Autism Spectrum Disorder (ASD) refers to a group of neurodevelopmental disorders including autism, Asperger's syndrome (AS) and pervasive developmental disorder-not otherwise specified (PDD-NOS). The ...new diagnostic criteria of ASD focuses on two core domains: social communication impairment and restricted interests/repetitive behaviors. The prevalence of ASD has been steadily increasing over the past two decades, with current estimates reaching up to 1 in 36 children. Hereditary factors, parental history of psychiatric disorders, pre-term births, and fetal exposure to psychotropic drugs or insecticides have all been linked to higher risk of ASD. Several scales such as the Childhood Autism Rating Scale (CARS), The Autism Spectrum Disorder–Observation for Children (ASD-OC), The Developmental, Dimensional, and Diagnostic Interview (3di), are available to aid in better assessing the behaviors and symptoms associated with ASD. Nearly 75% of ASD patients suffer from comorbid psychiatric illnesses or conditions, which may include attention-deficit hyperactivity disorder (ADHD), anxiety, bipolar disorder, depression, Tourette syndrome, and others. Both pharmacological and non-pharmacological interventions are available for ASD. Pharmacological treatments include psychostimulants, atypical antipsychotics, antidepressants, and alpha-2 adrenergic receptor agonists. These medications provide partial symptomatic relief of core symptoms of ASD or manage the symptoms of comorbid conditions. Non-pharmacological interventions, which show promising evidence in improving social interaction and verbal communication of ASD patients, include music therapy, cognitive behavioral therapy and social behavioral therapy. Hormonal therapies with oxytocyin or vasopressin receptor antagonists have also shown some promise in improving core ASD symptoms. The use of vitamins, herbal remedies and nutritional supplements in conjunction with pharmacological and behavioral treatment appear to have some effect in symptomatic improvement in ASD, though additional studies are needed to confirm these benefits. Developing novel disease-modifying therapies may prove to be the ultimate intervention for sustained improvement of symptoms in ASD.
Abstract Urban Political Ecology (UPE) has explored human–soil relations, emphasising the political dimensions of environmental degradation in and through urbanisation. However, UPE lacks critical ...reflection on governance collusions with illicit actors. Bridging this gap, my paper combines UPE with literature on criminal urban governance, focusing on how urban sand shapes illicit urbanisation. To address UPE's oversight of criminal governance, I explore Rio de Janeiro's militias expanding their illegal portfolio through terrain modification, linking illicit activities to territorial control. Integrating criminal governance with UPE, I argue for the concept of Urban Illicit Ecologies (UIE). Urban sandscapes become multi‐sited, illicit geographies revealing imbrications of formal state and criminal actors, political dimensions, and inequalities in resource extraction and environmental processes. By understanding urban illicit ecology, we gain insights into the contested claims of political authority and territorial control between militias and the state.
Resumo A Urban Political Ecology (UPE) explora as relações entre o ser human e o solo, enfatizando as dimensões políticas da degradação ambiental na urbanização e por meio dela. No entanto, a UPE carece de uma reflexão crítica sobre os conluios de governança com atores ilícitos. Para preencher essa lacuna, meu artigo combina a UPE com a literatura sobre governança urbana criminosa, concentrando‐se em como a areia urbana molda a urbanização ilícita. Para abordar a supervisão da UPE sobre a governança criminal, exploro as milícias do Rio de Janeiro expandindo seu portfólio ilegal por meio da modificação do terreno, vinculando atividades ilícitas ao controle territorial. Integrando a governança criminal com a UPE, proponho o conceito de Urban Illicit Ecology (UIE). As paisagens de areias urbanas tornam‐se geografias ilícitas em vários locais, revelando imbricações de atores formais estatais e criminosos, dimensões políticas e desigualdades na extração de recursos e nos processos ambientais. Ao compreender a Urban Illicit Ecology, obtemos insights sobre as reivindicações contestadas de autoridade política e controle territorial entre as milícias e o Estado.
