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The objective of this study was to assess differences in myocardial systolic and diastolic function and vascular function in children 2−5 years of age born to diabetic as compared to non-diabetic mothers.
This study was a retrospective cohort conducted in 2016 at The Aga Khan University Hospital, Karachi, Pakistan. It included children between 2 and 5 years of age born to mothers with and without exposure to diabetes in utero (n = 68 in each group) and who were appropriate for gestational age. Myocardial morphology and function using echocardiogram and carotid intima media thickness (cIMT) and pulse wave velocity was performed to evaluate cardiac function as well as macrovascular remodelling in these children. Multiple linear regression was used to compare the groups.
There was no significant difference in cardiac morphology, myocardial systolic and diastolic function, and macrovascular assessment between the exposed and unexposed groups of AGA children. Subgroup analysis demonstrated a significantly decreased mitral E/A ratio in children whose mothers were on medications as compared to those on dietary control (median [IQR] = 1.7 [1.6–1.9] and 1.56 [1.4–1.7], respectively, p = 0.02), and a higher cIMT in children whose mothers were on medication as compared to controls (0.48 [0.44–0.52] and 0.46 [0.44–0.50], respectively, p = 0.03).
In utero exposure to uncontrolled maternal diabetes has an effect on the cardiovascular structure and function in children aged 2−5 years. However, future work requires long-term follow-up from fetal to adult life to assess these changes over the life course.
The appeal of ketamine – in promptly ameliorating depressive symptoms even in those with non-response – has led to a dramatic increase in its off-label use. Initial promising results await robust corroboration and key questions remain, particularly concerning its long-term administration. It is, therefore, timely to review the opinions of mood disorder experts worldwide pertaining to ketamine's potential as an option for treating depression and provide a synthesis of perspectives – derived from evidence and clinical experience – and to consider strategies for future investigations.
We report on our recent progress in the study of single Dibenzoterrylene (DBT) molecules as single photon sources and nanoscale probes. We consider DBT molecules embedded in thin anthracene films, a system that allows stable single photon emission both at room and at cryogenic temperatures. We investigate the most important optical properties of the DBT:anthracene system as a whole. We then perform a full statistical study of the coupling between single DBT molecules by measuring the lifetimes of DBT both in the coupled and in the uncoupled case. The experimental results are framed into a simple universal scaling model, where the magnitude of coupling depends solely on universal parameters and on the distance d between the single emitter and the graphene monolayer. We apply this model to infer d and provide a proof of principle for a position ruler at the nanoscale .
Graduate entry medical students’ views of psychiatry may differ from those of school leavers. This study hypothesised that (i) exposure to a psychiatry attachment is associated with a positive change in attitudes towards psychiatry in both graduate entry and non-graduate entry students, (ii) graduate entry students exhibit a more positive attitude to psychiatry compared to non-graduate entry students and (iii) graduate entry students are more interested in a career in psychiatry than non-graduate entry students.
In this study 247 medical students (118 females and 129 males) completing their psychiatry rotation were invited to complete questionnaires examining career choice, attitudes to psychiatry and career attractiveness for a range of specialties including surgery, medicine, general practice and psychiatry before and after their psychiatry attachment. Questionnaires were distributed prior to commencement of their attachment and redistributed on the final day of the attachment.
Of the 165 participants in the study, 75 students entered medicine via the traditional route (without a primary degree), 49 entered via the graduate entry programme and 41 had a primary degree. Overall, medical students displayed positive attitudes towards psychiatry. However, while there was an improvement in attitudes towards psychiatry and the career attractiveness of psychiatry on completion of the rotation, no differences were found between graduate and non-graduate entry students. Psychiatry and general practice had lower ratings for career attractiveness than other specialities. No significant changes were found in the first and second choice of specialty.
Our results show that improvements in attitude and career attractiveness do not necessarily correlate with increased choice of psychiatry as a specialty. Graduate entry has been considered a possible opportunity for increasing recruitment in psychiatry but our results suggest that this may not be the case. Follow-up studies are required to determine whether career attractiveness correlates with future career choice.
Predicting and evaluating response to therapy may become one of the most important indications for FDG-PET in oncology. The FDG-PET result could serve as a surrogate for actual patient outcomes in clinical practice and in drug development. The FDG-PET end result can be qualitative or, increasingly often, quantitative.
In this context, three methodological aspects of a totally different nature are of crucial importance: getting the right numbers out of the scan (standardization, validation of simplified quantitative measures), validating the biological relevance of the tracer signal (changes), and developing and validating the response criteria. In this chapter, examples of each of these domains (physics, biology, and epidemiology) will be discussed. To some extent, the cases have been modified from actual practice for didactical reasons.
A 62-year-old female with locally advanced cancer of the left
breast was treated with experimental neoadjuvant chemotherapy.
No data have been published on FDG-PET and this new
therapeutic agent. A secondary aim of the study is to explore
the use of FDG-PET to evaluate the response to this therapy.
