Elephants in the room: chronically ill people and access to LGBTQA+ spaces

The article explores the issue of accessibility for disabled and chronically ill people in LGBTQA* spaces and its implications on a political level. The first part focuses on the theoretical premises that understand able-bodiedness as a system of compulsion: drawing from the insights offered by crip studies, accessibility is framed as a political claim that challenges the supposed normalcy built on able-bodied and heterosexual models. Also, the notion of LGBT spaces as paradoxical spaces is discussed. The empirical context of the research is explained in the second part, which also outlines a brief overview on chronic illness and on some aspects of LGBT activism in relation to intersectionality in Italy and Portugal. In the following section, the article discusses the inaccessibility of some practices of activism: the focus is on how activism happens and how many of the common practices adopted are actually based on presumptions of able-bodiedness. Pride Parades, assemblies, marches all constitute challenging moments in which interviewees are confronted with the difficulty of complying with the expectation of having a "bionic body". In the last section, the focus moves to relations within activist circles in relation to invisibility and coming out as chronically ill: interviews show the tension between coming out or staying in the closet, and the contradictions of doing intersectional politics without including accessible practices within collectives. Through these narratives, I suggest the idea that LGBTQA* spaces are still very much embedded into able-bodied presumptions which result in multiple obstacles for the participation of chronically ill members; also, I argue that, in order to create inclusive and safe spaces for LGBTQA* people, it is necessary to make advancements in the way disability and chronic illness are thought within LGBTQA* communities

Genere e sessualità nei vissuti di malattia e invecchiamento: tra narrazioni dominanti e contro-discorsi

The article investigates the intersection of doing gender and sexuality within chronic conditions and aging, adopting an analytical framework that mixes different theoretical approaches (Crip theory and Disability studies, Gender studies and Ageing studies). The empirical basis derives from two different research projects: the first one analysed the experiences of young adults LGBTQ+ with chronic illness through 24 narrative interviews carried out in Italy and Portugal; the second investigated discourses and practices related to sexuality and aging through in-depth interviews with Italian women aged 50+. For the reflection elaborated in this article, in both researches it was decided to focus only on the sub-sample of interviews made in Italy to cisgender women and non-binary people (8 in the first, 15 in the second research). The article interrogates this empirical material with the aim of understanding to what extent, and according to what modalities, situations of chronic illness or psycho-physical conditions related to aging, are perceived, adhering to a medicalizing framework, as desexualizing; and whether instead forms of redefinition, reworking and renegotiation of their sexual experience at the level of desire and practices are activated

Impella versus VA-ECMO for patients with cardiogenic shock: comprehensive systematic literature review and meta-analyses

Comprehensive systematic review of clinic and economic outcomes of studies on health technologies used in patients suffering from cardiogenic shock. Socio-economic outcomes including quality of life or resource use were not reported in any study. The study highlighted areas where further data collection is needed to clarify the value of complex, new technologies in the treatment of CS, that will enable comparative assessments focusing both on the health impact on patient outcomes, and on the financial burden for government budgets. Future studies need to fill the gap to comply with recent regulatory updates at the European and national levels

Cardiac surgery in 260 octogenarians: a case series

Background: The elderly undergo cardiac surgery more and more frequently, often present multiple comorbidities, assume chronic therapies, and present a unique physiology. Aim of our study was to analyze the experience of a referral cardiac surgery center with all types of cardiac surgery interventions performed in patients ≥80 years old over a six years' period. Methods: A retrospective observational study performed in a university hospital. 260 patients were included in the study (3.5% of the patients undergoing cardiac surgery in the study period). Results: Mean age was 82 ± 1.8 years. Eighty-five percent of patients underwent elective surgery, 15% unplanned surgery and 4.2% redo surgery. Intervention for aortic valve pathology and coronary artery bypass grafting were performed in 51% and 46% of the patients, respectively. Interventions involving the mitral valve were the 26% of the total, those on the tricuspid valve were 13% and those on the ascending aortic arch the 9.6%. Postoperative low output syndrome was identified in 44 patients (17%). Mortality was 3.9% and most of the patients (91%) were discharged from hospital in good clinical conditions. Hospital mortality was lower in planned vs unplanned surgery: 3.8% vs 14% respectively. Chronic obstructive pulmonary disease (OR 9.106, CI 2.275 - 36.450) was the unique independent predictor of mortality. Conclusions: Clinicians should be aware that cardiac surgery can be safely performed at all ages, that risk stratification is mandatory and that hemodynamic treatment to avoid complications is expected

