Predicting clinically unrecognized coronary artery disease: use of two- dimensional echocardiography

<p>Abstract</p> <p>Background</p> <p>2-D Echo is often performed in patients without history of coronary artery disease (CAD). We sought to determine echo features predictive of CAD.</p> <p>Methods</p> <p>2-D Echo of 328 patients without known CAD performed within one year prior to stress myocardial SPECT and angiography were reviewed. Echo features examined were left ventricular and atrial enlargement, LV hypertrophy, wall motion abnormality (WMA), LV ejection fraction (EF) < 50%, mitral annular calcification (MAC) and aortic sclerosis/stenosis (AS). High risk myocardial perfusion abnormality (MPA) was defined as >15% LV perfusion defect or multivessel distribution. Severe coronary artery stenosis (CAS) was defined as left main, 3 VD or 2VD involving proximal LAD.</p> <p>Results</p> <p>The mean age was 62 ± 13 years, 59% men, 29% diabetic (DM) and 148 (45%) had > 2 risk factors. Pharmacologic stress was performed in 109 patients (33%). MPA was present in 200 pts (60%) of which, 137 were high risk. CAS was present in 166 pts (51%), 75 were severe. Of 87 patients with WMA, 83% had MPA and 78% had CAS. Multivariate analysis identified age >65, male, inability to exercise, DM, WMA, MAC and AS as independent predictors of MPA and CAS. Independent predictors of high risk MPA and severe CAS were age, DM, inability to exercise and WMA.</p> <p>2-D echo findings offered incremental value over clinical information in predicting CAD by angiography. (Chi square: 360 vs. 320 p = 0.02).</p> <p>Conclusion</p> <p>2-D Echo was valuable in predicting presence of physiological and anatomical CAD in addition to clinical information.</p

Q10 COENZYME FOR THE PROPHYLAXIS OF MIGRAINE IN CHILDREN AND ADOLESCENTS

The article presents the results of an open study of administration of a dietary supplement – coenzyme Q10, for the prophylaxis of migraine, on a group of 14 children aged between 10 an 14 years. A small dose, of only 60 mg daily, produced a more than 50% decrease of the number of days with headache, in 8 of the 14 children. The doses of NSAID taken by 9 of the 14 children were reduced by more than 50%. These results were obtained after only two months of supplementation. In previous adult studies, there have been noticed results after longer periods of supplementation, and with higher doses of coenzyme Q10 . There have been no adverse effects. This is a preliminary, open study, without placebo control, on a very small group of children. Coenzyme Q10 looks promising for migraine prophylaxis in children. But further, larger studies are needed to confirm its usefulnes

Emotionally Vulnerable Storytelling as Peacebuilding: Muslim/Jewish Interfaith Activism in the United States

How do American Muslim-Jewish interfaith activists use emotionally vulnerable storytelling in service of their goal of realizing a pluralistic society in which minority groups with histories of conflict support one another as allies? As with many groups in conflict, American Jews and Muslims often grow up with truth perspectives that differ so radically that they are unable to find a narrative whose truth value can be agreed upon by members of both groups. How do Jewish-Muslim interfaith activists learn to communicate and reconcile differences in the truth values of their respective group narratives? What is the role of this kind of knowledge production in constructing a collective identity as interfaith activists?In order to answer these questions, I spent four years conducting participant observation at One Hamsa (a pseudonym), an interfaith organization aimed specifically at bridging Muslim and Jewish communities in Southern California. Using an engaged feminist activist approach to conducting and writing ethnography, I attended meetings, formal and informal events, and conducted interviews of One Hamsa leaders and participants. I argue that through emotionally vulnerable storytelling, Jews and Muslims challenge master narratives about their communities and co-construct a third narrative that all participants can agree upon as true. Through this process, One Hamsa community members build a collective identity as interfaith activists. Practices like community agreements help to create safe spaces where ideally, all participants feel safe sharing vulnerably. Even when such practices are used, sometimes activists are unsuccessful at avoiding replicating harmful societal power structures within their community. Like engaged scholars, activists should and often do recognize the contradictions inherent in their project. Both engaged scholars and activists must continue to prioritize interrogating power structures and ensuring that the benefits of their projects outweigh the harms

