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1.
Med Teach ; : 1-7, 2024 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-39382290

RESUMO

PURPOSE: Significant gender disparities exist in the medical field. Medical schools play an important role in promoting gender inclusion, which can lead to increased gender equity in clinical settings. This study explores participants' experiences and gender perspectives at the University of Global Health Equity (UGHE) in Rwanda, which is prioritizing gender inclusion across several initiatives. MATERIALS AND METHODS: This is a qualitative study with a feminist social constructivist approach. Participants included faculty and students in UGHE's School of Medicine. Participants were selected via random stratified sampling by their role and sex. Twelve semi-structured interviews were conducted, six with faculty and six with students. The data was analyzed via coding and narrative analysis. RESULTS: Participants described their experiences at UGHE, including strengths, weaknesses, shifts in their own gender perspectives, and recommendations for the future. Three overarching themes included the role of affirmative action, integrating gender-based training and curriculum, and strengthening institutional policies to promote inclusion. CONCLUSION: Medical schools play a key role in promoting gender equity and catalyzing a shift in gender perspective. Internal systems and policies impact gender inclusion. Medical schools should consider ways to build capacity for both its faculty and students in gender-related topics.

2.
J Pediatr ; 238: 135-144.e10, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34245768

RESUMO

OBJECTIVES: To evaluate whether intrauterine growth restriction (IUGR) adds further neurodevelopmental risk to that posed by very preterm birth alone in terms of alterations in brain growth and poorer toddlerhood outcomes. STUDY DESIGN: Participants were 314 infants of very preterm birth enrolled in the Evaluation of Preterm Imaging Study (e-Prime) who were subsequently followed up in toddlerhood. IUGR was identified postnatally from discharge records (n = 49) and defined according to prenatal evaluation of growth restriction confirmed by birth weight <10th percentile for gestational age and/or alterations in fetal Doppler. Appropriate for gestational age (AGA; n = 265) was defined as birth weight >10th percentile for gestational age at delivery. Infants underwent magnetic resonance imaging at term-equivalent age (median = 42 weeks); T2-weighted images were obtained for voxelwise gray matter volumes. Follow-up assessments were conducted at corrected median age of 22 months using the Bayley Scales of Infant and Toddler Development III and the Modified-Checklist for Autism in Toddlers. RESULTS: Infants of very preterm birth with IUGR displayed a relative volumetric decrease in gray matter in limbic regions and a relative increase in frontoinsular, temporal-parietal, and frontal areas compared with peers of very preterm birth who were AGA. At follow-up, toddlers born very preterm with IUGR had significantly lower cognitive (effect size = 0.42) and motor (effect size = 0.41) scores and were more likely to have a positive Modified-Checklist for Autism in Toddlers screening for autism (OR = 2.12) compared with peers of very preterm birth who were AGA. CONCLUSIONS: IUGR might confer a neurodevelopmental risk that is greater than that posed by very preterm alone, in terms of both alterations in brain growth and poorer toddlerhood outcomes.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Encéfalo/patologia , Retardo do Crescimento Fetal/diagnóstico por imagem , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Retardo do Crescimento Fetal/patologia , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Estudos Longitudinais , Imageamento por Ressonância Magnética/métodos , Masculino , Gravidez
3.
NMR Biomed ; 34(4): e4475, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33480110

