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We present the case of a 6-year-old patient with double-orifice mitral valve and severe regurgitation, which was successfully repaired. We demonstrate that mitral valve repair may be attempted even in complex anatomy such as the double-orifice mitral valve, where it can offer excellent results.
The Spanish National Network (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. The necessity of considering a Quality Management System has been detected and, consequently, a common tool for all the members needs to be developed. We describe in this study the process to achieve that goal.
Based on both a review of previous literature and the proposal for a self-evaluating tool, a group of experts from each agency through consensus have developed a tool for self-evaluation in Health Technology Assessment (HTA) agencies. Through the structure described in the handbook of the Andalusian Agency for Healthcare Quality (ACSA), each standard should have a statement or proposal that needs to also include evidence or good practices, and the corresponding evaluation questions. In separate workgroups, the definition of these proposals, evidence and evaluation questions were developed. One face-to-face meeting and two meetings via teleconference were necessary to achieve a final document with all the quality standards.
From a proposed structure of sixty-six standards, the titles, definitions, statements and evidence as well as good practices and evaluation questions were established in workgroups with consensus among all of the members (1 - 3). The final version of the self-assessment tool was composed of sixty-eight standards, grouped in twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process, and IV Resources.
Quality management requires an evaluation tool and this version, based on a systematic review and consensus, is a useful and practical instrument for developing a handbook by each member of REDETS. An online version of the tool is in process of development.
Neonatal cardiac lupus is a rare, passively acquired autoimmune disease. We report a case of in utero myocarditis, confirmed postnatally, with papillary muscle rupture and severe tricuspid regurgitation after birth in the absence of conduction disturbances. Tricuspid repair was successfully performed with polytetrafluoroethylene neochordae. In this article, we discuss the pathophysiology, medical and surgical management, and implications at follow-up in this unique scenario.
Echinococcus granulosus is the causative agent of cystic echinococcosis. The disease is a significant global public health concern and human infections are most commonly associated with E. granulosus sensu stricto (s. s.) genotype G1. The objectives of this study were to: (i) analyse the genetic variation and phylogeography of E. granulosus s. s. G1 in part of its main distribution range in Europe using 8274 bp of mtDNA; (ii) compare the results with those derived from previously used shorter mtDNA sequences and highlight the major differences. We sequenced a total of 91 E. granulosus s. s. G1 isolates from six different intermediate host species, including humans. The isolates originated from seven countries representing primarily Turkey, Italy and Spain. Few samples were also from Albania, Greece, Romania and from a patient originating from Algeria, but diagnosed in Finland. The analysed 91 sequences were divided into 83 haplotypes, revealing complex phylogeography and high genetic variation of E. granulosus s. s. G1 in Europe, particularly in the high-diversity domestication centre of western Asia. Comparisons with shorter mtDNA datasets revealed that 8274 bp sequences provided significantly higher phylogenetic resolution and thus more power to reveal the genetic relations between different haplotypes.
Understanding magnetosome magnetite biomineralization is of fundamental interest to devising the strategies for bioinspired synthesis of magnetic materials at the nanoscale. Thus, we investigated the early stages of magnetosome formation in this work and correlated the size and emergent crystallinity of magnetosome nanoparticles with the changes in chemical environment of iron and oxygen by utilizing advanced analytical electron microscopy techniques. We observed that magnetosomes in the early stages of biomineralization with the sizes of 5–10 nm were amorphous, with a majority of iron present as Fe3+, indicative of ferric hydroxide. The magnetosomes with intermediate sizes showed partially crystalline structure with a majority of iron present as Fe3+ and trace amounts of Fe2+. The fully maturated magnetosomes were indexed to magnetite. Our approach provides spatially resolved structural and chemical information of individual magnetosomes with different particle sizes, attributed to magnetosomes at different stages of biomineralization.
Dementia is a significant public health problem. One non-pharmacological therapy that has shown its effectiveness is reminiscence, which is a psychological intervention designed to address issues of particular relevance to older adults. The aim of this study was to examine the benefits of an integrative reminiscence program in elderly people with dementia.
A quasi-experimental design and purposeful sampling were conducted at two retirement homes. Forty-two elderly adults with dementia were studied to measure the effect of the therapy (23 in the experimental group and 19 in the control group). The treatment group activity was held in 10 sessions.
The treatment group significantly improved their depressive symptoms and self-acceptance, positive relations with others, autonomy, and environmental mastery.
This study provides support for the effectiveness of integrative reminiscence therapy (RT) as an intervention in people with dementia, especially in reducing depressive symptoms and improving psychological well-being, with the therapy being effective on personal and emotional variables.
