Percutaneous closure of patent foramen ovale in cryptogenic embolism

BACKGROUND The options for secondary prevention of cryptogenic embolism in patients with patent foramen ovale are administration of antithrombotic medications or percutaneous closure of the patent foramen ovale. We investigated whether closure is superior to medical therapy. METHODS We performed a multicenter, superiority trial in 29 centers in Europe, Canada, Brazil, and Australia in which the assessors of end points were unaware of the study-group assignments. Patients with a patent foramen ovale and ischemic stroke, transient ischemic attack (TIA), or a peripheral thromboembolic event were randomly assigned to undergo closure of the patent foramen ovale with the Amplatzer PFO Occluder or to receive medical therapy. The primary end point was a composite of death, nonfatal stroke, TIA, or peripheral embolism. Analysis was performed on data for the intention-to-treat population. RESULTS The mean duration of follow-up was 4.1 years in the closure group and 4.0 years in the medical-therapy group. The primary end point occurred in 7 of the 204 patients (3.4%) in the closure group and in 11 of the 210 patients (5.2%) in the medical-therapy group (hazard ratio for closure vs. medical therapy, 0.63; 95% confidence interval [CI], 0.24 to 1.62; P=0.34). Nonfatal stroke occurred in 1 patient (0.5%) in the closure group and 5 patients (2.4%) in the medical-therapy group (hazard ratio, 0.20; 95% CI, 0.02 to 1.72; P=0.14), and TIA occurred in 5 patients (2.5%) and 7 patients (3.3%), respectively (hazard ratio, 0.71; 95% CI, 0.23 to 2.24; P=0.56). CONCLUSIONS Closure of a patent foramen ovale for secondary prevention of cryptogenic embolism did not result in a significant reduction in the risk of recurrent embolic events or death as compared with medical therapy. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT00166257.).

Right ventricle best predicts the race performance in amateur ironman athletes

PURPOSE The ironman (IM) triathlon is a popular ultraendurance competition, consisting of 3.8 km of swimming, 180.2 km of cycling, and 42.2 km of running. The aim of this study was to investigate the predictors of IM race time, comparing echocardiographic findings, anthropometric measures, and training characteristics. METHODS Amateur IM athletes (ATHL) participating in the Zurich IM race in 2010 were included. Participants were examined the day before the race by a comprehensive echocardiographic examination. Moreover, anthropometric measurements were obtained the same day. During the 3 months before the race, each IM-ATHL maintained a detailed training diary. Recorded data were related to total IM race time. RESULTS Thirty-eight IM finishers (mean ± SD age = 38 ± 9 yr, 32 men [84%]) were evaluated. Total race time was 684 ± 89 min (mean ± SD). For right ventricular fractional area change (45% ± 7%, Spearman ρ = -0.33, P = 0.05), a weak correlation with race time was observed. Race performance exhibited stronger associations with percent body fat (15.2 ± 5.6%, ρ = 0.56, P = 0.001), speed in running training (11.7 ± 1.2 km · h(-1), ρ = -0.52, P = 0.002), and left ventricular myocardial mass index (98 ± 24 g · m(-2), ρ = -0.42, P = 0.009). The strongest association was found between race time and right ventricular end-diastolic area (22 ± 4 cm2, ρ = -0.64, P < 0.0001). In multivariate analysis, right ventricular end-diastolic area (β = -16.7, 95% confidence interval = -27.3 to -6.1, P = 0.003) and percent body fat (β = 6.8, 95% confidence interval = 1.1-12.6, P = 0.02) were independently predictive of IM race time. CONCLUSIONS In amateur IM-ATHL, RV end-diastolic area and percent body fat were independently related to race performance. RV end-diastolic area was the strongest predictor of race time. The role of the RV in endurance exercise may thus be more important than previously thought and needs to be further studied.

Intensive Family Reunification Services: A Conceptual Framework and Case Example

Recent federal mandates require child welfare agencies to make reasonable efforts to reunify families after out-of-home placement. Consistent with those mandates, agencies are increasingly employing techniques from family preservation services intended initially to prevent out-of-home placement. The purpose of this article is to articulate a conceptual framework and practice guidelines for family reunification services and to describe an experimental reunification program based on a family preservation model. A case example illustrates the way in which the services affected one family that participated in the experiment.

Targeting Families to Receive Intensive Family Preservation Services: Assessing the Use of Imminent Risk of Placement as a Service Criterion

The process for targeting families to receive intensive family preservation services was examined for 71 child welfare agencies in the United States. The focus of this exploratory/descriptive study was the concept of imminent risk of placement as a criterion for providing services. Findings indicated that agencies had difficulty defining imminent risk and were unable to successfully restrict services to imminent risk cases. Several factors besides imminent risk were identified in relation to the targeting process.

