Learning about Turner Syndrome

MedlinePlus

... heart murmur, sometimes associated with narrowing of the aorta (blood vessel exiting the heart). A tendency to ... with a heart murmur or narrowing of the aorta may need surgery to correct the problem. A ...

When a Heart Murmur Signals Valve Disease

MedlinePlus

... in adults may be related to: Valve calcification Endocarditis Rheumatic fever In children, abnormal heart murmurs may ... Problem: Pulmonary Valve Regurgitation Heart Valves and Infective Endocarditis Left Ventricular Hypertrophy • Risks, Signs and Symptoms • Accurate ...

Time-frequency characterisation of paediatric heart sounds

NASA Astrophysics Data System (ADS)

Leung, Terence Sze-Tat

1998-08-01

The operation of the heart can be monitored by the sounds it emits. Structural defects or malfunction of the heart valves will cause additional abnormal sounds such as murmurs and ejection clicks. This thesis aims to characterise the heart sounds of three groups of children who either have an Atrial Septal Defect (ASD), a Ventricular Septal Defect (VSD), or are normal. Two aspects of heart sounds have been specifically investigated; the time-frequency analysis of systolic murmurs and the identification of splitting patterns in the second heart sound. The analysis is based on 42 paediatric heart sound recordings. Murmurs are sounds generated by turbulent flow of blood in the heart. They can be found in patients with both pathological and non-pathological conditions. The acoustic quality of the murmurs generated in each heart condition are different. The first aspect of this work is to characterise the three types of murmurs in the time- frequency domain. Modern time-frequency methods including, the Wigner-Ville Distribution, Smoothed Pseudo Wigner-Ville Distribution, Choi-Williams Distribution and spectrogram have been applied to characterise the murmurs. It was found that the three classes of murmurs exhibited different signatures in their time-frequency representations. By performing Discriminant Analysis, it was shown that spectral features extracted from the time- frequency representations can be used to distinguish between the three classes. The second aspect of the research is to identify splitting patterns in the second heart sound, which consists of two acoustic components due to the closure of the aortic valve and pulmonary valve. The aortic valve usually closes before the pulmonary valve, introducing a time delay known as 'split'. The split normally varies in duration over the respiratory cycle. In certain pathologies such as the ASD, the split becomes fixed over the respiration cycle. A technique based on adaptive signal decomposition is developed to measure the split and hence to identify the splitting pattern as either 'variable' or 'fixed'. This work has successfully characterised the murmurs and splitting patterns in the three groups of patients. Features extracted can be used for diagnostic purposes.

Development and Evaluation of Methods for Structured Recording of Heart Murmur Findings Using SNOMED-CT® Post-Coordination

PubMed Central

Green, Julie M.; Wilcke, Jeffrey R.; Abbott, Jonathon; Rees, Loren P.

2006-01-01

Objective: This study evaluated an existing SNOMED-CT® model for structured recording of heart murmur findings and compared it to a concept-dependent attributes model using content from SNOMED-CT. Methods: The authors developed a model for recording heart murmur findings as an alternative to SNOMED-CT's use of Interprets and Has interpretation. A micro-nomenclature was then created to support each model using subset and extension mechanisms described for SNOMED-CT. Each micro-nomenclature included a partonomy of cardiac cycle timing values. A mechanism for handling ranges of values was also devised. One hundred clinical heart murmurs were recorded using purpose-built recording software based on both models. Results: Each micro-nomenclature was extended through the addition of the same list of concepts. SNOMED role grouping was required in both models. All 100 clinical murmurs were described using each model. The only major differences between the two models were the number of relationship rows required for storage and the hierarchical assignments of concepts within the micro-nomenclatures. Conclusion: The authors were able to capture 100 clinical heart murmurs with both models. Requirements for implementing the two models were virtually identical. In fact, data stored using these models could be easily interconverted. There is no apparent penalty for implementing either approach. PMID:16501179

A Signal Processing Module for the Analysis of Heart Sounds and Heart Murmurs

NASA Astrophysics Data System (ADS)

Javed, Faizan; Venkatachalam, P. A.; H, Ahmad Fadzil M.

2006-04-01

In this paper a Signal Processing Module (SPM) for the computer-aided analysis of heart sounds has been developed. The module reveals important information of cardiovascular disorders and can assist general physician to come up with more accurate and reliable diagnosis at early stages. It can overcome the deficiency of expert doctors in rural as well as urban clinics and hospitals. The module has five main blocks: Data Acquisition & Pre-processing, Segmentation, Feature Extraction, Murmur Detection and Murmur Classification. The heart sounds are first acquired using an electronic stethoscope which has the capability of transferring these signals to the near by workstation using wireless media. Then the signals are segmented into individual cycles as well as individual components using the spectral analysis of heart without using any reference signal like ECG. Then the features are extracted from the individual components using Spectrogram and are used as an input to a MLP (Multiple Layer Perceptron) Neural Network that is trained to detect the presence of heart murmurs. Once the murmur is detected they are classified into seven classes depending on their timing within the cardiac cycle using Smoothed Pseudo Wigner-Ville distribution. The module has been tested with real heart sounds from 40 patients and has proved to be quite efficient and robust while dealing with a large variety of pathological conditions.

Ventricular Septal Defect (VSD)

MedlinePlus

... hears a murmur while listening to your baby's heart with a stethoscope. Sometimes VSDs can be detected by ultrasound before ... murmur your doctor hears when listening to your heart with a stethoscope. When to see a doctor Call your doctor ...

Use of signal analysis of heart sounds and murmurs to assess severity of mitral valve regurgitation attributable to myxomatous mitral valve disease in dogs.

PubMed

Ljungvall, Ingrid; Ahlstrom, Christer; Höglund, Katja; Hult, Peter; Kvart, Clarence; Borgarelli, Michele; Ask, Per; Häggström, Jens

2009-05-01

To investigate use of signal analysis of heart sounds and murmurs in assessing severity of mitral valve regurgitation (mitral regurgitation [MR]) in dogs with myxomatous mitral valve disease (MMVD). 77 client-owned dogs. Cardiac sounds were recorded from dogs evaluated by use of auscultatory and echocardiographic classification systems. Signal analysis techniques were developed to extract 7 sound variables (first frequency peak, murmur energy ratio, murmur duration > 200 Hz, sample entropy and first minimum of the auto mutual information function of the murmurs, and energy ratios of the first heart sound [S1] and second heart sound [S2]). Significant associations were detected between severity of MR and all sound variables, except the energy ratio of S1. An increase in severity of MR resulted in greater contribution of higher frequencies, increased signal irregularity, and decreased energy ratio of S2. The optimal combination of variables for distinguishing dogs with high-intensity murmurs from other dogs was energy ratio of S2 and murmur duration > 200 Hz (sensitivity, 79%; specificity, 71%) by use of the auscultatory classification. By use of the echocardiographic classification, corresponding variables were auto mutual information, first frequency peak, and energy ratio of S2 (sensitivity, 88%; specificity, 82%). Most of the investigated sound variables were significantly associated with severity of MR, which indicated a powerful diagnostic potential for monitoring MMVD. Signal analysis techniques could be valuable for clinicians when performing risk assessment or determining whether special care and more extensive examinations are required.

Fluid Dynamics of the Generation and Transmission of Heart Sounds: (1) A Cardiothoracic Phantom Based Study of Aortic Stenosis Murmurs

NASA Astrophysics Data System (ADS)

Bakhshaee, Hani; Seo, Jung-Hee; Zhu, Chi; Welsh, Nathaniel; Garreau, Guillaume; Tognetti, Gaspar; Andreou, Andreas; Mittal, Rajat

2015-11-01

A novel and versatile cardiothoracic phantom has been designed to study the biophysics of heart murmurs associated with aortic stenosis. The key features of the cardiothoracic phantom include the use of tissue-mimetic gel to model the sound transmission through the thorax and the embedded fluid circuit that is designed to mimic the heart sound mechanisms in large vessels with obstructions. The effect of the lungs on heart murmur propagation can also be studied through the insertion of lung-mimicking material into gel. Sounds on the surface of the phantom are measured using a variety of sensors and the spectrum of the recorded signal and the streamwise variation in total signal strength is recorded. Based on these results, we provide insights into the biophysics of heart murmurs and the effect of lungs on sound propagation through the thorax. Data from these experiments is also used to validate the results of a companion computational study. Authors want to acknowledge the financial supports for this study by SCH grant (IIS 1344772) from National Science Foundation.

A novel murmur-based heart sound feature extraction technique using envelope-morphological analysis

NASA Astrophysics Data System (ADS)

Yao, Hao-Dong; Ma, Jia-Li; Fu, Bin-Bin; Wang, Hai-Yang; Dong, Ming-Chui

2015-07-01

Auscultation of heart sound (HS) signals serves as an important primary approach to diagnose cardiovascular diseases (CVDs) for centuries. Confronting the intrinsic drawbacks of traditional HS auscultation, computer-aided automatic HS auscultation based on feature extraction technique has witnessed explosive development. Yet, most existing HS feature extraction methods adopt acoustic or time-frequency features which exhibit poor relationship with diagnostic information, thus restricting the performance of further interpretation and analysis. Tackling such a bottleneck problem, this paper innovatively proposes a novel murmur-based HS feature extraction method since murmurs contain massive pathological information and are regarded as the first indications of pathological occurrences of heart valves. Adapting discrete wavelet transform (DWT) and Shannon envelope, the envelope-morphological characteristics of murmurs are obtained and three features are extracted accordingly. Validated by discriminating normal HS and 5 various abnormal HS signals with extracted features, the proposed method provides an attractive candidate in automatic HS auscultation.

Heart murmur detection based on wavelet transformation and a synergy between artificial neural network and modified neighbor annealing methods.

PubMed

Eslamizadeh, Gholamhossein; Barati, Ramin

2017-05-01

Early recognition of heart disease plays a vital role in saving lives. Heart murmurs are one of the common heart problems. In this study, Artificial Neural Network (ANN) is trained with Modified Neighbor Annealing (MNA) to classify heart cycles into normal and murmur classes. Heart cycles are separated from heart sounds using wavelet transformer. The network inputs are features extracted from individual heart cycles, and two classification outputs. Classification accuracy of the proposed model is compared with five multilayer perceptron trained with Levenberg-Marquardt, Extreme-learning-machine, back-propagation, simulated-annealing, and neighbor-annealing algorithms. It is also compared with a Self-Organizing Map (SOM) ANN. The proposed model is trained and tested using real heart sounds available in the Pascal database to show the applicability of the proposed scheme. Also, a device to record real heart sounds has been developed and used for comparison purposes too. Based on the results of this study, MNA can be used to produce considerable results as a heart cycle classifier. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical evaluation of the 3M Littmann Electronic Stethoscope Model 3200 in 150 cats.

PubMed

Blass, Keith A; Schober, Karsten E; Bonagura, John D; Scansen, Brian A; Visser, Lance C; Lu, Jennifer; Smith, Danielle N; Ward, Jessica L

2013-10-01

Detection of murmurs and gallops may help to identify cats with heart disease. However, auscultatory findings may be subject to clinically relevant observer variation. The objective of this study was to evaluate an electronic stethoscope (ES) in cats. We hypothesized that the ES would perform at least as well as a conventional stethoscope (CS) in the detection of abnormal heart sounds. One hundred and fifty consecutive cats undergoing echocardiography were enrolled prospectively. Cats were ausculted with a CS (WA Tycos Harvey Elite) by two observers, and heart sounds were recorded digitally using an ES (3M Littmann Stethoscope Model 3200) for off-line analysis. Echocardiography was used as the clinical standard method for validation of auscultatory findings. Additionally, digital recordings (DRs) were assessed by eight independent observers with various levels of expertise, and compared using interclass correlation and Cohen's weighted kappa analyses. Using the CS, a heart murmur (n = 88 cats) or gallop sound (n = 17) was identified in 105 cats, whereas 45 cats lacked abnormal heart sounds. There was good total agreement (83-90%) between the two observers using the CS. In contrast, there was only moderate agreement (P <0.001) between results from the CS and the DRs for murmurs, and poor agreement for gallops. The CS was more sensitive compared with the DRs with regard to murmurs and gallops. Agreement among the eight observers was good-to-excellent for murmur detection (81%). In conclusion, DRs made with the ES are less sensitive but comparably specific to a CS at detecting abnormal heart sounds in cats.

Variation in effectiveness of a cardiac auscultation training class with a cardiology patient simulator among heart sounds and murmurs.

PubMed

Kagaya, Yutaka; Tabata, Masao; Arata, Yutaro; Kameoka, Junichi; Ishii, Seiichi

2017-08-01

Effectiveness of simulation-based education in cardiac auscultation training is controversial, and may vary among a variety of heart sounds and murmurs. We investigated whether a single auscultation training class using a cardiology patient simulator for medical students provides competence required for clinical clerkship, and whether students' proficiency after the training differs among heart sounds and murmurs. A total of 324 fourth-year medical students (93-117/year for 3 years) were divided into groups of 6-8 students; each group participated in a three-hour training session using a cardiology patient simulator. After a mini-lecture and facilitated training, each student took two different tests. In the first test, they tried to identify three sounds of Category A (non-split, respiratory split, and abnormally wide split S2s) in random order, after being informed that they were from Category A. They then did the same with sounds of Category B (S3, S4, and S3+S4) and Category C (four heart murmurs). In the second test, they tried to identify only one from each of the three categories in random order without any category information. The overall accuracy rate declined from 80.4% in the first test to 62.0% in the second test (p<0.0001). The accuracy rate of all the heart murmurs was similar in the first (81.3%) and second tests (77.5%). That of all the heart sounds (S2/S3/S4) decreased from 79.9% to 54.3% in the second test (p<0.0001). The individual accuracy rate decreased in the second test as compared with the first test in all three S2s, S3, and S3+S4 (p<0.0001). Medical students may be less likely to correctly identify S2/S3/S4 as compared with heart murmurs in a situation close to clinical setting even immediately after training. We may have to consider such a characteristic of students when we provide them with cardiac auscultation training. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Efficient method for events detection in phonocardiographic signals

NASA Astrophysics Data System (ADS)

Martinez-Alajarin, Juan; Ruiz-Merino, Ramon

2005-06-01

The auscultation of the heart is still the first basic analysis tool used to evaluate the functional state of the heart, as well as the first indicator used to submit the patient to a cardiologist. In order to improve the diagnosis capabilities of auscultation, signal processing algorithms are currently being developed to assist the physician at primary care centers for adult and pediatric population. A basic task for the diagnosis from the phonocardiogram is to detect the events (main and additional sounds, murmurs and clicks) present in the cardiac cycle. This is usually made by applying a threshold and detecting the events that are bigger than the threshold. However, this method usually does not allow the detection of the main sounds when additional sounds and murmurs exist, or it may join several events into a unique one. In this paper we present a reliable method to detect the events present in the phonocardiogram, even in the presence of heart murmurs or additional sounds. The method detects relative maxima peaks in the amplitude envelope of the phonocardiogram, and computes a set of parameters associated with each event. Finally, a set of characteristics is extracted from each event to aid in the identification of the events. Besides, the morphology of the murmurs is also detected, which aids in the differentiation of different diseases that can occur in the same temporal localization. The algorithms have been applied to real normal heart sounds and murmurs, achieving satisfactory results.

Williams-Beuren's Syndrome: A Case Report.

PubMed

Zamani, Hassan; Babazadeh, Kazem; Fattahi, Saeid; Mokhtari-Esbuie, Farzad

2012-01-01

Williams-Beuren syndrome is a rare familial multisystem disorder occurring in 1 per 20,000 live births. It is characterized by congenital heart defects (CHD), skeletal and renal anomalies, cognitive disorder, social personality disorder and dysmorphic facies. We present a case of Williams syndrome that presented to us with heart murmur and cognitive problem. A 5-year-old girl referred to pediatric cardiologist because of heart murmurs. She had a systolic murmur (2-3/6) in right upper sternal border with radiation to right cervical region. She also had a bulge forehead. Angiography showed mild supra valvular aortic stenosis and mild multiple peripheral pulmonary stenosis. Fluorescent in situ hybridization (FISH) was performed and the result was: 46.XX, ish del (7q11.2) (ELN X1) (7q22 X2) ELN deletion compatible with Williams syndrome. Peripheral pulmonary artery stenosis is associated with Noonan syndrome, Alagille syndrome, Cutis laxa, Ehler-Danlos syndrome, and Silver-Russel syndrome. The patient had peripheral pulmonary artery stenosis, but no other signs of these syndromes were present, and also she had a supravalvular aortic stenosis which was not seen in other syndromes except Williams syndrome. Conclusion. According to primary symptoms, paraclinical and clinical finding such as dysmorphic facies, cognitive disorder and congenital heart defect, Williams syndrome was the first diagnosis. We suggest a more attention for evaluating heart murmur in childhood period, especially when the patient has abnormal facial features or mental problem.

Comparison of conventional and sensor-based electronic stethoscopes in detecting cardiac murmurs of dogs.