RESUMO

Magnetic resonance imaging (MRI) in pregnancy is commonly undertaken in the left lateral tilt (LLT) position to prevent inferior vena cava (IVC) compression and supine hypotensive events, although this may be suboptimal for image quality. The supine position may also have an adverse effect on fetal well-being. The spinal venous plexus may provide an alternative pathway for venous return in the presence of IVC compression. This study assesses morphology and blood flow of the IVC and spinal venous plexus for pregnant women in LLT and supine positions to ascertain the effect of maternal position on venous return during MRI. Eighty-two pregnant women underwent phase contrast MRI (PC-MRI) of the IVC and spinal venous plexus in the supine position; 25 were also imaged in the LLT position. Differences in life monitoring, IVC, spinal venous plexus and total venous return between the two positions were assessed. A linear regression assessed the relationship between flow in the IVC and the spinal venous plexus in the supine position. Increasing gestational age and the right-sided position of the uterus on IVC and spinal venous plexus venous return were also evaluated. Hypotension symptoms were similar in supine (10%) and LLT (8%) positioning. Supine positioning decreased IVC height (p < 0.004) and flow (p = 0.045) but flow in the spinal venous plexus increased (p < 0.001) compared with the LLT position. Total venous return showed no difference (p = 0.989) between the two positions. Additional measurements of flow in the aorta also showed no significant difference between the two groups (p = 0.866). Reduced IVC flow in the supine position was associated with increasing gestational age (p = 0.004) and degree of right-sided uterine position (p = 0.004). Women in the left lateral decubitus position who then rotated supine had greater flow in the IVC (p = 0.008) and spinal venous plexus (p = 0.029) than those who started supine. For the majority of women, the spinal venous plexus acts as a complementary venous return system for pregnant women in the supine position, maintaining vascular homeostasis. Further study is needed to assess the effects on the health of the fetus.


Assuntos
Imageamento por Ressonância Magnética/métodos , Posicionamento do Paciente , Gravidez/fisiologia , Veia Cava Inferior/fisiologia , Feminino , Humanos , Gestantes , Fluxo Sanguíneo Regional , Coluna Vertebral/irrigação sanguínea , Decúbito Dorsal
4.
Echocardiography ; 36(2): 276-284, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30729587

RESUMO

BACKGROUND: Septal myectomy relieves left ventricular outflow obstruction (LVOTO) and is associated with excellent long-term outcomes. LVOTO is associated with diastolic dysfunction and increased left atrial (LA) size. We sought to investigate the changes in LA volumes and function postmyectomy and the association between these changes with clinical outcomes postmyectomy. METHODS: Sixty-six hypertrophic cardiomyopathy patients undergoing myectomy were retrospectively studied. Preprocedural and 6- to 18-month postmyectomy follow-up transthoracic echocardiographic images were obtained. LA volumes and strain were assessed by two-dimensional speckle-tracking echocardiography. RESULTS: Left atrial volumes, that is, indexed maximal, minimal, and pre-A volumes reduced postmyectomy, yet remained increased compared to controls (105.6 ± 34.5 mL vs 84.9 ± 26.7 mL, 45.2 ± 25.7 mL vs 35.4 ± 22.6 mL, 70.1 ± 31.4 mL vs 35.4 ± 22.6 mL, respectively, P < 0.05). The total emptying index did not improve postmyectomy and remained lower than controls (58.6 ± 12.4 vs 59.9 ± 12.8, P = NS) whereas atrial contraction improved, yet did not normalize (active emptying index 36.1 ± 14.9 vs 41.1 ± 16.2, P < 0.05). The conduit volume remained reduced postmyectomy (18.6 ± 13.3 mL vs 16.6 ± 15.1 mL, P = NS). LA strain also did not improve postmyectomy (26.8 ± 7.3 vs 28.5 ± 8.8, P = NS). A multivariable logistic regression identified preprocedural E/e' ratio and indexed maximal LA volume, as independent predictors for LA volume reduction ≥20% postmyectomy. During a mean follow-up of 4.9 ± 2.3 years postmyectomy, 24.2% of the patients developed atrial fibrillation and <5% of patients were severely symptomatic. We found no associations between LA volumes/function and atrial fibrillation or symptoms postmyectomy. CONCLUSION: Postmyectomy LA volumes decreased, and the contractile function improved. There was no association between LA volumes/function and clinical outcomes postmyectomy. Notably, the LA remained enlarged (though to a lesser degree) with reduced strain and emptying fraction, suggesting possible atrial myopathy.


