure to an altitude of 3450 m and in an age-matched European population permanently living at this altitude. STUDY DESIGN We tested executive function (inhibition, shifting, and working memory), memory (verbal, short-term visuospatial, and verbal episodic memory), and speed processing ability in: (1) 48 healthy nonacclimatized European children and adolescents, 24 hours after arrival at high altitude and 3 months after return to low altitude; (2) 21 matched European subjects permanently living at high altitude; and (3) a matched control group tested twice at low altitude. RESULTS Short-term hypoxia significantly impaired all but 2 (visuospatial memory and processing speed) of the neuropsychological abilities that were tested. These impairments were even more severe in the children permanently living at high altitude. Three months after return to low altitude, the neuropsychological performances significantly improved and were comparable with those observed in the control group tested only at low altitude. CONCLUSIONS Acute short-term exposure to an altitude at which major tourist destinations are located induces marked executive and memory deficits in healthy children. These deficits are equally marked or more severe in children permanently living at high altitude and are expected to impair their learning abilities.

Effect of calf purchase and other herd-level risk factors on mortality, unwanted early slaughter, and use of antimicrobial group treatments in Swiss veal calf operations.

The objective of this survey was to determine herd level risk factors for mortality, unwanted early slaughter, and metaphylactic application of antimicrobial group therapy in Swiss veal calves in 2013. A questionnaire regarding farm structure, farm management, mortality and antimicrobial use was sent to all farmers registered in a Swiss label program setting requirements for improved animal welfare and sustainability. Risk factors were determined by multivariable logistic regression. A total of 619 veal producers returned a useable questionnaire (response rate=28.5%), of which 40.9% only fattened their own calves (group O), 56.9% their own calves and additional purchased calves (group O&P), and 2.3% only purchased calves for fattening (group P). A total number of 19,077 calves entered the fattening units in 2013, of which 21.7%, 66.7%, and 11.6% belonged to groups O, O&P, and P, respectively. Mortality was 0% in 322 herds (52.0%), between 0% and 3% in 47 herds (7.6%), and ≥3% in 250 herds (40.4%). Significant risk factors for mortality were purchasing calves, herd size, higher incidence of BRD, and access to an outside pen. Metaphylaxis was used on 13.4% of the farms (7.9% only upon arrival, 4.4% only later in the fattening period, 1.1% upon arrival and later), in 3.2% of the herds of group O, 17.9% of those in group O&P, and 92.9% of those of group P. Application of metaphylaxis upon arrival was positively associated with purchase (OR=8.9) and herd size (OR=1.2 per 10 calves). Metaphylaxis later in the production cycle was positively associated with group size (OR=2.9) and risk of respiratory disease (OR=1.2 per 10% higher risk) and negatively with the use of individual antimicrobial treatment (OR=0.3). In many countries, purchase and a large herd size are inherently connected to veal production. The Swiss situation with large commercial but also smaller herds with little or no purchase of calves made it possible to investigate the effect of these factors on mortality and antimicrobial drug use. The results of this study show that a system where small farms raise the calves from their own herds has a substantial potential to improve animal health and reduce antimicrobial drug use.

Antimicrobial drug use and risk factors associated with treatment incidence and mortality in Swiss veal calves reared under improved welfare conditions

Ninety-one Swiss veal farms producing under a label with improved welfare standards were visited between August and December 2014 to investigate risk factors related to antimicrobial drug use and mortality. All herds consisted of own and purchased calves, with a median of 77.4% of purchased calves. The calves' mean age was 29±15days at purchasing and the fattening period lasted at average 120±28 days. The mean carcass weight was 125±12kg. A mean of 58±33 calves were fattened per farm and year, and purchased calves were bought from a mean of 20±17 farms of origin. Antimicrobial drug treatment incidence was calculated with the defined daily dose methodology. The mean treatment incidence (TIADD) was 21±15 daily doses per calf and year. The mean mortality risk was 4.1%, calves died at a mean age of 94±50 days, and the main causes of death were bovine respiratory disease (BRD, 50%) and gastro-intestinal disease (33%). Two multivariable models were constructed, for antimicrobial drug treatment incidence (53 farms) and mortality (91 farms). No quarantine, shared air space for several groups of calves, and no clinical examination upon arrival at the farm were associated with increased antimicrobial treatment incidence. Maximum group size and weight differences >100kg within a group were associated with increased mortality risk, while vaccination and beef breed were associated with decreased mortality risk. The majority of antimicrobial treatments (84.6%) were given as group treatments with oral powder fed through an automatic milk feeding system. Combination products containing chlortetracycline with tylosin and sulfadimidine or with spiramycin were used for 54.9%, and amoxicillin for 43.7% of the oral group treatments. The main indication for individual treatment was BRD (73%). The mean age at the time of treatment was 51 days, corresponding to an estimated weight of 80-100kg. Individual treatments were mainly applied through injections (88.5%), and included administration of fluoroquinolones in 38.3%, penicillines (amoxicillin or benzylpenicillin) in 25.6%, macrolides in 13.1%, tetracyclines in 12.0%, 3th and 4th generation cephalosporines in 4.7%, and florfenicol in 3.9% of the cases. The present study allowed for identifying risk factors for increased antimicrobial drug treatment and mortality. This is an important basis for future studies aiming at reducing treatment incidence and mortality in veal farms. Our results indicate that improvement is needed in the selection of drugs for the treatment of veal calves according to the principles of prudent use of antibiotics.

A simulation study on the statistical monitoring of condemnation rates from slaughterhouses for syndromic surveillance: an evaluation based on Swiss data

Syndromic surveillance (SyS) systems currently exploit various sources of health-related data, most of which are collected for purposes other than surveillance (e.g. economic). Several European SyS systems use data collected during meat inspection for syndromic surveillance of animal health, as some diseases may be more easily detected post-mortem than at their point of origin or during the ante-mortem inspection upon arrival at the slaughterhouse. In this paper we use simulation to evaluate the performance of a quasi-Poisson regression (also known as an improved Farrington) algorithm for the detection of disease outbreaks during post-mortem inspection of slaughtered animals. When parameterizing the algorithm based on the retrospective analyses of 6 years of historic data, the probability of detection was satisfactory for large (range 83-445 cases) outbreaks but poor for small (range 20-177 cases) outbreaks. Varying the amount of historical data used to fit the algorithm can help increasing the probability of detection for small outbreaks. However, while the use of a 0·975 quantile generated a low false-positive rate, in most cases, more than 50% of outbreak cases had already occurred at the time of detection. High variance observed in the whole carcass condemnations time-series, and lack of flexibility in terms of the temporal distribution of simulated outbreaks resulting from low reporting frequency (monthly), constitute major challenges for early detection of outbreaks in the livestock population based on meat inspection data. Reporting frequency should be increased in the future to improve timeliness of the SyS system while increased sensitivity may be achieved by integrating meat inspection data into a multivariate system simultaneously evaluating multiple sources of data on livestock health.

A sex difference in seasonal timing of birth in a livebearing fish

Sex differences in seasonal timing include differences in hatch- or birth-date distribution and differences in the timing of migration or maturation such as protandrous arrival timing (PAT), which is early male arrival at breeding sites. I describe a novel form of protandrous arrival timing, as a sex difference in birth-date distribution in a live-bearing fish (Dwarf Perch, Micrometrus minimus). In this species, birth coincides with arrival at breeding sites because newborn males are sexually active. A series of samples of pregnant females and young of year was collected in Tomales Bay, CA. I analyzed the daily age record in otoliths to estimate the conception date of broods and the age that young-of-year individuals were born. Males were born at a younger age than females, as indicated by the daily age record and also by the predominance of females in broods from which some young had already been born, which was a common occurrence in pregnant females with older embryos. Sex ratio of broods varied with conception date such that early-season broods were predominantly male, possibly as a result of temperature-dependent sex determination. The combined effects of the sex difference in age at birth and seasonal shift in sex ratio were to shift the mean birth date of males relative to females by five days. The most likely ultimate explanation for PAT in the Dwarf Perch is that it arises from exploitation (scramble) competition for mating opportunities among recently-born young-of-year males.

