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Sample records for aco

  1. Pioneer ACO PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — Pioneer ACO PUF - To address the increasing number of requests for Pioneer ACO data, the Centers for Medicare and Medicaid Services (CMS) has created a standard...

  2. Pioneer ACO Model

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Pioneer ACO Model is designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings. It...

  3. Financial Performance of Rural Medicare ACOs.

    Science.gov (United States)

    Nattinger, Matthew C; Mueller, Keith; Ullrich, Fred; Zhu, Xi

    2018-12-01

    The Centers for Medicare & Medicaid Services (CMS) has facilitated the development of Medicare accountable care organizations (ACOs), mostly through the Medicare Shared Savings Program (MSSP). To inform the operation of the Center for Medicare & Medicaid Innovation's (CMMI) ACO programs, we assess the financial performance of rural ACOs based on different levels of rural presence. We used the 2014 performance data for Medicare ACOs to examine the financial performance of rural ACOs with different levels of rural presence: exclusively rural, mostly rural, and mixed rural/metropolitan. Of the ACOs reporting performance data, we identified 97 ACOs with a measurable rural presence. We found that successful rural ACO financial performance is associated with the ACO's organizational type (eg, physician-based) and that 8 of the 11 rural ACOs participating in the Advanced Payment Program (APP) garnered savings for Medicare. Unlike previous work, we did not find an association between ACO size or experience and rural ACO financial performance. Our findings suggest that rural ACO financial success is likely associated with factors unique to rural environments. Given the emphasis CMS has placed on rural ACO development, further research to identify these factors is warranted. © 2016 National Rural Health Association.

  4. Feocromocitoma cardíaco

    Directory of Open Access Journals (Sweden)

    Gustavo L. Knop

    2006-01-01

    Full Text Available Los feocromocitomas cardíacos primarios (FCP son sumamente infrecuentes. Hasta el presente son menos de 50 los casos comunicados en el mundo. Presentamos el caso de un tumor intrapericárdico, que resultó ser un feocromocitoma primario, en una mujer de mediana edad, cuyo signo principal fue hipertensión arterial severa (HTAs. Los estudios diagnósticos por imágenes corroboraron la presencia de un tumor intrapericárdico como único hallazgo y los estudios bioquímicos de catecolaminas y sus metabolitos excretados por orina reafirmaron el diagnóstico etiológico. El tumor fue resecado quirúrgicamente sin complicaciones mediante cirugía cardíaca convencional con circulación extracorpórea (CEC y paro cardíaco con cardioplejía. Siete meses después de la operación, la paciente se encuentra asintomática y normotensa.

  5. ACO model should encourage efficient care delivery.

    Science.gov (United States)

    Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M

    2015-09-01

    The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Super ACO FEL oscillation at 300 nm

    CERN Document Server

    Nutarelli, D; Renault, E; Nahon, L; Couprie, Marie Emmanuelle

    2000-01-01

    Some recent improvements, involving both the optical cavity mirrors and the positron beam dynamics in the storage ring, have allowed us to achieve a laser oscillation at 300 nm on the Super ACO Storage Ring FEL. The Super ACO storage ring is operated at 800 MeV which is the nominal energy for the usual synchrotron radiation users, and the highest energy for a storage ring FEL. The lasing at 300 nm could be kept during 2 h per injection, with a stored current ranging between 30 and 60 mA. The FEL characteristics are presented here. The longitudinal stability and the FEL optics behaviour are also discussed.

  7. Tumores cardíacos primarios

    Directory of Open Access Journals (Sweden)

    Rosa Eugenia Díaz Garriga

    2013-10-01

    Full Text Available Introducción: los tumores cardíacos primarios son aquellos que se originan en Miocardio o Pericardio. El 90% son benignos, no son invasivos, pero debido a su localización pueden provocar alteraciones hemodinámicas graves y arrítmias. Presentación del caso: dos casos portadores de tumores cardíacos diagnosticados en la etapa prenatal, una gestante de 32 años, portadora de una Neurofribromatosis que en la ecocardiografía fetal de su hijo, se identifican dos tipos de tumores cardíacos, un mixoma auricular y un fibroma, y un niño que desde la etapa prenatal se diagnosticó un rabdomioma, lo cual se confirmó al nacimiento y que regresó espontáneamente. Conclusiones: a ecocardiografía fetal permite cada vez con más frecuencia, el diagnóstico intraútero de tumores cardíacos. Los rabdomiomas regresan en más del 50% de los casos, pero pueden ser un marcador de Esclerosis Tuberosa. Los tumores cardiacos se asocian a otras afecciones congénitas y requieren de tratamiento quirúrgico. Aspectos todos a tener en consideración para realizar el asesoramiento genético a la familia.

  8. Organizational Attributes Associated With Medicare ACO Quality Performance.

    Science.gov (United States)

    Zhu, Xi; Mueller, Keith; Huang, Huang; Ullrich, Fred; Vaughn, Thomas; MacKinney, A Clinton

    2018-05-08

    To evaluate associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance. We conducted cross-sectional and longitudinal analyses of ACO quality performance using data from the Centers for Medicare and Medicaid Services and additional sources. The sample included 322 and 385 MSSP ACOs that had successfully reported quality measures in 2014 and 2015, respectively. Results show that after adjusting for other organizational factors, rural ACOs' average quality score was comparable to that of ACOs serving other geographic categories. ACOs with hospital-system sponsorship, larger beneficiary panels, and higher posthospitalization follow-up rates achieved better quality performance. There is no significant difference in average quality performance between rural ACOs and other ACOs after adjusting for structural and service-provision factors. MSSP ACO quality performance is positively associated with hospital-system sponsorship, beneficiary panel size, and posthospitalization follow-up rate. © 2018 National Rural Health Association.

  9. Unveiling the unicorn: a leader's guide to ACO preparation.

    Science.gov (United States)

    Aslin, Paul

    2011-01-01

    The great uncertainty surrounding healthcare reform provides little incentive for action. However, as healthcare leaders wait for final rules and clarity about accountable care organizations (ACOs), inaction is the inappropriate response. Several central themes emerge from research about beginning the ACO process. Leaders should be able to understand and articulate ACO concepts. They should champion embracing cultural change while partnering with physicians. Inventory of skills and capabilities should take place to understand any deficiencies required to implement an ACO. Finally, a plan should be formed by asking strategic questions on each platform needed to ensure performance and strategic goals are at the forefront of decisions regarding structure and function of an ACO. It takes a visionary leader to accept these challenges.

  10. ALOHA Cabled Observatory (ACO): Acoustic Doppler Current Profiler (ADCP): Velocity

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The University of Hawaii's ALOHA ("A Long-term Oligotrophic Habitat Assessment") Cabled Observatory (ACO) is located 100 km north of the island of Oahu, Hawaii (22...

  11. Paro Cardíaco en el Embarazo

    OpenAIRE

    Manuel Eduardo Sáenz Madrigal; Carlos Adrián Vindas Morera

    2013-01-01

    El paro cardíaco en el embarazo presenta un escenario único en el que están incluidos dos pacientes: la madre y el feto. El manejo de este escenario requiere de un equipo multidisciplinario incluyendo especialistas en anestesia, obstetricia, neonatología, cardiología y en ocasiones cirugía cardíaca. Los protocolos de soporte vital básico y soporte cardíaco avanzado deben ser implementados, sin embargo, dados los cambios anatómicos y fisiológicos que ocurren en el embarazo, algunas modificacio...

  12. 178. Linfoma cardíaco. Una neoplasia infrecuente

    Directory of Open Access Journals (Sweden)

    E. Sandoval

    2010-01-01

    Conclusiones: Los linfomas cardíacos son de alto grado de agresividad. La localización principal es la aurícula derecha, con clínica inespecífica y variable. No existe claro consenso sobre el tratamiento de elección, pero parece haber mayor supervivencia con tratamiento combinado con quimioterapia con antraciclínicos y radioterapia.

  13. Determinants of success in Shared Savings Programs: An analysis of ACO and market characteristics.

    Science.gov (United States)

    Ouayogodé, Mariétou H; Colla, Carrie H; Lewis, Valerie A

    2017-03-01

    Medicare's Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. To examine ACO and market factors associated with superior financial performance in Medicare ACO programs. We obtained financial performance data from the Centers for Medicare and Medicaid Services (CMS); we derived market-level characteristics from Medicare claims; and we collected ACO characteristics from the National Survey of ACOs for 215 ACOs. We examined the association between ACO financial performance and ACO provider composition, leadership structure, beneficiary characteristics, risk bearing experience, quality and process improvement capabilities, physician performance management, market competition, CMS-assigned financial benchmark, and ACO contract start date. We examined two outcomes from Medicare ACOs' first performance year: savings per Medicare beneficiary and earning shared savings payments (a dichotomous variable). When modeling the ACO ability to save and earn shared savings payments, we estimated positive regression coefficients for a greater proportion of primary care providers in the ACO, more practicing physicians on the governing board, physician leadership, active engagement in reducing hospital re-admissions, a greater proportion of disabled Medicare beneficiaries assigned to the ACO, financial incentives offered to physicians, a larger financial benchmark, and greater ACO market penetration. No characteristic of organizational structure was significantly associated with both outcomes of savings per beneficiary and likelihood of achieving shared savings. ACO prior experience with risk-bearing contracts was positively correlated with savings and significantly increased the likelihood of receiving shared savings payments. In the first year, performance is quite heterogeneous, yet organizational structure does not

  14. Free electron laser on the ACO storage ring

    International Nuclear Information System (INIS)

    Elleaume, P.

    1984-06-01

    This dissertation presents the design and characteristics of a Free Electron Laser built on the electron storage ring ACO at Orsay. The weak optical gain available (approximately 0.1% per pass) necessitated the use of an optical klystron instead of an undulator and the use of mirror with extremely high reflectivity. The laser characteristics: spectra, micro and macro-temporal structures, transverse structure and power are presented. They are in very good agreement with a classical theory based on the Lorentz force and Maxwell equations [fr

  15. MODELO ACO PARA LA RECOLECCIÓN DE RESIDUOS POR CONTENEDORES ACO MODEL APPLIED TO THE WASTE COLLECTION BY CONTAINERS

    Directory of Open Access Journals (Sweden)

    Eduardo Salazar Hornig

    2009-08-01

    Full Text Available ACO es una metaheurística inspirada en el comportamiento de las colonias de hormigas para solucionar problemas de optimización combinatoria, por medio de la utilización de agentes computacionales simples que trabajan de manera cooperativa y se comunican mediante rastros de feromona artificiales. En este trabajo se presenta un modelo para resolver el Problema de Recolección de Residuos Domiciliarios por Contenedores, el que aplica un concepto de secuencias parciales de recolección que deben ser unidas para minimizar la distancia total de recolección. El problema de unir las secuencias parciales se representa como un TSP, el que es resuelto mediante un algoritmo ACO. En base a recomendaciones de la literatura, se calibran experimentalmente los parámetros del algoritmo y se recomiendan rangos de valores que representan buenos rendimientos promedio. El modelo se aplica a un sector de recolección de la comuna de San Pedro de la Paz, Chile, obteniéndose rutas de recolección que reducen la distancia total recorrida respecto de la actual ruta utilizada y de la solución obtenida con otro modelo desarrollado previamente.ACO is a metaheuristic inspired in the behavior of natural ant colonies to solve combinatorial optimization problems, based on simple agents that work cooperatively communicating by artificial pheromone trails. In this paper a model to solve the municipal waste collection problem by containers is presented, which applies a concept of partial collection sequences that must be joined to minimize the total collection distance. The problem to join the partial collection sequences is represented as a TSP, which is solved by an ACO algorithm. Based on the literature, algorithm parameters are experimentally calibrated and range of variations that represents good average solutions are recommended. The model is applied to a waste collection sector of the San Pedro de la Paz commune in Chile, obtaining recollection routes with less total

  16. ENHANCED HYBRID PSO – ACO ALGORITHM FOR GRID SCHEDULING

    Directory of Open Access Journals (Sweden)

    P. Mathiyalagan

    2010-07-01

    Full Text Available Grid computing is a high performance computing environment to solve larger scale computational demands. Grid computing contains resource management, task scheduling, security problems, information management and so on. Task scheduling is a fundamental issue in achieving high performance in grid computing systems. A computational GRID is typically heterogeneous in the sense that it combines clusters of varying sizes, and different clusters typically contains processing elements with different level of performance. In this, heuristic approaches based on particle swarm optimization and ant colony optimization algorithms are adopted for solving task scheduling problems in grid environment. Particle Swarm Optimization (PSO is one of the latest evolutionary optimization techniques by nature. It has the better ability of global searching and has been successfully applied to many areas such as, neural network training etc. Due to the linear decreasing of inertia weight in PSO the convergence rate becomes faster, which leads to the minimal makespan time when used for scheduling. To make the convergence rate faster, the PSO algorithm is improved by modifying the inertia parameter, such that it produces better performance and gives an optimized result. The ACO algorithm is improved by modifying the pheromone updating rule. ACO algorithm is hybridized with PSO algorithm for efficient result and better convergence in PSO algorithm.

  17. Substantial Physician Turnover And Beneficiary 'Churn' In A Large Medicare Pioneer ACO.

    Science.gov (United States)

    Hsu, John; Vogeli, Christine; Price, Mary; Brand, Richard; Chernew, Michael E; Mohta, Namita; Chaguturu, Sreekanth K; Weil, Eric; Ferris, Timothy G

    2017-04-01

    Alternative payment models, such as accountable care organizations (ACOs), attempt to stimulate improvements in care delivery by better alignment of payer and provider incentives. However, limited attention has been paid to the physicians who actually deliver the care. In a large Medicare Pioneer ACO, we found that the number of beneficiaries per physician was low (median of seventy beneficiaries per physician, or less than 5 percent of a typical panel). We also found substantial physician turnover: More than half of physicians either joined (41 percent) or left (18 percent) the ACO during the 2012-14 contract period studied. When physicians left the ACO, most of their attributed beneficiaries also left the ACO. Conversely, about half of the growth in the beneficiary population was because of new physicians affiliating with the ACO; the remainder joined after switching physicians. These findings may help explain the muted financial impact ACOs have had overall, and they raise the possibility of future gaming on the part of ACOs to artificially control spending. Policy refinements include coordinated and standardized risk-sharing parameters across payers to prevent any dilution of the payment incentives or confusion from a cacophony of incentives across payers. Project HOPE—The People-to-People Health Foundation, Inc.

  18. The asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): opportunities and challenges.

    Science.gov (United States)

    Barrecheguren, Miriam; Esquinas, Cristina; Miravitlles, Marc

    2015-01-01

    Some individuals share characteristics of asthma and chronic obstructive pulmonary disease (COPD). The asthma-COPD overlap syndrome (ACOS) has been defined as symptoms of increased variability of airflow in association with an incompletely reversible airflow obstruction. In this review, we present the latest findings in the diagnosis, characterization and management of ACOS. Around 15-20% of COPD patients may have an ACOS. Patients with ACOS are characterized by increased reversibility of airflow obstruction, eosinophilic bronchial and systemic inflammation, and increased response to inhaled corticosteroids, compared with the remaining patients with COPD. Patients with ACOS have more frequent exacerbations, more wheezing and dyspnoea, but similar cough and sputum production compared with COPD. The relevance of the ACOS is to identify patients with COPD who may have underlying eosinophilic inflammation that responds to inhaled corticosteroids. So far, the previous diagnosis of asthma in a patient with COPD is the more reliable criterion for ACOS. Ongoing studies will clarify if concentrations of blood eosinophils may be useful to identify this subgroup of patients with COPD. If this is the case, the interest of ACOS may shift to that of eosinophilic COPD, which is easier to diagnose and has clear therapeutic implications.

  19. Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data.

    Science.gov (United States)

    Colla, Carrie H; Lewis, Valerie A; Tierney, Emily; Muhlestein, David B

    2016-03-01

    Relationships between physicians and hospitals have changed considerably over the past decade, as hospitals and physician groups have integrated and new public and private payment policies have created financial interdependence. The extent to which accountable care organizations (ACOs) involve hospitals in their operations may prove to be vitally important, because managing hospital care is a key part of improving health care quality and lowering cost growth. Using primary data on ACO composition and capabilities paired with hospital characteristics, we found that 20 percent of US hospitals were part of an ACO in 2014. Hospitals that were in urban areas, were nonprofit, or had a smaller share of Medicare patients were more likely to participate in ACOs, compared to hospitals that were in more rural areas, were for-profit or government owned, or had a larger share of Medicare patients, respectively. Qualitative data identified the following advantages of including a hospital in an ACO: the availability of start-up capital, advanced data sharing, and engagement of providers across the care continuum. Although the 63 percent of ACOs that included hospitals offered more comprehensive services compared to ACOs without hospitals, we found no differences between the two groups in their ability to manage hospital-related aspects of patient care. Project HOPE—The People-to-People Health Foundation, Inc.

  20. Layered ACO-OFDM for intensity-modulated direct-detection optical wireless transmission.

    Science.gov (United States)

    Wang, Qi; Qian, Chen; Guo, Xuhan; Wang, Zhaocheng; Cunningham, David G; White, Ian H

    2015-05-04

    Layered asymmetrically clipped optical orthogonal frequency division multiplexing (ACO-OFDM) with high spectral efficiency is proposed in this paper for optical wireless transmission employing intensity modulation with direct detection. In contrast to the conventional ACO-OFDM, which only utilizes odd subcarriers for modulation, leading to an obvious spectral efficiency loss, in layered ACO-OFDM, the subcarriers are divided into different layers and modulated by different kinds of ACO-OFDM, which are combined for simultaneous transmission. In this way, more subcarriers are used for data transmission and the spectral efficiency is improved. An iterative receiver is also proposed for layered ACO-OFDM, where the negative clipping distortion of each layer is subtracted once it is detected so that the signals from different layers can be recovered. Theoretical analysis shows that the proposed scheme can improve the spectral efficiency by up to 2 times compared with conventional ACO-OFDM approaches with the same modulation order. Meanwhile, simulation results confirm a considerable signal-to-noise ratio gain over ACO-OFDM at the same spectral efficiency.

  1. ACO-Initialized Wavelet Neural Network for Vibration Fault Diagnosis of Hydroturbine Generating Unit

    OpenAIRE

    Xiao, Zhihuai; He, Xinying; Fu, Xiangqian; Malik, O. P.

    2015-01-01

    Considering the drawbacks of traditional wavelet neural network, such as low convergence speed and high sensitivity to initial parameters, an ant colony optimization- (ACO-) initialized wavelet neural network is proposed in this paper for vibration fault diagnosis of a hydroturbine generating unit. In this method, parameters of the wavelet neural network are initialized by the ACO algorithm, and then the wavelet neural network is trained by the gradient descent algorithm. Amplitudes of the fr...

  2. RNA Interference of 1-Aminocyclopropane-1-carboxylic Acid Oxidase (ACO1 and ACO2 Genes Expression Prolongs the Shelf Life of Eksotika (Carica papaya L. Papaya Fruit

    Directory of Open Access Journals (Sweden)

    Rogayah Sekeli

    2014-06-01

    Full Text Available The purpose of this study was to evaluate the effectiveness of using RNA interference in down regulating the expression of 1-aminocyclopropane-1-carboxylic acid oxidase gene in Eksotika papaya. One-month old embryogenic calli were separately transformed with Agrobacterium strain LBA 4404 harbouring the three different RNAi pOpOff2 constructs bearing the 1-aminocyclopropane-1-carboxylic acid oxidase gene. A total of 176 putative transformed lines were produced from 15,000 calli transformed, selected, then regenerated on medium supplemented with kanamycin. Integration and expression of the targeted gene in putatively transformed lines were verified by PCR and real-time RT-PCR. Confined field evaluation of a total of 31 putative transgenic lines planted showed a knockdown expression of the targeted ACO1 and ACO2 genes in 13 lines, which required more than 8 days to achieve the full yellow colour (Index 6. Fruits harvested from lines pRNAiACO2 L2-9 and pRNAiACO1 L2 exhibited about 20 and 14 days extended post-harvest shelf life to reach Index 6, respectively. The total soluble solids contents of the fruits ranged from 11 to 14° Brix, a range similar to fruits from non-transformed, wild type seed-derived plants.

  3. [ACOS: Clinical and functional features The Russian formulation mesalazine (kansalazine) in the therapy of ulcerative colitis].

    Science.gov (United States)

    Sobko, E A; Chubarova, S V; Demko, I V; Loktionova, M M; Ishchenko, O P; Solovyeva, I A; Kraposhina, A Yu; Gordeeva, N V

    To investigate the clinical and functional parameters in patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) versus those with chronic obstructive pulmonary disease (COPD) and asthma. A total of 129 people were examined. 51 patients with ACOS were followed up in Group 1; Group 2 included 38 patients with severe asthma; Group 3 consisted of 40 patients with severe COPD. All the patients underwent clinical examination: history data collection, physical examination, evaluation of disease symptoms, and study of respiratory function (spirometry, body plethysmography). ACOS is clinically characterized by considerable demands for emergency drugs and by more frequent asthmatic fits and exacerbations, which require hospitalization. The parameters of bronchial resistance in ACOS were established to be increased throughout the follow-up period and to be comparable with those in patients with COPD. In the patients with ACOS, the severity of pulmonary hyperinflation was associated with increased demands for emergency drugs (r=0.59; p=0.015). Fixed bronchial obstruction in ACOS can be caused by smoking intensity and duration associated with increased bronchial resistance in expiration (r=0.51; p=0.003) and intrathoracic volume (r=0.71; p=0.0001); as well as increased body mass index (p<0.001) and disease duration, which were interrelated with a reduction in the forced expiratory volume in one second/forced vital capacity ratio (r=-0.63; p=0.001 and r=-0.71; p=0.0034, respectively). Patients with ACOS show more severe clinical manifestations and a substantial increase in functional residual capacity and intrathoracic volume throughout the follow-up period, suggesting that the distal bronchi are impaired and pulmonary hyperinflation develops.

  4. MGA trajectory planning with an ACO-inspired algorithm

    Science.gov (United States)

    Ceriotti, Matteo; Vasile, Massimiliano

    2010-11-01

    Given a set of celestial bodies, the problem of finding an optimal sequence of swing-bys, deep space manoeuvres (DSM) and transfer arcs connecting the elements of the set is combinatorial in nature. The number of possible paths grows exponentially with the number of celestial bodies. Therefore, the design of an optimal multiple gravity assist (MGA) trajectory is a NP-hard mixed combinatorial-continuous problem. Its automated solution would greatly improve the design of future space missions, allowing the assessment of a large number of alternative mission options in a short time. This work proposes to formulate the complete automated design of a multiple gravity assist trajectory as an autonomous planning and scheduling problem. The resulting scheduled plan will provide the optimal planetary sequence and a good estimation of the set of associated optimal trajectories. The trajectory model consists of a sequence of celestial bodies connected by two-dimensional transfer arcs containing one DSM. For each transfer arc, the position of the planet and the spacecraft, at the time of arrival, are matched by varying the pericentre of the preceding swing-by, or the magnitude of the launch excess velocity, for the first arc. For each departure date, this model generates a full tree of possible transfers from the departure to the destination planet. Each leaf of the tree represents a planetary encounter and a possible way to reach that planet. An algorithm inspired by ant colony optimization (ACO) is devised to explore the space of possible plans. The ants explore the tree from departure to destination adding one node at the time: every time an ant is at a node, a probability function is used to select a feasible direction. This approach to automatic trajectory planning is applied to the design of optimal transfers to Saturn and among the Galilean moons of Jupiter. Solutions are compared to those found through more traditional genetic-algorithm techniques.

  5. ACO-Initialized Wavelet Neural Network for Vibration Fault Diagnosis of Hydroturbine Generating Unit

    Directory of Open Access Journals (Sweden)

    Zhihuai Xiao

    2015-01-01

    Full Text Available Considering the drawbacks of traditional wavelet neural network, such as low convergence speed and high sensitivity to initial parameters, an ant colony optimization- (ACO- initialized wavelet neural network is proposed in this paper for vibration fault diagnosis of a hydroturbine generating unit. In this method, parameters of the wavelet neural network are initialized by the ACO algorithm, and then the wavelet neural network is trained by the gradient descent algorithm. Amplitudes of the frequency components of the hydroturbine generating unit vibration signals are used as feature vectors for wavelet neural network training to realize mapping relationship from vibration features to fault types. A real vibration fault diagnosis case result of a hydroturbine generating unit shows that the proposed method has faster convergence speed and stronger generalization ability than the traditional wavelet neural network and ACO wavelet neural network. Thus it can provide an effective solution for online vibration fault diagnosis of a hydroturbine generating unit.

  6. Susceptibility to false memories in patients with ACoA aneurysm.

    Science.gov (United States)

    Borsutzky, Sabine; Fujiwara, Esther; Brand, Matthias; Markowitsch, Hans J

    2010-08-01

    We examined ACoA patients regarding their susceptibility to a range of false memory phenomena. We targeted provoked confabulation, false recall and false recognition in the Deese-Roediger-McDermott-paradigm (DRM-paradigm) as well as false recognition in a mirror reading task. ACoA patients produced more provoked confabulations and more false recognition in mirror reading than comparison subjects. Conversely, false recall/false recognition in the DRM-paradigm were similar in patients and controls. Whereas the former two indices of false memories were correlated, no relationship was revealed with the DRM-paradigm. Our results suggest that rupture of ACoA aneurysm leads to an increased susceptibility to a subset of false memories types. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  7. Trasplante cardíaco pediátrico: pasado, presente y futuro

    Directory of Open Access Journals (Sweden)

    María-Teresa González-López

    2017-01-01

    Conclusión: El trasplante cardíaco pediátrico presenta óptimos resultados en nuestro medio, superponibles a series mundiales. Aunque el perfil de riesgo está incrementándose, los resultados actuales reflejan los avances en el manejo de estos pacientes.

  8. Tests were inconclusive: California's experiment with ACOs raises questions about whether they'll save money.

    Science.gov (United States)

    Vesely, Rebecca

    2010-11-01

    In California, many providers have been working in accountable care organizations for decades, and they say they can work well. "It's not the type of organization that defines the success of an ACO, it's the leadership," said Tom Williams, executive director of the Oakland, Calif.-based Integrated Healthcare Association. "For success, there needs to be alignment between hospitals and physicians."

  9. Towards the Fourier limit on the super-ACO Storage Ring FEL

    International Nuclear Information System (INIS)

    Couprie, M.E.; De Ninno, G.; Moneron, G.; Nutarelli, D.; Hirsch, M.; Garzella, D.; Renault, E.; Roux, R.; Thomas, C.

    2001-01-01

    Systematic studies on the Free Electron Laser (FEL) line and micropulse have been performed on the Super-ACO storage ring FEL with a monochromator and a double-sweep streak camera under various conditions of operation (detuning, 'CW' and Q-switched mode). From these data, it appears that the FEL is usually operated very close to the Fourier limit

  10. Towards the Fourier limit on the super-ACO Storage Ring FEL

    CERN Document Server

    Couprie, Marie Emmanuelle; Garzella, D; Hirsch, M; Moneron, G; Nutarelli, D; Renault, E; Roux, R; Thomas, C

    2001-01-01

    Systematic studies on the Free Electron Laser (FEL) line and micropulse have been performed on the Super-ACO storage ring FEL with a monochromator and a double-sweep streak camera under various conditions of operation (detuning, 'CW' and Q-switched mode). From these data, it appears that the FEL is usually operated very close to the Fourier limit.

  11. 288. Feocromocitoma Cardíaco a Nivel Del Surco Interauricular

    Directory of Open Access Journals (Sweden)

    C. Iglesias Gil

    2012-04-01

    La localización extraadrenal de los feocromocitomas es infrecuente, siendo la torácica inferior al 2% y la intrapericárdica excepcional. Dado que son escasos los reportes de tumores secretores de catecolaminas a nivel cardíaco, presentamos este caso.

  12. Optimization of reload of nuclear power plants using ACO together with the GENES reactor physics code

    Energy Technology Data Exchange (ETDEWEB)

    Lima, Alan M.M. de; Freire, Fernando S.; Nicolau, Andressa S.; Schirru, Roberto, E-mail: alan@lmp.ufrj.br, E-mail: andressa@lmp.ufrj.br, E-mail: schirru@lmp.ufrj.br, E-mail: ffreire@eletronuclear.gov.br [Coordenacao de Pos-Graduacao e Pesquisa de Engenharia (PEN/COPPE/UFRJ), Rio de Janeiro, RJ (Brazil); Eletrobras Termonuclear S.A. (ELETRONUCLEAR), Rio de Janeiro, RJ (Brazil)

    2017-11-01

    The Nuclear reload of a Pressurized Water Reactor (PWR) occurs whenever the burning of the fuel elements can no longer maintain the criticality of the reactor, that is, it cannot maintain the Nuclear power plant operates within its nominal power. Nuclear reactor reload optimization problem consists of finding a loading pattern of fuel assemblies in the reactor core in order to minimize the cost/benefit ratio, trying to obtain maximum power generation with a minimum of cost, since in all reloads an average of one third of the new fuel elements are purchased. This loading pattern must also satisfy constraints of symmetry and security. In practice, it consists of the placing 121 fuel elements in 121 core positions, in the case of the Angra 1 Brazilian Nuclear Power Plant (NPP), making this new arrangement provide the best cost/benefit ratio. It is an extremely complex problem, since it has around 1% of great places. A core of 121 fuel elements has approximately 10{sup 13} combinations and 10{sup 11} great locations. With this number of possible combinations it is impossible to test all, in order to choose the best. In this work a system called ACO-GENES is proposed in order to optimization the Nuclear Reactor Reload Problem. ACO is successfully used in combination problems, and it is expected that ACO-GENES will show a robust optimization system, since in addition to optimizing ACO, it allows important prior knowledge such as K infinite, burn, etc. After optimization by ACO-GENES, the best results will be validated by a licensed reactor physics code and will be compared with the actual results of the cycle. (author)

  13. Optimization of reload of nuclear power plants using ACO together with the GENES reactor physics code

    International Nuclear Information System (INIS)

    Lima, Alan M.M. de; Freire, Fernando S.; Nicolau, Andressa S.; Schirru, Roberto

    2017-01-01

    The Nuclear reload of a Pressurized Water Reactor (PWR) occurs whenever the burning of the fuel elements can no longer maintain the criticality of the reactor, that is, it cannot maintain the Nuclear power plant operates within its nominal power. Nuclear reactor reload optimization problem consists of finding a loading pattern of fuel assemblies in the reactor core in order to minimize the cost/benefit ratio, trying to obtain maximum power generation with a minimum of cost, since in all reloads an average of one third of the new fuel elements are purchased. This loading pattern must also satisfy constraints of symmetry and security. In practice, it consists of the placing 121 fuel elements in 121 core positions, in the case of the Angra 1 Brazilian Nuclear Power Plant (NPP), making this new arrangement provide the best cost/benefit ratio. It is an extremely complex problem, since it has around 1% of great places. A core of 121 fuel elements has approximately 10"1"3 combinations and 10"1"1 great locations. With this number of possible combinations it is impossible to test all, in order to choose the best. In this work a system called ACO-GENES is proposed in order to optimization the Nuclear Reactor Reload Problem. ACO is successfully used in combination problems, and it is expected that ACO-GENES will show a robust optimization system, since in addition to optimizing ACO, it allows important prior knowledge such as K infinite, burn, etc. After optimization by ACO-GENES, the best results will be validated by a licensed reactor physics code and will be compared with the actual results of the cycle. (author)

  14. Topology in two dimensions. II - The Abell and ACO cluster catalogues

    Science.gov (United States)

    Plionis, Manolis; Valdarnini, Riccardo; Coles, Peter

    1992-09-01

    We apply a method for quantifying the topology of projected galaxy clustering to the Abell and ACO catalogues of rich clusters. We use numerical simulations to quantify the statistical bias involved in using high peaks to define the large-scale structure, and we use the results obtained to correct our observational determinations for this known selection effect and also for possible errors introduced by boundary effects. We find that the Abell cluster sample is consistent with clusters being identified with high peaks of a Gaussian random field, but that the ACO shows a slight meatball shift away from the Gaussian behavior over and above that expected purely from the high-peak selection. The most conservative explanation of this effect is that it is caused by some artefact of the procedure used to select the clusters in the two samples.

  15. Protocolo del manejo y selección del donante cardíaco

    Directory of Open Access Journals (Sweden)

    José Elizalde

    2008-01-01

    Full Text Available El trasplante cardíaco es una terapia aceptada en grupos de pacientes afectos de insuficiencia cardíaca terminal. El envejecimiento progresivo de los donantes y la reducción del número de traumatismos craneoencefálicos mortales obliga a una valoración exhaustiva en cada caso. La ecocardiografía es, hoy en día, una exploración obligada en la valoración del donante. La Organización Nacional de Trasplantes ha elaborado un protocolo de manejo del donante torácico para optimizar su aprovechamiento. Se revisan los criterios de selección del donante cardíaco insistiendo en las contraindicaciones, en el despistaje de enfermedad coronaria y el mantenimiento durante el proceso de selección.

  16. Applications of UV-storage ring free electron lasers: the case of super-ACO

    CERN Document Server

    Nahon, L; Couprie, Marie Emmanuelle; Merola, F; Dumas, P; Marsi, M; Taleb-Ibrahimi, A; Nutarelli, D; Roux, R; Billardon, M

    1999-01-01

    The potential of UV-storage ring free electron lasers (SRFELs) for the performance of original application experiments is shown with a special emphasis concerning their combination with the naturally synchronized synchrotron radiation (SR). The first two-color FEL+SR experiment, performed in surface science at Super-ACO is reported. The experimental parameters found to be the most important as gathered from the acquired experience, are underlined and discussed. Finally, future prospects for the scientific program of the Super-ACO FEL are presented with two-color experiments combining the FEL with SR undulator-based XUV and VUV beamlines as well as with a SR white light bending magnet beamline emiting in the IR-UV (20 mu m-0.25 mu m).

  17. Do accountable care organizations (ACOs) help or hinder primary care physicians' ability to deliver high-quality care?

    Science.gov (United States)

    Berenson, Robert A; Burton, Rachel A; McGrath, Megan

    2016-09-01

    Many view advanced primary care models such as the patient-centered medical home as foundational for accountable care organizations (ACOs), but it remains unclear how these two delivery reforms are complementary and how they may produce conflict. The objective of this study was to identify how joining an ACO could help or hinder a primary care practice's efforts to deliver high-quality care. This qualitative study involved interviews with a purposive sample of 32 early adopters of advanced primary care and/or ACO models, drawn from across the U.S. and conducted in mid-2014. Interview notes were coded using qualitative data analysis software, permitting topic-specific queries which were then summarized. Respondents perceived many potential benefits of joining an ACO, including care coordination staff, data analytics, and improved communication with other providers. However, respondents were also concerned about added "bureaucratic" requirements, referral restrictions, and a potential inability to recoup investments in practice improvements. Interviewees generally thought joining an ACO could complement a practice's efforts to deliver high-quality care, yet noted some concerns that could undermine these synergies. Both the advantages and disadvantages of joining an ACO seemed exacerbated for small practices, since they are most likely to benefit from additional resources yet are most likely to chafe under added bureaucratic requirements. Our identification of the potential pros and cons of joining an ACO may help providers identify areas to examine when weighing whether to enter into such an arrangement, and may help ACOs identify potential areas for improvement. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Betting on change: Tenet deal with Vanguard shows it's primed to try ACO effort, new payment model.

    Science.gov (United States)

    Kutscher, Beth

    2013-07-01

    Tenet Healthcare Corp.'s acquisition of Vanguard Health Systems is a sign the investor-owned chain is willing to take a chance on alternative payment models such as accountable care organizations. There's no certainty that ACOs will deliver the improvements on quality or cost savings, but Vanguard Vice Chairman Keith Pitts, left, says his system's Pioneer ACO in Detroit has already achieved some cost savings.

  19. BER Performance of Stratified ACO-OFDM for Optical Wireless Communications over Multipath Channel

    OpenAIRE

    Gebeyehu, Zelalem Hailu; Langat, Philip Kibet; Maina, Ciira Wa

    2018-01-01

    In intensity modulation/direct detection- (IM/DD-) based optical OFDM systems, the requirement of the input signal to be real and positive unipolar imposes a reduction of system performances. Among previously proposed unipolar optical OFDM schemes for optical wireless communications (OWC), asymmetrically clipped optical OFDM (ACO-OFDM) and direct current biased optical OFDM (DCO-OFDM) are the most accepted ones. But those proposed schemes experience either spectral efficiency loss or energy e...

  20. Doctors on deck. ACOs led by doctors seek to manage costs, quality and hospital relationships.

    Science.gov (United States)

    Evans, Melanie

    2012-04-16

    Most of the first crop of ACOs in the Medicare Shared Savings Program are owned and operated by physicians without formal participation of a hospital in the efforts to improve quality and curb costs. "There were some people who feared that the only entities that would participate would be hospital-dominated systems," says Jonathan Blum, director of the Center for Medicare Management at the CMS, left. "That has not happened".

  1. Impact of Provider Participation in ACO Programs on Preventive Care Services, Patient Experiences, and Health Care Expenditures in US Adults Aged 18-64.

    Science.gov (United States)

    Hong, Young-Rock; Sonawane, Kalyani; Larson, Samantha; Mainous, Arch G; Marlow, Nicole M

    2018-05-15

    Little is known about the impact of accountable care organization (ACO) on US adults aged 18-64. To examine whether having a usual source of care (USC) provider participating in an ACO affects receipt of preventive care services, patient experiences, and health care expenditures among nonelderly Americans. A cross-sectional analysis of the 2015 Medical Organizations Survey linked with the Medical Expenditure Panel Survey. Survey respondents aged 18-64 with an identified USC and continuous health insurance coverage during 2015. Preventative care services (routine checkup, flu vaccination, and cancer screening), patient experiences with health care (access to care, interaction quality with providers, and global satisfaction), and health care expenditures (total and out-of-pocket expenditures) for respondents with USC by ACO and non-ACO provider groups. Among 1563, nonelderly Americans having a USC, we found that nearly 62.7% [95% confidence interval (CI), 58.6%-66.7%; representing 15,722,208 Americans] were cared for by ACO providers. Our analysis showed no significant differences in preventive care services or patient experiences between ACO and non-ACO groups. Adjusted mean total health expenditures were slightly higher for the ACO than non-ACO group [$7016 (95% CI, $4949-$9914) vs. $6796 (95% CI, $4724-$9892)]; however, this difference was not statistically significant (P=0.250). Our findings suggest that having a USC provider participating in an ACO is not associated with preventive care services use, patient experiences, or health care expenditures among a nonelderly population.

  2. Tailoring Systems Engineering Processes in a Conceptual Design Environment: A Case Study at NASA Marshall Spaceflight Center's ACO

    Science.gov (United States)

    Mulqueen, John; Maples, C. Dauphne; Fabisinski, Leo, III

    2012-01-01

    This paper provides an overview of Systems Engineering as it is applied in a conceptual design space systems department at the National Aeronautics and Space Administration (NASA) Marshall Spaceflight Center (MSFC) Advanced Concepts Office (ACO). Engineering work performed in the NASA MFSC's ACO is targeted toward the Exploratory Research and Concepts Development life cycle stages, as defined in the International Council on Systems Engineering (INCOSE) System Engineering Handbook. This paper addresses three ACO Systems Engineering tools that correspond to three INCOSE Technical Processes: Stakeholder Requirements Definition, Requirements Analysis, and Integration, as well as one Project Process Risk Management. These processes are used to facilitate, streamline, and manage systems engineering processes tailored for the earliest two life cycle stages, which is the environment in which ACO engineers work. The role of systems engineers and systems engineering as performed in ACO is explored in this paper. The need for tailoring Systems Engineering processes, tools, and products in the ever-changing engineering services ACO provides to its customers is addressed.

  3. Housing, Transportation, And Food: How ACOs Seek To Improve Population Health By Addressing Nonmedical Needs Of Patients.

    Science.gov (United States)

    Fraze, Taressa; Lewis, Valerie A; Rodriguez, Hector P; Fisher, Elliott S

    2016-11-01

    Addressing nonmedical needs-such as the need for housing-is critical to advancing population health, improving the quality of care, and lowering the costs of care. Accountable care organizations (ACOs) are well positioned to address these needs. We used qualitative interviews with ACO leaders and site visits to examine how these organizations addressed the nonmedical needs of their patients, and the extent to which they did so. We developed a typology of medical and social services integration among ACOs that disentangles service and organizational integration. We found that the nonmedical needs most commonly addressed by ACOs were the need for transportation and housing and food insecurity. ACOs identified nonmedical needs through processes that were part of the primary care visit or care transformation programs. Approaches to meeting patients' nonmedical needs were either individualized solutions (developed patient by patient) or targeted approaches (programs developed to address specific needs). As policy makers continue to provide incentives for health care organizations to meet a broader spectrum of patients' needs, these findings offer insights into how health care organizations such as ACOs integrate themselves with nonmedical organizations. Project HOPE—The People-to-People Health Foundation, Inc.

  4. A performance improvement and cost-efficient ACO-OFDM scheme for visible light communications

    Science.gov (United States)

    Zhang, Tiantian; Zhou, Ji; Zhang, Zhenshan; Qiao, Yaojun; Su, Fei; Yang, Aiying

    2017-11-01

    In this paper, we propose a performance improvement and cost-efficient discrete Hartley transform (DHT)-based asymmetrically clipped optical orthogonal frequency division multiplexing (ACO-OFDM) scheme for visible light communications (VLC). The simple one-dimensional modulation constellation and simplified encoding structure reduce the complexity of system considerably. The DHT-spreading technique is employed to reduce peak-to-average power ratio (PAPR) of ACO-OFDM signals. Moreover, the intra-symbol frequency-domain averaging (ISFA) technique is used to increase the accuracy of channel estimation by removing the effect of ambient noise in the VLC channel effectively. To verify the feasibility of the proposed scheme, we study its performance via simulation. This scheme reduces the requirement to the resolution of DAC and increases the tolerance to the nonlinear characteristics of LED, both of which are cost-efficient. At forward error correction (FEC) limit (BER = 1 × 10-3), simulation results illustrate that compared with DHT-based ACO-OFDM without the ISFA technique, our scheme has 3.2 dB and 2.7 dB improvement of the required Eb /N0 when BPSK and 4-PAM are modulated, respectively.

  5. Solving optimum operation of single pump unit problem with ant colony optimization (ACO) algorithm

    International Nuclear Information System (INIS)

    Yuan, Y; Liu, C

    2012-01-01

    For pumping stations, the effective scheduling of daily pump operations from solutions to the optimum design operation problem is one of the greatest potential areas for energy cost-savings, there are some difficulties in solving this problem with traditional optimization methods due to the multimodality of the solution region. In this case, an ACO model for optimum operation of pumping unit is proposed and the solution method by ants searching is presented by rationally setting the object function and constrained conditions. A weighted directed graph was constructed and feasible solutions may be found by iteratively searching of artificial ants, and then the optimal solution can be obtained by applying the rule of state transition and the pheromone updating. An example calculation was conducted and the minimum cost was found as 4.9979. The result of ant colony algorithm was compared with the result from dynamic programming or evolutionary solving method in commercial software under the same discrete condition. The result of ACO is better and the computing time is shorter which indicates that ACO algorithm can provide a high application value to the field of optimal operation of pumping stations and related fields.

  6. Processing time tolerance-based ACO algorithm for solving job-shop scheduling problem

    Science.gov (United States)

    Luo, Yabo; Waden, Yongo P.

    2017-06-01

    Ordinarily, Job Shop Scheduling Problem (JSSP) is known as NP-hard problem which has uncertainty and complexity that cannot be handled by a linear method. Thus, currently studies on JSSP are concentrated mainly on applying different methods of improving the heuristics for optimizing the JSSP. However, there still exist many problems for efficient optimization in the JSSP, namely, low efficiency and poor reliability, which can easily trap the optimization process of JSSP into local optima. Therefore, to solve this problem, a study on Ant Colony Optimization (ACO) algorithm combined with constraint handling tactics is carried out in this paper. Further, the problem is subdivided into three parts: (1) Analysis of processing time tolerance-based constraint features in the JSSP which is performed by the constraint satisfying model; (2) Satisfying the constraints by considering the consistency technology and the constraint spreading algorithm in order to improve the performance of ACO algorithm. Hence, the JSSP model based on the improved ACO algorithm is constructed; (3) The effectiveness of the proposed method based on reliability and efficiency is shown through comparative experiments which are performed on benchmark problems. Consequently, the results obtained by the proposed method are better, and the applied technique can be used in optimizing JSSP.

  7. Trasplante cardíaco: organización e indicaciones

    Directory of Open Access Journals (Sweden)

    José M. Revuelta

    2008-01-01

    La experiencia clínica está demostrando que las indicaciones y las contraindicaciones del trasplante cardíaco están en constante cambio, debido principalmente a los avances en los cuidados pre, per y postoperatorios, a los nuevos fármacos y otras novedosas alternativas terapéuticas. La clase funcional (NY HA del paciente es poco precisa para indicar el trasplante cardíaco, por lo que se precisa de otras determinaciones, como el consumo máximo de oxígeno: VO2 máx < 10 ml/kg/min conlleva un mortalidad hospitalaria elevada. Asimismo, la fracción de eyección ventricular izquierda disminuida (FEVI < 20% no debe considerarse como el indicador principal para establecer la indicación de trasplante, siendo necesario valorar otros factores de riesgo preoperatorios. En la última década, la experiencia ha puesto de manifiesto que algunas de las contraindicaciones absolutas, antes vigentes, no siempre deben desaconsejar el trasplante cardíaco.

  8. Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO.

    Science.gov (United States)

    Hsu, John; Price, Mary; Vogeli, Christine; Brand, Richard; Chernew, Michael E; Chaguturu, Sreekanth K; Weil, Eric; Ferris, Timothy G

    2017-05-01

    Accountable care organizations (ACOs) appear to lower medical spending, but there is little information on how they do so. We examined the impact of patient participation in a Pioneer ACO and its care management program on rates of emergency department (ED) visits and hospitalizations and on Medicare spending. We used data for the period 2009-14, exploiting naturally staggered program entry to create concurrent controls to help isolate the program effects. The care management program (the ACO's primary intervention) targeted beneficiaries with elevated but modifiable risks for future spending. ACO participation had a modest effect on spending, in line with previous estimates. Participation in the care management program was associated with substantial reductions in rates for hospitalizations and both all and nonemergency ED visits, as well as Medicare spending, when compared to preparticipation levels and to rates and spending for a concurrent sample of beneficiaries who were eligible for but had not yet started the program. Rates of ED visits and hospitalizations were reduced by 6 percent and 8 percent, respectively, and Medicare spending was reduced by 6 percent. Targeting beneficiaries with modifiable high risks and shifting care away from the ED represent viable mechanisms for altering spending within ACOs. Project HOPE—The People-to-People Health Foundation, Inc.

  9. Hardware-efficient signal generation of layered/enhanced ACO-OFDM for short-haul fiber-optic links.

    Science.gov (United States)

    Wang, Qibing; Song, Binhuang; Corcoran, Bill; Boland, David; Zhu, Chen; Zhuang, Leimeng; Lowery, Arthur J

    2017-06-12

    Layered/enhanced ACO-OFDM is a promising candidate for intensity modulation and direct-detection based short-haul fiber-optic links due to its both power and spectral efficiency. In this paper, we firstly demonstrate a hardware-efficient real-time 9.375 Gb/s QPSK-encoded layered/enhanced asymmetrical clipped optical OFDM (L/E-ACO-OFDM) transmitter using a Virtex-6 FPGA. This L/E-ACO-OFDM signal is successfully transmitted over 20-km uncompensated standard single-mode fiber (S-SMF) using a directly modulated laser. Several methods are explored to reduce the FPGA's logic resource utilization by taking advantage of the L/E-ACO-OFDM's signal characteristics. We show that the logic resource occupation of L/E-ACO-OFDM transmitter is almost the same as that of DC-biased OFDM transmitter when they achieve the same spectral efficiency, proving its great potential to be used in a real-time short-haul optical transmission link.

  10. Domainwise Web Page Optimization Based On Clustered Query Sessions Using Hybrid Of Trust And ACO For Effective Information Retrieval

    Directory of Open Access Journals (Sweden)

    Dr. Suruchi Chawla

    2015-08-01

    Full Text Available Abstract In this paper hybrid of Ant Colony OptimizationACO and trust has been used for domainwise web page optimization in clustered query sessions for effective Information retrieval. The trust of the web page identifies its degree of relevance in satisfying specific information need of the user. The trusted web pages when optimized using pheromone updates in ACO will identify the trusted colonies of web pages which will be relevant to users information need in a given domain. Hence in this paper the hybrid of Trust and ACO has been used on clustered query sessions for identifying more and more relevant number of documents in a given domain in order to better satisfy the information need of the user. Experiment was conducted on the data set of web query sessions to test the effectiveness of the proposed approach in selected three domains Academics Entertainment and Sports and the results confirm the improvement in the precision of search results.

  11. The development and psychometric validation of an instrument to evaluate nurses' attitudes towards communication with the patient (ACO).

    Science.gov (United States)

    Giménez-Espert, María Del Carmen; Prado-Gascó, Vicente Javier

    2018-05-01

    Patient communication is a key skill for nurses involved in clinical care. Its measurement is a complex phenomenon that can be addressed through attitude evaluation. To develop and psychometrically test a measure of nurses' attitudes towards communication with patients (ACO), to study the relationship between these dimensions, and to analyse nursing attitudes. To develop and psychometrically test the ACO questionnaire. All hospitals in the province of Valencia were invited by e-mail to distribute the ACO instrument. Ten hospitals took part in the study. The study population was composed of a convenience sample of 400 hospital nurses on general or special services. The inclusion criteria were nurses at the selected centres who had previously provided an informed consent to participate. A literature review and expert consultation (N = 10) was used to develop the content of the questionnaire. The 62-item version of the instrument was applied to a convenience sample of 400 nurses between May 2015 and March 2016. Factor structure was evaluated with exploratory and confirmatory factor analysis (EFA, CFA), and reliability was evaluated with Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE). The final instrument (ACO), composed of 25 items grouped into three attitude dimensions (cognitive, affective and behavioural), had good psychometric properties. In the study sample, nurses had a favourable attitude towards communication. The cognitive and affective dimensions of the ACO should be able to predict the behaviour dimension. The ACO is useful for evaluating current clinical practices, identifying educational needs and assessing the effectiveness of communication training or other interventions intended to improve communication. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. A Family of ACO Routing Protocols for Mobile Ad Hoc Networks

    Science.gov (United States)

    Rupérez Cañas, Delfín; Sandoval Orozco, Ana Lucila; García Villalba, Luis Javier; Kim, Tai-hoon

    2017-01-01

    In this work, an ACO routing protocol for mobile ad hoc networks based on AntHocNet is specified. As its predecessor, this new protocol, called AntOR, is hybrid in the sense that it contains elements from both reactive and proactive routing. Specifically, it combines a reactive route setup process with a proactive route maintenance and improvement process. Key aspects of the AntOR protocol are the disjoint-link and disjoint-node routes, separation between the regular pheromone and the virtual pheromone in the diffusion process and the exploration of routes, taking into consideration the number of hops in the best routes. In this work, a family of ACO routing protocols based on AntOR is also specified. These protocols are based on protocol successive refinements. In this work, we also present a parallelized version of AntOR that we call PAntOR. Using programming multiprocessor architectures based on the shared memory protocol, PAntOR allows running tasks in parallel using threads. This parallelization is applicable in the route setup phase, route local repair process and link failure notification. In addition, a variant of PAntOR that consists of having more than one interface, which we call PAntOR-MI (PAntOR-Multiple Interface), is specified. This approach parallelizes the sending of broadcast messages by interface through threads. PMID:28531159

  13. A Family of ACO Routing Protocols for Mobile Ad Hoc Networks.

    Science.gov (United States)

    Rupérez Cañas, Delfín; Sandoval Orozco, Ana Lucila; García Villalba, Luis Javier; Kim, Tai-Hoon

    2017-05-22

    In this work, an ACO routing protocol for mobile ad hoc networks based on AntHocNet is specified. As its predecessor, this new protocol, called AntOR, is hybrid in the sense that it contains elements from both reactive and proactive routing. Specifically, it combines a reactive route setup process with a proactive route maintenance and improvement process. Key aspects of the AntOR protocol are the disjoint-link and disjoint-node routes, separation between the regular pheromone and the virtual pheromone in the diffusion process and the exploration of routes, taking into consideration the number of hops in the best routes. In this work, a family of ACO routing protocols based on AntOR is also specified. These protocols are based on protocol successive refinements. In this work, we also present a parallelized version of AntOR that we call PAntOR. Using programming multiprocessor architectures based on the shared memory protocol, PAntOR allows running tasks in parallel using threads. This parallelization is applicable in the route setup phase, route local repair process and link failure notification. In addition, a variant of PAntOR that consists of having more than one interface, which we call PAntOR-MI (PAntOR-Multiple Interface), is specified. This approach parallelizes the sending of broadcast messages by interface through threads.

  14. NHETS - Estudo de Necrópsias de Pacientes Submetidos a Transplante Cardíaco

    Directory of Open Access Journals (Sweden)

    Thiago Ninck Valette

    2014-06-01

    Full Text Available Fundamento: Discordâncias entre diagnóstico pre e post-mortem são relatadas na literatura, podendo variar de 4,1 a 49,8% dentre os casos encaminhados para exame necroscópico, com importante repercussão no tratamento dos pacientes. Objetivo: Analisar pacientes com óbito após o transplante cardíaco e confrontar os diagnósticos pre e post-mortem. Métodos: Por meio da revisão de prontuários, foram analisados dados clínicos, presença de comorbidades, esquema de imunossupressão, exames laboratoriais, causa clínica do óbito e causa do óbito à necrópsia. Foram confrontadas, então, a causa clínica e a causa necroscópica do óbito de cada paciente. Resultados: Foram analisados 48 óbitos submetidos à necrópsia no período de 2000 a 2010; 29 (60,4% tiveram diagnósticos clínico e necroscópico concordantes, 16 (33,3% tiveram diagnósticos discordantes e três (6,3% tiveram diagnóstico não esclarecido. Entre os discordantes, 15 (31,3% apresentaram possível impacto na sobrevida e um (2,1% não apresentou impacto na sobrevida. O principal diagnóstico clínico feito equivocadamente foi o de infecção, com cinco casos (26,7% dos discordantes, seguido por rejeição hiperaguda, com quatro casos (20% dos discordantes, e tromboembolismo pulmonar, com três casos (13,3% dos discordantes. Conclusão: Discordâncias entre o diagnóstico clínico e achados da necrópsia são comumente encontradas no transplante cardíaco. Novas estratégias no aperfeiçoamento do diagnóstico clínico devem ser introduzidas, considerando-se os resultados da necrópsia para melhoria do tratamento da insuficiência cardíaca por meio do transplante cardíaco.

  15. Dynamic Fuzzy Logic Parameter Tuning for ACO and Its Application in the Fuzzy Logic Control of an Autonomous Mobile Robot

    Directory of Open Access Journals (Sweden)

    Oscar Castillo

    2013-01-01

    Full Text Available Ant Colony Optimization (ACO is a population-based constructive meta-heuristic that exploits a form of past performance memory inspired by the foraging behaviour of real ants. The behaviour of the ACO algorithm is highly dependent on the values defined for its parameters. Adaptation and parameter control are recurring themes in the field of bio-inspired algorithms. The present paper explores a new approach to diversity control in ACO. The central idea is to avoid or slow down full convergence through the dynamic variation of certain parameters. The performance of different variants of the ACO algorithm was observed to choose one as the basis for the proposed approach. A convergence fuzzy logic controller with the objective of maintaining diversity at some level to avoid premature convergence was created. Encouraging results have been obtained on its application to the design of fuzzy controllers. In particular, the optimization of membership functions for a unicycle mobile robot trajectory control is presented with the proposed method.

  16. Integrating Medication Therapy Management (MTM Services Provided by Community Pharmacists into a Community-Based Accountable Care Organization (ACO

    Directory of Open Access Journals (Sweden)

    Brian Isetts

    2017-10-01

    Full Text Available (1 Background: As the U.S. healthcare system evolves from fee-for-service financing to global population-based payments designed to be accountable for both quality and total cost of care, the effective and safe use of medications is gaining increased importance. The purpose of this project was to determine the feasibility of integrating medication therapy management (MTM services provided by community pharmacists into the clinical care teams and the health information technology (HIT infrastructure for Minnesota Medicaid recipients of a 12-county community-based accountable care organization (ACO. (2 Methods: The continuous quality improvement evaluation methodology employed in this project was the context + mechanism = outcome (CMO model to account for the fact that programs only work insofar as they introduce promising ideas, solutions and opportunities in the appropriate social and cultural contexts. Collaborations between a 12-county ACO and 15 community pharmacies in Southwest Minnesota served as the social context for this feasibility study of MTM referrals to community pharmacists. (3 Results: All 15 community pharmacy sites were integrated into the HIT infrastructure through Direct Secure Messaging, and there were 32 recipients who received MTM services subsequent to referrals from the ACO at 5 of the 15 community pharmacies over a 1-year implementation phase. (4 Conclusion: At the conclusion of this project, an effective electronic communication and MTM referral system was activated, and consideration was given to community pharmacists providing MTM in future ACO shared savings agreements.

  17. Trasplante cardíaco en pacientes con enfermedad de Chagas. Experiencia de un único centro

    Directory of Open Access Journals (Sweden)

    Alfredo Inácio Fiorelli

    2011-07-01

    Conclusiones: El trasplante cardíaco es el único tratamiento actual eficaz de tratamiento de la enfermedad de Chagas en fase terminal. La reactivación de la enfermedad es un problema real que es fácilmente revertido con la introducción de la terapéutica farmacológica específica, restaurando los padrones histológicos del miocardio sin dejar secuelas. La inmunosupresión, en especial los corticoides, predisponen al desarrollo de neoplasias y a la reactivación de la enfermedad, exigiendo una atención especial su interrupción o reducción precoz.

  18. Transfer function fitting using a continuous Ant Colony Optimization (ACO algorithm

    Directory of Open Access Journals (Sweden)

    A. Reineix

    2015-03-01

    Full Text Available An original approach is proposed in order to achieve the  fitting of ultra-wideband complex frequency functions, such  as the complex impedances, by using the so-called ACO  (Ant Colony Optimization methods. First, we present the  optimization principle of ACO, which originally was  dedicated to the combinatorial problems. Further on, the  extension to the continuous and mixed problems is  explained in more details. The interest in this approach is  proved by its ability to define practical constraints and  objectives, such as minimizing the number of filters used in  the model with respect to a fixed relative error. Finally, the  establishment of the model for the first and second order  filter types illustrates the power of the method and its  interest for the time-domain electromagnetic computation.

  19. Multi-criteria ACO-based Algorithm for Ship’s Trajectory Planning

    Directory of Open Access Journals (Sweden)

    Agnieszka Lazarowska

    2017-03-01

    Full Text Available The paper presents a new approach for solving a path planning problem for ships in the environment with static and dynamic obstacles. The algorithm utilizes a heuristic method, classified to the group of Swarm Intelligence approaches, called the Ant Colony Optimization. The method is inspired by a collective behaviour of ant colonies. A group of agents - artificial ants searches through the solution space in order to find a safe, optimal trajectory for a ship. The problem is considered as a multi-criteria optimization task. The criteria taken into account during problem solving are: path safety, path length, the International Regulations for Preventing Collisions at Sea (COLREGs compliance and path smoothness. The paper includes the description of the new multi-criteria ACO-based algorithm along with the presentation and discussion of simulation tests results.

  20. Controlling‏ ‏the Balance of Exploration and ‎Exploitation in ACO Algorithm ‎

    Directory of Open Access Journals (Sweden)

    Ayad ‎ Mohammed Jabbar

    2018-02-01

    Full Text Available Ant colony optimization is a meta-heuristic algorithm inspired by the foraging behavior of real ant colony. The algorithm is a population-based solution employed in different optimization problems such as classification, image processing, clustering, and so on. This paper sheds the light on the side of improving the results of traveling salesman problem produced by the algorithm. The key success that produces the valuable results is due to the two important components of exploration and exploitation. Balancing both components is the foundation of controlling search within the ACO. This paper proposes to modify the main probabilistic method to overcome the drawbacks of the exploration problem and produces global optimal results in high dimensional space. Experiments on six variant of ant colony optimization indicate that the proposed work produces high-quality results in terms of shortest route

  1. Changes in health care spending and quality for Medicare beneficiaries associated with a commercial ACO contract.

    Science.gov (United States)

    McWilliams, J Michael; Landon, Bruce E; Chernew, Michael E

    2013-08-28

    In a multipayer system, new payment incentives implemented by one insurer for an accountable care organization (ACO) may also affect spending and quality of care for another insurer's enrollees served by the ACO. Such spillover effects reflect the extent of organizational efforts to reform care delivery and can contribute to the net impact of ACOs. We examined whether the Blue Cross Blue Shield (BCBS) of Massachusetts' Alternative Quality Contract (AQC), an early commercial ACO initiative associated with reduced spending and improved quality for BCBS enrollees, was also associated with changes in spending and quality for Medicare beneficiaries, who were not covered by the AQC. Quasi-experimental comparisons from 2007-2010 of elderly fee-for-service Medicare beneficiaries in Massachusetts (1,761,325 person-years) served by 11 provider organizations entering the AQC in 2009 or 2010 (intervention group) vs beneficiaries served by other providers (control group). Using a difference-in-differences approach, we estimated changes in spending and quality for the intervention group in the first and second years of exposure to the AQC relative to concurrent changes for the control group. Regression and propensity score methods were used to adjust for differences in sociodemographic and clinical characteristics. The primary outcome was total quarterly medical spending per beneficiary. Secondary outcomes included spending by setting and type of service, 5 process measures of quality, potentially avoidable hospitalizations, and 30-day readmissions. Before entering the AQC, total quarterly spending per beneficiary for the intervention group was $150 (95% CI, $25-$274) higher than for the control group and increased at a similar rate. In year 2 of the intervention group's exposure to the AQC, this difference was reduced to $51 (95% CI, -$109 to $210; P = .53), constituting a significant differential change of -$99 (95% CI, -$183 to -$16; P = .02) or a 3.4% savings

  2. Interdisciplinariedade: entre o desejo e a prática dos profissionais do transplante cardíaco no Instituto Dante Pazzanese de Cardiologia

    OpenAIRE

    Santos, Nadja Maria Codá dos

    2005-01-01

    Esta dissertação tem o objetivo geral de: analisar a prática interdisciplinar nos 13 anos de transplante cardíaco no Instituto Dante Pazzanese de Cardiologia IDPC. Buscou como objetivos específicos: resgatar a história do transplante cardíaco no IDPC; analisar as perspectivas dos profissionais sobre a contribuição de sua profissão e das demais para o trabalho interdisciplinar; estudar contribuição do Serviço Social para a prática interdisciplinar. Na prática do transplante cardíaco, inserid...

  3. Construction of the Orsay ACO storage ring, 1: progress report. 2: detecting systems; La construction de l'anneau de stockage ACO d'Orsay, 1: etat des travaux. 2: systemes de detection

    Energy Technology Data Exchange (ETDEWEB)

    Blanc-Lapierre, A; Arzelier, G; Beck, R A; Belbeoch, R; Boutouyrie, B; Bruck, H; Burnod, L; Gendreau, G; Gratreau, P; Haissinski, J; Jolivot, R; Laborde, J; Le Duff, J; Leleux, G; Marin, P C; Milman, B; Sommer, E; Zyngier, H [Laboratoire de l' Accelerateur Lineaire, 91 - Orsay (France); [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires; Augustin, J E; Rumpf, F; Silva, E

    1966-07-01

    1. - A brief progress report is given, with mention of the difficulties solved since the 1963 Dubna Conference and the extra facilities which will be available on the ring (beam observation and measurements); 2. - Typical large solid angle detecting systems and equipment for accurate monitoring under construction at Orsay are also presented. Emphasis is put on some peculiar features at ACO as a tool for physics: long experimental straight section and short length of the bunches. (authors) [French] 1. - Un bref rapport est presente sur l'etat d'avancement du projet ACO en precisant les difficultes resolues depuis la Conference de Dubna en 1963, et les moyens nouveaux mis en place sur l'anneau pour les observations et mesures sur les faisceaux; 2. - Des systemes de detection a grand angle solide et de monitorage precis, en construction a Orsay, sont egalement presentes. On insiste sur quelques traits particuliers d'ACO en tant qu'outil de travail de physique: section droite experimentale longue et paquets courts. (auteurs)

  4. Taponamiento cardíaco secundario a carcinoma papilar esclerosante difuso de tiroides

    Directory of Open Access Journals (Sweden)

    Verónica Riva

    2011-12-01

    Full Text Available El carcinoma papilar, variante esclerosante difusa, corresponde al 2% de todos los carcinomas papilares de la tiroides. Se caracteriza por comprometer de manera difusa y bilateral a la glándula tiroides. Clínicamente se manifiesta con metástasis ganglionares y pulmonares, afectando predominantemente a mujeres jóvenes. Se describe un caso de taponamiento cardíaco como presentación inicial de un carcinoma papilar de tiroides variante esclerosante difusa. Una mujer de 32 años concurrió al servicio de emergencias médicas refiriendo epigastralgia y tos seca. Durante el examen físico se constató hipotensión arterial, taquicardia y ruidos cardíacos disminuidos. Se realizó un ecocardiograma, observándose derrame pericárdico. Por medio de una pericardiocentesis se obtuvo líquido pericárdico, cuyo análisis mostró células neoplásicas. Durante la evolución la paciente presentó recurrencia del derrame pericárdico por lo que se realizó una ventana pleuropericárdica, detectándose durante la cirugía una lesión nodular subpleural, la cual fue biopsiada e informada posteriormente como una metástasis de carcinoma papilar vinculable a origen tiroideo. Se realizó una tiroidectomía total con linfadenectomía cervical bilateral. El diagnóstico final fue carcinoma papilar, variante esclerosante difusa. Esta variante infiltra el tejido conectivo de los espacios interfoliculares, simulando una tiroiditis y se caracteriza por una permeación vascular temprana. En oposición a la variante clásica, la esclerosante difusa presenta mayor agresividad y mayor tasa de recurrencia. El carcinoma papilar de tiroides debe tenerse presente como diagnóstico diferencial en nuestro medio, en todas aquellas lesiones neoplásicas papilares metastásicas, más aún si se trata de mujeres jóvenes.

  5. Implementation of a Pilot ACO Payment Model and the Use of Discretionary and Non-Discretionary Cardiovascular Care

    Science.gov (United States)

    Colla, Carrie. H.; Goodney, Philip P.; Lewis, Valerie A.; Nallamothu, Brahmajee K.; Gottlieb, Daniel J.; Meara, Ellen R.

    2014-01-01

    Background Accountable care organizations (ACOs) seek to reduce growth in healthcare spending while ensuring high-quality care. We hypothesized that ACO implementation would selectively limit utilization of discretionary cardiovascular care (defined as care occurring in the absence of indications such as myocardial infarction or stroke), while maintaining high-quality care such as non-discretionary cardiovascular imaging and procedures. Methods and Results The intervention group was composed of fee-for-service Medicare patients (n=819,779) from 10 groups participating in a Medicare pilot ACO, the Physician Group Practice Demonstration (PGPD). Matched controls were patients (n=934,621) from non-participating groups in the same regions. We compared utilization of cardiovascular care before (2002-2004) and after (2005-2009) PGPD implementation, studying both discretionary and non-discretionary carotid and coronary imaging and procedures. Our main outcome measure was the difference in the proportion of patients treated with imaging and procedures, among patients of PGPD practices compared to patients in control practices, before and after PGPD implementation (difference-in-difference). For discretionary imaging, the difference-in-difference between PGPD practices and controls was not statistically significant for discretionary carotid imaging (0.17%; 95% CI -0.51% to 0.85%, p=0.595) or discretionary coronary imaging (-0.19%; 95% CI -0.73% to 0.35%, p=0.468). Similarly, the difference-in-difference was also minimal for discretionary carotid revascularization (0.003%; 95% CI -0.008% to 0.002%, p=0.705) and coronary revascularization (-0.02%, 95% CI -0.11% to 0.07%, p=0.06). The difference-in-difference associated with PGPD implementation was also essentially zero for non-discretionary cardiovascular imaging or procedures. Conclusions Implementation of a pilot ACO did not limit the utilization of discretionary or non-discretionary cardiovascular care in ten large health

  6. Silencing of ACO decreases reproduction and energy metabolism in triazophos-treated female brown plant hoppers, Nilaparvata lugens Stål (Hemiptera: Delphacidae).

    Science.gov (United States)

    Liu, Zong-Yu; Jiang, Yi-Ping; Li, Lei; You, Lin-Lin; Wu, You; Xu, Bin; Ge, Lin-Quan; Wu, Jin-Cai

    2016-03-01

    The brown plant hopper (BPH), Nilaparvata lugens Stål (Hemiptera: Delphacidae), is a major pest affecting rice in Asia, and outbreaks of this pest are closely linked to pesticide-induced stimulation of reproduction. Therefore, the BPH is a classic example of a resurgent pest. However, the effects of different genes on the regulation of pesticide-induced reproductive stimulation in the BPH are unclear. In this study, the regulatory effects of acyl-coenzyme A oxidase (ACO) on the reproduction and biochemistry of the BPH were investigated with gene silencing. The number of eggs laid per female by triazophos (TZP)+dsACO BPH females was significantly lower than those of TZP-treated (without ACO silencing) or TZP+GFP females (negative control), with the number of eggs decreasing by 30.8% (from 529.5 to 366.3) and 32.0% (from 540.5 to 366.3), respectively. The preoviposition period, oviposition period, and longevity of the TZP-treated females were also influenced by dsACO treatment. Additionally, the amounts of crude fat, protein, and some fatty acids (oleic acid, palmitic acid, linoleic acid, stearic acid, and myristoleic acid) in TZP+dsACO females were significantly lower than in TZP-treated females. Thus, ACO is one of the key genes regulating the TZP-induced stimulation of reproduction in BPH females. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Eight reasons payer interoperability and data sharing are essential in ACOs. Interoperability standards could be a prerequisite to measuring care.

    Science.gov (United States)

    Mookencherry, Shefali

    2012-01-01

    It makes strategic and business sense for payers and providers to collaborate on how to take substantial cost out of the healthcare delivery system. Acting independently, neither medical groups, hospitals nor health plans have the optimal mix of resources and incentives to significantly reduce costs. Payers have core assets such as marketing, claims data, claims processing, reimbursement systems and capital. It would be cost prohibitive for all but the largest providers to develop these capabilities in order to compete directly with insurers. Likewise, medical groups and hospitals are positioned to foster financial interdependence among providers and coordinate the continuum of patient illnesses and care settings. Payers and providers should commit to reasonable clinical and cost goals, and share resources to minimize expenses and financial risks. It is in the interest of payers to work closely with providers on risk-management strategies because insurers need synergy with ACOs to remain cost competitive. It is in the interest of ACOs to work collaboratively with payers early on to develop reasonable and effective performance benchmarks. Hence, it is essential to have payer interoperability and data sharing integrated in an ACO model.

  8. Ant Colony Optimization ACO For The Traveling Salesman Problem TSP Using Partitioning

    Directory of Open Access Journals (Sweden)

    Alok Bajpai

    2015-08-01

    Full Text Available Abstract An ant colony optimization is a technique which was introduced in 1990s and which can be applied to a variety of discrete combinatorial optimization problem and to continuous optimization. The ACO algorithm is simulated with the foraging behavior of the real ants to find the incremental solution constructions and to realize a pheromone laying-and-following mechanism. This pheromone is the indirect communication among the ants. In this paper we introduces the partitioning technique based on the divide and conquer strategy for the traveling salesman problem which is one of the most important combinatorial problem in which the original problem is partitioned into the group of sub problems. And then we apply the ant colony algorithm using candidate list strategy for each smaller sub problems. After that by applying the local optimization and combining the sub problems to find the good solution for the original problem by improving the exploration efficiency of the ants. At the end of this paper we have also be presented the comparison of result with the normal ant colony system for finding the optimal solution to the traveling salesman problem.

  9. Tumores cardíacos: 10 anos de experiência

    Directory of Open Access Journals (Sweden)

    Antônio Augusto MIANA

    1997-01-01

    Full Text Available Objetivo: Avaliar a experiência cirúrgica do grupo no tratamento dos tumores cardíacos durante o período de janeiro de 1985 a dezembro de 1994. Casuística e Métodos: De um total de 2268 cirurgias cardíacas com circulação extracorpórea realizadas neste período de 10 anos, 6 foram para extirpação de tumores intracavitários, perfazendo 0,26% dos casos. Destes, 3 eram mixomas de átrio esquerdo, 1 fibroelastoma papilar de valva mitral, 1 rabdomioma de ventrículo esquerdo e 1 fibroma de ventrículo esquerdo. A forma clínica de apresentação foi embolia sistêmica (3 casos ou insuficiência cardíaca (3 casos. O diagnóstico foi ecocardiográfico (5 casos e angiográfico (6 casos. Resultados: Todos os pacientes tiveram evolução imediata favorável, exceto 1 deles, com mixoma de átrio equerdo, que evoluiu com mediastinite e septicemia, vindo a falecer e constituindo o único óbito hospitalar. O seguimento pós-operatório tardio, obtido em 4 pacientes (15 a 111 meses - média 49 ± 36,8 meses, não detectou qualquer recidiva, encontrando-se todos em classe funcional I (NYHA. Conclusões: Os autores concluem que os tumores cardíacos são bastante raros, de fácil diagnóstico desde que considerados, na grande maioria benignos e que cursam favoravelmente com a extirpação cirúrgica.Purpose: To review the surgical experience of our group in the treatment of primary cardiac tumors, during a 10 year period beginning January 1985 till December 1994. Material and Methods: From a total of 2268 cardiac surgeries with the aid of extracorporeal circulation performed during this 10 year period, there were 6 cases of intracavitary tumor resection, an incidence of 0.26%. Three were myxomas of the left atrium, 1 papillary fibroelastoma of the mitral valve, 1 rhabdomyoma of the left ventricule and 1 fibroma of the left ventricle. Three patients presented systemic embolism and the other three congestive heart failure. The diagnosis was confirmed

  10. Transplante cardíaco humano: experiência inicial Human cardiac transplant: initial experience

    Directory of Open Access Journals (Sweden)

    Noedir A. G Stolf

    1986-12-01

    Full Text Available No Instituto do Coração, de março de 1985 a fevereiro de 1986,11 pacientes foram submetidos a transplante cardíaco ortotópico. Eram todos do sexo masculino, com idade variando de 39 a 54 anos; 6 com cardiopatia isquémica, 4 com cardiomiopatia dilatada e um com cardiomiopatia chagásica. Foi realizado estudo hemodinâmico através de catéter de Swan-Ganz, no pré-operatório, no pós-operatório, após estabilização na unidade de recuperação, e trinta ou mais dias após o transplante. Os dados mostram melhora progressiva em relação ao índice cardíaco, pressão em artéria pulmonar, pressão de capilar pulmonar, resistência vascular pulmonar e resistência vascular sistêmica. Três dos 11 pacientes apresentaram disfunção renal transitória no pós-operatório imediato e que regrediram até o 15º dia, enquanto que 2 pacientes apresentaram aumento moderado da creatinina plasmática. Apenas 3 pacientes não apresentaram qualquer episódio de rejeição; nos demais, esses episódios foram um diagnóstico histológico sem repercussões clínicas. Complicações infecciosas ocorreram em 9 pacientes e foram de fácil controle clínico. No pós-operatório tardio, a hipertensão esteve presente em 8 pacientes, sendo mais acentuada em 2 deles. Não houve óbitos, nesta série de pacientes; todos estão assintomáticos e os 6 primeiros estão trabalhando.At the Instituto do Cora��ão, University of São Paulo Medical School, 11 patients were submitted to heart transplantation from march 1985 up to february 1986. All were male, with ages of 39-59 years, 6 with coronary heart disease, 4 with dilated cardiomyopathy and 1 with Chagas cardiomyopathy. The patients were studied hemodynamically with a Swan-Ganz catheter pre-operatively, at the arrival in the intensive care unit, in the first postoperative day and 30 or more days after the transplant. The data showed that there was a progressive increase of cardiac index and decreases of

  11. Changes in oxidative stress in transgenic RNAi ACO1 tomato fruit during ripening

    Science.gov (United States)

    Eglous, Najat Mohamed; Ali, Zainon Mohd; Hassan, Maizom; Zainal, Zamri

    2013-11-01

    Tomato (Solanum Lycopersicum L.) is the second most cultivated vegetable in the world and widely used as a system for studying the role of ethylene during fruit ripening. Our objective was to study the oxidative stress and antioxidative metabolism during ripening of non transgenic tomato and transgenic line-21 tomato which reduced ethylene. The line-21 of transgenic tomato plants (RNAi ACO1) had lower ethylene production and longer shelf-life more than 32 days as compared to the wild-type fruits which have very short shelf-life. In this study, tomato fruit were divided into five different stages (MG: mature green 5%, B: breaker 25%, T: turning 50%, O: orange75%, RR: red ripe100%). The activity of lipoxygenase (LOX) and lipid peroxidation (MDA) were measured to assess changes in oxidative stress. The LOX activity and MDA content decreased significantly obtaining 2.6-fold and 1.2-fold, respectively, as compared to the wild type fruit. However, superoxide dismutase (SOD) and catalase (CAT) activities were increased to 1.9 and 1.2 folds from the mature green to the fully ripe stage in transgenic tomatoes. Furthermore, the wild type tomato increases 1.3 in SOD and 1.6 in CAT activities. The overall results indicate that the wild type tomato fruit showed a faster rate of ripening, parallel to decline in the rate of enzymatic antioxidative systems as compared to the transgenic line-21 tomato fruit. In addition, the results show that the antioxidant capacity is improved during the ripening process and is accompanied by an increase in the oxidative stress.

  12. Sedação com sufentanil e clonidina em pacientes submetidos a cateterismo cardíaco

    Directory of Open Access Journals (Sweden)

    Anita Perpetua Carvalho Rocha

    2011-03-01

    Full Text Available FUNDAMENTO: A sedação para a realização de cateterismo cardíaco tem sido alvo de preocupação. Benzodiazepínicos, agonistas alfa-2 adrenérgicos e opioides são utilizados para esse fim, entretanto, cada um destes medicamentos possui vantagens e desvantagens. OBJETIVO: Avaliar a eficácia do sufentanil e da clonidina como sedativos em pacientes submetidos a cateterismo cardíaco, observando o impacto dos mesmos sobre os parâmetros hemodinâmicos e respiratórios, a presença de efeitos colaterais, além da satisfação do paciente e do hemodinamicista com o exame. MÉTODOS: Trata-se de um ensaio clínico prospectivo, duplo-cego, randomizado e controlado, que envolveu 60 pacientes que receberam 0,1 µg/kg de sufentanil ou 0,5 µg/kg de clonidina antes da realização do cateterismo cardíaco. O escore de sedação segundo a escala de Ramsay, a necessidade de utilização de midazolam, os efeitos colaterais, os parâmetros hemodinâmicos e respiratórios foram registrados, sendo os dados analisados em 06 diferentes momentos. RESULTADOS: O comportamento da pressão arterial, da frequência cardíaca e da frequência respiratória foi semelhante nos dois grupos, entretanto, no momento 2, os pacientes do grupo sufentanil (Grupo S apresentaram menor escore de sedação segundo a escala de Ramsay, e a saturação periférica da oxihemoglobina foi menor que o grupo clonidina (Grupo C no momento 6. Os pacientes do Grupo S apresentaram maior incidência de náusea e vômito pós-operatório que os pacientes do Grupo C. A satisfação dos pacientes foi maior no grupo clonidina. Os hemodinamicistas mostraram-se satisfeitos nos dois grupos. CONCLUSÃO: O sufentanil e a clonidina foram efetivos como sedativos em pacientes submetidos a cateterismo cardíaco.

  13. Manejo de las dislipidemias en pacientes cardíacos trasplantados. Hallazgos sobre nuevos factores de riesgo

    OpenAIRE

    Walter Masson; Norberto Vulcano; Sandra Fernández; Alberto Domenech; Ricardo Marenchino; Daniel Bracco; César Belziti

    2008-01-01

    En pacientes cardíacos trasplantados, el desarrollo de enfermedad vascular coronaria es una complicación frecuente y la dislipidemia es uno de los predictores más importantes. Los inmunosupresores predisponen a las dislipidemias y dificultan la utilización de hipolipemiantes. En este grupo particular de pacientes se recomienda alcanzar las metas terapéuticas de prevención secundaria. Las estatinas son los hipolipemiantes de elección. No existen recomendaciones claras sobre nuevos factores de ...

  14. Manejo de las dislipidemias en pacientes cardíacos trasplantados: Hallazgos sobre nuevos factores de riesgo

    OpenAIRE

    Masson, Walter; Vulcano, Norberto; Fernández, Sandra; Domenech, Alberto; Marenchino, Ricardo; Braccomtsac, Daniel; Belziti, César

    2008-01-01

    En pacientes cardíacos trasplantados, el desarrollo de enfermedad vascular coronaria es una complicación frecuente y la dislipidemia es uno de los predictores más importantes. Los inmunosupresores predisponen a las dislipidemias y dificultan la utilización de hipolipemiantes. En este grupo particular de pacientes se recomienda alcanzar las metas terapéuticas de prevención secundaria. Las estatinas son los hipolipemiantes de elección. No existen recomendaciones claras sobre nuevos factores de ...

  15. CO2 Measurements from Space: Lessons Learned from the Collaboration between the ACOS/OCO-2 and GOSAT Teams

    Science.gov (United States)

    Crisp, D.; Eldering, A.; Gunson, M. R.

