Extra-cardiac manifestations of adult congenital heart disease.

Advancement in correction or palliation of congenital cardiac lesions has greatly improved the lifespan of congenital heart disease patients, resulting in a rapidly growing adult congenital heart disease (ACHD) population. As this group has increased in number and age, emerging science has highlighted the systemic nature of ACHD. Providers caring for these patients are tasked with long-term management of multiple neurologic, pulmonary, hepatic, renal, and endocrine manifestations that arise as syndromic associations with congenital heart defects or as sequelae of primary structural or hemodynamic abnormalities. In this review, we outline the current understanding and recent research into these extra-cardiac manifestations.

Prospective Estimation of Radiation Dose and Image Quality for Optimized CT Performance

X-ray computed tomography (CT) is a non-invasive medical imaging technique that generates cross-sectional images by acquiring attenuation-based projection measurements at multiple angles. Since its first introduction in the 1970s, substantial technical improvements have led to the expanding use of CT in clinical examinations. CT has become an indispensable imaging modality for the diagnosis of a wide array of diseases in both pediatric and adult populations [1, 2]. Currently, approximately 272 million CT examinations are performed annually worldwide, with nearly 85 million of these in the United States alone [3]. Although this trend has decelerated in recent years, CT usage is still expected to increase mainly due to advanced technologies such as multi-energy [4], photon counting [5], and cone-beam CT [6].

Despite the significant clinical benefits, concerns have been raised regarding the population-based radiation dose associated with CT examinations [7]. From 1980 to 2006, the effective dose from medical diagnostic procedures rose six-fold, with CT contributing to almost half of the total dose from medical exposure [8]. For each patient, the risk associated with a single CT examination is likely to be minimal. However, the relatively large population-based radiation level has led to enormous efforts among the community to manage and optimize the CT dose.

As promoted by the international campaigns Image Gently and Image Wisely, exposure to CT radiation should be appropriate and safe [9, 10]. It is thus a responsibility to optimize the amount of radiation dose for CT examinations. The key for dose optimization is to determine the minimum amount of radiation dose that achieves the targeted image quality [11]. Based on such principle, dose optimization would significantly benefit from effective metrics to characterize radiation dose and image quality for a CT exam. Moreover, if accurate predictions of the radiation dose and image quality were possible before the initiation of the exam, it would be feasible to personalize it by adjusting the scanning parameters to achieve a desired level of image quality. The purpose of this thesis is to design and validate models to quantify patient-specific radiation dose prospectively and task-based image quality. The dual aim of the study is to implement the theoretical models into clinical practice by developing an organ-based dose monitoring system and an image-based noise addition software for protocol optimization.

More specifically, Chapter 3 aims to develop an organ dose-prediction method for CT examinations of the body under constant tube current condition. The study effectively modeled the anatomical diversity and complexity using a large number of patient models with representative age, size, and gender distribution. The dependence of organ dose coefficients on patient size and scanner models was further evaluated. Distinct from prior work, these studies use the largest number of patient models to date with representative age, weight percentile, and body mass index (BMI) range.

With effective quantification of organ dose under constant tube current condition, Chapter 4 aims to extend the organ dose prediction system to tube current modulated (TCM) CT examinations. The prediction, applied to chest and abdominopelvic exams, was achieved by combining a convolution-based estimation technique that quantifies the radiation field, a TCM scheme that emulates modulation profiles from major CT vendors, and a library of computational phantoms with representative sizes, ages, and genders. The prospective quantification model is validated by comparing the predicted organ dose with the dose estimated based on Monte Carlo simulations with TCM function explicitly modeled.

Chapter 5 aims to implement the organ dose-estimation framework in clinical practice to develop an organ dose-monitoring program based on a commercial software (Dose Watch, GE Healthcare, Waukesha, WI). In the first phase of the study we focused on body CT examinations, and so the patient’s major body landmark information was extracted from the patient scout image in order to match clinical patients against a computational phantom in the library. The organ dose coefficients were estimated based on CT protocol and patient size as reported in Chapter 3. The exam CTDIvol, DLP, and TCM profiles were extracted and used to quantify the radiation field using the convolution technique proposed in Chapter 4.