Differences in performance for quality of care indicators for acute myocardial infarction (AMI) across various hospital categories in Texas

The study analyzed Hospital Compare data for Medicare Fee-for-service patients at least 65 years of age to determine whether hospital performance for AMI outcome and processes of care measures differ amongst Texas hospitals with respect to ownership status (for profit vs. not-for-profit), academic status (teaching vs. non-teaching) and geographical setting (rural vs. urban). ^ The study found a statistically significant difference between for-profit and not-for-profit hospitals in four process-of-care measures (aspirin at discharge, P=0.028; ACE or ARB inhibitor for LSVD, P=0.048; Smoking cessation advice: P=0.034; outpatients who got aspirin with 24 hours of arrival in the ED, P=0.044). No significant difference in performance was found between COTH-member teaching and non-teaching hospitals for any of the eight process-of-care measures or the two outcome measures for AMI. The study was unable to compare performance based on geographic setting of hospitals due to lack of sufficient data for rural hospitals. ^ The results of the study suggest that for-profit Texas hospitals might be slightly better than not-for –profit hospitals at providing possible heart attack patients with certain processes of care.^

Comparison of two strategies for the treatment of acute myocardial infarction: In-hospital outcomes analysis

A strategy of pre-hospital reduced dose fibrinolytic administration coupled with urgent coronary intervention (PCI) for patients with STEMI (FAST-PCI) has been found to be superior to primary PCI (PPCI) alone. A coordinated STEMI system-of-care that includes FAST-PCI might offer better outcomes than pre-hospital diagnosis and STEMI team activation followed by PPCI alone. We compared the in-hospital outcomes for patients treated with the FAST-PCI approach with outcomes for patients treated with the PPCI approach during a pause in the FAST-PCI protocol. In-hospital data for 253 STEMI patients (03/2003–12/2009), treated with FAST-PCI protocol were compared to 124 patients (12/2009–08/2011), treated with PPCI strategy alone. In-hospital mortality was the primary endpoint. Stroke, major bleeding, and reinfarction during index hospitalization were secondary endpoints. Comparing the strategies used during the two time intervals, in-hospital mortality was significantly lower with FAST-PCI than with PPCI (2.77% vs. 10.48%, p = 0.0017). Rates of stroke, reinfarction and major bleeding were similar between the two groups. There was a lower frequency of pre- PCI TIMI 0 flow (no patency) seen in patients treated with FAST-PCI compared to the PPCI patients (26.7% vs. 62.7%, p<0.0001). Earlier infarct related artery patency in the FAST-PCI group had a favorable impact on the incidence of cardiogenic shock at hospital admission (FAST-PCI- 3.1% vs. PPCI- 20.9%, p<0.0001). The FAST-PCI strategy was associated with earlier infarct related artery patency and the lower incidence of cardiogenic shock on hospital arrival, as well as with reduced in-hospital mortality among STEMI patients.^

(Table 1) 40Ar-39Ar incremental heating ages for ODP Hole 163-988A basalt and plagioclase

