Arrhythmias After Tetralogy of Fallot Repair

Tetralogy of Fallot is the most common cyanotic congenital heart disease, with a good outcome after total surgical correction. In spite of a low perioperative mortality and a good quality of life, late sudden death remains a significant clinical problem, mainly related to episodes of sustained ventricular tachycardia and ventricular fibrillation. Fibro-fatty substitution around infundibular resection, intraventricular septal scar, and patchy myocardial fibrosis, may provide anatomical substrates of abnormal depolarization and repolarization causing reentrant ventricular arrhythmias. Several non-invasive indices based on classical examination such as ECG, signal-averaging ECG, and echocardiography have been proposed to identify patients at high risk of sudden death, with hopeful results. In the last years other more sophisticated invasive and non-invasive tools, such as heart rate variability, electroanatomic mapping and cardiac magnetic resonance added a relevant contribution to risk stratification. Even if each method per se is affected by some limitations, a comprehensive multifactorial clinical and investigative examination can provide an accurate risk evaluation for every patien

King Ferdinand’s journey to Naples. The reorganization of patronage networks to stabilize the kingdom, 1506-1507

Luego de la Concordia de Villafáfila entre Felipe I Habsburgo y Fernando el Católico, el monarca aragonés se vio en la necesidad de reafirmar su dominio y control sobre los estados de los que quedó siendo rey. El viaje de 1506 a Nápoles nació como la forma en que el monarca reafirmaba los lazos con el Reino Partenopeo a través de la configuración de un sistema virreinal nuevo y de la fijación de amplios sectores de la nobleza local a su servicio.Fil: Tambella, Franco Luciano. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones En Ciencias Sociales y Humanidades. Universidad Nacional de Salta. Facultad de Humanidades. Instituto de Investigaciones En Ciencias Sociales y Humanidades; Argentin

Economia della banca e cultura: sono sufficienti saperi tecnici parziali?

Le radici finanziarie della lunga e impietosa crisi economica e finanziaria globale richiedono studi storici e analisi specifiche da più punti di vista. In questo ambito e in questa prospettiva, gli studiosi di economia degli intermediari finanziari possono dare contributi notevoli e significativamente integrati con quelli di matrice diversa: sono anche i fondamenti della gestione aziendale degli intermediari finanziari – in particolare delle banche – e i rischi da essi assunti a determinare squilibri che portano a crisi; e sono le situazioni e le prospettive economico-finanziarie generali che definiscono i contesti in cui le banche operano. Studi e analisi storico-economiche hanno dunque bisogno di aggiungere il punto di vista di chi opera prevalentemente con strumenti di economia e finanza aziendale e di economia e finanza generale; così come aziendalisti ed economisti possono saper leggere più profondamente ove sappiano guardare anche al passato e alle riflessioni che ne sono scaturite e ne scaturiscono per interpretare il presente e impostare decisioni per il futuro

INFLUENCE OF BOLT DIAMETER ON THE BEARING FAILURE LOAD OF GFRP BOLTED LAMINATES

Many theoretical as well as experimental studies have been recently carried out by researchers working in the field of civil engineering on the design and verification problem of structural bolted joints for structures realized with Fibre Reinforced Polymers (FRP). It worth taking into account the results obtained by Camanho and Matthews [2], Ekh, Schön and Melin [3, 4], Hassan, Mohamedien and Rizkalla [5], Ireman [6], Kelly and Hallström [7], Li, Kelly and Crosky [8], Lie, Yu and Zhao [9], Starikov and Schön [10], Vangrimde and Boukhili [11, 12], Xiao and Ishikawa [13], Yan, Wen, Chang and Shyprykevich [14]. The results of these studies have highlighted the influence on typical failure modes of FRP bolted joints of some main factors as being: 1) stacking sequence of the laminates; 2) joint geometry: bolt diameter, plate width, end distance and thickness of the composite member; 3) matrix type and fibre nature. In this context, the aim of the research carried out by the authors is to investigate on the bearing failure mode of a laminate bolted joint and, in particular, to underline the effects of the fibre inclination angle, the laminate stacking sequence and the bolt diameter on the aforementioned failure mode. For the experimental tests circular specimens have been used, with 300mm in diameter, built-in at the edge with a central hole. Some results, in terms of fiber inclination angle and laminate stacking sequence, have been just published by the authors in [15, 16]. The experimental results, showing the influence of bolt diameter on the bearing strength, represent the subject of the present paper. In order to perform the experimental investigation, two types of GFRP laminates were tested: unidirectional and cross-ply. In particular the stacking sequence of the unidirectional laminates (10mm thick) was [CSM/08/CSM], while for the cross-ply laminates were used two different stacking sequence . These latter were: [(CSM/06/906)s] and [(CSM/03/903)2]s, where the number of plies and the thickness (12mm) was constant. On both types of laminates three different values of the bolt diameter have been considered: 20mm, 19mm and 18mm. All of them are relative to the same value of the hole diameter, equal to 21mm. The experimental results have shown that the bearing strength depends significantly on the bolt diameter for both types of laminates considered. In particular, in the case of unidirectional laminates the experimental analysis carried out put in evidence a reduction of the bearing strength, passing from the maximum diameter considered of 20mm to the minimum one of 18mm, equal to 13%. For what concerns the cross-ply laminates the analysis also shows a reduction of the bearing strength equal to 24%, replacing the bolt of 20mm in diameter with one of 18mm, as in the case of unidirectional laminates. For both types of laminates considered, the analysis shows that the bearing strength reduction, varying the bolt diameter, is independent from the fiber inclination angle as well as from stacking sequence. Finally, the authors give a new design formula for the bearing failure load, which takes into account, near the fiber inclination angle and the stacking sequence, the bolt diameter also