    2012-12-01

    The NASA Orbiting Carbon Observatory (OCO) and the Japanese Greenhouse gases Observing SATellite (GOSAT) were the first two missions designed to collect space-based observations of the column-averaged CO2 dry air mole fraction, XCO2, with the sensitivity, coverage, and resolution needed to quantify CO2 fluxes on regional scales over the globe. The OCO and GOSAT teams formed a close collaboration during the development phases of these missions. After the loss of OCO, the GOSAT project team invited the OCO team to contribute to the analysis of measurements collected by the GOSAT Thermal And Near infrared Sensor for carbon Observations-Fourier Transform Spectrometer (TANSO-FTS). NASA responded by reformulating the OCO science team under the Atmospheric CO2 Observations from Space (ACOS) task to exploit this opportunity. This collaboration is providing an independent GOSAT XCO2 product, and valuable insights into the retrieval algorithms, calibration methods, and validation techniques that are being developed to analyze data anticipated the NASA Orbiting Carbon Observatory-2 (OCO-2). The ACOS/OCO-2 and GOSAT teams have conducted four, joint, vicarious calibration campaigns at Railroad Valley, Nevada to track the long-term radiometric performance of the TANSO-FTS instrument. The methods used in these campaigns evolved from those used to characterize the radiometric performance of high spatial resolution, imaging spectroradiometers. For TANSO-FTS, the conventional, surface based radiometric measurements have been augmented with surface and aircraft measurements of atmospheric temperature and trace gas profiles, as well as surface observations from MODIS and ASTER to characterize spatial variations of the surface reflectance within the (relatively large) sounding footprints. Similar methods will be needed for OCO-2. The ACOS/OCO-2 retrieval algorithm and associated data screening methods have been modified to estimate XCO2 from TANSO-FTS observations. Comparisons of TANSO

  16. Impacto del riesgo cardíaco sobre la Aneurismectomía

    Directory of Open Access Journals (Sweden)

    Orestes Díaz Hernández

    2000-04-01

    Full Text Available Se realiza un análisis cardiológico a 100 pacientes a los cuales se les efectuó cirugía electiva por aneurisma de la aorta abdominal infrarrenal; para esto se emplearon 5 métodos: el índice de riesgo cardíaco de Goldman original y modificado, los marcadores coronarios de Eagle, las indicaciones por niveles recomendadas por Hollier y la ecuación de Cooperman. La cardiopatía isquémica se detectó en el 59 % del total de los pacientes. De ellos, el 43 % tenía antecedentes de infarto del miocardio, el 33 % angina estable bajo tratamiento medicamentoso, el 6 % insuficiencia cardíaca congestiva con tratamiento digitálico y el 11 % un ritmo no sinusal detectado en el electrocardiograma. La supervivencia a largo plazo en la cardiopatía isquémica se comportó al año y 2 años en el 80 %, a los 5 años en el 72 % y a los 10 y 13 años en el 35 %. Se propone un algoritmo simple y modificado de valoración cardiológica en los pacientes que muestran aneurisma de la aorta abdominalA cardiological analysis of 100 patients whe underwent elective surgery due to infrarenal abdominal aortic aneurysm was made. 5 methods were used to this end: the original and modified Goldman´s cardiac resk index, Eagle´s coronary markers, the indications by levels recommended by Hollier and Cooperman´s equation. Ischaemic heart disease was detected in 59 % of the patients. 43 % of them had history of myocardial infarction, 33 % of stable angina under drug treatment, 6 % of congestive heart failure with digitalis treatment and 11 % had a nonsinusal rate detected in the EKG. Among those suffering from schemic heart disease there was a long term survival of 80 % at the lst and 2nd year, 72 % at the 5 th year, and 35 % at the 10th and 13th year. A simple and modified algorithm of cardiological assessment was proposed for patients with abdominal aortic aneurysm

  17. Transplante cardíaco ortotópico pela técnica bicaval

    Directory of Open Access Journals (Sweden)

    CHACCUR Paulo

    1997-01-01

    Full Text Available Há trinta anos tem sido empregada a técnica descrita por Lower e Shumway para o transplante cardíaco ortotópico, com bons resultados. Complicações, como estase venosa, formação de trombos, arritmias atriais e insuficiência das valvas tricúspide e mitral, estão presentes no pós-operatório tardio. A partir de 1995, passamos a utilizar a técnica bicaval em todos os casos (6 pacientes. Cinco eram do sexo masculino e a média de idades dos receptores era de 50,6 anos. A cardiomiopatia era dilatada e isquêmica em 2 casos cada, e chagásica e reumática nos demais. Três pacientes apresentavam operações prévias, sendo que um deles havia sido submetido a três operações de prótese valvar aórtica, o segundo a implante de marcapasso epimiocárdico definitivo, e o último a duas operações de revascularização do miocárdio associada a aneurismectomia de ventrículo esquerdo. A técnica cirúrgica consistiu, na maioria dos casos, na anastomose das veias pulmonares, em conjunto com o átrio esquerdo do coração a ser implantado e, a seguir, a da cava superior, inferior, do tronco pulmonar e aorta. Todos os doadores estavam em hospitais da cidade e com retirada múltipla de órgãos. Não tivemos óbito hospitalar e todos os pacientes estão vivos para um período de um a quinze meses de pós-operatório. Não houve diferença significativa quando se comparou as duas técnicas para o tempo de anóxia, tempo de C E C, tempo de implante, presença de taquiarritmias atriais, sangramento e permanência hospitalar. Houve diferença significativa (p<0,05 para a utilização de marcapasso temporário e presença de insuficiência tricúspide. Acreditamos que a técnica bicaval, além de reduzir o tamanho das cavidades atriais, é uma técnica simples, com índice menor de complicações e que poderá ser empregada com mais freqüência.

  18. Interacciones entre dispositivos cardíacos implantables y modalidades fisioterapéuticas: ¿Mito o realidad?

    Directory of Open Access Journals (Sweden)

    Genevieve C. Digby

    2011-04-01

    Full Text Available La fisioterapia se ha transformado en una especialidad que claramente incide en la calidad de vida de nuestros pacientes. En poblaciones añosas, el uso de fisioterapia incluye múltiples modalidades para un alto número de distintas enfermedades. Varios informes sobre posibles interacciones negativas entre las distintas modalidades de fisioterapia y los dispositivos cardíacos implantables (marcapasos y cardiodesfibriladores han sido publicados en los últimos aňos. A pesar de ello, existe muy poca evidencia y guías precisas para identificar cuáles son las modalidades de fisioterapia seguras a utilizar en esta población de pacientes. En la siguiente revisión, nos propusimos resumir las interacciones documentadas entre fisioterapia y dispositivos cardíacos implantables (DCI, discutir el estándar actual de estas prácticas e identificar las principales consideraciones que existen desde la perspectiva de un servicio de electrofisiología cardíaca, para el tratamiento adecuado en estos pacientes. Finalmente, abogamos por fortalecer la colaboración entre fisioterapeutas y electrofisiólogos, con el fin de asegurar una óptima y segura atención de este grupo de pacientes.

  19. Quantifying Spatiotemporal Dynamics of Solar Radiation over the Northeast China Based on ACO-BPNN Model and Intensity Analysis

    Directory of Open Access Journals (Sweden)

    Xiangqian Li

    2017-01-01

    Full Text Available Reliable information on the spatiotemporal dynamics of solar radiation plays a crucial role in studies relating to global climate change. In this study, a new backpropagation neural network (BPNN model optimized with an Ant Colony Optimization (ACO algorithm was developed to generate the ACO-BPNN model, which had demonstrated superior performance for simulating solar radiation compared to traditional BPNN modelling, for Northeast China. On this basis, we applied an intensity analysis to investigate the spatiotemporal variation of solar radiation from 1982 to 2010 over the study region at three levels: interval, category, and conversion. Research findings revealed that (1 the solar radiation resource in the study region increased from the 1980s to the 2000s and the average annual rate of variation from the 1980s to the 1990s was lower than that from the 1990s to the 2000s and (2 the gains and losses of solar radiation at each level were in different conditions. The poor, normal, and comparatively abundant levels were transferred to higher levels, whereas the abundant level was transferred to lower levels. We believe our findings contribute to implementing ad hoc energy management strategies to optimize the use of solar radiation resources and provide scientific suggestions for policy planning.

  20. Manejo de las dislipidemias en pacientes cardíacos trasplantados. Hallazgos sobre nuevos factores de riesgo

    Directory of Open Access Journals (Sweden)

    Walter Masson

    2008-01-01

    Full Text Available En pacientes cardíacos trasplantados, el desarrollo de enfermedad vascular coronaria es una complicación frecuente y la dislipidemia es uno de los predictores más importantes. Los inmunosupresores predisponen a las dislipidemias y dificultan la utilización de hipolipemiantes. En este grupo particular de pacientes se recomienda alcanzar las metas terapéuticas de prevención secundaria. Las estatinas son los hipolipemiantes de elección. No existen recomendaciones claras sobre nuevos factores de riesgo, como la homocisteína y la lipoproteína (a [Lp(a].Con el objetivo de conocer el perfil lipídico, la prevalencia de homocisteinemia y de Lp(a elevadas, el cumplimiento de las metas terapéuticas y la tolerancia a la medicación, se incluyeron en el estudio 23 pacientes cardíacos trasplantados. Los resultados mostraron que el cumplimiento de las metas lipídicas fue aceptable y que el 65% recibía tratamiento hipolipemiante. El uso de estatinas fue seguro. Se encontró una prevalencia alta de homocisteína y Lp(a elevadas. Su implicación en la modificación del tratamiento se desconoce.

  1. Transient absorption spectroscopy in biology using the Super-ACO storage ring FEL and the synchrotron radiation combination

    International Nuclear Information System (INIS)

    Renault, Eric; Nahon, Laurent; Garzella, David; Nutarelli, Daniele; De Ninno, Giovanni; Hirsch, Matthias; Couprie, Marie Emmanuelle

    2001-01-01

    The Super-ACO storage ring FEL, covering the UV range down to 300 nm with a high average power (300 mW at 350 nm) together with a high stability and long lifetime, is a unique tool for the performance of users applications. We present here the first pump-probe two color experiments on biological species using a storage ring FEL coupled to the synchrotron radiation. The intense UV pulse of the Super-ACO FEL is used to prepare a high initial concentration of chromophores in their first singlet electronic excited state. The nearby bending magnet synchrotron radiation provides, on the other hand a pulsed, white light continuum (UV-IR), naturally synchronized with the FEL pulses and used to probe the photochemical subsequent events and the associated transient species. We have demonstrated the feasibility with a dye molecule (POPOP) observing a two-color effect, signature of excited state absorption and a temporal signature with Acridine. Applications on various chromophores of biological interest are carried out, such as the time-resolved absorption study of the first excited state of Acridine

  2. Transient absorption spectroscopy in biology using the Super-ACO storage ring FEL and the synchrotron radiation combination

    CERN Document Server

    Renault, E; De Ninno, G; Garzella, D; Hirsch, M; Nahon, L; Nutarelli, D

    2001-01-01

    The Super-ACO storage ring FEL, covering the UV range down to 300 nm with a high average power (300 mW at 350 nm) together with a high stability and long lifetime, is a unique tool for the performance of users applications. We present here the first pump-probe two color experiments on biological species using a storage ring FEL coupled to the synchrotron radiation. The intense UV pulse of the Super-ACO FEL is used to prepare a high initial concentration of chromophores in their first singlet electronic excited state. The nearby bending magnet synchrotron radiation provides, on the other hand a pulsed, white light continuum (UV-IR), naturally synchronized with the FEL pulses and used to probe the photochemical subsequent events and the associated transient species. We have demonstrated the feasibility with a dye molecule (POPOP) observing a two-color effect, signature of excited state absorption and a temporal signature with Acridine. Applications on various chromophores of biological interest are carried out,...

  3. Mensuração do tamanho cardíaco em radiografias de gatos com hipertireoidismo experimental

    Directory of Open Access Journals (Sweden)

    Mauro José Lahm Cardoso

    2007-04-01

    Full Text Available O hipertireoidismo felino ou tireotoxicose é a doença endócrina mais freqüente em gatos domésticos. O hipertireoidismo felino é uma desordem multissistêmica associada com aumento das concentrações dos hormônios tireoidianos circulantes, triidotironina (T3 e tiroxina (T4. Anormalidades cardiovasculares em gatos com hipertireoidismo espontâneo já foram bem descritas. O objetivo deste trabalho foi realizar a mensuração cardíaca em 19 gatos submetidos a tireotoxicose experimental, utilizando o "vertebral heart size" (VHS. A mensuração utilizando o VHS foi realizada a partir de radiografias torácicas lateral, dorsoventral e ventrodorsal. As radiografias torácicas laterais foram mais eficazes do que as ventrodorsal e dorsoventral em ilustrar o aumento progressivo do coração. O VHS é um método fácil de ser usado, permitindo a avaliação do tamanho cardíaco em gatos hipertireóideos, e facilita a identificação de cardiomegalia e progressão do tamanho cardíaco.

  4. Experiencia con hipotermia terapéutica en el paro cardíaco extrahospitalario

    Directory of Open Access Journals (Sweden)

    Ricardo Levin

    2016-01-01

    Full Text Available Introducción: El paro cardíaco extrahospitalario (PCEH, una de las principales causas de mortalidad en el mundo occidental, se asocia con una muy baja sobrevida hospitalaria y con un número elevado de secuelas neurológicas entre los sobrevivientes, sin modificaciones significativas en el pronóstico en las últimas tres décadas. Estudios clínicos más recientes plantearon la utilidad de la hipotermia terapéutica en la reducción de la mortalidad y el grado de deterioro neurológico en sobrevivientes de un PCEH. Objetivos: Evaluar la mortalidad y el resultado neurológico de pacientes comatosos resucitados de un PCEH tratados con hipotermia terapéutica. Considerar las indicaciones y los hallazgos de la cinecoronariografía y detectar complicaciones asociadas con la hipotermia. Material y métodos: Se incluyeron pacientes resucitados de un PCEH tratados bajo hipotermia terapéutica, que consistió en una fase de enfriamiento a 33 °C, un mantenimiento durante 24 horas y recalentamiento a 0,25 °C/hora. Se analizaron las indicaciones y los hallazgos de la cinecoronariografía. Se evaluaron complicaciones metabólicas, arrítmicas, infecciosas y hemorrágicas. Se consideró significativo valor de p menor de 0,05. Resultados: De los 213 pacientes incluidos, la sobrevida hospitalaria fue de 109 pacientes (51,2%, de los que 96 (46,1% presentaron al egreso buena recuperación neurológica. Se observó mayor sobrevida en pacientes con ritmos pasibles de desfibrilación respecto de aquellos con ritmos no pasibles de desfibrilación (58,2% vs. 37,7%; p = 0,007. Se derivaron (3,5 horas en promedio a cinecoronariografía 147 (69% pacientes, de los cuales 121 (82,3% mostraron enfermedad significativa, observándose en 69 (57% oclusión coronaria completa. Ciento siete pacientes fueron sometidos a angioplastia; 43 (40,2% de ellos fallecieron durante la internación frente a 61 (58,6% óbitos entre los no intervenidos o no estudiados (p = 0,005. Entre

  5. Intelligent Search Method Based ACO Techniques for a Multistage Decision Problem EDP/LFP

    Directory of Open Access Journals (Sweden)

    Mostefa RAHLI

    2006-07-01

    the algorithm getting to him a rate preferably more or less justifiable. In operational research, this subject is known under the name of CPO [14] (combinatory problem optimization.The choice of a numerical method to use for a merged case study and calculation of the LFP/Fitting/EDP what is [7, 8, 9, 10, 18, 19, 20] (in theoretical form of a problem compensates the final decision to adopt and a strategy of optimal production (which is a practical problem form and the final task most wanted.Each method is imposed by:· The algorithm complexity.· In an application gathering all calculations, the number of uses of method compared to the total number of later issues.· The maximum number of iterations for a given use.· The maximum iterations count allowed for this algorithm kind.· The limitations of the algorithm such as: applicability of a method (algorithm adapted or not to the problem; does the problem constrained or not; problem dimension or order N (N ≤ Nmax; the algorithm stability.It's well-known that for an approached calculation method, the propagation of errors strongly conditions the need of making its adequate choice and if it can be adopted compared to others for the same area.More is the number of the elementary operations is large more the final result misses precision and especially if the finality of the study is a responsible decision to make and a satisfaction of constraints and multiple conditions. Our study proposes an inference based solution (AI with the use of ACO technique (Ant colony Optimization2.

  6. Expression Study of LeGAPDH, LeACO1, LeACS1A, and LeACS2 in Tomato Fruit (Solanum lycopersicum

    Directory of Open Access Journals (Sweden)

    Pijar Riza Anugerah

    2015-10-01

    Full Text Available Tomato is a climacteric fruit, which is characterized by ripening-related increase of respiration and elevated ethylene synthesis. Ethylene is the key hormone in ripening process of climacteric fruits. The objective of this research is to study the expression of three ethylene synthesis genes: LeACO1, LeACS1A, LeACS2, and a housekeeping gene LeGAPDH in ripening tomato fruit. Specific primers have been designed to amplify complementary DNA fragment of LeGAPDH (143 bp, LeACO1 (240 bp, LeACS1A (169 bp, and LeACS2 (148 bp using polymerase chain reaction. Nucleotide BLAST results of the complementary DNA fragments show high similarity with LeGAPDH (NM_001247874.1, LeACO1 (NM_001247095.1, LeACS1A (NM_001246993.1, LeACS2 (NM_001247249.1, respectively. Expression study showed that LeACO1, LeACS1A, LeACS2, and LeGAPDH genes were expressed in ripening tomato fruit. Isolation methods, reference sequences, and primers used in this study can be used in future experiments to study expression of genes responsible for ethylene synthesis using quantitative polymerase chain reaction and to design better strategy for controlling fruit ripening in agroindustry.

  7. Hacia una descripción del cuento policíaco español contemporáneo

    Directory of Open Access Journals (Sweden)

    Alicia Valverde Velasco

    2014-06-01

    Full Text Available Desde su recepción en España, ya en el siglo XIX, el cuento policíaco nunca había experimentado un auge en su cultivo y aceptación como el acaecido a partir de los años setenta. Desde entonces, el cuento literario, como forma narrativa susceptible de desarrollar tramas de muy distinta índole, entre ellas la del hecho criminal, ha experimentado un período de reconocimiento paulatino por parte de los autores, las editoriales, el público y la crítica, por lo que no es de extrañar que los escritores del llamado “género criminal” se atreviesen a explorar las posibilidades del relato breve con mayor fortuna que durante las décadas precedentes.

  8. Citrus CitNAC62 cooperates with CitWRKY1 to participate in citric acid degradation via up-regulation of CitAco3.

    Science.gov (United States)

    Li, Shao-Jia; Yin, Xue-Ren; Wang, Wen-Li; Liu, Xiao-Fen; Zhang, Bo; Chen, Kun-Song

    2017-06-15

    Citric acid is the predominant organic acid of citrus fruit. Degradation of citric acid occurs during fruit development, influencing fruit acidity. Associations of CitAco3 transcripts and citric acid degradation have been reported for citrus fruit. Here, transient overexpression of CitAco3 significantly reduced the citric acid content of citrus leaves and fruits. Using dual luciferase assays, it was shown that CitNAC62 and CitWRKY1 could transactivate the promoter of CitAco3. Subcellular localization results showed that CitWRKY1 was located in the nucleus and CitNAC62 was not. Yeast two-hybrid analysis and bimolecular fluorescence complementation (BiFC) assays indicated that the two differently located transcription factors could interact with each other. Furthermore, BiFC showed that the protein-protein interaction occurred only in the nucleus, indicating the potential mobility of CitNAC62 in plant cells. A synergistic effect on citrate content was observed between CitNAC62 and CitWRKY1. Transient overexpression of CitNAC62 or CitWRKY1 led to significantly lower citrate content in citrus fruit. The combined expression of CitNAC62 and CitWRKY1 resulted in lower citrate content compared with the expression of CitNAC62 or CitWRKY1 alone. The transcript abundance of CitAco3 was consistent with the citrate content. Thus, we propose that a complex of CitWRKY1 and CitNAC62 contributes to citric acid degradation in citrus fruit, potentially via modulation of CitAco3. © The Author 2017. Published by Oxford University Press on behalf of the Society for Experimental Biology.

  9. Certeza diagnóstica en la mortalidad de una población de pacientes con trasplante cardíaco

    Directory of Open Access Journals (Sweden)

    Marcos Amuchástegui

    2008-01-01

    Full Text Available RESUMENIntroducciónA pesar de que la morbimortalidad en el trasplante cardíaco ha sido motivo de extensoanálisis, la mayoría de los estudios y registros de mortalidad en pacientes trasplantados sebasan sobre datos clínicos. En la bibliografía existen comunicaciones aisladas de autopsiasen pacientes con trasplante cardíaco.ObjetivoDeterminar la importancia de la realización de estudios anatomopatológicos para el diagnósticode causa de muerte en un programa de trasplante cardíaco.Material y métodosSe incluyeron todos los pacientes con trasplante cardíaco fallecidos entre enero 1990 y enero2005. El diagnóstico definitivo de la causa de muerte fue corroborado por autopsia obiopsia de órgano sólido. Las causas de muerte evaluadas fueron falla precoz del injerto,rechazo celular, infección, enfermedad vascular del injerto, neoplasia y otros.ResultadosDurante el período en estudio 73 pacientes fueron sometidos a trasplante cardíaco; de ellos,fallecieron 31. Se obtuvieron 12 autopsias y 7 biopsias de órgano sólido que certificaron lacausa de muerte (61%. La causa de muerte más frecuente fue el rechazo celular mayor degrado III. En el 12,9%, la anatomía patológica difirió de la sospecha clínica de la causa demuerte.ConclusiónLa información clinicopatológica derivada de estudios post mortem es un indicador de nuestrarealidad asistencial y se constituye en un pilar fundamental para el conocimiento y elmanejo futuro de los pacientes trasplantados, por lo que consideramos que la realización deautopsias en estos pacientes es de vital importancia.REV ARGENT CARDIOL 2008;76:292-294.

  10. Transplante cardíaco e infecção Cardiac transplantation and infection

    Directory of Open Access Journals (Sweden)

    Wilson José COUTO

    2001-06-01

    Full Text Available Objetivo: O presente estudo visa avaliar a incidência de infecções, os agentes etiológicos, e a apresentação clínica e a morbi-mortalidade operatória nos pacientes submetidos a transplante cardíaco na Universidade Federal de São Paulo. Casuística e Métodos: No período de novembro de 1996 a junho de 1998, 97 pacientes transplantados pela equipe de Cirurgia Cardiovascular da UNIFESP sobreviveram por período superior a uma semana após o transplante e foram analisados, retrospectivamente, quanto aos processos infecciosos diagnosticados. A idade dos pacientes variou de 3 a 63 anos (média de 44,4 ± 13,0 anos, sendo que a maioria apresentava miocardiopatia dilatada (46, seguida de chagásica (24 e isquêmica (23. O tempo de seguimento variou de 0,33 a 119 meses (36 ± 30,7 meses. Resultados: Dos 97 pacientes estudados, 16 (16,4% morreram, sendo infecção a principal causa, seguido pela rejeição em 10 (10,30%. As causas de óbito por infecção foram: sepse bacteriana em 6 pacientes, pneumonia em outros 6, infecção intra-abdominal em 2, toxoplasmose disseminada em 1 e infecção pelo citomegalovírus em 1. Ocorreram 142 episódios infecciosos diagnosticados distribuídos da seguinte forma: bacterianos 76 (52,5%; virais 34 (28,8%; fúngicos 20 (17,5% e protozoários 12 (12,4%. Houve 8 episódios de reativação da doença de Chagas (média 4,9 meses após o transplante diagnosticados principalmente através do aparecimento de nódulos subcutâneos. Todos os casos de reativação foram tratados com alopurinol e evoluíram bem. Conclusão: Os dados apresentados mostraram o predomínio de infecções bacterianas que causaram maior mortalidade. Nos transplantados por doença de Chagas a reativação da doença pode ser controlada adequadamente com uso de alopurinol. Os dados são importantes para orientação em nossa comunidade dos programas de transplantes, uma vez que traz à tona particularidades do nosso meio.Objective: To evaluate

  11. Estimación del gasto cardíaco: Utilidad en la práctica clínica. Monitorización disponible invasiva y no invasiva

    OpenAIRE

    García, X.; Mateu, L.; Maynar, J.; Mercadal, J.; Ochagavía, A.; Ferrandiz, A.

    2011-01-01

    Esta revisión pretende profundizar en el conocimiento del gasto cardíaco, sus variables y sus condicionantes, así como repasar exhaustivamente las diferentes técnicas disponibles para su monitorización y establecer las situaciones en que el conocimiento del gasto cardíaco nos aporta una información fundamental en el manejo del paciente crítico. La técnica de Fick, utilizada en los inicios para calcular el gasto cardíaco de los pacientes, ha sido sustituida hoy en día en la práctica clínica po...

  12. Autotransplante cardíaco: um novo método no tratamento de problemas cardíacos complexos Heart autotransplantation: a new technique to complex intracardiac reppairs

    Directory of Open Access Journals (Sweden)

    Randas J. V Batista

    1995-06-01

    Full Text Available No período de janeiro de 1990 a maio de 1995 foram operados com a técnica do autotransplante cardíaco 92 pacientes com cardiopatias complexas e arritmias supraventriculares, principalmente fibrilação atrial (n=89, reentrada (n=2, QT longo (n=1. O sexo feminino predominou (n=63. A idade variou de 18 a 76 anos (m=43. Os defeitos concomitantes foram: átrio esquerdo gigante (medido pelo ecocardiograma > 6 cm (n=65; átrio direito gigante (n=9; átrio esquerdo aumentado (4 cm (n=23; estenose mitral (n=46; insuficiência mitral (n=28; dupla lesão mitral (n=16; estenose aórtica (n=12; insuficiência aórtica (n=5; insuficiência tricúspide (n=78; trombose atrial (n=23; calcificação atrial (n=12; hipertensão pulmonar (n=86; fibroelastose biventricular (n=3; rotura atrioventricular (pós-troca de valva mitral (n=1; aneurisma da raiz aórtica (n=1; ventriculectomia parcial (n=8; 88 pacientes saíram do centro cirúrgico em ritmo sinusal e assim permaneceram; 6 precisaram de drogas inotrópicas e 3 de drogas antiarrítmicas. Todos os pacientes que apresentavam átrio esquerdo ou direito gigante com fibrilação atrial tiveram seus átrios reduzidos ao tamanho normal. Não houve mortalidade operatória e 6 evoluíram a óbito hospitalar. Na reavaliação aos seis meses de pós-operatório, os sobreviventes estavam bem, em ritmo sinusal. A técnica do autotransplante cardíaco facilita o reparo intracardíaco, proporciona a redução atrial e conseqüente retorno do paciente ao ritmo sinusal e abre novas perspectivas.From January 1990 to May 1995,92 patients with complex cardiac problems and supraventricular arrhythmias were operated upon with the technique of heart autotransplantation. The arrhythmias were: atrial fibrillation (n=89; reentry (n=2; long QT syndrome (n=1. Females predominated (n=63. The age varied from 18 to 76 years (m=43. Concomittant defects were: giant left atrium (> 6 cm measured by echo (n=65; giant right atrium (n=9; large

  13. Síndrome de bajo gasto cardíaco en la tetralogía de Fallot

    Directory of Open Access Journals (Sweden)

    Lincoln de la Parte Pérez

    2002-06-01

    Full Text Available Se realiza un estudio retrospectivo de 200 niños operados de tetralogía de Fallot en el Cardiocentro del Hospital Pediátrico Universitario "William Soler" durante el período comprendido entre los años 1990 y 1993. Se observó una relación directamente proporcional entre el tiempo de pinzamiento aórtico (paro anóxico, el tiempo de circulación extracorpórea (CEC y el desarrollo del síndrome de bajo gasto cardíaco. La incidencia de bajo gasto cardíaco en los niños con tiempo de pinzamiento aórtico menor a los 30 min fue nula, en los pacientes con tiempo menor a los 60 min la incidencia fue del 23,2 % (40 pacientes. En los 24 pacientes que sufrieron procedimientos quirúrgicos prolongados y tiempo de pinzamiento aórtico mayor de 1 hora la incidencia fue del 95,8 %. En los pacientes con tiempo de CEC menor de 90 min la incidencia de bajo gasto cardíaco que de sólo el 9,75 %, en los niños con tiempo de CEC entre 91 y 105 min fue de 15,53 %, en los que necesitaron entre 106 y 120 min de CEC fue del 62,5 % y en los procedimientos quirúrgicos prolongados fue del 95,8 %. La mayoría de los pacientes respondió bien al tratamiento, aunque en un pequeño número de ellos se mantuvo la disfunción ventricular a pesar del tratamiento. Siete niños fallecieron en el posoperatorio para una mortalidad del 3,5 %.A retrospective study of 200 children with Tetralogy of Fallot, who were operated on the Cardiology Center of "William Soler" University Pediatric Hospital from 1990 to 1993, was performed. There was a direct proportional relation between time of holding aorta with forceps (anoxic arrest, time of extracorporeal circulation and the development of low cardiac output syndrome. The incidence of low cardiac output in children who underwent holding of aorta with forceps for less than 30 minutes was zero, but the same procedure applied in patients for less than 60 minutes, the incidence was 23,2%(40 patients. The 24 patients that underwent

  14. Sildenafil vs. Nitroprussiato de Sódio durante Teste de Reatividade Pulmonar pré-transplante cardíaco

    Directory of Open Access Journals (Sweden)

    Aguinaldo Figueiredo Freitas Jr

    2012-09-01

    Full Text Available FUNDAMENTO: A hipertensão pulmonar é associada ao pior prognóstico no pós-transplante cardíaco. O teste de reatividade pulmonar com Nitroprussiato de Sódio (NPS está associado a elevados índices de hipotensão arterial sistêmica, disfunção ventricular do enxerto transplantado e elevadas taxas de desqualificação para o transplante. OBJETIVO: Neste estudo, objetivou-se comparar os efeitos do Sildenafil (SIL e NPS sobre variáveis hemodinâmicas, neuro-hormonais e ecocardiográficas durante teste de reatividade pulmonar. MÉTODOS: Os pacientes foram submetidos, simultaneamente, ao cateterismo cardíaco direito, ao ecocardiograma e à dosagem de BNP e gasometria venosa, antes e após administração de NPS (1 - 2 µg/Kg/min ou SIL (100 mg, dose única. RESULTADOS: Ambos reduziram a hipertensão pulmonar, porém o nitrato promoveu hipotensão sistêmica significativa (Pressão Arterial Média - PAM: 85,2 vs. 69,8 mmHg, p < 0,001. Ambos reduziram as dimensões cardíacas e melhoraram a função cardíaca esquerda (NPS: 23,5 vs. 24,8 %, p = 0,02; SIL: 23,8 vs. 26 %, p < 0,001 e direita (SIL: 6,57 ± 2,08 vs. 8,11 ± 1,81 cm/s, p = 0,002; NPS: 6,64 ± 1,51 vs. 7,72 ± 1,44 cm/s, p = 0,003, medidas pela fração de ejeção ventricular esquerda e Doppler tecidual, respectivamente. O SIL, ao contrário do NPS, apresentou melhora no índice de saturação venosa de oxigênio, medido pela gasometria venosa. CONCLUSÃO: Sildenafil e NPS são vasodilatadores que reduzem, de forma significativa, a hipertensão pulmonar e a geometria cardíaca, além de melhorar a função biventricular. O NPS, ao contrário do SIL, esteve associado a hipotensão arterial sistêmica e piora da saturação venosa de oxigênio.

  15. Primary cardiac lymphoma in dogLinfoma cardíaco primário em cão

    Directory of Open Access Journals (Sweden)

    Mirela Tinucci Costa

    2013-10-01

    Full Text Available Lymphomas are malignant neoplasm characterized by proliferation of lymphocytes that originate primarily in lymphoid organ such as lymph nodes, liver, spleen and bone marrow. However the feature of continuous migration of lymphocytes in different organs, this tumor can develop in any organ. Although lymphoma is a very common hematopoietic neoplasm in dogs, cardiac location is rare. The diagnosis of primary cardiac lymphoma may be performed when there is involvement of the heart and / or the pericardium without evidence of involvement in other organs. In veterinary medicine there are few reports on the diagnosis, treatment and prognosis of cardiac lymphoma. Therefore, the purpose of this report is to describe a case of cardiac lymphoma in which the patient responded favorably to chemotherapy employee with disease-free interval of 19 months and highlight the importance of including this neoplasm in the differential diagnosis of diseases that affect the cardiovascular system. Os linfomas são neoplasias caracterizadas pela proliferação maligna de linfócitos, que originamse principalmente em órgão linfóides como linfonodos, fígado, baço e medula óssea. Entretanto pela característica de contínua migração dos linfócitos por diferentes órgãos, esta neoplasia pode se desenvolver em qualquer órgão. Embora o linfoma seja a neoplasia hematopoiética de maior incidência em cães, a localização cardíaca é rara. O diagnóstico de linfoma cardíaco primário pode ser realizado quando há envolvimento do coração e/ou pericárdio sem evidências de ocorrência de órgãos linfáticos ou extranodais. Em medicina veterinária existem poucos relatos sobre o diagnóstico, tratamento e prognóstico desta neoplasia cardíaca. Portanto o objetivo do presente relato é descrever um caso de linfoma cardíaco em que o paciente respondeu favoravelmente ao tratamento quimioterápico empregado com intervalo livre de doença de 19 meses e salientar a

  16. A cena constituinte da psicose maníaco-depressiva no Brasil The emergence of manic depressive psychosis as a diagnosis in Brazil

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    Joel Birman

    2010-12-01

    Full Text Available A intenção deste ensaio é esboçar a leitura da psicose maníaco-depressiva no Brasil, no começo do século XX. Destaca a transformação teórica ocorrida na psiquiatria brasileira, que se deslocou da tradição francesa para a alemã. Sublinha o modo como a problemática da histeria foi substituída pela da psicose maníaco-depressiva nesse contexto histórico.This essay examines the early twentieth-century interpretation of manic depressive psychosis in Brazil, during a moment when Brazilian psychiatry witnessed a theoretical shift from the French to German traditions. It calls special attention to how the problem of hysteria was replaced by manic depressive psychosis within this historical context.

  17. Registro Español de Trasplante Cardíaco. XX Informe oficial de la sección de insuficiencia Cardíaca y Trasplante Cardíaco de la sociedad Española de Cardiología (1984-2008

    Directory of Open Access Journals (Sweden)

    Luis Almenar Bonet

    2009-07-01

    Conclusiones: La supervivencia obtenida en España con el TC, sobre todo en los últimos años, sitúa al trasplante cardíaco como el tratamiento de elección para cardiopatías irreversibles en situación funcional avanzada y sin otras opciones médicas o quirúrgicas establecidas.

  18. Acute Care of At-Risk Newborns (ACoRN: quantitative and qualitative educational evaluation of the program in a region of China

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    Singhal Nalini

    2012-06-01

    Full Text Available Abstract Background The Acute Care of at-Risk Newborns (ACoRN program was developed in Canada for trained health care providers for the identification and management of newborns who are at-risk and/or become unwell in the first few hours or days after birth. The ACoRN process follows an 8-step framework that enables the evaluation and management of babies irrespective of the experience or expertise of the caregiving individual or team. This study assesses the applicability of the program to Chinese pediatric practitioners. Methods Course content and educational materials were translated from English into Chinese by bilingual neonatal practitioners. Confidence and knowledge questionnaires were developed and reviewed for face and content validity by a team of ACoRN instructors. Bilingual Chinese instructors were trained at the tertiary perinatal centre in Hangzhou Zhejiang to deliver the course at 15 level II county hospitals. Participants completed pre- and post-course confidence and knowledge questionnaires and provided feedback through post-course focus groups. Results 216 physicians and nurses were trained. Confidence and knowledge relating to neonatal stabilization improved significantly following the courses. Participants rated course utility and function between 4.2 and 4.6/5 on all items. Pre/post measures of confidence were significantly correlated with post course knowledge. Focus group data supported the perceived value of the program and recommended course adjustments to include pre-course reading, and increased content related to simulation, communication skills, and management of respiratory illness and jaundice. Conclusions ACoRN, a Canadian educational program, appears to be well received by Chinese health care providers and results in improved knowledge and confidence. International program adaptation for use by health care professionals requires structured and systematic evaluation to ensure that the program meets the needs of

  19. Current situation of asthma-COPD overlap syndrome (ACOS) in Chinese patients older than 40 years with airflow limitation: rationale and design for a multicenter, cross-sectional trial (study protocol).

    Science.gov (United States)

    Kang, Jian; Yao, Wanzhen; Cai, Baiqiang; Chen, Ping; Ling, Xia; Shang, Hongyan

    2016-12-01

    Asthma and chronic obstructive pulmonary disease (COPD) are the frequently occurring chronic airway diseases, and the overlapping syndrome observed in the majority of patients has been recently defined as asthma-COPD overlap syndrome (ACOS) by the Global Initiative for Chronic Obstructive Lung (GOLD, 2014) and Global initiative for Asthma (GINA, 2015). The proportion, features, and clinical practice of ACOS still remain elusive in China. We are conducting this multicenter, cross-sectional, observational study (NCT02600221) to investigate the distributions of chronic obstructive diseases in patients >40 years of age with chronic airflow limitation in China along with determination of the main clinical practice and features of these diseases. The study will also explore the factors that may influence the exacerbations and severity of ACOS in Chinese patients (>40 years of age). A total of 2,000 patients (age, ≥40 years; either sex) who are clinically diagnosed as having asthma, COPD/chronic bronchitis/emphysema, or ACOS for at least 12 months with airflow limitation [post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV 1 /FVC): current situation, main clinical practice, and features of ACOS, asthma, and COPD conditions in Chinese patients. The insights will be helpful in designing optimal management strategies for ACOS and redefining the healthcare development programs.

  20. Omalizumab (anti-IgE) therapy in the asthma-COPD overlap syndrome (ACOS) and its effects on circulating cytokine levels.

    Science.gov (United States)

    Yalcin, Arzu Didem; Celik, Betul; Yalcin, Ata Nevzat

    2016-06-01

    The term "asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome" (ACOS) has been applied to the condition, in which a person has clinical features of both asthma and COPD. The patients (N = 10) were presented to our clinic with low lung function, limited reversibility of airway obstruction, hyperinflation, abnormal body composition, dyspnea and episodic wheezing. Based on the clinical and laboratory findings, the patients were diagnosed with ACOS. Patients' serum IL-2 (sIL-2), sIL-4 sIL-6, sIL-10, sIL-17, sTNF-α and sIFN-γ levels were investigated as an apoptotic marker and a marker for inflammation. Having undergone omalizumab treatment and a long-term (12 months) later, patients had a decreased IgE, fractional exhaled nitric oxide concentrations (FENO), eosinophil, neutrophils, macrophages, eosinophil cationic peptide (ECP) and sIL-4 levels. To our knowledge, this is the first documentation of omalizumab use in ACOS. We demonstrated decreased IL-4, allergic pulmonary symptoms (dyspnea, wheezing, bronchial hyper responsiveness) and migraine attacks in the patients.

  1. Caso clínico del Departamento de Psiquiatría: Trastorno afectivo bipolar 1, episodio maníaco

    Directory of Open Access Journals (Sweden)

    José Manuel Calvo Gómez

    1995-04-01

    Full Text Available Se trata de un paciente de 21 años con un cuadro clínico de una semana de evolución cuyas características satisfacen los criterios diagnósticos de la Cuarta Edición del Manual Estadístico y Diagnóstico de los Trastornos Mentales (DSM IV para trastorno afectivo bipolar 1,episodio maníaco severo con características psicóticas congruentes con el estado de ánimo. Criterios diagnósticos para trastorno afectivo bipolar 1: A. Actualmente (o recientemente en episodio maníaco. B. Ha existido previamente al menos un episodio depresivo mayor, episodio maníaco o episodio mixto. C. Los episodios afectivos de los criterios A y B no son producidos por un trastorno esquizoafectivo y no están superpuestos sobre esquizofrenia, trastorno esquizofreniforme, trastorno delirante, o trastorno psicótico no especificado en otro sitio.

  2. DESIGN AND OPTIMIZATION OF PERMANENT MAGNET SYNCHRONOUS GENERATOR FOR USE IN HYDRODYNAMIC RENEWABLE ENERGY BY APPLYING ACO AND FEA

    Directory of Open Access Journals (Sweden)

    Amir Nikbakhsh

    2017-12-01

    Full Text Available One of the most important ways to reduce fossil fuel consumption and consequently reduce greenhouse gases and environmental pollution is the use of renewable energies such as water, sun, wind, etc. One of the most efficient ways to take advantages of the shallow flowing waters such as rivers and fountains in electrical power generation is the use of hydrodynamic screw in the direction of water flow. The design of the generator for this application results in environmental dangers decrease. On the other hand, it provides some part of electrical energy required for human beings. Generators in hydrodynamic renewable energy system ought to have features such as high efficiency, power density and reliability as well as low volume. Among various generators, the permanent magnet synchronous generator (PMSG meets these requirements very well. In this paper, first, analytical calculations and the design process of PMSG were explained. Then, the ant colony optimization (ACO was used for the optimization of design quantities. PMSG design optimization increased in efficiency and decreased in volume. By improving these two parameters in the designed PMSG, it gets very suitable to be used in hydrodynamic renewable energy system. Finally, the results of the optimized design of PMSG were validated through simulation of it in Maxwell software and applying finite element analysis (FEA. Also the final results have been compared to similar experimental researches results.

  3. Optimizing VM allocation and data placement for data-intensive applications in cloud using ACO metaheuristic algorithm

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    T.P. Shabeera

    2017-04-01

    Full Text Available Nowadays data-intensive applications for processing big data are being hosted in the cloud. Since the cloud environment provides virtualized resources for computation, and data-intensive applications require communication between the computing nodes, the placement of Virtual Machines (VMs and location of data affect the overall computation time. Majority of the research work reported in the current literature consider the selection of physical nodes for placing data and VMs as independent problems. This paper proposes an approach which considers VM placement and data placement hand in hand. The primary objective is to reduce cross network traffic and bandwidth usage, by placing required number of VMs and data in Physical Machines (PMs which are physically closer. The VM and data placement problem (referred as MinDistVMDataPlacement problem is defined in this paper and has been proved to be NP- Hard. This paper presents and evaluates a metaheuristic algorithm based on Ant Colony Optimization (ACO, which selects a set of adjacent PMs for placing data and VMs. Data is distributed in the physical storage devices of the selected PMs. According to the processing capacity of each PM, a set of VMs are placed on these PMs to process data stored in them. We use simulation to evaluate our algorithm. The results show that the proposed algorithm selects PMs in close proximity and the jobs executed in the VMs allocated by the proposed scheme outperforms other allocation schemes.

  4. Oxigenación de membrana extracorpórea para soporte cardíaco o respiratorio en adultos

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    Salvador Torregrosa

    2009-04-01

    Full Text Available La oxigenación de membrana extracorpórea (ECMO es un sistema de asistencia mecánica circulatoria y respiratoria extracorpórea de corta duración. Está indicado en el shock cardiogénico e insuficiencia respiratoria con compromiso vital de cualquier causa, cuando las medidas terapéuticas médicas o quirúrgicas convencionales, incluyendo el empleo del balón intraaórtico de contrapulsación, han fracasado. Sus ventajas respecto a otros sistemas de asistencia mecánica circulatoria son: 1 inicio rápido de la asistencia mediante canulación periférica; 2 es una técnica poco agresiva, por lo que es mejor tolerada en estos pacientes críticos; 3 al no necesitar toracotomía, permite continuar con las medidas de resucitación cardiopulmonar en los pacientes con parada cardíaca; 4 proporciona soporte pulmonar, univentricular o biventricular; 5 se ha mostrado eficaz como puente a una asistencia ventricular de larga duración o como puente a trasplante cardíaco, y 6 es mucho más económico que otros dispositivos de asistencia ventricular.

  5. Multi-objective ACO algorithms to minimise the makespan and the total rejection cost on BPMs with arbitrary job weights

    Science.gov (United States)

    Jia, Zhao-hong; Pei, Ming-li; Leung, Joseph Y.-T.

    2017-12-01

    In this paper, we investigate the batch-scheduling problem with rejection on parallel machines with non-identical job sizes and arbitrary job-rejected weights. If a job is rejected, the corresponding penalty has to be paid. Our objective is to minimise the makespan of the processed jobs and the total rejection cost of the rejected jobs. Based on the selected multi-objective optimisation approaches, two problems, P1 and P2, are considered. In P1, the two objectives are linearly combined into one single objective. In P2, the two objectives are simultaneously minimised and the Pareto non-dominated solution set is to be found. Based on the ant colony optimisation (ACO), two algorithms, called LACO and PACO, are proposed to address the two problems, respectively. Two different objective-oriented pheromone matrices and heuristic information are designed. Additionally, a local optimisation algorithm is adopted to improve the solution quality. Finally, simulated experiments are conducted, and the comparative results verify the effectiveness and efficiency of the proposed algorithms, especially on large-scale instances.

  6. Qualidade de vida de pacientes submetidos ao transplante cardíaco: aplicação da escala Whoqol-Bref

    Directory of Open Access Journals (Sweden)

    Maria Isis Freire de Aguiar

    2011-01-01

    Full Text Available FUNDAMENTO: O sucesso do transplante cardíaco significa garantir a sobrevida dos pacientes com cardiopatia e permitir-lhes desenvolver suas atividades diárias. O transplante cardíaco apresenta-se como a primeira opção de tratamento na falência cardíaca, representando um aumento de sobrevida e qualidade de vida dos transplantados. OBJETIVO: Avaliar a qualidade de vida de pacientes submetidos ao transplante cardíaco através da aplicação de uma escala padronizada (Whoqol-Bref. MÉTODOS: Estudo exploratório descritivo de abordagem quantitativa, realizado com 55 pacientes submetidos ao transplante cardíaco, em um período entre o terceiro e o 103º mês, que realizam acompanhamento na Unidade de Transplante e Insuficiência Cardíaca em um Hospital de Referência em Cardiologia na cidade de Fortaleza, CE. Os dados foram coletados no período de fevereiro a abril de 2009, por meio da aplicação de um questionário padronizado pela Organização Mundial da Saúde e utilização de dados constantes nos prontuários. RESULTADOS: Com relação ao domínio físico, 62,8% e 58,3% dos pacientes, dos sexos masculino e feminino, respectivamente, estão satisfeitos. No domínio psicológico, dentre pacientes do sexo masculino, 65,1% apresentam satisfação quanto à qualidade de vida e, no sexo feminino, 58,3% encontram-se satisfeitas. No domínio das relações sociais, observou-se que, no sexo masculino, 53,5% estão muito satisfeitos, e apresentou-se um nível de satisfação de 100% no sexo feminino. No domínio do meio ambiente, 65,1% do sexo masculino encontram-se satisfeitos, e no sexo feminino, 83,3% estão satisfeitas. CONCLUSÃO: O transplante cardíaco teve bastante influência na qualidade de vida dos pacientes transplantados, pois os resultados mostram-se estatisticamente significantes no pós-transplante.

  7. Transplante cardíaco no Instituto Dante Pazzanese de Cardiologia: análise da sobrevida

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    ASSEF Marco Aurélio Salles

    2001-01-01

    Full Text Available CASUÍSTICA E MÉTODOS: Foram analisados, retrospectivamente, 80 transplantes cardíacos realizados no Instituto Dante Pazzanese de Cardiologia (IDPC no período de novembro de 1991 a agosto de 2000. Houve predomínio do sexo masculino em 70% dos casos e a idade variou de 7 a 69 anos, com média de 44,8 anos. Doze (15% pacientes se encontravam em prioridade, em uso de drogas inotrópicas endovenosas no momento do transplante. As etiologias determinantes da insuficiência cardíaca congestiva grave foram: miocardiopatia dilatada idiopática em 37,5%, miocardiopatia isquêmica em 33,75%, miocardiopatia chagásica em 17,5% e outras causas em 11,25%. Foram realizados 78 transplantes ortotópicos e 2 heterotópicos. A técnica empregada foi bicaval/bipulmonar em 63,75%, atrial em 27,5%, bicaval/unipulmonar em 6,25% e heterotópico em 2,5%. A mortalidade hospitalar (30 dias foi de 18,75%. RESULTADOS: A sobrevida para o transplante ortotópico em um ano foi de 72,7%, em cinco anos 61,5% e em sete anos 56,4%. A sobrevida após o transplante foi correlacionada com as variáveis idade, causa de óbito e sexo do doador, e pelo transplante ter sido ou não a primeira cirurgia cardíaca do paciente.

  8. Optimization on Paddy Crops in Central Java (with Solver, SVD on Least Square and ACO (Ant Colony Algorithm))

    Science.gov (United States)

    Parhusip, H. A.; Trihandaru, S.; Susanto, B.; Prasetyo, S. Y. J.; Agus, Y. H.; Simanjuntak, B. H.

    2017-03-01

    Several algorithms and objective functions on paddy crops have been studied to get optimal paddy crops in Central Java based on the data given from Surakarta and Boyolali. The algorithms are linear solver, least square and Ant Colony Algorithms (ACO) to develop optimization procedures on paddy crops modelled with Modified GSTAR (Generalized Space-Time Autoregressive) and nonlinear models where the nonlinear models are quadratic and power functions. The studied data contain paddy crops from Surakarta and Boyolali determining the best period of planting in the year 1992-2012 for Surakarta where 3 periods for planting are known and the optimal amount of paddy crops in Boyolali in the year 2008-2013. Having these analyses may guide the local agriculture government to give a decision on rice sustainability in its region. The best period for planting in Surakarta is observed, i.e. the best period is in September-December based on the data 1992-2012 by considering the planting area, the cropping area, and the paddy crops are the most important factors to be taken into account. As a result, we can refer the paddy crops in this best period (about 60.4 thousand tons per year) as the optimal results in 1992-2012 where the used objective function is quadratic. According to the research, the optimal paddy crops in Boyolali about 280 thousand tons per year where the studied factors are the amount of rainfalls, the harvested area and the paddy crops in 2008-2013. In this case, linear and power functions are studied to be the objective functions. Compared to all studied algorithms, the linear solver is still recommended to be an optimization tool for a local agriculture government to predict paddy crops in future.

  9. 314. Extracción de dispositivos intracardíacos en pacientes sometidos previamente a procedimientos de cardiología intervencionista

    OpenAIRE

    E. Villagrán; L. Montes; Z. Garcés; A. Ayaon; M. Carnero; J. Silva; A. Alswies; J.E. Rodríguez

    2012-01-01

    Descripción de una cohorte de pacientes sometidos a la implantación de algún dispositivo intracardíaco percutáneo (DCIP) que finalmente fueron intervenidos quirúrgicamente por disfunción de los mismos. Material y métodos: Se analizó de forma retrospectiva toda la cohorte de pacientes sometidos a extracción de DCIP intervenidos en nuestro centro. Se describe la muestra de pacientes y se resumen los resultados quirúrgicos. Resultados: Desde julio de 2007 – julio de 2011, 25 pacientes inte...

  10. Avaliação da doença vascular do enxerto no transplante cardíaco: experiência de um centro brasileiro

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    Elide Sbardellotto Mariano da Costa

    2012-10-01

    Full Text Available FUNDAMENTO: O transplante cardíaco continua sendo o tratamento de escolha para a insuficiência cardíaca refratária ao tratamento otimizado. Dois métodos diagnósticos apresentam elevada sensibilidade no diagnóstico de episódios de rejeição ao enxerto e Doença Vascular do Enxerto (DVE, causas importantes de mortalidade no pós-transplante. OBJETIVO: Avaliar a relação entre os resultados do ultrassom intracoronariano (USIV e os laudos das biópsias endomiocárdicas (BX no seguimento de pacientes submetidos a transplante cardíaco em um serviço de referência brasileiro. MÉTODOS: Foi realizado um ensaio epidemiológico retrospectivo observacional, com pacientes submetidos a transplante cardíaco ortotópico, no período de 2000 a 2009. Foram analisados os prontuários desses pacientes e os resultados dos USIV e BX realizados rotineiramente no seguimento clínico pós-transplante e terapêutica em uso. RESULTADOS: Dos 77 pacientes analisados, 63,63% são do sexo masculino, nas faixas etárias de 22 a 69 anos. Quanto aos resultados dos USIV, 33,96% foram classificados em Stanford classe I, e 32,08%, como Stanford IV. Dos 143 laudos das biópsias, 51,08% tiveram resultado 1R, 3R em 0,69% dos laudos, e 14,48% apresentaram a descrição de efeito Quilty. Todos usaram antiproliferativos, 80,51% usaram inibidores da calcineurina e 19,48% usaram inibidores do sinal de proliferação (ISP. CONCLUSÃO: A avaliação dos pacientes pós-transplante cardíaco por meio do USIV incorpora informações detalhadas para o diagnóstico precoce e sensível da DVE, que são complementadas pelas informações histológicas fornecidas pelas BX, estabelecendo uma possível relação causal entre a DVE e os episódios de rejeição humoral.

  11. Inter-dependence of the electron beam excitations with the free electron laser stability on the super-ACO storage ring

    CERN Document Server

    Couprie, Marie Emmanuelle; Nutarelli, D; Renault, E; Billardon, M

    1999-01-01

    Storage ring free electron lasers have a complex dynamics as compared to the LINAC driven FEL sources since both the laser and the recirculating electron beam behaviours are involved. Electron beam perturbations can strongly affect the FEL operation (start-up, stability) whereas the FEL can stabilize beam instabilities. Experimental analysis together with simulations are reported here. Improvements of the Super-ACO FEL for users is discussed, and consequences are given in terms of electron beam tolerances for a source development for users.

  12. Extracción de un catéter fracturado mediante cateterismo cardíaco intervencionista en un paciente prematuro de 1 600 g

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    Francisco Javier Ozores Suárez

    2011-06-01

    Full Text Available Se documenta el caso de un paciente de 1 mes de edad, prematuro, con peso de 1 600 g, cuyo catéter epicutáneo se fracturó y desplazó hasta ubicarse en la porción distal en la rama izquierda de la arteria pulmonar. El catéter se extrajo por vía femoral mediante un procedimiento de cateterismo cardíaco intervencionista, con lo que se demostró la efectividad de dicho procedimiento ante este tipo de complicación.

  13. Significados dos episódios maníacos para pacientes com transtorno bipolar em remissão: um estudo qualitativo

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Pereira Bin

    2014-07-01

    Full Text Available Objetivo Discutir os significados da vivência de episódios maníacos para pacientes com transtorno bipolar (TAB. Métodos Trata-se de uma pesquisa qualitativa, feita por meio de entrevistas semidirigidas em profundidade, em uma amostra fechada pelo critério de saturação com oito pacientes com TAB em remissão. A técnica de tratamento de dados foi feita por meio da análise de conteúdo das entrevistas transcritas na íntegra e categorização. Os resultados foram submetidos à validação externa, no Laboratório de Pesquisa Clínico-Qualitativa do Departamento de Psicologia Médica e Psiquiatria da Unicamp, composto por 37 pesquisadores do método, entre eles mestrandos, doutorandos, pós-doutorados e pesquisadores seniores. Resultados Foram identificadas três categorias – Ambivalência e vergonha: pensar ou não pensar sobre os episódios maníacos; Organizando sentimentos pessoais: a remissão como um momento de autoconsciência; Episódios maníacos estruturando relações interpessoais versus projeções da angústia. Conclusão Os achados da presente pesquisa contribuem para a maior compreensão dos quadros maníacos no TAB, que podem auxiliar nas reflexões acerca da relação profissional-paciente, para elaborar estratégias para aderência e para as medidas terapêuticas e preventivas da recorrência dos episódios. Podem auxiliar a equipe de saúde envolvida no acompanhamento desses casos e também os pesquisadores na investigação da contribuição dos significados aqui discutidos nos fenômenos de aderência ao tratamento e de um melhor prognóstico.

  14. Ação do resveratrol sobre proteoglicanos de membrana presentes no músculo cardíaco em modelo animal de cardiomiopatia diabética

    OpenAIRE

    Paula Lazara Cruz

    2016-01-01

    Introdução: Ratos com diabetes induzido por estreptozotocina (STZ) apresentam alterações nos proteoglicanos Sindecan-4 e Glipican-1 no tecido cardíaco concomitantes à instalação da disfunção diastólica, evento precoce que culmina na cardiomiopatia diabética. O uso de resveratrol (RSV) em modelos animais foi capaz de melhorar a função cardíaca e o controle autonômico. Espera-se que o tratamento com esse flavonoide atue nos níveis alterados dos proteoglicanos em animais diabéticos. Objetivo: Av...

  15. Espectro óculo-aurículo-vertebral em pacientes com defeitos cardíacos congênitos

    Directory of Open Access Journals (Sweden)

    Rafael Fabiano Machado Rosa

    2010-10-01

    Full Text Available FUNDAMENTO: Há poucos estudos avaliando a frequência do espectro óculo-aurículo-vertebral (EOAV nos pacientes com defeitos cardíacos congênitos (DCC. OBJETIVO: Verificar a frequência do EOAV em uma amostra de pacientes com malformações cardíacas graves. MÉTODOS: Avaliamos uma coorte prospectiva de pacientes com DCC, admitidos em uma unidade de terapia intensiva (UTI cardiopediátrica no Brasil. O diagnóstico de EOAV foi feito com base em dados clínicos, considerando critérios padrões. Os pacientes que preenchiam esses critérios foram submetidos ao cariótipo de alta resolução com bandamento GTG e hibridização fluorescente in situ para a microdeleção 22q11.2. O teste exato de Fisher (P < 0,05 foi usado para as análises estatísticas. RESULTADOS: Durante o período de avaliação, 330 pacientes foram hospitalizados pela primeira vez na UTI, mas trinta deles não participaram deste estudo. Dos 300 pacientes que constituíram a amostragem final, o EOAV foi verificado em três casos (1%. Todos apresentaram estudos citogenéticos normais. CONCLUSÃO: O EOAV parece ser uma condição frequente em pacientes com DCC. Contudo, não podemos excluir a possibilidade de que a frequência de EOAV encontrada em nosso estudo possa ter sido subestimada devido à baixa taxa de detecção pré-natal de DCC e ao acesso limitado dos pacientes ao tratamento médico apropriado em nosso meio. Estudos prospectivos futuros com critérios clínicos bem definidos e pacientes com defeitos leves e graves serão importantes para avaliar o papel do EOAV na população em geral de indivíduos com malformações cardíacas.

  16. Advance Payment ACO Model

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Advance Payment Model is designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the...

  17. Dynamics and performance of the free electron laser at Super-Aco with a harmonic RF cavity set on 500 MHz

    International Nuclear Information System (INIS)

    Nutarelli, D.

    2000-01-01

    This work is dedicated to the development of the potentialities of the free electron laser that has been installed on the storage ring Super-Aco at Orsay university. We have studied the dynamics of the electron beam inside a harmonic RF cavity set on 500 MHz. The impact of the geometric characteristics of the optical cavity on the transverse overlapping between laser radiation and the electron beam has been studied in details. An important part of the work has been the assessment of the optical characterization of the dielectric multi-layer mirrors of the cavity. For that purpose a complete system has been designed to assess the changes in optical properties of mirrors during laser operation. Another important part of this work was the study of the interaction process between laser radiation and the electron bunch leading to saturation. This interaction process has been simulated through a new model and some predictions given by this model have been successfully confronted to experimental data. The installation of the harmonic RF cavity has led to a significant increase of the laser radiation gain and the value of the mean power of the laser radiation has reached 300 mW. An interesting application of this technique is the generation of high energy gamma photons through Compton backscattering. A collimated 35 MeV-energy photon beam has been produced at Super-Aco with a rate of 5.10 6 photons per second. (A.C.)

  18. Consistent Evaluation of ACOS-GOSAT, BESD-SCIAMACHY, CarbonTracker, and MACC Through Comparisons to TCCON

    Science.gov (United States)

    Kulawik, Susan; Wunch, Debra; O’Dell, Christopher; Frankenberg, Christian; Reuter, Maximilian; Chevallier, Frederic; Oda, Tomohiro; Sherlock, Vanessa; Buchwitz, Michael; Osterman, Greg; hide

    2016-01-01

    Consistent validation of satellite CO2 estimates is a prerequisite for using multiple satellite CO2 measurements for joint flux inversion, and for establishing an accurate long-term atmospheric CO2 data record. Harmonizing satellite CO2 measurements is particularly important since the differences in instruments, observing geometries, sampling strategies, etc. imbue different measurement characteristics in the various satellite CO2 data products. We focus on validating model and satellite observation attributes that impact flux estimates and CO2 assimilation, including accurate error estimates, correlated and random errors, overall biases, biases by season and latitude, the impact of coincidence criteria, validation of seasonal cycle phase and amplitude, yearly growth, and daily variability. We evaluate dry-air mole fraction (X(sub CO2)) for Greenhouse gases Observing SATellite (GOSAT) (Atmospheric CO2 Observations from Space, ACOS b3.5) and SCanning Imaging Absorption spectroMeter for Atmospheric CHartographY (SCIAMACHY) (Bremen Optimal Estimation DOAS, BESD v2.00.08) as well as the CarbonTracker (CT2013b) simulated CO2 mole fraction fields and the Monitoring Atmospheric Composition and Climate (MACC) CO2 inversion system (v13.1) and compare these to Total Carbon Column Observing Network (TCCON) observations (GGG2012/2014). We find standard deviations of 0.9, 0.9, 1.7, and 2.1 parts per million vs. TCCON for CT2013b, MACC, GOSAT, and SCIAMACHY, respectively, with the single observation errors 1.9 and 0.9 times the predicted errors for GOSAT and SCIAMACHY, respectively. We quantify how satellite error drops with data averaging by interpreting according to (error(sup 2) equals a(sup 2) plus b(sup 2) divided by n (with n being the number of observations averaged, a the systematic (correlated) errors, and b the random (uncorrelated) errors). a and b are estimated by satellites, coincidence criteria, and hemisphere. Biases at individual stations have year

  19. Tamponamento cardíaco tardio traumático: análise de cinco casos Traumatic late cardiac tamponade: analysis of five cases

    Directory of Open Access Journals (Sweden)

    FERNANDO LUIZ WESTPHAL

    2000-09-01

    Full Text Available São analisados cinco casos de tamponamento cardíaco tardio traumático. Os pacientes eram masculinos, idade média de 26,2 anos, vítimas de ferimento por arma branca em região precordial, área de Ziedler, sendo admitidos em centro de referência para trauma. Foram classificados pelo índice fisiológico de Ivatury para trauma cardíaco e inicialmente tratados por pleurotomia intercostal e reposição volêmica, com estabilização do quadro hemodinâmico e respiratório. Os pacientes foram readmitidos após intervalo de oito a 24 dias (mediana de 20 dias, agora no serviço de cirurgia torácica de um hospital de referência terciária, com sinais de tamponamento cardíaco. Os exames diagnósticos confirmaram derrame pericárdico com espessamento pericárdico associado a encarceramento de base pulmonar esquerdo em quatro casos, os quais foram abordados por toracotomia póstero-lateral, com realização de pericardiectomia parcial e descorticação pulmonar. Um paciente evoluiu com pericardite purulenta, comprovada por exames complementares, e foi submetido à drenagem pericárdica subxifóidea. Ocorreu arritmia pós-operatória em um paciente; os demais evoluíram sem complicações pós-operatórias ou recidiva do tamponamento.Five traumatic late cardiac tamponade cases were analyzed. All patients were male, mean age was 26.2, victims of thoracic penetrating stabbing wound in the precordial region, Ziedler area, admitted to a trauma reference center. They were classified by the Ivatury physiological index for cardiac trauma. The first treatment approach was intercostal pleurectomy and volemic resuscitation followed by hemodynamic and respiratory recovery. Patients with cardiac tamponade symptoms were re-admitted within an interval from eight to twenty four days (mean 20 days in a thoracic surgery service of a tertiary reference hospital. Diagnostic exams confirmed thickening and pericardial effusion associated with a left pulmonary base

  20. Avaliação do sopro cardíaco na infância Assessment of heart murmurs in childhood

    Directory of Open Access Journals (Sweden)

    Maria Elisabeth B.A. Kobinger

    2003-06-01

    Full Text Available OBJETIVO: discutir a avaliação clínica e laboratorial do sopro cardíaco, considerando sua alta freqüência no atendimento ambulatorial do pediatra geral. FONTE DE DADOS: revisão baseada na análise crítica da literatura atual e consulta a compêndios de cardiologia pediátrica e pediatria contendo informações básicas sobre o tema. SÍNTESE DOS DADOS: os principais destaques do artigo referem-se à importância da anamnese e exame físico do sistema cardiovascular, essenciais para o pediatra geral diagnosticar o sopro cardíaco inocente, e identificar situações que indiquem a ocorrência de cardiopatias congênitas, ou adquiridas, e a necessidade de encaminhamento ao especialista. CONCLUSÕES: o pediatra geral é geralmente o primeiro médico a detectar um sopro cardíaco e deve estar apto a reconhecer o sopro inocente, assim como a suspeitar precocemente de doenças cardiovasculares.OBJECTIVE: to discuss clinical and laboratorial evaluation of heart murmurs in children, an important problem faced by pediatricians in their practice. SOURCES OF DATA: this review was based on a critical analysis of the current literature, as well as pediatrics and pediatric cardiology textbooks, which were found to be an important source of information on the subject. SUMMARY OS THE FINDINGS: it is important for pediatricians to know how to obtain precise information regarding the patient's medical history and to perform extensive physical examination of a child with heart murmur. The diagnosis of innocent heart murmur is essentially clinical and it can help the pediatrician to identify situations which are associated with cardiovascular diseases. CONCLUSIONS: in our series, short-term video-EEG monitoring established a reliable diagnosis in most patients due to correlation between clinical and EEG data. This procedure was well tolerated by children, including infants and those with psychiatric disorders.

  1. Cardiac beta-receptors in experimental Chagas' disease Receptores beta cardíacos na doença de Chagas experimental

    Directory of Open Access Journals (Sweden)

    Julio E. Enders

    1995-02-01

    Full Text Available Experimental Chagas' disease (45 to 90 days post-infection showed serious cardiac alterations in the contractility and in the pharmacological response to beta adrenergic receptors in normal and T. cruzi infected mice (post-acute phase. Chagasic infection did not change the beta receptors density (78.591 ± 3.125 fmol/mg protein and 73.647 ± 2.194 fmol/mg protein for controls but their affinity was significantly diminished (Kd = 7.299 ± 0.426 nM and Kd = 3.759 ± 0.212 nM for the control p Estudaram-se os receptores beta cardíacos de camundongos infectados pelo Trypanosoma cruzi na fase pós-aguda da doença de Chagas para estabelecer em que medida os mesmos contribuem a gerar respostas anômalas às catecolaminas observadas nestes miocardios. Utilizara-se 3-H/DHA para a marcação dos receptores beta cardíacos dos camundongos normais e dos infectados na fase pós-aguda (45 a 90 dias pós-infecção. O número dos sítios de fixação foi similar nos dois grupos, 78.591 ± 3.125 fmol/mg. Proteína nos chagásicos e 73.647 ± 2.194 fmol/mg. Proteína no grupo controle. Em vez disso, a afinidade verificou-se significativamente diminuida no grupo chagásico (Kd = 7.299 ± 0.426 nM respeito do controle (Kd = 3.759 ± 0.212 nM p < 0.001. Os resultados obtidos demonstram que as modificações observadas na estimulação adrenérgica do miocárdio chagásico se correlacionam com a menor afinidade dos receptores beta cardíacos e que estas alterações exerceriam uma parte determinante para as consequências funcionais que são detectadas na fase crônica.

  2. Imunodepressão induzida por talidomida e ciclosporina em transplante cardíaco heterotópico de coelho

    Directory of Open Access Journals (Sweden)

    João Batista Vieira de Carvalho

    Full Text Available OBJETIVO: A talidomida, por seus efeitos antiinflamatórios e imunodepressores, tem sido utilizada no tratamento de doenças dermatológicas e na doença enxerto-contra-hospedeiro no transplante de medula óssea. O objetivo deste trabalho é avaliar a ação deste medicamento como imunodepressor em transplante de órgãos, estudando sua ação isoladamente ou em combinação com a ciclosporina na prevenção da rejeição ao aloenxerto cardíaco heterotópico em coelho. MÉTODO: Foram utilizados 50 coelhos, sendo 25 doadores e 25 receptores.Os animais receptores foram subdivididos em cinco grupos (n= 5 : Grupo I (controle animais não-imunodeprimidos; Grupo II (imunodeprimidos com ciclosporina na dose de 10 mg/kg/dia; Grupo III (imunodeprimidos com talidomida na dose de 100 mg/kg/dia; Grupo IV (imunodeprimidos com ciclosporina na dose de 5,0 mg/kg/dia e Grupo V (imunodeprimidos com ciclosporina na dose de 5,0 mg/kg/dia associada a talidomida na dose de 50 mg/kg/dia. Os medicamentos foram administrados através de cateter orogástrico, a partir do dia anterior ao transplante. RESULTADOS: O coração do doador foi implantado no abdome dos receptores. A associação de talidomida e ciclosporina apresentou o menor escore histopatológico de rejeição (p < 0,05. Observou-se que a talidomida empregada isoladamente ou associada à ciclosporina foi efetiva contra a rejeição, aumentando a sobrevida (p < 0,01 de animais submetidos ao transplante cardíaco heterotópico em posição abdominal. CONCLUSÕES: A talidomida empregada isoladamente, ou associada à ciclosporina, pode representar uma opção de imunodepressão em transplantes cardíaco heterotópico experimental de coelho.

  3. Transplante experimental cardíaco heterotópico e cutâneo em camundongos Experimental heterotopic cardiac and cutaneous transplantation in mice

    Directory of Open Access Journals (Sweden)

    Patrícia Sestrheim

    2005-06-01

    Full Text Available OBJETIVO: Estudo experimental com o objetivo de desenvolver e avaliar a viabilidade das técnicas de transplante experimental cardíaco heterotópico abdominal vascularizado e cutâneo em camundongos, criando um instrumento para investigação da eficácia de soluções de preservação, novas drogas imunossupressoras, agentes biológicos, terapia gênica e indução de tolerância imunológica. MÉTODO: Para este estudo, as técnicas utilizadas foram descritas previamente por Corry et al. e Billingham et al. RESULTADOS: O tempo cirúrgico total para a realização dos transplantes cardíacos (n=20 foi, em média, 60,3±6,3 minutos e para os transplantes cutâneos (n=20, 17,75±0,71 minutos. A média de sobrevida dos aloenxertos cutâneos (n=34 e cardíacos (n=24 foi, respectivamente, 7 e 11 dias, enquanto que os isoenxertos sobreviveram por mais de 100 dias. CONCLUSÕES: Ambas as técnicas se caracterizaram pela fácil reprodutibilidade dos modelos experimentais. As diferenças entre as técnicas não se limitaram às peculiaridades metodológicas ou ao tempo de sobrevida e vascularização, mas principalmente à sua imunogenicidade e suscetibilidade à rejeição.OBJECTIVE: This is an experimental study which aims at developing and evaluating the feasibility of experimental techniques of vascularized and cutaneous abdominal heterotopic heart transplant in mice, creating an instrument of investigation for the effectiveness of prservation solutions, new immunosuppressive drugs, biological agents, genetic therapy and induction of immunological tolerance. METHOD: The techniques used in this work were previously described by Corry et al. and Billingham et al. RESULTS: The total surgical time to perform the cardiac transplants (n=20 was on average 60.3+6.3 minutes and the time of cutaneous transplants (n= 20 17.75+0.71 minutes. The average survival of the cutaneous allografts (n=34 and cardiac (n=24 allografts was 7 and 11 days, respectively, while

  4. Quantificação de tecido conjuntivo do músculo cardíaco de cães

    Directory of Open Access Journals (Sweden)

    Hildebrando Gomes Benedicto

    2003-01-01

    Full Text Available Objetivou-se, neste trabalho, estudar a proporção de tecido conjuntivo existente na fração ventricular direita e esquerda do músculo cardíaco de cães, buscando, através da morfometria, dados referentes a inter-relação entre o tecido conjuntivo e o tecido muscular cardíaco, para o conhecimento das relações anátomo-funcionais da estrutura cardíaca, característica de determinados processos ligados a diminuição do trabalho do órgão. Utilizou-se 6 corações de cães SRD, machos e fêmeas, com idade entre 48 e 150 meses, pesando entre 18 e 30 Kg, sem alterações cardíacas, confirmado mediante exames eletrocardiográfico e ecocardiográfico. Preparou-se o material oriundo de três regiões ventriculares em relação a sua base, proximal, média e distal, tanto da face direita quanto da esquerda, segundo as técnicas histológicas convencionais e corados com Picrosirius red, Fucsina-Paraldeido e Tricromo de Gomori, para evidenciação das fibras conjuntivas. As lâminas foram analisadas com auxílio do Axioscópio Zeiss acoplado ao programa de análise de imagens KS-400 Zeiss. A quantidade de tecido conjuntivo no Ventrículo Esquerdo variou de 0,44 a 26,26%; no Ventrículo Direito variou de 0,97 a 21,18%; no ápice variou de 1,32 a 29,24% e no septo interventricular variou de 5,41 a 11,24%. Os resultados obtidos mostram que há uma complexa rede de fibras conjuntivas envolvendo as fibras do tecido muscular cardíaco e que sua quantidade e disposição é muito variada, dependendo da região estudada.

  5. Investigating fractional exhaled nitric oxide (FeNO) in chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO): a scoping review protocol.

    Science.gov (United States)

    Mostafavi-Pour-Manshadi, Seyed-Mohammad-Yousof; Naderi, Nafiseh; Barrecheguren, Miriam; Dehghan, Abolfazl; Bourbeau, Jean

    2017-12-21

    During the last decade, many articles have been published, including reviews on fractional exhaled nitric oxide (FeNO) use and utility in clinical practice and for monitoring and identifying eosinophilic airway inflammation, especially in asthma, and evaluating corticosteroid responsiveness. However, the exact role of FeNO in patients with chronic obstructive pulmonary disease (COPD) and its ability to distinguish patients with COPD and those having concomitant asthma, that is, asthma-COPD overlap (ACO) is still unclear and needs to be defined. Due to the broad topics of FeNO in chronic airway disease, we undertook a scoping review. The present article describes the protocol of a scoping review of peer-reviewed published literature specific to FeNO in COPD/ACO over the last decade. We used Joanna Briggs Institute Reviewers' Manual scoping review methodology as well as Levac et al 's and Arksey et al 's framework as guides. We searched a variety of databases, including Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Web of Science, and BioSciences Information Service (BIOSIS) on 29 June 2016. Additional studies will be recognised by exploring the reference list of identified eligible studies. Screening of eligible studies will be independently performed by two reviewers and any disagreement will be solved by the third reviewer. We will analyse the gathered data from article bibliographies and abstracts. To investigate the body of published studies regarding the role of FeNO in patients with COPD and its usefulness in the clinical setting, a scoping review can be used as a modern and pioneer model, which does not need ethics approval. By this review, new insights for conducting new research specific to FeNO in COPD/ACO population will emerge. The results of this study will be reported in the scientific meetings and conferences, which aim to provide information to the clinicians, primary care providers and basic

  6. Endovascular repair of an aorto-iliac aneurysm succeeded by kidney transplantation Tratamento endovascular de aneurisma aorto-ilíaco sucedido por transplante renal

    Directory of Open Access Journals (Sweden)

    Marcelo Bellini Dalio

    2010-09-01

    Full Text Available We present the case of aorto-iliac aneurysm in a patient with chronic renal failure requiring dialysis who were treated with an endovascular stent graft and, later on, submitted to kidney transplantation. A 53-year-old male with renal failure requiring dialysis presented with an asymptomatic abdominal aorto-iliac aneurysm measuring 5.0cm of diameter. He was treated with endovascular repair technique, being used an endoprosthesis Excluder®. After four months, he was successfully submitted to kidney transplantation (dead donor, with anastomosis of the graft renal artery in the external iliac artery distal to the endoprosthesis. The magnetic resonance imaging, carried out 30 days after the procedure, showed a good positioning of the endoprosthesis and adequate perfusion of the renal graft. In the follow-up, the patient presented improvement of nitrogenous waste, good positioning of the endoprosthesis without migration or endoleak. The endovascular repair of aorto-iliac aneurysm in a patient with end-stage renal failure under hemodialysis treatment showed to be feasible, safe and efficient, as it did not prevent the success of the posterior kidney transplantation.Apresentamos o caso de aneurisma aortoilíaco em um paciente com insuficiência renal crônica dialítica tratado com uma endoprótese vascular, sendo, após, submetido a transplante renal. Um homem de 53 anos com insuficiência renal dialítica apresentava um aneurisma abdominal aortoilíaco assintomático com 5,0cm de diâmetro. Foi tratado com técnica endovascular com uma endoprótese Excluderâ. Após quatro meses, foi submetido a transplante renal (doador cadáver com sucesso, com anastomose da artéria renal do enxerto na artéria ilíaca externa distal à endoprótese. A ressonância magnética 30 dias após o procedimento mostrou a endoprótese bem posicionada e o enxerto renal bem perfundido. No seguimento, o paciente evoluiu com melhora das escórias nitrogenadas, bom

  7. 123. Intervención quirúrgica urgente en paciente varón joven con angiosarcoma primario cardíaco con diagnóstico de tromboembolismo pulmonar agudo

    Directory of Open Access Journals (Sweden)

    N. Miranda

    2012-04-01

    Conclusiones: Son infrecuentes los casos de sarcoma cardíaco primario publicados en la bibliografía y muy pocos los que han cursado como tromboembolismo pulmonar agudo. Este caso ilustra la enorme dificultad que presentan para un diagnóstico y tratamiento precoz que ofrezca unas mínimas expectativas de vida a medio plazo.

  8. Bioimpedância transtorácica comparada à ressonância magnética na avaliação do débito cardíaco

    Directory of Open Access Journals (Sweden)

    Humberto Villacorta Junior

    Full Text Available FUNDAMENTO: A ressonância magnética cardíaca é considerada o método padrão-ouro para o cálculo de volumes cardíacos. A bioimpedância transtorácica cardíaca avalia o débito cardíaco. Não há trabalhos que validem essa medida comparada à ressonância. OBJETIVO: Avaliar o desempenho da bioimpedância transtorácica cardíaca no cálculo do débito cardíaco, índice cardíaco e volume sistólico, utilizando a ressonância como padrão-ouro. MÉTODOS: Avaliados 31 pacientes, com média de idade de 56,7 ± 18 anos, sendo 18 (58% do sexo masculino. Foram excluídos os pacientes cuja indicação para a ressonância magnética cardíaca incluía avaliação sob estresse farmacológico. A correlação entre os métodos foi avaliada pelo coeficiente de Pearson, e a dispersão das diferenças absolutas em relação à média foi demonstrada pelo método de Bland-Altman. A concordância entre os métodos foi realizada pelo coeficiente de correlação intraclasses. RESULTADOS: A média do débito cardíaco pela bioimpedância transtorácica cardíaca e pela ressonância foi, respectivamente, 5,16 ± 0,9 e 5,13 ± 0,9 L/min. Observou-se boa correlação entre os métodos para o débito cardíaco (r = 0,79; p = 0,0001, índice cardíaco (r = 0,74; p = 0,0001 e volume sistólico (r = 0,88; p = 0,0001. A avaliação pelo gráfico de Bland-Altman mostrou pequena dispersão das diferenças em relação à média, com baixa amplitude dos intervalos de concordância. Houve boa concordância entre os dois métodos quando avaliados pelo coeficiente de correlação intraclasses, com coeficientes para débito cardíaco, índice cardíaco e volume sistólico de 0,78, 0,73 e 0,88, respectivamente (p < 0,0001 para todas as comparações. CONCLUSÃO: A bioimpedância transtorácica cardíaca mostrou-se acurada no cálculo do débito cardíaco quando comparada à ressonância magnética cardíaca.

  9. Investigação de lipofuscina em miócitos cardíacos de camundongos após tratamento com oxamniquine

    Directory of Open Access Journals (Sweden)

    Maria Luiza Silveira Mello

    1984-10-01

    Full Text Available A fluorescencia natural devida à presença de corpos de lipofuscina foi pesquisada em miócitos cardíacos de camundongos adultos jovens tratados com oxamniquine. O objetivo foi buscar uma evidência de indução de envelhecimento celular precoce, com base em dados prévios de acentuação poliploidia, promovida pela droga. Comparando o miocárdio dos camundongos tratados com animais contrôle jovens e velhos, não foi observada a presença de lipofuscina nos seus miócitos. Isto possivelmente se deva a um não comprometimento da eficiência das lipases lisossomiais apesar da acentuação do fenômeno de poliploidização induzida pela droga.

  10. Efecto de la incorporación de fibras dietéticas en la calidad de panes para celíacos

    OpenAIRE

    Díaz Malmierca, Álvaro

    2013-01-01

    La investigación en la elaboración de panes sin gluten está muy avanzada, siendo el déficit en micronutrientes de estos productos uno de los problemas sobre el que se está centrando la investigación. Uno de los nutrientes más deficitarios, y que más problemas causa sobre la salud de los pacientes celíacos es la fibra dietética. En este estudio se ha investigado el efecto que produce la adición de un 10% de diferentes fibras sobre las características de los panes, la influencia ...

  11. Cerebral physiology and preservation during cardiac arrest Fisiología y preservación cerebral durante el paro cardíaco: vulnerabilidad del cerebro

    Directory of Open Access Journals (Sweden)

    Luis M. Gómez

    1991-03-01

    Full Text Available

    Cerebral physiology during cardiac arrest is discussed with particular Interest on selective neuronal damage. Previous concepts on brain tolerance to hypoxia are analyzed and new information about brain function prognosis after cardiac arrest is presented. Therapeutic alternatives for brain preservation are discussed with emphasis on the lack of effectiveness of barbiturates, the results of research with other drugs and the future role that blockers of excitatory neurotransmission may have as elements of cerebral preservation.

