RESUMO Objetivo. Avaliar a relevância do fluxo de pessoas entre comunidades em comparação com a vacinação e tipo de vetor para a propagação e potenciais surtos de febre amarela em uma comunidade de destino livre da doença. Métodos. Usando um modelo SEIRV-SEI para humanos e vetores, foram aplicadas simulações numéricas aos seguintes cenários: (1) migração de uma comunidade endêmica para uma comunidade de destino livre da doença, comparando o desempenho de Haemagogus janthinomys e de Aedes aegypti como vetores; (2) migração através de uma comunidade de trânsito localizada em uma rota migratória, onde a doença é endêmica, para uma comunidade de destino livre da doença; e (3) efeitos de diferentes taxas de vacinação na comunidade de destino, considerando-se a vacinação dos migrantes ao chegarem. Resultados. Os resultados não revelaram diferenças marcantes entre os cenários 1 e 2. O tipo de vetor e a cobertura vacinal na comunidade de destino são mais relevantes para a ocorrência de surtos do que as taxas de migração; o vetor H. janthinomys é mais efetivo do que A. aegypti. Conclusões. Na medida em que a vacinação é mais determinante para um potencial surto que as taxas de migração, a vacinação de migrantes na chegada pode ser uma das medidas mais efetivas contra a febre amarela. Além disso, o H. janthinomys é um vetor mais competente do que o A. aegypti em densidades similares, mas a presença de A. aegypti é um alerta para manter a vacinação acima dos níveis recomendados.

RESUMEN Objetivo. Evaluar la importancia del flujo de personas entre comunidades, en comparación con la vacunación y el tipo de vector, para la propagación y los posibles brotes de fiebre amarilla en una comunidad de acogida libre de la enfermedad. Métodos. Con el empleo de un modelo SEIRV—SEI para personas y vectores, aplicamos simulaciones numéricas a las siguientes situaciones hipotéticas: 1) migración desde una comunidad con endemicidad a una comunidad de acogida libre de la enfermedad, en la que se compararon los resultados producidos por Haemagogus janthinomys y Aedes aegypti como vectores; 2) migración a través de una comunidad de tránsito situada en una ruta migratoria, donde la enfermedad es endémica, hacia otra comunidad libre de la enfermedad; y 3) efectos de tasas de vacunación diferentes en la comunidad de acogida, tomando en consideración la vacunación de las personas migrantes a su llegada. Resultados. Los resultados no muestran diferencias notables entre las situaciones 1 y 2. En cuanto a la aparición de brotes, tanto la cobertura vacunal en la comunidad de acogida como el tipo de vector tienen más importancia que las tasas de migración; y H. janthinomys muestra mayor eficacia que A. aegypti. Conclusiones. Dado que, para determinar la aparición de un posible brote, la vacunación tiene mayor importancia que las tasas de migración, la vacunación de las personas migrantes a su llegada puede ser una de las medidas más eficaces contra la fiebre amarilla. Además, a densidades similares, H. janthinomys es un vector más competente que A. aegypti, por lo que la presencia de A. aegypti constituye una señal de alerta para mantener la vacunación por encima de los niveles recomendados.

ABSTRACT Objective. To assess how relevant the flow of people between communities is, compared to vaccination and type of vector, on the spread and potential outbreaks of yellow fever in a disease-free host community. Methods. Using a SEIRV-SEI model for humans and vectors, we applied numerical simulations to the scenarios: (1) migration from an endemic community to a disease-free host community, comparing the performance of Haemagogus janthinomys and Aedes aegypti as vectors; (2) migration through a transit community located on a migratory route, where the disease is endemic, to a disease-free one; and (3) effects of different vaccination rates in the host community, considering the vaccination of migrants upon arrival. Results. Results show no remarkable differences between scenarios 1 and 2. The type of vector and vaccination coverage in the host community are more relevant for the occurrence of outbreaks than migration rates, with H. janthinomys being more effective than A. aegypti. Conclusions. With vaccination being more determinant for a potential outbreak than migration rates, vaccinating migrants on arrival may be one of the most effective measures against yellow fever. Furthermore, H. janthinomys is a more competent vector than A. aegypti at similar densities, but the presence of A. aegypti is a warning to maintain vaccination above recommended levels.