Acquisition and processing parameters
Dynamic FDG-PET scans were obtained at baseline and after
one cycle of therapy. The PET scanner (ECAT EXACT HR+;
Siemens/CTI, Knoxville) used provides an axial field of view of
15.5 cmand produces 63 transaxial slices with a slice thickness of
2.5mm. The patient fasted for at least 6 hours prior to the
imaging sessions. The patient was scanned in the supine position
with arms at her sides. The patient was positioned in such a way
that the dominant lesions were in the center of the field of view.
Independent outbreaks of dengue virus (DENV) infection and sporadic cases of chikungunya virus (CHIKV) have been recorded in the metropolitan city of Delhi on several occasions in the past. However, during a recent 2010 arboviral outbreak in Delhi many cases turned negative for DENV. This prompted us to use duplex reverse transcriptase–polymerase chain reaction (D-RT–PCR) to establish the aetiology of dengue/chikungunya through sequencing of CprM and E1 genes of dengue and chikungunya viruses. Interestingly, for the first time, both DENV and CHIKV co-circulated simultaneously and in equally dominant proportion during the post-monsoon period of 2010. DENV-1 genotype III and the East Central South African genotype of CHIKV were associated with post-monsoon spread of these viruses.
We investigate the behavior of the quasi-Baer and the right FI-extending right ring hulls under various ring extensions including group ring extensions, full and triangular matrix ring extensions, and infinite matrix ring extensions. As a consequence, we show that for semiprime rings
are Morita equivalent, then so are the quasi-Baer right ring hulls
, respectively. As an application, we prove that if unital
are Morita equivalent as rings, then the bounded central closure of
and that of B are strongly Morita equivalent as
-algebras. Our results show that the quasi-Baer property is always preserved by infinite matrix rings, unlike the Baer property. Moreover, we give an affirmative answer to an open question of Goel and Jain for the commutative group ring
of a torsion-free Abelian group
over a commutative semiprime quasi-continuous ring
. Examples that illustrate and delimit the results of this paper are provided.
If the injective hull E = E(RR) of a ring R is a rational extension of RR, then E has a unique structure as a ring whose multiplication is compatible with R-module multiplication. We give some known examples where such a compatible ring structure exists when E is a not a rational extension of RR, and other examples where such a compatible ring structure on E cannot exist. With insights gleaned from these examples, we study compatible ring structures on E, especially in the case when ER, and hence RR ⊆ ER, has finite length. We show that for RR and ER of finite length, if ER has a ring structure compatible with R-module multiplication, then E is a quasi-Frobenius ring under that ring structure and any two compatible ring structures on E have left regular representations conjugate in Λ = EndR(ER), so the ring structure is unique up to isomorphism. We also show that if ER is of finite length, then ER has a ring structure compatible with its R-module structure and this ring structure is unique as a set of left multiplications if and only if ER is a rational extension of RR.
It is shown that every finitely generated projective module PR over a semiprime ring R has the smallest FI-extending essential module extension (called the absolute FI-extending hull of PR) in a fixed injective hull of PR. This module hull is explicitly described. It is proved that , where is the smallest right FI-extending right ring of quotients of End(PR) (in a fixed maximal right ring of quotients of End(PR). Moreover, we show that a finitely generated projective module PR over a semiprime ring R is FI-extending if and only if it is a quasi-Baer module and if and only if End(PR) is a quasi-Baer ring. An application of this result to C*-algebras is considered. Various examples which illustrate and delimit the results of this paper are provided.
Poverty and Inequality. Edited by David B. Grusky and Ravi
Kanbur. Stanford: Stanford University Press, 2006. 200p. $55.00 cloth,
Capabilities Equality: Basic Issues and Problems. Edited by
Alexander Kaufman. New York: Routledge, 2005. 224p. $125.00.
Two trends, each a generation in the making, have affected the recent
study of poverty and inequality. In 1979, Amartya Sen asked
“Equality of What?” in his Tanner Lecture at Stanford
University. There, and in numerous articles and books since, Sen and his
collaborators developed a rich account of poverty, inequality, and of
human well-being more generally considered. This work, though its original
basis was in the classical political economy of subsistence and human
freedom, grew to be buttressed by a wide range of ethical, social, and
other economic matters. In so doing, it encouraged the development of the
second trend, the greater interweaving of developments in the different
social sciences and in political and philosophical theory that might be
brought to bear on the consideration of poverty and inequality. There has
come to be a greater understanding by economists, sociologists, political
theorists, and philosophers of what they might learn from one another.
A module M is said to satisfy the condition (℘*) if M is a direct sum of a projective module and a quasi-continuous module. In an earlier paper, we described the structure of rings over which every (countably generated) right module satisfies (℘*), and it was shown that such a ring is right artinian. In this note some additional properties of these rings are obtained. Among other results, we show that a ring over which all right modules satisfy (℘*) is also left artinian, but the property (℘*) is not left-right symmetric.