    Se hace una aproximación a la fisiología cerebral durante el paro cardíaco, destacando el concepto de darlo neuronal selectivo. Se presentan elementos que permiten modificar concepciones antiguas sobre la tolerancia del cerebro a la hipoxia severa. Además, se hace un nuevo planteamiento sobre el pronóstico cerebral luego de un paro cardíaco y se esbozan las alternativas terapéuticas utilizadas hasta la fecha para la preservación cerebral. Se hace énfasis en la inefectividad de los barbitúricos, en la investigación sobre la terapia con otras drogas y en el futuro abierto hacia los bloqueadores de los neurotransmisores excitadores, como elementos terapéuticos para la preservación cerebral.

  12. Sedação com sufentanil e clonidina em pacientes submetidos a cateterismo cardíaco Sedación con sufentanil y clonidina en pacientes sometidos a cateterismo cardíaco Sedation with sufentanil and clonidine in patients undergoing heart catheterization

    Directory of Open Access Journals (Sweden)

    Anita Perpetua Carvalho Rocha

    2011-03-01

    Full Text Available FUNDAMENTO: A sedação para a realização de cateterismo cardíaco tem sido alvo de preocupação. Benzodiazepínicos, agonistas alfa-2 adrenérgicos e opioides são utilizados para esse fim, entretanto, cada um destes medicamentos possui vantagens e desvantagens. OBJETIVO: Avaliar a eficácia do sufentanil e da clonidina como sedativos em pacientes submetidos a cateterismo cardíaco, observando o impacto dos mesmos sobre os parâmetros hemodinâmicos e respiratórios, a presença de efeitos colaterais, além da satisfação do paciente e do hemodinamicista com o exame. MÉTODOS: Trata-se de um ensaio clínico prospectivo, duplo-cego, randomizado e controlado, que envolveu 60 pacientes que receberam 0,1 µg/kg de sufentanil ou 0,5 µg/kg de clonidina antes da realização do cateterismo cardíaco. O escore de sedação segundo a escala de Ramsay, a necessidade de utilização de midazolam, os efeitos colaterais, os parâmetros hemodinâmicos e respiratórios foram registrados, sendo os dados analisados em 06 diferentes momentos. RESULTADOS: O comportamento da pressão arterial, da frequência cardíaca e da frequência respiratória foi semelhante nos dois grupos, entretanto, no momento 2, os pacientes do grupo sufentanil (Grupo S apresentaram menor escore de sedação segundo a escala de Ramsay, e a saturação periférica da oxihemoglobina foi menor que o grupo clonidina (Grupo C no momento 6. Os pacientes do Grupo S apresentaram maior incidência de náusea e vômito pós-operatório que os pacientes do Grupo C. A satisfação dos pacientes foi maior no grupo clonidina. Os hemodinamicistas mostraram-se satisfeitos nos dois grupos. CONCLUSÃO: O sufentanil e a clonidina foram efetivos como sedativos em pacientes submetidos a cateterismo cardíaco.FUNDAMENTO: La sedación para la realización de cateterismo cardíaco ha sido blanco de preocupación. Benzodiazepínicos, agonistas alfa-2 adrenérgicos y opioides son utilizados para ese fin

  13. Perfil dos pacientes na Lista Única de Espera para transplante cardíaco no estado do Ceará Perfil de los pacientes en la lista única de espera para transplante cardíaco en el estado de Ceará Profile of patients in the Unified Waiting List for heart transplantation in state of Ceará

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    Francisca Elisângela Teixeira Lima

    2010-07-01

    Full Text Available FUNDAMENTO: Os transplantes de órgãos têm aumentado consideravelmente nos últimos anos em razão da evolução tecnológica e da sensibilização da sociedade para doação de órgãos. OBJETIVO: Descrever as características dos pacientes da Lista Única de Espera para transplante cardíaco; identificar as principais cardiopatias; e verificar o tempo médio de permanência do paciente na Lista até a realização da cirurgia. MÉTODOS: Trata-se de um estudo descritivo, documental e retrospectivo, com abordagem quantitativa, desenvolvido na Central de Transplante do Estado do Ceará, com 156 pacientes incluídos na Lista Única de Espera do ano de 1999 a 2006. Os dados foram organizados em figuras. RESULTADOS: Foram encontrados: 81% do sexo masculino; 22,4% adultos jovens (20 a 40 anos e 56,4% adultos de meia-idade (40 a 64 anos, com uma média de 36 anos; 79% procedentes de Fortaleza-CE; 91% tinham miocardiopatia como causa do transplante cardíaco. Dentre esses pacientes 102 (69% foram transplantados; 37 (25% evoluíram para óbito antes do transplante e 8 (6% foram excluídos por melhora ou piora do quadro clínico. CONCLUSÃO: Os pacientes da Lista Única de Espera para transplante cardíaco no Estado do Ceará, no período de 1999 a 2006, eram do sexo masculino (80%, com faixa etária variando de 1 a 71 anos, com predomínio da miocardiopatia dilatada (53,4%, e o tempo médio de espera foi de 136 dias até o dia do transplante cardíaco.FUNDAMENTO: Los transplantes de órganos han aumentado considerablemente en los últimos años, en razón de la evolución tecnológica y de la sensibilización de la sociedad para la donación de órganos. OBJETIVO: Describir las características de los pacientes de la Lista Única de Espera para transplante cardíaco; identificar las principales cardiopatías; y verificar el tiempo medio de permanencia del paciente en la Lista hasta la realización de la cirugía. MÉTODOS: Se trata de un estudio

  14. Prevalence of nursing diagnosis of decreased cardiac output and the predictive value of defining characteristics in patients under evaluation for heart transplant Prevalencia del diagnóstico de enfermería de disminución del gasto cardíaco y valor predictivo de las características definidoras en pacientes en fase de evaluación para trasplante cardíaco Prevalência do diagnóstico de enfermagem de débito cardíaco diminuído e valor preditivo das características definidoras em pacientes em avaliação para transplante cardíaco

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    Lígia Neres Matos

    2012-04-01

    Full Text Available The purposes of the study were to identify the prevalence of defining characteristics (DC of decreased cardiac output (DCO in patients with cardiac insufficiency under evaluation for heart transplantation, and to ascertain the likelihood of defining characteristics being predictive factors for the existence of reduction in cardiac output. Data was obtained by retrospective documental analysis of the clinical records of right-sided heart catheterizations in 38 patients between 2004 and 2009. The results showed that 71.1% of the patients had decreased cardiac output (measured by cardiac index. The majority of the NANDA-International defining characteristics for DCO were more frequent in individuals with reduced cardiac index levels. The study emphasizes the odds ratio (OR for increased Systemic Vascular Resistance of OR=4.533, of the third heart sound with OR=3.429 and the reduced ejection fraction with OR=2.850. By obtaining the predictive values for the defining characteristics the study identifies them as diagnostic indicators of decreased cardiac output.El estudio tiene como objetivos identificar la prevalencia de las características definitorias de la disminución del gasto cardíaco (DGC en pacientes con insuficiencia cardíaca (IC en evaluación para el trasplante de corazón y ver la probabilidad de las características definitorias sean factores predictivos de la existencia de una disminución del gasto cardíaco. Los datos se obtuvieron mediante el análisis documental retrospectivo de historias clínicas de cateterismo cordiaco derecho en 38 pacientes con insuficiencia cardíaca en la evaluación para el trasplante de corazón entre 2004 y 2009. Los resultados mostraron que el 71% de los pacientes habían reducido el gasto cardíaco (medido por el índice cardíaco. La mayoría de las características definitorias de la NANDA-International para el DGC fueron más frecuentes en individuos con índice cardíaco reducido. Los aspectos m

  15. Qualidade de vida de pacientes submetidos ao transplante cardíaco: aplicação da escala Whoqol-Bref Calidad de vida de pacientes sometidos a transplante cardíaco: aplicación de la escala Whoqol-Bref Quality of life of patients that had a heart transplant: application of Whoqol-Bref scale

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    Maria Isis Freire de Aguiar

    2011-01-01

    Full Text Available FUNDAMENTO: O sucesso do transplante cardíaco significa garantir a sobrevida dos pacientes com cardiopatia e permitir-lhes desenvolver suas atividades diárias. O transplante cardíaco apresenta-se como a primeira opção de tratamento na falência cardíaca, representando um aumento de sobrevida e qualidade de vida dos transplantados. OBJETIVO: Avaliar a qualidade de vida de pacientes submetidos ao transplante cardíaco através da aplicação de uma escala padronizada (Whoqol-Bref. MÉTODOS: Estudo exploratório descritivo de abordagem quantitativa, realizado com 55 pacientes submetidos ao transplante cardíaco, em um período entre o terceiro e o 103º mês, que realizam acompanhamento na Unidade de Transplante e Insuficiência Cardíaca em um Hospital de Referência em Cardiologia na cidade de Fortaleza, CE. Os dados foram coletados no período de fevereiro a abril de 2009, por meio da aplicação de um questionário padronizado pela Organização Mundial da Saúde e utilização de dados constantes nos prontuários. RESULTADOS: Com relação ao domínio físico, 62,8% e 58,3% dos pacientes, dos sexos masculino e feminino, respectivamente, estão satisfeitos. No domínio psicológico, dentre pacientes do sexo masculino, 65,1% apresentam satisfação quanto à qualidade de vida e, no sexo feminino, 58,3% encontram-se satisfeitas. No domínio das relações sociais, observou-se que, no sexo masculino, 53,5% estão muito satisfeitos, e apresentou-se um nível de satisfação de 100% no sexo feminino. No domínio do meio ambiente, 65,1% do sexo masculino encontram-se satisfeitos, e no sexo feminino, 83,3% estão satisfeitas. CONCLUSÃO: O transplante cardíaco teve bastante influência na qualidade de vida dos pacientes transplantados, pois os resultados mostram-se estatisticamente significantes no pós-transplante.FUNDAMENTO: El éxito del transplante cardíaco significa garantizar la sobrevida de los pacientes con cardiopatía y permitirles

  16. Evolução hemodinâmica seqüencial no transplante cardíaco Sequential hemodynamic evaluation in heart transplantation

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    Noedir A. G Stolf

    1988-12-01

    Full Text Available O transplante cardíaco tem tido ampla aplicação no tratamento da cardiomiopatia em fase terminal. Grande interesse existe no estudo das alterações hemodinâmicas imediatas e na identificação dos fatores que determinam essas alterações. Quarenta e três pacientes transplantados foram estudados com esse objetivo. Os seguintes dados foram obtidos: índice cardíaco, as pressões nas câmaras cardíacas, capilar pulmonar, aorta, artéria pulmonar, volume sistólico, fração de ejeção do ventrículo esquerdo (VE, resistência vascular pulmonar e sistêmica, índice do trabalho sistólico do ventrículo esquerdo e direito (VD e o tríplice produto. Esses valores foram comparados de acordo com os episódios de rejeição e com diferentes valores do gradiente transpulmonar. Verificou-se que no pós-operatório imediato há depressão da função dos ventrículos decorrente de uma série de fatores. O índice cardíaco se mantém em valore adequados através de vários mecanismos e adaptação dos ventrículos, que ocorre mais precocemente para o VE do que para o VD. Tardiamente as alterações hemodinâmicas dependem do aparecimento de hipertensão arterial sistêmica e da aterosclerose coronária. A presença e os valores mais elevados do gradiente transpulmonar não tiveram influência estatisticamente significativa nas condições hemodinâmicas dos pacientes.heart transplantation has been widely employed in treatment of end stage cardiomyopathy. Great interest exists in the study of early and late hemodynamic alterations following the procedure. Fourty three patients submited to heart transplantation were studied with this aim. The data obtained were: cardiac index, pressure in the heart chambers, capillary wedge pressure, aorta and pulmonary artery pressure, systolic volume and ejection fraction of left ventricle, pulmonary and systemic vascular resistances; left and right work systolic indexes; triple product. The data were compared in

  17. Hemorrhage in cerebral metastasis from angiosarcoma of the heart: case report Hemorragia em metástase cerebral de angiossarcoma cardíaco: relato de caso

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    Pasquale Gallo

    2001-09-01

    Full Text Available The purpose of this article is to describe the clinical and pathological features of metastatic angiosarcoma in the central nervous system. Only a few cases of cerebral metastasis from angiosarcoma of the heart have been recorded in the literature; particulary related to intracerebral hemorrhage. A case of secondary cerebral angiosarcoma of the heart in a 33 years old man is presented. The initial symptoms were headache, vomiting, lethargy and aphasia. There was a mass in the left temporal lobe with hemorrhage and edema on the computerized tomography (CT. After 24 hours the neurological status worsened and another CT scan showed rebleeding on the tumor area. He underwent an emergency craniotomy but died two days after. Considering the longer survival of sarcoma patients with new modalities of treatment, the incidence of brain metastasis may increase, demanding a bether preventive and more aggressive approach. Besides, due to the hemorrhagic nature of such lesions, we suggest the imediate surgery to prevent a fast and lethal evolution because rebleeding.O propósito deste artigo é descrever os achados clínicos e patológicos das metástases de angiossarcoma no sistema nervoso central. Apenas poucos casos de metástases cerebrais de angiossarcoma cardíaco foram relatados na literatura, menos ainda relacionados a hemorragia intracerebral. Relatamos o caso de um tumor cerebral secundário a angiossarcoma cardíaco em um paciente masculino de 33 anos. Os sintomas iniciais foram: cefaléia, vômitos, letargia e afasia. A tomografia computadorizada mostrou massa no lobo temporal esquerdo associada a hemorragia e edema. Após 24 horas houve piora do estado neurológico e nova tomografia demonstrou ressangramento no leito tumoral. Foi submetido a uma craniotomia de urgência mas faleceu dois dias após. Considerando a longa sobrevida dos pacientes com sarcoma devido às novas modalidades terapêuticas, poderá aumentar a incidência de met

  18. Theory of monochromators based on holographic toroidal arrays for the X-UV spectrum band. Tests of the 'TGM 10 metres, 4 degrees' on the ACO storage ring

    International Nuclear Information System (INIS)

    Lizon a Lugrin, Eric

    1988-01-01

    As the use of synchrotron radiation is strongly increasing, needs for monochromators in the X-UV range are very important. This research thesis aimed at the development of prototype monochromator based toroidal lamellar arrays with grazing incidence. In the first part, the author recalls theoretical aspects of light scattering rules adapted to a lamellar array, and of wave-matter interaction rules. In the second part, he reports the calculation of the monochromator, its mechanical description, and its implementation on the light line of the ACO storage ring. In the third part, the author reports tests performed without any input slot and in reverse optical configuration on the ACO storage ring. The energy range, the linearity with respect to wave length, the rejection of higher orders of scattered light, flow and resolution are in compliance with expected values [fr

  19. Study of the multipionic modes e+e-→π+π-π0 and e+e-→π+π-π+π- at the Orsay storage ring ACO

    International Nuclear Information System (INIS)

    Cordier, A.

    1978-03-01

    The results obtained with the magnetic detector DMI at the Orsay storage ring ACO are presented for the reactions e + e - →π + π - π 0 from 750 to 1100 MeV and e + e - →π + π - π + π - from 810 to 1100 MeV in the centre of mass. The magnetic detector DM1 consists of four cylindrical multiwire proportional chambers with anode and cathode readout in a solenoid providing a field of 0.9 T. The data for e + e - →π + π - π 0 show without ambiguity an interference effect between the ω and phi mesons, however new measurement above the phi performed using kinematical analysis can only be explained by higher energy contribution. In addition, the parameters of the ω have been obtained with improved accuracy compared to other experiments, and particularly the branching ratio Bsub(ω→e + e - )=(6.75+-0.69)10 -5 . The cross section of e + e - →π + π - π + π - is also measured and particularly an upper limit on the branching of phi→π + π - π + π - given [fr

  20. Tamponamento cardíaco como uma das primeiras manifestações do lúpus eritematoso sistêmico

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    Michelle keiko Molina

    2012-09-01

    Full Text Available O Lúpus Eritematoso Sistêmico (LES é uma doença autoimune de causa desconhecida que pode produzir apresentações clínicas variáveis, com períodos de remissões e de recaídas. O diagnóstico é confirmado pela presença de quatro dos onze critérios clínicos e/ou laboratoriais (erupção malar, erupção discoide, fotossensibilidade, úlceras da mucosa oral, artrite, serosite, distúrbio renal, distúrbio neurológico, distúrbio hematológico, distúrbio imunológico e anticorpo antinuclear. Dentre as manifestações cardiovasculares, o derrame pericárdico e a pericardite clínica são observados na maioria dos pacientes. Porém, o tamponamento cardíaco é raro como manifestação clínica.

  1. Mixoma cardíaco con diagnóstico prenatal: Presentación de un caso y revisión de literatura

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    Josías Ríos

    2012-10-01

    Full Text Available El mixoma es la tumoración cardíaca más frecuente en el adulto, constituyendo aproximadamente el 50% de las mismas. En la edad pediátrica el tumor cardíaco más frecuente es el rabdomioma, generalmente asociado a esclerosis tuberosa. La presentación del mixoma en pacientes pediátricos es muy rara y más aun en la etapa neonatal. Presentamos el caso de una paciente de sexo femenino que fue sometida a cirugía a los 8 días de nacida por presentar dos tumoraciones intracardiacas diagnosticadas en la etapa intrauterina a las 38 semanas de gestación. La cirugía se realizó mediante esternotomía media, con circulación extracorpórea y arresto circulatorio. Las tumoraciones, que eran de aspecto polipoide se localizaban en la aurícula derecha, los estudios de patología fueron compatibles con mixoma. La evolución postoperatoria fue satisfactoria y la paciente fue dada de alta a los 14 días después de la cirugía.

  2. Retransplante cardíaco em criança sem o uso de hemoderivados Heart retransplantation in children without the use of blood product

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    Antonio Alceu dos Santos

    2012-06-01

    Full Text Available Este artigo relata um caso de retransplante cardíaco sem o uso de hemoderivados, em uma criança de 6 anos, com miocardiopatia dilatada grave, após rejeição crônica do enxerto e refratária ao tratamento clínico. Para evitar transfusão sanguínea nessa cirurgia, foi realizado planejamento multidisciplinar, que envolveu o uso de eritropoietina no pré-operatório, hemodiluição normovolêmica aguda e recuperação de sangue autólogo no intraoperatório (cell saver, bem como hemostasia meticulosa e redução de flebotomias no pós-operatório.This article reports a case of a cardiac retransplantation without the use of blood products, in a 6 year old, with severe dilated cardiomyopathy after chronic graft rejection and refractory to clinical treatment. To avoid a blood transfusion in this surgery a multidisciplinary approach was planned, which involved the use of preoperative erythropoietin, acute normovolemic hemodilution and intraoperative cell savage with autologous blood recovery system, as well as a meticulous hemostasis and reduced postoperative phlebotomy.

  3. Experiência com transplante cardíaco heterotópico em pacientes com resistência pulmonar elevada: seguimento tardio Experiencia con trasplante cardíaco heterotópico en pacientes con resistencia pulmonar elevada: seguimiento tardío Experience with heterotopic heart transplantation in patients with elevated pulmonary vascular resistance: late follow-up

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    Jose Henrique Andrade Vila

    2010-02-01

    Full Text Available FUNDAMENTO: Nos últimos anos o numero de artigos sobre transplante cardíaco heterotópico tem sido escasso na literatura, inclusive internacional, e em particular do seguimento de longo prazo destes pacientes, o que levou ao presente relato. OBJETIVO: Relatar a experiência clínica inicial e evolução tardia de quatro pacientes submetidos a transplante cardíaco heterotópico, sua indicação e principais complicações. MÉTODOS: As cirurgias ocorreram entre 1992 e 2001, sendo que a indicação de transplante heterotópico, em todas, foi pela RVP, variável de 4,8UW a 6.5UW, com gradiente transpulmonar acima de 15mmHg. No 3º paciente, foi realizada uma anastomose direta entre as artérias pulmonares sem emprego de tubo protético e, no coração nativo, foi realizada uma valvoplastia mitral e aneurismectomia de ventrículo esquerdo (VE. O esquema imunossupressor imediato foi duplo com ciclosporina e azatioprina nos três primeiros pacientes e ciclosporina e micofenolato mofetil no 4º paciente. RESULTADOS: Um óbito imediato por falência do enxerto, um óbito após dois anos e meio por endocardite em trombo intraventricular no coração nativo, e um terceiro óbito seis anos após o transplante, por complicações pós-operatórias de cirurgia na valva aórtica do coração nativo. O remanescente, 15 anos após o transplante, encontra-se bem, em classe funcional II (NYHA, seis anos após a oclusão cirúrgica da valva aórtica do coração nativo. CONCLUSÃO: O transplante cardíaco heterotópico é um procedimento com resultado inferior ao transplante cardíaco ortotópico, por apresentarem maior RVP. Os trombos intraventriculares no coração nativo, que exigem anticoagulação prolongada, bem como as complicações de válvula aórtica, também no coração nativo, podem exigir tratamento cirúrgico. Entretanto, em um paciente, a sobrevida de 15 anos mostrou a eficácia de longo prazo desse tipo de alternativa, para pacientes

  4. Reprodutibilidade do teste de caminhada de 6 minutos e marcadores autonômicos cardíacos em idosas ativas e sedentárias

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    André Igor Fonteles

    2016-07-01

    Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n3p287   Objetivou-se verificar a reprodutibilidade do teste de caminhada de 6 minutos (TC6 e de marcadores autonômicos cardíacos pós-esforço em idosas fisicamente ativas e sedentárias. Dezoito idosas ativas (64,2 ± 3,1 anos; 63,0 ± 2,7 kg; 1,52 ± 0,06 m; 26,9 ± 2,7 kg.m-2 praticantes de Tai Chi Chuan (≥6 meses de prática e 18 idosas sedentárias (64,0 ± 3,7 anos; 63,8 ± 8,9 kg; 1,49 ± 0,05 m; 28,4 ± 3,5 kg.m-2 foram submetidas a dois TC6 com uma semana de intervalo. Foram medidas a frequência cardíaca de recuperação (FCR de um e dois minutos (FCR1’ e FCR2’, respectivamente e variabilidade da frequência cardíaca (VFC pós-esforço. A reprodutibilidade foi verificada pelos: coeficiente de correlação intraclasse (CCI com 95% de intervalo de confiança; análise de concordância de Bland-Altman; e coeficiente de variação (CV. O desempenho no TC6 (528,8±71,4 m e 473,2±62,4 m; CV=7,9% e CV=8,5% apresentou alta reprodutibilidade (CCI=0,86 em idosas ativas e sedentárias, respectivamente. Similarmente, as medidas pós-esforço da FCR1’ (29,0±11,0 bpm e 17,0±8,0 bpm; CV=30,1% e CV=40,2% e FCR2’ (36,0±10,0 bpm e 24,0±9,0 bpm; CV=23,7% e CV=22,8% apresentaram alta reprodutibilidade (CCI≥0,84 e CCI≥0,80 em ambos os grupos. Quanto a VFC verificou-se reprodutibilidade moderada (CCI≥0,57; CV=35-47% em idosas ativas e moderada-alta nas sedentárias (CCI=0,65-0,76; CV=34-69%. Todas as variáveis apresentaram concordância em ambos os grupos. Conclui-se que o TC6, FCR e VFC pós-esforço são instrumentos reprodutíveis na avaliação da capacidade funcional e controle autonômico cardíaco em idosas ativas e sedentárias.

  5. Mixomas cardíacos: análisis estadístico de 20 años Cardiac myxomas: a 20 years-statistical analysis

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    Alejandro Villar Inclán

    2009-12-01

    Full Text Available INTRODUCCIÓN. Los tumores primarios del corazón pueden ser malignos o benignos, mientras que los tumores secundarios son siempre metastásicos. El 75 % de los tumores primarios son benignos y de localización endocavitaria, la mayoría es del tipo mixoma, sobre todo en los adultos. MÉTODOS. De un total de 2925 pacientes operados con circulación extracorpórea entre enero de 1986 y enero del 2006 en el Hospital «Hermanos Ameijeiras», se seleccionaron 30 expedientes clínicos de pacientes con diagnóstico histopatológico de mixoma cardíaco. Para el análisis de los resultados se aplicaron cálculos de incidencia. A las variables se aplicaron porcentajes, medias y desviación estándar. RESULTADOS. Diecinueve pacientes fueron del sexo femenino y 11 del masculino, con rango de edad entre 15 y 66 años (media, 44 años. Los elementos clínicos desde el punto de vista semiológico fueron muy variados, y predominaron las palpitaciones y la disnea en el 83 % y 73 % de los pacientes, respectivamente. El intervalo de aparición de los síntomas fue desde 1 mes hasta 92 meses (media, 15 meses. El ecocardiograma confirmó el 100 % del diagnóstico en los pacientes. La localización más frecuente de los mixomas fue la aurícula izquierda (80 % de los casos. A todos los pacientes se les practicó la exéresis del tumor y su base de implantación. La mortalidad observada fue del 6,6 %. CONCLUSIONES. La incidencia de esta enfermedad fue del 1,2 % de todos los pacientes operados en este tiempo. La proporción sexo femenino-masculino fue de 2:1. El ecocardiograma constituye la piedra angular del diagnóstico positivo de los mixomas cardíacos. La mortalidad en la serie estuvo dentro de los rangos documentados en la literatura médica internacional.INTRODUCTION: Heart primary tumors may be maligns or benigns, whereas the secondary tumors always are of metastatic origin. The 75% of primary tumors are benigns and of a endocavitary localization, most are of

  6. Taponamiento cardíaco secundario a carcinoma papilar esclerosante difuso de tiroides Metastatic cardiac tamponade as initial manifestation of papillary thyroid carcinoma

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    Verónica Riva

    2011-12-01

    Full Text Available El carcinoma papilar, variante esclerosante difusa, corresponde al 2% de todos los carcinomas papilares de la tiroides. Se caracteriza por comprometer de manera difusa y bilateral a la glándula tiroides. Clínicamente se manifiesta con metástasis ganglionares y pulmonares, afectando predominantemente a mujeres jóvenes. Se describe un caso de taponamiento cardíaco como presentación inicial de un carcinoma papilar de tiroides variante esclerosante difusa. Una mujer de 32 años concurrió al servicio de emergencias médicas refiriendo epigastralgia y tos seca. Durante el examen físico se constató hipotensión arterial, taquicardia y ruidos cardíacos disminuidos. Se realizó un ecocardiograma, observándose derrame pericárdico. Por medio de una pericardiocentesis se obtuvo líquido pericárdico, cuyo análisis mostró células neoplásicas. Durante la evolución la paciente presentó recurrencia del derrame pericárdico por lo que se realizó una ventana pleuropericárdica, detectándose durante la cirugía una lesión nodular subpleural, la cual fue biopsiada e informada posteriormente como una metástasis de carcinoma papilar vinculable a origen tiroideo. Se realizó una tiroidectomía total con linfadenectomía cervical bilateral. El diagnóstico final fue carcinoma papilar, variante esclerosante difusa. Esta variante infiltra el tejido conectivo de los espacios interfoliculares, simulando una tiroiditis y se caracteriza por una permeación vascular temprana. En oposición a la variante clásica, la esclerosante difusa presenta mayor agresividad y mayor tasa de recurrencia. El carcinoma papilar de tiroides debe tenerse presente como diagnóstico diferencial en nuestro medio, en todas aquellas lesiones neoplásicas papilares metastásicas, más aún si se trata de mujeres jóvenes.Papillary carcinoma, diffuse sclerosing variant corresponds to 2% of all papillary thyroid carcinomas. It is usually diffuse and bilateral, affecting the entire

  7. Treinamento físico de natação promove remodelamento cardíaco e melhora a perfusão sanguínea no músculo cardíaco de SHR via mecanismo dependente de adenosina

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    Juliana Gonçalves de Barros

    2011-06-01

    Full Text Available INTRODUÇÃO: Exercícios físicos são utilizados como terapia não farmacológica para o tratamento da hipertensão arterial, e o treinamento físico (TF por natação é reconhecido por produzir remodelamento cardíaco em animais experimentais. Entretanto, a ação vasodilatadora da adenosina (ado resultante do exercício físico como prevenção e tratamento da hipertensão é pouco explorada. OBJETIVO: Avaliar o remodelamento cardíaco e o papel da adenosina na distribuição do fluxo sanguíneo para o miocárdio após treinamento físico em SHR. Método: 28 SHR machos babies e adultos foram submetidos ao TF aeróbio de natação, durante 10 semanas (5x/sem -1h/dia. Foram utilizados protocolos de microesferas coloridas para avaliar fluxo sanguíneo, técnicas de morfologia para avaliar hipertrofia cardíaca e análises bioquímicas para verificar atividade de enzimas envolvidas na formação de adenosina. RESULTADOS: TF por natação atenuou a evolução da HA em SHR babies (S: 145 ± 2; T: 140 ± 2mmHg, promoveu bradicardia de repouso em SHR adultos (S: 340 ± 4; T: 321 ± 6bpm e desenvolveu HC nos dois grupos (TB: 12%; TA: 10%. Na condição basal, o TF aumentou o FS coronário em SHR babies (S: 4.745 ± 2.145; T: 6.970 ± 2.374mi/coração e maior resposta vasodilatadora à infusão de adenosina foi observada (S: 18.946 ± 6.685; T: 25.045 ± 7.031mi/coração. Neste grupo, o TF promoveu maior atividade da enzima 5'-nucleotidase, levando à maior formação de adenosina (S: 0,45 ± 0,09; T: 1,01 ± 0,05. CONCLUSÃO: O TF de natação, além de desenvolver HC e apresentar maior hidrólise de AMP, promoveu aumento no FS coronário, sendo mostrado que desempenha um importante papel na regulação da hipertensão

  8. Correção simultânea de defeito congênito intracardíaco e pectus excavatum Simultaneous repair of congenital heart defect and pectus excavatum

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    João Roberto Breda

    2007-09-01

    Full Text Available Relatamos tratamento simultâneo de pectus excavatum e defeito congênito intracardíaco representado por comunicação interatrial ostium secundum. Paciente do sexo masculino, 8 anos de idade, com diagnóstico clínico e ecocardiográfico de comunicação interatrial, associada à deformidade da parede torácica tipo pectus excavatum. Foi encaminhado para operação com correção simultânea do defeito congênito intracardíaco associado ao reparo do pectus. O tratamento operatório simultâneo do pectus excavatum e defeitos congênitos intracardíacos torna difícil o acesso ao coração. Foi feita a correção simultânea dessas alterações, com satisfatório resultado, sobretudo estético, para o paciente.The author describes the simultaneous treatment of pectus excavatum and congenital intracardiac defect (atrial septal defect represented by the interatrial foramen secundum. An 8-year-old boy, with clinical and echocardiography diagnosis of atrial septal defect associated with pectus excavatum was referred to a simultaneous surgical treatment of both abnormalities. The simultaneous surgical treatment of both pectus excavatum and congenital intracardiac defects make it difficult to access the heart. In this case, the simultaneous surgical treatment of atrial septal defect and pectus excavatum was a valuable alternative to surgical repair of both abnormalities, mainly due to its cosmetic outcome.

  9. Grado de información, acceso y prácticasde elaboración de alimentos sin TACC de beneficios del programa de Asistencia Alimentaria para Celíacos de General Madariaga

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    Chaparro, María Victoria

    2015-01-01

    La Enfermedad Celíaca, también conocida como esprúe celíaco o enteropatía sensible al gluten, se la define como la intolerancia alimentaria de orden genético más frecuente de la especie humana. El único tratamiento es una dieta estricta y de por vida Sin TACC. La incidencia es mayor en mujeres, que en varones, siendo su prevalencia aproximadamente el 1% de la población. Objetivos: Determinar el grado de información, el acceso y las prácticas de elaboración de alimentos Sin T...

  10. 150. ¿Tres en uno? Implante de tres dispositivos de asistencia circulatoria a un mismo paciente como terapia pre y postrasplante cardíaco. A propósito de un caso

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    J.A. Fernández-Divar

    2012-04-01

    Conclusiones: El implante ECMO es rápido y seguro, y permite mantener con vida a pacientes en shock cardiogénico grave. La reconversión a asistencias de media duración nos ayuda a mejorar el estado del paciente y que éste llegue al trasplante cardíaco en mejores condiciones. La incorporación de asistencias en pacientes con fallo primario del injerto (FPI tras el trasplante supone un avance en el tratamiento de esta patología.

  11. Análisis acústico sobre señales de auscultación digital para la detección de soplos cardíacos

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    CASTAÑO, ANDRÉS M.; DELGADO T., EDILSON; GODINO, JUANI; CASTELLANOS, GERMÁN

    2009-01-01

    Se presenta la metodología basada en el análisis acústico de señales fonocardiográficas (FCG) par a detectar soplos cardíacos. En primer lugar se desarrolla un sistema de filtración basado en la transformada wavelet para reducir las perturbaciones que usualmente se presentan en la etapa de adquisición, ajustando la calidad del sonido de acuerdo a los requerimientos clínicos y validados por especialistas en semiología. Se propone un algoritmo de segmentación basado en la energía promedio norm...

  12. Estudo anatômico dos gânglios celíaco, celiacomesentérico e mesentérico cranial e de suas conexões no gato doméstico (Felix domestica, Linnaeus, 1758

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    Antonio Augusto Coppi Maciel Ribeiro

    2000-01-01

    Full Text Available O gânglio celíaco é um dos principais responsáveis pela inervação do estômago, intestinos, fígado, pâncreas e ainda contribui para a inervação do baço, sendo desta forma essencial ao controle da motilidade gastrointestinal. O conhecimento do suprimento nervoso endereçado a estes órgãos é fundamental na clínica médica e cirúrgica no tocante às atonias digestivas, gastroenterites hemorrágicas, torções gástricas e invaginações intestinais. Neste trabalho, estudou-se a anatomia macro e microscópica dos gânglios celíaco, celiacomesentérico e mesentérico cranial. Foram utilizados trinta gatos domésticos, adultos, 10 machos e 20 fêmeas. A aorta torácica desses gatos foi injetada com solução de Neoprene látex 650 corada, sendo os animais congelados por no mínimo 48 horas. A fixação foi feita posteriormente com solução aquosa de formol a 10%. Nos estudos microscópicos, utilizaram-se as seguintes colorações: hematoxilina-eosina, tricrômico de Masson, reticulina e hematoxilina ácida fosfotúngstica. O gânglio celíaco ocorreu 7 vezes, sendo 4 direitos e 3 esquerdos, predominando a forma elíptica (23,3% e a situação periarterial. Os gânglios celiacomesentéricos foram contados em número de 24, sendo 11 independentes; 2 apresentando as porções direita e esquerda e 11 gânglios celiacomesentéricos direitos com uma porção mesentérica cranial esquerda, tendo formato semilunar assimétrico. Esses achados sugerem o predomínio da fusão do gânglio celíaco ao mesentérico cranial, constituindo assim o gânglio celiacomesentérico. Este é formado por neurônios imersos em abundante matriz conjuntiva fibrosa, envoltos por uma cápsula contendo fibras elásticas, colágenas e reticulares, apresentando uma continuidade nos pontos de fusão ganglionar.

  13. Equilibrios ácido-base. Aspectos teóricos. ¿Es posible la neutralización cuantitativa de dos protolitos débiles? Estudio del caso ácido bórico-amoníaco.

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    Milla González, Miguel

    2016-01-01

    Mediante la combinación de los balances de masa y las constantes de equilibrio del sistema, se encuentra la función y=f(x) [y = cantidad valorada del ácido débil y x la cantidad añadida de la base débil]. Se representa dicha función y se calcula su límite cuando x tiende a infinito para comprobar que no es posible la valoración (neutralización cuantitativa) del ácido bórico con la base amoníaco.

  14. Débito cardíaco diminuído: revisão sistemática das características definidoras Débito cardíaco disminuído: revisión sistemática de las características definidoras Decreased cardiac output: a systematic review of the defining characteristics

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    Vanessa de Souza

    2011-01-01

    Full Text Available OBJETIVOS: Caracterizar os artrigos científicos relacionados ao diagnóstico de enfermagem débito cardíaco diminuído. Verificar os artigos que descrevem o comportamento das características definidoras deste diagnóstico, identificando aquelas que ocorrem com maior frequência. MÉTODOS: Trata-se de uma revisão sistemática realizada nas bases de dados: Lilacs, SciELO, Embase, Medline, Pubmed e Cochrane, no período de 1985 a 2008. RESULTADOS: Foram selecionados 13 artigos, identificando 50 características definidoras, sendo dez com maior frequência: alteração da frequência/ritmo cardíaco, dispneia, labilidade da pressão arterial, estertores, oligúria anúria, edema, pele fria, fadiga/fraqueza, diminuição dos pulsos periféricos e diminuição da perfusão periférica. CONCLUSÃO: A temática vem sendo pouco explorada. Constatou-se a importância do exame físico, a utilização de técnicas menos invasivas e a necessidade de rever as características definidoras propostas a fim de proporcionar clareza e objetividade na identificação desse diagnóstico de enfermagemOBJETIVOS: Caracterizar los artículos científicos relacionados al diagnóstico de enfermería débito cardíaco disminuído. Verificar los artículos que describen el comportamiento de las características definidoras de este diagnóstico, identificando aquellas que ocurren con mayor frecuencia. MÉTODOS: Se trata de una revisión sistemática realizada en las bases de datos: Lilacs, SciELO, Embase, Medline, Pubmed y Cochrane, en el período de 1985 al 2008. RESULTADOS: Fueron seleccionados 13 artículos, identificando 50 características definidoras, siendo diez con mayor frecuencia: alteración de la frecuencia/ritmo cardíaco, disnea, labilidad de la presión arterial, estertores, oliguria anuria, edema, piel fría, fatiga/debilidad, disminución de los pulsos periféricos y disminución de la perfusión periférica. CONCLUSIÓN: La temática viene siendo poco

  15. Osteoma osteoide no osso ilíaco: relato de dois casos Osteoid osteoma in the iliac bone: report on two cases

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    Elmano de Araújo Loures

    2012-04-01

    Full Text Available O osteoma osteoide é um tumor benigno do osso que se apresenta geralmente com dor noturna em adultos jovens, aliviada por repouso e salicilatos. Pode acometer qualquer osso, mas sua ocorrência no ilíaco é infrequente. Os autores descrevem dois casos de osteoma osteoide intramedular, localizado junto à articulação sacroilíaca, com sintomas que simulavam dor ciática e cujo diagnóstico se deu de forma tardia, apesar de o exame radiológico inicial mostrar lesão esclerótica em ambos os casos. O diagnóstico foi ratificado por tomografia computadorizada e o tratamento proposto foi a ressecção em bloco da lesão, com excisão do nidus. O diagnóstico definitivo foi confirmado pelo exame histopatológico. No seguimento de longo prazo, ambos estão assintomáticos e observou-se completa remodelação óssea no sítio cirúrgico. Os autores enfatizam as características típicas do tumor, a localização não usual, o diagnóstico diferencial e o tratamento.Osteoid osteoma is a benign bone tumor that generally presents with nighttime pain among young adults and is relieved by rest and salicylates. It can affect any bone, but occurrences in the iliac are unusual. The authors describe two cases of intramedullary osteoid osteoma next to the sacroiliac joint, with symptoms that simulated sciatic pain. The cases were diagnosed late, although the initial radiographs showed sclerotic lesions in both cases. The diagnosis was confirmed by means of CT scan and the nidus was excised surgically through en bloc resection. The definitive diagnosis was given by means of histopathological examination. Over long-term follow-up, both cases remained asymptomatic and complete bone remodeling at the surgical site was observed. The authors highlight the typical characteristics of the tumor, the unusual location, the differential diagnosis and the treatment.

  16. Ecocardiografia por Doppler tecidual no diagnóstico de rejeição após transplante cardíaco

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    Marcos Valério Coimbra Resende

    2011-07-01

    Full Text Available FUNDAMENTO: A biópsia endomiocárdica (BEM é o método padrão-ouro para o diagnóstico de rejeição celular (RC após transplante cardíaco (TC. OBJETIVO: Testar a hipótese de que o exame de imagem por Doppler tecidual (IDT pode detectar RC > 3A e agregar informação diagnóstica, comparado ao Doppler convencional. MÉTODOS: Cinquenta e quatro pacientes com TC foram submetidos à BEM e estudo ecocardiográfico através de IDT em até 24 horas. Comparamos os pacientes com TC e RC > 3A com pacientes com TC e RC 3A em 39/129 (30,2% das BEM. O melhor preditor isolado para o diagnóstico de RC foi a a'LAT, com sensibilidade de 76,3%, especificidade de 73,8% (p = 0,001. Na análise multivariada, a a'LAT (p = 0,001, a'SEP (p = 0,002, relação e'/a' LAT (p = 0,006, relação e'Mitral/ e'LAT (p = 0,014, SINF (p = 0,009 foram preditores de RC > 3A. Obtivemos um escore com sensibilidade de 88,2%, acurácia de 79,6%, e valor preditivo negativo de 92,9% para diagnosticar RC > 3A. O Doppler convencional (fluxo mitral e pulmonar venoso não foi relevante para predizer a RC > 3A. CONCLUSÃO: O estudo de IDT agregou informação diagnóstica para predizer RC > 3A quando comparado ao Doppler convencional. O modelo baseado em IDT pode ser tornar um método em potencial para detectar RC > 3A após TC.

  17. Caracterización de los síntomas de angina en hombres adultos con cateterismo cardíaco positivo para enfermedad coronaria

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    Clemencia Bernal

    2013-06-01

    Full Text Available Introducción: en Colombia la enfermedad coronaria ocasionó 29.394 muertes en 2011 ocupando el primer lugar como causa de mortalidad, según el Departamento Nacional de Estadística. Es importante disminuir el tiempo entre el inicio de los síntomas y el tratamiento, etapa en que la sintomatología, la interpretación y la manifestación del paciente son esenciales, así como su reconocimiento por parte del personal de salud para la definición oportuna del tratamiento. Objetivo: describir los síntomas de angina de un grupo de hombres con edades entre 40 y 80 años, con cateterismo cardíaco positivo para enfermedad coronaria en el marco de la teoría de Elizabeth Lenz según factores determinantes, dimensiones y consecuencias del síntoma. Materiales y métodos: estudio descriptivo con abordaje cualitativo. Se realizó entrevista semiestructurada a 27 hombres en relación con las características de los síntomas experimentados y se analizó la información mediante la técnica de análisis de contenido. Resultados: categorías emergentes relevantes dentro de factores determinantes: "Pienso que hice un sobreesfuerzo", "No controlo la comida", "Es la herencia", "Tanto estrés". Dimensiones: las palabras más utilizadas fueron: "dolor", a veces acompañado de "presión" en el pecho y "dolor de oreja a oreja". Irradiación a brazo izquierdo y ocasionalmente a espalda. Síntomas acompañantes: gastrointestinales, fatiga y hormigueo. Consecuencias: "Me toca cambiar", "Nada va a cambiar", "Me va a afectar". Conclusiones: se obtuvo un perfil característico que refleja la forma de vivir la enfermedad coronaria que facilita la comprensión del fenómeno y que orienta los cuidados pertinentes.

  18. O carvedilol no tecido conjuntivo cardíaco de ratos durante o desenvolvimento da hipertrofia miocárdica concêntrica

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    Leomil Neto Moacir

    2006-01-01

    Full Text Available A estimulação catecolaminérgica precoce e excessiva do coração, que ocorre na insuficiência cardíaca congestiva, acentua a sobrecarga de pressão e o volume nos ventrículos, agravando, conseqüentemente, a isquemia miocárdica, causando morte de miócitos com deposição de tecido conjuntivo e progressiva redução do débito cardíaco. O carvedilol, um b e alfa1-bloqueador não cardio-seletivo, vem sendo associado a melhorias na função miocárdica e à regressão da hipertrofia ventricular esquerda. O objetivo do presente trabalho foi avaliar a ação do carvedilol em ratos submetidos a um modelo experimental de hipertrofia miocárdica por sobrecarga de pressão, por meio da coartação da aorta subdiafragmática. Ratos Wistar (65 animais foram divididos em quatro grupos: não coartados/tratados com placebo, coartados/tratados com placebo, coartados/tratados com 0,1mg kg-1 de carvedilol e coartados/tratados com 1mg kg-1 de carvedilol. Após o procedimento cirúrgico e 20 dias de tratamento, os animais foram submetidos à eutanásia e coletados fragmentos que, depois de fixados em formol a 10% e processados pela técnica histológica convencional utilizando coloração picrossirius, permitiram contagem de tecido conjuntivo nos ventrículos esquerdo e direito. Resultados: nos animais coartados/tratados com placebo, houve aumento na porcentagem de tecido conjuntivo nos ventrículos esquerdo e direito; nos coartados/tratados com 0,1mg kg-1 de carvedilol, houve uma redução parcial da quantidade de tecido colágeno do ventrículo esquerdo e direito, e, nos coartados/tratados com 1mg kg-1 de carvedilol, houve uma redução significativa na quantidade de tecido colágeno do ventrículo esquerdo.

  19. Incidência de coronariopatia após o transplante cardíaco ortotópico Incidence of coronariopathy after orthotopic heart transplantation

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    Alfredo I Fiorelli

    1994-06-01

    Full Text Available O presente estudo tem por finalidade analisar tardiamente o padrão anatômico evolutivo das artérias coronárias do coração transplantado. Para cumprir tal proposição foram selecionados 22 pacientes submetidos ao transplante cardíaco ortotópico, com seguimento pós-operatório superior a 36 meses. As variáveis eleitas para este fim foram aferidas anualmente até o quinto ano de pós-operatório. A análise da ventriculografia mostrou a estabilidade da fração de ejeção (p=0,99 em valores normais. A cineangiocoronariografia seqüencial evidenciou incidência crescente de lesões arteriais com comprometimento da função contrátil. As lesões obstrutivas acometeram as artérias coronárias difusamente, com predomínio no território distai. Os episódios de rejeição aguda e a etiologia da cardiomiopatia não modificaram a evolução natural da aterosclerose coronária.The purpose of this study was to analise late anatomical status of coronary arteries in patients (pts in whom orthotopic heart transplantation(OHT was perfomed. We studied 22 pts submitted to OHT with post-operative follow-up longer than 36 months. They were evaluated by cinecoronariography every year in a 5 years follow-up. Ventriculography analisis showed stability (in normal values of the left ventricular ejection fraction (p= 0,99 during the follow-up period. The sequential coronary studies showed a progressive increase on incidence of abnormalities in coronary arteries with disorders of contratile function. The obstructive abnormalities were present in all segments but more in distal territories. The acute rejection episodes and cardiomiopathy etiologies didn't change the natural evolution of coronary atherosclerosis.

  20. Drenagem anômala total das veias pulmonares: terapêutica cirúrgica dos tipos anatômicos infracardíaco e misto

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    Atik Fernando Antibas

    2004-01-01

    Full Text Available OBJETIVO: Estudar a evolução hospitalar em portadores de drenagem anômala total de veias pulmonares (DATVP, nas formas infracardíaca e mista, submetidos a tratamento cirúrgico. MÉTODOS: De 65 pacientes operados com o diagnóstico isolado de DATVP, de dezembro/1993 a março/2002, foram selecionados, retrospectivamente, 7 (10,8% pacientes das formas mista e infradiafragmática, sendo 5 (71,4% do sexo masculino, idades variando de 5 dias a 19 (média de 7 meses, com diagnóstico clínico feito pelo ecocardiograma bidimensional. Quatro (57,1% pacientes apresentavam formas mistas, em um, obstrutiva intrínseca, com estenose discreta da veia inferior esquerda. Os restantes três (42,9% apresentavam a forma infradiafragmática obstrutiva, extrínseca ao nível do diafragma. Todas as operações foram realizadas através de esternotomia mediana, sob circulação extracorpórea hipotérmica com parada circulatória total em 2 casos. RESULTADOS: Óbito hospitalar ocorreu em 1 paciente com DATVP infradiafragmática com conexão da veia vertical inferior com a veia porta. A causa mortis foi relacionada à falência de múltiplos órgãos e sistemas. O pós-operatório foi caracterizado pela presença de baixo débito cardíaco e hipertensão pulmonar em 4 (57,1% pacientes. CONCLUSÃO: O resultado da correção cirúrgica desta anomalia está associado à morbidade e mortalidade aceitáveis, na dependência do encaminhamento e tratamento cirúrgico precoces, sem progressão do quadro de hipertensão vascular pulmonar.

  1. Estado, iglesia y sociedad en la Monarquía Hispana de Carlos IV. Las apreciaciones de un embajador austríaco en Madrid

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    Álvarez Gutiérrez, Luis

    2003-12-01

    Full Text Available This writing deals with an historiographical analysis of the contents of the diplomatic dispatches sent to Vienna by the imperial ambassador, John Frederick count of Kageneck, accredited at the Court of Charles IV. They concern to the first seven years of that reign (1789-1795. Provide issues, appreciations, and commentaries about the conditions of the contemporaneous Hispanic kingdom in the matter of institutional, administrative, political, economic, social, religious, military affairs, international relations and geostrategical interests. The Austrian diplomat pays much attention to the consequences of the French revolution in Spain; to the measures adopted by the Spanish authorities against the spread of the subversive ideas, as much in the metropolis, as in the overseas dominions, with special reference to the outstanding rôle played by the clergy, as the ideological and moral bulwark against the impetuous attacks of the French revolutionary activity; to the attitude of Spain with regard to the purpose of forming an international coalition against the revolutionary France; and to the later access of Spain in the war against the France of the Convention (1793-1795.

    Este trabajo propone un análisis historiográfico del contenido de los despachos diplomáticos enviados a Viena por el embajador imperial, Juan Federico de Kageneck, acreditado ante la Corte de Carlos IV. Corresponden a los siete primeros años de aquel reinado (1789-1795. Proporcionan datos, apreciaciones y comentarios sobre el estado de la monarquía hispana de la época en sus aspectos institucionales, administrativos, políticos, económicos, sociales, religiosos, militares, relaciones internacionales, e intereses geoestratégicos. El diplomático austríaco dedica atención preferente a las repercusiones de la Revolución francesa en España; a las medidas adoptadas por las autoridades españolas para contrarrestar la difusión de las ideas subversivas, tanto en la

  2. Cintilografia de perfusão miocárdica e comprometimento cardíaco na fase indeterminada da doença de chagas

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    Amalia Peix

    2013-02-01

    Full Text Available FUNDAMENTO: A cintilografia de perfusão miocárdica (CPM tem sido utilizada na avaliação da cardiopatia chagásica. OBJETIVO: Investigar o valor da CPM com tomografia computadorizada por emissão de fóton único (gated-SPECT para detectar comprometimento cardíaco precoce em pacientes chagásicos na fase indeterminada, que apresentam anomalias de movimento segmentar detectadas por exame de imagem por Doppler tecidual (IDT strain derivada. MÉTODOS: Foram incluídos 40 indivíduos (idade média: 25 ± 2 anos, 50% homens de uma área endêmica da doença de Chagas e com diagnóstico sorológico positivo. Todos foram submetidos à CPM com gated-SPECT de 2 dias (repouso e estresse e ecocardiografia. RESULTADOS: Trinta indivíduos (75% apresentaram resultados normais. Em três casos (8%, a CPM apresentou resultado ligeiramente anormal e em sete foi ambígua. Em todos os casos com defeitos reversíveis, os segmentos afetados foram coincidentes com aqueles com anomalias de movimento. Foi encontrada redução na fração de ejeção ventricular esquerda (FEVE > 5% (ΔLVEF% < -5 pós-estresse em 11 dos 40 indivíduos (28%. Tanto o desvio padrão fasederivado como a largura da banda do histograma mostraram diferença significativa entre o pós-estresse e a fase de repouso. Em ambos os casos, houve ligeira dessincronia em repouso normalizado no pós-estresse. CONCLUSÃO: Uma abordagem estresse-repouso com gated-SPECT é válida para detectar alterações miocárdicas precoces, bem como dessincronia intraventricular na fase indeterminada da doença de Chagas em pacientes com anomalias no movimento segmentar previamente detectadas pela IDT strain derivada.

  3. “Manifestos do Coração”: Significados Atribuídos à Doença por Pacientes Cardíacos Pré-cirúrgicos

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    Shana Hastenpflug Wottrich

    Full Text Available RESUMOEste estudo objetivou explorar os significados atribuídos à doença cardíaca por pacientes cardíacos pré-cirúrgicos em tratamento ambulatorial no sul do Brasil. É um estudo clínico-qualitativo, de caráter exploratório e descritivo, cuja coleta de dados aconteceu por meio de entrevistas semiestruturadas e da autofotografia, propostas a 15 indivíduos. Foi realizada análise de conteúdo temática, emergindo as categorias: Confrontação com a doença: os saberes em questão, Negação da doença, Doença e trabalho e Sexualidade rompida. Os resultados destacaram as dificuldades dos participantes relacionadas à apropriação do quadro da doença e à aceitação dessa condição. Salienta-se a premência de ações de saúde, que possam ser coadjuvantes na reestruturação das possibilidades de vida para os pacientes cardíacos pré-cirúrgicos.

  4. Utilização de valvas homólogas e heterólogas em condutos extracardíacos The use of homograph and heterograph valves in extracardiac conduits

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    Rui Siqueira de Almeida

    1988-08-01

    Full Text Available O conceito do uso de um conduto extracardíaco para estabelecer uma via de saída, conectando o ventrículo direito com o tronco pulmonar, ou seus ramos, foi desenvolvido na década de 60. Entre 1971 e 1986, 335 pacientes receberam, no The Hospital for Sick Children, de Londres, condutos extracardíacos para o lado direito do coração; 176 destes foram homoenxertos aórticos, preservados em solução antibióticonutriente; 140 heteroenxertos (Hancock, Ross, Carpentier-Edwards, lonescu-Shiley e 19 tubos não valvulados. Estes condutos foram usados na correção de defeitos cardíacos complexos. A idade média foi de 6,34 anos e o peso médio, de 17,8 kg. O diâmetro interno dos condutos variou de 8 a 30 mm. A mortalidade hospitalar foi de 29,2% e o seguimento dos sobrevivente teve uma duração máxima de 14,3 anos, sendo que apenas 40% delas foram relacionadas ao conduto extracardíaco. A curva atuarial, livre de obstrução, dos condutos extracardíacos foi significativa, quando se analisaram os homoenxertos, face a cada grupo de heteroenxertos (p The concept of using extracardiac conduits, to establish an outflow tract between the right ventricle and the pulmonary artery was developed on the sixties. Between 1971 and 1986, 335 patients received extracardiac conduits for the right heart, at The Hospital for Sick Children, London; 176 were antibiotic preserved aortic homografts (Hancock, Ross, Carpentier-Edwards, lonescu-Shiley and 19 non-valved tubes. These conduits were used for the repair of complex congenital heart defects. The mean age of these groups was 6.34 ± 4.6 years and the mean weight 17.8 ± 10.8 kg. The internal diameter of the conduits varied from 8 to 30 mm. The hospital mortality was 29.2% and long-term follow-up of the survivals had a maximum period of 14,39 years. Sixty patients (17.9% were submited to 60 reoperations, being only 40% conduit related. The actuarial survival cun/e of freedom from obstruction was significant

  5. Consulta de enfermagem ao cliente transplantado cardíaco: impacto das ações educativas em saúde Consulta de Enfermería al cliente trasplantado cardíaco: impacto de las acciones en salud Appointment with nurses for transplanted heart clients: impact of educative health actions

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    Zélia Maria de Sousa Araújo Santos

    2004-12-01

    Full Text Available O estudo teve como objetivo avaliar o impacto das ações educativas em saúde, na consulta de Enfermagem com 18 clientes transplantados cardíacos, embasado na Teoria de Orem. Foi realizado em uma Unidade de Transplante e Insuficiência Cardíaca de uma Instituição Pública de Saúde de Fortaleza - Ce. Os dados foram coletados através da consulta de Enfermagem. Identificou-se 14 diagnósticos de enfermagem na primeira consulta e 7 na última. Constatou-se que, os clientes desenvolveram habilidades para o autocuidado, com a implementação das ações educativas em saúde, tornando-os agentes de autocuidado, com o alcance de um bom nível de saúde e bem-estar. Por outro lado, despertou no enfermeiro, um direcionamento sistemático e eficaz no acompanhamento ambulatorial a esta clientela.El estudio tiene como objetivo, evaluar el impacto de las acciones educativas en salud, en la consulta de Enfermería con 18 cliente trasplantados cardíacos, basado en la teoría de Orem. Se realizó en una Unidad de Trasplante e Insuficiencia Cardiaca de una Institución Pública de Fortaleza-Ce. Se colectaron los datos a través de consulta de enfermería. Se identificaron 14 diagnósticos en la primera consulta y 7 en la última. Hubo la constatación de que, los clientes desarrollaron habilidades para el autocuidado, con la implementación de las acciones educativas en salud, volviéndose agentes de autocuidado, con el alcance de un buen nivel de salud y bienestar. Por otro lado, estimuló en el enfermero, una dirección sistemática y eficaz en el acompañamiento ambulatorial a esta clientela.The study was aimed at evaluating the impact of educative health actions on nursing appointments with 18 transplanted heart clients, based on Orem's Theory. It was conducted in a Heart Transplant and Insufficiency Unit of a Public Health Institution in Fortaleza - CE. The data were collected by way of nursing appointments. 14 nursing diagnoses were identified in

  6. Transplante cardíaco infantil: perspectivas e sentimentos maternos Trasplante cardiaco infantil: perspectivas y sentimientos maternos Heart transplant in children: maternal perspectives and feelings

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    Kiarelle Lourenço Penaforte

    2009-12-01

    Full Text Available Objetiva-se descrever as perspectivas maternas e sentimentos despertados pelo transplante cardíaco infantil. Estudo descritivo com abordagem qualitativa, desenvolvido no Hospital do Coração, de Messejana, em Fortaleza-CE, no período de agosto a novembro de 2007. Os sujeitos foram sete mães de crianças transplantadas. Utilizaram-se como técnicas a entrevista semiestruturada e a análise dos prontuários. Os dados foram submetidos à análise de conteúdo, em três etapas, segundo Bardin, organizados, analisados e interpretados à luz da literatura pertinente, vivência das pesquisadoras e experiência das entrevistadas. Da análise das falas, emergiram as unidades temáticas: necessidade do transplante; fonte de apoio; sentimentos externados pelas mães; a doação e perspectivas. Conclui-se que a doação é um momento de felicidade vivenciada por todas as mães, tratando-se da solução para vida de seus filhos, e a presença autêntica do enfermeiro nesta ocasião torna-se ainda mais essencial, pois humanizar faz parte do cuidar da enfermagem.El objetivo fue describir las perspectivas maternas y los sentimientos provocados por el trasplante cardiaco infantil. Estudio descriptivo con abordaje cualitativo, desarrollado en el Hospital del Corazón, de Messejana, en Fortaleza-CE, en el período de agosto a noviembre del 2007. Los sujetos del estudio fueron siete madres de niños con transplante . Se utilizó como técnica la entrevista semiestructurada y el análisis de los registros médicos. Los datos fueron sometidos al análisis del contenido, en tres etapas, según Bardin, siendo organizados, analizados e interpretados a la luz de la bibliografía pertinente, de la vivencia de las investigadoras y de la experiencia de las entrevistadas. Del análisis del discurso , surgieron las unidades temáticas la necesidad del trasplante; las fuente de ayuda; los sentimientos expresados por las madres; la donación y sus perspectivas. Se concluy

  7. Evolução tardia do transplante cardíaco na doença de Chagas: long-term evolution in cardiac transplantation Chagas' Disease

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    Alfredo I Fiorelli

    1990-08-01

    Full Text Available Nas formas cardíacas da doença de Chagas que evoluem com insuficiência cardíaca refratária ao tratamento clínico, o transplante é a única alternativa, ao lado da cardiomioplastia. Os autores apresentam a evolução tardia de seis pacientes com miocardiopatia chagásica terminal submetidos a transplante cardíaco ortotópico. O período médio de observação foi de 25,2 meses. O diagnóstico de reativação da doença de Chagas apoiou-se na observação clínica, na investigação laboratorial do parasita, nas biópsias endomiocárdicas e dos nódulos de subcutâneo. A análise dos resultados demonstra que: 1 os testes laboratoriais mostraram-se ineficazes no diagnóstico da reativação da doença, sendo que as biópsias mostraram maior índice de positividade; 2 a pulsoterapia com corticóide predispõe à reativação; 3 a doença linfoproliferativa apresenta alta incidência na doença de Chagas, sendo a principal complicação tardia. Possivelmente, o benzonidazol apresente seu efeito oncogênico potencializado. Tendo em vista o caráter endêmico da doença e a falta de alternativa terapêutica, tornou-se obrigatória a analise do esquema imunossupressor, do tratamento da reativação e a maior experiência clínica, para posições mais definidas.In the cardiac forms of Chagas' Disease that develop with refractory cardiac failure under clinical treatment, the transplant is the only alternative along with the cardiomyoplasty. The authors present the six patient late evolution with terminal chagasic myocardiopathy submitted under on orthopic heart transplantation. The average period of observation was of 25.2 months. The diagnosis of Chagas' Disease reativation relies on the clinical observation, laboratory investigation of parasito, endomyocardial biopsy and subcutaneous nodules. The analyses of the results show that: 1 the laboratory exams were useless in the diagnosis of the disease reativation, but the biopsy presented hight

  8. Identificação da comunidade componente de helmintos, gastrointestinais hepáticos, pulmonares, cardíacos e renais de Otaria flavescens (Leão-marinho-do-sul), no litoral sul do Brasil

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    PEREIRA, Eliane Machado

    2012-01-01

    Este estudo analisou os helmintos parasitos gastrointestinais, pulmonares, cardíacos e renais do O. flavescens no litoral sul do Rio Grande do Sul, Brasil. Foram necropsiados 29 leões-marinhos, cujas carcaças apresentavam baixo estado de decomposição. Os órgãos coletados mediante necropsia a campo para análise em laboratório foram 24 intestinos delgado e grosso, 24 fígados incluindo parênquima e vesícula biliar e 29 estômagos, 24 corações e 24 pares de rins. Os órgãos foram congelados a 2...

  9. Division des activités économiques entre chinois, 'injertos' et métis dans la communauté d'Acos 1920-1950. Vallée de Chancay - Pérou

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    1981-01-01

    Full Text Available Ce second article traitant de la micro-colonie chinoise établie depuis 1870 dans la communauté d'Acos (Vallée de Chancay s'attache cette fois à montrer la division nette des activités économiques pratiquées d'un côté par les Chinois et métis chinois ou 'injertos' et les membres des 'familles dites légitimes' qui détenaient le pouvoir depuis plusieurs siècles. Au départ il s'agit d'une opposition entre deux formes de pouvoir: le pouvoir foncier des métis blancs acosinos et le pouvoir économique des Chinois et 'injertos'. Entre 1920 et 1950, la puissance des Chinois et le retour après un temps d'intégration (cf article précédent à un certain individualisme furent autant de facteurs favorisant racisme et tension. Après avoir stimulé par leur présence et leurs activités l'économie locale, les Chinois abandonnèrent la place et laissèrent les familles 'légitimes' reprendre pouvoir foncier et pouvoir économique. Este segundo artículo relativo a la micro colonia china establecida desde 1870 en la Comunidad de Acos (Valle de Chancay trata esta vez de mostrar la clara división de las actividades económicas practicadas de un lado por los Chinos y mestizos Chinos o 'Injertos' y por otro lado por los miembros de las familias llamadas 'legítimas' que tenían el poder desde varios siglos. Al principio se trata de un antagonismo entre dos formas de poder: el poder de los Mestizos blancos de Acos basado en la propiedad de las tierras y el poder económico de los chinos e Injertos. De 1920 a 1950, el poder de los chinos y la vuelta después de una etapa de integración (cf artículo anterior a un cierto individualismo, fueron factores que favorecieron el racismo y la tensión. Después de haber impulsado por su presencia y sus actividades la economía local, los chinos abandonaron el lugar y dejaron que las familias 'legítimas' retomaran la propiedad de la tierra y un poder económico de origen comercial. This second article on

  10. Utilidade do Ultrassom intracardíaco no isolamento de veias pulmonares usando cateter-balão a laser Utilidad del ultrasonido intracardíaco en el aislamiento de venas pulmonares usando catéter-balón láser Utility of intracardiac ultrasound imaging to guide pulmonary vein ablation using laser balloon catheter

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    Luiz Leite

    2009-12-01

    Full Text Available FUNDAMENTO: O isolamento das veias pulmonares (IVP tem sido usado como endpoint para a ablação da fibrilação atrial (FA com cateter balão. OBJETIVO: Determinar a utilidade do ultrassom intracardíaco (USIC para guiar o IVP, usando cateter balão a laser. MÉTODOS: 59 VP foram ablacionadas em 27 cães. Imagens de Doppler foram usadas para identificar os vazamentos do fluxo sanguíneo entre a VP e o balão. Após cada liberação de energia, o cateter de mapeamento circular foi reposicionado para verificar se o isolamento tinha sido obtido. A posição de vazamento foi então correlacionada com a posição do gap no estudo patológico. A análise de regressão logística multivariada foi realizada. RESULTADOS: Cinquenta e nove VP foram submetidas à ablação. O tempo médio de energia liberada foi de 279±177 seg., o diâmetro médio do balão era de 23±3 mm, e o comprimento médio do balão era 25±4 mm. O isolamento completo foi obtido em 38/59 (64%, e foi significantemente mais comum sem vazamento: [30/38 (79% versus 8/23 (35%, pFUNDAMENTO: Se usó el aislamiento de las venas pulmonares (AVP como endpoint para la ablación de la fibrilación atrial (FA con catéter-balón. OBJETIVO: Determinar la utilidad del ultrasonido intracardíaco (USIC para guiar el AVP, usando catéter-balón láser. MÉTODOS: Se ablacionaron 59 VP en 27 perros. Se usaron imágenes de Doppler para identificar los derrames del flujo sanguíneo entre la VP y el balón. Tras cada liberación de energía, se reposicionó el catéter de mapeamiento circular para verificar si se obtuvo el aislamiento. Se correlaccionó, entonces, la posición del derrame con la posición del gap en el estudio patológico. Se realizó el análisis de regresión logística multivariada. RESULTADOS: Se sometieron 59 VP a la ablación. El tiempo promedio de energía liberada fue de 279±177 seg., el diámetro promedio del balón era de 23±3 mm, y la largura promedio del balón era 25±4 mm

  11. Ecocardiografia por Doppler tecidual no diagnóstico de rejeição após transplante cardíaco Ecocardiografía con Doppler tisular en el diagnóstico de rechazo después de transplante cardíaco Tissue doppler echocardiography in the diagnosis of heart transplantation rejection

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    Marcos Valério Coimbra Resende

    2011-07-01

    Full Text Available FUNDAMENTO: A biópsia endomiocárdica (BEM é o método padrão-ouro para o diagnóstico de rejeição celular (RC após transplante cardíaco (TC. OBJETIVO: Testar a hipótese de que o exame de imagem por Doppler tecidual (IDT pode detectar RC > 3A e agregar informação diagnóstica, comparado ao Doppler convencional. MÉTODOS: Cinquenta e quatro pacientes com TC foram submetidos à BEM e estudo ecocardiográfico através de IDT em até 24 horas. Comparamos os pacientes com TC e RC > 3A com pacientes com TC e RC 3A em 39/129 (30,2% das BEM. O melhor preditor isolado para o diagnóstico de RC foi a a'LAT, com sensibilidade de 76,3%, especificidade de 73,8% (p = 0,001. Na análise multivariada, a a'LAT (p = 0,001, a'SEP (p = 0,002, relação e'/a' LAT (p = 0,006, relação e'Mitral/ e'LAT (p = 0,014, SINF (p = 0,009 foram preditores de RC > 3A. Obtivemos um escore com sensibilidade de 88,2%, acurácia de 79,6%, e valor preditivo negativo de 92,9% para diagnosticar RC > 3A. O Doppler convencional (fluxo mitral e pulmonar venoso não foi relevante para predizer a RC > 3A. CONCLUSÃO: O estudo de IDT agregou informação diagnóstica para predizer RC > 3A quando comparado ao Doppler convencional. O modelo baseado em IDT pode ser tornar um método em potencial para detectar RC > 3A após TC.FUNDAMENTO: La biopsia endomiocárdica (BEM es el método gold standard para el diagnóstico de rechazo celular (RC después de transplante cardíaco (TC. OBJETIVO: Testear la hipótesis de que el examen de imagen con Doppler tisular (IDT puede detectar RC > 3A y agregar información diagnóstica, comparado al Doppler convencional. MÉTODOS: Cincuenta y cuatro pacientes con TC fueron sometidos a BEM y estudio ecocardiográfico a través de IDT en hasta 24 horas. Comparamos los pacientes con TC y RC > 3A con pacientes con TC y RC 3A en 39/129 (30,2% de las BEM. El mejor predictor aislado para el diagnóstico de RC fue la a'LAT, con sensibilidad de 76

  12. Vasculites e eosinófilos em biópsia endomiocárdica, como preditores de rejeição em transplante cardíaco Vasculitis y eosinófilos en biopsia endomiocárdica, como predictores de rechazo en transplante cardíaco Vasculitides and eosinophils in emdomyocardial biopsies as rejection predictors in heart transplantation

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    Reginaldo Cipullo

    2011-08-01

    Full Text Available FUNDAMENTO: O significado clínico de vasculites, lesões isquêmicas, efeito Quilty e da presença de eosinófilos em biópsias endomiocárdicas de receptores de transplante cardíaco com rejeições leves não foi ainda estabelecido. OBJETIVO: Verificar se esses achados histológicos encontrados nas biópsias endomiocárdicas (eosinófilos, vasculites, efeito Quilty e lesões isquêmicas são capazes de predizer rejeição aguda do enxerto. MÉTODOS: Foram reavaliadas 1.012 biópsias endomiocárdicas consecutivas; dessas, 939 foram classificadas como OR ou 1R pela Nomenclatura da Sociedade Internacional de Transplante de Coração e Pulmão de 2005, e divididas em dois grupos: (1 Biópsias preditoras: aquelas que precederam rejeição aguda; e (2 Biópsias não preditoras: aquelas que não precederam rejeição aguda. Comparamos a ocorrência dos seguintes achados histológicos: vasculites, lesões isquêmicas, efeito Quilty e eosinófilos por análise uni e multivariada entre os grupos. RESULTADOS: Após análise estatística verificou-se a presença de vasculite intensa e de eosinófilos como maiores preditores para rejeição aguda futura, apresentando respectivamente as seguintes razões de chance: 10,60 (IC95%: 3,62 - 31,06. p FUNDAMENTO: El significado clínico de vasculitis, lesiones isquémicas, efecto Quilty y de la presencia de eosinófilos en biopsias endomiocárdicas de receptores de transplante cardíaco con rechazos leves no fue aun establecido. OBJETIVO: Verificar si esos hallazgos histológicos encontrados en las biopsias endomiocárdicas (eosinófilos, vasculitis, efecto Quilty y lesiones isquémicas son capaces de predecir rechazo agudo del injerto. MÉTODOS: Fueron reevaluadas 1.012 biopsias endomiocárdicas consecutivas; de esas, 939 fueron clasificadas como OR o 1R por la Nomenclatura de la Sociedad Internacional de Transplante de Corazón y Pulmón de 2005, y divididas en dos grupos: (1 Biopsias predictoras: aquellas que

  13. Validation of the concept Risk for Decreased Cardiac Output Validación del concepto riesgo de débito cardiaco disminuido Validação do conceito risco de débito cardíaco diminuído

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    Eduarda Ribeiro dos Santos

    2013-02-01

    Full Text Available OBJECTIVES: to validate the concept "risk for decreased cardiac output". METHOD: Six of the eight steps suggested in the technique developed by Walker & Avant were adopted to analyze the concept of the phenomenon under study and the proposal made by Hoskins was used for content validation, taking into account agreement achieved among five experts. RESULTS: the concept "decreased cardiac output" was found in the nursing and medical fields and refers to the heart's pumping capacity while the concept "risk" is found in a large number of disciplines. In regard to the defining attributes, "impaired pumping capacity" was the main attribute of decreased cardiac output and "probability" was the main attribute of risk. The uses and defining attributes of the concepts "decreased cardiac output" and "risk" were analyzed as well as their antecedent and consequent events in order to establish the definition of "risk for decreased cardiac output", which was validated by 100% of the experts. CONCLUSION: The obtained data indicate that the risk for decreased cardiac output phenomenon can be a nursing diagnosis and refining it can contribute to the advancement of nursing classifications in this context.OBJETIVO: Validar el concepto riesgo del débito cardíaco disminuido. MÉTODO: Fue adoptada la técnica de Walker & Avant para analizar la definición del fenómeno enfocado, utilizando seis de las ocho etapas sugeridas y la propuesta de Hoskins para validar el contenido, considerándose la conformidad entre cinco expertos. RESULTADOS: el concepto de debito cardíaco disminuido se encuentra en las áreas enfermería y médica y su atención se centra en la capacidad de bombeo del corazón. Sin embargo, el concepto de riesgo es presente en un gran número de áreas. Las características definitorias de la disminución del gasto cardíaco mostraron como principal atributo deficiencia de la bomba cardiaca y, para el riesgo, el atributo de probabilidad. Analizados

  14. Metastização pulmonar na apresentação de angiossarcoma cardíaco – Caso clínico e discussão

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    Vítor Fonseca

    2009-11-01

    Full Text Available Resumo: Apresenta-se um caso clínico referente a doente de 35 anos, do sexo masculino sem antecedentes pessoais relevantes, admitido no serviço de urgência por quadro de toracalgia e tosse produtiva com alterações electrocardiográficas sugestivas de pericardite. Inicialmente admitido pelo Serviço de Cardiologia, com melhoria do quadro clínico após terapêutica anti-inflamatória; contudo, no internamento houve como intercorrência pneumonia de provável etiologia bacteriana, complicada por derrame pleural. Após a alta, foi referenciado à consulta de pneumologia, onde se manteve o estudo etiológico do derrame persistente, tendo vindo a complicar-se o seu quadro com alterações das cavidades cardiacas e múltiplos nódulos pulmonares, sugestivos de endocardite subaguda com embolização séptica pulmonar. Internado no serviço de Pneumologia e submetido a videotoracoscopia, foi-lhe diagnosticado angiossarcoma cardíaco com metastização pulmonar. Assistiu-se a uma rápida evolução do quadro clínico, quase fulminante, com falência cardíaca e óbito do doente sem ter iniciado radioterapia ou quimioterapia adjuvante. Abstract: We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti-inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE. After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the pulmonology unit patient underwent

  15. Dosagem de marcadores cardíacos CK-MB e TnIc e eletrólitos no envenenamento experimental por veneno de sapo em cães

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    Annelise C. Camplesi

    2009-08-01

    Full Text Available Dentre os sinais sistêmicos causados pelo envenenamento por veneno de sapo (bufotoxina em cães, os efeitos cardiotóxicos são um dos mais importantes. O objetivo deste estudo foi avaliar as potenciais alterações no músculo cardíaco de cães envenenados experimentalmente por veneno de sapo e observar as alterações eletrolíticas que podem ocorrer nesse tipo de envenenamento. Utilizaram-se 20 cães divididos em grupo controle (n=5 e grupo envenenado (n=15. O veneno de sapo foi extraído por meio de compressão manual das glândulas paratóides. Após anestesia geral, os cães do grupo controle receberam placebo (solução fisiológica e os do grupo envenenado uma alíquota do veneno por sonda orogástrica. As colheitas de sangue para dosagem dos marcadores cardíacos foram realizadas seis e 24 horas após o envenenamento. As colheitas de sangue para dosagem dos eletrólitos foram realizadas antes e duas, quatro, seis e 12 horas após o envenenamento. A análise estatística empregada foi o teste não-paramétrico de Mann-Withney (PAmong the systemic signs of toad venom (bufotoxin poisoning in dogs, the cardiotoxic effects are one of the most important. Thus, the objective of this experiment was to evaluate potential changes in the cardiac muscle in dogs poisoned experimentally by toad venom and to observe the eletrolyte alterations which may occur in this condition. Twenty dogs divided into control group (n=5 and poisoned group (n=15 were utilized. The toad venom was extracted by manual compression of the paratoidic glands. After general anesthesia, dogs in the control group received placebo and dogs in the poisoned group received the venom by orogastric catheter. Samples for dosage were collected 6 hours and 24 hours after poisoning and 0, 2, 4, 6 and 12 hours after poisoning for electrolytes dosage. The Man-Withney test was used for statistical analysis (P<0.05. The poisoned dogs showed (saline elevated levels of cardiac markers CK

  16. Avaliação ecocardiográfica do desenvolvimento cardíaco de cavalos atletas: comparação entre atividades físicas distintas

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    Carolina C.M. Bonomo

    2014-09-01

    Full Text Available A capacidade aeróbica dos equinos atletas pode ser explicada, em partes, pelo seu desenvolvimento cardíaco associado ao treinamento físico. O exame ecocardiográfico de equinos atletas permite a visualização destas alterações e da função cardíaca destes animais. Buscou-se avaliar ecocardiograficamente equinos de diferentes modalidades esportivas, para verificar se o tipo de atividade física desempenhada por cada grupo de animais promove diferenças estruturais ou funcionais cardíacas. 196 equinos foram submetidos à avaliação ecocardiográfica em repouso, sendo divididos em três grupos: grupo Polo, 44 equinos participantes de provas de Polo; grupo QM, 49 equinos da raça Quarto de Milha, participantes de provas de baliza e tambor, e grupo PSI, 103 equinos da raça Puro Sangue Inglês participantes de provas de corridas. Foram avaliados os seguintes índices cardíacos: SIV, DIVE e PLVE em sístole e diástole, AE em sístole, Ao em diástole, relação AE:Ao, FEj, VEj, VSFVE, VDFVE, FS%, E-S, TEVE, DC e FC. Os animais do grupo PSI apresentaram os maiores volumes de ventrículo esquerdo, tendo apresentado proporcionalmente menor eficiência quando analisado o VEj. Os animais do grupo Polo e QM apresentaram melhores valores quando analisadas as variáveis de função cardíaca. A atividade física mais intensa desempenhada pelos animais do grupo QM e Polo permitiu melhor desenvolvimento funcional do coração destes animais, tendo o grupo PSI, apresentado valores que sugerem que sua capacidade aeróbica ainda pode ser melhor explorada através de melhor orientação de seu treinamento físico.

  17. ANÁLISIS DE LA CALIDAD DEL REGISTRO DE PARO CARDÍACO EN CASOS DE RESPONSABILIDAD MÉDICO LEGAL EN MÉDICOS GENERALES, 1999-2007

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    Gabriel Barragán

    2009-01-01

    Full Text Available Antecedentes. El registro del paro cardíaco es una actividad que se debe acompañar en la reanimación cerebro cardio pulmonar. En Colombia no existe un formato de registro oficial de paro cardiorrespiratorio, lo que dificulta la investigación en reanimación y la conducción de los procesos de responsabilidad médica que se deriven de esta atención. Objetivo. Analizar la calidad del registro de paro cardíaco en casos de responsabilidad médico legal iniciada a médicos generales que tuvieron asesoría científica del Fondo para Auxilio de Demandas de la Sociedad Colombiana de Anestesiología y Reanimación (SCARE-FEPASDE, 1999-2007. Material y métodos. Se realizó una investigación tipo serie de casos, en donde se incluyeron los casos de paro cardiorrespiratorio que tuvieron demanda médico legal y que fueron atendidos por médicos generales, entre 1999 y 2007, y que requirieron asesoría jurídica por SCARE-FEPASDE. La información se registró en tablas de Excel®, según las recomendaciones Utstein. La calificación de calidad se hizo por tres médicos expertos en responsabilidad médica de manera independiente. Se utilizó un formato de calificación sobre la proporción de registros realizados sobre 25 ítem posibles. La calidad se consideró alta (mayor de 95% ítem, media (70-94% ítem y baja (menor de 70%. En los casos de desacuerdo se realizó consenso. Resultados. Se incluyeron en total 83 casos. La calidad del registro del paro fue media en 49 casos (59%, baja en 32 casos (39% y alta en dos casos. Conclusión. El registro de paro cardiorrespiratorio en casos de responsabilidad médica es de mediana calidad, por lo que no se alcanza a cumplir con los estándares internacionales y las guías al estilo Utstein.

  18. Vasculites e eosinófilos em biópsia endomiocárdica, como preditores de rejeição em transplante cardíaco

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    Reginaldo Cipullo

    2011-08-01

    Full Text Available FUNDAMENTO: O significado clínico de vasculites, lesões isquêmicas, efeito Quilty e da presença de eosinófilos em biópsias endomiocárdicas de receptores de transplante cardíaco com rejeições leves não foi ainda estabelecido. OBJETIVO: Verificar se esses achados histológicos encontrados nas biópsias endomiocárdicas (eosinófilos, vasculites, efeito Quilty e lesões isquêmicas são capazes de predizer rejeição aguda do enxerto. MÉTODOS: Foram reavaliadas 1.012 biópsias endomiocárdicas consecutivas; dessas, 939 foram classificadas como OR ou 1R pela Nomenclatura da Sociedade Internacional de Transplante de Coração e Pulmão de 2005, e divididas em dois grupos: (1 Biópsias preditoras: aquelas que precederam rejeição aguda; e (2 Biópsias não preditoras: aquelas que não precederam rejeição aguda. Comparamos a ocorrência dos seguintes achados histológicos: vasculites, lesões isquêmicas, efeito Quilty e eosinófilos por análise uni e multivariada entre os grupos. RESULTADOS: Após análise estatística verificou-se a presença de vasculite intensa e de eosinófilos como maiores preditores para rejeição aguda futura, apresentando respectivamente as seguintes razões de chance: 10,60 (IC95%: 3,62 - 31,06. p < 0,001 e 6,26 (IC95%: 3,16 - 12,43. p < 0,001. CONCLUSÃO: Vasculites intensas e eosinófilos em biópsias do miocárdio são os principais fatores preditores de rejeição aguda pós-transplante cardíaco.

