Vulnerability to Suicide Ideation: Comparative Study between Adolescents with and without Psychosocial Risk.

Adolescents are characterized as a risk group for suicide, being the fourth leading cause of death in young people. The main aim was to compare vulnerability to suicidal ideation in a sample of young people with and without psychosocial risk. The total sample consisted of 137 adolescents, aged between 10 and 19 years (M = 14.76; SD = 1.40), and it was composed of two groups-the psychosocial risk group (n = 60) and general population group (n = 77). In both groups, suicidal ideation correlated positively with negative events and negatively with self-esteem and social support satisfaction. When comparing the two groups, the psychosocial risk group presented significantly higher mean values of negative life events (mainly separations/losses and physical and sexual abuse) and significantly lower mean values of satisfaction with social support (particularly with family and social activities). It was also found that, in the psychosocial risk group, negative life events were the only significant predictors of suicidal ideation. This study allowed identifying the role of risk and protective factors in suicidal ideation, according to the psychosocial risk of adolescents. The practical implications of the findings on adolescents' mental health and the promotion of their well-being are discussed.

Natural climate solutions for the United States.

Limiting climate warming to <2°C requires increased mitigation efforts, including land stewardship, whose potential in the United States is poorly understood. We quantified the potential of natural climate solutions (NCS)-21 conservation, restoration, and improved land management interventions on natural and agricultural lands-to increase carbon storage and avoid greenhouse gas emissions in the United States. We found a maximum potential of 1.2 (0.9 to 1.6) Pg CO2e year-1, the equivalent of 21% of current net annual emissions of the United States. At current carbon market prices (USD 10 per Mg CO2e), 299 Tg CO2e year-1 could be achieved. NCS would also provide air and water filtration, flood control, soil health, wildlife habitat, and climate resilience benefits.

Natural climate solutions.

Better stewardship of land is needed to achieve the Paris Climate Agreement goal of holding warming to below 2 °C; however, confusion persists about the specific set of land stewardship options available and their mitigation potential. To address this, we identify and quantify "natural climate solutions" (NCS): 20 conservation, restoration, and improved land management actions that increase carbon storage and/or avoid greenhouse gas emissions across global forests, wetlands, grasslands, and agricultural lands. We find that the maximum potential of NCS-when constrained by food security, fiber security, and biodiversity conservation-is 23.8 petagrams of CO2 equivalent (PgCO2e) y-1 (95% CI 20.3-37.4). This is ≥30% higher than prior estimates, which did not include the full range of options and safeguards considered here. About half of this maximum (11.3 PgCO2e y-1) represents cost-effective climate mitigation, assuming the social cost of CO2 pollution is ≥100 USD MgCO2e-1 by 2030. Natural climate solutions can provide 37% of cost-effective CO2 mitigation needed through 2030 for a >66% chance of holding warming to below 2 °C. One-third of this cost-effective NCS mitigation can be delivered at or below 10 USD MgCO2-1 Most NCS actions-if effectively implemented-also offer water filtration, flood buffering, soil health, biodiversity habitat, and enhanced climate resilience. Work remains to better constrain uncertainty of NCS mitigation estimates. Nevertheless, existing knowledge reported here provides a robust basis for immediate global action to improve ecosystem stewardship as a major solution to climate change.

Exercise Capacity Long-Term after Arterial Switch Operation for Transposition of the Great Arteries.

UNLABELLED: Transposition of the great arteries (TGA) is a congenital heart defect successfully corrected through arterial switch operation (ASO). Although this technique had significant impact in improving survival, little is known about the functional capacity of the operated patients long-term after surgery. OBJECTIVE: The aim of this study was to compare the functional capacity of children with TGA long-term after ASO with that of healthy children. DESIGN: Retrospective study. PATIENTS: All patients that performed cardiopulmonary exercise test (CPET) were included in the study. As a control group, healthy children in evaluation for physical activity that performed CPET during the same period were also enrolled. RESULTS: Thirty-one TGA patients (19 male) were compared with 29 age-matched controls (21 male). Maximum oxygen consumption was higher in the control group (45.47 ± 8.05 vs. 40.52 ± 7.19, P = .017), although within normal limits in both groups (above 90% of predicted value). The heart rate behavior during exercise was different in both groups, with a mean chronotropic index significantly lower in the TGA group (63% ± 14 vs. 81% ± 12, P < .001). CONCLUSIONS: Our results showed that exercise capacity long-term after ASO in TGA is well preserved although lower than in healthy children what might be explained by the presence of chronotropic incompetence in the TGA group.

