Accelerometer-based atrioventricular synchronous pacing with a ventricular leadless pacemaker: Results from the Micra atrioventricular feasibility studies

BACKGROUND: Micra is a leadless pacemaker that is implanted in the right ventricle and provides rate response via a 3-axis accelerometer (ACC). Custom software was developed to detect atrial contraction using the ACC enabling atrioventricular (AV) synchronous pacing. OBJECTIVE: The purpose of this study was to sense atrial contractions from the Micra ACC signal and provide AV synchronous pacing. METHODS: The Micra Accelerometer Sensor Sub-Study (MASS) and MASS2 early feasibility studies showed intracardiac accelerations related to atrial contraction can be measured via ACC in the Micra leadless pacemaker. The Micra Atrial TRacking Using A Ventricular AccELerometer (MARVEL) study was a prospective multicenter study designed to characterize the closed-loop performance of an AV synchronous algorithm downloaded into previously implanted Micra devices. Atrioventricular synchrony (AVS) was measured during 30 minutes of rest and during VVI pacing. AVS was defined as a P wave visible on surface ECG followed by a ventricular event \u3c300 ms. RESULTS: A total of 64 patients completed the MARVEL study procedure at 12 centers in 9 countries. Patients were implanted with a Micra for a median of 6.0 months (range 0-41.4). High-degree AV block was present in 33 patients, whereas 31 had predominantly intrinsic conduction during the study. Average AVS during AV algorithm pacing was 87.0% (95% confidence interval 81.8%-90.9%), 80.0% in high-degree block patients and 94.4% in patients with intrinsic conduction. AVS was significantly greater (P \u3c.001) during AV algorithm pacing compared to VVI in high-degree block patients, whereas AVS was maintained in patients with intrinsic conduction. CONCLUSION: Accelerometer-based atrial sensing is feasible and significantly improves AVS in patients with AV block and a single-chamber leadless pacemaker implanted in the right ventricle

El Kurdistán Iraquí: identidad e intereses, nacionalismo e independencia

Trabajo de Conclusión de Curso presentado al Instituto Latinoamericano de Economía, Sociedad y Política de la Universidad Federal de Integración Latinoamericana, como requisito parcial a la obtención del título de Licenciada en Relaciones Internacionales e Integración. Orientador: Prof. Dr. Mamadou Alpha Diallo Coorientador: Prof. Dr. Marcelino Teixeira LisboaEste trabajo tiene por objetivo mostrar la trayectoria de la cuestión kurda en Irak y responder a la pregunta: ¿Qué efectos trajo la caída del régimen del líder Saddam Hussein (2003) en el Kurdistán iraquí para que desembocara en el referéndum independentista desarrollado en 2017? El método de investigación será cualitativo y el análisis será desarrollado bajo la lupa de la Teoría Constructivista de las relaciones internacionales, principalmente la vertiente de Alexander Wendt, además de la ayuda de otros autores como Benedict Anderson, Manuel Castells y Eric Hobsbawm. Así se llegó a la conclusión de que después que la invasión a Irak se concretizó, se puede demostrar el fortalecimiento de los kurdos en el nuevo panorama político en Irak, en donde ahora tienen voz y voto, evidenciándolo en la participación activa en las negociaciones entabladas en el poder ejecutivo transitorio, quedando a cargo de diferentes ministerios y posicionándose Jalal Talabani como presidente del país.Este trabalho tem como objetivo mostrar a trajetória da questão curda no Iraque e responder a pergunta Que efeitos trouxe a queda do regime do líder Saddam Hussein (2003) no Curdistão iraquiano que levaram ao desenvolvimento do referendo independentista em 2017. O método de pesquisa vai ser qualitativo e a análise feita sob a lente da Teoria Construtivista das relações internacionais, principalmente a vertente de Alexander Wendt, além da ajuda de outros autores como Benedict Anderson, Manuel Castells e Eric Hobsbawm. Assim se chegou a conclusão de que depois que a invasão do Iraque se concretizou, pode-se demostrar o fortalecimento dos curdos no novo panorama político no Iraque, onde agora têm voz e voto, evidenciando-o na participação ativa nas negociações estabelecidas no poder executivo transitório, ficando ao cargo de diferentes ministérios e posicionando-se Jalal Talabani como presidente do paísThis study aims to show the trajectory of the Kurdish issue in Iraq and to answer which were the effects of the fall of the regime of the leader Saddam Hussein (2003) in the Iraqi Kurdistan to result in the independence referendum that took place in 2017? The research method will be qualitative and the analysis will be studied according to the constructivist theory of international relations, mainly the point of view of Alexander Wendt as well as with the help of other authors such as Benedict Anderson, Manuel Castells and Eric Hobsbawm. Thus, it was concluded that after the invasion of Iraq concretized, it can be demonstrated the strengthening of the Kurds in the new political landscape in Iraq, where they now have a voice and vote, evidencing it in their active participation in the negotiations held in the transitory executive power, being in charge of different ministries and positioning Jalal Talabani as president of the countr

