Early detection and management of the high-risk patient with elevated blood pressure

Severe or important blood pressure elevations are associated with the risk of cardiovascular disease. However, a significant proportion of myocardial infarctions and strokes occur in subjects with only slight elevations or even with normal blood pressure. Both the coexistence of other cardiovascular risk factors, such as diabetes or dyslipidemia, or those recently recognized, such as elevations of C-reactive protein or abdominal obesity and metabolic syndrome, or the presence of target organ damage, such as microalbuminuria, left ventricular hypertrophy, mild renal dysfunction or increased intima-media thickness, all indicate the existence of a high cardiovascular risk in mild hypertensives or in subjects with normal or high-normal blood pressure. Unfortunately, these high-risk patients are often not recognized and thus under-treated

Effects of Eprosartan on Target Organ Protection

Hypertension is the most important cardiovascular risk factor for stroke. Blood pressure reduction by antihypertensive treatment is clearly efficacious in the prevention of stroke (both primary and secondary), although no clear differences have yet been observed between antihypertensive drug classes. However, a recent study reported the clear superiority of the angiotensin-receptor blocker eprosartan over the calcium channel blocker nitrendipine in cardiovascular protection of hypertensive patients with a previous stroke. Comparative studies using angiotensin-receptor blockers have also suggested the superiority of this class of drugs on primary stroke prevention. This effect may be linked to their beneficial actions on left ventricular hypertrophy, atrial enlargement, and supraventricular arrhythmias, endothelial dysfunction, inflammation, and remodelling, as well as a direct neuroprotective effect mediated through the stimulation of the angiotensin II type-2 receptor. In addition, a sympathoinhibition observed with the renin–angiotensin system blockers and particularly demonstrated with eprosartan, may help to explain the better cardiovascular and cerebrovascular protection in comparison with the calcium antagonist nitrendipine

Passive Microstrip Transmitarray Lens for Ku Band

The aim of this paper is to introduce a novel 12 GHz radiating design based on the idea of transmitarray lens device. In this document, an overview of the functioning of this kind of devices is given and the proposed transmitarray lens is studied, with architecture discussion and selection, as well as some ideas about the design, and manufacturing. In the document, some design, manufacturing and validation of the constituting elements of the lens (radiating elements, transmission circuits and transitions) are presented, together with a complete prototype of assembled transmitarray lens. Radiation pattern measurements in anechoic chamber, as well as gain and directivity values are offered

