6,088 research outputs found

    Pregnancy and cardiac disease

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    Pregnancy and cardiac disease

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    Pathophysiology of myocardial infarction with non-obstructive coronary arteries and Takotsubo syndrome

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    Introduction: The working diagnosis myocardial infarction with non-obstructive coronary arteries (MINOCA), with the subgroup myocardial infarction with normal coronary arteries (MINCA), encompasses conditions of diverse aetiological origin. One of them is Takotsubo syndrome (TTS), a reversible and often stress-induced condition of acute heart failure, predominantly affecting postmenopausal women. Both MINOCA and TTS are associated with substantial morbidity and mortality, yet evidence-based treatment is lacking. The overall aim of this thesis was to expand the knowledge on pathophysiological mechanisms of MINOCA and TTS, with a view to guide future clinical management. The study specific aims were I) to characterise MINCA patients regarding risk factors and markers for endothelial function and atherosclerosis, II) to improve the diagnostics of MINOCA, III) to study if coronary microvascular dysfunction (CMD) is a prominent feature of acute TTS, and whether CMD in TTS is associated with clinical parameters, and IV) to determine whether sympathetic activity and reactivity are enhanced in the early recovery phase of TTS. Methods and results: In study I, the first Stockholm Myocardial Infarction with Normal Coronaries (SMINC) study, we included 100 MINCA patients together with two age- and sexmatched control groups of MI patients with coronary heart disease, respectively healthy volunteers. Endothelial function was evaluated with peripheral arterial tonometry measuring reactive hyperaemia index. Atherosclerosis was evaluated with carotid ultrasound measuring intima-media thickness. MINCA was associated with many established cardiovascular risk factors and female sex. Measures of endothelial function and atherosclerosis did not differ between study groups. One out of four MINCA patients received a clinical diagnosis of TTS. In study II, the SMINC-2 study, 148 MINOCA patients were examined by comprehensive cardiovascular magnetic resonance (CMR) imaging at median 3 days after admission. 150 patients from the screening phase of the SMINC-1 study, examined by standard CMR imaging at median 12 days after admission, served as historical controls. The underlying diagnosis was identified in 77% of patients in the SMINC-2 study, compared to 47% of patients in SMINC-1. The improved diagnostic yield was mainly due to increased detection of myocarditis and TTS. In study III, the Sympathetic And vascular Function in Takotsubo syndrome (SAFT) study, we included 27 female TTS patients together with age- and sexmatched controls with ischemia and no obstructive coronary arteries (INOCA). CMD was assessed invasively with thermodilution technique during index coronary angiography. Cardiac function was determined by echocardiography and CMR imaging in TTS patients. CMD was more common in TTS patients than in INOCA controls (78% vs. 44%). CMD was related to left ventricular function in TTS and more pronounced in the apical than midventricular phenotype. In study IV, muscle sympathetic nerve activity (MSNA) was determined by microneurography of the peroneal nerve at rest and during stress in 18 TTS patients from the SAFT study together with 13 age- and sex-matched healthy controls. Cardiac specific sympathetic activity was depicted by 123Imetaiodobenzylguanidine scintigraphy in 10 TTS patients. Despite signs of increased cardiac sympathetic activity in TTS, MSNA at rest and in response to stress did not differ between TTS patients and controls. Conclusions: MINCA is associated with many cardiovascular risk factors, female sex, and TTS, but not with markers of endothelial function and atherosclerosis. Early and comprehensive CMR imaging significantly improves the diagnostic yield in MINOCA and is therefore strongly suggested as a standard diagnostic tool. CMD is highly prevalent in the acute phase of TTS, associated with left ventricular function, and thus proposed as a key mediator in TTS pathophysiology. An altered cardiac response to sympathetic activation, rather than an underlying sympathetic hyperactivity or hyperreactivity, is likely central for TTS development