The composition and structure of sublittoral faunal assemblages inhabiting soft bottoms (15–72 m depth) within the Marine Protected Area ‘Acantilados y Fondos Marinos de Calahonda-Castell de Ferro’ in southern Spain (North Alboran Sea, Mediterranean) have been studied in relation to sediment and water column variables. Three assemblages were identified and corresponded to mixed bottom, unstable bottom and coastal detritic bottom assemblages, based on Pérès & Picard's (1964) benthic classification. A total of 14,318 individuals were collected and 218 species identified, molluscs being the best represented group (141 species). Species richness displayed significant differences with depth and transect, with the highest values observed in the medium to very fine sand and muddy bottoms with bioclasts located at the shallowest sampling stations. The presence of some rare and poorly known invertebrates that are scarce in other areas of the Mediterranean Sea is remarkable, such as the crustacean decapods Bythocaris cosmetops and Pagurus mbizi, Atlantic species with no records in the Mediterranean Sea, and the bathyal molluscs Poromya granulata and Alvania testae, collected at shallow depths. The spatial distribution of faunal assemblages was mainly related to depth and percentage of gravel and clay according to the canonical correspondence analysis. The geographic location of the area, the heterogeneity of soft bottoms and the presence of upwellings in the area may favour the high biodiversity found in the studied soft bottoms. This study increases the scarce knowledge of the circalittoral fauna of sedimentary habitats of the Alboran Sea, providing a baseline for the management of this interesting SCI and for the EU Marine Strategy Framework Directive.
A study by electron microscopy techniques of the structural and compositional properties of AlxGa1-xN/GaN nanowire (NW) heterostructures on Si(111) is presented. AlxGa1-xN depositions grown without catalyst by plasma-assisted molecular beam epitaxy were designed to form NWs in the range of 0.20<x<0.40 with different lengths and growth temperatures. The NWs exhibit a well-defined core-shell radial structure with a complex chemical distribution along and across the growth direction that finally affects the NW morphology. All the wires have an initial stage with a maximum Al content in the core slightly above the GaN/AlxGa1-xN interface, which initially decreases exponentially with the NW height depending on the nominal Al content and the growth temperature. In longer NWs, this trend changes and evolves increasing both the Al/Ga ratio and the core diameter as well as sharpening the shell. Adatom surface kinetic differences and the geometrical shadow effect during the growth are the probable drivers of this behavior.
Steven Totosy de Zepetnek, Professor of Comparative Literature and Cultural Studies, Purdue University, Purdue, USA,Tutun Mukherjee, Professor, Centre for Comparative Literature, University of Hyderabad
Abstract: In their article “Comparative Literature in Iberian Spanish and Portuguese” María Teresa Vilariño Picos and Anxo Abuín González present the current situation of comparative literature in the region. Their description of the discipline's intellectual and institutional situation suggests that starting with the mid-twentieth century scholars on the Iberian peninsula adopted comparative literature's theory orientation and proceeded in applying the framework in the study of literature. Vilariño Picos and Abuín González pay particular attention to the development of intermediality and digital humanities, fields which attract scholars who work in comparative literature in particular and produce(d) seminal scholarship. Further, they suggest that scholarship ought to place emphasis of the value of the local in a global context and to explore linguistic difference, while at the same time accompanying this exploration with theoretical reflection on the importance of digital humanities.
We should not be surprised—given the lamentations about the state of affairs of comparative literature since its inception in the nineteenth century—that the discipline is associated with “crisis” (see, e.g., Gumbrecht and Moser). The reasons for this view are multiple and well-known. Not least important is the decline of the study of literature conceived as an expression of national identity, as was traditionally the case in comparative literature. We now know that the crisis of the discipline was accompanied by a considerable extension of its area of study and its implication with other spheres of thought.
To evaluate the dietary quality of Mexican adults’ diet, we constructed three dietary quality indices: a cardioprotective index (CPI), a micronutrient adequacy index (MAI) and a dietary diversity index (DDI).
Data were derived from the 2006 National Health and Nutrition Survey, which is a national survey representative of the Mexican population with a stratified, multistage, probabilistic sample design. Dietary intake was assessed from an FFQ with 101 different foods and daily nutrient intakes were computed. The CPI evaluated compliance with seven WHO recommendations for the prevention of CVD, the MAI evaluated the intake of six micronutrients based on the estimated average requirements from the US Institute of Medicine and the DDI was constructed based on the consumption of thirty different food groups.
Mexican adults aged 19–59 years old.
We evaluated the diet of 15 675 males and females. Adjusted means and adjusted proportions by age and sex were computed to predict adherence to dietary recommendations. Rural inhabitants, those living in the South and those from the lowest socio-economic status reported a significantly higher CPI (4·5 (se 0·08), 4·3 (se 0·08) and 4·2 (se 0·09), respectively; P < 0·05), but a significantly lower MAI and DDI, compared with urban inhabitants, those from the North and those of upper socio-economic status (P < 0·05).
