Assessing carbon tax using a CGE model with firm heterogeneity: An application to Vietnam.

Vietnam's government is considering introducing a carbon market as part of its decarbonization strategy. The carbon tax is an option for the government to regulate greenhouse gas emissions. We evaluate the potential macroeconomic and climate impacts of carbon tax policy in Vietnam using a unique data set and simulation analysis with a multi-sector dynamic computable general equilibrium model. The model allows for firm heterogeneity: domestic firms and foreign-invested enterprises. The results show that with plausible tax rates, emissions can be reduced to levels 1.3-2.8 percent below the target value of emissions in 2030. The cost is a loss in GDP by 1.2-2.7 percent in 2030. The results also show that foreign-invested enterprises tend to increase emissions in the medium run even with a carbon tax while a carbon tax is more effective when applied to domestic firms. In addition, a substantial reduction in emissions from the energy sector and improvement in energy efficiency are keys to success in carbon abatement.

Efficacy and Safety of Direct Oral Anticoagulants (DOACs) Versus Warfarin in Atrial Fibrillation Patients with Prior Stroke: a Systematic Review and Meta-analysis.

BACKGROUND: The purpose of this meta-analysis was to compare efficacy and safety of direct oral anticoagulants (DOACs) to warfarin for secondary stroke prevention among adult patients with atrial fibrillation and prior stroke. METHODS: Major repositories were screened for randomized controlled trials (RCTs), RCT subgroups, and observational studies (OBSs, divided in claims and non-claims). Occurrences of ischemic stroke or transient ischemic attack, systemic embolism, all-cause mortality, intracranial hemorrhage (ICH), and major bleeding were outcomes of interest. Hazard ratios (HRs) and their confidence intervals (95%CIs) were pooled using random-effects models for each study design. Claims studies were analyzed separately from non-claims, while RCT subgroups were grouped with OBSs (non-claims) as the randomization was broken. RESULTS: Of 8647 articles, 20 were included (one RCT, six RCT subgroups, nine claims, and four non-claims). Comparing DOACs to warfarin, pooled HRs (95%CI) were consistently in favor of DOACs although some did not reach statistical significance: for ischemic stroke, 0.84 (0.66-1.07) in claims; 0.90 (0.77-1.06) in non-claims and RCT subgroups; for systemic embolism, 0.77 (0.62-0.96) in claims; 0.86 (0.77-0.96) in non-claims and RCT subgroups; for all-cause mortality, 0.57 (0.33-0.99) in claims; 0.87 (0.79-0.96) in non-claims and RCT subgroups; for ICH, 0.72 (0.39-1.33) in claims; 0.51 (0.38-0.67) in non-claims and RCT subgroups; and for major bleeding, 0.86 (0.71-1.03) in claims; 0.90 (0.76-1.08) for non-claims and RCT subgroups. CONCLUSION: DOACs were associated with better efficacy and safety profiles than warfarin in atrial fibrillation patients with prior stroke, more specifically a lower risk of systemic embolism, all-cause mortality, and ICH.

Food for Thought or Feeding a Dogma? Diet and Coronary Artery Disease: a Clinician's Perspective.

PURPOSE OF REVIEW: To provide an overview of nutrition studies evaluating the association of dietary saturated fat and meat intake with the development of coronary artery disease (CAD) and discuss implications of recent data. RECENT FINDINGS: Recent studies have led to the re-evaluation of the role of saturated fat in CAD. Randomized controlled trials (RCTs) support Mediterranean diet to reduce cardiovascular risk. Recent data revealed significant association of intake of meat or poultry with increased risk, but fish consumption was associated with lower risk of incident CAD. In this review, we provide a brief overview of the studies and data that have led to the re-evaluation of the link between saturated fat and CAD. Due to conflicting data from long-term prospective cohort studies and significant heterogeneity, associations of unprocessed meat with CAD are less clear compared to the role of processed meat. Pooled data from prospective cohort studies have overcome some of these limitations and show association of both processed and unprocessed meat and poultry intake but not fish consumption with incident CAD. These findings were also validated recently in a large UK Biobank prospective study. While recognizing the limitations of these cohort studies, we discuss relevant landmark RCTs. We finally consider the challenges with RCTs in nutrition research to improve the quality of evidence and need for evidence-based dietary guidelines with respect to saturated fat intake from a clinical perspective.

