2017/2018
Na ália de Sousa An unes
A u ilidade da a iabilidade da
equência ca díaca como a o de
p ognós ico em c ianças com
auma ismo c aniano
The u ili y o hea a e a iabili y as a
p ognos ic ac o in child en wi h
auma ic b ain inju y
ma ço, 2018
Mes ado In eg ado em Medicina
Á ea: Pedia ia
Tipologia: Monog a ia
T abalho e e uado sob a O ien ação de:
Dou o Ma a João Rod igues da Sil a
T abalho o ganizado de aco do com as no mas da e is a:
Childs Ne Sys
Na ália de Sousa An unes
A u ilidade da a iabilidade da
equência ca díaca como a o de
p ognós ico em c ianças com
auma ismo c aniano
The u ili y o hea a e a iabili y as a
p ognos ic ac o in child en wi h
auma ic b ain inju y
ma ço, 2018
5
Pu pose
Hea a e a iabili y in child en su e ing om head auma is no ye well s udied. This s udy aimed o assess
he ca dio ascula epe cussions o he au onomic ne ous sys em, h ough he e alua ion o hea a e a iabili y (HRV),
as a p ognos ic ac o in child en wi h auma ic b ain inju y (TBI).
Me hods
Da abases (Pubmed, Wo ld o Science and Scopus) - s udies we e conduc ed om 1996 o 2017, conside ing hea
a e a iabili y o pedia ic pa ien s (1 mon h o 18 yea s), based on Task Fo ce guidelines (1996). We analyzed eigh (8)
s udies ha included ou inclusion c i e ia.
Resul s
The no malized o al powe o 0.04 o 0.15 Hz was used o quan i y he hea a e low equency (LF) and om
0.15 o 0.40 Hz o quan i y hea a e high equency (HF). An LF / HF a io was used as a measu e o sympa he ic hea
a e modula ion.
Pa ien s wi h b ain inju y ha became b ain dead had a ma kedly lowe LF/HF a io (p <0.001), wi h a signi ican
dec ease a e he i s ew hou s o hospi aliza ion. Pa ien s wi h a mo e a o able p ognosis had signi ican ly highe LF/
HF a ios.
Conclusions
Au onomic Ne ous Sys em (ANS) dys unc ion in child en su e ing om b ain inju y leads o oscilla ions in
hea a e a iabili y.
A e e iewing he li e a u e, we concluded ha HRV can be use ul o he de e mina ion o he se e i y o neu ological
damage and a p ognos ic ac o in he e alua ion o i s eco e y.
LF/HF a io may be use ul o p edic which pa ien s will become b ain dead and which ones will ha e a be e
p ognosis.
KEYWORDS
Hea a e a iabili y; Child en; Head auma; Pedia ic pa ien s; Dysau onomia;

6
INTRODUCTION
Hea Ra e Va iabili y (HRV) is de ined as he a ia ion o e ime o he in e al be ween consecu i e hea bea s.
I e lec s he hea ´s abili y o adap and espond o changing ci cums ances by de ec ing and esponding o unp edic able
s imuli. I se es as an indica o o au onomous ac i i y in he egula ion o ci cula ion. I is also conside ed as he me hod
o analysis o au onomic ne ous sys em ac i i y. Changes in HRV ha e been associa ed wi h se e al pa hological
condi ions.
HRV measu emen s can be g ouped in ime domain, equency domain and non-linea measu emen s.
HRV de i es om he di e ence in du a ion o in e als be ween wo consecu i e bea s, called R-R in e als, and
is measu ed in milliseconds. These in e als a e ob ained on he ECG: he QRS complexes co espond o hea bea s and
R-R1 and R-R2 a e in e als be ween bea s.
Se e al equency bands ha e been de ined in humans, namely, high equency band (HF): be ween 0.15 and 0.4
Hz - modula ed by he pa asympa he ic ne ous sys em and gene a ed by espi a o y, low equency band (LF): be ween
0.04 and 0.15 Hz - de i es om he ac i i y o he sympa he ic sys em and is hough o e lec he delay in he ba o ecep o
e lex sys em. This delay is a ibu ed o he ac ha he sympa he ic sys em uses a second messenge sys em known as
cyclic AMP (cyclic adenosine monophospha e) and e y low equency band (VLF): be ween 0.01 and 0.04 Hz. I is o
unce ain o igin bu has been a ibu ed o a ma ke o sympa he ic ac i i y [1].
