.1241 Preamble This document has been developed as an Expert Consensus Document (ECD) by the American College of Cardiology Foundation (ACCF), American Association for Thoracic Surgery (AATS), ...Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons in collaboration with the American Heart Association (AHA), American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Society of Cardiovascular Computed Tomography, Society of Cardiac Magnetic Resonance, Society of Cardiovascular Anesthesiologists, and Mended Hearts. Often the topic is the subject of considerable ongoing investigation. ...the reader should view the ECD as the best attempt of the ACCF and document cosponsors to inform and guide clinical practice in areas where rigorous evidence may not yet be available or evidence to date is not widely applied to clinical practice. Conference calls of the writing committee were confidential and attended only by committee members.\n AR = aortic regurgitation AS = aortic stenosis AVA = aortic valve area AVR = aortic valve replacement CAD = coronary artery disease CMR = cardiac magnetic resonance COPD = chronic obstructive pulmonary disease CT = computed tomography EF = ejection fraction EOA = effective orifice area EuroSCORE = European system for cardiac operative risk evaluation LV = left ventricular LVOT = left ventricular outflow pact MDCT = multidetector computed tomography NCDR = National Cardiovascular Data Registry PARTNER = Placement of Aortic Transcatheter Valve trial PH = pulmonary hypertension RV = right ventricular SOURCE = SAPIEN Aortic Biosprosthesis European Outcome registry STS = Society of Thoracic Surgeons TAVR = transcatheter aortic valve replacement TEE = transesophageal echocardiogram TTE = transthoracic echocardiography VARC = Valve Academic Research Consortium * This table represents the relationships of reviewers with industry and other entities that were disclosed at the time of peer review and determined to be relevant. A person is deemed to have a significant interest in a business if the interest represents ownership of >=5% of the voting stock or share of the business entity, or ownership of >=$10,000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person's gross income for the previous year. Names are listed in alphabetical order within each category of review.According to the ACCF/AHA, a person has a relevant relationship IF: a) the relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or b) the company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or c) the person or a member of the person's household, has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.AATS indicates American Association for Thoracic Surgery; ACCF, American College of Cardiology Foundation; ACE, Accreditation for Cardiovascular Excellence; AHA, American Heart Association; ASE, American Society of Echocardiography; DCRI, Duke Clinical Research Institute; EACTS, European Association for Cardio-Thoracic Surgery; HFSA, Heart Failure Society of America; NCDR-CARE, National Cardiovascular Data Registry-Carotid Artery Revascularization and Endarterectomy; NIH, National Institutes of Health; PARTNER, Placement of Aortic Transcatheter Valve Trial; PI, principal investigator; SCA, Society of Cardiovascular Anesthesiologists; SCAI, Society for Cardiovascular Angiography and Interventions; SCCT, Society of Cardiovascular Computed Tomography; SCMR, Society for Cardiovascular Magnetic Resonance; and STS, Society of Thoracic Surgeons.