Essays on the Economics of Statelessness and State Formation

This dissertation empirically examines economic exchange in the absence of the state. While economic analysis focuses traditionally on economic exchange within a state able to enforce property rights, functioning states are an anomalous environment in the development process. However, a fundamental problem is that in the absence of a functioning state, there is no data collection capacity. In order to observe economic exchange in the absence of a state, I focus on a collapsed state in the current period: the Democratic Republic of the Congo (DRC). As a foundation for this dissertation, I conducted fieldwork in areas of the Eastern provinces of the Democratic Republic of the Congo that are removed from the central state. I managed a team of 12 surveyors, as well as a team of 20 traders, in order to observe economic exchange in such areas. The DRC is a well suited location to study the rules that govern economic exchange in the absence of the state. The central state is considered a failed state", the second weakest state in the world. Lacking a state to protect property rights and provide a judicial system, the economy has organized informally. Actors independent of the state regularly use coercion to define property rights. Contracts are enforced under the threat of social sanctions, or the threat of village armed men who administer disputes. To analyze economic exchange without a state, I use standard economic analysis and standard econometrics but I am constrained to introduce different notions than the ones on which traditional economic analysis usually relies (Acemoglu and Wolitzky, 2011, Grossman, 1999, Hirshleifer, 1995). Instead of assuming that property rights are stable, I allow some agents to use coercion in order to dene property rights over goods and labor services. In anarchy, coercion can lead to large efficiency losses, since uncoordinated coercive actors do not internalize the distortions they generate on the incentives of those who produce (Grossman, 1999). This leads me to the question of Chapter 1: when will individuals with a comparative advantage in coercion organize violence in a particular location, and hold a "monopoly of violence"? Since a dominant view across disciplines views a "monopoly of violence" as a sufficient characterization of the state and traces back state origins to coercion and organized crime in medieval Europe (Tilly, 1985), my exercise uncovers the economic forces that lead to the formation of states - whether these monopolies of violence are recognized as states by the international community or not. However, in this exercise, I take the notion of the state as a "monopoly of violence" as given. But is this a useful view of the state? Why should any monopoly of violence, even those with purely criminal motives, act as states? Olson (1993) endows this view of the state with theoretical foundations: since criminals who hold a monopoly of violence are partial residual claimants through the taxes they collect, it is in their interest to protect economic activity, promote growth. Indeed, by doing so they can increase the tax revenues they collect. Therefore, in Chapter 2, I confront these theoretical foundations to the data. I examine in detail the behavior of village monopolies of violence held by armed men in Eastern Congo, and introduce economic analysis to predict state-like behavior: optimal taxation, public goods provision, and popular support. I go a step further to refine this view of the state, and show that the view of the state as a "monopoly of violence" is useful only if the time horizon is long and the monopoly of violence is uncontested. Once I have established the economic causes of state formation and the links between organized crime and states, I turn to the impact of the state on economic organization. In Chapter 3, I implement a field experiment that allows me to observe the impact of the penetration of the state legal system. I find that the state legal system allows for an increase in trade, and does not crowd-out pre-existing social mechanisms generating trust and trade. However, there are limits to the effectiveness of the formal system of contract enforcement. Indeed, I nd that only the groups which have captured the state benefit from the leverage provided by the legal system. This confirms the view of the state, as an organization that holds a monopoly of violence but which can be captured by a subset of the population. In what follows, I describe each chapter in more detail. In Chapter 1, I focus on the following question: why do states arise, and when do they fail to arise? A dominant view across disciplines is that states arise when violent actors impose a "monopoly of violence" in order to extract taxes (Tilly, 1985). One key fact underlies all existing studies: statistics exist only after the state is formed. In this chapter, I provide the first econometric evidence on the determinants of state formation at their early stages. As a foundation for this chapter, I conducted fieldwork in areas of Eastern Congo removed from control by the central state, managing