Objective. To examine gender differences in the association between beliefs in heart disease preventability and 10-year incidence of coronary heart disease (CHD) in a population-based sample. ...Methods. A total of 2,688 Noninstitutionalized Nova Scotians without prior CHD enrolled in the Nova Scotia Health Study (NSHS95) and were followed for 10 years. Risk factors, health behaviors, and incident CHD were assessed. Participants responded "yes" or "no" to a question about heart disease preventability. Survival models, adjusted for age, income, total and high-density lipoprotein cholesterol, and systolic blood pressure, were used to estimate the relation between health belief and incident CHD. Gender differences in the relation between health beliefs and health behaviors were assessed. Results. Gender was a significant moderator of the relation between belief and CHD incidence; specifically, women who believed heart disease could be prevented were less likely to have incident CHD events compared with women who believed heart disease could not be prevented (hazard ratio HR = 0.36,95% confidence interval CI = 0.24-0.55, p < .001).This relation was not found for men. Belief was also related to smoking behavior for women (ß = -0.70, odds ratio OR = 0.50,95% CI = 0.33-0.74, p = .001 ) but not for men. Smoking significantly mediated the relation between health beliefs and incident CHD for women (z = -1.96, p = .05), but not for men. Conclusion. Health belief in prevention and subsequent smoking was an important independent predictor of incident CHD in women but not in men.
The flow in the human trachea is turbulent. Thus, the tracheal resistance (R) and the pressure gradient (ΔP) required to maintain a given flow across the trachea is inversely related to its radius ...raised to the fifth power. If the caliber reduction ratio (X) after endotracheal intubation is calculated as X = radius of the endotracheal tube (rETT)/radius of the trachea (rT), then ΔP and/or R will be increased by (1/X)5.
To measure the actual ratio between rETT and rT following endotracheal intubation of pediatric patients with respiratory failure and to calculate the resulting increase in the tracheal R and ΔP for a given inspiratory flow rate.
Retrospective chart review.
Pediatric ICU in a tertiary-care teaching children's medical center.
Twenty consecutive pediatric patients (mean ± SD age, 6.4 ± 7.2 years) whose tracheas had been intubated for various causes of respiratory failure, and who had received a CT scan, were included in our study. All patients received an endotracheal tube the size of which was derived from the following formula: (age in years/4) + 4.
rT and rETT were measured from CT scan sections at and around the level of the thoracic inlet, and the average values were used to calculate X. These values ranged from 0.33 to 0.65 (mean, 0.55 ± 0.8). The factor (1/X)5 was calculated for each patient and then was multiplied by the known normal value for tracheal R for adolescents and adults (0.07 cm H2O/L/s) to obtain the value of R resulting from the artificial airway, (1/X)5 × 0.07. Our results showed that tracheal R increased due to caliber reduction of the trachea after endotracheal intubation by 33.9 ± 52.5-fold (range, 8.6- to 255.5-fold). In order to maintain an inspiratory flow of 1 L/s, the value of P for the intubated trachea would increase from 0.07 cm H2O to a mean of 2.4 ± 3.7 cm H2O (range, 0.6 to 18 cm H2O). In two of our patients, the rT/rETT ratios were < 0.5 (0.33 and 0.44, respectively); this translated into a more significant increase in the calculated ΔPs, 18 and 4.2 cm H2O, respectively.
The common value of X due to endotracheal intubation is between 0.5 and 0.6, which in and of itself results in an increase in R across the intubated trachea up to 32-fold. The calculated increase in P as a result of this is between 2 and 3 cm H2O for adolescents or young adults. The addition of pressure support of at least 3 cm H2O during spontaneous ventilation via an endotracheal tube, which is common practice in pediatric critical care, should alleviate any respiratory distress emanating from the increased R. However, a value for X < 0.5, which was found in 10% of our patients (2 of 20 patients), results in a much higher calculated increase in the pressure gradient and, therefore, a higher level of pressure support is required to overcome this increase.
We systematically searched published empirical research on depression and cardiovascular disease (CVD) and found 494 unique articles published in 2009. Several particularly notable and provocative ...findings and controversies emerged from this survey of the 2009 literature. First, multiple large observational studies found that antidepressant use was associated with increased risk of incident stroke, CVD, or sudden cardiac death. Second, four randomized controlled trials on depression interventions in CVD patients reported important efficacy results that should guide future trials. Finally, the vigorous debate on whether patients with CVD should be routinely screened (and subsequently treated) for depression continued in 2009 even as some observed that routine screening for CVD in depressed patients is more evidence-based and appropriate. This article reviews these selected provocative findings and controversies from our search and explores their clinical implications.
With the completion of the Human Genome Project in 2000, the number of genetic tests available has increased dramatically. The medical community will need genetic services, and specifically genetic ...counselors, to translate and make sense of complicated information about risk and susceptibility that will result from these genetic tests. Genetic counselors aid in the process of decision making through means of non-directive counseling, translating the language of genomics into terms that the client can understand, and helping the client make informed decisions. This dissertation aims to answer the following questions: (1) How and to what extent do doctors and genetic counselors perceive the development of genetic counseling as a profession? (2) What is the role of the genetic counselor within the genetic services model? (3) Why has genetic counseling not developed into a fully autonomous profession? Using the sociological framework of professionalization theory, these questions were informed by a qualitative study of in-depth, semi-structured interviews with genetic counselors, clinical geneticists, obstetricians, and key informants in the genetics field, and a thorough literature review. Results showed that there are critical differences between how genetic counselors and the medical community view the profession. It was found that within the genetic counseling profession there is a divergence of viewpoints between generations, resulting in a lack of clear direction for the profession as a whole. The data pointed to the absence of licensure as a critical obstacle to the establishment of genetic counseling as a truly autonomous profession. For example, a direct consequence of lack of licensure is the inability to receive direct compensation for services rendered. The increase in demand for genetic counseling services coupled with the small number of genetic counselors and stagnation in educating new counselors lead to the conclusion that the profession's jurisdiction is in jeopardy. Findings also highlighted the need for additional empirical study of counseling methodologies in order to revisit the efficacy of the current emphasis on non-directiveness. Implications of the study underscore the importance of a broad and clear agenda for the genetics community in order to promote a successful integration into current medical practice. Data revealed that pursuit of this agenda was inextricably linked to three factors: (1) the interaction between genetic service providers and the medical community; (2) improving the public's understanding of genetics; and (3) promoting and proving the utility of genetic services.