Este trabajo intenta complementar lo expuesto por el autor en El enigma Erich Prywara (Gregorianum, Roma 2009, 723-783), en tres facetas fundamentales en Przywara. Dado que zlas tesis doctorales ...alemanas acerca de Przywara, aprobadas en la 2ª mitad del s. XX no enfocan la unidad interna coherente de su enfoque metafísico, aludo brevemente a la unidad abierta de su «analogia entis» respecto de «analogia fidei» inseparada del dato revelado. La Mariología es temática recurrente, incluso en sus diálogos ecuménicos con K. Barth en Münster 1928, según deja constancia Przywara: «Si una "analogia entis" (y en ella, como pensaba Barth, lo mariológico) ha de ser "principio fundamental católico", entonces jamás en tanto "principio", sino como "contextura coherente de algo pura y libremente fáctico"»; es decir, como contextura de un hecho religioso originario, según expliqué en el trabajo mencionado. En sus Escritos Religiosos, Przywara abunda en citas a San Ireneo, antes que A. Orbe rescatara su coherencia teológica. En su última época, Przywara enfatiza la centralidad de las nupcias en la redención en Cristo, así como antes en-fatizó la centralidad antropológica de una metafísica de lo sexuado, con María Virgen, Madre de esta Iglesia. El sentir con la Iglesia -manifiesto en toda su obra-, se patentiza en su intelección honda del Concilio Vaticano I y de la obra de Josef Kleutgen S.J., a quien se encomendó redactar la Constit. Dei Filius. De aquí repercutió en la Neo-Escolástica católica en Francia, Inglaterra y Alemania. Se ejemplifica también con la insistencia del Papado en el estudio a fondo de Tomás de Aquino, desde Leon XIII a Pío XI. El espíritu misionero subyace al Presupuesto que San Ignacio pone en quien da los Ejercicios Espirituales. Przywara inició el diálogo ecuménico en Alemania. Su respeto a la alteridad confesional a lo largo de su tarea como escritor libre, obtuvo su triunfo epocal en el Vaticano II. Su trabajo AnsatzderPhilosophie (1926), centrado en el punto de partida del pensar, ejemplifica su arte de reseñar obras que tratan el tema del pensar desde diversas perspectivas, y al destacar su respectiva verdad, las enfrenta al hecho religioso originario (en el que converge la tesis de Kleutgen con Max Scheler en su época católica).
Newborn piglets have a high incidence of preweaning mortality that is not only associated with low birth weights but also with the presence of intra-uterine growth-restricted (IUGR) piglets. Such ...IUGR piglets are commonly seen in litters from hyperprolific sows as a result of insufficient placental transfer of nutrients. Nutritional strategies can be used prior to and during gestation to enhance foetal development and can also be implemented in the transition period to reduce the duration of farrowing and increase colostrum yield. Recent findings showed that the energy status of sows at the onset of farrowing is crucial to diminish stillbirth rate. Newborn piglets often fail to consume enough colostrum to promote thermostability and subsequent growth, and this is particularly problematic in very large litters when there are fewer available teats than the number of suckling piglets. One injection of 75 IU of oxytocin approximately 14 h after farrowing can prolong the colostral phase, hence increasing the supply of immunoglobulins to piglets. Nevertheless, assistance must be provided to piglets after birth in order to increase their chance of survival. Various approaches can be used, such as: (1) optimising the farrowing environment, (2) supervising farrowing and assisting newborn piglets, (3) using cross-fostering techniques, (4) providing nurse sows, and 5) providing artificial milk. Although research advances have been made in developing feeding and management strategies for sows that increase performance of their newborn piglets, much work still remains to be done to ensure that maximal outcomes are achieved.
Abstract
STUDY QUESTION
Is there a temporal relationship between endometriosis and infertility?
SUMMARY ANSWER
Endometriosis is associated with a higher risk of subsequent infertility, but only among ...women age <35 years.
WHAT IS KNOWN ALREADY
Endometriosis is the most commonly observed gynecologic pathology among infertile women undergoing laparoscopic examination. Whether endometriosis is a cause of infertility or an incidental discovery during the infertility examination is unknown.
STUDY DESIGN, SIZE, DURATION
This study included data collected from 58 427 married premenopausal female nurses <40 years of age from 1989 to 2005, who are participants of the Nurses' Health Study II prospective cohort.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Our exposure was laparoscopically confirmed endometriosis. Multivariate Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for infertility risk (defined as attempting to conceive for >12 months) among women with and without endometriosis.
MAIN RESULTS AND THE ROLE OF CHANCE
We identified 4612 incident cases of infertility due to any cause over 362 219 person-years of follow-up. Compared with women without a history of endometriosis, women with endometriosis had an age-adjusted 2-fold increased risk of incident infertility (HR = 2.12, 95% CI = 1.76–2.56) that attenuated slightly after accounting for parity. The relationship with endometriosis was only observed among women <35 years of age (multivariate HR <35 years = 1.77, 95% CI = 1.46–2.14; multivariate HR 35–39 years = 1.20, 95% CI = 0.94–1.53; P-interaction = 0.008). Risk of primary versus secondary infertility was similar subsequent to endometriosis diagnosis. Among women with primary infertility, 50% became parous after the endometriosis diagnosis, and among all women with endometriosis, 83% were parous by age 40 years.