ABSTRACT BACKGROUND: After validation in multiple types of liver disease patients, the MELD score was adopted as a standard by which liver transplant candidates with end-stage liver disease were prioritized for organ allocation in the United States since 2002, and in Brazil, since 2006. AIMS: To analyze the mortality profile of patients on the liver transplant waiting list correlated to MELD score at the moment of transplantation. METHODS: This study used the data from the Secretary of Health of the São Paulo State, Brazil, which listed 22,522 patients, from 2006 (when MELD score was introduced in Brazil) until June 2009. Patients with acute hepatic failure and tumors were included as well. We also considered the mortality of both non-transplanted and transplanted patients as a function of the MELD score at presentation. RESULTS: Our model showed that the best MELD score for patients on the liver transplant waiting list associated to better results after liver transplantation was 26. CONCLUSIONS: We found that the best score for applying to liver transplant waiting list in the State of São Paulo was 26. This is the score that minimizes the mortality in both non-transplanted and liver transplanted patients.

RESUMO RACIONAL: Desde 2002, após validação em múltiplos tipos de hepatopatias, o escore MELD foi adotado como padrão pelo qual os candidatos a transplante de fígado com doença hepática terminal têm sido priorizados para alocação de órgãos nos Estados Unidos, e em 2006 no Brasil. OBJETIVOS: Analisar a mortalidade de pacientes em lista de espera para transplante de fígado correlacionando com o MELD, no momento do transplante. MÉTODOS: Foram utilizados os dados da Secretaria de Saúde do Estado de São Paulo, Brasil, onde foram listados 22.522 pacientes, desde 2006 (quando o escore MELD foi introduzido no Brasil) até junho de 2009. Foram incluídos pacientes com falência hepática e tumores. A mortalidade de pacientes não transplantados e transplantados também foi considerada em função do escore MELD. RESULTADOS: Nosso modelo mostrou que o melhor valor do MELD, em pacientes em lista de espera para transplante e com melhores resultados, foi de 26. Este valor minimiza mortalidade em pacientes não transplantados bem comem pacientes na lista de espera para transplante de fígado. CONCLUSÕES: O escore MELD ótimo para entrar na lista de espera para transplante de fígado, no estado de São Paulo, é em torno de 26. Esse é o valor que minimiza a mortalidade tanto dos pacientes não transplantados em lista de espera, quanto dos submetidos à transplante de fígado.

Abstract The paper presents a comparative study between semi-empirical methods for the estimation of pre-consolidation pressure and undrained shear strength from Piezocone (CPTu) data. The first method, proposed by Massad, was developed from observing the variation of these parameters with depth; the second method, proposed by Mayne, was developed from simplifications and relationships between the Spherical Cavity Expansion Theory (SCET) and the Critical State Theory; the third method was proposed by Mayne, which considers the variations due to soil type from the CPT Index to estimate the pre-consolidation pressure. The methods were validated based on their applications to the marine clay from Santos Coastal Plain, Brazil, Bothkennar clay from Scotland, and Torp Clay from Sweden. It is intended to verify if the results are consistent with each other, with the stress history of these soils and with the available test results. The application of the Massad’s method led to results close to the available reference values. The results of the Mayne’s method based on SCET showed great variability in behavior comparing to the test data depending on the case study. By the Mayne’s method based on CPT Index values, the calculated pre-consolidation pressures were slightly higher than the values of the available test data. The variations in the results highlighted the importance of validating estimates based on semi-empirical methods through specific tests and the knowledge of geological history contributes to predicting the behavior of clays, since they showed good agreement with the available data from oedometer tests.

SUMMARY: The aim of our study was to determine the prevalence and the anatomical variations of the posterolateral tubercle of talus in relation to sex on CT imaging. A total of 1478 ankle CT scans was retrospectively reviewed for the different anatomical variants of the posterolateral tubercle of talus, the type and size of os trigonum. Normal sized lateral tubercle was found in 46.1 %, an enlarged posterolateral tubercle (Stieda’s process) in 26.1 %, os trigonum in 20.5 % and almost absent tubercle in 7.3 %. A statistically higher prevalence of Stieda’s process was found in males while os trigonum was higher in females (p<0.05). Among feet with os trigonum, 25.7 % were non-articulating and identified as a separate bone located posterior to the posterolateral tubercle of talus and 74.3% of os trigonum were identified as fused to the posterolateral tubercle by synchondrosis or syndesmosis. Additionally, 17.5 % of os trigonum were associated with intact lateral tubercle, 53.5 % were considered as part of the lateral tubercle and 29.0 % were without a lateral tubercle. According to its size, 22.8 % of os trigonum were smaller than 0.5 cm, 55.4 % were between 0.5 and 1cm, and 21.8 % were larger than 1 cm. No significant differences were found between the different types/sizes of os trigonum according to gender (p>0.05). The posterolateral tubercle of talus and its accessory ossicle, the os trigonum, could vary morphologically. The data of this study could be helpful in understanding the clinical problems that could be associated with some of these variants.