  19. Aplicación de un algoritmo ACO al problema de taller de flujo de permutación con tiempos de preparación dependientes de la secuencia y minimización de makespan An ant colony algorithm for the permutation flowshop with sequence dependent setup times and makespan minimization

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    Eduardo Salazar Hornig

    2011-08-01

    Full Text Available En este trabajo se estudió el problema de secuenciamiento de trabajos en el taller de flujo de permutación con tiempos de preparación dependientes de la secuencia y minimización de makespan. Para ello se propuso un algoritmo de optimización mediante colonia de hormigas (ACO, llevando el problema original a una estructura semejante al problema del vendedor viajero TSP (Traveling Salesman Problem asimétrico, utilizado para su evaluación problemas propuestos en la literatura y se compara con una adaptación de la heurística NEH (Nawaz-Enscore-Ham. Posteriormente se aplica una búsqueda en vecindad a la solución obtenida tanto por ACO como NEH.This paper studied the permutation flowshop with sequence dependent setup times and makespan minimization. An ant colony algorithm which turns the original problem into an asymmetric TSP (Traveling Salesman Problem structure is presented, and applied to problems proposed in the literature and is compared with an adaptation of the NEH heuristic. Subsequently a neighborhood search was applied to the solution obtained by the ACO algorithm and the NEH heuristic.

  20. Fisiopatologia da Dispneia em doentes cardíacos com Congestão Pulmonar** Trabalbo vencedor ex-aqueo do Prémio Thomé Villar/Boehringer Ingelheim, 1995

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    Miguel Mota Carmo

    1997-03-01

    Full Text Available SUMÁRIO: O objectivo deste estudo foi avaliar a importância da comparticipação das alterações do controlo da ventilaçõe da força dos músculos respiratórios na génese da dispneia em doentes cardíacos com estase pulmonar. Para isso comparámos 48 doentes (GI, com uma idade média de 61 anos e uma pressão capilar pulmonar (PCP de 19,9 mmHg, com um grupo de 35 controlos (GII, com uma idade média de 62 anos. Foram efectuadas as seguintes avaliações: volumes e capacidades pulmonares pelo método de diluição do hétio e por pneumotacografia, pressão de oclusão e resposta ventilatória em hipercánia, bem como a quantificação simultânea da dispneia utilizando uma escala visual analógica. Foram também medidas as pressões máximas dos músculos respiratórios, ao nível da boca, em repouso. Os doentes cardíacos foram submetidos a cateterismo cardíaco direito com determinação do débito cardíaco por termodilui determinação. Nestes doentes encontrou-se um aumento da pressão de oclusão basal em comparação com o grupo controlo (P0,1 GI-1,7 cmH20 / GII -1,35 cmH20; p<0,001, provavelmente devido ao padrão espirométrico restritivo que apresentavam. Não se detectaram alterações na variação da P0,1 durante a prova de hiperclápnia pelo que admitimos que o controlo central da ventilação se encontrava integro. Durante esta prova e para um mesmo aumento da ventilação, os doentes cardiacos apresentaram um maior grau de dispneia. A redução das pressões máximas respiratórias, bem como o aumento da “drive” respiratória em repouso, poderão estar implicadas na génese da dispneia oeste grupo de doentes. ABSTRACT: The purpose of this study was to evaluate whether pulmonary congestion (PC in cardiac patients may induce changes in the control of breathing or in the

  1. Avaliação da doença vascular do enxerto no transplante cardíaco: experiência de um centro brasileiro Assessment of cardiac allograft vasculopathy in cardiac transplantation: experience of a Brazilian center

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    Elide Sbardellotto Mariano da Costa

    2012-10-01

    Full Text Available FUNDAMENTO: O transplante cardíaco continua sendo o tratamento de escolha para a insuficiência cardíaca refratária ao tratamento otimizado. Dois métodos diagnósticos apresentam elevada sensibilidade no diagnóstico de episódios de rejeição ao enxerto e Doença Vascular do Enxerto (DVE, causas importantes de mortalidade no pós-transplante. OBJETIVO: Avaliar a relação entre os resultados do ultrassom intracoronariano (USIV e os laudos das biópsias endomiocárdicas (BX no seguimento de pacientes submetidos a transplante cardíaco em um serviço de referência brasileiro. MÉTODOS: Foi realizado um ensaio epidemiológico retrospectivo observacional, com pacientes submetidos a transplante cardíaco ortotópico, no período de 2000 a 2009. Foram analisados os prontuários desses pacientes e os resultados dos USIV e BX realizados rotineiramente no seguimento clínico pós-transplante e terapêutica em uso. RESULTADOS: Dos 77 pacientes analisados, 63,63% são do sexo masculino, nas faixas etárias de 22 a 69 anos. Quanto aos resultados dos USIV, 33,96% foram classificados em Stanford classe I, e 32,08%, como Stanford IV. Dos 143 laudos das biópsias, 51,08% tiveram resultado 1R, 3R em 0,69% dos laudos, e 14,48% apresentaram a descrição de efeito Quilty. Todos usaram antiproliferativos, 80,51% usaram inibidores da calcineurina e 19,48% usaram inibidores do sinal de proliferação (ISP. CONCLUSÃO: A avaliação dos pacientes pós-transplante cardíaco por meio do USIV incorpora informações detalhadas para o diagnóstico precoce e sensível da DVE, que são complementadas pelas informações histológicas fornecidas pelas BX, estabelecendo uma possível relação causal entre a DVE e os episódios de rejeição humoral.BACKGROUND: Cardiac transplantation continues to be the treatment of choice for heart failure refractory to optimized treatment. Two methods have high sensitivity for diagnosing allograft rejection episodes and cardiac

  2. Transplante cardíaco com anastomose bicaval e anuloplastia tricúspide profilática no enxerto Cardiac transplantation with bicaval anastomosis and prophylactic graft tricuspid annuloplasty

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    Alfredo Inácio Fiorelli

    2008-03-01

    Full Text Available OBJETIVO: O presente estudo tem por objetivo avaliar os efeitos da anuloplastia tricúspide profilática no coração doador em transplante cardíaco com anastomose bicaval. MÉTODOS: De 2002 a 2005, foram selecionados de forma não aleatória 20 pacientes submetidos ao transplante cardíaco pela técnica bicaval e com sobrevida superior a seis meses. Eles foram divididos em dois grupos: Grupo I - 10 pacientes que receberam coração doador com anuloplastia tricúspide profilática, pela técnica de De Vega; e Grupo II - 10 pacientes que não receberam a anuloplastia, ambos com características semelhantes. O grau de regurgitação tricúspide foi avaliado pela ecocardiografia transtorácica com Doppler e foi quantificado entre 0 e 3 (0=ausente, 1=discreto, 2=moderado, 3=grave. O desempenho miocárdico foi avaliado pela fração de ejeção ventricular e pelo estudo hemodinâmico invasivo, durante as biópsias endomiocárdicas de rotina. RESULTADOS: O período médio de observação foi de 14,6±4,3 meses (6 e 16 meses. Houve apenas um óbito no grupo II não relacionado à anuloplastia. O grau médio de regurgitação tricúspide no Grupo I foi de 0,4±0,6 e no Grupo II foi de 1,6±0,8 (p OBJECTIVE: This study aims to evaluate the effects of prophylactic heart donor tricuspid annuloplasty in patients after heart transplantation with bicaval anastomosis. METHODS: From 2002 to 2005, 20 patients undergoing heart transplantation with bicaval anastomosis and with a survival rate over 6 months were deliberately selected. Patients were divided into two groups: Group I - 10 patients who underwent prophylactic heart donor tricuspid annuloplasty by the De Vega technique; and Group II - 10 patients did not undergo annuloplasty. In both groups, presurgical clinical characteristics were the same. The tricuspid regurgitation degree was evaluated by transthoracic Doppler echocardiography and it was qualified from 0 to 3 (0=absent, 1=mild, 2=moderated, 3

  3. Sildenafil vs. Nitroprussiato de Sódio durante Teste de Reatividade Pulmonar pré-transplante cardíaco Sildenafil vs. sodium before nitroprusside for the pulmonary hypertension reversibility test before cardiac transplantation

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    Aguinaldo Figueiredo Freitas Jr

    2012-09-01

    Full Text Available FUNDAMENTO: A hipertensão pulmonar é associada ao pior prognóstico no pós-transplante cardíaco. O teste de reatividade pulmonar com Nitroprussiato de Sódio (NPS está associado a elevados índices de hipotensão arterial sistêmica, disfunção ventricular do enxerto transplantado e elevadas taxas de desqualificação para o transplante. OBJETIVO: Neste estudo, objetivou-se comparar os efeitos do Sildenafil (SIL e NPS sobre variáveis hemodinâmicas, neuro-hormonais e ecocardiográficas durante teste de reatividade pulmonar. MÉTODOS: Os pacientes foram submetidos, simultaneamente, ao cateterismo cardíaco direito, ao ecocardiograma e à dosagem de BNP e gasometria venosa, antes e após administração de NPS (1 - 2 µg/Kg/min ou SIL (100 mg, dose única. RESULTADOS: Ambos reduziram a hipertensão pulmonar, porém o nitrato promoveu hipotensão sistêmica significativa (Pressão Arterial Média - PAM: 85,2 vs. 69,8 mmHg, p BACKGROUND: Pulmonary hypertension is associated with a worse prognosis after cardiac transplantation. The pulmonary hypertension reversibility test with sodium nitroprusside (SNP is associated with a high rate of systemic arterial hypotension, ventricular dysfunction of the transplanted graft and high rates of disqualification from transplantation. OBJECTIVE: This study was aimed at comparing the effects of sildenafil (SIL and SNP on hemodynamic, neurohormonal and echocardiographic variables during the pulmonary reversibility test. METHODS: The patients underwent simultaneously right cardiac catheterization, echocardiography, BNP measurement, and venous blood gas analysis before and after receiving either SNP (1 - 2 µg/kg/min or SIL (100 mg, single dose. RESULTS: Both drugs reduced pulmonary hypertension, but SNP caused a significant systemic hypotension (mean blood pressure - MBP: 85.2 vs. 69.8 mm Hg; p < 0.001. Both drugs reduced cardiac dimensions and improved left cardiac function (SNP: 23.5 vs. 24.8%, p = 0

  4. Metastização pulmonar na apresentação de angiossarcoma cardíaco – Caso clínico e discussão

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    Vítor Fonseca

    2009-11-01

    Full Text Available Resumo: Apresenta-se um caso clínico referente a doente de 35 anos, do sexo masculino sem antecedentes pessoais relevantes, admitido no serviço de urgência por quadro de toracalgia e tosse produtiva com alterações electrocardiográficas sugestivas de pericardite. Inicialmente admitido pelo Serviço de Cardiologia, com melhoria do quadro clínico após terapêutica anti-inflamatória; contudo, no internamento houve como intercorrência pneumonia de provável etiologia bacteriana, complicada por derrame pleural. Após a alta, foi referenciado à consulta de pneumologia, onde se manteve o estudo etiológico do derrame persistente, tendo vindo a complicar-se o seu quadro com alterações das cavidades cardiacas e múltiplos nódulos pulmonares, sugestivos de endocardite subaguda com embolização séptica pulmonar. Internado no serviço de Pneumologia e submetido a videotoracoscopia, foi-lhe diagnosticado angiossarcoma cardíaco com metastização pulmonar. Assistiu-se a uma rápida evolução do quadro clínico, quase fulminante, com falência cardíaca e óbito do doente sem ter iniciado radioterapia ou quimioterapia adjuvante.Rev Port Pneumol 2009; XV (6: 1175-1184 Abstract: We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti-inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE. After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the

  5. Elaboração e caracterização de cookies sem glúten enriquecidos com farinha de coco: uma alternativa para celíacos

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    Ana Maria Queiroz

    2017-05-01

    Full Text Available Resumo Os celíacos encontram dificuldades na adoção de uma dieta totalmente isenta de glúten e com qualidade nutricional. Para tanto, objetivou-se desenvolver e avaliar cookies sem glúten enriquecidos com farinha de coco. A farinha de coco com elevado teor de cinzas, proteínas e lipídios pode ser utilizada para enriquecer produtos alimentícios. Foram elaborados cookies com base na composição de uma mistura da Federação Nacional das Associações de Celíacos do Brasil - Fenacelbra (“mix de farinha preparada II” para cookies sem glúten: Padrão FP (formulação semelhante à composição do “mix de farinha preparada II” da Fenacelbra, F1 (modificação de FP com substituição da fécula de batata por 10% de farinha de coco, F2 (modificação de FP com adição de 5% de farinha de coco, F3 (modificação de FP com substituição do polvilho doce por 5% de farinha de coco. Os cookies foram avaliados quanto às características físicas (peso pós-cocção, diâmetro e espessura pós-cocção, fator de expansão, rendimento, Aw, dureza e cor – L*a*b*, físico-químicas (umidade, cinzas, proteínas, lipídios, carboidratos e valor calórico, aceitabilidade quanto aos atributos sensoriais (aceitação global, aparência, cor, aroma, sabor e textura e atitude de compra. A adição de farinha de coco às formulações melhorou as propriedades nutricionais dos cookies sem glúten, aumentando o teor de lipídios e proteínas, e reduzindo o teor de carboidratos. Os cookies desenvolvidos apresentaram boa aceitação sensorial e intenção de compra satisfatória., A adição de 10% de farinha de coco em substituição da fécula de batata na formulação F1 não alterou as características sensoriais do produto, porém proporcionou propriedades físicas e físico-químicas superiores. Dessa forma, cookies sem glúten enriquecidos com farinha de coco constituem uma alternativa viável de alimentos destinados para pessoas portadoras de

  6. Explanatory digital video disc with patients undergoing diagnostic cardiac catheterization Disco digital explicativo para pacientes sometidos al cateterismo cardiaco diagnóstico Digital video disc explicativo em pacientes submetidos ao cateterismo cardíaco diagnóstico

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    Sabrina Koehler Torrano

    2011-08-01

    ámico.O objetivo deste estudo foi avaliar o conhecimento dos pacientes pré-cateterismo cardíaco com diagnóstico ambulatorial, após digital video disc explicativo, em um hospital de referência em cardiologia. Usou-se o estudo transversal como metodologia, com pacientes submetidos ao primeiro cateterismo cardíaco, realizado de maio a junho de 2009, no setor de hemodinâmica. Foi utilizado instrumento com questões (12 referentes ao entendimento dos pacientes sobre o procedimento. A intervenção foi um vídeo com duração de cinco minutos, elaborado pelos pesquisadores. A amostra foi constituída por 94 pacientes, divididos em grupo intervenção-GI (45 e grupo controle-GC (49, com idade média de 55±9 anos e predominância do sexo masculino. Pacientes do GI apresentaram maior índice de acertos (74,6±17,1, quando comparados ao GC (31,6±18,8, p=0,000. Pode-se concluir, por meio dos resultados, que houve eficácia da apresentação de um vídeo de orientações para pacientes submetidos ao procedimento hemodinâmico.

  7. Impacto da variabilidade de peso na estabilidade metabólica dos pacientes transplantados cardíacos no Ceará Impact of weight variation on the metabolic stability of cardiac transplant patients in the state of Ceara

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    Daniele Maria de Oliveira Carlos

    2008-04-01

    Full Text Available FUNDAMENTO: As alterações de peso após o transplante cardíaco (TC freqüentemente ocorrem e aumentam os riscos de doenças secundárias. OBJETIVO: Determinar o impacto da variabilidade do peso nos níveis séricos de glicose, triglicérides, colesterol total e frações dos pacientes transplantados cardíacos. MÉTODOS: Estudo retrospectivo documental realizado com 82 pacientes adultos submetidos a TC entre outubro de 1997 e dezembro de 2005 no Ceará, sendo 83% do sexo masculino e a idade média de 45,06±12,04 anos. As variáveis estudadas foram o perfil biopatológico, o peso e o índice de massa corporal (IMC relacionadas às alterações bioquímico-metabólicas. Os dados foram descritos usando freqüências, medidas de tendência central, teste t de Student e coeficiente de correlação de Pearson. RESULTADOS: A média global do IMC aumentou de 23,77±3,68kg/m² antes do TC, para 25,48±3,92kg/m² no primeiro ano e para 28,38±4,97kg/m² no quinto. Os pacientes com sobrepeso/obesidade (IMC > 25 kg/m² apresentaram valores médios de glicose, colesterol total, lipoproteína de baixa densidade (LDL e triglicérides maiores que os pacientes com eutrofia/desnutrição (IMC BACKGROUND: Weight alterations post cardiac transplant (CT frequently occur and increase the risks of secondary diseases. OBJECTIVE: This study aimed at determining the impact of weight variability on serum levels of glucose, triglycerides, total cholesterol and its fractions of cardiac transplant patients. METHODS: This was a retrospective documental study held with 82 patients submitted to CT between October, 1997 and December, 2005 in Ceará, Brazil. 83% were male and the average age was 45.06±12.04 years. The studied variables were: biopathology profile, the weight and the body mass index (BMI related to the biochemical-metabolic alterations and to the survival. Data were described using frequencies, measures of central tendency, t-Student test and Pearson

  8. QUINOA (CHENOPODIUM QUINOA WILLD: DIGESTIBILIDADE IN VITRO, DESENVOLVIMENTO E ANÁLISE SENSORIAL DE PREPARAÇÕES DESTINADAS A PACIENTES CELÍACOS

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    L. I. A. CASTRO

    2008-11-01

    Full Text Available

    A quinoa (Chenopodium quinoa Willd é um pseudocereal isento de glúten, oriundo dos Andes, onde tem sido cultivado há milhares de anos. O objetivo deste trabalho foi desenvolver e avaliar sensorialmente algumas preparações contendo quinoa em grãos, flocos e farinha, destinadas ao paciente celíaco, e determinar a digestibilidade in vitro de sua proteína, submetida ou não ao tratamento térmico. As amostras foram avaliadas sensorialmente através de um teste de aceitação utilizando a escala hedônica nominal de 9 pontos. O método utilizado na análise da digestibilidade protéica in vitro foi o da queda de pH após 10 minutos, com a adição das enzimas tripsina e pancreatina às amostras de quinoa, tratadas e não tratadas termicamente. Das sete preparações testadas, seis foram bem aceitas, já que apresentaram um Índice de Aceitabilidade maior que 70%. Os flocos e grãos de quinoa, após serem testados termicamente, tiveram sua digestibilidade otimizada. Portanto, a quinoa e seus derivados podem ser considerados uma boa opção para a alimentação dos indivíduos portadores da doença celíaca.

  9. Late gadolinium enhancement by magnetic resonance explains adverse cardiac events in individuals with ventricular arrhythmia; Realce tardío con gadolinio por resonancia magnética explica eventos cardíacos adversos en individuos con arritmia ventricular

    Energy Technology Data Exchange (ETDEWEB)

    Courtis, J.; Vasallo, J.; Arabia, L. [Departamento de Imágenes, Cardiología Intervencionista y Electrofisiología Instituto Oulton, Córdoba (Argentina); Dimitroff, M.; Gonzalez, A. [Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Códoba (Argentina); Tibaldi, M., E-mail: javiercourtis@oulton.com.ar [Técnicas no Invasivas y Arritmias, Instituto Modelo de Cardiología, Córdoba (Argentina)

    2012-07-01

    ) predice eventos cardíacos adversos en pacientes con arritmia ventricular. Métodos: se seleccionaron 74 pacientes consecutivos con arritmia ventricular sintomática (extrasístoles ventriculares y taquicardia ventricular) y fracción de eyección del ventrículo izquierdo (FEVI) >55% enviados a RMC para evaluación de cardiopatía estructural no detectada previamente por otros métodos complementarios. Se analizó el RTG, la función sistólica y los volúmenes de ambos ventrículos. En el seguimiento se evaluó un punto final combinado: hospitalización por arritmia ventricular, descarga apropiada de cardiodesfibrilador implantable y muerte cardíaca. Resultados: durante una mediana de seguimiento de 575 días (rango intercuartil 24-1120 días) y al analizar la población según tuvieran (n=9, 12%) o no (n=65, 88%) RTG se observó que el grupo con Gd positivo presentaba una FEVI menor (58% vs. 66% respectivamente, p=0.01) y volúmenes mayores (VTD: 185 ml vs. 123 ml respectivamente, p=0.01 y VTS: 81 ml vs. 42 ml respectivamente, p=0.01) que el otro grupo. Dos (22%) pacientes del grupo RTG positivo vs. 1 (4%) de aquellos sin RTG presentaron el punto final combinado (p=0.01) y al realizar un análisis de regresión logística se halló que el RTG es predictor de los eventos cardíacos adversos analizados (p=0.029). Conclusiones: en esta serie consecutiva de pacientes con arritmia ventricular demostramos una fuerte asociación entre el RTG miocárdico y eventos cardíacos adversos; esto soporta la hipótesis que la fibrosis miocárdica es un importante sustrato arritmogénico. Además, casi la totalidad de los individuos sin RTG estuvieron libres de eventos en el seguimiento sugiriendo que es posible identificar a través de la RMC sujetos de bajo riesgo los cuales pueden ser tratados conservadoramente. (autores)

  10. Avaliação da qualidade de vida e mortalidade em pacientes com eventos cardíacos graves no pós-operatório Evaluación de la calidad de vida y de la mortalidad en pacientes con eventos cardíacos mayores en el postoperatorio Quality of life and mortality assessment in patients with major cardiac events in the postoperative period

    Directory of Open Access Journals (Sweden)

    Fernando José Abelha

    2010-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Complicações cardiovasculares no pós-operatório associam-se a elevadas mortalidade e morbidade. Poucos estudos avaliaram o grau de dependência desses doentes e a percepção da sua saúde. O objetivo deste trabalho foi avaliar a mortalidade e a qualidade de vida em doentes que desenvolveram eventos cardíacos graves (EC no pós-operatório. MÉTODO: Estudo retrospectivo numa Unidade de Tratamento Intensivo Cirúrgica (UTI-Cirúrgica, entre março de 2006 e março de 2008. Os doen tes foram avaliados quanto à ocorrência de EC. Seis meses após a alta, foi preenchido o questionário Short-Form-36 (SF-36 e avaliada a dependência nas atividades da vida diária (AVD. As comparações entre grupos independentes de doentes foram efetuadas com teste t de Student. A comparação entre cada variável e a ocorrência de EC foi efetuada por regressão logística envolvendo todos os doentes. RESULTADOS: Dos 1.280 doentes que apresentaram critérios de inclusão, 26 (2% desenvolveram EC. A análise univariada identificou como determinantes independentes para o desenvolvimento de EC: estado físico ASA, hipertensão arterial, doença cardíaca isquêmica, doença cardíaca congestiva e escore do Índice de Risco Cardíaco Revisado. A mortalidade seis meses após alta da UTI-Cirúrgica foi de 35%. Dos 17 sobreviventes aos seis meses, 13 completaram os questionários. Trinta e um por cento referiram que sua saúde em geral era melhor no dia em que responderam ao questionário do que 12 meses antes. Sessenta e nove por cento dos doentes estavam dependentes nas AVD instrumentais e 15%, nas AVD pessoais. CONCLUSÕES: O desenvolvimento de EC tem sério impacto no tempo de hospitalização e nas taxas de mortalidade. Seis meses após a alta da UTI-Cirúrgica, mais de metade dos doentes estavam dependentes em pelo menos uma AVD instrumental.JUSTIFICATIVA Y OBJETIVOS: Las complicaciones cardiovasculares en el postoperatorio est

  11. Comparação entre a medida contínua do débito cardíaco e por termodiluição em bolus durante a revascularização miocárdica sem circulação extracorpórea

    Directory of Open Access Journals (Sweden)

    Kim Sílvia M.

    2004-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A cirurgia de revascularização miocárdica sem o uso de circulação extracorpórea (CEC relaciona-se a importantes alterações hemodinâmicas bruscas, que podem não ser prontamente detectadas pela medida contínua de débito cardíaco. Este estudo compara resultados obtidos pela medida do índice cardíaco com o cateter de artéria pulmonar com filamento térmico (Baxter Edwards Critical Care, Irvine, CA com o método padrão por termodiluição com solução, durante a anastomose coronariana distal. MÉTODO: Dez pacientes submetidos à cirurgia de revascularização miocárdica sem CEC foram monitorizados com o cateter de artéria pulmonar com filamento térmico. As medidas de índice cardíaco foram obtidas em quatro momentos: no início da anestesia, enquanto o tórax ainda estava fechado (M1, após a esternotomia (M2, após a estabilização do coração com o aparelho octopus (M3 e ao final da anastomose coronariana distal (M4. RESULTADOS: Houve diminuição significativa (p < 0,05 do índice cardíaco durante a anastomose coronariana, detectada pela medida com termodiluição com bolus de solução. O índice cardíaco variou de 2,8 ± 0,7 para 2,3 ± 0,8 l.min.m-2 no início da anastomose e 2,5 ± 0,8 l.min.m-2 ao final da mesma. Essa variação não foi detectada pela medida contínua (de 3 ± 0,6 para 3,2 ± 0,5 e 3,1 ± 0,6 l.min.m-2 durante a anastomose coronariana. CONCLUSÕES: A medida de débito cardíaco contínuo utilizando o cateter de artéria pulmonar com filamento térmico apresentou atraso na detecção das alterações hemodinâmicas agudas relacionadas à mudança do posicionamento do coração na cirurgia de revascularização miocárdica sem CEC.

  12. Técnica para correção de truncus arteriosus tipos I e II sem condutos extracardíacos Technique for correction of truncus arteriosus type I and II without extracardiac conduits

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    Miguel Barbero-Marcial

    1989-04-01

    Full Text Available Uma nova técnica para correção cirúrgica do truncus arteriosus (TA sem o uso de conduto extracardíaco foi realizada em 7 pacientes, senão 6 do tipo I, e do tipo II em 1 paciente; a idade variou de 2 a 9 meses. O tronco comum foi septado com retalho, dividindo-o em uma posição aórtica e outra pulmonar; a comunicação interventricular (CIV foi fechada através de ventriculotomia; anastomose direta entre as artérias pulmonares e o ventrículo direito foi realizada, sendo a parede anterior construída com retalho de pericárdio bovino com válvula monocúspide. Houve apenas 1 óbito no pós-operatório. Nos 6 pacientes restantes, a relação entre as pressões sistólicas ventrículo direito/ventrículo esquerdo (VD/VE foi menor que 0,51 em 5 pacientes; em 1 paciente, essa relação foi de 0,60, associada a CIV residual. Todos os pacientes encontram-se em classe funcional I (NYHA, em um período de 1 a 14 meses de pós-operatório. Baseados nestes resultados, propomos esta técnica para pacientes com TA tipo I ou II, no primeiro ano de vida.A new corrective surgery for truncus arteriosus (TA without the use of extracardiac conduit was employed in 7 patients with truncus (TA type I in 6 cases and type II in 1 case, aged from two to nine months. The common TA was septated with a patch into aortic and pulmonary segments and the ventricular septal defect was closed through ventriculotomy; a direct anastomosis between the pulmonary arteries and the right ventricle was performed, the anterior wall of this, being contructed with a patch with a monocusp valve. There was one imediate postoperative death. In the surviving six patients the RV/LV postoperative peak systolic was less than 0.51 in five and 0.60 in one with residual VSD; all are in functional class I, in postoperative period between one and fourteen months. Based in these results we propose this technique for patients with type I or II, in the first year of life.

  13. Uso de fluorescência em um método de dissector modificado para estimar o número de miócitos no tecido cardíaco

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    Rômulo Dias Novaes

    2012-03-01

    Full Text Available FUNDAMENTO: Métodos convencionais de dissector atualmente requerem consideráveis custos financeiros, técnicos e operacionais para estimar o número de células, incluindo cardiomiócitos, em uma área de 3D. OBJETIVO: Usar a microscopia de fluorescência em um método de dissector modificado para determinar o número de miócitos no tecido cardíaco em condições normais e patológicas. MÉTODOS: O estudo empregou camundongos Wistar machos com quatro meses de idade e peso de 366,25 ± 88,21 g randomizados em grupos controles (GC, n = 8 e infectados (GI, n = 8. Os animais do GI foram inoculados com cepa Y de T. cruzi (300.000 tripomastigotas/50 g. Após oito semanas, os animais foram pesados e sacrificados. Os Ventrículos Esquerdos (VE foram removidos para análise estereológica da densidade numérica de cardiomiócitos (Nv [c] e o número total dessas células no VE (N [c]. Esses parâmetros foram estimados usando um dissector fluorescente (DF e comparados com os métodos convencionais de dissector óptico (DO e dissector físico (DFi. RESULTADOS: Em ambos os métodos de dissector, os animais do GI apresentaram queda significativa de Nv[c] e N[c] em comparação com os animais do GC (P > 0,05. Uma correlação forte, igual ou superior a 96%, foi obtida entre DF, DO e DFi. CONCLUSÃO: O método DF parece ser igualmente confiável para determinar Nv[c] e N[c] em condições normais e patológicas, apresentando algumas vantagens em relação aos métodos convencionais de dissector: redução de cortes histológicos e imagens na análise estereológica, redução do tempo de análise das imagens, a construção de DF em microscópios simples, utilizando o modo de epifluorescência, distinção de planos de dissector em ampliações inferiores.

  14. Análise histomorfométrica dos cardiomiócitos e deposição de colágeno no músculo cardíaco de ratas ooforectomizadas

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    Maria C.R. Silva

    2016-03-01

    Full Text Available Resumo: Esse estudo objetivou avaliar o efeito da ooforectomia sob os parâmetros histomorfométricos dos cardiomiócitos e quantificação de colágeno em ratas Wistar. Vinte ratas foram utilizadas e separadas em dois grupos: GI - ooforectomizada e GII - sham-ooforectomizada. Após a recuperação anestésica os animais foram acomodados em gaiolas e separados nas condições de ciclo claro/escuro 12/12h por um período de 6 meses. Passado o período experimental, os animais foram anestesiados, o coração retirado e mergulhado em formaldeído a 10%. Os fragmentos dos ventrículos foram submetidos ao processamento histológico e corados com hematoxilina e eosina. As análises histomorfométricas (área celular e área e volume nuclear foram realizadas pelo microscópio de luz e software ImageJ versão 1.44. Os dados foram submetidos à análise ANOVA e quando significantes, complementados pelo teste t de student (p<0,001. Observou-se uma diminuição significativa das áreas celular e nuclear dos cardiomiócitos do grupo GI quando comparado ao grupo GII, bem como a área ocupada, pelo colágeno, no músculo cardíaco foi maior em GI, quando comparado a GII. Diante disso, conclui-se que as alterações observadas nos cardiomiócitos do grupo GI, sugerem uma maior atividade apoptótica nesse grupo, devido à diminuição dos níveis séricos do estrógeno provocado pela ooforectomia e o aumento da área ocupada pelo colágeno, no grupo ooforectomizado, está associada ao efeito cardioprotetor do estrógeno.

  15. Sevoflurano e desflurano sobre o ritmo cardíaco de cães tratados com infusão contínua de doses crescentes de adrenalina

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    Nunes Newton

    2004-01-01

    Full Text Available Os anestésicos inalatórios sensibilizam o miocárdio ou seu sistema de condução à ação das catecolaminas endógenas e/ou exógenas, predispondo o animal às arritmias cardíacas. Dentre os anestésicos voláteis, o sevoflurano e o desflurano são fármacos relativamente recentes e, embora sejam dotados de características relacionadas a não sensibilização do miocárdio às catecolaminas, desconhecem-se estudos que comparem suas eventuais propriedades antiarritmogênicas. Com o objetivo de estudar, comparativamente, o comportamento do ritmo cardíaco e observar eventuais bloqueios atrioventriculares em cães anestesiados pelo sevoflurano e desflurano e submetidos à infusão contínua de adrenalina, foram utilizados 20 animais adultos, os quais foram separados em dois grupos de igual número (G1 e G2. Aos cães do G1, foi administrado propofol, na dose média de 10mmg.kg-1; em seguida os animais receberam sevoflurano, a 1,5CAM. Decorridos 30 minutos do início da administração do anestésico volátil, iniciou-se a infusão de adrenalina na dose de 1mmg.kg-1.min-1. A cada 10 minutos, a dose da catecolamina foi acrescida em uma unidade, cessando-se a administração em 6mmg.kg-1.min-1. Para o G2, empregou-se a mesma metodologia, substituindo-se o sevoflurano pelo desflurano, administrado a 1,5CAM. A cada dose de adrenalina, foi feita contagem de batimentos ventriculares ectópicos, bem como a observação de bloqueios atrioventriculares. Os achados foram tratados pelos métodos estatísticos de Análise de Perfil e Kruskall-Wallis. Os resultados permitiram concluir que o desflurano minimiza de maneira mais eficiente a arritmia induzida pela adrenalina, além de reduzir a incidência de bloqueios atrioventriculares.

  16. Predictive analytics can support the ACO model.

    Science.gov (United States)

    Bradley, Paul

    2012-04-01

    Predictive analytics can be used to rapidly spot hard-to-identify opportunities to better manage care--a key tool in accountable care. When considering analytics models, healthcare providers should: Make value-based care a priority and act on information from analytics models. Create a road map that includes achievable steps, rather than major endeavors. Set long-term expectations and recognize that the effectiveness of an analytics program takes time, unlike revenue cycle initiatives that may show a quick return.

  17. Uso do óxido nítrico inalatório no tratamento da crise hipertensiva pulmonar no pós-operatório de transplante cardíaco

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    Juan Alberto Cosquillo MEJIA

    2002-09-01

    Full Text Available OBJETIVO: Este trabalho relata a experiência no manuseio da crise hipertensiva pulmonar (CHP refratária, com o uso do óxido nítrico inalatório (NOi no pós-operatório imediato do transplante cardíaco (TC ortotópico. MÉTODOS: De outubro/1997 a fevereiro/2002 foram realizados 31 TC em adultos, sendo incluídos pacientes com RVP ±5,1horas.RESULTADOS: Cinco pacientes (1 mulher, com idade média de 42 anos, fizeram uso de NOi por apresentarem critérios de CHP, todos com sinais de baixo débito cardíaco. O tempo médio de CEC foi de 150,8±34,3 minutos, a média sistólica arterial pulmonar foi de 87mmHg (75-115 e a PO2 média de 60mmHg (FiO2 100%, sendo evidenciada dilatação moderada a severa do ventrículo direito no ETT. Foi administrado NOi durante uma média 35h (6-96, iniciando-se desmame após estabilização hemodinâmica. O tempo médio de ME do doador foi de 27,6±5,5horas, a internação hospitalar média foi de 63 dias (17-145, uma morte ocorreu por sepse no 17º PO e os demais pacientes estão em CF I (NYHA. CONCLUSÕES: O tempo de CEC superior a 120 minutos e tempo de ME do doador superior a 20 horas sugerem fatores de risco para CHP no período pós-operatório imediato do TC. O NOi é uma ferramenta útil no manuseio desta complicação, refratária ao tratamento convencional no POI de pacientes submetidos ao TC.OBJECTIVE: This study reviews our experience with the use of nitric oxide inhalation (NOi in the treatment of the refractory pulmonary hypertensive crisis (PHC during the immediate post-operative period (IPOP of heart transplantation (HT. METHOD: Between Oct/97 and Feb/02, 31 HT in adults were performed. Among them were patients with Pulmonary Vascular Resistance (PVR greater than 6 uW, or patients with PVR greater than 2,5 uW during the pharmacological test. All patients were weaned from the CPB (M=101±21 minutes in use of dobutamine, dopamine and milrinone. In the absence of an adequate response to these drugs

  18. Consenso brasileiro de monitorização e suporte hemodinâmico - parte III: métodos alternativos de monitorização do débito cardíaco e da volemia Brazilian consensus of monitoring and hemodynamic support - part III: alternative methods for cardiac output monitoring and volemia estimation

    Directory of Open Access Journals (Sweden)

    Guilherme Schettino

    2006-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A interpretação do débito cardíaco e da pré-carga como números absolutos não traz grandes informações sobre a hemodinâmica do paciente crítico. Em contrapartida, a monitorização da resposta do débito cardíaco à expansão volêmica ou suporte inotrópico é uma ferramenta muito útil na unidade de terapia intensiva, quando o paciente apresenta algum sinal de má perfusão tecidual. Apesar do CAP ser considerado como " padrão-ouro" na avaliação destes parâmetros, foram desenvolvidas tecnologias alternativas bastante confiáveis para a sua monitorização. MÉTODO: O processo de desenvolvimento de recomendações utilizou o método Delphi modificado para criar e quantificar o consenso entre os participantes. A AMIB determinou um coordenador para o consenso, o qual escolheu seis especialistas para comporem o comitê consultivo. Outros 18 peritos de diferentes regiões do país foram selecionados para completar o painel de 25 especialistas, médicos e enfermeiros. Um levantamento bibliográfico na MEDLINE de artigos na língua inglesa foi realizado no período de 1966 a 2004. RESULTADOS: Foram apresentadas recomendações referentes à análise da variação da pressão arterial durante ventilação mecânica, débito cardíaco contínuo por contorno de pulso arterial, débito cardíaco por diluição do lítio, Doppler transesofágico, bioimpedância transtorácica, ecocardiografia e reinalação parcial de gás carbônico. CONCLUSÕES: As novas e menos invasivas técnicas para medida do débito cardíaco, pré-carga e fluidoresponsividade apresentam adequada precisão e podem ser uma alternativa ao uso do CAP em pacientes graves.BACKGROUND AND OBJECTIVES: Cardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. However, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the

  19. Correlação entre gasometria atrial direita e índice cardíaco no pós-operatório de cirurgia cardíaca Correlation between right atrial venous blood gasometry and cardiac index in cardiac surgery postoperative period

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    João Jackson Duarte

    2010-06-01

    Full Text Available OBJETIVO: Determinar a confiabilidade em se correlacionar o índice cardíaco com os dados fornecidos pela gasometria do sangue venoso atrial direito em pacientes submetidos à cirurgia cardíaca, durante o período pós-operatório. MÉTODOS: A partir das amostras de sangue arterial e venoso do átrio direito, colhidas no pós-operatório de cirurgia cardíaca, foram determinados os parâmetros de oxigênio do sangue venoso do átrio direito. Estes parâmetros foram então comparados com o índice cardíaco determinado pela termodiluição. RESULTADOS: Houve boa correlação entre a saturação de oxigênio do sangue venoso do átrio direito (SvO2, diferença artério-venosa do conteúdo de oxigênio do sangue colhido no átrio direito e o índice cardíaco aferido pela termodiluição, com boa sensibilidade e especificidade e alto valor preditivo positivo e negativo. A pressão do sangue do átrio direito (PvO2 apresentou baixa sensibilidade na estimativa de baixo débito cardíaco. CONCLUSÃO: No pós-operatório de cirurgia cardíaca, a SvO2e a diferença artério-venosa do conteúdo de oxigênio (C(avO2 apresentaram-se como parâmetros confiáveis correlacionados a baixo débito cardíaco. A PvO2 foi pouco sensível no diagnóstico de baixo débito no pós-operatório de cirurgia cardíaca.OBJECTIVE: To determine, even during postoperative period, the confiability of the cardiac index correlate with the data data given by a central atrial venous blood gasometry in patients who underwent cardiac surgery. METHODS: From the sample of arterial and venous blood of right atrium gathered in postoperative of cardiac surgery, it was determinated the hemoglobin concentration and the gasometric study through what was observed of the venous oxygen saturation (SvO2 and the partial pressure of oxygen from venous blood gathered in right atrium (PvO2, add to the calculation of artery-venous difference of the oxygen content - radial artery / right atrium (C

  20. Transplante cardíaco em Campo Grande - MS. Redução significativa de lesão coronária pós transplante: relato de caso

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    Marcos Vinícius R. P. CALDAS

    1997-04-01

    Full Text Available No Serviço de Cirurgia Cardíaca da Santa Casa de Campo Grande/MS - foi realizado, em 23 de setembro de 1994, um transplante cardíaco ortotópico no paciente C.A.D., 27 anos, portador de miocardiopatia dilatada idiopática, o qual transcorreu sem anormalidades. O paciente recebeu alta da UTI com 7 dias e alta hospitalar no 40º dia de pós-operatório, recebendo ciclosporina, azatioprina e prednisona para manutenção do enxerto, captopril, furosemida e aspirina. Apresentou no 1º ano de seguimento 2 episódios de rejeição, leve e moderada, sendo modificada a posologia dos imunossupressores. Em setembro de 1995, nos exames de seguimento, foi detectada, na coronariografia, lesão obstrutiva de 50% em artéria coronária direita. Decidiu-se modificar a terapêutica do paciente, iniciando diltiazen substituindo o captopril, e associando-se complexo vitamínico (betacaroteno, C e E mais selênio, na tentativa de evitar progressão da lesão obstrutiva. Foi também realizada orientação dietética por nutricionista. Após 12 meses com a nova terapêutica, a coronariografia mostrou redução significativa da lesão obstrutiva em artéria coronária direita. Durante todo o período de seguimento o paciente apresentou níveis normais no lipidograma. Hoje o paciente encontra-se no terceiro ano de seguimento, assintomático e tendo suas atividades habituais sem intercorrências.The Cardiac Surgery Service of Campo Grande, Santa Casa/MS performed on September 23 rd, 1994 an orthotopic cardiac transplantation in a 27 year-old man with idiopathic dilated cardiomyopathy, which elapsed without abnormalities. The patient left the ICU in 7 days and was discharged at 40 th postoperative day, receiving cyclosporine, azathioprine and prednisone for graft support; captopril, furosemide and aspirin. Presented at one year follow-up, 2 rejection episodes, mil and moderate, when the immunesupressivet herapy dose was modified. On September 1995, at follow up, an

  1. Intervenção coronária percutânea utilizando Full Metal Jacket com stents farmacológicos: eventos cardíacos adversos maiores em um ano

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    Rita Calé

    2013-08-01

    Full Text Available FUNDAMENTO: O benefício clínico de intervenção coronária percutânea (ICP para lesões coronárias longas é incerto; além disso, foram levantadas dúvidas questões sobre a sua segurança. OBJETIVO: Avaliar os preditores de eventos cardíacos adversos maiores (ECAM associados à ICP utilizando Full Metal Jacket (FMJ, definido como a sobreposição de stents farmacológicos (SF medindo >60 mm de comprimento, para lesões muito longas. MÉTODOS: Foram incluídos 136 pacientes consecutivos com lesões coronárias longas, requerendo FMJ em nosso cadastro de centro único. O desfecho primário incluiu a ocorrência combinada de todas as causas de morte, infarto do miocárdio (IM e revascularização do vaso alvo (RVA. Variáveis demográficas, clínicas, angiográficas e de procedimento foram avaliadas por meio de análise de regressão de Cox para determinar os preditores independentes de desfecho. RESULTADOS: O comprimento médio do stent por lesão foi de 73,2 ± 12,3 mm e o diâmetro médio do vaso de referência foi de 2,9 ± 0,6 mm. O sucesso angiográfico foi de 96,3%. A ausência de ECAM foi de 94,9% em 30 dias e 85,3% em um ano. No acompanhamento de um ano, a taxa de mortalidade por todas as causas foi de 3,7% (1,5% por mortes cardíacas, a taxa de IM foi de 3,7%, e a incidência de trombose de stent (TS definitiva ou provável foi de 2,9%. O gênero feminino [risco relativo (RR, 4,40; intervalo de confiança de 95% (IC, 1,81-10,66, p = 0,001 e ICP de artéria coronária não direita (RR, 3,49; p = 0,006; IC 95%, 1,42-8,59 foram preditores independentes de ECAM em um ano. A ausência de eventos adversos em um ano foi maior em pacientes com angina estável submetidos à ICP (RR, 0,33; IC 95% 0,13-0,80, p = 0,014. CONCLUSÕES: A ICP utilizando FMJ com SF para lesões muito longas foi eficaz, mas associada a uma alta taxa de TS em acompanhamento de um ano. No entanto, a taxa de mortalidade cardíaca, IM não relacionado a procedimento, e

  2. Tratamento da Isquemia Mesentérica Crônica através da Angioplastia do Tronco Celíaco: Série de Casos / Treatment of Chronic Mesenteric Ischemia through Celiac Trunk Angioplasty: Case Series

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    Dante Togeiro Bastos Filgueiras

    2016-09-01

    Full Text Available Introdução: A estenose aterosclerótica das artérias viscerais pode ser responsável pela manifestação da Isquemia Mesentérica Crônica (IMC. Apesar de o Tronco Celíaco (TC ser o vaso mais frequentemente acometido, o tratamento cirúrgico é cada vez menos utilizado. O tratamento endovascular, apesar de possuir perviedade inferior a longo prazo, tornou-se o método de escolha devido à fácil execução e baixo índice de complicações. Relato de Casos: Descreve-se quatro casos de revascularização endovascular do TC com implante de stent em pacientes com sintomas de IMC. A avaliação diagnóstica foi realizada através de angioTC helicoidal. Três casos foram realizados por meio do acesso femoral. O sucesso técnico foi de 100%, entretanto um caso necessitou de conversão para acesso braquial. Houve um caso de migração proximal do stent. Todos os pacientes apresentaram melhora subjetiva dos sintomas. Conclusão: Os métodos de imagem são fundamentais para o diagnóstico e planejamento terapêutico. O tratamento endovascular para as lesões estenóticas do TC é o método de escolha na atualidade, devido aos baixos índices de complicações e aceitável taxa de perviedade primária no curto e médio prazo. A aplicação objetiva de questionários de qualidade de vida, entretanto, é necessária para confirmar a eficácia clínica do tratamento. Introduction: Atherosclerotic stenosis of visceral arteries may be responsible for the manifestation of Chronic Mesenteric Ischemia (CMI. Although the Celiac Trunk (CT is the most commonly affected vessel, surgical treatment has been less used. Endovascular treatment, despite lower long-term patency, has become the method of choice due to feasibility and low complication rates. Cases Report: Four cases of endovascular revascularization of CT with stenting are described in patients with suggestive symptoms of CMI. The diagnostic evaluation was performed using multislice CT angiography. Three

  3. Assistência de enfermagem a idosos que realizam cateterismo cardíaco: uma proposta a partir do modelo de adaptação de Calista Roy Asistencia de enfermería a ancianos que realizan cateterismo cardíaco: una propuesta a partir del modelo de adaptación de Calista Roy Nursing care to elderly patients undergoing heart catheterization: a proposal according to the Adaptation model of Calista Roy

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    Maria Célia de Freitas

    2006-10-01

    Full Text Available O estudo objetivou identificar os diagnósticos de enfermagem de idosos que realizam cateterismo cardíaco, abordando os aspectos psicossociais, segundo a Teoria de Adaptação de Roy. Desenvolveu-se em hospital de pronto-atendimento em cardiologia de Fortaleza-CE, de janeiro a julho de 2005. Utilizou-se entrevista semi-estruturada, com 18 idosos de ambos os sexos, no pré-cateterismo. Na análise reconheceram-se os diagnósticos: alteração na manutenção da saúde, ansiedade, medo e alteração no processo familiar. Como intervenções propõe-se: criar um clima de confiança, antes do exame; escutar e respeitar sentimentos, crenças e valores, orientar quanto ao procedimento. A utilização desta teoria permitiu reconhecer que as pessoas, mediante estímulos, podem desencadear respostas positivas ou negativas, cabendo ao enfermeiro atuar como mediador.El estúdio objetivó identificar los diagnósticos de enfermería abordando los aspectos psico-sociales de los pacientes que realizan cateterismo cardiaco, según la Teoría de Adaptación de Roy. Se desarrolló en la sección de cardiología de un hospital de Fortaleza-CE, de Janeiro a Julio de 2005. Se utilizó la entrevista semi-estructurada, con 18 ancianos, en el pre-cateterismo. En el análisis reconocieron los diagnósticos: alteración en la manutención de la salud, ansiedad, miedo y alteración en el proceso familiar. Entre las acciones se elaboraron las siguientes: crearse un clima de confianza para el paciente después del examen; escuchar y respetar sentimientos, creencias y valores referentes a la situación; orientar el paciente cuanto al procedimiento. La utilización de esta teoría permitió reconocer que las personas, mediante estímulos, pueden desencadenar respuestas ora positivas ora negativas, cabiendo al enfermero actuar como mediador.The study aimed at identifying the nursing diagnoses related to the psychological and social aspects of elderly patients undergoing

  4. LA DEGRADACIÓN DE TIERRAS MEDIANTE ANÁLISIS FISIOGRÁFICO Y LA APLICACIÓN DE TÉCNICAS DE TELEDETECCIÓN EN LA CUENCA DEL RÍO GUAÑACOS, Resumen DEPARTAMENTO MINAS, NEUQUÉN

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    Ana Paula Salcedo

    2010-12-01

    Full Text Available Este estudio evalúa el estado de degradación en un sector sur del Departamento Minas, Provincia del Neuquén, correspondiente al valle y las planicies circundantes del río Guañacos. El análisis central se realiza mediante la utilización de técnicas de teledetección en el Sistema de Información Geográfica (SIG IDRISI 32, aplicando índices y algoritmos de vegetación específicos sobre imágenes del satélite Landsat 7. Además, se ha realizado un exhaustivo trabajo de campo relevando los indicadores de degradación con el objetivo de profundizar la clasificación e interpretación del medio natural y cotejar los resultados del análisis satelital.

  5. Pressão pulmonar aferida pela ecocardiografia em pacientes chagásicos indicados para transplante cardíaco Pulmonary pressure by echocardiophy in chagasic patients on heart transplant waiting list

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    Cláudio Léo Gelape

    2011-03-01

    Full Text Available INTRODUÇÃO: O paciente com insuficiência cardíaca desenvolve aumento da pressão pulmonar por mecanismo retrógrado e a hipertensão arterial pulmonar (HP é um marcador de mau prognóstico. OBJETIVO: Correlacionar pressão pulmonar ao ecogardiograma (eco e ao cateterismo, em pacientes em lista de espera para transplante cardíaco (TC, especialmente nos chagásicos. MÉTODOS: Avaliamos 90 pacientes no HC-UFMG entre 2004 e 2009. Todos realizaram cateterismo e eco no pré-transplante. A idade média foi de 45,5 anos, sendo 68(75,6% homens, 42(46,7% chagásicos, 32(35,6% portadores de miocardiopatia dilatada e 10(11,1% isquêmicos. RESULTADOS: A eco-PSAP (pressão sistólica arterial pulmonar média foi de 45 ± 12mmHg. A cat-PSAP média foi de 47 ± 14mmHg. A eco-PSAP-chagásicos foi 41,7 ±12,5 mmHg e não-chagásicos, 47,6 ±12,8 mmHg P=0,04. A cat-PSAP-chagásicos foi de 46 ±12,1 mmHg e não-chagásicos 48,7±12,8mmHg; P=0,43. Oito pacientes apresentavam cat-PSAP>60. A correlação entre a eco-PSAP e o cat-PSAP nos chagásicos foi r=0,45, P=0,008 e nos não-chagásicos de r=0,66, P32,5mmHg tem uma sensibilidade de 79% e especificidade de 75% para diagnosticar HP, com área sob a curva ROC de 0,819. A eco-PSAP-não chagásico>35,5 mmHg tem sensibilidade de 82% e especificidade de 70% para HP, com área sob a curva ROC de 0,776. CONCLUSÕES: Há boa correlação entre a eco-PSAP e a cat-PSAP (r=0,54 entre os pacientes em fila de espera. A eco-PSAP foi menor no grupo dos chagásicos. O ecocardiograma é um método útil para diagnosticar e monitorar a pressão pulmonar previamente ao TC, especialmente em pacientes chagásicos. Entretanto, não é possível prescindirmos do cateterismo para avaliar a reatividade pulmonar com o teste com vasodilatador e indicar com segurança o TC mesmo nos pacientes chagásicos.INTRODUCTION: The patients suffering heart failure develop an increase in pulmonary pressure because of a retrograde mechanism. The

  6. Comparação dos valores de débito cardíaco obtidos por termodiluição e dopplerfluxometria transesofágica Comparison between two methods for hemodynamic measurement: thermodilution and oesophageal doppler

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    Roberto Manara Victorio Ferreira

    2007-08-01

    Full Text Available OBJETIVO: A termodiluição (TD é padrão de monitorização hemodinâmica. Alguns par��metros hemodinâmicos podem ser medidos através do Doppler Transesofágico (DTE. Método simples, menos invasivo. Com o objetivo de avaliar a acurácia do DTE foram comparados TD e DTE na determinação de medidas de débito cardíaco (DC. MÉTODOS: Foram determinadas 192 medidas simultâneas, em diferentes situações clínicas em dez pacientes com idade entre 21 85 anos (cinco do gênero masculino e cinco do feminino, oito internados sépticos em uso de drogas vasoativas e dois monitorizados para laringectomia e transplante hepático; todas avaliadas ao longo de quatro horas, em intervalos de 30 minutos. Foram utilizados dois tipos de doppler: o DeltexR, e o ArrowR, introduzidos entre 35 e 45 cm da fossa nasal e localizados no ponto de maior diâmetro da aorta descendente. Na TD, foi utilizado cateter de artéria pulmonar (Swan Ganz BaxterR e monitor DX-2001R, confirmado o posicionamento radiologicamente e através das curvas pressóricas geradas. As medidas do DC realizadas através da TD foram obtidas com soro fisiológico gelado, sendo considerada a média de quatro medidas não diferentes de 5%. Foi aplicado o método estatístico de Bland e Altman, com utilização de gráfico de regressão linear. RESULTADOS: Não houve diferença estatisticamente significante entre esses dois métodos de medida hemodinâmica, com coeficiente de correlação de 0,88 para o DC (Doppler DeltexR X Swan Ganz BaxterR e coeficiente de correlação de 0,99 DC (Doppler Arrow rR X Swan Ganz BaxterR respectivamente, observando-se correlação. CONCLUSÃO: A medida das variáveis hemodinâmicas ao DTE foi obtida com facilidade nos dez pacientes estudados e revelou ter este dispositivo acurácia compatível à TD.OBJECTIVES: Thermodilution (TD is the "gold standard method" for hemodynamic monitoring. Some parameters can be measured by Oesophageal Doppler (OD, which is

  7. Validação de conteúdo das atuais e de novas características definidoras do diagnóstico de enfermagem débito cardíaco diminuído Validación de contenido de las actuales y nuevas características que definen el diagnostico de enfermería: disminución del gasto cardíaco Content validation of current and new defining characteristics of the nursing diagnosis: decreased cardiac output

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    Juliana de Lima Lopes

    2010-01-01

    Full Text Available OBJETIVO: Validar o conteúdo das características definidoras, tanto aquelas atualmente aprovadas como as identificadas por meio de revisão de literatura, para o diagnóstico de enfermagem Débito Cardíaco Diminuído. MÉTODOS: Trata-se de um estudo de validação de conteúdo utilizando o modelo proposto por Fehring. As características definidoras foram validadas por 18 peritos (oito enfermeiros e dez médicos, usando uma escala do tipo Likert de cinco pontos e seguindo a classificação: escore maior do que 0,80 foram consideradas como as características principais, as com peso entre 0,50 a 0,79 como secundárias e as com média menor ou igual a 0,50, como irrelevantes. RESULTADOS: Dentre as 79 características definidoras investigadas, 38 (48,1% foram validadas, dentre elas, 17 presentes na NANDA-I e, 41 (51,9% foram consideradas como irrelevantes para este diagnóstico, sendo que oito estão listadas na NANDA-I. CONCLUSÃO: As características definidoras listadas atualmente na classificação da Taxonomia da NANDA-I não abrangem completamente o diagnóstico de enfermagem débito cardíaco diminuído.OBJETIVO: Validar el contenido de las características definidoras, tanto de las actualmente aprobadas como las identificadas por medio de una revisión de la literatura, para el diagnóstico de enfermería: disminución del gasto cardíaco. MÉTODOS: Se trata de un estudio de validación de contenido utilizando el modelo propuesto por Fehring. Las características definidoras fueron validadas por 18 expertos (ocho enfermeros y diez médicos, usando una escala de tipo Likert de cinco puntos y siguiendo la siguiente clasificación: las con puntaje mayor que 0,80 fueron consideradas como características principales; las con peso entre 0,50 y 0,79 como secundarias; y, las con promedio menor o igual a 0,50, como irrelevantes. RESULTADOS: Entre las 79 características definidoras investigadas, 38 (48,1% fueron validadas, entre ellas, 17 se

  8. Avaliação hemodinâmica e evolução clínica de crianças portadoras de cardiomiopatia dilatada grave candidatas a transplante cardíaco Hemodynamic evaluation and clinical outcome of children candidates for heart transplantation with severe dilated cardiomyopathy

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    Estela Azeka

    1998-11-01

    Full Text Available OBJETIVO: Estudar o perfil dos parâmetros hemodinâmicos e a evolução clínica de crianças candidatas a transplante cardíaco, portadoras de cardiomiopatia grave. MÉTODOS: Foram 24 crianças, com idade entre 4 meses e 10 anos e 8 meses (média de 3,7±2,5 anos, no período de fevereiro/92 a maio/96, submetidas a estudo hemodinâmico e medidos os seguintes parâmetros: débito cardíaco, pressão média de artéria pulmonar (PMAP e pressão capilar pulmonar. Foram calculados o índice de resistência vascular pulmonar (IRVP e gradiente de pressão transpulmonar (GPT. RESULTADOS: Do ponto de vista evolutivo, 10 (41,6% crianças foram transplantadas (grupo A, 5 (20,8% aguardam o transplante (grupo B e 9 (37,6% faleceram (grupo C. Observou-se que a média das idades dos pacientes do grupo B foi significativamente menor que do grupo C. Dos dados hemodinâmicos, a PMAP, GTP e IRVP apresentaram médias significativamente menores no grupo A em relação ao grupo C. CONCLUSÃO: O perfil hemodinâmico de crianças candidatas ao transplante cardíaco mostrou-se compatível ao quadro clínico de insuficiência cardíaca grave. A idade foi o único fator que diferenciou o grupo B e C (p= 0,036. O IRVP, PMAP e o GTP foram fatores que diferenciaram de modo significativo o grupo A e o grupo C (p=0,010; p=0,044 e p=0,023, respectivamente. Quanto maior a idade no momento da indicação do transplante na criança, pior foi seu prognóstico.PURPOSE: To evaluate hemodynamic parameters and clinical outcome of children with severe cardiomyopathy who are candidates for heart transplantation. METHODS: Twenty four children aged from 4 months to 10 years and 8 months (mean 3.7±2.5 years from February 1992 to May 1996, were submitted to hemodynamic study and the following parameters were measured: cardiac output, mean pulmonary artery pressure (MPAP and capillary wedge pressure. The pulmonary vascular resistance index (PVRI and transpulmonary pressure gradient (TGP

  9. Perfil clínico de pacientes chagásicos e não-chagásicos portadores de marca-passo cardíaco artificial Clinical profile of Chagas and non-Chagas' disease patients with cardiac pacemaker

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    Leonor Garcia Rincon

    2006-06-01

    Full Text Available O objetivo do estudo foi comparar pacientes chagásicos e não-chagásicos com marca-passo cardíaco artificial uni ou bicameral quanto à fração de ejeção do ventrículo esquerdo, o limiar de estimulação ventricular e a incidência de arritmias cardíacas. Entre janeiro/2001 e novembro/2002 foram avaliados 45 pacientes chagásicos e 35 não-chagásicos portadores de marca-passo quanto à história clínica, radiografia do tórax, ecocardiograma, Holter 24h e análise telemétrica do marca-passo. Embora os chagásicos fossem mais jovens, os dois grupos foram semelhantes quanto a variáveis radiológicas e o limiar de estimulação ventricular direito. Os chagásicos apresentaram menor fração de ejeção do ventrículo esquerdo ao ecocardiograma e maior incidência de arritmia ventricular ao Holter 24h. Observou-se correlação positiva entre a baixa fração de ejeção do ventrículo esquerdo e a intensidade da arritmia ventricular ao Holter 24h. Em pacientes com marca-passo, a doença de Chagas está associada a marcadores cardíacos de prognóstico adverso.The aim of this study was to compare Chagas and non-Chagas' disease patients using single or dual-chamber pacemaker in relation to the ejection fraction of the left ventricle, the ventricular stimulation threshold and the occurrence of ventricular arrhythmia. From January, 2001 to November, 2002, 45 Chagas' disease patients and 35 non-Chagas' disease patients, all pacemaker users, were evaluated considering clinical history, echocardiographic study, Holter monitoring and analysis of the pacemaker telemetry data. Chagas' disease patients were significantly younger, but both groups were similar when chest X-Ray variables and right ventricular stimulation threshold were analyzed. Chagas' disease patients had a lower left ventricular ejection fraction and more frequent ventricular arrhythmia during Holter monitoring. A positive correlation between the low ejection fraction of the left

  10. Efeitos da suplementação do 17beta-estradiol no dano oxidativo cardíaco de ratas submetidas à privação dos hormônios ovarianos Effects of 17beta-estradiol replacement on cardiac oxidative damage in rats submitted to ovarian hormone deprivation

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    Sônia Maria Rolim Rosa Lima

    2007-01-01

    Full Text Available OBJETIVO: avaliar o estresse oxidativo em tecido cardíaco de ratas ooforectomizadas, com ou sem terapia hormonal. MÉTODOS: ratas Wistar foram divididas em três grupos: grupo controle (GC, grupo ooforectomizada (GO e grupo ooforectomizada + suplementação hormonal (GOS. A privação estrogênica foi obtida pela ooforectomia bilateral. Uma semana após a ooforectomia, um pellet de 1,5 mg de 17beta-estradiol foi implantado nos animais do grupo GOS. Nove semanas após a ooforectomia, o tecido cardíaco foi obtido para a análise do estresse oxidativo por meio da medida da quimiluminescência e da atividade das enzimas antioxidantes catalase (CAT, superóxido dismutase (SOD e glutationa peroxidase (GPx. RESULTADOS: a quimiluminescência estava aumentada no GO (7348±312 cps/mg proteína quando comparado ao GC (6250±41 cps/mg proteína, pPURPOSE: to evaluate oxidative stress in cardiac tissue of ovariectomized rats, with and without hormonal therapy. METHODS: female Wistar rats were divided in three groups: control group (CG; ovariectomized group (OG; ovariectomized group with estrogen supplementation (ESG. The estrogen deprivation was done through bilateral ovariectomy. After one week from the ovariectomy, a pellet of 1.5 mg of 17beta-estradiol was implanted in the ESG animals. Nine weeks after the ovariectomy, cardiac tissue was obtained for the analysis of the oxidative stress through CL (chemiluminescence, and measurement of antioxidant enzymes catalase (CAT, superoxide dismutase (SOD and gluthatione peroxidase (GPx. RESULTS: CL was increased in the OG (7348±312 cps/mg protein when compared with the CG (6250±41 cps/mg protein, p<0.01, but there was no significant difference between the CG and the ESG (6170±237 cps/mg protein. Ovariectomy reduced SOD (35%, p<0.05 and CAT (22%, p<0.001 activities in the OG as compared with the CG. Hormonal therapy normalized antioxidant enzymes activities in the ESG. There was no statistically significant

  11. Transplante cardíaco: complicações apresentadas por pacientes durante a internação Trasplante de corazón: complicaciones que presentan los pacientes durante la hospitalización Heart Transplantation: complications presented by patients during the hospitalization

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    Elaine Araújo da Silva

    2012-12-01

    Full Text Available Com o avanço da ciência, a insuficiência cardíaca tem como possibilidade de intervenção o transplante cardíaco. Este trabalho teve como objetivos traçar o perfil demográfico dos pacientes submetidos ao transplante cardíaco e identificar as complicações apresentadas durante a internação. Trata-se de um estudo descritivo, quantitativo, realizado com 44 prontuários de pacientes submetidos a transplante de junho/2006 a julho/2009 em um Hospital Universitário de Belo Horizonte, Minas Gerais, Brasil. O projeto atendeu às recomendações da Resolução 196/96. Pelos resultados, a maioria dos pacientes era do sexo masculino, casada, escolaridade de nível fundamental e idade média de 45,2 anos. A miocardiopatia chagásica foi a principal causa de insuficiência cardíaca. As complicações predominantes foram alteração da glicemia, insuficiência renal e infecções. A taxa de mortalidade na internação foi de 20,4%. Além das complicações biológicas só foram registradas ansiedade e depressão. São necessárias pesquisas sobre o tema nos âmbitos psicossociais e espirituais, contribuindo para o desenvolvimento científico.Hoy día, con los avances de la medicina y de la tecnología para el tratamiento de la insuficiencia cardiaca irreversible, se ha utilizado como última intervención el trasplante cardíaco. Este trabajo se desarrolló con los objetivos de delinear el perfil demográfico de los pacientes sometidos a trasplante cardíaco e identificar las complicaciones presentadas por ellos después del trasplante de corazón. Estudio descriptivo y cuantitativo, realizado en conjunto con los registros de 44 pacientes sometidos a trasplante de corazón desde Jun/2006 hasta Jul/2009, en un Hospital Universitario de Belo Horizonte, Minas Gerais, Brasil. El proyecto cumplió con las recomendaciones de la Resolución 196/96. Los resultados mostraron que la mayoría de los pacientes eran del sexo masculino, casados, con educaci

  12. Prevalência da estenose aterosclerótica do tronco celíaco e da artéria mesentérica superior na arteriopatia oclusiva dos membros inferiores Prevalence of atherosclerotic stenosis of celiac trunk and superior mesenteric artery in occlusive arteriopathy of lower limbs

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    Wenes Pereira Reis

    2010-01-01

    Full Text Available Contexto: A eventual relação entre a aterosclerose das artérias dos membros inferiores com a aterosclerose das artérias intestinais foi pouco estudada. Objetivo: Avaliar pela ecografia vascular (Doppler presença de lesões com estenose 70% na artéria mesentérica superior e/ou tronco celíaco em doentes com arteriopatia obstrutiva crônica dos membros inferiores. Método: Foram estudados dois grupos, cada um com 60 doentes (40 homens e 20 mulheres. O grupo-caso foi composto por doentes com arteriopatia obstrutiva crônica dos membros inferiores, claudicação intermitente limitante ou dor de repouso e/ou lesões tróficas de extremidade, sem queixas gastrintestinais. O grupo-controle foi constituído por enfermos sem doença arterial obstrutiva dos membros inferiores e sem queixas gastrintestinais. Consideraram-se fatores de risco presença de diabetes melito, hipertensão arterial, obesidade, angina/infarto, tabagismo e dislipidemia. Todos os doentes foram submetidos a ecografia vascular do tronco celíaco e da artéria mesentérica superior. Os doentes do grupo-caso foram separados pela presença de claudicação intermitente limitante (N = 12 ou lesão trófica e/ou dor de repouso (N = 48. Resultados: Houve associação significante entre idade (p = 0,04 e cardiopatia isquêmica (p = 0,04 com aterosclerose da artéria mesentérica superior. Os fatores de risco não mostraram associação significante com presença de estenose do tronco celíaco. Observou-se associação significante entre arteriopatia dos membros inferiores e lesão estenótica da artéria mesentérica superior (p = 0,006 e do tronco celíaco (p Background: The occasional relationship between arterial atherosclerosis of lower limbs and atherosclerosis of intestinal arteries has not been fully studied yet. Objective: To assess the presence of lesions with ≥ 70% stenosis in the superior mesenteric artery and/or in the celiac trunk in patients with chronic obstructive

  13. Constitution et processus d'intégration socio-économique d'une micro-colonie chinoise dans une communauté andine à la fin du XIXe siècle: Acos - vallée du Chancay

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    1980-01-01

    Full Text Available Plus de 80000 Chinois furent 'importés de force' au Pérou entre 1854 et 1874, année où le Traité de Tien Tsin mit fin à ce trafic. Le Pérou de cette seconde moitié du XIXe souffrait d'un manque de main-d'oeuvre aigu, situation aggravée par la libération des esclaves noirs d'une part et d'autre part par l'essor prit par les haciendas sucrières, la construction des premières lignes de chemin de fer et l'extraction du guano. Entre 1860 et 1870 par exemple arrivèrent au seul port de Callao plus de 38000 'coolies'. En 1876, dans la province de Chancay à Aucallama étaient employés 1225 'asiáticos' soit plus de 66% de la population locale. A la fin du siècle, beaucoup étaient morts, certains avaient réussi à retourner en Chine, et d'autres s'étaient définitivement installés, rejoints par une seconde vague de Chinois commerçants attirés par l'essor du Pérou. La plupart des Chinois s'établirent sur la côte où ils étaient arrivés et dans des centres urbains. Même parmi ceux qui travaillèrent dans la construction des chemins de fer, très peu s'installèrent définitivement dans les régions minières d'altitude. A Acos, petite communauté (300 à 400 habitants de la vallée du Chancay établie dans un fond de vallée chaude ou 'quebrada de yunga', on a retrouvé la présence d'une micro-colonie de Chinois. Dans quelles circonstances aboutirent-ils dans ce village de 'sierra' (1 550 m? Comment s'y intégrèrent-ils et quel fut leur rôle économique sont les questions que nous nous poserons dans cet article, puis dans un suivant traitant spécifiquement de leur rôle dans l'essor du village. Notons un dernier point: le village d'Acos à l'arrivée des Chinois était dominé par un groupe de familles dites 'légitimes' qui détenaient surtout un pouvoir fondé sur la propriété foncière. Les Chinois, en contribuant à développer l'économie de marché, entrèrent en conflit avec ce groupe mais surent aussi se le

  14. Avaliação da correlação entre o dióxido de carbono expirado e o débito cardíaco em pacientes submetidos à cirurgia cardíaca com circulação extracorpórea Evaluación de la correlación entre el dióxido de carbono expirado y el débito cardíaco en pacientes sometidos a la cirugía cardíaca con circulación extracorpórea Correlation between end-tidal carbon dioxide levels and cardiac output during cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Karina Takesaki Miyaji

    2004-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O CO2 expirado (P ET CO2 reflete, além da ventilação pulmonar (eliminação, a produção de dióxido de carbono (metabolismo e o fluxo sangüíneo pulmonar (circulação. Quando o metabolismo e a ventilação são constantes, o CO2 expirado reflete o fluxo sangüíneo pulmonar e, desta forma, o débito cardíaco (DC. Este estudo tem como objetivo a avaliação da correlação entre o dióxido de carbono expirado (P ET CO2 e o débito cardíaco em pacientes submetidos à cirurgia cardíaca com circulação extracorpórea (CEC. MÉTODO: Foram estudados 25 pacientes submetidos à cirurgia de revascularização miocárdica com CEC. Após a intubação traqueal iniciou-se a monitorização da P ET CO2. A determinação do débito cardíaco (DC foi feita por método de termodiluição com o uso de cateter de Swan-Ganz e a PaCO2 foi avaliada através de gasometria arterial. Os parâmetros do estudo foram avaliados em quatro momentos: logo após a indução da anestesia geral; antes da circulação extracorpórea, ao término da circulação extracorpórea e ao final da cirurgia. RESULTADOS: O teste estatístico não demonstrou uma correlação entre o CO2 expirado e o DC, assim como o gradiente de dióxido de carbono arterial e expirado (Ga-eCO2 e o DC. Foi encontrada correlação entre a variação dos valores da P ET CO2, Ga-eCO2 e DC em relação ao basal antes da CEC com perda da correlação após a CEC até o final da cirurgia. CONCLUSÕES: Neste estudo, onde se avaliam pacientes submetidos à cirurgia cardíaca com CEC, as alterações de relação ventilação/perfusão ocorridas ao longo do procedimento são, provavelmente, os fatores determinantes da diminuição da correlação entre o débito cardíaco e o valor de dióxido de carbono expirado.JUSTIFICATIVA Y OBJETIVOS: El CO2 expirado (P ET CO2 refleja, además de la ventilación pulmonar (eliminación, la producción de dióxido de carbono (metabolismo y el

  15. Dimensão fractal na quantificação do grau de rejeição celular miocárdica pós-transplante cardíaco Fractal dimension in quantifying the degree of myocardial cellular rejection after cardiac transplantation

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    Roberto Douglas Moreira

    2011-06-01

    Full Text Available INTRODUÇÃO: O termo "fractal" é derivado do latim fractus, que significa "irregular" ou "quebrado", considerando a estrutura observada como tendo uma dimensão não-inteira. Há muitos estudos que empregaram a Dimensão Fractal (DF como uma ferramenta de diagnóstico. Um dos métodos mais comuns para o seu estudo é a "Box-plot counting" (Método de contagem de caixas. OBJETIVO: O objetivo do estudo foi tentar estabelecer a contribuição da DF na quantificação da rejeição celular miocárdica após o transplante cardíaco. MÉTODOS: Imagens microscópicas digitalizadas foram capturadas na resolução 800x600 (aumento de 100x. A DF foi calculada com auxílio do "software ImageJ", com adaptações. A classificação dos graus de rejeição foi de acordo com a "Sociedade Internacional de Transplante Cardíaco e Pulmonar" (ISHLT 2004. O relatório final do grau de rejeição foi confirmado e redefinido após exaustiva revisão das lâminas por um patologista experiente externo. No total, 658 lâminas foram avaliadas, com a seguinte distribuição entre os graus de rejeição (R: 335 (0R, 214 (1R, 70 (2R, 39 (3R. Os dados foram analisados estatisticamente com os testes Kruskal-Wallis e curvas ROC sendo considerados significantes valores de P INTRODUCTION: The term "Fractal" is derived from the Latin fractus meaning "irregular" or "broken" considering the observed structure with a non-integer dimension. There are many studies which employed the Fractal Dimension (FD as a diagnostic tool. One of the most common methods for its study is the "Box Counting Method". OBJECTIVE: The aim of the present study was to try to establish the contribution of FD in the quantification of myocardial cellular rejection after cardiac transplantation. METHODS: Microscopic digital images were captured at 800x600 resolution (magnification 100x. FD was calculated with the aid of "ImageJ software" with adaptations. The classification of the degrees of rejection was in

  16. Diagnósticos de Enfermagem em pacientes pós-cateterismo cardíaco: contribuição de Orem Diagnósticos de Enfermería en pacientes post-cateterismo cardiaco: contribuición de Orem Nursing Diagnoses in patients after heart catheterization: contribution of Orem

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    Luciano Ramos de Lima

    2006-06-01

    Full Text Available Estudo de múltiplos casos, transversal, envolvendo 30 clientes, no período pós-cateterismo cardíaco. Objetivou estabelecer Diagnósticos de Enfermagem da North American Nursing Diagnosis Association (NANDA. O método de coleta de dados foi o Processo de Enfermagem fundamentado na Teoria Déficit do Autocuidado. Foram estabelecidos 25 diferentes Diagnósticos de Enfermagem. Todos os pacientes apresentaram Integridade tissular prejudicada; Risco para infecção; Dor aguda (região inguinal; Mobilidade física prejudicada, Déficit do autocuidado para higiene íntima e Risco para lesão orgânica renal. Conclui-se que a Teoria do Déficit de autocuidado facilitou a classificação de Diagnósticos de Enfermagem da NANDA, contribuindo para individualização, humanização e qualificação da assistência de enfermagem, além de promover o auto-conhecimento, auto-controle e a participação dos clientes no próprio cuidado.Estudio transversal de múltiplos casos, incluyendo 30 pacientes, en período post-cateterismo cardíaco. Con el objectivo de establecer Diagnósticos de Enfermería de North American Nursing Diagnosis Association (NANDA-Asociación Norteamericana de Diagnósticos de Enfermería.El método de recolecta de datos fue el Proceso de Enfermería, fundamentado en la Teoría de Déficit del Autocuidado de Dorothea Orem. Fueron establecidos 25 diferentes Diagnósticos de Enfermería. Todos los pacientes presentaron perfusión tisular perjudicada; Riesgo para infección; Dolor aguda em la región ingle, Movilidad física prejudicada. Déficit de autocuidado para higiene íntima y riesgo para lesión orgánica renal fue identificado en 100% de los pacientes. Se concluye que, la Teoría de Déficit de Autocuidado de Dorothea Orem, facilitó la clasificación de Diagnósticos de Enfermería de NANDA. Contribuyó para individualización, humanización y calificación de la asistencia de enfermería, incentivando la participación del

  17. Perspectivas da evolução clínica de pacientes com cardiomiopatia chagásica listados em prioridade para o transplante cardíaco Clinical perspectives of patients with Chagas cardiomyopathy listed as high priority for heart transplantation

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    Luiz Felipe P. Moreira

    2005-09-01

    Full Text Available INTRODUÇÃO: O choque cardiogênico é responsável por elevados índices de mortalidade na fila de espera para o transplante cardíaco. Na cardiomiopatia chagásica, a alta incidência de disfunção biventricular pode contribuir com a gravidade desta complicação. MÉTODO: Foram estudados 141 pacientes indicados em caráter de prioridade para o transplante. Destes pacientes, 46 eram portadores de cardiomiopatia chagásica e 95 de outras cardiomiopatias. O choque cardiogênico foi tratado farmacologicamente e com o implante ocasional do balão intra-aórtico. Em cinco pacientes chagásicos, foi realizado o implante de dispositivo paracorpóreo de assistência ventricular esquerda. RESULTADOS: Num período médio de 2,8 meses, 58 (41,1% dos 141 pacientes foram transplantados, 73 (51,7% faleceram e 10 foram retirados da fila. A mortalidade entre os pacientes chagásicos e não chagásicos foi de 45,6% e 54,7%, respectivamente. No entanto, a expectativa média de vida, sem a realização do transplante cardíaco, dos pacientes chagásicos foi de apenas 1,5 meses, sendo observado risco relativo de mortalidade de 1,6 para estes pacientes em relação aos não chagásicos (pINTRODUCTION: Heart failure is responsible for high mortality rates of patients on heart transplantation waiting lists. In Chagas cardiomyopathy, the presence of biventricular dysfunction increases the severity of this situation. METHOD: One hundred and forty-one patients suffering from cardiogenic shock, listed as high priority for heart transplantation, were studied. Forty-six patients presented with Chagas cardiomyopathy and 95 with other cardiomyopathies. Heart failure was treated using intravenous inotropic drugs and intra-aortic balloon pump implantation. Five patients with Chagas disease underwent paracorporeal left ventricular assist device implantation. RESULTS: During a mean follow-up of 2.8 months, 58 (41.1% of the 141 patients were transplanted, while 73 (53.7% died

  18. Efeitos do exercício aeróbico e anaeróbico em variáveis de risco cardíaco em adultos com sobrepeso Effects of aerobic and anaerobic exercise on cardiac risk variables in overweight adults

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    Mônica Medeiros Moreira

    2008-10-01

    Full Text Available FUNDAMENTO: O exercício físico aeróbico é importante aliado no combate aos fatores de risco cardiovascular. No entanto, os efeitos de exercícios de alta intensidade sobre tais fatores ainda são pouco conhecidos. OBJETIVO: Comparar os efeitos de protocolos de exercícios aeróbico e anaeróbico sobre fatores associados ao risco cardíaco. MÉTODOS: Vinte e dois indivíduos com idade média de 40±8 anos foram alocados nos grupos: controle (CO, treinamento de endurance (ET e treinamento intermitente (IT. Os protocolos tiveram duração de 12 semanas, três vezes por semana; e intensidades de 10% abaixo e 20% acima do limiar anaeróbico (LAn. Foram medidas: massa corporal total (MCT, índice de massa corporal (IMC, circunferências de cintura (CINT e quadril (QUA e a composição corporal, além das concentrações plasmáticas de glicose (GLI, colesterol total (CHO e triglicérides (TG; ainda foram calculados a razão cintura-quadril (PCCQ e o índice de conicidade (Índice C. RESULTADOS: As variáveis de MCT, IMC, CINT, GLI e a composição corporal apresentaram alterações significativas nos grupos ET e IT. Os valores de CHO e QUA foram significativamente reduzidos no grupo ET, enquanto a PCCQ mostrou redução significativa no grupo IT. O LAn e o índice C, no grupo IT foram significativamente diferentes em relação a ET. CONCLUSÃO: Tendo em vista as diferenças encontradas nas respostas das variáveis estudadas, em razão do treinamento empregado, concluímos que um programa de exercício que contemple atividades de alta e baixa intensidades seja mais completo para garantir a redução de maior número de variáveis de risco cardíaco.BACKGROUND: Aerobic exercise is an important ally in the fight against cardiovascular risk factors. However, the effects of high-intensity exercise on these factors are still poorly known. OBJECTIVE: To compare the effects of aerobic and anaerobic exercise protocols on cardiac risk factors. METHODS: 22

  19. Um modelo experimental de ablação do Sistema Nervoso Intrínseco Cardíaco reduz a contratilidade do coração de ratos A new experimental model of chemical ablation of the Intrinsic Cardiac Nervous System reduces heart contractility and causes a type of dilated cardiopathy in rats

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    Adilson Scorzoni Filho

    2004-09-01

    Full Text Available OBJETIVO: A função do Sistema Nervoso Intrínseco Cardíaco e o seu papel na doença cardíaca permanecem pobremente compreendidos. Sabe-se que o cloreto de benzalcônio (CB induz a desnervação intrínseca do tubo digestivo. O objetivo deste estudo foi tentar produzir um modelo experimental de desnervação intrínseca do coração utilizando o CB. MÉTODO: Trinta ratos Wistar foram submetidos à aplicação intrapericárdica de CB (0,3% e trinta animais controle receberam a solução salina. Após 15 dias, os animais foram divididos em três grupos, com 10 animais tratados e 10 controles em cada. Os animais do grupo I foram submetidos a estudo radiológico e histopatológico. A área cardíaca e o índice cardiotorácico (ICT foram medidos nas radiografias. Os animais do grupo II foram submetidos a estudo hemodinâmico com registro da pressão arterial, freqüência cardíaca e débito cardíaco. No grupo III, a integridade da inervação parassimpática extrínseca do coração foi avaliada por estimulação vagal direita. O sistema de condução foi avaliado pelo ECG basal. RESULTADOS: A aplicação de CB acarretou aumento do ICT, da área cardíaca, pressão arterial e débito cardíaco, bem como do peso ponderal e do fígado. Nestes animais, a análise histopatológica mostrou redução do número de neurônios atriais e congestão passiva crônica do fígado. A estimulação vagal não mostrou diferenças entre os grupos experimentais. CONCLUSÃO: A ablação do sistema nervoso intrínseco propiciou o aparecimento de cardiopatia dilatada com insuficiência cardíaca direita e esquerda. Esse modelo experimental inédito deverá nortear futuros estudos na tentativa da elucidação da relação entre lesão neuronal e miocardiopatia.OBJECTIVE: The function of Intrinsic Cardiac Nervous System is largely unknown, as is its role in heart disease. In the digestive system, a topic aplication of Benzalkonium chloride (BC leads to intrinsic

  20. Biomarcadores cardíacos: Presente y futuro

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    Eduardo Fernández, MD

    2012-11-01

    Fruto de estas investigaciones, en los últimos treinta años se ha producido un avance importante en el desarrollo de biomarcadores cardiacos. Entre ellos están los recién desarrollados ensayos de troponinas ultrasensibles para diagnóstico temprano, la medición de la albúmina modificada por isquemia que cuenta con alto valor predictivo negativo para la detección de isquemia miocárdica, el ligando de CD40 soluble para la clasificación e individualización del tratamiento, la utilidad de la proteína C reactiva como marcador de riesgo de enfermedad coronaria y las diversas técnicas de alto rendimiento como la proteómica, que permite la detección de múltiples biomarcadores potenciales. A pesar de ello, aún no se dispone de evidencia suficiente para sustituir los marcadores que recomiendan las asociaciones científicas por los nuevos marcadores que se han ido desarrollando, y continúa el debate sobre qué combinación utilizar para alcanzar mayor rendimiento diagnóstico, pronostico y terapéutico. A continuación se revisan los avances actuales en biomarcadores cardiacos y su potencial integración a la práctica clínica habitual.