Yo vi a mi hijo nacer”: vivencia de padres en sala de parto

Foi realizado um estudo exploratório descritivo, com abordagem qualitativa na maternidade municipal de Londrina, Paraná, com o objetivo de apreender o conhecimento dos pais sobre o direito do acompanhante durante o trabalho de parto e parto e conhecer a vivência dele durante o nascimento do filho. Para isto, foram entrevistados, no período de 15 a 22 de junho de 2006, quarenta pais, jovens em sua maioria, que vivenciavam o nascimento do primeiro filho. Para análise das informações, utilizou-se o método de análise de conteúdo. Verificou-se que eles desconheciam o direito que lhes é resguardado por lei de estarem presentes durante este evento, ao atribuírem sua presença à benevolência da equipe médica. Pode-se julgar a experiência positiva pelo suporte à parturiente, por desmistificar temores e sofrimentos relacionados ao parto.A descriptive exploratory study with qualitative approach was carried out in the Municipal Maternity of Londrina, Paraná, Brazil, with the aim of assessing the knowledge of parents as to the rights of the partner during labor and delivery, and to find out about his experience during the birth of his child. Forty young fathers experiencing the birth of their first child were interviewed from June 15th to June 22nd, 2006. It was verified that they were unaware of their right to be present during these events, attributing their presence to the generosity of the medical team. The experience was considered as positive because of the support given to the mothers, demystifying fears and suffering related to childbirth.Fue realizado un estudio exploratorio descriptivo, con abordage en la Maternidad Municipal de Londrina, Paraná, Brasil, cuyo objetivo fue aprehender el conocimiento de los padres sobre el derecho del compañero durante el trabajo del parto y conocer la vivencia de él durante el nacimiento del hijo. Para esto, fueron entrevistados, en el período de 15 a 22 de junio de 2006, cuarenta padres, en su mayoría, jóvenes que vivenciaban el nacimiento del primer hijo. Data analysis was performed with content. Fue averiguado que ellos desconocen el derecho que les es asegurado por ley de que estén presentes durante este evento, por el hecho de que hayan atribuido su presencia a la benevolencia del equipo médico. Fue posible juzgar la experiencia positiva por el soporte dado a la parturienta, por desengañar temores y sufrimientos con relación al parto

Comprehensive Brain Tumour Characterisation with VERDICT-MRI: Evaluation of Cellular and Vascular Measures Validated by Histology

The aim of this work was to extend the VERDICT-MRI framework for modelling brain tumours, enabling comprehensive characterisation of both intra- and peritumoural areas with a particular focus on cellular and vascular features. Diffusion MRI data were acquired with multiple b-values (ranging from 50 to 3500 s/mm2), diffusion times, and echo times in 21 patients with brain tumours of different types and with a wide range of cellular and vascular features. We fitted a selection of diffusion models that resulted from the combination of different types of intracellular, extracellular, and vascular compartments to the signal. We compared the models using criteria for parsimony while aiming at good characterisation of all of the key histological brain tumour components. Finally, we evaluated the parameters of the best-performing model in the differentiation of tumour histotypes, using ADC (Apparent Diffusion Coefficient) as a clinical standard reference, and compared them to histopathology and relevant perfusion MRI metrics. The best-performing model for VERDICT in brain tumours was a three-compartment model accounting for anisotropically hindered and isotropically restricted diffusion and isotropic pseudo-diffusion. VERDICT metrics were compatible with the histological appearance of low-grade gliomas and metastases and reflected differences found by histopathology between multiple biopsy samples within tumours. The comparison between histotypes showed that both the intracellular and vascular fractions tended to be higher in tumours with high cellularity (glioblastoma and metastasis), and quantitative analysis showed a trend toward higher values of the intracellular fraction (fic) within the tumour core with increasing glioma grade. We also observed a trend towards a higher free water fraction in vasogenic oedemas around metastases compared to infiltrative oedemas around glioblastomas and WHO 3 gliomas as well as the periphery of low-grade gliomas. In conclusion, we developed and evaluated a multi-compartment diffusion MRI model for brain tumours based on the VERDICT framework, which showed agreement between non-invasive microstructural estimates and histology and encouraging trends for the differentiation of tumour types and sub-regions