As he hea a e (HR) is a nons a iona y signal, i s a iabili y (especially a educ ion) may indica e he exis ence
o eminence o cu en disease: he educ ion o he HRV is associa ed o inc eased mo ali y. HRV is widely used o
e icien ly moni o he human body, mo e p ecisely in he e alua ion o ANS, h ough i s sympa he ic and pa asympa he ic
componen s. The e o e, i has become a ele an non-in asi e clinical ool [2].
C anioencephalic auma (TBI), which is associa ed wi h au onomic dys unc ion and co esponds o 40% o dea hs
in Ame ican child en unde 1 yea o age [3], is he main cause o auma ic dea h [4].
Despi e he as expe ience and esea ch in his ield, he de e minan s o i s occu ence in child en is s ill no well
de ined.
TBI may esul in dysau onomia, which is a condi ion cha ac e ized by ma ked, pa oxysmal changes in blood
p essu e, hea a e, espi a o y a e, empe a u e and/o swea ing. and is associa ed o dys unc ion o he au onomic ne ous
sys em [5].
Dysau onomy a ec s a small sub-g oup o su i o s who ha e su e ed se e e TBI. They a e mo e likely o su e
om se e e physical o cogni i e impai men , a p olonged pe iod o hospi aliza ion, as well as a long- e m dependence on
heal h ca e [6].
The e o e, he pu pose o his e iew was o examine he ele ance o HRV as a p ognos ic ac o in child en who
su e ed head auma, in he belie ha a dec ease in HRV may lead o a lowe p obabili y o su i al and a highe a e o
mo ali y and mo bidi y.
METHODS
A sys ema ic esea ch o he li e a u e was made in Janua y 2018, based on h ee da abases (Pubmed, Wo ld o
Science and Scopus) wi h he keywo ds: (hea a e a iabili y) and (child en) and (head auma) and (pedia ic pa ien s)
and (dysau onomia). Two hund ed and wen y one a icles om Pubmed, 102 om he Web o Science and 2 om he
Scopus da abase we e ound.
7
The abs ac s we e analyzed acco ding o he ollowing c i e ia: a icles om 1996 o 2017, human s udies in
pedia ic age (1 mon h o 18 yea s), wi hou congeni al diseases o como bidi ies, o empi ical in es iga ions (excluding
me a-analyzes, e iew a icles and epo s o single cases), using ime and equency domain me hods as VFC e alua ion
acco ding o he Task Fo ce guidelines [1] and a ailable in ull ex in Po uguese o English.
Eigh (8) a icles we e included acco ding o he inclusion c i e ia and in o ma ion included in he abs ac s.
In eg al ex s o a icles wi h ma ching p ede ined c i e ia we e sc eened.
Da a ex ac ion eco ds we e pe o med o each o he en selec ed a icles.
The aim, s udy o ma , au ho and yea , cha ac e is ics o pa icipan s, pa ame e s used o measu e HRV ( ime
domain and equency), expe imen al condi ions and key ideas we e ex ac ed.
RESULTS
Acco ding o he Task Fo ce o he Eu opean Socie y o Ca diology and he No h Ame ican Socie y o Rhy hm
and Elec ophysiology [1] and se e al s udies [6-15] we used he ime and equency domains o de e mine he u ili y o
HRV as a p ognos ic ac o in child en wi h TBI. The esul s a e summa ized in Tables 1 and 2.
The da a ex ac ed om he selec ed a icles we e summa ized in able 3.
We e i ied ha he e was a a ia ion (p = 0.027/ p = 0.59), be ween he low equency (LF) and high equency
(HF) alues, espec i ely, in he analyzed s udies when compa ed wi h hose sugges ed by he Task Fo ce (Table 2).
The HF band s a s a he alue a which he LF band ends: 0.15Hz (Table 3).
Six s udies excluded he e y low equency band (VLF), s a ing he LF band be ween 0.01 and 0.04Hz and
hose ha included he VLF band, used he alue 0.01Hz o s a i (Table 3).
Baguley I e al (2006) in es iga ed dysau onomia and HRV ollowing se e e auma ic b ain inju y h ough he
analysis o HRV. Da a was collec ed on age-ma ched subjec s wi h and wi hou dysau onomia and non-inju ed con ols.
The TBI g oup e ealed signi ican di e ences in HRV pa ame e s bo h compa ed o con ols and be ween dysau onomic
and non-dysau onomic subjec s.