a team that collected village-level panel data on current armed groups. I develop a model that introduces optimal taxation theory to the decision of armed groups to form local "monopolies of violence", and argue that the returns to such decision hinge on their ability to tax the local population. A sharp, exogenous rise in the price of a bulky commodity used in the electronics industry, coltan, leads armed groups to impose a "monopoly of violence" in coltan villages. A later increase in the price of gold, easier to conceal and hence more dicult to tax, does not. Results from auxiliary tests provide additional support to the theory. The findings support the hypothesis that the expected Revenue from taxation, in particular tax base elasticity, is a determinant of state formation. In Chapter 2, I go a step further, and challenge the theory associating monopolies of violence to state-like behavior. A dominant view across disciplines defines states as a monopoly of violence" and argues that states are a developed form of successful organized crime. But, is this a useful definition of the state? If current states are monopolies of violence and also engage in state-like behavior, this may be the result of a long historical process unrelated to the fact that they are a "monopoly of violence". In this chapter, I examine this view of the state empirically, and provide one of the first studies with econometric evidence linking criminal "monopolies of violence" before they develop into the states as most of us know them, to state-like behavior. To observe the behavior of criminal "monopolies of violence", I draw on the same data collection exercise as in Chapter 1. I apply optimal taxation theory to armed groups, and show that armed groups will tax and promote growth like states whenever their "monopoly of violence" is uncontested. Based on this data, I find that criminal "monopolies of violence" consistently provide public goods, develop popular support, and elaborate taxation schemes consistent with optimal taxation and European medieval states. In addition, using the timing of a peace agreement as an instrument for the presence of armed men in the village, I establish that the village "monopolies of violence" have a positive impact on economic activity. In 2003, a peace agreement (Sun-city agreement) led a large number of village "monopolies of violence" to relocate, in order to integrate the national government. This led to a security vacuum. I find that the vacuum caused by this peace agreement led to reductions in economic activity. I then use the timing of a large scale military operation in order to instrument for changes in the time horizon of existing village "monopolies of violence", which came under threat as a result of the military operation. I find that when their "monopoly of violence" comes under threat, armed groups turn from partial expropriation through stable taxation with full commitment, to full-scale violent expropriations. These findings support the view that the origins and workings of states can be obtained from criminal "monopolies of violence", but only if they have a stable time horizon. In Chapter 3, I turn to the experimental component of the dissertation. Having established the causes that lead to the emergence of states - taxation and coercion - I investigate how to take advantage of the state in order to increase trade in contexts where distrust prevents trade to occur. Absent states to enforce contracts, societies may develop group-based mechanisms to generate trade when commitment problems prevail (Greif, 1993). However, groups are often fragmented. Can expanding access to the state legal system complement social mechanisms of contract enforcement sustained by groups? Or does legal intermediation by the state crowd them out? In this chapter, I provide evidence on the impact of state contracts on trade. As a foundation for this chapter, I created a home delivery business in East Congo. Traders sell a domestic good in households of different ethnic groups, and commit to deliver the good in the future. Shared ethnicity and formal contracts are equally effective at increasing trade by sustaining trust. Furthermore, contracts do not crowd-out ethnic group based mechanisms of trust production. Why do contracts increase trust? Results from a last experiment suggest that contracts are enforceable. However, they only protect claimants of ethnic groups that have captured the state administration. These findings suggest that even the state apparatus is embedded in the social structure, and expanding the reach of the state may have positive welfare effects, only for the groups that have vested control in the state institutions. Each of the three chapters is self-contained, so a reader interested in only one of these parts can focus on only one chapter. Each chapter contains an overview of the context relevant for that chapter. There are overlaps in the descriptions of the context. Chapters one and two are based on the same data collection exercise, but are the focus of different questions and different variables. Chapter 3 draws on a different field experiment

