Prognostic Value of the Persistence or Change in Pericardial Effusion Status on Serial Echocardiograms in Pulmonary Arterial Hypertension

Background: Pericardial effusion in pulmonary arterial hypertension (PAH) is an indicator of right heart failure and a marker of poor prognosis; its significance on serial transthoracic echocardiograms (TTE) is not clear. Methods: We examined our database for PAH patients followed at our center (10/99-11/07). Baseline and follow-up TTE (1.0±0.5y) and outcomes were studied (N=200). The presence of pericardial effusion was evaluated at baseline and follow-up. The persistence or change in pericardial effusion status was categorized into four categories. Kaplan Meier methods were used to estimate survival functions of the various categories. Cox proportional hazards modeling was used to adjust for other covariates and identify independent predictors. Results: Over a mean follow-up of 4.6 ± 2.6 y, 53% (n=106) patients died. Pericardial effusion was present in 20% (n=40) at baseline and 22% (n=44) during follow up. Patients with pericardial effusion at baseline or follow-up had significantly higher creatinine, pulmonary vascular resistance, lower cardiac output, and were more likely to be treated with prostanoids. During follow-up, there was significantly increased prostanoids (58% vs. 28%) and combination therapy (8% vs. 2%) use compared to baseline. New or persistence of pericardial effusion was associated with worse outcomes (p<0.001) and an independent predictor of survival after adjusting for age, creatinine, sodium, cardiac output, mean right atrial pressure, New York Heart Association (NYHA ) functional class, and presence of connective tissue disease as the etiology of PAH (p-value<0.001). Conclusion: New or persistent pericardial effusion in PAH despite vasoactive therapy predicts worse outcomes; absence or resolution of pericardial effusion with therapy suggests better prognosis. Its public health significance is the ability to identify patients that may benefit from closer follow-up for reassessment and consideration of more aggressive medical therapy or referral for lung transplant to prevent worsening health and/or death

The Burden and Order of Proof in WTO Claims: Evolving Issues

The World Trade Organization (WTO) is one of the best dispute settlement mechanisms in the world. Under WTO rules, aggrieved parties must establish a “prima facie” case before the panel can call on the offending party to respond to the claims. The objective of the present study is to critically evaluate the application of the concept of burden of proof underWTOdispute settlement mechanism

Scattering regimes for underwater optical wireless communications using Monte Carlo simulation

Optical wireless communications has shown tremendous potential for underwater applications as it can provide higher bandwidth and better security compared to acoustic technologies. In this paper,  an investigation on scattering regimes for underwater links using Monte Carlo simulation has been presented.While the focus of this paper is on diffuse links, the simulation results of collimated links is also provided for comparison purpose. Three types of water namely clear, coastal and turbid water are being used in the simulation. It is shown that the effect of scattering on the path loss cannot be accurately modeled by the existing channel model; ie. Beers-Lambert (BL) law.  It has been shown that  the distance at which the unscattered light drops to zero can be used to estimate the transition point for the scattering regimes in case of diffuse links. The transition point for diffuse links in coastal water and turbid water can be estimated to be around 22 m and 4 m respectively. Further analysis on the scattering order probability at different scattering regimes illustrates how scattering is affected by beam size, water turbidity and distance. From the frequency response plot, it is estimated that the bandwidth of several order of GHz can be achieved when the links are operating in the minimal scattering region and will reduce to several hundreds of MHz when the link is operating in multiple scattering region

UNDERSTANDING POTENTIAL EFFECTS OF THE DAILY ACTIVITIES OF INFANTS SCALE WITHIN AN EDUCATIONAL PACKAGE FOR PARENTS OF INFANTS BORN PRETERM: A PILOT STUDY

An educational package was proposed to enhance parental knowledge, confidence and childrearing practices to support early motor development of infants bom preterm. This educational package is based on: the Alberta Infant Motor Scale (AIMS), the Infant Characteristics Questionnaire (ICQ), the Environmental Opportunities Questionnaire (EOQ), and the Daily Activities of Infants Scale (DAIS). The educational package was assessed through a longitudinal case series of three infants bom preterm at moderate risk for adverse motor outcomes, and their parents, who were followed monthly through home visits. Parents found the AIMS to be a more useful educational tool than the DAIS. The DAIS was found difficult to complete. However, the AIMS and DAIS fulfilled their role in providing anticipatory guidance, suitability and readability of information due to the written information and pictorial illustrations. Parents did not perceive the ICQ and EOQ to be useful as educational tools despite their role in intervention planning

Plural Belonging: The Samaritans\u27 Negotiation of Space in the Occupied Palestinian Territory

Created in 1993 in accordance with the Israeli-Palestinian Peace Accords, the Palestinian Authority (PA) has grappled with the administration and maintenance of a vortex of highly fragmented legal and judicial systems. These fractured frameworks are the result of centuries-old colonial and military administrations that have exercised jurisdiction over the occupied Palestinian territory (oPt). A self-governing entity whose sovereignty has been undermined since its inception, the PA idealizes a democratic modus-operandi for the nation’s future, while actively participating in and benefiting from an overarching network of laws, court systems, and regulatory frameworks designed to discriminate against and abuse their subjects. Palestinian subjects as a whole struggle to gain access to the majority of their fundamental rights within these interweaving legal and judicial systems. Minority communities and vulnerable populations in particular have been harshly affected by these systems’ shortcomings and castigate the PA for its reluctance to incite meaningful change