929 resultados para Older Sub-acute ED Presentations
Resumo:
This paper uses three films adapted from the novels of John Grisham, The Firm, The Rainmaker and A Time To Kill, as well as associated television series like Ed to map a vernacular theory of what I have termed the 'postmaterial' lawyer. Grisham's work has been the focus of much critique by legal scholars who suggests he hates lawyers, is critical of the concept of law, and provides 'outlandishly' happy endings. I will challenge these critiques and, in tracing the history of legal thrillers and trial movies, suggest that Grisham and the related texts' explorations of how a just practitioner can operate in an unjust system constitute a powerful interrogation of what law can be.
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The left ventricular response to dobutamine may be quantified using tissue Doppler measurement of myocardial velocity or displacement or 3-dimensional echocardiography to measure ventricular volume and ejection fraction. This study sought to explore the accuracy of these methods for predicting segmental and global responses to therapy. Standard dobutamine and 3-dimensional echocardiography were performed in 92 consecutive patients with abnormal left ventricular function at rest. Recovery of function was defined by comparison with follow-up echocardiography at rest 5 months later. Segments that showed improved regional function at follow-up showed a higher increment in peak tissue Doppler velocity with dobutamine therapy than in nonviable segments (1.2 +/- 0.4 vs 0.3 +/- 0.2 cm/s, p = 0.001). Similarly, patients who showed a > 5% improvement of ejection fraction at follow-up showed a greater displacement response to dobutamine (6.9 +/- 3.2 vs 2.1 +/- 2.3 mm, p = 0.001), as well as a higher rate of ejection fraction, response to dobutamine (9 +/- 3% vs 2 +/- 2%, p = 0.001). The optimal cutoff values for predicting subsequent recovery of function at rest were an increment of peak velocity > 1 cm/s, >5 mm of displacement, and a >5% improvement of ejection fraction with low-dose dobutamine. (C) 2003 by Excerpta Medica, Inc.
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Three confirmed cases of acute iron tablet-induced necrosis due to a fulminant chemical burn injury to the tracheobronchial tree as a result of accidental inhalation and/or aspiration of iron tablets are described. Although histological confirmation has been relied upon for diagnosis, the distinctive bronchoscopic features may allow prompt recognition and treatment by bronchoscopists to prevent this potentially fatal condition.
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Background : Femoral shaft fracture incidence increases in older adults and is associated with low-energy trauma. Apart from bone density, the distribution and size of bone contributes to its strength. Aim : To examine if bone geometry and density of the femoral mid-shaft in older adults differs by sex and race, we studied 197 White women, 225 Black women, 242 White men, and 148 Black men aged 70-79 years participating in the Health, Aging, and Body Composition study; a prospective cohort study in the USA. A secondary purpose of the study was to examine the association of site-specific muscle and fat to bone geometry and density. Subjects and methods : Subjects were community-dwelling and reported no difficulty walking one-quarter of a mile or climbing stairs. Mid-femoral volumetric bone mineral density (vBMD, mg cm -3 ), total area (TA), cortical area (CA), medullary area (MA), cross-sectional moments of inertia (CSMI: I x , I y , J ), and muscle and fat areas (cm 2 ) were determined by computed tomography (CT; GE CT-9800, 10 mm slice thickness). Results : vBMD was greater in men than women with no difference by race ( p < 0.001). Bone areas and area moments of inertia were also greater in men than women ( p < 0.001), with Black women having higher values than White women for TA and CA. Standardizing geometric parameters for body size differences by dividing by powers of femur length did not negate the sex difference for TA and MA. Significant differences ( p < 0.05) among the four groups also remained for I x and J . Mid-thigh muscle area was an independent contributor to TA in all groups (Std beta = 0.181-0.351, p < 0.05) as well as CA in women (Std beta = 0.246-0.254, p < 0.01) and CSMI in White women (Std beta = 0.175-0.185, p < 0.05). Further, muscle area was a significant contributor to vBMD in Black women. Conclusion : These results indicate that bone geometry and density of the femoral diaphysis differs primarily by sex, rather than race, in older well-functioning adults. In addition, site-specific muscle area appears to have a potential contributory role to bone geometry parameters, especially in women.