  1. A Hybrid ACO Approach to the Matrix Bandwidth Minimization Problem

    Science.gov (United States)

    Pintea, Camelia-M.; Crişan, Gloria-Cerasela; Chira, Camelia

    The evolution of the human society raises more and more difficult endeavors. For some of the real-life problems, the computing time-restriction enhances their complexity. The Matrix Bandwidth Minimization Problem (MBMP) seeks for a simultaneous permutation of the rows and the columns of a square matrix in order to keep its nonzero entries close to the main diagonal. The MBMP is a highly investigated {NP}-complete problem, as it has broad applications in industry, logistics, artificial intelligence or information recovery. This paper describes a new attempt to use the Ant Colony Optimization framework in tackling MBMP. The introduced model is based on the hybridization of the Ant Colony System technique with new local search mechanisms. Computational experiments confirm a good performance of the proposed algorithm for the considered set of MBMP instances.

  2. Ação do soro de cabra anti-soro de coelho imunizado ou não com células linfóides do doador sobre o alotransplante cardíaco em ratos: immunosupression of goat antiserum against rabbit serum immunized or not with donor lymphoid cells Cardiac allograft in rats

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    Haylton Jorge Suaid

    2002-01-01

    Full Text Available INTRODUÇÃO: A rejeição imunológica é uma das principais causas da perda de órgãos transplantados. A tentativa do controle da reação imunológica é clinicamente feita através da imunossupressão inespecífica e experimentalmente também por bloqueio específico. O alotransplante cardíaco em ratos pela técnica de ONO,K é um bom método para avaliação clínica da rejeição e de estudos voltados para o controle da rejeição. Objetivo : estudar o efeito de um anti-antisoro linfocitário, anti-linfócitos do doador sobre a rejeição do alotransplante cardíaco de ratos Wistar para ratos Holtzman. MÉTODOS: o soro anti-linfocitário (SAL foi obtido através da imunização de coelhos com linfócitos obtidos de gânglios linfáticos da cadeia mesentérica de ratos Wistar, em solução de Tyrode, contendo 3x10(9 células/ ml. A inoculação de 3 coelhos foi feita com 1 ml da suspensão celular e 1 ml de adjuvante completo de Freund. Duas semanas após a primeira inoculação fez-se 4 doses semanais de reforço. Os coelhos foram sangrados na 5ª semana, quando então foram separados os soros. A titulação dos soros foi realizada pelo teste de citotoxicidade, sendo verificado que ambos apresentaram título de 1:1024. A dosagem de proteínas mostrou albumina com 3,1 e 2,7 g% e globulinas com 3,5 e 2,9 g%, sendo o normal 3,7 e 2,2 g% respectivamente. Os dois SAL foram misturados. Duas cabras foram inoculados, com 3 ml da mistura desses SAL, associados a 2 ml de adjuvante de Freund. As doses de reforço com 5 ml do SAL foram iniciadas 2 semanas após. A cabra A recebeu 8 doses (1,4 g de globulinas. A cabra B recebeu 4 doses de reforço (0,7 g de globulinas. Uma semana após a última inoculação retirou-se 125 ml de sangue de cada cabra, fazendo a separação dos anti-soro anti-SAL (ASAL. Uma terceira cabra C foi imunizada com soro normal de coelho. A determinação de precipitinas foi feita pelo método de OUCHTERLONY. O ASAL A teve t

  3. Perfil sérico da molécula de adesão intercelular-1 no pós-operatório cardíaco de lactentes submetidos à circulação extracorpórea

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    Hunsche Angela

    2002-01-01

    Full Text Available Objetivos: mensurar os níveis séricos da molécula de adesão intercelular-1, solúvel em condições basais e após exposição ao circuito de circulação extracorpórea, em lactentes submetidos à cirurgia cardíaca para correção de defeitos cardíacos congênitos. Métodos: estudo de coorte contemporâneo envolvendo 21 lactentes submetidos à cirurgia cardíaca com uso de circulação extracorpórea. Foram medidos os níveis séricos da molécula de adesão intercelular-1, solúvel na indução anestésica, ao término e 8 e 26 horas após o término da circulação extracorpórea. As amostras foram dosadas através do método de ELISA. Resultados: as patologias cardíacas congênitas mais comuns foram defeito do septo atrioventricular e Tetralogia de Fallot. As médias de idade e de peso foram 6,6 meses e 5,8 quilos. As medianas dos tempos de circulação extracorpórea e de clampeamento da aorta foram, respectivamente, 87 e 53 minutos. Todos os lactentes utilizaram inotrópicos. As medianas dos tempos de intubação e de internação foram 72 horas e 21 dias. A taxa de mortalidade dos pacientes foi de 9,5%. Os níveis basais da molécula avaliada foram mais elevados do que aqueles considerados normais (p<0,0001. Seus níveis diminuíram significativamente ao término da circulação extracorpórea (p<0,001, voltando a aumentar significativamente 8 horas após o término desse período (p<0,005, sem, no entanto, alcançar os valores basais 26 horas depois. Conclusões: o nível sérico basal da molécula de adesão intercelular-1 solúvel é aumentado em lactentes com cardiopatias congênitas. Os níveis séricos desta molécula variam após exposição ao circuito de circulação extracorpórea, e apresentam um comportamento característico nesses pacientes.

  4. Pressão expiratória positiva na via aérea por máscara facial na hemodinâmica de pós-operatórios cardíacos Expiratory positive airway pressure in postoperative cardiac hemodynamics

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    Ana Claudia Borges dos Santos Sena

    2010-10-01

    Full Text Available FUNDAMENTOS: A pressão expiratória positiva na via aérea por máscara facial (EPAP é utilizada no pós-operatório de cirurgias cardíacas, entretanto, seus efeitos hemodinâmicos não foram claramente estudados. OBJETIVO: Avaliar as alterações hemodinâmicas causadas pela EPAP em pacientes pós-cirurgia cardíaca monitorados por cateter de Swan-Ganz. MÉTODOS: Foram incluídos no estudo, pacientes no primeiro ou segundo pós-operatório de cirurgia cardíaca, estáveis hemodinamicamente e com cateter de Swan-Ganz. Eles foram avaliados em repouso e após o uso de 10 cmH2O de EPAP, de forma randomizada. As variáveis estudadas foram: saturação de oxigênio, frequências cardíaca e respiratória, pressões arteriais médias sistêmica e pulmonar (PAM e PAMP, pressões venosa central (PVC e de oclusão da atéria pulmonar (POAP, débito e índice cardíacos, e resistências vasculares sistêmica e pulmonar. Os pacientes foram divididos em subgrupos (com fração de ejeção 50% e os dados foram comparados por teste t e ANOVA. RESULTADOS: Vinte e oito pacientes foram estudados (22 homens, idade média 68 ± 11 anos. Comparando o período de repouso versus EPAP, as alterações observadas foram: POAP (11,9 ± 3,8 para 17,1 ± 4,9 mmHg, p BACKGROND: Expiratory positive airway pressure (EPAP is used in after cardiac surgeries. However, its hemodynamic effects have not been clearly studied. OBJECTIVE: To evaluate the hemodynamic changes caused by EPAP in patients after cardiac surgery monitored by Swan-Ganz. METHODS: Patients at the first or second cardiac surgery postoperative period hemodynamically stable with a Swan-Ganz catheter were included in the study. They were assessed at rest and after using 10 cmH2O EPAP at random. The variables studied were: oxygen saturation, heart rate and respiratory rate, mean artery pressures and pulmonary artery mean pressures (MAP and PAMP, central venous pressure (CVP and pulmonary capillary wedge pressure

  5. Incidência de trombo intracardíaco e de tromboembolismo nos três primeiros meses após o implante de bioprótese valvar Incidence of intracardiac thrombus and thromboembolism in the first three months after bioprosthetic valve implantation

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    Auristela Isabel de Oliveira Ramos

    2004-12-01

    Full Text Available OBJETIVO: Avaliar a incidência de trombo intracardíaco e de tromboembolismo nos três primeiros meses após a troca valvar por bioprótese e identificar fatores de risco para a formação de trombo. MÉTODO:Incluídos 184 pacientes, entre 15 e 75 anos de idade, submetidos a implante de bioprótese e realizados ecocardiogramas transtorácico e transesofágico (ETE na fase hospitalar, média 8,4±3 dias, e três meses após, média 97,4±21,7 dias. RESULTADOS: Incidência de trombo foi significativamente mais elevada nos pacientes com prótese em posição mitral ou mitroaórtica (21,0% do que em posição aórtica (2,8%, pOBJECTIVE: To assess the incidence of intracardiac thrombus and thromboembolism in the first 3 months after bioprosthetic valve replacement and to identify the risk factors for thrombus formation. METHODS: The study comprised 184 patients, aged between 15 and 75 years, who underwent bioprosthetic valve implantation. Transthoracic and transesophageal (TEE echocardiographies were performed in the in-hospital phase (mean, 8.4±3 days and after 3 months (mean, 97.4±21.7 days. RESULTS: The incidence of thrombus was significantly greater in patients with a prosthesis in the mitral or mitroaortic position (21.0% than in those with a prosthesis in the aortic position (2.8%, P<0.001. The multiple logistic regression identified the prosthesis in the mitral or mitroaortic position as the only independent variable for thrombus formation. On the 3-month follow-up, TEE showed a thrombus in 35 (20.7% of the 169 patients on echocardiographic assessment, 31.7% in mitral patients and 3.1% in aortic patients, P<0.001. In the third month, the multiple logistic regression also identified the prosthesis in the mitral or mitroaortic position as the only independent variable for thrombus formation. During the 3-month follow-up, 3 (1.6% patients died and 8 (4.3% experienced embolic phenomena, all in the cerebral territory. CONCLUSION: The incidence

  6. Débito cardíaco e fração de ejeção fetal por meio do spatio-temporal image correlation (STIC: comparação entre fetos masculinos e femininos Fetal cardiac output and ejection fraction by spatio-temporal image correlation (STIC: comparison between male and female fetuses

    Directory of Open Access Journals (Sweden)

    Christiane Simioni

    2012-06-01

    Full Text Available OBJETIVO: Comparar do débito cardíaco (DC e a fração de ejeção (FE do coração de fetos masculinos e femininos obtidos por meio da ultrassonografia tridimensional, utilizando o spatio-temporal image correlation (STIC. MÉTODOS: Realizou-se um estudo de corte transversal com 216 fetos normais, entre 20 a 34 semanas de gestação, sendo 108 masculinos e 108 femininos. Os volumes ventriculares no final da sístole e diástole foram obtidos por meio do STIC, sendo as avaliações volumétricas realizadas pelo virtual organ computer-aided analysis (VOCAL com rotação de 30º. Para o cálculo do DC utilizou-se a fórmula: DC= volume sistólico/frequência cardíaca fetal, enquanto que para a FE utilizou-se a fórmula: FE= volume sistólico/volume diastólico final. O DC (combinado, feminino e masculino e a FE (masculina e feminina foram comparadas utilizando-se o teste t não pareado e ANCOVA. Foram criados gráficos de dispersão com os percentis 5, 50 e 95. RESULTADOS: A média do DC combinado, DC direito, DC esquerdo, FE direita e FE esquerda, para feminino e masculino, foram 240,07 mL/min; 122,67 mL/min; 123,40 mL/min; 72,84%; 67,22%; 270,56 mL/min; 139,22 mL/min; 131,34 mL/min; 70,73% e 64,76%, respectivamente; sem diferença estatística (P> 0,05. CONCLUSÕES: O DC e a FE fetal obtidos por meio da ultrassonografia tridimensional (STIC não apresentaram diferença significativa em relação ao gênero.OBJECTIVE: To compare the cardiac output (CO and ejection fraction (EF of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC. METHODS: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL rotated 30º. To calculate the DC used the formula

  7. Cytomegalovirus and other herpesviruses infections in heart and bone marrow transplant recipients Infecções causadas por citomegalovírus e outros vírus do grupo herpes em transplantados cardíacos e de medula óssea

    Directory of Open Access Journals (Sweden)

    Adriana Weinberg

    1990-10-01

    Full Text Available From January 1988 to January 1989 all the heart transplant and bone marrow recipients at the Instituto do Coração of the Hospital das Clínicas of the University of São Paulo Medical School were studied for the incidence and morbidity associated with herpesviruses infections after transplantation. Five bone marrow and 5 heart transplant recipients were followed for a mean of 4.2 months post-transplantation. All the patients were seropositive for cytomegalovirus (CMV before admission and 80% experienced one or more recurrences during the observation period. Of the 12 episodes of CMV infection, that were identified in this study, 83% were accompanied by clinical or laboratory abnormalities. However, there was only one case of severe disease. The overall incidence of infection for herpes simplex (HSV was 50%. Although most of HSV reactivations were oral or genital, one case of HSV hepatitis occurred. One of the 6 episodes of HSV infections that were treated with acyclovir showed an unsatisfactory response and was successfully managed with ganciclovir. All the individuals had anti-varicella zoster virus antibodies, but none of them developed infection. The study emphasizes the importance of active diagnostic surveillance of herpesvirus infections in transplant patients. Both CMV and HSV reactivations showed high incidence and important morbidity and thus, deserve prophylactic therapy.De janeiro de 1988 a janeiro de 1989 todos os pacientes submetidos a transplante de coração ou de medula óssea no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram estudados quanto à incidência e morbidade das infecções pós-transplante causadas por vírus do grupo herpes. Cinco recipientes de medula óssea e 5 transplantados cardíacos foram observados por um período médio de 4.2 meses após o transplante. Todos os pacientes tinham sorologia positiva para citomegalovírus (CMV antes do transplante

  8. Transplante cardíaco pediátrico em vigência de choque cardiogênico refratário: análise crítica da viabilidade, aplicabilidade e resultados Pediatric heart transplantation in refractory cardiogenic shock: a critical analysis of feasibility, applicability and results

    Directory of Open Access Journals (Sweden)

    Marcelo Biscegli Jatene

    2008-05-01

    Full Text Available FUNDAMENTO: Considerando crianças com miocardiopatia dilatada, na lista de espera de transplante de coração, podemos avaliar a gravidade do quadro hemodinâmico desses pacientes. Alguns apresentam choque cardiogênico e um elevado índice de mortalidade. Mesmo com suporte inotrópico e respiratório, o transplante de coração é considerado uma condição de extrema gravidade. OBJETIVO: Apresentar nossa experiência com crianças na circunstância de transplante cardíaco em vigência de choque cardiogênico refratário, procurando analisar a viabilidade, a aplicabilidade e os resultados desses transplantes. MÉTODOS: De março de 2001 a fevereiro de 2004, 22 crianças com miocardiopatia dilatada, previamente registradas na lista de transplante, apresentaram choque cardiogênico, necessitando transferência para unidade de terapia intensiva (UTI pediátrica, intubação e suporte inotrópico. As idades variaram de 11 meses a 11 anos (média = 4,3 idade, com 55% do sexo masculino; 14 poderiam ser listados como prioridade clínica e os outros 8 foram excluídos da lista de espera em razão de condição clínica desfavorável. RESULTADOS: Oito transplantes de coração foram executados, 6 crianças faleceram na fila de espera (42,9%. Duas crianças faleceram (25% após o transplante; as outras 6 receberam alta hospitalar com boas condições clínicas. As duas principais complicação são rejeição, em 4 casos, e infecção, em 5 casos. Dois apresentaram complicações neurológicas, com recuperação total em um dos casos. CONCLUSÃO: Crianças com miocardiopatia e choque cardiogênico necessitam de transplante imediato; somente 57,1% podiam ser transplantadas, com mortalidade de 25%. Daquelas que sobreviveram ao transplante, a evolução clínica foi boa, similar às crianças transplantas em cirurgias eletivas.BACKGROUND: In children with dilated cardiomyopathy who are on the waiting list for heart transplantation, we evaluate the

  9. Uso de endoprótesis en el tratamiento de lesiones no oclusivas del territorio iliaco Uso de endoprótese no tratamento de lesões não-oclusivas do território ilíaco

    Directory of Open Access Journals (Sweden)

    Renato Mertens

    2006-06-01

    íacas. Entretanto, o uso desses procedimentos para tratar outros tipos de lesão ainda não foi bem estudado. Nosso objetivo é analisar indicações e resultados do uso de endoprótese em lesões ilíacas não-oclusivas. MATERIAL E MÉTODOS: Revisamos retrospectivamente os registros de 14 pacientes consecutivos, todos homens, com idade média de 61,6 anos (faixa: 25-80 anos, tratados por via endovascular entre 2001 e 2006 por lesões ilíacas não-oclusivas. O estudo pré e pós-operatório incluiu tomografia computadorizada. O procedimento foi realizado em bloco cirúrgico, utilizando um angiógrafo digital. Foi utilizado acesso femoral, com a inserção de endopróteses tubulares. RESULTADOS: Em 11 pacientes, houve embolização de artéria hipogástrica ipsilateral associada. As patologias tratadas foram: oito aneurismas ateroscleróticos, 3 dissecções, 2 lesões traumáticas e um pseudo-aneurisma anastomótico. A comorbidade mais freqüente foi hipertensão, em 43% dos casos. Não houve mortalidade operatória. Um paciente apresentou um pseudo-aneurisma femoral tratado com compressão. Um paciente tratado por fístula arteriovenosa traumática em nível ilíaco teve sua insuficiência cardíaca resolvida, com persistência assintomática de mínimo fluxo. A estada pós-operatória foi de 3 dias (média. Não se apresentaram outras endofugas inciais ou tardias. Durante um acompanhamento médio de 20,5 meses (faixa de 1 a 49 meses, um paciente morreu de câncer e nenhum requereu procedimentos complementares. CONCLUSÃO: O tratamento endovascular de lesões ilíacas através de endoprótese é seguro e permite um resultado durável no manejo de um amplo espectro de patologias.

  10. Peso dos ventrículos cardíacos determinado em necropsia de indivíduos saudáveis mortos por causas externas Cardiac ventricular weights recorded at the autopsy of healthy subjects who died of external causes

    Directory of Open Access Journals (Sweden)

    Sérgio Lamêgo Rodrigues

    2007-11-01

    Full Text Available OBJETIVO: Determinar o peso dos ventrículos cardíacos em necropsia de indivíduos sadios vítimas de morte acidental, visando determinar padrões de normalidade em nossa população. MÉTODOS: Foram examinados 94 corações no Instituto Médico Legal de Vitória. Após remoção do coração e ressecção dos átrios e gordura epicárdica, os ventrículos direito (VD e esquerdo (VE, incluindo o septo, foram separados e pesados e a massa indexada pela altura. O teste de Kolmogorov-Smirnov foi usado para testar normalidade da distribuição. Os dados são apresentados como média ± desvio padrão. RESULTADOS: Após 12 exclusões (doença cardiovascular possível detectada após a morte foram analisados 82 corações (52 homens e 30 mulheres, 16-68 anos, média 31±12 anos. O peso do VE foi de 181±25 g e 125±15 g, do VD foi de 54±7 g e 38±6 g e a massa de VE indexada pela altura foi de 105±14 g/m e 78±8 g/m para homens e mulheres, respectivamente. O P95 do peso do VE foi de 218 g e 128 g/m em homens e 148 g e 88 g/m em mulheres. Não detectamos correlação significante entre a massa ventricular e idade. CONCLUSÃO: O peso do ventrículo esquerdo do coração dos homens da nossa amostra foi superior aos relatados na literatura contemporânea. Nossos resultados sugerem que a presença de hipertrofia de VE pode ser inferida em presença de massa de VE superior a 218 g ou 128 g/m nos homens e 148 g ou 88 g/m nas mulheres.OBJECTIVE:To establish cardiac ventricular weights recorded during the autopsy of healthy individuals who died of external causes, aiming at determining normality patterns in our population. METHODS:A total of 94 hearts were evaluated at the Forensics Department of the city of Vitória, Espírito Santo. After the heart removal and resection of the atria and epicardial fat, the right ventricle (RV and the left ventricle (LV, including the septum, were separated and weighed and the mass was indexed by the height. The Kolmogorov

  11. Comparação dos efeitos da dobutamina e da milrinona sobre a hemodinâmica e o transporte de oxigênio em pacientes submetidos à cirurgia cardíaca com baixo débito cardíaco após indução anestésica Comparación de los efectos de la dobutamina y de la milrinona sobre la hemodinámica y el transporte de oxígeno en pacientes sometidos a cirugía cardiaca con bajo débito cardiaco después de inducción anestésica Comparison of the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in patients undergoing cardiac surgery with low cardiac output after anesthetic induction

    Directory of Open Access Journals (Sweden)

    Maria José Carvalho Carmona

    2010-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Diversas classes de fármacos inotrópicos, com efeitos hemodinâmicos diferentes, são utilizadas no tratamento do baixo débito cardíaco em pacientes com disfunção sistólica submetidos a procedimento cirúrgico cardíaco. O objetivo deste estudo foi comparar o efeito da dobutamina e da milrinona sobre a hemodinâmica e o transporte de oxigênio nessa população de pacientes. MÉTODO: Após aprovação do Comitê de Ética institucional e obtenção do consentimento escrito pós-informado, 20 pacientes submetidos à cirurgia cardíaca e com índice cardíaco JUSTIFICATIVA Y OBJETIVOS: Diversas clases de fármacos inotrópicos con efectos hemodinámicos diferentes, se usan en el tratamiento del bajo débito cardíaco en pacientes con disfunción sistólica sometidos al procedimiento quirúrgico cardíaco. El objetivo de este estudio, fue comparar el efecto de la dobutamina y de la milrinona sobre la hemodinámica y el transporte de oxígeno en esa población de pacientes. MÉTODO: Después de la aprobación del Comité de Ética institucional y de la obtención del consentimiento informado, 20 pacientes sometidos a la cirugía cardíaca y con índice cardíaco BACKGROUND AND OBJECTIVES: Several classes of inotropic drugs with different hemodynamic effects are used in the treatment of low cardiac output in patients with diastolic dysfunction undergoing cardiac surgery. The objective of the present study was to compare the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in this population of patients. METHODS: After approval by the Ethics Committee of the institution and signing of the informed consent, 20 patients undergoing cardiac surgery with cardiac index < 2 L.min-1.m2 after anesthetic induction and place ment of a pulmonary artery catheter were randomly divided to receive dobutamine 5 µg.kg-1. min-1 (n = 10, or milrinone 0.5 µg.kg-1.min-1 (n = 10. Hemodynamic parameters were

  12. Tratamento da luxação paralítica do quadril na paralisia cerebral tetraparética espástica com osteotomia do fêmur e do ilíaco sem abertura da cápsula articular (capsuloplastia Hip dislocation treatment in cerebral palsy patients with spastic quadriplegia with femoral and pelvic osteotomies, without opening of the joint capsule (capsuloplasty

    Directory of Open Access Journals (Sweden)

    Fernando Farcetta Junior

    2010-01-01

    Full Text Available OBJETIVO: Mostrar o planejamento pré-operatório, e os resultados do tratamento cirúrgico da luxação paralítica do quadril em pacientes com paralisia cerebral. A técnica utilizada foi a osteotomia derrotatória e varizante do fêmur proximal, associada à osteotomia do ilíaco tipo Dega, sem abertura da cápsula articular. MÉTODOS: Realizamos um estudo retrospectivo de 10 quadris em oito pacientes com paralisia cerebral tipo tetraparesia espástico, submetidos a tratamento cirúrgico entre 2003 e 2005 com a mesma técnica cirúrgica. Foram avaliados parâmetros clínicos e radiográficos pré e pós-operatórios, bem como o planejamento pré-operatório com uso do intensificador de imagem. Os parâmetros clínicos analisados foram: dor, dificuldade de higiene e dificuldade de posicionamento. Os parâmetros radiológicos foram os índices de Reimers, índice acetabular e ângulo cervicodiafisário. Estes resultados foram submetidos a análise estatística. RESULTADOS: Obtivemos bons resultados com esta técnica. Com um seguimento médio de três anos, todos os quadris estavam reduzidos na última consulta, com alto grau de satisfação dos familiares, em relação ao tratamento. Além disso, mostramos que o planejamento pré-operatório com uso do intensificador de imagem nos permite a redução e estabilização desses quadris sem a necessidade de capsuloplastia. CONCLUSÃO: Os autores concluíram que no tratamento da luxação do quadril dos pacientes com paralisia cerebral tetraparéticos espásticos com o planejamento pré-operatório, não é necessária a capsuloplastia para estabilização da articulação coxofemoral.OBJECTIVES: To show the preoperative planning and the results of surgical treatment for paralytic hip dislocation in children with cerebral palsy. The techniques used were proximal femoral varus derotation osteotomy and Dega osteotomy without opening of the joint capsule. METHODS: We performed a retrospective review of

  13. Avaliação do peptídeo natriurético tipo B no diagnóstico de rejeição após transplante cardíaco pediátrico Evaluación del péptido natriurético tipo B en el diagnóstico de rechazo tras transplante cardiaco pediátrico B-type natriuretic peptide assessment in the diagnosis of rejection after pediatric heart transplant

    Directory of Open Access Journals (Sweden)

    Cristina de Sylos

    2009-03-01

    Full Text Available FUNDAMENTO: A rejeição constitui-se em uma das principais causas de mortalidade após o transplante cardíaco pediátrico. O peptídeo natriurético tipo B (BNP tem sido estudado como método no diagnóstico de rejeição aguda, especialmente em pacientes adultos submetidos a transplante cardíaco. OBJETIVO:Correlacionar o nível sérico de BNP à rejeição aguda diagnosticada pela biópsia endomiocárdica em pacientes do grupo de transplante cardíaco pediátrico. MÉTODOS:Foram coletadas 50 amostras de BNP de 33 crianças em pós-operatório de transplante cardíaco e analisados dados de idade, sexo, cor, grupo sangüíneo, painel imunológico, tempo de evolução após o transplante, classe funcional, imunossupressão utilizada e número de rejeições. RESULTADOS:Foram 33 crianças com idade mediana de 10,13 anos, predomínio do sexo feminino (54% e da cor branca (78%. No momento da dosagem de BNP o tempo médio de transplante foi 4,25 anos. A biópsia endomiocárdica diagnosticou nove rejeições em oito pacientes (27%, sendo três com grau 3 A, cinco com grau 2 e um com rejeição humoral. No momento da biópsia, a maioria dos pacientes encontrava-se assintomática. O nível sérico de BNP foi em média 77,18 pg/ml, sendo 144,22 pg/ml no grupo com rejeição e 62,46 pg/ml no grupo sem rejeição, com p = 0,02. CONCLUSÃO: Crianças assintomáticas podem apresentar rejeição aguda no pós-operatório de transplante cardíaco. O nível sérico de BNP apresentou diferença estatisticamente significante no grupo com rejeição, podendo ser método adicional no diagnóstico de rejeição cardíaca.FUNDAMENTO: El rechazo constituye una de las principales causas de mortalidad tras el transplante cardiaco pediátrico. El péptido natriurético tipo B (BNP ha sido estudiado como método en el diagnóstico de rechazo agudo, sobre todo en pacientes adultos sometidos a transplante cardiaco. OBJETIVO:Correlacionar el nivel sérico de BNP al rechazo

  14. ACOS GOSAT/TANSO-FTS Level 2 Full Physics Standard Product V7.3 (ACOS_L2S) at GES DISC

    Data.gov (United States)

    National Aeronautics and Space Administration — Version 7.3 is the current version of the data set. Version 3.5 is no longer available and has been superseded by Version 7.3. This data set is currently provided by...

  15. Doença celíaca: avaliação da obediência à dieta isenta de glúten e do conhecimento da doença pelos pacientes cadastrados na Associação dos Celíacos do Brasil (ACELBRA Celiac disease: evaluation of compliance to a gluten-free diet and knowledge of the disease in celiac patients registered at the Brazilian Celiac Association (BCA

    Directory of Open Access Journals (Sweden)

    Vera Lucia SDEPANIAN

    2001-10-01

    Full Text Available Racional — A obediência à dieta isenta de glúten previne a ocorrência de complicações malignas e não-malignas. Objetivo - Avaliar a obediência à dieta isenta de glúten e o conhecimento teórico acerca da doença celíaca e seu tratamento pelos pacientes cadastrados na Associação dos Celíacos do Brasil (ACELBRA. Métodos - Foi enviado por correio um questionário a respeito da obediência à dieta isenta de glúten e do conhecimento teórico da doença celíaca e seu tratamento a 584 membros cadastrados na ACELBRA. Resultados - Dos 534 (91,4% questionários recebidos, foram analisados 529 (90,6%. Quanto à obediência à dieta, 69,4% dos pacientes responderam que nunca ingerem glúten e 29,5% que não obedecem à dieta. A proporção de pacientes que ingerem glúten freqüentemente ou sem restrição alguma é maior entre aqueles com idade igual ou maior a 21 anos (17,7% do que os com idade menor (9,9%. A freqüência de obediência à dieta foi maior quando o intervalo de tempo em que foi estabelecido o diagnóstico da doença foi inferior a 5 anos. O intestino delgado foi assinalado como o principal órgão afetado na doença celíaca por 82% dos pacientes. Os principais sintomas assinalados foram diarréia (96,6%, emagrecimento (93,4%, barriga inchada (90,4%, anemia (68,1% e vômitos (59,6%. Apenas 59,0% concordaram com a existência de predisposição genética. Segundo 90,4% das respostas, a doença é permanente e 96,2% assinalaram que a dieta deve ser totalmente isenta de glúten; 67,1% responderam que o glúten é uma proteína que está presente, segundo 92,1% dos inquéritos, no trigo, centeio, cevada e aveia. Observou-se maior proporção de obediência à dieta quando há conhecimento da doença e dieta. A biopsia de intestino delgado foi considerada necessária por apenas 67,5% dos pacientes, observando-se maior freqüência de obediência à dieta nos pacientes que realizaram pelo menos uma biopsia de intestino delgado

  16. Importância da troponina-I cardíaca nos portadores de obstrução no tronco da artéria coronária esquerda sem evento cardíaco prévio Importance of cardiac troponin-I in the preoperative period of patients without prior cardiac events but suffering from left coronary branch obstruction

    Directory of Open Access Journals (Sweden)

    Domingo M. Braile

    2004-12-01

    Full Text Available OBJETIVO: Avaliar a importância dos níveis séricos de troponina I-cardíaca no pré-operatório de pacientes portadores de obstrução no tronco da artéria coronária esquerda (OTCE sem evento cardíaco prévio. MÉTODO: Foram analisados os níveis séricos da troponina I-cardíaca de 115 pacientes com doença coronariana obstrutiva, com idade variando entre 32 e 81 anos (média e desvio-padrão de 59,7±10,5 anos. Os pacientes foram divididos em dois grupos: Grupo A - 41 pacientes portadores de OTCE, variando o grau de obstrução entre 20% de perda do diâmetro e subtotal (moda de 60%; Grupo B - 74 pacientes sem OTCE. Todos os pacientes foram submetidos a cineangiocoronariografia de forma eletiva e não apresentavam infarto agudo do miocárdio prévio. O método empregado na dosagem da troponina-I cardíaca foi o da Quimioluminiscência, admitindo-se como valor normal abaixo de 0,1 nanogramas por mililitro (ng/ml. RESULTADOS: Não houve correlação entre o grau de OTCE e os níveis séricos de troponina-Ic (P= 0,4617, porém a média dos níveis séricos da troponina-I nos grupos A e B foi, respectivamente, 0,3841 ng/ml e 0,1711 ng/ml (P=0,0324; teste de Mann-Whithey; OR= 4,44 (IC95% 1,60 _ 12,31. CONCLUSÕES: Os pacientes do grupo A têm 3,44 vezes mais chance de apresentar lesão miocárdica representada por elevação de troponina I-cardíaca que o grupo B, independente do grau da OTCE. A sensibilidade para suspeita clínica de mionecrose foi relativamente baixa (31,7%, porém a especificidade foi elevada (90,5%. Destaca-se, entretanto, a importância clínica da documentação de mionecrose em uma determinada porcentagem de pacientes com lesão de tronco, sem constatação eletrocardiográfica. Assim, os pacientes com OTCE devem ser submetidos com rapidez a procedimento operatório, a fim de evitar extensão da mionecrose.OBJECTIVE: To evaluate the importance of cardiac troponin-I serum levels in the preoperative period of patients

  17. Theoretical analysis of two ACO approaches for the traveling salesman problem

    DEFF Research Database (Denmark)

    Kötzing, Timo; Neumann, Frank; Röglin, Heiko

    2012-01-01

    Bioinspired algorithms, such as evolutionary algorithms and ant colony optimization, are widely used for different combinatorial optimization problems. These algorithms rely heavily on the use of randomness and are hard to understand from a theoretical point of view. This paper contributes...... to the theoretical analysis of ant colony optimization and studies this type of algorithm on one of the most prominent combinatorial optimization problems, namely the traveling salesperson problem (TSP). We present a new construction graph and show that it has a stronger local property than one commonly used...... for constructing solutions of the TSP. The rigorous runtime analysis for two ant colony optimization algorithms, based on these two construction procedures, shows that they lead to good approximation in expected polynomial time on random instances. Furthermore, we point out in which situations our algorithms get...

  18. Project of a photoelectron X-ray microscope on ACO storage ring

    International Nuclear Information System (INIS)

    Polack, F.; Lowenthal, S.

    1983-01-01

    A photoelectron X-ray microscope is described which is based on the principles of contact X-ray imaging and of image converters. An X-ray image is projected by a parallel X-ray beam on a thin transmission photocathode. The emitted electrons are accelerated and imaged at large magnification by an emission microscope. The instrument, which is presently under construction, is designed to provide high resolution. An electron velocity filter has been added to the usual cross-over aperture so as to reduce the spherochromatic aberration, and the cathode lens has been designed to reduce field curvature. Resolution and detection efficiency of Au and CsI cathodes are compared. The interest of the instrument for soft X-ray microscopy is briefly discussed. (orig.)

  19. Non-line-of-sight ultraviolet communication based on DHT ACO-OFDM

    Science.gov (United States)

    Gao, Qian; Chen, Gang

    2012-10-01

    Free space optical (FSO) communication has attracted tremendous research interest in the recent year. Most existing works focus only on the line-of-sight (LOS) transmission by infrared (IR) or visible light lasers/LEDs, while this article suggested a framework of non-line-of-sight (NLOS) FSO, motivated by our recent experimental results on the successful transmission of NLOS ultraviolet (UV) beams for up to kilometers, which is comparable to the typical distance a LOS FSO transmission. The NLOS provides an alternate path when the LOS path is shadowed or is highly attenuated. In order to mitigate the multipath dispersion of the NLOS FSO, a baseband orthogonal frequency division multiplexing (OFDM) modulation scheme was proposed, based on Discrete Hartley Transform (DHT) and asymmetric clipping to guarantee the positive-realness of the transmitted optical intensity. The proposed system could reduce the hardware complexity of transmitter and receiver. Minimum mean square error (MMSE) precoder was applied before the DHT to remove the crosstalk between subcarriers, i.e. the frequency domain orthogonality of OFDM was preserved. Performance of the BPSK modulated communication system was given under lognormal atmospheric turbulence for demonstration of the feasibility of the proposed method.

  20. 164. Extracción endovascular de dispositivos cardíacos infectados

    OpenAIRE

    Gutiérrez Carretero, E.; Hernández Fernández, A.; Borrego Domínguez, J.M.; Alarcón, A.; Eslava, J.; Bibiloni Lage, I.; Ruiz Solano, E.; Romero Rodríguez, N.

    2010-01-01

    La tasa de infección publicada en la literatura para implantes de marcapasos y desfibriladores es del 1-7%, siendo en nuestro hospital de 1,5% para marcapasos y 3% para desfibrilador automático implantable (DAI), con una mortalidad del 10%. En un estudio realizado por la Sociedad Andaluza de Enfermedades Infecciosas sobre seis hospitales andaluces, se han detectado 243 infecciones de MP/DAI entre 1998-2008, de las cuales un 44,5% han sido infecciones locales y en un 55,5% infecciones sistémic...

  1. An Effective Mechanism for Virtual Machine Placement using Aco in IAAS Cloud

    Science.gov (United States)

    Shenbaga Moorthy, Rajalakshmi; Fareentaj, U.; Divya, T. K.

    2017-08-01

    Cloud computing provides an effective way to dynamically provide numerous resources to meet customer demands. A major challenging problem for cloud providers is designing efficient mechanisms for optimal virtual machine Placement (OVMP). Such mechanisms enable the cloud providers to effectively utilize their available resources and obtain higher profits. In order to provide appropriate resources to the clients an optimal virtual machine placement algorithm is proposed. Virtual machine placement is NP-Hard problem. Such NP-Hard problem can be solved using heuristic algorithm. In this paper, Ant Colony Optimization based virtual machine placement is proposed. Our proposed system focuses on minimizing the cost spending in each plan for hosting virtual machines in a multiple cloud provider environment and the response time of each cloud provider is monitored periodically, in such a way to minimize delay in providing the resources to the users. The performance of the proposed algorithm is compared with greedy mechanism. The proposed algorithm is simulated in Eclipse IDE. The results clearly show that the proposed algorithm minimizes the cost, response time and also number of migrations.

  2. Recent developments in metal forming; Desenvolvimento na conformacao mecanica dos acos

    Energy Technology Data Exchange (ETDEWEB)

    Schaeffer, Lirio [Rio Grande do Sul Univ., Porto Alegre, RS (Brazil)

    1990-12-31

    This work presents and discuss several processes concerning metal forming, specially steel forming. In the area of rolling, aspects related with liquid rolling and process simulation was analyzed. In the forging extrusion process, advances in cold and warm metal forming are reviewed. With regard to drawing of steel, a method for the evaluation of the lubrication efficiency through measurements of forces is presented. Finally, general considerations in forming of sintered products are also considered. 12 figs., 7 tabs., 10 refs.

  3. AN ADAPTIVE ACO-DRIVEN SCHEME FOR LEARNING AIM ORIENTED PERSONALIZED E-LEARNING

    Directory of Open Access Journals (Sweden)

    Sushma Hans

    2014-10-01

    Full Text Available The e-learning paradigm is now a well-established vehicle of modern education. It caters to a wide spectrum of students with diverse backgrounds who enroll with their own learning aims. A core challenge under this scenario is to generate personalized learning paths so that each student can achieve her learning aim most effectively. Prior works used static attributes such as prior knowledge level, learning ability, browsing preferences, learning style etc. to generate personalized learning paths. In this paper, we take an entirely new route by taking into account the continuous improvement of a learner in the light of her own learning aim, to redefine her learning path at each level of the course. We introduce the concept of personalized examination system that systematically evaluates the dynamic learning ability of every student according to her pre-set goals. The proposed intelligent e-learning system uses Ant Colony Optimization to iteratively optimize the forward learning paths. Experimental results reveal that the system is able to tap a student’s improved learning ability to choose more difficult paths that contribute highly towards her own aims. We demonstrate that the overall learning success of weaker students doubles as compared to statically generated paths while there is considerable improvement of 50% in the learning success for average students as well. This clearly indicates that our approach gives realistic benefits to initially weak students who gradually evolve as the course progresses.

  4. Fibroma cardíaco mimetizando cardiomiopatia hipertrófica Cardiac fibroma mimicking hypertrophic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Luís Alberto Dallan

    1989-12-01

    Full Text Available É relatado o caso de paciente com queixa de dor precordial, dispnéia e arritmia desde a adolescência, tratada clinicamente por mais de 10 anos. Nesse período, foi submetida a inúmeros exames ângio e ecocardiográficos, com suspeita inicial de endomiocardiofibrose e, posteriormente, de cardiomiopatia hipertrófica de ventrículo esquerdo. Como houve piora progressiva da sintomatologia e ausência de resposta à medicação, foi encaminhada ao nosso Serviço, onde se diagnosticou fibroma de ventrículo esquerdo. Foi submetida, com sucesso, à ressecção cirúrgica do tumor, sendo realizada reconstrução geométrica do ventrículo esquerdo. Apresenta boa evolução, decorridos dois anos, com remissão completa dos sintomas. Destacamos a dificuldade no diagnóstico diferencial desses tumores benignos e de crescimento lento, com as cardiomiopatias hipertróficas do ventrículo esquerdo.A 33 year-old woman was seen, for the first time, ten years ago, for evaluation of a recurrent chest pain, dyspnea and arrhythmia. She was submitted to echocardiographic studies and a cardiac catheterization. The diagnoses was endomyocardial fibrosis at first, and hypertrophic cardiomyopathy after. Despite treatment with propranolol and quinidine, the episodes of dyspnea and tachyarrhythmias became more frequent and severe, and the patient was guided to our Service. Cardiac re-catheterization, echocardiographic and computed tomography studies identified in traumural cardiac fibroma and the patient was referred for surgical treatment. The cardiac fibroma was successfully resected on extracorporeal bypass and with cardioplegic arrest of the heart. Repair of the heart was accomplished with a patch placed to close the left ventricular cavity. The postoperative course was uncomplicated, and she remains assymptomatic two years later. We have emphazied tha this tumor often produces clinically obscure disease, simulating particularly the left ventricle hypertrophic cardiomiopathy.

  5. Observation of the substructure in the electron bunch on the ACO storage ring

    International Nuclear Information System (INIS)

    Bergher, M.; Velghe, M.; Mialocq, J.P.

    1984-09-01

    In the future, one interesting point of the SRFEL at Orsay will be the microtemporal analysis of the laser beam correlated with that of the electron bunch. In a first time, we have only analysed the temporal structure of the electron bunch with an Electrophotonic streak camera. The first results seem to indicate that the bunch is not an homogeneous bunch but presents a substructure. We discuss with details this data

  6. Corpo estranho intracardíaco: complicação da ventriculoauriculostomia

    Directory of Open Access Journals (Sweden)

    Gilberto Machado de Almeida

    1965-09-01

    Full Text Available A ventriculoauriculostomia, apesar das complicações que pode determinar, continua a ser a técnica cirúrgica mais freqüentemente usada para o tratamento da hidrocefalia. Na literatura, existe referência a apenas três casos em que a extremidade inferior do sistema de derivação deslocou-se para o ventrículo direito. Nestes doentes o corpo estranho foi retirado ci-rùrgicamente. Apresentamos um caso operado segundo a técnica de Spitz-Holter, com embolização cardíaca pelo cateter jugular. O doente permanece há 22 meses com o corpo estranho no coração direito, porque a família não permitiu que fôsse realizada a cardiotomia.

  7. Biomarcadores cardíacos: presente y futuro Cardiac biomarkers: present and future

    Directory of Open Access Journals (Sweden)

    Eduardo Fernández

    2012-12-01

    Full Text Available En la actualidad, las enfermedades cardiovasculares se consideran la pandemia más significativa del siglo XXI. Dentro de ellas, la enfermedad coronaria es la más prevalente y la que más morbi-mortalidad genera; en el caso particular de Colombia, es la principal causa de muerte en individuos mayores de 45 años. La característica silenciosa de esta enfermedad ha impulsado la investigación de moléculas que permitan su diagnóstico precoz y sirvan como predictores pronóstico tanto en la fase crónica como en la aguda. Fruto de estas investigaciones, en los últimos treinta años se ha producido un avance importante en el desarrollo de biomarcadores cardiacos. Entre ellos están los recién desarrollados ensayos de troponinas ultrasensibles para diagnóstico temprano, la medición de la albúmina modificada por isquemia que cuenta con alto valor predictivo negativo para la detección de isquemia miocárdica, el ligando de CD40 soluble para la clasificación e individualización del tratamiento, la utilidad de la proteína C reactiva como marcador de riesgo de enfermedad coronaria y las diversas técnicas de alto rendimiento como la proteómica, que permite la detección de múltiples biomarcadores potenciales. A pesar de ello, aún no se dispone de evidencia suficiente para sustituir los marcadores que recomiendan las asociaciones científicas por los nuevos marcadores que se han ido desarrollando, y continúa el debate sobre qué combinación utilizar para alcanzar mayor rendimiento diagnóstico, pronostico y terapéutico. A continuación se revisan los avances actuales en biomarcadores cardiacos y su potencial integración a la práctica clínica habitual.En la actualidad, las enfermedades cardiovasculares se consideran la pandemia más significativa del siglo XXI. Dentro de ellas, la enfermedad coronaria es la más prevalente y la que más morbi-mortalidad genera; en el caso particular de Colombia, es la principal causa de muerte en individuos mayores de 45 años. La característica silenciosa de esta enfermedad ha impulsado la investigación de moléculas que permitan su diagnóstico precoz y sirvan como predictores pronóstico tanto en la fase crónica como en la aguda. Fruto de estas investigaciones, en los últimos treinta años se ha producido un avance importante en el desarrollo de biomarcadores cardiacos. Entre ellos están los recién desarrollados ensayos de troponinas ultrasensibles para diagnóstico temprano, la medición de la albúmina modificada por isquemia que cuenta con alto valor predictivo negativo para la detección de isquemia miocárdica, el ligando de CD40 soluble para la clasificación e individualización del tratamiento, la utilidad de la proteína C reactiva como marcador de riesgo de enfermedad coronaria y las diversas técnicas de alto rendimiento como la proteómica, que permite la detección de múltiples biomarcadores potenciales. A pesar de ello, aún no se dispone de evidencia suficiente para sustituir los marcadores que recomiendan las asociaciones científicas por los nuevos marcadores que se han ido desarrollando, y continúa el debate sobre qué combinación utilizar para alcanzar mayor rendimiento diagnóstico, pronostico y terapéutico. A continuación se revisan los avances actuales en biomarcadores cardiacos y su potencial integración a la práctica clínica habitual.

  8. LAS RAZONES DEL SIMPOSIARCA: UNA APROXIMACIÓN A LOS MISTERIOS DIONISÍACOS

    Directory of Open Access Journals (Sweden)

    Yidy P ez Casadiegos

    2008-01-01

    Full Text Available En este trabajo, el simposiarca pone a consideración del auditorio una aproximación a las sombras creadas por los efectos de luz, de las mímicas y representaciones de lo sagrado, comenzando por el propio nombre del dios invitado, y una narrativa del mythos, que habla de la genealogía, diáspora, epidemias y epifanías y el calendario festivo de Dionisos; segundo, una descripción, análisis de las fiestas y misterios dionisiacos y tercero, una etiología de las necesidades socio-políticas vinculadas al culto y de los posibles enteógenos responsables de las experiencias místico-milagrosas de las bacantes extáticas.

  9. A Novel Framework for Medical Web Information Foraging Using Hybrid ACO and Tabu Search.

    Science.gov (United States)

    Drias, Yassine; Kechid, Samir; Pasi, Gabriella

    2016-01-01

    We present in this paper a novel approach based on multi-agent technology for Web information foraging. We proposed for this purpose an architecture in which we distinguish two important phases. The first one is a learning process for localizing the most relevant pages that might interest the user. This is performed on a fixed instance of the Web. The second takes into account the openness and dynamicity of the Web. It consists on an incremental learning starting from the result of the first phase and reshaping the outcomes taking into account the changes that undergoes the Web. The system was implemented using a colony of artificial ants hybridized with tabu search in order to achieve more effectiveness and efficiency. To validate our proposal, experiments were conducted on MedlinePlus, a real website dedicated for research in the domain of Health in contrast to other previous works where experiments were performed on web logs datasets. The main results are promising either for those related to strong Web regularities and for the response time, which is very short and hence complies the real time constraint.

  10. A performance evaluation of ACO and SA TSP in a supply chain network

    Science.gov (United States)

    Rao, T. Srinivas

    2017-07-01

    Supply Chain management and E commerce business solutions are one of the prominent areas of active research. In our paper we have modelled a supply chain model which aggregates all the manufacturers requirement and the products are supplied to all the manufacturer through a common vehicle routing algorithm. An appropriate tsp has been constructed for all the manufacturers which determines the shortest route thru which the aggregated material can be supplied in the shortest possible time. In this paper we have solved the shortest route through constructing a Simulated annealing algorithm and Ant colony algorithm and their performance is evaluated.

  11. Multi-criteria ACO-based Algorithm for Ship’s Trajectory Planning

    OpenAIRE

    Agnieszka Lazarowska

    2017-01-01

    The paper presents a new approach for solving a path planning problem for ships in the environment with static and dynamic obstacles. The algorithm utilizes a heuristic method, classified to the group of Swarm Intelligence approaches, called the Ant Colony Optimization. The method is inspired by a collective behaviour of ant colonies. A group of agents - artificial ants searches through the solution space in order to find a safe, optimal trajectory for a ship. The problem is considered as a ...

  12. Asfixia perinatal e problemas cardíacos Perinatal asphyxia and heart problems

    Directory of Open Access Journals (Sweden)

    Gesmar Volga H. Herdy

    1998-08-01

    Full Text Available OBJETIVO: Avaliar a gravidade das complicações cardíacas na asfixia neonatal, sua evolução e correlacioná-las com o grau e duração do processo hipóxico. MÉTODOS: Foram estudados 90 bebês nos últimos 7 anos com grau de Apgar PURPOSE: To evaluate the severity of cardiac complications of neonatal asphyxia in relation to the length and degree of hipoxia. METHODS: Ninety babies with an Apgar score <6 were examined in the intensive care unit at our institution during seven years. Arterial blood for measuring pH, glucose, LDH and MB fraction of CK, together with serial electrocardiogram (ECG, echocardiogram and chest X rays was obtained. The fatal cases were studied with macro and microscopic examination. RESULTS: From a total of 90 cases, 73 were premature: 30 (41% appropriate for gestation age (AGA and 43 (59% small for gestation age (SGA. Twenty one (23% cases had arterial pH <7.2. The most common clinical conditions were: pneumonia 28 (31%, anemia 24 (26% and jaundice 12 (13%. The main cardiological findings were: systolic murmur in 46 (50%, signs of heart hypertrophy in 18 (20% and heart failure in 8 (9%. On ECG the main findings were ST and T abnormalities. The echocardiogram showed a patent ductus arteriosus (PDA in 20 (22%, tricuspid regurgitation in 6 (7%, pulmonary hypertension in 6 (7%, dyskinesia and ventricular dilatation in 4 (5%. Necropsy was performed in 23 cases and macro and microscopy obtained in 14; the most frequent findings were: myocite necrosis in 8 (54%, congestion, vacuolization and loss of striae in 4 (29%. CONCLUSION: In the majority of cases, patients had a benign course, even those presenting with severe acidemia. Many abnormal EKGs and echocardiograms became normal after a few weeks. Among those who had a fatal outcome, the severity of histological lesions was observed in babies who had suffered asphyxia for more prolonged periods.

  13. Joint Venture Health Plans May Give ACOs a Run for Their Money.

    Science.gov (United States)

    Reinke, Thomas

    2016-12-01

    Joint venture plans are starting to demonstrate their ability to implement clinical management and financial management reforms. A JV health plan replaces the offloading of financial risk by health plans to ill-equipped providers with an executive-level cost management committee stated jointly by the hospital and payer.

  14. Sistema de monitoramento remoto online de sinais cardíacos via rede GPRS

    OpenAIRE

    Vargas, Ricardo Emanuel Vaz

    2008-01-01

    Doenças cardiovasculares são consideradas atualmente a principal causa de morte e de lesões físicas limitantes e definitivas, que ocorrem em muitas das vezes em idade precoce. O exame de ECG é considerado, pelos especialistas, o padrão ouro para diagnóstico desse tipo de doença. Isso porque tal exame é barato, não-invasivo e fundamental para diagnóstico de diversas arritmias cardíacas. Portanto, o monitoramento de ECG pode significar a diferença entre o falecimento e a vida de muitos pa...

  15. ACOS GOSAT/TANSO-FTS Level 2 Full Physics Standard Product V2.9

    Data.gov (United States)

    National Aeronautics and Space Administration — This data set contains Carbon Dioxide (CO2) column averaged dry air mole fraction for all soundings for which retrieval was attempted. These are the highest-level...

  16. Dependência tabágica, assertividade e alexitimia em doentes cardíacos

    Directory of Open Access Journals (Sweden)

    Vânia Rocha

    2010-08-01

    Full Text Available O tabagismo é uma das principais causas evitáveis de morte, aumentando acentuadamente o risco de infarto do miocárdio. Este último está associado a certas variáveis psicossociais relacionadas com o tabagismo, nomeadamente a alexitimia e a falta de assertividade. O objetivo do presente artigo foi caracterizar os dois tipos de dependência tabágica (fisiológica e comportamental, a assertividade e a alexitimia, e avaliar a relação das variáveis entre si, em 30 doentes homens internados com infarto. Foram aplicados o Teste de Fagerström, o Questionário de Glover-Nilsson, a Escala de "Rathus" e a TAS-20. Os resultados indicam que a alexitimia encontra-se relacionada com a dependência comportamental e com a assertividade, sugerindo que os sujeitos menos assertivos e com dificuldade em gerir afetos negativos e situações de estresse, podem recorrer ao tabagismo como mecanismo de enfrentamento. Nas intervenções voltadas à interrupção do hábito de fumar em doentes infartados deve-se enfatizar as competências sociais e de regulação emocional.

  17. Colorado: 2002 Economic Census. Educational Services, Geographic Area Series, EC02-61A-CO.

    Science.gov (United States)

    US Department of Commerce, 2005

    2005-01-01

    The economic census is the major source of facts about the structure and functioning of the nation's economy. It provides essential information for government, business, industry, and the general public. This document contains statistical census data from 2002 for the state of Colorado. Statistical information is presented in table form, on the…

  18. Update Strength in EDAs and ACO: How to Avoid Genetic Drift

    DEFF Research Database (Denmark)

    Sudholt, Dirk; Witt, Carsten

    2016-01-01

    , showing that the update strength should be limited to 1/K, ρ = O(1/(√n log n)). In fact, choosing 1/K, ρ ∼ 1/(√n log n) both algorithms efficiently optimize OneMax in expected time O (n log n). Our analyses provide new insights into the stochastic behavior of probabilistic model-building GAs and propose...

  19. Efeito da administração oral de arginina sobre a pressão arterial e parâmetros cardíacos em ratos submetidos ao bloqueio crônico da síntese de óxido nítrico Efecto de la administración oral de arginina sobre la presión arterial y los parámetros cardiacos en ratones sometidos al bloqueo crónico de síntesis de óxido nítrico Effect of oral arginine administration over blood pressure and cardiac parameters in rats submitted to chronic inhibition of nitric oxide synthesis

    Directory of Open Access Journals (Sweden)

    Luciano Ramos

    2006-08-01

    Full Text Available Já está claramente estabelecido, que a inibição crônica da síntese de óxido nítrico resulta em hipertensão sustentada, remodelamento cardíaco e fibrose. Além disso, resultados de nosso grupo demonstraram que a suplementação oral com L-arginina foi capaz de aumentar a resistência da musculatura esquelética a fadiga muscular localizada em humanos. O tratamento experimental de ratos com L-NAME é um dos modelos mais comumente utilizados para se induzir hipertensão. A resposta compensatória esperada contra o aumento da resistência vascular sistêmica seria a hipertrofia ventricular esquerda; entretanto, isso tem sido um ponto bastante controverso na literatura. O objetivo do presente estudo foi verificar os efeitos da inibição do óxido nítrico pela administração oral de L-NAME sobre o tecido cardíaco de ratos e a possível reversão pela L-arginina. Foram utilizados 30 ratos Wistar machos (250-350g, mantidos em condições de temperatura, luz e umidade controlada, e com água e comida ad libitum. Ao final de quatro semanas, os animais foram sacrificados por inalação de CO2 e os corações foram removidos e imediatamente dissecados, sendo separados átrios e ventrículos, obtendo-se os pesos total e parcial. Os valores foram corrigidos em função do peso corporal obtido na última semana de tratamento e expressos como índice cardíaco. O L-NAME foi capaz de induzir hipertensão e aumento significativo do duplo produto, porém sem resultados significativos sobre os pesos cardíacos, não sendo observada hipertrofia do órgão. Os aumentos de pressão arterial e duplo produto foram revertidos pela administração concomitante de arginina, de maneira dependente da dose. Dados preliminares não publicados demonstraram a reversão da fibrose cardíaca induzida pelo L-NAME, nos animais que receberam tratamento com arginina. Podemos concluir que a arginina pode vir a ser uma ferramenta valiosa na prevenção da hipertensão e do

  20. Deleção 22q11.2 em pacientes com defeito cardíaco conotruncal e fenótipo da síndrome da deleção 22q11.2 Deleción 22q11.2 en pacientes con defecto cardiaco conotruncal y fenotipo del síndrome de la deleción 22q11.2 22q11.2 deletion in patients with conotruncal heart defect and del22q syndrome phenotype

    Directory of Open Access Journals (Sweden)

    Sintia Iole Nogueira Belangero

    2009-04-01

    Full Text Available FUNDAMENTO: A síndrome da deleção 22q11.2 é a mais freqüente síndrome de microdeleção humana. O fenótipo é altamente variável e caracterizado por defeito cardíaco conotruncal, dismorfias faciais, insuficiência velofaríngea, dificuldade de aprendizagem e retardo mental. OBJETIVO: O objetivo deste trabalho foi investigar a freqüência da deleção 22q11.2 em uma amostra brasileira de indivíduos portadores de cardiopatia conontrucal isolada e do fenótipo da síndrome da deleção 22q11.2. MÉTODOS: Vinte e nove pacientes foram estudados por meio de citogenética clássica, por hibridação in situ fluorescente (FISH e por técnicas moleculares. RESULTADOS: A análise citogenética por meio de bandamento G revelou cariótipo normal em todos os pacientes, com exceção de um que apresentou cariótipo 47,XX,+idic(22(q11.2. Com o uso de técnicas moleculares, a deleção foi observada em 25% dos pacientes, todos portadores do fenótipo da síndrome da deleção 22q11.2. Em nenhum dos casos, a deleção foi herdada dos pais. A freqüência da deleção 22q11.2 foi maior no grupo de pacientes portadores do espectro clínico da síndrome da deleção 22q11.2 do que no grupo de pacientes com cardiopatia conotruncal isolada. CONCLUSÃO: A investigação da presença da deleção e sua correlação com os dados clínicos dos pacientes podem auxiliar os pacientes e suas famílias a terem um melhor aconselhamento genético e um seguimento clínico mais adequado.FUNDAMENTO: El síndrome de la deleción 22q11.2 es el más frecuente síndrome de microdeleción humana. El fenotipo, altamente variable, se caracteriza por defecto cardiaco conotruncal, dismorfias faciales, insuficiencia velofaríngea, dificultad de aprendizaje y retardo mental. OBJETIVO: El objetivo de este trabajo fue investigar la frecuencia tanto de la deleción 22q11.2 en una muestra brasileña de individuos portadores de cardiopatía conotrucal aislada, como del fenotipo del s

  1. Vale do Aco pipeline: pipeline natural gas implementation in ArcelorMittal Monlevade steel work; Gasoduto Vale do Aco: implantacao do gas natural via gasoduto na ArcelorMittal Monlevade

    Energy Technology Data Exchange (ETDEWEB)

    Goncalves, Eduardo Sergio da Silva; Arantes, Luiz Flavio Mourao; Ribeiro, Vicente Aleixo Pinheiro [ArcelorMittal Monlevade, Joao Monlevade, MG (Brazil)

    2011-12-21

    Since September 2010, ArcelorMittal Monlevade has gained flexibility and an important opportunity to reduce the cost of its energy mix due to the arrival of the Natural Gas (NG) via Steel Valley Pipeline. The proposal of the project included the substitution of the Liquefied Petroleum Gas (LPG), Fuel Oil and Compressed Natural Gas for natural gas via pipeline. To support the investment decision, in addition to domestic economic and technical aspects, the macro economic environment concerning the NG was also taken into account. This paper shows the analysis for adjustment of internal equipment, the structure of the contract, the conceptual project of the gas distribution built inside the main events, the gains achieved, the alternatives for the acquisition of NG and operational flexibility of ArcelorMittal Monlevade in case of interruption of supply of natural gas. (author)

  2. Equipment stainless steel entire versus steels bimetallics clad or overlay; Utilizacao de equipamentos de processo construidos em aco inoxidavel integral versus acos bimetalicos cladeado ou 'overlay'

    Energy Technology Data Exchange (ETDEWEB)

    Batista, Itamar da Silva; Lima, Jadival Carneiro de; Leal, Murilo Fonseca; Cardoso, Amauri dos Santos; Jorjan, Roberto [PETROBRAS S.A., Sao Francisco do Conde, BA (Brazil). Refinaria Landulfo Alves Mataripen (RLAM)

    2008-07-01

    This study does not recommend the use of a pressure vessel made of integral stainless steel, due to the failure mechanisms under stress corrosion assisted by chlorides or polythionic acid. Are presented case studies of literature and analysis of reports of proceedings of RLAM reactors, showing that the materials produced by bimetallic clad overlay or are more appropriate, in terms of integrity, for use in equipment that the internal environment requires austenitic stainless steel specification.

  3. Influencia del perfil clínico del donante, receptor y tiempo de isquemia en la supervivencia del trasplante cardíaco. Subanálisis del Registro Español de Trasplante Cardíaco

    Directory of Open Access Journals (Sweden)

    María J. Paniagua

    2015-11-01

    Conclusiones: Muchas características del donante y el receptor, así como el tiempo de isquemia, influyen en la supervivencia del TC. El acúmulo de variables consideradas no óptimas repercutirá negativamente y de forma significativa en la supervivencia del TC.

  4. Registro Español de Trasplante Cardíaco. XIV Informe Oficial (1984–2003

    Directory of Open Access Journals (Sweden)

    Luis Almenar

    2005-01-01

    El análisis comparativo de la supervivencia muestra que los resultados a largo plazo son ligeramente superiores a los publicados en la literatura médica mundial, con una progresiva tendencia a mejorar la supervivencia en los últimos años.

  5. Asistencia ventricular y trasplante cardíaco en las cardiopatías congénitas

    Directory of Open Access Journals (Sweden)

    Javier Cabo

    2011-07-01

    La estrategia del momento de implantación de la asistencia circulatoria (ECMO y AVM, la anticoagulación y su monitorización siguen siendo uno de los factores más problemáticos, especialmente en niños pequeños.

  6. Mechanical And Microstructural Evaluation Of A Wear Resistant Steel; Avaliacao mecanica e microestrutural de um aco resistente ao desgaste

    Energy Technology Data Exchange (ETDEWEB)

    Santos, F.L.F. dos; Vieira, A.G.; Correa, E.C.S.; Pinheiro, I.P., E-mail: falletti@hotmail.co [Centro Federal de Educacao Tecnologica de Minas Gerais (CEFET/MG), Belo Horizonte, MG (Brazil). Dept. de Engenharia de Materiais

    2010-07-01

    In the present work, the analysis of the mechanical properties and the microstructural features of a high strength low alloy steel, containing chromium, molybdenum and boron, subjected to different heat treatments, was conducted. After austenitizing at 910 deg C for 10 minutes, three operations were carried out: oil quenching, oil quenching followed by tempering at 200 deg C for 120 minutes and austempering at 400 deg C for 5 minutes followed by water cooling. The analysis was performed through tensile and hardness tests, optical microscopy and X-ray diffraction. The bainitic structure led to high strength and toughness, both essential mechanical properties for wear resistant steels. The occurrence of allotriomorphic ferrite and retained austenite in the samples also increased the wear resistance. This phenomenon is related to the fact that both structures are able to be deformed and, in the case of the retained austenite, the transformation induced plasticity TRIP effect may take place as the material is used. (author)

  7. Evaluation of welding by MIG in martensitic stainless steel; Avaliacao da soldagem pelo processo MIG em aco inoxidavel martensitico

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, M.A. [Universidade Estadual de Campinas (UNICAMP), SP (Brazil); Mariano, N.A.; Marinho, D.H.C. Marinho, E-mail: neideaparecidamariano@gmail.co [Universidade Federal de Alfenas (UNIFAL), Pocos de Caldas, MG (Brazil)

    2010-07-01

    This work evaluated structure's characterization and mechanical properties after the welding process of the stainless steel CA6NM. The employed welding process was the metal active gas with tubular wire. The control of the thermal cycle in the welding process has fundamental importance regarding the properties of the welded joint, particularly in the thermally affected zone. The mechanical properties were appraised through impact resistance tests and the hardness and microstructure through metallographic characterization and Ray-X diffraction. The parameters and the process of welding used promoted the hardness and toughness appropriate to the applications of the steel. Welding energy's control becomes an essential factor that can affect the temperature of carbide precipitation and the nucleation of the retained austenite in the in the region of the in the thermally affected zone. (author)

  8. Del conocimiento y enseñanza de los indios, según José de Aco

    Directory of Open Access Journals (Sweden)

    Alejandro SANVISENS MARFULL

    2011-07-01

    Full Text Available RESUMEN: Tenemos algún conocimiento del sistema de crianza que algunos pueblos indios americanos tenían y transmitían de generación en generación. Según esto, los modos de enseñanza de los indios americanos, especialmente por lo que se refiere a la juventud, se ponen de manifiesto, si no en toda su extensión, por lo menos en grado suficiente para que podamos pensar y hablar de una pedagogía subyacente en ciertos pueblos de la América precolombina. El jesuita José de Acosta (1539-16001, que vivió en Centroamérica y en América del Sur y conoció directamente los usos y costumbres de los indios americanos, en su valiosa Historia natural y moral de las Indias

  9. Corrosion behavior of stainless steel in bio diesel production; Comportamento quanto a corrosao de acos inoxidaveis na producao do biodiesel

    Energy Technology Data Exchange (ETDEWEB)

    Miranda, E.F. de [ArcelorMittal Sao Paulo Servicos, SP (Brazil); Moreira, M.C.; Lebrao, S.M.G. [Centro Universitario do Instituto Maua de Tecnologia, Sao Paulo, SP (Brazil)], e-mail: susana.lebrao@maua.br

    2010-07-01

    Biodiesel has become more attractive due to the benefits to the environment, mainly because it is a renewable resource. However, the main barrier to biodiesel is it cost. One factor which is charged to marketing is the use of stainless steel throughout the production line, the most used is AISI 304. To evaluate more economical stainless steels, weight loss and stress corrosion tests were performed on samples of AISI 304 and 439 in methanol PS X30% sodium methylate solution, crude soybean oil, glycerol and biodiesel for about two hundred and fifty days. The mass loss was negligible, and there was complete absence of pitting and stress corrosion cracking in all media studied, showing that both alloys are suitable for the manufacture of such equipment. (author)

  10. Circumferential welding of API X80 steel pipes; Soldagem circunferencial em tubos de aco da classe API X80

    Energy Technology Data Exchange (ETDEWEB)

    Castello Branco, J.F.; Bott, Ivani de S. [Pontificia Univ. Catolica do Rio de Janeiro, RJ (Brazil). Dept. de Ciencia dos Materiais e Metalurgia]. E-mails: joaofcb@uol.com.br; bott@dcmm.puc-rio.br; Fedele, R.A. [Boehler Thyssen Welding, Sao Paulo, SP (Brazil)]. E-mail: engenharia@btwbr.com.br; Souza, Luis Felipe G. de [Centro Federal de Educacao Tecnologica Celso Suckow da Fonseca (CEFET-RJ), Rio de Janeiro, RJ (Brazil). Dept. de Engenharia Industrial Mecanica]. E-mail: lfelipe@cefet-rj.br

    2003-07-01

    The present work is a part of an extensive program for the development of API 5L Gr.X80 grade steel , produced by the well-known UOE production process, for pipeline fabrication. The current stage of this program involves the characterization and performance evaluation/qualification of girth welds produced by Shield Metal Arc Weld (SMAW) under simulated field conditions, with tubes fixed in the horizontal position. Three types of electrodes were utilized for the basic tasks; the root pass, the hot pass and fill and cap passes. The root pass was carried out with an E-6010 electrode to avoid incomplete joint penetration. The hot pass, applied over the root pass, was performed with an E-9010-G electrode. The fill and cap passes were executed with E-10018-G electrodes. The welded joints produced were evaluated according to the API 1104 specification, which requires: side bend, nick- break and tensile tests. Additionally, non-destructive tests, Charpy-V impact tests and metallographic characterization were undertaken. It was verified that this welding procedure, based on three types of electrodes, could produce welded joints in accordance to the API 1104 specification. These results ensure the applicability of the API 5L Gr. X80 steel developed in this research project for use in pipeline construction. (author)

  11. Environmental impacts of water resources exploitation works: prevention acts; Impactos ambientais de obras de exploracao de recursos hidricos: acoes preventivas

    Energy Technology Data Exchange (ETDEWEB)

    Mota, Suetonio [Ceara Univ., Fortaleza, CE (Brazil)

    1989-11-01

    This paper discusses the environmental impacts that becomes from works of water resources exploitation, like dam construction, river rectification and irrigation projects, and its impacts on the biotic, physical and social environment, and shows the actions will be made to prevent or minimize this impacts 6 refs., 3 tabs.

  12. Medium carbon vanadium steels for closed die forging; Acos de medio carbono microligados ao vanadio para forjaria em matriz fechada

    Energy Technology Data Exchange (ETDEWEB)

    Jeszensky, Gabor; Plaut, Ronald Lesley

    1994-12-31

    This work analyses the medium carbon micro alloyed vanadium potential for closed die forged production. The steels reach the mechanical resistance requests during cooling after forging, eliminating the subsequent thermal treatment. Those steels also present good fatigue resistance and machinability. The industrial scale experiments are also reported 16 refs., 21 figs.

  13. Characterization of alonized steel used in the oil industry; Caracterizacao de acos alonizados utilizados na industria do petroleo

    Energy Technology Data Exchange (ETDEWEB)

    Cortes Paredes, Ramon; D' Oliveira, Ana Sofia C.M.; Capra, Andre [Parana Univ., Curitiba, PR (Brazil). Dept. de Engenharia Mecanica]. E-mails: ramon@demec.ufpr.br; sofmat@demec.ufpr.br; capra@demec.ufpr.br

    2001-07-01

    The problems and the damages caused by the corrosion in the production and refining of the oil are enormous. In the process of refining it is present among other substances, naphtenic gas where the character of the corrosive attack is significantly aggressive. The deterioration provoked by hydrogen is the most harmful deterioration in an oil refinery. There are several publications that certify eht excellent protection conferred to the steel in industrial atmosphere given by aluminum coating. This covering represents a pure ideal compromise between the passive protection and the active protection. Moreover, the presence of a metal to metal layer (Fe/Al) in the zone between aluminum and steel, obtained by additional thermal heat treatment, represents an additional protective barrier, in particular against the diffusion of hydrogen in the steel in environments that contains naphtenic gas ou sulfide acid. In industrial scale, tubes are manufactured through the process of alonizing and it is already used in the Presidente Getulio Vargas Refinery - REPAR, PR, Brazil. The process require a heat treatment to allow the diffusion of aluminum in the tube in order to form the Fe/Al intermetallic, which presents recognized resistance to the sulfurous corrosive environment in the oil refining. This was the motivation for the characterization of these alonized steel in order to determine what types of intermetallic are formed. Test samples have been prepared and optic and electronic microscopy examinations was varied out. The studied alonized surface showed enhanced hardness and additionally, it was observed that the aluminum diffusion permits the formation of a different types of Fe/Al. It was also found the presence of aluminum without the formation of intermetallic. (author)

  14. Natural gas use in treatment of steel surfaces; Utilizacao de gas natural em tratamento de superficies de aco

    Energy Technology Data Exchange (ETDEWEB)

    Ferraz, Andre Dias; Machado, Antonio Rogerio; Rocha, Ivan; Azevedo, Jorge; Oshiro, Hugo K.; Konishi, Ricardo; Lehmkuhl, Willian [Companhia de Gas de Santa Catarina (SCGAS), Florianopolis, SC (Brazil); Piazza, Walter [PETROBRAS, Rio de Janeiro, RJ (Brazil)

    2011-12-21

    The surface treatments of metals, such as carburizing, rely on processing under high temperature in carbon rich atmospheres. The atmosphere is industrially generated using the partial oxidation of a carbon rich fuel, such as propane, butane or methanol. This article reports a study of the production of a carburizing atmosphere for surface treatment of steel from the partial oxidation of natural gas in a catalytic reactor. The reactor studied was a production size reactor with 300 mm of diameter and 1500 mm of length, packed with alumina supported nickel catalyst. The quality of the carburizing gas was evaluated from its carbon potential of the carburizing gas that was calculated from the concentrations of carbon monoxide (CO), carbon dioxide (CO{sub 2}), oxygen (O{sub 2}) and methane (CH{sub 4}) measured at the reactor's exit. The results indicate that CO concentration is very close to equilibrium, while CO{sub 2} is higher and CH{sub 4} is lower. Examining the reactor, the conclusion was that there was an axial temperature gradient, resulting in lower residence time under the required processing temperature. This resulted in smaller decomposition of CH{sub 4} and smaller production of CO{sub 2}. An equilibrium calculation of carbon potential, expressed as weight percent of carbon in iron, was developed to predict the possible optimizations of mixture composition and reactor temperature for a given required carbon potential. Conclusion: it is possible to generate a carburizing atmosphere under well controlled and repeatable conditions for the carbon potentials required for surface carburizing of steels in industrial processing using natural gas and air mixtures. (author)

  15. Development and characterization of high collapse boron alloys heat treated pipes for oil wells; Tubos de aco TiB para aplicacao em revestimento de pocos de petroleo

    Energy Technology Data Exchange (ETDEWEB)

    Moreira, Fabio A.; Silva, Ronaldo; Chad, Luis [Tenaris Confab, Pindamonhangaba SP (Brazil); Fritz, Marcelo C. [Tenaris Confab, Pindamonhangaba SP (Brazil). Dept. de Engenharia do Produto

    2008-07-01

    The utilization of OCTG (Oil Country Tubular Goods) pipes will increase with the discovery of new oil wells in ultra deep waters. This study aims to evaluate the mechanical and microstructural performance of welded and heat treated pipes through quenching and tempering using a steel project based in titanium/boron for casing pipes. The objective of this development is to present a set of techniques used during the manufacturing of heated treated ERW pipes boron allowing, discussing mechanical and metallurgical aspects of the steel project, coil conformation, heat treatment and test procedures. The results are within the limits set by the API 5CT standard. It was found that the pipes obtained good geometry and uniformity of mechanical properties, showing that this product can be applied safely and reliability as wells' casing. (author)

  16. Analysis of mechanical damage by drawing on spheroid ABNT 1080 steel wire; Analise do dano mecanico na trefilacao de arame de aco ABNT 1080 esferoidizado

    Energy Technology Data Exchange (ETDEWEB)

    Almeida Ferreira, Sergio A. de; Cetlin, Paulo R.; Coutinho, Carlos A.B. [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Dept. de Engenheria Metalurgica

    1990-12-31

    Patented Brazilian 1080 carbon steel wires were isothermal annealed at 720 deg C for different times to produce spheroid carbides of varying average diameters. The heat treated wires were then drawn to rupture. Longitudinal sections of the drawn wires were prepared after each drawing pass for analysis of the mechanical damage caused by the process. It was found that the damage observed in the drawn wires showed a similar development to the damage caused by uniaxial tensile stresses in the same material. 8 figs., 1 tab., 4 refs.

  17. Modification and characterization of the AISI 410 martensitic stainless steels surface; Modificacao e caracterizacao da superficie do aco inoxidavel martensitico AISI 410

    Energy Technology Data Exchange (ETDEWEB)

    Bincoleto, A.V.L. [Universidade Federal de Sao Carlos (PPG-CEM/UFSCar), SP (Brazil). Programa de Pos-Graduacao em Ciencia e Engenharia de Materiais; Nascente, P.A.P. [Universidade Federal de Sao Carlos (DEMa/UFSCar), SP (Brazil). Dept. de Engenharia de Materiais

    2010-07-01

    Steam turbines are used in the generation of more than half the electric energy produced in the world nowadays. It is important the study which aims to improve the efficiency by means of the optimization of leaks and of the aerodynamic profiles, as well as to maintain the integrity of the components. The martensitic stainless steels are widely employed due to the combination of their good mechanical properties with higher corrosion resistance. However, their lower wear resistance and their poor tribological behavior limit their use, since they decrease the component life time. In order to evaluate the improvement in the performance of the AISI 410 stainless steel, several process of surface modification were employed. Five samples were produced: the first one was not treated, the second one received liquid nitriding, the third, gas nitriding, the forth, thermal aspersion of tungsten carbide, and the fifth, boronizing. The samples were characterized by optical microscopy, surface microhardness, and X-ray diffractometry. (author)

  18. Study of residual stresses generated in machining of AISI 4340 steel; Estudo das tensoes residuais geradas na usinagem de aco AISI 4340

    Energy Technology Data Exchange (ETDEWEB)

    Reis, W.P. dos; Fonseca, M.P. Cindra; Serrao, L.F.; Chuvas, T.C.; Oliveira, L.C., E-mail: mcindra@vm.uff.b [Universidade Federal Fluminense (PGMEC/UFF), Niteroi, RJ (Brazil). Dept. de Engenharia Mecanica

    2010-07-01

    Among the mechanical construction steels, AISI 4340 has good harden ability, while combining high strength with toughness and good fatigue strength, making it excellent for application in the metalworking industry, where it can work at different levels and types of requests. Residual stresses are generated in almost all processes of mechanical manufacturing. In this study, the residual stresses generated in different machining processes and heat treatment hardening of AISI 4340 were analyzed by X-ray diffraction, by the sen{sup 2} {psi} method, using Cr{kappa}{beta} radiation and compared. All samples, except for turned and cut by EDM, presented compressive residual stresses in the surface with various magnitudes. (author)

  19. Ventriculectomia parcial mediante oclusão do influxo venoso cardíaco em cães Partial ventriculectomy through cardiac inflow occlusion in dogs

    Directory of Open Access Journals (Sweden)

    Liége Georgia Andrioli Martins

    2009-09-01

    Full Text Available A redução na função sistólica do ventrículo esquerdo em cães com insuficiência cardíaca congestiva está relacionada ao aumento de volume do ventrículo. A despeito dos avanços no tratamento conservador, o prognóstico é desfavorável com alta taxa de mortalidade. Este trabalho propôs um protocolo cirúrgico da redução ventricular para tratamento de cardiomiopatia dilatada em cães, a ventriculectomia parcial. A intervenção cirúrgica foi realizada sem circulação extracorpórea, mediante oclusão do influxo sangüíneo ao coração. Avaliou-se a execução da técnica à curto prazo, por eletrocardiograma, radiografia simples de tórax e biópsia cardíaca. Os resultados mostraram-se favoráveis pela fácil execução da técnica. Os animais sobreviveram ao período de sessenta dias de observação apresentando alterações eletrocardiográficas transitórias, redução da silhueta ventricular e cicatrização miocárdica normal.The reduction of the systolic function in the left ventricle of dogs with congestive heart failure is related to increased ventricular volume. Despite of the advances in conservative treatments to dilated cardiomiopathy, the prognosis is guarded with a high mortality rate. This research aimed to evaluate a surgical protocol of cardiac chamber reduction (partial ventriculectomy to treat dilated cardiomiopathy in dogs, like the procedure realized in humans. The surgery was realized by mean inflow occlusion without cardiopulmonary by-pass. The dogs postoperative evolution of was evaluated in a short period by electrocardiogram, and simple thoracic radiography. Patients were observed for sixty days and during this period did´nt present hemodynamic alterations.