RESUMEN: El objetivo de nuestro estudio fue determinar la prevalencia y las variaciones anatómicas del tubérculo posterolateral del talo en relación con el sexo en la imagen de TC. Se revisaron retrospectivamente un total de 1478 TC de tobillo para las diferentes variantes anatómicas del tubérculo posterolateral del talo, el tipo y tamaño del os trigonum. Se encontró tubérculo lateral de tamaño normal en 46,1 %, tubérculo posterolateral (proceso de Stieda) en 26,1 %, os trigonum en 20,5% y tubérculo casi ausente en 7,3 %. Se encontró una prevalencia estadísticamente más alta del proceso de Stieda en los hombres, mientras que el os trigonum fue mayor en las mujeres (p <0,05). Entre los pies con os trigonum, el 25,7 % no se articulaban y se identificaba como un hueso separado ubicado posterior al tubérculo posterolateral del talo y el 74,3 % del os trigonum se identificaba como fusionado con el tubérculo posterolateral por sincondrosis o sindesmosis. Además, el 17,5 % del os trigonum se asoció con tubérculo lateral intacto, el 53,5 % fue considerado como parte del tubérculo lateral y el 29,0 % sin tubérculo lateral. Según su tamaño, el 22,8 % de los os trigonum eran menores de 0,5 cm, el 55,4 % tenían entre 0,5 y 1 cm y el 21,8 % eran mayores de 1 cm. Entre los diferentes tipos / tamaños de os trigonum según el sexo (p>0,05) no se observaron diferencias significativas. El tubérculo posterolateral del talo y su osículo accesorio, el os trigonum, podrían originar problemas clínicos que podrían estar asociados con algunas de estas variantes.

RESUMO Objetivo: analisar novo tubo de silicone como material para prótese vascular e compará-lo a prótese de PTFE, em modelo experimental com coelhos. Métodos: quarenta coelhos foram submetidos a interposição, na aorta infrarrenal, de próteses de 4mm de diâmetro, sendo 20 animais com PDMS e 20 com PTFE (grupo controle). Foi realizada arteriografia retrógrada da aorta para avaliar a patência das próteses. Para avaliar a endotelização das próteses foi realizada microscopia eletrônica de maneira amostral pareada. Resultados: a patência em 30 dias foi de 100% para as duas próteses. Aos 60 dias, a taxa de patência do PDMS foi de 92,3% (± 7,4), e de 73,8% (±13,1) em 90 dias; as próteses de PTFE tiveram taxas de patência de 87,5% (± 11,7) aos 60 e 90 dias. Não foi observada diferença significativa entre as taxas de patência dos grupos (p=0,62). Não foi observada diferença entre os grupos quanto à evolução com complicações pós-operatórias (p=0,526) e quanto ao tempo de clampeamento da aorta (p=0,299). Não houve diferença significativa entre os grupos quanto ao grau de estenose das próteses (p=0,650) à avaliação angiográfica. A microscopia eletrônica mostrou crescimento endotelial limitado às regiões próximas às anastomoses nos dois tipos de próteses. Conclusões: o PDMS mostrou-se passível de utilização como prótese vascular, com resultados comparáveis aos do PTFE no modelo utilizado.