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Este projeto trata de experi??ncia realizada na Dataprev sobre a implanta????o de um novo sistema de benef??cios, utilizando tecnologia de banco de dados e metodologia de desenvolvimento de sistemas. Foi elaborado um programa que substituiu outros existentes no processamento central, atendendo ??s fun????es de benef??cio do INSS. Trabalhou se em parceira com o INSS, envolvendo a migra????o de mais de 10 milh??es de benef??cios com regras complexas e por vezes n??o documentadas. O sistema est?? funcionando em mais de mil postos e outras inst??ncias do INSS, em todo o pa??s. Diminui????o dr??stica da possibilidade de fraudes e melhoria do atendimento aos benefici??rios foram os prop??sitos do projeto, que se realizaram na pr??tica
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Chronic lead exposure induces hypertension in humans and animals, affecting endothelial function. However, studies concerning acute cardiovascular effects are lacking. We investigated the effects of acute administration of a high concentration of lead acetate (100 µΜ) on the pressor response to phenylephrine (PHE) in the tail vascular bed of male Wistar rats. Animals were anesthetized with sodium pentobarbital and heparinized. The tail artery was dissected and cannulated for drug infusion and mean perfusion pressure measurements. Endothelium and vascular smooth muscle relaxation were tested with acetylcholine (5 µg/100 µL) and sodium nitroprusside (0.1 µg/100 µL), respectively, in arteries precontracted with 0.1 µM PHE. Concentration-response curves to PHE (0.001-300 µg/100 µL) were constructed before and after perfusion for 1 h with 100 µΜ lead acetate. In the presence of endothelium (E+), lead acetate increased maximal response (Emax) (control: 364.4 ± 36, Pb2+: 480.0 ± 27 mmHg; P < 0.05) and the sensitivity (pD2; control: 1.98 ± 0.07, 2.38 ± 0.14 log mM) to PHE. In the absence of endothelium (E-) lead had no effect but increased baseline perfusion pressure (E+: 79.5 ± 2.4, E-: 118 ± 2.2 mmHg; P < 0.05). To investigate the underlying mechanisms, this protocol was repeated after treatment with 100 µM L-NAME, 10 µM indomethacin and 1 µM tempol in the presence of lead. Lead actions on Emax and pD2 were abolished in the presence of indomethacin, and partially abolished with L-NAME and tempol. Results suggest that acute lead administration affects the endothelium, releasing cyclooxygenase-derived vasoconstrictors and involving reactive oxygen species.
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Obstructive apnea (OA) can exert significant effects on renal sympathetic nerve activity (RSNA) and hemodynamic parameters. The present study focuses on the modulatory actions of RSNA on OA-induced sodium and water retention. The experiments were performed in renal-denervated rats (D; N = 9), which were compared to sham (S; N = 9) rats. Mean arterial pressure (MAP) and heart rate (HR) were assessed via an intrafemoral catheter. A catheter was inserted into the bladder for urinary measurements. OA episodes were induced via occlusion of the catheter inserted into the trachea. After an equilibration period, OA was induced for 20 s every 2 min and the changes in urine, MAP, HR and RSNA were recorded. Renal denervation did not alter resting MAP (S: 113 ± 4 vs D: 115 ± 4 mmHg) or HR (S: 340 ± 12 vs D: 368 ± 11 bpm). An OA episode resulted in decreased HR and MAP in both groups, but D rats showed exacerbated hypotension and attenuated bradycardia (S: -12 ± 1 mmHg and -16 ± 2 bpm vs D: -16 ± 1 mmHg and 9 ± 2 bpm; P < 0.01). The basal urinary parameters did not change during or after OA in S rats. However, D rats showed significant increases both during and after OA. Renal sympathetic nerve activity in S rats increased (34 ± 9%) during apnea episodes. These results indicate that renal denervation induces elevations of sodium content and urine volume and alters bradycardia and hypotension patterns during total OA in unconscious rats.
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The rise of large developing countries has led to considerable discussions of re-balancing global relations and giving greater priority to understanding South-South relations. This paper, in exploring the central ideas of Chinese and Brazilian foreign policy and the behavior of these two rising Southern countries toward Sub-Saharan Africa, argues that the English School of International Relations is well suited to understanding the intentions and actions that characterize South-South relations.
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Utilizing China's leadership projects in the Great Mekong Sub-Region (GMS) as a case study, this paper aims to investigate whether China qualifies as an international leader. This work argues that its geographic position and economic rise allow China to be a "system maker and privilege taker," which is a dual role forming in economic-political relations in the GMS in the last ten years. China is among major driving forces to set up an economic zone in GMS. Growing Chinese regional power is intimately related to the creation of various hubs connecting regional transportation, communication and energy systems that foster the economic development of this region. However, China also proves dark sides of rising powers which take advantage of their privileges to gain benefits. As a "system maker" with its own position and capability, China has notably benefited from building hydropower systems. More importantly, while China is pursuing its benefits and privileges, its hydropower projects have caused some negative effects for the ecosystem in the region. The inflation of dam constructions in both China and GMS countries is raising concerns about using natural resources of the Mekong River. Our concluding part addresses the pressing need to start a serious discussion on the balance between national interests and regional solidarity within the formulation of Chinese foreign policy in GMS.
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A evapotranspiração define a perda total de água do sistema solo-planta para a atmosfera. Nas áreas agrícolas, particularmente onde se pratica algum tipo de irrigação, a determinação da evapotranspiração, por via de sensoriamento remoto, vem ganhando cada vez mais importância, pois possibilita identificar a eficiência com que a água tem sido utilizada. Nesse contexto, este trabalho tem o objetivo de determinar a evapotranspiração real diária (ETr diária), com a utilização de produtos do sensor MODIS, nas sub-bacias do Ribeirão Entre Ribeiros e Rio Preto, que ficam entre os Estados de Goiás e Minas Gerais. O SEBAL (Surface Energy Balance Algorithm for Land) foi utilizado para a obtenção da ETr diária em quatro dias diferentes, no período de julho a outubro de 2007. Os resultados encontrados foram compatíveis com os citados em outras literaturas e a comparação entre a evapotranspiração, obtida pelo SEBAL, e a evapotranspiração da cultura (ETc) demonstraram que esse algoritmo pode ser utilizado como boa opção para determinar, com a utilização de produtos do sensor MODIS, a evapotranspiração diária nas condições das sub-bacias do ribeirão Entre Ribeiros e rio Preto.