Assuntos
Remodelamento Atrial/fisiologia , Cardiomiopatia Hipertrófica/cirurgia , Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Função Atrial/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
J Vasc Surg ; 61(1): 275-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25307131

RESUMO

Type I endoleaks associated with sac enlargement after endovascular abdominal aortic aneurysm repair mandate urgent intervention. Endoluminal treatments are generally considered first, but when these fail, open surgery has been advocated as a last resort. Open surgery is associated with significant mortality and morbidity, and thus, approaches that reduce this risk would be of interest. We report a successful case of laparoscopic treatment of a refractory type Ia endoleak after endovascular abdominal aortic aneurysm repair in an 83-year-old man.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Endoleak/cirurgia , Procedimentos Endovasculares/efeitos adversos , Laparoscopia , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia/métodos , Endoleak/diagnóstico , Endoleak/etiologia , Humanos , Masculino , Reoperação , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler em Cores
7.
Eur Heart J ; 35(39): 2706-13, 2014 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-24810389

RESUMO

AIMS: Cardiovascular magnetic resonance (CMR) has improved diagnostic and management strategies in hypertrophic cardiomyopathy (HCM) by expanding our appreciation for the diverse phenotypic expression. We sought to characterize the prevalence and clinical significance of a recently identified accessory left ventricular (LV) muscle bundle extending from the apex to the basal septum or anterior wall (i.e. apical-basal). METHODS AND RESULTS: CMR was performed in 230 genotyped HCM patients (48 ± 15 years, 69% male), 30 genotype-positive/phenotype-negative (G+/P-) family members (32 ± 15 years, 30% male), and 126 controls. Left ventricular apical-basal muscle bundle was identified in 145 of 230 (63%) HCM patients, 18 of 30 (60%) G+/P- family members, and 12 of 126 (10%) controls (G+/P- vs. controls; P < 0.01). In HCM patients, the prevalence of an apical-basal muscle bundle was similar among those with disease-causing sarcomere mutations compared with patients without mutation (64 vs. 62%; P = 0.88). The presence of an LV apical-basal muscle bundle was not associated with LV outflow tract obstruction (P = 0.61). In follow-up, 33 patients underwent surgical myectomy of whom 22 (67%) were identified to have an accessory LV apical-basal muscle bundle, which was resected in all patients. CONCLUSION: Apical-basal muscle bundles are a unique myocardial structure commonly present in HCM patients as well as in G+/P- family members and may represent an additional morphologic marker for HCM diagnosis in genotype-positive status.


Assuntos
Cardiomiopatia Hipertrófica/patologia , Miocárdio/patologia , Adulto , Análise de Variância , Cardiomiopatia Hipertrófica/genética , Estudos de Casos e Controles , Análise Mutacional de DNA , Genótipo , Ventrículos do Coração , Humanos , Hipertrofia Ventricular Esquerda/genética , Hipertrofia Ventricular Esquerda/patologia , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mutação/genética , Linhagem , Fenótipo , Obstrução do Fluxo Ventricular Externo/genética , Obstrução do Fluxo Ventricular Externo/patologia
8.
J Cardiovasc Magn Reson ; 16: 54, 2014 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-25160730

RESUMO

BACKGROUND: Many pathologies seen in the preterm population are associated with abnormal blood supply, yet robust evaluation of preterm cardiac function is scarce and consequently normative ranges in this population are limited. The aim of this study was to quantify and validate left ventricular dimension and function in preterm infants using cardiovascular magnetic resonance (CMR). An initial investigation of the impact of the common congenital defect patent ductus arteriosus (PDA) was then carried out. METHODS: Steady State Free Procession short axis stacks were acquired. Normative ranges of left ventricular end diastolic volume (EDV), stroke volume (SV), left ventricular output (LVO), ejection fraction (EF), left ventricular (LV) mass, wall thickness and fractional thickening were determined in "healthy" (control) neonates. Left ventricular parameters were then investigated in PDA infants. Unpaired student t-tests compared the 2 groups. Multiple linear regression analysis assessed impact of shunt volume in PDA infants, p-value ≤ 0.05 being significant. RESULTS: 29 control infants median (range) corrected gestational age at scan 34+6(31+1-39+3) weeks were scanned. EDV, SV, LVO, LV mass normalized by weight and EF were shown to decrease with increasing corrected gestational age (cGA) in controls. In 16 PDA infants (cGA 30+3(27+3-36+1) weeks) left ventricular dimension and output were significantly increased, yet there was no significant difference in ejection fraction and fractional thickening between the two groups. A significant association between shunt volume and increased left ventricular mass correcting for postnatal age and corrected gestational age existed. CONCLUSION: CMR assessment of left ventricular function has been validated in neonates, providing more robust normative ranges of left ventricular dimension and function in this population. Initial investigation of PDA infants would suggest that function is relatively maintained.


