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Femoral vein access is the first choice for percutaneous atrial septal defect closure, and when it cannot be used due to anatomic reasons, the alternative sites should be considered, frequently increasing the complexity of the procedure. Here we report the case of a 3-year-old boy, with situs inversus and dextrocardia, electively referred for percutaneous closure of an ostium secundum atrial septal defect. During the procedure, agenesis of the infra-hepatic segment of the inferior caval vein was diagnosed, and no double inferior caval vein or right superior caval vein were identified by ultrasound or angiography. Therefore, we opted to perform the procedure through the left internal jugular vein, with fluoroscopy and transesophageal echocardiographic guidance. Catheters were navigated through a hydrophilic guidewire, and a Stiff guidewire was positioned in the left ventricle for better support. An Amplatzer septa occluder 19 was successfully deployed without major difficulties and the patient was discharged after 24 hours in good clinical condition. Percutaneous atrial septal defect closure through alternative access sites, especially in the presence of situs inversus, may pose significant challenges to the interventional team. In this case, the left internal jugular vein has shown to be a feasible option, allowing the navigation and manipulation of devices without complications. Provided the expertise of the interventional team, and awareness of the risks involved, alternative access sites can be successfully used for paediatric structural interventions.
With respect to De Dreu and Gross's article, we comment on the psychological functions for attack and defense, focusing on associations between individual differences in psychopathic personality traits and the behavioral patterns observed in attack-defense conflicts. We highlight the dimensional nature of psychopathy and formulate hypothetical associations between distinct traits, their different behavioral outcomes, and associated brain mechanisms.
Sleep disturbance is a symptom of and a well-known risk factor for depression. Further, atypical functioning of the HPA axis has been linked to the pathogenesis of depression. The purpose of this study was to examine the role of adolescent HPA axis functioning in the link between adolescent sleep problems and later depressive symptoms. Methods: A sample of 157 17–18 year old adolescents (61.8% female) completed the Pittsburgh Sleep Quality Inventory (PSQI) and provided salivary cortisol samples throughout the day for three consecutive days. Two years later, adolescents reported their depressive symptoms via the Center for Epidemiological Studies Depression Scale (CES-D). Results: Individuals (age 17–18) with greater sleep disturbance reported greater depressive symptoms two years later (age 19–20). This association occurred through the indirect effect of sleep disturbance on the cortisol awakening response (CAR) (indirect effect = 0.14, 95%CI [.02 -.39]). Conclusions: One pathway through which sleep problems may lead to depressive symptoms is by up-regulating components of the body’s physiological stress response system that can be measured through the cortisol awakening response. Behavioral interventions that target sleep disturbance in adolescents may mitigate this neurobiological pathway to depression during this high-risk developmental phase.
Older-age bipolar disorder (OABD), which has been defined as the occurrence of bipolar disorder in individuals who are aged 60 years or older  represents as much as one-quarter of the population with bipolar disorder. In spite of the early mortality that is known to occur among individuals with bipolar disorder , the absolute numbers of individuals with mental health conditions such as OABD are expected to increase in upcoming years. Given these global demographic changes and emerging evidence base, there has been growing interest in OABD. However, complicating the study and characterisation of OABD, there is substantial variability in clinical expression, such as early onset versus late onset illness with a potentially different pathogenesis, clinical course and care needs. A hierarchical terminology for OABD that considers age of onset and course of illness has been proposed by the International Society for Bipolar Disorders Task Force on Older-Age Bipolar Disorder .
Psychotic symptoms (i.e. delusions or hallucinations) are relatively common in later life, with prevalence estimates ranging from 6% in the community to as high as 63% in residential care settings . In some instances, these symptoms are the clinical expression of disorders that had their onset early in life (e.g., schizophrenia), but for a large proportion of older adults they arise for the first time in later life. Dementia-related conditions appear to be the most common cause of psychotic symptoms in older adults, with mood disorders, delirium and schizophrenia spectrum disorders contributing to the majority of the other cases . These symptoms are a source of considerable distress for individuals and those who care for them, and will become a major health issue as the world’s population ages.
Between 1845 and 1850, the Congo coast became the most important source of slaves for the coffee growing areas in the Brazilian Empire. This essay develops a new methodology to understand the making of the ‘nations’ of 290 Africans found on the slave ship Jovem Maria, which boarded slaves in the Congo river and was captured by the Brazilian Navy near Rio de Janeiro in 1850. A close reading of such ‘nations’ reveals a complex overlapping between languages and forms of identification that alters the historian's use of concepts such as ‘ethnolinguistic group’ and ‘Bantu-based lingua franca’ in the Atlantic world. Building on recent developments in Central African linguistics, the article develops a social history of African languages in the Atlantic that foregrounds how recaptives negotiated commonalities and boundaries in the diaspora by drawing on a political vocabulary indigenous to their nineteenth-century homes in Central Africa.