Diseño de estrategia de marketing para incrementar las ventas de la línea diaria de la empresa su Carne

Al presentarse ciertas falencias en determinadas compañías de productos cárnicos, nace Su Carne; que es una empresa comercializadora de pollo, cerdo, res, y embutidos. Sin embargo su última línea no ha tenido los crecimientos esperados, por lo que es necesario generar una estrategia de marketing que incremente las ventas, a través de herramientas como la investigación, por medio de encuestas que permitan conocer las necesidades del mercado a través de sus actores como son el detallista (punto de venta PDV) y el consumidor; éste último que si bien es cierto no es atendido de manera directa por la empresa, es clave en la rotación del producto, por ende se lo considera participante indirecto y esencial en el proceso compra-venta. Las necesidades son diferentes en cada actor, por lo que se requiere que la mejora de procesos como las promociones a proponer como producto adicional o mas producto, o descuentos; sean de satisfacción para los participantes de éste escenario, esto implica también conocer que hace la competencia para no coincidir en actividades similares y evitar un desgaste. El seguimiento oportuno permitirá tomar los correctivos necesarios para llegar a lo planificado, siendo la comunicación un medio neurálgico para lograr el planteamiento, ya que instrumentos como afiches, flyer, procesos de merchandising, serán los ayudantes en las actividades a desarrollarse.At present certain shortcomings in certain meat products companies, born His Flesh; which it is a marketer of chicken, pork, beef, and sausages. However his last line has not had the expected growth, so it is necessary to create a marketing plan to increase sales, through tools such as research, through surveys to meet market needs through its actors such as retailer (point of sale PDV) and the consumer; the latter if it is true is not served directly by the company, it is a key product rotation thus is considered indirect and essential participant in the buying and selling process. The needs are different for each actor, so it is required to process improvement as promotions to propose as an additional product or more product or discounts; are satisfaction for the participants of this scenario, this also involves knowing the competition does not coincide in similar activities and to prevent wear. Timely monitoring will take the necessary corrective measures to reach planned, being a powerhouse communication means to the approach, as instruments such as posters, flyers, merchandising processes will be assistants in activities to develop

Generador de un vórtice horizontal confinado

Since there is no theory for its dimensioning, in this paper, the design, construction and testing of a device that induces inside a horizontal axis vortex is described. The apparatus consists of a semi-convergent nozzle attached to a cylindrical vortex chamber with a side orifice and works horizontally submerged in a water flow with the intake nozzle forward. The coupling of these elements determines an incident tangential flow in the vortex chamber and causes it to develop a horizontal vortex. Thisvortex generator was tested on an experimental open channel without producing stagnation inside, despite being intrusive and with high form drag. The trials showed that the rotational velocity of the vortex increases in decreasing the radius and the axial distance to the drain orifice. Because of its ability to convert the initial translational movement of the flow into rotation, the vortex could be used to generate power. Other applications are not discarded though.Dado que no hay teoría para su dimensionamiento, en este trabajo sedescribe la concepción, construcción y prueba de un dispositivo queinduce en su interior un vórtice de eje horizontal. El aparato consta deuna tobera semiconvergente unida a una cámara de vórtice cilíndricacon orificio lateral y funciona sumergido horizontalmente en un flujode agua con la admisión de la tobera hacia adelante. El acople de estoselementos determina un flujo incidente tangencial en la cámara de vórticey hace que en ella se desarrolle un vórtice horizontal. Este generador devórtice se probó en un canal experimental de laboratorio sin producir ensu interior estancamiento, pese a ser intrusivo y con elevada resistenciade forma. Los ensayos mostraron que la velocidad de giro del vórticeaumenta al disminuir el radio y la distancia axial al orificio de desagüe.Por su capacidad para convertir en rotación el movimiento inicial detraslación del flujo podría servir para generar potencia, aunque no sedescartan otras aplicaciones

Una propuesta metodológica para la construcción de videojuegos

Este artículo presenta una propuesta metodológica llamada CASCRUM para el desarrollo de videojuegos en 2d como una herramienta para la construcción de este tipo de software. Esta propuesta se fundamenta en las etapas del ciclo de vida de la metodología de Cascada y como método de seguimiento de las etapas de CASCRUM integramos de la metodología Scrum el ciclo de reuniones Daily Scrum con una variante de la misma semanal la cual llamamos Week Meeting Planning. Para la evaluación de la propuesta tomamos como escenario a la Facultad de Ingeniería en Sistemas Computacionales de la Universidad Tecnológica de Panamá Campus Central. El tiempo de experimentación fue durante los años 2013 al 2014. En el periodo académico del 2013 los estudiantes recibían la guía de un instructor con conocimientos avanzados en videojuegos en 2d, para el año 2014 algunos de los estudiantes del periodo anterior fueron los monitores de los grupos. Con el fin de evaluar si CASCRUM era eficiente para la construcción de videojuegos en 2d, se formaron tres grupos en ambos periodos y cada grupo se le asignaba una única metodología de desarrollo a lo largo del periodo de experimentación, las metodologías que se implementaron fueron (Cascada, Scrum y CASCRUM), para homologar los resultados se utilizaron las métricas del ciclo de vida de videojuegos

Moraxella Peritonitis in a Non-Peritoneal Dialysis Patient

Background: Spontaneous Bacterial Peritonitis is a serious complication of ascites in patients with liver cirrhosis. Most commonly, the cause is monomicrobial, the usual suspects being E. Coli, K. pneumoniae, and sometimes, S. pneumoniae. Moraxella, a gram-negative coccobacillus, is a rare cause of secondary bacterial peritonitis in patients undergoing peritoneal dialysis. In this paper, we present a patient with spontaneous bacterial peritonitis, with no history of peritoneal catheterization or peritoneal dialysis, with Moraxella spp. as the causative agent. To the best of our knowledge, this is the only reported case of spontaneous Moraxella peritonitis. Presentation: A 63-year-old gentleman, with alcoholic liver cirrhosis and chronic refractory ascites, was referred to the Emergency Room, from the Gastroenterology outpatient clinic, when he presented with the chief complaints of worsening abdominal distension and abdominal discomfort. Leukocytosis was noted and abdominal ultrasound showed moderate ascites. The patient underwent diagnostic and therapeutic paracentesis. The SAAG was calculated to be 0.8 with a total WBC count of 330 cells/mm3 (98% lymphocytes and 2% polymorphs). While the laboratory analysis of the ascitic fluid did not meet the criteria for spontaneous bacterial peritonitis (SBP), the cultures grew Moraxella spp. No other source of infection was identified. The patient was started on Doxycycline and Cefpodoxime for likely spontaneous bacterial peritonitis as sensitivities were not available, and the patient demonstrated clinical improvement, with a decrease in abdominal pain and tenderness, and a decrease in leukocytosis. He was discharged with an outpatient gastroenterology appointment and antibiotics for secondary prophylaxis. Discussion: Although rare, there is data to establish Moraxella as an often-encountered pathogen causing peritonitis in peritoneal dialysis patients. However, there is insufficient literature regarding its role in SBP, resulting in delays in establishing a diagnosis and in initiating treatment. A greater understanding of this organism will help further the knowledge of its pathogenicity and help recognize optimal antibiotic choices

A metabolomic platform to identify and quantify polyphenols in coffee and related species using liquid chromatography mass spectrometry

IntroductionProducts of plant secondary metabolism, such as phenolic compounds, flavonoids, alkaloids, and hormones, play an important role in plant growth, development, stress resistance. The plant family Rubiaceae is extremely diverse and abundant in Central America and contains several economically important genera, e.g. Coffea and other medicinal plants. These are known for the production of bioactive polyphenols (e.g. caffeine and quinine), which have had major impacts on human society. The overall goal of this study was to develop a high-throughput workflow to identify and quantify plant polyphenols.MethodsFirst, a method was optimized to extract over 40 families of phytochemicals. Then, a high-throughput metabolomic platform has been developed to identify and quantify 184 polyphenols in 15 min.ResultsThe current metabolomics study of secondary metabolites was conducted on leaves from one commercial coffee variety and two wild species that also belong to the Rubiaceae family. Global profiling was performed using liquid chromatography high-resolution time-of-flight mass spectrometry. Features whose abundance was significantly different between coffee species were discriminated using statistical analysis and annotated using spectral databases. The identified features were validated by commercially available standards using our newly developed liquid chromatography tandem mass spectrometry method.DiscussionCaffeine, trigonelline and theobromine were highly abundant in coffee leaves, as expected. Interestingly, wild Rubiaceae leaves had a higher diversity of phytochemicals in comparison to commercial coffee: defense-related molecules, such as phenylpropanoids (e.g., cinnamic acid), the terpenoid gibberellic acid, and the monolignol sinapaldehyde were found more abundantly in wild Rubiaceae leaves