Peripheral vascular manifestation in patients receiving an amphetamine analog: A case series.

Amphetamine and its related derivatives and analogues (ADRA) are highly addictive central nervous system stimulants that are used commonly in the treatment of attention-deficit/hyperactivity disorder and narcolepsy. These medications are associated with many side effects but reports of peripheral arterial manifestations associated with ADRA usage are scarce. We retrospectively reviewed the records of 16 patients (median age 37 years (IQR 31-47), 13 females) referred to a single tertiary referral service while receiving ADRA. Follow-up was available for a median of 3 years (IQR 3-4.5). The most common presentation (62.5%) was mild vasospastic symptoms involving the upper, lower or both extremities. Six patients developed severe manifestations including tissue loss and the need for lower extremity amputation. Most patients (75%) refused to stop the medication during follow-up. Underlying rheumatologic disorders were found in 25% of the patients, and the presence of rheumatologic disease seemed to be associated with more severe vascular manifestations. In conclusion, it is important to search for ADRA usage as part of the differential diagnosis of digital ischemia.

Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used to stabilize patients with massive pulmonary embolism though few reports describe this approach. We describe the presentation, management and outcomes of patients who received ECMO for massive pulmonary embolism (PE) in our pulmonary embolism response team (PERT) registry. METHODS: We enrolled a consecutive cohort of patients with confirmed PE for whom PERT was activated and selected patients treated with ECMO. We prospectively captured clinical, therapeutic and outcome data at the time of PERT activation and during the follow-up period for up to 365 days. RESULTS: Thirteen patients who had PERT activation with confirmed PE diagnosis have undergone ECMO since the initiation of our PERT program in 2012. The mean age was 49 ± 19 years. Six (46%) patients were female. All the patients had cardiac arrest, either as an initial presentation or in-hospital cardiac arrest after presentation. All the patients exhibited right ventricular (RV) dilation on echocardiogram with RV hypokinesis. Eight (62%) patients received systemic thrombolysis with intravenous tissue plasminogen activator (tPA) and three (23%) patients underwent catheter-directed thrombolysis therapy using the EKOS system (EKOS Corporation, Bothell, WA, USA). Four (31%) patients underwent surgical embolectomy. Mean ECMO duration was 5.5 days, ranging from 2-18 days. Thirty-day mortality was 31% and one-year mortality was 54%. CONCLUSIONS: Patients with massive pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. ECMO can be used in conjunction with systemic thrombolysis, catheter-directed therapy or as a bridge to surgical embolectomy.

Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection.

Spontaneous isolated celiac or superior mesenteric artery (SMA) dissection (SICMAD) is a rare clinical entity. Not much is known about the natural history and appropriate treatment. We retrospectively queried a prospectively collected institutional radiology database for all patients diagnosed with SICMAD from 1990 to 2017. We identified 42 arteries in 40 patients (83.3% male), mean age 54.8 ± 10.9 years, consisting of 24 celiac arteries and 18 SMA. SMA lesions were longer than celiac lesions (5.15 ± 3.81 vs 2.38 ± 1.40 cm, p = 0.008). Thirty-one patients had follow-up; mean follow-up was 4.9 ± 4.8 years. Morphologic improvement was seen in 20 (48%) arteries. Sakamoto IV lesions were more likely to remodel (OR: 11.26, 95% CI: 1.13, 588.26, p = 0.039), and Sakamoto II lesions less likely to remodel (OR: 0, 95% CI: 0.00, 0.93, p = 0.05). Patients received an average of 2.35 scans during follow-up. Symptom resolution occurred in all symptomatic patients, and 16% of patients had recurrence of symptoms. Follow-up CT scans revealed a stable arterial diameter for the majority of patients. In conclusion, the majority of patients with SICMAD improve with medical therapy alone. Aneurysmal dilatation is uncommon.

