Performance of rest myocardial perfusion imaging in the management of acute chest pain in the emergency room in developing nations (PREMIER trial)

Background. Rest myocardial perfusion imaging (MPI) is effective in managing patients with acute chest pain in developed countries. We aimed to define the role and feasibility of rest MPI in low-to-middle income countries. Methods and Results. Low-to-intermediate risk patients (n = 356) presenting with chest pain to ten centers in eight developing countries were injected with a Tc-99m-based tracer, and standard imaging was performed. The primary outcome was a composite of death, non-fatal myocardial infarction (MI), recurrent angina, and coronary revascularization at 30 days. Sixty-nine patients had a positive MPI (19.4%), and 52 patients (14.6%) had a primary outcome event. An abnormal rest-MPI result was the only variable which independently predicted the primary outcome [adjusted odds ratio (OR) 8.19, 95% confidence interval 4.10-16.40, P = .0001]. The association of MPI result and the primary outcome was stronger (adjusted OR 17.35) when only the patients injected during pain were considered. Rest-MPI had a negative predictive value of 92.7% for the primary outcome, improving to 99.3% for the hard event composite of death or MI. Conclusions. Our study demonstrates that rest-MPI is a reliable test for ruling out MI when applied to patients in developing countries. (J Nucl Cardiol 2012;19:1146-53.)

Rest left ventricular function and contractile reserve by dobutamine stress echocardiography in peripartum cardiomyopathy

Aims: To assess whether contractile reserve during dobutamine stress echocardiography (DSE) can predict left ventricular functional recovery in patients with peripartum cardiomyopathy and to assess myocardial fibrosis by magnetic resonance imaging (MRI) in these patients. Methods: Nine patients with peripartum cardiomyopathy were enrolled. All patients underwent DSE and were followed for six months, when a rest Doppler echocardiogram was repeated. MRI was also performed at the beginning of follow-up to identify myocardial fibrosis. Results: Mean age was 29 +/- 7.9 years and mean left ventricular ejection fraction at baseline was 39.4 +/- 8.6% (range 24-49%). Eight of the nine patients showed left ventricular functional recovery with mean ejection fraction at follow-up of 57.1 +/- 13.8%. The ejection fraction response to DSE did not predict recovery at follow-up. On the other hand, left ventricular ejection fraction at baseline correlated with ejection fraction at follow-up. Mild fibrosis was detected in only one patient. Conclusion: Left ventricular ejection fraction at baseline was a predictor of left ventricular functional recovery in patients with peripartum cardiomyopathy. Dobutamine stress echocardiography at presentation of the disease did not predict recovery at follow-up. Myocardial fibrosis appeared to be uncommon in this cardiomyopathy. (C) 2011 Sociedade Portuguesa de Cardiologia Published by Elsevier Espana, S.L. All rights reserved.

Long-term leucine supplementation reduces fat mass gain without changing body protein status of aging rats

Objective: Aging is characterized by alterations in body composition such as an increase in body fat and decreases in muscle mass (sarcopenia) and bone density (osteopenia). Leucine supplementation has been shown to acutely stimulate protein synthesis and to decrease body fat. However, the long-term effect of consistent leucine supplementation is not well defined. This study investigated the effect of leucine supplementation during aging. Methods: Six-month-old rats were divided into three groups: an adult group (n = 10) euthanized at 6 mo of age, a leucine group (n = 16) that received a diet supplemented with 4% leucine for 40 wk, and a control group (n = 19) that received the control diet for 40 wk. The following parameters were evaluated: body weight, food intake, chemical carcass composition, indicators of acquired chronic diseases, and indicators of protein nutritional status. Results: Body weight and fat were lower in the leucine group after 40 wk of supplementation compared with the control group but still higher than in the adult group. The lipid and glycemic profiles were equally altered in the control and leucine groups because of aging. In addition, leucine supplementation did not affect the changes in protein status parameters associated with aging, such as decreases in body and muscle protein and total serum protein. Conclusion: The results indicate that leucine supplementation attenuates body fat gain during aging but does not affect risk indicators of acquired chronic diseases. Furthermore, supplemented animals did not show signs of a prevention of the decrease in lean mass associated with aging. (C) 2012 Elsevier Inc. All rights reserved.