Assuntos
Permeabilidade do Canal Arterial/diagnóstico , Canal Arterial/patologia , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Recém-Nascido Prematuro , Imageamento por Ressonância Magnética , Miocárdio/patologia , Função Ventricular Esquerda , Estudos de Casos e Controles , Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/patologia , Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia Doppler em Cores , Idade Gestacional , Humanos , Interpretação de Imagem Assistida por Computador , Recém-Nascido , Modelos Lineares , Modelos Cardiovasculares , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Volume Sistólico
9.
Paediatr Anaesth ; 24(2): 190-5, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24387147

RESUMO

BACKGROUND: The aim of this study was to look for clinically significant adverse effects of chloral hydrate used in a large cohort of infants sedated for magnetic resonance imaging. METHOD: Case notes of infants who underwent magnetic resonance imaging (MRI) scanning from 2008 to 2010 were reviewed, with patient demographics, sedation dose, comorbidities, time to discharge, and side effects of sedation noted. RESULTS: Four hundred and eleven infants (median [range] postmenstrual age per weight at scan 42 [31(+4) -60] weeks per 3500 g [1060-9900 g]) were sedated with chloral hydrate (median [range] dose 50 [20-80] mg·kg(-1)). In three cases (0.7%), desaturations occurred which prompted termination of the scan. One infant (0.2%) was admitted for additional observation following sedation but had no prolonged effects. In 17 (3.1%) cases, infants had desaturations which were self-limiting or responded to additional inspired oxygen such that scanning was allowed to continue. CONCLUSION: When adhering to strict protocols, MRI scanning in newborn infants in this cohort was performed using chloral hydrate sedation with a relatively low risk of significant adverse effects.


Assuntos
Hidrato de Cloral , Sedação Consciente/métodos , Hipnóticos e Sedativos , Imageamento por Ressonância Magnética/métodos , Peso ao Nascer , Hidrato de Cloral/administração & dosagem , Hidrato de Cloral/efeitos adversos , Idade Gestacional , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Recém-Nascido , Recém-Nascido Prematuro , Oxigênio/sangue
10.
J Vasc Interv Radiol ; 24(8): 1218-26, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23725793

RESUMO

PURPOSE: Unresectable intrahepatic cholangiocarcinoma represents a devastating illness with poor outcomes when treated with standard systemic therapies. Several smaller nonrandomized outcomes studies have been reported for such patients undergoing transarterial therapies. A metaanalysis was performed to assess primary clinical and imaging outcomes, as well as complication rates, following transarterial interventions in this patient population. MATERIALS AND METHODS: By using standard search techniques and metaanalysis methodology, published reports (published in 2012 and before) evaluating survival, complications, and imaging response following transarterial treatments for patients with unresectable intrahepatic cholangiocarcinoma were identified and evaluated. RESULTS: A total of 16 articles (N = 542 subjects) met the inclusion criteria and are included. Overall survival times were 15.7 months ± 5.8 and 13.4 months ± 6.7 from the time of diagnosis and time of first treatment, respectively. The overall weighted 1-year survival rate was 58.0% ± 14.5. More than three fourths of all subjects (76.8%) exhibited a response or stable disease on postprocedure imaging; 18.9% of all subjects experienced severe toxicities (National Cancer Institute/World Health Organization grade ≥ 3), and most experienced some form of postembolization syndrome. Overall 30-day mortality rate was 0.7%. CONCLUSIONS: As demonstrated by this metaanalysis, transarterial chemotherapy-based treatments for cholangiocarcinoma appears to confer a survival benefit of 2-7 months compared with systemic therapies, demonstrate a favorable response by imaging criteria, and have an acceptable postprocedural complication profile. Such therapies should be strongly considered in the treatment of patients with this devastating illness.