ABSTRACT Objectives: the aim of this study was to compare the outcomes of a new silicone vascular prostheses with PTFE vascular prostheses, on a rabbit experimental model. Methods: forty rabbits underwent infra-renal aorta replacement with 4 mm diameter prostheses, twenty animals with PDMS and twenty animals with PTFE (control group). Retrograde aortic angiography was performed to assess patency. Histological graft samples were examined by electron microscopy to evaluate prostheses endothelialization. Results: patency rates were 100% for both grafts after 30 days; after 60 days, patency rate for PDMS was 92.3% (±7.4), and 73,8% (±13.1) at 90 days. PTFE grafts had patency rates of 87.5% (±11.7) at 60 and 90 days. No statistically significant difference was found in between groups for patency rates (p=0.62). Postoperative complications (death, paraplegia) rates (p=0.526) and aortic clamping times (p=0.299) were comparable in both groups. No statistically significant difference for stenosis was found on angiographical analysis between groups (p=0.650). Electron microscopy revealed limited anastomotic endothelial ingrowth in both prostheses. Conclusion: in this experimental model, PDMS and PTFE vascular prostheses had comparable outcomes and PDMS prosthesis could be used as a vascular graft.

OBJECTIVES: With the declining numbers of coronavirus disease 2019 (COVID-19) cases in the state of São Paulo, Brazil, social distancing measures have gradually been lifted. However, the risk of a surge in the number of cases cannot be overlooked. Even with the adoption of nonpharmaceutical interventions, such as restrictions on mass gatherings, wearing of masks, and complete or partial closure of schools, other public health measures may help control the epidemic. We aimed to evaluate the impact of the contact tracing of symptomatic individuals on the COVID-19 epidemic regardless of the use of diagnostic testing. METHODS: We developed a mathematical model that includes isolation of symptomatic individuals and tracing of contacts to assess the effects of the contact tracing of symptomatic individuals on the COVID-19 epidemic in the state of São Paulo. RESULTS: For a selection efficacy (proportion of isolated contacts who are infected) of 80%, cases and deaths may be reduced by 80% after 60 days when 5000 symptomatic individuals are isolated per day, each of them together with 10 contacts. On the other hand, for a selection efficacy of 20%, the number of cases and deaths may be reduced by approximately 40% and 50%, respectively, compared with the scenario in which no contact-tracing strategy is implemented. CONCLUSION: Contact tracing of symptomatic individuals may potentially be an alternative strategy when the number of diagnostic tests available is not sufficient for massive testing.

Abstract This paper presents the interpretation of bi-directional load tests performed on three auger piles, in the city of São Paulo, Brazil, using a method based on transfer functions for the shaft and toe. Elastic shortenings of the shaft were directly measured through a displacement indicator at the pile top and two telltales at the upper and bottom plates of the expansive cell. The equivalent top-down load-settlement curves were estimated and compared with two other methods from the literature, one which considers the pile infinitely rigid; and the other, which takes the pile elastic shortening into account. The curves resulted in good agreement considering the pile compressibility. Yet for the infinitely rigid pile, the settlements resulted in up to 75% smaller. Furthermore, the influence of stress relief on the toe behavior due to shaft lifting was investigated. For the cases studied, involving bored and auger piles with the slenderness ratio (Ls/r) greater than 20, the percentage of this effect was generally small, up to 5% of the toe load, being negligible for practical uses.

Abstract The advances in pile monitoring have motivated attempts to support dynamic formulas to estimate pile bearing capacity. Based on numerical analysis of the wave equation and the results of dynamic loading tests in three piles the paper deals with the investigation of the soundness of some of the most used in Brazil, namely, the so called Chellis-Velloso Formula, the Energy Approach Equation and Uto’s Formula. The former gained strength through a misinterpretation of Casagrande (1942) statement that the elastic compression of a pile during driving is a measure of the dynamic force with which the soil is tested, and not of its static resistance. Therefore, the elastic compression and rebound, measured during driving, are generally smaller than the corresponding static values. The second is based on an elasto-plastic load-displacement relationship without physical meaning, besides the fact that the effective energy in driving a pile is related to the work of dynamic forces and has nothing to do with the static resistances. The third was derived from a simplified solution of the wave equation, assuming among other hypothesis that there is no friction along pile shaft. The paper shows the ineffectiveness of attempts to universally validate these formulas with dynamic pile monitoring and the implications in the simulation of static loadings.

This is the first of a series of articles dealing with the casual use of distributions made by physicists and engineers. This use is very economical but sometimes leads to embarrassing conclusions that are difficult to justify with rigorous theories of distributions.