A systematic review of biochar research, with a focus on its stability in situ and its promise as a climate mitigation strategy.

BACKGROUND: Claims about the environmental benefits of charring biomass and applying the resulting "biochar" to soil are impressive. If true, they could influence land management worldwide. Alleged benefits include increased crop yields, soil fertility, and water-holding capacity; the most widely discussed idea is that applying biochar to soil will mitigate climate change. This claim rests on the assumption that biochar persists for hundreds or thousands of years, thus storing carbon that would otherwise decompose. We conducted a systematic review to quantify research effort directed toward ten aspects of biochar and closely evaluated the literature concerning biochar's stability. FINDINGS: We identified 311 peer-reviewed research articles published through 2011. We found very few field studies that addressed biochar's influence on several ecosystem processes: one on soil nutrient loss, one on soil contaminants, six concerning non-CO2 greenhouse gas (GHG) fluxes (some of which fail to support claims that biochar decreases non-CO2 GHG fluxes), and 16-19 on plants and soil properties. Of 74 studies related to biochar stability, transport or fate in soil, only seven estimated biochar decomposition rates in situ, with mean residence times ranging from 8 to almost 4,000 years. CONCLUSIONS: Our review shows there are not enough data to draw conclusions about how biochar production and application affect whole-system GHG budgets. Wide-ranging estimates of a key variable, biochar stability in situ, likely result from diverse environmental conditions, feedstocks, and study designs. There are even fewer data about the extent to which biochar stimulates decomposition of soil organic matter or affects non-CO2 GHG emissions. Identifying conditions where biochar amendments yield favorable GHG budgets requires a systematic field research program. Finally, evaluating biochar's suitability as a climate mitigation strategy requires comparing its effects with alternative uses of biomass and considering GHG budgets over both long and short time scales.

Prevalence of dyslipidemia in children with congenital heart disease.

Dyslipidemia is one of the main risk factors associated with cardiovascular diseases. Few data on the impacts of congenital heart diseases are available with regard to the prevalence of dyslipidemia in children. Our study evaluated the lipid profile in children with congenital heart disease at a referral center. From January 2011 to July 2012, 52 pediatric patients had their lipid, metabolic and clinical profiles traced. The mean age was 10.4 ± 2.8 years and male/female rate of 1.38:1. Our population had 53.8% patients with high levels of total cholesterol and 13.4% (CI 95 %, from 6.6 to 25.2%) of them also presenting LDL levels ≥ 130 mg/dL, which characterizes dyslipidemia. The group of dyslipidemic patients presented only two obese individuals. Our data show that the presence of congenital heart disease does not lead to higher risk associated with the prevalence of dyslipidemia. Therefore, the screening of this specific population should follow the regular pediatric guidelines, which are also independent of the nutritional status of the children tested.

Factibilidade, segurança e eficácia do fechamento percutâneo da comunicação interatrial em crianças pequenas / Feasibility, safety and efficacy of percutaneous atrial septal defect closure in infants

INTRODUÇÃO: A experiência com o fechamento percutâneo da comunicação interatrial (CIA) em crianças pequenas é limitada. Avaliamos a factibilidade, a segurança e a eficácia desse procedimento em crianças com peso < 20 kg. MÉTODOS: Estudo descritivo observacional de uma coorte de crianças < 20 kg submetidas a tratamento percutâneo. Pacientes com dilatação ventricular direita e sintomas evidentes foram incluídos. Implantamos próteses aprovadas pela ANVISA, sob monitorização ecocardiográfica transesofágica. Os pacientes foram avaliados 1 mês, 3 meses, 6 meses e 12 meses após. RESULTADOS: Entre outubro de 1997 e maio de 2012, 80 pacientes foram tratados. As medianas de idade e peso foram de 4 anos (1-12) e 13,5 kg (5-20), respectivamente, 20 pacientes apresentavam alguma síndrome genética (25%) e 4 pacientes (5%) apresentavam CIA adicional. Somente um paciente necessitou duas próteses. Dois pacientes tinham defeitos associados, os quais foram tratados no mesmo procedimento (estenose pulmonar valvar e fístula arteriovenosa). Um paciente desenvolveu bloqueio atrioventricular total durante o implante da prótese, resolvido espontaneamente 36 horas após a remoção da prótese, sem necessidade de implante de marca-passo. Esse paciente foi tratado percutaneamente 6 meses após com sucesso, sem complicações. Setenta e nove pacientes receberam alta hospitalar em até 24 horas após o procedimento. Fluxo residual discreto (1-2 mm) foi observado em 5% dos casos antes da alta. Após 6 meses de seguimento, não foi detectado fluxo residual. Não houve complicações tardias no seguimento. CONCLUSÕES: O fechamento percutâneo da CIA em crianças pequenas selecionadas e sintomáticas é uma alternativa tera­pêutica factível, segura e eficaz, devendo ser a primeira opção para seu tratamento.