Evaluation of Adrenal Reserve in Children with Acute Lymphocytic Leukemia Treated with Prednisone or Dexamethasone

Background/Aims: The purpose of this study was to compare adrenal gland reserve in acute lymphocytic leukemia (ALL) patients 8 weeks after treatment with either prednisone (PRED) or dexamethasone (DEX) during the induction phase of therapy. Methods: A double-blind comparative study of patients treated with PRED and DEX was performed. Sixteen patients received PRED (40 mg/m(2)/day) and 13 patients received DEX (6 mg/m(2)/day), both for 28 days. A low-dose adrenocorticotropic hormone test (1.0 mu g/m(2), IV) was performed before and weekly for 8 weeks after abrupt cessation of glucocorticoid therapy. Sixteen children without ALL were used as controls to determine the cutoff peak cortisol level (14.2 mu g/dl). Results: Both groups (PRED and DEX) displayed similar mean peak cortisol levels before treatment and during the 8 weeks of evaluation (p = 0.652). No relationship was observed between the incidence of infection/stress and peak cortisol level within each group, nor was there a difference in the frequency of infection/stress between groups (p = 0.359). Although the patients presented variations in peak cortisol during the study period, no signs or symptoms of adrenal insufficiency were observed. Conclusion: Patients who received PRED or DEX for 4 weeks showed similar adrenal reserves and infection rates for 8 weeks after abruptly stopping glucocorticoid therapy, suggesting that DEX, which is a better antileukemic drug than PRED, has similar adrenal suppression and recovery rates. Copyright (c) 2012 S. Karger AG, Basel

Improvement of Older Women's Sexuality Through Emancipatory Education

The purpose of this action research (AR) was to explore the ways in which sexuality is experienced daily and to improve the expression of older women's sexuality. The pedagogy of autonomy as proposed by the Brazilian educator Paulo Freire theoretically supported this AR, with the participation of six older adult women living in a rural setting in southwest Brazil. The older women's experiences regarding sexuality, their concerns, and their educational demands could be summarized through five phrases: the improvement of self-esteem as a way to promote sexuality; sexuality impaired by loneliness and lack of affection; men's sexual satisfaction seen as a woman's obligation; women's sexuality controlled by the society; and relinquishment of the companion to attend to the expectations of family members. Dialogical and participative educational approaches and continuous observation-participation strategies were performed to support the women's care and educational requirements.

Star formation in H I tails: HCG 92, HCG 100 and six interacting systems

We present new Gemini spectra of 14 new objects found within the H?i tails of Hickson Compact Groups (HCGs) 92 and 100. Nine of them are Galaxy Evolution Explorer (GALEX) far-ultraviolet (FUV) and near-ultraviolet (NUV) sources. The spectra confirm that these objects are members of the compact groups and have metallicities close to solar, with an average value of 12+log(O/H) similar to 8.5. They have average FUV luminosities 7 x 10(40)?erg?s-1 and very young ages (<100?Myr), and two of them resemble tidal dwarf galaxy (TDG) candidates. We suggest that they were created within gas clouds that were ejected during galaxygalaxy interactions into the intergalactic medium, which would explain the high metallicities of the objects, inherited from the parent galaxies from which the gas originated. We conduct a search for similar objects in six interacting systems with extended H?i tails: NGC 2623, NGC 3079, NGC 3359, NGC 3627, NGC 3718 and NGC 4656. We found 35 ultraviolet (UV) sources with ages < 100?Myr; however, most of them are on average less luminous/massive than the UV sources found around HCG 92 and HCG 100. We speculate that this might be an environmental effect and that compact groups of galaxies are more favourable to TDG formation than other interacting systems.

