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1.
Nature ; 543(7643): 83-86, 2017 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-28252065

RESUMO

The brightness of an active galactic nucleus is set by the gas falling onto it from the galaxy, and the gas infall rate is regulated by the brightness of the active galactic nucleus; this feedback loop is the process by which supermassive black holes in the centres of galaxies may moderate the growth of their hosts. Gas outflows (in the form of disk winds) release huge quantities of energy into the interstellar medium, potentially clearing the surrounding gas. The most extreme (in terms of speed and energy) of these-the ultrafast outflows-are the subset of X-ray-detected outflows with velocities higher than 10,000 kilometres per second, believed to originate in relativistic (that is, near the speed of light) disk winds a few hundred gravitational radii from the black hole. The absorption features produced by these outflows are variable, but no clear link has been found between the behaviour of the X-ray continuum and the velocity or optical depth of the outflows, owing to the long timescales of quasar variability. Here we report the observation of multiple absorption lines from an extreme ultrafast gas flow in the X-ray spectrum of the active galactic nucleus IRAS 13224-3809, at 0.236 ± 0.006 times the speed of light (71,000 kilometres per second), where the absorption is strongly anti-correlated with the emission of X-rays from the inner regions of the accretion disk. If the gas flow is identified as a genuine outflow then it is in the fastest five per cent of such winds, and its variability is hundreds of times faster than in other variable winds, allowing us to observe in hours what would take months in a quasar. We find X-ray spectral signatures of the wind simultaneously in both low- and high-energy detectors, suggesting a single ionized outflow, linking the low- and high-energy absorption lines. That this disk wind is responding to the emission from the inner accretion disk demonstrates a connection between accretion processes occurring on very different scales: the X-ray emission from within a few gravitational radii of the black hole ionizing the disk wind hundreds of gravitational radii further away as the X-ray flux rises.

2.
Paediatr Anaesth ; 33(3): 193-200, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36052662

RESUMO

BACKGROUND: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has shown to improve survival in patients with extensive or refractory abdominal tumors of many different histologies. Postoperative pain control can be challenging as the surgical procedure is performed through a midline laparotomy incision from xiphoid to symphysis pubis, and patients are usually nothing by mouth for the first 8-10 postoperative days. AIMS: We present the anesthetic management and postoperative pain control strategies for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy using a multimodal, opioid-sparing, and total intravenous anesthetic technique with a tunneled thoracic epidural. METHODS: A single institution retrospective review of anesthetic management, intraoperative fluid and blood administration, and postoperative pain control for pediatric patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy between July 2018 and December 2020 was conducted. We employed a novel anesthetic and analgesia protocol consisting of premedication with gabapentin followed by intraoperative infusions of propofol, dexmedetomidine, ketamine, and cisatracurium. A tunneled thoracic epidural catheter was placed for management of pain. RESULTS: We reviewed and analyzed the first 25 patient records. The most common diagnosis was desmoplastic small round cell tumor (n = 12). Median age of patients was 14 years (range 21 months-22 years). All patients were extubated in the operating room and no patients required reintubation. There were no incidences of acute kidney injury. Epidural infusions were used for a median of 8 days (range 2-14 days). Median postoperative intravenous opioid use (morphine equivalent) through postoperative day 10 was 0.02 mg/kg/day (range 0-0.86 mg/kg/day) administered for a median of 2 days (range 0-17 days). Nine patients (36%) did not require any intravenous opioids in the postoperative period. CONCLUSIONS: Utilizing a multimodal, opioid-sparing, total intravenous anesthetic technique in conjunction with a tunneled thoracic epidural catheter, we were able to avoid the need for postoperative mechanical ventilation and minimize both intraoperative and postoperative opioid requirements.


Assuntos
Analgesia Epidural , Anestesia , Anestésicos , Hipertermia Induzida , Criança , Humanos , Lactente , Analgesia Epidural/métodos , Analgésicos Opioides/uso terapêutico , Anestésicos/uso terapêutico , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Quimioterapia Intraperitoneal Hipertérmica , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Pré-Escolar , Adolescente , Adulto Jovem
3.
J Clin Psychol ; 79(1): 201-209, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35751901

RESUMO

AIMS: This exploratory pilot study (N = 3 sessions, 793 speech units) used task analysis to refine an early model of the attachment task in attachment-based family therapy (ABFT). The attachment task aims to repair long-standing parent-adolescent relational ruptures that inhibit parents from being a resource for adolescents recovering from depression and/or suicidality. METHODS: Video recordings of three attachment task sessions with strong adherence to the model were selected for intensive study. Two sessions were rated as successful (i.e., attachment was repaired) and one as unsuccessful (i.e., attachment repair did not occur). Sessions were then coded using Structural Analysis of Social Behavior (SASB). RESULTS: The current SASB analysis provided empirical support for our previous clinical impression that the task involves three parts: (I) adolescent disclosure of attachment rupture, (II) parent disclosure, and (III) a more mutual conversation. SASB also provided insights into more subtle elements of the model. CONCLUSION: Successful attachment sessions were associated with high parent affiliation and autonomy-both while affirming the adolescent's story and when disclosing their own experience. Unsuccessful task attempts were associated with parental enmeshment and hostile belittling, blaming, and distancing. An enhanced model of ideal parent behaviors during the attachment task is offered, including space for parent disclosure-perhaps even apology-that is both warm and independent, leading to a more mutual parent-adolescent conversation. Clinically, the findings support the importance of the therapist focusing on the process and quality of parent-child interactions to facilitate attachment repair.


Assuntos
Apego ao Objeto , Relações Pais-Filho , Adolescente , Humanos , Projetos Piloto , Terapia Familiar , Pais
4.
Ear Hear ; 43(5): 1515-1525, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35075042

RESUMO

OBJECTIVE: The purpose of this study was to provide empirical data describing the relationship between behavioral responses to dynamic visual motion in adults with chronic dizziness symptoms with and without clinically identifiable peripheral vestibular impairment. DESIGN: Prospective, quasi-experimental study including individuals with chronic dizziness symptoms with identified unilateral peripheral vestibular impairment (n=27), and individuals with chronic dizziness symptoms without identified vestibular impairment (n=26). We measured (a) visual perception of verticality in a dynamic background, (b) postural displacement in a dynamic background, (c) eye movement behaviors in various visual contexts, and (d) self-rating degree of anxiety. RESULTS: Status of peripheral vestibular function was not a significant predictor of behavioral responses to visual motion. The data show that the ability to fixate on a visual target was predictive of postural control in a dynamic visual background. Trial-to-trial variability in verticality responses and degree of self-rated anxiety were also associated with postural control. CONCLUSIONS: Apart from vestibular function, oculomotor control is important for maintaining control of whole-body motor responses during exposure to a dynamic visual stimulus. Vertical perception precision-not accuracy-may be more important for understanding real-world consequences of visual motion sensitivity. Traditional diagnostic evaluations focusing exclusively on characterizing the peripheral vestibular system may not provide insight into the behaviors associated with visual motion sensitivity.


Assuntos
Tontura , Doenças Vestibulares , Adulto , Tontura/diagnóstico , Movimentos Oculares , Humanos , Equilíbrio Postural/fisiologia , Estudos Prospectivos , Doenças Vestibulares/diagnóstico
5.
Ear Hear ; 41(1): 125-135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31107362

RESUMO

OBJECTIVES: The Subjective Visual Vertical (SVV) test and the closely related Rod and Disk Test (RDT) are measures of perceived verticality measured in static and dynamic visual backgrounds. However, the equipment used for these tests is variable across clinics and is often too expensive or too primitive to be appropriate for widespread use. Commercial virtual reality technology, which is now widely available, may provide a more suitable alternative for collecting these measures in clinical populations. This study was designed to investigate verticality perception in symptomatic patients using a modified RDT paradigm administered through a head-mounted display (HMD). DESIGN: A group of adult patients referred by a physician for vestibular testing based on the presence of dizziness symptoms and a group of healthy adults without dizziness symptoms were included. We investigated degree of visual dependence in both groups by measuring SVV as a function of kinematic changes to the visual background. RESULTS: When a dynamic background was introduced into the HMD to simulate the RDT, significantly greater shifts in SVV were found for the patient population than for the control population. In patients referred for vestibular testing, the SVV measured with the HMD was significantly correlated with traditional measures of SVV collected in a rotary chair when accounting for head tilt. CONCLUSIONS: This study provides initial proof of concept evidence that reliable SVV measures in static and dynamic visual backgrounds can be obtained using a low-cost commercial HMD system. This initial evidence also suggests that this tool can distinguish individuals with dizziness symptomatology based on SVV performance in dynamic visual backgrounds.


Assuntos
Realidade Virtual , Adulto , Tontura , Humanos , Tecnologia , Vertigem , Percepção Visual
6.
Inorg Chem ; 58(9): 6399-6409, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31016964

RESUMO

A series of intermolecular transition metal frustrated Lewis pairs (FLPs) based on zirconocene alkoxide complexes ([Cp2Zr(OMes)]+ 1 or ([Cp*2Zr(OMes)]+ 2) with nitrogen Lewis bases (NEt3, NEtiPr2, pyridine, 2-methylpyridine, 2,6-lutidine) are reported. The interaction between Zr and N depends on the specific derivatives used, in general more sterically encumbered pairs leading to a more frustrated interaction; however, DOSY NMR spectroscopy reveals these interactions to be dynamic in nature. The pairs undergo typical FLP-type reactivity with D2, CO2, THF, and PhCCD. The catalytic dehydrocoupling of Me2NH·BH3 is also reported. Comparisons can be made with previous work employing phosphines as Lewis bases suggesting that hard-hard or hard-soft acid-base considerations are of little importance compared to the more prominent roles of steric bulk and basicity.

7.
Neurourol Urodyn ; 38(3): 968-974, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30801793

RESUMO

AIMS: Neurogenic lower urinary tract dysfunction is common in individuals with spinal cord injury and disorders (SCI/D). The purpose of this study was to identify specific demographic, neurologic, and urologic factors associated with different bladder management methods (BMMs) in individuals with SCI/D. METHODS: A retrospective review of BMMs at a large Veterans Affairs SCI/D center was performed to identify associated risk factors including demographics, neurologic factors, and urologic factors. Bivariate analysis was performed to identify factors associated with specific BMMs. Then, a propensity-matched racial group analysis was performed to identify independent factors associated with differences in BMM. RESULTS: Data from 833 patients with SCI/D were reviewed and included 52.1% Caucasians and 39.6% African Americans. On bivariate analysis, current age, years since the injury, the severity of functional impairment, nonmedical mechanism of injury, and Caucasian race were associated with increased rates of indwelling catheter use. In an analysis of propensity-matched racial groups, African-American race was found to be an independent risk factor for not using indwelling catheters on multivariate analysis (odds ratio = 0.55). This finding was not related to access to care, as the rate of urodynamic testing was similar between races ( P = 0.174). CONCLUSIONS: Caucasians were more likely to use indwelling catheters and less likely to use conservative BMMs despite proper urodynamic evaluation. The racial discrepancy suggests a need for future research aimed at identifying unknown psychosocial factors associated with the use of indwelling catheters in individuals with SCI/D.


Assuntos
Doenças da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/reabilitação , Bexiga Urinaria Neurogênica/reabilitação , Bexiga Urinária , Veteranos/estatística & dados numéricos , Adulto , População Negra , Cateteres de Demora , Tratamento Conservador , Etnicidade , Feminino , Humanos , Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/reabilitação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Doenças da Medula Espinal/complicações , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia , Cateterismo Urinário , População Branca
8.
Neurourol Urodyn ; 36(2): 349-353, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-26588591

RESUMO

AIMS: The primary objectives were to describe the rate of repeat surgery for stress urinary incontinence (SUI) after release of an obstructing synthetic mid-urethral sling (MUS) and to evaluate the effect of time from sling placement to sling release on repeat surgery rates. The secondary objective was to assess rates of recurrent and persistent SUI. METHODS: This is a retrospective review of women who underwent synthetic MUS release (incision or excision of segment of sling) from 2005-2013. SUI rates and repeat surgery were ascertained by patient report and urinary distress inventory (UDI-6) questionnaire responses. Data analysis included descriptive statistics and multivariable logistic regression analysis. RESULTS: 107 patients were included. Median time to sling release was 22 months (IQR 5-49 months). 43.2% were transobturator slings. 15/107 patients (14%) underwent repeat surgery for SUI. On multivariable analysis, women were significantly less likely to undergo repeat surgery for SUI when sling release was performed >24 months after initial sling surgery (OR 0.12, 95% CI 0.02-0.85, P = 0.03) compared to release within 3 months. 49% and 77% reported recurrent and persistent SUI after sling release, of which 83% were significantly bothered. CONCLUSION: The repeat surgery rate for SUI was 14%. The rate of recurrent SUI was 49%. Most of these women were significantly bothered. On multivariate analysis, longer interval to sling release was associated with decreased likelihood of repeat surgery for SUI. The reason for a low repeat surgery rate for SUI despite a high rate of bothersome SUI should be explored in future studies. Neurourol. Urodynam. 36:349-353, 2017. © 2015 Wiley Periodicals, Inc.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Implantação de Prótese , Reoperação , Estudos Retrospectivos , Fatores de Tempo
9.
World J Urol ; 33(9): 1257-62, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25991600

RESUMO

INTRODUCTION: Concomitant anti-incontinence surgery at the time of prolapse repair has been a long-debated topic. Still today, there remains no clear answer to this question, although in recent years the literature has become more robust with the addition of more randomized controlled trials. The lifetime risk for women of undergoing surgical correction of pelvic organ prolapse is significant, and concomitant anti-incontinence surgery is an important question during surgical planning. MATERIALS AND METHODS: This review delves further into the current literature to discuss a possible algorithm for managing the risk of stress incontinence after pelvic organ prolapse repair and examines the support in the literature for the following treatment methods: (1) anti-incontinence surgery for all women undergoing pelvic organ prolapse repair, (2) anti-incontinence surgery for no women undergoing pelvic organ prolapse repair, and (3) anti-incontinence surgery in select women undergoing pelvic organ prolapse repair. CONCLUSIONS: While there are data both for and against each of these approaches, after a review of the literature, we recommend anti-incontinence surgery for select women undergoing pelvic organ prolapse repair, including women with a history of symptomatic and occult stress incontinence diagnosed preoperatively.


Assuntos
Gerenciamento Clínico , Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária por Estresse/cirurgia , Feminino , Humanos , Prolapso de Órgão Pélvico/complicações , Incontinência Urinária por Estresse/etiologia
10.
Nat Rev Immunol ; 2(9): 656-63, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12209134

RESUMO

The fetus is considered to be an allograft that, paradoxically, survives pregnancy despite the laws of classical transplantation immunology. There is no direct contact of the mother with the embryo, only with the extraembryonic placenta as it implants in the uterus. No convincing evidence of uterine maternal T-cell recognition of placental trophoblast cells has been found, but instead, there might be maternal allorecognition mediated by uterine natural killer cells that recognize unusual fetal trophoblast MHC ligands.


Assuntos
Células Matadoras Naturais/imunologia , Placenta/imunologia , Gravidez/imunologia , Útero/imunologia , Animais , Feminino , Feto/imunologia , Humanos , Tolerância Imunológica , Imunidade Inata , Complexo Principal de Histocompatibilidade/imunologia , Modelos Animais , Placenta/citologia , Placentação/imunologia , Imunologia de Transplantes , Trofoblastos/citologia , Trofoblastos/imunologia , Útero/irrigação sanguínea
11.
J Urol ; 191(2): 389-94, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23973517

RESUMO

PURPOSE: The Elevate® Anterior and Apical Prolapse Repair System is a polypropylene mesh that is anchored through sacrospinous ligament and obturator fascia fixation points. We present a comprehensive evaluation of this prolapse repair system through 2 years with a focus on safety, operative characteristics, and anatomical, subjective and quality of life outcomes. MATERIALS AND METHODS: A total of 42 women underwent repair of stage II or greater anterior/apical compartment prolapse using the repair system, of whom 2 were lost to followup. Anatomical outcomes were assessed using POP-Q (Pelvic Organ Prolapse Quantification) staging. Subjective and quality of life outcomes were assessed by the validated ICIQ (International Consultation on Incontinence Questionnaire)-VS (Vaginal Symptoms), ICIQ-FLUTS (Female Lower Urinary Tract Symptoms) and IIQ-7 (Incontinence Impact Questionnaire-7). Additional outcomes included a 3-day bladder diary and cough test with outcomes assessed preoperatively, at 6 weeks, and at 1 and 2 years. RESULTS: Mean ± SD blood loss was 93 ± 55 cc and mean operative time was 58 ± 27 minutes. POP-Q points Aa, Ba and C improved from 0.9, 0.8 and -1.3 preoperatively to -2.1, -2.7 and -6.1 cm at 2 years, respectively (each p <0.05). Four patients experienced anatomical recurrence, which was associated in 2 with symptomatic recurrence on the ICIQ-VS. Statistically significant improvements in the ICIQ-VS, ICIQ-FLUTS and IIQ-7 were seen throughout followup. Adverse events included leg pain, vaginal exposure and urinary retention in 1, 2 and 5 patients, respectively. CONCLUSIONS: The Elevate Anterior and Apical Prolapse Repair System was associated with good anatomical restoration and significant improvements in validated symptom and quality of life indexes through 2 years of assessments. Our experience suggests that the system is a safe, effective surgical procedure in appropriately selected patients. Long-term followup is important, given the FDA (Food and Drug Administration) warning regarding the use of surgical mesh in the repair of pelvic organ prolapse.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Prolapso de Órgão Pélvico/complicações , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia
12.
World J Urol ; 32(1): 85-90, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23633125

RESUMO

INTRODUCTION: There is growing acceptance that the detrusor muscle is not silent during the filling phase of the micturition cycle but displays low-amplitude phasic contractions that have been associated with urinary urgency. Unfortunately, there is currently no standardized methodology to quantify detrusor rhythm during the filling phase. Therefore, the purpose of this study was to develop an automated computer algorithm to analyze rat detrusor rhythm in a quick, accurate, and reproducible manner. MATERIALS AND METHODS: Strips of detrusor smooth muscle from rats (n = 17) were placed on force transducers and subjected to escalating doses of PGE2 to generate contractile rhythm tracings. An automated computer algorithm was developed to analyze contractile frequency, amplitude, and tone on the generated rhythm tracings. Results of the automated computerized analysis were compared to human (n = 3) interpretations. Human interpreters manually counted contractions and then recounted the same data two weeks later. Intra-observer, inter-observer, and human-to-computer comparisons were performed. RESULTS: The computer algorithm quantified concentration-dependent changes in contractile frequency, amplitude, and tone after administration of PGE2 (10(-9)-10(-6)M). Concentration-response curves were similar for all contractile components with increases in frequency identified mainly at physiologic concentrations of PGE2 and increases in amplitude at supra-physiologic concentrations. The computer algorithm consistently over-counted the human interpreters, but with less variability. Differences in inter-observer consistency were statistically significant. CONCLUSIONS: Our computerized algorithm accurately and consistently identified changes in detrusor muscle contractile frequency, amplitude, and tone with varying doses of PGE2. Frequency counts were consistently higher than those obtained by human interpreters but without variability or bias. Refinements of this method may allow for more standardized approach in the study of pharmacologic agents on filling phase rhythmic activity.


Assuntos
Algoritmos , Simulação por Computador , Contração Muscular/fisiologia , Músculo Liso/fisiologia , Bexiga Urinária/fisiologia , Micção/fisiologia , Animais , Dinoprostona/farmacologia , Relação Dose-Resposta a Droga , Feminino , Masculino , Modelos Animais , Músculo Liso/efeitos dos fármacos , Variações Dependentes do Observador , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY , Ratos Wistar , Bexiga Urinária/efeitos dos fármacos
13.
Curr Urol Rep ; 15(11): 453, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25234187

RESUMO

Midurethral synthetic slings are the gold standard treatment for stress urinary incontinence. However, recent concerns have been raised regarding a possible association between synthetic midurethral slings and malignancy. The aim of this editorial was to examine the data behind these concerns. After a review of the data, no evidence was found to suggest that polypropylene midurethral slings are associated with a risk of malignancy.ᅟ


Assuntos
Slings Suburetrais , Telas Cirúrgicas , Neoplasias Uretrais/etiologia , Feminino , Reação a Corpo Estranho/epidemiologia , Humanos , Fichas de Dados de Segurança de Materiais , Polipropilenos , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Neoplasias da Bexiga Urinária/etiologia , Neoplasias Vaginais/etiologia
14.
Curr Urol Rep ; 15(9): 436, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25059639

RESUMO

Bladder outlet obstruction (BOO) in women has received less focus in the past, as compared with BOO in men; however, more recently, studies have further examined BOO and voiding dysfunction in women to define the various etiologies, diagnostic criteria, and treatment strategies. The differential diagnosis in women is broad and includes anatomic, neurologic, and functional etiologies. This review focuses on the functional etiologies, including dysfunctional voiding, Fowler's syndrome, and primary bladder neck obstruction in adult women.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Terapia por Estimulação Elétrica/métodos , Distúrbios do Assoalho Pélvico/terapia , Modalidades de Fisioterapia , Obstrução do Colo da Bexiga Urinária/terapia , Feminino , Humanos , Plexo Lombossacral , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/diagnóstico , Doenças Uretrais/complicações , Doenças Uretrais/diagnóstico , Doenças Uretrais/terapia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia
15.
Nat Commun ; 15(1): 778, 2024 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-38278803

RESUMO

Organic matter in extraterrestrial samples is a complex material that might have played an important role in the delivery of prebiotic molecules to the early Earth. We report here on the identification of nitrogen-containing compounds such as amino acids and N-heterocycles within the recent observed meteorite fall Winchcombe by high-spatial resolution spectroscopy techniques. Although nitrogen contents of Winchcombe organic matter are low (N/C ~ 1-3%), we were able to detect the presence of these compounds using a low-noise direct electron detector. These biologically relevant molecules have therefore been tentatively found within a fresh, minimally processed meteorite sample by high spatial resolution techniques conserving the overall petrographic context. Carbon functional chemistry investigations show that sizes of aromatic domains are small and that abundances of carboxylic functional groups are low. Our observations demonstrate that Winchcombe represents an important addition to the collection of carbonaceous chondrites and still preserves pristine extraterrestrial organic matter.

16.
Can J Urol ; 20(6): 7042-5, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24331346

RESUMO

INTRODUCTION: Audience response systems (ARS) have not been used to gauge knowledge transfer and retention in the setting of large medical conferences. In this study, we explore the utility of an ARS as an educational tool in the setting of a large urology conference. MATERIALS AND METHODS: At the 2011 joint meeting of the Mid-Atlantic and New England sections of the American Urological Association, conference attendees were able to use a web-based and cell-phone accessed ARS. At the meeting, six ARS questions were asked during five point-counterpoint debate topics covering areas of prostate cancer, incontinence, pediatrics, stone disease, and renal cancer. Questions were presented by expert representatives from each of the sections; questions were structured as management options for predefined cases. At the beginning and end of each 15-minute session, attendees were asked to use the ARS to select the best management option. RESULTS: In five out of the six questions (83%) more than 10% of responses were changed following the presentation of the point-counterpoint session and a > 25% change in response was noted in two out of the six questions (33%). A statistically significant change was noted for one question relating to management of urolithiasis in pregnancy (p = 0.037). CONCLUSIONS: This is the first study which demonstrates the potential utility of an ARS in a large urology conference. With further research it may be possible to use this technology to identify high-yield topics for medical education and improve outcomes during lecture-based educational activities.


Assuntos
Congressos como Assunto , Coleta de Dados/métodos , Conhecimentos, Atitudes e Prática em Saúde , Urologia/educação , Educação Médica Continuada , Humanos , Aprendizagem , Sociedades Médicas
17.
J Marital Fam Ther ; 49(3): 654-674, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37403806

RESUMO

Therapists report significant countertransference reactions when treating clients with eating disorders (EDs). Countertransference may be pronounced among therapists with eating disorder lived experience (EDLE). Minimal research examines how therapists with EDLE negotiate their experiences while treating ED clients. Informed by the person-of-the-therapist philosophy, this study sought to understand how therapists use and manage their EDLE when working with ED clients. Using constructivist grounded theory methodology, semistructured interviews (Mtime = 89 min) were conducted with 22 therapists with EDLE. Results revealed that therapists engaged in two interconnected systems. The Central System helps therapists transform their lived experiences into clinical guidance. The Checks and Balances System allows therapists to find a balance between connecting with the client and allowing for differences in experiences to emerge. Lastly, three personal processes existing outside of these systems were found to impact therapists' use of self. Findings provide novel ways that therapists can use their EDLE.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Humanos , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Relações Profissional-Paciente , Psicoterapia/métodos
18.
J Am Acad Audiol ; 2023 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-36070782

RESUMO

BACKGROUND: Vestibular migraine (VM) is one of the common causes of episodic dizziness, but it is underdiagnosed and poorly understood. Previous research suggests that otolith reflex pathway performance is often impaired in this patient group, leading to altered perception of roll plane stimuli. Clinically, this perception can be measured with subjective visual vertical (SVV) testing. PURPOSE: The aim of this study is to compare static SVV performance (absolute mean SVV tilt, variance) in a cohort of patients diagnosed with VM to results obtained from clinically derived normative data. STUDY DESIGN: Retrospective case review. STUDY SAMPLE: Ninety-four consecutive patients between 18 and 65 years of age diagnosed with VM were included in this comparison to clinically derived normative data. DATA COLLECTION AND ANALYSIS: Retrospective chart review was completed. Demographic data, symptom report, and vestibular laboratory results were documented. SVV performance was documented in terms of absolute mean SVV tilt and response variance. RESULTS: Abnormal mean SVV tilt was described in 54% (n = 51) of patients with VM. Including abnormal response variance increased those identified with abnormal presentation to 67% (n = 63). Laboratory findings were insignificant for semicircular canal function, but of those with abnormal ocular vestibular myogenic potential results (n = 30), 77% (n = 23) demonstrated both abnormal SVV and utriculo-ocular reflex performance. There were no associations noted for SVV performance and demographic or other self-report variables. CONCLUSION: Absolute mean SVV tilt and response variance are often abnormal in patients diagnosed with VM. These findings support theories suggesting atypical intralabyrinthine integration within the vestibular nuclei and cerebellar nodular pathways.

19.
J Pediatr Surg ; 58(6): 1170-1177, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36922278

RESUMO

BACKGROUND: Resection-associated liver steatosis, injury, and fibrosis is a devastating complication associated with massive small bowel resection (SBR). Peroxisome proliferator-activated receptor-alpha (PPARα) is a key regulator of intestinal lipid transport and metabolism whose expression is selectively increased after SBR. Here we asked if attenuating intestinal PPARα signaling would prevent steatosis and liver injury after SBR. METHODS: Pparα was deleted selectively in adult mouse intestine using a tamoxifen-inducible Cre-LoxP breeding schema. Mice underwent 50% SBR. At 10 weeks post-operatively, metabolic phenotyping, body composition analysis, in vivo assessment of lipid absorption and intestinal permeability, and assessment of adaptation and liver injury was completed. RESULTS: Pparα intestinal knockout and littermate control mice were phenotypically similar in terms of weight trends and body composition after SBR. All mice demonstrated intestinal adaptation with increased villus height and crypt depth; however, Pparα intestinal knockout mice exhibited decreased villus growth at 10 weeks compared to littermate controls. Liver injury and fibrosis were similar between groups as assessed by serum AST and ALT levels, Sirius Red staining, and hepatic expression of Col1a1 and Acta2. CONCLUSIONS: Inducible intestinal deletion of Pparα influences structural adaptation but does not mitigate liver injury after SBR. These findings suggest that enterocyte PPARα signaling in adult mice is dispensable for resection-induced liver injury. The results are critical for understanding the contribution of intestinal lipid metabolic signaling pathways to the pathogenesis of hepatic injury associated with short bowel syndrome.


Assuntos
Intestino Delgado , PPAR alfa , Animais , Camundongos , Adaptação Fisiológica , Intestino Delgado/cirurgia , Lipídeos , Camundongos Endogâmicos C57BL , Camundongos Knockout , PPAR alfa/genética , PPAR alfa/metabolismo
20.
Artigo em Inglês | MEDLINE | ID: mdl-37623193

RESUMO

People on buprenorphine maintenance treatment (BMT) commonly present cognitive deficits that have been associated with illicit drug use and dropout from buprenorphine treatment. This study has compared cognitive responses to the Stroop Task and the Continuous Performance Task (CPT) among individuals on BMT, with recent drug use, and healthy controls and explored the associations between cognitive responses and drug use, craving, and buprenorphine use among participants on BMT. The participants were 16 individuals on BMT and 23 healthy controls. All participants completed a 60 min laboratory session in which they completed the Stroop Task and the CPT, a saliva drug test, a brief clinical history that collected substance-use- and treatment-related information, and the Opioid Craving Scale. The results showed that the BMT participants presented more commission errors (MBMT participants = 2.49; Mhealthy controls = 1.38; p = 0.048) and longer reaction times (MBMT participants = 798.09; Mhealthy controls = 699.09; p = 0.047) in the Stroop Task than did the healthy controls. More days on buprenorphine were negatively associated with reaction time in the CPT (-0.52) and the number of commission errors (-0.53), simple reaction time (-0.54), and reaction time correct (-0.57) in the Stroop Task. Neither drug use nor craving was significantly associated with the results for the cognitive tasks. Relative to the control participants, the BMT individuals performed worse in terms of longer reaction times and more commission errors in the Stroop Task. Within the BMT participants, longer times on buprenorphine were associated with better cognitive results in terms of faster reaction times for both tasks and lower commission errors for the Stroop Task.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Humanos , Buprenorfina/uso terapêutico , Projetos Piloto , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Analgésicos Opioides , Cognição
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