Reverse doming of the anterior mitral leaflet with severe aortic regurgitation

The normal anatomic relation of the anterior mitral leaflet to the left ventricular outflow tract suggests that significant aortic regurgitation should have a predictable hemodynamic effect on the motion and configuration of the leaflet, an effect that should be seen by two-dimensional echocardiography. Previous reports have identified an abnormality of mitral opening in the short-axis view that was quite specific but not sensitive. This study was undertaken to evaluate mitral valve motion and configuration in aortic insufficiency using two-dimensional echocardiography. A characteristic pattern of anterior leaflet motion was found in patients with moderately severe and severe aortic regurgitation. This pattern, termed “reverse doming,” was seen in the apical and long-axis views in 19 of 22 such patients. The previously described “diastolic indentation” in the short-axis view was found in 16 of these 22 patients. Only 2 of 16 patients with lesser degrees of insufficiency had reverse doming. The sign was not seen in normal subjects nor in 16 patients with cardiomyopathy. For each of the few false positive and false negative findings, there is a seemingly logical hemodynamic explanation.It is concluded that reverse doming of the anterior mitral leaflet appears to be a sensitive and specific sign for moderately severe and severe aortic regurgitation

The effect of duration of exercise at the ventilation threshold on subjective appetite and short-term food intake in 9 to 14 year old boys and girls

<p>Abstract</p> <p>Background</p> <p>The effect of exercise on subjective appetite and short-term food intake has received little investigation in children. Despite a lack of reported evaluation of short-duration activity programs, they are currently being implemented in schools as a means to benefit energy balance. The purpose of this study was to determine the effect of duration of exercise at the ventilation threshold (VeT) on subjective appetite and short-term food intake in normal weight boys and girls aged 9 to 14 years.</p> <p>Methods</p> <p>On 4 separate mornings and in random order, boys (n = 14) and girls (n = 15) completed 2 rest or 2 exercise treatments for 15 (short-duration; SD) or 45 min (long-duration; LD) at their previously measured VeT, 2 h after a standardized breakfast. Subjective appetite was measured at regular intervals during the study sessions and food intake from a pizza meal was measured 30 min after rest or exercise.</p> <p>Results</p> <p>An increase in average appetite, desire to eat, and hunger (p < 0.05) was attenuated by SD exercise, but was further increased (p < 0.05) by LD exercise. However, food intake after SD and LD exercise was similar to after rest in both boys and girls (p = 0.55). The energy cost of SD and LD exercise resulted in a lower net energy balance compared to resting during the study measurement period in boys (SD: Δ = -418 ± 301 kJ; LD: Δ = -928 ± 196 kJ) and in girls (SD: Δ = -297 ± 105 kJ; LD: Δ = -432 ± 115 kJ).</p> <p>Conclusion</p> <p>Neither SD nor LD exercise at the VeT increased short-term food intake and SD exercise attenuated increases in appetite. Thus, SD exercise programs in schools may be an effective strategy for maintaining healthier body weights in children.</p

A briefing for mental health professionals : why asking about abuse matters to service users (REVA project, briefing 3)

There are high prevalence rates of violent and abusive experience in both the childhoods and adult lives of mental health service users. Histories of childhood sexual and physical abuse amongst women service users are particularly well documented. Although many of the samples in studies are small, figures of over 50% are not unusual (Palmer et al, 1992; Bryer et al, 1987; Walker and James, 1992; Wurr and Partridge, 1996). In secure settings this figure is even higher (Bland et al, 1999). Studies of severe domestic violence among psychiatric in-patients report lifetime prevalence ranging from 30% to 60% (Golding, 1999; Howard et al. 2010). The REVA study, on which this briefing is based, has also found that people who suffer violence and abuse are much more likely to have a mental disorder, self-harm or attempt suicide than those with little or no experience of this kind (Scott et al, 2013). Given the prevalence of experiences of abuse among users of adult mental health services it is vitally important that these experiences are identified to ensure appropriate diagnosis, support and referral. Since 2003 it has been Department of Health policy that all adult service users should be asked about experiences of violence and abuse in mental health assessments. Yet actually disclosing experiences of violence and abuse can be very difficult. Survivors can feel a deep sense of shame and responsibility for the abuse they have experienced – feelings that are often strategically encouraged by their abusers (Clark and Quadara, 2010). These feelings can be compounded by unhelpful responses from professionals when they try to disclose (Imkaanetal, 2014). And survivors consistently say that disclosure has to be ‘at the right time for them’, which may be immediately or many years after the abuse (McNaughton Nicholls, 2012). In this briefing paper we present findings from research funded by the Department of Health Policy Research Programme on responding effectively to the needs of survivors of violence and abuse: the REVA study. The study included specifically asking survivors of violence and abuse about their views on routine enquiry, their experiences of disclosing abuse and their recommendations for how staff should ask clients about abuse

Guidance for Trust managers : implementing and sustaining routine enquiry about violence and abuse in mental health services (REVA project, briefing 2)

Since 2003 it has been Department of Health policy that all adult service users should be asked about experiences of violence and abuse in mental health assessments. However, by 2006 it was apparent that mental health provider trusts were not generally implementing the policy and a two-year initiative was launched to pilot an approach to introducing routine enquiry and embedding it in clinical practice. The pilot involved a total of 15 trusts and its evaluation identified key lessons for effective implementation of routine enquiry in all trusts. In 2012 the Department of Health funded follow-up research on responding effectively to the needs of survivors of violence and abuse to include case-studies of four of the original pilot trusts to implement routine enquiry (the REVA study). This guidance is based on findings from this study

