Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: the long-term coronary computed tomography angiography CONFIRM registry.

AimsIn patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent.Methods and resultsPatients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3-4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3-2.2) and 1.4 (95% CI 1.1-1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004).ConclusionAmong patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both

Coronary atherosclerosis scoring with semiquantitative CCTA risk scores for prediction of major adverse cardiac events: Propensity score-based analysis of diabetic and non-diabetic patients.

AIMS:We aimed to compare semiquantitative coronary computed tomography angiography (CCTA) risk scores - which score presence, extent, composition, stenosis and/or location of coronary artery disease (CAD) - and their prognostic value between patients with and without diabetes mellitus (DM). Risk scores derived from general chest-pain populations are often challenging to apply in DM patients, because of numerous confounders. METHODS:Out of a combined cohort from the Leiden University Medical Center and the CONFIRM registry with 5-year follow-up data, we performed a secondary analysis in diabetic patients with suspected CAD who were clinically referred for CCTA. A total of 732 DM patients was 1:1 propensity-matched with 732 non-DM patients by age, sex and cardiovascular risk factors. A subset of 7 semiquantitative CCTA risk scores was compared between groups: 1) any stenosis ≥50%, 2) any stenosis ≥70%, 3) stenosis-severity component of the coronary artery disease-reporting and data system (CAD-RADS), 4) segment involvement score (SIS), 5) segment stenosis score (SSS), 6) CT-adapted Leaman score (CT-LeSc), and 7) Leiden CCTA risk score. Cox-regression analysis was performed to assess the association between the scores and the primary endpoint of all-cause death and non-fatal myocardial infarction. Also, area under the receiver-operating characteristics curves were compared to evaluate discriminatory ability. RESULTS:A total of 1,464 DM and non-DM patients (mean age 58 ± 12 years, 40% women) underwent CCTA and 155 (11%) events were documented after median follow-up of 5.1 years. In DM patients, the 7 semiquantitative CCTA risk scores were significantly more prevalent or higher as compared to non-DM patients (p ≤ 0.022). All scores were independently associated with the primary endpoint in both patients with and without DM (p ≤ 0.020), with non-significant interaction between the scores and diabetes (interaction p ≥ 0.109). Discriminatory ability of the Leiden CCTA risk score in DM patients was significantly better than any stenosis ≥50% and ≥70% (p = 0.003 and p = 0.007, respectively), but comparable to the CAD-RADS, SIS, SSS and CT-LeSc that also focus on the extent of CAD (p ≥ 0.265). CONCLUSION:Coronary atherosclerosis scoring with semiquantitative CCTA risk scores incorporating the total extent of CAD discriminate major adverse cardiac events well, and might be useful for risk stratification of patients with DM beyond the binary evaluation of obstructive stenosis alone

Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography

AIMS: The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment that patients need. This study examines the differences in age onset and prognostic significance of atherosclerotic plaque burden between sexes. METHODS AND RESULTS: From a large multi-center CCTA registry the Leiden CCTA score was calculated in 24 950 individuals. A total of 11 678 women (58.5 ± 12.4 years) and 13 272 men (55.6 ± 12.5 years) were followed for 3.7 years for major adverse cardiovascular events (MACE) (death or myocardial infarction). The age where the median risk score was above zero was 12 years higher in women vs. men (64-68 years vs. 52-56 years, respectively, P 20: HR 6.71 (4.36-10.32) in women, and score 6-20: HR 1.64 (1.29-2.08); score > 20: HR 2.38 (1.73-3.29) in men. The risk was significantly higher for women within the highest score group (adjusted P-interaction = 0.003). In pre-menopausal women, the risk score was equally predictive and comparable with men. In post-menopausal women, the prognostic value was higher for women [score 6-20: HR 2.21 (1.57-3.11); score > 20: HR 6.11 (3.84-9.70) in women; score 6-20: HR 1.57 (1.19-2.09); score > 20: HR 2.25 (1.58-3.22) in men], with a significant interaction for the highest risk group (adjusted P-interaction = 0.004). CONCLUSION: Women developed coronary atherosclerosis approximately 12 years later than men. Post-menopausal women within the highest atherosclerotic burden group were at significantly higher risk for MACE than their male counterparts, which may have implications for the medical treatment intensity.publishersversionpublishe

Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography

AIMS The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment that patients need. This study examines the differences in age onset and prognostic significance of atherosclerotic plaque burden between sexes. METHODS AND RESULTS From a large multi-center CCTA registry the Leiden CCTA score was calculated in 24 950 individuals. A total of 11 678 women (58.5 ± 12.4 years) and 13 272 men (55.6 ± 12.5 years) were followed for 3.7 years for major adverse cardiovascular events (MACE) (death or myocardial infarction). The age where the median risk score was above zero was 12 years higher in women vs. men (64-68 years vs. 52-56 years, respectively, P 20: HR 6.71 (4.36-10.32) in women, and score 6-20: HR 1.64 (1.29-2.08); score > 20: HR 2.38 (1.73-3.29) in men. The risk was significantly higher for women within the highest score group (adjusted P-interaction = 0.003). In pre-menopausal women, the risk score was equally predictive and comparable with men. In post-menopausal women, the prognostic value was higher for women [score 6-20: HR 2.21 (1.57-3.11); score > 20: HR 6.11 (3.84-9.70) in women; score 6-20: HR 1.57 (1.19-2.09); score > 20: HR 2.25 (1.58-3.22) in men], with a significant interaction for the highest risk group (adjusted P-interaction = 0.004). CONCLUSION Women developed coronary atherosclerosis approximately 12 years later than men. Post-menopausal women within the highest atherosclerotic burden group were at significantly higher risk for MACE than their male counterparts, which may have implications for the medical treatment intensity

Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography

Aims: The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment that patients need. This study examines the differences in age onset and prognostic significance of atherosclerotic plaque burden between sexes. Methods and results: From a large multi-center CCTA registry the Leiden CCTA score was calculated in 24 950 individuals. A total of 11 678 women (58.5 ± 12.4 years) and 13 272 men (55.6 ± 12.5 years) were followed for 3.7 years for major adverse cardiovascular events (MACE) (death or myocardial infarction). The age where the median risk score was above zero was 12 years higher in women vs. men (64-68 years vs. 52-56 years, respectively, P 20: HR 6.71 (4.36-10.32) in women, and score 6-20: HR 1.64 (1.29-2.08); score > 20: HR 2.38 (1.73-3.29) in men. The risk was significantly higher for women within the highest score group (adjusted P-interaction = 0.003). In pre-menopausal women, the risk score was equally predictive and comparable with men. In post-menopausal women, the prognostic value was higher for women [score 6-20: HR 2.21 (1.57-3.11); score > 20: HR 6.11 (3.84-9.70) in women; score 6-20: HR 1.57 (1.19-2.09); score > 20: HR 2.25 (1.58-3.22) in men], with a significant interaction for the highest risk group (adjusted P-interaction = 0.004). Conclusion: Women developed coronary atherosclerosis approximately 12 years later than men. Post-menopausal women within the highest atherosclerotic burden group were at significantly higher risk for MACE than their male counterparts, which may have implications for the medical treatment intensity.info:eu-repo/semantics/publishedVersio

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The relationship between professor and student in the higher education seen through reprobation

