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Transesophageal echocardiography is an important tool for point of care diagnostic imaging, with minimal complications by trained practitioners. The trans-gastric mid-papillary short axis view allows for assessment of preload, ventricular function, myocardial ischemia, and pericardial effusions. The mid-esophageal views allow for further evaluation of right and left ventricular function, as well as mitral, tricuspid, and aortic valve evaluation. The descending aortic views are used for the evaluation of aortic pathology such as aortic dissections.
In a large and comprehensively assessed sample of patients with bipolar disorder type I (BDI), we investigated the prevalence of psychotic features and their relationship with life course, demographic, clinical, and cognitive characteristics. We hypothesized that groups of psychotic symptoms (Schneiderian, mood incongruent, thought disorder, delusions, and hallucinations) have distinct relations to risk factors.
In a cross-sectional study of 1342 BDI patients, comprehensive demographical and clinical characteristics were assessed using the Structured Clinical Interview for DSM-IV (SCID-I) interview. In addition, levels of childhood maltreatment and intelligence quotient (IQ) were assessed. The relationships between these characteristics and psychotic symptoms were analyzed using multiple general linear models.
A lifetime history of psychotic symptoms was present in 73.8% of BDI patients and included delusions in 68.9% of patients and hallucinations in 42.6%. Patients with psychotic symptoms showed a significant younger age of disease onset (β = −0.09, t = −3.38, p = 0.001) and a higher number of hospitalizations for manic episodes (F11 338 = 56.53, p < 0.001). Total IQ was comparable between groups. Patients with hallucinations had significant higher levels of childhood maltreatment (β = 0.09, t = 3.04, p = 0.002).
In this large cohort of BDI patients, the vast majority of patients had experienced psychotic symptoms. Psychotic symptoms in BDI were associated with an earlier disease onset and more frequent hospitalizations particularly for manic episodes. The study emphasizes the strength of the relation between childhood maltreatment and hallucinations but did not identify distinct subgroups based on psychotic features and instead reported of a large heterogeneity of psychotic symptoms in BD.
Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions (often defined as 1-100 nm, but sometimes defined to include dimensions up to 1000 nm, as discussed further below) where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products (biologics), implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. Nanotherapeutics and in vivo nanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes (including the bloodbrain barrier) and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents.
Monitoring in Anesthesia and Perioperative Care is a practical and comprehensive resource documenting the current art and science of perioperative patient monitoring, addressing the systems-based practice issues that drive the highly regulated health care industry of the early twenty-first century. Initial chapters cover the history, medicolegal implications, validity of measurement and education issues relating to monitoring. The core of the book addresses the many monitoring modalities, with the majority of the chapters organized in a systematic fashion to describe technical concepts, parameters monitored, evidence of utility complications, credentialing and monitoring standards, and practice guidelines. Describing each device, technique and principle of clinical monitoring in an accessible style, Monitoring in Anesthesia and Perioperative Care is full of invaluable advice from the leading experts in the field, making it an essential tool for every anesthesiologist.
Robert Kagan has three main objectives in writing this book: to demonstrate that the American systems of criminal and civil law, social welfare, and environmental regulation are dominated by “adversarial legalism,” to critique and explain why it has taken hold in the United States, and to make proposals for reform in light of findings in the United States and the advanced capitalist nations of Europe, the Commonwealth, and Japan.
I seek to counter a view commonly held by scholars that the Burger Court is pragmatic in its constitutional choices in contrast to the Warren Court, which is viewed as ideological. I propose a methodology to study the effects of process values and rights values held by members of the Burger Court on their decision making. To view its decision making as pragmatic, without awareness of underlying values of process and rights, results in an oversimplified view and leads to the unwarranted conclusion that the Burger Court is case-specific in making constitutional choices. I limit my discussion to separation of church and state cases, primarily in the area of aid to parochial education, because traditionally scholars have emphasized the pragmatic nature of Burger Court choices in this area. A finding of consistency of values in justices' orientations in this area suggests that the methodology reported here might have general utility in the study of Supreme Court decision making.