A briefing for commissioners : what survivors of violence and abuse say about mental health services (REVA project, briefing 4)

The Department of Health publication, Commissioning services for women and children who have experienced violence or abuse – a guide for health commissioners, clearly acknowledges that ‘victims of violence or abuse tend to use health services more than average’ and that this is ‘despite often finding it hard to access services’ (Golding and Duggal, 2011: 22). The guidance goes on to state that it is precisely because of this that ‘it is in the NHS interest to identify these women and children, provide opportunities for them to disclose, and provide services [..] to help them improve their physical and mental health’ (ibid). The policy that has been implemented to support this process is known as ‘routine enquiry’ (RE). Since 2003 it has been Department of Health policy that all adult service users should be asked about experiences of violence and abuse in mental health assessments. However, asking about experiences of abuse and violence is not enough. To be effective the policy of routine enquiry has to be underpinned by the provision of appropriate and effective services for survivors of abuse. As the commissioning guidance notes, ‘commissioners should be aware of the importance of clear referral pathways, so that health professionals know where and how to refer women and children to local services’. For appropriate services to be available, commissioners also need to be aware of the type of services and care pathways that people who have experienced abuse feel are appropriate to meet their needs. In this briefing we present information drawn from interviews with mental health service users who have experienced domestic and/or sexual violence. This briefing focusses on the links between experience of abuse and mental health and the implications this has for commissioners to create an effective service landscape. The REVA research included the experience of both male and female service users. Useful guidance focussing on commissioning services specifically for women and girls who have survived violence is also available: see Woman’s Aid and Imkaan, 2014 ‘Successful commissioning: a guide to commissioning services that support women and children survivors of violence’, see www.womensaid.org.uk for details

A briefing for service providers and commissioners : measuring outcomes for survivors of violence and abuse (REVA project, briefing 5)

The long-term consequences of violence and abuse can only be addressed if appropriate services for survivors are available. Many such services are located within the voluntary sector, and the fact that they are oversubscribed indicates a high level of demand, but there is limited robust evidence as to whether, how and why they work. Third sector organisations need to demonstrate their effectiveness, particularly in the context of competitive commissioning (Harlock, 2013). However, cuts to already under-resourced services in the violence against women and girls (VAWG) sector have made it difficult for many, especially smaller services, to develop meaningful measurement frameworks or to fully engage in commissioning processes (Callanan et al., 2012; Women’s Aid & Imkaan, 2014). The lack of standardised sector-specific outcome measures also means that services may be required to conduct multiple monitoring exercises for a variety of different funding streams, with none fully reflecting the reality of their work. To address these gaps, one strand of the REVA project has involved developing an outcomes framework to reflect the work of such services more accurately. In doing this, we built upon work underway in the specialist women’s voluntary sector by Women’s Aid, Imkaan, Rape Crisis England and Wales, and consulted with a range of individuals and organisations through the REVA Reference Network. We also drew on tools developed and used within the health and mental health sectors. Our aim was for the measures to be suitable for use in a range of types of services addressing various forms of violence and abuse located in both the voluntary and statutory sectors. The resulting outcomes tool was piloted in seven voluntary sector and NHS settings in 2013-14

Empathy in action: Developing a sense of belonging with the pedagogy of ‘real talk’

A collaborative group of interdisciplinary faculty-researchers at a regional comprehensive university in the United States implemented two pedagogical practices, real talks and alternative lessons (together called the pedagogy of real talk), and investigated students’ sense of belonging in classrooms using these practices. Real talks are planned interactions wherein faculty share human stories from their lives on a universal theme and invite students to share their own stories on that theme. Alternative lessons are faculty-designed learning experiences that build upon understandings of students’ worldviews and experiences. Survey data from over 30 student classes across two semesters in 2021 were compared with university-wide climate survey data to posit that sense of belonging in these classes was higher than that in the university as a whole. Case study data selected from a repository of faculty descriptions written between 2020 and 2021 further fleshed out examples of specific real talks and alternative lessons. The authors found these practices are particularly significant in their impact on typically underrepresented students, who often contend with feelings of exclusion in their pursuit of higher education

A trio of new Local Group galaxies with extreme properties

We report on the discovery of three new dwarf galaxies in the Local Group. These galaxies are found in new CFHT/MegaPrime g,i imaging of the south-western quadrant of M31, extending our extant survey area to include the majority of the southern hemisphere of M31's halo out to 150 kpc. All these galaxies have stellar populations which appear typical of dwarf spheroidal (dSph) systems. The first of these galaxies, Andromeda XVIII, is the most distant Local Group dwarf discovered in recent years, at ~1.4 Mpc from the Milky Way (~ 600 kpc from M31). The second galaxy, Andromeda XIX, a satellite of M31, is the most extended dwarf galaxy known in the Local Group, with a half-light radius of r_h ~ 1.7 kpc. This is approximately an order of magnitude larger than the typical half-light radius of many Milky Way dSphs, and reinforces the difference in scale sizes seen between the Milky Way and M31 dSphs (such that the M31 dwarfs are generally more extended than their Milky Way counterparts). The third galaxy, Andromeda XX, is one of the faintest galaxies so far discovered in the vicinity of M31, with an absolute magnitude of order M_V ~ -6.3. Andromeda XVIII, XIX and XX highlight different aspects of, and raise important questions regarding, the formation and evolution of galaxies at the extreme faint-end of the luminosity function. These findings indicate that we have not yet sampled the full parameter space occupied by dwarf galaxies, although this is an essential pre-requisite for successfully and consistently linking these systems to the predicted cosmological dark matter sub-structure.Comment: 32 pages, 7 figures (ApJ preprint format). Accepted for publication in Ap