Report from the Annual Conference of the British Society of Echocardiography, November 2016, Queen Elizabeth II Conference Centre, London.

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Gender representations in the illustrations of the 6th Grade Language Textbook used in Greek Elementary School

This study explores the way in which the two sexes are presented in education and particularly in the illustration of the language textbook used in the 6th Grade of Greek elementary school. In a society where gender equality is constitutionally enshrined and displayed as an educational policy objective, it attempts to examine if school textbook images respond to the demands of social reality, or perpetuate outdated gender stereotyped educational practices. The visual communication system that school textbooks use has the same rhetoric in of the conveyance of ideological and cultural messages as the linguistic system. Therefore, students receive plenty of information from both communication systems about the roles and stereotypes that are considered appropriate for each sex. In the past, several studies have analyzed the linguistic system, while this is the first attempt at an organized and systematic analysis of the visual system in language textbooks, and specifically the one in 6th Grade. Both content analysis, as a measurement technique, and semiotics, as a visual analysis method, were used as a research method. The analysis of data showed that (a) the presentation of the two sexes in the illustration of this language textbook is not objectively compared with social changes, (b) apart from the quantitative inequality that exists in the presentation of the two sexes, there also appears to be a big difference in qualities such as behavioral characteristics, occupations, and activities, and (c) there is a reduction in the representation of outdated gender stereotypes, which is not necessarily positive, as the diversity of roles they undertake in the modern social sphere is not emphasized. Keywords: textbook, illustration, representation, gender roles, stereotypes, semiotic

Gender representations in the illustrations of the 6th Grade Language Textbook used in Greek Elementary School

This study explores the way in which the two sexes are presented in education and particularly in the illustration of the language textbook used in the 6th Grade of Greek elementary school. In a society where gender equality is constitutionally enshrined and displayed as an educational policy objective, it attempts to examine if school textbook images respond to the demands of social reality, or perpetuate outdated gender stereotyped educational practices. The visual communication system that school textbooks use has the same rhetoric in of the conveyance of ideological and cultural messages as the linguistic system. Therefore, students receive plenty of information from both communication systems about the roles and stereotypes that are considered appropriate for each sex. In the past, several studies have analyzed the linguistic system, while this is the first attempt at an organized and systematic analysis of the visual system in language textbooks, and specifically the one in 6th Grade. Both content analysis, as a measurement technique, and semiotics, as a visual analysis method, were used as a research method. The analysis of data showed that (a) the presentation of the two sexes in the illustration of this language textbook is not objectively compared with social changes, (b) apart from the quantitative inequality that exists in the presentation of the two sexes, there also appears to be a big difference in qualities such as behavioral characteristics, occupations, and activities, and (c) there is a reduction in the representation of outdated gender stereotypes, which is not necessarily positive, as the diversity of roles they undertake in the modern social sphere is not emphasized.Keywords: textbook, illustration, representation, gender roles, stereotypes, semiotic

A case report of myocardial infarction with non-obstructive coronary artery disease: Graves' disease-induced coronary artery vasospasm

Background: Coronary artery spasm can occur either in response to drugs or toxins. This response may result in hyper-reactivity of vascular smooth muscles or may occur spontaneously as a result of disorders in the coronary vasomotor tone. Hyperthyroidism is associated with coronary artery spasm. Case summary: A 49-year-old female patient with a 2-day history of intermittent chest pain and electrocardiographic evidence of myocardial ischaemia was referred for emergency coronary angiography. This revealed severe right coronary artery (RCA) and left main (LM) coronary artery ostial vasospasm, both subsequently relieved with administration of multiple doses intracoronary nitroglycerine. Intravascular optical coherence tomography showed absence of atherosclerosis and no evidence of thrombus or dissection confirming the diagnosis of coronary artery vasospasm. Laboratory tests of the thyroid function were performed immediately after coronary angiography revealing Graves' disease as the cause of vasospasm. Discussion: Our case represents a rare presentation of Graves' disease-induced RCA and LM coronary artery ostial vasospasm. In patients with coronary artery vasospasm thyroid function study should be mandatory, especially in young female patients

Clinical value of stress transaortic flow rate during dobutamine echocardiography in reduced left ventricular ejection fraction, low-gradient aortic stenosis : a multicenter study

BACKGROUND: Low rest transaortic flow rate (FR) has been shown previously to predict mortality in low-gradient aortic stenosis. However limited prognostic data exists on stress FR during low-dose dobutamine stress echocardiography. We aimed to assess the value of stress FR for the detection of aortic valve stenosis (AS) severity and the prediction of mortality. METHODS: This is a multicenter cohort study of patients with reduced left ventricular ejection fraction and low-gradient aortic stenosis (aortic valve area <1 cm2 and mean gradient <40 mmHg) who underwent low-dose dobutamine stress echocardiography to identify the AS severity and presence of flow reserve. The outcome assessed was all-cause mortality. RESULTS: Of the 287 patients (mean age, 75±10 years; males, 71%; left ventricular ejection fraction, 31±10%) over a mean follow-up of 24±30 months there were 127 (44.3%) deaths and 147 (51.2%) patients underwent aortic valve intervention. Higher stress FR was independently associated with reduced risk of mortality (hazard ratio, 0.97 [95% CI, 0.94–0.99]; P=0.01) after adjusting for age, chronic kidney disease, heart failure symptoms, aortic valve intervention, and rest left ventricular ejection fraction. The minimum cutoff for prediction of mortality was stress FR 210 mL/s. Following adjustment to the same important clinical and echocardiographic parameters, among the three criteria of AS severity during stress, ie, the guideline definition of aortic valve area <1cm2 and aortic valve mean gradient ≥40 mm Hg, or aortic valve mean gradient ≥40 mm Hg, or the novel definition of aortic valve area <1 cm2 at stress FR ≥210 mL/s, only the latter was independently associated with mortality (hazard ratio, 1.72 [95% CI, 1.05–2.82]; P=0.03). Furthermore aortic valve area <1cm2 at stress FR ≥210 mL/s was the only severe aortic stenosis criterion that was associated with improved outcome following aortic valve intervention (P<0.001). Guideline-defined stroke volume flow reserve did not predict mortality. CONCLUSIONS: Stress FR during low-dose dobutamine stress echocardiography was useful for the detection of both AS severity and flow reserve and was associated with improved prediction of outcome following aortic valve intervention

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of &lt;30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy