High-Bandpass Filters in Electrocardiography: Source of Error in the Interpretation of the ST Segment

Introduction. Artifactual variations in the ST segment may lead to confusion with acute coronary syndromes. Objective. To evaluate how the technical characteristics of the recording mode may distort the ST segment. Material and Method. We made a series of electrocardiograms using different filter configurations in 45 asymptomatic patients. A spectral analysis of the electrocardiograms was made by discrete Fourier transforms, and an accurate recomposition of the ECG signal was obtained from the addition of successive harmonics. Digital high-pass filters of 0.05 and 0.5 Hz were used, and the resulting shapes were compared with the originals. Results. In 42 patients (93%) clinically significant alterations in ST segment level were detected. These changes were only seen in “real time mode” with high-pass filter of 0.5 Hz. Conclusions. Interpretation of the ST segment in “real time mode” should only be carried out using high-pass filters of 0.05 Hz.Buendıa Fuentes, F.; Arnau Vives, M.; Arnau Vives, A.; Jiménez Jiménez, Y.; Rueda-Soriano, J.; Zorio-Grima, E..; Osa-Saez, A.... (2012). High-Bandpass Filters in Electrocardiography: Source of Error in the Interpretation of the ST Segment. ISRN Cardiology. 2012:706217-706227. doi:10.5402/2012/706217S706217706227201

Unidad de Valoración del Riesgo de Muerte Súbita Familiar: Experiencia en la Comunidad Valenciana

The sudden death is defined as the unexpected death that occurs within an hour of the onset of symptoms. This type of death has a high social, media and economic impact. The first cause is of cardiac origin, and within this, the ischemic heart disease is the most frequent, but family heart diseases (channelopathies and cardiomyopathies) are more important in children and young people, where they represent the first cause of sudden cardiac death. These family heart diseases have a clear genetic substrate that justifies the indication of an adequate study of the relatives of the deceased. According to the data of the Spanish population of the 2013 census (46.7 million inhabitants) in the Valencian Community, which represents 10% of this population, it is estimated that there are 20.000 people with some potentially lethal heart disease. Given the importance and the social impact of sudden death of cardiac origin, and since the medical-legal autopsy has limitations to diagnose the underlying disease in these types of deaths, the most opportune strategy is the multidisciplinary approach, which is why in 2008, the Family Sudden Death and Family Heart Diseases Unit was created in this region. La muerte súbita se define como el fallecimiento inesperado que acontece antes de una hora desde el inicio de los síntomas, este tipo de muerte tiene un alto impacto social, mediático y económico. La primera causa es la de origen cardíaco y dentro de estas la cardiopatía isquémica es la más frecuente, pero las cardiopatías familiares (canalopatías y miocardiopatías) son porcentualmente más importantes en niños y jóvenes, donde representan la primera causa de muerte súbita cardíaca. Estas cardiopatías familiares tienen un claro sustrato genético que justifica la indicación de un adecuado estudio de los familiares de los fallecidos. De acuerdo a los datos de la población española del censo de 2013 (46,7 millones de habitantes) en la Comunidad Valenciana, que representa el 10% de esta población, se estima que residen 20000 personas con alguna cardiopatía familiar potencialmente letal. Dada la importancia y el impacto social de la muerte súbita de origen cardíaco, y puesto que la autopsia médico-legal tiene limitaciones para diagnosticar la enfermedad subyacente en este tipo de muertes, la estrategia más oportuna es el enfoque multidisciplinar, motivo por el cual en el año 2008  se creó la Unidad de Muerte Súbita Familiar y Cardiopatías Familiares en esta región

Massive open online courses in higher education: A data analysis of the MOOC supply

Purpose: The aim of this study is to analyze the factors influencing the MOOC supply level. Specifically, this paper analyzes certain internal and strategic factors associated with universities, such as prestige, public or private status, age, size (measured by the number of faculty members or students) and region. Design/methodology/approach: We apply a descriptive methodology and then use multivariate analysis to test five hypotheses related to the institutional profile of 151 universities in 29 countries. Empirical evidence is provided from universities offering MOOCs through the four of the most commonly used private global platforms that emerged as part of the booming MOOC movement (Udacity, Coursera, edX and MiríadaX). Findings: The findings show some differences when prestige is measured according to the Shanghai ranking (model 1) and the Webometrics ranking (model 2). In both cases, the private nature of the university and the region (North America) are factors that have a significant influence on the MOOC university supply. Depending on both rankings, size and age are influential factors. It is important to emphasize that prestige is a significant factor according to model 2.    Research limitations/implications: MOOCs are a phenomenon with a growing trend, and for which the supply data change frequently. Therefore, the results of our empirical research are limited to a specific period.   Practical implications: This paper provides new empirical evidence for use in future studies to analyze and compare the behavior of the MOOC supply by different universities.  Social implications: This study contributes to the comprehension of the factors that influence the extent to which universities participate in the MOOC supply. It also suggests relevant aspects for innovation policies in university education, since universities must make strategic decisions in a competitive environment that affects their institutional philosophy. Originality/value: This paper makes an empirical contribution to the existing international literature on MOOC supply. It analyzes the relevance of the factor of prestige, as measured by two university rankings, Webometrics, the emphasis of which is focused on visibility on the Internet, and Shanghai, in which emphasis is placed on the impact on scientific research

Estudio y prevención de la muerte súbita infantil: Experiencia en la comunidad valenciana

