Avaliação ecocardiográfica e auscultação electrónica de 27 casos de gatos por presença de sopro à auscultação cardíaca convencional

Dissertação de Mestrado Integrado em Medicina VeterináriaContexto: ao longo dos anos, as doenças cardíacas do paciente felino têm recebido menos atenção do que as doenças cardíacas em cães pela classe médico-veterinária (Fuentes, 2015). Numa avaliação comparativa sobre o tema, o Journal of Veterinary Cardiology conteve cerca de quatro vezes mais estudos relacionados com cães do que com gatos durante os últimos dez anos (Fuentes, 2015). Para além disso, a presença de sopro à auscultação num cão é um indicador de doença cardíaca muito mais fidedigno do que um sopro ouvido num gato (Wagner, Fuentes, Payne, McDermott & Brodbelt, 2010), o que dificulta ainda mais a interpretação deste som que, muitas vezes, é dinâmico (Dirven, Cornelissen, Barendse, Van Mook & Sterenborg, 2010). Objectivos [principais (P) e secundários (S)] deste estudo: Ρ Compreender a prevalência das doenças cardíacas numa população representativa de gatos que se apresentaram à consulta com sopro à auscultação; Ρ Aferir qualitativamente a relevância clínica do uso do estetoscópio electrónico quando comparado com o método convencional; Ρ Tentativa de compreender a presença de sopro cardíaco em gatos cujos exames ecocardiográficos não fundamentam a presença de sopro; S Calcular a sensibilidade e especificidade da auscultação cardíaca em gatos; S Tentar compreender a ausência de sopro cardíaco em gatos cujos exames ecocardiográficos fundamentam a presença de sopro; S Sensibilizar a classe médico-veterinária para a importância de uma auscultação detalhada no paciente felino. Principais conclusões e relevância clínica: cerca de 70% (n=20) dos 27 gatos com sopro cardíaco apresentaram algum tipo de hipertrofia do ventrículo esquerdo (SIVd ≥ 0,50cm), destes, 50% (n=10) possuíam concomitantemente algum grau de regurgitação valvular, sendo a regurgitação mitral a mais prevalente. Apenas um gato se apresentou com sopro (II/VI) e sem achados ecocardiográficos significativos, podendo este dever-se à sedação administrada, a alterações hemodinâmicas (anemia, estados infecciosos) ou outras alterações sistémicas. Dos 27 gatos, houve apenas dois casos (7%) de cardiomiopatia restritiva e um caso (4%) de cardiomiopatia dilatada. Sete porcento (n=2) apresentou doença cardíaca congénita. O uso do estetoscópio electrónico provou-se indispensável, principalmente, na detecção de ruídos de galope e na análise morfológica das ondas e seu relacionamento com a doença cardíaca presente; na classificação da intensidade de sopros, contudo, mostrou-se ineficiente.ABSTRACT - Echocardiographic assessment and electronic auscultation of 27 cases of cats by presence of heart murmur on conventional cardiac auscultation - Background: throughout the years, feline heart diseases have received less attention than dog’s heart disease by the veterinary professionals (Fuentes, 2015). In one comparative assessment regarding the subject, the ‘Journal of Veterinary Cardiology’ has about four times more research related to dogs than cats during the last ten years (Fuentes, 2015). Besides, a murmur auscultated on a dog is a much more reliable marker of heart disease than the same sound heard on a cat (Wagner, Fuentes, Payne, McDermott & Brodbelt, 2010), what makes the interpretation of murmurs, sometimes dynamic, much harder (Dirven, Cornelissen, Barendse, Van Mook & Sterenborg, 2010). Objectives [prime (P) and secondary (S)]: Ρ Comprehension of the prevalence of cardiac diseases on a population of cats that were present with heart murmur at auscultation; Ρ Understanding the clinical relevance of the use of electronic stethoscopes compared with the conventional method; Ρ Explanation for the presence of heart murmur in cats which have no significant alteration on echocardiographic examination; S Sensitivity and sensibility calculation for cats’ auscultation; S Explanation for the absence of heart murmurs in cats with alterations on echocardiographic examination; S Sensitize veterinary professionals for the importance of a thorough auscultation of the feline patient. Leading conclusions and clinical significance: about 70% (n=20) of the 27 cats presented with a heart murmur showed some kind of hypertrophy of the left ventricle (SIVd ≥ 0,50cm), half of which (n=10) had some degree of valvular regurgitation at the same time, being mitral regurgitation the most common. Only 1 cat was present with a murmur (II/VI) and no significant echocardiographic findings, probably due to the tranquilization that was administered, hemodynamic alterations (anaemia, infectious states, stress) or other systemic disorders. Of the 27 cats, there were only two cases (7%) of restrictive cardiomyopathy and one case (4%) of dilated cardiomyopathy. Seven percent (n=2) were present with a congenital heart disease. The use of an electronic stethoscope proved itself useful, mainly at the detection of gallop sounds and analysis of wave morphologies and its connection with each cardiac disease; for the classification of the intensity of the murmur, however, it proved itself inefficient.N/