Vehicle emissions and PM2.5 mass concentrations in six Brazilian cities

In Brazil, the principal source of air pollution is the combustion of fuels (ethanol, gasohol, and diesel). In this study, we quantify the contributions that vehicle emissions make to the urban fine particulate matter (PM2.5) mass in six state capitals in Brazil, collecting data for use in a larger project evaluating the impact of air pollution on human health. From winter 2007 to winter 2008, we collected 24-h PM2.5 samples, employing gravimetry to determine PM2.5 mass concentrations; reflectance to quantify black carbon concentrations; X-ray fluorescence to characterize elemental composition; and ion chromatography to determine the composition and concentrations of anions and cations. Mean PM2.5 concentrations in the cities of Sao Paulo, Rio de Janeiro, Belo Horizonte, Curitiba, Porto Alegre, and Recife were 28, 17.2, 14.7, 14.4, 13.4, and 7.3 mu g/m(3), respectively. In Sao Paulo and Rio de Janeiro, black carbon explained approximately 30% of the PM2.5 mass. We used receptor models to identify distinct source-related PM2.5 fractions and correlate those fractions with daily mortality rates. Using specific rotation factor analysis, we identified the following principal contributing factors: soil and crustal material; vehicle emissions and biomass burning (black carbon factor); and fuel oil combustion in industries (sulfur factor). In all six cities, vehicle emissions explained at least 40% of the PM2.5 mass. Elemental composition determination with receptor modeling proved an adequate strategy to identify air pollution sources and to evaluate their short- and long-term effects on human health. Our data could inform decisions regarding environmental policies vis-a-vis health care costs.

Wind-driven cross-equatorial flow in the Indian ocean

Máster en Oceanografía

Infanzie migranti. La narrativa per ragazzi nelle opere di scrittrici indiane residenti nel Regno Unito e in Canada

L’oggetto dell’analisi si situa all’intersezione di diversi ambiti disciplinari: letteratura, scienze dell’educazione, sociologia, psicologia. Nel presente lavoro, viene privilegiata un’analisi tematica della narrativa e la definizione identitaria delle “infanzie migranti” viene declinata seguendo percorsi di lettura che mettano in risalto alcune prospettive ricorrenti nei romanzi. Il corpus letterario selezionato include alcuni romanzi scritti in lingua inglese da sei scrittrici di origine indiana, in particolare Jamila Gavin, Rachna Gilmore, Anjali Banerjee, Rukhsana Khan, Ravinder Randhawa e Meera Syal. Nel primo capitolo si tracciano le premesse teoriche e metodologiche del lavoro, definendo il genere della letteratura per l’infanzia e interrogandoci sulle sue specificità in un contesto postcoloniale qual è quello indiano. Il secondo capitolo è dedicato alla definizione identitaria delle seconde generazioni, in particolar modo di quelle indo-britanniche e indo-canadesi, cui appartengono i protagonisti dei romanzi presi in esame. Nel terzo capitolo viene posta attenzione agli elementi che concorrono alla definizione identitaria dei giovani protagonisti dei romanzi, i quali si interrogano sul loro essere e sull’appartenenza interculturale. I dialoghi intergenerazionali tra i protagonisti e i nonni - o altre figure di guida - permettono alle scrittrici di raccontare la storia dell’India coloniale e della lotta per l’indipendenza dal punto di vista degli esclusi dalla storiografia ufficiale. Nel capitolo conclusivo si argomenta invece come la definizione identitaria si attui per mezzo dello spazio, tramite l’appartenenza ai luoghi, spazi caricati di significato, e per mezzo del viaggio, che può essere reale, immaginario o iniziatico. In tutti i casi, il viaggio porta alla scoperta del Sé, di un’identità ibrida e molteplice da parte dei personaggi.

Psychosocial correlates of rehabilitation from stroke: a longitudinal study

The general aim of this dissertation was to uncover the association between psychosocial factors and rehabilitation outcome after stroke. METHOD. A sample of patients with stroke (n=40) and their caregivers (n=36) were assessed at admission to and six months after discharge from rehabilitation hospital, using the following instruments: Structured Clinical Interview for DSM-IV, structured interview based on Diagnostic Criteria for Psychosomatic Research, Symptom Questionnaire, Psychosocial Index, Psychological Well-Being Scales, and Family Assessment Device. 40 subjects from the general population underwent the same psychological assessment. In addition, patients' functional status was measured using the Functional Independence Measure. RESULTS. Stroke survivors reported lower education and higher alcohol consumption than controls. No significant differences emerged between the two groups in the prevalence of psychiatric diagnoses or psychosomatic syndromes, however patients reported significantly higher levels of anxiety, depression, somatic symptoms, and lower autonomy than controls. Caregivers reported significantly higher scores in anxiety, depression, and somatic symptoms compared to normative data, while no impairments emerged in psychological well-being and family functioning. At six-month follow-up, in patients a significant decrease in smoking habit and an increase in DSM diagnoses were reported. Both stroke survivors and caregivers showed significant reductions in anxiety, with patients displaying also a decrease in somatic symptoms, an increase in stress and a deterioration in quality of life. Significant deteriorations in several aspects of family functioning was perceived only by patients. An association between patients' functional recovery in the cognitive domain and family behavior control emerged. For caregivers, family functioning significantly predicted hostility and somatic symptoms were associated with family affective involvement. CONCLUSIONS. These data highlight the utility in the Italian setting of the adoption of a psychosocial assessment and a family-systems approach in stroke rehabilitation, in order to development interventions properly targeted to the characteristics of patients and their family members.