ABSTRACT INTRODUCTION Population aging is a worldwide phenomenon. It is estimated that by 2050, one of five persons will be aged ≥60 years. In Chile, 15.8% of the population is now aged ≥60 years, and this figure will reach 30.7% by 2050. In 2006, a national program was implemented to provide assistive devices to older adults aged ≥65 years with limited mobility or difficulty performing activities of daily living. To date, there have been no assessments of the program’s effectiveness. OBJECTIVE Assess the effectiveness of an assistive devices policy in Chile on improving functional capacity of older adults aged ≥65 years, and beneficiaries’ perceptions of the services received, including changes in their quality of life. METHODS This was a before–after longitudinal study. A cohort of 309 persons was recruited, consisting of patients who received care at a public hospital in Santiago, Chile during 2014–2015. They were assessed before delivery of assistive devices, then followed for seven months, with repeated evaluations made in their homes. The following indicators were measured: functional capacity (Tinetti scale and Barthel Index); changes in perceived quality of life related to use of assistive devices; and other sociodemographic, clinical and protocol-compliance variables. A longitudinal analysis of before–after progress was carried out, as well as a description of service delivery and medical followup. RESULTS Sixty-eight percent of those surveyed were women; median age was 74 years, average schooling was 6 years, and 93% had low income (monthly income <US$398). Assistive devices increased independence in activities of daily living, improved mobility and perceived quality of life, and decreased fall risk and pain. One hundred percent felt satisfied with the service received, 91% were trained in use of the device, and delivery deadlines were met in 83% of cases, but only 2% were followed up. One negative aspect is that the program covers only 25% of estimated need. CONCLUSIONS This assistive device program helps improve functional capacity and perceived quality of life in vulnerable patients who are able to access it. It addresses a real need and is highly valued by patients. Although delivery schedules were fulfilled, followup care schedules were not.

RESUMEN Este artículo investiga las elasticidades a largo y corto plazo entre el producto interno bruto y la IED en Jordania. El estudio utiliza datos anuales para analizar la relación entre la IED y el crecimiento económico para el periodo de 1992-2013. Los datos para las variables IED y PIB se obtuvieron de los Indicadores del Desarrollo Mundial y del Banco Mundial, y se utilizó el enfoque ARDL. Los resultados muestran elasticidades de largo y corto plazo en la IED y el PIB. En general, los responsables políticos de Jordania centran sus esfuerzos para atraer más IED a la economía jordana. Esto se debe a que se espera que más IED en la economía jordana conduzca a una disminución de los obstáculos económicos (por ejemplo, disminución de la tasa de desempleo y mayor nivel de inversión).

ABSTRACT This paper investigates both long-run and short-run elasticities between gross domestic product and foreign direct investment (FDI) in Jordan. Annual data have been used in order to explore the relationship between foreign direct investments (FDI) with economic growth for the period 1992-2013. Data were collected for both variables (FDI and GDP) from the World Bank and World Development Indicators, and the Autoregressive Distributed Lag Model (ARDL) approach was used. The results show long-run and short-run elasticities in foreign direct investment (FDI) and GDP The results indicate that Jordanian policy makers focus their efforts to attract more FDI to Jordanian economy. This is because more FDI is expected to lead to a decrease in economic obstacles in Jordan (e.g., increased level of investment, decreased unemployment rate). JEL: C10, E22, O47.

RESUMO Este artigo pesquisa sobre as elasticidades em curto e longo prazo entre o produto interno bruto (PIB) e o investimento estrangeiro direto (IED) na Jordânia. Este estudo utiliza dados anuais para analisar a relação entre a IED e o crescimento econômico para o período de 1992-2013. Os dados para as variáveis IED e PIB foram obtidos dos Indicadores do Desenvolvimento Mundial e do Banco Mundial, e foi utilizada a abordagem Autorregressiva com Defasagens Distribuídas (ARDL). Os resultados indicam elasticidades de curto e longo prazo no IED e no PIB. Em geral, os responsáveis políticos da Jordânia focam seus esforços para atrair mais IED à economia jordana. Isso se deve a que se espera que mais IED na economia jordana leve a uma diminuição dos obstáculos econômicos (por exemplo, diminuição da taxa de desemprego, maior nível de investimento).