In this work, a poly-Si0.35Ge0.65 microelectromechanical systems (MEMS)- based actuator was designed and fabricated using a CMOS compatible standard process to specifically strain a bi-layered (2L) MoS2 flake and measure its electrical properties. Experimental results of the MEMS-TMDC device show an increase of conductivity up to three orders of magnitude by means of vertical actuation using the substrate as the body terminal. A force balance model of the MEMS-TMDC was used to determine the amount of strain induced in the MoS2 flake. Strains as high as 3.3% is reported using the model fitted to the experimental data.
Tuberculosis (TB) is the leading cause of death among infectious diseases worldwide. Among the estimated cases of drug-resistant TB, approximately 60% occur in the BRICS countries (Brazil, Russia, India, China and South Africa). Among Brazilian states, primary and acquired multidrug-resistant TB (MDR-TB) rates were the highest in Rio Grande do Sul (RS). This study aimed to perform molecular characterisation of MDR-TB in the State of RS, a high-burden Brazilian state. We performed molecular characterisation of MDR-TB cases in RS, defined by drug susceptibility testing, using 131 Mycobacterium tuberculosis (M.tb) DNA samples from the Central Laboratory. We carried out MIRU-VNTR 24loci, spoligotyping, sequencing of the katG, inhA and rpoB genes and RDRio sublineage identification. The most frequent families found were LAM (65.6%) and Haarlem (22.1%). RDRio deletion was observed in 42 (32%) of the M.tb isolates. Among MDR-TB cases, eight (6.1%) did not present mutations in the studied genes. In 116 (88.5%) M.tb isolates, we found mutations associated with rifampicin (RIF) resistance in rpoB gene, and in 112 isolates (85.5%), we observed mutations related to isoniazid resistance in katG and inhA genes. An insertion of 12 nucleotides (CCAGAACAACCC) at the 516 codon in the rpoB gene, possibly responsible for a decreased interaction of RIF and RNA polymerase, was found in 19/131 of the isolates, belonging mostly to LAM and Haarlem families. These results enable a better understanding of the dynamics of transmission and evolution of MDR-TB in the region.
Little is known about the long-term effect of breastfeeding on dietary habits. We examined the association between breastfeeding duration and adherence to current dietary patterns of young women. This was a cross-sectional analysis of 587 healthy women aged ≤45 years, undergraduates or nutrition graduates. Maternal characteristics and breastfeeding duration [<6; 6–<12; ≥12 months (reference)] were recalled. Diet was assessed using a food frequency questionnaire and patterns were identified using factor analysis by principal component. Adherence to patterns was categorized in tertiles; the first (T1 = reference) was compared to T2 + T3 (moderate-to-high adherence). Logistic regression was performed considering the minimal sufficient adjustment recommended by the directed acyclic graph. Median age was 22 (interquartile range (IQR) 20; 27) years and body mass index (BMI) 22.2 (IQR 20.4; 25.0) kg/m2. The four dietary patterns identified (Processed, Prudent, Brazilian and Lacto-vegetarian) explained 27% of diet variance. Women breastfed for <6 months showed lower chance of moderate-to-high adherence to the Prudent pattern (odds ratio (OR) = 0.53, p = 0.04). Breastfeeding was not associated with the other patterns. Maternal pre-pregnancy BMI was directly associated with moderate-to-high adherence to the Processed pattern (OR = 2.01, p = 0.03) and inversely to the Prudent pattern (OR = 0.52, p = 0.02). Higher adherence to the Brazilian pattern was associated with proxies of low socioeconomic status and the Lacto-vegetarian pattern with the opposite. Confirmation in prospective studies of the association found in this study between breastfeeding with the Prudent pattern in adult offspring could suggest that early feeding practices influence long-term dietary habits, which could then affect the risk of nutrition-related diseases.
Early-life chronic exposure to environmental contaminants, such as bisphenol-A, particulate matter air pollution, organophosphorus pesticides, and pharmaceutical drugs, among others, may affect central tissues, such as the hypothalamus, and peripheral tissues, such as the endocrine pancreas, causing inflammation and apoptosis with severe implications to the metabolism. The Developmental Origins of Health and Disease (DOHaD) concept articulates events in developmental phases of life, such as intrauterine, lactation, and adolescence, to later-life metabolism and health. These developmental phases are more susceptible to environmental changes, such as those caused by environmental contaminants, which may predispose individuals to obesity, metabolic syndrome, and chronic noncommunicable diseases later in life. Alterations in the epigenome are explored as an underlying mechanism to the programming effects on metabolism, as the expression of key genes related with central and peripheral metabolic functions may be altered in response to environmental disturbances. Studies show that environmental contaminants may affect gene expressions in mammals, especially when exposed to during the developmental phases of life, leading to metabolic disorders in adulthood. In this review, we discuss the current obesity epidemics, the DOHaD concept, pollutants’ toxicology, environmental control, and the role of environmental contaminants in the central and peripheral programming of obesity and metabolic syndrome. Improving environmental monitoring may directly affect the quality of life of the population and help protect the future generations from metabolic diseases.
