Desempenho contrátil do ventrículo direito 7 dias após infarto em ratos com e sem sinais de insuficiência cardíaca.

Estudos realizados em nosso laboratório demonstraram que o desempenho cardíaco de ratos, com mesma área de cicatriz, aos 30 e 60 dias após infarto agudo do miocárdio (IAM), depende da presença ou não de sinais de insuficiência cardíaca (IC). Considerando esta dicotomia funcional identificada na fase crônica, o objetivo deste estudo foi avaliar a contratilidade do ventrículo direito (VD) em uma fase precoce (7 dias) após IAM. Ratos Wistar (200 230 g) foram divididos em 3 grupos: controle (SHAM), infartado sem sinais de IC (INF) e infartado com sinais de IC (IC). Os corações foram isolados e nutridos com solução de Krebs a 35oC, pH 7,35 usando a técnica de Langendorff. A contratilidade do VD foi avaliada através medida das pressões intraventriculares direita e de sua primeira derivada temporal (dP/dt), frente a: curva estiramento-tensão (0 até 30 mmHg), dose única de angiotensina I (ANG I), angiotensina II (ANG II), isoproterenol e concentração crescente de cálcio (0,62 a 3,5 mM). A análise hemodinâmica evidenciou um aumento das pressões sistólica (PSVD) e diastólica final (PDfVD) do VD no grupo IC comparado aos grupos INF e SHAM. (PSVD; SHAM=29±2,2; INF=28±2,2; IC=40±2,3*# mmHg; PDfVD: SHAM=1,13±0,2; INF=1,33±0,3; IC=2,2±1,2*#mmHg; dP/dt+ VD: SHAM=971±191; IC=1915±210* mmHg/s). No ventrículo esquerdo (VE), houve diferença nas pressões intraventriculares entre o grupo INF e IC (PSVE: SHAM=104±1,58; INF=92±1,17*; IC=95±2,9* mmHg; PDfVE: SHAM=3,35±0,9; INF=3,6±0,9; IC=18±1,5* mmHg, dP/dt- VE(SHAM=5563±353 INF=4330±316* mmHg/s). Os grupos apresentaram a mesma área de cicatriz. O grupo IC apresentou redução da contratilidade para todos os parâmetros analisados, enquanto o grupo INF apresentou alteração somente na curva estiramento-tensão. Entretanto, ANG I e ANG II não promoveram nenhum efeito inotrópico nos grupos estudados. Podemos concluir que a função de bomba do VD, in vivo, esta preservada no grupo INF e exacerbada no grupo IC. Por outro lado, a análise do VD, na preparação de coração isolado, confirmou a manutenção da contratilidade do grupo INF, e evidenciou um prejuízo no grupo IC. No grupo IC as respostas inotrópicas ao Ca2+ e β-adrenérgica estavam prejudicadas sem modificação na resposta inotrópica a ANG II. Estes resultados demonstram uma precocidade da dicotomia funcional em ratos após IAM com mesma área de infarto

Social Value of Marine and Coastal Protected Areas in England and Wales.

The U.K. government is committed to establishing a coherent network of marine protected areas by 2012 and the recentMarine and Coastal Access Act, 2009 will designate marine conservation zones and provide wider access rights to the coast. To fulfill these goals, this article argues the need for a clearer, shared understanding of the social value of protected areas in creating new designations and managing existing ones. Although marine and coastal environments attract many people and are vitally important in terms of realized and potential social value, the majority of the public in the United Kingdom lacks understanding and awareness regarding them. Combined with this, the social value of marine and coastal protected areas (MCPAs) have been largely ignored relative to conservation and economics, with the latter invariably taking precedence in environmental policymaking. Social value reflects the complex, individual responses that people experience in a given place. Many reasons determine why one area is valued above another, and this research investigates the social value of MCPAs from a practitioner’s perspective through a series of interviews. Understanding why we “socially” value MCPAs will ultimately equip managers with an informed understanding of these spaces, influence management decisions, and, potentially, policymaking. This article defines social value in the context of MCPAs in England and Wales from a practitioner perspective, explores key concepts, and suggests possible improvements in decision-making

