The role of loneliness in the development of depressive symptoms among partnered dementia caregivers: Evidence from the English Longitudinal Study of Aging.

BACKGROUND: Depressive symptoms are highly prevalent among partnered dementia caregivers, but the mechanisms are unclear. This study examined the mediating role of loneliness in the association between dementia and other types of care on subsequent depressive symptoms. METHODS: Prospective data from partnered caregivers were drawn from the English Longitudinal Study of Aging. The sample consisted of 4,672 partnered adults aged 50-70 living in England and Wales, followed up between 2006-2007 and 2014-2015. Caregiving was assessed across waves 3 (2006-2007), 4 (2008-2009), and 5 (2010-2011), loneliness at wave 6 (2012-2013), and subsequent depressive symptoms at wave 7 (2014-15). Multivariable logistic regression models were used to assess the association between caregiving for dementia and depressive symptoms compared to caregiving for other illnesses (e.g., diabetes, coronary heart disease (CHD), cancer, and stroke). Binary mediation analysis was used to estimate the indirect effects of caregiving on depressive symptoms via loneliness. RESULTS: Care for a partner with dementia was associated with higher odds of depressive symptoms at follow-up compared to those not caring for a partner at all (odds ratio [OR] = 2.6, 95% confidence intervals [CI]: 1.4, 5.1). This association was partially mediated by loneliness (34%). Care for a partner with other conditions was also associated with higher odds of depressive symptoms compared to non-caregiving partners (OR = 1.7, 95% CI: 1.2, 2.5), but there was no evidence of an indirect pathway via loneliness. CONCLUSION: Loneliness represents an important contributor to the relationship between dementia caregiving and subsequent depressive symptoms; therefore, interventions to reduce loneliness among partnered dementia caregivers should be considered.

Tropospheric Emissions: Monitoring of Pollution (TEMPO).

TEMPO was selected in 2012 by NASA as the first Earth Venture Instrument, for launch between 2018 and 2021. It will measure atmospheric pollution for greater North America from space using ultraviolet and visible spectroscopy. TEMPO observes from Mexico City, Cuba, and the Bahamas to the Canadian oil sands, and from the Atlantic to the Pacific, hourly and at high spatial resolution (~2.1 km N/S×4.4 km E/W at 36.5°N, 100°W). TEMPO provides a tropospheric measurement suite that includes the key elements of tropospheric air pollution chemistry, as well as contributing to carbon cycle knowledge. Measurements are made hourly from geostationary (GEO) orbit, to capture the high variability present in the diurnal cycle of emissions and chemistry that are unobservable from current low-Earth orbit (LEO) satellites that measure once per day. The small product spatial footprint resolves pollution sources at sub-urban scale. Together, this temporal and spatial resolution improves emission inventories, monitors population exposure, and enables effective emission-control strategies. TEMPO takes advantage of a commercial GEO host spacecraft to provide a modest cost mission that measures the spectra required to retrieve ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), formaldehyde (H2CO), glyoxal (C2H2O2), bromine monoxide (BrO), IO (iodine monoxide),water vapor, aerosols, cloud parameters, ultraviolet radiation, and foliage properties. TEMPO thus measures the major elements, directly or by proxy, in the tropospheric O3 chemistry cycle. Multi-spectral observations provide sensitivity to O3 in the lowermost troposphere, substantially reducing uncertainty in air quality predictions. TEMPO quantifies and tracks the evolution of aerosol loading. It provides these near-real-time air quality products that will be made publicly available. TEMPO will launch at a prime time to be the North American component of the global geostationary constellation of pollution monitoring together with the European Sentinel-4 (S4) and Korean Geostationary Environment Monitoring Spectrometer (GEMS) instruments.

[Optimization of inventory levels in the blood transfusion centers in Morocco]. / Optimisation des niveaux de stock dans les centres de transfusion sanguine au Maroc.

PURPOSE OF THE STUDY: Improve the flow of quantities of blood products between the different centers to restore the ideal quantities at low cost. MATERIALS AND METHODS: The problem addressed in this work concerns the balancing inventory levels between blood transfusion centers in Morocco. This problem is characterized by a number of constraints to be taken into account: safety stock, stock ideal proportional balancing of stocks, etc. An integer linear model has been proposed to determine the optimal allocation between different centers. Two variants are examined; the first which aims to minimize the level of inventory loss, the second is to balance the different levels of stock, so that all centers have a level of surplus stock and/or loss proportional to the ideal stock. RESULTS: Two variants of an integer linear model that determine the optimal allocation between different centers has been proposed and their performance was evaluated by experimental results obtained using a solver commercial. CONCLUSION: The results of this study allow us to meet the goal of PSL availability of sufficient and subsequently the quality of service required blood transfusion.

[Multiple recurrences of cardiac myxomas with acute tumoral pulmonary embolism]. / Múltipla recorrência de Mixomas Cardíacos com embolia pulmonar aguda.

We report the case of a 42-year-old female with a second recurrence of cardiac myxoma. Her first diagnosis was at the age of 24 years, when cardiac tumors were withdrawn from her right ventricle and left atrium. Her first recurrence was at the age of 36 years, when tumors were removed from the left and right atria, and the right ventricle. Six years later, the patient was admitted to the Hospital das Clínicas de Porto Alegre complaining of sudden dyspnea, dry cough, and pain in the right hypochondrium, which bore no relation to breathing. The transesophageal echocardiography showed a small tumor in the interatrial septum, close to the superior vena cava, and 2 larger tumors in the right ventricle, 1 close to the outflow tract and the other almost completely obstructing the right branch of the pulmonary artery. The patient was referred to surgery, in which myxomas were removed from the right atrium and ventricle with extension to the right pulmonary artery. The postoperative period was uneventful.

