High-degree atrioventricular block. An unusual presentation of Takotsubo cardiomyopathy: a case report

Background: Takotsubo cardiomyopathy is a non-ischemic cardiomyopathy characterized by acute left ventricular systolic dysfunction with transient wall motion abnormalities without a culprit coronary stenosis or other concurrent diagnoses. Its coexistence with transient high-degree AV block is very infrequent. Case presentation: A 61-year-old man presented with a new onset of high degree AV block without ST segment deviations developing an anterior and apical dyskinesia with a low left ventricular ejection fraction in the absence of coronary artery disease. Conclusion: Atrioventricular block is an uncommon presentation of Takotsubo syndrome. The management of patients with relevant conduction disorders in this scenario is a challenge for the clinician. In case of persistence of advanced conduction disorders, it seems appropriate to implant a pacemaker

Determination of the anomalous dimension of gluonic operators in deep inelastic scattering at O(1/N_f)

Using large N_f methods we compute the anomalous dimension of the predominantly gluonic flavour singlet twist-2 composite operator which arises in the operator product expansion used in deep inelastic scattering. We obtain a d-dimensional expression for it which depends on the operator moment n. Its expansion in powers of epsilon = (4-d)/2 agrees with the explicit exact three loop MSbar results available for n less than or equal to 8 and allows us to determine some new information on the explicit n-dependence of the three and higher order coefficients. In particular the n-dependence of the three loop anomalous dimension gamma_{gg}(a) is determined in the C_2(G) sector at O(1/N_f).Comment: 26 latex pages, 7 postscript figure

The behavior of Baserca and Llauset dams in the new energetic scenarios

The growing energetic demands are promoting new business strategies in the operating of hydroelectric power plants. These are materialized by increasing the role of the reversible plants to produce high quality energy. This fact becomes in an abrupt and quick variation of the water level of the reservoirs. This influences at the temperature levels in the dams. Furthermore, since the dams have been working for years, temperature registers from them are available. This enlarges the initial hypotheses considered in the project calculation. This paper summarizes the results obtained in the enlargement of the operating system involving the Baserca and Llauset dams. The initial experimental data come from the measurements which have been taken in those dams after 30 years of operation.Postprint (published version

El comportamiento de las presas de Baserca y Llauset en los nuevos escenarios energéticos

Las crecientes demandas energéticas están promoviendo nuevas estrategias comerciales en la explotación de las infraestructuras hidráulicas que se materializan aumentando el protagonismo de los saltos reversibles en la producción de energía. Estos nuevos escenarios dan lugar a operaciones, de embalse y desembalse, más bruscas y frecuentes que pueden alterar, entre otros, los efectos que ocasionan en las estructuras las acciones térmicas durante la explotación. Adicional mente al actuar sobre estructuras con un largo recorrido funcional, se dispone de una información muy completa sobre su comportamiento que complementa y enriquece las hipótesis consideradas en el cálculo durante la fase de proyecto. En esta comunicación se presentan los resultados obtenidos en los análisis realizados en este contexto en las presas bóveda de Baserca y Llauset, el tratamiento de los datos experimentales disponibles después de más de 25 años de funcionamiento satisfactorio y como se han incorporado a los cálculos realizados buscando un equilibrio y una coherencia con las hipótesis utilizadas durante su diseño y construcción.Postprint (published version

Event Shape/Energy Flow Correlations

We introduce a set of correlations between energy flow and event shapes that are sensitive to the flow of color at short distances in jet events. These correlations are formulated for a general set of event shapes, which includes jet broadening and thrust as special cases. We illustrate the method for electron-positron annihilation dijet events, and calculate the correlation at leading logarithm in the energy flow and at next-to-leading-logarithm in the event shape.Comment: 43 pages, eight eps figures; minor changes, references adde

Economic Valuation of Health Care Services in Public Health Systems: A Study about Willingness to Pay (WTP) for Nursing Consultations

Background: Identifying the economic value assigned by users to a particular health service is of principal interest in planning the service. The aim of this study was to evaluate the perception of economic value of nursing consultation in primary care (PC) by its users. Methods and Results: Economic study using contingent valuation methodology. A total of 662 users of nursing consultation from 23 health centers were included. Data on demographic and socioeconomic characteristics, health needs, pattern of usage, and satisfaction with provided service were compiled. The validity of the response was evaluated by an explanatory mixed-effects multilevel model in order to assess the factors associated with the response according to the welfare theory. Response reliability was also evaluated. Subjects included in the study indicated an average Willingness to Pay (WTP) of €14.4 (CI 95%: €13.2–15.5; median €10) and an average Willingness to Accept [Compensation] (WTA) of €20.9 (CI 95%: €19.6–22.2; median €20). Average area income, personal income, consultation duration, home visit, and education level correlated with greater WTP. Women and older subjects showed lower WTP. Fixed parameters explained 8.41% of the residual variability, and response clustering in different health centers explained 4–6% of the total variability. The influence of income on WTP was different in each center. The responses for WTP and WTA in a subgroup of subjects were consistent when reassessed after 2 weeks (intraclass correlation coefficients 0.952 and 0.893, respectively). Conclusions: The economic value of nursing services provided within PC in a public health system is clearly perceived by its user. The perception of this value is influenced by socioeconomic and demographic characteristics of the subjects and their environment, and by the unique characteristics of the evaluated service. The method of contingent valuation is useful for making explicit this perception of value of health services