Bench-to-bedside review: Chest wall elastance in acute lung injury/acute respiratory distress syndrome patients

The importance of chest wall elastance in characterizing acute lung injury/acute respiratory distress syndrome patients and in setting mechanical ventilation is increasingly recognized. Nearly 30% of patients admitted to a general intensive care unit have an abnormal high intra-abdominal pressure (due to ascites, bowel edema, ileus), which leads to an increase in the chest wall elastance. At a given applied airway pressure, the pleural pressure increases according to (in the static condition) the equation: pleural pressure = airway pressure × (chest wall elastance/total respiratory system elastance). Consequently, for a given applied pressure, the increase in pleural pressure implies a decrease in transpulmonary pressure (airway pressure – pleural pressure), which is the distending force of the lung, implies a decrease of the strain and of ventilator-induced lung injury, implies the need to use a higher airway pressure during the recruitment maneuvers to reach a sufficient transpulmonary opening pressure, implies hemodynamic risk due to the reductions in venous return and heart size, and implies a possible increase of lung edema, partially due to the reduced edema clearance. It is always important in the most critically ill patients to assess the intra-abdominal pressure and the chest wall elastance

A model to improve the effectiveness of the Occupational Health and Safety Inspectorate function relative to South African construction

Irrespective of all the efforts made by the Department of Labour (DoL) and other relevant stakeholders to improve the performance of Occupational Health and Safety (OH&S) in construction. In the Construction Industry, there is still a very high level of accidents and fatalities in South Africa. Injuries and accidents to workers do not help a community in any nation. The construction industry in South Africa is generally known to be one of the most hazardous and has one of the most dismal OH&S records among all industrial segments with an unacceptably high level of injuries and fatalities resulting in considerable human suffering. A doctoral study was recently conducted with the aim of investigating the effectiveness and performance of the DoL OH&S Inspectorate in South Africa. The empirical study was conducted among a range of stakeholders: civil engineering and building contractors; OH&S consultants; project managers; DoL inspectors; and designers by means of a questionnaire survey. The methodology adopted in this study included the exploratory and descriptive methods, which entails the technique of observation including the use of questionnaires and data analysis. The salient findings of the study are presented and elucidate that the DoL OH&S Inspectorate is not effective in terms of OH&S relative to the construction industry in South Africa. Conclusions and recommendations included expound that the DoL OH&S Inspectorate is not effectively conducting their duties reinforcing the need for a reviewed OH&S Inspectorate model framework. The proposed structured normative model consists of fundamental elements which would improve the effectiveness of the DoL OH&S Inspectorate. The findings of the study with recommendations are included

Evasão nos cursos superiores da região norte e estudo comparativo para avaliação das IFES tocantinenses

In recent decades, education has been changed mainly in Brazil. In higher education, the expansion of educational institutions, public and private, and the increasing number of vacancies were due to educational programs implemented by public policies of higher education nationwide. This new reality, characterized by the existence of various social programs, created conditions for the students without graduation perspective could have access to higher education. It is because of developmental needs of the Government, towards citizen’s formation in front of a global scenario of competitiveness and internationalization of markets. However, for the educational programs being effective, the politics also need to be evaluated and remodeled when necessary. Educational indicators are very useful in the evaluation’s processes of public policies and are widely used for this purpose in Brazil. This paper presents evasion indicators of higher education in the North Region of Brazil, among others, grouped by states from Federation, and administrative categories. These indicators were collected from the microdata of Higher Education census, extracted from INEP during 2010 to 2014. It is used to a comparative study in order to evaluate the performance of Higher Education Federal Institutions operating in the State of Tocantins. The results showed that in the states, in general, the federal category presented better indicators on the evasion that the other administrative categories. Among the federal institutions, the State of Tocantins had the fourth best evasion rate. Comparing the administrative categories within the State of Tocantins, the federal institutions performed well, achieving the best average rate of annual evasion in the period.Nas últimas décadas a educação sofreu grandes transformações no Brasil. Na educação superior, a expansão das instituições de ensino, públicas e privadas, e o crescente aumento do número de vagas, são decorrentes de programas educacionais implantados pelas políticas públicas da educação superior, de abrangência nacional. Essa nova realidade, caracterizada pela existência de programas sociais diversos, criou condições para que estudantes até então sem perspectiva de graduação pudessem ter acesso à educação superior. Isso se deve, em grande parte, à necessidade desenvolvimentista do Estado, de formar cidadãos preparados para um cenário mundial de competitividade e internacionalização dos mercados. Entretanto, para que os programas educacionais sejam efetivos, eles também precisam ser avaliados e reformulados, caso necessário. Os indicadores educacionais são de grande utilidade nos processos avaliativos das políticas públicas e são amplamente utilizados com esse propósito no Brasil. Este trabalho apresenta indicadores de evasão da educação superior da Região Norte do Brasil, agrupados por Estado da Federação e categoria administrativa. Esses indicadores foram calculados a partir dos microdados extraídos do Censo da Educação Superior do Inep no período de 2010 a 2014, e utilizados em um estudo comparativo para avaliar o desempenho das Instituições Púbicas Federais de Ensino Superior em funcionamento no Estado do Tocantins. Os resultados apontaram que nos Estados, de uma forma geral, a categoria pública federal apresentou melhor desempenho quanto à evasão que as demais categorias administrativas. Dentre as Instituições Federais, as do Estado do Tocantins apresentaram o quarto melhor índice de evasão. Na comparação entre as categorias administrativas dentro do Estado do Tocantins, as Instituições Federais apresentaram bom desempenho, obtendo o melhor índice médio de evasão anual no período