BACKGROUND: The experience with percutaneous closure of atrial septal defect (ASD) in infants is limited. We sought to determine the feasibility, safety and efficacy of this procedure in children weighing < 20 kg. METHODS: Observational study of a cohort of children weighing < 20 kg undergoing percutaneous closure. Patients with right ventricular enlargement and evident symptoms were included. ANVISA approved devices were implanted under transesophageal echocardiography monitoring. Patients were evaluated 1, 3, 6 and 12 months after the procedure. RESULTS: Eighty patients were treated between October 1997 and May 2012. Median age and weight were 4 years (1-12) and 13.5 kg (5-20), respectively, 20 patients had a genetic syndrome (25%) and 4 patients (5%) had an additional ASD. Only one patient required 2 devices. Two patients had associated defects that were treated in the same procedure (pulmonary valve stenosis and arteriovenous fistula). One patient developed total atrioventricular block during device implantation, solved spontaneously 36 hours after device removal, with no need for pacemaker implantation. This patient was successfully treated percutaneously 6 months later without complications. Seventy-nine patients were discharged within 24 hours after the procedure. A mild residual shunt (1-2 mm) was observed in 5% of the cases before discharge. There was no residual shunt 6 months after the procedure. There were no complications in the late follow-up. CONCLUSIONS: Percutaneous ASD closure in selected symptomatic infants is a feasible, safe and effective alternative and should be the first option therapy.

Use of octreotide in the treatment of chylothorax and chyloperitoneum.

Report of three cases of chylothorax and one case of chylous ascites in children who had undergone cardiac surgery with no response to routine clinical treatment, based on fasting and long-term parenteral nutrition. Treatment with octreotide at an initial dose of 1.0 mcg/kg/h was chosen, with a gradual increase of 1.0 mcg/kg/hr/day until a maximum dose of 4.0 mcg/kg/h. All cases had a favorable response, with gradual reduction of drainage output until prognosis improvement with no significant side effects.

Uso do octreotide no tratamento do quilotórax e quiloperitôneo / Use of octreotide in the treatment of chylothorax and chyloperitoneum / Uso del octreotide en el tratamiento del quilotórax y quiloperitoneo

Relato de três casos de quilotórax e um caso de ascite quilosa em crianças em pós-operatório de cirurgia cardíaca, que evoluíram sem resposta ao tratamento clínico habitual, baseado em jejum e nutrição parenteral prolongada. Tratamento com octreotide na dose inicial de 1,0 mcg/kg/h foi escolhido, com aumento progressivo de 1,0 mcg/kg/h/dia até a dose máxima de 4,0 mcg/kg/h. Todos os casos tiveram resposta favorável, com redução progressiva do débito do dreno, até resolução do quadro, sem efeito colateral significativo.

Report of three cases of chylothorax and one case of chylous ascites in children who had undergone cardiac surgery with no response to routine clinical treatment, based on fasting and long-term parenteral nutrition. Treatment with octreotide at an initial dose of 1.0 mcg/kg/h was chosen, with a gradual increase of 1.0 mcg/kg/hr/day until a maximum dose of 4.0 mcg/kg/h. All cases had a favorable response, with gradual reduction of drainage output until prognosis improvement with no significant side effects.

Relato de tres casos de quilotórax y un caso de ascitis quilosa en niños en postoperatorio de cirugía cardíaca, que evolucionaron sin respuesta al tratamiento clínico habitual, basado en ayuno y nutrición parenteral prolongada. Fue elegido tratamiento con octreotide en dosis inicial de 1,0 mcg/kg/h , con aumento progresivo de 1,0 mcg/kg/h/día hasta la dosis máxima de 4,0 mcg/kg/h. Todos los casos tuvieron respuesta favorable, con reducción progresiva del débito del drenaje, hasta resolución del cuadro, sin efecto colateral significativo.

Adsorption of aqueous uranyl complexes onto Bacillus subtilis cells.