Reprobation, resulting from failure in the course of certain subject, be it by grade and/or absence of the student, has commonly as responsible the student or the master. From a perspective which takes into consideration the importance of social relations for the constitution of subjects, the current research has based upon the Historical-Cultural Psychology and focused on the higher education, having as main objective to understand the relations between masters and students through reprobation, with a view to understand the reality which involves this pair in this context and investigate their influence on the professional formation during graduation. Five students from the Federal University of Uberlândia (UFU) were interviewed, two from the area of Social Sciences, two from Exact Sciences and one from Biological Science, and five students from the same university, being two from Exact Sciences, two from Biological Sciences and one from Social Sciences. For data building open interviews, recorded in audio were used, with a question referring to reprobation, which werer later transcripted and transcreated. Data were analysed through content analysis. Three categories were created: a) Student´s education, in which aspects related to graduation courses were approached, such as the relation of the students with the subjects in which were reproved, the insatisfaction concerning evaluation and teaching methodology, absences during the semester and the meanings attributed to reprobation; b) The relation between masters and students concerning the teaching-learning processes, complying aspects related to limits, distancing and possibilities of approximations existing in this relation, the characteristics of the masters considered to be good mediators, considerations about the responsibility for academical failure and reflexions about the feelings of impotence from the student before the master´s authority; c) The master´s education in the higher education, in which some considerations were commented about such process and detailed reflexions about the existence of gaps in the initial education of the master, as well as a presentation of the need for School Psychology in this phase of the graduation. With this investigation it is possible to infer that pedagogical mediation offered by the master compose one of the solid bases for the teaching-learning process and that, besides, the educational situation is constituted by affective questions which directly influence learning. All these dimensions end up to reflect in the ways that the student relate to the subject content, the master and his own learning. Finally, one reafirms the necessity of the presence of School Psychology in the search for proposals which colaborate to professional formation as well as the proposition of continual courses for the master, benefiting a teaching-learning process process whose objective may be intelectual enhancement of everyone involved.Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorMestre em Psicologia AplicadaA reprovação, resultante de insucesso no curso de determinada disciplina, seja por nota e/ou por abandono na frequência desta por parte do estudante, comumente tem como sujeito responsabilizado este ou seu professor. Em uma perspectiva que considera a importância das relações sociais para a constituição dos sujeitos, a presente pesquisa baseou-se na Psicologia Histórico-Cultural e focalizou o Ensino Superior de graduação, tendo como objetivo principal compreender as relações entre docentes e alunos por meio da reprovação, visando entender a realidade que envolve esta díade neste contexto e investigar suas influências na formação profissional durante a graduação. Foram entrevistados cinco alunos de graduação da Universidade Federal de Uberlândia (UFU), sendo dois da área de Ciências Humanas, dois de Exatas e um de Biológicas e cinco docentes, da mesma universidade, dos quais dois eram das Ciências Exatas, duas da área de Biológicas e uma de Humanas. Para a construção dos dados foram utilizadas entrevistas abertas, gravadas em áudio, com uma questão referente à reprovação, que foram posteriormente transcritas e transcriadas. Os dados foram analisados por meio da análise de conteúdo. Foram construídas três categorias de análise: a) A formação discente, na qual os aspectos relacionados aos cursos de graduação foram abordados, como a relação dos estudantes com as disciplinas nas quais foram reprovados, a insatisfação quanto à avaliação e à metodologia de ensino, as ausências durante o semestre letivo e os sentidos atribuídos à reprovação; b) A relação entre professores e alunos no que concerne aos processos de ensino-aprendizagem, contemplando os aspectos referentes aos limites, distanciamentos e possibilidades de aproximações existentes nesta relação, características dos professores considerados bons mediadores, considerações sobre a responsabilização pelo fracasso acadêmico e reflexões sobre os sentimentos de impotência do aluno diante da autoridade do educador; c) A formação docente no Ensino Superior, em que foram tecidas algumas considerações sobre este processo e pormenorizadas reflexões sobre a existência de lacunas na formação inicial do docente, bem como apresentada a necessidade da Psicologia Escolar nesta etapa de ensino. Com esta investigação é possível inferir que a mediação pedagógica oferecida pelo professor compõe uma das bases sólidas do processo de ensino-aprendizagem e que, além disto, a situação educacional é constituída por questões afetivas que influenciam diretamente a aprendizagem. Todas estas dimensões acabam repercutindo nos modos com que o estudante se relaciona com o conteúdo da disciplina, com o professor e com seu próprio aprendizado. Por fim, reafirmamos a necessidade da presença da Psicologia Escolar na busca por propostas que colaborem tanto para a formação profissional de graduação quanto para a proposição de cursos de formação continuada para o docente do Ensino Superior, em prol de um processo de ensino-aprendizagem que vise à emancipação intelectual de todos nele envolvidos

The (in)invisibility of the Technician in Educational Affairs: mishaps and possibilities of acting at the Federal University of Uberlândia