Shape‐morphing active networks of mesoscale filaments are a common hierarchical feature in biology for applying forces, transporting materials, and inducing motility with microscale resolution. ...Synthetic morphing systems of similar dimensions and capabilities hold potential for a range of technological applications, from micro‐muscles to shape‐morphing optical devices. Here, the fabrication of highly‐ordered 2D networks hierarchically constructed of thermoresponsive mesoscale polymeric fibers, which can exhibit morphing with microscale resolution, is presented. It is demonstrated both experimentally and computationally that the morphing of such networks strongly depends on the physical attributes of the single fiber, in particular on two intrinsic length scales—the fiber diameter and mesh size, which stems from network's density. It is shown that depending on these parameters, such fiber‐networks exhibit one of two thermally driven morphing behaviors: i) the fibers stay straight, and the network preserves its ordered morphology, exhibiting a bulk‐like behavior; or ii) the fibers buckle and the network becomes messy and highly disordered. Notably, in both cases, the networks display memory and regain their original ordered morphology upon shrinking. This hierarchically induced phase transition, demonstrated here on a range of networks, offers a new way of controlling the shape‐morphing of synthetic materials with mesoscale resolutions.
Shape‐morphing Cartesian 2D networks of microscale thermoresponsive fibers are fabricated using the jet‐writing approach. The networks exhibit two morphing behaviors: i) shape‐preserving, which keeps the Cartesian morphology, or ii) disordered swelling into a messy network. The factors controlling this transition are analyzed and modeled, providing a novel strategy for designing functional materials with microscale morphing resolutions and unique morphing abilities.
A central finding of functional MRI studies is the highly selective response of distinct brain areas in the occipital temporal cortex to faces and places. However, little is known about the ...association of white matter fibers with the processing of these object categories. In the current study we used DTI-based tractography to reconstruct two main fibers that connect the occipital lobe with the anterior temporal lobe (inferior longitudinal fasciculus-ILF) and with the frontal lobe (inferior fronto-occipital fasciculus-IFOF) in normal individuals. In addition to MRI scans subjects performed face, scene and body recognition tasks outside the scanner. Results show that recognition of faces and scenes were selectively associated with separate parts of the ILF. In particular, face recognition was highly associated with the fractional anisotropy (FA) of the anterior part of the ILF in the right hemisphere. In contrast, scene recognition was strongly correlated with the FA of the posterior and middle but not the anterior part of the ILF bilaterally. Our findings provide the first demonstration that faces and places are not only associated with distinct brain areas but also with separate parts of white matter fibers.
•White matter characteristics are correlated with visual recognition abilities.•Different regions within the ILF are correlated with different object categories.•Face recognition is correlated with properties of the anterior right ILF.•Scene recognition is correlated with middle\posterior ILF bilaterally.
Air sampling for analysis of CO and its isotopic composition (13C, 18O, and 14C) has been performed at the alpine station Sonnblick (47°N, 13°E, 3106 m above sea level) since September 1996. A high ...degree of variability is observed, which is due to the wide variation in the origin of air masses sampled. On the basis of the CO and isotope results, a classification of the different samples is performed. Other data such as 7Be, O3, relative humidity, and back trajectories are used to give additional information about the air mass origin. Background values, representative of the NH midlatitudes free troposphere, are observed about 50% of the time and are used to define seasonal cycles. CO and its isotopes show a minimum in summer and a maximum in winter with extreme values of 90 and 160 ppb for CO, −30 and −25‰ for δ13C, 0 and 8‰ for δ18O, and 8 and 20 molecules cm−3 STP for 14CO. CO and stable isotope data are compared with results from a three‐dimensional model (TM2). Generally good agreement supports the CO, δ13CO, and δC18O source/sink distributions inferred by the model. According to model calculations, fossil fuel combustion contributes 35% in summer and 50% in winter of total CO for such a midlatitude location. Other categories of sampled air are “subtropical,” “polluted,” and “stratospheric” and are observed 24%, 18%, and 4% of the time. Corresponding signatures of CO and its isotopic variations are presented, and some specific events are discussed.
This paper presents a 2-year record (from September 1996 to July 1998) of atmospheric
14CO measurements on whole air samples taken at the Mt. Sonnblick observatory (3106 m), a remote high-altitude ...site in Central Europe. An overall measurement precision of ca. 1/4 molecule
14CO per cm
3 air has been achieved. A few events including unexpectedly low CO and
14CO values in winter 1996/97 will be discussed in some detail incorporating stable isotope information. Since the amount of
14CO data available for the Northern Hemisphere (NH) is rather sparse, this most detailed long-term
14CO record for NH temperate latitudes may be a valuable contribution to the assessment of global atmospheric OH concentrations.
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