1,721,316 research outputs found
Role of heart rate variability in the early diagnosis of diabetic autonomic neuropathy in children
No full textBackground: Diabetic autonomic neuropathy (DAN) is a major complication of diabetes. DAN has been shown to be closely related to glycemic control, to contribute significantly to the morbidity and mortality of the disease, and to be indicative of an increased risk of cardiovascular events. Tests assessing the function of the autonomic nervous system, such as the response of heart rate and blood pressure to maneuvers stimulating the autonomic nervous system, including deep breathing, Valsalva maneuver and standing, allowed to detect signs of DAN in adolescents; however, the sensitivity of such tests in revealing an early impairment of the autonomic nervous system proved low. Several studies found heart rate variability (HRV) to be useful in assessing the dysfunction of the autonomic nervous system in diabetic children and adolescents, but only few HRV parameters were evaluated in most of them. Objective: To study cardiac autonomic nervous system in diabetic children, and to investigate whether the duration of diabetes and the degree of metabolic control are determinants for the development of DAN in children. Patients and Methods: We analyzed HRV in 50 asymptomatic patients with insulin-dependent diabetes mellitus (IDDM) and 30 healthy children matched for age and sex. Results: Patients with a history of diabetes > 8 years showed significant alterations of the autonomic nervous system (significant reduction of r-MSSD, pNN50, HF and increase in LF/HF). Conversely, only a reduction in pNN50 was found in patients with a disease duration < 8 years. Furthermore, we also observed significant HRV abnormalities in patients with an impaired metabolic control of diabetes. Compared to controls, patients with glycosylated hemoglobin blood levels (HbA1C) > 8% showed a significant reduction of r-MSSD, pNN50 and total power spectrum, whereas no HRV abnormalities were detected in patients with an HbA1C < 8%. Conclusions: HRV analysis can detect early subclinical alterations of the autonomic nervous system in asymptomatic patients with IDDM, which seem to consist mainly in a parasympathetic impairment. Autonomic dysfunction is associated both with the duration and an inadequate metabolic control of the disease
The Bargaining Set for Sharing the Power
No full textThe evaluation of the power of the parties of a Parliament is usually carried out following a static approach, counting their numbers of seats and possible ideological relations among them. In this paper we propose a dynamic model in which parties may blackmail each other in order to increase their power at the expense of others. This model may be solved in terms of the Bargaining Set (Aumann and Maschler, 1964), a set valued solution, in contrast to the classical power indices that are point valued; so it may be used to check the robustness of a power division taking into account possible blackmailing activities. The paper is mainly based on the idea of proposing an existing instrument, the Bargaining Set, as power index to analyze this blackmailing situation.
The computational complexity limits the possibility of applying it to real-world situations, but the possibility of making the computation easier is shown using some examples
Open Problems in Veto Theory
No full textThe issue of veto may play an important role in an approval situation, mainly in political science, where several scholars dealt with this topic. In this survey we want to update the state-of-the-art, paying particular attention to the open problems that various authors pointed out in their research fields
HFpEF, HFmEF, HFrEF in adults with congenital heart disease: Time to face it
No full textIn a compelling review on heart failure (HF) in adults with congenital heart disease (ACHD), Brida et al. [1] emphasized that its management is challenged by a wide spectrum of anatomic and pathophysiologic substrates. More specifically, the authors distinguished the univentricular from the biventricular circulation and, in this setting, the presence of right and left ventricular failure.
Even though HF with preserved ejection fraction (EF) is described as uncommon in ACHD, its prevalence could be underestimated, as patients may consider symptoms they have been used to since infancy as normal. Searching for additional criteria, including raised natriuretic peptides and increased filling pressures of the systemic ventricle may be necessary to apply for a proper diagnosis and tailored management [2].
The prevalence of HF with reduced EF (≤40%) (HFrEF), mildly reduced EF (41–49%) (HFmEF) and preserved EF (≥50%) (HFpEF) is still unknown in ACHD population, although it may reveal clinical implications. For example, the lack of survival impact of renin-angiotensin-aldosterone-system (RAAS) inhibition on patients with systemic right ventricle in the VAL-SERVE trial may partially be related to just a mild degree of ventricular impairment in half of the enrolled patients [3]. In fact, only HFrEF has shown a clear benefit of medical treatment in non-ACHD HF patients, whereas, in HFmEF, β-blockers and RAAS inhibition have a class IIb C recommendation based on current evidence [2].
Although challenging, a characterization of HF based on EF in ACHD, may lead to a better pathophysiological comprehension, risk stratification, and clinical management of this wide-range population
The sense of being there during online classes: analysis of usability and presence in web-conferencing systems and virtual reality social platforms
No full textDue to the Covid-19 pandemic, millions of people had to stay at home for several months and to move their everyday activities online. From smart-working to online learning, also considering entertainment activities, people started to extensively use platforms for remote communication and for sharing video, text, and audio content. Such systems are able to cope with the need of communicating, but the common feeling is that people, and especially students, are missing the physical relationships with classmates and colleagues. In this paper, we analyse two modalities that can be used to give an online University lecture, by focusing on the ‘sense of presence’, i.e. on the ability to produce into students the psychological sense of being in a classroom together with the teacher and their classmates. We consider a standard web-conferencing system, and a Virtual Reality social platform. We also take into account the ‘usability’ factors, to understand if extended reality systems could be, in a near future, a possible alternative to improve distance lectures and meetings
Congenital heart diseases
No full textIntroduction: Congenital heart defect (CHD) may be defined as an anatomic malformation of the heart or great vessels which occurs during intrauterine development. CHDs are serious and chronic illnesses. Congenital heart defects may be classified into acyanotic and cyanotic depending on the presence or absence of cyanosis. As survival has improved, evidence has accumulated that CHD touches many aspects of the lives of those affected. Children and adults with CHDs report difficulties in physical, behavioral, and psychiatric abnormalities. - Aim: To emphasize that people with CHDs often need treatment over their life and therefore require specialist review during childhood and adulthood. This is because people with complex heart problems can develop further problems with their heart rhythm or valves over time. Also they may report physical, psychological, and behavioral abnormalities. - Conclusion: A significant proportion of survivors of open-heart surgery for CHD are at risk for physical and psychological maladjustment. This calls for an integrated approach to family support, taking the child's individual needs into account as well as the needs of the parents
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