VLF powe was ela i ely p ese ed be ween g oups. Only LF was signi ican ly lowe in he TBI g oup (p =
0.009). The mean LF/HF a io was in he no mal ange o con ols and ele a ed in he TBI g oup (1.8 and 3.7, espec i ely,
p < 0.05). The con ol g oup mean SDNN in TBI g oup was signi ican ly lowe han con ols (p = 0.018). HRV da a
demons a ed ha subjec s wi h dysau onomia had signi ican ly lowe LF powe (p < 0.05). The e was no s a is ical
di e ence be ween mean LF/HF a io o he dysau onomic s non-dysau onomic g oups (p = 0.164).
In he cu en s udy, he dysau onomia g oup had signi ican ly educed LF powe and g ea e LF/HF a io
a iabili y ( anging om 0.3 – 12.3) compa ed o he non-dysau onomic g oup [6].
Acco ding o Bismas A e al (2000) pa ien s who p og essed o b ain dea h had a e y low LF / HF a io (p <0.001),
wi h a signi ican dec ease in he i s 4 hou s o hospi aliza ion. Pa ien s wi h be e p ognosis had highe LF / HF a ios
[7].
Golds ein B e al (1998) ound signi ican co ela ions be ween su i al and mean hea a e (p = 0.004) and LF
(p = 0.009). In o he wo ds, he se e i y o he neu ological inju y, p ognosis and su i al we e in e sely ela ed o he
deg ee o ca dio ascula a iabili y. B ain dea h occu ed a e y low alues o HRV (nea ze o). In addi ion, he
ca dio ascula and au onomic sys ems we e p opo ionally decoupled a a ious le els du ing acu e b ain inju y. Thus,
moni o ing he deg ee o decoupling in hese sys ems allows a be e unde s anding o neu oau onomic and ca dio ascula
in e ac ions du ing acu e b ain inju y [8].
8
Golds ein B e al (1998) ound a nega i e co ela ion be ween he minimum alue o LF (p < 0.001), HF (p <
0.001) and LF/HF (p = 0.007), eco ded du ing hospi aliza ion. A discha ge om In ensi e Ca e Uni (ICU), he p ognos ic
showed a nega i e co ela ion be ween he minimum alue o LF (p < 0.001), HF (p < 0.001) and LF/HF (p = 0.008), in
o he wo ds, low alues o HRV demons a ed a g ea e se e i y o he illness and a wo se p ognos ic [9].
Acco ding o Golds ein B e al. (1996), maximal alues o LF (p <0.001), and minimum alues o HF (p < 0.001)
demons a ed a highe p obabili y o su i al, sugges ing ha HRV may p o e o be a sensi i e and speci ic me hod use ul
in de e mining he se e i y o he neu ological inju y in child en who su e ed b ain inju y [10].
Almeida R e al (2013), concluded ha he g oup o pa ien s wi h b ain dea h p esen ed educed HRV in all
equency bands (p <10-16) [11].
Su e al. (2005) p o ed ha a pe cen age inc ease in he LF band and in he LF / HF wi h he dec ease in HF
indica ed a g ea e powe on he pa o he sympa he ic ne ous sys em and a enua ed pa asympa he ic. These changes
we e ela ed o he se e i y o damage o he b ains em.
I was also obse ed ha in b ain dea h, LF and HF p esen ed e y low alues, concluding ha HRV may be a
use ul ool in he e alua ion o ANS unc ions in pa ien s wi h a ious le els o b ain inju y [12].
Kim S e al (2017) ound ha a signi ican inc ease in LF (p = 0.0119) in pa ien s wi h acu e b ain inju y indica ed
a high sympa he ic exci a o y ac i i y since LF had a sympa he ic p edominance. Howe e , HF had a pa asympa he ic
modula ion. The signi ican ly dec eased alues obse ed in he g oup o pa ien s wi h acu e b ain inju y (ABI) sugges ed
a dec eased pa asympa he ic ac i i y. The signi ican inc ease in he LF / HF a io o he g oup o pa ien s wi h acqui ed
b ain inju y in e s a g ea e powe on he pa o hei sympa he ic ne ous sys em (p = 0.0018). In he ime domain, SDNN,
which e lec s e e y cyclic aspec ha was ela ed o he a iabili y du ing he eco ding pe iod, was dec eased in ABI
g oup (p = 0.0134); mSSD, which ep esen s he pa asympa he ic egula ion o he hea , was signi ican ly di e en
be ween he wo g oups (p = 0.0240). In summa y, acco ding o his s udy, he g oup wi h acu e b ain inju y had a
sympa he ic p edominance when compa ed o he con ol g oup [13].