  20. Evaluation to a long term remediation actions after Goiania radiological accident; Avaliacao a longo prazo das acoes de remediacao apos o acidente radiologico de Goiania

    Energy Technology Data Exchange (ETDEWEB)

    Rochedo, Elaine R.R.; Rio, Monica A. Pires do; Coutinho, Celia M.C.; Acar, Maria E.D.; Romeiro, Carlos H. [Instituto de Radioprotecao e Dosimetria (IRD), Rio de Janeiro, RJ (Brazil)

    2000-07-01

    Ten years after the Goiania radiological accident, the results obtained by the IRD Environmental Monitoring Program are compared to the values adopted for establishing the intervention levels at the time of the accident occurrence (1987), and to the values of the parameters obtained by European countries, after the Chernobyl accident. Significant differences were observed in parameter values, particularly, those related to a long term prediction of the contamination behaviour in an urban area. This paper shows the importance of the survey for the environmental behaviour of pollutants in tropical climate conditions. (author)

  1. Liberación de endotelina-1 por angiotensina ll en miocitos cardíacos aislados Angiotensin II-induced endothelin-1 release in cardiac myocytes

    Directory of Open Access Journals (Sweden)

    María C. Villa-Abrille

    2006-06-01

    Full Text Available Muchos de los efectos de la angiotensina II (Ang II son mediados en realidad por la acción de endotelina (ET endógena liberada y/o producida en respuesta a la Ang II. En este trabajo evaluamos la interacción Ang II/ET-1, sus consecuencias en la contractilidad cardíaca y el papel de las especies reactivas del oxígeno (EROs. Se usaron cardiomiocitos aislados de gato. La Ang II, 1 nM, produjo un efecto inotrópico positivo (EIP de 31.8±3.8% que fue cancelado por inhibición de los receptores AT1, de los receptores de ET, del intercambiador Na+/H+ (NHE, del modo inverso del intercambiador Na+/Ca2+ (NCX o por el secuestro de EROs. La Ang II, 100 nM, produjo un EIP de 70.5±7.6% que fue cancelado por inhibición de los receptores AT1 y bloqueado en parte por inhibición de los receptores de ET, del NHE, del modo inverso del NCX o por el secuestro de EROs. La Ang II, 1 nM, incrementó el ARNm de la preproET-1 lo cual fue anulado por el bloqueo de los receptores AT1. Los resultados permiten concluir que el EIP de la Ang II es debido a la acción de la ET-1 endógena liberada/formada por la Ang II. La ET-1 produce: estimulación del NHE, activación del modo inverso del NCX y un consecuente EIP. Dentro de esta cascada también participarían los EROs.Many of the effects thought to be due to angiotensin II (Ang II are due to the release/formation of endothelin (ET. We tested whether Ang II elicits its positive inotropic effect (PIE by the action of endogenous ET-1 and the role played by the reactive oxygen species (ROS in this mechanism. Experiments were performed in cat isolated ventricular myocytes in which sarcomere shortening (SS was measured to asses contractility after pharmacological interventions and the effect of Ang II on inotropism were analyzed. Ang II 1 nM increased SS by 31.8±3.8% (p<0.05. This PIE was cancelled by AT1 receptor blockade, by ET-1 receptors blockade, by Na+/H+ exchanger (NHE inhibition, by reverse mode Na+/Ca2+ exchanger (NCX blockade or by ROS scavenging. Ang II 100 nM increases SS by 70.5±7.6% (p<0.05. This PIE was completely abolished by AT1 receptors blockade and were partially bocked by ET-1 receptors blockade, by NHE inhibition, by reverse mode NCX blockade or by ROS scavenging. Ang II increased preproET-1 mRNA, effect that was blunted by AT1 receptors blockade. We conclude that Ang II induces (through its AT1 receptor release/formation of ET-1, which acting in autocrine fashion on ET receptors of the isolated myocytes increases inotropism through NHE stimulation and NCX reverse mode activation. The participation of ROS is involved is this chain of events.

  2. A newly developed highly selective Zn2+-AcO- ion-pair sensor through partner preference: equal efficiency under solitary and colonial situation.

    Science.gov (United States)

    Karar, Monaj; Paul, Suvendu; Biswas, Bhaskar; Majumdar, Tapas; Mallick, Arabinda

    2018-05-10

    Unusual self-sorting of an ion-pair under highly crowded conditions driven by a synthesized intelligent molecule 2-((E)-(3-((E)-2-hydroxy-3-methoxybenzylideneamino)-2-hydroxypropyl imino)methyl)-6-methoxyphenol, hereafter HBP, is described. When a mixture of various metal salts was allowed to react with HBP, only a specific ion-pair ZnII/AcO- in the solution simultaneously reacted, resulting in high-fidelity ion-pair recognition of HBP. This phenomenon was evidenced by significant changes in the absorption spectra and huge enhancement in emission intensity of HBP. The property that one molecule preferring one particular cation-anion pair over others is a rare but interesting phenomenon. Thus, the potential to interact selectively with the targeted ion-pair resulting in the formation of a specific complex recognized HBP as a new class of molecule that might find future applications in real time and on-site monitoring and separation of new molecules.

  3. Relativistic actions for bound-states and applications in the meson spectroscopy; Acoes relativisticas para estados ligados e aplicacoes na espectroscopia de mesons

    Energy Technology Data Exchange (ETDEWEB)

    Silva Carvalho, Hendly da

    1991-08-01

    We study relativistic equations for bound states of two-body systems using Dirac`s constraint formalism and supersymmetry. The two-body system can be of spinless particles, one of them spinning and the other one spinless, or both of them spinning. The interaction is described by scalar, timelike four-vector and spacelike four-vector potentials under Lorentz transformations. As an application we use the relativistic wave equation for two scalar particles and calculate the mass spectra of the mesons treating them as spinless quark-antiquark bound states. The interaction potential in this case is a convenient adaptation of the potential employed in non-relativistic calculations. Finally, we compare our results with more recent experimental data and with theoretical results obtained with the same potential used by us but with a non-relativistic wave equation. We also compare our results with results obtained with the relativistic wave equation but with a different interaction potential. (author). 38 refs, 9 figs, 8 tabs.

  4. Study creep in 4340 steels with different microstructure and plasma carbon nitridation processing; Estudo de fluencia em acos 4340 com diferentes microestruturas e tratamento de carbonitretacao a plasma

    Energy Technology Data Exchange (ETDEWEB)

    Abdalla, A.J., E-mail: abdalla@ieav.cta.b [Departamento de Ciencia e Tecnologia Aeroespacial (IEAv/DCTA), Sao Jose dos Campos, SP (Brazil). Inst. de Estudos Avancados; Carrer, I.R.; Barboza, M.J.R.; Baggio-Scheid, V.H. [Universidade de Sao Paulo (EEL/USP), Lorena, SP (Brazil). Escola de Engenharia; Moura Neto, C.; Reis, D.A.P. [Departamento de Ciencia e Tecnologia Aeroespacial (ITA/DCTA), Sao Jose dos Campos, SP (Brazil). Inst. Tecnologico de Aeronautica

    2010-07-01

    From the AISI 4340 bars specimens were made-for-test of creep, they were subjected to different heat treatments for the formation of multiphase microstructures. After this initial treatment, a lot of the specimens were tested in creep. One second batch of specimens was treated with a plasma carbonitriding, and later, were also tested. The carbonitriding layer and microstructure were characterized with X-ray analysis, laser confocal microscopy and hardness testing. Tests showed that the hardness in the steel was reduced due to thermochemical treatment at 500 deg C. We observed variation in creep behavior due to different microstructures formed. After the plasma treatment, there was a considerable reduction in the rate of creep and an increase in the time required for fracture. (author)

  5. Expanded austenite in nitrided layers deposited on austenitic and super austenitic stainless steel grades; Analise da austenita expandida em camadas nitretadas em acos inoxidaveis austeniticos e superaustenitico

    Energy Technology Data Exchange (ETDEWEB)

    Casteletti, L.C.; Fernandes, F.A.P.; Heck, S.C. [Universidade de Sao Paulo (EESC/USP), Sao Carlos, SP (Brazil). Escola de Engenharia. Dept. de Engenharia de Materais, Aeronautica e Automobilistica; Oliveira, A.M. [Instituto de Educacao, Ciencia e Tecnologia do Maranhao (IFMA), Sao Luis, MA (Brazil); Gallego, J., E-mail: gallego@dem.feis.unesp.b [UNESP, Ilha Solteira, SP (Brazil). Dept. Engenharia Mecanica

    2010-07-01

    In this work nitrided layers deposited on austenitic and super austenitic stainless steels were analyzed through optical microscopy and X-rays diffraction analysis (XRD). It was observed that the formation of N supersaturated phase, called expanded austenite, has promoted significant increment of hardness (> 1000HV). XRD results have indicated the anomalous displacement of the diffracted peaks, in comparison with the normal austenite. This behavior, combined with peaks broadening, it was analyzed in different nitriding temperatures which results showed good agreement with the literature. (author)

  6. Storage analysis of steel pipes used in pipelines; Analise do sistema de estocagem de tubos de aco para dutos de transporte

    Energy Technology Data Exchange (ETDEWEB)

    Provenzano, Carlos E.C.; Silva, Breno S.; Fernandes, Lincoln F.; Santos Junior, Sergio J.F. [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil); Louzada, Carlos H.C.M.

    2005-07-01

    New pipelines, request the use of great amount of tubes stored during its construction. Therefore, the cost generated by the storage areas motivates the reconsideration of the stockpiling system. Large areas demand high costs related to its acquisition or rent. The use of small areas can reduce the immediate cost with rent, but also can increase the total cost due to damage of the tubes or increase the risk at the storage conditions. The same considerations could be made for inadequate use of support materials on the stockpiling piles, regarding the quality or amount used. This work presents the modelling of the pyramidal stockpiling system of steel tubes and evaluations to a better configuration. (author)

  7. Selección de Características 2D en Representaciones Tiempo Frecuencia para la Detección de Soplos Cardíacos

    OpenAIRE

    Juan D. Martínez-Vargas; Luis D. Avendaño-Valencia; Germán Castellanos-Domínguez

    2011-01-01

    En el presente trabajo se propone una metodología para la reducción de dimensión en representaciones tiempo frecuencia (TFRs) enfocada a la clasificación de bioseñales no estacionarias, que trata directamente su cantidad de datos irrelevantes y redundantes, combinando una etapa de selección de características con una etapa de reducción de dimensión por medio de métodos de descomposición lineal extendidos a datos bidimensionales. La metodología se prueba sobre un conjunto de TFRs paramétricas ...

  8. Analysis of ferritic stainless steel tube applied in radiation furnaces; Analise de tubos de aco inoxidavel ferritico para aplicacao em fornos de radiacao

    Energy Technology Data Exchange (ETDEWEB)

    Porto, P.C.R.; Spim, J.A. [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil). Centro de Tecnologia. Lab. de Fundicao], e-mail: spim@ufrgs.br; Santos, C.A. [Pontificia Universidade Catolica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS (Brazil). Fac. de Engenharia. Programa de Pos-Graduacao em Engenharia e Tecnologia de Materiais (PGETEMA)

    2006-07-01

    The objective of this work was to evaluate the change in mechanic properties and phase transformations of ferritic stainless steel tube, ASTM 268 Gr 446, applied in high temperature conditions. The work has used tubes from radiation furnaces of the PETROBRAS Xisto Industrialization Unit. The samples used for comparison were obtained from new tubes and tubes already used in furnaces. The test analyses were optical metallography, scanning electron microscopy, energy dispersive spectrometer, hardness and microhardness test and tension test. Results have shown that the new tubes presented a ferritic matrix and in old tubes were observed a great quantity of sigma phase and carbides. Along with the thickness of the tubes it was verified that the inside region presented an increase of sulfate and the outside region an increase of carbides. (author)

  9. Cardiac markers: profile in rats experimentally infected with Toxocara canis Marcadores cardíacos: perfil em ratos infectados experimentalmente com Toxocara canis

    Directory of Open Access Journals (Sweden)

    Cecília Braga Laposy

    2012-09-01

    Full Text Available The aim of this study was to evaluate the profile of the enzymes creatine kinase (CK, creatine kinase MB (CK-MB and lactate dehydrogenase (LDH in Wistar rats infected with 250 (GI, n = 24 or 1000 (GII, n = 24 Toxocara canis eggs. Animals were evaluated on days 7, 15, 30, 60, 120 and 180 post-infection (DPI. Only the GI rats showed an increase in CK and CK-MB, at 15 and 30 DPI, respectively. Anti-Toxocara spp. antibodies were detected by ELISA in infected animals. Despite of the presence of eosinophilic infiltrate in the heart of three infected animals, none larva was recovered from the organ neither by acid digestion nor by Baermann procedure. Eosinophilia was observed in both groups but there was no significant difference in the eosinophil counts between GI and GII (p = 0.2239. It is possible to consider that cardiac lesion is an eventual finding in murine model for toxocariasis.O objetivo do presente estudo foi avaliar o perfil das enzimas creatinoquinase (CK, creatinoquinase-MB (CK-MB e lactato desidrogenase (LDH em ratos Wistar infectados com 250 (GI, n = 24 ou 1000 (GII, n = 24 ovos de Toxocara canis. Os animais foram avaliados nos dias 7, 15, 30, 60, 120 e 180 pós-infecção (DPI. Observou-se que apenas os animais do GI apresentaram aumento da atividade de CK e CK-MB aos 15 e 30 DPI, respectivamente. Anticorpos anti-T. canis foram detectados por ELISA nos animais infectados. Apesar da presença de infiltrado eosinofílico em três animais infectados, nenhuma larva foi recuperada do coração pela digestão ácida ou pela técnica de Baermann. Eosinofilia foi observada em todos os momentos em GI e GII, sem diferença significativa entre os grupos (p = 0,2239. Pode-se considerar que as lesões cardíacas foram um achado eventual no modelo murino para toxocaríase.

  10. Perfil de risco cardíaco no diabetes mellitus e na glicemia de jejum alterada Cardiac risk profile in diabetes mellitus and impaired fasting glucose

    Directory of Open Access Journals (Sweden)

    Beatriz D'Agord Schaan

    2004-08-01

    Full Text Available OBJETIVO: A mortalidade dos pacientes diabéticos é maior do que a da população em geral e decorre especialmente das doenças cardiovasculares. O objetivo do estudo foi identificar a prevalência dos fatores de risco cardiovasculares em indivíduos com diabetes mellitus (DM ou glicemia de jejum alterada, a fim de direcionar as ações em saúde. MÉTODOS: Estudo transversal de base populacional, com amostragem aleatória por conglomerado, constituída de 1.066 individuos, representativa da população urbana adulta (>20 anos do Estado do Rio Grande do Sul, realizado entre 1999 e 2000. Foi aplicado um questionário estruturado sobre os fatores de risco coronariano e as características sociodemográficas a todos os adultos maiores de 20 anos residentes no domicílio selecionado. Após.os pacientes foram submetidos à avaliação clínica e coleta de sangue para determinação de colesterol total e glicemia de jejum. Para a análise dos dados foi utilizado o pacote estatístico Stata 7. Foi estabelecido nível prévio de significância de 5%. As variáveis categóricas foram comparadas utilizando-se qui-quadrado de Pearson, enquanto que as contínuas mediante teste t de Student ou Anova, além de análise multivariável, todas controladas para efeito de conglomerado. RESULTADOS: De 992 indivíduos, 12,4% eram diabéticos e 7,4% apresentavam glicemia de jejum alterada. Dos fatores de risco estudados, os indivíduos com algum grau de alteração da homeostase glicêmica apresentaram maior prevalência de obesidade (17,8, 29,2 e 35,3% em normais, glicemia de jejum alterada e DM, respectivamente, pOBJECTIVE: Mortality of diabetic patients is higher than that of the population at large, and mainly results from cardiovascular diseases. The purpose of the present study was to identify the prevalence of cardiovascular risk factors in subjects with diabetes mellitus (DM or abnormal fasting glucose (FG in order to guide health actions. METHODS: A population-based cross-sectional study was carried out in a representative random cluster sampling of 1,066 adult urban population (>20 years in the state of Rio Grande do Sul between 1999 and 2000. A structured questionnaire on coronary risk factors was applied and sociodemographic characteristics of all adults older than 20 years living in the same dwelling were collected. Subjects were clinically evaluated and blood samples were obtained for measuring total cholesterol and fasting glycemia. Statistical analysis was performed using Stata 7 and a 5% significance level was set. Categorical variables were compared by Pearson's chi-square and continuous variables were compared using Student's t-test or Anova and multivariate analysis, all controlled for the cluster effect. RESULTS: Of 992 subjects, 12.4% were diabetic and 7.4% had impaired fasting glucose. Among the risk factors evaluated, subjects who presented any kind of glucose homeostasis abnormality were at a higher prevalence of obesity (17.8, 29.2 and 35.3% in healthy subjects, impaired fasting glucose and DM respectively, p<0.001, hypertension (30.1, 56.3 and 50.5% in healthy subjects, impaired fasting glucose and DM, respectively, p<0.001, and hypercholesterolemia (23.2, 35.1 and 39.5 in healthy subjects, impaired fasting glucose and DM respectively, p=0.01. CONCLUSION: Subjects with any kind of glucose homeostasis abnormality represent a group, which preventive individual and population health policies should target since they have higher prevalence of coronary artery disease risk factors.

  11. Role of the genes Md-ACO1 and Md-ACS1 in ethylene production and shelf life of apple (Malus domestica Borkh)

    NARCIS (Netherlands)

    Costa, F.; Stella, S.; Weg, van de W.E.; Guerra, W.; Cecchinel, M.; Dallavia, J.; Koller, B.; Sansavini, S.

    2005-01-01

    Shelf life determines the economic life time of mature apples, which can be either freshly harvested or stored. Good shelf life is highly associated with a slow decrease of fruit firmness at room temperature. Apple is a climacteric fruit, in which loss of firmness seems to be physiologically related

  12. Marble waste characterization as a desulfurizing slag component for steel; Caracterizacao do residuo de marmore como componente de escorias dessulfurantes para aco

    Energy Technology Data Exchange (ETDEWEB)

    Coleti, J.L.; Grillo, F.F.; Tenorio, J.A.S. [Universidade de Sao Paulo (USP), SP (Brazil); De Oliveira, J.R. [Instituto Federal do Espirito Santo (IFES), ES (Brazil)

    2014-07-01

    The current steel market requires from steel plants better quality of its products. As a result, steel plants need to search for improvements and costs reduction in its process. Hence, the residue of marble containing significant quantities of calcium and magnesium carbonates, raw materials of steel refining slag, was characterized in order to replace the conventional lime used. Therefore, it will be possible to reduce the cost and volume of waste produced by the ornamental rock industry. The following methods were applied to test the waste potential: SEM with EDS, x-ray diffraction, x-ray fluorescence (EDX), Thermogravimetry (TG) and analysis of surface area and particle size by the BET method using dispersion leisure. The results indicated the feasibility of waste as raw material in the composition of desulfurizing slags. (author)

  13. 278. Terapia vacuum assisted closure como tratamiento de mediastinitis en pacientes que se han sometido a trasplante cardíaco

    Directory of Open Access Journals (Sweden)

    M. Schuler

    2012-04-01

    Conclusiones: No hubo ningún caso de muerte hospitala-ria. En todos los pacientes se evidenció una evolución satisfactoria con la utilización de la terapia VAC que permitió la resolución definitiva de la herida sin ser necesaria en ningún caso una reducción en la terapia inmunosupresora.

  14. Investigation of the benzotriazole as addictive for carbon steel phosphating; Estudo da utilizacao do benzotriazol como aditivo para a fosfatizacao de aco carbono

    Energy Technology Data Exchange (ETDEWEB)

    Annies, V.; Cunha, M.T.; Rodrigues, P.R.P.; Banczek, E.P. [Universidade Estadual do Centro-Oeste, Guarapuava, PR (Brazil). Dept. de Quimica; Costa, I. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Terada, M. [Universidade de Sao Paulo (POLI/USP), SP (Brazil). Escola Politecnica. Dept. de Engenharia Metalurgica e de Materiais

    2010-07-01

    This work studied the viability of substitution of sodium nitrite (NaNO{sub 2}) for benzotriazole (BTAH) in the zinc phosphate bath (PZn+NaNO{sub 2}) for phosphating of carbon steel (SAE 1010). The characterization of the samples was carried out by Scanning Electron Microscopy, Optical Microscopy and X-ray diffraction. The chemical composition was evaluated by Energy Dispersive Spectroscopy. The corrosion behavior of the samples was investigated by Open Circuit Potential, Electrochemical Impedance Spectroscopy and Anodic Potentiodynamic Polarization Curves in a 0.5 mol L{sup -1} NaCl electrolyte. The experimental results showed that the phosphate layer obtained in the solution with benzotriazole (PZn+BTAH) presented better corrosion resistance properties than that obtained in sodium nitrite. The results demonstrated that the sodium nitrite NaNO{sub 2} can be replaced by benzotriazole (BTAH) in zinc phosphate baths. (author)

  15. Influência do jet lag social em marcadores circadianos de atividade - repouso e cardíaco em estudantes de medicina

    OpenAIRE

    Ferreira, Luana Gabrielle de França

    2015-01-01

    Diversos estudos revelam que nas últimas décadas ocorreu uma diminuição na duração do sono. Os compromissos sociais, como o trabalho e a escola, muitas vezes não estão alinhados ao “tempo biológico” dos indivíduos. Somada a isso, observa-se uma menor força do zeitgeber causada pela menor exposição à luz durante o dia e maior à noite. Isso gera um débito crônico de sono que é compensado nos dias livres, ocorrendo semanalmente uma restrição e extensão do sono denominada de jet...

  16. Transport of iron particles generated during milling operations in multilateral wells; Transporte de particulas de aco geradas pela abertura de janelas em pocos multilaterais

    Energy Technology Data Exchange (ETDEWEB)

    Martins, Andre Leibsohn; Rezende, Carla Leonor Teixeira; Leal, Rafael Amorim Ferreira; Lourenco, Fabio Gustavo Fernandes [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil). Centro de Pesquisas]. E-mail: aleibsohn@cenpes.petrobras.com.br; rezenc@hotmail.com; ramorim@cenpes.petrobras.com.br; fabiolou@urbi.com.br

    2000-07-01

    This paper presents a series of numerical simulations aimng the definition of requirements (flow rate and fluid properties) to remove iron particles both in the inclined sections and in the riser annulus. Additionally, experimental work was developed in a pilot scale flow loop in order tocompare the behavior of water and sinthetic oil baed fluids in milling operations. (author)

  17. The effect of hot deformation on the bainite transformation of a working tool steel; Efeito da deformacao a quente sobre a transformacao bainitica de um aco ferramenta

    Energy Technology Data Exchange (ETDEWEB)

    Mendonca Lima, Ricardo F. de; Carvalho, Miguel A.; Nogueira, Marcos A.S. [Acos Villares SA, Rio de Janeiro, RJ (Brazil)

    1989-12-31

    The effect of hot deformation of austenite on its isothermal transformation at 400 degrees Celsius for a hot working steel has been investigated. The degrees of transformation was varied and the results were analysed by optical metallography. Increasing the deformation, the bainite nucleation occurs in twins and grain boundaries, and also inside the austenitic grains. (author). 10 refs., 8 figs.

  18. Función valvular tricúspide y trasplante cardíaco. Importancia de la técnica

    Directory of Open Access Journals (Sweden)

    Carlos García-Montero

    2012-10-01

    Conclusiones. La RT es un hallazgo frecuente tras el TxC, y sus efectos dependen de la gravedad del cuadro. la anastomosis cavo-atrial, con o sin anuloplastia tricúspide profiláctica (ATP, preserva la función sinusal, la geometría del anillo valvular y la función de VD. El beneficio clínico derivado de estas modificaciones técnicas supone menor necesidad de marcapaso (MP y de medidas de soporte mecánico.

  19. Analysis of the structural steels corrosion resistance in sour water from petroleum refineries; Analise da resistencia a corrosao de acos estruturais em aguas acidas de refinarias de petroleo

    Energy Technology Data Exchange (ETDEWEB)

    Proenca, Marcos B.; Freire, Celia M. de A. [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Engenharia Mecanica; Santos, Margatita B. [Universidade Estadual de Campinas, SP (Brazil). Inst. de Fisica. Dept. de Fisica Aplicada

    1994-07-01

    The presence of H{sub 2} S in refineries FCC sour water provokes the formation of a passive Fe S scale. The cyanides present on sour water remove this scale, raising the corrosion rate in pipping and vessels. In this work it was measured the corrosion rate of structural steels in this water by electrochemical methods. Anodic polarization curves were plotted and the corrosion rates of the steels were determined. (author)

  20. Mechanical analysis of ferritic stainless steel applied in radiation tubes in high temperature; Analise mecanica de acos inoxidaveis ferriticos aplicados em tubos de radiacao em altas temperaturas

    Energy Technology Data Exchange (ETDEWEB)

    Moreto, J.A.; Ponte, H.A.; Oliveira, V.L.; Silva, C.A. [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil)

    2008-07-01

    Nowadays Brazilian oil refineries face an important challenge: to adjust their units to the processing of more aggressive crudes. The use of this kind of oil has caused an increase on corrosion on process streams in high temperatures. This study's objective is to evaluate the changes in mechanic properties and phases processing occurred in tubes from de radiation furnaces type A268/446 Tp ferritic stainless steel tubes used in conditions of high temperatures. For comparison samples of the APM/Kanthal alloy tube were examined. Hot tensile tests were performed in the studied materials evidence bodies. The evidence bodies for the hot tensile tests were extracted from the longitudinal position of the tubes and were machined with cylindrical shape with threads. There was a series of trials for each tube (at different traction speeds) at temperature of 600 deg C. With the traction test it was possible to evaluate resistance and ductility characteristics and was used to establish criteria for quality control to ensure satisfactory performance in certain applications. Data testing creep were performed in the evidence bodies taken from the longitudinal position of the tubes in constant charge form. Data testing creep were executed in the constant stress mode at various levels of temperature. Through data testing creep it was possible to predict for how long the material is good for use. Data from testing creep were treated by the method of Larson and Miller. (author)

  1. GPS for QSP: A Summary of the ACoP6 Symposium on Quantitative Systems Pharmacology and a Stage for Near-Term Efforts in the Field.

    Science.gov (United States)

    Musante, C J; Abernethy, D R; Allerheiligen, S R; Lauffenburger, D A; Zager, M G

    2016-09-01

    Quantitative Systems Pharmacology (QSP) is experiencing increased application in the drug discovery and development process. Like its older sibling, systems biology, the QSP field is comprised of a mix of established disciplines and methods, from molecular biology to engineering to pharmacometrics. As a result, there exist critical segments of the discipline that differ dramatically in approach and a need to bring these groups together toward a common goal. © 2016 The Authors CPT: Pharmacometrics & Systems Pharmacology published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

  2. GPS for QSP: A Summary of the ACoP6 Symposium on Quantitative Systems Pharmacology and a Stage for Near‐Term Efforts in the Field

    Science.gov (United States)

    Musante, CJ; Abernethy, DR; Allerheiligen, SR; Lauffenburger, DA

    2016-01-01

    Quantitative Systems Pharmacology (QSP) is experiencing increased application in the drug discovery and development process. Like its older sibling, systems biology, the QSP field is comprised of a mix of established disciplines and methods, from molecular biology to engineering to pharmacometrics.1 As a result, there exist critical segments of the discipline that differ dramatically in approach and a need to bring these groups together toward a common goal. PMID:27639191

  3. Study of corrosion in metallic coating in steel-carbon by thermal spray; Estudo de corrosao em revestimentos metalicos em aco-carbono obtidos por aspersao termica

    Energy Technology Data Exchange (ETDEWEB)

    Cruz, Maria C.P.; Cavalcanti, Eliane B.; Rambo, Elisabeth S.M.; Araujo, Paulo M.M. [Instituto de Tecnologia e Pesquisa (IPT), Aracaju, SE (Brazil); Santos, Anderson O. [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil)

    2008-07-01

    The effect caused for constituent elements of the watery environment of production of the oil on metallic coverings was studied that simulate the artificial rise of the oil (connecting rods of pump mechanic). For in such a way, the techniques of electrochemical analysis had been used, as the method of linear polarization and the extrapolation of the straight line of Tafel of metallic coverings [alloy of Bronze and Aluminum; alloy of CrNi 80/20; NiCr 80/20; 95MXC (Cr: 26.5% - 31.5%, Cr: 26.5% - 31.5%, B: 3.35% - 4.15%, Mn: 1.1% - 2.2%, Itself: 1.1% -2.1%, Faith) and aluminum] on the substratum steel simulating covering in the connecting rods of pump. Oil well had been raised the resistance characteristics the polarization of the metal when submitted to the watery way surrounding it. They had been evaluated the resistance the covering polarization applied on the steel, with the objective to analyze its resistance the corrosion and to verify the possibility of its use as barrier against the problems originated for the degradation in connecting rods of pump. For the calculated Taxes of Corrosion, it can be concluded that the Aluminum coverings (0,003 mm/year) and NiCr 80/20 (0,179 mm/year) had been the ones that had presented a bigger resistance to the corrosive way. (author)

  4. Study of corrosive effect of oil in super duplex stainless steels; Estudo do efeito corrosivo do petroleo em acos super duplex

    Energy Technology Data Exchange (ETDEWEB)

    Gusmao, E.F.; Azambuja, V.M. [IFES, Coordenadoria de Metalurgia, Vitoria, ES (Brazil); Santos, D.S. [Universidade Federal do Rio de Janeiro (PEMM/COPPE/UFRJ), RJ (Brazil). Pos-Graduacao em Engenharia Metalurgica e de Materiais

    2010-07-01

    The super duplex stainless steel was exposed in an environment at 75 degree C with oil for days, weeks and month to observe the change in mass. The corrosion leads to loss of weight of material which could harm the economy of a company, as this will have to stop production to replace the corroded part. Hence the great importance of studies on ways to mitigate the corrosion. There was a chemical attack by the reagent Behara and testing to study the quality of the protective coating after the tests with oil by electrochemical impedance. (author)

  5. Plasma nitriding and simultaneous tempering of VF 800AT tool steel; Nitretacao por plasma com revenimento simultaneo do aco ferramenta VF 800AT

    Energy Technology Data Exchange (ETDEWEB)

    Prass, Andre Ricardo; Fontana, Luis Cesar; Recco, Abel Andre Candido, E-mail: prass.andrericardo@gmail.com, E-mail: luis.fontana@udesc.br, E-mail: abel.recco@udesc.br [Universidade do Estado de Santa Catarina (UDESC), Joinville, SC (Brazil)

    2017-04-15

    Plasma nitriding of tool steels improves the surface hardness due to formation of diffusion zone and/or compound layer. The process parameters such as temperature, gas composition and dwell time, allow to control the layer thickness, the microstructure, the crystalline phases and the type of layer (for example white layer or diffusion zone). This paper discusses an alternative procedure for the heat treatment of tempering and surface treatment, both in plasma or combining conventional heat treatment with subsequent plasma nitriding. Carrying out both treatments in plasma could enable reduction in manufacturing costs, lower energy consumption and less time for tools manufacturing. Samples of VF800AT steel were treated and characterized (at surface and core of samples) through the following technique: X-ray diffraction, optical microscopy, scanning electron microscopy, micro-hardness profile and Rockwell C measurement. Temperature measurements during the plasma treatment, show that arise thermal gradient between the surface and the core of the samples. In this work, it was observed that the surface was up to 7% hotter than the core of sample, during the plasma treatment with temperature of magnitude about 5 x 10{sup 2} °C. This thermal gradient seems inherent to the plasma process, so that it can produce different microstructure, hardness and crystalline phases between core and edge of samples. However, when two tempering operations are prior carried out in a muffle furnace and the third tempering treatment is subsequently carried out simultaneously with the plasma nitriding, it is observed that the microstructure, the crystalline phases, hardness and micro hardness (in both, edge and core) are similar to treatments done in conventional mode cycle (in muffle furnace) with subsequent plasma nitriding. (author)

  6. Cuidado sistematizado em pré-operatório cardíaco: Teoria do Cuidado Transpessoal na perspectiva de enfermeiros e usuários

    Directory of Open Access Journals (Sweden)

    Thais Vasconselos Amorim

    2014-07-01

    Full Text Available Estudo de caso que objetivou desvelar, a partir da adoção da Teoria do Cuidado Transpessoal, os significados do relacionamento interpessoal terapêutico entre enfermeiro e usuário, sobre a visita pré-operatória de enfermagem após a vivência do processo cirúrgico. A amostra, de conveniência, foi constituída por três enfermeiros e três usuários de uma instituição que possui cadastro atualizado para realizar cirurgia de alta complexidade cardiovascular, perfazendo nove combinações de interações terapêuticas. Foram utilizados impressos estruturados segundo a teoria de Jean Watson e as taxonomias North American Nursing Diagnosis Association, Nursing Intervention Classification e Nursing Outcome Classification. Os aspectos éticos e legais de pesquisa envolvendo seres humanos foram assegurados. Nos resultados, identificaram-se três clusters para apreender a significação da visita pré-operatória pelos usuários e cinco clusters para apreender a percepção dos enfermeiros ao vivenciarem esta experiência clínica.

  7. Analysis of martensitic transformation and residual tension in an 304L stainless steel; Analise da transformacao martensitica e tensao residual em um aco inoxidavel 304L

    Energy Technology Data Exchange (ETDEWEB)

    Alves, Juciane Maria

    2014-07-01

    The relationship between plastic deformation and the strain induced phase transformation, that provides a practical route to the development of new engineering materials with excellent mechanical properties, characterize the TRIP effect 'Transformation Induced Plasticity'. Among the stainless steels, the metastable 304 L austenitic steel is susceptible to transformation of austenite-martensite phase from tensile tests at room temperature by increments of plastic deformation. It is of great technological and scientific interest the knowledge of the evolution of phase transformation and residual stress from different levels and rates of plastic deformation imposed to the material. It is also important to evaluate the interference of metallographic preparation in quantitative analyzes of this steel. The main techniques used in this study consisted of X-rays diffraction and Ferritoscopy for the quantitation phase, and XRD to residual stress analysis also. As observed, the phase transformation quantification has not suffered significant influence of the metallographic preparation and evolved from increments of plastic deformation due to different stop charges and strain rates, leading to a further strengthening of the austenite matrix. The evaluation of residual stress resulting from the martensitic transformation was susceptible to the metallographic preparation and increased its value on comparison to sample without metallographic preparation. It was also observed that the residual stress decreased with the increase of the fraction of transformed martensite. (author)

  8. UNS S32750 super duplex steel welding using pulsed Nd:YAG laser; Soldagem do aco superduplex UNS S32750 com laser pulsado Nd:YAG

    Energy Technology Data Exchange (ETDEWEB)

    Francini, O.D.; Andrade, G.G.; Clemente, M.S.; Gallego, J.; Ventrella, V.A., E-mail: ventrella@dem.feis.unesp.br [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Ilha Solteira, SP (Brazil). Departamento de Engenharia Mecanica

    2016-07-01

    Laser is a flexible and powerful tool with many relevant applications in industry, mainly in the welding area. Lasers today provide the welding industry technical solutions to many problems. This work studied the weld metal obtained by pulsed laser welding of Nd: YAG super duplex stainless steel UNS S32750 employed in the oil and natural gas, analyzing the influence of high cooling rate, due to the laser process, the swing phase ferrite / austenite. Were performed weld beads in butt joint with different repetition rates. The different microstructures were obtained by optical microscopy and scanning electron microscopy. The results showed that the effect of varying the welding energy of Nd: YAG laser on the volume fractions of the phases ferrite/austenite in the weld metal was its ferritization and low austenite amount on the grain boundary. (author)

  9. Significados e vivências mediante a indicação cirúrgica para pacientes cardíacos

    OpenAIRE

    Wottrich,Shana Hastenpflug; Quintana,Alberto Manuel; Camargo,Valéri Pereira; Quadros,Carlos Oclides Pereira de; Naujorks,Alexandre Antonio

    2013-01-01

    Este é um estudo qualitativo, de cunho exploratório e descritivo, cujo objetivo consistiu em compreender os significados atribuídos à cirurgia cardíaca por pacientes pré-cirúrgicos. Para sua realização participaram quinze usuários de ambulatório de cardiologia de um hospital universitário. A coleta de dados aconteceu através de entrevistas semiestruturadas. A análise dos dados foi realizada através da análise de conteúdo, da qual emergiram quatro categorias: A ansiedade da espera; A cirurgia ...

  10. Significados e vivências mediante a indicação cirúrgica para pacientes cardíacos

    Directory of Open Access Journals (Sweden)

    Shana Hastenpflug Wottrich

    2013-12-01

    Full Text Available Este é um estudo qualitativo, de cunho exploratório e descritivo, cujo objetivo consistiu em compreender os significados atribuídos à cirurgia cardíaca por pacientes pré-cirúrgicos. Para sua realização participaram quinze usuários de ambulatório de cardiologia de um hospital universitário. A coleta de dados aconteceu através de entrevistas semiestruturadas. A análise dos dados foi realizada através da análise de conteúdo, da qual emergiram quatro categorias: A ansiedade da espera; A cirurgia e o medo; Expectativas de futuro após a cirurgia; e Religiosidade e introspecção. Os resultados mostram as repercussões emocionais decorrentes do caráter de imprevisibilidade atribuído à cirurgia, evidenciando um cenário de vulnerabilidade e de fragilização emocional. Constata-se a necessidade de refletir sobre aspectos da cirurgia que estão além do adoecimento físico, abarcando as mais diversas áreas profissionais e de conhecimento no âmbito da atenção à saúde.

  11. Non destructive method to follow the phase sigma in a duplex stainless steel; Metodologia nao destrutiva para acompanhamento da fase sigma, em um aco inoxidavel duplex

    Energy Technology Data Exchange (ETDEWEB)

    Silva, E.M.; Andrade, A.L.S. Souza; Fialho, W.M.L.; Araujo, B.R., E-mail: edgard@ifpb.edu.br [Instituto Federal de Educacao Ciencia e Tecnologia da Paraiba (IFPB), Joao Pessoa, PB (Brazil); Silva, J.H.R.; Leite, Josinaldo P.; Silva, Eloy M. [Instituto Federal de Educacao Ciencia e Tecnologia do Ceara (IFCE), CE (Brazil); Leite, Joao P. [Universidade Federal da Paraiba (UFPB), PB (Brazil)

    2014-07-01

    Duplex stainless steels are subject to embrittlement due to the formation of sigma phase, which is one with the greatest effect of weakening because they are rich in chromium and deplete the matrix of this element. In this paper, a non-destructive methodology based on measurements of Hall voltage, is presented for monitoring the formation of sigma phase at temperatures of 800 deg C and 900 deg C. Different field intensities are generated by an electromagnet and the flow of field lines is detected by a Hall effect sensor. Hall voltage measurements are proportional to the formation of sigma phase generated by different times of aging methods. The results are correlated with results of microscopic, hardness and X-ray diffraction. It was showed that exist a correlation between the Hall voltage and the amount of sigma phase. The formation of this phase influences the signal voltage by reducing the voltage. (author)

  12. Monitorização de transplante cardíaco usando análises do eletrograma intracavitário

    Directory of Open Access Journals (Sweden)

    BROFMAN Paulo Roberto S.

    1997-01-01

    Full Text Available Uma série de registros do eletrograma intracavitário tem sido utilizada para monitorização não invasiva da rejeição em pacientes transplantados usando um marcapasso de dupla câmara e eletrodos endocavitários revestidos com estrutura fractal. Os sinais têm sido avaliados usando o sistema CHARM (Computerized Heart Acute Rejection Monitoring _ sistema computadorizado para monitorização da rejeição cardíaca aguda. Os relatórios obtidos com este sistema contêm curvas com parâmetros sensíveis à rejeição, que demonstram uma boa correlação com a clínica e os resultados das biópsias convencionais. A monitorização a longo prazo, usando estas análises, mostrou ser uma ferramenta valiosa no acompanhamento destes pacientes.

  13. An 8-year, high-resolution reanalysis of atmospheric carbon dioxide mixing ratios based on OCO-2 and GOSAT-ACOS retrievals

    Science.gov (United States)

    Weir, B.; Chatterjee, A.; Ott, L. E.; Pawson, S.

    2017-12-01

    This talk presents an overview of results from the GEOS-Carb reanalysis of retrievals of average-column carbon dioxide (XCO2) from the Orbiting Carbon Observatory 2 (OCO-2) and Greenhouse Gases Observing Satellite (GOSAT) satellite missions. The reanalysis is a Level 3 (L3) product: a collection of 3D fields of carbon dioxide (CO2) mixing ratios every 6 hours beginning in April 2009 going until the present on a grid with a 0.5 degree horizontal resolution and 72 vertical levels from the surface to 0.01 hPa. Using an assimilation methodology based on the Goddard Earth Observing System (GEOS) atmospheric data assimilation system (ADAS), the L3 fields are weighted averages of the two satellite retrievals and predictions from the GEOS general circulation model driven by assimilated meteorology from the Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2). In places and times where there are a dense number of soundings, the observations dominate the predicted mixing ratios, while the model is used to fill in locations with fewer soundings, e.g., high latitudes and the Amazon. Blending the satellite observations with model predictions has at least two notable benefits. First, it provides a bridge for evaluating the satellite retrievals and their uncertainties against a heterogeneous collection of observations including those from surface sites, towers, aircraft, and soundings from the Total Carbon Column Observing Network (TCCON). Extensive evaluations of the L3 reanalysis clearly demonstrate both the strength and the deficiency of the satellite retrievals. Second, it is possible to estimate variables from the reanalysis without introducing bias due to spatiotemporal variability in sounding coverage. For example, the assimilated product provides robust estimates of the monthly CO2 global growth rate. These monthly growth rate estimates show significant differences from estimates based on in situ observations, which have sparse coverage, and those based on model surface fluxes, which imperfectly represent key processes. This presentation discusses the implications of this finding as well as ongoing strategies to extract more information from the satellite retrievals in future L3 reanalyses.

  14. Characterization of steel grit recovered from ornamental rocks waste by magnetic separation; Caracterizacao da granalha de aco recuperada do residuo de rochas ornamentais por separacao magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Junca, E.; Telles, V.B.; Rodrigues, G.F.; Oliveira, J.R. de; Tenorio, J.A.S., E-mail: eduardojunca@gmail.co [Universidade de Sao Paulo (USP), SP (Brazil). Dept. de Engenharia Metalurgica e de Materiais; Instituto Federal de Ciencia e Tecnologia do Espirito Santo (IFES), Vitoria, ES (Brazil)

    2010-07-01

    The aim of this work is characterization of steel grit recovered from ornamental rock waste by magnetic separation. The magnetic separation was realized in three steps: first, using a high intensity wet magnetic separator, which used only the remaining magnetic field of equipment. In the second step, the magnetic material obtained in the first phase was subjected to a new manual magnetic separation using rare earth magnets. In a third step, magnetic material obtained with rare earth magnets was subjected to manual magnetic separation using ferrite magnets. After the magnetic separation, the material was sent to characterization which was obtained by chemical analysis, scanning electron microscopy, X-ray diffraction and size analysis. The size analysis showed that the concentrate range from 0,5 to 563,67 {mu}m with 4 wt.% over 100 {mu}m and content metallic iron of 93 wt%. (author)

  15. Cyclic oxidation of stainless steel ferritic AISI 409, AISI 439 and AISI 441; Oxidacao ciclica dos acos inoxidaveis ferriticos AISI 409, AISI 439 e AISI 441

    Energy Technology Data Exchange (ETDEWEB)

    Salgado, Maria de Fatima; Santos, Diego Machado dos; Oliveira, Givanilson Brito de, E-mail: fatima.salgado@pq.cnpq.br [Universidade Estadual do Maranhao (CESC/UEMA), Caxias, MA (Brazil). Centro de Estudos Superiores; Rodrigues, Samara Clotildes Saraiva; Brandim, Ayrton de Sa [Instituto Federal do Piaui (PPGEM/IFPI), PI (Brazil); Lins, Vanessa de Freitas Cunha [Universidade Federal de Minas Gerais (IFMG), MG (Brazil)

    2014-07-01

    Stainless steels have many industrial applications. The cyclic oxidation of ferritic stainless steels technical and scientific importance presents, because they are less susceptible to peeling the austenitic alloys. For the purpose of investigating the behavior of these steels under thermal cycling, cyclic oxidation of AISI 409, AISI 441 and AISI 439 was carried out in a tubular furnace under two different conditions: oxidation by dipping the steel in the synthetic condensate for 10h and without oxidation immersion in the condensate, for up to 1500h at 300° C temperature. Using techniques: SEM, EDS and XRD revealed a microstructure with increased oxidation in the samples were immersed in the condensate. The oxide film remained intact during oxidation for steels 439 and 441 409 The Steel immersed in the condensate was rupture of the film after the 20th cycle of oxidation. The chemical characterization of the films allowed the identification of elements: Chromium, Iron, Aluminium and Silicon To a great extent, Cr{sub 2}O{sub 3}. (author)

  16. Lethal effects of solar radiation in proficient and deficient bacteria in repair systems; Efeitos letais da luz solar em bacterias proficientes e deficientes em reparos: acoes e interacoes

    Energy Technology Data Exchange (ETDEWEB)

    Sousa Neto, A de

    1981-12-31

    A study of the lethal action of solar radiation on strains of E.coli K12, proficient or deficient in repair systems, as well as the wild type strain gene products are involved in repair of damage induced by solar radiation. The inactivation of the various bacterial strains (normalized to a dose equivalent to radiation at a wavelength 254 nm) suggests that the more energetic wavelengths of the solar spectrum (290-320 nm) could be responsible for the primary damage that occurs in the DNA. The reduction in the shoulder of the survival curve in wild type strains in indicative of induction of sub-lethal damage in this region of the curve. Analysing solar inactivation curves of the bacterial strains (normalised by spore dosimetry) together with those of the same strains irradiated with UV at 254 nm, it was evident that 254 nm is not the ideal wavelength for comparison. This analysis also indicated that in addition to damage to DNA, other factors are involved in the solar radiation inactivation of wild type strains. (author).

  17. Selección de Características 2D en Representaciones Tiempo Frecuencia para la Detección de Soplos Cardíacos

    Directory of Open Access Journals (Sweden)

    Juan D. Martínez-Vargas

    2011-06-01

    Full Text Available En el presente trabajo se propone una metodología para la reducción de dimensión en representaciones tiempo frecuencia (TFRs enfocada a la clasificación de bioseñales no estacionarias, que trata directamente su cantidad de datos irrelevantes y redundantes, combinando una etapa de selección de características con una etapa de reducción de dimensión por medio de métodos de descomposición lineal extendidos a datos bidimensionales. La metodología se prueba sobre un conjunto de TFRs paramétricas calculadas sobre una base de datos de señales fonocardiográficas (FCG para la detección de soplos cardiacos. Los resultados muestran una mejora comparados con otras metodologías que no tienen en cuenta la presencia de datos irrelevantes y redundantes en las representaciones, además, el uso de las metodologías de descomposición lineal bidimensionales reducen adecuadamente la redundancia de las TFRs, obteniendo un nuevo conjunto de características 2D de menor dimensión que el conjunto inicial.

  18. Welding by submerged arc of steel with addition of iron powder; Soldagem por arco submerso de aco microligado com adicao de po de ferro

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Samuel I.N.; Spinelli, Dirceu [Sao Paulo Univ., Sao Carlos, SP (Brazil). Escola de Engenharia; Souza, Paulo C.R. D. de [SICOM Compressores Ltda., Sao Carlos, SP (Brazil); Magalhaes Bento Goncalves, Gilberto de [Bauru Univ., SP (Brazil)

    1993-12-31

    Welding metals with and without iron powder addition were produced in steel plates ASTM A 242 by submerged arc process. as a conclusion, the mechanical properties of hardness and toughness of weld metal and heat affect zone were more affected when the welding were done with lower heat input. (author). 16 refs., 3 figs., 9 tabs.

  19. Analysis of decarburization in RH process of vacuum degasification; Analise da descarburacao do aco no processo rh de desgaseificacao a vacuo

    Energy Technology Data Exchange (ETDEWEB)

    Souza Costa, Sergio L. de; Oliveira Barros, Hudson N. de; Almeida, Claudio X [USIMINAS, Ipatinga, MG (Brazil). Centro de Pesquisas

    1990-12-31

    USIMINAS has made significant progress in the development of technology to produce ultra low carbon steels using the RH vacuum degassing unit in its number 1 BOF Shop. The decarburization rate is controlled by the circulation rate of liquid steel. On substituting conventional legs with oval shaped legs the circulation rate increased from 40 t/min to 80 t/min with a consequent increase in the global decarburization constant from 0.13 min{sup -1} to 0.28 min{sup -1}. With those practice it has been possible to achieve carbon levels as low as 45 ppm in ten minutes. (author). 5 refs., 8 figs., 2 tabs.

  20. Registro Español de Trasplante Cardíaco. XXIII Informe Oficial de la sección de Insuficiencia Cardíaca y Trasplante Cardíaco de la Sociedad Española de Cardiología (1984–2011

    Directory of Open Access Journals (Sweden)

    Luis Almenar

    2012-07-01

    Conclusiones: La supervivencia obtenida en España con el TC, sobre todo en los últimos años, sitúa al TC como el tratamiento de elección para cardiopatías irreversibles en situación funcional avanzada y sin otras opciones médicas o quirúrgicas establecidas.

  1. Validation of methods for WDXRF and OES-spark techniques in steel analysis. Determination of the uncertainty of measurements for API steel plant sample; Validacao de metodos para as tecnicas de WDXRF e OES-spark na analise de acos. Calculo de incerteza de medicao para amostras de processo, aco classe API

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Carlos Eduardo da

    2009-07-01

    The increase of gas and petroleum demanding in the national and international markets, the specification and certification of the chemical analysis results of gas and oil pipe-line have became more and more challenging. A continuous development has been outlined to improve API grade alloy steels (American Petroleum Institute). The steel properties depend on the chemical composition control and process parameters during its manufacturing. In this work, a comparison of the measurement uncertainty between X-ray fluorescence (WD system) and Optical Emission (OES-spark) spectrometry, for API grade steel plant samples analysis, was outlined. Usually, this kind of analyze requires less than 40 seconds for full chemical characterization for adjustment in the process parameters production. The main influence source in the chemical analysis was evaluated for design of experiments. The constituents and trace elements such as Al, Si, P, S, Ti, V, Cr, Mn, Co, Ni, Cu, As, Nb, Mo and Sn were determined using the ASTM E-322, E-415, E-1009 and E-1085 standard methodologies. The 185A and 187A certified reference materials from CMI (Czech Metrology Institute) were used for evaluation of the methods. The uncertainty of the measurement, precision, accuracy, repeatability and reproducibility of the measurements were obtained applying statistic tests, recommended by ISO/IEC 17025. The uncertainty of measurement for each element is discussed for both techniques. (author)

  2. Ferrite re-crystallization kinetics on a C-Mn steel and on two micro alloyed steels after dual-phase strain; Cinetica de recristalizacao da ferrita em um aco C-Mn e dois acos microligados apos deformacao na regiao bifasica

    Energy Technology Data Exchange (ETDEWEB)

    Simieli, Eider A. [Instituto de Pesquisas Tecnologicas (IPT), Sao Paulo, SP (Brazil)

    1991-12-31

    Ferrite recrystallization was investigated in two micro alloyed steels deformed in the inter critical range. A reference steel was also used, which had a composition of 0,06% C and 1,31% Mn. (author). 15 refs., 7 figs., 3 tabs.

  3. O paciente portador de marcapasso cardíaco e a repercussão em seu estilo de vida El Paciente Portador de Marcapaso Cardíaco y la Repercusión en su Estilo de Vida Cardiac Pacemaker Bearer Pacient and the Repercussion in the Lifestyle

    Directory of Open Access Journals (Sweden)

    Mirna Albuquerque Frota

    2007-06-01

    Full Text Available Objetivou-se discutir a repercussão no estilo de vida do paciente portador de marca-passo. Os informantes foram sete usuários que se submeteram ao implante de marca-passo definitivo no Hospital de Messejana - CE, Brasil, de maio a junho de 2004. A análise dos dados foi desenvolvida a partir da categorização dos conteúdos das entrevistas, emergindo como resultado duas categorias temáticas: condições de vida mediante a descoberta da doença e repercussão do autocuidado no estilo de vida no contexto da promoção da saúde. Conclui-se que há necessidade de formar equipes multiprofissionais para atuar com estratégias em educação em saúde, ampliando e divulgando a utilização do marca-passo definitivo, e objetivando a adesão destas pessoas à prática do autocuidado.El objetivo fue discutir la repercusión en el estilo de vida del paciente portador de marcapaso. Los informantes fueron siete usuarios que se sometieron al implante de marcapaso definitivo en el Hospital de Messejana Ceará (Brasil, entre mayo y junio de 2004. El análisis de los datos se desarrolló a partir de la categorización de los contenidos de las entrevistas, surgiendo como resultado dos categorías temáticas: Condiciones de vida mediante el descubrimiento de la enfermedad y repercusión del autocuidado en el estilo de vida en el contexto de la promoción de la salud. Se concluyó que existe la necesidad de formar equipos multiprofesionales para actuar con estrategias en Educación para la Salud, ampliando y divulgando la utilización del marcapasos definitivo, con el objetivo de que estas personas adhieran a la práctica del autocuidado.This study aimed to discuss the repercussion in the lifestyle of the pacemaker bearer patient. The informants were seven patients that were submitted to the definitive pacemaker implant in the Messejana Hospital Ceára (Brazil, from May to June 2004. The data analysis was developed from the categorization of the interviews contents, emerging as a result two thematic categories: life conditions because of the disease discovery and self-care repercussion in the lifestyle change in the context of the health promotion. It is concluded the need of forming multi-professional teams to act in strategies in Health Education, enlarging and publishing the use of the definitive pacemaker, aiming at these people's adherence for the similar self-care.

  4. Electro-economic, environmental and social consequences in the efficient abatement of a hydroelectric plant (C. H. Santa Rosa, CFE-ACO); Consecuencias electro-economicas, ambientales y sociales del abatimiento eficiente de una central hidroelectrica (C. H. Santa Rosa, CFE-ACO)

    Energy Technology Data Exchange (ETDEWEB)

    Narvaez Perez, Camilo; Garcia Conejo, Dante Aristoteles [Comision Federal de Electricidad, Centro Nacional de Control de Energia, Area de Control Occidental, Zapopan, Jalisco (Mexico)]. E-mail: camilo.narvaez@cfe.gob.mx; camilo.narvaez@univa.mx; Narvaez Perez, Claudia Universidad de Guadalajara, Zapopan, Jalisco [Mexico]). E-mail: claudia_narvaez@hotmail.com; Blanco Gomez, Cesar Eduardo [Comision Federal de Electricidad, Centro Nacional de Control de Energia, Area de Control Occidental, Zapopan, Jalisco (Mexico)

    2013-03-15

    Renewable energy systems, like hydroelectric generation system gives electric energy, in reliable economic, it takes care with environment, and growths the society, if the hydroelectric dam is suitably drained in non rainy season, if we consider, flow rate in its river, rain, thunderstorms and floods, dam's size, load shape per day, generators capacity unit and the flow in turbines, generating units maintenance and other necessities like irrigation crops in farms. In this research we propose a new methodology about hydroelectric dam drained in non rainy season. But in rainy season, you can consider this methodology with few changes and you would obtain satisfactory results. The methodology is used since 2010 in the Area de Control Occidental in the Comision Federal de Electricidad with results compared with data from previous years, in which different methodologies were applied. [Spanish] Los sistemas de energias renovables, como los complejos hidroelectricos impactan de manera electrica, economica, ambiental y social, siempre y cuando se realice adecuadamente el abatimiento de la presa en el estiaje, considerando, el aporte del cauce, las lluvias aun siendo escasas, el tamano del embalse, la demanda horaria de la carga abastecida, el tamano de los generadores y su gasto turbinado, los mantenimientos de las unidades, las necesidades hidraulicas aguas abajo y demas imponderantes. En esta investigacion se propone una metodologia de abatimiento de presas de centrales hidroelectricas en estiaje. Y para tiempo de lluvias se aplica la metodologia con variantes pequenas y con resultados satisfactorios. La metodologia es utilizada desde el 2010 en el Area de Control Occidental de la Comision Federal de Electricidad, con resultados comparados con los datos de los anos anteriores, en los cuales se aplicaron metodologias diversas.

  5. The correlation between accelerated and field corrosion tests performed in carbon steel and weathering steel coupons, coated and non-coated; Correlacao entre ensaios acelerados e ensaios de campo em corpos-de-provas de aco carbono e aco patinavel, sem e com revestimento

    Energy Technology Data Exchange (ETDEWEB)

    Antunes, Renato Altobelli

    2002-07-01

    The performance of four different organic coating systems applied to carbon and weathering steel coupons has been assessed in this investigation. applied on the surface of carbon steel and weathering steel coupons. The coupons have been evaluated using five different tests, three field tests and two accelerated tests. The field tests were carried out at three atmospheric stations, located at COSIPA in Cubatao-SP, at Alto da Serra in Cubatao-SP and at Paula Souza in Sao Paulo city. The accelerated tests consisted of (a) exposure to alternate cycles of ultraviolet radiation/condensation combined with salt spray cycles (UVCON combined with Salt Spray) and of (b) exposure to alternate cycles of ultraviolet radiation/condensation combined with the Prohesion test. The performance of the coatings was assessed by visual observation and photographs, using a method based on ASTM D-610, ASTM D-714 and ASTM-1654 standards to rank them. The oxide phases formed on the surfaces of the non-coated specimens of carbon and weathering steels, exposed to the same tests performed with the coated specimens, were identified using three different techniques: X-ray diffraction, Raman microscopy and Moessbauer spectroscopy. In the field tests, the specimens have been exposed for 1, 2, 3, 6 and 9 months. In the accelerated ones, the results were obtained after 1340 hours (4 cycles) test. The main component identified in all the specimens collected from the field tests and from the UVCON combined with the Prohesion test was lepidocrocite ({gamma}-FeOOH). Goethite ({alpha}-FeOOH ) and magnetite (Fe{sub 3}O{sub 4}) were identified as the other two main phases present in ali the specimens. In the UVCON combined with Salt Spray test, the dominant phase was magnetite, followed by goethite and lepidocrocite. The morphology of the rust formed on the specimens was examined by scanning electron microscopy (SEM). Structures corresponding to goethite and lepidocrocited were recognized on ali specimens, except those exposed to the UVCON combined with Salt Spray testo In this case, the structures corresponding to the phases magnetite and goethite were more frequently observed than that of lepidocrocite. The weathering steel specimens, in general, presented a more compact and less porous rust layer, than that of the carbon steel specimens. The atmosphere of the COSIPA station can be considered to be the most aggressive one compared to that of Alto da Serra and Paula Souza stations, because the oxide layer on its specimens was more irregular and porous than that on the specimens exposed at the other two stations. In the specimens from the Paula Souza station, the oxide layer was found to be more compact, and its atmosphere can be considered to be the least aggressive of the three locations. (author)

  6. The Hidden Roles That Management Partners Play In Accountable Care Organizations.

    Science.gov (United States)

    Lewis, Valerie A; D'Aunno, Thomas; Murray, Genevra F; Shortell, Stephen M; Colla, Carrie H

    2018-02-01

    Accountable care organizations (ACOs) are often discussed and promoted as driven by physicians, hospitals, and other health care providers. However, because of the flexible nature of ACO contracts, management organizations may also become partners in ACOs. We used data from 2013-15 on 276 ACOs from the National Survey of Accountable Care Organizations to understand the prevalence of nonprovider management partners' involvement in ACOs, the services these partners provide, and the structure of ACOs that have such partners. We found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards. Among ACOs with partners, 94 percent had data services provided by the partner, 87 percent received administrative services, 68 percent received educational services, and 66 percent received care coordination services. Half received all four of these services from their partner. ACOs with partners were more heavily primary care than other ACOs. ACOs with and without partners had similar performance on costs and quality in Medicare ACO programs. Our findings suggest that management partners play a central role in many ACOs, perhaps supplying smaller and physician-run ACOs with services or expertise perceived as necessary for ACO success.

  7. 75 FR 57039 - Medicare Program; Workshop Regarding Accountable Care Organizations, and Implications Regarding...

    Science.gov (United States)

    2010-09-17

    ... 2010), available at: http://www.law.berkeley.edu/files/chefs/Implementing_ACOs_May_2010.pdf . II... physicians or other professionals into ACOs, and we are interested in how these types of arrangements might... ACOs and participating physicians (and other participating suppliers or ACO professionals), or whether...

  8. INFRASTRUCTURAL MECHANISMS LEADING TOWARD PRO-ACCOUNTABLE CARE ORGANISATION ORIENTATION: A SURVEY OF HOSPITAL MANAGERS

    Science.gov (United States)

    Wan, Thomas T.H.; Masri, Maysoun Dimachkie; Ortiz, Judith

    2013-01-01

    Organisations across the country are transforming the way they deliver care, in ways similar to the accountable care organisation (ACO) model supported by Medicare. ACOs modalities are varying in size, type, and financing structure. Little is known about how specific infrastructural mechanisms influence hospital managers’ pro-ACO orientation. Using an electronic-survey of hospital managers, this study explores how pro-ACO orientation, as a latent construct, is captured from the perceptions of hospital managers; and identify infrastructural mechanisms leading to the formation of pro-ACO orientation. Of the total hospital respondents, 58% are moving toward the establishment of ACOs; 56% are planning to join in the next two years; 48% are considering joining ACOs; while 25% had already participated in ACOs during 2012. Urban hospitals are more likely than rural hospitals to be engaged in ACO development. The health provider network size is one of the strongest indicators in predicting pro-ACO orientation. PMID:25374609

  9. Survey on Recent Research and Implementation of Ant Colony Optimization in Various Engineering Applications

    Directory of Open Access Journals (Sweden)

    Mohan B. Chandra

    2011-08-01

    Full Text Available Ant colony optimization (ACO takes inspiration from the foraging behaviour of real ant species. This ACO exploits a similar mechanism for solving optimization problems for the various engineering field of study. Many successful implementations using ACO are now available in many applications. This paper reviewing varies systematic approach on recent research and implementation of ACO. Finally it presents the experimental result of ACO which is applied for routing problem and compared with existing algorithms.

  10. Identifying possible asthma-COPD overlap syndrome in patients with a new diagnosis of COPD in primary care

    DEFF Research Database (Denmark)

    Baarnes, Camilla Boslev; Kjeldgaard, Peter; Nielsen, Mia

    2017-01-01

    (ACOS wheeze) and/or significant BD reversibility (ACOS BD reversibility). Of 3,875 (50% females, mean age 57 years) subjects screened, 700 (18.1%) were diagnosed with COPD, i.e., symptom(s), tobacco exposure and chronic airflow obstruction. Indications for ACOS were found in 264 (38%) of the COPD...... of the applied ACOS definition, no significant difference in life-time tobacco exposure was found between ACOS- and COPD-only patients. In subjects with a new diagnosis of COPD, the prevalence of ACOS is high. When screening for COPD in general practice among patients with no previous diagnosis of obstructive...

  11. The new frontier of strategic alliances in health care: New partnerships under accountable care organizations.

    Science.gov (United States)

    Lewis, Valerie A; Tierney, Katherine I; Colla, Carrie H; Shortell, Stephen M

    2017-10-01

    Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form. We find that a striking percentage of ACOs - 81% - involve new partnerships between independent health care organizations. These "partnership ACOs" generally report lower capabilities on care management, care coordination, and health information technology. Additionally, under Medicare ACO programs partnership ACO achieved somewhat lower quality performance. Qualitative interviews revealed that providers are motivated to partner for resource complementarity, risk reduction, and legislative requirements, and are using a variety of formal and informal accountability mechanisms. Most partnership ACOs were formed out of existing, positive relationships, but a minority of ACOs formed out of previously competitive or conflictual relationships. Our findings suggests that the success of the ACO model will hinge in large part upon the success of new partnerships, with important implications for understanding ACO readiness and capabilities, the relatively small savings achieved to date by ACO programs, and the path to providers bearing more risk for population health management. In addition, ACO partnerships may provide an important window to monitor a potential wave of health care consolidation or, in contrast, a new model of independent providers successfully coordinating patient care. Copyright © 2017 Elsevier Ltd

  12. Medicare Accountable Care Organizations of Diverse Structures Achieve Comparable Quality and Cost Performance.

    Science.gov (United States)

    Comfort, Leeann N; Shortell, Stephen M; Rodriguez, Hector P; Colla, Carrie H

    2018-01-31

    To examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) is associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). Three waves of the National Survey of ACOs and corresponding publicly available Centers for Medicare & Medicaid Services performance data for NSACO respondents participating in the MSSP (N = 204); SK&A Office Based Physicians Database from QuintilesIMS. We compare the performance of three ACO types (physician-led, integrated, and hybrid) for three domains: quality, spending, and likelihood of achieving savings. Sources of performance variation within and between ACO types are compared for each performance measure. There is greater heterogeneity within ACO types than between ACO types. There were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year. There was evidence for higher spending on physician services for physician-led ACOs. ACOs of diverse structures perform comparably on core MSSP quality and spending measures. CMS should maintain its flexibility and continue to support participation of diverse ACOs. Future research to identify modifiable organizational factors that account for performance variation within ACO types may provide insight as to how best to improve ACO performance based on organizational structure and ownership. © Health Research and Educational Trust.

  13. The Economics of Medicare Accountable Care Organizations

    Science.gov (United States)

    Blackstone, Erwin A.; Fuhr, Joseph P.

    2016-01-01

    Background Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. Objective To examine whether the current Medicare ACOs are likely to be successful. Discussion Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. Conclusion The question remains whether Medicare ACOs can achieve the Triple Aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs. PMID:27066191

  14. Structural steels for fixed offshore platforms: technical challenges at the Brazilian national supply chain; Acos estruturais para plataformas fixas offshore: desafios tecnicos junto a cadeia de suprimentos nacional brasileira

    Energy Technology Data Exchange (ETDEWEB)

    Castro, Fabio Modesti Orsini de [Promon Engenharia Ltda., Rio de Janeiro, RJ (Brazil)

    2012-07-01

    This paper presents the main technical requirements for structural steel applied to the construction of bottom fixed offshore platforms, based on the most widely adopted and recognized actual standards. The mechanical properties and lab tests necessary to fulfill the Risk Management and E and P companies requirements are presented aiming to build the theoretical bases necessary for the engineering design of projects of this kind. The main types of steel available in the national market are presented at the end, giving an overall look at the Brazilian steel supply chain. (author)

  15. Evaluation of the potential of additives as corrosion inhibitors of CA-50 carbon steel used as reinforcement in concretes; Avaliacao da potencialidade de aditivos como inibidores de corrosao do aco carbono CA-50 usado como armadura de estruturas de concreto

    Energy Technology Data Exchange (ETDEWEB)

    Mennucci, Marina Martins

    2006-07-01

    In this work, various compounds were tested to evaluate their potential capability for their use as corrosion inhibitors of carbon steel reinforcement in concretes. The additives tested were sodium benzoate, polyethylene glycol, hexamethylenetetramine, benzotriazole and yttrium carbonate. Initially, exploratory tests were carried out to select the ones to be used as corrosion inhibitors, based on the inhibit ion efficiency determined from electrochemical tests, specifically polarization tests and electrochemical impedance spectroscopy. These tests were carried out in a solution composed of 0.01 N sodium hydroxide (NaOH) and 0.05 N potassium hydroxide (KOH) to simulate the composition of the solution inside the pores in concretes. The additive that presented the most promising potential to be used as corrosion inhibitor was benzotriazole (BTA). After the elimination of some compounds and selection of the additive with higher corrosion inhibit ion efficiency in the test medium, the effect of its concentration on the corrosion inhibition efficiency was evaluated. Sodium nitrite solutions with the same concentrations as those solutions with BTA were tested for comparison reasons. Sodium nitrite is a well established corrosion inhibitor for carbon steel reinforcement in concretes but it has been related to toxic effects. The BTA was associated to higher corrosion inhibition efficiencies than that of sodium nitrite in similar concentrations. A blackish adherent film was formed on the steel surface exposed to BTA solutions during long periods of immersion in the alkaline medium. The results suggest that BTA is a potential candidate for substitution of nitrites as corrosion inhibitor of reinforcements in concrete. (author)

  16. Obtaining and analysis of results of fatigue and corrosion-fatigue in steel API 5L X60; Obtencao e analise de resultados de fadiga e corrosao-fadiga em aco API 5L X60

    Energy Technology Data Exchange (ETDEWEB)

    Araujo, Bruno Allison [Universidade Federal de Campina Grande (UFCG), PB (Brazil). Programa de Pos-Graduacao em Ciencia e Engenharia de Materiais; Silva, Antonio Almeida; Santos, Fabio Gualberto Chagas [Universidade Federal de Campina Grande (UFCG), PB (Brazil)

    2008-07-01

    The corrosion process allied to the fatigue, due to repetitive efforts of several natures, is the main responsible for the damages in pipeline and offshore structures that results in the appears of located faults, and by the way can results in leaks and financial and environmental loss. This phenomenon calls corrosion-fatigue, however, it is very complex, and mainly, in what it concerns the form as this it develops in the structure. The objective of this work is to present some results of experimental fatigue tests and corrosion-fatigue accomplished with specimen that the material originated a pipeline steel API 5L X60. The tests developed in a machine which could test until 12 specimens per time. For test of corrosion-fatigue was used a cell-of-corrosion especially projected, in this way simulated an aggressive environmental condition in a corrosion conditions. With the results of tests, was possible estimate the fatigue limits of the specimen when submitted to the repeated flexing, and compare it with evaluate corrosion-fatigue graphs, that as the literature comes moved down of the curve, in relation to the fatigue curve. (author)

  17. Marca-passo cardíaco definitivo em crianças com bradicardia pós-operatória: resultados tardios Permanent cardiac pacing in children with postoperative bradycardia: long-term follow-up

    Directory of Open Access Journals (Sweden)

    Roberto Costa

    2005-12-01

    Full Text Available OBJETIVO: Avaliar a evolução tardia de crianças com marca-passo definitivo por bradicardia pós-operatória, e identificar fatores de risco para a mortalidade. MÉTODO: De 1980 a 2004, 120 crianças receberam implante de marca-passo definitivo por bradicardia pós-operatória. O intervalo médio entre a correção do defeito e o implante foi de 1,2 ± 2,8 anos, com mediana de 21 dias. Bloqueio atrioventricular esteve presente em 94,2% dos pacientes. A via de acesso transvenosa (78,3% e marca-passos (MP definitivos ventriculares (79,2% foram os mais utilizados. Empregou-se o método de Kaplan-Meier e o teste de Log-Rank para a análise de sobrevivência. RESULTADOS: Após 5,7 ± 5,9 anos de seguimento (máximo= 22,5 anos, 97 pacientes estavam vivos e 11 haviam sido perdidos para o seguimento. As principais causas de morte foram insuficiência cardíaca (10, infecção não relacionada ao marca-passo (seis e morte súbita (três. A expectativa de sobrevida aos cinco, 10 e 15 anos de seguimento mostrou, respectivamente, índices de 80,9 ± 4,1%, 75,4 ± 5,5% e 67,2 ± 7,4%. A persistência de problemas hemodinâmicos após a correção (correções paliativas, uso de próteses valvares ou defeitos residuais foi identificada como única variável preditora independente de risco para mortalidade, alterando significativamente as curvas de sobrevivência (p = 0,0123. CONCLUSÕES: O implante de marca-passo em casos de bradicardia pós-operatória possibilitou boa expectativa de sobrevida. A realização de correções paliativas, assim como a presença de defeitos residuais ou de próteses valvares, foram os únicos fatores preditores de mau prognóstico para essas crianças.OBJECTIVE: To evaluate the long-term outcomes of children submitted to permanent cardiac pacing due to postoperative bradycardia and to identify risk factors for mortality. METHODS: From 1980 to 2004, 120 children were submitted to permanent pacemaker (PM implantation. Interval between the defect correction and PM implantation was 1.2 ± 2.8 years, on average (median = 21 days. Atrioventricular blocks were present in 94.2% of patients. Transvenous leads (78.3% and ventricular pacemaker systems (79.2% were used in most of the cases. Risk factors were studied using the Cox proportional model. The Kaplan-Meier method and the Log-Rank test were used to analyze survival. RESULTS: After a mean of 5.7 ± 5.9 years (maximum = 22.5 years of follow-up, 97 patients were alive and 11 were lost from the follow-up study. The main causes of death were terminal heart failure (10, infection not related to implantation (six, and sudden death (three. The 5-, 10-, and 15-year survival rates were 80.9 ± 4.1%, 75.4 ± 5.5% and 67.2 ± 7.4%, respectively. The persistence of hemodynamic problems (palliative procedures, the use of valve prostheses or the presence of residual defects was identified as the only independent risk predictors for mortality, with significant alterations in the survival curves (p=0.0123. CONCLUSION: The implant of permanent pacemakers in children provided good survival expectancy, mainly depending on the underlying disease and the type of the correction made. Palliative corrections, such as the presence of residual defects or valve prostheses were the only predictors of poor results in these children.

  18. Effects of rolling orientation in the fracture behaviour of a hot rolled structural steel; Efeito da orientacao de laminacao no comportamento a fratura de um aco estrutural laminado a quente

    Energy Technology Data Exchange (ETDEWEB)

    Strohaecker, Telmo R; Bastian, Fernando L; Salles, Ricardo M. Correia; Vilarom, Alexandre B [Rio de Janeiro Univ., RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia

    1988-12-31

    The crack opening displacement (COD) testing method was used to evaluate the anisotropy of the fracture behaviour of a C-Mn (A36) structural steel. The values of COD at initiation, at maximum load and the resistance curve were obtained. The differences in fracture behaviour of the differently oriented samples was attributed to the orientation of the inclusion and the banding of the microstructure. Fractographic and metallographic analyses showed that there is a strong influence of banding on the fracture behaviour of the steel. 7 refs., 9 figs., 3 tabs.

  19. Study of corrosion resistance of AISI 444 ferritic stainless steel for application as a biomaterial; Estudo da resistencia a corrosao do aco inoxidavel ferritico AISI 444 para aplicacao como biomaterial

    Energy Technology Data Exchange (ETDEWEB)

    Marques, Rogerio Albuquerque

    2014-09-01

    Ferritic stainless steels are ferromagnetic materials. This property does not allow their use in orthopedic prosthesis. Nevertheless, in some specific applications, this characteristic is very useful, such as, for fixing dental and facial prostheses by using magnetic attachments. In this study, the corrosion resistance and cytotoxicity of the AISI 444 ferritic stainless steel, with low nickel content, extra-low interstitial levels (C and N) and Ti and Nb stabilizers, were investigated for magnetic dental attachments application. The ISO 5832-1 (ASTM F-139) austenitic stainless steel and a commercial universal keeper for dental attachment (Neo-magnet System) were evaluated for comparison reasons. The first stainless steel is the most used metallic material for prostheses, and the second one, is a ferromagnetic keeper for dental prostheses (NeoM). In vitro cytotoxicity analysis was performed by the red neutral incorporation method. The results showed that the AISI 444 stainless steel is non cytotoxic. The corrosion resistance was studied by anodic polarization methods and electrochemical impedance spectroscopy (EIS), in a saline phosphate buffered solution (PBS) at 37 °C. The electronic properties of the passive film formed on AISI 444 SS were evaluated by the Mott-Schottky approach. All tested materials showed passivity in the PBS medium and the passive oxide film presented a duplex nature. The highest susceptibility to pitting corrosion was associated to the NeoM SS. This steel was also associated to the highest dopant concentration. The comparatively low levels of chromium (nearly 12.5%) and molybdenum (0.3%) of NeoM relatively to the other studied stainless steels are the probable cause of its lower corrosion resistance. The NeoM chemical composition does not match that of the SUS444 standards. The AISI 444 SS pitting resistance was equivalent to the ISO 5832-1 pointing out that it is a potential candidate for replacement of commercial ferromagnetic alloys used in dental prosthesis. (author)

  20. Effect of shot peening treatment in the behavior of residual stress in duplex stainless steel during medium cycle fatigue; Efeito do tratamento de shot peening no comportamento das tensoes residuais em aco inoxidavel duplex durante fadiga de medio ciclo

    Energy Technology Data Exchange (ETDEWEB)

    Pedrosa, Peter D.S.; Rebello, Joao Marcos A. [Coordenacao dos Programas de Pos-Graduacao de Engenharia (PEMM/COPPE/UFRJ), Rio de Janeiro, RJ (Brazil). Programa de Engenharia Metalurgica e de Materiais; Fonseca, Maria P. Cindra, E-mail: mcindra@vm.uff.b [Universidade Federal Fluminense (PGMEC/UFF), Niteroi, RJ (Brazil). Escola de Engenharia. Programa de Pos-Graduacao em Engenharia Mecanica

    2010-07-01

    The lifetime of duplex stainless steel parts experiencing cyclic fatigue is directly influenced by the residual stresses present in the ferrite and austenite phases. The motivation for this work was to analyze the behaviour of the residual stresses fields introduced by shot peening treatment in both phases, in the sample surface as in the subsurface layers, in low fatigue cycles, using the X-rays diffraction technique. The results shows that the compressive residual stresses introduced by the shot peening treatment in both phases improved fatigue life of the material. However, the cyclical loads produce partial or total relief in these residual stresses fields. It was verified that the shot peening process induced the formation of microcracks only in the ferrite phase. The largest variations in the total compressive residual stresses fields also occurred in this phase. The samples surfaces were analyzed by scanning electron microscopy. (author)

  1. Effect of annealing temperature on microstructure of ferritic stainless steels with high Mo content; Efeito da temperatura de recozimento na microestrutura em acos inoxidaveis ferriticos com alto teor de Mo

    Energy Technology Data Exchange (ETDEWEB)

    Abreu, H.F.G.; Miranda, H.C. [Universidade Federal do Ceara (UFC), Fortaleza (Brazil). Dept. de Engenharia Metalurgica e de Materiais; Herculano, L.F.G. [Universidade Federal do Ceara (UFC), Fortaleza (Brazil). Lab. de Caracterizacao de Materiais; Tavares, S.S.M. [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil). Dept. de Engenharia Mecanica

    2006-07-01

    The petroleum refined in Brazilian refining plants is characterized by its high content of sulphur. This fact has increased problems related to naphtenic corrosion. It is known by the experience in refining that steels with high contents of Mo present good naphtenic corrosion resistance. This papers studied aspects referring to mechanical properties and microstructure of high Mo ferritic stainless steels developed in laboratory as a function of annealing temperature. Results showed that temperatures between 1000 and 1050 deg C were more suitable to the steels studied. (author)

  2. Effect of liquid phase sintering on the mechanical properties and corrosion resistance of infiltrated austenitic stainless steel; Efeito da sinterizacao com fase liquida sobre as propriedades mecanicas e resistencia a corrosao do aco inoxidavel austenitico infiltrado

    Energy Technology Data Exchange (ETDEWEB)

    Machado, Cristine F. [Rio Grande do Sul Univ., Porto Alegre, RS (Brazil). Programa de Pos-graduacao em Engenharia Metalurgica e dos Materiais; Matos Dias, Arao de; Schaeffer, Lirio [Rio Grande do Sul Univ., Porto Alegre, RS (Brazil). Centro de Tecnologia. Lab. de Metalurgia do Po

    1996-12-31

    First, this work presents some considerations on the properties and corrosion resistance of the stainless steels and its relation with porosity. The infiltration technique of copper into compacted steels is presented as an efficacy alternative to improve both mechanical properties and corrosion resistance. In experimental development, it was carried out mechanical tests with stainless steel AISI 316 L to ratify the copper infiltration effects on the yield stress of the material, and corrosion tests in salt spray. The results confirm a considerable improvement in properties on the whole to infiltrated stainless steel. (author) 18 refs., 8 figs., 4 tabs.

  3. Prevalence of nursing diagnosis of decreased cardiac output and the predictive value of defining characteristics in patients under evaluation for heart transplant Prevalencia del diagnóstico de enfermería de disminución del gasto cardíaco y valor predictivo de las características definidoras en pacientes en fase de evaluación para trasplante cardíaco Prevalência do diagnóstico de enfermagem de débito cardíaco diminuído e valor preditivo das características definidoras em pacientes em avaliação para transplante cardíaco

    OpenAIRE

    Lígia Neres Matos; Tereza Cristina Felippe Guimarães; Marcos Antônio Gomes Brandão; Deyse Conceição Santoro

    2012-01-01

    The purposes of the study were to identify the prevalence of defining characteristics (DC) of decreased cardiac output (DCO) in patients with cardiac insufficiency under evaluation for heart transplantation, and to ascertain the likelihood of defining characteristics being predictive factors for the existence of reduction in cardiac output. Data was obtained by retrospective documental analysis of the clinical records of right-sided heart catheterizations in 38 patients between 2004 and 2009....

  4. 151. Paciente con implantación de oxigenador de membrana extracorpórea para traslado a un centro de referencia donde se implanta asistencia biventricular como puente al trasplante cardíaco

    Directory of Open Access Journals (Sweden)

    J.A. Sarralde

    2012-04-01

    Conclusiones: El sistema ECMO está indicado para el traslado de pacientes en shock cardiogénico entre hospitales de una misma región e incluso de una comunidad a otra. La asistencia biventricular permite el mantenimiento y la mejoría significativa del paciente para incluirlo en lista y trasplantarlo en las mejores condiciones.