Intensive In-Home Family-Based Services: Reactions from Consumers and Providers

An intensive family preservation program was examined through interviews with 31 families who received the services and four caseworkers who provided the services. The primary finding from interviews with both care givers and caseworkers was that a positive therapeutic relationship between the worker and the client family contributes most to the success of the program. Workers who provided the services stressed the need for making concrete services available as well as clinical intervention and skills training, and they were adamant about screening families for appropriateness before including them in an intensive, inhome program.

Family Preservation Journal, 1999, Volume 4, Issue 2. (Entire issue)

Entire issue (large pdf file) Articles include: Behavior Problems of Maltreated Children Receiving In-Home Child Welfare Services. Ferol Mennen, William Meezan, Gino Aisenberg, and Jacquelyn McCroskey Measuring Consumer Satisfaction in Family Preservation Services: Identifying Instrument Domains. Stephen A. Kapp and Rebecca H Vela Intensive In-Home Family-Based Services: Reactions from Consumers and Providers Elaine Walton, and Alfred C. Dodini Coordination of Family Preservation Services in a Rural Community: A Case Study. Richard Freer and Kathleen Wells The Effectiveness of Court Mandated Intervention Versus Voluntary Services in Child Protective Services: Abbreviated Version. Loring Jones, Irene Becker, and Krista F alk

Family Preservation Journal, 1997, Volume 2, Issue 2. (Entire issue)

Entire issue (large pdf file) Articles include: A Model for Family Preservation Case Assessment. Kam-fong Monit Cheung, Patrick Leung and Sharon Alpert Behavioral Outcomes of Home-Based Services for Children and Adolescents with Serious Emotional Disorders. Edwin Morris, Lourdes Suarez, John C. Reid A Multi-Faceted, Intensive Family Preservation Program Evaluation. Michael Raschick Targeting Families to Receive Intensive Family Preservation Services: Assessing the Use of Imminent Risk of Placement as a Service Criterion. Elaine Walton and Ramona W. Denby

Survival effects of inferior vena cava filter in patients with acute symptomatic venous thromboembolism and a significant bleeding risk.

OBJECTIVES The purpose of this study was to investigate the survival effects of inferior vena cava filters in patients with venous thromboembolism (VTE) who had a significant bleeding risk. BACKGROUND The effectiveness of inferior vena cava filter use among patients with acute symptomatic VTE and known significant bleeding risk remains unclear. METHODS In this prospective cohort study of patients with acute VTE identified from the RIETE (Computerized Registry of Patients With Venous Thromboembolism), we assessed the association between inferior vena cava filter insertion for known significant bleeding risk and the outcomes of all-cause mortality, pulmonary embolism (PE)-related mortality, and VTE rates through 30 days after the initiation of VTE treatment. Propensity score matching was used to adjust for the likelihood of receiving a filter. RESULTS Of the 40,142 eligible patients who had acute symptomatic VTE, 371 underwent filter placement because of known significant bleeding risk. A total of 344 patients treated with a filter were matched with 344 patients treated without a filter. Propensity score-matched pairs showed a nonsignificant trend toward lower risk of all-cause death for filter insertion compared with no insertion (6.6% vs. 10.2%; p = 0.12). The risk-adjusted PE-related mortality rate was lower for filter insertion than no insertion (1.7% vs. 4.9%; p = 0.03). Risk-adjusted recurrent VTE rates were higher for filter insertion than for no insertion (6.1% vs. 0.6%; p < 0.001). CONCLUSIONS In patients presenting with VTE and with a significant bleeding risk, inferior vena cava filter insertion compared with anticoagulant therapy was associated with a lower risk of PE-related death and a higher risk of recurrent VTE. However, study design limitations do not imply a causal relationship between filter insertion and outcome.

HLA class II antigen expression in colorectal carcinoma tumors as a favorable prognostic marker.

The goal of this study was to determine the frequency of HLA class II antigen expression in colorectal carcinoma (CRC) tumors, its association with the clinical course of the disease, and the underlying mechanism(s). Two tissue microarrays constructed with 220 and 778 CRC tumors were stained with HLA-DR, DQ, and DP antigen-specific monoclonal antibody LGII-612.14, using the immunoperoxidase staining technique. The immunohistochemical staining results were correlated with the clinical course of the disease. The functional role of HLA class II antigens expressed on CRC cells was analyzed by investigating their in vitro interactions with immune cells. HLA class II antigens were expressed in about 25% of the 220 and 21% of the 778 tumors analyzed with an overall frequency of 23%. HLA class II antigens were detected in 19% of colorectal adenomas. Importantly, the percentage of stained cells and the staining intensity were significantly lower than those detected in CRC tumors. However, HLA class II antigen staining was weakly detected only in 5.4% of 37 normal mucosa tissues. HLA class II antigen expression was associated with a favorable clinical course of the disease. In vitro stimulation with interferon gamma (IFNγ) induced HLA class II antigen expression on two of the four CRC cell lines tested. HLA class II antigen expression on CRC cells triggered interleukin-1β (IL-1β) production by resting monocytes. HLA class II antigen expression in CRC tumors is a favorable prognostic marker. This association may reflect stimulation of IL-1β production by monocytes.