Results of 40Ar-39Ar Ar dating constrain the age of the submerged volcanic succession, part of the seaward-dipping reflector sequence of the Southeast Greenland volcanic rifted margin, recovered during Leg 163. At the 63ºN drilling transect, the fully normally magnetized volcanic units at Holes 989B (Unit 1) and 990A (Units 1 and 2) are dated at 57.1 ± 1.3 Ma and 55.6 ± 0.6 Ma, respectively. This correlates with a common magnetochron, C25n. The underlying, reversely magnetized lavas at Hole 990A (Units 3-13) yield an average age of 55.8 ± 0.7 Ma and may correlate with C25r. The argon data, however, are also consistent with eruption of the lavas at Site 990 during the very earliest portion of C24. If so, the normally polarized units have to be correlated to a cryptochron (e.g., C24r-11 at ~55.57 Ma). The lavas at Holes 989B and 990A have typical oceanic compositions, implying that final plate separation between Greenland and northwest Europe took place at ~56 Ma. The age for Hole 989B lava is younger than expected from the seismic interpretations, posing questions about the structural evolution of the margin. An age of 49.6 ± 0.2 Ma for the basaltic lava at Site 988 (~66ºN) points to the importance of postbreakup tholeiitic magmatism at the rifted margin. Together with results from Leg 152, a virtually complete time frame for ~12 m.y. of pre-, syn-, and postbreakup volcanism during rifted margin evolution in Southeast Greenland can now be assembled. This time frame includes continental type volcanism at ~61-60 Ma, synbreakup volcanism beginning at ~57 Ma, and postbreakup volcanism at ~49.6 Ma. These discrete time windows coincide with distinct periods of tholeiitic magmatism from the onshore East Greenland Tertiary Igneous Province and is consistent with discrete mantle-melting events triggered by plume arrival (~61-60 Ma) under central Greenland, continental breakup (~57-54 Ma), and passage of the plume axis beneath the East Greenland rifted margin after breakup (~50-49 Ma), respectively.

Nuevos movimientos sociales y política : formas emergentes de reivindicación en el contexto de la posmodernidad

Para entender el surgimiento de los llamados nuevos movimientos sociales partiremos del estudio de la posmodernidad. La crisis de los modelos totalizantes de liberación, de los grandes relatos, y de los cambios en la cultura posmoderna, han permitido el advenimiento de identidades locales y grupos fragmentarios de identificación societaria.

Rosalía de Flichman, también escritora

Rosalía L. de Flichman (1908-1992) es conocida en Mendoza sobre todo por su labor pictórica, la que creció y evolucionó desde la década de 1950, tanto en la difusión alcanzada por sus obras, como en los nuevos y diversos estilos transitados por la artista. También su nombre apareció en relatos de viaje a lejanos países publicados en diarios y revistas locales. En 1987 publicó el texto Rojos y blancos, Ucrania, que pertenece por su temática a la Literatura de Inmigración. En el libro, la autora recupera algunos recuerdos de su infancia en Ucrania, narra la huida familiar hacia el Oeste de Europa por causa de los pogromos de zaristas y bolcheviques y, por último, concluye con el viaje y la llegada a la Argentina en 1922. La perspectiva femenina del relato, su entrecruzamiento con la etapa vital por la que atraviesa la protagonista, así como la utilización del color y la luz otorgan a Rojos y blancos. Ucrania un valor literario más allá del puramente testimonial, que sin dudas enriquece la Literatura de Inmigración argentina y, dentro de ella, las letras femeninas de escritoras de origen judío.

Captar lo sensible estéticamente : solución bonaventuriana al reto aristotélico

La llegada del Corpus aristotelicum al mundo occidental suscitó numerosas reacciones, tantas como eran las sensibilidades receptoras. San Buenaventura no es ajeno al pensamiento del Estagirita, y junto a las fuentes patrísticas y bíblicas, los argumentos filosóficos formarán parte en la solución de los problemas. Y si todo el edificio filosófico se vio tocado por la filosofía griega de Aristóteles, y en todo se necesitaba una respuesta, más aún aconteció con el mundo de lo sensible, sobre todo, en los pensadores de la llamada Escuela franciscana, que de una u otra manera manejaron este tema con delicada pericia, toda vez, que el espíritu franciscano reverenciaba la «Hermana naturaleza» y lo sensible como manifestación del Amor de Dios. En especial, nos fijamos en san Buenaventura, y en su esfuerzo por realizar una respuesta original desde las fuentes escolásticas al pensamiento nuevo de la filosofía de la naturaleza aristotélica en el espíritu de Asís. Creemos que es posible realizar una lectura de la epistemología y antropología de la captación de lo sensible en san Buenaventura desde una metafísica-estética de la naturaleza, como alternativa a la filosofía de la naturaleza de corte aristotélico.

