The Current Role of Viability Imaging to Guide Revascularization and Therapy Decisions in Patients With Heart Failure and Reduced Left Ventricular Function

This review describes the current evidence and controversies for viability imaging to direct revascularization decisions and the impact on patient outcomes. Balancing procedural risks and possible benefit from revascularization is a key question in patients with heart failure of ischemic origin (IHF). Different stages of ischemia induce adaptive changes in myocardial metabolism and function. Viable but dysfunctional myocardium has the potential to recover after restoring blood flow. Modern imaging techniques demonstrate different aspects of viable myocardium; perfusion (single-photon emission computed tomography [SPECT], positron emission tomography [PET], cardiovascular magnetic resonance [CMR]), cell metabolism (PET), cell membrane integrity and mitochondrial function (201Tl and 99mTc-based SPECT), contractile reserve (stress echocardiography, CMR) and scar (CMR). Observational studies suggest that patients with IHF and significant viable myocardium may benefit from revascularization compared with medical treatment alone but that in patients without significant viability, revascularization appears to offer no survival benefit or could even worsen the outcome. This was not supported by 2 randomized trials (Surgical Treatment for Ischemic Heart Failure [STICH] and PET and Recovery Following Revascularization [PARR] -2) although post-hoc analyses suggest that benefit can be achieved if decisions had been strictly based on viability imaging recommendations. Based on current evidence, viability testing should not be the routine for all patients with IHF considered for revascularization but rather integrated with clinical data to guide decisions on revascularization of high-risk patients with comorbidities.Peer reviewe

Discussão sobre a regularização da piscicultura brasileira: da produção à comercialização.

Introdução. Regularização de projetos aquícolas. Regularização de projetos aquícolas. Exemplos da abertura de empresa rural em outros países. Registro de Aquicultor e Licença de Aquicultor. Espécies cultiváveis. Exemplos de permissão de espécies exóticas para cultivo em outros países. Resumo do processo de regularização das pisciculturas em águas da União. Licenciamento ambiental de projetos de piscicultura. Particularidades do licenciamento em viveiros escavados, barragem e PCH e águas Estaduais. Custos do processo de regularização da área aquícola no Brasil. Exemplos internacionais sobre a regularização das áreas produtivas. Outorga de direito de uso de recursos hídricos para a piscicultura. Exemplos internacionais sobre cessão de uso das áreas produtivas. Regularização da produção. Incentivos para a produção. Tarifa da energia elétrica. Contribuição previdenciária. Regularização na comercialização. Despesca e Abate. Transporte. Guia de trânsito animal e outros documentos. Problemas causados pela falta de Inspeção Sanitária. Registros de estabelecimentos de processamento de pescado. SISB - Uma opção. Considerações Finais. Referências. Anexo 1 - Referências de interesse

Standards for the Characterization of Endurance in Resistive Switching Devices

Resistive switching (RS) devices are emerging electronic components that could have applications in multiple types of integrated circuits, including electronic memories, true random number generators, radiofrequency switches, neuromorphic vision sensors, and artificial neural networks. The main factor hindering the massive employment of RS devices in commercial circuits is related to variability and reliability issues, which are usually evaluated through switching endurance tests. However, we note that most studies that claimed high endurances >106 cycles were based on resistance versus cycle plots that contain very few data points (in many cases even <20), and which are collected in only one device. We recommend not to use such a characterization method because it is highly inaccurate and unreliable (i.e., it cannot reliably demonstrate that the device effectively switches in every cycle and it ignores cycle-to-cycle and device-to-device variability). This has created a blurry vision of the real performance of RS devices and in many cases has exaggerated their potential. This article proposes and describes a method for the correct characterization of switching endurance in RS devices; this method aims to construct endurance plots showing one data point per cycle and resistive state and combine data from multiple devices. Adopting this recommended method should result in more reliable literature in the field of RS technologies, which should accelerate their integration in commercial products

Exatidão dos dados do sistema de vigilância epidemiológica da malária no estado do Amazonas

The Epidemiological Surveillance System for Malaria (SIVEP-Malaria) is the Brazilian governmental program that registers all information about compulsory reporting of detected cases of malaria by all medical units and medical practitioners. The objective of this study is to point out the main sources of errors in the SIVEP-Malaria database by applying a data cleaning method to assist researchers about the best way to use it and to report the problems to authorities. The aim of this study was to assess the quality of the data collected by the surveillance system and its accuracy. The SIVEP-Malaria data base used was for the state of Amazonas, Brazil, with data collected from 2003 to 2014. A data cleaning method was applied to the database to detect and remove erroneous records. It was observed that the collecting procedure of the database is not homogeneous among the municipalities and over the years. Some of the variables had different data collection periods, missing data, outliers and inconsistencies. Variables depending on the health agents showed a good quality but those that rely on patients were often inaccurate. We showed that a punctilious preprocessing is needed to produce statistically correct data from the SIVEP-Malaria data base. Fine spatial scale and multi-temporal analysis are of particular concern due to the local concentration of uncertainties and the data collecting seasonality observed. This assessment should help to enhance the quality of studies and the monitoring of the use of the SIVEP database.O Sistema de Vigilância Epidemiológica de Malária (SIVEP-Malária) é um programa governamental brasileiro que arquiva automaticamente todas as informações sobre casos de malária registrados em todas as unidades de saúde e consultórios medicos. O objetivo deste estudo foi avaliar a qualidade dos dados coletados pelo sistema de vigilância e sua precisão. Foram utilizados os dados do SIVEP-Malária para o estado do Amazonas, Brasil, de 2003 a 2014. Um método de limpeza de dados foi aplicado para detectar e remover registros errôneos. Observamos que a coleta de dados não é homogênea entre os municipios e ao longo dos anos. Algumas variaveis tinham diferentes padrões de coleta, falta de dados, dados discrepantes e inconsistências. Dados que dependem do agente de saúde possuem boa qualidade mas aqueles que dependem dos pacientes são frequentemente imprecisos. Mostramos que um pre-processamento meticuloso é necessário para produzir dados estatisticamente corretos a partir do SIVEP-Malária. Analises em escala espacial detalhada ou multi-temporais são particularmente afetadas devido à concentração local de incertezas e a sazonalidade observada na coleta de dados. Esta avaliação deve auxiliar a melhorar os estudos e monitoramentos que fazem uso dos dados do SIVEP