Discussion
The main esul o his s udy is ha HRV can be use ul when de e mining he se e i y o neu ological damage and
a p ognos ic ac o in he e alua ion o i s eco e y. I was ound ha he mo e se e e he neu ological inju y, he wo se
he p ognosis and he lowe he HRV. This sugges s ha as HRV is commonly used o e icien ly moni o he human body
in he e alua ion o ANS, h ough i s sympa he ic and pa asympa he ic componen s, i is a ele an non-in asi e clinical
ool [2].
Sho - e m a ia ions in hea a e a e obse ed a all ages and a e an impo an sign o no mal homeos a ic
mechanisms o he ca dio ascula sys em. The deg ee o hea a e a iabili y p o ides in o ma ion abou how he ne ous
sys em in e e es wi h hea a e and hea esponsi eness. In addi ion, diso de s o he cen al and pe iphe al ne ous
sys em ha e e ec s on HRV. Fu he mo e, all no mal cyclic changes in hea a e a e a enua ed in he p esence o se e e
b ain damage [14].
Ou in e es in he p esen s udy was o explo e HRV changes and o in es iga e hei ela ionship in he p ognosis
o child en wi h TBI. E en hough no much has been published abou his ma e , in he analyzed s udies, HRV was
ma kedly dep essed in child en who p og essed o b ain dea h a e TBI and in pa ien s wi h dysau onomia. In addi ion,
LF / HF a io was signi ican ly educed in b ain-dead child en. The low LF / HF a io was e iden in all b ain-dead and
non-su i ing pa ien s, while in he con ol g oup he e was a p og essi e inc ease in all measu ed a iables. Howe e , i
9
is hypo hesized ha hese conclusions a e biased in ela ion o he impo ance o each a iable, due o he small sample
size o each s udy. Fo his eason, we hink ha a simila s udy wi h a la ge and mo e homogenous g oup could ha e a
signi ican alue in HRV as a p edic i e elemen , a he han simply associa ed, wi h mo ali y.
The mos ele an limi a ion o his e iew was he lack o s anda diza ion o he Task Fo ce guidelines o he
pedia ic popula ion. The s anda d alues desc ibed may no apply o child en wi h he esul ha di e en au ho s used
di e en equency bands. Fu he mo e, he implemen a ion o a s anda d me hod o collec and analyze HRV would
con ibu e o mo e eliable indings. This and he ac ha mos s udies included mos ly adul s and only a small numbe o
child en made i di icul o es ablish a compa ison abou he impo ance o HRV and i s ole in he p ognosis o child en
wi h TBI. Hence, he impo ance o se ing app op ia e guidelines o he pedia ic age as well as a cu -o o de ine he
p ognosis o child en wi h TBI on admission. On he o he hand, he ac ha each s udy uses small samples only, limi ed
he esul s o he s udies. None heless, is seems well es ablished ha LF/HF a io may be help ul no only in iden i ying
hose pa ien s who will p og ess o b ain dea h bu also in p edic ing which pa ien s will ha e a o able ou comes.
Conclusions
In summa y, acco ding o he eligible s udies he analysis o HRV in child en wi h se e e b ain lesions caused by
TBI and he p ognosis o hei eco e y is in e sely associa ed wi h HRV, wi h ce eb al dea h le els o almos ze o
a iabili y.
The equency domain is used mo e equen ly and he LF e lec ed he ac i i y o he sympa he ic componen .
The e idence indica ed ha du ing se e e b ain inju y, he ca dio ascula and au onomic sys ems a e
p opo ionally decoupled a a ious le els in ela ion o he deg ee o neu ological inju y, and hei moni o ing may lead
o a be e unde s anding o neu oau onomic in e ac ions.
Pa ien s who a e b ain inju y e ol ed o b ain dea h had a ma kedly lowe LF / HF a io (p <0.001) wi h a
signi ican dec ease a e he i s hou s o hospi aliza ion. Pa ien s wi h a mo e a o able p ognosis had signi ican ly highe
LF / HF a ios. Thus, he LF / HF a io may be use ul in iden i ying pa ien s who will p og ess o b ain dea h, as well as in
he p ognosis o hose who will eco e a o ably.
16
To ind e idence o au onomic
imbalance and p esen e he
HRV pa ame e s ha e lec
he se e i y o pa oxysmal
sympa he ic hype ac i i y in
child en wi h acqui ed b ain
inju y.