Assuntos
Quimioembolização Terapêutica , Colangiocarcinoma/terapia , Neoplasias Hepáticas/terapia , Neoplasias dos Ductos Biliares , Ductos Biliares Intra-Hepáticos , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/mortalidade , Distribuição de Qui-Quadrado , Colangiocarcinoma/mortalidade , Colangiocarcinoma/patologia , Progressão da Doença , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Can J Cardiol ; 39(12): 1931-1937, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37355230

RESUMO

BACKGROUND: The optimal management of hypertrophic cardiomyopathy (HCM) patients with postoperative atrial fibrillation (POAF) after surgical myectomy remains unknown. We sought to investigate the association between POAF and atrial fibrillation (AF) or cardioembolic events during follow-up to bridge this gap. METHODS: Patients undergoing surgical myectomy at 2 HCM referral centres in North America from 2002 to 2020 were included in this study. Patients with preoperative AF were excluded. POAF was defined as any episode of AF within 30 days after surgery. RESULTS: Of 1176 patients, 375 (31.9%) had POAF. Age (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03-1.06; P < 0.001), premyectomy left atrial diameter (LAD; adjusted HR 1.6, 95% CI 1.32-2.02; P < 0.001), and smoking (adjusted HR 1.60, 95% CI 1.17-2.20; P = 0.001) were associated with POAF on multivariable analysis. Of 934 patients with follow-up data, of duration 4.3 ± 4.1 years, AF was detected in 86 (9.2%). Only POAF (HR 4.20, 95% CI 2.44-7.23; P < 0.001), previous history of stroke (HR 4.81, 95% CI 1.63-14.17; P = 0.01), and postmyectomy LAD (HR 1.80, 95% CI 1.21-2.70; P = 0.004) were associated with AF incidence during follow-up. Cardioembolic events occurred in only 15 patients (1.6%). POAF was not associated with increased cardioembolic risk, with only 3 patients with POAF suffering such an event, all more than 4 years after surgery. CONCLUSIONS: POAF is common in HCM patients undergoing myectomy and is a predictor of AF during follow-up. Over long-term follow-up, cardioembolic events are uncommon. These findings suggest that routine long-term anticoagulation for all HCM patients with postmyectomy AF is not justified after the initial postoperative period.


Assuntos
Fibrilação Atrial , Cardiomiopatia Hipertrófica , Humanos , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Relevância Clínica , Fatores de Risco , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/cirurgia , Período Pós-Operatório , Complicações Pós-Operatórias/epidemiologia
12.
J Environ Manage ; 97: 141-7, 2012 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-22281947

RESUMO

Soil science research has probably underestimated the significance that short-term, episodic cycles of reduction and oxidation has had on phosphorus (P) reactivity. Here, the effects of eleven pulsed reduction-oxidation (including wet-dry) cycles on soil P dynamics are compared for 12 soils having contrasting properties and all overfertilised with respect to P. The laboratory based incubation conditions attempted to simulate transient waterlogging of the soil profile and involved repeated sampling and analysis of both the solution and solid phase P forms. An initial increase in P concentration in solution that occurred up to and including the fourth full cycle was followed by a sharp decline in concentration for all but one soil. Accompanying changes in the main extractable forms of P, which appeared to be cumulative, could be summarised as a general decline in the organic P fraction and an overall increase in amorphous associated inorganic forms of P. The fact that up to 60% of the total soil P was demonstrated to change its sensitivity for a particular extractant suggests that these operationally defined P forms are susceptible to transformation as a consequence of changing environmental conditions. There was also a suggestion that certain of the changes in P forms were irreversible. While the laboratory conditions imposed do represent extreme conditions the soils only experienced cyclic changes in their moisture regime. If timing and frequency of intense precipitation events are likely to increase, as predicted in many climate change scenarios, then these results suggest that the effects of episodic redox pulses may have implications for P cycling in agricultural soils.