Culture Negative Infective Endocarditis Atypically Diagnosed From Mycotic Cerebral Aneurysm.

Cerebral mycotic aneurysms (CMA) are a rare consequence of infective endocarditis (IE). We report a case of a 75-year-old left-handed male with comorbidities who was admitted to our facility with left-sided weakness, dysarthria, and left-sided facial droop. Initial computed tomography of the head without contrast and angiography of the head showed acute hemorrhage in the paramedian right frontal lobe with extension into the right lateral ventricle, occlusion of the left intracranial internal carotid artery, and an associated 0.3 cm aneurysm involving the distal right anterior cerebral artery. C-reactive protein and erythrocyte sedimentation rate were elevated but blood cultures showed no growth for more than five days. The patient underwent a two-vessel cerebral angiogram, primary coil embolization of the aneurysm, and selective catheterization of the left common carotid artery, right internal carotid artery, and right anterior cerebral artery. Transesophageal echocardiography showed an echogenic, highly mobile structure attached to the aortic valve suggestive of vegetation. The patient was subsequently started on a vancomycin regimen and stably discharged for further outpatient follow-up. This case highlights an uncommon presentation of CMA and the retroactive diagnosis of IE.

Not So Benign Chest Pain in the Young: A Story of Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia.

Spontaneous coronary artery dissection (SCAD) is a rare clinical entity, often presenting similar to atherosclerotic acute coronary syndrome (ACS), although it is a non-atherosclerotic, non-traumatic, and non-iatrogenic coronary artery pathology. We report the case of a 36-year-old woman who presented with substernal, pressure-like chest pain without aggravating, alleviating, or associated symptoms. Initial evaluation revealed elevated troponin levels which peaked at 8.71 ng/mL. Electrocardiogram showed borderline J point elevation in the lateral leads. A transthoracic echocardiography revealed mild left ventricular dysfunction with an estimated ejection fraction of 45% to 50%, an akinetic apex with hyperdynamic basal segments, suggestive of stress cardiomyopathy. However, a left anterior descending artery (LAD) infarction could not be excluded. Emergent coronary angiography revealed SCAD of the LAD. No coronary interventions were performed. The patient was managed medically with dual antiplatelet therapy and beta-blockers. Given the high suspicion for fibromuscular dysplasia (FMD), computed tomographic angiography (CTA) of the head to pelvis was performed. The CTA neck showed bilateral focal areas of mild stenosis and dilation of the distal cervical internal carotid artery, and CTA abdomen revealed multiple splenic artery aneurysms, diagnostic of FMD. Unlike atherosclerotic ACS, our patient was managed medically without percutaneous intervention. This case illustrates the rare occurrence of myocardial injury due to SCAD which results in spontaneous intramural hematoma formation rather than atherosclerotic plaque rupture typically seen in ACS. FMD remains the most commonly associated condition with SCAD.

The Clot Thickens: COVID-19-Related ST-Elevation Myocardial Infarction in the Setting of Recent Boosters.

The coronavirus disease of 2019 (COVID-19) has an array of pathological effects that continue to be discovered. Vaccines against COVID-19 have quickly emerged as our main tool. However, the thrombotic risk of both the virus and the vaccine is yet to be established, let alone together. In this case report, we present a case involving a recently diagnosed COVID-19 patient who developed an ST-elevated myocardial infarction (STEMI) after receiving his booster shot. Our aim is to highlight the standard of treatment outcomes in COVID-19-associated clots, familiarize ourselves with the complexity of the clot burden in a COVID-19-associated STEMI, and illustrate the potential role of the cumulative pro-thrombotic effects of a recent COVID-19 booster with a concomitant symptomatic COVID-19 infection.

COVID-19-Associated Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia.