The Global Reach of the 26 December 2004 Sumatra Tsunami Titov, Vasily; Rabinovich, Alexander B.; Mofjeld, Harold O. ...
Science (American Association for the Advancement of Science),
09/2005, Letnik:
309, Številka:
5743
Journal Article
Recenzirano
Odprti dostop
Numerical model simulations, combined with tide-gauge and satellite altimetry data, reveal that wave amplitudes, directionality, and global propagation patterns of the 26 December 2004 Sumatra ...tsunami were primarily determined by the orientation and intensity of the offshore seismic line source and subsequently by the trapping effect of mid-ocean ridge topographic waveguides.
To perform probabilistic tsunami hazard assessment for subduction zone earthquakes, it is necessary to start with a catalog of possible future events along with the annual probability of occurrence, ...or a probability distribution of such events that can be easily sampled. For near-field events, the distribution of slip on the fault can have a significant effect on the resulting tsunami. We present an approach to defining a probability distribution based on subdividing the fault geometry into many subfaults and prescribing a desired covariance matrix relating slip on one subfault to slip on any other subfault. The eigenvalues and eigenvectors of this matrix are then used to define a Karhunen-Loève expansion for random slip patterns. This is similar to a spectral representation of random slip based on Fourier series but conforms to a general fault geometry. We show that only a few terms in this series are needed to represent the features of the slip distribution that are most important in tsunami generation, first with a simple one-dimensional example where slip varies only in the down-dip direction and then on a portion of the Cascadia Subduction Zone.
Arrhythmogenic right ventricular cardiomyopathy Basso, Cristina, MD; Corrado, Domenico, MD; Marcus, Frank I, Prof ...
The Lancet (British edition),
04/2009, Letnik:
373, Številka:
9671
Journal Article
Recenzirano
Summary Arrhythmogenic right ventricular cardiomyopathy is a rare inherited heart-muscle disease that is a cause of sudden death in young people and athletes. Causative mutations in genes encoding ...desmosomal proteins have been identified and the disease is nowadays regarded as a genetically determined myocardial dystrophy. The left ventricle is so frequently involved as to support the adoption of the broad term arrhythmogenic cardiomyopathy. Clinical diagnosis can be achieved by demonstrating function and structure changes of the right ventricle, electrocardiogram depolarisation and repolarisation abnormalities, ventricular arrhythmias, and fibrofatty replacement through endomyocardial biopsy. Although specific, the standardised diagnostic criteria lack sensitivity for early disease and their primary application remains in establishing the diagnosis in probands. However, the main clinical targets are early detection of concealed forms and risk stratification for preventive strategies, which include physical exercise restriction, antiarrhythmic drugs, and implantable cardioverter-defibrillator therapy. Cascade genetic screening of family members of gene-positive probands allows the identification of asymptomatic carriers who would require lifelong follow-up due to the age-related penetrance.
The incidence and prevalence of Crohn's disease (CD) is rising globally. Patients with moderate to severe CD are at high risk for needing surgery and hospitalization and for developing ...disease-related complications, corticosteroid dependence, and serious infections. Optimal management of outpatients with moderate to severe luminal and/or fistulizing (including perianal) CD often requires the use of immunomodulator (thiopurines, methotrexate) and/or biologic therapies, including tumor necrosis factor–α antagonists, vedolizumab, or ustekinumab, either as monotherapy or in combination (with immunomodulators) to mitigate these risks. Decisions about optimal drug therapy in moderate to severe CD are complex, with limited guidance on comparative efficacy and safety of different treatments, leading to considerable practice variability. Since the last iteration of these guidelines published in 2013, significant advances have been made in the field, including the regulatory approval of 2 new biologic agents, vedolizumab and ustekinumab. Therefore, the American Gastroenterological Association prioritized updating clinical guidelines on this topic. To inform the clinical guidelines, this technical review was completed in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. The review addressed the following focused questions (in adult outpatients with moderate to severe luminal CD): overall and comparative efficacy of different medications for induction and maintenance of remission in patients with or without prior exposure to tumor necrosis factor–α antagonists, comparative efficacy and safety of biologic monotherapy vs combination therapy with immunomodulators, comparative efficacy of a top-down (upfront use of biologics and/or immunomodulator therapy) vs step-up treatment strategy (acceleration to biologic and/or immunomodulator therapy only after failure of mesalamine), and the role of corticosteroids and mesalamine for induction and/or maintenance of remission. Finally, in adult outpatients with moderate to severe fistulizing CD, this review addressed the efficacy of pharmacologic interventions for achieving fistula and the role of adjunctive antibiotics without clear evidence of active infection.
Applying probabilistic methods to infrequent but devastating natural events is intrinsically challenging. For tsunami analyses, a suite of geophysical assessments should be in principle evaluated ...because of the different causes generating tsunamis (earthquakes, landslides, volcanic activity, meteorological events, and asteroid impacts) with varying mean recurrence rates. Probabilistic Tsunami Hazard Analyses (PTHAs) are conducted in different areas of the world at global, regional, and local scales with the aim of understanding tsunami hazard to inform tsunami risk reduction activities. PTHAs enhance knowledge of the potential tsunamigenic threat by estimating the probability of exceeding specific levels of tsunami intensity metrics (e.g., run‐up or maximum inundation heights) within a certain period of time (exposure time) at given locations (target sites); these estimates can be summarized in hazard maps or hazard curves. This discussion presents a broad overview of PTHA, including (i) sources and mechanisms of tsunami generation, emphasizing the variety and complexity of the tsunami sources and their generation mechanisms, (ii) developments in modeling the propagation and impact of tsunami waves, and (iii) statistical procedures for tsunami hazard estimates that include the associated epistemic and aleatoric uncertainties. Key elements in understanding the potential tsunami hazard are discussed, in light of the rapid development of PTHA methods during the last decade and the globally distributed applications, including the importance of considering multiple sources, their relative intensities, probabilities of occurrence, and uncertainties in an integrated and consistent probabilistic framework.
Key Points
PTHA quantifies the probability that different hazard intensity levels will be exceeded in a given time window at a specific place
PTHA is the first step toward tsunami risk assessment and risk reduction planning
A comprehensive review of PTHA is discussed for seismic and nonseismic tsunami sources with uncertainty quantification methods
Whereas benign pheochromocytomas and paragangliomas are often successfully cured by surgical resection, treatment of metastatic disease can be challenging in terms of both disease control and symptom ...control. Fortunately, several options are available, including chemotherapy, radiation therapy, and surgical debulking. Radiolabeled metaiodobenzylguanidine (MIBG) and somatostatin receptor imaging have laid the groundwork for use of these radiopharmaceuticals as theranostic agents.
I-MIBG therapy of neuroendocrine tumors has a long history, and the recent approval of high-specific-activity
I-MIBG for metastatic or inoperable pheochromocytoma or paraganglioma by the U.S. Food and Drug Administration has resulted in general availability of, and renewed interest in, this treatment. Although reports of peptide receptor radionuclide therapy of pheochromocytoma and paraganglioma with
Y- or
Lu-DOTA conjugated somatostatin analogs have appeared in the literature, the approval of
Lu-DOTATATE in the United States and Europe, together with National Comprehensive Cancer Network guidelines suggesting its use in patients with metastatic or inoperable pheochromocytoma and paraganglioma, has resulted in renewed interest. These agents have shown evidence of efficacy as palliative treatments in patients with metastatic or inoperable pheochromocytoma or paraganglioma. In this continuing medical education article, we discuss the therapy of pheochromocytoma and paraganglioma with
I-MIBG and
Y- or
Lu-DOTA-somatostatin analogs.
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