The Fourteenth Data Release of the Sloan Digital Sky Survey: First Spectroscopic Data from the extended Baryon Oscillation Spectroscopic Survey and from the second phase of the Apache Point Observatory Galactic Evolution Experiment

The fourth generation of the Sloan Digital Sky Survey (SDSS-IV) has been in operation since July 2014. This paper describes the second data release from this phase, and the fourteenth from SDSS overall (making this, Data Release Fourteen or DR14). This release makes public data taken by SDSS-IV in its first two years of operation (July 2014-2016). Like all previous SDSS releases, DR14 is cumulative, including the most recent reductions and calibrations of all data taken by SDSS since the first phase began operations in 2000. New in DR14 is the first public release of data from the extended Baryon Oscillation Spectroscopic Survey (eBOSS); the first data from the second phase of the Apache Point Observatory (APO) Galactic Evolution Experiment (APOGEE-2), including stellar parameter estimates from an innovative data driven machine learning algorithm known as "The Cannon"; and almost twice as many data cubes from the Mapping Nearby Galaxies at APO (MaNGA) survey as were in the previous release (N = 2812 in total). This paper describes the location and format of the publicly available data from SDSS-IV surveys. We provide references to the important technical papers describing how these data have been taken (both targeting and observation details) and processed for scientific use. The SDSS website (www.sdss.org) has been updated for this release, and provides links to data downloads, as well as tutorials and examples of data use. SDSS-IV is planning to continue to collect astronomical data until 2020, and will be followed by SDSS-V.Comment: SDSS-IV collaboration alphabetical author data release paper. DR14 happened on 31st July 2017. 19 pages, 5 figures. Accepted by ApJS on 28th Nov 2017 (this is the "post-print" and "post-proofs" version; minor corrections only from v1, and most of errors found in proofs corrected

The 13th Data Release of the Sloan Digital Sky Survey: First Spectroscopic Data from the SDSS-IV Survey Mapping Nearby Galaxies at Apache Point Observatory

The fourth generation of the Sloan Digital Sky Survey (SDSS-IV) began observations in July 2014. It pursues three core programs: APOGEE-2,MaNGA, and eBOSS. In addition, eBOSS contains two major subprograms: TDSS and SPIDERS. This paper describes the first data release from SDSS-IV, Data Release 13 (DR13), which contains new data, reanalysis of existing data sets and, like all SDSS data releases, is inclusive of previously released data. DR13 makes publicly available 1390 spatially resolved integral field unit observations of nearby galaxies from MaNGA,the first data released from this survey. It includes new observations from eBOSS, completing SEQUELS. In addition to targeting galaxies and quasars, SEQUELS also targeted variability-selected objects from TDSS and X-ray selected objects from SPIDERS. DR13 includes new reductions ofthe SDSS-III BOSS data, improving the spectrophotometric calibration and redshift classification. DR13 releases new reductions of the APOGEE-1data from SDSS-III, with abundances of elements not previously included and improved stellar parameters for dwarf stars and cooler stars. For the SDSS imaging data, DR13 provides new, more robust and precise photometric calibrations. Several value-added catalogs are being released in tandem with DR13, in particular target catalogs relevant for eBOSS, TDSS, and SPIDERS, and an updated red-clump catalog for APOGEE.This paper describes the location and format of the data now publicly available, as well as providing references to the important technical papers that describe the targeting, observing, and data reduction. The SDSS website, http://www.sdss.org, provides links to the data, tutorials and examples of data access, and extensive documentation of the reduction and analysis procedures. DR13 is the first of a scheduled set that will contain new data and analyses from the planned ~6-year operations of SDSS-IV.PostprintPeer reviewe