The prothrombotic nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been well-established since the start of the global coronavirus disease 2019 (COVID-19) pandemic. Mesenteric artery thrombosis and acute mesenteric ischemia are, on their own, rare occurrences and often present with fatal gastrointestinal (GI) pathologies requiring quick identification and intervention by the clinician to improve clinical outcomes. SARS-CoV-2 infection can present with acute GI pathologies and warrants further investigation regarding anticoagulation therapy in COVID-19 positive patients. We report on a 64-year-old woman infected with SARS-CoV-2 who presented with superior mesenteric artery thrombosis and acute intestinal ischemia.

Effects of an Intensive Discharge Intervention on Medication Adherence, Glycemic Control, and Readmission Rates in Patients With Type 2 Diabetes.

OBJECTIVES: Patients with diabetes are at particularly high risk for adverse outcomes after hospitalization. The goals of this study were to design, implement, and evaluate a multipronged transitional care intervention among hospitalized patients with diabetes. METHODS: We randomly assigned inpatients likely to be discharged home on insulin to an intensive transitional care intervention or usual care. The primary outcome was 90-day postdischarge insulin adherence, using prescription refill information to calculate a medication possession ratio. Unadjusted analyses were conducted using Wilcoxon rank sum; adjusted analyses used multivariable linear regression and weighted propensity scoring methods, with general estimating equations to account for clustering by admitting physician. RESULTS: One hundred eighty patients participated. The mean (SD) medication possession ratio to all insulin types was 84.5% (22.6) among intervention and 76.4% (25.1) among usual care patients (difference = 8.1, 95% confidence interval = -1.0 to 17.2, P = 0.06), with a smaller difference for adherence to all medications (86.3% versus 82.0%). A1c levels decreased in both groups but was larger in the intervention arm (1.09 and 0.11, respectively) (difference = -0.98, 95% confidence interval = -2.03 to -0.07, P = 0.04). Differences between study arms were not significant for rates of hypoglycemic episodes, 30-day readmissions, or emergency department visits. In adjusted/clustered analyses, the difference in A1c reduction remained statistically significant, whereas differences in all other outcomes remained nonsignificant. CONCLUSIONS: The intervention was associated with improvements in glycemic control, with nonsignificant trends toward greater medication adherence. Further research is needed to optimize and successfully implement interventions to improve patient safety and health outcomes during care transitions.

Levels of physical activity in children and adolescents with asthma: A systematic review and meta-analysis.

BACKGROUND: In children and adolescents with asthma, the disease may reduce the perceived capability to participate in physical activity (PA) contributing to an increase in the sedentary lifestyle. The literature is unclear as to whether children and adolescents with asthma differ their PA levels from their healthy peers. OBJECTIVE: Our objective was to describe the different methods and instruments used to measure PA and to compare the PA levels of children and adolescents with asthma with those of their healthy peers. STUDY DESIGN: We conducted a systematic review of five databases. We included studies that compared the PA measured by objective and subjective instruments in children and adolescents with asthma versus controls. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. RESULTS: Of the 5966 reports returned by the initial search, 28 articles reporting on 3184 patients were included in the data synthesis. A forest plot showed that both groups had similar values of moderate to vigorous PA (MVPA; mean difference, -0.05 h/day; 95% confidence interval [CI], -0.11-0.01; p = .13), sedentary time (mean difference 0.00 h/day; 95% CI, -0.22-0.23 h/day; p = .99) and steps/day (mean difference 354 steps/day; 95% CI, -563-1270 steps/day; p = .45). CONCLUSION: Children and adolescents with asthma have similar MVPA, steps/day, and sedentary time compared to the controls. The main instruments used were questionnaires and accelerometers.

Pulmonary Embolism Response Team: Inpatient Structure, Outpatient Follow-up, and Is It the Current Standard of Care?