Kim S e al
(2017) [13]
13 child en (8 males/5 emales) wi h acu e
b ain inju y who we e admi ed om
Oc obe 2013 o Janua y 2016.
4 child en had TBI
SA-6000 de ice (Medico e
Co.,Seoul, Ko ea).
Du a ion o eco ding: 5
minu es.
TD: SDNN and mSSD.
FD: LF (0.04 o 0.15), HF
(0.15 o 0.40 Hz) and LF/HF
a io.
13 age-and sex-ma ched pa ien s
wi h ce eb al palsy we e selec ed
as he con ol g oup.
Tes we e conduc ed in a noise-
ee en i onmen a e 30 minu es
o es , in a elaxed supine
posi ion.
In o de o a oid he in luence3 o
ci cadian changes in he HRV
esul s, da a was collec ed be ween
1:00 PM and 3:00 PM in e e y
pa ien .
The oom empe a u e du ing da a
collec ion was 24-26ºC.
Exclusion c i e ia
His o y o ca diac disease,
diabe es o o he pe iphe al
neu ological impai men , pa ien s
aking ca dio ascula medica ions
and sépsis o suspicion o
signi ican in ec ion.
The e was a s a is ically
signi ican inc ease in he
mean hea a e o he acu e
b ain inju y g oup compa ed o
he con ol g oup (p = 0.0119).
Acco ding o he ime domain
analysis, he mSSD was
signi ican ly di e en be ween
he wo g oups (p = 0.0240).
All indices o he equency
domain analysis demons a ed
a s a is ically signi ican
di e ence be ween he wo
g oups.
The LF and HF dec eased in
he acu e b ain inju y g oup
compa ed o he con ol g oup.
Only he LF / HF a io
inc eased in he acu e b ain
inju y g oup compa ed o he
con ol (p=0.0018 and
p=0.0018 espec i ely).
LF – low equency; VLF – e y low equency; MLF – mid-low equency; HF – high equency; Secs - seconds; FD – equency domain; TD – ime domain;

17
Re e ences
[1] Task o ce o he Eu opean Socie y o Ca diology and he No h Ame ican Socie y o Pacing and
Elec ophysiology (1996). Hea a e Va iabili y. S anda ds o measu emen , physiological in e p e a ion and
clinical use. Eu o Hea J. 17:354-381.
[2] Acha ya U, Joseph K, Kanna hal N e al (2006) Hea a e a iabili y: a e iew. Med Bio Eng Compu 44:1031-
1051.
[3] Finley JP, Nugen ST, Hellenb and W (1995) Hea a e a iabili y in in an s, child en and young adul s. J.
Au on Ne Sys 51:103-8.
[4] Massimo SS, Fab izio D, Ragonese P (2001) Hea a e a iabili y in heal hy child en and adolescen s is
pa ially ela ed o age and gende . In J Ca diol 81:169-174.
[5] Ryan ML, Tho son CM, O e o Ca, Vu T, P oc o KG (2011) Clinical applica ions o hea a e a iabili y in
he iage and assessmen o auma ically inju ed pa ien s. Anes hesiol Res P ac . 2011:416590.
[6] Baguley I, He iseanu R, Felmingham K e al (2006) Dysau onomia and hea a e a iabili y ollowing
se e e auma ic b ain inju y. B ain Inj 20(4):437-444.
[7] Biswas A, Sco W, Somme aue J e al (2000) Hea a e a iabili y a e acu e auma ic b ain inju y in
child en. C i Ca e Med 12:3907-3912.
[8] Golds ein B, Toweill D, Lai S, e al (1998) Uncoupling o he au onomic and ca dio ascula sys ems in acu e
b ain inju y. J. Physiol. 44:1287-1292.
[9] Golds ein B, Fise D, Kelly M, e al (1998) Decomplexi ica ion in c i ical illness and inju y: Rela ionship
be ween hea a e a iabili y, se e i y o illness and ou come. C i . Ca e Med 26:352-357.
[10] Golds ein B, Kempski M, DeKing D, e al (1996) Au onomic con ol o hea a e a e b ain inju y in
child en. C i . Ca e Med 24:234-240.
[11] Almeida R, Sil a M, Rocha A (2013) Explo ing QT a iabili y dependence om hea a e in coma and b ain
dea h on pedia ic pa ien s. Compu ing in ca diology 40:61-64.