LIMITATIONS, REASONS FOR CAUTION
We did not have information on participants' intentions to conceive, but by restricting the analytic population to married women we increased the likelihood that pregnancies were planned (and therefore infertility would be recognized). Women in our cohort with undiagnosed asymptomatic endometriosis will be misclassified as unexposed. However, the small proportion of these women are diluted among the >50 000 women accurately classified as endometriosis-free, minimizing the impact of exposure misclassification on the effect estimates.
WIDER IMPLICATIONS OF THE FINDINGS
This study supports a temporal association between endometriosis and infertility risk. Our prospective analysis indicates a possible detection bias in previous studies, with our findings suggesting that the infertility risk posed by endometriosis is about half the estimates observed in cross-sectional analyses.
STUDY FUNDING/COMPETING INTERESTS
This work was supported by the National Institutes of Health (grant numbers: UM1 CA176726, HD52473, HD57210, T32DK007703, T32HD060454, K01DK103720). We have no competing interests to declare.
•At the urban scale, there is limited explicit consideration of climate justice.•We find that within cities a common focus is on the distribution of rights.•In terms of adaptation, rights are often ...framed in terms of individual benefits.•In terms of mitigation, collective rights are also often articulated.•In the global south, emphasis is also on collective rights and procedural justice.
Ever since climate change came to be a matter of political concern, questions of justice have been at the forefront of academic and policy debates in the international arena. Curiously, as attention has shifted to other sites and scales of climate change politics matters of justice have tended to be neglected. In this paper, we examine how discourses of justice are emerging within urban responses to climate change. Drawing on a database of initiatives taking place in 100 global cities and qualitative case-study research in Philadelphia, Quito and Toronto, we examine how notions of distributive and procedural justice are articulated in climate change projects and plans in relation to both adaptation and mitigation. We find that there is limited explicit concern with justice at the urban level. However, where discourses of justice are evident there are important differences emerging between urban responses to adaptation and mitigation, and between those in the north and in the south. Adaptation responses tend to stress the distribution of ‘rights’ to protection, although those in the South also stress the importance of procedural justice. Mitigation responses also stress ‘rights’ to the benefits of responding to climate change, with limited concern for ‘responsibilities’ or for procedural justice. Intriguingly, while adaptation responses tend to stress the rights of individuals, we also find discourses of collective rights emerging in relation to mitigation.
•Climate justice is not just a matter for international debates. It must also be understood at the urban scale.•Climate justice involves distributions, procedures, rights, responsibilities and ...recognition.•Climate justice is better conceptualized as a 3D pyramid rather than a 2D plane.•Understanding climate justice demands a focus on urban climate change interventions.
Debates about climate justice have mainly occurred at the international scale, and have focussed on the rights and responsibilities of nation-states to either be protected from the effects of climate change, or to take action to reduce emissions or support adaptation. In this paper, we argue that it is both productive and necessary to examine how climate justice is being pursued at the urban scale, which brings into focus the need for attention to issues of recognition as well as rights and responsibilities. Building on work from environmental justice, which has conceptualized justice as trivalent, we propose that climate justice can be understood as a pyramid, the faces of which are distributions, procedures, rights, responsibilities and recognition. We then apply this conceptual framework to examine climate change interventions in five cities; Bangalore, Monterrey, Hong Kong, Philadelphia and Berlin. Arguing that the politics and practices of urban climate change interventions are constantly engaging with and refracting the idea of justice, we examine how justice was articulated, practiced and contested across our cases. The perspective of recognition emerges as a particularly useful entry point through which to explore the types of rights, responsibilities, distributions and procedures required to respond justly to climate change. We conclude by reflecting on our framework, arguing that it is useful both as an analytical device to interrogate climate justice and to shape the design of climate change interventions which seek to ensure climate justice.
Highlights • First known systematic review reporting the impact of pharmacist immunizers on vaccination rates. • Limited number of randomized controlled trials and high quality studies. • Pharmacist ...involvement in immunization services increased vaccine coverage rates.
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