  5. Effect of sigma phase in the repassivation potential of austenitic-ferritic stainless steel SEW 410 Nr. 14517; Efeito da fase sigma no potencial de repassivacao do aco inoxidavel austeno-ferritico SEW 410 Nr. 14517

    Energy Technology Data Exchange (ETDEWEB)

    Itman Filho, A.; Pimenta, C.C.; Santos, C.M.L. [Instituto Federal do Espirito Santo, Vitoria (Brazil)], e-mail: andrei@ifes.edu.br; Casteletti, L.C. [Escola de Engenharia de Sao Carlos - EESC/USP, SP (Brazil)

    2010-07-01

    The austenitic-ferritic stainless steels, due to the optimum compromise between mechanical properties and corrosion resistance, are being used in many applications, as chemical and oil industries. In the oil exploitation, the effect of erosion-corrosion in acid environment is responsible for the increment in the equipment maintenance costs. Regarding the interest in researches of deep water oil exploitation, the proposal of this study was to evaluate the effect of the heat treatment at 850 degree C of the austenitic-ferritic stainless steel SEW 410 Nr.14517. Microstructural characterizations, microhardness measurements of the phases and corrosion tests were accomplished to evaluate the samples. The pitting potential values were obtained by galvanostatic tests in H{sub 2}SO{sub 4} acid solution. The results showed that the volumetric percentages of sigma phase increased while the ferritic phase percentages decreased, when the heat treatment time increased. The sigma phase promoted hardness increase with little corrosion resistance decrease in the austenitic-ferritic stainless steel, too. (author)

  6. Characterization by X ray diffraction of deleterious phases precipitated in a super duplex stainless steel; Caracterizacao por difracao de raios X de fases deleterias precipitadas em aco inoxidavel superduplex

    Energy Technology Data Exchange (ETDEWEB)

    Pardal, Juan M.; Tavares, Sergio S. Maior; Fonseca, Maria P. Cindra; Montenegro, Talles Ribeiro, E-mail: juanpardal@vm.uff.b [Universidade Federal Fluminense (PGEMEC/UFF), Niteroi, RJ (Brazil). Programa de Pos-graduacao em Engenharia Mecanica; Dias, Antonio Jose N.; Almeida, Sergio L. de [Instituto Nacional de Tecnologia (INT), Rio de Janeiro, RJ (Brazil). Div. de Materiais Ceramicos e Metalicos. Lab. de Tecnologia de Materiais

    2010-07-01

    In this work the identification and quantification of deleterious phases in two super duplex stainless steels grade UNS S32750, with quite different grain sizes, was performed by X-ray diffraction. The materials were isothermally aged in the 800 . 950 deg C range. Direct comparison method was used to quantify the ferrite phase in each sample. The amount of deleterious phases ({sigma}, {chi} and {gamma}2) formed was calculated by the difference of the amount of ferrite phase measured in each specimen to the amount of ferrite initially measured in the un-aged steel. The results obtained give an useful contribution to the understanding of kinetics of deleterious phases precipitation in super duplex steels. (author)

  7. Plasma sintering of ferritic steel reinforced with niobium carbide prepared by high energy milling; Sinterizacao a plasma de aco ferritico reforcado com carbeto de niobio preparado por moagem de alta energia

    Energy Technology Data Exchange (ETDEWEB)

    Silva Junior, J.F. da; Almeida, E.O.; Gomes, U.U.; Alves Junior, C.; Messias, A.P. [Universidade Federal do Rio Grande do Norte (UFRN), Natal (Brazil). Lab. de Materiais Ceramicos e Metais Especiais; Universidade Federal do Rio Grande do Norte (UFRN), Natal (Brazil). Lab. de Processamento de Materiais por Plasma

    2010-07-01

    Plasma is an ionized gas where ions are accelerated from anode to cathode surface, where the sample is placed. There are a lot of collisions on cathode surface by ions heating and sintering the sample. High energy milling (HEM) is often used to produce composite particles to be used on powder metallurgy. These particles can exhibit fine particles and high phase dispersion. This present work aim to study ferritic steels reinforced with 3%NbC prepared by HEM and sintered on plasma furnace. Ferritic steel and NbC powders were milled during 5 hours and characterized by SEM, XRD and laser scattering. Then, these composite powders were compacted in a cylindrical steel die and then sintered in a plasma furnace. Vickers microhardness tests and SEM and XRD analysis were performed on sintered samples. (author)

  8. Surface enrichment with chrome and nitriding of IF steel under an abnormal glow discharge; Enriquecimento superficial com cromo e nitretacao do aco IF em descarga eletrica em regime anormal

    Energy Technology Data Exchange (ETDEWEB)

    Meira, S.R.; Borges, P.C., E-mail: sabrina.r.meira@gmail.com [Universidade Tecnologica Federal do Parana (UTFPR), Curitiba, PR (Brazil). Grupo de Materiais; Bernardelli, E.A. [Instituto Federal do Parana (IFPR), Paranagua, PR (Brazil). Laboratorio de Materiais

    2014-07-01

    The objective of this work is to evaluate the influence of surface enrichment of IF steel with chrome, and nitriding, the formation of the nitrided layer. Thus, IF steel samples were subjected to surface enrichment process, using 409 stainless steel as a target for sputtering, followed by plasma nitriding, both under a dc abnormal glow discharge. The enrichment treatment was operated at 1200 ° C for 3h. The nitriding treatment was operated at 510 ° C for 2 h. The influence of the treatments on the layers formed was studied through optical microscopy (OM), scan electron microscopy (SEM), X-ray diffraction (XRD) and Vickers microindentation. The results show that the enrichment is effective to enrich the IF surface, furthermore, improves the characteristics of nitriding, comparing nitriding samples to nitriding and enriched, was observed needles of nitrides, as well as a higher hardness, which is associated with the nitrides of chrome, on the nitriding and enriched samples. (author)

  9. Utilization of aluminum to obtaining a duplex type stainless steel using high energy ball milling; Obtencao de um aco inoxidavel de estrutura duplex do sistema FeMnAl processado por moagem de alta energia

    Energy Technology Data Exchange (ETDEWEB)

    Pavlak, I.E.; Cintho, O.M., E-mail: eng.igorpavlak@yahoo.com.b [Universidade Estadual de Ponta Grossa (UEPG), PR (Brazil); Capocchi, J.D.T. [Universidade de Sao Paulo (USP), SP (Brazil)

    2010-07-01

    The obtaining of stainless steel using aluminum in its composition - FeMnAl system, has been researches subject since the sixties, by good mechanical properties and resistance to oxidation presented, when compared with conventional FeNiCr stainless steel system. In another point, the aluminum and manganese are low cost then traditional elements. This work, metallic powders of iron, manganese and pure aluminum, were processed in a Spex type high-energy ball mill in nitrogen atmosphere. The milling products were compressed into pastille form and sintered under inert atmosphere. The final products were characterized by optical and electronic microscopy and microhardness test. The metallographic analysis shows a typical austenite and ferrite duplex type microstructure. The presence of these phases was confirmed according X ray diffraction analysis. (author)

  10. Evaluación de la validez y fiabilidad de un cuestionario específico de calidad de vida relacionada con la salud en celíacos de 8-18 años.

    OpenAIRE

    Barrio Torres, Josefa

    2016-01-01

    Tesis Doctoral leída en la Universidad Rey Juan Carlos de Madrid en 2015. Directores de la Tesis: Angel Gil Miguel, Enriqueta Román Riechmann y Mª Luz Cilleruelo La enfermedad celíaca (EC) es una enfermedad sistémica mediada por el sistema inmune y ocasionada por el gluten y las prolaminas relacionadas que se produce en individuos genéticamente predispuestos. Cursa con una atrofia de las vellosidades intestinales de la mucosa del intestino delgado superior y como consecuencia s...

  11. Soplos cardíacos fisiológicos y patológicos en el caballo de deporte. Su diagnóstico diferencial Physiological and pathological cardiac murmurs in the sport of horse. Its differential diagnosis

    OpenAIRE

    G Pidal; C.H Lightowler

    2010-01-01

    Los autores describen las pautas utilizadas para mejorar el diagnóstico diferencial entre los soplos patológicos y los soplos fisiológicos en el caballo, particularmente en los utilizados en deportes ecuestres. Asimismo, presentan la incidencia encontrada en la población estudiada de los soplos funcionales según válvula afectada y uso del caballo. Finalmente hace referencia al "error diagnóstico" en la clasificación de los soplos (patológicos / fisiológicos) cuando son estudiados por medio de...

  12. Análisis y procesamiento de la señal auscultada del corazón para el diagnóstico presuntivo de soplos cardíacos y arritmia cardíaca

    OpenAIRE

    García Cedeño, Andrea Estefanía

    2017-01-01

    El presente documento detalla los procedimientos realizados para la elaboración de este proyecto, mismo que consta de dos fases: la adquisición de la señal, y la identificación del signo clínico y la patología en cuestión. Los resultados obtenidos son alentadores ya que finalmente se obtuvo un valor de sensibilidad del 80% y de especificidad del 91%. This document details the procedures performed for the development of this project, which consists of two phases: the acquisition of the sign...

  13. Evaluation of non-conformities of hip prostheses made of titanium alloys and stainless steel; Avaliacao de nao conformidades de proteses de quadril fabricadas com ligas de titanio e aco inox

    Energy Technology Data Exchange (ETDEWEB)

    Bezerra, Ewerton de Oliveira Teotonio; Nascimento, Jose Jeferson da Silva; Luna, Carlos Bruno Barreto; Morais, Crislene Rodrigues da Silva; Campos, Karla Valeria Miranda de, E-mail: ewerton.teotonio@hotmail.com, E-mail: brunobarretodemaufcg@hotmail.com [Universidade Federal de Campina Grande (UAEMa/CCT/UFCG), PB (Brazil). Unidade Academinca de Engenharia de Materiais

    2017-01-15

    A large number of metallic alloys has satisfactory behavior when used to manufacture implants for hip prostheses. However, they must be in conformity with standards, to ensure their quality for long periods without losing its functionality. Therefore, this paper aims to study the non-conformities in two hip prostheses, one of titanium and other stainless steel according to standards. The implants studied passed by X-ray diffraction (XRD), X-ray fluorescence, tensile test and optical microscopy (OM). Specimens for the tensile test were made according to ASTM E 8M, as well, MO samples passed by metallographic procedure. The results evidenced that some chemical compositions showed in relation to the standards. The XRD analysis showed peaks of austenite and absence of ferrite for the stainless steel, while the titanium alloy presents an alpha phase (HCP) more significant than the beta phase (BCC). The stainless steel alloys and titanium have yield strength and tensile strength that meet the standards. On the other hand, the elastic modulus of the titanium alloy and stainless steel, comes to be ten times greater than the human bone. Therefore, the high modulus of elasticity of the alloys, favors bone resorption problems. The stainless steel microstructure is typical of an austenitic matrix, while the titanium alloy presents α + β microstructure. (author)

  14. Study of residual stresses generated in P91 pipe steel welded by MCAW / FCAW processes; Estudo das tensoes residuais geradas na soldagem de tubulacao de aco P91 pelos processos MCAW/FCAW

    Energy Technology Data Exchange (ETDEWEB)

    Chuvas, Tatiane C.; Pardal, Juan M.; Garcia, Pedro P.; Souza, Guttemberg C. de; Fonseca, Maria P. Cindra, E-mail: chuvas@vm.uff.br [Universidade Federal Fluminense (PGMEC/UFF), Niteroi, RJ (Brazil). Departamento de Engenharia Mecanica; Cardote, Ismael [UTC Engenharia S/A, Niteroi, Rio de Janeiro, RJ (Brazil)

    2014-07-01

    The welding is one of the main industrial manufacturing processes structures and piping, knowledge of residual stress from this process is of paramount importance because the mechanical properties of welded components are not only determined by the microstructures present in the joint, but also by residual stresses heterogeneous introduced by thermal cycling during the process. The aim of this work is the characterization ASTM P91 joints welded by MCAW / FCAW (Metal Cored Arc Welding / Flux Cored Arc Welding) processes through the residual stresses evaluating associated with welding and post-weld heat treatments. Residual stresses were measured using X-rays diffraction sin2psi method, with Crκα radiation and they presented tensile at the root joints with larger magnitudes in the weld metal region and compressive on the surface. The post weld heat treatment resulted relief of residual stresses at the root of the joints. However, the same effect was observed in compressive surface stresses, which could adversely affect the service life of the pipe, reducing the fatigue and stress corrosion cracking resistances. (author)

  15. Hardness and microstructural characterization of API 5L X70 steel pipes welded by HF/ERW process; Caracterizacao microestrutural e de dureza em tubos de aco API 5L X70 soldados pelo processo HF/ERW

    Energy Technology Data Exchange (ETDEWEB)

    Calcada, Mauricio Vieira; Voorwald, Herman Jacobus Cornelis; Nascimento, Marcelino Pereira do [UNESP, Guaratingueta, SP (Brazil). Faculdade de Engenharia

    2010-07-01

    The materials that stand in the manufacture of steel pipes are called API, that should have, high mechanical resistance, high corrosion resistance, high fatigue resistance, good weldability, and other properties. Thus, the purpose of this project was to evaluate the microstructure and hardness of welded joints by the HF/ERW process of API 5L X70 steel pipes. The microstructural analysis was performed using a surface finish with grit sizes from 220 to 25 {mu}m e polishing with diamond paste from 9 {mu}m to 0.05 {mu}m; the revelation was made with 3% Nital attack. The Vickers hardness was performed across the welded joint by 33 points to indentation. The results were: 80.5 {+-} 3.4% of ferrite and 19.5 {+-} 3.4% of perlite for microanalysis. As for hardness, the values were: 215.69 HV10 for weld line, 218.65 HV10 for ZTA and 218.95 HV10 for base metal. (author)

  16. Desarrollo de métodos cuantitativos de alto poder de detección de proteínas en alimentos : Certificación de alimentos destinados a enfermos celíacos

    OpenAIRE

    Doña, Vanina V.

    2009-01-01

    La enfermedad celíaca (EC) es una enteropatía crónica mediada por mecanismos inmunológicos, que se desencadena en individuos genéticamente susceptibles por la ingestión de un grupo de proteínas (llamadas prolaminas) presentes en trigo, cebada, centeno y avena (aunque se debate sobre la toxicidad de esta última). La activación del sistema inmune genera alteraciones histológicas típicas (atrofia vellositaria, hiperplasia de criptas) y funcionales en la mucosa intestinal, produciendo un síndrome...

  17. Fuel performance computer code simulation of steady-state and transient regimes of the stainless steel fuel rods; Simulacao com programas computacionais de desempenho do combustivel em regimes permanente e transiente de varetas combustiveis de aco inoxidavel austenitico

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Daniel de Souza

    2014-07-01

    The immediate cause of the accident at the Fukushima Daiichi nuclear plant in March 2011 was the meltdown of the reactor core. During this process, the zirconium cladding of the fuel reacts with water, producing a large amount of hydrogen. This hydrogen, combined with volatile radioactive materials leaked from the containment vessel and entered the building of the reactor, resulting in explosions. In the past, stainless steel was used as the coating in many pressurized water reactors (PWR) under irradiation and their performance was excellent, however, the stainless steel was replaced by a zirconium-based alloy as a coating material mainly due to its lower section shock-absorbing neutrons. Today, the stainless steel finish appears again as a possible solution for security issues related to the explosion and hydrogen production. The objective of this thesis is to discuss the performance under irradiation of fuel rods using stainless steel as a coating material. The results showed that stainless steel rods exhibit lower temperatures and higher fuel pellet width of the gap - coating the coated rods Zircaloy and this gap does not close during the irradiation. The thermal performance of the two fuel rods is very similar, and the penalty of increased absorption of neutrons due to the use of stainless steel can be offset by the combination of a small increase in the enrichment of U- 235 and changes in the size of the spacing between the fuel rods. (author)

  18. Hot deforming effect on the isothermal transformation of a steel for hot working schedules; Efeito da deformacao a quente sobre a transformacao isotermica de um aco para trabalho a quente

    Energy Technology Data Exchange (ETDEWEB)

    Mendonca Lima, Ricardo Fonseca de; Nogueira, Marcos Alexandre Stuart [Acos Villares SA, Rio de Janeiro, RJ (Brazil)

    1989-12-31

    The effect of hot deformation of austenite on its isothermal deformation at 645 deg C and on the final grain size, obtained after hardening, has been investigated. The deformation was given to compression with different degrees of reduction of the material. (author) 18 refs., 13 figs., 1 tab.

  19. Software for computers in the safety systems of nuclear power stations. Identical with IEC 45A(Central Office)88. Draft. Software fuer Rechner im Sicherheitssystem von Kernkraftwerken. Identisch mit IEC 45A(CO)88. Entwurf

    Energy Technology Data Exchange (ETDEWEB)

    1986-01-01

    The basic principles for the design of nuclear instrumentation as specifically applied to the safety systems of nuclear power plants have been interpreted in existing standards as the IAEA ''Safety Guide 50-SG-D3'' with a view to hardwired systems. This publication has been developed to interprete these principles for the utilization of digital systems - multiprocessor distributed systems as well as larger scale central processor systems - in the safety systems of nuclear power plants. It is important to note that this document establishes no additional functional requirements for safety systems. Areas which have been dealt with because of the unique nature of digital computer systems especially the software are: a) Established hardware criterea as far as they affect the software with care taken to account for the high degree of interdependency between hardware and software. b) A general approach to software development to assure the production of the highly reliable software required. c) A general approach to software verification and computer system validation. d) Procedures for software maintenance, modification and configuration control. The systems are in accordance with the German KTA regulation KTA 3501.2. (orig./HP).

  20. Effects of chemical composition and test parameters on the hot ductility of C-Mn-Al steels; Efeito da composicao quimica e parametros de ensaios sobre a ductilidade a quente de acos C-Mn-Al

    Energy Technology Data Exchange (ETDEWEB)

    Macedo, Marcelo C.S. de; Comineli, Osvaldo G; Pancieri, Jose G.P.; Oliveira, Maria A.L. de [Espirito Santo Univ., Vitoria, ES (Brazil). Dept. de Engenharia Mecanica; Souza Lima Cardoso, Geraldo I. de [Companhia Siderurgica de Tubarao (CST), Serra, ES (Brazil); Mintz, Barry [The City Univ., London (United Kingdom)

    1987-12-31

    The effects of Al content, as well as hot tensile test parameters on hot ductility of two C-Mn-Al steels are presented. Thermal cycle were carried out to study the influence of thermal oscillations during those compositions cooling, consisting of heating the samples up to a solubilization temperature, high enough to dissolve any phase which could possibly be present in the original ingot, and also to produce a coarser grain size. After 5 minutes at 1330 deg C, the steels were cooled in three different ways to reach test temperature and samples remain at this temperature for 5 minutes for stabilization before testing. Further, a preliminary comparison between hot ductility results, obtained when samples are molten and continuously cooled at two different rates, and those obtained for solution treated samples which are cooled at an intermediate cooling rate. For the two composition solution treated, a ductility was observed trough displaced from each other about 50 deg C, being the Al content the responsible for this difference. (author) 14 refs., 11 figs., 1 tab.

  1. Microstructural characterization of IF steel after severe plastic deformation via ARB and subsequent heat treatment; Caracterizacao microestrutural de um aco IF apos deformacao plastica severa via ARB e posterior recozimento

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, F.C.; Abrantes, A.L.A.; Lins, J.F.C., E-mail: cristinafo2@hotmail.co [Universidade Federal Fluminense (PPGEM/UFF), Volta Redonda, RJ (Brazil). Programa de Pos-graduacao em Engenharia Metalurgica

    2010-07-01

    This study aimed to evaluate the microstructural evolution of a titanium stabilized IF steel deformed to warm through the ARB process for 5 consecutive cycles and then annealing at 600 deg C for 1 h. The material was characterized with the aid of the techniques of scanning electron microscopy and electron backscatter diffraction (Electron Backscatter Diffraction - EBSD). An intense process of microstructural refinement was observed in the deformed material and the phenomenon of dynamic recovery was predominant. It can be concluded that the annealing of severely deformed material was not sufficient for a complete recrystallization of the microstructure. (author)

  2. Comparative experimental study of myocardial protection with crystalloid solutions for heart transplantation Estudo comparativo experimental da proteção miocárdica com soluções cristalóides para transplante cardíaco

    Directory of Open Access Journals (Sweden)

    Melchior Luiz Lima

    2012-03-01

    Full Text Available BACKGROUND: There is a growing need to improve myocardial protection, which will lead to better performance of cardiac operations and reduce morbidity and mortality. Therefore, the objective of this study was to compare the efficacy of myocardial protection solution using both intracellular and extracellular crystalloid type regarding the performance of the electrical conduction system, left ventricular contractility and edema, after being subjected to ischemic arrest and reperfusion. METHODS: Hearts isolated from male Wistar (n=32 rats were prepared using Langendorff method and randomly divided equally into four groups according the cardioprotective solutions used Krebs-Henseleit-Buffer (KHB, Bretschneider-HTK (HTK, St. Thomas-1 (STH-1 and Celsior (CEL. After stabilization with KHB at 37ºC, baseline values (control were collected for heart rate (HR, left ventricle systolic pressure (LVSP, maximum first derivate of rise left ventricular pressure (+dP/dt, maximum first derivate of fall left ventricular pressure (-dP/dt and coronary flow (CF. The hearts were then perfused at 10ºC for 5 min and kept for 2 h in static ischemia at 20ºC in each cardioprotective solution. Data evaluation was done using analysis of variance in completely randomized One-Way ANOVA and Tukey's test for multiple comparisons. The level of statistical significance chosen was PKHB>STH-1.INTRODUÇÃO: Existe crescente necessidade de aprimorar a proteção miocárdica, para melhor desempenho das operações cardíacas e diminuição da morbimortalidade. Portanto, o objetivo deste estudo foi comparar a eficácia da proteção miocárdica usando tanto solução cristaloide tipo intracelular como extracelular quanto ao desempenho do sistema de condução elétrica, contratilidade do ventrículo esquerdo e edema, após parada isquêmica e posterior reperfusão. MÉTODOS: Corações isolados de ratos Wistar foram montados em Langendorff e aleatoriamente divididos em quatro grupos. de acordo com as soluções cardioprotetoras utilizadas Krebs-Henseleit-Buffer (KHB, Bretschneider-HTK (HTK, St. Thomas-1(STH-1 e Celsior (CEL. Após a estabilização com KHB a 37ºC, valores basais (controle foram coletados para frequência cardíaca (FC, pressão sistólica do ventrículo esquerdo (PSVE, derivada máxima de aumento da pressão ventricular esquerda (+dP/dt, derivada máxima de queda da pressão ventricular esquerda (-dP/dt e fluxo coronariano (FCo. Os corações foram então perfundidos a 10ºC por 5 min e mantidos por 2 h em isquemia estática a 20ºC em cada solução cardioprotetora. Avaliação dos dados foi por análise de variância inteiramente casualizados em One-Way ANOVA e teste de Tukey para comparações múltiplas. O nível de significância estatística escolhido foi PKHB>STH-1.

  3. Study of API 5L X70 steel corrosion processes when in contact with some Brazilian soils; Estudo dos processos de corrosao de acos API 5L X70 em contato com alguns dos solos do Brasil

    Energy Technology Data Exchange (ETDEWEB)

    Jesus, Sergio Luis de

    2007-07-01

    Pipelines, fuel storage tanks and other metallic structures are in permanent contact and exposed to different types of soils, of horizons or layers, or of soil aggressiveness. This interaction may cause expressive damages to the environment and to the planned work. Contamination may occur due to leakage of stored products, splitting during transportation, accidents caused by pipelines without extensive maintenance. The result of these accidents could be, among others, some financial losses. In order to recognize the dynamic interactions between metallic surfaces and the environment it is crucial to have preventive actions and to develop better-applied materials. API steel 5L X70 has been used in structures of low and high pressure with high mechanical strength and corrosion and, even so, it is susceptible to etching corrosion since it is in contact with different environments from mangrove regions to industrial environments. The present case evaluated the role of 5L X70 API steel in contact with different soil horizons representative of the Brazilian soil. This investigation correlated chemical species with solute ions in soil solution, secondary and primary phase minerals besides physical and chemical characteristics as pH, electric conductivity, total dissolved solids, among others, to the results of corrosion resistance and ways of corrosion. The evaluation was carried out using x-ray diffractometry, scanning electron microscopy, total reflection x-ray fluorescence, fuel injection flow besides texture and gravimetric analyses to soil characterization and mineralogy, identification of corrosion products, soil solution analyses, evaluation of tested materials and classification of ways and types of corrosion. This was an attempt to integrate the data to a better understanding of the process involving reagents and products. The results showed that different soil horizons such as different types of analyzed soils produce specific etching in metallic structures showing this selectivity. The study also shows that these results can be readily obtained with soil solution as an analytical means in comparison with nowadays evaluations. (author)

  4. Study of the mechanical metallic coating properties on the steel used on sucker rods; Estudo das propriedades mecanicas de revetimentos mtalicos aplicados sobre o aco utilizado em hastes de bombeio

    Energy Technology Data Exchange (ETDEWEB)

    Santos, A.O.; Cavalcanti, E.B.; Cruz, M.C.P.; Souza, L.P. [Universidade Tiradentes, Aracaju, SE (Brazil). Inst. de Tecnologia e Pesquisa. Lab. de Energia e Materiais; Araujo, P.M.M. [Universidade Federal de Sergipe (UFS), Sao Cristovao, SE (Brazil). Nucleo de Engenharia Mecanica], e-mail: paubaumma@yahoo.com.br

    2008-07-01

    The mechanical properties of the steel carbon alloy coating with NiCr 80/20, NiCr 20/80, 95 MXC, aluminum and cupper had been studied about hardness and modulus of elasticity of coating. A time that the sucker rods will be submitted the efforts stress, is important that the applied coverings are not more rigid of what the steel carbon, because has problems of deformations in the material applied on the sucker rods. One observed that the coverings are less rigid than the steel carbon used on the sucker rods, presenting small modulus of elasticity to the ones of the sucker rods. This property is interesting for being to the sucker rods submitted the efforts stress and compression when in operation in the oil. With regard to the hardness, it was verified that the cupper and aluminum coating are less hard than the steel carbon, therefore more degradation to the consuming for abrasion. (author)

  5. Mechanical properties of API X80 steel pipe joints welded by Flux Core Arc Weld Process; Propriedades mecanicas de juntas de tubos de aco API X80 soldadas com arame tubulares

    Energy Technology Data Exchange (ETDEWEB)

    Ordonez, Robert E. Cooper; Silva, Jose Hilton F.; Trevisan, Roseana E. [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Engenharia Mecanica. Dept. de Engenharia de Fabricacao

    2003-07-01

    Flux Core Arc Welding processes (FCAW) are beginning to be applied in pipeline welds, however, very limited experimental data regarding mechanical properties of pipeline weld joints with these processes are available in the literature. In this paper, the effects of preheat temperature and type of FCAW on mechanical properties (microhardness and tensile strength) of API X80 weld joint steel are presented. FCAW processes with gas protection and self-shielded were used. Multipasses welding were applied in 30'' diameter and 0,625'' thickness tubes. Influence factors were: FCAW type and preheat temperature. Acceptance criteria of welded joints were evaluated by API 1104 standard for tensile strength test and ASTM E384-99 for microhardness test. The results obtained showed that FCAW type and preheat temperature have no influence on mechanical properties of API X80 joint steel. (author)

  6. Evaluation of the susceptibility to corrosion by pites of supermartensitic stainless steel with different superficial finishing; Avaliacao da susceptibilidade a corrosao por pites do aco inoxidavel supermartensitico com diferentes acabamentos superficiais

    Energy Technology Data Exchange (ETDEWEB)

    Freitas, Mario Jose Bueno de Souza

    2015-07-01

    The objective of this study is to evaluate the susceptibility by pitting corrosion in a supermartensitic stainless steel (13%Cr) with different surface finishes, in an environment that simulates the conditions found in the range of the Brazilian marine subsoil before the dense layer of salt - the so-called pre-salt. In this study were conducted electrochemical tests of potentiodynamic anodic polarization and electrochemical impedance spectroscopy (EIS) in environment containing 35, 50 and 190 g/L of NaCl and dissolved oxygen concentrations <10, 100 and 500ppb. Were also used the techniques of Moessbauer spectroscopy and EDS (Energy Dispersive Spectrometry) coupled to a scanning electron microscope (SEM) for microstructural characterization of 13%Cr steel. It was observed by the electrochemical tests, the increase in the concentration of chloride ions in solution makes the studied steel more susceptible to localized corrosion. It was also observed that the material showed less susceptibility to pitting corrosion when its surface was less rough. (author)

  7. Influência do treinamento físico aeróbio sobre os prejuízos metabólicos e cardíacos induzidos pelo estresse crônico em ratos

    OpenAIRE

    Andréa Sanches

    2016-01-01

    Resumo: O estresse crônico é um fator de risco para o desenvolvimento de hipertensão, aterosclerose e diabetes, e já demonstramos que o protocolo experimental de estresse crônico moderado e imprevisível (ECMI) é capaz de induzir resistência à insulina, dislipidemia, diminuição na produção de óxido nítrico, aumento da atividade do sistema renina-angiotensina e disfunção endotelial em ratos. Por outro lado, é vasta a literatura demonstrando que a prática regular de exercício físico é uma ferram...

  8. Machining tools in AISI M2 high-speed steel obtained by spray forming process; Ferramentas de usinagem em aco rapido AISI M2 obtido por conformacao por 'spray'

    Energy Technology Data Exchange (ETDEWEB)

    Jesus, Edilson Rosa Barbosa de. E-mail: erbjesus@usp.br

    2004-07-01

    The aim of the present work was the obtention of AISI M2 high-speed steel by spray forming technique and the material evaluation when used as machining tool. The obtained material was hot rolled at 50% and 72% reduction ratios, and from which it was manufactured inserts for machining tests. The performance of inserts made of the spray formed material was compared to inserts obtained from conventional and powder metallurgy (MP) processed materials. The spray formed material was chemical, physical, mechanical and microstructural characterised. For further characterisation, the materials were submitted to machining tests for performance evaluation under real work condition. The results of material characterisation highlight the potential of the spray forming technique, in the obtention of materials with good characteristics and properties. Under the current processing, hot rolling and heat treatments condition, the analysis of the results of the machining tests revealed a very similar behaviour among the tested materials. Proceeding a criterious analysis of the machining results tests, it was verified that the performance presented by the powder metallurgy material (MP) was slight superior, followed by conventional obtained material (MConv), which presented a insignificant advantage over the spray formed and hot rolled (72% reduction ratio) material. The worst result was encountered for the spray forming and hot rolled (50% reduction ratio) material that presented the highest wear values. (author)

  9. Sliding wear of steels (used in polished rods of oil pump jack) against polyurethane; Desgaste de deslizamento de acos (usados em hastes de unidade de bombeio de petroleo) contra poliuretano

    Energy Technology Data Exchange (ETDEWEB)

    Gois, Gelsoneide da Silva [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Engenharia de Materiais; Farias, Aline Cristina Mendes; Lima da Silva, Ruthilene Catarina; Medeiros, Joao Telesforo Nobrega [Universidade Federal do Rio Grande do Norte (PPGEM/UFRN), Natal, RN (Brazil). Programa de Pos-Graduacao em Engenharia de Materiais], e-mail: gelsoneidegg@yahoo.com.br, e-mail: alineastro@yahoo.com.br, e-mail: ruthilene@ufrnet.br, e-mail: medeirosj2@asme.org

    2008-07-01

    Accelerated sliding tests were carried out in the steels AISI 316, AISI 4140, AISI 1045 coated and AISI 4142 coated, in the dry and lubricated with contaminated oil with 10% SiO{sub 2} conditions. Each cylindrical counterbody with angular generatrix of polyurethane slid against a stationary metallic specimen. The contact pressure changed by increment of normal loads of 10,0 and 2,3 N, velocity of 0,91 m/s and distance of 12 km. The wear rates were calculated through of the mass variation from specimens after each test. The wear morphology was characterized by Optical and Scanning Electron Microscopy, where identified damages by abrasion at two and three bodies. The contaminated lubricant increase the wear rate due to action of the abrasive particles. (author)

  10. Evaluation of performance of AISI 444 steel for application in distillation towers; Avaliacao do desempenho do aco AISI 444 para aplicacao como 'lining' em torres de destilacao

    Energy Technology Data Exchange (ETDEWEB)

    Guimaraes, R.F.; Miranda, H.C. de; Farias, J.P. [Universidade Federal do Ceara (DEMM/UFC), Fortaleza, CE (Brazil). Dept. de Engenharia Metalurgica e de Materiais. Lab. de Caracterizacao de Materiais], e-mail: rf.guimaraes@yahoo.com.br

    2008-07-01

    In this work, the behavior of the AISI 444 ferritic stainless steel submitted to thermal fatigue test and their corrosion resistance in heavy crude oil was evaluated. The AWS E309MoL-16 and E316L-17 weld metal was employed as filler metal. Plates of the AISI 444 were welded on ASTM A-516 Gr. 60 plates and submitted to fatigue thermal cycle. Samples were extracted from plates welded and heat treated immersed in heavy crude oil at 300 deg C. Optical microscopy (OM), scanning electron microscopy (SEM) and energy dispersive of X-ray analysis (EDX) were used to characterize the microstructure and the corroded surface. The results show that the AISI 444 stainless steels did not present cracks after the thermal fatigue cycle and the heat treated immerse in heavy crude oil. The electrode AWS E309MoL-16 show better corrosion resistance than the AWS E316L-17. (author)

  11. Study of residual stresses in welded joints of dual phase HSLA steel used in automotive industry; Estudo das tensoes residuais em juntas soldadas de aco ARBL bifasico usado na industria automobilistica

    Energy Technology Data Exchange (ETDEWEB)

    Barbato, D.S.; Fonseca, M.P. Cindra; Marques Junior, A.S.; Chuvas, T.C.; Pardal, J.M., E-mail: mcindra@vm.uff.b [Universidade Federal Fluminense (PGMEC/UFF), Niteroi, RJ (Brazil). Programa de Pos-graduacao em Engenharia Mecanica; Berretta, J.R. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2010-07-01

    One way of weight reduction in automotive vehicles is through the use of high strength and low alloy (HSLA) steels, which enables the use of small thickness plates. Whereas the appearance of residual stresses is intrinsic to the welding process, this study evaluates the residual stresses generated in welded joints obtained by TIG and LASER welding processes and comparing them. Residual stresses were measured by X-rays diffraction technique, using a portable device with Cr{kappa}{alpha} radiation applying the double exposure method. It also evaluates the influence of shot peening treatment applied after welding, in the bend tests conducted for both welding conditions and TIG welded joints showed higher stability of compressive stresses after welding. The metallographic analysis by optical microscopy complemented the welded joints characterization. (author)

  12. Abordagem Anestésica na Síndrome de Kounis - Um Inimigo Cardíaco Pouco Conhecido: A Propósito de um Caso Clínico

    Directory of Open Access Journals (Sweden)

    Carolina Gonçalves

    2018-05-01

    Com esta publicação pretende-se fazer uma revisão teórica acerca da abordagem anestésica direcionada para esta síndrome dado que se trata de um tema re-cente, pouco conhecido e com envolvimento multidisciplinar (Anestesiologia, Cardiologia e Medicina Intensiva.

  13. Criteria and procedures for stability studies - adopted measures for improving system dynamic performance; Criterios e procedimentos para estudos de estabilidade - definicao de acoes para a melhoria do desempenho em regime transitorio e dinamico de sistemas de transmissao

    Energy Technology Data Exchange (ETDEWEB)

    Figueiredo, Erli F [FURNAS, Rio de Janeiro, RJ (Brazil); Fontoura, Roberto N [ELETROBRAS, Rio de Janeiro, RJ (Brazil); Souza, Luiz Gastao C [ELETROSUL, Curitiba, PR (Brazil); Barros, Joao Ricardo P. de [Companhia Hidroeletrica do Sao Francisco (CHESF), Recife, PE (Brazil); Aires, Joao C. de O. [Light Servicos de Eletricidade S.A., Rio de Janeiro, RJ (Brazil); Etrusco, Wellignton [Companhia Energetica de Sao Paulo (CESP), SP (Brazil); Rosa, Aciron B. de [Companhia Estadual de Energia Eletrica do Estado do Rio Grande do Sul (CEEE), Porto Alegre, RS (Brazil); Daldagan, Maria L [Companhia Paranaense de Energia (COPEL), Curitiba, PR (Brazil); Bastos, Jose R [Eletricidade de Sao Paulo, Sao Paulo, SP (Brazil); Yamamura, Paulo [ELETRONORTE, Belem, PA (Brazil); Luz, Ariosto [Companhia de Energia Eltrica da Bahia, Salvador, BA (Brazil); Oliveira, Elizabeth F [CELG (Brazil); Mello, Albert C.G. de [Centro de Pesquisas de Energia Eletrica (CEPEL), Rio de Janeiro, RJ (Brazil); Souza, Itamar [Centrais Eletricas de Santa Catarina S.A. (CELESC), Florianopolis, SC (Brazil); Oliveira, Amaury R.C. [Companhia Energetica de Minas Gerais (CEMIG), Belo Horizonte, MG (Brazil); Martins, Junior, Jose A [Companhia Paulista de Forca e Luz (CPFL), Campinas, SP (Brazil); Ferreira, Jose S [Espirito Santo Centrias Eletricas S.A. (ESCELSA), Vitotia, ES (Brazil); Molina, Jair M [Empresa Energetica do Mato Grosso do Sul S.A. (ENERSUL), Campo Grande, MS (Brazil); Pereira, Marcel J.A. [Centrais Eltricas do Para S.A. (CELPA); [Belem, PA (Brazil); Rocha Neto, Cassiano, C. [Companhia Energetica do Ceara (COELCE), Fortaleza, CE (Brazil); Coelho, Simone N [CELPE (Brazil); Silva, Robson P [CEAL (Brazil)

    1994-12-31

    This work presents criterion and proceedings to the analysis of the performance of AC and DC transmission systems point to point and multi-terminal, in dynamic and transient regime. (author) 9 refs., 2 figs., 2 tabs.

  14. Influencia de la reacticivad cardiovascular sobre la discriminación del latido cardíaco: implicaciones en la detección precoz de síntomas

    Directory of Open Access Journals (Sweden)

    P. QUIRÓS

    2004-01-01

    Full Text Available Una respuesta metabólicamente exagerada en personas jóvenes ante situaciones de estrés es considerada como un marcador de riesgo de una futura hipertensión. Asimismo, los autores que investigan las diferencias individuales en la percepción de síntomas consideran que una mayor percepción visceral puede estar asociada con un mejor reconocimiento de síntomas en aquellas personas que padecen enfermedades crónicas con manifestaciones sutiles o vagas, como por ejemplo, la hipertensión esencial. En consecuencia, este estudio examina la relación entre reactividad cardiovascular y percepción del latido cardiaco. Una muestra de 42 sujetos participó en dos sesiones experimentales: en la primera de ellas realizaron una tarea evocadora de reactividad cardiovascular, en la segunda una tarea de discriminación del latido cardiaco mediante el método de los estímulos constantes. La reactividad cardiovascular fue definida como la diferencia en puntuación entre una condición de línea base y la condición de tarea. Las variables fisiológicas en las que se midió la reactividad cardiovascular fueron el periodo cardiaco (PC, la presión arterial sistólica (PAS y la presión arterial diastólica (PAD. Si bien en el total de la muestra se encontraron diferencias significativas en todas las variables fisiológicas entre la condición de línea base y la condición de tarea, el grupo que logró discriminar el latido cardiaco no mostró una reactividad cardiovascular más elevada que el grupo que no logró discriminarlo, al menos en cuanto al periodo cardiaco y a la presión arterial se refiere.

  15. One safety critical indicators model for regulatory actions on nuclear power plants based on a level 1 PSA; Um modelo de indicadores criticos de seguranca para acoes regulatorias em usinas nucleares baseado em uma APS nivel 1

    Energy Technology Data Exchange (ETDEWEB)

    Araujo, Jefferson Borges

    2006-03-15

    This study presents a general methodology to the establishment, selection and use of safety indicators for a two loop PWR plant, as Angra 1. The study performed identifies areas considered critical for the plant operational safety. For each of these areas, strategic sub-areas are defined. For each strategic sub-area, specific safety indicators are defined. These proposed Safety Indicators are based on the contribution to risk considering a quantitative risk analysis. For each safety indicator, a goal, a bounded interval and proper bases are developed, to allow for a clear and comprehensive individual behavior evaluation. Additionally, an integrated evaluation of the indicators, using expert systems, was done to obtain an overview of the plant general safety. This methodology can be used for identifying situations where the plant safety is challenged, by giving a general overview of the plant operational condition. Additionally, this study can also identify eventual room for improvements by generating suggestions and recommendations, as a complement for regulatory actions and inspections, focusing resources on eventual existing weaknesses, in order to increase or maintain a high pattern of operational safety. (author)

  16. Construction of cardiac anthropomorphic phantom for simulation of radiological exams; Construção de fantoma antropomórfico cardíaco para simulação de exames radiológicos

    Energy Technology Data Exchange (ETDEWEB)

    Bandeira, C.K.; Vieira Neto, H., E-mail: cbandeira@alunos.utfpr.edu.br, E-mail: hvieir@utfpr.edu.br [Universidade Tecnológica Federal do Paraná (UTFPR), Curitiba (Brazil). Programa de Pós-Graduação em Engenharia Elétrica e Informática Industrial; Vieira, M.P.M.M., E-mail: michele.vieira@ifpr.edu.br [Instituto Federal do Paraná (IFPR), Curitiba, PR (Brazil). Curso Técnico em Radiologia

    2017-07-01

    Phantoms are simulating objects of structures of the human body and can be applied in the quality control and calibration of radiological equipment. The aim of the work is the development of a cardiac anthropomorphic phantom to assist in the elaboration of protocols of dynamic studies that demonstrate the blood circulation inside the cardiac chambers. For the construction of the phantom was used latex, applied in layers on an anatomical model of heart, having been constructed the cardiac chambers and atrioventricular valves. Cardiac chambers were connected to the cannulas for fluid injection and simulation of the circulatory system. The constructed phantom presents anthropomorphic characteristics and allows the circulation of the fluid without reflux, but the thickness of the catheters used does not yet allow flows of greater order of magnitude. This phantom has the potential to be used in the dynamic simulation of cardiac exams, contributing to the elaboration and adequacy of computed tomography protocols.

  17. Carbamazepine does not alter the intrinsic cardiac function in rats with epilepsy Carbamazepina não altera o funcionamento cardíaco intrínseco em ratos com epilepsia

    Directory of Open Access Journals (Sweden)

    Diego B Colugnati

    2010-08-01

    Full Text Available Among the causes for sudden unexpected death (SUDEP in epilepsy, the effects of antiepileptic drugs on the heart have been poorly explored. Based on this, the aim of our study was to evaluate the heart rate (in vivo and isolated ex vivo and ventricular pressure (isolated ex vivo of rats with and without epilepsy treated with carbamazepine. Four groups of adult, male Wistar rats (200-250 g were studied: [A] control rats (n=8, received neither pilocarpine nor carbamazepine [B] carbamazepine-treated rats (n=8, received a daily dose of 120 mg/Kg, i.p. of carbamazepine for two weeks; [C] rats with epilepsy that received just saline solution (n=8; [D] rats with epilepsy that received a daily dose of 120 mg/Kg, i.p. of carbamazepine for two weeks (n=8. Our results showed significant increase in heart rate in animals with epilepsy (with and without the use of carbamazepine when compared to the control groups in vivo. In contrast, we did not find differences during isolated ex vivo experiments comparing animals with and without epilepsy and despite the use of carbamazepine. Our results suggest that, in isolation, carbamazepine may not be a potential risk factor for sudden unexpected death in epilepsy.Entre as causas de morte súbita em epilepsia (SUDEPE, os efeitos das drogas antiepilépticas no coração têm sido pobremente explorados. Desta forma, o objetivo deste estudo foi avaliar a frequência cardíaca (in vivo e de forma isolada ex vivo e a pressão ventricular (de forma isolada ex vivo de ratos com e sem epilepsia tratados com carbamazepina. Quatro grupos de ratos Wistar machos adultos (peso 200 a 250 g foram estudados: [A] ratos controle (n=8, não receberam pilocarpina ou carbamazepina; [B] ratos tratados com carbamazepina (n=8, receberam dose diária de carbamazepina de 120 mg/kg intraperitoneal, durante duas semanas (n=8; [C] ratos com epilepsia que receberam solução salina; [D] ratos com epilepsia que receberam dose diária de carbamazepina de 120 mg/kg intraperitoneal durante duas semanas. Nossos resultados evidenciaram uma diferença estatisticamente significativa na média da freqüência cardíaca in vivo entre os animais com epilepsia (com e sem o uso de carbamazepina quando comparados aos grupos controles in vivo. Em contraste, não observamos diferenças estatísticas nos experimentos ex vivo quando comparados os animais com ou sem epilepsia, a despeito do uso da carbamazepina. Nossos resultados sugerem que, de forma isolada, a carbamazepina pode não ser um fator de risco potencial para a ocorrência de morte súbita em epilepsia.

  18. Main radiation protection actions for medical personnel as primary responders front of an event with radiological dispersive device; Principais acoes de protecao radiologica para equipe medica como primeiros respondedores frente a um evento com dispositivo de dispersao radiologica

    Energy Technology Data Exchange (ETDEWEB)

    Duque, Hildanielle Ramos

    2015-07-01

    After the terrorist attack in New York, USA, in 2001, there was a worldwide concern about possible attacks using radioactive material in conventional detonators, called as Radiological Dispersal Device (RDD) or 'dirty bomb'. Several studies have been and are being made to form a global knowledge about this type of event. As until now, fortunately, there has not been an event with RDD, the Goiania Radiological Accident in Brazil, 1987, is used as a reference for decision-making. Several teams with technical experts should act in an event with RDD, but the medical staffs who respond quickly to the event must be properly protected from the harmful effects of radiation. Based on the radiological protection experts performance during the Goiania accident and the knowledge from lessons learned of many radiological accidents worldwide, this work presents an adaptation of the radiation protection actions for an event with RDD that helps a medical team as primary responders. The following aspects are presented: the problem of radioactive contamination from the explosion of the device in underground environment, the actions of the first responders and evaluation of health radiation effects. This work was based on specialized articles and papers about radiological accidents and RDD; as well as personal communication and academic information of the Institute of Radiation Protection and Dosimetry. The radiation protection actions, adapted to a terrorist attack event with RDD, have as a scenario a subway station in the capital. The main results are: the use of the basic radiation protection principle of time because there is no condition to take care of a patient keeping distance or using a shielding; the use of full appropriate protection cloths for contaminating materials ensuring the physical safety of professionals, and the medical team monitoring at the end of a medical procedure, checking for surface contamination. The main conclusion is that all medical actions as primary responders must be followed up by radiation protection specialists. (author)

  19. Comparative study of AISI M3:2 high speed steel produced through different techniques of manufacturing; Estudo comparativo de acos rapidos AISI M3:2 produzidos por diferentes processos de fabricacao

    Energy Technology Data Exchange (ETDEWEB)

    Araujo Filho, Oscar Olimpio de

    2006-07-01

    In this work AISI M3:2 high speed steels obtained through different techniques of manufacturing, submitted to the same heat treatment procedure were evaluated by measuring their mechanical properties of transverse rupture strength and hardness. Sinter 23 obtained by hot isostatic pressing (HIP), VWM3C obtained by the conventional route and a M3:2 high speed steel obtained by cold compaction of water atomized powders and vacuum sintered with and without the addition of a small quantity of carbon were evaluated after the same heat treatment procedure. The vacuum sintered M3:2 high speed steel can be an alternative to the more expensive high speed steel produced by hot isostatic pressing and with similar properties presented by the conventional one. The characterization of the vacuum sintered M3:2 high speed steel was performed by measuring the densities of the green compacts and after the sintering cycle. The sintering produced an acceptable microstructure and densities near to the theoretical. The transverse rupture strength was evaluated by means of three point bending tests and the hardness by means of Rockwell C and Vickers tests. The technique of scanning electronic microscopy (SEM) was used to evaluate the microstructure and to establish a relation with the property of transverse rupture strength. The structure was determined by means of X-ray diffraction (XRD) patterns and the retained austenite was detected to all the conditions of heat treatment. The main contribution of this work is to establish a relation between the microstructure and the mechanical property of transverse rupture strength and to evaluate the AISI M3:2 vacuum sintered high speed steel as an alternative to the similar commercial high speed steels. (author)

  20. Revascularização do miocárdio sem circulação extracorpórea com uso de shunt intracardíaco: 12 anos de experiência

    Directory of Open Access Journals (Sweden)

    Luiz Antônio RIVETTI

    1997-07-01

    Full Text Available Os autores apresentam a experiência com a técnica desenvolvida em 1983, na Faculdade de Ciências Médicas da Santa Casa de São Paulo, que consiste em substituir a circulação extracorpórea nas operações de revascularização do miocárdio, por uma derivação (shunt, introduzida na luz da coronária. Este shunt consiste em um pequeno tubo de silicone, flexível, transparente, com diâmetros variando de 1 a 3 mm, que permanece na luz do vaso durante a feitura da anastomose entre o enxerto e a coronária. Esta técnica oferece mais segurança ao paciente, por dispensar o uso da circulação extracorpórea e, conseqüentemente, os seus malefícios, além de evitar isquemia do miocárdio durante a anastomose e mantendo um campo cirúrgico sem sangue, facilitando, assim, a realização da anastomose. De 1983 a 1995, foram operados 419 pacientes, tendo sido realizados 671 enxertos, dos quais 153 com a artéria torácica interna para as coronárias das faces anterior e inferior do coração. A mortalidade hospitalar foi de 1,43%, com 1,67% de incidência de infarto do miocárdio no intra-operatório. A técnica mostrou ser segura, sem complicações graves durante o seu emprego. Os pacientes evoluíram bem no pós-operatório imediato, necessitando menor tempo de intubação, menor permanência na UTI ou internação. Em um grupo inicial estudou-se a qualidade das anastomoses, através da cinecoronariografia pós-operatória em um período médio de 24 meses, mostrando uma taxa de enxertos pérvios de 84%. A técnica mostrou ser simples, segura e econômica, além dos benefícios ao paciente, por ser menos agressiva. Com o advento da cirurgia minimamente invasiva, esta técnica traz a contribuição definitiva para maior segurança dos pacientes.An analysis was made of the results in a group of 419 patients that underwent myocardial revascularization without cardiopulmonary bypass, by means of a technique using a temporary intraluminal shunt (TIS described originally by Rivetti and Gandra in 1991. The technique consists of inserting a shunt of a flexible and transparent sylastic tube with external diameter varying from 1 mm to 3 mm into the coronary artery which allows distal irrigation of the coronary artery during the anastomosis between the vein or mammary artery and the coronaries. It offers safety to the patient by avoiding ischemia and its consequences, by molding the coronary artery and maintaining a bloodless field. Mortality was 1,4% in this series and 1,6% of myocardial infarction. There were no life-threatening complications during the procedure. There were no complications similar those normally occurring in the post-operative period of cardiopulmonary procedures. This technique is useful for any patient with coronary stenosis in the antero-diaphragmatic region, but it also provided a good quality of the anastomosis in the cases studied.

  1. Microstructural characteristics of steel rebar submitted to the process of self - tempering; Caracterizacao microestrutural de superficies e interfaces de vergalhoes de aco auto-revenidos utilizando Microscopia Eletronica de Varredura (MEV) e analise quimica

    Energy Technology Data Exchange (ETDEWEB)

    Barreto, M.F.O., E-mail: matheusfob@yahoo.com.br [Universidade Federal de Minas Gerais (UFMG), MG (Brazil)

    2014-07-01

    Every day the construction industry seeks new alternatives to maximize use of the materials provided new tools for structural design of the new techniques in welding rods. In this sense, this work proposes to study the mechanical properties of steel rebar self-tempering for civil construction, choosing the bars from 6.3 to 25.4 mm in diameter for the study. The cooling process of rebar, after rolling, known as self-tempering produces a rebar with excellent mechanical properties and low cost to the plant, they put the rebar shall be composed of concentric layers with different mechanical properties among themselves. To study the influence of these layers on the mechanical behavior of rebar microstructural characterization was made by means of electron microscopy analysis of transmitted light and scanning of all samples. From the results it was found that only the bars 20 and 25mm diameter had a heat treatment for self-tempering relevant. (author)

  2. TBG program on preventing third part action in gas pipelines; Prevencao de acoes de terceiros em gasodutos: esclarecimentos a prefeituras, concessionarias de energia/estradas de rodagem/distribuicao de gas natural

    Energy Technology Data Exchange (ETDEWEB)

    Correa, Rosana P.; Hernandes, Gilberto L.S.; Noda, Kiyoshi [Transportadora Brasileira Gasoduto Bolivia-Brasil, S.A., Rio de Janeiro, RJ (Brazil). Gerencia Regional do Sudeste (GRSE)

    2005-07-01

    This paper presents the proceedings of TBG's Southeast Regional, responsible by Bolivia-Brazil Gas Pipeline on Sao Paulo's State, related to meetings with External Entity in order to prevent Third Party Action. The Entities are town halls, power concessionaires, roads departments/concessionaires and gas natural distribution concessionaires. Every year, TBG's Southeast Regional to make contact with External Entity for actualization of information, like telephones, address, contact person, material and human resources available. For each town hall or concessionaire is prepared a 'book' with information of TBG, like TBG presentation, One Call, excavation on pipeline zone, satellite images, telephones list, maps and 'as built' plants. The 'book' is delivered to External Entity in the course of the meeting, where TBG presents for authority and responsible by Entity the precautions that Gas Pipeline require to security operation. (author)

  3. Behaviour of steel pipe exposed to fouling by heavy oil during core-annular flow; Comportamento de tubo de aco exposto a sujeira de oleo pesado durante escoamento nucleo-anular

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa, Adriana; Bannwart, Antonio C. [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Engenharia Mecanica. Dept. de Engenharia de Petroleo

    2004-07-01

    The use of water-assisted technologies such as core-annular flow to the pipelines of viscous oils has been proposed as an attractive alternative for production and transportation of heavy crudes in both onshore and offshore scenarios. Usually, core-annular flow can be created by injecting a relatively small water flow rate laterally in the pipe, so as to form a thin water annulus surrounding the viscous oil, which is pumped through the center. The reduction in friction losses obtained thanks to lubrication by water is significant, since the pressure drop in a steady state core flow becomes comparable to water flow only. For a complete assessment of core flow technology, however, unwanted effects associated with possible oil adhesion onto the pipe wall should be investigated, since these may cause severe fouling of the wall and pressure drop increase. It has been observed that oil adhesion on metallic surfaces may occur for certain types of crude and oilphilic pipe materials. In this work we present results of pressure drop monitoring during 35 hour-operation of a heavy oil-water core annular flow in a 26.08 mm. i.d. horizontal steel pipe. The oil used is described in terms of its main components and the results of static wet ability tests are also presented for comparison (author)

  4. Evaluation of ultrasound inspection of steel H K-40 tubes used in oil processing plant furnaces; Avaliacao da inspecao ultra-sonica de tubos de aco HK-40 usado em fornos de plantas de processamento de petroleo

    Energy Technology Data Exchange (ETDEWEB)

    Staszczak, Eduardo Jose; Rebello, Joao Marcos Alcoforado; Riguera, Glaucio [Universidade Federal, Rio de Janeiro, RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia. Lab. de Ensaios Nao-Destrutivos; Martins, Marcus Vinicius M.; Carneval, Ricardo de Oliveira [PETROBRAS, Rio de Janeiro, RJ (Brazil). Centro de Pesquisas

    2003-06-01

    The ultra-sound inspection is usually an alternative to the techniques used for the inspection of tubes of steel H K-40. Even so up to now it was not very analyzed it remains so much to real potentiality of the technique in what it refers to the minimum size of discontinuities for its detection with relationship to the characterization of the size of discontinuities and the respective ultra-sound signal. This work besides reviewing fundamental aspects of the problems of inspection of these tubes tries to relate the form of the ultra-sound signal with the size of the found discontinuities. (author)

  5. Avaliação molecular e fenotípica da superexpressão e do silenciamento de MEF2C em miócitos cardíacos

    OpenAIRE

    Ana Helena Macedo Pereira

    2013-01-01

    Resumo: Os fatores MEF2 (Myocyte Enhancer Factor 2) pertencem à família MADS Box (MCM1-Agamous-Deficiens-Serum response factor) e foram descritos pela primeira vez como fatores de transcrição que se ligam a sequencias de DNA ricas em A/T nos promotores de vários genes músculo específicos. Existem 4 genes da família MEF2 que foram identificados em vertebrados: MEF2A, B, C e D que são expressos de forma distinta durante a embriogênese e nos tecidos adultos. Estudos anteriores do nosso laboratór...

  6. Effect of welding process on microstructure, microhardness and composition chemistry of stainless steel coatings applied by welding; Efeito do processo de soldagem na microestrutura, microdureza e composicao quimica de revestimentos de aco inoxidavel aplicados por soldagem

    Energy Technology Data Exchange (ETDEWEB)

    Melo, R.H.F. de; Maciel, T.M., E-mail: raphael.engmec@gmail.com [Universidade Federal de Campina Grande (UFCG), PB (Brazil). Programa de Pos-Graduacao em Mecanica; Costa, J.; Santa, R.A.C. [Universidade Federal de Campina Grande (UFCG), Cuite, PB (Brazil). Unidade Academica de Quimica

    2012-07-01

    This study evaluates the influence of welding parameters on the chemical composition of weld overlays of the AWS E 308-L T1 applied by the FCAW and SAW process, as well as their influence on the microstructure and microhardness of the weld overlays. The characterization of chemical composition was performed by EDX (Energy Dispersive X-ray Analysis), the microstructure was investigated by optical microscopy and Vickers microhardness. The contents of Cr, Ni, Mn, Mo, Nb and Si varied as a function of welding parameters, the microstructure and microhardness varied as a function of heat input and chemical composition. The resulting microstructure showed an austenitic matrix with lacy ferrite and ferrite FA, with an average hardness of 191.6 HV for the FCAW process and 210 HV for the SAW process. (author)

  7. Desarrollo de producto sobre la base de harinas de cereales y leguminosa para niños celíacos entre 6 y 24 meses; II: Propiedades de las mezclas

    OpenAIRE

    Cerezal Mezquita, P.; Urtuvia Gatica, V.; Ramírez Quintanilla, V.; Arcos Zavala, R.

    2011-01-01

    Las formulaciones alimenticias de alto contenido proteico, aportado por una mezcla de harinas a partir de dos cultivos andinos, quinua (Chenopodium quinua Willd) y lupino (Lupi-nus albus L), con dos cereales tradicionales maíz (Zea mays L.) y arroz (Oryza sativa L.), conllevaron a la preparación de una 'mezcla dulce' para la elaboración de queques y otra "mezcla postre" saborizada con plátano, que puede ser preparada con agua o con leche, constituyeron una buena alternativa como suplemento al...

  8. Desarrollo de producto sobre la base de harinas de cereales y leguminosa para niños celíacos entre 6 y 24 meses; I: Formulación y aceptabilidad

    OpenAIRE

    Cerezal Mezquita, P.; Urtuvia Gatica, V.; Ramírez Quintanilla, V.; Romero Palacios, N.; Arcos Zavala, R.

    2011-01-01

    La revalorización de los cultivos andinos, quinua (Chenopodium quinua Willd) y lupino (Lupinus albus L), para ser utilizados en mezclas alimenticias, con cereales tradicionales como maíz (Zea mays L.) y arroz (Oryza sativa L.), originan mezclas sin gluten que constituyen una buena alternativa para la alimentación de niños menores de 24 meses que sufren la enfermedad celíaca, ya que mejoran la calidad de la proteína, por compensación de los aminoácidos esenciales, e incide en la diversificació...

  9. Microstructural evaluation of a low carbon steel submitted to boriding treatment pre and post GTAW welding; Avaliacao microestrutural de um aco de baixo carbono submetido ao tratamento de boretacao pre e pos-soldagem GTAW

    Energy Technology Data Exchange (ETDEWEB)

    Pollnow, Edilson Nunes; Osorio, Alice Goncalves, E-mail: edilson.pollnow@hotmail.com, E-mail: osorio.alice@gmail.com [Universidade Federal de Pelotas (CDTec/UFPel), Pelotas, RS (Brazil). Centro de Desenvolvimento Tecnologico; Araujo, Douglas Bezerra de, E-mail: dbaraujo@ufu.br [Universidade Federal de Uberlandia (FEMEC/UFU), Uberlandia, MG (Brazil). Faculdade de Engenharia Mecanica; Passos, Thais Andrezza dos; Souza, Daniel, E-mail: thais.andrezza.passos@gmail.com, E-mail: danielsouza@furg.br [Universidade Federal do Rio Grande (EE/FURG), Rio Grande, RS (Brazil). Escola de Engenharia

    2017-04-15

    Studies on surface engineering area are given great importance due to the improvement that surface modifications provide to materials. With a global market that has the need to provide parts and equipment with extended service life and low cost, to support stringent requests and thus maintain its high performance, surface treatments may bring what was impossible into reality. Among the surface treatments that have received attention recently, we have the thermochemical process of boriding. The boriding process consists of saturate the surface of steels and metal alloys with boron. This saturation provides an increase in the surface properties not inherent to the base metal, such as hardness, resistance to abrasion and corrosion. Although the properties of boriding steels have already been studied, the effects that the boriding process perform on the steel during or after the welding processes are not known. Hence, it is the purpose of this study to evaluate the microstructure of a low carbon steel treated with boriding before and after GTAW welding. The results indicated poor metallurgical weldability of low carbon steel with boride layer, with the presence of solidification cracks. Nonetheless, the steel welded previous to boring treatment presented a more ductile nucleus, with harder surface. Although the values of hardness within the nucleus of the steel had dropped drastically at the welded zone after the boring, the surface of this steel showed higher values of hardness due to the boriding layer. This fact should be considered when applications where wear resistance is needed. (author)

  10. Influence of iron powder addition onto heat inputs, at stainless steels welds; Influencia da adicao do po de ferro no insumo de calor e na ZAC, em soldas de aco ARBL

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Samuel I.N.; Spinelli, Dirceu [Sao Paulo Univ., Sao Carlos, SP (Brazil). Escola de Engenharia; Magalhaes B Goncalves, Gilberto de; Souza, Paulo C.R.D. de

    1992-12-31

    In this work, welding with or without iron powder addition in stainless steels were produced. The welds obtained in only one pass with three different angles of grooves and several welding condition. The results showed that the heat input changes with and without iron powder addition that were found out by the cooling rates changes in weld pool. (author). 10 refs., 4 figs., 4 tabs.

  11. Shared Savings Program Accountable Care Organizations PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — SSP ACO PUF - To address the increasing number of requests for SSP ACO data, the Centers for Medicare (CM) has created a standard analytical file that CMS can use to...

  12. 48 CFR 242.771-3 - Responsibilities.

    Science.gov (United States)

    2010-10-01

    ....771-3 Responsibilities. (a) The cognizant administrative contracting officer (ACO) or corporate ACO... (OUSD(AT&L)DDR&E), is responsible for establishing a regular method for communication— (1) From DoD to...

  13. Evaluation of social support among surgical cardiac patients: support for nursing care planning Evaluación del apoyo social entre pacientes cardíacos quirúrgicos: subsidio para la planificación en la atención de enfermería Avaliação do suporte social entre pacientes cardíacos cirúrgicos: subsídio para o planejamento da assistência de enfermagem

    Directory of Open Access Journals (Sweden)

    Talita Poliana Roveroni Moraes

    2007-04-01

    Full Text Available This descriptive and cross-sectional study aimed to measure social support among subjects hospitalized for surgical treatment of cardiac diseases and to verify the relations between social support and socio-demographic variables. Data were collected between May, 2004 and June, 2005. A total of 86 patients were studied, 47 men, 58 married and the average age was 53 years old. Regarding social support, in an interval from 1 to 5, we found an average of 4.2+0.74 (interval of 1.92 to 5 for the emotional support and 4.2+0.6 (interval of 2.3 to 5 for the instrumental support, which indicate high satisfaction and availability of received supports. We found weak but statistically significant correlations between instrumental and emotional supports and the participants' age and between instrumental support and years of education. We did not find any differences in the perception of social support in terms of participants' gender and marital status.Las finalidades de este estudio descriptivo y transversal fueron medir el apoyo social de individuos hospitalizados para tratamiento quirúrgico de cardiopatías y verificar las relaciones existentes entre el apoyo social y las variables sociodemográficas. La recopilación de datos ocurrió entre mayo de 2004 y junio de 2005. Participaron del estudio 86 individuos, 47 de los cuales eran hombres, 58 casados, con edad promedio de 53 años. Con respecto al apoyo social, en un intervalo de 1 a 5, se observó una media de 4,2+0,74 (intervalo de 1,92 a 5 para el apoyo emocional, y de 4,2+0,6 (intervalo de 2,3 a 5 para el apoyo instrumental, lo que indica alta satisfacción y disponibilidad con relación a los apoyos recibidos. Se constató correlaciones bajas y estadísticamente significativas entre los apoyos instrumental - emocional y la edad; y entre el apoyo instrumental y la escolaridad. No fueron encontradas diferencias entre el apoyo social con relación al sexo y situación conyugal de los participantes.Estudo descritivo e transversal com objetivo de medir o suporte social de indivíduos internados para tratamento cirúrgico de cardiopatias e verificar as relações existentes entre suporte social e variáveis sociodemográficas. Os dados foram coletados no período de maio de 2004 a junho de 2005. Participaram do estudo 86 sujeitos, sendo 47 homens, 58 casados, com idade média de 53 anos. Quanto ao suporte social, em um intervalo possível de 1 a 5, constatou-se média de 4,2+0,74 (intervalo de 1,92 a 5 para o suporte emocional e de 4,2+0,6 (intervalo de 2,3 a 5 para o suporte instrumental, indicando elevada satisfação e disponibilidade quanto aos suportes recebidos. Houve correlações fracas e estatisticamente significantes entre os suportes instrumental e emocional e a idade dos participantes e entre suporte instrumental e escolaridade. Não foram encontradas diferenças na percepção do suporte social quanto ao sexo e a situação conjugal dos sujeitos do estudo.

  14. Avaliação da ansiedade e depressão no período pré-operatório em pacientes submetidos a procedimentos cardíacos invasivos Evaluación de la ansiedad y depresión en el período preoperatorio en pacientes sometidos a procedimientos cardíacos Evaluation of preoperative anxiety and depression in patients undergoing invasive cardiac procedures

    Directory of Open Access Journals (Sweden)

    Antonio Fernando Carneiro

    2009-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A avaliação específica da ansiedade e da depressão não está incluída na rotina de avaliação pré-operatória, o que faz com que em situações como as doenças cardíacas, em que o estado emocional dos pacientes pode estar modificado pela própria doença, possam não ser diagnosticadas. O objetivo do estudo foi comparar o nível e a prevalência de ansiedade e depressão em pacientes com doença cardíaca a serem submetidos a procedimentos invasivos e/ou cirúrgicos, utilizando a Escala Hospitalar de Ansiedade e Depressão (Hospital Anxiety and Depression Scale - HAD. MÉTODO: Após a aprovação pelos Comitês de Ética, foram incluídos 96 pacientes, estado físico ASA II e III, que constituíram três grupos: estudo eletrofisiológico (EEF, implante de marcapasso (MP e revascularização do miocárdio (RM. Os escores considerados "ponto de corte" foram: escala HAD-ansiedade (HAD-A com ansiedade > 9; escala HAD-depressão (HAD-D com depressão > 9. RESULTADOS: Os grupos foram homogêneos quanto às variáveis sociodemográficas. Observou-se diferença estatística significativa entre os três grupos (p = 0,006; p = 0,034 quanto ao nível e prevalência de ansiedade (HAD-A e na comparação do nível de ansiedade grupo a grupo verificou-se diferença significativa entre os grupos EEF × RM e EEF × MP (p JUSTIFICATIVA Y OBJETIVOS: La evaluación específica de la ansiedad y de la depresión no está incluida en la rutina de evaluación preoperatoria, lo que hace con que en algunas situaciones como las enfermedades cardiacas, en que el estado emocional de los pacientes puede estar modificado por la propia enfermedad, puedan no quedar diagnosticadas. El objetivo del estudio fue comparar el nivel y la prevalencia de ansiedad y depresión en pacientes con enfermedad cardiaca a ser sometidos a procedimientos invasivos y/o quirúrgicos, utilizando la Escala Hospitalaria de Ansiedad y Depresión (Hospital Anxiety and Depression Scale - HAD. MÉTODO: Después de la aprobación por parte de los Comités de Ética, se incluyeron 96 pacientes, estado físico ASA II y III, que constituyeron tres grupos: estudio electrofisiológico (EEF, implante de marcapaso (MP y revascularización del miocardio (RM. Las puntuaciones consideradas "punto de corte" fueron las siguientes: escala HAD-ansiedad (HAD-A: con ansiedad > 9; escala HAD-depresión (HAD-D: con depresión > 9. RESULTADOS: Los grupos fueron homogéneos en cuanto a las variables sociodemográficas. Se observó una diferencia estadística significativa entre los tres grupos (p = 0,006; p = 0,034 en lo concerniente al nivel y a la prevalencia de ansiedad (HAD-A y en la comparación del nivel de ansiedad grupo a grupo, se verificó la diferencia significativa entre los grupos EEF x RM y EEF x MP (p BACKGROUND AND OBJECTIVES: Specific assessment of anxiety and depression is not included in routine preoperative evaluation; therefore, in cases of cardiac diseases in which the emotional status of the patient may be modified by the disease those disorders may not be diagnosed. The objective of the present study was to compare the level and prevalence of anxiety and depression in patients with cardiac disease undergoing invasive and/or surgical procedures using the Hospital Anxiety and Depression Scale - HAD. METHODS: After approval by the Ethics Committee, 96 patients, physical status ASA II and III, were divided in three groups: electrophysiological study (EPS, pacemaker (PM placement, and myocardial revascularization (MR. "Cutting points" were as follows: HAD-anxiety scale (HAD-A with anxiety > 9; HAD-depression scale (HAD-D with depression > 9. RESULTS: All three groups were homogenous regarding sociodemographic parameters. Statistically significant differences were observed among the three groups (p = 0.006; p = 0.034 in the level and prevalence of anxiety (HAD-A; and in the intergroup comparison of the anxiety level significant differences were observed between the EPS x MR and EPS x PM groups (p < 0.05. Significant differences in the level and prevalence of depression (HAD-D among the study groups were not observed. CONCLUSIONS: Patients with cardiac diseases undergoing electrophysiological studies, pacemaker implantation, and myocardial revascularization have different levels and prevalence of anxiety, but they do not show differences in the level and prevalence of depression.

  15. Facilitating the formation of accountable care organizations in rural areas.

    Science.gov (United States)

    Baloh, Jure; Zhu, Xi; Vaughn, Tom; MacKinney, A Clinton; Mueller, Keith J; Ullrich, Fred; Nattinger, Matthew

    2014-07-01

    This Policy Brief presents characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries. Doing so provides considerations for provider organizations contemplating creating rural-based ACOs. Key Findings. (1) Previous organizational integration and risk-sharing experience facilitated ACO formation. (2) Use of an electronic health record system fostered core ACO capabilities, including care coordination and population health management. (3) Partnerships across the care continuum supported utilization of local health care resources.

  16. Quality of Care Improves for Patients with Diabetes in Medicare Shared Savings Accountable Care Organizations: Organizational Characteristics Associated with Performance.

    Science.gov (United States)

    Fraze, Taressa K; Lewis, Valerie A; Tierney, Emily; Colla, Carrie H

    2017-12-06

    Accountable care organizations (ACOs), a primary care-centric delivery and payment model, aim to promote integrated population health, which may improve care for those with chronic conditions such as diabetes. Research has shown that, overall, the ACO model is effective at reducing costs, but there is substantial variation in how effective different types of ACOs are at impacting costs and improving care delivery. This study examines how ACO organizational characteristics - such as composition, staffing, care management, and experiences with health reform - were associated with quality of care delivered to patients with diabetes. Secondary data were analyzed retrospectively to examine Medicare Shared Savings Program (MSSP) ACOs' performance on diabetes metrics in the first 2 years of ACO contracts. Ordinary least squares was used to analyze 162 MSSP ACOs with publicly available performance data and the National Survey of ACOs. ACOs improved performance significantly for patients with diabetes between contract years 1 and 2. In year 1, also having a private payer contract and an increased number of services within the ACO were positively associated with performance, while having a community health center or a hospital were negatively associated with performance. Better performance in year 1 was negatively associated with improved performance in year 2. This study found that ACOs substantively improved diabetes management within initial contract years. ACOs may need different types of support throughout their contracts to ensure continued improvements in performance.

  17. Cloning and sequence of cDNA encoding 1-aminocyclo- propane-1-carboxylate oxidase in Vanda flowers

    Directory of Open Access Journals (Sweden)

    Pattana Srifah Huehne

    2013-08-01

    Full Text Available The 1-aminocyclopropane-1-carboxylate oxidase (ACO gene in the final step of ethylene biosynthesis was isolated from ethylene-sensitive Vanda Miss Joaquim flowers. This consists of 1,242 base pairs (bp encoding for 326 amino acid residues. To investigate the specific divergence in orchid ACO sequences, the deduced Vanda ACO was aligned with five other orchid ACOs. The results reveal that the ACO sequences within Doritaenopsis, Phalaenopsis and Vanda show highly conserved and almost 95% identical homology, while the ACOs isolated from Cymbidium, Dendrobium and Cattleya are 8788% identical to Vanda ACO. In addition, the 2-oxoglutarate- Fe(II_oxygenase (Oxy domain of orchid ACOs consists of a higher degree of amino acid conservation than that of the non-haem dioxygenase (DIOX_N domain. The overall homology regions of Vanda ACO are commonly folded into 12 α-helices and 12 β-sheets similar to the three dimensional template-structure of Petunia ACO. This Vanda ACO cloned gene is highly expressed in flower tissue compared with root and leaf tissues. In particular, there is an abundance of ACO transcript accumulation in the column followed by the lip and the perianth of Vanda Miss Joaquim flowers at the fully-open stage.

  18. Ethical challenges for accountable care organizations: a structured review.

    Science.gov (United States)

    DeCamp, Matthew; Farber, Neil J; Torke, Alexia M; George, Maura; Berger, Zackary; Keirns, Carla C; Kaldjian, Lauris C

    2014-10-01

    Accountable care organizations (ACOs) are proliferating as a solution to the cost crisis in American health care, and already involve as many as 31 million patients. ACOs hold clinicians, group practices, and in many circumstances hospitals financially accountable for reducing expenditures and improving their patients' health outcomes. The structure of health care affects the ethical issues arising in the practice of medicine; therefore, like all health care organizational structures, ACOs will experience ethical challenges. No framework exists to assist key ACO stakeholders in identifying or managing these challenges. We conducted a structured review of the medical ACO literature using qualitative content analysis to inform identification of ethical challenges for ACOs. Our analysis found infrequent discussion of ethics as an explicit concern for ACOs. Nonetheless, we identified nine critical ethical challenges, often described in other terms, for ACO stakeholders. Leaders could face challenges regarding fair resource allocation (e.g., about fairly using ACOs' shared savings), protection of professionals' ethical obligations (especially related to the design of financial incentives), and development of fair decision processes (e.g., ensuring that beneficiary representatives on the ACO board truly represent the ACO's patients). Clinicians could perceive threats to their professional autonomy (e.g., through cost control measures), a sense of dual or conflicted responsibility to their patients and the ACO, or competition with other clinicians. For patients, critical ethical challenges will include protecting their autonomy, ensuring privacy and confidentiality, and effectively engaging them with the ACO. ACOs are not inherently more or less "ethical" than other health care payment models, such as fee-for-service or pure capitation. ACOs' nascent development and flexibility in design, however, present a time-sensitive opportunity to ensure their ethical operation

  19. Omalizumab treatment in asthma-COPD overlap syndrome.

    Science.gov (United States)

    Tat, Tugba Songul; Cilli, Aykut

    2016-12-01

    Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a poorly understood disease with an increasing morbidity and mortality. Currently, the most effective treatment for ACOS is unknown and omalizumab for ACOS has not yet been reported. We report our experience with anti-IgE, omalizumab treatment on 3 patients with ACOS as a retrospective case study. After 1 year of omalizumab treatment, patients experienced significantly lower rates of asthma exacerbation and hospitalization and better asthma control test results. Our study shows that omalizumab may be an effective and safe therapy for patients with ACOS. However larger randomized trials are needed.

  20. Risk bearing and use of fee-for-service billing among accountable care organizations.

    Science.gov (United States)

    Muhlestein, David B; Croshaw, Andrew A; Merrill, Thomas P

    2013-07-01

    To determine the willingness of accountable care organizations (ACOs) to bear financial risk for the healthcare they provide. Structured interviews conducted between January and June 2012 with 57 ACOs led by hospitals and physician groups located throughout the United States. Findings are based on the 38 ACOs that were actively providing care under an ACO payment arrangement at the time of the interview. Among these ACOs, 71% cover a portion of their ACO population with contracts that put the ACOs at some financial risk, while 45% have risk-based contracts for their entire ACO population. Payments based on fee-for-service (FFS) billing still dominate, as 92% of ACOs use FFS-based billing for at least a portion of their ACO population and 71% are fully reimbursed using FFS-based billing. Under the auspices of an ACO, providers are accepting some financial risk for their accountable care patient population. There is still strong reliance on FFS-based billing methods as providers experiment with different payment models.

  1. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    Science.gov (United States)

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients. Project HOPE—The People-to-People Health Foundation, Inc.

  2. Private sector accountable care organization development: a qualitative study.

    Science.gov (United States)

    Scheck McAlearney, Ann; Hilligoss, Brian; Song, Paula H

    2017-03-01

    To explore accountable care organizations (ACOs) as they develop in the private sector, including their motivation for development, perspectives from consumers regarding these emerging ACOs, and the critical success factors associated with ACO development. Comprehensive organizational case studies of 4 full-risk private sector ACOs that included in-person interviews with providers and administrators and focus groups with local consumers. Sixty-eight key informant interviews conducted during site visits, supplemented by document collection and telephone interviews, and 5 focus groups were held with 52 consumers associated with the study ACOs. We found 3 main motivators for private sector ACO development: 1) opportunity to improve quality and efficiency, 2) potential to improve population health, and 3) belief that payment reform is inevitable. With respect to consumer perspectives, consumers were unaware they received care from an ACO. From the perspectives of ACO stakeholders, these ACOs noted that they prefer to focus on patients' relationships with providers and typically do not emphasize the ACO name or entity. Critical success factors for private sector ACO development included provider engagement, strategic buy-in, prior experience managing risk, IT infrastructure, and leadership, all meant to shift the culture to a focus on value instead of volume. These organizations perceived that pursuing an accountable care strategy allowed them to respond to policy changes anticipated to impact the way healthcare is delivered and reimbursed. Increased understanding of factors that have been important for more mature private sector ACOs may help other healthcare organizations as they strive to enhance value and advance in their ACO journeys.

  3. Accountable Care Organizations: The National Landscape.

    Science.gov (United States)

    Shortell, Stephen M; Colla, Carrie H; Lewis, Valerie A; Fisher, Elliott; Kessell, Eric; Ramsay, Patricia

    2015-08-01

    There are now more than seven hundred accountable care organizations (ACOs) in the United States. This article describes some of their most salient characteristics including the number and types of contracts involved, organizational structures, the scope of services offered, care management capabilities, and the development of a three-category taxonomy that can be used to target technical assistance efforts and to examine performance. The current evidence on the performance of ACOs is reviewed. Since California has the largest number of ACOs (N=67) and a history of providing care under risk-bearing contracts, some additional assessments of quality and patient experience are made between California ACOs and non-ACO provider organizations. Six key issues likely to affect future ACO growth and development are discussed, and some potential "diagnostic" indicators for assessing the likelihood of potential antitrust violations are presented. Copyright © 2015 by Duke University Press.

  4. An Early Assessment of Accountable Care Organizations Efforts to Engage Patients and Their Families

    Science.gov (United States)

    Shortell, Stephen M.; Sehgal, Neil; Bibi, Salma; Ramsay, Patricia P.; Neuhauser, Linda; Colla, Carrie H.; Lewis, Valerie A.

    2017-01-01

    Accountable Care Organizations (ACOs) have incentives to meet quality and expenditure targets and share in resulting savings. Achieving these goals will require ACOs to engage more actively with patients and their families. The extent to which ACOs do so is currently unknown. Using mixed-methods including a national survey, phone interviews and site-visits; we examine the extent to which ACOs actively engage patients and their families, explore challenges involved; and consider approaches for dealing with those challenges. Results indicate that greater ACO use of patient activation and engagement (PAE) activities at the point-of-care may influence more positive leadership perceptions of the impact of PAE investments on ACO costs, quality, and outcomes of care. We identify a number of important practices associated with greater PAE, including high-level leadership commitment, goal-setting supported by adequate resources, extensive provider training and use of inter-disciplinary care teams, and frequent monitoring and reporting on progress. PMID:26038349

  5. Ant Colony Optimization Approaches to Clustering of Lung Nodules from CT Images

    Directory of Open Access Journals (Sweden)

    Ravichandran C. Gopalakrishnan

    2014-01-01

    Full Text Available Lung cancer is becoming a threat to mankind. Applying machine learning algorithms for detection and segmentation of irregular shaped lung nodules remains a remarkable milestone in CT scan image analysis research. In this paper, we apply ACO algorithm for lung nodule detection. We have compared the performance against three other algorithms, namely, Otsu algorithm, watershed algorithm, and global region based segmentation. In addition, we suggest a novel approach which involves variations of ACO, namely, refined ACO, logical ACO, and variant ACO. Variant ACO shows better reduction in false positives. In addition we propose black circular neighborhood approach to detect nodule centers from the edge detected image. Genetic algorithm based clustering is performed to cluster the nodules based on intensity, shape, and size. The performance of the overall approach is compared with hierarchical clustering to establish the improvisation in the proposed approach.

