Increased prevalence of ECG markers for sudden cardiac arrest in refractory epilepsy.

BACKGROUND AND AIM: People with epilepsy are at increased risk of sudden cardiac arrest (SCA) due to ECG-confirmed ventricular tachycardia/fibrillation, as seen in a community-based study. We aimed to determine whether ECG-risk markers of SCA are more prevalent in people with epilepsy. METHODS: In a cross-sectional, retrospective study, we analysed the ECG recordings of 185 people with refractory epilepsy and 178 controls without epilepsy. Data on epilepsy characteristics, cardiac comorbidity, and drug use were collected, and general ECG variables (heart rate (HR), PQ and QRS intervals) assessed. We analysed ECGs for three markers of SCA risk: severe QTc prolongation (male >450 ms, female >470 ms), Brugada ECG pattern, and early repolarisation pattern (ERP). Multivariate regression models were used to analyse differences between groups, and to identify associated clinical and epilepsy-related characteristics. RESULTS: People with epilepsy had higher HR (71 vs 62 bpm, p<0.001) and a longer PQ interval (162.8 vs 152.6 ms, p=0.001). Severe QTc prolongation and ERP were more prevalent in people with epilepsy (QTc prolongation: 5% vs 0%; p=0.002; ERP: 34% vs 13%, p<0.001), while the Brugada ECG pattern was equally frequent in both groups (2% vs 1%, p>0.999). After adjustment for covariates, epilepsy remained associated with ERP (ORadj 2.4, 95% CI 1.1 to 5.5) and severe QTc prolongation (ORadj 9.9, 95% CI 1.1 to 1317.7). CONCLUSIONS: ERP and severe QTc prolongation appear to be more prevalent in people with refractory epilepsy. Future studies must determine whether this contributes to increased SCA risk in people with epilepsy

Dinâmica das áreas de agricultura anual a partir de dados temporais do projeto TerraClass para o município de Paragominas, PA.

Because of diversification of the production systems in Paragominas municipality (Pará State, Brazil), the grain production and the agroindustry sector is expanding. This paper aims to analyze the spatiotemporal dynamics of areas associated with ?Annual Crop? class in the municipality of Paragominas. We considered, in the analyses the Land Use and Land Cover mapping data of the TerraClass Project for the years 2004, 2008, 2010, 2012 and 2014. The results indicate that areas of the ?Annual Crop? in the study area, have been growing over the years and concentrate mainly near the municipality´s main roads. It was verified that a significant portion of these areas remained stable for consecutive periods considered. The new cropped areas come mainly from, the previously classified as "Clean Pasture" class, although there is also a significant conversion rates presented by "Not Observed Area" and ?Secondary Vegetation" classes

Dinâmica do uso e cobertura da terra em Projeto de Desenvolvimento Sustentável na região da rodovia Transamazônica, Pará.

A região da rodovia Transamazônica, no estado do Pará, constitui uma das áreas críticas de desflorestamento na Amazônia, visto as transformações socioeconômicas que tem atravessado. Este trabalho analisa mudanças espaço-temporais do uso da terra e seus impactos na cobertura vegetal no Projeto de Desenvolvimento Sustentável Virola-Jatobá, Anapu, Pará, no período de 1984 a 2015. Como suporte principal destas análises, foram utilizadas imagens Landsat, processadas e analisadas a partir da plataforma Spring. Nos primeiros anos de análise, registrou-se taxas de desflorestamento muito modestas, só atingindo um incremento mais expressivos sete anos após a criação do PDS, mas, mesmo assim, em um patamar muito baixo. Como reflexo, a paisagem desta área é dominada por áreas florestais, sendo as classes de uso da terra associadas principalmente às pastagens, já que as áreas agrícolas são muito modestas. Em geral, as áreas florestais apresentaram altas taxas de estabilidade. Dentre as classes de uso da terra, as pastagens apresentaram taxas de estabilidade expressivas, apesar de a classe Pasto Sujo ter registrado certa dinamicidade

Relações entre a paisagem e a dinâmica de uso da terra no município de Paragominas-PA. Uso de produtos SRTM e dados do Terraclass no mapeamento, distribuição e conversões entre sistemas de pecuária e agricultura anual.