Prokaryotic community structure in ultra-slow spreading Southwest Indian Ridge.

The Southwest Indian Ridge segment that extends between 10° and 16° E has the slowest spreading rate of any other oceanic ridge (about 8.4 mm/year). In 2013 during the expedition ANTXXIX/8 seismology, geology, microbiology, heat flow analyses were carried out. Here, no hydrothermal plumes or black smoker systems were found but the results of the survey allowed to identify areas with peculiar characteristics: Area 1 with higher heat flux bsf; Area 2 where in 2002 the presence of hydrothermal emissions was hypothesized (Bach et al., 2002); Area 3 with anomalies of methane, ammonium, sulphide and dissolved inorganic carbon in pore water sediment profiles, and recovery of fauna vents. All these aspects suggest the presence of a hydrothermal circulation. Using Illumina 16S gene tag, statistical tools and phylogenetic trees, I provided a biological proof of the presence of hydrothermal circulation in this ridge segment. At Area 3, alpha and beta diversity indexes showed similarities with those described for venting microbial communities and about 40-70% of the dominant microbial community was found phylogenetically related to clones isolated hydrothermal-driven environments. Although the majority of chemosynthetic environment related taxa were not classified like autotrophic prokaryotes, some of them are key taxa in support of the presence of hydrothermal circulation, since they are partners of consortia or mediate specific reaction typically described for hydrothermal and seep environments, or are specialized organisms in exploiting labile organic substrates. Concluding, these results are remarkable because support the importance of ultra slow spreading ridge systems in contributing to global geochemical cycles and larval dispersion of vent fauna.

Beyond Belief: Japanese Approaches to the Meaning of Religion

For several centuries, Japanese scholars have argued that their nation’s culture—including its language, religion and ways of thinking—is somehow unique. The darker side of this rhetoric, sometimes known by the English term “Japanism” (nihon-jinron), played no small role in the nationalist fervor of the late-nineteenth and early twentieth centuries. While much of the so-called “ideology of Japanese uniqueness” can be dismissed, in terms of the Japanese approach to “religion,” there may be something to it. This paper highlights some distinctive—if not entirely unique—features of the way religion has been categorized and understood in Japanese tradition, contrasting these with Western (i.e., Abrahamic), and to a lesser extent Indian and Chinese understandings. Particular attention is given to the priority of praxis over belief in the Japanese religious context. Des siècles durant, des chercheurs japonais ont soutenu que leur culture – soit leur langue, leur religion et leurs façons de penser – était en quelque sorte unique. Or, sous son jour le plus sombre, cette rhétorique, parfois désignée du terme de « japonisme » (nihon-jinron), ne fut pas sans jouer un rôle déterminant dans la mont��e de la ferveur nationaliste à la fin du XIXe siècle, ainsi qu’au début du XXe siècle. Bien que l’on puisse discréditer pour l’essentiel cette soi-disant « idéologie de l’unicité japonaise », la conception nippone de la « religion » constitue, quant à elle, un objet d’analyse des plus utiles et pertinents. Cet article met en évidence quelques caractéristiques, sinon uniques du moins distinctives, de la manière dont la religion a été élaborée et comprise au sein de la tradition japonaise, pour ensuite les constrater avec les conceptions occidentale (abrahamique) et, dans une moindre mesure, indienne et chinoise. Une attention toute particulière est ici accordée à la praxis plutôt qu’à la croyance dans le contexte religieux japonais.