In oxygenated, CO2-rich systems, negatively charged uranyl complexes dominate the aqueous uranium speciation, and it is commonly assumed that these complexes exhibit negligible adsorption onto negatively charged surfaces such as bacteria. We measured the adsorption of 4.2 x 10(-6) M aqueous uranium onto Bacillus subtilis from pH 1.5 to 9 and with wet weight bacterial concentrations from 0.125 to 0.5 g/L. Experiments were performed in the presence and absence of dissolved CO2, and additional experiments were performed in the presence of dissolved CO2 and Ca. We observed extensive uranium adsorption onto the bacterial surface under all conditions. Thermodynamic modeling of the data suggests that uranylhydroxide, uranyl-carbonate, and calcium-uranylcarbonate species each can form stable surface complexes on the bacterial cell wall. These results could dramatically alter predictions of uranium mobility in near-surface environments.

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis.

OBJECTIVE: To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis. METHODS: Seventy-five patients (median age: 8 years) underwent the procedure through the retrograde femoral or carotid route. RESULTS: The procedure was completed in 74 patients (98.6%). The peak-to-peak systolic gradient dropped from 79.6 27.7 to 22.3 17.8 mmHg (P<0.001), the left ventricular systolic pressure dropped from 164 39.1 to 110 24.8 mmHg (P<0.001), and the left ventricular end diastolic pressure dropped from 13.3 5.5 to 8.5 8.3 mmHg (P< 0.01). Four patients (5.3%) died due to the procedure. Aortic regurgitation (AoR) appeared or worsened in 27/71 (38%) patients, and no immediate surgical intervention was required. A mean follow-up of 50 38 months was obtained in 37 patients. Restenosis and significant AoR were observed in 16.6% of the patients. The estimates for being restenosis-free and for having significant AoR in 90 months were 60% and 50%, respectively. CONCLUSION: Aortic valvuloplasty was considered the initial palliative method of choice in managing congenital aortic stenosis, with satisfactory short- and midterm results.

Resultados imediatos e de seguimento a médio prazo da valvoplastia com cateter balão para estenose aórtica congênita / Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

OBJECTIVE: To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis. METHODS: Seventy-five patients (median age: 8 years) underwent the procedure through the retrograde femoral or carotid route. RESULTS: The procedure was completed in 74 patients (98.6 percent). The peak-to-peak systolic gradient dropped from 79.6±27.7 to 22.3±17.8 mmHg (P<0.001), the left ventricular systolic pressure dropped from 164±39.1 to 110±24.8 mmHg (P<0.001), and the left ventricular end diastolic pressure dropped from 13.3±5.5 to 8.5±8.3 mmHg (P< 0.01). Four patients (5.3 percent) died due to the procedure. Aortic regurgitation (AoR) appeared or worsened in 27/71 (38 percent) patients, and no immediate surgical intervention was required. A mean follow-up of 50±38 months was obtained in 37 patients. Restenosis and significant AoR were observed in 16.6 percent of the patients. The estimates for being restenosis-free and for having significant AoR in 90 months were 60 percent and 50 percent, respectively. CONCLUSION: Aortic valvuloplasty was considered the initial palliative method of choice in managing congenital aortic stenosis, with satisfactory short- and midterm results

Aplicações clínicas do eletrocardiograma na criança / Clinical uses of electrocardiogram in children

O eletrocardiograma associado ao exame físico e ao estudo radiológico constituem a base para o diagnóstico clínico em cardiologia pediátrica. O primeiro eletrocardiograma em humano foi realizado em 1887. Entretanto, somente em 1901 Willem Einthoven descreveu um galvanômetro para gravar as alterações da atividade elétrica na superfície corpórea. O traçado eletrocardiográfico deve ser consi- derado em relação a idade, deformidade torácica, más posições cardíacas, etc. Por outro lado, ao se interpretar um eletrocardiograma deve-se obedecer a uma sistemática. Existem tabelas que co-relacionam a idade e a freqüência cardíaca com as medidas obtidas no eletrocardiograma, sendo a mais elucidativa a idealizada por Davignon. Em relação ao eletrocardiograma anormal, considera-se que o eixo e a morfologia da onda P e do complexo QRS são parâmetros fundamentais na orientação das câmaras cardíacas. A análise da onda P permite estabelecer o diagnóstico da sobrecarga atrial direita ou esquerda. O diagnóstico de hipertrofia ventricular direita ou esquerda obedece a alguns critérios que valori- zam o complexo QRS. O que se considera normal para um determinado período de vida pode ser anormal em outra idade. Finalmente, o eletrocardiograma é um exame de fácil realização, baixo custo e sensível em muitas cardiopatias congênitas. É de grande ajuda quando bem analisado e em associação com a história clínica e o exame físico permite o diagnóstico adequado...