Pulmonary Embolism Response Teams (PERTs) are being created around the United States to immediately and simultaneously bring together multiple specialists to determine the best course of action and coordinate clinical care for patients with severe pulmonary embolism (PE). The organization and structure of each PERT will depend on local clinical demands and resources. Creating a follow up clinic for PE patients after discharge from the hospital is an essential component of any PERT program. PERT programs, which have come together to form the PERT Consortium®, are changing the landscape of PE treatment and may represent a new standard of care.

Ten-year clinical experience of humanitarian cardiothoracic surgery in Rwanda: Building a platform for ultimate sustainability in a resource-limited setting.

OBJECTIVE: Despite its near complete eradication in resource-rich countries, rheumatic heart disease remains the most common acquired cardiovascular disease in sub-Saharan Africa. With a ratio of physicians/population of 1 per 10,500, including only 4 cardiologists for a population of 11.4 million, Rwanda represents a resource-limited setting lacking the local capacity to detect and treat early cases of strep throat and perform lifesaving operations for advanced rheumatic heart disease. Humanitarian surgical outreach in this region can improve the delivery of cardiovascular care by providing sustainability through mentorship, medical expertise, training, and knowledge transfer, and ultimately the creation of a cardiac center. METHODS: We describe the experience of consecutive annual visits to Rwanda since 2008 and report the outcomes of a collaborative approach to enable sustainable cardiac surgery in the region. The Ferrans and Powers Quality of Life Index tool's Cardiac Version (http://www.uic.edu/orgs/qli/) was administered to assess the postoperative quality of life. RESULTS: Ten visits have been completed, performing 149 open procedures, including 200 valve implantations, New York Heart Association class III or IV, with 4.7% 30-day mortality. All procedures were performed with the participation of local Rwandan personnel, expatriate physicians, nurses, residents, and support staff. Early complications included cerebrovascular accident (n = 4), hemorrhage requiring reoperation (n = 6), and death (n = 7). Quality of life was assessed to further understand challenges encountered after cardiac surgery in this resource-limited setting. Four major domains were considered: health and functioning, social and economic, psychologic/spiritual, and family. The mean total quality of life index was 20.79 ± 4.07 on a scale from 0 to 30, for which higher scores indicated higher quality of life. Women had significantly lower "social and economic" subscores (16.81 ± 4.17) than men (18.64 ± 4.10) (P < .05). Patients who reported receiving their follow-up care in rural health centers also had significantly lower "social and economic" subscores (15.67 ± 3.81) when compared with those receiving follow-up care in urban health facilities (18.28 ± 4.16) (P < .005). Value afforded to family and psychologic factors remained high among all groups. Major postsurgical challenges faced included barriers to follow-up and systemic anticoagulation. CONCLUSIONS: This report represents the first account of a long-term humanitarian effort to develop sustainability in cardiac surgery in a resource-limited setting, Rwanda. With the use of volunteer teams to deliver care, transfer knowledge, and mentor local personnel, the results demonstrate superior outcomes and favorable indices of quality of life. The credibility gained over a decade of effort has created the opportunity for a partnership with Rwanda to establish a dedicated center of cardiac care to assist in mitigating the burden of cardiovascular disease throughout sub-Saharan Africa.

La Didáctica en la preparación del personal docente: sugerencias del Dr. Juan Virgilio López Palacio / Didactics in the preparation of the teaching staff: suggestions of Ph D. Juan Virgilio López Palacio