Devolving the heartland: making up a new social policy for the 'South East'

Devolution appears to challenge the traditional regional and national hierarchies of the UK, but in practice the dominance of the South East of England has been maintained through active state intervention. As social welfare has increasingly been redefined through economic success and access to the labour market, the focus of social policy has shifted accordingly. In this context the South East has been re-imagined not as a symbol of inequality and a potential source of redistribution, but rather as driver of economic prosperity and 'national' (UK) well-being

A randomised controlled trial of a lengthened and multi-disciplinary consultation model in a socially deprived community: a study protocol

<p>Abstract</p> <p>Background</p> <p>There has been little development of the general practice consultation over the years, and many aspects of the present consultation do not serve communities with multiple health and social problems well. Many of the problems presenting to general practitioners in socio-economically disadvantaged areas are not amenable to a purely medical solution, and would particularly benefit from a multidisciplinary approach. Socio-economic deprivation is also associated with those very factors (more psychosocial problems, greater need for health promotion, more chronic diseases, more need for patient enablement) that longer consultations have been shown to address. This paper describes our study protocol, which aims to evaluate whether a lengthened multidisciplinary primary care team consultation with families in a socially deprived area can improve the psychological health of mothers in the families.</p> <p>Methods/Design</p> <p>In a randomised controlled trial, families with a history of social problems, substance misuse or depression are randomly allocated to an intervention or control group. The study is based in three general practices in a highly deprived area of North Dublin. Primary health care teams will be trained in conducting a multidisciplinary lengthened consultation. Families in the intervention group will participate in the new style multidisciplinary consultation. Outcomes of families receiving the intervention will be compared to the control group who will receive only usual general practitioner care. The primary outcome is the psychological health of mothers of the families and secondary outcomes include general health status, quality of life measures and health service usage.</p> <p>Discussion</p> <p>The main aim of this study is to evaluate the effectiveness of a lengthened multidisciplinary team consultation in primary care. The embedded nature of this study in general practices in a highly deprived area ensures generalisability to other deprived communities, but more particularly it promises relevance to primary care.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN70578736</p

Addressing Criticisms of Large-Scale Marine Protected Areas

Designated large-scale marine protected areas (LSMPAs, 100,000 or more square kilometers) constitute over two-thirds of the approximately 6.6% of the ocean and approximately 14.5% of the exclusive economic zones within marine protected areas. Although LSMPAs have received support among scientists and conservation bodies for wilderness protection, regional ecological connectivity, and improving resilience to climate change, there are also concerns. We identified 10 common criticisms of LSMPAs along three themes: (1) placement, governance, and management; (2) political expediency; and (3) social–ecological value and cost. Through critical evaluation of scientific evidence, we discuss the value, achievements, challenges, and potential of LSMPAs in these arenas. We conclude that although some criticisms are valid and need addressing, none pertain exclusively to LSMPAs, and many involve challenges ubiquitous in management. We argue that LSMPAs are an important component of a diversified management portfolio that tempers potential losses, hedges against uncertainty, and enhances the probability of achieving sustainably managed oceans

Choosing best practices for managing impacts of trawl fishing on seabed habitats and biota

Bottom trawling accounts for almost one quarter of global fish landings but may also have significant and unwanted impacts on seabed habitats and biota. Management measures and voluntary industry actions can reduce these impacts, helping to meet sustainability objectives for fisheries, conservation and environmental management. These include changes in gear design and operation of trawls, spatial controls, impact quotas and effort controls. We review nine different measures and actions and use published studies anda simple conceptual model to evaluate and compare their performance. The risks and benefits of these management measures depend on the extent to which the fishery is already achieving management objectives for target stocks and the characteristics of the management system that is already in place. We offer guidance on identifying best practices for trawl-fisheries management and show that best practices and their likelihood of reducing trawling impacts depend on local, national and regional management objectives and priorities, societal values and resources for implementation. There is no universalbest practice, and multiple management measures and industry actions are required to meet sustainability objectives and improve trade-offs between food production and environmental protection