Abordaje interdisciplinario a Viaje por los estados del Plata de Hermann Burmeister : parte I : abordaje desde la literatura comparada

Este trabajo es fruto de las lecturas interdisciplinarias del relato de viaje de Hermann Burmeister Viaje por los Estados del Plata" (1861) llevadas a cabo por el subproyecto "iterología mendocina" incluido en el Proyecto Argentino de Literatura Comparada. Los pasajes seleccionados ilustran significativamente la relevancia literaria, histórica y geográfica de la obra. Se trata de los capítulos VIII y IX del mismo, que abarcan el informe del viajero en diligencia desde Río Cuarto (provincia de Córdoba) hasta la descripción de los alrededores de la ciudad de Mendoza a su arribo en marzo de 1857. La particularidad metodológica de cada disciplina se ha preservado con el objetivo común de revelar los múltiples objetivos científicos del autor. Desde el punto de vista de la Literatura Comparada a mi cargo he puesto de relieve la poética del discurso iterológico de Burmeister que a su vez conduce a la valoración intrínsecamente comparatista de historia y geografía, en la configuración poética de la montaña o del estereotipo de /a ciudad de Mendoza como paraíso.

Liberdade - ponto de chegada de uma criação contínua : os portuguez (1814-1826)

Razão de uma escolha: a importância do periódico O Portuguez e do seu redactor João Bernardo da Rocha Loureiro no desencadear da Revolução Liberal portuguesa de 1820, que deu início ao processo que colocou fim à monarquia absoluta e desencadeou a desconstrução do Antigo Regime em Portugal. Nesta panorâmica, e tendo como horizonte de chegada a fruição da liberdade, pode dizer-se que, enquanto sistema de significações colectivas, o imaginário do redactor Rocha Loureiro parece actuar como reacção ao poder dissolvedor da inteligência, como regulador que satisfaz a busca apaixonada de um grupo ou sociedade que persegue a sua identidade da qual a liberdade é elemento constituinte, fundamental e fundamentador. A liberdade define-se pela ausência de limitação às garantias necessárias para o harmonioso desenvolvimento do indivíduo. Antes de mais a liberdade é, na sua essência, uma ausência de limitação, sendo simultaneamente uma determinação positiva e espontânea da vontade de liberdade em que cada um procura atingir o fim racional de que está possuído. O indivíduo deseja a liberdade com vista a alcançar o melhor possível do seu ser. Na essência, a vontade de liberdade de cada um confunde-se com a vontade colectiva que encontra a sua expressão no poder político.

Las prácticas de lectura en el entorno digital : industria editorial, mercado y consumo

Si bien la industria editorial ha atravesado grandes trasformaciones con la incorporación de las tecnologías de la información y la comunicación (TIC) en el ámbito de la producción, tanto editorial como autoral, el presente artículo atiende particularmente a las nuevas características que presentan las prácticas de lectura a partir de dicha inscripción. Se propone aquí un análisis de la cuestión de la lectura en estricta relación al nuevo escenario editorial marcado por un continuo replanteo del “quehacer editorial", del rol del editor y los diversos agentes del campo, de los soportes y formatos válidos para la lectura. La primera sección propone una sintética caracterización del funcionamiento de la industria editorial. El segundo apartado hace foco en las transformaciones puntuales del sector del libro en relación con la llegada de las tecnologías de la comunicación. La tercera parte presenta un breve repaso del estado de la cuestión vinculado a las prácticas de lectura en el entorno digital, y a continuación se desarrollan algunos rasgos y tendencias de la lectura en los soportes electrónicos en Argentina, Estados Unidos y España. El artículo concluye con una serie de reflexiones finales.