Los factores lingüísticos de la /-s/ implosiva en el nivel de estudios altos de Granada

En este trabajo se muestra un estudio sociolingüístico sobre la variación de la /-s/ en posición implosiva en el habla de Granada. El corpus de base sobre el que se realizarán los análisis es el Corpus PRESEEA-Granada (Moya coord. 2007-2009) establecido mediante las variables de preestratificación que se incluyen en la propuesta metodológica del PRESEEA (sexo, edad y grado de instrucción), para llevarlo a cabo seguiremos la metodología propia de los estudios variacionistas. Nuestro objetivo es mostrar un estudio detallado sobre la /-s/ en distensión silábica en el nivel de estudios altos de la ciudad de Granada. Como resultado de nuestra investigación mostraremos los datos obtenidos tras el estudio de los factores lingüísticos considerados más relevante

"Hospital utilization by Mexican migrants returning to Mexico due to health needs"

<p>Abstract</p> <p>Background</p> <p>A total of 12.7 million Mexicans reside as migrants in the United States, of whom only 45% have health insurance in this country while access to health insurance by migrants in Mexico is fraught with difficulties. Health insurance has been shown to impact the use of health care in both countries. This paper quantifies hospitalizations by migrants who return from the US seeking medical care in public and private hospitals in the US-Mexico border area and in communities of origin. The proportion of bed utilization and the proportion of hospitalizations in Mexico out of the total expected by migrants in the US were estimated.</p> <p>Methods</p> <p>The universe included 48 Ministry of Health and 47 private hospitals serving municipalities of high or very high migration in Mexico, where 17% of remittance-receiving households are located, as well as 15 public and 159 private hospitals in 10 Mexican cities along the border with the US. Hospitals were sampled through various methods to include 27% of beds. Patients and staff were interviewed and data triangulated to quantify migrants that returned to Mexico seeking medical care. Official hospital discharge statistics and secondary data from migration databases and published statistics were analyzed to identify bed occupancy, general migrant hospitalization rates and the size of the migrant population that maintains close relationships with households in communities of origin.</p> <p>Results</p> <p>Up to 1609 migrants were admitted to public hospitals (76.6%) and 492 to private hospitals (23.4%) serving municipalities of high and very high migration intensity in 2008. Up to 0.90% of public hospital capacity was used. In the border area up to 908 and 2416 migrants were admitted to public (27.3%) and private (72.7%) hospitals, respectively. Up to 1.18% of public hospital capacity was used. Between 2.4% and 20.4% of the expected hospitalization needs of migrants with dependent households are satisfied through these services. The most common diagnostic categories mentioned across hospitals were traumatisms, complications of diabetes and elective surgery, in that order. Private hospitals mention elective surgeries as the main diagnostic category followed by complications of diabetes.</p> <p>Conclusions</p> <p>Hospitals in communities of origin in Mexico are devoting few resources to respond to hospitalization needs of migrants in the US. Currently no hospital programs exist to stimulate migrant demand or to cater to their specific needs. Registering migratory history in clinical and administrative records can be readily implemented. Developing bi-national referral networks and insuring migrants in the US within current Mexican federal programs could greatly increase migrant access to hospitals.</p

Mutual Coupling Reduction Techniques in Electronic Steering Antennas in X Band

This work provides the development of an antenna for satellite communications onboard systems based on the recommendations ITU-R S.580-6 [1] and ITU-R S.465-5 [2]. The antenna consists of printed elements grouped in an array, working in a frequency band from 7.25 up to 8.4 GHz (15% of bandwidth). In this working band, transmission and reception are included simultaneously. The antenna reaches a gain about 31 dBi, has a radiation pattern with a beam width smaller than 10oand dual circular polarization. It has the capability to steer in elevation through a Butler matrix to 4

Influencia del analfabetismo en la salud de la población que asiste al Centro de Salud n° 167 de el Divisadero

En el presente trabajo se busca descubrir qué hay detrás de cada acto de servicio y de nuestro accionar de ayuda a los demás. Se debe estar atento, no solo a los avances tecnológicos o a los problemas psíquicos o espirituales que el paciente pueda sufrir, sino que es importante reparar en los aspectos socio-culturales, como su sistema de valores y el estilo de vida tradicional, que se ven influenciados por las transformaciones sociales existentes, donde se sienten discriminados y con baja autoestima al no saber leer ni escribir. Cuando deben interpretar una indicación médica o leer prospectos de medicamentos, hay personas que no lo saben hacer porque nunca fueron a la escuela, o no completaron ningún ciclo escolar, solo asistieron a primer grado, y si bien saben leer, no saben interpretar lo leído. En su vida cotidiana tienen hijos en edad escolar a los cuales no pueden prestarle ayuda en sus tareas y mucho menos corregir los errores que puedan tener.Fil: Alvares, Olga. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..Fil: De la Sierra, Gricelda. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..Fil: Resca, Adriana. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería.

Electronically Reconfigurable Patches for Transmit-array Structures at 12GHz

The aim of the paper below is to develop certain active radiating elements for reconfigurable patch arrays. In literature it could be found different possibilities to obtain feasible reconfigurable antennas, whether placing the active circuitry in the transmission lines or directly over the patch. In this paper, the second option is chosen and active radiating elements are analyzed, designed, simulated and prototyped. Finally, measurements of these prototypes are shown. This work is part of a more complete and ambitious project to design and prototype reconfigurable transmit-array structures for microwave applications