With effective methods to predict and monitor organ dose, Chapters 6 aims to develop and validate improved measurement techniques for image quality assessment. Chapter 6 outlines the method that was developed to assess and predict quantum noise in clinical body CT images. Compared with previous phantom-based studies, this study accurately assessed the quantum noise in clinical images and further validated the correspondence between phantom-based measurements and the expected clinical image quality as a function of patient size and scanner attributes.

Chapter 7 aims to develop a practical strategy to generate hybrid CT images and assess the impact of dose reduction on diagnostic confidence for the diagnosis of acute pancreatitis. The general strategy is (1) to simulate synthetic CT images at multiple reduced-dose levels from clinical datasets using an image-based noise addition technique; (2) to develop quantitative and observer-based methods to validate the realism of simulated low-dose images; (3) to perform multi-reader observer studies on the low-dose image series to assess the impact of dose reduction on the diagnostic confidence for multiple diagnostic tasks; and (4) to determine the dose operating point for clinical CT examinations based on the minimum diagnostic performance to achieve protocol optimization.

Chapter 8 concludes the thesis with a summary of accomplished work and a discussion about future research.

(Table 1) Dissolved organic carbon and dissolved sugar of interstitial water of DSDP Holes 96-618, 96-619 and 96-623

Preliminary data on dissolved organic carbon (DOC) and dissolved sugars in interstitial water samples collected at Sites 618, 619, and 623 of Deep Sea Drilling Project Leg 96 are presented. At Site 618 in Orca Basin, the DOC content of the interstitial water peaks in the hypersaline sulfate reduction zone. The sugar content reaches a maximum and the DOC content begins to decrease at the depth of methane gas generation. Below that depth, the sugar and DOC contents are about constant. At Site 619 in Pigmy Basin, the DOC content increases slightly with depth in the sulfate reduction and the methane fermentation zones. The sugar content is lower in the sulfate reduction zone than in the methane fermentation zone; sugar concentration increases and fluctuates with methane gas percentages within the methane fermentation zone. At Site 623 in the lower fan region of the Mississippi Fan, there is no sulfate reduction zone. The DOC and sugar contents of the interstitial water are almost constant with depth.

Comportamento informacional e avaliação de serviços bibliotecários

Estudo sobre o comportamento informacional dos servidores técnico-especializados do Tribunal de Contas dos Municípios do Estado de Goiás, de forma a identificar suas necessidades, seus hábitos de busca e formas de utilização das informações nas atividades diárias realizadas na Instituição e, ao mesmo tempo, avaliar os serviços prestados pela biblioteca. Apresenta conceitos básicos relacionados a estudos de usuários e comportamento informacional, passando pelas abordagens tradicional e alternativa. Foi utilizado o modelo conceitual de comportamento informacional de Wilson (1981). Trata-se de uma pesquisa qualitativa, de caráter exploratório. Como instrumento de coleta de dados utilizou-se o questionário autoadministrado. Os resultados da pesquisa mostram que as necessidades de informação desses profissionais decorrem de seu trabalho na Instituição e que a busca por informações se dá em diferentes fontes, com a finalidade principal de formação e atualização profissional e para o desempenho de suas atividades profissionais. Os produtos e serviços da Biblioteca da instituição mostraram-se adequados, porém há necessidade de mais divulgação e desenvolvimento de sistemas informatizados para recuperação das informações

Computational and experimental study of the behavior of cyano-based ionic liquids in aqueous solution

The solvation of cyano- (CN-) based ionic liquids (ILs) and their capacity to establish hydrogen bonds (H-bonds) with water was studied by means of experimental and computational approaches. Experimentally, water activity data were measured for aqueous solutions of ILs based on 1-butyl-3-methylimidazolium ([BMIM](+)) cation combined with one of the following anions: thiocyanate ([SCN](-)), dicyanamide ([DCA](-)), or tricyanomethanide ([TCM](-)), and of 1-ethyl-3-methylimidazolium tetracyanoborate ([EMIM][TCB]). From the latter data, water activity coefficients were estimated showing that [BMIM][SCN] and [BMIM][DCA], unlike [BMIM][TCM] and [EMIM][TCB], are able to establish favorable interactions with water. Computationally, the conductor like screening model for real solvents (COSMO-RS) was used to estimate the water activity coefficients which compare well with the experimental ones. From the COSMO-RS results, it is suggested that the polarity of each ion composing the ILs has a strong effect on the solvation phenomena. Furthermore, classical molecular dynamics (MD) simulations were performed for obtaining an atomic level picture of the local molecular neighborhood of the different species. From the experimental and computational data it is showed that increasing the number of CN groups in the ILs' anions does not enhance their ability to establish H-bonds with water but decreases their polarities, being [BMIM][DCA] and [BMIM][SCN] the ones presenting higher propensity to interact.

Impacto del Real Decreto de la Troncalidad en la formación en medicina preventiva y salud pública y en otras especialidades del tronco común médico

Objetivo: El Real Decreto de Troncalidad (RDT) plantea modificar la formación sanitaria especializada, estableciendo 24 meses de formación troncal común. El objetivo de este estudio es valorar su potencial impacto en la formación especializada de medicina preventiva y salud pública (MPSP) y en otras especialidades del tronco común médico (TCM). Métodos: Se analizaron los programas de las 21 especialidades del TCM, recogiendo los periodos de rotación recomendados por cada especialidad y consensuando la información entre tres observadores. El impacto formativo se calculó como el porcentaje de meses que cada especialidad debería modificar para adaptarse al periodo común. Resultados: MPSP (100%, 24 meses) es la especialidad en la cual el RDT tendrá más impacto. Medicina intensiva (0%, 0 meses) y oncología médica (17%, 4 meses) son las especialidades menos afectadas. Conclusiones: El RDT va a afectar de manera diferente a las especialidades del TCM. El RDT supondrá un replanteamiento completo de sus actividades y de las competencias de los profesionales de MPSP.

Agreement of Mixed Venous Carbon Dioxide Tension (PvCO2) and Transcutaneous Carbon Dioxide (PtCO2) Measurements in Ventilated Infants

Background: Noninvasive transcutaneous carbon dioxide monitoring has been shown to be accurate in infants and children, limited data are available to show the usefulness and limitations of partial transcutaneous carbon dioxide tension (PtCO2) value. Objectives: The current study prospectively determines the effectiveness and accuracy of PtCO2 measurements in newborns. Materials and Methods: Venous blood gas sampling and monitoring of the PtCO2 level (TCM TOSCA, Radiometer) were done simultaneously. All measurements are performed on mechanically ventilated infants. Partial venous carbon dioxide tension (PvCO2) values divided into three groups according to hypocapnia (Group 1: < 4.68 kPa), normocapnia (Group 2: 4.68–7.33 kPa), hypercapnia (Group 3: > 7.33 kPa) and then PvCO2 and PtCO2 data within each group were compared separately. Results: A total of 168 measurements of each PvCO2 and PtCO2 data were compared in three separated groups simultaneously (13 in Group 1, 118 in Group 2, and 37 in Group 3). A bias of more than ± 0.7 kPa was considered unacceptable. PtCO2 was related to PvCO2 with acceptable results between the two measurements in hypocapnia (mean difference 0.20 ± 0.19 kPa) and normocapnia (0.002 ± 0.30 kPa) groups. On the other hand in hypercapnia group PtCO2 values were statistically significant (P < 0.001) and lower than PvCO2 data (mean difference 0.81 ± 1.19 kPa) Conclusions: PtCO2 measurements have generally good agreement with PvCO2 in hypocapnic and normocapnic intubated infants but there are some limitations especially with high level of CO2 tension. Monitoring of PtCO2 is generally a useful non-invasive indicator of PvCO2 in hypocapnic and normocapnic infants.

The potential of symbolic approximation. Disentangling the effects of approximation vs. calculation demands in nonsymbolic and symbolic representations.