Geology and genesis of the cerro la mina porphyry-high sulfidation Au (Cu-Mo) prospect, Mexico

The Cerro la Mina Au (Cu-Mo) porphyry-high sulfidation prospect is located in Chiapas State, southeastern Mexico, outside of the major metallogenic provinces of Mexico. The prospect is hosted by Pleistocene alkaline volcanic rocks of the Chiapanecan volcanic arc that formed in a complex triple-junction tectonic setting. Cerro la Mina's stratigraphy comprises pyroclastic flows that were intruded by monzodiorites and diorites at 1.04 ± 0.04 Ma (U-Pb, zircon), and that were overlain by debris flows and synvolcanic trachyandesite domes. The volcanic stratigraphy of Cerro la Mina is dominated by pyroclastic flows and rare basalts that are cut by the Cerro la Mina breccia pipe, a matrix-rich granular, vertically oriented, downward-Tapering, polymict lithic rock unit that is host to all of the significant alteration and mineralization. A NW-Trending sinistral wrench fault, which was active throughout the history of Cerro la Mina, is responsible for dismembering the prospect after mineralization. The magmatic hydrothermal system was composed of early porphyry-style potassic veins (quartz + K-feldspar ± biotite) and stage 1 pyrite that are preserved in clasts within the breccia pipe, suggesting that brecciation disrupted an embryonic porphyry system. Late potassic alteration occurred after the formation of the breccia pipe, as its matrix is strongly K-feldspar altered. Hydrothermal fluids then produced phyllic alteration composed of quartz, muscovite, illite, illite-smectite, and chlorite that is associated with stage 2 pyrite ± chalcopyrite ± molybdenite ± quartz veins. An unusual zoned pattern of advanced argillic-Argillic alteration overprinted potassic and phyllic alteration. This zoning included a low-Temperature (<110°C) halloysite + kaolinite that extends from 800 to 250 m below present-day surface and is deeper than higher temperature (>120°C) quartz + dickite ± kaolinite ± pyrophyllite ± alunite that occurs from 250 m to the present-day surface. The advanced argillic-Argillic altered rocks host the most significant Au-Cu mineralization, which is associated with stage 3 marcasite, sphalerite, galena, and barite, and stage 4 arsenian pyrite ± enargite ± covellite. The magmatic hydrothermal system at Cerro la Mina began sometime between monzodiorite emplacement (1.04 ± 0.04 Ma; zircon U-Pb) and the precipitation of porphyry stage 2 molybdenite at 780 ± 10 ka (Re-Os). 40Ar/39Ar dating of biotite (689 ± 13 ka) records the age at which the hydrothermal system cooled below the biotite closure temperature of 300°C and provides a maximum estimate for the onset of advanced argillicargillic alteration. Sulfur isotope results of sulfides (-2.5 to +4.9‰; mean +0.7‰; n = 20) and a sulfate (barite; +10.5‰; n = 1) suggest a magmatic source of sulfur for all four stages of mineralization. The lack of residual quartz, rare alunite, and anomalous halloysite-kaolinite alteration may be explained by the high acid-buffering capacity of alkaline volcanic host rocks, high CO2 contents of the alkaline magma, and/or potentially by a highly reduced magmatic hydrothermal fluid. At the regional metallogenic scale, the Cerro la Mina prospect along with the nearby Santa Fé mine and Campamento deposit represent parts of a porphyry copper system-specifically, a porphyry/high-sulfidation, proximal skarn and intermediate sulfidation deposit, respectively. The characteristics of Cerro la Mina (i.e., anomalous halloysite-kaolinite alteration) broaden the window for additional discoveries to be made in the porphyry-epithermal environment

Workplace violence in Queensland, Australia: the results of a comparative study

[Abstract]: This paper presents the results on workplace violence from a larger study undertaken in 2004. Comparison is made with the results of a similar study undertaken in 2001. The study involved the random sampling of 3000 nurses from the Queensland Nurses’ Union’s membership in the public (acute hospital and community nursing), private (acute hospital and domiciliary nursing) and aged care sectors (both public and private aged care facilities). The self-reported results suggest an increase in workplace violence in all three sectors. Whilst there are differences in the sources of workplace violence across the sectors, the major causes of workplace violence are: clients/patients, visitors/relatives, other nurses, nursing management and medical practitioners. Associations were also found between workplace violence and gender, the designation of the nurse, hours of employment, the age of the nurse, morale and perceptions of workplace safety. Whilst the majority of nurses reported that policies were in place for the management of workplace violence, these policies were not always adequate

Behavioural responses to SARS-CoV-2 antibody testing in England: REACT-2 study

Background: This study assesses the behavioural responses to SARS-CoV-2 antibody test results as part of the REal-time Assessment of Community Transmission-2 (REACT-2) research programme, a large community-based surveillance study of antibody prevalence in England. Methods: A follow-up survey was conducted six weeks after the SARS-CoV-2 antibody test. The follow-up survey included 4500 people with a positive result and 4039 with a negative result. Reported changes in behaviour were assessed using difference-in-differences models. A nested interview study was conducted with 40 people to explore how they thought through their behavioural decisions. Results: While respondents reduced their protective behaviours over the six weeks, we did not find evidence that positive test results changed participant behaviour trajectories in relation to the number of contacts the respondents had, for leaving the house to go to work, or for leaving the house to socialise in a personal place. The qualitative findings supported these results. Most people did not think that they had changed their behaviours because of their test results, however they did allude to some changes in their attitudes and perceptions around risk, susceptibility, and potential severity of symptoms. Conclusions: We found limited evidence that knowing your antibody status leads to behaviour change in the context of a research study. While this finding should not be generalised to widespread self-testing in other contexts, it is reassuring given the importance of large prevalence studies, and the practicalities of doing these at scale using self-testing with lateral flow immunoassay (LFIA)

Neuronal network dynamics in the posterodorsal amygdala: shaping reproductive hormone pulsatility

This is the final version. Available on open access from the Royal Society via the DOI in this recordData accessibility: The code to reproduce the analysis and data can be found on Zenodo [48]. Supplementary material is available online: https://doi.org/10.6084/m9.figshare.c.7402649Normal reproductive function and fertility rely on the rhythmic secretion of gonadotropin-releasing hormone (GnRH), which is driven by the hypothalamic GnRH pulse generator. A key regulator of the GnRH pulse generator is the posterodorsal subnucleus of the medial amygdala (MePD), a brain region that is involved in processing external environmental cues, including the effect of stress. However, the neuronal pathways enabling the dynamic, stress-triggered modulation of GnRH secretion remain largely unknown. Here, we employ in silico modelling in order to explore the impact of dynamic inputs on GnRH pulse generator activity. We introduce and analyse a mathematical model representing MePD neuronal circuits composed of GABAergic and glutamatergic neuronal populations, integrating it with our GnRH pulse generator model. Our analysis dissects the influence of excitatory and inhibitory MePD projections' outputs on the GnRH pulse generator's activity and reveals a functionally relevant MePD glutamatergic projection to the GnRH pulse generator, which we probe with in vivo optogenetics. Our study sheds light on how MePD neuronal dynamics affect the GnRH pulse generator activity and offers insights into stress-related dysregulation.Engineering and Physical Sciences Research Council (EPSRC)Biotechnology and Biological Sciences Research Council (BBSRC)Medical Research Council (MRC

Adaptive Management and the Value of Information: Learning Via Intervention in Epidemiology