Assuntos
Agricultura , Clima , Fósforo/análise , Solo/química , Fertilizantes , Oxirredução , Fósforo/química
13.
Children (Basel) ; 9(4)2022 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-35455552

RESUMO

Childhood temperament is an early characteristic shaping later life adjustment. However, little is currently known about the stability of early temperament and its susceptibility to the environment in children born very preterm (VPT; <33 weeks' gestation). Here, we investigated infant-to-childhood temperamental trajectories, and their interaction with parental practices, in VPT children. Maternal reports of infant temperament were collected in 190 infants (mean age: 11.27 months; range 9−18 months) enrolled in the longitudinal Evaluation of Preterm Imaging (ePrime; Eudra: CT 2009-011602-42) study, using the ePrime questionnaire on infant temperament. At 4−7 years of age, further assessments of child temperament (Children's Behavior Questionnaire­Very Short Form) and parenting style (Arnold's Parenting Scale) were conducted. Results showed that more difficult temperament in infancy was associated with increased Negative Affectivity in childhood, regardless of parenting practices. This lends support to the stability of early temperamental traits reflecting negative emotionality. In contrast, a lax parenting style moderated the relationship between easy infant temperament and Negative Affectivity at 4−7 years, such that an easier infant temperament was increasingly associated with higher childhood Negative Affectivity scores as parental laxness increased. These results highlight a potential vulnerability of VPT infants considered by their mothers to be easy to handle, as they may be more susceptible to the effects of suboptimal parenting in childhood.

14.
Am J Cardiol ; 180: 124-139, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35965115

RESUMO

Surgical myectomy remains the time-honored primary treatment for hypertrophic cardiomyopathy patients with drug refractory limiting symptoms due to LV outflow obstruction. Based on >50 years experience, surgery reliably reverses disabling heart failure by permanently abolishing mechanical outflow impedance and mitral regurgitation, with normalization of LV pressures and preserved systolic function. A consortium of 10 international currently active myectomy centers report about 11,000 operations, increasing significantly in number over the most recent 15 years. Performed in experienced multidisciplinary institutions, perioperative mortality for myectomy has declined to 0.6%, becoming one of the safest currently performed open-heart procedures. Extended myectomy relieves symptoms in >90% of patients by ≥ 1 NYHA functional class, returning most to normal daily activity, and also with a long-term survival benefit; concomitant Cox-Maze procedure can reduce the number of atrial fibrillation episodes. Surgery, preferably performed in high volume clinical environments, continues to flourish as a guideline-based and preferred high benefit: low treatment risk option for adults and children with drug refractory disabling symptoms from obstruction, despite prior challenges: higher operative mortality/skepticism in 1960s/1970s; dual-chamber pacing in 1990s, alcohol ablation in 2000s, and now introduction of novel negative inotropic drugs potentially useful for symptom management.


Assuntos
Fibrilação Atrial , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica , Obstrução do Fluxo Ventricular Externo , Adulto , Fibrilação Atrial/complicações , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/complicações , Criança , Humanos , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/complicações , Obstrução do Fluxo Ventricular Externo/cirurgia
15.
Environ Sci Technol ; 45(12): 5112-7, 2011 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-21609007

RESUMO

Changes in land use/cover that are commonly associated with urbanization can dramatically influence the amount, chemical form, and spatial distribution of carbon (C) stocks. Measured values and relative literature for composition of natural and anthropogenic materials have been compiled. These data are used in conjunction with land cover statistics and expert assessment of building design to calculate C stocks associated with 150 years of land use change and development for an area of the Po River Valley, Northern Italy. Using 4 time periods (1853, 1954, 1976, and 2003), we demonstrate that the C stocks within this densely populated area have undergone considerable modification. A 52% increase in population density has been associated with an increase in the proportion of total C stored in anthropogenic stocks from 0.2% to 6%; this has been accompanied by a one order of magnitude increase in the carbon emission per capita per unit area. These changes have also been accompanied by a major shift in stocks from organic to inorganic forms of C.