Energy-efficient condensation of steam contained in atmospheric air has emerged as a solution to the water scarcity. Academic and industrial research works that seeks to develop water collection devices with high efficiency has great relevance for the scientific community. In this work, we aim to show that modified carbon nanotubes forest can remove the condensed drops easier than a hydrophobic and a super-hydrophilic surface. In addition, this result was reached at high super saturation level which is an innovative aspect of this work. The Vertically Aligned Carbon Nanotubes (VACNTs) were grown on steel pipes. We used a CO2 laser and an O2 plasma to perform the post treatments that changed the CNTs to super-hydrophobic and super-hydrophilic, respectively. In addition, the CO2 laser treatment added a second level of roughness in the surface by etching the nanotubes walls. A polyethylene coating attached the carbon nanotubes to the substrate. We experimentally demonstrated a 24% higher vapor condensation rate at high supersaturations levels.
Very few practical frameworks exist to guide the formulation of recommendations at hospital-based health technology assessment (HTA) units. The objectives of our study were: (i) to identify decision criteria specific to the context of hospital-based health technologies and interventions, (ii) to estimate the extent to which the expert community agrees on the importance of the identified criteria, (iii) to incorporate the identified criteria into a decision-aid tool, and (iv) to illustrate the application of a prototype decision-aid tool.
Relevant decision criteria were identified using existing frameworks for HTA recommendations, our past experience, a literature search, and feedback from a survey of diverse stakeholders.
Based on the survey results, twenty-three decision criteria were incorporated into the final framework. We defined an approach that eschewed a scoring system, but instead relied on a visual means for arriving at a final recommendation, by juxtaposing the importance rating for each criterion against the results of the health technology assessment. For a technology to be approved, a majority of criteria considered important should also have received favorable findings.
We created a simple and practical decision-aid tool that incorporates all decision criteria relevant to a hospital-based HTA unit. With its ease of use and accessibility, our tool renders the subjective decision-making process more structured and transparent.
Obtention of titanium (Ti)- and titanium dioxide (TiO2)–based nanocomposites is of great interest for biological nanomaterial applications, including for dental implants. Their mechanical properties can be improved by use of hydroxyapatite (HA) and chitosan through their biological anchorage with osseointegration and antibacterial activity. Electrochemical methods were chosen to obtain these composites in a quick and controllable way. In this work, electrochemical synthesis in one (alternated potential) or two steps (alternated or constant potential) was successfully applied. The single step (SS) obtained TiO2 + HA sample had different optical properties, as shown using ultraviolet–visible spectrometry, and the HA phase formation was proved using Raman spectroscopy. Thereby, SS_TiO2 + HA increased the corrosion resistance of titanium in artificial saliva medium, as shown by linear polarization and electrochemical impedance spectroscopy results. When using chitosan, the samples showed two corrosion interfaces, indicating its dissolution in human medium. These results indicate that the samples are excellent materials for dental implants.
It is suggested that bovine enteroviruses (BEV) are involved in the aetiology of enteric infections, respiratory disease, reproductive disorders and infertility. In this study, bovine faecal samples collected in different Brazilian states were subjected to RNA extraction, reverse transcription-polymerase chain reaction analysis and partial sequencing of the 5′-terminal portion of BEV. One hundred and three samples were tested with an overall positivity of 14.5%. Phylogenetic analysis clustered these BEV Brazilian samples into the Enterovirus F clade. Our results bring an important update of the virus presence in Brazil and contribute to a better understanding of the distribution and characterisation of BEV in cattle.
Habitat loss and fragmentation, especially due to agriculture expansion, pose the main threats to biodiversity conservation. While some species are able to survive and proliferate in human-modified habitats (winner species), others are highly dependent on well-preserved habitats, being more vulnerable to extinction (losers). Many raptors can be considered loser species due to their high trophic position, large home ranges, and low reproductive rates. Consequently, this group is frequently used to reflect the environmental quality of habitats and the biodiversity status of communities. Here we describe the diurnal raptor assemblages found in shaded-cocoa agroforests (cabrucas) of Southern Bahia, Brazil, and the determinants of raptor occupancy in this system. We systematically surveyed diurnal raptors in 16 cabruca sites using complementary sampling methods – active search, playback, and point-count – and modeled species occupancy using covariates related to vegetation structure, landscape, management intensity, and biological traits (body mass, trophic level, and diet specialisation). We found a high number of species (at least 18) as able to use cabrucas and a negative relationship between species occupancy and the degree of diet specialisation. Thus, our results suggest that cabrucas have a high potential to mitigate the effects of forest loss and fragmentation on diurnal raptors, but this system alone may not support complete assemblages of this group. It highlights the need for the maintenance of forest remnants in the landscapes to increase species diversity at a regional scale and to assure the conservation of this group in Southern Bahian Atlantic Forest.