RESUMEN Introducción: refiere la importancia de la Didáctica en la preparación del personal docente universitario, teniendo en cuenta las sugerencias del Dr. Juan Virgilio López Palacio, profesor destacado de la Universidad Central "Marta Abreu" de Las Villas, quien reafirma la necesidad de incluir estos programas en todas las carreras universitarias, donde se forman alumnos que más tarde ejercerán como docentes. Objetivo: fundamentar la importancia de la Didáctica en la preparación del personal docente universitario, según las sugerencias del Dr. Juan Virgilio López Palacio. Métodos: se realizó una revisión bibliográfica entre enero-marzo 2019. Se consideraron artículos originales y de revisión en textos digitales e impresos, en español. Los artículos digitalizados se consultaron en SciELO, Dialnet y Google Académico. Se tuvo como criterios de inclusión: mención a la Didáctica y a la formación del personal docente universitario. Desarrollo: se exponen criterios de varios autores y en especial se toman como referente las sugerencias del Dr. López Palacio, sobre la preparación del profesor universitario como una prioridad de la universidad del siglo XXI y la influencia de la Didáctica en su formación, se proponen algunas acciones que demandan su aplicación como ciencia que ofrece al docente una preparación integral, válida para los diferentes niveles de enseñanza. Conclusiones: la preparación docente del profesor universitario debe comenzar desde el inicio de su carrera con la introducción de la Didáctica en sus currículos, y tendrá su continuidad en programas de posgrado para garantizar su actualización permanente y sistemática.

ABSTRACT Background: it refers to the importance of Didactics in the preparation of the university teaching staff, taking into account the suggestions of PhD. López Palacio, an outstanding professor at "Marta Abreu" Central University of Las Villas, who reaffirms the need to include these programs in all university degrees, where students who will later practice as teachers are trained. Objective: to base the importance of Didactics in the preparation of the university teaching staff, according to the suggestions of PhD. López Palacio. Method: a bibliographic review was carried out from January to March 2019. Original and review articles were considered in electronic and printed texts, in Spanish. The scanned articles were consulted on SciELO, Dialnet and Google Scholar. The inclusion criteria were included: mention of Didactics and the training of the university teaching staff. Development: criteria of several authors are presented and in particular the suggestions of PhD. López Palacio are taken as a reference, about the preparation of the university professor as a priority of the university of the 21st century and the role that Didactics plays in its formation, they propose some actions that demand the application of Didactics, as a science that offers the teacher a comprehensive preparation, valid for the different teaching levels. Conclusions: the teaching preparation of the university professor must begin since the beginning of its career with the introduction of Didactics in its curricula, and it will have its continuity in postgraduate programs to guarantee its steady and systematic updating.

Educación a distancia: reflexiones desde la obra del Dr. Juan Virgilio López Palacio / Distance learning: reflections from the work of Ph D. Juan Virgilio López Palacio

RESUMEN Introducción: refiere la importancia del uso de las tecnologías de la informática y las comunicaciones en la educación a distancia, considerando las reflexiones del Dr. Juan Virgilio López Palacio, Profesor de Mérito de la Universidad Central "Marta Abreu" de Las Villas, quien apuesta por la calidad de la educación en esta modalidad. Objetivo: fundamentar el uso de las tecnologías de la información y las comunicaciones en la educación a distancia, atendiendo a las reflexiones del Dr. Juan Virgilio López Palacio. Métodos: se realizó una revisión bibliográfica entre enero-marzo 2019. Se consideraron artículos originales y de revisión en textos digitales e impresos, en español. Los artículos en soporte digital fueron seleccionados en las bases de datos SciELO, Dialnet y Google Académico. Se tuvieron como criterios de inclusión: mención al uso de las tecnologías de la información y las comunicaciones y la educación a distancia. Desarrollo: se exponen criterios de varios autores, y en especial las reflexiones del Dr. Juan Virgilio López Palacio; se fundamentan el desarrollo de la ciencia y la tecnología en Cuba y su influencia en el campo educativo, su aplicación en la pedagogía desde el punto de vista teórico y práctico, y las características de la educación a distancia y sus perspectivas en el contexto educacional cubano. Conclusiones: el uso de estas tecnologías sustenta hoy el trabajo con la modalidad a distancia en la educación superior; constituye un enfoque renovador que favorece el estudio autónomo e independiente de los estudiantes en formación.

