992 research outputs found

    Fetal in vivo continuous cardiovascular function during chronic hypoxia.

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    Although the fetal cardiovascular defence to acute hypoxia and the physiology underlying it have been established for decades, how the fetal cardiovascular system responds to chronic hypoxia has been comparatively understudied. We designed and created isobaric hypoxic chambers able to maintain pregnant sheep for prolonged periods of gestation under controlled significant (10% O2) hypoxia, yielding fetal mean P(aO2) levels (11.5 ± 0.6 mmHg) similar to those measured in human fetuses of hypoxic pregnancy. We also created a wireless data acquisition system able to record fetal blood flow signals in addition to fetal blood pressure and heart rate from free moving ewes as the hypoxic pregnancy is developing. We determined in vivo longitudinal changes in fetal cardiovascular function including parallel measurement of fetal carotid and femoral blood flow and oxygen and glucose delivery during the last third of gestation. The ratio of oxygen (from 2.7 ± 0.2 to 3.8 ± 0.8; P < 0.05) and of glucose (from 2.3 ± 0.1 to 3.3 ± 0.6; P < 0.05) delivery to the fetal carotid, relative to the fetal femoral circulation, increased during and shortly after the period of chronic hypoxia. In contrast, oxygen and glucose delivery remained unchanged from baseline in normoxic fetuses. Fetal plasma urate concentration increased significantly during chronic hypoxia but not during normoxia (Δ: 4.8 ± 1.6 vs. 0.5 ± 1.4 μmol l(-1), P<0.05). The data support the hypotheses tested and show persisting redistribution of substrate delivery away from peripheral and towards essential circulations in the chronically hypoxic fetus, associated with increases in xanthine oxidase-derived reactive oxygen species.This work was supported by the British Heart Foundation.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1113/JP27109

    Acolhimento na Atenção Básica: Navegações e Mergulhos nos Discursos e Práticas Produzidos no Cotidiano de uma Unidade de Saúde da Família.

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    RESUMO HOFFMANN, Catharina. Acolhimento na Atenção Básica: navegações e mergulhos nos discursos e práticas produzidos no cotidiano de uma Unidade de Saúde da Família. Orientadora: Profa. Dra. Maristela Dalbello Araújo. Vitória/ES: PPGPSI/UFES, 2009. 167f. Dissertação de Mestrado. Esta pesquisa abrange os processos de produção de saúde, tendo como objeto de estudo os discursos e práticas de saúde relacionados ao acolhimento. O contexto de análise é a Atenção Básica do município de Vitória/ES e o campo de pesquisa, o cotidiano da Unidade de Saúde da Família da Ilha do Príncipe. O estudo utilizou como referência os aportes teóricos da Análise Institucional e da Saúde Coletiva. Buscou-se analisar o modo como os trabalhadores fazem acolhimento no cotidiano do serviço, além de escutar as concepções e os discursos produzidos a respeito, na relação com suas práticas cotidianas, o que inclui os processos de trabalho e as interações com os usuários. Para isso, utilizou-se a Cartografia como estratégia metodológica. Os dados foram produzidos no período de fevereiro a setembro de 2008, por meio de observação, diário de campo e entrevistas realizadas com usuários e trabalhadores da USF. Os resultados produzidos expressam que o processo de trabalho e sua gestão são fragmentados e burocratizantes. Há intenção dos trabalhadores de rever os processos de trabalho, entretanto, isto encontra obstáculos na prática. No tocante ao acolhimento, a exigência que os trabalhadores sofrem para que atendam a uma certa produtividade é um aspecto que compromete a qualidade da relação entre as equipes e destas com o usuário, afetando o atendimento às necessidades destes e a própria oferta de ações de saúde. As necessidades que os trabalhadores esperam acolher estão circunscritas à doença ou sintoma manifesto fisicamente. Demonstrou-se que ir ao serviço para conversar constitui-se em uma demanda valorizada pelos usuários, sendo acolhida por alguns trabalhadores. Evidenciou-se que a comunicação nas equipes é restrita às discussões de questões administrativas e procedimentos. A hierarquização entre os níveis de formação contribui para entender o acolhimento como uma atividade ou procedimento que é atribuição de uma categoria específica (auxiliares de enfermagem), a qual supõe-se, tem capacidade técnica para fazê-lo no ato de recepção do usuário. Constatou-se que as ações de saúde não são pactuadas com os usuários, de modo que o PSF não garante o acolhimento. Porém, os tensionamentos nas relações cotidianas entre trabalhador e usuário favorecem a problematização do acolhimento como ação que pode ultrapassar a recepção. Fica evidente a necessidade de reorganização dos processos de trabalho e de se engendrar subjetividades por uma humanização que valorize os processos de singularização, de modo a se promover uma real democracia no acesso à saúde, na qualidade da assistência e na garantia dos princípios do SUS. Palavras-chave: acolhimento; processos de trabalho em saúde; produção de subjetividade; relação trabalhador-usuário

