Capability: A Distributive Justice Approach to Healthcare, Medicine, and Human Biology

Honors (Bachelor's)PhilosophyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/120578/1/samfcusi.pd

Resultados atuais da cirurgia coronária em pacientes de alto risco

No período e 4 anos (1984 a 1987), 427 pacientes (313 homens e 114 mulheres, idade média 61,83 anos) foram submetidos a cirurgia coronária de emergência. A indicação para cirurgia foi angina instável, que requeria uso intravenoso de nitroglicerina. Quanto à classe funcional, 369 (86,41%) pacientes estavam em classe IV e 51,95% estavam em grau funcional III ou IV de ventrículo esquerdo, pelo estudo hemodinâmico e 30,44% tinham lesão de tronco. Foram realizadas 2,99 pontes/pacientes. A mortalidade total foi de 7,72% e 17,09% tiveram síndrome de baixo débito; déficit neurológico ocorreu em 2,85% e infarto do miocárdio, em 16,86% dos casos. Durante o mesmo período, 30 pacientes (16 do sexo masculino e 14 do feminino) com idade média de 64,03 anos, com amgina instável e em choque cardiogênico, foram submetidos a revascularização de emergência. Quanto à classe funcional, 86,66% estavam em classe IV, 13,33% em classe III e 56,66% estavam em grau funcional IV de ventrículo esquerdo e 13,33% em grau III; 40% dos pacientes tinham lesão de tronco. O número médio de pontes foi de 2,76 pontes/pacientes. A mortalidade foi de 60%; déficit neurológico ocorreu em 16,66% e 43,33% sofreram infarto do miocárdio. Em conclusão, a mortalidade e a morbidade, para pacientes submetidos a cirurgia de revascularização, permanecem elevadas, principalmente, em pacientes com choque cardiogênico. Portanto, mais estudos futuros são requeridos em relação à proteção miocárdica, para melhores resultados

A Simple Model of Right Ventricular Hypertrophy

Previous models of right ventricular hypertrophy (RVH) created by pulmonary artery (PA) banding in adult large animals have been associated with an unpredictable response of the right ventricle to the band and a high mortality due to the variable degree of acute stenosis. We studied the efficacy of PA banding in young pigs to produce RVH by progressive gradual stenosis during growth. Sixteen Yorkshire pigs at 6 weeks of age had nonconstricting 5-mm wide Dacron™ strips placed around the PA via a left minithoracotomy. The animals were returned for study in 2-3 months. There were no deaths during the growth period. Five sham-operated pigs acted as controls. Right ventricular free wall (RVFW) to total heart weight ratio was greater in the banded group (0.38 ± 0.05 vs. 0.28 ± 0.01, P > 005) as was the RVFW to left ventricular free wall (LVFW) weight (1.09 ± 0.25 versus 0.66 ± 0.03, P > 005). While the LVFW to total heart weight ratio decreased (0.36 ± 0.04 vs. 0.45 ± 0.05, P > 005), the septal ratio did not change (0.26 ± 0.04 vs. 0.29 ± 0.02, NS), indicating concomitant septal hypertrophy. This technique is simple, reliable, and reproducible in creating right ventricular and septal hypertrophy in the young pig with no mortality during maturatio

Myocardial protection in the hypertrophied right ventricle

Hypertrophied right ventricle presents a sensitive state that may not be adequately protected by modern cardioplegic methods. Cardiac metabolism, performance, and ultrastructure were measured in response to 1 hour of cardioplegic arrest in 15 pigs with right ventricular hypertrophy using intermittent hypothermic crystalloid, blood, and Fluosol DA 20%-based cardioplegia. Reperfusion time was 1 hour. One hour after a 60-minute cross-clamp period, there were no differences in light microscopy. Total energy stores increased in 4 of 5 animals given blood cardioplegia compared with 1 of 5 for each of the other groups. Cardiac performance data also showed better results for animals treated with blood cardioplegia. After 30 minutes of reperfusion, animals receiving blood cardioplegia recovered 131% ± 42% of preoperative systolic performance compared with 106% ± 49% for Fluosol-treated animals and only 82% ± 27% recovery for the crystalloid-treated group. After 60 minutes of reperfusion, the blood group showed 119% ± 20% recovery compared with 89% ± 23% and 85% ± 50% recovery for Fluosol- and crystalloid-treated hearts, respectively. In conclusion, blood cardioplegia provided better protection than did crystalloid or Fluosol DA 20% cardioplegia when animals with right ventricular hypertrophy underwent 1 hour of cardioplegic arrest. It may have repaired damaged myocardium, leaving better hearts after cross-clamping than before

Technique and pitfalls of retrograde continuous warm blood cardioplegia

The recent development of normothermic myocardial preservation and systemic perfusion during bypass has questioned the fundamental need for hypothermia during cardiac operations. The antegrade technique of almost continuous perfusion by the aortic root and vein grafts has been supplemented by continuous normothermic blood cardioplegia through the coronary sinus. Recently, great interest has been shown in this technique. It is important to describe the method in detail along with its potential shortcomings and dangers. This communication describes the technical details, pitfalls, and shortcomings of retrograde continuous warm blood cardioplegia