ABSTRACT Introduction: it refers to the importance of the use of information and communication technologies in distance learning, considering the reflections of Ph D. López Palacio, Professor of Merit of "Marta Abreu" Central University of Las Villas, who has committed himself with the quality of education in this modality. Objective: to base the use of information and communication technologies in distance learning, according to the reflections of Ph D. López Palacio. Methods: a literature review was carried out from January to March 2019. Original and review articles in electronic and printed texts, in Spanish, were considered. Electronic articles were selected in SciELO, Dialnet and Google Scholar databases. The following criteria were included: mention of the use of information and communication technologies and distance learning. Development: criteria of several authors are presented, and especially the reflections of Ph D. López Palacio; the development of science and technology in Cuba and its influence in the educational field, its application in pedagogy from a theoretical and practical point of view, and the characteristics of distance learning and its perspectives in the Cuban educational context are based. Conclusions: the use of these technologies at present supports the work with the distance learning modality in higher education; it constitutes a renewal approach that favors the autonomous and independent study of students in training.

Potencial energético e alternativas para o aproveitamento do biogás e lodo de reatores UASB: estudo de caso Estação de tratamento de efluentes Laboreaux (Itabira) / Energy potential and alternative usages of biogas and sludge from UASB reactors: case study of the Laboreaux wastewater treatment plant (Itabira)

RESUMO: Este trabalho estuda o potencial de aproveitamento energético dos subprodutos biogás e lodo gerados na estação de tratamento de efluentes (ETE) Laboreaux em Itabira (MG), composta de reatores UASB, filtros biológicos percoladores e unidade de desaguamento do lodo por filtro prensa. Os subprodutos biogás e lodo foram caracterizados em termos quantitativos (produção) e qualitativos (composição e poder calorífico) durante 12 meses de monitoramento. Foram estudados dois cenários de aproveitamento energético dos subprodutos: (i) uso prioritário do biogás para a secagem térmica do lodo e o excedente de biogás para geração de eletricidade em motor de combustão interna; e (ii) uso prioritário do biogás visando à geração de eletricidade e ao aproveitamento do calor dos gases de exaustão para a secagem térmica de lodo. Para a análise desses cenários, utilizou-se o software CHEMCAD(r) a fim de determinar as condições de queima do biogás em câmara de combustão e em motor de combustão interna, assim como na determinação dos balanços de massa e energia. O estudo analisou o potencial de aproveitamento dos subprodutos do tratamento como fonte de energia renovável para uso na própria ETE e para fornecimento a terceiros. No cenário 1, a geração de eletricidade é menor (atendendo 22,2% da demanda de energia da ETE), mas a secagem térmica possibilita maior redução no volume final de lodo a ser disposto ou a eliminação completa de disposição final se o lodo seco final (com 10% de umidade) for utilizado como combustível por terceiros. No cenário 2, a geração de eletricidade é capaz de suprir 57,6% da demanda de energia da ETE, todavia o calor contido nos gases de exaustão não é suficiente para a secagem de todo o lodo desaguado, configurando uma menor redução na quantidade de lodo a ser disposto (13,5 ou 24,9% de redução em massa, conforme a alternativa de remoção de umidade selecionada).

ABSTRACT: This work assesses the potential of energy recovery of the byproducts biogas and sludge produced at the Laboreaux wastewater treatment plant (WWTP), in Itabira (MG), which is integrated by UASB reactors, trickling filters and sludge dehydration unit (filter press). The byproducts biogas and sludge were quantitatively (production) and qualitatively (composition and calorific value) characterized during a monitoring period of 12 months. Two scenarios for energy recovery from the byproducts were considered: (i) priority use of biogas for sludge thermal drying and the excess of biogas being used for power generation in an internal combustion engine (ICE); and (ii) primary use of biogas for power generation and the heat of the engine exhaustion gases being used for sludge thermal drying. Biogas burning conditions into a combustion chamber and in an internal combustion engine, as well as mass and energy balances for each scenario, were assessed with the CHEMCAD(r) software. The study analysed the potential use of the byproducts as sources of renewable energy for use in the WWTP itself and to be offered to third party. In scenario 1, the electricity generation is lower (fulfilling 22.2% of the WWTP energy demand), but thermal drying allows greater reduction of sludge volume to be disposed of, or the entire elimination of final disposal if the dry sludge (with 10% moisture content) is used as fuel by the third party. As for scenario 2, the electricity generation is sufficient to supply 57.6% of the WWTP energy demand, nevertheless the heat contained in exhausted gases is not enough to dry the whole dehydrated sludge, configuring a lower reduction of sludge amount to be disposed of (13.5 or 24.9% of mass reduction, depending on the moisture reduction alternative chosen).