Introduction: The sudden infant death syndrome (SIDS) is the first cause of death in the first year of life. In addition to the of San Diego definition, the autopsy must be complemented with clinical data and examination of the circumstances of death.Objective: To apply this classification in cases of sudden infant death. Method: Multidisciplinary study in 109 infants who died suddenly between September/2006 and December/2015 and who were admitted to the Institutes of Legal Medicine of the Valencian Community in Spain. An examination of the involved place, collection of perinatal data, epidemiological survey and judicial autopsy with complementary studies were carried out. Results: From the 109 cases, 60 males and 49 females, 53 (48.6%) were diagnosed as SIDS: 6 IB category, 47 II category (36 with risk factor of accidental suffocation with 19 co-sleeping, 13 prones and 1 with both), 46 cases (42.2%) were due to an explained cause of death (54.4% by infectious diseases, 30.4% heart diseases, 2.2% neonatal hemochromatosis and immunodeficiency, 4.3% congenital malformations and, 2.2 % violent death) and 10 cases (9.2%) of undetermined cause. The average age at death was of 3.53 months. The higher incidence of co-sleeping in SIDS took place at 2 months, of prone position to 4, and most cases presented during the winter. Conclusions: The multidisciplinary study of sudden infant death provides key information for classifying it by categories and for confirming the presence of risk factors, enabling to focus the prevention measures and the family cardiological study.Introducción: El síndrome de muerte súbita del lactante (SMSL) es la primera causa de muerte en el primer año de vida. Además de la clasificación de San Diego, la autopsia debe complementarse con datos clínicos y examen de las circunstancias de la muerte.Objetivo: Aplicar esta clasificación en casos de muerte súbita de lactantes.Método: Estudio multidisciplinar en 109 lactantes que fallecieron de forma súbita entre septiembre/2006 y diciembre/2015, y que ingresaron en los Institutos de Medicina Legal de la comunidad valenciana, en España. Se realizó examen del lugar del levantamiento, recogida de datos perinatales, encuesta epidemiológica y autopsia judicial con estudios complementarios.Resultados: De los 109 casos, 60 masculinos y 49 féminas, 53 (48,6%) fueron diagnosticados como SMSL: 6 categoría IB, 47 categoría II (36 con factor de riesgo de sofocación accidental con 19 colechos, 13 pronos y 1 con ambos), 46 casos (42,2%) fueron muerte de causa explicada (54,4% enfermedades infecciosas, 30,4% enfermedades cardíacas, 2,2% hemocromatosis neonatal e inmunodeficiencia, 4,3% malformaciones congénitas y 2,2% muerte violenta) y 10 casos (9,2%) de causa indeterminada. La edad media al fallecimiento fue de 3,53 meses. La mayor incidencia de colecho en el SMSL ocurrió a los 2 meses, de decúbito prono a los 4, y el mayor número de casos se presentó en invierno.Conclusiones: El estudio multidisciplinar de la muerte súbita del lactante proporciona información clave para clasificarlas por categorías y confirmar la presencia de factores de riesgo que permitan dirigir las medidas de prevención y el estudio cardiológico familiar

Factores psicosociales y de adaptación en familiares de pacientes fallecidos por muerte súbita cardíaca

Introduction: Although grief is a natural process that, in most cases, develops without complications, 10-20% of people who suffer a significant loss will experience complicated grief and percentages are much higher in relatives bereaved by sudden cardiac death.Objective: To study the relationship between attachment styles, stressful life events accumulation and psychopathology development, especially complicated grief, in relatives of patients who died of sudden cardiac death. Method: The sample consisted of 16 mourners of deceased from this cause. Questionnaires were used to evaluate, among other variables, stressful life events, psychopathological symptoms, attachment and grief. Results: Sixty-two percent of the cases were middle-aged women (average 49 years), predominantly married or with unmarried partner (60%), and 31% widows (of the deceased). Prior to death, most of the mourners (81%) did not have a histo-ry of anxious-depressive symptoms. At present more than 50% attend psychotherapy sessions, showing clear signs of risk to their physical-psychological health, with sleep disturbances, anxious-depressive symptoms and general exhaustion. Particularly relevant in our study is the fact that half of them have very high levels of chronic stress. About 40% of family members have insecure attachment style: 15% anxious and 25% avoidant. Conclusions: Presenting insecure attachment style is considered a risk factor for developing complicated grief. Its indicators show 56% of subjects at clear risk of suffering it.Introducción: Aunque el duelo es un proceso natural que, en la mayoría de los casos, se desarrolla sin complicaciones, un 10-20% de los individuos que sufren una pérdida significativa experimentarán duelo complicado y los porcentajes son muy superiores en los familiares en duelo por muerte súbita cardíaca.Objetivo: Estudiar la relación entre los estilos de apego, la acumulación de acontecimientos vitales estresantes y el desarrollo de psicopatología, especialmente duelo complicado, en familiares de pacientes fallecidos por muerte súbita cardíaca.Método: La muestra estuvo conformada por 16 dolientes de fallecidos por esta causa. Se utilizaron cuestionarios para evaluar, entre otras variables, los sucesos vitales estresantes, la sintomatología psicopatológica, el apego y el duelo.Resultados: El 62% de los casos eran mujeres de mediana edad (media 49 años), predominantemente casadas o en pareja (60%), y un 31% viudas (del fallecido). Previo al fallecimiento, la mayoría de los dolientes (81%) no contaban con antecedentes de clínica ansioso-depresiva. Actualmente más del 50% acude a psicoterapia, y presentan claros signos de riesgo para su salud física-psicológica, con dificultades para dormir, síntomas ansioso-depresivos y agotamiento general. Un dato especialmente relevante de nuestro estudio es que la mitad tiene niveles muy elevados de estrés crónico. Cerca del 40% de los familiares presenta un estilo de apego inseguro: 15% ansioso y 25% evitativo.Conclusiones: El presentar un estilo de apego inseguro se considera factor de riesgo para el desarrollo de duelo complicado. Sus indicadores muestran un 56% de sujetos con un claro riesgo de padecerlo