PubMed

Vörös, K; Bonnevie, A; Reiczigel, J

2012-04-24

Cardiac auscultation is one of the most important parts of the cardiological examination traditionally performed with acoustic stethoscopes. The aim of this study was to compare the sensitivities and the diagnostic capabilities of traditional and electronic stethoscopes in detecting canine heart murmurs. The study was performed on 21 dogs referred for cardiologic examination with suspected heart murmurs. Six out of these dogs had cardiac murmurs bilaterally. Cardiac auscultation was performed independently by a final-year veterinary student (AB=I1) and by an experienced clinician (KV=I2), both using a traditional and a Welch Allyn Meditron electronic sensor-based stethoscope. Final diagnoses were established by echocardiography and by digital phonocardiography. Correct detection of a murmur was made by I1 with a traditional stethoscope in 20/27 (74.0%) of the suspected murmurs (p=0.30, kappa[κ] =0.2) and with the electronic stethoscope in 26/27 (96.3%), respectively (p=0.0013, κ=0.75). I2 correctly detected the murmurs with the traditional stethoscope in 25/27 (92.6%) cases (p=0.0013, κ=0.75) and with the electronic stethoscope in all 27/27 (100%) cases (p=0.00012, κ=1). Agreements of murmur intensity gradings between traditional and electronic stethoscopes were highly significant (I1: p=6.9´10⁻⁸; κ=0.79), (I2: p=5.2´10⁻¹¹; κ=0.92). When grading the murmurs with the traditional stethoscope, there was a significant agreement between I1 and I2 (p=2.9´10⁻⁷; κ=0.79), being even higher with the electronic stethoscope (p=1.1´10⁻¹¹; κ=0.92). The electronic stethoscope was more sensitive than the traditional one in detecting and grading cardiac murmurs being especially useful for I1 with less experience. However, it can be suggested to use a traditional and an electronic stethoscopes simultaneously to optimally utilize their advantages.

Evaluation of cardiac auscultation skills in pediatric residents.

PubMed

Kumar, Komal; Thompson, W Reid

2013-01-01

Auscultation skills are in decline, but few studies have shown which specific aspects are most difficult for trainees. We evaluated individual aspects of cardiac auscultation among pediatric residents using recorded heart sounds to determine which elements pose the most difficulty. Auscultation proficiency was assessed among 34 trainees following a pediatric cardiology rotation using an open-set format evaluation module, similar to the actual clinical auscultation description process. Diagnostic accuracy for distinguishing normal from abnormal cases was 73%. Findings most commonly correctly identified included pathological systolic and diastolic murmurs and widely split second heart sounds. Those least likely to be identified included continuous murmurs and clicks. Accuracy was low for identifying specific diagnoses. Given time constraints for clinical skills teaching, this suggests that focusing on distinguishing normal from abnormal heart sounds and murmurs instead of making specific diagnoses may be a more realistic goal for pediatric resident auscultation training.

Williams-Beuren's Syndrome: A Case Report

PubMed Central

Zamani, Hassan; Babazadeh, Kazem; Fattahi, Saeid; Mokhtari-Esbuie, Farzad

2012-01-01

Williams-Beuren syndrome is a rare familial multisystem disorder occurring in 1 per 20,000 live births. It is characterized by congenital heart defects (CHD), skeletal and renal anomalies, cognitive disorder, social personality disorder and dysmorphic facies. We present a case of Williams syndrome that presented to us with heart murmur and cognitive problem. A 5-year-old girl referred to pediatric cardiologist because of heart murmurs. She had a systolic murmur (2-3/6) in right upper sternal border with radiation to right cervical region. She also had a bulge forehead. Angiography showed mild supra valvular aortic stenosis and mild multiple peripheral pulmonary stenosis. Fluorescent in situ hybridization (FISH) was performed and the result was: 46.XX, ish del (7q11.2) (ELN X1) (7q22 X2) ELN deletion compatible with Williams syndrome. Peripheral pulmonary artery stenosis is associated with Noonan syndrome, Alagille syndrome, Cutis laxa, Ehler-Danlos syndrome, and Silver-Russel syndrome. The patient had peripheral pulmonary artery stenosis, but no other signs of these syndromes were present, and also she had a supravalvular aortic stenosis which was not seen in other syndromes except Williams syndrome. Conclusion. According to primary symptoms, paraclinical and clinical finding such as dysmorphic facies, cognitive disorder and congenital heart defect, Williams syndrome was the first diagnosis. We suggest a more attention for evaluating heart murmur in childhood period, especially when the patient has abnormal facial features or mental problem. PMID:22927862

Prevalence and diagnostic characteristics of non-clinical mitral regurgitation murmurs in North American Whippets.

PubMed

Stepien, R L; Kellihan, H B; Luis Fuentes, V

2017-08-01

To assess the prevalence of functional ejection murmurs and murmurs of mitral regurgitation (MR) due to myxomatous mitral valve disease in healthy whippets; to assess the diagnostic value of auscultation to detect MR; and investigate the relationship between age and presence of echocardiographically documented MR (MR echo ). A total of 200 healthy client-owned Whippets, recruited at national shows between 2005 and 2009 were involved in this study. Cross-sectional study. Dogs were examined by auscultation by one examiner and Doppler echocardiography by another, and results were compared. Prevalence of types of murmurs and MR echo were calculated and correlated to age. Accuracy of auscultation to predict MR echo was calculated. Left-sided systolic heart murmurs were detected in 185/200 (93%) of dogs. Left apical systolic murmurs (L apex ) were detected in 57/200 (29%) and left basilar systolic murmurs (L base ) in 128/200 of the dogs (64%). MR echo was present in 76/200 (38%) dogs. Prevalence MR echo was correlated with age (r = 0.96, p=0.0028). Mitral regurgitation detected by echocardiography was present in 12/78 (15%) of the dogs ≤ 2 years of age and in 59% of the dogs at 7-8 years old. Detection of L apex predicted MR echo with sensitivity 65%, specificity 94%, positive predictive value 86%, and negative predictive value 81%; and accuracy improved when only dogs with more intense L apex (grade ≥ 3/6) were considered. Systolic murmurs are common in North American Whippets and this breed exhibits a high prevalence of MR echo , which may be documented at a relatively early age. Whippets with non-clinical MR echo may not be identifiable by auscultation alone; echocardiographic examination may be required to exclude a diagnosis of MR. Louder heart murmurs allow more accurate localization in this population. Copyright © 2017 Elsevier B.V. All rights reserved.

[Influence of detomidine on echocardiographic function parameters and cardiac hemodynamics in horses with and without heart murmur].

PubMed

Gehlen, H; Kroker, K; Deegen, E; Stadler, P

2004-03-01

30 warmblood horses were examined before and after sedation with 20 micrograms/kg BW detomidine, to determine changes of cardiac function parameters, using B-mode, M-mode and Doppler echocardiography. 15 horses showed a heart murmur, but no clinical signs of cardiac heart failure, 15 horses had neither a heart murmur nor other signs of cardiac disease. After sedation with detomidine we could recognise a significant increase of end-diastolic left atrium diameter, an increase of end-systolic left ventricular diameter and aortic root diameter. The end-systolic thickness of papillary muscle and interventricular septum showed a decrease. Fractional shortening and amplitude of left ventricular wall motion was decreased after sedation. The mitral valve echogram revealed a presystolic valve closure and an inflection in the Ac slope (B-notch) in xy horses before sedation. Both increased after sedation with detomidine. Doppler echocardiography showed a decrease of blood flow velocity and velocity time integral (VTI) in the left and right ventricular outflow tract after sedation. Regurgitant flow signals were intensified following sedation in xy horses, especially at the mitral valve.

Mitral valve prolapse

MedlinePlus

... and lungs. The provider may feel a thrill (vibration) over the heart, and hear a heart murmur ( ... many heart medicines that may be used to control this condition. You may need surgery to repair ...

Fluid Dynamics of the Generation and Transmission of Heart Sounds: (2): Direct Simulation using a Coupled Hemo-Elastodynamic Method

NASA Astrophysics Data System (ADS)

Seo, Jung-Hee; Bakhshaee, Hani; Zhu, Chi; Mittal, Rajat

2015-11-01

Patterns of blood flow associated with abnormal heart conditions generate characteristic sounds that can be measured on the chest surface using a stethoscope. This technique of `cardiac auscultation' has been used effectively for over a hundred years to diagnose heart conditions, but the mechanisms that generate heart sounds, as well as the physics of sound transmission through the thorax, are not well understood. Here we present a new computational method for simulating the physics of heart murmur generation and transmission and use it to simulate the murmurs associated with a modeled aortic stenosis. The flow in the model aorta is simulated by the incompressible Navier-Stokes equations and the three-dimensional elastic wave generation and propagation on the surrounding viscoelastic structure are solved with a high-order finite difference method in the time domain. The simulation results are compared with experimental measurements and show good agreement. The present study confirms that the pressure fluctuations on the vessel wall are the source of these heart murmurs, and both compression and shear waves likely plan an important role in cardiac auscultation. Supported by the NSF Grants IOS-1124804 and IIS-1344772, Computational resource by XSEDE NSF grant TG-CTS100002.

Congenital heart diseases in the boxer dog: A retrospective study of 105 cases (1998-2005).

PubMed

Chetboul, V; Trollé, J M; Nicolle, A; Carlos Sampedrano, C; Gouni, V; Laforge, H; Benalloul, T; Tissier, R; Pouchelon, J-L

2006-09-01

Subaortic stenosis (SAS) is one of the most common congenital heart diseases (CHD) in dogs with Boxers being predominantly affected. However, the increasing availability of modern diagnostic imaging systems now allows a better assessment of cardiac morphology and function, thereby facilitating early detection of CHD in awake animals. In this context, the case records of Boxer dogs diagnosed with CHD using echocardiography combined with Doppler mode, were retrospectively reviewed (1998-2005). One hundred and five Boxers exhibiting either a single CHD (53/105, 50.5%) or association of several CHD (52/105, 49.5%) were included. The most common CHD was atrial septal defect (ASD) observed in 56.2% of these animals (59/105), followed by mitral dysplasia (58/105, 55.2%), and SAS (49/105, 46.7%). SAS was associated with one or two CHD in 29.5% of cases (31/105). Most of the dogs with a low intensity left heart base systolic murmur had an isolated ASD whereas most of the dogs with a similar but high intensity murmur had SAS, either isolated or associated with a concurrent CHD. The incidence of ASD and mitral dysplasia in Boxer dogs is higher than previously assumed, and ASD is a common cause of left heart base systolic murmur in this breed of dog. This confirms that the detection of such a murmur should not be used as the unique criterion for diagnostic confirmation of SAS.

Valvular dysplasia and congestive heart failure in a juvenile African penguin (Spheniscus demersus).

PubMed

McNaughton, Allyson; Frasca, Salvatore; Mishra, Neha; Tuttle, Allison D

2014-12-01

Abstract: An aquarium-housed, 6-mo-old African penguin (Spheniscus demersus) presented with acute respiratory distress. Auscultation revealed a grade II-III systolic murmur in the absence of adventitial sounds, and an enlarged heart without pulmonary edema was seen radiographically. Echocardiographic evaluation revealed atrioventricular (AV) valvular dysplasia and ventricular enlargement. The penguin was treated with enalapril, furosemide, and pimobendan but died within 3 wk of detection of the murmur. Congenital dysplasia of the right AV valve with right atrial and ventricular dilation and ventricular hypertrophy were diagnosed on postmortem examination.

Anxiety and depressive symptoms and anxiety sensitivity in youngsters with noncardiac chest pain and benign heart murmurs.

PubMed

Lipsitz, Joshua D; Masia-Warner, Carrie; Apfel, Howard; Marans, Zvi; Hellstern, Beth; Forand, Nicholas; Levenbraun, Yosef; Fyer, Abby J

2004-12-01

Chest pain in children and adolescents is rarely associated with cardiac disease. We sought to examine psychological symptoms in youngsters with medically unexplained chest pain. We hypothesized that children and adolescents with medically unexplained chest pain would have high rates of anxiety and depressive symptoms. We assessed 65 youngsters with noncardiac chest pain (NCCP) and 45 comparison youngsters with benign heart murmurs using self-report measures of anxiety and depressive symptoms and anxiety sensitivity. Compared with the asymptomatic benign-murmur group, youngsters with NCCP had higher levels of some anxiety symptoms and anxiety sensitivity. Differences on depressive symptoms were not significant. Though preliminary, results suggest that youngsters with chest pain may experience increased levels of some psychological symptoms. Future studies of noncardiac chest pain in youngsters should include larger samples and comprehensive diagnostic assessments as well as long-term follow-up evaluations.

A PDA-based instructional tool to monitor students' cardiac auscultation during a medicine clerkship.

PubMed

Torre, D M; Sebastian, J L; Simpson, D E

2005-09-01

Cardiac auscultation is an important skill for medical students to master but students' exposure to cardiac auscultation is often unmonitored. The objective of this study was to gather data at the point of care about students' cardiac auscultation experience on a required medicine rotation using a Personal Digital Assistant (PDA) 'murmur form'. During an eight-month period, 120 M3 students used the authors' PDA-based learning tool to record information on 940 heart sounds and murmurs. Some 93% of all heart sounds/murmurs reported by students were verified by either a faculty member (56%) or a supervising resident (43%). A PDA can be a useful tool to monitor students' experiences of cardiac auscultation and to track direct observation of such skills by faculty or residents. Medical students are eager to use technology at the point of care to practice their clinical skills.

Dynamic right ventricular outflow tract (infundibular) stenosis and pectus excavatum in a dog

PubMed Central

Fournier, Tanya E.

2008-01-01

This is the first published report of a dog with dynamic right ventricular outflow tract (infundibular) stenosis, right ventricular hypertrophy, and pectus excavatum. A juvenile dog presented with a grade V/VI left base systolic heart murmur, tachycardia, and pectus excavatum. Diagnosis of the aforementioned conditions was based on radiography, electrocardiography, and echocardiography. At 9 1/2 wk of age the heart murmur was no longer audible and the right ventricular stenosis and hypertrophy had dissipated and regressed, respectively. Resolution may be associated with growth of the dog. A good prognosis is foreseen. PMID:18512460

What Is a Heart Murmur?

MedlinePlus

... Pressure Holes in the Heart How the Heart Works Stress Testing Tetralogy of Fallot Building 31 31 Center Drive Bethesda, MD 20892 Learn more about getting to NIH Get Email Alerts Receive automatic alerts about NHLBI related news and highlights from across the Institute. Learn ...

Evaluation of a focussed protocol for hand-held echocardiography and computer-assisted auscultation in detecting latent rheumatic heart disease in scholars.

PubMed

Zühlke, Liesl J; Engel, Mark E; Nkepu, Simpiwe; Mayosi, Bongani M

2016-08-01

Introduction Echocardiography is the diagnostic test of choice for latent rheumatic heart disease. The utility of echocardiography for large-scale screening is limited by high cost, complex diagnostic protocols, and time to acquire multiple images. We evaluated the performance of a brief hand-held echocardiography protocol and computer-assisted auscultation in detecting latent rheumatic heart disease with or without pathological murmur. A total of 27 asymptomatic patients with latent rheumatic heart disease based on the World Heart Federation criteria and 66 healthy controls were examined by standard cardiac auscultation to detect pathological murmur. Hand-held echocardiography using a focussed protocol that utilises one view - that is, the parasternal long-axis view - and one measurement - that is, mitral regurgitant jet - and a computer-assisted auscultation utilising an automated decision tool were performed on all patients. The sensitivity and specificity of computer-assisted auscultation in latent rheumatic heart disease were 4% (95% CI 1.0-20.4%) and 93.7% (95% CI 84.5-98.3%), respectively. The sensitivity and specificity of the focussed hand-held echocardiography protocol for definite rheumatic heart disease were 92.3% (95% CI 63.9-99.8%) and 100%, respectively. The test reliability of hand-held echocardiography was 98.7% for definite and 94.7% for borderline disease, and the adjusted diagnostic odds ratios were 1041 and 263.9 for definite and borderline disease, respectively. Computer-assisted auscultation has extremely low sensitivity but high specificity for pathological murmur in latent rheumatic heart disease. Focussed hand-held echocardiography has fair sensitivity but high specificity and diagnostic utility for definite or borderline rheumatic heart disease in asymptomatic patients.

Innocence and resisting confession during interrogation: effects on physiologic activity.

PubMed

Guyll, Max; Madon, Stephanie; Yang, Yueran; Lannin, Daniel G; Scherr, Kyle; Greathouse, Sarah

2013-10-01

Innocent suspects may not adequately protect themselves during interrogation because they fail to fully appreciate the danger of the situation. This experiment tested whether innocent suspects experience less stress during interrogation than guilty suspects, and whether refusing to confess expends physiologic resources. After experimentally manipulating innocence and guilt, 132 participants were accused and interrogated for misconduct, and then pressured to confess. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), respiratory sinus arrhythmia (RSA), and preejection period (PEP) responses quantified stress reactions. As hypothesized, the innocent evidenced smaller stress responses to interrogation for SBP, DBP, HR, and RSA than did the guilty. Furthermore, innocents who refused to confess exhibited greater sympathetic nervous system activation, as evidenced by shorter PEPs, than did innocent or guilty confessors. These findings suggest that innocent suspects underestimate the threat of interrogation and that resisting pressures to confess can diminish suspects' physiologic resources and lead to false confessions. PsycINFO Database Record (c) 2013 APA, all rights reserved

Retrospective study of 156 atrial septal defects in dogs and cats (2001-2005).

PubMed

Chetboul, V; Charles, V; Nicolle, A; Sampedrano, C Carlos; Gouni, V; Pouchelon, J-L; Tissier, R

2006-05-01

Atrial septal defect (ASD) is a common congenital heart disease (CHD) in humans, but considered relatively rare in veterinary medicine. However, modern echocardiographic and Doppler techniques currently offer a good view of the morphology of the interatrial septum, thus facilitating earlier detection of ASD in awake animals. In this context, we carried out a retrospective study of cases of recently diagnosed ASD in dogs and cats at the Cardiology Unit of Alfort (2001-2005) using echocardiography combined with colour Doppler mode. ASD was diagnosed in 156 animals and represented 37.7% of all canine and feline CHDs (n = 414). ASD was the most common CHD after mitral dysplasia in both species. Boxer and Domestic shorthair were the most common canine and feline breeds affected. Most defects (98.7%) were secundum-type ASD, without clinical signs in 73.7% of cases. The most common clinical signs included systolic murmur heard over the left heart base (20.2%), exercise intolerance (7.0%), syncope (5.3%), dyspnoea (2.6%) and cough (2.6%). Animals that presented a systolic heart murmur over the left base had a significantly larger ASD than others (P < 0.05). These data suggest that the incidence of ASD is higher than previously assumed. ASD should be suspected, for example, in instances of left basal systolic heart murmur, although its clinical and haemodynamic consequences are usually minor.

[NT-proBNP as a diagnostic marker in dogs with dyspnea and in asymptomatic dogs with heart murmur].

PubMed

Haßdenteufel, E; Kresken, J-G; Henrich, E; Hildebrandt, N; Schneider, C; Stosic, A; Schneider, M

2012-01-01

The cardiac biomarker NT-proBNP indicates cardiac load in terms of myocardial wall stress. The objective of the study was to compare the results of NT-proBNP measurements in healthy dogs and dogs with dyspnea as well as asymptomatic dogs with heart murmur with the literature. Between April 2007 and December 2007 dogs with dyspnea of non-cardiac origin (n=11), dogs with dyspnea of cardiac origin (n=18) and asymptomatic dogs with heart murmur (n=22) were included. Twelve clinically healthy dogs served as a control group. All animals underwent cardiologic examination including echocardiography and measurement of serum NT-proBNP concentration. Serum was centrifuged and frozen within 30 minutes and was stored frozen until analysis was performed. Median NT-proBNP concentration in healthy dogs was 240 pmol/l (range 131-546 pmol/l). Dogs with dyspnea and primary respiratory disease displayed a median NT-proBNP concentration of 876 pmol/l (range 97-2614 pmol/l). In patients with dyspnea of non-cardiac origin, there was a difference in the values of NT-proBNP of dogs with and without pulmonary hypertension diagnosed by echocardiography. Dogs with dyspnea of cardiac origin displayed a median NT-proBNP concentration of 2000 pmol/l (range 137-2614 pmol/l). Low normal NT-proBNP values were only found in patients with pericardial effusion. Median NT-proBNP concentration in asymptomatic dogs with heart murmur was 698.5 pmol/l (range 121-2614 pmol/l). Considerably increased values were particularly measured in asymptomatic patients with severe congenital heart disease. NT-proBNP represents a useful additional diagnostic parameter in veterinary clinical cardiology to assess the severity of cardiac disease. Interpretation must take into consideration the clinical picture of the patient, as dogs with severe arrhythmias, sepsis and pulmonary thromboembolism may display high NT-proBNP levels without congestive heart failure. Our results indicate the following cut-off values: <500 pmol/l: no relevant cardiac load; 500-900 pmol/l: moderate cardiac load; >900 pmol/l: severe cardiac load.

A method for the computational modeling of the physics of heart murmurs

NASA Astrophysics Data System (ADS)

Seo, Jung Hee; Bakhshaee, Hani; Garreau, Guillaume; Zhu, Chi; Andreou, Andreas; Thompson, William R.; Mittal, Rajat

2017-05-01

A computational method for direct simulation of the generation and propagation of blood flow induced sounds is proposed. This computational hemoacoustic method is based on the immersed boundary approach and employs high-order finite difference methods to resolve wave propagation and scattering accurately. The current method employs a two-step, one-way coupled approach for the sound generation and its propagation through the tissue. The blood flow is simulated by solving the incompressible Navier-Stokes equations using the sharp-interface immersed boundary method, and the equations corresponding to the generation and propagation of the three-dimensional elastic wave corresponding to the murmur are resolved with a high-order, immersed boundary based, finite-difference methods in the time-domain. The proposed method is applied to a model problem of aortic stenosis murmur and the simulation results are verified and validated by comparing with known solutions as well as experimental measurements. The murmur propagation in a realistic model of a human thorax is also simulated by using the computational method. The roles of hemodynamics and elastic wave propagation on the murmur are discussed based on the simulation results.

Digital signal processing of the phonocardiogram: review of the most recent advancements.

PubMed

Durand, L G; Pibarot, P

1995-01-01

The objective of the present paper is to provide a detailed review of the most recent developments in instrumentation and signal processing of digital phonocardiography and heart auscultation. After a short introduction, the paper presents a brief history of heart auscultation and phonocardiography, which is followed by a summary of the basic theories and controversies regarding the genesis of the heart sounds. The application of spectral analysis and the potential of new time-frequency representations and cardiac acoustic mapping to resolve the controversies and better understand the genesis and transmission of heart sounds and murmurs within the heart-thorax acoustic system are reviewed. The most recent developments in the application of linear predictive coding, spectral analysis, time-frequency representation techniques, and pattern recognition for the detection and follow-up of native and prosthetic valve degeneration and dysfunction are also presented in detail. New areas of research and clinical applications and areas of potential future developments are then highlighted. The final section is a discussion about a multidegree of freedom theory on the origin of the heart sounds and murmurs, which is completed by the authors' conclusion.

Atrial Septal Defect (For Kids)

MedlinePlus

... eventually become the walls and chambers of the baby's heart. If a problem happens during this process, a ... was exposed to chemicals or drugs while the baby was growing inside her. For ... who have ASDs have their heart murmur found by their regular doctor. Then they ...

Asymptomatic young man with an incidental murmur.

PubMed

Shojaeifard, Maryam; Pouraliakbar, Hamid Reza; Houshmand, Golnaz

2018-05-31

A 32-year old man was referred to our institution for transthoracic echocardiography (TTE) following detection of an incidental murmur on physical examination before blood donation. He was asymptomatic with no significant medical history. Physical examination revealed dual heart sounds with a grade II/VI systolic murmur heard in the left sternal border. An ECG was in normal sinus rhythm. TTE was performed (figure 1A-C, online supplementary videos 1-4) followed by cardiac CT angiography (CTA) (figure 1D,E).heartjnl;heartjnl-2018-313223v1/F1F1F1Figure 1(A) Transthoracic echocardiography, parasternal left ventricular long axis view. (B) Colour Doppler of modified short axis in the mid-left ventricular level. (C) Doppler flow velocity profile. (D) Cardiac CT angiography (CTA) sagittal reconstruction. (E) Three-dimensional CTA reconstruction of the heart. What is the diagnosis?Pericardial cyst.Ventricular septal defect.Kawasaki.Anomalous left coronary artery from pulmonary artery (ALCAPA). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Biophysics of Heart Sounds and Its Application to Clinical Auscultation

PubMed Central

Faber, J. Job; Burton, Alan C.

1964-01-01

Much research has been carried out recently into the means by which heart sounds and murmurs reach the stethoscope from their point of origin. Heart sounds originate as vibrations of the cardiac valves and travel as transverse vibrations with low velocity over the walls of the ventricles and great vessels. Where these structures are in contact with the thoracic surface they emerge, at the `auscultatory areas', and spread like ripples over the chest surface. Murmurs originate in the cavities receiving the blood stream, and are loudest in the cavity that is less distensible. Frequency, damping in transit and the possible misinterpretation of apparent `splitting' seen in phonocardiographic records are discussed. This basic knowledge of modes of transmission allows the interpretation of unusual locations of auscultatory areas in disease states, and explains some puzzling findings obtained with microphones mounted on cardiac catheters. ImagesFig. 3Fig. 6 PMID:14174528

Effects of sounds generated by a dental turbine and a stream on regional cerebral blood flow and cardiovascular responses.

PubMed

Mishima, Riho; Kudo, Takumu; Tsunetsugu, Yuko; Miyazaki, Yoshifumi; Yamamura, Chie; Yamada, Yoshiaki

2004-09-01

Effects of sound generated by a dental turbine and a small stream (murmur) and the effects of no sound (null, control) on heart rate, systolic and diastolic blood pressure, and hemodynamic changes (oxygenated, deoxygenated, and total hemoglobin concentrations) in the frontal cortex were measured in 18 young volunteers. Questionnaires completed by the volunteers were also evaluated. Near-infrared spectroscopy and the Finapres technique were employed to measure hemodynamic and vascular responses, respectively. The subjects assessed the murmur, null, and turbine sounds as "pleasant," "natural," and "unpleasant," respectively. Blood pressures changed in response to the murmur, null, and turbine sound stimuli as expected: lower than the control level, unchanged, and higher than the control level, respectively. Mean blood pressure values tended to increase gradually over the recording time even during the null sound stimulation, possibly because of the recording environment. Oxygenated hemoglobin concentrations decreased drastically in response to the dental turbine sound, while deoxygenated hemoglobin concentrations remained unchanged and thus total hemoglobin concentrations decreased (due to the decreased oxygenated hemoglobin concentrations). Hemodynamic responses to the murmuring sound and the null sound were slight or unchanged, respectively. Surprisingly, heart rate measurements remained fairly stable in response to the stimulatory noises. In conclusion, we demonstrate here that sound generated by a dental turbine may affect cerebral blood flow and metabolism as well as autonomic responses. Copyright 2004 The Society of the Nippon Dental University

Dynamic left ventricular outflow tract obstruction secondary to hypovolemia in a German Shepard dog with splenic hemangiosarcoma.

PubMed

Aoki, Takuma; Sunahara, Hiroshi; Sugimoto, Keisuke; Ito, Tetsuro; Kanai, Eiichi; Neo, Sakurako; Fujii, Yoko; Wakao, Yoshito

2015-09-01

Dynamic left ventricular outflow tract obstruction (DLVOTO) is a common condition in cats and humans. In this case report, a dog is described with DLVOTO secondary to severe intra-abdominal hemorrhage caused by a hemangiosarcoma. The dog was a 9-year-old, 35.7-kg, spayed female German Shepard dog that presented with a history of tachypnea and collapse. A Levine II/VI systolic murmur was present at the heart base. Abdominal ultrasonography revealed a splenic mass and a large amount of ascites. Echocardiography showed a reduced left ventricular diameter and an increased aortic velocity caused by systolic anterior motion (SAM) of the mitral valve apparatus. The heart murmur and the SAM were resolved after treatment including a splenectomy and a blood transfusion.

Left coronary aneurysmal dilation and subaortic stenosis in a dog.

PubMed

Hernandez, Juan L; Bélanger, Marie-Claude; Benoit-Biancamano, Marie-Odile; Girard, Christiane; Pibarot, Philippe

2008-06-01

A 6-month-old German shepherd dog was referred for evaluation of a cardiac murmur. Upon physical examination, the auscultated heart rate was 120 beats/min, and a grade IV/VI systolic heart murmur with a point of maximal intensity over the left heart base radiating up the neck was heard. The standard echocardiographic examination showed subaortic stenosis and an anechoic tubular structure extending from the sinus of Valsalva to the left ventricular posterior wall. Aneurysmal left coronary artery (CA) was confirmed by angiography. The dog was euthanized and post-mortem examination showed severe dilatation of the proximal left CA and confirmed the subaortic stenosis. Histopathology did not demonstrate abnormalities in the walls of the CA, aorta or pulmonary artery. The exact cause of the CA aneurysmal dilation remains unknown. Subaortic stenosis, elevated coronary vascular resistance or a congenital anomaly may have contributed to the dilation. To our knowledge, coronary aneurysmal dilation has never been described in dogs. Standard echocardiography provides reliable information on coronary anatomy.

Pulmonary artery dissection following balloon valvuloplasty in a dog with pulmonic stenosis.

PubMed

Grint, K A; Kellihan, H B

2017-04-01

A 3-month-old, 9.9 kg, male pit bull cross was referred for evaluation of collapse. A left basilar systolic heart murmur graded V/VI and a grade IV/VI right basilar systolic heart murmur were ausculted. Echocardiography showed severe pulmonic stenosis characterized by annular hypoplasia, leaflet thickening, and leaflet fusion. After 1 month of atenolol therapy, a pulmonic valve balloon valvuloplasty procedure was performed, and the intra-operative right ventricular pressure was reduced by 43%. Echocardiography, performed the following day, showed apparent rupture of a pulmonary valve leaflet and a membranous structure within the pulmonary artery consistent with a dissecting membrane. Short-term follow-up has shown no apparent progression of the pulmonary artery dissection and the patient remains free of clinical signs. Copyright © 2016 Elsevier B.V. All rights reserved.

Quality of Care Provided by Physician’s Extenders in Air Force Primary Medicine Clinics.

DTIC Science & Technology

1980-01-01

WITHOUT 214 ARRHYTHMIAS OR HEART BLOCK GASTROENTERITIS :634 HEART MURMUR [ 11 13. 15 MEASLES. MUMPS, CHICKEN POX 213. 215. 217 OTHER HEART DISEASES 01...mumps, chicken pox 8 11 7 16 Hepatitis or exposure to hepatitis 11 8 4 17 Infectious mononucleosis 1 15 2 *4 Gonorrhea (or exposure to gonorrhea) 17 28...Operation of the New Mexico Experimental Medical Care Review Organization," Medical Care 14 (Supplement 9), December 1976. Daniels, M., and S. A

The relevance of echocardiography heart measures for breeding against the risk of subaortic and pulmonic stenosis in Boxer dogs.

PubMed

Menegazzo, L; Bussadori, C; Chiavegato, D; Quintavalla, C; Bonfatti, V; Guglielmini, C; Sturaro, E; Gallo, L; Carnier, P

2012-02-01

The aims of this study were to investigate the role and relative importance of auscultation and echocardiography traits as risk factors for the diagnosis of subaortic (SubAS) and pulmonic (PS) stenosis and to estimate the heritability (h(2)) of cardiac measurements taken through echocardiography for a random sample of Italian Boxer dogs. The data were cardiovascular examination results of 1,283 Italian Boxer dogs (686 females and 597 males) enrolled in the national screening program for heart defects arranged by the Italian Boxer Club. Examinations were performed during a 6-yr period by a group of 7 veterinary cardiologists following a standard protocol. Occurrence and severity of SubAS and PS were diagnosed, taking into account clinical and echocardiography findings such as the grade of cardiac murmur, direct ultrasound imaging of the anatomic obstructive lesions, and values of aortic or pulmonary blood flow velocities. A Bayesian logistic regression analysis was performed to identify clinical and echocardiography variables related to SubAS and PS diagnosis. Estimation of variance components for clinical and echocardiography traits was performed using a mixed linear animal model, Bayesian procedures, and the Gibbs sampler. Prevalence of SubAS (PS) was 8.4% (2.2) and 10.7% (6.4) for female and male dogs, respectively. Cardiac murmur, peak velocities, and annulus areas behaved as risk factors for SubAS and PS. The risk of a positive diagnosis for SubAS was 3 times greater for dogs with aortic annulus area <2.1 cm(2) relative to dogs with areas >2.37 cm(2), 84 times greater for dogs showing aortic peak velocities >2.19 m/s relative to dogs with peak velocities <1.97 m/s, and 41 times greater for dogs with moderate to severe murmur grades relative to dogs with absent murmur. Similar results were obtained for PS. The estimated h(2) for the occurrence of cardiac defects was 23.3% for SubAS and 8.6% for PS. Echocardiography and cardiac murmur grades exhibited moderate h(2) estimates and exploitable additive genetic variation. The estimated h(2) was 36, 24, and 20% for aortic annulus area, aortic peak velocity, and cardiac murmur score, respectively. For the area of the pulmonary annulus and peak pulmonary velocity, the estimated h(2) were smaller, ranging from 9.5 to 12.8%. These measures are candidate indicator traits that might be effectively used in dog breeding to reduce the prevalence and severity of cardiac defects.

Progression of aortic stenosis in the boxer.

PubMed

French, A; Luis Fuentes, V; Dukes-McEwan, J; Darke, P G; Martin, M; Corcoran, B

2000-10-01

Thirty-five boxers that had been referred to the Royal (Dick) School of Veterinary Studies between 1989 and 1994 with left heart base murmurs and aortic velocities greater than 1.5 m/second on Doppler echocardiography were recalled for clinical examination and Doppler echocardiography between 1995 and 1996. Five dogs (14 per cent) showed an increase in murmur grade on repeat visit. Six dogs (17 per cent) showed an increase in aortic velocity of greater than 20 per cent. Eight dogs (23 per cent) had developed aortic valvular or subvalvular two-dimensional echocardiographic changes that had not been present at the initial visit. Seven dogs (20 per cent) had developed aortic regurgitation, and three dogs (8 per cent) mitral regurgitation.

A quality assessment of cardiac auscultation material on YouTube.

PubMed

Camm, Christian F; Sunderland, Nicholas; Camm, A John

2013-02-01

YouTube is a highly utilized Web site that contains a large amount of medical educational material. Although some studies have assessed the education material contained on the Web site, little analysis of cardiology content has been made. This study aimed to assess the quality of videos relating to heart sounds and murmurs contained on YouTube. We hypothesized that the quality of video files purporting to provide education on heart auscultation would be highly variable. Videos were searched for using the terms "heart sounds," "heart murmur," and "heart auscultation." A built-in educational filter was employed, and manual rejection of non-English language and nonrelated videos was undertaken. Remaining videos were analyzed for content, and suitable videos were scored using a purpose-built tool. YouTube search located 3350 videos in total, and of these, 22 were considered suitable for scoring. The average score was 4.07 out of 7 (standard deviation, 1.35). Six videos scored 5.5 or greater and 5 videos scoring 2.5 or less. There was no correlation between video score and YouTube indices of preference (hits, likes, dislikes, or search page). The quality of videos found in this study was highly variable. YouTube indications of preference were of no value in determining the value of video content. Therefore, teaching institutions or professional societies should endeavor to identify and highlight good online teaching resources. YouTube contains many videos relating to cardiac auscultation, but very few are valuable education resources. © 2012 Wiley Periodicals, Inc.

Diastolic mitral and tricuspid regurgitation by Doppler echocardiography in patients with atrioventricular block: new insight into the mechanism of atrioventricular valve closure.

PubMed

Schnittger, I; Appleton, C P; Hatle, L K; Popp, R L

1988-01-01

The purpose of this study was to prospectively determine the incidence of diastolic mitral and tricuspid regurgitation in atrioventricular (AV) block using Doppler echocardiography. The temporal relation between mitral and tricuspid diastolic insufficiency and the diastolic murmur recorded in patients with complete heart block was also investigated. Twenty-two consecutive patients with AV block (referred to the Echo-Doppler laboratory for routine clinical studies), aged 18 to 87 years, were enrolled in the study. Eleven patients had third degree AV block and a ventricular-inhibited (VVI) pacemaker, two patients had second degree AV block, seven patients had first degree AV block, one patient had blocked premature atrial complexes and one patient had atrial flutter with 4:1 AV block. Diastolic mitral regurgitation was detected in 20 patients, and diastolic tricuspid regurgitation in 21. A mid-diastolic murmur was detected in all patients except in the three youngest. The murmur occurred before diastolic regurgitation and coincided with peak forward flow through the AV valve after atrial contraction. M-mode mitral valve echocardiograms obtained in nine patients demonstrated near closure of some portions of the mitral valve after atrial contraction. Effective closure of the valve, however, did not occur unless ventricular systole supervened. In conclusion, diastolic mitral and tricuspid regurgitation are almost universally present in patients with AV block and are associated with a diastolic murmur. The murmur coincides with forward AV valve flow. Diastolic regurgitation is silent. Effective AV valve closure is not established until ventricular systole occurs, as demonstrated by M-mode echocardiographic recording of the mitral valve.

Carcinoid heart disease: Diagnosis and management.

PubMed

Luis, Sushil A; Pellikka, Patricia A

2016-01-01

Hedinger syndrome refers to carcinoid valvular heart disease. The disease is believed to be triggered by vasoactive substances that result in valvular fibrosis. It classically occurs in patients with metastatic carcinoid and preferentially involves the right sided cardiac valves. Affected valves become thickened and retracted, exhibiting regurgitation and sometimes, stenosis. Echocardiography is recommended in patients with carcinoid syndrome and a follow up study is advisable in those who develop a murmur or other symptoms or signs of valvular heart disease. For appropriately selected patients, valve replacement surgery appears to improve outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?

PubMed Central

Favrat, B; Pécoud, A; Jaussi, A

2004-01-01

Background The general proficiency in physical diagnostic skills seems to be declining in relation to the development of new technologies. The few studies that have examined this question have invariably used recordings of cardiac events obtained from patients. However, this type of evaluation may not correlate particularly well with bedside skills. Our objectives were 1) To compare the cardiac auscultatory skills of physicians in training with those of experienced cardiologists by using real patients to test bedside diagnostic skills. 2) To evaluate the impact of a five-month bedside cardiac auscultation training program. Methods 1) In an academic primary care center, 20 physicians (trainees in internal medicine and family practice) and two skilled academic cardiologists listened to 33 cardiac events in 13 patients directly at bedside and identified the cardiac events by completing an open questionnaire. Heart sounds, murmurs and diagnosis were determined beforehand by an independent skilled cardiologist and were validated by echocardiography. Thirteen primary cardiologic diagnoses were possible. 2) Ten of the physicians agreed to participate in a course of 45-minute sessions once a week for 5 months. After the course they listened again to the same patients (pre/post-interventional study). Results 1) The experts were the most skillful, achieving 69% recognition of heart sounds and murmurs and correct diagnoses in 62% of cases. They also heard all of the diastolic murmurs. The residents heard only 40% of the extra heart sounds and made a correct diagnosis in 24% of cases. 2) After the weekly training sessions, their mean percentage for correct diagnosis was 35% [an increase of 66% (p < 0.05)]. Conclusions The level of bedside diagnostic skills in this relatively small group of physicians in training is indeed low, but can be improved by a course focusing on realistic bedside teaching. PMID:15056393

Digital auscultation analysis for heart murmur detection.

PubMed

Delgado-Trejos, Edilson; Quiceno-Manrique, A F; Godino-Llorente, J I; Blanco-Velasco, M; Castellanos-Dominguez, G

2009-02-01

This work presents a comparison of different approaches for the detection of murmurs from phonocardiographic signals. Taking into account the variability of the phonocardiographic signals induced by valve disorders, three families of features were analyzed: (a) time-varying & time-frequency features; (b) perceptual; and (c) fractal features. With the aim of improving the performance of the system, the accuracy of the system was tested using several combinations of the aforementioned families of parameters. In the second stage, the main components extracted from each family were combined together with the goal of improving the accuracy of the system. The contribution of each family of features extracted was evaluated by means of a simple k-nearest neighbors classifier, showing that fractal features provide the best accuracy (97.17%), followed by time-varying & time-frequency (95.28%), and perceptual features (88.7%). However, an accuracy around 94% can be reached just by using the two main features of the fractal family; therefore, considering the difficulties related to the automatic intrabeat segmentation needed for spectral and perceptual features, this scheme becomes an interesting alternative. The conclusion is that fractal type features were the most robust family of parameters (in the sense of accuracy vs. computational load) for the automatic detection of murmurs. This work was carried out using a database that contains 164 phonocardiographic recordings (81 normal and 83 records with murmurs). The database was segmented to extract 360 representative individual beats (180 per class).

A retrospective study of clinical signs and epidemiology of chronic valve disease in a group of 207 Dachshunds in Poland

PubMed Central

2013-01-01

Background Chronic mitral valve disease is frequently seen in the Dachshund. Dachshunds (n=207) made up 11.73% of the dogs admitted to the Cardiology Service at the Small Animal Clinic, Warsaw University of Life Sciences, Poland (first visits only). Results Of these, 35 dogs had no clinically detectable heart disease while 172 had chronic valve disease with the mitral valve affected most often (130 dogs), both mitral and tricuspid valves infrequently (39 dogs) and rarely the tricuspid valve (3 dogs). Males were affected more frequently than females and the average age of dogs with chronic valve disease was 11.9 years for females and 11.3 years for males. A majority of the diseased Dachshunds were classified as ISACHC 2 (79), followed by ISACHC 1 (60). Most frequent clinical signs noted by owners included coughing, exercise intolerance, dyspnea and tachypnea. Heart murmurs were generally louder with increased disease severity; however there were 20 dogs in the ISACHC 1 group with no audible heart murmurs. The most frequent electrocardiographic abnormalities included an increased P wave and QRS complex duration, increased R wave amplitude and tachycardia. With increased disease severity, echocardiography revealed an increase in heart size. A higher ISACHC class was related to increased heart size (based on echocardiography) and increased percentage of patients exhibiting enlargement of both left atrium and left ventricle (based on radiography). Conclusions The Dachshund is often affected by chronic mitral valvular disease with a late onset of associated clinical signs and few cardiac complications. PMID:23844824

An Ineffective Differential Diagnosis of Infective Endocarditis and Rheumatic Heart Disease after Streptococcal Skin and Soft Tissue Infection.

PubMed

Suzuki, Tetsuya; Mawatari, Momoko; Iizuka, Toshihiko; Amano, Tatsuya; Kutsuna, Satoshi; Fujiya, Yoshihiro; Takeshita, Nozomi; Hayakawa, Kayoko; Ohmagari, Norio

2017-09-01

We herein report the case of a 68-year-old woman with a skin and soft tissue infection at her extremities. The blood culture results were positive for Streptococcus pyogenes, and we started treatment using ampicillin and clindamycin, although subsequent auscultation revealed a new-onset heart murmur. We therefore suspected rheumatic heart disease and infective endocarditis. The case met both the Jones criteria and the modified Duke criteria. Transesophageal echocardiography revealed vegetation on the aortic valve, although the pathological findings were also compatible with both rheumatic heart disease and infective endocarditis. The present findings suggest that these two diseases can coexist in some cases.

An Ineffective Differential Diagnosis of Infective Endocarditis and Rheumatic Heart Disease after Streptococcal Skin and Soft Tissue Infection

PubMed Central

Suzuki, Tetsuya; Mawatari, Momoko; Iizuka, Toshihiko; Amano, Tatsuya; Kutsuna, Satoshi; Fujiya, Yoshihiro; Takeshita, Nozomi; Hayakawa, Kayoko; Ohmagari, Norio

2017-01-01

We herein report the case of a 68-year-old woman with a skin and soft tissue infection at her extremities. The blood culture results were positive for Streptococcus pyogenes, and we started treatment using ampicillin and clindamycin, although subsequent auscultation revealed a new-onset heart murmur. We therefore suspected rheumatic heart disease and infective endocarditis. The case met both the Jones criteria and the modified Duke criteria. Transesophageal echocardiography revealed vegetation on the aortic valve, although the pathological findings were also compatible with both rheumatic heart disease and infective endocarditis. The present findings suggest that these two diseases can coexist in some cases. PMID:28794364

Congenital cardiac anomalies in an English bulldog.

PubMed

McConkey, Marina J

2011-11-01

A 4-year-old male castrated English bulldog was referred to the Atlantic Veterinary College for evaluation of exercise intolerance, multiple syncopal episodes, and a grade IV/VI heart murmur. The dog was shown to have 3 congenital cardiac anomalies: atrial septal defect, mitral valve dysplasia, and subaortic stenosis. Medical management consisted of exercise restriction, atenolol, pimobendan, and taurine.

Combining Simulated Patients and Simulators: Pilot Study of Hybrid Simulation in Teaching Cardiac Auscultation

ERIC Educational Resources Information Center

Friederichs, Hendrik; Weissenstein, Anne; Ligges, Sandra; Möller, David; Becker, Jan C.; Marschall, Bernhard

2014-01-01

Auscultation torsos are widely used to teach position-dependent heart sounds and murmurs. To provide a more realistic teaching experience, both whole body auscultation mannequins and torsos have been used in clinical examination skills training at the Medical Faculty of the University of Muenster since the winter term of 2008-2009. This training…

Simulation Training in Health Care

DTIC Science & Technology

2015-06-01

Harvey simulates cardiac and lung disease , including blood pressure, breathing, pulses, heart sounds, and murmurs. A significant step toward the...fluoroscopy, cardiovascu- lar and pulmonary disease diagnosis and treatment, anesthesia, patient -centered programs, basic vital signs emergency care, infant...effectiveness. However, in health care, ethical considerations and the quantification of the expenses of clinician “learning” on patients is a challenge to

Murmur intensity in adult dogs with pulmonic and subaortic stenosis reflects disease severity.

PubMed

Caivano, D; Dickson, D; Martin, M; Rishniw, M

2018-03-01

The aims of this study were to determine whether murmur intensity in adult dogs with pulmonic stenosis or subaortic stenosis reflects echocardiographic disease severity and to determine whether a six-level murmur grading scheme provides clinical advantages over a four-level scheme. In this retrospective multi-investigator study on adult dogs with pulmonic stenosis or subaortic stenosis, murmur intensity was compared to echocardiographically determined pressure gradient across the affected valve. Disease severity, based on pressure gradients, was assessed between sequential murmur grades to identify redundancy in classification. A simplified four-level murmur intensity classification scheme ('soft', 'moderate', 'loud', 'palpable') was evaluated. In total, 284 dogs (153 with pulmonic stenosis, 131 with subaortic stenosis) were included; 55 dogs had soft, 59 had moderate, 72 had loud and 98 had palpable murmurs. 95 dogs had mild stenosis, 46 had moderate stenosis, and 143 had severe stenosis. No dogs with soft murmurs of either pulmonic or subaortic stenosis had transvalvular pressure gradients greater than 50 mmHg. Dogs with loud or palpable murmurs mostly, but not always, had severe stenosis. Stenosis severity increased with increasing murmur intensity. The traditional six-level murmur grading scheme provided no additional clinical information than the four-level descriptive murmur grading scheme. A simplified descriptive four-level murmur grading scheme differentiated stenosis severity without loss of clinical information, compared to the traditional six-level scheme. Soft murmurs in dogs with pulmonic or subaortic stenosis are strongly indicative of mild lesions. Loud or palpable murmurs are strongly suggestive of severe stenosis. © 2017 British Small Animal Veterinary Association.

Isolated severe tricuspid regurgitation: the importance of identifying underlying mechanism.

PubMed

Poh, Kian Keong; Solis, Jorge; Hung, Judy

2008-07-21

An 88-year-old woman presented with right heart failure, history of diarrhoea, abdominal pain, weight lost, dyspnoea over several weeks and a new pan-systolic murmur. Echocardiography showed retracted tricuspid leaflets with incomplete coaptation resulting in severe regurgitation. Subcostal view showed an adjacent hepatic cyst leading to biopsy, which revealed neoplastic neuroendocrine cells. Her 24-hour urinary 5-hydroxyindoleacetic acid level was elevated. The unifying diagnosis was carcinoid syndrome for which she was treated. Echocardiography is an important tool for diagnosis, management and prognosis of carcinoid heart disease.

Results from a Web-Based Family History Questionnaire for the Cohort of the Robert E. Mitchell Center for Prisoner of War Studies

DTIC Science & Technology

2014-05-21

0 0 0 1 1 2 Stent 0 0 0 0 2 2 Stress 0 0 0 1 1 2 Cerebral Hemorrhage 0 0 1 0 0 1 Some Neurological Problems Traced to Vitamin B12... Stents 0 0 0 0 1 1 Grand Mal Seizure 0 0 0 1 0 1 Hardening of the Liver 0 1 0 0 0 1 Heart Murmur 0 0 0 0 1 1 Heart Valve damage from

Measurement and classification of heart and lung sounds by using LabView for educational use.

PubMed

Altrabsheh, B

2010-01-01

This study presents the design, development and implementation of a simple low-cost method of phonocardiography signal detection. Human heart and lung signals are detected by using a simple microphone through a personal computer; the signals are recorded and analysed using LabView software. Amplitude and frequency analyses are carried out for various phonocardiography pathological cases. Methods for automatic classification of normal and abnormal heart sounds, murmurs and lung sounds are presented. Various cases of heart and lung sound measurement are recorded and analysed. The measurements can be saved for further analysis. The method in this study can be used by doctors as a detection tool aid and may be useful for teaching purposes at medical and nursing schools.

Tricuspid valve dysplasia: A retrospective study of clinical features and outcome in dogs in the UK

PubMed Central

Navarro-Cubas, Xavier; Palermo, Valentina; French, Anne; Sanchis-Mora, Sandra; Culshaw, Geoff

2017-01-01

The objective of this study was to determine the demographic, clinical and survival characteristics and to identify risk factors for mortality due to tricuspid valve dysplasia in UK dogs. Records of client-owned dogs diagnosed with tricuspid valve dysplasia at a referral centre were retrospectively reviewed. Only dogs diagnosed with tricuspid valve dysplasia based on the presence of a right-sided heart murmur identified prior to one year of age, and confirmed with Doppler echocardiography, were included. Dogs with concomitant cardiac diseases, pulmonary hypertension and/or trivial tricuspid regurgitation were excluded. Analysed data included signalment, reason for presentation, clinical signs, electrocardiographic and echocardiographic features, survival status and cause of death. Survival times and risk factors for mortality were evaluated using Kaplan-Meier curves and Cox regression. Eighteen dogs met inclusion criteria. Border collies were over-represented (p= 0.014). Dogs were most frequently referred for investigation of heart murmur. The most common arrhythmia was atrial fibrillation (n=3). Median survival time from diagnosis of tricuspid valve dysplasia was 2775 days (range 1-3696 days; 95% CI 1542.41-4007.59) and from onset of right-sided congestive heart failure was 181 days (range 1-2130 days; 95% CI 0-455.59). Syncope was the sole risk factor for cardiac death. In this population of UK dogs, tricuspid valve dysplasia was uncommon but, when severe, frequently led to right-sided congestive heart failure. Prognosis was favourable for mild and moderate tricuspid dysplasia. Survival time was reduced with right-sided congestive heart failure but varied widely. Risk of cardiac death was significantly increased if syncope had occurred. PMID:29296595

Fetal phonocardiography--past and future possibilities.

PubMed

Kovács, Ferenc; Horváth, Csaba; Balogh, Adám T; Hosszú, Gábor

2011-10-01

The paper presents an overview of the 15 year long development of fetal phonocardiography including the works on the applied signal processing methods for identification of sound components. Based on the improvements achieved on this field, the paper shows that beyond the traditional CTG test the phonocardiography may be successfully applied for long-term fetal measurements and home monitoring. In addition, by indication of heart murmurs based on a comprehensive analysis of the recorded heart sound congenital heart defects can also be detected together with additional features in the third trimester. This makes an early widespread screening possible combined with the prescribed CTG test even at home using a telemedicine system. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

'Athlete's heart' in prepubertal children.

PubMed

Rowland, T W; Delaney, B C; Siconolfi, S F

1987-05-01

Bradycardia, cardiomegaly, heart murmurs, and ECG changes are typically observed in adult endurance athletes, but frequency of such changes among children involved in sports training is unclear. Pediatricians need to be aware of whether these features of the "athlete's heart" occur in their patients, because such features may mimic those of cardiac disease. Fourteen prepubertal competitive male swimmers were evaluated by physical examination, ECG and echocardiogram, and findings were compared to those of a group of active but nontrained control boys. Lower resting heart rates and echocardiographic manifestations of chronic left ventricular volume overload were observed among the swimmers. These changes were not manifest on physical examination, however, and no significant ECG alterations were identified among the athletes. These findings indicate that, although features of the athlete's heart are present in children involved in endurance training, seldom will these findings simulate heart disease or be apparent on routine clinical examination.

Cardiac and Respiratory Disease in Aged Horses.

PubMed

Marr, Celia M

2016-08-01

Respiratory and cardiac diseases are common in older horses. Advancing age is a specific risk factor for cardiac murmurs and these are more likely in males and small horses. Airway inflammation is the most common respiratory diagnosis. Recurrent airway obstruction can lead to irreversible structural change and bronchiectasis; with chronic hypoxia, right heart dysfunction and failure can develop. Valvular heart disease most often affects the aortic and/or the mitral valve. Management of comorbidity is an essential element of the therapeutic approach to cardiac and respiratory disease in older equids. Copyright © 2016 Elsevier Inc. All rights reserved.

Association of periodontal disease, oral procedures, and other clinical findings with bacterial endocarditis in dogs.

PubMed

Peddle, Gordon D; Drobatz, Kenneth J; Harvey, Colin E; Adams, Allison; Sleeper, Meg M

2009-01-01

To identify risk factors potentially associated with the development of bacterial endocarditis in dogs and determine whether periodontal disease and surgical procedures (oral and nonoral) were associated with bacterial endocarditis. Retrospective case-control study. 76 dogs with (cases) and 80 dogs without (controls) bacterial endocarditis. Medical records were reviewed for information on signalment, physical examination findings, recent medical history, and results of echocardiography, clinicopathologic testing, and necropsy. None of the dogs with endocarditis had a history of undergoing any dental or oral procedure in the 3 months prior to the diagnosis of endocarditis, and no significant difference was found between groups with regard to the prevalence of oral infection. Dogs with endocarditis were significantly more likely to have undergone a nonoral surgical procedure that required general anesthesia in the preceding 3 months or to have developed a new heart murmur or a change in intensity of an existing heart murmur. Preexisting cardiac dis-ease (congenital or acquired) was not found to be a risk factor. Results did not provide any evidence of an association between bacterial endocarditis in dogs and either dental or oral surgical procedures or oral infection. Findings suggested that the routine use of prophylactic antimicrobial administration in dogs undergoing oral procedures needs to be reevaluated.

Mitral valve repair under cardiopulmonary bypass in small-breed dogs: 48 cases (2006-2009).

PubMed

Uechi, Masami; Mizukoshi, Takahiro; Mizuno, Takeshi; Mizuno, Masashi; Harada, Kayoko; Ebisawa, Takashi; Takeuchi, Junichirou; Sawada, Tamotsu; Uchida, Shuhei; Shinoda, Asako; Kasuya, Arane; Endo, Masaaki; Nishida, Miki; Kono, Shota; Fujiwara, Megumi; Nakamura, Takashi

2012-05-15

To determine whether mitral valve repair (MVR) under cardiopulmonary bypass would be an effective treatment for mitral regurgitation in small-breed dogs. Retrospective case series. 48 small-breed dogs (body weight, 1.88 to 4.65 kg [4.11 to 10.25 lb]; age, 5 to 15 years) with mitral regurgitation that underwent surgery between August 2006 and August 2009. Cardiopulmonary bypass was performed with a cardiopulmonary bypass circuit. After induction of cardiac arrest, a mitral annuloplasty was performed, and the chordae tendineae were replaced with expanded polytetrafluoroethylene chordal prostheses. After closure of the left atrium and declamping to restart the heart, the thorax was closed. Preoperatively, cardiac murmur was grade 3 of 6 to 6 of 6, thoracic radiography showed cardiac enlargement (median vertebral heart size, 12.0 vertebrae; range, 9.5 to 14.5 vertebrae), and echocardiography showed severe mitral regurgitation and left atrial enlargement (median left atrium-to-aortic root ratio, 2.6; range, 1.7 to 4.0). 45 of 48 dogs survived to discharge. Three months after surgery, cardiac murmur grade was reduced to 0/6 to 3/6, and the heart shadow was reduced (median vertebral heart size, 11.1 vertebrae, range, 9.2 to 13.0 vertebrae) on thoracic radiographs. Echocardiography confirmed a marked reduction in mitral regurgitation and left atrium-to-aortic root ratio (median, 1.7; range, 1.0 to 3.0). We successfully performed MVR under cardiopulmonary bypass in small-breed dogs, suggesting this may be an effective surgical treatment for dogs with mitral regurgitation. Mitral valve repair with cardiopulmonary bypass can be beneficial for the treatment of mitral regurgitation in small-breed dogs.

Please, Do (Not) Disturb

ERIC Educational Resources Information Center

Baggesen, Lise Haller

2011-01-01

In the language of the collective subconscious the term "pure" applies to both the "pure innocence of childhood" as well as the "pure artistic genius." However, the "pure at heart" come in many shapes and sizes, and the thought of these mingling leaves many people feeling uncomfortable. There is something slightly unsettling about this potential…

Heart sound segmentation of pediatric auscultations using wavelet analysis.

PubMed

Castro, Ana; Vinhoza, Tiago T V; Mattos, Sandra S; Coimbra, Miguel T

2013-01-01

Auscultation is widely applied in clinical activity, nonetheless sound interpretation is dependent on clinician training and experience. Heart sound features such as spatial loudness, relative amplitude, murmurs, and localization of each component may be indicative of pathology. In this study we propose a segmentation algorithm to extract heart sound components (S1 and S2) based on it's time and frequency characteristics. This algorithm takes advantage of the knowledge of the heart cycle times (systolic and diastolic periods) and of the spectral characteristics of each component, through wavelet analysis. Data collected in a clinical environment, and annotated by a clinician was used to assess algorithm's performance. Heart sound components were correctly identified in 99.5% of the annotated events. S1 and S2 detection rates were 90.9% and 93.3% respectively. The median difference between annotated and detected events was of 33.9 ms.

Elemental Study on Auscultaiting Diagnosis Support System of Hemodialysis Shunt Stenosis by ANN

NASA Astrophysics Data System (ADS)

Suzuki, Yutaka; Fukasawa, Mizuya; Mori, Takahiro; Sakata, Osamu; Hattori, Asobu; Kato, Takaya

It is desired to detect stenosis at an early stage to use hemodailysis shunt for longer time. Stethoscope auscultation of vascular murmurs is useful noninvasive diagnostic approach, but an experienced expert operator is necessary. Some experts often say that the high-pitch murmurs exist if the shunt becomes stenosed, and some studies report that there are some features detected at high frequency by time-frequency analysis. However, some of the murmurs are difficult to detect, and the final judgment is difficult. This study proposes a new diagnosis support system to screen stenosis by using vascular murmurs. The system is performed using artificial neural networks (ANN) with the analyzed frequency data by maximum entropy method (MEM). The author recorded vascular murmurs both before percutaneous transluminal angioplasty (PTA) and after. Examining the MEM spectral characteristics of the high-pitch stenosis murmurs, three features could be classified, which covered 85 percent of stenosis vascular murmurs. The features were learnt by the ANN, and judged. As a result, a percentage of judging the classified stenosis murmurs was 100%, and that of normal was 86%.

Fungal Endocarditis

PubMed Central

Yuan, Shi-Min

2016-01-01

Fungal endocarditis is a rare and fatal condition. The Candida and Aspergillus species are the two most common etiologic fungi found responsible for fungal endocarditis. Fever and changing heart murmur are the most common clinical manifestations. Some patients may have a fever of unknown origin as the onset symptom. The diagnosis of fungal endocarditis is challenging, and diagnosis of prosthetic valve fungal endocarditis is extremely difficult. The optimum antifungal therapy still remains debatable. Treating Candida endocarditis can be difficult because the Candida species can form biofilms on native and prosthetic heart valves. Combined treatment appears superior to monotherapy. Combination of antifungal therapy and surgical debridement might bring about better prognosis. PMID:27737409

Fungal Endocarditis.

PubMed

Yuan, Shi-Min

2016-01-01

Fungal endocarditis is a rare and fatal condition. The Candida and Aspergillus species are the two most common etiologic fungi found responsible for fungal endocarditis. Fever and changing heart murmur are the most common clinical manifestations. Some patients may have a fever of unknown origin as the onset symptom. The diagnosis of fungal endocarditis is challenging, and diagnosis of prosthetic valve fungal endocarditis is extremely difficult. The optimum antifungal therapy still remains debatable. Treating Candida endocarditis can be difficult because the Candida species can form biofilms on native and prosthetic heart valves. Combined treatment appears superior to monotherapy. Combination of antifungal therapy and surgical debridement might bring about better prognosis.

Clinical and echocardiographic characteristics associated with the evolution of the ductus arteriosus in the neonate with birth weight lower than 1,500g.

PubMed

Visconti, Luiza Fortunato; Morhy, Samira Saady; Deutsch, Alice D'Agostini; Tavares, Gláucia Maria Penha; Wilberg, Tatiana Jardim Mussi; Rossi, Felipe de Souza

2013-01-01

To identify clinical and echocardiographic parameters associated with the evolution of the ductus arteriosus in neonates with birth weight lower than 1,500g. Retrospective study of 119 neonates in which clinical parameters (Prenatal: maternal age, risk of infection and chorioamnionitis, use of corticosteroid, mode of delivery and gestational age. Perinatal: weight, Apgar score, gender and birth weight/gestational age classification; Postnatal: use of surfactant, sepsis, fluid intake, heart murmur, heart rate, precordial movement and pulses, use of diuretics, oxygenation index, desaturation/apnea, ventilatory support, food intolerance, chest radiography, renal function, hemodynamic instability, and metabolic changes) and echocardiographic parameters (ductus arteriosus diameter, ductus arteriosus/weight ratio, left atrium/ aorta ratio, left ventricular diastolic diameter, and transductal flow direction, pattern and velocity) were analyzed. The clinical and echocardiographic parameters analyzed were considered statistically significant when p<0.05. In the 119 neonates, the incidence of patent ductus arteriosus was 61.3%; 56 received treatment (46 pharmacological and 10 surgical treatment), 11 had spontaneous closure, 4 died, and 2 were discharged with patent ductus arteriosus. A higher incidence of chorioamnionitis, use of surfactant, lower weight and gestational age, sepsis, heart murmur, ventilatory support and worse oxygenation indices were observed in the neonates receiving treatment. The group with spontaneous closure had a smaller ductus arteriosus diameter, lower ductus arteriosus/weight ratio, and higher transductal flow velocity. Based on clinical and echocardiographic parameters, the neonates with spontaneous closure of the ductus arteriosus could be differentiated from those who required treatment.

Fatal thrombocytopenia: A rare case with possible explanation

PubMed Central

Barik, Ramachandra; Patnaik, A. N.; Gulati, A. S.

2012-01-01

A 22 year old male presented with breathlessness on exertion, ecchymosis, jaundice and features of worsening right heart failure for the last fifteen days. On physical examination, he had a mid diastolic murmur in the tricuspid area and an ejection systolic murmur in the pulmonary area. Bone marrow histopathology report showed an increased in megakaryocytes count. Routine investigations reports were normal. Echocardiography and computerized tomography (CT) revealed a single mobile large intra cardiac mass originating from the right atrium and causing dynamic obstruction of the right ventricular inflow and outflow tract. Associated fatal thrombocytopenia did not respond to intravenous steroids or platelet transfusion. Patient could not be operated because of very low platelet count, and died during hospital stay before excision biopsy could be done. Pathological autopsy was not done. This is a rare case, as the fatal thrombocytopenia observed here was the result of mechanical effects like frictional and shear force, which can be attributed to the physical presence of a large intra cardiac mass resulting in obstruction to flow. PMID:22629036

Fatal thrombocytopenia: A rare case with possible explanation.

PubMed

Barik, Ramachandra; Patnaik, A N; Gulati, A S

2012-04-01

A 22 year old male presented with breathlessness on exertion, ecchymosis, jaundice and features of worsening right heart failure for the last fifteen days. On physical examination, he had a mid diastolic murmur in the tricuspid area and an ejection systolic murmur in the pulmonary area. Bone marrow histopathology report showed an increased in megakaryocytes count. Routine investigations reports were normal. Echocardiography and computerized tomography (CT) revealed a single mobile large intra cardiac mass originating from the right atrium and causing dynamic obstruction of the right ventricular inflow and outflow tract. Associated fatal thrombocytopenia did not respond to intravenous steroids or platelet transfusion. Patient could not be operated because of very low platelet count, and died during hospital stay before excision biopsy could be done. Pathological autopsy was not done. This is a rare case, as the fatal thrombocytopenia observed here was the result of mechanical effects like frictional and shear force, which can be attributed to the physical presence of a large intra cardiac mass resulting in obstruction to flow.

The Diagnostic Utility of Computer-Assisted Auscultation for the Early Detection of Cardiac Murmurs of Structural Origin in the Periodic Health Evaluation

PubMed Central

Viviers, Pierre L.; Kirby, Jo-Anne H.; Viljoen, Jeandré T.; Derman, Wayne

2017-01-01

Background: Identification of the nature of cardiac murmurs during the periodic health evaluation (PHE) of athletes is challenging due to the difficulty in distinguishing between murmurs of physiological or structural origin. Previously, computer-assisted auscultation (CAA) has shown promise to support appropriate referrals in the nonathlete pediatric population. Hypothesis: CAA has the ability to accurately detect cardiac murmurs of structural origin during a PHE in collegiate athletes. Study Design: Cross-sectional, descriptive study. Level of Evidence: Level 3. Methods: A total of 131 collegiate athletes (104 men, 28 women; mean age, 20 ± 2 years) completed a sports physician (SP)–driven PHE consisting of a cardiac history questionnaire and a physical examination. An independent CAA assessment was performed by a technician who was blinded to the SP findings. Athletes with suspected structural murmurs or other clinical reasons for concern were referred to a cardiologist for confirmatory echocardiography (EC). Results: Twenty-five athletes were referred for further investigation (17 murmurs, 6 abnormal electrocardiographs, 1 displaced apex, and 1 possible case of Marfan syndrome). EC confirmed 3 structural and 22 physiological murmurs. The SP flagged 5 individuals with possible underlying structural pathology; 2 of these murmurs were confirmed as structural in nature. Fourteen murmurs were referred by CAA; 3 of these were confirmed as structural in origin by EC. One such murmur was not detected by the SP, however, and detected by CAA. The sensitivity of CAA was 100% compared with 66.7% shown by the SP, while specificity was 50% and 66.7%, respectively. Conclusion: CAA shows potential to be a feasible adjunct for improving the identification of structural murmurs in the athlete population. Over-referral by CAA for EC requires further investigation and possible refinements to the current algorithm. Further studies are needed to determine the true sensitivity, specificity, and cost efficacy of the device among the athletic population. Clinical Relevance: CAA may be a useful cardiac screening adjunct during the PHE of athletes, particularly as it may guide appropriate referral of suspected structural murmurs for further investigation. PMID:28661830

The Diagnostic Utility of Computer-Assisted Auscultation for the Early Detection of Cardiac Murmurs of Structural Origin in the Periodic Health Evaluation.

PubMed

Viviers, Pierre L; Kirby, Jo-Anne H; Viljoen, Jeandré T; Derman, Wayne

Identification of the nature of cardiac murmurs during the periodic health evaluation (PHE) of athletes is challenging due to the difficulty in distinguishing between murmurs of physiological or structural origin. Previously, computer-assisted auscultation (CAA) has shown promise to support appropriate referrals in the nonathlete pediatric population. CAA has the ability to accurately detect cardiac murmurs of structural origin during a PHE in collegiate athletes. Cross-sectional, descriptive study. Level 3. A total of 131 collegiate athletes (104 men, 28 women; mean age, 20 ± 2 years) completed a sports physician (SP)-driven PHE consisting of a cardiac history questionnaire and a physical examination. An independent CAA assessment was performed by a technician who was blinded to the SP findings. Athletes with suspected structural murmurs or other clinical reasons for concern were referred to a cardiologist for confirmatory echocardiography (EC). Twenty-five athletes were referred for further investigation (17 murmurs, 6 abnormal electrocardiographs, 1 displaced apex, and 1 possible case of Marfan syndrome). EC confirmed 3 structural and 22 physiological murmurs. The SP flagged 5 individuals with possible underlying structural pathology; 2 of these murmurs were confirmed as structural in nature. Fourteen murmurs were referred by CAA; 3 of these were confirmed as structural in origin by EC. One such murmur was not detected by the SP, however, and detected by CAA. The sensitivity of CAA was 100% compared with 66.7% shown by the SP, while specificity was 50% and 66.7%, respectively. CAA shows potential to be a feasible adjunct for improving the identification of structural murmurs in the athlete population. Over-referral by CAA for EC requires further investigation and possible refinements to the current algorithm. Further studies are needed to determine the true sensitivity, specificity, and cost efficacy of the device among the athletic population. CAA may be a useful cardiac screening adjunct during the PHE of athletes, particularly as it may guide appropriate referral of suspected structural murmurs for further investigation.

NEW THORACIC MURMURS, WITH TWO NEW INSTRUMENTS, THE REFRACTOSCOPE AND THE PARTIAL STETHOSCOPE

PubMed Central

Parker, Frederick D.

1918-01-01

1. An understanding of the physics of sound is essential for a better comprehension of refined auscultation, tone analysis, and the use of these instruments. 2. The detection of variations of the third heart sound should prove a valuable aid in predicting mitral disease. 3. The variations of the outflow sound should prove a valuable aid in determining early aortic lesions with the type of accompanying intimal changes. 4. The character of chamber timbre as distinct from loudness heard as the first and second heart sounds denotes more often the condition of heart muscle, and must not be confounded with valvular disease. 5. The full significance of sound shadows is uncertain. Cardiac sound shadows appear normally in the right axilla and below the left clavicle. Their mode of production is quite clear. 6. Both the third heart sound and the outflow sound may be heard with the ordinary stethoscope. PMID:19868281

Value and limitations of auscultation in the management of congenital heart disease.

PubMed

McNamara, D G

1990-02-01

With advances in technology, especially that of ultrasonography, the art and science of auscultation could become relegated to that of an obsolete technique. Physicians in a cardiovascular training program involved in learning modern instrumentation diagnostic techniques often become expert in these areas before they have mastered the use of the stethoscope. Although the technology of ultrasonic examination, cardiac catheterization, and angiocardiography must be learned, the value of auscultation of the heart cannot be ignored. Many highly competent physicians who are responsible for diagnosis and treatment of the pediatric patient, including some pediatric cardiologists, may not be aware that they have not yet become experts at auscultation. The skill of auscultation of the heart must be learned by supervised experience with patients in whom a wide variety of normal and abnormal heart sounds and murmurs can be heard. Once learned, the skill can be maintained only by frequent practice in hearing and evaluating both subtle and obvious sounds emanating from the heart and from the pulmonary and systemic blood vessels.

Time-frequency analysis of pediatric murmurs

NASA Astrophysics Data System (ADS)

Lombardo, Joseph S.; Blodgett, Lisa A.; Rosen, Ron S.; Najmi, Amir-Homayoon; Thompson, W. Reid

1998-05-01

Technology has provided many new tools to assist in the diagnosis of pathologic conditions of the heart. Echocardiography, Ultrafast CT, and MRI are just a few. While these tools are a valuable resource, they are typically too expensive, large and complex in operation for use in rural, homecare, and physician's office settings. Recent advances in computer performance, miniaturization, and acoustic signal processing, have yielded new technologies that when applied to heart sounds can provide low cost screening for pathologic conditions. The short duration and transient nature of these signals requires processing techniques that provide high resolution in both time and frequency. Short-time Fourier transforms, Wigner distributions, and wavelet transforms have been applied to signals form hearts with various pathologic conditions. While no single technique provides the ideal solution, the combination of tools provides a good representation of the acoustic features of the pathologies selected.

Unvoiced Speech Recognition Using Tissue-Conductive Acoustic Sensor

NASA Astrophysics Data System (ADS)

Heracleous, Panikos; Kaino, Tomomi; Saruwatari, Hiroshi; Shikano, Kiyohiro

2006-12-01

We present the use of stethoscope and silicon NAM (nonaudible murmur) microphones in automatic speech recognition. NAM microphones are special acoustic sensors, which are attached behind the talker's ear and can capture not only normal (audible) speech, but also very quietly uttered speech (nonaudible murmur). As a result, NAM microphones can be applied in automatic speech recognition systems when privacy is desired in human-machine communication. Moreover, NAM microphones show robustness against noise and they might be used in special systems (speech recognition, speech transform, etc.) for sound-impaired people. Using adaptation techniques and a small amount of training data, we achieved for a 20 k dictation task a[InlineEquation not available: see fulltext.] word accuracy for nonaudible murmur recognition in a clean environment. In this paper, we also investigate nonaudible murmur recognition in noisy environments and the effect of the Lombard reflex on nonaudible murmur recognition. We also propose three methods to integrate audible speech and nonaudible murmur recognition using a stethoscope NAM microphone with very promising results.

Iatrogenic left ventricular-right atrial communication after tricuspid annuloplasty; a case report.

PubMed

Tayama, Eiki; Tomita, Yukihiro; Imasaka, Ken-ichi; Kono, Takanori

2014-06-18

A 75-year-old man (Asian, Japanese) was readmitted for examination of a heart murmur and haemolytic anemia 3 months after mitral valve and tricuspid annuloplasties and coronary artery bypass. A new systolic murmur was heard, and echocardiography showed a high-velocity jet originating from the left ventricular outflow tract and extending to the right atrium, a small defect between the left ventricle and the right atrium. No periprosthetic leaks were found in the mitral position. We judged that surgical repair of the defect was essential to treat mechanical haemolysis. At operation, we found a communication (3 mm in diameter) just beneath the detached prosthetic ring at the anteroseptal commissure of the tricuspid valve. After partially removing the tricuspid ring from the anteroseptal commissure area, the defect was closed using a single mattress suture with pledget. In this case, the tricuspid annuloplasty stitch in the atrioventricular region was probably placed on the membranous septum rather than on the tricuspid annulus. A tear then occurred in the atrioventricular membranous septum, leading to left ventricular-right atrial communication.

3 CFR 8860 - Proclamation 8860 of September 10, 2012. Patriot Day and National Day of Service and Remembrance...

Code of Federal Regulations, 2013 CFR

2013-01-01

... bright autumn day was darkened by the worst attack on the American people in our history. Thousands of innocent men, women, and children perished when mighty towers collapsed in the heart of New York City and... victims who perished as a result of the terrorist attacks of September 11, 2001. IN WITNESS WHEREOF, I...

Systemic arterial hypertension secondary to chronic kidney disease in two captive-born large felids.

PubMed

Leclerc, A; Trehiou-Sechi, E; Greunz, E M; Damoiseaux, C; Bouvard, J; Chetboul, V

2017-06-01

Systemic arterial hypertension (SHT) has been widely described in the domestic cat (Felis catus). In these feline patients, SHT is considered as the most common vascular disorder of middle-aged to older animals, and secondary SHT related to chronic kidney disease (CKD) represents the most common form of the disease. We describe here the first two cases of spontaneous SHT in large felids, i.e. one 18-year old, 34.4 kg, male North-Chinese leopard (Panthera pardus japonensis, case #1) and one 20-year old, 28.7 kg, female snow leopard (Panthera uncia, case #2), both captive-bred and previously diagnosed with CKD. Both animals underwent complete echocardiographic examination under general anesthesia due to abnormal cardiac auscultation (heart murmur and/or gallop sound), and recurrent lethargy in case #1. The combination of left ventricular remodeling with moderate aortic regurgitation of high velocity was highly suggestive of SHT, which was confirmed by indirect blood pressure measurement (systolic arterial blood pressure of 183 mmHg for case #1 and 180 mmHg for case #2). Amlodipine was prescribed (0.35-0.70 mg/kg/day orally) for 31 and 6 months respectively after the initial diagnosis. In case #1, concurrent amlodipine and benazepril treatment was associated with decreased heart murmur grade and reduced aortic insufficiency severity. These reports illustrate that, similarly to domestic cats, SHT should be suspected in old large felids with CKD and that amlodipine is a well-tolerated antihypertensive drug in these species. Copyright © 2017 Elsevier B.V. All rights reserved.

On the psychology of confessions: does innocence put innocents at risk?

PubMed

Kassin, Saul M

2005-04-01

The Central Park jogger case and other recent exonerations highlight the problem of wrongful convictions, 15% to 25% of which have contained confessions in evidence. Recent research suggests that actual innocence does not protect people across a sequence of pivotal decisions: (a) In preinterrogation interviews, investigators commit false-positive errors, presuming innocent suspects guilty; (b) naively believing in the transparency of their innocence, innocent suspects waive their rights; (c) despite or because of their denials, innocent suspects elicit highly confrontational interrogations; (d) certain commonly used techniques lead suspects to confess to crimes they did not commit; and (e) police and others cannot distinguish between uncorroborated true and false confessions. It appears that innocence puts innocents at risk, that consideration should be given to reforming current practices, and that a policy of videotaping interrogations is a necessary means of protection. 2005 APA, all rights reserved

Hemodynamics of Aortic Stenosis and Implications for Non-invasive Diagnosis via Auscultation

NASA Astrophysics Data System (ADS)

Zhu, Chi; Seo, Jung-Hee; Mittal, Rajat

2017-11-01

Aortic stenosis refers to the abnormal narrowing of the aortic valve and it is one of the most common valvular diseases. It is also known to generate ejection murmurs, which contain valuable disease-related information. However, an incomplete understanding of the flow mechanism(s) responsible for the murmur generation, as well as the effect of intervening tissue on murmur propagation has limited the diagnostic information can be extracted through cardiac auscultation. In this study, a canonical model of the aorta with stenosis is used, and a multiphysics computational modeling approach is employed to investigate the generation and propagation of the murmurs. First, direct numerical simulation (DNS) is used to explore the hemodynamics of the post-stenotic flow. Then, a high-order, linear viscoelastic wave solver is used to investigate the wave propagation in a modeled thorax. The results show that both the aortic jet and the secondary flow contribute significantly to the murmur generation. The murmur signals on the epidermal surface are measured and analyzed. The break frequencies obtained from the spectra of cases with different degrees of stenosis are found to follow a universal scaling. The implications of these results for cardiac auscultation are discussed. The authors would like to acknowledge support from NSF Grants IIS-1344772, CBET-1511200, and NSF XSEDE Grant TG-CTS100002.

Beyond auscultation: acoustic cardiography in clinical practice.

PubMed

Wen, Yong-Na; Lee, Alex Pui-Wai; Fang, Fang; Jin, Chun-Na; Yu, Cheuk-Man

2014-04-01

Cardiac auscultation by stethoscope is widely used but limited by low sensitivity and accuracy. Phonocardiogram was developed in an attempt to provide quantitative and qualitative information of heart sounds and murmurs by transforming acoustic signal into visual wavelet. Although phonocardiogram provides objective heart sound information and holds diagnostic potentials of different heart problems, its examination procedure is time-consuming and it requires specially trained technicians to operate the device. Acoustic cardiography (AUDICOR, Inovise Medical, Inc., Portland, OR, USA) is a major recent advance in the evolution of cardiac auscultation technology. The technique is more efficient and less operator-dependent. It synchronizes cardiac auscultation with ECG recording and provides a comprehensive assessment of both mechanical and electronic function of the heart. The application of acoustic cardiography is far beyond auscultation only. It generates various parameters which have been proven to correlate with gold standards in heart failure diagnosis and ischemic heart disease detection. Its application can be extended to other diseases, including LV hypertrophy, constrictive pericarditis, sleep apnea and ventricular fibrillation. The newly developed ambulatory acoustic cardiography is potentially used in heart failure follow-up in both home and hospital setting. This review comprehensively summarizes acoustic cardiographic research, including the most recent development. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Fractal dimension to classify the heart sound recordings with KNN and fuzzy c-mean clustering methods

NASA Astrophysics Data System (ADS)

Juniati, D.; Khotimah, C.; Wardani, D. E. K.; Budayasa, K.

2018-01-01

The heart abnormalities can be detected from heart sound. A heart sound can be heard directly with a stethoscope or indirectly by a phonocardiograph, a machine of the heart sound recording. This paper presents the implementation of fractal dimension theory to make a classification of phonocardiograms into a normal heart sound, a murmur, or an extrasystole. The main algorithm used to calculate the fractal dimension was Higuchi’s Algorithm. There were two steps to make a classification of phonocardiograms, feature extraction, and classification. For feature extraction, we used Discrete Wavelet Transform to decompose the signal of heart sound into several sub-bands depending on the selected level. After the decomposition process, the signal was processed using Fast Fourier Transform (FFT) to determine the spectral frequency. The fractal dimension of the FFT output was calculated using Higuchi Algorithm. The classification of fractal dimension of all phonocardiograms was done with KNN and Fuzzy c-mean clustering methods. Based on the research results, the best accuracy obtained was 86.17%, the feature extraction by DWT decomposition level 3 with the value of kmax 50, using 5-fold cross validation and the number of neighbors was 5 at K-NN algorithm. Meanwhile, for fuzzy c-mean clustering, the accuracy was 78.56%.

Classic Peripheral Signs of Subacute Bacterial Endocarditis

PubMed Central

Chong, Yooyoung; Han, Sung Joon; Rhee, Youn Ju; Kang, Shin Kwang; Yu, Jae Hyeon; Na, Myung Hoon

2016-01-01

A 50-year-old female patient with visual disturbances was referred for further evaluation of a heart murmur. Fundoscopy revealed a Roth spot in both eyes. A physical examination showed peripheral signs of infective endocarditis, including Osler nodes, Janeway lesions, and splinter hemorrhages. Our preoperative diagnosis was subacute bacterial endocarditis with severe aortic regurgitation. The patient underwent aortic valve replacement and was treated with intravenous antibiotics for 6 weeks postoperatively. The patient made a remarkable recovery and was discharged without complications. We report this case of subacute endocarditis with all 4 classic peripheral signs in a patient who presented with visual disturbance. PMID:27734006

Fatal aortic endocarditis associated with community-acquired Serratia marcescens infection in a dog.

PubMed

Perez, Cristina; Fujii, Yoko; Fauls, Megan; Hummel, James; Breitschwerdt, Edward

2011-01-01

A 12 yr old Dalmatian was referred for evaluation of acute lethargy, fever, neurologic signs, and a recently ausculted heart murmur. Echocardiography in combination with blood cultures resulted in a diagnosis of nonhospital-acquired Serratia marcescens bacteremia and aortic valve endocarditis. Despite early diagnosis and aggressive therapy, the dog failed to respond to antimicrobials and died within 6 hr after admission. Necropsy findings included aortic valve endocarditis, septicemia, and diffuse thromboembolic disease. There was no history of pre-existing underlying disease or immunosuppressive therapy, and the dog had not been hospitalized before referral.

An Auscultaiting Diagnosis Support System for Assessing Hemodialysis Shunt Stenosis by Using Self-organizing Map

NASA Astrophysics Data System (ADS)

Suzuki, Yutaka; Fukasawa, Mizuya; Sakata, Osamu; Kato, Hatsuhiro; Hattori, Asobu; Kato, Takaya

Vascular access for hemodialysis is a lifeline for over 280,000 chronic renal failure patients in Japan. Early detection of stenosis may facilitate long-term use of hemodialysis shunts. Stethoscope auscultation of vascular murmurs has some utility in the assessment of access patency; however, the sensitivity of this diagnostic approach is skill dependent. This study proposes a novel diagnosis support system to detect stenosis by using vascular murmurs. The system is based on a self-organizing map (SOM) and short-time maximum entropy method (STMEM) for data analysis. SOM is an artificial neural network, which is trained using unsupervised learning to produce a feature map that is useful for visualizing the analogous relationship between input data. The author recorded vascular murmurs before and after percutaneous transluminal angioplasty (PTA). The SOM-based classification was consistent with to the classification based on MEM spectral and spectrogram characteristics. The ratio of pre-PTA murmurs in the stenosis category was much higher than the post-PTA murmurs. The results suggest that the proposed method may be an effective tool in the determination of shunt stenosis.

Congenital Heart Disease: Causes, Diagnosis, Symptoms, and Treatments.

PubMed

Sun, RongRong; Liu, Min; Lu, Lei; Zheng, Yi; Zhang, Peiying

2015-07-01

The congenital heart disease includes abnormalities in heart structure that occur before birth. Such defects occur in the fetus while it is developing in the uterus during pregnancy. About 500,000 adults have congenital heart disease in USA (WebMD, Congenital heart defects medications, www.WebMD.com/heart-disease/tc/congenital-heart-defects-medications , 2014). 1 in every 100 children has defects in their heart due to genetic or chromosomal abnormalities, such as Down syndrome. The excessive alcohol consumption during pregnancy and use of medications, maternal viral infection, such as Rubella virus, measles (German), in the first trimester of pregnancy, all these are risk factors for congenital heart disease in children, and the risk increases if parent or sibling has a congenital heart defect. These are heart valves defects, atrial and ventricular septa defects, stenosis, the heart muscle abnormalities, and a hole inside wall of the heart which causes defect in blood circulation, heart failure, and eventual death. There are no particular symptoms of congenital heart disease, but shortness of breath and limited ability to do exercise, fatigue, abnormal sound of heart as heart murmur, which is diagnosed by a physician while listening to the heart beats. The echocardiogram or transesophageal echocardiogram, electrocardiogram, chest X-ray, cardiac catheterization, and MRI methods are used to detect congenital heart disease. Several medications are given depending on the severity of this disease, and catheter method and surgery are required for serious cases to repair heart valves or heart transplantation as in endocarditis. For genetic study, first DNA is extracted from blood followed by DNA sequence analysis and any defect in nucleotide sequence of DNA is determined. For congenital heart disease, genes in chromosome 1 show some defects in nucleotide sequence. In this review the causes, diagnosis, symptoms, and treatments of congenital heart disease are described.

Successful balloon dilatation of both orifices in a case of double-orifice mitral valve with severe rheumatic stenosis.

PubMed

Nath, Ranjit Kumar; Soni, Dheeraj Kumar

2016-08-01

A 24-year-old female patient presented to us with progressive dyspnea on exertion for last three year. She was not a known case of rheumatic heart disease. Her physical examination showed regular pulse and her blood pressure was 100/76 mm Hg. Cardiac palpation showed grade 3 parasternal heave and auscultation revelled an accentuated first heart sound, loud P2 and mid-diastolic long rumbling murmur at apex and pansystolic murmur of tricuspid regurgitation at lower left sterna border. Chest X-ray showed evidence of grade 3 pulmonary venous congestion. Transthoracic and transesophageal two-dimensional echocardiography revealed a double-orifice mitral valve of complete bridge type at the leaflet level. Both orifice sizes were unequal, with the anterolateral orifice being smaller than its counterpart. There was moderate subvalvular fusion and both commisures were fused. Color doppler examination showed two separate mitral diastolic flows with mean gradients of 22 mm and 20 mm of Hg, respectively. There was no mitral regurgitation and no left atrial or appendage clot was seen by transesophageal echocardiography. Transseptal puncture was done by the modified fluoroscopic method. Posteromedial orifice was crossed with a 24 mm Inoue balloon and dilated using the stepwise dilation technique. Anterolateral orifice was not crossed by Inuoe balloon after multiple attempts. A TYSHAK (NuMAD Canada Inc.) balloon (16 × 40mm) was taken over the wire and inflated successfully across the anterolateral orifice with the help of transthoracic echocardiography guidance. Mean gradient become 9 and 8 mm across the medial and lateral orifice. Patient was discharged in stable condition after two day. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Unusual Survival of Anomalous Left Coronary Artery From the Pulmonary Artery With Severe Rheumatic Mitral Stenosis in Septuagenarian Women: Foes Becoming Friends?

PubMed

Sinha, Santosh Kumar; Khanra, Dibbendhu; Jha, Mukesh Jitendra; Singh, Karandeep; Razi, Mahamdulla; Goel, Amit; Mishra, Vikas; Asif, Mohammad; Sachan, Mohit; Afdaali, Nasar; Kumar, Ashutosh; Thakur, Ramesh; Krishna, Vinay; Pandey, Umeshwar; Varma, Chandra Mohan

2016-10-01

ALCAPA syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a rare disease but lethal with clinical expression from myocardial infarction, congestive heart failure to death during early infancy and unusual survival to adulthood. We report a 73-year-old woman with ALCAPA who presented with exertional dyspnea (NYHA functional class II) over past 2 years. Physical examination revealed soft S, long mid diastolic rumbling murmur and apical pan-systolic murmur. Electrocardiography displayed biatrial enlargement and poor R progression and normal sinus rhythm. Echocardiography established calcified severe mitral stenosis (MS), presence of continuous flow entering the pulmonary trunk, turbulent continuous flow in inter-ventricular septum with left to right shunt in contrast echocardiography and normal systolic function. Coronary angiogram showed absence of left coronary artery (LCA) originating from aorta, dilated and tortuous right coronary artery (RCA) and abundant Rentrop grade 3 intercoronary collateral communicating with LCA originating from pulmonary trunk which was also confirmed on coronary CT angiogram thus establishing diagnosis of ALCAPA. It is exceedingly rare to be associated with severe MS. However, such a long survival in our patient can be explained by the severe pulmonary arterial hypertension which may be contributing to lesser coronary steal.

Mitral stenosis in 15 dogs.

PubMed

Lehmkuhl, L B; Ware, W A; Bonagura, J D

1994-01-01

Mitral stenosis was diagnosed in 15 young to middle-aged dogs. There were 5 Newfoundlands and 4 bull terriers affected, suggesting a breed predisposition for this disorder. Clinical signs included cough, dyspnea, exercise intolerance, and syncope. Soft left apical diastolic murmurs were heard only in 4 dogs, whereas 8 dogs had systolic murmurs characteristic of mitral regurgitation. Left atrial enlargement was the most prominent radiographic feature. Left-sided congestive heart failure was detected by radiographs in 11 dogs within 1 year of diagnosis. Electrocardiographic abnormalities varied among dogs and included atrial and ventricular enlargement, as well as atrial and ventricular arrhythmias. Abnormalities on M-mode and two-dimensional echocardiograms included abnormal diastolic motion of the mitral valve characterized by decreased leaflet separation, valve doming, concordant motion of the parietal mitral valve leaflet, and a decreased E-to-F slope. Increased mitral valve inflow velocities and prolonged pressure half-times were detected by Doppler echocardiography. Cardiac catheterization, performed in 8 dogs, documented a diastolic pressure gradient between the left atrial, pulmonary capillary wedge, or pulmonary artery diastolic pressures and the left ventricular diastolic pressure. Necropsy showed mitral stenosis caused by thickened, fused mitral valve leaflets in 5 dogs and a supramitral ring in another dog. The outcome in affected dogs was poor; 9 of 15 dogs were euthanatized or died by 2 1/2 years of age.

[Heart disease in sports horses: Current recommendations of the 2014 ACVIM / ECEIM consensus statement].

PubMed

Schwarzwald, C

2016-10-01

Heart murmurs and arrhythmias are common in horses. Assessment of their clinical relevance concerning health, performance, safety and longevity of sports horses is of highest importance. A comprehensive cardiovascular examination is crucial for diagnosis and assessment of the severity of disease. Recently, an expert panel of the American College of Veterinary Internal Medicine (ACVIM) and the European College of Equine Internal Medicine (ECEIM) developed a consensus statement containing recommendations for sports horses with heart disease. This article summarizes the most relevant recommendations for practitioners, considering the most common and most important cardiac disorders in adult sports horses. These include mitral, aortic and tricuspid insufficiency, ventricular septal defects, atrial fibrillation as well as supraventricular and ventricular arrhythmias. Despite the fact that most horses with cardiovascular disease maintain a sufficient performance capacity, regular evaluations are indicated in horses with clinically relevant disorders. Under certain circumstances, horses with moderate to severe structural disease, with persistent untreated atrial fibrillation and with certain ventricular arrhythmias might still be used by informed adult riders. Horses with complex ventricular arrhythmias, pulmonary hypertension or congestive heart failure must not be ridden or driven and should be retired.

Acquired pulmonary artery stenosis in four dogs.

PubMed

Scansen, Brian A; Schober, Karsten E; Bonagura, John D; Smeak, Daniel D

2008-04-15

4 dogs with acquired pulmonary artery stenosis (PAS) were examined for various clinical signs. One was a mixed-breed dog with congenital valvular PAS that subsequently developed peripheral PAS, one was a Golden Retriever with pulmonary valve fibrosarcoma, one was a Pembroke Welsh Corgi in which the left pulmonary artery had inadvertently been ligated during surgery for correction of patent ductus arteriosus, and one was a Boston Terrier with a heart-base mass compressing the pulmonary arteries. All 4 dogs were evaluated with 2-dimensional and Doppler echocardiography to characterize the nature and severity of the stenoses; other diagnostic tests were also performed. The mixed-breed dog with valvular and peripheral PAS was euthanized, surgical resection of the pulmonic valve mass was performed in the Golden Retriever, corrective surgery was performed on the Pembroke Welsh Corgi with left pulmonary artery ligation, and the Boston Terrier with the heart-base mass was managed medically. Acquired PAS in dogs may manifest as a clinically silent heart murmur, syncope, or right-sided heart failure. The diagnosis is made on the basis of imaging findings, particularly results of 2-dimensional and Doppler echocardiography. Treatment may include surgical, interventional, or medical modalities and is targeted at resolving the inciting cause.

[Cardiac manifestations of sickle cell anemia].

PubMed

Gacon, P H; Donatien, Y

HEMOGLOBINS S AND C: Drepanocytosis, the occurrence of sickle cells (drepanocytes) in the blood, is an inherited condition. Electrophoresis demonstrates hemoglobin SS in homozygous subjects who present the typical clinical features of severe hemolytic sickle-cell anemia. Heterozygous subjects have sickle-cell anemia trait, an asymptomatic condition associated with a 50% hemoglobin S and 50% hemoglobin C at electrophoresis. Hemoglobin S and C are transmitted by Mendelian inheritance. CARDIAC DISORDERS: Well-known, cardiac disorders occur in more than 82% of homozygous subjects while only 2% of heterozygous subjects are affected. Heart murmur, radiological cardiomegaly, or eletrocardiographic anomalies are often the only signs. There is a risk of fatal heart failure in children and neonates. Acute rheumatic fever or infectious endocarditis, particularly due to pneumococcal or Haemophilus influenzae infection, may trigger heart failure. CARDIAC ANOMALIES: Patients with sickle-cell anemia can develop an "anemic heart" expressed by an elevated cardiac output and systemic ejection volume at rest and a fall in arteriolar peripheral resistance. Patients who develop cor pulmonae have an elevated pulmonary pressure at exercise and experience venous occlusive events with a progressive reduction in the pulmonary vascular bed and development of a left-right shunt. Myocardiopathy leads to left ventricular dysfunction contrasting with the dilated right heart seen at echocardiography and rare cases of transmural infarction.

Development of cardiac prescreening device for rural population using ultralow-power embedded system.

PubMed

Mandal, Subhamoy; Basak, Kausik; Mandana, K M; Ray, Ajoy K; Chatterjee, Jyotirmoy; Mahadevappa, Manjunatha

2011-03-01

The invention is inspired by the desire to understand the opportunities and expectations of developing economies in terms of healthcare. The designed system is a point-of-care (POC) device that can deliver heart-care services to the rural population and bridge the rural-urban divide in healthcare delivery. The product design incorporates several innovations including the effective use of adaptive and multiresolution signal-processing techniques for acquisition, denoising, segmentation, and characterization of the heart sounds (HS) and murmurs using an ultralow-power embedded Mixed Signal Processor. The device is able to provide indicative diagnosis of cardiac conditions and classify a subject into either normal, abnormal, ischemic, or valvular abnormalities category. Preliminary results demonstrated by the prototype confirm the applicability of the device as a prescreening tool that can be used by paramedics in rural outreach programs. Feedback from medical professionals also shows that such a device is helpful in early detection of common congenital heart diseases. This letter aims to determine a framework for utilization of automated HS analysis system for community healthcare and healthcare inclusion.

The Generation and Propagation of Arterial Murmurs from a Stenosed Artery: A Computational Study

NASA Astrophysics Data System (ADS)

Zhu, Chi; Seo, Jung-Hee; Bakhshaee, Hani; Mittal, Rajat

2015-11-01

Cardiac auscultation - the procedure of diagnosing cardiovascular conditions using the stethoscope - has been used effectively for over a hundred years but still, the flow mechanism(s) responsible for the generation of these murmurs, as well as the effect of intervening tissue on the propagation of these murmurs, is not well understood. In this study, a one-way coupled, hybrid approach is used to investigate the propagation of murmurs generated from the flow in a stenosed artery. Specifically, the flow in the modeled artery is solved by an incompressible Navier-Stokes solver with the immersed-boundary method. The structural wave propagation in the tissue is resolved by a high-order, linear viscoelastic wave solver, and a mathematical decomposition is applied to separate the compressional and shear component of the acoustic wave propagating through the tissue. The simulations suggest, somewhat counterintuitively, that the shear wave contributes a significant component to the signal picked up by a stethoscope, and that this component carries much of the information that characterizes the source of the murmur. The implications of this for cardiac auscultation and further modeling of hemoacoustics are discussed. The effect of the stenosis severity and the flow pulsatility will also be investigated. The authors would like to acknowledge the SCH for funding this project.

Treatment of High Flow Arteriovenous Fistulas after Successful Renal Transplant Using a Simple Precision Banding Technique.

PubMed

Gkotsis, Georgios; Jennings, William C; Malik, Jan; Mallios, Alexandros; Taubman, Kevin

2016-02-01

Observation versus ligation of a functional arteriovenous fistula (AVF) after successful renal transplantation (SRT) has been a controversial topic of debate. Congestive heart failure and pulmonary hypertension are common in dialysis patients, and more frequent when vascular access flow is excessive. Renal transplant failure may occur in up to 34% of patients after 5 years, therefore maintaining a moderate flow AVF appears warranted. We review SRT patients with high flow-AVFs (HF-AVF) and clinical signs of heart failure where a modified precision banding procedure was used for access flow reduction. Patients referred for HF-AVF evaluation after SRT were identified and records reviewed retrospectively. In addition to recording clinical signs of heart failure, each patient had ultrasound AVF flow measurement before and after temporary AVF occlusion of the access by digital compression. Pulse rate and the presence or absence of a cardiac murmur was noted before and after AVF compression. Adequacy of access flow restriction was evaluated intraoperatively using ultrasound flow measurements, adjusting the banding diameter in 0.5 mm increments to achieve the targeted AVF flow. Twelve patients were evaluated over a 19-month period. Eight (66%) were male and one (8%) obese. Ages were 15-73 years (mean = 42). The AVFs were established 24-86 months previously. The mean pulse rate declined after AVF compression from 90/min to 72/min (range 110-78). Six patients had a precompression cardiac flow murmur that disappeared with temporary AVF compression. One patient with poor cardiac function underwent immediate AVF ligation with dramatic improvement in cardiac status. All other patients underwent a precision banding procedure with real-time flow monitoring. Mean access flow was 2,280 mL/min (1,148-3,320 mL/min) before access banding and was 598 mL/min (481-876) after flow reduction. The clinical signs of heart failure disappeared in all patients. All AVFs remained patent although one individual later requested ligation for cosmesis. Two patients had renal transplant failure and later successfully used the AVF. Follow-up postbanding was 1-18 months (mean = 12). Patients with successful renal transplants and HF-AVFs had resolution of heart failure findings and maintenance of access patency using a modified precision banding procedure. Flow reduction in symptomatic renal transplant patients with elevated access flow is recommended. Further study is warranted to substantiate these recommendations and clarify the appropriate thresholds for such interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

The world is not fair: an examination of innocent and guilty suspects' waiver decisions.

PubMed

Scherr, Kyle C; Franks, Andrew S

2015-04-01

Suspects' decisions to waive or invoke their interrogation rights can have a considerable impact on their eventual legal fate. Although innocent and guilty suspects show differences in waiver rates, research has yet to examine whether innocent and guilty individuals' waiver decisions are differentially influenced by dispositional and situational factors. The current research examined the relationship among a dispositional factor (just world beliefs), a situational factor (social proof pressures-i.e., influencing others to believe that certain behaviors are normative) and innocent and guilty individuals' waiver decisions. Social proof pressures influenced the preinterrogation decisions of guilty individuals holding strong just world beliefs but not guilty individuals holding weak just world beliefs. However, social proof pressures influenced the preinterrogation decisions of innocent individuals holding weak just world beliefs but not innocent individuals holding strong just world beliefs. Results also indicated that strong just world beliefs are associated with attenuated stress responses to an accusation among innocent individuals but exacerbated stress responses among guilty individuals, thereby helping to explain why guilty and innocent individuals are differentially influenced by situational and dispositional factors. The theoretical and applied implications of these effects are discussed with an emphasis on the consequences of suspects' mindset during the preinterrogation decision-making process. (c) 2015 APA, all rights reserved).

A low-cost, portable, high-throughput wireless sensor system for phonocardiography applications.

PubMed

Sa-Ngasoongsong, Akkarapol; Kunthong, Jakkrit; Sarangan, Venkatesh; Cai, Xinwei; Bukkapatnam, Satish T S

2012-01-01

This paper presents the design and testing of a wireless sensor system developed using a Microchip PICDEM developer kit to acquire and monitor human heart sounds for phonocardiography applications. This system can serve as a cost-effective option to the recent developments in wireless phonocardiography sensors that have primarily focused on Bluetooth technology. This wireless sensor system has been designed and developed in-house using off-the-shelf components and open source software for remote and mobile applications. The small form factor (3.75 cm × 5 cm × 1 cm), high throughput (6,000 Hz data streaming rate), and low cost ($13 per unit for a 1,000 unit batch) of this wireless sensor system make it particularly attractive for phonocardiography and other sensing applications. The experimental results of sensor signal analysis using several signal characterization techniques suggest that this wireless sensor system can capture both fundamental heart sounds (S1 and S2), and is also capable of capturing abnormal heart sounds (S3 and S4) and heart murmurs without aliasing. The results of a denoising application using Wavelet Transform show that the undesirable noises of sensor signals in the surrounding environment can be reduced dramatically. The exercising experiment results also show that this proposed wireless PCG system can capture heart sounds over different heart conditions simulated by varying heart rates of six subjects over a range of 60-180 Hz through exercise testing.

Determination of heart rate variability with an electronic stethoscope.

PubMed

Kamran, Haroon; Naggar, Isaac; Oniyuke, Francisca; Palomeque, Mercy; Chokshi, Priya; Salciccioli, Louis; Stewart, Mark; Lazar, Jason M

2013-02-01

Heart rate variability (HRV) is widely used to characterize cardiac autonomic function by measuring beat-to-beat alterations in heart rate. Decreased HRV has been found predictive of worse cardiovascular (CV) outcomes. HRV is determined from time intervals between QRS complexes recorded by electrocardiography (ECG) for several minutes to 24 h. Although cardiac auscultation with a stethoscope is performed routinely on patients, the human ear cannot detect heart sound time intervals. The electronic stethoscope digitally processes heart sounds, from which cardiac time intervals can be obtained. Accordingly, the objective of this study was to determine the feasibility of obtaining HRV from electronically recorded heart sounds. We prospectively studied 50 subjects with and without CV risk factors/disease and simultaneously recorded single lead ECG and heart sounds for 2 min. Time and frequency measures of HRV were calculated from R-R and S1-S1 intervals and were compared using intra-class correlation coefficients (ICC). The majority of the indices were strongly correlated (ICC 0.73-1.0), while the remaining indices were moderately correlated (ICC 0.56-0.63). In conclusion, we found HRV measures determined from S1-S1 are in agreement with those determined by single lead ECG, and we demonstrate and discuss differences in the measures in detail. In addition to characterizing cardiac murmurs and time intervals, the electronic stethoscope holds promise as a convenient low-cost tool to determine HRV in the hospital and outpatient settings as a practical extension of the physical examination.

A Low-Cost, Portable, High-Throughput Wireless Sensor System for Phonocardiography Applications

PubMed Central

Sa-ngasoongsong, Akkarapol; Kunthong, Jakkrit; Sarangan, Venkatesh; Cai, Xinwei; Bukkapatnam, Satish T. S.

2012-01-01

This paper presents the design and testing of a wireless sensor system developed using a Microchip PICDEM developer kit to acquire and monitor human heart sounds for phonocardiography applications. This system can serve as a cost-effective option to the recent developments in wireless phonocardiography sensors that have primarily focused on Bluetooth technology. This wireless sensor system has been designed and developed in-house using off-the-shelf components and open source software for remote and mobile applications. The small form factor (3.75 cm × 5 cm × 1 cm), high throughput (6,000 Hz data streaming rate), and low cost ($13 per unit for a 1,000 unit batch) of this wireless sensor system make it particularly attractive for phonocardiography and other sensing applications. The experimental results of sensor signal analysis using several signal characterization techniques suggest that this wireless sensor system can capture both fundamental heart sounds (S1 and S2), and is also capable of capturing abnormal heart sounds (S3 and S4) and heart murmurs without aliasing. The results of a denoising application using Wavelet Transform show that the undesirable noises of sensor signals in the surrounding environment can be reduced dramatically. The exercising experiment results also show that this proposed wireless PCG system can capture heart sounds over different heart conditions simulated by varying heart rates of six subjects over a range of 60–180 Hz through exercise testing. PMID:23112633

Overcoming Innocents' Naiveté: Pre-interrogation Decision-making Among Innocent Suspects.