Design Simulation for Solar Energy Research and Education

Solar research is primarily conducted in regions with consistent sunlight, severely limiting research opportunities in many areas. Unfortunately, the unreliable weather in Lewisburg, PA, can prove difficult for such testing to be conducted. As such, a solar simulator was developed for educational purposes for the Mechanical Engineering department at Bucknell University. The objective of this work was to first develop a geometric model to evaluate a one sun solar simulator. This was intended to provide a simplified model that could be used without the necessity of expensive software. This model was originally intended to be validated experimentally, but instead was done using a proven ray tracing program, TracePro. Analyses with the geometrical model and TracePro demonstrated the influence the geometrical properties had results, specifically the reflector (aperture) diameter and the rim angle. Subsequently, the two were approaches were consistent with one another for aperture diameters 0.5 m and larger, and for rim angles larger than 45°. The constructed prototype, that is currently untested, was designed from information provided by the geometric model, includes a metal halide lamp with a 9.5 mm arc diameter and parabolic reflector with an aperture diameter of 0.631 meters. The maximum angular divergence from the geometrical model was predicted to be 30 mRadians. The average angular divergence in TraceProof the system was 19.5 mRadians, compared to the sun’s divergence of 9.2 mRadians. Flux mapping in TracePro showed an intensity of 1000 W/m2 over the target plane located 40 meters from the lamp. The error between spectrum of the metal halide lamp and the solar spectrum was 10.9%, which was found by comparing their respective Plank radiation distributions. The project did not satisfy the original goal of matching the angular divergence of sunlight, although the system could still to be used for optical testing. The geometric model indicated performance in this area could be improved by increasing the diameter of the reflector, as well as decreasing the source diameter. Although ray tracing software provides more information to analyze the simulator system, the geometrical model is adequate to provide enough information to design a system.

Six-year follow-up of azathioprine and mycophenolate mofetil use during the first 6 months of renal transplantation

Long-term follow-up examination to test whether therapy with mycophenolate mofetil (MMF) or azathioprine (AZA) during the first year translates into different graft or patient survival and graft function is important. Therefore, 6-year follow-up data of a group of 80 consecutive renal transplant recipients were analyzed. The first group of 40 patients was treated with AZA, cyclosporine and prednisone and the second group with MMF, cyclosporine and prednisone for the first 6 months. Graft failure rates were compared during follow-up. Creatinine, inverse slope of creatinine (delta/creatinine) and 24-hour proteinuria at 6 years post transplantation were compared. The Kaplan-Meier analyses for death-censored and non-censored graft failure showed no difference between the groups. Creatinine values at 6 years for the AZA Group were 139 +/- 36 micromol/l (95% CI 125.9-151.2 micromol/l) and for the MMF Group 149 +/- 52 micromol/l (95% CI 133.9-164.9 micromol/l). Delta/creatinine and 24-hour proteinuria at 6 years did not differ between the two groups. We conclude that an initial 6-month treatment with MMF as opposed to AZA reduced the early rejection rate, but did not result in superior long-term graft function or survival after 6 years of follow-up observation.

Short-term effects of hygiene education for preschool (kindergarten) children: a clinical study

AIM: To evaluate the outcomes of short (15 minutes) oral hygiene vs. hand hygiene education for preschool children 4 weeks after these interventions. MATERIALS AND METHODS: Sixty-one preschool children (age range 4-6 years) attending four kindergarten classes participated in a 15-minute health education programme on the importance of body cleanliness for general health. In addition, specific instructions on oral hygiene were provided for two randomly selected classes (30 children), while the remaining two classes (31 children) were given instruction of hand and nail cleaning. The oral hygiene status was assessed usingthe plaque control record (PCR). The cleanliness of the hands and fingernails was determined using a hand hygiene index (HHI) and a nail hygiene index (NHI). All three parameters were assessed before the intervention as well as 4 weeks thereafter. RESULTS: Four weeks after education, the PCR had improved for all children from 79.95% to 72.35% (p < 0.001). The NHI had improved from 74.91% to 61.71% (p < 0.001). In addition, the mean PCR of the children given oral hygiene instruction decreased from 83.67% to 72.40%, while the mean PCR of the children given hand and nail cleaning instruction decreased from 76.23% to 72.29% (interaction effect 'time x type of instruction': p = 0.044). Girls' PCR improved significantly more than boys' PCR (Girls, 80.98 vs. 69.71; boys, 78.33 vs. 75.31; p = 0.021). CONCLUSIONS: The results of the study show that even a short, school-based educational intervention at an early age may affect children's oral health promotion significantly. Teachers should, therefore, be encouraged to educate children from an early age about oral hygiene promotion.