This paper presents the preliminary results of the Environmental Monitoring by Satellites Project of the Amazon Biome, subproject 1 - Mapping of land use and cover in the Legal Amazon, through the field mission in the Eastern Amazon, in the state of Pará, during the period From May 23 to 25, 2016 in Paragominas-PA. Land use classes and validation of the past mapping of deforestation were recognized through mappings for the years 2004, 2008, 2010, 2012 and 2014, from which the land use dynamics were obtained, considering the annual agriculture classes And productive pasture, also referred to as clean pasture, degraded pastures, which included the regeneration classes with pasture, dirty pasture and exposed soil, as well as SRTM sensor products, through which a map of landscape compartments was produced, which allowed mapping The distribution of said land use classes in each of the four landscape units found in the municipality of Paragominas. The results show that there is a predominance of pastures in the lower areas that contain higher drainage densities and water courses that provide watering for livestock, while in the plateaus, where only the dry springs and gaps and flat relief are located in the larger ones altitudes, areas of agriculture predominate

Do borrão às aguadas: os engenheiros militares e a representação da Capitania de São Paulo

A análise do papel dos engenheiros militares perpassa as discussões sobre regiões específicas, mesmo quando eles, aparentemente, estão ausentes delas. Sua presença ou ausência sempre foi sinônimo de interesse e de projeto colonizador mais ou menos dirigido. Este ensaio tem como objeto de estudo a cartografia dos engenheiros militares atuantes na Capitania de São Paulo, território comumente visto como economicamente periférico e mais autônomo face aos desígnios da Coroa portuguesa. Com foco no corpus cartográfico de alguns profissionais que aqui atuaram, trata indiretamente da multifacetada atuação desses engenheiros, bem como do processo de feitura das cartas geográficas, corográficas e topográficas, do borrão às aguadas. Investigar a cartografia de alguns desses profissionais permite não apenas explorar a riqueza de suas biografias, como, também, acompanhar o processo de produção técnica dos mapas e os desígnios políticos envolvidos no devassamento e representação das terras descobertas no Novo Mundo.Analyzing the role of military engineers means venturing into discussions about specific regions, even those from which they are apparently absent. Their presence or absence has always been synonymous with interest and a more or less directed colonization project. This essay examines the maps produced by the military engineers working in the Captaincy of São Paulo, a territory often looked upon as one of little economic import and a rather autonomous area in light of the plans of the Portuguese Crown. By focusing on the cartographic corpus bequeathed by certain professionals serving in this region, we deal indirectly with the multifaceted role of these engineers as well as with the process of making geographic, chorographic and topographic charts - all the way from the sketch to watercolored maps. Perusing the charts constructed by some of these professionals enabled us not only to delve into the rich details of their biographies but also to observe the technical mapmaking process and to unravel the political designs behind the exploration and representation of the lands discovered in the New World

Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan.

OBJECTIVE: Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact. METHODS: We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Eligible tools had to offer information about warfarin and ≥1 direct oral anticoagulant. We extracted tool characteristics, assessed their adherence to the International Patient Decision Aids Standards, and obtained information about their efficacy in promoting SDM. RESULTS: We found 14 SDM tools. Most tools provided up-to-date information about the options, but very few included practical considerations (e.g., out-of-pocket cost). Five of these SDM tools, all used by patients prior to the encounter, were tested in trials at high risk of bias and were found to produce small improvements in patient knowledge and reductions in decisional conflict. CONCLUSION: Several SDM tools for stroke prevention in AF are available, but whether they promote high-quality SDM is yet to be known. The implementation of guidelines for SDM in this context requires user-centered development and evaluation of SDM tools that can effectively promote high-quality SDM and improve stroke prevention in patients with AF