Mathematical skills that we acquire during formal education mostly entail exact numerical processing. Besides this specifically human faculty, an additional system exists to represent and manipulate quantities in an approximate manner. We share this innate approximate number system (ANS) with other nonhuman animals and are able to use it to process large numerosities long before we can master the formal algorithms taught in school. Dehaene´s (1992) Triple Code Model (TCM) states that also after the onset of formal education, approximate processing is carried out in this analogue magnitude code no matter if the original problem was presented nonsymbolically or symbolically. Despite the wide acceptance of the model, most research only uses nonsymbolic tasks to assess ANS acuity. Due to this silent assumption that genuine approximation can only be tested with nonsymbolic presentations, up to now important implications in research domains of high practical relevance remain unclear, and existing potential is not fully exploited. For instance, it has been found that nonsymbolic approximation can predict math achievement one year later (Gilmore, McCarthy, & Spelke, 2010), that it is robust against the detrimental influence of learners´ socioeconomic status (SES), and that it is suited to foster performance in exact arithmetic in the short-term (Hyde, Khanum, & Spelke, 2014). We provided evidence that symbolic approximation might be equally and in some cases even better suited to generate predictions and foster more formal math skills independently of SES. In two longitudinal studies, we realized exact and approximate arithmetic tasks in both a nonsymbolic and a symbolic format. With first graders, we demonstrated that performance in symbolic approximation at the beginning of term was the only measure consistently not varying according to children´s SES, and among both approximate tasks it was the better predictor for math achievement at the end of first grade. In part, the strong connection seems to come about from mediation through ordinal skills. In two further experiments, we tested the suitability of both approximation formats to induce an arithmetic principle in elementary school children. We found that symbolic approximation was equally effective in making children exploit the additive law of commutativity in a subsequent formal task as a direct instruction. Nonsymbolic approximation on the other hand had no beneficial effect. The positive influence of the symbolic approximate induction was strongest in children just starting school and decreased with age. However, even third graders still profited from the induction. The results show that also symbolic problems can be processed as genuine approximation, but that beyond that they have their own specific value with regard to didactic-educational concerns. Our findings furthermore demonstrate that the two often con-founded factors ꞌformatꞌ and ꞌdemanded accuracyꞌ cannot be disentangled easily in first graders numerical understanding, but that children´s SES also influences existing interrelations between the different abilities tested here.

Evaluación biológica poblacional de macha (Mesodesma donacium, Lamarck 1818) en la provincia de Islay, Arequipa. Febrero 2015

La evaluación se realizó entre el 20 y 26 de febrero 2015, el área de distribución de la macha comprendió la playa entre punta Corio y Sombrero Chico en la provincia de Islay; no se registró entre el Boquerón y La Ensenada. La mayor concentración se observó entre Las Cuevas y El Tablón (área de repoblamiento de Islay). La densidad relativa de las estaciones/transectos varió entre 0 y 20,39 ejem/m2. El área efectiva de distribución se calculó en 1´413.514 m2, se estimó abundancia en 7´722.393 ejemplares y biomasa total 147,58 t. Se analizó biométricamente 2.612 ejemplares, la talla varió entre 26 y 90 mm de longitud valvar (LV), con moda principal en 62 mm y secundaria en 76 mm, la longitud promedio fue 59,17 mm, el 89,43% estuvo debajo de la Talla Mínima de Captura (TCM= 70 mm). Los perfiles medios de playa fueron de pendiente suave que varió entre 1,00° y 1,72°; en el Sector sur (Punta de Bombón) se observó playas intermedias acercándose a los límites de playas disipativas (Ω entre 3,14 y 5,92), en el Sector norte (Dean Valdivia - Mejía) se observaron playas intermedias - disipativas (Ω entre 4,53 y 5,22). La temperatura superficial del mar varió entre 16,4 y 21,0 °C, promedio 18,2±0,02 °C. En el análisis del plancton, entre El Molle y Cardones y El Conto y Mejía, se observó larvas D y umbonadas con características similares a Mesodesma donacium.

Multicultural work environment as a key in cross-cultural negotiations and organizations’ performance: Canada overview

Es necesario que los gerentes sean líderes y establezcan relaciones sólidas con los empleados, para luego establecer las mismas con socios potenciales. Para lograr este objetivo, Con el fin de cumplir este objetivo, el uso de estrategias y técnicas de negociación es crucial, así como la importancia de la conciencia cultural y de la diversidad. La globalización no sólo ha movido a los mercados sino también a las personas, la inmigración es un fenómeno fuerte hoy en día y varios países, como Canadá, han sido inclusivos y han apoyado a estos nuevos ciudadanos. Las empresas de Canadá, sin importar la industria, han asumido el reto de integrar una fuerza laboral diversa con el propósito de adquirir nuevos conocimientos y crecer a nivel nacional, pero sobre todo en el ámbito internacional. Igualmente, es esencial tener en cuenta las ventajas y limitaciones del multiculturalismo dentro de la empresa y específicamente en las negociaciones interculturales.