Abstract: In my master’s dissertation (Castro 2013), I analysed personal nicknaming and nickames having as a corpus the 2011 phone book by nicknames of the residents of Cláudio (MG), the Apelista 2011. The analysis were developed inside the Semântica do Acontecimento framework proposed by Guimarães (2002, among others). Having done the description of the formal regularities of the nicknames (phonetical, morphological and morphosyntatical) and the description of the nicknaming enunciative scene, I could compare them with the descriptions developed by Guimarães (2002) for what I called personal juridical names and juridical nomination. This comparison allowed me to show a proper functioning of the personal nicknaming and nicknames and characterize them respectively as ludic nomination and ludic names inspired by the typology of discourses proposed by Orlandi (1983). In this paper I present, making some reviews, the descriptions that allowed me to reach this result.

Resumo: Em minha dissertação de mestrado (Castro 2013), analisei a apelidação e os apelidos de pessoa tendo como corpus a lista telefônica por apelidos do ano de 2011 dos moradores da cidade de Cláudio (MG), a Apelista 2011. As análises foram feitas dentro do quadro teórico-descritivo da Semântica do Acontecimento proposta por Guimarães (2002, entre outros). Feita a descrição das regularidades formais dos apelidos (fonética, morfológica e morfossintática) e a descrição da cena enunciativa da apelidação, pude compará-las com descrições realizadas por Guimarães (2002) para o que chamei de nomes jurídicos e nomeação jurídica de pessoa. Essa comparação me permitiu mostrar um funcionamento próprio da apelidação e dos apelidos de pessoa e caracterizá-los respectivamente de nomeação lúdica e nomes lúdicos inspirado na tipologia de discurso proposta por Orlandi (1983). Neste artigo apresento, fazendo algumas revisões, as descrições que me permitiram chegar a esse resultado.

OBJECTIVES: The aim of this study was to analyze silicone tubes with an internal diameter of 4 mm as a possible material for vascular prostheses. METHODS: Grafts were implanted into the infrarenal aortas of 33 rabbits. Fluoroscopic examinations were performed within 150 days after surgical implantation. Sample grafts were analyzed via electron microscopy to evaluate the eventual endothelialization of the prostheses. RESULTS: The patency rates of the prostheses were 87% (±6.7%) after 30 days, 73% (±9.3%) after 60 days and 48% (±12%) after 120 days. The material presented characteristics that support surgical implantation: good tolerance promoted by polyester tear reinforcement, ease of postoperative removal and a lack of pseudoaneurysms. However, intimal hyperplasia was a limiting factor for the patency rate. CONCLUSIONS: We concluded that polydimethylsiloxane has limited potential as an alternative material for small vascular prostheses.

OBJECTIVE: To compare responses to a cardiopulmonary exercise test on land versus on an underwater treadmill, to assess the cardiorespiratory performance of coronary artery disease patients while immersed in warm water and to compare with the performance of healthy individuals. METHODS: The sample population consisted of 40 subjects, which included 20 coronary artery disease patients aged 63.7±8.89 years old, functional class I and II, according to the New York Hearth Association, and 20 healthy subjects aged 64.7±7.09 years old. The statistical significances were calculated through an ANOVA test with a (1 - β) power of 0.861. ClinicalTrials.gov: NCT00989248 (22). RESULTS: Significant differences were uncovered in coronary artery disease group regarding the variables heart beats (HB), (p>0.01), oxygen consumption (VO2), (p>0.01) and carbon dioxide production (VCO2) (p<0.01). Also, for the same group, in relation to the environment, water versus on land for HB, VO2, VCO2 and oxygen for each heart beat (VO2/HB) all of than (p<0.01). The stages for data collected featured the subject’s performance throughout the experiment, and within the given context, variables rating of perceived exertion (RPE), HB, VO2, VCO2 and VO2/HB (p<0.01) showed significant interactions between test stages and environment. Additionally, there was a significant interaction between the etiology and the test stages for the variables HB, VO2 and VCO2 (p<0.01). Electrocardiographic changes compatible with myocardial ischemia or arrhythmia were not observed. The subjects exhibited lower scores on Borg’s perceived exertion scale in the water than at every one of the test stages on land (p<0.01). CONCLUSION: This study show that a cardiopulmonary exercise test can be safely conducted in subjects in immersion and that the procedures, resources and equipment used yielded replicable and reliable data. Significant differences observed in water versus on land allow us to conclude that coronary artery disease patients are able to do physical exercise in water and that the physiological effects of immersion do not present any risk for such patients, as exercise was well tolerated by all subjects.