Doppler echocardiography in the human fetus : normal flow velocities and the effect of fetal variables

The objectives of this thesis were as follows. 1. To establish the intra-observer variability in the assessment of fetal atrioventricular flow velocity parameters in the second half of pregnancy. The results are discussed in chapter 3 .2. 2. To assess the distribution of flow velocity waveform parameters at fetal atrioventricular and outflow tract level during the second half of normal pregnancy and to determine whether these parameters are fetal heart rate dependent in the normal fetal heart rate range. Data are presented in chapter 4.1. 3. To determine whether flow velocity waveform parameters at fetal atrioventricular and outflow tract level are changed by fetal breathing movements and, if so, whether this change is gestational-age dependent. To investigate whether time-averaged velocity at fetal atrioventricular and outflow tract level during fetal breathing movements is different from that observed during fetal apnoea. This is discussed in chapter 4.2. 4. To establish the distribution of flow velocity waveform parameters from the fetal ductus arteriosus during the second half of normal gestation and to determi11e whether there is fetal heart rate dependency for these parameters in the normal fetal heart rate range. Results are presented in chapter 5.1. 5. To determine whether flow velocity waveforms in the ductus arteriosus change during fetal breathing movements. If so, to establish (i) whether this change is gestational age-dependent and (ii) whether the presence of normal breathing related ductal blood flow velocity changes is indicative of absent pulmonaty hypoplasia in cases of prolonged severe oligohydramnios following premature rupture of membranes. Data are presented in chapter 5.2. 6. To investigate the relationship between fetal ductal blood flow velocity waveforms and fetal behavioural states. Data are presented in chapter 5.3. 7. To determine the nature of flow velocity waveforms at atrioventricular and outflow tract level during blocked and conducted supraventricular extrasystoles when compared with waveforms obtained from normal sinus beats; to assess the relation between these waveform changes and the preceding beat-to-beat interval. This is discussed in chapter 6

Effect of fetal breathing movements on fetal cardiac hemodynamics

__Abstract__ Maximum flow velocity waveforms were studied at atrioventricular and outflow tract level in 12 cases during fetal breathing activity and in 12 cases during fetal apnea matched for maternal and gestational age and maternal parity. Gestational age ranged between 27 and 40 weeks (median 30 weeks). All flow velocity waveforms were obtained using a mechanical sector scanner with a pulsed Doppler system (carrier frequency 3.5 MHz). Time-averaged flow velocities were clearly different between inspiration and expiration at all four recording levels, reflecting changes in venous return as a result of fluctuations in intrathoracic pressure during fetal breathing activity. Percentage change between inspiration and expiration at outflow tract level was positively correlated with gestational age. Time-averaged flow velocity at mitral level and ascending aorta level was significantly higher during fetal breathing activity than during apnea, suggesting increased shunting of blood flow through the foramen ovale. Acceleration time at outflow tract level demonstrated very little change relative to inspiration and expiration

Assessment of explanatory models of mental illness: effects of patient and interviewer characteristics

Background: Explanatory models (EMs) refer to patients’ causal attributions of illness and have been shown to affect treatment preference and outcome. Reliable and valid assessment of EMs may be hindered by interviewer and respondent disparities on certain demographic characteristics, such as ethnicity. The present study examined (a) whether ethnic minority patients reported different EMs to ethnically similar interviewers in comparison with those with a different ethnicity, and (b) whether this effect was related to respondents’ social desirability, the perceived rapport with the interviewer and level of uncertainty toward their EMs. Methods: A total of 55 patients of Turkish and Moroccan origins with mood and anxiety disorders were randomly assigned to ethnically similar or dissimilar interviewers. EMs were assessed, using a semi-structured interview, across 11 different categories of causes. Results: Participants who were interviewed by an ethnically similar interviewer perceived interpersonal, victimization and religious/mystical causes as more important, whereas interviews by ethnically dissimilar interviewers generated higher scores on medical causes. These effects were not mediated by the perceived rapport with the interviewer, and social desirability had a modest impact on the results. Higher uncertainty among participants toward medical and religious/mystical causes seemed to be associated with greater adjustment in the report of these EMs. Conclusion: The findings have significant implications for interviewer selection in epidemiological research and clinical practice

The Influence of Education and Socialization on Radicalization: An Exploration of Theoretical Presumptions and Empirical Research