Subsistence need carries the moral authority of the community. Because it carries this authority, subsistence need has power over the member, the power to determine what the member needs and how that need will be satisfied. The community's power over its members carries with it an obligation to assure, so far as possible, that the member's needs, which are also the community's needs, are satisfied. The member has his or her obligation to do work of a particular kind and, more generally, to perform his or her designated function. And the community has its obligation to assure, so far as possible, the livelihood of its members. In a world where the community no longer carries the moral authority to determine need and how need is satisfied, what replaces the community's moral authority and the system of mutual obligation that goes with it is the ideal of individual right. The growing hegemony of this ideal has the most far-reaching implications for the theory of need and the idea of poverty. To see where the ideal of right takes the theory of need, we will first consider that ideal more closely.
The language of right links conduct to volition. In a moral order, conduct is determined by external imperatives. In a system of individual rights, conduct originates in individual will.
The facilitating environment and the normative order
In this book, we treat poverty as the lack of something vital in living. We consider this something vital the capacity and opportunity to make doing the expression of being. The availability of the capacity depends on a number of factors, the most important of which fall into the category Winnicott refers to as a “facilitating environment.” In concluding, we would like to explore this dimension of the problem in a preliminary way to indicate what our concept of poverty might imply for policy and institutions.
The literature directly concerned with the facilitating environment tends to conceive it narrowly as the environment in the family, and especially the relationships that shape early emotional development. If we were to summarize the issue at this level, the main elements would be (1) the conception of the emerging person held in the mind of the parent, especially whether that conception is animated by the principle of the “freedom of opportunities yet undetermined” as Erikson terms it, and (2) the provision of a setting in which it is safe to make doing an expression of being so that it is possible for self-development to occur.
We can make our main point in the following way. The parent relates to the infant or young child in a specific way, shaping a relationship that has a specific meaning into which the infant or young child fits. We can divide the modes of relating into two groups.
In this chapter, we explore three examples of how thinking about poverty and unemployment shapes poverty policy. The link forged by the Puritans between personal character and fortune has been particularly influential in shaping poverty policy. Recent and contemporary accounts of poverty often revert to the formula that character is all, circumstances nothing, while other, opposed, accounts formulate the issue in the same framework, simply reversing the causality favored by the Puritans and insisting that circumstance is all and character has nothing to do with the problem. This view, in its more recent formulations, has required that we find ways to measure poverty so that we can gauge the effectiveness of poverty initiatives, the second topic of the chapter. We begin with the problem of unemployment and suggest that the way we understand the causes of unemployment affects who we judge to be responsible and what measures for alleviating poverty are seen as appropriate. We end by considering the idea of individual responsibility and its implications for thinking about poverty policy.
Self-correcting and crisis prone markets
England's New Poor Law of 1834 responded to the concern that poor relief leads to withdrawal from the labor market and encourages idleness. We see the same concern in the last quarter of the twentieth century in the idea that welfare payments would encourage people to remain outside of the workforce.
The problem of poverty is a central issue in thinking about underdevelopment. A way to organize this thinking is to ask what the different approaches to development see as missing in the lives of the poor. In broad terms, development thought has seen the poor as lacking income, the ability to satisfy basic needs, or the capabilities to lead a fully human life. In this chapter, we consider each of these possibilities in turn.
Growth and income
An emphasis on improving outcomes in developing countries by fostering economic growth can follow from neoclassical economics. The neoclassical approach takes as its building blocks information on preferences, endowments, and technology (Debreu 1959). In order for individual welfare to improve, given that preferences are held fixed by assumption, endowments need to increase or technology needs to develop. The emphasis on technological change is consistent with a focus on industrialization. And the idea of increasing endowments is also consistent with growth. Endowments, namely goods and services that individuals have access to for consumption and production purposes, would increase with growth and are themselves inputs for growth. Some of these services can be productive, such as those provided by labor or capital. From this point of view, we can also see why there might be a specific emphasis on increasing the productivity of labor. Hence, there is a neoclassical emphasis on human capital, the idea that through education and other means, workers will invest in their own productive capacity.
We speak about the poor as if we know who they are. We speak, for example, as if the arbitrary definitions used by government agencies to determine eligibility for their programs tell us who is poor and who is not. If we know who are the poor, the problem is what, if anything, to do about them. For some, knowing what to do about poverty means becoming an advocate for the poor, or for what their interests are imagined to be. Then, the problem becomes one of representation of interests, and possibly of the struggle on behalf of those interests against the interests of those who are not poor and whose interests might be opposed to the interests of the poor.
Sometimes we speak about poverty as if it were defined by wealth. The poor are those who do not have enough wealth. This is the approach taken by Adam Smith in the first paragraphs of The Wealth of Nations, where he defines the problem of political economy as the problem of wealth and poverty. When we speak this way, poverty often becomes a relative matter; the more wealth on average in our society, the more wealth we need to avoid being poor. This way of thinking about poverty makes it an implication of inequality, which, for some, makes poverty a problem of injustice. This follows if we convince ourselves that those who have less (and therefore are poor) do so because others have more.