Attentive Learning of Sequential Handwriting Movements: A Neural Network Model

Defense Advanced research Projects Agency and the Office of Naval Research (N00014-95-1-0409, N00014-92-J-1309); National Science Foundation (IRI-97-20333); National Institutes of Health (I-R29-DC02952-01)

Long-term effect of 2 intensive statin regimens on treatment and incidence of cardiovascular events in familial hypercholesterolemia : The SAFEHEART study

Funding: This study was supported by Fundación Hipercolesterolemia Familiar; Grant G03/181 Grant 08-2008 Centro Nacional de Investigaci?n Cardiovascular (CNIC).Background: Maximal doses of potent statins are the basement of treatment of familial hypercholesterolemia (FH). Little is known about the use of different statin regimens in FH. Objectives: The objectives of the study were to describe the treatment changes and low-density lipoprotein cholesterol (LDL-C) goal achievement with atorvastatin (ATV) and rosuvastatin (RV) in the SAFEHEART cohort, as well as to analyze the incidence of atherosclerotic cardiovascular events (ACVEs) and changes in the cardiovascular risk. Methods: SAFEHEART is a prospective follow-up nationwide cohort study in a molecularly defined FH population. The patients were contacted on a yearly basis to obtain relevant changes in life habits, medication, and ACVEs. Results: A total of 1939 patients were analyzed. Median follow-up was 6.6 years (5-10). The estimated 10-year risk according the SAFEHEART risk equation was 1.61 (0.67-3.39) and 1.22 (0.54-2.93) at enrollment for ATV and RV, respectively (P <.001). There were no significant differences at the follow-up: 1.29 (0.54-2.82) and 1.22 (0.54-2.76) in the ATV and RV groups, respectively (P =.51). Sixteen percent of patients in primary prevention with ATV and 18% with RV achieved an LDL-C <100 mg/dL and 4% in secondary prevention with ATV and 5% with RV achieved an LDL-C <70 mg/dL. The use of ezetimibe was marginally greater in the RV group. One hundred sixty ACVEs occurred during follow-up, being its incidence rate 1.1 events/100 patient-years in the ATV group and 1.2 in the RV group (P =.58). Conclusion: ATV and RV are 2 high-potency statins widely used in FH. Although the reduction in LDL-C levels was greater with RV than with ATV, the superiority of RV for reducing ACVEs was not demonstrated

Seasonal drought limits tree species across the Neotropics

Within the tropics, the species richness of tree communities is strongly and positively associated with precipitation. Previous research has suggested that this macroecological pattern is driven by the negative effect of water-stress on the physiological processes of most tree species. This process implies that the range limits of taxa are defined by their ability to occur under dry conditions, and thus in terms of species distributions it predicts a nested pattern of taxa distribution from wet to dry areas. However, this ‘dry-tolerance’ hypothesis has yet to be adequately tested at large spatial and taxonomic scales. Here, using a dataset of 531 inventory plots of closed canopy forest distributed across the Western Neotropics we investigated how precipitation, evaluated both as mean annual precipitation and as the maximum climatological water deficit, influences the distribution of tropical tree species, genera and families. We find that the distributions of tree taxa are indeed nested along precipitation gradients in the western Neotropics. Taxa tolerant to seasonal drought are disproportionally widespread across the precipitation gradient, with most reaching even the wettest climates sampled; however, most taxa analysed are restricted to wet areas. Our results suggest that the ‘dry tolerance’ hypothesis has broad applicability in the world's most species-rich forests. In addition, the large number of species restricted to wetter conditions strongly indicates that an increased frequency of drought could severely threaten biodiversity in this region. Overall, this study establishes a baseline for exploring how tropical forest tree composition may change in response to current and future environmental changes in this region

Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures

Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain, but may be followed by unusual and severe postoperative complications. This review deals with the pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures and fecal incontinence. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma and perforation with pelvic sepsis often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for fourth-degree piles. Enterocele and anismus are contraindications to PPH and STARR and both operations should be used with caution in patients with weak sphincters. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented