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2.
Nature ; 541(7635): 77-80, 2017 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-27880756

RESUMO

The West Antarctic Ice Sheet is one of the largest potential sources of rising sea levels. Over the past 40 years, glaciers flowing into the Amundsen Sea sector of the ice sheet have thinned at an accelerating rate, and several numerical models suggest that unstable and irreversible retreat of the grounding line-which marks the boundary between grounded ice and floating ice shelf-is underway. Understanding this recent retreat requires a detailed knowledge of grounding-line history, but the locations of the grounding line before the advent of satellite monitoring in the 1990s are poorly dated. In particular, a history of grounding-line retreat is required to understand the relative roles of contemporaneous ocean-forced change and of ongoing glacier response to an earlier perturbation in driving ice-sheet loss. Here we show that the present thinning and retreat of Pine Island Glacier in West Antarctica is part of a climatically forced trend that was triggered in the 1940s. Our conclusions arise from analysis of sediment cores recovered beneath the floating Pine Island Glacier ice shelf, and constrain the date at which the grounding line retreated from a prominent seafloor ridge. We find that incursion of marine water beyond the crest of this ridge, forming an ocean cavity beneath the ice shelf, occurred in 1945 (±12 years); final ungrounding of the ice shelf from the ridge occurred in 1970 (±4 years). The initial opening of this ocean cavity followed a period of strong warming of West Antarctica, associated with El Niño activity. Thus our results suggest that, even when climate forcing weakened, ice-sheet retreat continued.

3.
Eur Psychiatry ; 24(6): 373-9, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19726165

RESUMO

BACKGROUND: Antisocial behaviour is common among patients with severe mental illness (SMI) requiring hospitalisation. AIM: To determine whether differential treatments and services are provided to patients with SMI who engage in antisocial behaviour. METHOD: A random sample of 161 inpatients with SMI were recruited from general adult wards and assessed at baseline and two years later. Information on symptoms, aggressive behaviour, substance misuse, and service use was obtained from patients and clinical files. RESULTS: Past antisocial behaviours were not associated with type or intensity of treatments and services. Severity of positive symptoms, aggressive behaviour, and illicit drug use were positively associated with the frequency of CMHT contact, but not with the type of CMHT, type of medication, or other treatments and benefits. CONCLUSIONS: While the frequency of meetings with CMHTs increased with the severity of antisocial behaviours, no specific treatments were provided to patients with SMI engaging in antisocial behaviours.


Assuntos
Transtorno da Personalidade Antissocial/reabilitação , Internação Compulsória de Doente Mental/legislação & jurisprudência , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Crime/legislação & jurisprudência , Equipe de Assistência ao Paciente/legislação & jurisprudência , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Adulto , Agressão/psicologia , Alcoolismo/diagnóstico , Alcoolismo/reabilitação , Transtorno da Personalidade Antissocial/diagnóstico , Transtorno da Personalidade Antissocial/epidemiologia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/reabilitação , Terapia Combinada/estatística & dados numéricos , Internação Compulsória de Doente Mental/estatística & dados numéricos , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Estudos Transversais , Feminino , Seguimentos , Humanos , Drogas Ilícitas , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Readmissão do Paciente/legislação & jurisprudência , Readmissão do Paciente/estatística & dados numéricos , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Recidiva , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Reino Unido , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos , Violência/legislação & jurisprudência , Violência/prevenção & controle , Violência/estatística & dados numéricos
4.
Lancet ; 345(8953): 811-6, 1995 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-7898227

RESUMO

Low-density-lipoprotein (LDL) apheresis has the theoretical advantage over anion-exchange resins and hydroxymethylglutaryl coenzyme A inhibitors of decreasing lipoprotein(a) as well as LDL. To confirm this advantage, patients with heterozygous familial hypercholesterolaemia and coronary artery disease were randomised to receive LDL apheresis fortnightly (with disposable dextran sulphate/cellulose columns) plus simvastatin 40 mg daily, or colestipol 20 g plus simvastatin 40 mg daily. Quantitative coronary angiography was repeated after a mean of 2.1 years in 20 patients undergoing apheresis and in 19 on combination drug therapy. Changes in serum lipoproteins were similar in both groups apart from greater lowering by apheresis of LDL cholesterol (3.2 vs 3.4 mmol/L in drug group, p = 0.03) and lipoprotein(a) (geometric means 14 vs 21 mg/dL, p = 0.03). There were no significant differences in primary angiographic endpoints per patient but lesion-based and segment-based secondary endpoints were biased in favour of the drug group (change in minimum lumen diameter of lesions 0.07 vs -0.004 mm, p = 0.046; change in mean lumen diameter of segments 0.02 vs -0.06 mm, p = 0.01). None of the angiographic changes correlated with lipoprotein(a) concentrations. Per patient changes in % diameter stenosis and minimum lumen diameter in the two groups were as or more favourable than those observed in five published trials that assessed lipid-lowering drug therapy by quantitative coronary angiography. Although LDL apheresis combined with simvastatin was more effective than colestipol plus simvastatin in reducing LDL cholesterol and lipoprotein(a), it was less beneficial in influencing coronary atherosclerosis and should be reserved for patients unresponsive to drugs. Decreasing lipoprotein(a) seems to be unnecessary if LDL cholesterol is reduced to 3.4 mmol/L or less.


Assuntos
Remoção de Componentes Sanguíneos , Hiperlipoproteinemia Tipo II/terapia , Lipoproteínas LDL/sangue , Adulto , Resina de Colestiramina/uso terapêutico , Colestipol/uso terapêutico , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/terapia , Interpretação Estatística de Dados , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/complicações , Hipolipemiantes/uso terapêutico , Lipídeos/sangue , Lipoproteína(a)/sangue , Lovastatina/análogos & derivados , Lovastatina/uso terapêutico , Pessoa de Meia-Idade , Razão de Chances , Sinvastatina
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