Propofol action in both spinal cord and brain blunts electroencephalographic responses to noxious stimulation in goats.

STUDY OBJECTIVES: Anesthetics, including propofol, depress the electroencephalogram (EEG) and neuronal activity in the midbrain reticular formation (MRF). Because propofol has anesthetic effects in the spinal cord, we hypothesized that it would indirectly depress EEG and MRF neuronal responses to noxious stimulation in part by a spinal cord action. DESIGN: Six goats were anesthetized with isoflurane and the jugular veins and carotid arteries were isolated to permit cranial bypass and differential propofol delivery. A noxious mechanical stimulus was applied to the distal forelimb while recording bifrontal EEG and MRF single-unit activities. Propofol was separately administered to the cranial (0.08 +/- 0.06 mg/kg) and torso circulations (4 mg/kg) and the noxious stimulus applied at 1,5, 10, and 15 min after each injection. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Noxious stimulation decreased total power (TP) from 96 +/- 33, microV2/Hz to 38 +/- 20microV2/Hz, (mean +/- SD) and increased spectral edge frequency (SEF) from 10 +/- 3 Hz to 19 +/- 5 Hz (p<0.01). Propofol administered to the torso prevented stimulus-evoked changes in TP (121+/- 80 microV2/Hz, 121 +/- 74 microV2/Hz, 114 +/- 74 microV2/Hz at 1,5, and 10 min respectively, p<0.01 compared to control evoked response) and SEF (11 +/- 6Hz, 9 +/- 2Hz, 10 +/- 6Hz, and 12 +/- 5Hz at 1, 5, 10 and 15 min, respectively, p<0.001 compared to control evoked response). Propofol administered to the cranial circulation significantly blunted the EEG and MRF response, while torso-administered propofol had slight effects on MRF responses. CONCLUSIONS: Propofol blunted the EEG response to noxious stimulation in part via a subcortical action.

[Recurrence of multicavitating cardiac myxoma]. / Recorrência de mixoma cardíaco multicavitário.

A 24 years-old female patient with congestive heart failure and clinical, electrocardiographic and radiologic findings compatible with pulmonary stenosis. Angiocardiography study diagnosed a tumor of the right ventricule (RV). Large tumor of the RV and smaller tumors of the left atrium were removed by surgical treatment. Six years later, a 2 cm tumor was identified in the RV. The tumor's growth was accompanied by bidimensional transthoracic echocardiograms. After 6 years a transesophageal echocardiogram showed three tumors, one in the RV and one in each of the right and left atria. These tumors were successful removed by new surgical treatment.

[Refractory heart failure and sepsis in a patient with hypertrophic cardiomyopathy]. / Insuficiência cardíaca refratária e sepse em portador de miocardiopatia hipertrófica.

A twenty one years old man with obstructive hypertrophic cardiomyopathy with resting gradient and which develops subacute infectious endocarditis and acute mitral regurgitation by valvular apparatus destruction. During the course occurs refractory heart failure and sepsis. The association between these diseases and difficulties in management are analyzed, and literature is reviewed. It is emphasized the high mortality of this condition and indication for surgical referral, as well the necessity for infectious endocarditis prophylaxis in patients with obstruction at rest.

Late results of endoscopic sphincterotomy for bile duct stones in elderly patients with gall bladders in situ.

Endoscopic sphincterotomy was undertaken in 186 patients with common bile duct stones and an intact gall bladder who were considered unfit for surgery. One hundred and seventy one patients had jaundice of whom 18 also had clinical cholangitis. The mean age of treated patients was 79.7 years (range 27-92) and only 13 were aged less than 60. Sphincterotomy was successful in 185 (99%) and complete clearance achieved in 172 (92.5%). Early complications occurred in nine patients (4.8%) of whom three died (1.6%). The patients have been followed on average for 32 months (range six to 72 months). Eighteen patients have subsequently required cholecystectomy (9.6%), with six major complications, but no deaths. There have been 27 natural deaths and 156 patients remain alive and symptom free. Endoscopic treatment alone is safe and effective in the majority of frail and elderly patients and can reduce the need for surgery in this high risk group.

Mixoma de ventrículo direito: relato de um caso / Myxoma of the right ventricle: report of a case

Os autores relatam um caso de mixoma de ventriculo direito acompanhado por discretas lesoes mixomatosas em atrio esquerdo.As manifestacoes clinicas encontradas foram semelhantes as dos demais casos de mixoma de ventriculo direito publicados na literatura, sendo as mais importantes:quadro clinico semelhante ao da estenose pulmonar; presenca de ecos multiplos em ventriculo direito; existencia de gradiente pressorico entre ventriculo direito e arteria pulmonar; presenca de defeitos de enchimento no infundibulo ventricular direito, evertendo para a arteria pulmonar a angiocardiografia. Foi realizada cirurgia cardiaca com pleno sucesso, tendo-se encontrado um volumoso mixoma de ventriculo direito e discretas lesoes mixomatosas em atrio esquerdo. O diagnostico de mixoma foi confirmado por exame anatomopatologico