This doctoral thesis is inserted in the context of the educational public policies in the interface with the Critical Scholar and Educational Psychology. The aim was to comprehend and analyze the labor of the Technician in Educational Affairs (TEA) who works with Higher Education at the Federal University of Uberlândia (UFU) between 2016 and 2017, in accordance with the legal mark established by the circular letter number 15/2005 CGGP/SAA/SE/MEC. This case study has a qualitative nature and employed bibliographical, documental and field research methods. The former provided a theoretical fundament, with a historical contextualization and discussion of essential concepts, such as professional identity, work and integral education. The examination of documents enabled to describe and analyze legal marks which regulated and delineated this designation focusing on the creation and development of the occupation, within the federal public service. In the field study, semi-structured interviews were carried out with seven TEA’s and three institutional managers, intending to promote the professional praxis evaluation in the UFU. Dialectical hermeneutics method was applied for data interpretation regarding Cultural-Historical Psychology theoretical premises. Three analytical categories were used. The first considered the aspects of the social constitution of the TEA identity in the UFU, discussing the process of position institutionalization in the University, assignments and effective forms of acting, TEA conceptions about their role in the higher education, influence of the relationship with other workers. The second one analyzed the professional contradictions, mainly the dichotomies among prescript legacy and controversies for the occupation, including official edict composition, reception in/from University, diversion of function, (un)satisfaction with the job tasks, improvement of specific skills, invisibility within the academic community. In the last category, reality of the TEA labor was correlated to the possibilities of overcoming the contradictions, with the subjects comprehending which activities are consonant with the occupation. It was discussed about the necessity of TEA’s union, the interpretation on the expected duties, integral education as the support for adequate practices, association among work and research, community extension and teaching-learning processes. Finally, an institutional resolution was proposed aiming to adequate the activities of the TEA’s. In conclusion, diversion of function and underuse of the TEA occur at UFU due to its structural functioning and to relations established in the institution. The subjects considered that it is possible to surpass the identified contradictions, integrating the TEA’s, regulating activities according to the law and with institutional interest for function adjustments. These appointments could be legitimated by means of the proposed resolution.Tese (Doutorado)Esta tese de doutorado, inserida no bojo das políticas públicas educacionais, em interface com a área de Psicologia Educacional e Escolar crítica, teve como objetivo geral conhecer e analisar o trabalho do Técnico em Assuntos Educacionais – TAED, lotado na educação superior ofertada da Universidade Federal de Uberlândia – UFU, no período entre 2016 e 2017, à luz do marco legal estabelecido pelo Ofício Circular nº 15/2005 CGGP/SAA/SE/MEC para o exercício das suas funções. De natureza qualitativa, trata-se de um estudo de caso, com utilização dos recursos de pesquisa bibliográfica, documental e de campo. A pesquisa bibliográfica fundamentou teoricamente o estudo e possibilitou a contextualização histórica do objeto de pesquisa e dos aspectos que o permeiam, bem como a discussão de conceitos fundamentais, como por exemplo os de identidade profissional, trabalho e educação integral. A pesquisa documental possibilitou a descrição e análise dos marcos legais que delinearam e regulamentaram essa designação, com foco na criação e desenvolvimento do cargo no âmbito do serviço público federal. A pesquisa de campo se deu por meio da realização de entrevistas semiestruturadas com sete TAEDs e três gestores da instituição e fomentou a análise da práxis profissional desempenhada na UFU. Os dados foram interpretados com a utilização do método dialético-hermenêutico, por meio de análise ancorada nos pressupostos teóricos da Psicologia Histórico-Cultural. Na primeira categoria de análise, foram abordados aspectos sobre a constituição social da identidade do TAED no âmbito da UFU, que passaram pelas discussões: do processo de institucionalização do cargo, no contexto da universidade; das atribuições e formas efetivas de atuação; das concepções que tais servidores possuem sobre sua função na educação superior; da influência das relações estabelecidas com outros servidores. Na segunda categoria foram analisadas as contradições que permeiam seu trabalho, com foco nas dicotomias entre a legalidade prescrita e as controvérsias praticadas para o cargo, as quais abrangem os aspectos: composição dos editais para ingresso no cargo e o acolhimento na/da universidade; desvios de função; (in)satisfação com as atribuições desenvolvidas; capacitação destinada ao exercício da função; sua invisibilidade para a comunidade acadêmica. Na terceira categoria, a discussão articula a realidade deste trabalhador e as possibilidades de superação das contradições apontadas, por meio de compreensão quanto às atividades consoantes com o cargo. Foram realizadas discussões sobre: necessidade de união dos ocupantes do cargo; suas interpretações quanto ao fazer previsto; a educação integral como base para adequação da atuação; vinculação do trabalho aos processos de ensino-aprendizagem, pesquisa e extensão. Por fim, foi proposta uma normativa, materializada em Resolução, para fins de adequação das atividades dos ocupantes do cargo na instituição. Conclui-se quanto à existência de desvio de função e subaproveitamento do cargo TAED na UFU, questões estas permeadas pela estrutura e funcionamento desta instituição e pelas relações que nela se estabelecem. As contradições foram apontadas como passíveis de superação, desde que haja integração entre os ocupantes do cargo, normatização das atividades em acordo com a lei e interesse institucional em adequação das funções, o que pode se legitimar por meio da efetivação do regulamento proposto

ATRIBUIÇÃO DE CAUSALIDADE À INFIDELIDADE EM RELACIONAMENTOS DE NAMORO

Os objetivos deste estudo foram identificar as causas percebidas da infidelidade e analisar o significado de traição, ambos durante o namoro. Foi utilizado um questionário estruturado e auto-aplicável contendo oito questões abertas, que foi respondido por 153 participantes, posteriormente separados para análise em três grupos de acordo com a situação: os atores, as vítimas de traição e os observadores externos. Os resultados revelaram que a amostra atribuiu predominantemente causas internas instáveis e referentes ao ator para a traição em relacionamentos de namoro, com diferenças entre grupos que mostraram tendência para a atribuição diferencial. As respostas sobre o conceito de traição convergiram para o significado de envolvimento físico e emocional com pessoa externa à díade