[12] Su C, Kuo T, Kuo J e al (2005) Sympa he ic and pa asympa he ic ac i i ies e alua ed by hea - a e a iabili y
in head inju y o a ious se e i ies. Clinical Neu ophysiology 116:1273-1279.
[13] Kim S, Jeon H, Kim J e al (2017) Hea a e a iabili y among child en wi h acqui ed b ain inju y. Ann
Rehabil Med 41(6):951-960.
[14] Lowensohn I, Weiss M, Hon H (1977) Hea - a e a iabili y in b ain-damaged adul s. Lance 1:626-628.
18
A achmen s
 Re iew a icles and in i ed pape s
Re iew pape s may be na a i e o sys ema ic and a e subjec o he pee e iew p ocess. They should o e
exhaus i e in o ma ion on a gi en subjec . The Edi o will in i e expe s in he a ious ields o he neu osciences
o publish In i ed pape s, al hough unsolici ed e iews may also be conside ed. The Abs ac mus no be
s uc u ed and he ex may be a anged eely. The con ibu ion should no be signed by mo e han 7 au ho s,
while he ex should no exceed 4000 wo ds. Up o 15 igu es o ables and 70 e e ences a e allowed. Excep ions
a he disc e ion o he Edi o in Chie .
Abs ac
Please p o ide a s uc u ed abs ac o 150 o 250 wo ds which should be di ided in o he ollowing sec ions:
 Pu pose (s a ing he main pu poses and esea ch ques ion)
 Me hods
 Resul s
 Conclusions
Keywo ds
Please p o ide 4 o 6 keywo ds which can be used o indexing pu poses.
Tex Fo ma ing
Manusc ip s should be submi ed in Wo d.
 Use a no mal, plain on (e.g., 10-poin Times Roman) o ex .
 Use i alics o emphasis.
 Use he au oma ic page numbe ing unc ion o numbe he pages.
 Do no use ield unc ions.
 Use ab s ops o o he commands o inden s, no he space ba .
 Use he able unc ion, no sp eadshee s, o make ables.
 Use he equa ion edi o o Ma hType o equa ions.
 Sa e you ile in docx o ma (Wo d 2007 o highe ) o doc o ma (olde Wo d e sions).
Headings
Please use no mo e han h ee le els o displayed headings.
Abb e ia ions
Abb e ia ions should be de ined a i s men ion and used consis en ly he ea e .
Foo no es
Foo no es can be used o gi e addi ional in o ma ion, which may include he ci a ion o a e e ence included in
he e e ence lis . They should no consis solely o a e e ence ci a ion, and hey should ne e include he
bibliog aphic de ails o a e e ence. They should also no con ain any igu es o ables.
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Foo no es o he ex a e numbe ed consecu i ely; hose o ables should be indica ed by supe sc ip lowe -case
le e s (o as e isks o signi icance alues and o he s a is ical da a). Foo no es o he i le o he au ho s o he
a icle a e no gi en e e ence symbols.
Always use oo no es ins ead o endno es.
Acknowledgmen s
Acknowledgmen s o people, g an s, unds, e c. should be placed in a sepa a e sec ion on he i le page. The names
o unding o ganiza ions should be w i en in ull.
Ci a ion
Re e ence ci a ions in he ex should be iden i ied by numbe s in squa e b acke s. Some examples:
1. Nego ia ion esea ch spans many disciplines [3].
2. This esul was la e con adic ed by Becke and Seligman [5].
3. This e ec has been widely s udied [1-3, 7].
Re e ence lis
The lis o e e ences should only include wo ks ha a e ci ed in he ex and ha ha e been published o accep ed
o publica ion. Pe sonal communica ions and unpublished wo ks should only be men ioned in he ex . Do no
use oo no es o endno es as a subs i u e o a e e ence lis .
Re e ence lis en ies should be alphabe ized by he las names o he i s au ho o each wo k and numbe ed
consecu i ely.
Tables
 All ables a e o be numbe ed using A abic nume als.
 Tables should always be ci ed in ex in consecu i e nume ical o de .
 Fo each able, please supply a able cap ion ( i le) explaining he componen s o he able.
 Iden i y any p e iously published ma e ial by gi ing he o iginal sou ce in he o m o a e e ence a
he end o he able cap ion.
 Foo no es o ables should be indica ed by supe sc ip lowe -case le e s (o as e isks o signi icance
alues and o he s a is ical da a) and included benea h he able body.