    Sociocultural Contexts of Emotion Socialization in BIPOC Families

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    Having effective emotion regulation skills is critical to socioemotional well-being, and parents play a key role in the development of children’s emotion regulation through emotion socialization behaviors. However, since emotion socialization research has been primarily conducted with majority culture families, extant studies have often lacked consideration of BIPOC families’ unique sociocultural contexts. The current dissertation aimed to expand our understanding of parent emotion socialization behaviors and their impact on child functioning among minoritized families through two studies. The first was a scoping review of how a predominant parent-report emotion socialization measure, the Coping with Children's Negative Emotions Scale (CCNES), has been utilized among ethnoracial minority families in the United States. Findings are discussed in relation to adaptation and psychometric validation of the CCNES. Results suggested that parent emotion socialization behaviors traditionally categorized as “supportive” or “nonsupportive” may be differentially associated with child outcomes among BIPOC families. Recommendations for best practices for using the CCNES are provided. The second study was an empirical evaluation of the association between maternal emotion socialization and child emotion regulation, testing the moderating role of racial identity among African American and White American families. Results showed that for Black/African American families, increased maternal emotion/problem-focused emotion socialization behaviors were associated with children's increased knowledge of sadness emotion regulation strategies, but this association was not significant among White families. Additionally, we conducted a preliminary examination of the role of culturally specific moderators with a subsample of Black/African American participants. Results suggested that associations between parent emotion socialization and child behavior problems were dependent on maternal racial socialization behaviors. Together, these results emphasize the importance of examining proximal factors of emotion socialization and considering normative developmental processes for minoritized youth that overlap with emotion regulation development. Future researchers should test the unique and additive role of various emotion socialization behaviors, consider employing mixed-methods approaches to facilitate understanding of culturally nuanced emotion socialization responses, and examine culturally specific mechanisms. By incorporating these factors, researchers will be able to go beyond cross-cultural comparisons toward a conceptualization of child emotional development that integrates the dynamic interactions between emotion socialization and sociocultural context

    Safe passage for attachment systems:Can attachment security at international schools be measured, and is it at risk?

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    Relocations challenge attachment networks. Regardless of whether a person moves or is moved away from, relocation produces separation and loss. When such losses are repeatedly experienced without being adequately processed, a defensive shutting down of the attachment system could result, particularly when such experiences occur during or across the developmental years. At schools with substantial turnover, this possibility could be shaping youth in ways that compromise attachment security and young people’s willingness or ability to develop and maintain deep long-term relationships. Given the well-documented associations between attachment security, social support, and long-term physical and mental health, the hypothesis that mobility could erode attachment and relational health warrants exploration. International schools are logical settings to test such a hypothesis, given their frequently high turnover without confounding factors (e.g. war trauma or refugee experiences). In addition, repeated experiences of separation and loss in international school settings would seem likely to create mental associations for the young people involved regarding how they and others tend to respond to such situations in such settings, raising the possibility that people at such schools, or even the school itself, could collectively be represented as an attachment figure. Questions like these have received scant attention in the literature. They warrant consideration because of their potential to shape young people’s most general convictions regarding attachment, which could, in turn, have implications for young people’s ability to experience meaning in their lives

    Effects of municipal smoke-free ordinances on secondhand smoke exposure in the Republic of Korea

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    ObjectiveTo reduce premature deaths due to secondhand smoke (SHS) exposure among non-smokers, the Republic of Korea (ROK) adopted changes to the National Health Promotion Act, which allowed local governments to enact municipal ordinances to strengthen their authority to designate smoke-free areas and levy penalty fines. In this study, we examined national trends in SHS exposure after the introduction of these municipal ordinances at the city level in 2010.MethodsWe used interrupted time series analysis to assess whether the trends of SHS exposure in the workplace and at home, and the primary cigarette smoking rate changed following the policy adjustment in the national legislation in ROK. Population-standardized data for selected variables were retrieved from a nationally representative survey dataset and used to study the policy action’s effectiveness.ResultsFollowing the change in the legislation, SHS exposure in the workplace reversed course from an increasing (18% per year) trend prior to the introduction of these smoke-free ordinances to a decreasing (−10% per year) trend after adoption and enforcement of these laws (β2 = 0.18, p-value = 0.07; β3 = −0.10, p-value = 0.02). SHS exposure at home (β2 = 0.10, p-value = 0.09; β3 = −0.03, p-value = 0.14) and the primary cigarette smoking rate (β2 = 0.03, p-value = 0.10; β3 = 0.008, p-value = 0.15) showed no significant changes in the sampled period. Although analyses stratified by sex showed that the allowance of municipal ordinances resulted in reduced SHS exposure in the workplace for both males and females, they did not affect the primary cigarette smoking rate as much, especially among females.ConclusionStrengthening the role of local governments by giving them the authority to enact and enforce penalties on SHS exposure violation helped ROK to reduce SHS exposure in the workplace. However, smoking behaviors and related activities seemed to shift to less restrictive areas such as on the streets and in apartment hallways, negating some of the effects due to these ordinances. Future studies should investigate how smoke-free policies beyond public places can further reduce the SHS exposure in ROK

    Utilization of the Pediatric Advanced Life Support Provider Course to Increase Resuscitation Self-Efficacy in Neonatal Nurse Practitioners

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    Infants with congenital heart disease are predisposed to develop intrinsic rhythm abnormalities in the heart's physiological structural and conduction systems. Arrhythmias require emergent medical intervention depending on the type of arrhythmia and the patient's tolerance. The Neonatal Resuscitation Program does not provide the necessary training to manage arrhythmias. This pilot quasi-experimental research study aimed to assess the impact of the Pediatric Advanced Life Support provider course on neonatal nurse practitioners caring for congenital heart disease infants. The study included eight neonatal nurse practitioners from a Level IV neonatal intensive care unit in a Midwest urban children's hospital setting. The primary outcome was the change in resuscitation self-efficacy immediately after and at six weeks following the Pediatric Advanced Life Support course, measured using the modified Pediatric Resuscitation and Escalation of Care Self-Efficacy Scale. The secondary outcomes of a change in resuscitation knowledge and general self-efficacy were measured using pre-and post-course written exams and the New General Self-Efficacy Scale. The results did not meet statistical significance due to small sample size, but descriptive statistics demonstrated an increase in all the measures from pre- to post-intervention and at six weeks post-intervention. The Pediatric Advanced Life Support provider course positively influenced resuscitation self-efficacy, general self-efficacy, and resuscitation knowledge in the pilot cohort of neonatal nurse practitioners

    Improving diagnostic procedures for epilepsy through automated recording and analysis of patients’ history

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    Transient loss of consciousness (TLOC) is a time-limited state of profound cognitive impairment characterised by amnesia, abnormal motor control, loss of responsiveness, a short duration and complete recovery. Most instances of TLOC are caused by one of three health conditions: epilepsy, functional (dissociative) seizures (FDS), or syncope. There is often a delay before the correct diagnosis is made and 10-20% of individuals initially receive an incorrect diagnosis. Clinical decision tools based on the endorsement of TLOC symptom lists have been limited to distinguishing between two causes of TLOC. The Initial Paroxysmal Event Profile (iPEP) has shown promise but was demonstrated to have greater accuracy in distinguishing between syncope and epilepsy or FDS than between epilepsy and FDS. The objective of this thesis was to investigate whether interactional, linguistic, and communicative differences in how people with epilepsy and people with FDS describe their experiences of TLOC can improve the predictive performance of the iPEP. An online web application was designed that collected information about TLOC symptoms and medical history from patients and witnesses using a binary questionnaire and verbal interaction with a virtual agent. We explored potential methods of automatically detecting these communicative differences, whether the differences were present during an interaction with a VA, to what extent these automatically detectable communicative differences improve the performance of the iPEP, and the acceptability of the application from the perspective of patients and witnesses. The two feature sets that were applied to previous doctor-patient interactions, features designed to measure formulation effort or detect semantic differences between the two groups, were able to predict the diagnosis with an accuracy of 71% and 81%, respectively. Individuals with epilepsy or FDS provided descriptions of TLOC to the VA that were qualitatively like those observed in previous research. Both feature sets were effective predictors of the diagnosis when applied to the web application recordings (85.7% and 85.7%). Overall, the accuracy of machine learning models trained for the threeway classification between epilepsy, FDS, and syncope using the iPEP responses from patients that were collected through the web application was worse than the performance observed in previous research (65.8% vs 78.3%), but the performance was increased by the inclusion of features extracted from the spoken descriptions on TLOC (85.5%). Finally, most participants who provided feedback reported that the online application was acceptable. These findings suggest that it is feasible to differentiate between people with epilepsy and people with FDS using an automated analysis of spoken seizure descriptions. Furthermore, incorporating these features into a clinical decision tool for TLOC can improve the predictive performance by improving the differential diagnosis between these two health conditions. Future research should use the feedback to improve the design of the application and increase perceived acceptability of the approach

    Seamless Multimodal Biometrics for Continuous Personalised Wellbeing Monitoring

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    Artificially intelligent perception is increasingly present in the lives of every one of us. Vehicles are no exception, (...) In the near future, pattern recognition will have an even stronger role in vehicles, as self-driving cars will require automated ways to understand what is happening around (and within) them and act accordingly. (...) This doctoral work focused on advancing in-vehicle sensing through the research of novel computer vision and pattern recognition methodologies for both biometrics and wellbeing monitoring. The main focus has been on electrocardiogram (ECG) biometrics, a trait well-known for its potential for seamless driver monitoring. Major efforts were devoted to achieving improved performance in identification and identity verification in off-the-person scenarios, well-known for increased noise and variability. Here, end-to-end deep learning ECG biometric solutions were proposed and important topics were addressed such as cross-database and long-term performance, waveform relevance through explainability, and interlead conversion. Face biometrics, a natural complement to the ECG in seamless unconstrained scenarios, was also studied in this work. The open challenges of masked face recognition and interpretability in biometrics were tackled in an effort to evolve towards algorithms that are more transparent, trustworthy, and robust to significant occlusions. Within the topic of wellbeing monitoring, improved solutions to multimodal emotion recognition in groups of people and activity/violence recognition in in-vehicle scenarios were proposed. At last, we also proposed a novel way to learn template security within end-to-end models, dismissing additional separate encryption processes, and a self-supervised learning approach tailored to sequential data, in order to ensure data security and optimal performance. (...)Comment: Doctoral thesis presented and approved on the 21st of December 2022 to the University of Port
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