Preliminary Study of Prospective ECG-Gated 320-Detector CT Coronary Angiography in Patients with Ventricular Premature Beats

BACKGROUND: To study the applicability of prospective ECG-gated 320-detector CT coronary angiography (CTCA) in patients with ventricular premature beats (VPB), and determine the scanning mode that best maximizes image quality and reduces radiation dose. METHODS: 110 patients were divided into a VPB group (60 cases) and a control group (50 cases) using CTCA. All the patients then underwent coronary angiography (CAG) within one month. CAG served as a reference standard through which the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTCA in diagnosing significant coronary artery stenosis (luminal stenosis ≥50%) could be analyzed. The two radiologists with more than 3 years' experience in cardiac CT each finished the image analysis after consultation. A personalized scanning mode was adopted to compare image quality and radiation dose between the two groups. METHODOLOGY/PRINCIPAL FINDINGS: At the coronary artery segment level, sensitivity, specificity, PPV, and NPV in the premature beat group were 92.55%, 98.21%, 88.51%, and 98.72% respectively. In the control group these values were found to be 95.79%, 98.42%, 90.11%, and 99.28% respectively. Between the two groups, specificity, sensitivity PPV, NPV was no significant difference. The two groups had no significant difference in image quality score (P>0.05). Heart rate (77.20±12.07 bpm) and radiation dose (14.62±1.37 mSv) in the premature beat group were higher than heart rate (58.72±4.73 bpm) and radiation dose (3.08±2.35 mSv) in the control group. In theVPB group, the radiation dose (34.55±7.12 mSv) for S-field scanning was significantly higher than the radiation dose (15.10±1.12 mSv) for M-field scanning. CONCLUSIONS/SIGNIFICANCE: With prospective ECG-gated scanning for VPB, the diagnostic accuracy of coronary artery stenosis is very high. Scanning field adjustment can reduce radiation dose while maintaining good image quality. For patients with slow heart rates and good rhythm, there was no statistically significant difference in image quality

Neighborhood Influences on Perceived Social Support Among Parents: Findings from the Project on Human Development in Chicago Neighborhoods

Background: Social support is frequently linked to positive parenting behavior. Similarly, studies increasingly show a link between neighborhood residential environment and positive parenting behavior. However, less is known about how the residential environment influences parental social support. To address this gap, we examine the relationship between neighborhood concentrated disadvantage and collective efficacy and the level and change in parental caregiver perceptions of non-familial social support. Methodology/Principal Findings: The data for this study came from three data sources, the Project on Human Development in Chicago Neighborhoods (PHDCN) Study's Longitudinal Cohort Survey of caregivers and their offspring, a Community Survey of adult residents in these same neighborhoods and the 1990 Census. Social support is measured at Wave 1 and Wave 3 and neighborhood characteristics are measured at Wave 1. Multilevel linear regression models are fit. The results show that neighborhood collective efficacy is a significant ($\beta$ = .04; SE = .02; p = .03), predictor of the positive change in perceived social support over a 7 year period, however, not of the level of social support, adjusting for key compositional variables and neighborhood concentrated disadvantage. In contrast concentrated neighborhood disadvantage is not a significant predictor of either the level or change in social support. Conclusion: Our finding suggests that neighborhood collective efficacy may be important for inducing the perception of support from friends in parental caregivers over time

Youth exposure to violence: prevalence, risks, and consequences.

Recent empirical work on the distribution, determinants, and consequences of children and adolescents' witnessing of community violence are reviewed. Major findings across studies indicate that males, ethnic minorities, and urban residents are at increased risk for witnessing violence, and that higher rates of PTSD, depression, distress, aggression, and externalizing behavior disturbances are reported among those who witness violence. Degree of family conflict, domestic violence, and family support were demonstrated to modify the impact of exposure to violence. Research and policy recommendations are offered

Body physique and heart rate variability determine the occurrence of stair-step artefacts in 64-slice CT coronary angiography with prospective ECG-triggering

The purpose of this study was to describe and characterize the frequency and extent of stair-step artefacts in computed tomography coronary angiography (CTCA) with prospective electrocardiogram (ECG)-triggering and to identify their determinants. One hundred and forty three consecutive patients (55 women, mean age 57 +/- 13 years) underwent 64-slice CTCA using prospective ECG-triggering. Occurrence of stair-step artefacts in CTCA of the thoracic wall and the coronary arteries was determined and maximum offset was measured. If stair-step artefacts occurred in both cases, a difference between thoracic wall and coronary artery offset of 0.6 mm or greater was attributed to additional motion of the heart. Mean effective radiation dose was 2.1 +/- 0.7 mSv (range 1.0-3.5 mSv). Eighty-nine patients (62%) had stair-step artefacts in CTCA of the coronary arteries (mean offset of 1.7 +/- 1.1 mm), while only 77 patients had thoracic wall stair-step artefacts (mean offset of 1.0 +/- 0.3 mm; significantly different, P < 0.001). Stair-step artefacts in CTCA of the thoracic wall were determined by BMI and weight (P < 0.01), while artefacts in CTCA of the coronary arteries were associated with heart rate variability (P < 0.05). Stair-step artefacts in CTCA with prospective ECG-triggering are determined by (a) motion of the entire patient during table travel, particularly in large patients and (b) by motion of the heart, particularly when heart rates are variable

Transtorno da conduta e comportamento anti-social

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Grupo Interdepartamental de Epidemiologia ClínicaMcMaster University Divisão de Psiquiatria da Infância e AdolescênciaMcMaster University Centro de Estudos sobre Crianças em Situação de RiscoMcMaster University Centro Chedoke para a Criança e a FamíliaUNIFESP, EPM, Depto. de PsiquiatriaUNIFESP, EPM, Grupo Interdepartamental de Epidemiologia ClínicaSciEL