    Vibrational lifetimes and friction in adsorbate motion determined from quasi-elastic scattering

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    The vibrational excitation of molecules adsorbed on a surface is typically probed by spectroscopic techniques such as infrared or Raman spectroscopy. In the present article we demonstrate an alternative method to determine vibrational lifetimes of adsorbate molecules using quasi-elastic helium atom scattering (QHAS). As a probe of diffusive motion of molecules on surfaces QHAS is well established. Here, we demonstrate that QHAS can also be used to probe the vibrational lifetime of a molecule in its adsorption well. Measurements of cyclopentadienyl, C5H5, on Cu(111) allow us to distinguish two substrate phonon modes as well as two molecular vibrational modes, perpendicular and parallel to the surface. We further find that the dephasing of the vibrational motion corresponds to the friction determined in previous diffusion measurements.Financial support by the EPSRC (EP/E0049621), the Austrian Academy of Sciences (BAJL), the Royal Society (APJ) and the US National Science Foundation (CHE1124879, BJH) is gratefully acknowledged

    Facemasks, Hand Hygiene, and Influenza among Young Adults: A Randomized Intervention Trial

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    Limited vaccine availability and the potential for resistance to antiviral medications have led to calls for establishing the efficacy of non-pharmaceutical measures for mitigating pandemic influenza. Our objective was to examine if the use of face masks and hand hygiene reduced rates of influenza-like illness (ILI) and laboratory-confirmed influenza in the natural setting. A cluster-randomized intervention trial was designed involving 1,178 young adults living in 37 residence houses in 5 university residence halls during the 2007–2008 influenza season. Participants were assigned to face mask and hand hygiene, face mask only, or control group during the study. Discrete-time survival models using generalized estimating equations to estimate intervention effects on ILI and confirmed influenza A/B infection over a 6-week study period were examined. A significant reduction in the rate of ILI was observed in weeks 3 through 6 of the study, with a maximum reduction of 75% during the final study week (rate ratio [RR] = 0.25, [95% CI, 0.07 to 0.87]). Both intervention groups compared to the control showed cumulative reductions in rates of influenza over the study period, although results did not reach statistical significance. Generalizability limited to similar settings and age groups. Face masks and hand hygiene combined may reduce the rate of ILI and confirmed influenza in community settings. These non-pharmaceutical measures should be recommended in crowded settings at the start of an influenza pandemic

    Professional Learning Through Everyday Work: How Finance Professionals Self-Regulate Their Learning

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    Professional learning is a critical component of ongoing improvement and innovation and the adoption of new practices in the workplace. Professional learning is often achieved through learning embedded in everyday work tasks. However, little is known about how professionals self-regulate their learning through regular work activities. This paper explores how professionals in the finance sector (n-30) self-regulate their learning through day-to-day work. Analysis focuses on three sub-processes of self-regulated learning that have been identified as significant predictors of good self-regulated learning at work. A key characteristic of good self-regulation is viewing learning as a form of long-term, personalised self-improvement. This study provides a foundation for future policy and planning in organisations aiming to encourage self-regulated learning

    Adiposity has differing associations with incident coronary heart disease and mortality in the Scottish population: cross-sectional surveys with follow-up