Five-year follow-up of angiographic disease progression after medicine, angioplasty, or surgery.

BACKGROUND: Progression of atherosclerosis in coronary artery disease is observed through consecutive angiograms. Prognosis of this progression in patients randomized to different treatments has not been established. This study compared progression of coronary artery disease in native coronary arteries in patients undergoing surgery, angioplasty, or medical treatment. METHODS: Patients (611) with stable multivessel coronary artery disease and preserved ventricular function were randomly assigned to CABG, PCI, or medical treatment alone (MT). After 5-year follow-up, 392 patients (64%) underwent new angiography. Progression was considered a new stenosis of ≥ 50% in an arterial segment previously considered normal or an increased grade of previous stenosis > 20% in nontreated vessels. RESULTS: Of the 392 patients, 136 underwent CABG, 146 PCI, and 110 MT. Baseline characteristics were similar among treatment groups, except for more smokers and statin users in the MT group, more hypertensives and lower LDL-cholesterol levels in the CABG group, and more angina in the PCI group at study entry. Analysis showed greater progression in at least one native vessel in PCI patients (84%) compared with CABG (57%) and MT (74%) patients (p < 0.001). LAD coronary territory had higher progression compared with LCX and RCA (P < 0.001). PCI treatment, hypertension, male sex, and previous MI were independent risk factors for progression. No statistical difference existed between coronary events and the development of progression. CONCLUSION: The angioplasty treatment conferred greater progression in native coronary arteries, especially in the left anterior descending territories and treated vessels. The progression was independently associated with hypertension, male sex, and previous myocardial infarction.

Quality of life after surgical myocardial revascularization, angioplasty or medical treatment.

BACKGROUND: Although the clinical benefits of coronary interventions seem to be confirmed, their effects on quality of life (QoL) are still scarcely studied. OBJECTIVE: To assess the QoL in multivessel coronary disease in patients randomly undergoing surgery, angioplasty or medical treatment. METHODS: The Short-Form Health Survey (SF-36) questionnaire was answered by 483 patients. Of these, 161 underwent surgical revascularization, 166 underwent angioplasty, and 153 were medically treated. RESULTS: At baseline, 86% of the patients referred angina, 34% referred infarction, and 32% were smokers. Medical Treatment: 12 patients (7.7%) had AMI, 24 (15.3%) underwent surgery, and 19 (12.1%) died. In addition, 5 (3.2%) had stroke, and 40 (25.6%) had angina. As regards the mental component, 64.1% and 30.8% had their condition improved and worsened, respectively. As regards the physical component, 70.5% and 27.6% had their condition improved and worsened, respectively. SURGERY: 13 patients (8.1%) had AMI, 2 (1.2%) underwent surgery, and 12(7.4%) died. Also, 9 (5.6%) had stroke and 30 (18.6%) had angina. As regards the mental component, 72.7 % and 25.5% had their condition improved and worsened, respectively. As regards the physical component, 82.6% and 16.1% had their condition improved and worsened, respectively. Angioplasty: 18 patients (10.9%) had AMI, 51 (30.7%) underwent interventions, and 18 (19.9%) died. Additionally, six (3.6%) presented stroke and 35 (21%) reported angina. As regards the mental component, 66.9% and 26.5% had their condition improved and worsened, respectively. As regards the physical component, 77.1% and 20.5% had their condition improved and worsened, respectively. CONCLUSION: Improvement was observed in all domains and in the three therapeutic modalities. Comparatively, surgery had provided a better quality of life after a four-year follow-up.