Assuntos
Carbono/análise , Conservação dos Recursos Naturais , Atividades Humanas , Dióxido de Carbono/análise , Humanos , Itália , Minerais/química , Compostos Orgânicos/análise , Solo/química
16.
J Card Surg ; 26(6): 614-6, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21951172

RESUMO

Left ventricular thrombus formation in the presence of normal ventricular function is a rare phenomenon, with only seven cases described in the literature. Their morbidity arises from the embolic sequelae that ensues. The management of these patients is complex, and requires the decision-making process of both the medical and surgical teams.


Assuntos
Cardiopatias/diagnóstico , Neoplasias Cardíacas/diagnóstico , Trombectomia/métodos , Trombose/diagnóstico , Função Ventricular/fisiologia , Angiografia , Diagnóstico Diferencial , Ecocardiografia , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/fisiopatologia , Trombose/cirurgia
17.
J Psychol ; 145(1): 59-72, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21290930

RESUMO

Pensioners currently compose nearly 20% of the British population; men and women can expect to spend an average of about 17 years and 19 years in retirement, respectively. The present study aimed to investigate the roles of preretirement occupation and self-rated health (SRH) on the attainment of life satisfaction in retired people. A total of 121 community-dwelling men and women (M age = 75.8 years, SD = 7.1) completed a survey to assess life satisfaction, self-rated health, retirement stress, retirement adjustment, and recollected aspects of preretirement occupation. Results revealed positive and significant correlations between scores on a life satisfaction measure and SRH, retirement stress, and retirement adjustment (all ps < .001). Path analysis indicated that aspects of previous employment that may predict an adverse influence on current life satisfaction and that engagement in voluntary work appears to have benefits for both life satisfaction and SRH. The authors conclude that many of the adverse effects of preretirement occupation can be helped or avoided through suitable retirement preparation and training.


Assuntos
Nível de Saúde , Ocupações , Satisfação Pessoal , Aposentadoria/psicologia , Estresse Psicológico , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Transl Psychiatry ; 10(1): 131, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32376820

RESUMO

Studies in animal models of autism spectrum disorders (ASD) suggest atypical early neural activity is a core vulnerability mechanism which alters functional connectivity and predisposes to dysmaturation of neural circuits. However, underlying biological changes associated to ASD in humans remain unclear. Results from functional connectivity studies of individuals diagnosed with ASD are highly heterogeneous, in part because of complex life-long secondary and/or compensatory events. To minimize these confounds and examine primary vulnerability mechanisms, we need to investigate very early brain development. Here, we tested the hypothesis that brain functional connectivity is altered in neonates who are vulnerable to this condition due to a family history of ASD. We acquired high temporal resolution multiband resting state functional magnetic resonance imaging (fMRI) in newborn infants with and without a first-degree relative with ASD. Differences in local functional connectivity were quantified using regional homogeneity (ReHo) analysis and long-range connectivity was assessed using distance correlation analysis. Neonates who have a first-degree relative with ASD had significantly higher ReHo within multiple resting state networks in comparison to age matched controls; there were no differences in long range connectivity. Atypical local functional activity may constitute a biomarker of vulnerability, that might precede disruptions in long range connectivity reported in older individuals diagnosed with ASD.