La contribución de la producción del cacao orgánico a la resiliencia socio-ecológica en el contexto del cambio climático en el Alto Beni – La Paz

El cultivo del cacao en pequeña escala, sustento básico de muchas familias del Alto Beni, es afectado por los impactos del cambio climático. Para el desarrollo sostenible, es necesario que las fincas adquieran resiliencia: la capacidad de un sistema para reducir su sensibilidad hacia factores de estrés y perturbaciones, manteniendo su productividad, capacidad auto-organizativa, de aprendizaje y adaptación al cambio. Investigamos las diferencias en la resiliencia entre las fincas orgánicas y no orgánicas de cacao, y los rasgos significativos que inciden en la resiliencia socio-ecológica de los sistemas agrícolas del cacao. Definimos indicadores de resiliencia con expertos locales y productores durante un taller y con grupos focales. Los indicadores de la capacidad de amortiguación fueron: materia orgánica de los suelos, densidad aparente del suelo, e infestación con Moniliophthora perniciosa, diversidad arbórea, diversidad de cultivos, hormigas y fuentes de ingresos de las familias productoras. Los indicadores de auto-organización fueron: afiliación a organizaciones productoras, nivel de subsistencia, rendimientos de cacao e ingreso familiar anual. La capacidad de adaptación se evaluó indagando la cantidad de capacitaciones en que participaron las familias y la cantidad de fuentes de información que poseían. Entrevistamos 52 hogares: 30 orgánicos, 22 no orgánicos. Las fincas orgánicas en el área eran más diversificadas y rendían más. El ingreso familiar anual de las fincas orgánicas era sustancialmente mayor al de las no orgánicas. Probablemente el mayor rendimiento se debió principalmente a que los productores orgánicos participaron en más capacitaciones debido a su pertenencia a las organizaciones locales. Concluimos que las organizaciones locales de agricultura orgánica contribuyeron a crear resiliencia proporcionando servicios de extensión mediante el establecimiento de parcelas, creación de capacidades y seguros sociales

Anstrengung bei wiederholter Selbstkontrolle: Effekte impliziter Theorien der Willenskraft auf Herzratenvariabilität

Vergangene Forschung konnte zeigen, dass Ego-Depletion nur dann auftritt, wenn Personen glauben, Willenskraft sei eine limitierte Ressource (Job, Dweck & Walton, 2010). Offen ist die Frage, welche Mechanismen den Effekten impliziter Theorien über Willenskraft auf Selbstkontrolle zugrunde liegen und welche Rolle dabei die Anstrengung spielt. Aus bestehender Forschung lassen sich zwei unterschiedliche Annahmen zu Anstrengung im Ego-Depletion Paradigma ableiten: Einerseits könnte es sein, dass Personen mit einer limitierten impliziten Theorie der Willenskraft versuchen, Ressourcen zu sparen und sich somit weniger stark anstrengen als Personen mit einer nicht-limitierten Theorie. Andererseits kann, basierend auf der Effort-Mobilization Theorie, angenommen werden, dass sich Personen mit einer limitierten Theorie mehr anstrengen, um für die Wahrnehmung mangelnder Ressourcen zu kompensieren. In einem Experiment wurde Herzratenvariabilität, als psychophysiologischer Indikator von Anstrengung, gemessen und in Abhängigkeit von impliziten Theorien über Willenskraft und vorangehender Verausgabung (Depletion) untersucht. Die Ergebnisse suggerieren, dass sich Personen mit einer limitierten Theorie der Willenskraft nach Depletion mehr anstrengen, um die gleiche Leistung zu erbringen, als Personen mit einer nicht-limitierten Theorie. Die Befunde sind somit konsistent mit den Annahmen der Effort-Mobilization Theorie.

Ancora su Hölderlin e gli scrittori di lingua italiana (da Giosue Carducci a Fabio Pusterla)

A discussion of the long-term “Hölderlinism” of Italian poets, starting from Vigolo’s essay on Hölderlin and the music (1966), moving back to Carducci’s translations, with a critical edition of his version of Hölderlin’s Achill (1874, see the leaf reproduced in the appendix), and concluding with a look at later Italian poets up to Pusterla (2004).

Giorgio Vigolo – Quali musiche suonò Hölderlin? (28 aprile 1966)

Giorgio Vigolo’s lecture Quali musiche suonò Hölderlin? (Which Pieces of Music Did Hölderlin Play?), which the Italian poet held in Rome on April 28th 1966, here edited for the first time, with notes, by Giovanna Cordibella.