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    Objective: Investigation of the association of excess adiposity with three different outcomes: all-cause mortality, coronary heart disease (CHD) mortality and incident CHD. Design: Cross-sectional surveys linked to hospital admissions and death records. Subjects: 19 329 adults (aged 18–86 years) from a representative sample of the Scottish population. Measurements: Gender-stratified Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality, CHD mortality and incident CHD. Separate models incorporating the anthropometric measurements body mass index (BMI), waist circumference (WC) or waist–hip ratio (WHR) were created adjusted for age, year of survey, smoking status and alcohol consumption. Results: For both genders, BMI-defined obesity (greater than or equal to30 kg m−2) was not associated with either an increased risk of all-cause mortality or CHD mortality. However, there was an increased risk of incident CHD among the obese men (hazard ratio (HR)=1.78; 95% confidence interval=1.37–2.31) and obese women (HR=1.93; 95% confidence interval=1.44–2.59). There was a similar pattern for WC with regard to the three outcomes; for incident CHD, the HR=1.70 (1.35–2.14) for men and 1.71 (1.28–2.29) for women in the highest WC category (men greater than or equal to102 cm, women greater than or equal to88 cm), synonymous with abdominal obesity. For men, the highest category of WHR (greater than or equal to1.0) was associated with an increased risk of all-cause mortality (1.29; 1.04–1.60) and incident CHD (1.55; 1.19–2.01). Among women with a high WHR (greater than or equal to0.85) there was an increased risk of all outcomes: all-cause mortality (1.56; 1.26–1.94), CHD mortality (2.49; 1.36–4.56) and incident CHD (1.76; 1.31–2.38). Conclusions: In this study excess adiposity was associated with an increased risk of incident CHD but not necessarily death. One possibility is that modern medical intervention has contributed to improved survival of first CHD events. The future health burden of increased obesity levels may manifest as an increase in the prevalence of individuals living with CHD and its consequences

    Growth characteristics in individuals with osteogenesis imperfecta in North America: results from a multicenter study.

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    PurposeOsteogenesis imperfecta (OI) predisposes people to recurrent fractures, bone deformities, and short stature. There is a lack of large-scale systematic studies that have investigated growth parameters in OI.MethodsUsing data from the Linked Clinical Research Centers, we compared height, growth velocity, weight, and body mass index (BMI) in 552 individuals with OI. Height, weight, and BMI were plotted on Centers for Disease Control and Prevention normative curves.ResultsIn children, the median z-scores for height in OI types I, III, and IV were -0.66, -6.91, and -2.79, respectively. Growth velocity was diminished in OI types III and IV. The median z-score for weight in children with OI type III was -4.55. The median z-scores for BMI in children with OI types I, III, and IV were 0.10, 0.91, and 0.67, respectively. Generalized linear model analyses demonstrated that the height z-score was positively correlated with the severity of the OI subtype (P &lt; 0.001), age, bisphosphonate use, and rodding (P &lt; 0.05).ConclusionFrom the largest cohort of individuals with OI, we provide median values for height, weight, and BMI z-scores that can aid the evaluation of overall growth in the clinic setting. This study is an important first step in the generation of OI-specific growth curves

    Genome-wide association study of bronchopulmonary dysplasia : a potential role for variants near the CRP gene

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    Bronchopulmonary dysplasia (BPD), the main consequence of prematurity, has a significant heritability, but little is known about predisposing genes. The aim of this study was to identify gene loci predisposing infants to BPD. The initial genome-wide association study (GWAS) included 174 Finnish preterm infants of gestational age 24-30 weeks. Thereafter, the most promising single-nucleotide polymorphisms (SNPs) associated with BPD were genotyped in both Finnish (n = 555) and non-Finnish (n = 388) replication cohorts. Finally, plasma CRP levels from the first week of life and the risk of BPD were assessed. SNP rs11265269, flanking the CRP gene, showed the strongest signal in GWAS (odds ratio [ OR] 3.2, p = 3.4 x 10(-6)). This association was nominally replicated in Finnish and French African populations. A number of other SNPs in the CRP region, including rs3093059, had nominal associations with BPD. During the first week of life the elevated plasma levels of CRP predicted the risk of BPD (OR 3.4, p = 2.9 x 10(-4)) and the SNP rs3093059 associated nominally with plasma CRP levels. Finally, SNP rs11265269 was identified as a risk factor of BPD (OR 1.8, p = 5.3 x 10(-5)), independently of the robust antenatal risk factors. As such, in BPD, a potential role for variants near CRP gene is proposed.Peer reviewe
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