Assuntos
Transtorno do Espectro Autista , Idoso , Transtorno do Espectro Autista/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Família , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Vias Neurais/diagnóstico por imagem
19.
Sci Total Environ ; 407(2): 975-90, 2009 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-18977514

RESUMO

A brief summary of the historical developments relating to plant distribution and aquatic macrophyte-nutrient indices provided a means of assessing the general context and validity of previous assumptions. This has particular current relevance because of the prominent use of bioindicators for defining nutrient enrichment. A survey of 161 sites distributed across two broadly contrasting groups of rivers (circum-neutral versus alkaline) recorded 110 species of aquatic macrophytes and these have been statistically analyzed to (i) rank and separate the individual effects of local environmental conditions and spatial isolation on species distribution in the two contrasting groups of sites; (ii) calculate a macrophyte index based on plant cover and species indicator values (Mean Trophic Rank, MTR); and finally (iii) investigate the implications for biomonitoring. Chemical, physical and hydrological site attributes together with spatial isolation, each explained a significant and at least partially independent influence over plant species distribution. It was extremely difficult, however, to separate the single effects of different site attributes on plant distribution. While some plant species are more restricted to certain environmental conditions, many appeared indifferent to the range of those being tested. The role played by nutrients (nitrogen (N) and phosphorus (P)) were either mostly indistinguishable from other site attributes (e.g., nitrate from conductivity) or subordinate (e.g., soluble reactive phosphorus, ammonium). It is therefore very unlikely that macrophyte species composition could provide a reliable bioindicator of the surrounding nutrient (N, P) status. The calculation of the plant index illustrated this unreliability by showing that strong correlations existed with many environmental variables, not just inorganic N and P.


Assuntos
Monitoramento Ambiental , Plantas/efeitos dos fármacos , Rios/química , Poluentes Químicos da Água , Abastecimento de Água/análise , Algoritmos , Inglaterra , Geografia , Concentração de Íons de Hidrogênio , Nitratos/metabolismo , Nitrogênio/metabolismo , Fósforo/metabolismo , Plantas/classificação , Plantas/metabolismo , Compostos de Amônio Quaternário/metabolismo , Escócia , Temperatura , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/metabolismo , Poluentes Químicos da Água/toxicidade , Abastecimento de Água/normas
20.
Can J Surg ; 52(2): 119-24, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19399206

RESUMO

BACKGROUND: Cardiac surgery is frequently associated with prolonged endotracheal intubation. Because oral feeding is an important component of patient recovery after high-risk surgery, we sought to examine the contribution of dysphagia in the recuperation process after prolonged endotracheal intubation. METHODS: All 254 adult patients who survived cardiac surgery between 2001 and 2004 at the Toronto General Hospital and in whom endotracheal intubation lasted for 48 hours or longer were eligible for our retrospective review. We used multivariate regression analysis and parametric modelling to identify patient-specific characteristics associated with postextubation dysphagia and the subsequent resumption of normal oral feeding. RESULTS: Dysphagia was diagnosed in 130 (51%) patients. Incremental factors associated with an increased risk for postextubation dysphagia included duration of endotracheal intubation (p < 0.001), the occurrence of a perioperative cerebrovascular event (p = 0.014) and the presence of perioperative sepsis (p = 0.016). Neither preoperative patient risks nor index procedural characteristics were influential factors. The occurrence of dysphagia (p < 0.001) and the duration of endotracheal intubation (p < 0.001) were the only independent factors associated with a delayed return to normal oral feeding. In contrast, several independent factors were associated with a delay to hospital discharge, including the presence of dysphagia (p < 0.001), occurrence of perioperative stroke (p < 0.001), duration of endotracheal intubation (p < 0.001) and number of endotracheal intubation events (p < 0.006). CONCLUSION: Dysphagia is more common in patients with prolonged endotracheal intubation after cardiac surgery than has previously been reported. The duration of postoperative endotracheal intubation is a strong predictor of subsequent dysphagia that both prolongs the return to normal oral feeding and delays subsequent hospital discharge. Patient-or procedure-specific factors are not good predictors. To accelerate discharge of high-risk patients, aggressive nutritional supplementation should pre-empt extubation and swallowing surveillance should follow.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares , Transtornos de Deglutição/etiologia , Intubação Intratraqueal/efeitos adversos , Idoso , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Período Pós-Operatório , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Sepse/complicações , Acidente Vascular Cerebral/complicações , Fatores de Tempo
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