The constructed diet quality indices identify nutrients and foods whose recommended intakes are not adequately consumed by the population. Given the epidemiological and nutritional transition that Mexico is experiencing, the CPI is the most relevant index and its components should be considered in Mexican dietary guidelines as well as in any food and nutrition programmes developed.
The objective of this study was, firstly, to determine the factor structure and factor invariance of the Zung Self-Rating Depression Scale (ZSDS) and, secondly, to justify its use in coronary patients (CPs) and healthy people (HP). Two comparable samples of males were studied: 217 CPs and 191 HP. Exploratory and confirmatory factor analyses (EFA and CFA) for ordinal data were carried out with Mplus. Two models obtained from all participants in this study and another two, the model of Shafer (2006) from a meta-analysis and that of Barefoot et al. (2000) with CPs, were analyzed in CFA. A two-factor structure was supported by EFA in both samples, but none of the models showed adequate goodness-of-fit for the CPs and the HP in CFA. Only the two and three-factor models obtained from the combined sample of CPs and HP showed adequate goodness-of-fit for HP. The ZSDS showed good reliability, replicated the prevalence of depressive symptoms found in other studies and was able to distinguish between CPs and HP. We conclude that the best fit is obtained from the two-factor solution in HP, that the factor structure of the ZSDS is not invariant and is linked to positively and negatively worded items.
One of the most widely used scales for the evaluation of stress is the Perceived Stress Scale (PSS), and it has been adapted into different languages. However, few studies have presented normative data from large samples, and there do not appear to be any studies of the PSS that provide normative data based on large samples for Mexico. Thus, the goal of this study was to provide normative data regarding gender and different age groups for a sample of 1990 Mexican subjects to validate the factor structure of the construct for this sample. The analysis of the 10- and 14-item versions of the PSS revealed that the scale had adequate reliability and that the factor structure was consistent with previous studies. With respect to the normative data, the means of the different groups ranged from 20.93 to 25.63 for the PSS14 and from 14.52 to 17.73 for the PSS10. We propose that scores within one standard deviation of these means be used as reference values for each group.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
The structure and similarity of the parasite communities of fish can be evaluated at the component community (CC) and infracommunity (IC) levels. Both hierarchical levels have been used to assess parasite variations in fish at large (biogeographic) scales. However, studies evaluating the consistency between these two hierarchical levels at smaller geographical scales are scarce. In this study, the parasite assemblages of 124 Paralabrax humeralis collected by local fishermen by spear fishing at four sites (El Fierro, EF; P. Angamos, PA; Santa María, ISM; San Jorge, BSJ) in northern Chile were compared to assess the variability (or similarity) of their CCs and ICs at a limited geographical scale using multivariate analysis. At the IC level, discriminant analyses showed that P. humeralis parasite communities varied significantly among sites; 70% of ectoparasite ICs were correctly assigned to each site, but only 55% of helminth parasite ICs were correctly classified. At the CC level, the composition of parasite communities as assessed by correspondence analyses varied significantly between sites. Tagia sp., Neobenedenia sp. and Philometra sp. were associated with BSJ, ISM and PA, respectively; Corynosoma sp. and most digeneans were associated with both ISM and EF. Analysis of similarities (ANOSIM) showed significant variations in the degree of similarity between P. humeralis CCs from different sites, but not between ICs. Variations between CCs from different sites reflect fish population processes (e.g., population age, reproductive segregation) and the particular conditions of their respective habitats, whereas ICs reflect individual host movements. This study demonstrated that, when examined at a limited geographical scale, IC is better than CC at capturing the local pool of parasite assemblages when host populations are spatially segregated. Therefore, in this study, it is demonstrated that at a small geographic scale, CC variations are not reflected by IC, when host population is spatially segregated.
One of the most complicated aspects of caring for patients with dementia is dementia-driven wandering due to its adverse ramifications. We report a case of an 80-year-old man who had been previously diagnosed with dementia (with a score of 6 on the Reisberg Global Deterioration Scale – GDS). The patient went to an Adult Day Care Center on a daily basis where he demonstrated wandering behavior with a high rate of escape attempts (the number of times the Center's glass exit door was approached). The objective of this study is to present effective non-pharmacological intervention strategies for dementia-driven wandering; assessed strategies included: environmental (subjective barriers), cognitive/behavioral (cognitive training with differential reinforcement), and combined (subjective barriers + cognitive/behavioral). The results showed that all of these three strategies significantly decreased the number of escape attempts.