Connecting the data landscape of long-term ecological studies : The SPI-Birds data hub

The integration and synthesis of the data in different areas of science is drastically slowed and hindered by a lack of standards and networking programmes. Long-term studies of individually marked animals are not an exception. These studies are especially important as instrumental for understanding evolutionary and ecological processes in the wild. Furthermore, their number and global distribution provides a unique opportunity to assess the generality of patterns and to address broad-scale global issues (e.g. climate change). To solve data integration issues and enable a new scale of ecological and evolutionary research based on long-term studies of birds, we have created the SPI-Birds Network and Database ()-a large-scale initiative that connects data from, and researchers working on, studies of wild populations of individually recognizable (usually ringed) birds. Within year and a half since the establishment, SPI-Birds has recruited over 120 members, and currently hosts data on almost 1.5 million individual birds collected in 80 populations over 2,000 cumulative years, and counting. SPI-Birds acts as a data hub and a catalogue of studied populations. It prevents data loss, secures easy data finding, use and integration and thus facilitates collaboration and synthesis. We provide community-derived data and meta-data standards and improve data integrity guided by the principles of Findable, Accessible, Interoperable and Reusable (FAIR), and aligned with the existing metadata languages (e.g. ecological meta-data language). The encouraging community involvement stems from SPI-Bird's decentralized approach: research groups retain full control over data use and their way of data management, while SPI-Birds creates tailored pipelines to convert each unique data format into a standard format. We outline the lessons learned, so that other communities (e.g. those working on other taxa) can adapt our successful model. Creating community-specific hubs (such as ours, COMADRE for animal demography, etc.) will aid much-needed large-scale ecological data integration.Peer reviewe

Connecting the data landscape of long‐term ecological studies: The SPI‐Birds data hub

The integration and synthesis of the data in different areas of science is drastically slowed and hindered by a lack of standards and networking programmes. Long‐term studies of individually marked animals are not an exception. These studies are especially important as instrumental for understanding evolutionary and ecological processes in the wild. Furthermore, their number and global distribution provides a unique opportunity to assess the generality of patterns and to address broad‐scale global issues (e.g. climate change). To solve data integration issues and enable a new scale of ecological and evolutionary research based on long‐term studies of birds, we have created the SPI‐Birds Network and Database (www.spibirds.org)—a large‐scale initiative that connects data from, and researchers working on, studies of wild populations of individually recognizable (usually ringed) birds. Within year and a half since the establishment, SPI‐Birds has recruited over 120 members, and currently hosts data on almost 1.5 million individual birds collected in 80 populations over 2,000 cumulative years, and counting. SPI‐Birds acts as a data hub and a catalogue of studied populations. It prevents data loss, secures easy data finding, use and integration and thus facilitates collaboration and synthesis. We provide community‐derived data and meta‐data standards and improve data integrity guided by the principles of Findable, Accessible, Interoperable and Reusable (FAIR), and aligned with the existing metadata languages (e.g. ecological meta‐data language). The encouraging community involvement stems from SPI‐Bird's decentralized approach: research groups retain full control over data use and their way of data management, while SPI‐Birds creates tailored pipelines to convert each unique data format into a standard format. We outline the lessons learned, so that other communities (e.g. those working on other taxa) can adapt our successful model. Creating community‐specific hubs (such as ours, COMADRE for animal demography, etc.) will aid much‐needed large‐scale ecological data integration

Connecting the data landscape of long‐term ecological studies: The SPI‐Birds data hub

The integration and synthesis of the data in different areas of science is drastically slowed and hindered by a lack of standards and networking programmes. Long‐term studies of individually marked animals are not an exception. These studies are especially important as instrumental for understanding evolutionary and ecological processes in the wild. Furthermore, their number and global distribution provides a unique opportunity to assess the generality of patterns and to address broad‐scale global issues (e.g. climate change). To solve data integration issues and enable a new scale of ecological and evolutionary research based on long‐term studies of birds, we have created the SPI‐Birds Network and Database (www.spibirds.org)—a large‐scale initiative that connects data from, and researchers working on, studies of wild populations of individually recognizable (usually ringed) birds. Within year and a half since the establishment, SPI‐Birds has recruited over 120 members, and currently hosts data on almost 1.5 million individual birds collected in 80 populations over 2,000 cumulative years, and counting. SPI‐Birds acts as a data hub and a catalogue of studied populations. It prevents data loss, secures easy data finding, use and integration and thus facilitates collaboration and synthesis. We provide community‐derived data and meta‐data standards and improve data integrity guided by the principles of Findable, Accessible, Interoperable and Reusable (FAIR), and aligned with the existing metadata languages (e.g. ecological meta‐data language). The encouraging community involvement stems from SPI‐Bird's decentralized approach: research groups retain full control over data use and their way of data management, while SPI‐Birds creates tailored pipelines to convert each unique data format into a standard format. We outline the lessons learned, so that other communities (e.g. those working on other taxa) can adapt our successful model. Creating community‐specific hubs (such as ours, COMADRE for animal demography, etc.) will aid much‐needed large‐scale ecological data integration