  6. Physician Competition in the Era of Accountable Care Organizations.

    Science.gov (United States)

    Richards, Michael R; Smith, Catherine T; Graves, Amy J; Buntin, Melinda B; Resnick, Matthew J

    2018-04-01

    To calculate physician concentration levels for all U.S. markets using detailed data on integration and accountable care organization (ACO) participation. 2015 SK&A office-based physician survey linked to all commercial and public payer ACOs. We construct three separate Herfindahl-Hirschman Index (HHI) measures and plot their distributions. We then investigate how prevailing levels of concentration change when incorporating more detailed organizational features into the HHI measure. Horizontal and vertical integration strongly influences measures of physician concentration; however, ACOs have limited impact overall. ACOs are often present in competitive markets, and only in a minority of these markets do ACOs substantively increase physician concentration. Monitoring ACO effects on physician competition will likely have to proceed on a case-by-case basis. © Health Research and Educational Trust.

  7. Global Transcriptomic Analysis of Targeted Silencing of Two Paralogous ACC Oxidase Genes in Banana

    Science.gov (United States)

    Xia, Yan; Kuan, Chi; Chiu, Chien-Hsiang; Chen, Xiao-Jing; Do, Yi-Yin; Huang, Pung-Ling

    2016-01-01

    Among 18 1-aminocyclopropane-1-carboxylic acid (ACC) oxidase homologous genes existing in the banana genome there are two genes, Mh-ACO1 and Mh-ACO2, that participate in banana fruit ripening. To better understand the physiological functions of Mh-ACO1 and Mh-ACO2, two hairpin-type siRNA expression vectors targeting both the Mh-ACO1 and Mh-ACO2 were constructed and incorporated into the banana genome by Agrobacterium-mediated transformation. The generation of Mh-ACO1 and Mh-ACO2 RNAi transgenic banana plants was confirmed by Southern blot analysis. To gain insights into the functional diversity and complexity between Mh-ACO1 and Mh-ACO2, transcriptome sequencing of banana fruits using the Illumina next-generation sequencer was performed. A total of 32,093,976 reads, assembled into 88,031 unigenes for 123,617 transcripts were obtained. Significantly enriched Gene Oncology (GO) terms and the number of differentially expressed genes (DEGs) with GO annotation were ‘catalytic activity’ (1327, 56.4%), ‘heme binding’ (65, 2.76%), ‘tetrapyrrole binding’ (66, 2.81%), and ‘oxidoreductase activity’ (287, 12.21%). Real-time RT-PCR was further performed with mRNAs from both peel and pulp of banana fruits in Mh-ACO1 and Mh-ACO2 RNAi transgenic plants. The results showed that expression levels of genes related to ethylene signaling in ripening banana fruits were strongly influenced by the expression of genes associated with ethylene biosynthesis. PMID:27681726

  8. Clinical characteristics of the asthma-COPD overlap syndrome--a systematic review.

    Science.gov (United States)

    Nielsen, Mia; Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

    2015-01-01

    In recent years, the so-called asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has received much attention, not least because elderly individuals may present characteristics suggesting a diagnosis of both asthma and COPD. At present, ACOS is described clinically as persistent airflow limitation combined with features of both asthma and COPD. The aim of this paper is, therefore, to review the currently available literature focusing on symptoms and clinical characteristics of patients regarded as having ACOS. Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic literature review was performed. A total of 11 studies met the inclusion criteria for the present review. All studies dealing with dyspnea (self-reported or assessed by the Medical Research Council dyspnea scale) reported more dyspnea among patients classified as having ACOS compared to the COPD and asthma groups. In line with this, ACOS patients have more concomitant wheezing and seem to have more cough and sputum production. Compared to COPD-only patients, the ACOS patients were found to have lower FEV1% predicted and FEV1/FVC ratio in spite of lower mean life-time tobacco exposure. Furthermore, studies have revealed that ACOS patients seem to have not only more frequent but also more severe exacerbations. Comorbidity, not least diabetes, has also been reported in a few studies, with a higher prevalence among ACOS patients. However, it should be acknowledged that only a limited number of studies have addressed the various comorbidities in patients with ACOS. The available studies indicate that ACOS patients may have more symptoms and a higher exacerbation rate than patients with asthma and COPD only, and by that, probably a higher overall respiratory-related morbidity. Similar to patients with COPD, ACOS patients seem to have a high occurrence of comorbidity, including diabetes. Further research into the ACOS, not least

  9. Improving the Interpretability of Classification Rules Discovered by an Ant Colony Algorithm: Extended Results

    OpenAIRE

    Otero, Fernando E.B.; Freitas, Alex A.

    2016-01-01

    The vast majority of Ant Colony Optimization (ACO) algorithms for inducing classification rules use an ACO-based procedure to create a rule in an one-at-a-time fashion. An improved search strategy has been proposed in the cAnt-MinerPB algorithm, where an ACO-based procedure is used to create a complete list of rules (ordered rules)-i.e., the ACO search is guided by the quality of a list of rules, instead of an individual rule. In this paper we propose an extension of the cAnt-MinerPB algorith...

  10. Summer Research Program (1992). Summer Faculty Research Program (SFRP) Reports. Volume 5B. Wright Laboratory

    Science.gov (United States)

    1992-12-01

    2] "Proposal for Space Integrated Control Exýeriment (SPICE)", Prepared by Lockheed Missiles & Space Company, Inc. (in col- laboration with...components are given as Xt(k) = AcosO + na(k) (3a) Xo(k) = AsinO + nQ(k). (3b) Since the amplitude, frequency and the phase of the received signal are...N( AcosO ,a 2 ) (12a) XQ(k) = N( AcosO ,a 2). (12b) In this case, the joint probability density function (PDF) is given by 12X,2e -J.w[((r - Acos0)2

  11. Asthma-COPD overlap syndrome: recent advances in diagnostic criteria and prognostic significance.

    Science.gov (United States)

    Sorino, Claudio; Scichilone, Nicola; D'Amato, Maria; Patella, Vincenzo; DI Marco, Fabiano

    2017-06-01

    The term asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has been proposed for individuals with features of both asthma and COPD. Several attempts have been done to define ACOS on the basis of medical history, symptoms, and functional findings. The main diagnostic criteria include airflow obstruction with a strong although incomplete reversibility to bronchodilation tests, a significant exposure to cigarette or biomass smoke, and a history of atopy or asthma. Additional diagnostic elements include eosinophilic airway and systemic inflammation, a good response to corticosteroid treatment, and a high concentration of exhaled nitric oxide. ACOS should be distinguished from asthma with not fully reversible bronchial obstruction due to airway remodeling, thus the lack of smoking exposure should exclude the diagnosis of ACOS. In patients without a documented history of asthma before 40 years of age, an increase in FEV1 after bronchodilator >400 mL should be required to diagnose ACOS. ACOS has been found to be associated with impaired physical performance, functional ability, and health-related quality of life. The prevalence of ACOS increases with aging, then it is relatively stable in elderly individuals (>65 years). Long-term mortality of subjects with ACOS is similar to COPD, and worse than asthma and healthy controls. Future research is still needed to improve the understanding and management of ACOS.

  12. Growth of Accountable Care Organizations in California: Number, Characteristics, and State Regulation.

    Science.gov (United States)

    Fulton, Brent D; Pegany, Vishaal; Keolanui, Beth; Scheffler, Richard M

    2015-08-01

    Accountable care organizations (ACOs) result in physician organizations' and hospitals' receiving risk-based payments tied to costs, health care quality, and patient outcomes. This article (1) describes California ACOs within Medicare, the commercial market, and Medi-Cal and the safety net; (2) discusses how ACOs are regulated by the California Department of Managed Health Care and the California Department of Insurance; and (3) analyzes the increase of ACOs in California using data from Cattaneo and Stroud. While ACOs in California are well established within Medicare and the commercial market, they are still emerging within Medi-Cal and the safety net. Notwithstanding, the state has not enacted a law or issued a regulation specific to ACOs; they are regulated under existing statutes and regulations. From August 2012 to February 2014, the number of lives covered by ACOs increased from 514,100 to 915,285, representing 2.4 percent of California's population, including 10.6 percent of California's Medicare fee-for-service beneficiaries and 2.3 percent of California's commercially insured lives. By emphasizing health care quality and patient outcomes, ACOs have the potential to build and improve on California's delegated model. If recent trends continue, ACOs will have a greater influence on health care delivery and financial risk sharing in California. Copyright © 2015 by Duke University Press.

  13. Inverse estimation of the spheroidal particle size distribution using Ant Colony Optimization algorithms in multispectral extinction technique

    Science.gov (United States)

    He, Zhenzong; Qi, Hong; Wang, Yuqing; Ruan, Liming

    2014-10-01

    Four improved Ant Colony Optimization (ACO) algorithms, i.e. the probability density function based ACO (PDF-ACO) algorithm, the Region ACO (RACO) algorithm, Stochastic ACO (SACO) algorithm and Homogeneous ACO (HACO) algorithm, are employed to estimate the particle size distribution (PSD) of the spheroidal particles. The direct problems are solved by the extended Anomalous Diffraction Approximation (ADA) and the Lambert-Beer law. Three commonly used monomodal distribution functions i.e. the Rosin-Rammer (R-R) distribution function, the normal (N-N) distribution function, and the logarithmic normal (L-N) distribution function are estimated under dependent model. The influence of random measurement errors on the inverse results is also investigated. All the results reveal that the PDF-ACO algorithm is more accurate than the other three ACO algorithms and can be used as an effective technique to investigate the PSD of the spheroidal particles. Furthermore, the Johnson's SB (J-SB) function and the modified beta (M-β) function are employed as the general distribution functions to retrieve the PSD of spheroidal particles using PDF-ACO algorithm. The investigation shows a reasonable agreement between the original distribution function and the general distribution function when only considering the variety of the length of the rotational semi-axis.

  14. 78 FR 38342 - Submission for OMB Review; Notification of Ownership Changes

    Science.gov (United States)

    2013-06-26

    ... that the extension of the information collection would violate the fundamental purposes of the... accounting records, to notify the Administrative Contracting Officer (ACO) within 30 days. Further, the...

  15. Applying Organization Theory to Understanding the Adoption and Implementation of Accountable Care Organizations: Commentary.

    Science.gov (United States)

    Shortell, Stephen M

    2016-12-01

    This commentary highights the key arguments and contributions of institutional thoery, transaction cost economics (TCE) theory, high reliability theory, and organizational learning theory to understanding the development and evolution of Accountable Care Organizations (ACOs). Institutional theory and TCE theory primarily emphasize the external influences shaping ACOs while high reliability theory and organizational learning theory underscore the internal fctors influencing ACO perfromance. A framework based on Implementation Science is proposed to conside the multiple perspectives on ACOs and, in particular, their abiity to innovate to achieve desired cost, quality, and population health goals. © The Author(s) 2016.

  16. Predictors of asthma-chronic obstructive pulmonary disease overlap syndrome in patients with chronic obstructive pulmonary disease from a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    Irfan Ismail Ayub

    2018-01-01

    Full Text Available Background: There is dearth of literature on asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS in India. The aim was to compare clinical characteristics between patients with ACOS and non-ACOS COPD and to identify clinical predictors of ACOS in patients with COPD. Methods: We conducted a retrospective study by reviewing data collected from patients performing spirometry at our hospital. Those with postbronchodilator FEV1/FVC <70% were included in the study. Among them, those with significant reversibility (change in FEV1or FVC by 12% and 200 ml postbronchodilator were diagnosed with ACOS and the rest were considered to have non-ACOS COPD. Data on the 2 groups were compared and statistical analysis was performed. Results: Out of a total of 324 patients, 100 of them had postbronchodilator FEV1/FVC <70%. Of them, 45 and 55 were diagnosed with ACOS and non-ACOS COPD, respectively. Patients with ACOS had significantly higher postbronchodilator FVC volumes and FVC % predicted values (P < 0.05, had higher reported wheeze (P = 0.02 and ankle edema (P < 0.05, were more likely to be smokers (P = 0.01 with lower smoking index (P = 0.03, and had frequent (≥2 ER visits (P = 0.04. However, very frequent (≥3 per year hospital admissions (P < 0.01 with higher rates of invasive mechanical ventilation (P = 0.02, and pulmonary hypertension diagnosed by two-dimensional echocardiography (P < 0.01 were significantly higher in the non-ACOS group. The two groups did not differ with respect to history of atopy, family history of wheeze, compliance to inhaler therapy, or blood absolute eosinophil counts. Conclusion: Our study highlights how the ACOS phenotype may clinically differ from their counterparts elsewhere, making it a clinical challenge to identify them in India.

  17. Efeitos da acupuntura nos acupontos Shenmen (C-7 e Neiguan (PC-6 sobre a frequência cardíaca, a variabilidade da frequência cardíaca e o ritmo cardíaco em cães saudáveis

    Directory of Open Access Journals (Sweden)

    E.G.M. Silva

    2016-02-01

    Full Text Available Acupuncture derives from traditional Chinese medicine, which aims to restore homeostasis. The action mechanism of this technique involves stimulation of certain points on the skin by inserting a needle. The aim of this study was to evaluate the influence of stimulation of acupoints C7 and PC6 on the heart rate variability, heart rate and heart rhythm in healthy dogs. 30 male and female adult dogs were used, with no breed restriction. The animals were analyzed at two different times in weekly intervals. Firstly were applied needles in the true acupoints, and on the second time we applied needles in false acupoints. Previously to the acupuncture an ECG with 2 minutes of recorder was performed, and after an insertion of needles the electrocardiographic recording was maintained during the 30 minutes of acupuncture. Results showed no significant difference between the HR when comparing true and false acupoints (p = 0.890. For heart rate variability a small difference was observed between the groups (p = 0.0051, however, when comparing the baseline with 15 and 25 minutes of monitoring in the false acupoint group, no significant results were found when compared with true acupoint. In conclusion, it is suggested that the stimulation of acupoints C-7 and PC-6 in healthy dogs does not promote change in sympathovagal balance, specifically on the heart rate variability, heart rate and heart rhythm on healthy dogs.

  18. Influência do nível de ruídos na percepção do estresse em pacientes cardíacos The influence of noise levels on the perception of stress in heart disease patients

    Directory of Open Access Journals (Sweden)

    Aline Maria Heidemann

    2011-03-01

    Full Text Available OBJETIVO: Identificar os principais fatores geradores de estresse em pacientes internados em unidade coronariana e a influência do nível de ruídos na percepção de estresse dos mesmos. MÉTODOS: Estudo prospectivo, descritivo e quantitativo, realizado de junho a novembro de 2009 na Unidade Coronariana do Hospital de Clínicas da Unicamp. Para identificar os fatores estressantes foi utilizada a Escala de Estressores em Unidade de Terapia Intensiva (Intensive Care Unit Environmental Stressor Scale ICUESS no primeiro, segundo e terceiro dias de internação. Na primeira e segunda noite de internação, foi mensurado o nível de ruído pelo decibelímetro marca Instrutherm - modelo DEC-460. RESULTADOS: Participaram do estudo 32 pacientes cardiopatas clínicos. A mediana para a Escala de Estressores em Unidade de Terapia Intensiva foi de 67,5, 60,5 e 59,5, no primeiro, segundo e terceiro dias respectivamente, não apresentando diferença estatisticamente significante entre os valores. O maior valor de nível de ruídos foi às 21 horas, da segunda noite com mediana de 58,7dB, e o me-nor, de 51,5dB à zero hora da primeira noite. Quando feita a regressão linear múltipla, o nível de ruídos da primeira noite teve correlação de 33% com a Escala de Estressores do segundo dia, e o nível de ruídos da segunda noite teve correlação de 32,8% com a Escala de Estressores do terceiro dia, com p=0,001. CONCLUSÃO: Pacientes internados em Unidade Coronariana apresentam maior percepção de estresse. O elevado nível de ruídos também é responsável pela percepção do estresse dos pacientes.OBJECTIVES: To identify the main causes of stress in patients staying in a coronary unit and to assess the influence of noise levels on their perception of stress. METHODS: This was a prospective, descriptive and quantitative study conducted between June and November 2009 in the Coronary Unit of the Hospital de Clínicas da Universidade Estadual de Campinas. The Intensive Care Unit Environmental Stressor Scale was used on the first, second and third days of hospitalization to identify stressors. The noise level was measured on the first and second nights using an Instrutherm DEC-460 decibel meter. RESULTS: Overall, 32 clinical heart disease patients were included. The median Intensive Care Unit Environmental Stressor Scale scores were 67.5, 60.5 and 59.5 for the first, second and third days, respectively. The differences were not statistically significant. The highest noise level (a median of 58.7 dB was detected on the second night at 9:00 pm; the lowest level (51.5 dB was measured on the first night at 12:00 am. In a multiple linear regression model, the first-night noise level had a 33% correlation with the second-day stress scale score, and for the second night, the correlation with the third-day stress scale score was 32.8% (p = 0.001. CONCLUSION: Patients admitted into a coronary unit have an increased perception of stress. Higher noise levels are also responsible for the perception of stress in these patients.

  19. Comparative study of the impacts of hydroelectric power plants with impacts avoided by a Virtual Plants Equivalents (VPEs) through of energy efficiency actions; Estudo comparativo dos impactos das usinas hidreletricas com os impactos evitados por uma usina virtual equivalente atraves das acoes de eficiencia energetica

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Roberto Perillo Barbosa da; Barros, Regiane Silva de [Universidade Estadual de Campinas (FEM/UNICAMP), SP (Brazil). Fac. de Engenharia Mecanica], emails: rpbsilva@fem.unicamp.br, rsbarros@fem.unicamp.br Rossi, Luiz Antonio [Universidade Estadual de Campinas (FEAGRI/UNICAMP), SP (Brazil). Fac. Engenharia Agricola], email: rossi@feagri.unicamp.br

    2010-07-01

    This article presents a comparative study of the impacts caused by Hydroelectric Power Plants (HPPs) in relation to the impacts avoided through actions that promotes energy efficiency called Virtual Plants Equivalents (VPEs). To do so, it was considering the recent results presented by the National Program for Electric Energy Conservation (PROCEL) to the year 2008, which shows that the program actions' in this period resulted in a Virtual Plant Equivalent of 1049 MW. It was performed a survey of the values of wetland and families displaced by the construction of hydropower plants and, later, it was compared these data with the values found in the literature and, finally, it was established that the actions of energy efficiency are important instruments to avoid (or at least postpone) the social and environmental impacts directly and indirectly that affects the whole society. Thus, it is suggested that there is a stimulus in relation to energy efficiency actions, what is observed nowadays in Brazil is that these actions are negligible before the potential that exists at industrial, commercial and residential sectors. (author)

  20. Avaliação da segurança do teste de caminhada dos 6 minutos em pacientes no pré-transplante cardíaco Evaluación de la seguridad de la test de marcha de 6 minutos en pacientes en el pre-transplante cardiaco Analysis of 6-minute walk test safety in pre-heart transplantation patients

    Directory of Open Access Journals (Sweden)

    Gerson Cipriano Jr

    2009-04-01

    Full Text Available FUNDAMENTO: O teste de caminhada dos 6 minutos (TC6 tem sido utilizado como forma de avaliação da capacidade funcional, estadiamento clínico e prognóstico cardiovascular. A segurança e o impacto metabólico são pouco descritos na literatura, principalmente em pacientes com insuficiência cardíaca grave, com indicação clínica para transplante cardiovascular. OBJETIVO: Avaliar a ocorrência de arritmias e alterações cardiovasculares durante o TC6. Correlacionar o desempenho no TC6 com o estadiamento clínico e prognóstico cardiovascular. MÉTODOS: Doze pacientes, sendo 10 masculinos, com idade de 52 ± 8 anos, foram submetidos à avaliação inicial. Realizaram o TC6 com monitoramento eletrocardiográfico por telemetria, sinais vitais e lactato. Foram acompanhados por 12 meses. RESULTADOS: Os pacientes percorreram 399,4 ± 122,5 (D, m, atingindo um esforço percebido (EP de 14,3 ± 1,5 e variação de 34% na freqüência cardíaca basal. Dois pacientes apresentaram arritmia de maior gravidade pré-TC6 e não pioraram ante o esforço, quatro tiveram elevação significativa nos níveis de lactato sangüíneo (>5 mmol/dl, e três interromperam o exame. A distância percorrida evidenciou correlação com a fração de ejeção (% e classificação funcional (NYHA. Após 12 meses de seguimento, três pacientes foram a óbito, e reinternaram-se sete por descompensação cardíaca. A relação (D/EP e freqüência cardíaca de recuperação no segundo minuto (FCR2, bpm foram inferiores no grupo-óbito. CONCLUSÃO: O comportamento clínico e eletrocardiográfico sugere que o método é seguro, mas pode ser considerado de alta intensidade para alguns pacientes com insuficiência cardíaca grave. Variáveis relacionadas ao desempenho no TC6 podem estar associadas com a mortalidade no seguimento de um ano.FUNDAMENTO: El test de marcha de 6 minutos (TM6m ha sido utilizado como forma de evaluación de la capacidad funcional, del estadiamiento clínico y el pronóstico cardiovascular. La seguridad y el impacto metabólico son poco descritos en la literatura, principalmente en pacientes con insuficiencia cardiaca severa e indicación clínica para transplante cardiovascular Objetivo: Evaluar la ocurrencia de arritmias y alteraciones cardiovasculares durante el TM6m. Correlacionar el desempeño en el TM6m con el estadiamiento clínico y el pronóstico cardiovascular. MÉTODOS: Un total de 12 pacientes, 10 varones, con edad de 52 ± 8 años, fueron sometidos a evaluación inicial. Realizaron el TM6m con monitoreo electrocardiográfico por telemetría, señales vitales y lactato. Se siguieron a los individuos por 12 meses. RESULTADOS: Los pacientes recorrieron 399,4 ± 122,5 (D, m, alcanzando un esfuerzo percibido (EP de 14,3 ± 1,5 y variación del 34% en la frecuencia cardiaca basal. Dos pacientes presentaron arritmia de mayor severidad pre-TM6m y no mostraron empeoramiento ante el esfuerzo; cuatro tuvieron elevación significativa en los niveles de lactato sanguíneo (>5 mmol/dl, y tres interrumpieron el examen. La distancia recorrida evidenció correlación con la fracción de eyección (% y la clasificación funcional (NYHA. Tras 12 meses de seguimiento, tres pacientes murieron, y siete se reinternaron por descompensación cardiaca. La relación (D/EP y frecuencia cardiaca de recuperación en el segundo minuto (FCR2, lpm fueron inferiores en el grupo óbito. CONCLUSIÓN: El comportamiento clínico y electrocardiográfico sugiere que el método es seguro, pero se puede considerarlo de alta intensidad para algunos pacientes con insuficiencia cardiaca severa. Variables relacionadas al desempeño en el TM6m pueden estar asociadas con la mortalidad en el seguimiento de un año.BACKGROUND: The 6-minute walk test (6WT has been used as a means of assessment of the functional capacity, clinical staging and cardiovascular prognosis. Its safety and metabolic impact have not been frequently described in the literature, especially in patients with severe heart failure with clinical indication for cardiovascular transplantation. OBJECTIVE: To evaluate the occurrence of arrhythmias and cardiovascular changes during 6WT. To correlate 6WT performance with clinical staging and cardiovascular prognosis. METHODS: Twelve patients, 10 of whom males, aged 52 ± 8 years were evaluated at baseline. 6WT was performed with telemetry electrocardiography, vital signs and lactate monitoring. The patients were followed-up for 12 months. RESULTS: The patients walked 399.4±122.5 (D, m, reaching a perceived exertion (PE of 14.3±1.5 and a 34% baseline heart rate variation. Two patients presented more severe pre-6WT arrhythmia which did not worsen with the exercice, four patients presented a significant increase of blood lactate levels (>5 mmol/dl, and three interrupted the test. The distance walked correlated with the ejection fraction (% and functional class (NYHA. After 12-month follow-up, three patients died and seven were rehospitalized for cardiac decompensation. The D/PE ratio and 2-minute heart rate recovery (HRR2, bpm were lower in the death group. CONCLUSION: The clinical and electrocardiographic behaviors suggest that the method is safe, but it may be considered too strenuous for some patients with severe heart failure. Variables related to 6WT performance may be associated with the one-year follow-up mortality.

  1. Environmental education at Bacia de Campos: activities sponsored by the Exploration and Production business Unit in the state of Rio de Janeiro, Brazil; Educacao ambiental na Bacia de Campos: acoes desenvolvidas na Unidade de Negocios de Exploracao e Producao do Rio de Janeiro

    Energy Technology Data Exchange (ETDEWEB)

    Freire, Ana Lucia Bueno; Vidal, Roseane Dias de Medeiros; Rocha, Valmir Gomes da [PETROBRAS, Rio de Janeiro, RJ (Brazil). Unidade de Negocios

    2004-07-01

    PETROBRAS Exploration and Production Business Unit in the State of Rio de Janeiro - PETROBRAS/UN-RIO has been developing environmental education actions as part of its environmental license process at Campos Basin. These actions are included in the project for the education of the multiplier groups in environmental education and core skills on environmental education. The goals of the project are either to create an integrated understanding of the environmental issue and a responsible conduction on natural resource and community values preservation. The multiplier groups are formed by associated professionals from the state government secretaries of education, health, environment and infra-structure areas. This Project has been developed at the north area of the State of Rio de Janeiro since 1999, in partnership of the Non Government Organization - NGO named 'Centro Norte Fluminense para Conservacao da Natureza - CNFCN'. Initial actions were based on a training course to prepare multiplier professionals on environmental education. In order to keep the multiplier Professional updated on environmental skills additional training course and local seminars are planned to be implemented in the region. Another project consider to create environmental skill cores to be implemented in the region based on training courses through either the use of the local public schools facilities and the volunteer contribution of the multiplier professionals. (author)

  2. Study of carbonitriding thermochemical treatment by plasma screen in active with pressures main austenitic stainless steels AISI 409 and AISI 316L; Estudo do tratamento termoquimico de carbonitretacao por plasma em tela ativa com pressoes variaveis nos acos inoxidaveis austenitico AISI 316L e ferririco AISI 409

    Energy Technology Data Exchange (ETDEWEB)

    Melo, M.S.; Oliveira, A.M.; Leal, V.S.; Sousa, R.R.M. de; Alves Junior, C. [Centro Federal de Educacao Tecnologica do Maranhao (CEFET/MA), Sao Luis, MA (Brazil); Centro Federal de Educacao Tecnologica do Piaui (CEFET/PI), Teresina, PI (Brazil); Universidade Federal do Rio Grande do Norte (DF/UFRN), Natal, RN (Brazil). Dept. de Fisica. Labplasma

    2010-07-01

    The technique called Active Screen Plasma Nitriding (ASPN) is being used as an alternative once it offers several advantages with respect to conventional DC plasma. In this method, the plasma does not form directly in the sample's surface but on a screen, in such a way that undesired effects such as the edge effect is minimized. Stainless steels present not very satisfactory wearing characteristics. However, plasma carbonitriding has been used as to improve its resistance to wearing due to the formation of a fine surface layer with good properties. In this work, samples of stainless steel AISI 316L and AISI 409 were treated at pressures of 2.5 and 5 mbar. After the treatments they were characterized by microhardness, microscopy and Xray diffraction. Microscopy and hardness analysis showed satisfactory layers and toughness in those steels. (author)

  3. Inflamação sistêmica causada pela periodontite crônica em pacientes vítimas de ataque cardíaco isquêmico agudo Systemic inflammation caused by chronic periodontitis in acute ischemic heart attack patients

    Directory of Open Access Journals (Sweden)

    Fernando José de Oliveira

    2010-03-01

    Full Text Available OBJETIVO: Processos inflamatórios e infecciosos mediados por bactérias em sítios distantes têm sido descritos como fator de risco à doença coronariana isquêmica aguda (DCIA. MÉTODOS: Cento e oitenta e um pacientes com DCIA, com e sem periodontites crônicas, foram incluídos neste estudo. Os pacientes foram admitidos no HC da UNICAMP e estratificados em três grupos: grupo 1 - pacientes com periodontite crônica grave (31 homens e 19 mulheres; média de idade 55,1 ± 11,29 anos; grupo 2 - pacientes com periodontite crônica leve (40 homens e 28 mulheres; média de idade 54,8 ± 10,37 anos; grupo 3 - pacientes desdentados (43 homens e 20 mulheres; média de idade 67,5 ± 8,55 anos. Amostras sanguíneas foram coletadas para mensurar os perfis lipídico, hematológico e glicêmico. Além disso, biópsias de 17 artérias coronárias com aterosclerose e igual número de artérias mamárias internas sem degeneração aterosclerótica no grupo 1 foram investigadas. Para análise estatística utilizou-se a análise de variância (ANOVA e o teste de Scheffé para comparações múltiplas. RESULTADOS: Triglicérides e LDL estavam elevados no grupo 1 em relação ao grupo 2. O HDL apresentou-se reduzido em 20% dos pacientes do grupo 1, e em 8% nos desdentados. A glicemia estava elevada no grupo 1. DNA de bactérias periodontais foram detectados em 58,8% das artérias coronárias. CONCLUSÕES: Pacientes com DCIA e periodontite crônica grave podem apresentar perfil lipídico alterado, como também microorganismos associados com as periodontites crônicas graves podem permear dentro de vasos coronarianos.OBJECTIVE: Infectious and inflammatory processes mediated by bacteria in distant sites have been described as a risk factor for acute ischemic heart disease (AIHD. METHODS: One hundred one patients with AIHD with and without chronic periodontitis (CP were included in this study. Patients were admitted to the HC UNICAMP and stratified into three groups: in group 1, we selected patients with severe chronic periodontitis (31 men and 19 women, mean age 55.1 ± 11.29 years old; the group 2 with mild chronic periodontitis (40 men and 28 women, mean age 54.8 ± 10.37 years old and group 3 represented by the toothless (43 men and 20 women, mean age 67.5 ± 8.55 years old. Blood samples were collected to measure the lipid profiles, hematological and blood glucose levels. In addition, biopsies of seventeen coronary arteries with atherosclerosis and an equal number of internal mammary arteries without atherosclerotic degeneration in group 1 were investigated. Statistical analysis by analysis of variance (ANOVA and Scheffé test for multiple comparisons was performed. RESULTS: Triglyceride and LDL levels were elevated in group 1 than in group 2. HDL were reduced by 20% in group 1 and remained reduced by 8% in toothless. Blood glucose was higher in group 1. DNA of periodontal bacteria was detected in 58.8% of the coronary arteries. CONCLUSIONS: Patients with (AIHD and severe chronic periodontitis may have altered lipid profile, as well as microorganisms associated with CP can permeate into coronary vessels.

  4. Actions to ensure the power and utilities supplying during the start-up and regular operation of the TKCSA steel complex through island operation mode; Acoes para garantir o suprimento de energia eletrica e utilidades durante a fase de start up e de operacao regular do complexo siderurgico da TKCSA (Thyssenkrupp - Companhia Siderurgica do Atlantico) atraves do modo de operacao em ilha

    Energy Technology Data Exchange (ETDEWEB)

    Vianna, Bernardo Matoso T.; Viana, Claudio Sobreira; Vaz, Daniel; Cesario, Fabricio; Pereira, Jose Antonio; Gimenez, Marcus Vinicius O.; Pascotto, Ricardo; Freitas Neto, Roberto Soares; Riederer, Werner [ThyssenKrupp Companhia Siderurgica do Atlantico (TKCSA), Rio de Janeiro, RJ (Brazil)

    2011-12-21

    At TKCSA, the energy and media distribution has an important function in the production processes. The electrical department is responsible for the power system operation, ensuring the receiving, transformation and supplying of this media for the regular and stable operation of the electrical equipment of the steel processes, and another important assignment of the electrical power sector is to guarantee the continuous power supply for the complex, even in case of interruption caused by the external grid, since the blast furnace, steel making and continuous casting cannot be interrupted abruptly. This continuous supply of energy is guaranteed by the Island Operation Mode (IOM), which always aims to ensure the supply of electricity from the Power Plant for the blowers, technical gases distribution system, fuel gases, steam and internal distribution of electricity and industrial water for the steel mill complex. During the complex start up and the regular operation phases, these two distribution systems (electricity and media) work interconnected and are kept in operation by the IOM, being guaranteed by the permanent operation of the electrical power generation system of Power Plant. This work presents how this concept was developed, tested and implemented at TKCSA. (author)

  5. Effect of the welding process on the microstructure and microhardness of API 5L X80 steel welded joint used for oil transportation pipeline; Efeito do processo de soldagem sobre a microestrutura e a microdureza de juntas soldadas de aco API 5L X80 usado em tubulacoes para transporte de petroleo

    Energy Technology Data Exchange (ETDEWEB)

    Alves, R.T.P.; Albuquerque, S.F. [Universidade Federal de Campina Grande (UFCG), PB (Brazil); Maciel, T.M.; Almeida, D.M.; Santos, M.A.

    2008-07-01

    This study had as objective to evaluate the microstructure and microhardness of API 5L X80 steel welded joints, used for pipelines to transport oil and gas, using the Shield Metal Arc Welding process with pre- heating temperature of 200 deg C and 400 deg C and the AWS E8010G electrode as filler metal. For this, besides the microhardness of the welded joint, the weld metals percentiles of micro-constituents and of columnar and regenerated grains and the medium size and extension of the heat affected zone were evaluated. The percentage of acicular ferrite in weld metal ranged from 13% to 33% which generated values of microhardness from 114 HV to 309 HV. (author)

  6. The use of steel and lead shieldings in radiotherapy rooms and its comparison with respect to neutrons doses at patients; Comparacao de blindagens de aco e de chumbo usadas em salas de radioterapia quanto a dose devido a neutrons depositada em pacientes

    Energy Technology Data Exchange (ETDEWEB)

    Silva, M.G.; Rebello, W.F.; Andrade, E.R.; Medeiros, M.P.C.; Mendes, R.M.S.; Braga, K.L.; Gomes, R.G., E-mail: maglosilva15@gmail.com, E-mail: rebello@ime.eb.br, E-mail: fisica.dna@gmail.com, E-mail: eng.cavaliere@gmail.com, E-mail: raphaelmsm@gmail.com, E-mail: kelmo.lins@gmail.com, E-mail: ggrprojetos@gmail.com [Instituto Militar de Engenharia (IME), Rio de Janeiro, RJ (Brazil); Santos, R.F.G., E-mail: raphaelfgsantos@gmail.com [Centro Universitario Anhanguera, Niteroi, RJ (Brazil). Departamento de Engenharia; Silva, Ademir X., E-mail: ademir@con.ufrj.br [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil)

    2015-07-01

    The NCRP Report No. 151, Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities, considers, in shielding calculations for radiotherapy rooms, the use of lead and/or steel to be applied on bunker walls. The NCRP Report calculations were performed foreseeing a better protection of people outside the radiotherapy room. However, contribution of lead and steel to patient dose should be taken into account for radioprotection purposes. This work presents calculations performed by MCNPX code in analyzing the Ambient Dose Equivalent due to neutron, H*(10){sub n}, within a radiotherapy room, in the patients area, considering the use of additional shielding of 1 TVL of lead or 1 TVL of steel, positioned at the inner faces of walls and ceiling of a bunker. The head of the linear accelerator Varian 2100/2300 C/D was modeled working at 18MeV, with 5x5cm{sup 2}, 10x10cm{sup 2}, 20x20cm{sup 2}, 30x30cm{sup 2} and 40x40cm{sup 2} openings for jaws and MLC and operating in eight gantry's angles. This study shows that the use of lead generates an average value of H*(10){sub n} at patients area, 8.02% higher than the expected when using steel. Further studies should be performed based on experimental data for comparison with those from MCNPX simulation.

  7. Exercício de força ativa a via AKT/mTor pelo receptor de angiotensina II tipo I no músculo cardíaco de ratos Activation of AKT-mTor signaling pathways by angiotensin II receptor type 1 after a session of strength exercise in cardiac muscle of rats

    Directory of Open Access Journals (Sweden)

    Stéphano Freitas Soares Melo

    2011-09-01

    Full Text Available O receptor de angiotensina II tipo I (AT1 tem uma importante participação no desenvolvimento da hipertrofia cardíaca. Em um trabalho publicado anteriormente, por nosso grupo, demonstramos que o bloqueio do receptor AT1 durante o treinamento de força inibiu a hipertrofia cardíaca em ratos. Por isso, o objetivo deste trabalho foi estudar a participação do receptor AT1 na ativação de vias de sinalização intracelular relacionadas com o aumento da síntese de proteína em ratos submetidos a uma sessão de exercício de força. Para isso, realizamos um experimento com seis grupos de animais (n = 6; cada: controle (Con, exercitado e sacrificado cinco minutos após o exercício (Exe 5, exercitado e sacrificado 30 minutos após o exercício (Exe 30, controle tratado com losartan (Con Los, tratado com losartan, exercitado e sacrificado cinco minutos após o exercício (Exe 5 Los, tratado com losartan, exercitado e sacrificado 30 minutos após o exercício (Exe 30 Los. Os resultados mostram que no grupo Exe 5 e Exe 30 ocorreu um aumento de 63% (P The angiotensin II type I (AT1 receptor has an important participation in the development of cardiac hypertrophy. Previously, we have shown that AT1 receptor participates in the cardiac hypertrophy induced by resistance training in rats. Here, we studied the involvement of AT1 receptor in the activation of intracellular signaling pathways related to the concentric HC in rats submitted to a session of strength exercise. Male Wistar rats were divided into 6 groups (n= 6 each: control (Con; exercised and killed 5 minutes after exercise (Exe 5; exercised and killed 30 minutes after exercise (Exe 30; control treated with Losartan (Con Los; treated with Losartan, exercised and killed 5 minutes after the exercise (Exe Los 5; treated with Losartan, exercised and killed 30 minutes after training (Exe Los 30. The results show that phosphorylation activity of AKT in group Exe 5 and Exe 30 increased 63% (P < 0.05 and 62% (P < 0.05, respectively, compared with Con. Whereas the phosphorylation of mTOR was increased 65% (P < 0.05, compared to Con, only in the group Exe 30. Furthermore, these effects were blocked by losartan treatment in groups Exe Los 5 and Exe Los 30. These results, together with ours previous data shows that the AT1 receptor has an role in the activation of AKT and mTOR pathway after a session of strength exercise.

  8. Takeover bid held by Natural Gas SDG on all of the shares of Iberdrola: a critical analysis and similarities to the Brazilian case; Oferta publica de aquisicao realizada pela Gas Natural SDG sobre a totalidade de acoes da Iberdrola: uma analise critica e similaridades com o caso brasileiro

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Julia Rotstein Smith da; Mathias, Melissa Cristina Pinto Pires; Cecchi, Jose Cesario [Agencia Nacional de Petroleo (ANP), Rio de Janeiro, RJ (Brazil)]. E-mails: jrotstein@anp.gov.br; mmathias@anp.gov.br; cecchi@anp.gov.br

    2004-07-01

    Competition defense is especially relevant to the industry of natural gas, because, in it, potentially competitive activities coexist with monopolistic activities. Thus, the regulatory agencies have an important role in regulating this sector, working on continuous improvement of the rules that govern and attempt for the actions of the agents that work on monopolistic segments or dominant in the competitive segments. Furthermore, it is mister monitoring the processes of alliances, joint ventures, mergers and acquisitions between business groups active in the gas industry and/or related sectors. In this context, the article describes the operation relating to Takeover bid held on 10 March 2003, for the company Gas Natural SDG SA for the whole of shares of Iberdrola S.A. It is examined the procedures performed by the Spanish regulatory agency, Comision Nacional de Energia (CNE), in decision making on this attempt to form a new business group, active both in the energy sector as in the gas sector. Simultaneously, covers up the Brazilian experience, which highlighted the activities of the National Petroleum Agency (ANP) in promoting competition, reducing the perceived risks for investors in infrastructure and prevention of anti competitive practices. It is also the need to undertaking of joint efforts between the ANP and the Agencia Nacional de Energia Eletrica (ANEEL), so that these two regulators consistently assess movements of merger and acquisition activities in the concerned gas and electric sectors in the country. Finally, it is proposed the ratification of an agreement on technical cooperation between the agencies in order to avoid unclear and/or possible problems of overlapping of responsibilities among the various regulatory spheres of national energy industry.

  9. Development of Nb{sub 2}O{sub 5}|Cu composite as AISI 1020 steel thermal spray coating for protection against corrosion by soil in buried structures; Desenvolvimento e uso do composito de Nb{sub 2}O{sub 5}|Cu como revestimento aplicado por aspersao termica sobre o aco AISI 1020 para protecao contra a corrosao pelo solo em estruturas enterradas

    Energy Technology Data Exchange (ETDEWEB)

    Regis Junior, Oscar [Universidade Tecnologica Federal do Parana, Ponta Grossa, PR (Brazil). Dept. de Mecanica; Silva, Jose Maurilio da; Portella, Kleber Franke [Instituto de Tecnologia para o Desenvolvimento, Curitiba, PR (Brazil). Dept. de Pesquisa em Engenharia Civil; Paredes, Ramon Sigifredo Cortes, E-mail: regis@utfpr.edu.br [Universidade Federal do Parana, Curitiba, PR (Brazil). Dept. de Mecanica

    2012-07-01

    An Nb{sub 2}O|Cu corrosion-resistant coating was developed and applied onto AISI 1020 steel substrate by Powder Flame Spray. A galvanostatic electrochemical technique was employed, with and without ohmic drop, in four different soils (two corrosively aggressive and two less aggressive). Behavior of coatings in different soils was compared using a cathodic hydrogen reduction reaction (equilibrium potential, overvoltage and exchange current density) focusing on the effect of ohmic drop. Results allow recommendation of Nb{sub 2}O{sub 5}|Cu composite for use in buried structure protection. (author)

  10. Efeito da intensidade do exercício físico sobre o controle inibitório, afeto, controle autonômico cardíaco e oxigenação do córtex pré-frontal

    OpenAIRE

    Silva, Weslley Quirino Alves da

    2016-01-01

    Introdução: A baixa aderência na maior parte da população em programas de atividade física tem sido associada a experiências emocionais de desprazer provocada pela intensidade do exercício físico. Estudos teóricos propõem o controle inibitório como elemento fundamental para a regulação emocional de prazer durante o exercício executado em diferentes intensidades. No entanto, ainda é desconhecida a relação do controle inibitório com as respostas afetivas acerca da intensidade do exercício. Obje...

  11. Increased oxidative stress as a mechanism for decreased BDNF levels in acute manic episodes Aumento do estresse oxidativo como um mecanismo para a diminuição dos níveis de BDNF em episódios maníacos agudos

    Directory of Open Access Journals (Sweden)

    Flávio Kapczinski

    2008-09-01

    Full Text Available OBJECTIVE AND METHOD: There is a growing amount of data indicating that alterations in brain-derived neurotrophic factor and increased oxidative stress may play a role in the pathophysiology of bipolar disorder. In light of recent evidence demonstrating that brain-derived neurotrophic factor levels are decreased in situations of increased oxidative stress, we have examined the correlation between serum thiobarbituric acid reactive substances, a measure of lipid peroxidation, and serum brain-derived neurotrophic factor levels in bipolar disorder patients during acute mania and in healthy controls. RESULTS: Serum thiobarbituric acid reactive substances and brain-derived neurotrophic factor levels were negatively correlated in bipolar disorder patients (r = -0.56; p = 0.001, whereas no significant correlation was observed in the control group.. CONCLUSION: These results suggest that alterations in oxidative status may be mechanistically associated with abnormal low levels of brain-derived neurotrophic factor observed in individuals with bipolar disorder.OBJETIVO E MÉTODO: Existem crescentes evidências indicando que alterações no fator neurotrófico derivado do cérebro e aumento do estresse oxidativo podem estar envolvidos na fisiopatologia do transtorno bipolar. Considerando os achados recentes de que os níveis de fator neurotrófico derivado do cérebro estão diminuídos em situações de aumento de estresse oxidativo, nós testamos a correlação entre os níveis séricos de substâncias reativas do ácido tiobarbitúrico, um índice de peroxidação lipídica, e os níveis séricos de fator neurotrófico derivado do cérebro em pacientes portadores de transtorno bipolar durante mania aguda e em controles saudáveis. RESULTADOS: Os níveis séricos de substâncias reativas do ácido tiobarbitúrico e fator neurotrófico derivado do cérebro apresentaram uma correlação negativa em pacientes bipolares (r = -0,56; p = 0,001, enquanto não houve correlação significativa no grupo controle. CONCLUSÃO: Estes resultados sugerem que alterações de estresse oxidativo podem ser mecanisticamente associadas com níveis reduzidos de BDNF observados em indivíduos com transtorno bipolar.

  12. Drenagem anômala de veia pulmonar inferior direita em veia cava inferior associada a apêndice hepático intracardíaco Anomalous drainage of the right inferior pulmonary vein into the inferior vena cava associated to intrathoracic hepatic appendix

    Directory of Open Access Journals (Sweden)

    Carlos R Moraes

    1988-08-01

    Full Text Available Descreve-se o caso de uma paciente de 61 anos de idade, com drenagem anômala de veia pulmonar inferior direita em veia cava inferior, associada a apêndice hepático intratorácico, herniado através de fenda no diafragma. A correção cirúrgica foi realizada por anastomose direta da veia anômala com o átrio esquerdo, pela redução do apêndice hepático para a cavidade abdominal e, finalmente, pelo fechamento do defeito diafragmático. O pós-operatório decorreu sem qualquer complicação. Os autores chamam a atenção para a raridade do caso.The authors present a case of a 61-year-old woman with anomalous drainage of the right inferior pulmonary vein into the inferior vena cava associated to an intrathoracic hepatic appendix herniated through a diaphragmatic defect. Surgical correction was obtained by direct anastomosis of the anomalous vein to the left atrium, reduction of the hepatic appendix to the abdominal cavity and closure of the diphragmatic defect. The postoperative course was unevenftul. The rarity of this condition is stressed.

  13. Sadhana | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    RSM) which was coupled with ant colony optimization (ACO) to optimize the media compositions so as to enhance the productivity of lipopeptide. The optimized media by ACO was found to yield 1.501 g/L of lipopeptide concentration which was ...

  14. 33 CFR 164.72 - Navigational-safety equipment, charts or maps, and publications required on towing vessels.

    Science.gov (United States)

    2010-07-01

    ..., published by the National Ocean Service (NOS), the ACOE, or a river authority that satisfy the following... the NOS, or river-current tables published by the ACOE or a river authority: (D) Tide tables published... (3) Tidal-current Tables (3) Tidal-current Tables. (4) Tide Tables (4) Tide Tables. (5) U.S. Coast...

  15. The Need for Dynamic Airspace Management in Coalition Operations (The International C2 Journal, Volume 5, Number 3, 2011)

    Science.gov (United States)

    2011-01-01

    Automated Deep Operations Coordination System (JADOCS), Theater Battle Management Core System ( TBMCS ), and Air Defense System Integrator (ADSI). NATO’s...be submitted to TBMCS at the AOC for inclusion in the daily ACO or change ACO. Missions requiring rapid response, such as MEDEVACs, fire missions

  16. 75 FR 70165 - Medicare Program; Request for Information Regarding Accountable Care Organizations and the...

    Science.gov (United States)

    2010-11-17

    ... incentives for health care providers to enhance health care quality and lower costs. One important delivery... generated. What payment models, financing mechanisms or other systems might we consider, either for the... to an ACO is important to ensure that expenditures, as well as any savings achieved by the ACO, are...

  17. Ant Colony Optimization and the Minimum Cut Problem

    DEFF Research Database (Denmark)

    Kötzing, Timo; Lehre, Per Kristian; Neumann, Frank

    2010-01-01

    Ant Colony Optimization (ACO) is a powerful metaheuristic for solving combinatorial optimization problems. With this paper we contribute to the theoretical understanding of this kind of algorithm by investigating the classical minimum cut problem. An ACO algorithm similar to the one that was prov...

  18. Parameter estimation of Lorenz chaotic system using a hybrid swarm intelligence algorithm

    International Nuclear Information System (INIS)

    Lazzús, Juan A.; Rivera, Marco; López-Caraballo, Carlos H.

    2016-01-01

    A novel hybrid swarm intelligence algorithm for chaotic system parameter estimation is present. For this purpose, the parameters estimation on Lorenz systems is formulated as a multidimensional problem, and a hybrid approach based on particle swarm optimization with ant colony optimization (PSO–ACO) is implemented to solve this problem. Firstly, the performance of the proposed PSO–ACO algorithm is tested on a set of three representative benchmark functions, and the impact of the parameter settings on PSO–ACO efficiency is studied. Secondly, the parameter estimation is converted into an optimization problem on a three-dimensional Lorenz system. Numerical simulations on Lorenz model and comparisons with results obtained by other algorithms showed that PSO–ACO is a very powerful tool for parameter estimation with high accuracy and low deviations. - Highlights: • PSO–ACO combined particle swarm optimization with ant colony optimization. • This study is the first research of PSO–ACO to estimate parameters of chaotic systems. • PSO–ACO algorithm can identify the parameters of the three-dimensional Lorenz system with low deviations. • PSO–ACO is a very powerful tool for the parameter estimation on other chaotic system.

  19. Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance.

    Science.gov (United States)

    Albright, Benjamin B; Lewis, Valerie A; Ross, Joseph S; Colla, Carrie H

    2016-03-01

    Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. This is a cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified 2 underlying factors among 8 measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration.

  20. 77 FR 74579 - Airworthiness Directives; Gulfstream Aerospace Corporation Airplanes

    Science.gov (United States)

    2012-12-17

    ... Certification Office (ACO), 1701 Columbia Avenue, College Park, Georgia 30337; phone: 404-474-5566; fax: 404-474... Management Branch, ACE-102A, FAA, Atlanta Aircraft Certification Office (ACO), 1701 Columbia Avenue, College... directive (AD) for certain Gulfstream Aerospace Corporation Model GIV-X airplanes. This AD requires...

  1. 76 FR 36392 - Airworthiness Directives; Gulfstream Aerospace Corporation Model GV and GV-SP Airplanes

    Science.gov (United States)

    2011-06-22

    ... Aircraft Certification Office (ACO) 1701 Columbia Avenue, College Park, Georgia 30337; phone: 404-474-5566..., Atlanta Aircraft Certification Office (ACO) 1701 Columbia Avenue, College Park, Georgia 30337; telephone... Aerospace Corporation Model GV and GV-SP Airplanes AGENCY: Federal Aviation Administration (FAA), DOT...

  2. 75 FR 7945 - Airworthiness Directives; Augustair, Inc. Models 2150, 2150A, and 2180 Airplanes

    Science.gov (United States)

    2010-02-23

    ... Certification Office (ACO), 1701 Columbia Avenue, College Park, Georgia 30337; fax: (404) 474-5606; e-mail: hal..., FAA, Atlanta Aircraft Certification Office (ACO), 1701 Columbia Avenue, College Park, Georgia 30337... Airworthiness Directives; Augustair, Inc. Models 2150, 2150A, and 2180 Airplanes AGENCY: Federal Aviation...

  3. 75 FR 34956 - Airworthiness Directives; Robert E. Rust, Jr. Model DeHavilland DH.C1 Chipmunk 21, DH.C1 Chipmunk...

    Science.gov (United States)

    2010-06-21

    ... Certification Office (ACO), 1701 Columbia Avenue, College Park, Georgia 30337; telephone: (404) 474-5543; fax..., FAA, Atlanta Aircraft Certification Office (ACO), 1701 Columbia Avenue, College Park, Georgia 30337.... Model DeHavilland DH.C1 Chipmunk 21, DH.C1 Chipmunk 22, and DH.C1 Chipmunk 22A Airplanes AGENCY: Federal...

  4. Parameter estimation of Lorenz chaotic system using a hybrid swarm intelligence algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Lazzús, Juan A., E-mail: jlazzus@dfuls.cl; Rivera, Marco; López-Caraballo, Carlos H.

    2016-03-11

    A novel hybrid swarm intelligence algorithm for chaotic system parameter estimation is present. For this purpose, the parameters estimation on Lorenz systems is formulated as a multidimensional problem, and a hybrid approach based on particle swarm optimization with ant colony optimization (PSO–ACO) is implemented to solve this problem. Firstly, the performance of the proposed PSO–ACO algorithm is tested on a set of three representative benchmark functions, and the impact of the parameter settings on PSO–ACO efficiency is studied. Secondly, the parameter estimation is converted into an optimization problem on a three-dimensional Lorenz system. Numerical simulations on Lorenz model and comparisons with results obtained by other algorithms showed that PSO–ACO is a very powerful tool for parameter estimation with high accuracy and low deviations. - Highlights: • PSO–ACO combined particle swarm optimization with ant colony optimization. • This study is the first research of PSO–ACO to estimate parameters of chaotic systems. • PSO–ACO algorithm can identify the parameters of the three-dimensional Lorenz system with low deviations. • PSO–ACO is a very powerful tool for the parameter estimation on other chaotic system.

  5. Economic Impact Forecast System (EIFS) II: User’s Manual. Updated Edition.

    Science.gov (United States)

    1984-05-01

    AYtr ACo - bo * AYtr AIh - ih *rpv *ACh Ala = io* ACo AS - Zc * C*(1-ZmW Pm+ PC] APY (av / amv) * (ABVt /tbv72) ACRe - (Zaf+ %as)*sc*AS AGRo - (tp...ga 35031 mc kinley, nm 13027 brooks, ga 35033 mora, nm 13037 calhoun, ga 35039 rio arriba , nm 13061 clay, ga 35043 sandoval, nm 13065 clinch, ga 35045

  6. Functional Expression of the Thiolase Gene thl from Clostridium beijerinckii P260 in Lactococcus lactis and Lactobacillus buchneri

    Science.gov (United States)

    The first step of the butanol pathway involves an acetyl-CoA acetyltransferase (ACoAAT), which controls the key branching point from acetyl-CoA to butanol. ACoAAT, also known as thiolase (EC 2.3.1.9), is encoded by the thl gene and catalyzes ligation of 2 acetyl-CoA into acetoacetyl-CoA. Bioinform...

  7. ADAPTIVE ANT COLONY OPTIMIZATION BASED GRADIENT FOR EDGE DETECTION

    Directory of Open Access Journals (Sweden)

    Febri Liantoni

    2014-08-01

    Full Text Available Ant Colony Optimization (ACO is a nature-inspired optimization algorithm which is motivated by ants foraging behavior. Due to its favorable advantages, ACO has been widely used to solve several NP-hard problems, including edge detection. Since ACO initially distributes ants at random, it may cause imbalance ant distribution which later affects path discovery process. In this paper an adaptive ACO is proposed to optimize edge detection by adaptively distributing ant according to gradient analysis. Ants are adaptively distributed according to gradient ratio of each image regions. Region which has bigger gradient ratio, will have bigger number of ant distribution. Experiments are conducted using images from various datasets. Precision and recall are used to quantitatively evaluate performance of the proposed algorithm. Precision and recall of adaptive ACO reaches 76.98 % and 96.8 %. Whereas highest precision and recall for standard ACO are 69.74 % and 74.85 %. Experimental results show that the adaptive ACO outperforms standard ACO which randomly distributes ants.

  8. Adiposity, physical activity and blood lipid profile in 13-year-old adolescents.

    Science.gov (United States)

    Ostojic, Sergej M; Stojanovic, Marko; Stojanovic, Vladan; Maric, Jelena

    2010-04-01

    The main aim of this study was to determine the extent to which physical activity and adiposity are associated with blood cholesterol levels in male adolescents. Anthropometric and physical fitness values were measured in all children. Body mass index (BMI) and physical activity index (PAI) were used to split participants into active overweight (ACO) and non-active normal-weight (NAN) groups. The cutoffs for the ACO group were BMI > or = 22.6 kg/m2 and PAI > or = 3.5, respectively, whereas the corresponding cutoffs for the NAN groups were BMI body fat as compared to their NAN counterparts (p HDL-cholesterol was higher in ACO group (p correlation between HDL-cholesterol and PAI in ACO group (r = 0.38; p index explained the majority of variance in HDL-cholesterol for ACO group (beta = 0.513; p adiposity per se, particularly for HDL-cholesterol.

  9. Phenotype of asthma-chronic obstructive pulmonary disease overlap syndrome.

    Science.gov (United States)

    Rhee, Chin Kook

    2015-07-01

    Many patients with asthma or chronic obstructive pulmonary disease (COPD) have overlapping characteristics of both diseases. By spirometric definition, patients with both fixed airflow obstruction (AO) and bronchodilator reversibility or fixed AO and bronchial hyperresponsiveness can be considered to have asthma-COPD overlap syndrome (ACOS). However, patients regarded to have ACOS by spirometric criteria alone are heterogeneous and can be classified by phenotype. Eosinophilic inflammation, a history of allergic disease, and smoke exposure are important components in the classification of ACOS. Each phenotype has a different underlying pathophysiology, set of characteristics, and prognosis. Medical treatment for ACOS should be tailored according to phenotype. A narrower definition of ACOS that includes both spirometric and clinical criteria is needed.

  10. Ant colony optimisation for economic dispatch problem with non-smooth cost functions

    Energy Technology Data Exchange (ETDEWEB)

    Pothiya, Saravuth; Kongprawechnon, Waree [School of Communication, Instrumentation and Control, Sirindhorn International Institute of Technology, Thammasat University, P.O. Box 22, Pathumthani (Thailand); Ngamroo, Issarachai [Center of Excellence for Innovative Energy Systems, Faculty of Engineering, King Mongkut' s Institute of Technology Ladkrabang, Bangkok 10520 (Thailand)

    2010-06-15

    This paper presents a novel and efficient optimisation approach based on the ant colony optimisation (ACO) for solving the economic dispatch (ED) problem with non-smooth cost functions. In order to improve the performance of ACO algorithm, three additional techniques, i.e. priority list, variable reduction, and zoom feature are presented. To show its efficiency and effectiveness, the proposed ACO is applied to two types of ED problems with non-smooth cost functions. Firstly, the ED problem with valve-point loading effects consists of 13 and 40 generating units. Secondly, the ED problem considering the multiple fuels consists of 10 units. Additionally, the results of the proposed ACO are compared with those of the conventional heuristic approaches. The experimental results show that the proposed ACO approach is comparatively capable of obtaining higher quality solution and faster computational time. (author)

  11. PMU Placement Methods in Power Systems based on Evolutionary Algorithms and GPS Receiver

    Directory of Open Access Journals (Sweden)

    M. R. Mosavi

    2013-06-01

    Full Text Available In this paper, optimal placement of Phasor Measurement Unit (PMU using Global Positioning System (GPS is discussed. Ant Colony Optimization (ACO, Simulated Annealing (SA, Particle Swarm Optimization (PSO and Genetic Algorithm (GA are used for this problem. Pheromone evaporation coefficient and the probability of moving from state x to state y by ant are introduced into the ACO. The modified algorithm overcomes the ACO in obtaining global optimal solution and convergence speed, when applied to optimizing the PMU placement problem. We also compare this simulink with SA, PSO and GA that to find capability of ACO in the search of optimal solution. The fitness function includes observability, redundancy and number of PMU. Logarithmic Least Square Method (LLSM is used to calculate the weights of fitness function. The suggested optimization method is applied in 30-bus IEEE system and the simulation results show modified ACO find results better than PSO and SA, but same result with GA.

  12. Analysis of parameter estimation and optimization application of ant colony algorithm in vehicle routing problem

    Science.gov (United States)

    Xu, Quan-Li; Cao, Yu-Wei; Yang, Kun

    2018-03-01

    Ant Colony Optimization (ACO) is the most widely used artificial intelligence algorithm at present. This study introduced the principle and mathematical model of ACO algorithm in solving Vehicle Routing Problem (VRP), and designed a vehicle routing optimization model based on ACO, then the vehicle routing optimization simulation system was developed by using c ++ programming language, and the sensitivity analyses, estimations and improvements of the three key parameters of ACO were carried out. The results indicated that the ACO algorithm designed in this paper can efficiently solve rational planning and optimization of VRP, and the different values of the key parameters have significant influence on the performance and optimization effects of the algorithm, and the improved algorithm is not easy to locally converge prematurely and has good robustness.

  13. Evaluating the Effects of Pioneer Accountable Care Organizations on Medicare Part D Drug Spending and Utilization.

    Science.gov (United States)

    Zhang, Yuting; Caines, Kadin J; Powers, Christopher A

    2017-05-01

    The improvement of medication use is a critical mechanism that accountable care organization (ACO) could use to save overall costs. Currently pharmaceutical spending is not part of the calculation for ACO-shared savings and risks. Thus, ACO providers may have strong incentives to prescribe more medications hoping to avoid expensive downstream medical costs. We designed a quasinatural experiment study to evaluate the effects of Pioneer ACOs on Medicare Part D spending and utilization. Medicare fee-for-service beneficiaries with Part D drug coverage who were aligned to a Pioneer ACO were compared with a random 5% sample of non-ACO beneficiaries. Outcomes included changes in Part D spending, number of prescription fills, percent of brand medications, and total Part A and B medical spending. We utilized a generalized linear model with a difference-in-differences approach to estimate 2011-2012 changes in these outcomes among beneficiaries aligned with Pioneer ACOs, adjusting for all beneficiary-level demographics, income and insurance status, clinical characteristics, and regional fixed effects. Being in an ACO did not significantly affect Part D spending (-$23.52; P=0.19), total prescriptions filled (-0.12; P=0.27), and the percent of claims for brand-name drugs (0.06%; P=0.23). The ACO group was associated with savings in Parts A and B spending of $345 (PPioneer ACOs were not associated with changes in pharmaceutical spending and use, but were associated with savings in Parts A and B spending in 2012.

  14. Retinal is formed from apo-carotenoids in Nostoc sp. PCC7120: in vitro characterization of an apo-carotenoid oxygenase

    Science.gov (United States)

    Scherzinger, Daniel; Ruch, Sandra; Kloer, Daniel P.; Wilde, Annegret; Al-Babili, Salim

    2006-01-01

    The sensory rhodopsin from Anabaena (Nostoc) sp. PCC7120 is the first cyanobacterial retinylidene protein identified. Here, we report on NosACO (Nostoc apo-carotenoid oxygenase), encoded by the ORF (open reading frame) all4284, as the candidate responsible for the formation of the required chromophore, retinal. In contrast with the enzymes from animals, NosACO converts β-apo-carotenals instead of β-carotene into retinal in vitro. The identity of the enzymatic products was proven by HPLC and gas chromatography–MS. NosACO exhibits a wide substrate specificity with respect to chain lengths and functional end-groups, converting β-apo-carotenals, (3R)-3-hydroxy-β-apo-carotenals and the corresponding alcohols into retinal and (3R)-3-hydroxyretinal respectively. However, kinetic analyses revealed very divergent Km and Vmax values. On the basis of the crystal structure of SynACO (Synechocystis sp. PCC6803 apo-carotenoid oxygenase), a related enzyme showing similar enzymatic activity, we designed a homology model of the native NosACO. The deduced structure explains the absence of β-carotene-cleavage activity and indicates that NosACO is a monotopic membrane protein. Accordingly, NosACO could be readily reconstituted into liposomes. To localize SynACO in vivo, a Synechocystis knock-out strain was generated expressing SynACO as the sole carotenoid oxygenase. Western-blot analyses showed that the main portion of SynACO occurred in a membrane-bound form. PMID:16759173

  15. Neural and psychological characteristics of college students with alcoholic parents differ depending on current alcohol use.

    Science.gov (United States)

    Brown-Rice, Kathleen A; Scholl, Jamie L; Fercho, Kelene A; Pearson, Kami; Kallsen, Noah A; Davies, Gareth E; Ehli, Erik A; Olson, Seth; Schweinle, Amy; Baugh, Lee A; Forster, Gina L

    2018-02-02

    A significant proportion of college students are adult children of an alcoholic parent (ACoA), which can confer greater risk of depression, poor self-esteem, alcohol and drug problems, and greater levels of college attrition. However, some ACoA are resilient to these negative outcomes. The goal of this study was to better understand the psychobiological factors that distinguish resilient and vulnerable college-aged ACoAs. To do so, scholastic performance and psychological health were measured in ACoA college students not engaged in hazardous alcohol use (resilient) and those currently engaged in hazardous alcohol use (vulnerable). Neural activity (as measured by functional magnetic resonance imaging) in response to performing working memory and emotion-based tasks were assessed. Furthermore, the frequency of polymorphisms in candidate genes associated with substance use, risk taking and stress reactivity were compared between the two ACoA groups. College ACoAs currently engaged in hazardous alcohol use reported more anxiety, depression and posttraumatic stress symptoms, and increased risky nicotine and marijuana use as compared to ACoAs resistant to problem alcohol use. ACoA college students with current problem alcohol showed greater activity of the middle frontal gyrus and reduced activation of the posterior cingulate in response to visual working memory and emotional processing tasks, which may relate to increased anxiety and problem alcohol and drug behaviors. Furthermore, polymorphisms of cholinergic receptor and the serotonin transporter genes also appear to contribute a role in problem alcohol use in ACoAs. Overall, findings point to several important psychobiological variables that distinguish ACoAs based on their current alcohol use that may be used in the future for early intervention. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Evaluating the Impact of an Accountable Care Organization on Population Health: The Quasi-Experimental Design of the German Gesundes Kinzigtal.

    Science.gov (United States)

    Pimperl, Alexander; Schulte, Timo; Mühlbacher, Axel; Rosenmöller, Magdalena; Busse, Reinhard; Groene, Oliver; Rodriguez, Hector P; Hildebrandt, Helmut

    2017-06-01

    A central goal of accountable care organizations (ACOs) is to improve the health of their accountable population. No evidence currently links ACO development to improved population health. A major challenge to establishing the evidence base for the impact of ACOs on population health is the absence of a theoretically grounded, robust, operationally feasible, and meaningful research design. The authors present an evaluation study design, provide an empirical example, and discuss considerations for generating the evidence base for ACO implementation. A quasi-experimental study design using propensity score matching in combination with small-scale exact matching is implemented. Outcome indicators based on claims data were constructed and analyzed. Population health is measured by using a range of mortality indicators: mortality ratio, age at time of death, years of potential life lost/gained, and survival time. The application is assessed using longitudinal data from Gesundes Kinzigtal, one of the leading population-based ACOs in Germany. The proposed matching approach resulted in a balanced control of observable differences between the intervention (ACO) and control groups. The mortality indicators used indicate positive results. For example, 635.6 fewer years of potential life lost (2005.8 vs. 2641.4; t-test: sig. P < 0.05*) in the ACO intervention group (n = 5411) attributable to the ACO, also after controlling for a potential (indirect) immortal time bias by excluding the first half year after enrollment from the outcome measurement. This empirical example of the impact of a German ACO on population health can be extended to the evaluation of ACOs and other integrated delivery models of care.

  17. Clinical characteristics of the asthma–COPD overlap syndrome – a systematic review

    Directory of Open Access Journals (Sweden)

    Nielsen M

    2015-07-01

    Full Text Available Mia Nielsen,1 Camilla Boslev Bårnes,1 Charlotte Suppli Ulrik1,2 1Department of Pulmonary Medicine, Hvidovre Hospital, 2University of Copenhagen, Copenhagen, Denmark Background and objective: In recent years, the so-called asthma–chronic obstructive pulmonary disease (COPD overlap syndrome (ACOS has received much attention, not least because elderly individuals may present characteristics suggesting a diagnosis of both asthma and COPD. At present, ACOS is described clinically as persistent airflow limitation combined with features of both asthma and COPD. The aim of this paper is, therefore, to review the currently available literature focusing on symptoms and clinical characteristics of patients regarded as having ACOS.Methods: Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA guidelines, a systematic literature review was performed.Results: A total of 11 studies met the inclusion criteria for the present review. All studies dealing with dyspnea (self-reported or assessed by the Medical Research Council dyspnea scale reported more dyspnea among patients classified as having ACOS compared to the COPD and asthma groups. In line with this, ACOS patients have more concomitant wheezing and seem to have more cough and sputum production. Compared to COPD-only patients, the ACOS patients were found to have lower FEV1% predicted and FEV1/FVC ratio in spite of lower mean life-time tobacco exposure. Furthermore, studies have revealed that ACOS patients seem to have not only more frequent but also more severe exacerbations. Comorbidity, not least diabetes, has also been reported in a few studies, with a higher prevalence among ACOS patients. However, it should be acknowledged that only a limited number of studies have addressed the various comorbidities in patients with ACOS.Conclusion: The available studies indicate that ACOS patients may have more symptoms and a higher exacerbation rate than patients with asthma

  18. Accountable Care Organizations and Transaction Cost Economics.

    Science.gov (United States)

    Mick, Stephen S Farnsworth; Shay, Patrick D

    2016-12-01

    Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information "impactedness." Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development. © The Author(s) 2016.

  19. An agent-based simulation model of patient choice of health care providers in accountable care organizations.

    Science.gov (United States)

    Alibrahim, Abdullah; Wu, Shinyi

    2018-03-01

    Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

  20. Serial position learning effects in patients with aneurysms of the anterior communicating artery.

    Science.gov (United States)

    Stefanova, Elka; Kostic, Vladimir S; Ziropadja, Ljubomir; Markovic, Milan; Ocic, Gordana

    2002-08-01

    Ruptured and repaired Anterior Communicating Artery (ACoA) aneurysm can result in devastating impairments involving memory, executive function, confabulation, and personality changes. This study tested serial position learning effects (SPEs) in patients following repaired and ruptured ACoA aneurysm, using results on the Rey Auditory Verbal Learning Test (RAVLT). Thirty patients with ruptured aneurysms of the ACoA and 31 matched controls were included in the study. The primacy-recency effects were maintained during five learning trials in ACoA group, albeit at an overall lower level than in the controls. There was no difference in primacy-recency relation across five learning trials in ACoA group. On the delayed recall trial the patient group demonstrated neither a primacy, nor a recency phenomenon, reflecting a lack of recall of any parts of the word list. This kind of primacy-recency profile across learning trials in ACoA group has no similarity with SPE results in frontal lesion groups, or with SPE distributions in other amnesic disorders, despite the fact that memory and executive deficits were evident in our ACoA group.

  1. Socioeconomic impact of asthma, chronic obstructive pulmonary disease and asthma-COPD overlap syndrome.

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    Kim, Jinhee; Kim, Young Sam; Kim, Kyungjoo; Oh, Yeon-Mok; Yoo, Kwang Ha; Rhee, Chin Kook; Lee, Jin Hwa

    2017-06-01

    Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is defined as having both features of asthma and COPD, which are airway hyper-responsiveness and incompletely reversible airway obstruction. However, socioeconomic impact of ACOS have not been well appreciated. Adults with available wheezing history and acceptable spirometry were selected from the fourth Korean National Health and Nutrition Examination Survey (KNHANES IV) in 2007-2009. Their data were merged with the Korean National Health Insurance claim data. 'Asthma group' was defined as having self-reported wheezing history and FEV 1 /FVC ≥0.7, 'COPD group' was defined as having FEV 1 /FVC COPD, 8.4%; asthma, 5.8% and NAD, 83.6%. Total length of healthcare utilization and medical costs of ACOS group was the top among four groups (PCOPD group (P=0.025). Multiple linear regression analyses showed that ACOS group (β=12.63, P<0.001) and asthma group (β=6.14, P<0.001) were significantly associated with longer duration of healthcare utilization and ACOS group (β=350,475.88, P=0.008) and asthma group (β=386,876.81, P<0.001) were associated with higher medical costs. This study demonstrated that ACOS independently influences healthcare utilization after adjusting several factors. In order to utilize limited medical resources efficiently, it may be necessary to find and manage ACOS patients.

  2. Structuring payment to medical homes after the affordable care act.

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    Edwards, Samuel T; Abrams, Melinda K; Baron, Richard J; Berenson, Robert A; Rich, Eugene C; Rosenthal, Gary E; Rosenthal, Meredith B; Landon, Bruce E

    2014-10-01

    The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

  3. Surgeon Participation in Early Accountable Care Organizations.

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    Resnick, Matthew J; Graves, Amy J; Buntin, Melinda B; Richards, Michael R; Penson, David F

    2018-03-01

    We aimed to characterize the landscape of surgeon participation in early accountable care organizations (ACOs) and to identify specialty-, organization-, and market-specific factors associated with ACO participation. Despite rapid deployment of alternative payment models (APMs), little is known about the prevalence of surgeon participation, and key drivers behind surgeon participation in APMs. Using data from SK&A, a research firm, we evaluated the near universe of US practices to characterize ACO participation among 125,425 US surgeons in 2015. We fit multivariable logistic regression models to characterize key drivers of ACO participation, and more specifically, the interaction between ACO affiliation and organizational structure. Of 125,425 US surgeons, 27,956 (22.3%) participated in at least 1 ACO program in 2015. We observed heterogeneity in participation by subspecialty, with trauma and transplant reporting the highest rate of ACO enrollment (36% for both) and plastic surgeons reporting the lowest (12.9%) followed by ophthalmology (16.0%) and hand (18.6%). Surgeons in group practices and integrated systems were more likely to participate relative to those practicing independently (aOR 1.57, 95% CI 1.50, 1.64; aOR 4.87, 95% CI 4.68, 5.07, respectively). We observed a statistically significant interaction (P organization. Model-derived predicted probabilities revealed that, within each specialty, surgeons in integrated health systems had the highest predicted probabilities of ACO and those practicing independently generally had the lowest. We observed considerable variation in ACO enrollment among US surgeons, mediated at least in part by differences in practice organization. These data underscore the need for development of frameworks to characterize the strategic advantages and disadvantages associated with APM participation.

  4. Aligning for accountable care: Strategic practices for change in accountable care organizations.

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    Hilligoss, Brian; Song, Paula H; McAlearney, Ann Scheck

    Alignment within accountable care organizations (ACOs) is crucial if these new entities are to achieve their lofty goals. However, the concept of alignment remains underexamined, and we know little about the work entailed in creating alignment. The aim of this study was to develop the concept of aligning by identifying and describing the strategic practices administrators use to align the structures, processes, and behaviors of their organizations and individual providers in pursuit of accountable care. We conducted 2-year qualitative case studies of four ACOs that have assumed full risk for the costs and quality of care for defined populations. Five strategic aligning practices were used by all four ACOs. Informing both aligns providers' understandings with the goals and value proposition of the ACO and aligns the providers' attention with the drivers of performance. Involving both aligns ACO leaders' understandings with the realities facing providers and aligns the policies of the ACO with the needs of providers. Enhancing both aligns the operations of individual provider practices with the operations of the ACO and aligns the trust of providers with the ACO. Motivating aligns what providers value with the goals of the ACO. Finally, evolving is a metapractice of learning and adapting that guides the execution of the other four practices. Our findings suggest that there are second-order cognitive (e.g., understandings and attention) and cultural (e.g., trust and values) levels of alignment, as well as a first-order operational level (organizational structures, processes, and incentives). A well-aligned organization may require ongoing repositioning at each of these levels, as well as attention to both cooperative and coordinative dimensions of alignment. Implications for research and practice are discussed.

  5. Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations.

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    T H Wan, Thomas; Masri, Maysoun Dimachkie; Ortiz, Judith

    2014-01-01

    The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective. A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures - 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received. RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis. The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act. Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

  6. Accountable care organization readiness and academic medical centers.

    Science.gov (United States)

    Berkowitz, Scott A; Pahira, Jennifer J

    2014-09-01

    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

  7. L-Type Calcium Channel Inhibition Contributes to the Proarrhythmic Effects of Aconitine in Human Cardiomyocytes.

    Directory of Open Access Journals (Sweden)

    Jianjun Wu

    Full Text Available Aconitine (ACO is well-known for causing lethal ventricular tachyarrhythmias. While cardiac Na+ channel opening during repolarization has long been documented in animal cardiac myocytes, the cellular effects and mechanism of ACO in human remain unexplored. This study aimed to assess the proarrhythmic effects of ACO in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs. ACO concentration-dependently (0.3 ~ 3.0 μM shortened the action potentials (AP durations (APD in ventricular-like hiPSC-CMs by > 40% and induced delayed after-depolarization. Laser-scanning confocal calcium imaging analysis showed that ACO decreased the duration and amplitude of [Ca2+]i transients and increased in the beating frequencies by over 60%. Moreover, ACO was found to markedly reduce the L-type calcium channel (LTCC currents (ICa,L in hiPSC-CMs associated with a positive-shift of activation and a negative shift of inactivation. ACO failed to alter the peak and late Na+ currents (INa in hiPSC-CMs while it drastically increased the late INa in Guinea-pig ventricular myocytes associated with enhanced activation/delayed inactivation of INa at -55 mV~ -85 mV. Further, the effects of ACO on ICa,L, INa and the rapid delayed rectifier potassium current (Ikr were validated in heterologous expression systems by automated voltage-clamping assays and a moderate suppression of Ikr was observed in addition to concentration-dependent ICa,L inhibition. Lastly, increased beating frequency, decreased Ca2+ wave and shortened field potential duration were recorded from hiPSC-CMs by microelectrode arrays assay. In summary, our data demonstrated that LTCC inhibition could play a main role in the proarrhythmic action of ACO in human cardiomyocytes.

  8. Redesigning Care Delivery with Patient Support Personnel: Learning from Accountable Care Organizations

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    Gorbenko, Ksenia O.; Fraze, Taressa; Lewis, Valerie A.

    2017-01-01

    INTRODUCTION Accountable care organizations (ACOs) are a value-based payment model in the United States rooted in holding groups of healthcare providers financially accountable for the quality and total cost of care of their attributed population. To succeed in reaching their quality and efficiency goals, ACOs implement a variety of care delivery changes, including workforce redesign. Patient support personnel (PSP)—non-physician staff such as care coordinators, community health workers, and others—are critical to restructuring care delivery. Little is known about how ACOs are redesigning their patient support personnel in terms of responsibilities, location, and evaluation. METHODS We conducted semi-structured one-hour interviews with 25 executives at 16 distinct ACOs. The interviews were recorded, transcribed, and coded for themes, using a qualitative coding and analysis process. RESULTS ACOs deployed PSP to perform four clusters of responsibilities: care provision, care coordination, logistical help with transportation, and social and emotional support. ACOs deployed these personnel strategically across settings (primary care, inpatient services, emergency department, home care and community) depending on their population needs. Most ACOs used personnel with the same level of training across settings. Few ACOs planned to conduct a comprehensive evaluation of their PSP to optimize their value. DISCUSSION ACO strategies in workforce redesign indicate a shift from a physician-centered to a team-based approach. Employing personnel with varying levels of clinical training to perform different tasks can help further optimize care delivery. More robust evaluation of the deployment of PSP and their performance is needed to demonstrate cost-saving benefits of workforce redesign. PMID:28217305

  9. The aconitate hydratase family from Citrus

    Directory of Open Access Journals (Sweden)

    Cercos Manuel

    2010-10-01

    Full Text Available Abstract Background Research on citrus fruit ripening has received considerable attention because of the importance of citrus fruits for the human diet. Organic acids are among the main determinants of taste and organoleptic quality of fruits and hence the control of fruit acidity loss has a strong economical relevance. In citrus, organic acids accumulate in the juice sac cells of developing fruits and are catabolized thereafter during ripening. Aconitase, that transforms citrate to isocitrate, is the first step of citric acid catabolism and a major component of the citrate utilization machinery. In this work, the citrus aconitase gene family was first characterized and a phylogenetic analysis was then carried out in order to understand the evolutionary history of this family in plants. Gene expression analyses of the citrus aconitase family were subsequently performed in several acidic and acidless genotypes to elucidate their involvement in acid homeostasis. Results Analysis of 460,000 citrus ESTs, followed by sequencing of complete cDNA clones, identified in citrus 3 transcription units coding for putatively active aconitate hydratase proteins, named as CcAco1, CcAco2 and CcAco3. A phylogenetic study carried on the Aco family in 14 plant species, shows the presence of 5 Aco subfamilies, and that the ancestor of monocot and dicot species shared at least one Aco gene. Real-time RT-PCR expression analyses of the three aconitase citrus genes were performed in pulp tissues along fruit development in acidic and acidless citrus varieties such as mandarins, oranges and lemons. While CcAco3 expression was always low, CcAco1 and CcAco2 genes were generally induced during the rapid phase of fruit growth along with the maximum in acidity and the beginning of the acid reduction. Two exceptions to this general pattern were found: 1 Clemenules mandarin failed inducing CcAco2 although acid levels were rapidly reduced; and 2 the acidless "Sucreña" orange

  10. Cloning and expression of 1-aminocyclopropane-1-carboxylate oxidase cDNA induced by thidiazuron during somatic embryogenesis of alfalfa (Medicago sativa).

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    Feng, Bi-Hong; Wu, Bei; Zhang, Chun-Rong; Huang, Xia; Chen, Yun-Feng; Huang, Xue-Lin

    2012-01-15

    Embryogenic callus (EC) induced from petioles of alfalfa (Medicago sativa L. cv. Jinnan) on B5h medium turned green, compact and non-embryogenic when the kinetin (KN) in the medium was replaced partially or completely by thidiazuron (TDZ). The application of CoCl₂, which is an inhibitor of 1-aminocyclopropane-1-carboxylate oxidase (ACO), counteracted the effect of TDZ. Ethylene has been shown to be involved in the modulation of TDZ-induced morphogenesis responses. However, very little is known about the genes involved in ethylene formation during somatic embryogenesis (SE). To investigate whether ethylene mediated by ACO is involved in the effect of TDZ on inhibition of embryogenic competence of the alfalfa callus. In this study we cloned full-length ACO cDNA from the alfalfa callus, named MsACO, and observed changes in this gene expression during callus formation and induction of SE under treatment with TDZ or TDZ plus CoCl₂. RNA blot analysis showed that during the EC subcultural period, the expression level of MsACO in EC was significantly increased on the 2nd day, rose to the highest level on the 8th day and remained at this high level until the 21st day. However, the ACO expression in the TDZ (0.93 μM)-treated callus was higher than in the EC especially on the 8th day. Moreover the ACO expression level increased with increasing TDZ concentration during the subcultural/maintenance period of the callus. It is wo