Optimal intervention for disease outbreaks is often impeded by severe scientific uncertainty. Adaptive management (AM), long-used in natural resource management, is a structured decision-making approach to solving dynamic problems that accounts for the value of resolving uncertainty via real-time evaluation of alternative models. We propose an AM approach to design and evaluate intervention strategies in epidemiology, using real-time surveillance to resolve model uncertainty as management proceeds, with foot-and-mouth disease (FMD) culling and measles vaccination as case studies. We use simulations of alternative intervention strategies under competing models to quantify the effect of model uncertainty on decision making, in terms of the value of information, and quantify the benefit of adaptive versus static intervention strategies. Culling decisions during the 2001 UK FMD outbreak were contentious due to uncertainty about the spatial scale of transmission. The expected benefit of resolving this uncertainty prior to a new outbreak on a UK-like landscape would be £45–£60 million relative to the strategy that minimizes livestock losses averaged over alternate transmission models. AM during the outbreak would be expected to recover up to £20.1 million of this expected benefit. AM would also recommend a more conservative initial approach (culling of infected premises and dangerous contact farms) than would a fixed strategy (which would additionally require culling of contiguous premises). For optimal targeting of measles vaccination, based on an outbreak in Malawi in 2010, AM allows better distribution of resources across the affected region; its utility depends on uncertainty about both the at-risk population and logistical capacity. When daily vaccination rates are highly constrained, the optimal initial strategy is to conduct a small, quick campaign; a reduction in expected burden of approximately 10,000 cases could result if campaign targets can be updated on the basis of the true susceptible population. Formal incorporation of a policy to update future management actions in response to information gained in the course of an outbreak can change the optimal initial response and result in significant cost savings. AM provides a framework for using multiple models to facilitate public-health decision making and an objective basis for updating management actions in response to improved scientific understanding

Impact of the COVID-19 pandemic on admission rates for, and management of, acute coronary syndromes in England

Background Several countries affected by the COVID-19 pandemic have reported a substantial drop in the number of patients attending the emergency department with acute coronary syndromes and a reduced number of cardiac procedures. We aimed to understand the scale, nature, and duration of changes to admissions for different types of acute coronary syndrome in England and to evaluate whether in-hospital management of patients has been affected as a result of the COVID-19 pandemic. Methods We analysed data on hospital admissions in England for types of acute coronary syndrome from Jan 1, 2019, to May 24, 2020, that were recorded in the Secondary Uses Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), myocardial infarction of unknown type, or other acute coronary syndromes (including unstable angina). We identified revascularisation procedures undertaken during these admissions (ie, coronary angiography without percutaneous coronary intervention [PCI], PCI, and coronary artery bypass graft surgery). We calculated the numbers of weekly admissions and procedures undertaken; percentage reductions in weekly admissions and across subgroups were also calculated, with 95% CIs. Findings Hospital admissions for acute coronary syndrome declined from mid-February, 2020, falling from a 2019 baseline rate of 3017 admissions per week to 1813 per week by the end of March, 2020, a reduction of 40% (95% CI 37–43). This decline was partly reversed during April and May, 2020, such that by the last week of May, 2020, there were 2522 admissions, representing a 16% (95% CI 13–20) reduction from baseline. During the period of declining admissions, there were reductions in the numbers of admissions for all types of acute coronary syndrome, including both STEMI and NSTEMI, but relative and absolute reductions were larger for NSTEMI, with 1267 admissions per week in 2019 and 733 per week by the end of March, 2020, a percent reduction of 42% (95% CI 38–46). In parallel, reductions were recorded in the number of PCI procedures for patients with both STEMI (438 PCI procedures per week in 2019 vs 346 by the end of March, 2020; percent reduction 21%, 95% CI 12–29) and NSTEMI (383 PCI procedures per week in 2019 vs 240 by the end of March, 2020; percent reduction 37%, 29–45). The median length of stay among patients with acute coronary syndrome fell from 4 days (IQR 2–9) in 2019 to 3 days (1–5) by the end of March, 2020. Interpretation Compared with the weekly average in 2019, there was a substantial reduction in the weekly numbers of patients with acute coronary syndrome who were admitted to hospital in England by the end of March, 2020, which had been partly reversed by the end of May, 2020. The reduced number of admissions during this period is likely to have resulted in increases in out-of-hospital deaths and long-term complications of myocardial infarction and missed opportunities to offer secondary prevention treatment for patients with coronary heart disease. The full extent of the effect of COVID-19 on the management of patients with acute coronary syndrome will continue to be assessed by updating these analyses

The early mathematical education of Ada Lovelace

Ada, Countess of Lovelace, is remembered for a paper published in 1843, which translated and considerably extended an article about the unbuilt Analytical Engine, a general-purpose computer designed by the mathematician and inventor Charles Babbage. Her substantial appendices, nearly twice the length of the original work, contain an account of the principles of the machine, along with a table often described as ‘the first computer program’. In this paper we look at Lovelace's education before 1840, which encompassed older traditions of practical geometry; newer textbooks influenced by continental approaches; wide reading; and a fascination with machinery. We also challenge judgements by Dorothy Stein and by Doron Swade of Lovelace's mathematical knowledge and skills before 1840, which have impacted later scholarly and popular discourse