Background Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly ...Background Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly aging population, the impact and utility of echocar- diography in centenarians is largely unknown. This study is to determine whether echocardiography in centenarians aids in making clinical patient management decisions. Methods A retrospective review of echocardiograms from 1986 to 2014, at two affiliated tertiary centers, in individuals who were 100 years or older at the time of the examination. Patient and echocardiogram characteristics, management decisions based on echocardiography, and mortality were documented. Results 114 centenarians had echocardiograms, with ages ranging from 100 to 107 years （101 - 1.4 years）. In 82 of the centenarians evaluated （72%）, no changes in management occurred as a consequence of the echocardiogram. From all management changes directly related to the echocardiogram, 81% （n = 26） of these corresponded to medication adjustments; interventional or surgical procedures followed the echocardiogram only in 4% （n = 5） of the total number of centenarians. Echocardiogram-based changes in management were only significant in patients that were referred for congestive heart failure （P = 0.02）. After the echocardiogram was performed, 1-month and 1-year mortality were 15% and 47%, respectively. The median survival after the echocardiogram was obtained was 13 months （range 0.03 to 145 months）, with no difference if there was a change or no change in manage- ment （P = 0.21）. Conclusions Among centenarians undergoing echocardiography, despite additional diagnostic information, echocardio- grams in centenarians influence management in a minority of cases, most commonly in the form of medication changes for treatment of heart failure. A significant proportion of centenarians are deceased within a year of undergoing echocardiographic assessment. These findings may question the overall utility of echocardiography in these late survivors.展开更多
The demand for energy, water and food will continuously increase, as the prediction states that 2.5 billion people will be added to the world population by 2050, representing not only an increase in the consumption bu...The demand for energy, water and food will continuously increase, as the prediction states that 2.5 billion people will be added to the world population by 2050, representing not only an increase in the consumption but also more waste production, greenhouse gas （GHG） emissions and depletion of natural resources. Taking into account that renewable sources of energy can help to overcome these challenges and diversify the energy matrix in the countries, this paper aims at analyzing the biogas potential in Brazil and the United States, especially in the livestock sector, and its benefits in the environmental, social and economic aspects. Both countries are among the top five countries globally in terms of water availability, energy consumption and food production. Until 2050, the world consumption of meat will have a significant increase： 206% of poultry meat, 56% of pork meat and 47% of beef meat, augmenting the need for sustainable management of waste and manure. This scenario can become a sustainable opportunity for biogas implementation, which provides multiple economic, environmental and social benefits for farmers, businesses and communities, including production of electrical, thermal and vehicular energy, production of high-quality biofertilizer, reduction of ground and surface water pollution and reduction of GHG emissions, and foments new income for the farmers, among others. A new concept is presented in this article to make biogas systems feasible, i.e., biogas condominiums, as small and medium-scale farms by themselves usually would not be able to afford the investments. This arrangement can bring benefits for the whole biogas supply chain that includes farmers, agroindustry, providers and local community.展开更多
Rapid economic growth, increasing populations and emergent prosperity are driving up demand tor energy, water anu food, especially in developing countries. In this scenario, the analysis of these three elements has ga...Rapid economic growth, increasing populations and emergent prosperity are driving up demand tor energy, water anu food, especially in developing countries. In this scenario, the analysis of these three elements has gained the increasing attention globally in research, business and policy spheres. This paper aims to provide an analysis of the perspectives of this nexus for Brazil and the United States, using current and predicted scenario for 2050. Considering the importance of renewable sources of energy to overcome these challenges and diversify the energy matrix in both countries, the paper will also present the biogas potential for both countries, which provides multiple economic, environmental and social benefits, such as electrical, thermal and vehicular energy, high-quality biofertilizer, reduction of odor and pathogenic vectors in the farms, decrease of ground and surface water pollution, promotion of new income for the farmers, reduction of the greenhouse gases emissions, among others.展开更多
文摘Background Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly aging population, the impact and utility of echocar- diography in centenarians is largely unknown. This study is to determine whether echocardiography in centenarians aids in making clinical patient management decisions. Methods A retrospective review of echocardiograms from 1986 to 2014, at two affiliated tertiary centers, in individuals who were 100 years or older at the time of the examination. Patient and echocardiogram characteristics, management decisions based on echocardiography, and mortality were documented. Results 114 centenarians had echocardiograms, with ages ranging from 100 to 107 years （101 - 1.4 years）. In 82 of the centenarians evaluated （72%）, no changes in management occurred as a consequence of the echocardiogram. From all management changes directly related to the echocardiogram, 81% （n = 26） of these corresponded to medication adjustments; interventional or surgical procedures followed the echocardiogram only in 4% （n = 5） of the total number of centenarians. Echocardiogram-based changes in management were only significant in patients that were referred for congestive heart failure （P = 0.02）. After the echocardiogram was performed, 1-month and 1-year mortality were 15% and 47%, respectively. The median survival after the echocardiogram was obtained was 13 months （range 0.03 to 145 months）, with no difference if there was a change or no change in manage- ment （P = 0.21）. Conclusions Among centenarians undergoing echocardiography, despite additional diagnostic information, echocardio- grams in centenarians influence management in a minority of cases, most commonly in the form of medication changes for treatment of heart failure. A significant proportion of centenarians are deceased within a year of undergoing echocardiographic assessment. These findings may question the overall utility of echocardiography in these late survivors.
文摘The demand for energy, water and food will continuously increase, as the prediction states that 2.5 billion people will be added to the world population by 2050, representing not only an increase in the consumption but also more waste production, greenhouse gas （GHG） emissions and depletion of natural resources. Taking into account that renewable sources of energy can help to overcome these challenges and diversify the energy matrix in the countries, this paper aims at analyzing the biogas potential in Brazil and the United States, especially in the livestock sector, and its benefits in the environmental, social and economic aspects. Both countries are among the top five countries globally in terms of water availability, energy consumption and food production. Until 2050, the world consumption of meat will have a significant increase： 206% of poultry meat, 56% of pork meat and 47% of beef meat, augmenting the need for sustainable management of waste and manure. This scenario can become a sustainable opportunity for biogas implementation, which provides multiple economic, environmental and social benefits for farmers, businesses and communities, including production of electrical, thermal and vehicular energy, production of high-quality biofertilizer, reduction of ground and surface water pollution and reduction of GHG emissions, and foments new income for the farmers, among others. A new concept is presented in this article to make biogas systems feasible, i.e., biogas condominiums, as small and medium-scale farms by themselves usually would not be able to afford the investments. This arrangement can bring benefits for the whole biogas supply chain that includes farmers, agroindustry, providers and local community.
文摘Rapid economic growth, increasing populations and emergent prosperity are driving up demand tor energy, water anu food, especially in developing countries. In this scenario, the analysis of these three elements has gained the increasing attention globally in research, business and policy spheres. This paper aims to provide an analysis of the perspectives of this nexus for Brazil and the United States, using current and predicted scenario for 2050. Considering the importance of renewable sources of energy to overcome these challenges and diversify the energy matrix in both countries, the paper will also present the biogas potential for both countries, which provides multiple economic, environmental and social benefits, such as electrical, thermal and vehicular energy, high-quality biofertilizer, reduction of odor and pathogenic vectors in the farms, decrease of ground and surface water pollution, promotion of new income for the farmers, reduction of the greenhouse gases emissions, among others.