Background and Objective: Research into radicalization does not pay much attention to education. This is remarkable and possibly misses an important influence on the process of radicalization. Therefore this article sets out to explore the relation between education on the one hand and the onset or prevention of radicalization on the other hand. Method: This article is a theoretical literature review. It has analyzed empirical studies-mainly from European countries-about the educational aims, content and style of Muslim parents and parents with (extreme) right-wing sympathies. Results: Research examining similarity in right-wing sympathies between parents and children yields mixed results, but studies among adolescents point to a significant concordance. Research also showed that authoritarian parenting may play a significant role. Similar research among Muslim families was not found. While raising children with distrust and an authoritarian style are prevalent, the impact on adolescents has not been investigated. The empirical literature we reviewed does not give sufficient evidence to conclude that democratic ideal in and an authoritative style of education are conducive to the development of a democratic attitude. Conclusion: There is a knowledge gap with regard to the influence of education on the onset or the prevention of radicalization. Schools and families are underappreciated sources of informal social control and social capital and therefore the gap should be closed. If there is a better understanding of the effect of education, policy as well as interventions can be developed to assist parents and teachers in preventing radicalization. © 2011 The Author(s)

The Attitudes of Pulmonologists Regarding Smoking Behavior of Their Patients with Advanced COPD: A Qualitative Research.

Contains fulltext : 215227.pdf (publisher's version ) (Open Access)Background: Patients with diseases linked with smoking, such as COPD, report a health-related stigma on their smoking behavior, which is related to a poorer quality of life and psychological distress. According to patients with COPD, health-care professionals sometimes reinforce the sense of stigma. However, little is known about the physicians' attitudes on this topic towards the patient with COPD. Purpose: To explore attitudes of pulmonologists regarding the smoking behavior of their patients with COPD and if (and to what extent) a stigma is present in their attitudes towards their smoking patients. Patients and methods: Eighteen pulmonologists were interviewed using a semi-structured guide with prespecified topics. The interview transcripts were coded using Atlas.ti. Analysis of data from these interviews was performed using conventional content analysis. Results: We identified three themes: attitudes towards smoking in general, the interaction between patient and physician, and smoking cessation. All participants said patients are not fully responsible for their smoking behavior. Contrarily, smoking was also seen as a free choice by most physicians. Moreover, smoking cessation was mostly seen as the responsibility of the patient. Feelings of powerlessness, frustration and compassion were reported in the guidance of patients with COPD. Conclusion: The results of this study show an ambivalent attitude of pulmonologists regarding the smoking behavior of their patients with COPD. The outcomes of this study can form a base for further research and can be used as insights for interventions that aim to raise awareness of physicians' own attitudes and increase the quality of physician-patient communication

Fetal atrioventricular and outflow tract flow velocity waveforms during conducted and blocked supraventricular extrasystoles

Maximum flow velocity waveforms at atrioventricular and outflow tract level were studied cross‐sectionally in 19 human fetuses with conducted and/or blocked supraventricular extrasystoles ranging from 25 to 38 weeks of gestation. At outflow tract level, peak systolic velocity and acceleration time for extrasystolic and post‐extrasystolic beats were compared with those for the immediately preceding normal beat. Regression lines were calculated for peak systolic velocities with filling time. At atrioventricular level, peak‐E wave and peak‐A wave velocities and E/A ratio for the extrasystolic and post‐extrasystolic beats were compared with those for the normal beat. At all levels, time‐averaged velocities were compared with reference charts standardized for gestational age. Peak systolic velocity and acceleration time during the post‐extrasystolic beat were higher than during the normal beat; the Frank‐Starling mechanism, post‐extrasystolic potentiation as well as reduced ventricular afterload may all play a role in this. At all measuring levels, time‐averaged velocity during the extrasystolic beat was strikingly lower than the reference velocities. It is postulated that the increased blood volume and contraction force during the post‐extrasystolic beat cause the valve area to become larger, resulting in a relative decrease in velocities measured by Doppler ultrasound. Copyrigh

Fetal atrioventricular and outflow tract flow velocity waveforms during conducted and blocked supraventricular extrasystoles

Maximum flow velocity waveforms at atrioventricular and outflow tract level were studied cross‐sectionally in 19 human fetuses with conducted and/or blocked supraventricular extrasystoles ranging from 25 to 38 weeks of gestation. At outflow tract level, peak systolic velocity and acceleration time for extrasystolic and post‐extrasystolic beats were compared with those for the immediately preceding normal beat. Regression lines were calculated for peak systolic velocities with filling time. At atrioventricular level, peak‐E wave and peak‐A wave velocities and E/A ratio for the extrasystolic and post‐extrasystolic beats were compared with those for the normal beat. At all levels, time‐averaged velocities were compared with reference charts standardized for gestational age. Peak systolic velocity and acceleration time during the post‐extrasystolic beat were higher than during the normal beat; the Frank‐Starling mechanism, post‐extrasystolic potentiation as well as reduced ventricular afterload may all play a role in this. At all measuring levels, time‐averaged velocity during the extrasystolic beat was strikingly lower than the reference velocities. It is postulated that the increased blood volume and contraction force during the post‐extrasystolic beat cause the valve area to become larger, resulting in a relative decrease in velocities measured by Doppler ultrasound. Copyrigh