Collapse Assessment of Reinforced Concrete Coupled Walls

ABSTRACT OF THE DISSERTATIONCollapse Assessment of Reinforced Concrete Ductile Coupled Walls byNegin Aryaee TaubergDoctor of Philosophy in Civil EngineeringUniversity of California, Los Angeles, 2019Professor John Wright Wallace, ChairReinforced concrete coupled shear walls are efficient lateral load resisting systems commonly constructed as part of core walls in mid to high-rise buildings. Coupled walls are constructed as a result of openings accommodating doorways and windows, thus separating a solid wall segment in two piers. Instead of summing the strength of two individual wall piers, the efficiency of the individual wall piers is improved by proper coupling of two adjacent walls linked by coupling beams. During earthquake shaking, coupling beams act as ductile fuses and dissipate seismic energy over the building height. This coupling action reduces the flexural demand at the base of the shear walls and results in increased strength, stiffness, and lateral load resistance. Coupling beams can dissipate energy well in the system and retain significant strength and stiffness through large displacement reversals when they are detailed to retain ductility with adequate longitudinal, diagonal, and confinement reinforcement.As part of this study, important parameters affecting the behavior of coupling beams and coupled wall systems are assessed. A thorough coupling beam database is compiled consisting of 104 individual beam specimen and 11 coupled wall system level tests. The database is used to derive trends for coupling beam effective stiffness and shear-deformation backbone relations.Based on a review of past experimental results, an expression is derived relating the coupling beam effective stiffness as a function of the beam aspect ratio, i.e., EcIeff/EcIg = 0.07ln/h, which represents the secant stiffness to yield and includes the stiffening impact of the slab and the post- tensioning stress. This expression has been adopted in the PEER TBI (2017) and LATBSDC (2017) guidelines. Experimental shear-deformation information from the database is also used to quantify plastic rotations at peak coupling beam shear strength and at strength loss.The subsequent part of this study focuses on proposing appropriate seismic response parameters for coupled wall systems. Current ASCE 7-16 and ACI 318-14 design provisions specify the same seismic response parameters to be used for coupled walls as are for special structural walls. However, well-designed coupled walls can have improved lateral performance and energy dissipation compared to uncoupled walls since part of the total overturning moment is resisted by coupling action and energy dissipation is distributed along the height of structure. In coordination with ASCE 7 and ACI 318, a new lateral system is introduced for Reinforced Concrete (RC) Ductile Coupled Walls as an assembly of walls with aspect ratio (hwcs/lw) greater than 2.0 which are linked by coupling beams having aspect ratios (ln/h) between 2.0 and 5.0.This study employs the FEMA P695 methodology to validate the proposed response modification factor of R = 8, deflection amplification factor of Cd = 8, and an overstrength factor of Ω0 = 2.5 for RC Ductile Coupled Walls. The collapse assessment studies include forty-one Archetypes designed using ASCE 7-16 and ACI 318-19 including new provisions that require wall shear amplification and a drift capacity check. The Archetypes vary in building height (6 to 30 stories), wall cross section (planar and flanged/core), coupling beam aspect ratio (ln/h = 2.0 to 5.0), and coupling beam reinforcement arrangement (conventionally reinforced and diagonally reinforced). Collapse of the Archetypes is evaluated using failure criteria models that account for flexural failure (concrete crushing, bar buckling, wall lateral instability, bar fracture), shear, and axial failures. In comparison to previous studies that have assumed failure to occur at a roof drift ratio of 5%, this study uses a conservative approach to define flexural failure as a 20% drop in lateral strength. Overall, nonlinear static pushover and incremental dynamic analysis results indicate that R = 8 and Ω0 = 2.5 are appropriate parameters for RC Ductile Coupled Wall systems that are designed per ASCE 7-16 and ACI 318-19 provisions

Emotionally Vulnerable Storytelling as Peacebuilding: Muslim/Jewish Interfaith Activism in the United States

How do American Muslim-Jewish interfaith activists use emotionally vulnerable storytelling in service of their goal of realizing a pluralistic society in which minority groups with histories of conflict support one another as allies? As with many groups in conflict, American Jews and Muslims often grow up with truth perspectives that differ so radically that they are unable to find a narrative whose truth value can be agreed upon by members of both groups. How do Jewish-Muslim interfaith activists learn to communicate and reconcile differences in the truth values of their respective group narratives? What is the role of this kind of knowledge production in constructing a collective identity as interfaith activists? In order to answer these questions, I spent four years conducting participant observation at One Hamsa (a pseudonym), an interfaith organization aimed specifically at bridging Muslim and Jewish communities in Southern California. Using an engaged feminist activist approach to conducting and writing ethnography, I attended meetings, formal and informal events, and conducted interviews of One Hamsa leaders and participants. I argue that through emotionally vulnerable storytelling, Jews and Muslims challenge master narratives about their communities and co-construct a third narrative that all participants can agree upon as true. Through this process, One Hamsa community members build a collective identity as interfaith activists. Practices like community agreements help to create safe spaces where ideally, all participants feel safe sharing vulnerably. Even when such practices are used, sometimes activists are unsuccessful at avoiding replicating harmful societal power structures within their community. Like engaged scholars, activists should and often do recognize the contradictions inherent in their project. Both engaged scholars and activists must continue to prioritize interrogating power structures and ensuring that the benefits of their projects outweigh the harms

Emotionally Vulnerable Storytelling as Peacebuilding: Muslim/Jewish Interfaith Activism in the United States

How do American Muslim-Jewish interfaith activists use emotionally vulnerable storytelling in service of their goal of realizing a pluralistic society in which minority groups with histories of conflict support one another as allies? As with many groups in conflict, American Jews and Muslims often grow up with truth perspectives that differ so radically that they are unable to find a narrative whose truth value can be agreed upon by members of both groups. How do Jewish-Muslim interfaith activists learn to communicate and reconcile differences in the truth values of their respective group narratives? What is the role of this kind of knowledge production in constructing a collective identity as interfaith activists?In order to answer these questions, I spent four years conducting participant observation at One Hamsa (a pseudonym), an interfaith organization aimed specifically at bridging Muslim and Jewish communities in Southern California. Using an engaged feminist activist approach to conducting and writing ethnography, I attended meetings, formal and informal events, and conducted interviews of One Hamsa leaders and participants. I argue that through emotionally vulnerable storytelling, Jews and Muslims challenge master narratives about their communities and co-construct a third narrative that all participants can agree upon as true. Through this process, One Hamsa community members build a collective identity as interfaith activists. Practices like community agreements help to create safe spaces where ideally, all participants feel safe sharing vulnerably. Even when such practices are used, sometimes activists are unsuccessful at avoiding replicating harmful societal power structures within their community. Like engaged scholars, activists should and often do recognize the contradictions inherent in their project. Both engaged scholars and activists must continue to prioritize interrogating power structures and ensuring that the benefits of their projects outweigh the harms

CHOLELITIAZA LA SUGAR ŞI COPIL

Calculii biliari sunt rari la copil, dar pot fi prezenţi la orice vâstă, chiar şi în viaţa intrauterină. Adeseori sunt descoperiţi întâmplător, la ecografi e. Cauzele pot fi genetice. Există şi cazuri legate de administrarea excesivă de calciu la femeia gravidă, dar şi pseudocalculi, apăruţi în urma tratamentelor cu ceftriaxonă. Adesea, la copii, calculii se resorb spontan, dar există şi cazuri în care este necesară intervenţia chirurgicală. La fi nalul articolului este prezentat cazul unei fetiţe în vârstă de 1 an şi 4 luni, internată pentru vărsături şi scaune diareice. Ecografi a a evidenţiat un calcul biliar cu diametrul de 1,4 cm