PubMed

Scherr, Kyle C; Alberts, Kimberly M; Franks, Andrew S; Hawkins, Ian

2016-07-01

Suspects, especially innocent ones, are highly susceptible to waiving their interrogation rights. This research tested the ability of two strategies to overcome innocent suspects' willingness to waive their rights. One strategy was based on the social influence of scarcity (i.e., not constraining the pre-interrogation time limit). The other strategy focused on disrupting individuals' cognitive fluency during the decision-making process (i.e., violating their induced expectation of offering a waiver). Disrupting innocent individuals' cognitive fluency increased their willingness to invoke their rights and, notably, was not qualified by interactions with any other factors. However, scarcity did not influence individuals' pre-interrogation decision-making. Results also further established the association between innocent individuals' naïve mindset and their willingness to waive their rights - specifically, innocents' willingness to waive their rights increased with the strength of their just world beliefs. The theoretical and applied implications of these findings are discussed. The importance and benefit of reforming pre-interrogation protocols using fair and feasible strategies that would disrupt suspects' cognitive fluency are emphasized. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Inflammatory biomarkers in heart failure revisited: much more than innocent bystanders.

PubMed

von Haehling, Stephan; Schefold, Joerg C; Lainscak, Mitja; Doehner, Wolfram; Anker, Stefan D

2009-10-01

Chronic heart failure is viewed as a state of chronic inflammation. Many inflammatory markers have been shown to be up-regulated in patients who have this condition, but the markers' roles in clinical decision making have not yet been fully elucidated. A panel of biomarkers is likely to have a strong impact on patient management. Inflammatory biomarkers are interesting candidates that could answer specific clinical questions on their own or complement a multi-marker approach. This article provides a broad overview of several inflammatory biomarkers, including the pro-inflammatory cytokines tumor necrosis factor-alpha, interleukin (IL)-6, IL-1, IL-18, and the soluble receptors TNFR-1, TNFR-2, IL-6R, and gp130. In addition to these acute phase reactants, several adhesion molecules, and lipopolysaccharide-signaling pathways are discussed.

[Traumatic tricuspid insufficiency. Apropos of 2 cases].

PubMed

Ventre, F; Bertinchant, J P; Noblet, D; Frapier, J M; Carabasse, D; Nigond, J; Ledermann, B; Cohen, S; Joubert, P; Grolleau-Raoux, R

1995-06-01

The authors report two cases of tricuspid regurgitation by a ruptured anterior papillary muscle secondary to non-penetrating thoracic trauma. In the presence of suggestive clinical and electrocardiographic abnormalities (systolic murmur, right heart failure, right bundle branch block), echocardiography confirmed the tricuspid regurgitation, showed its mechanism and excluded any other intracardiac lesions. Tricuspid annuloplasty was performed in both cases because of the persistence of failure or degradation of the patient's clinical condition. Peroperative echocardiography was used to judge the quality of the surgical repair in both cases. Traumatic tricuspid regurgitation is a rare condition and the diagnosis is often delayed. Echocardiography is the investigation of choice and guides treatment which is essentially valvular repair in symptomatic patients.

Knowingly but naively: The overpowering influence of innocence on interrogation rights decision-making.

PubMed

Scherr, Kyle C; Normile, Christopher J; Bierstetel, Sabrina J; Franks, Andrew S; Hawkins, Ian

2018-02-01

Most suspects waive the guaranteed protections that interrogation rights afford them against police intimidation. One factor thought to motivate suspects' inclination to waive their rights stems from the acquiescence bias whereby suspects mindlessly comply with interrogators' requests. However, research bearing on the phenomenology of innocence has demonstrated the power of innocents' mindset, which could motivate some innocent suspects to waive their rights knowingly (instead of mindlessly complying). To test these ideas, participants (N = 178) were (a) rightfully (guilty) or wrongfully (innocent) accused of wrongdoing during an experimental session, (b) administered 1 of 2 forms that by signing either waived or invoked their rights to a student advocate, and (c) given questions to assess their degree of knowing during the decision-making process (i.e., extent to which individuals were cognizant of their decisions). Results demonstrated that unknowing innocent and guilty individuals tended to passively comply, engaging in a pre-interrogation acquiescence bias by signing waive and invoke forms at similar rates. But, as participants became more cognizant of their decisions, they acquiesced at lower rates and their change from acquiescence differed depending on their status. As innocents became more cognizant, they signed the waiver form at higher rates than the invoke form, thereby demonstrating that innocence can motivate some suspects to knowingly forgo their rights. Conversely, as guilty individuals became more cognizant, they signed the invoke form at higher rates than the waiver form. These findings have implications for reforming pre-interrogation protocols, protecting suspects' civil liberties, and preventing innocents from offering false self-incriminating evidence. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Applying Magneto-rheology to Reduce Blood Viscosity and Suppress Turbulence to Prevent Heart Attacks

NASA Astrophysics Data System (ADS)

Tao, R.

Heart attacks are the leading causes of death in USA. Research indicates one common thread, high blood viscosity, linking all cardiovascular diseases. Turbulence in blood circulation makes different regions of the vasculature vulnerable to development of atherosclerotic plaque. Turbulence is also responsible for systolic ejection murmurs and places heavier workload on heart, a possible trigger of heart attacks. Presently, neither medicine nor method is available to suppress turbulence. The only method to reduce the blood viscosity is to take medicine, such as aspirin. However, using medicine to reduce the blood viscosity does not help suppressing turbulence. In fact, the turbulence gets worse as the Reynolds number goes up with the viscosity reduction by the medicine. Here we report our new discovery: application of a strong magnetic field to blood along its flow direction, red blood cells are polarized in the magnetic field and aggregated into short chains along the flow direction. The blood viscosity becomes anisotropic: Along the flow direction the viscosity is significantly reduced, but in the directions perpendicular to the flow the viscosity is considerably increased. In this way, the blood flow becomes laminar, turbulence is suppressed, the blood circulation is greatly improved, and the risk for heart attacks is reduced. While these effects are not permanent, they last for about 24 hours after one magnetic therapy treatment.

Anxiety sensitivity in smokers with indicators of cardiovascular disease.

PubMed

Farris, Samantha G; Abrantes, Ana M

2017-09-01

There is growing recognition of the importance of understanding the nature of the associations between anxiety and cardiovascular disease (CVD), although limited research has examined mechanisms that may explain the anxiety-CVD link. Anxiety sensitivity (fear of anxiety-relevant somatic sensations) is a cognitive-affective risk factor implicated in the development of anxiety psychopathology and various behavioral risk factors for CVD, although has not been examined among individuals with CVD. Adult daily smokers (n = 619; 50.9% female; M age  = 44.0, SD = 13.67) completed an online survey that included the Anxiety Sensitivity Index-3 (ASI-3) and the Patient Health Questionnaire (PHQ). The presence of CVD was assessed via the presence of ≥1 of the following: heart attack, heart murmur, positive stress test, heart valve abnormality, angina, and heart failure. Smokers with CVD indicators (n = 66, 10.7%) had significantly higher scores on the ASI-3 (M = 33.5, SD = 22.15), relative to smokers without CVD (M = 22.0, SD = 17.92; Cohen's d = .57). Those with CVD were significantly more likely to have moderate or high anxiety sensitivity (66.7%) relative to those without CVD (49.4%). Physical and social concerns about the meaning of somatic sensations were common among smokers with CVD.

The Preparticipation Sports Evaluation.

PubMed

Mirabelli, Mark H; Devine, Mathew J; Singh, Jaskaran; Mendoza, Michael

2015-09-01

The preparticipation physical evaluation is a commonly requested medical visit for amateur and professional athletes of all ages. The overarching goal is to maximize the health of athletes and their safe participation in sports. Although studies have not found that the preparticipation physical evaluation prevents morbidity and mortality associated with sports, it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries. Clearance depends on the outcome of the evaluation and the type of sport (and sometimes position or event) in which the athlete participates. All persons undergoing a preparticipation physical evaluation should be questioned about exertional symptoms, presence of a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death. The physical examination should focus on the cardiovascular and musculoskeletal systems. U.S. medical and athletic organizations discourage screening electrocardiography and blood and urine testing in asymptomatic patients. Further evaluation should be considered for persons with heart or lung disease, bleeding disorders, musculoskeletal problems, history of concussion, or other neurologic disorders.

77-year-old female with syncope.

PubMed

Abdelsalam, Mahmoud A; Geske, Jeffrey B

2017-02-15

A 77-year-old female was referred for evaluation of an episode of syncope while eating breakfast. There was no history of fall, syncope, prodrome, dyspnoea, chest discomfort or palpitations. Medical history was notable for hyperlipidaemia and treated hypertension. Blood pressure was 140/90 mm Hg, pulse 85  beats per minute (BPM). No murmurs were present on cardiac examination. ECG revealed normal sinus rhythm with left ventricular (LV) hypertrophy (see online supplementary figure S1). Holter monitor demonstrated rare premature ventricular complexes (<1% of beats), without heart block or ventricular tachycardia. Transthoracic echocardiogram is shown in figure 1. Which of the following is the explanation for the flow indicated by the yellow arrow? Aortic stenosisCoronary artery flow, indicative of coronary fistulaHypertrophic cardiomyopathy with apical pouchHypertensive heart diseaseMitral stenosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Hemodynamics of the Aortic Jet and Implications for Detection of Aortic Stenosis Murmurs

NASA Astrophysics Data System (ADS)

Zhu, Chi; Seo, Junghee; Bakhshaee, Hani; Mittal, Rajat

2016-11-01

Cardiac auscultation with a stethoscope has served as the primary method for qualitative screening of cardiovascular conditions for over a hundred years. However, a lack of quantitative understanding of the flow mechanism(s) responsible for the generation of the murmurs, as well as the effect of intervening tissue on the propagation of these murmurs has been a significant limiting factor in the advancement of automated cardiac auscultation. In this study, a multiphysics computational modeling approach is used to investigate these issues. Direct numerical simulation (DNS) is used to explore the fluid dynamics of the jets formed at the aortic valve and the pressure fluctuations generated by the interaction of this jet with the aortic wall. Subsequently, structural wave propagation in the tissue is resolved by a high-order, linear viscoelastic wave solver in order to explore the propagation of the murmurs through a tissue-like material. The implications of these results for cardiac auscultation are discussed. The authors would like to acknowledge the financial support from NSF Grants IIS-1344772, CBET-1511200, and computational resource by XSEDE NSF Grant TG-CTS100002.

[Echographic diagnosis of systolic murmur among 280 young French militaries. Implications for the expertise in military medicine].

PubMed

Vinsonneau, U; Vermeulen, L; Griffet, V; Delluc, A; Paleiron, N; Le Ven, F; Rohel, G; Jobic, Y; Piquemal, M; Mansourati, J; Paule, P

2015-04-01

Clinically discovering a systolic murmur is frequent among the young military population. When this murmur does not sound benign, a transthoracic echocardiography (TTE) is made to detect any cardiopathy, which could cause sudden cardiac death. The aim of this study was to evaluate the interest of systematic TTE in the assessment of any cardiac systolic murmur (CSM) among militaries. We ran a retrospective monocentric study in the "Clermont-Tonnerre" military hospital in Brest. We included all patients sent for TEE, aged 15 to 30 years old, from the 1st January 2010 until the 31st July 2013. Two hundred and eighty TTES assessing CSM were performed. We found 28/280 (10%) echocardiographic abnormalities: 13 were bicuspid aortic valves (4.6%), 6 were ventricular septal defects (2.15%), 3 were atrial septal defects (1.07%), 4 were mild mitral regurgitations (1.43%), one mild pulmonary stenosis (0.35%) and one aortic stenosis (0.35%). No hypertrophic cardiomyopathy was found. Concerning military expertise, 11 (3.92%) patients among these 28 with abnormal TEE were considered unfit for work or "fit for work with limitations". Assessing a cardiac systolic murmur with TEE lead to the diagnosis of a cardiomyopathy in 10% of the case. This study enhances the importance of systematic TEE when a CSM is detected in the young military, in order to determine if those soldiers can still fulfill their military duty. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

32 CFR 632.5 - Use of firearms.

Code of Federal Regulations, 2010 CFR

2010-07-01

... not fire if shots are likely to harm innocent bystanders. (3) Since warning shots could harm innocent bystanders, avoid firing them. However, when lesser degrees of force have failed, the law enforcement or.... If able to avoid hazards to innocent persons in these cases, fire warning shots. (4) Aim to disable...

33 CFR 151.2020 - Vessels in innocent passage.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Vessels in innocent passage. 151.2020 Section 151.2020 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY... United States § 151.2020 Vessels in innocent passage. A foreign vessel that is merely traversing the...

33 CFR 151.2020 - Vessels in innocent passage.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Vessels in innocent passage. 151.2020 Section 151.2020 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY... United States § 151.2020 Vessels in innocent passage. A foreign vessel that is merely traversing the...

33 CFR 151.2020 - Vessels in innocent passage.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Vessels in innocent passage. 151.2020 Section 151.2020 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY... United States § 151.2020 Vessels in innocent passage. A foreign vessel that is merely traversing the...

Editorial: Childhood Innocence.

ERIC Educational Resources Information Center

Frones, Ivar; Jenks, Chris; Rizzini, Irene

1998-01-01

Discusses the public perception of childhood innocence as a treasured concept that appears to be under attack according to media reports of child abuse and neglect and child murderers. Discusses cases of children who kill, focusing on the United Kingdom's 1968 case of Mary Bell. Considers causes of childhood crises that threaten innocence. (JPB)

The Place Where Waters Murmur: Taught and Learned Andean Space

ERIC Educational Resources Information Center

Garrido Pereira, Marcelo

2013-01-01

This text studies the phenomenon of teaching and learning of space, particularly the one inhabited and produced by those who live in a place of the Andes known as "the place where waters murmur" (Lugar donde murmura el agua or Putre). Notions of Humanistic Geography and Sociology of Social Experience are used to understand education as…

Auscultation and echocardiographic findings in Bull Terriers with and without polycystic kidney disease.

PubMed

O'Leary, C A; Mackay, B M; Taplin, R H; Atwell, R B

2005-05-01

To investigate a possible association between Bull Terrier polycystic kidney disease (BTPKD) and cardiac disease, to determine the prevalence of mitral valve disease (MVD) and left ventricular outflow tract obstruction (LVOTO) in the Australian Bull Terrier population, and to compare auscultation and echocardiography in detection of cardiac disease in Bull Terriers. Ninety-nine Bull Terriers, ranging in age from 8 weeks to 13 years and 11 months were auscultated and examined using renal ultrasonography; 86 were also examined using echocardiography. The prevalence and severity of heart defects in dogs with BTPKD was compared with that in dogs without BTPKD. Nineteen of these 99 dogs were diagnosed with BTPKD. Forty-two percent of Bull Terriers with BTPKD and 28% of those without BTPKD had murmurs characteristic of mitral regurgitation or LVOTO. How recently an animal was descended from an ancestor with BTPKD was associated with presence (P = 0.008) and loudness of a murmur (P = 0.009). Overall, echocardiography detected MVD in 39% of Bull Terriers, with increased prevalence in older animals (P = 0.003). Mitral stenosis was found in eight cases. Fifty-three percent of dogs in this study had evidence of LVOTO, with obstruction consisting of a complex of lesions including dynamic or fixed subvalvular LVOTO, significantly narrowed left ventricular outflow tract or valvular aortic stenosis. Dogs with BTPKD, or those descended from dogs with BTPKD, were more likely to have MVD (P = 0.006), and while LVOTO was not more common in these dogs, if they did have LVOTO, they were more likely to have severe obstruction than dogs with no ancestors with BTPKD (analysed in three ways P = 0.028 to 0.001). In this study, 46% of Bull Terriers without a murmur or arrhythmia had cardiac disease detected on echocardiographic examination. Cardiac disease, especially MVD and LVOTO, was common in Bull Terriers in this study, and those with BTPKD had an increased risk of cardiac abnormalities. Auscultation did not detect a significant number of Bull Terriers with cardiac disease.

High-pressure balloon dilation in a dog with supravalvular aortic stenosis.

PubMed

Pinkos, A; Stauthammer, C; Rittenberg, R; Barncord, K

2017-02-01

A 6-month-old female intact Goldendoodle was presented for diagnostic work up of a grade IV/VI left basilar systolic heart murmur. An echocardiogram was performed and revealed a ridge of tissue distal to the aortic valve leaflets at the sinotubular junction causing an instantaneous pressure gradient of 62 mmHg across the supravalvular aortic stenosis and moderate concentric hypertrophy of the left ventricle. Intervention with a high-pressure balloon dilation catheter was pursued and significantly decreased the pressure gradient to 34 mmHg. No complications were encountered. The patient returned in 5 months for re-evaluation and static long-term reduction in the pressure gradient was noted. Copyright © 2016 Elsevier B.V. All rights reserved.

[Transverse vaginal septum in the upper part of the vagina and pregnancy].

PubMed

Bautista Gómez, Esperanza; Morales-García, Victor; Flores-Romero, Ana Luisa; Pizarro Osorno, Noel; Velásquez-Valdivia, Abner

2012-07-01

Transverse vaginal septum is a congenital Mullerian malformation resulting from a failure of the fusion or canalization of the urogenital sinus and the Müllerian ducts. It may cause hematocolpos, dyspareunia and infertility in adult patients. In some cases, it is associated with congenital malformations such as coarctation of the aorta or atrial septal defects. A case of a transverse vaginal septum identified during a vaginal check-up of a 39-week pregnant patient during labour is reported. A cesarean surgery was performed with no complications. Septal defect was diagnosed due to heart murmur. It was decided to treat the transverse vaginal septum as soon as the puerperium was over. The patient left the hospital after proper response to treatment.

Parental Interpretations of "Childhood Innocence": Implications for Early Sexuality Education

ERIC Educational Resources Information Center

McGinn, Laura; Stone, Nicole; Ingham, Roger; Bengry-Howell, Andrew

2016-01-01

Purpose: Despite general recognition of the benefits of talking openly about sexuality with children, parents encounter and/or create barriers to such communication. One of the key barriers is a desire to protect childhood innocence. The purpose of this paper is to explore parental interpretations of childhood innocence and the influence this has…

Blame Conformity: Innocent Bystanders Can Be Blamed for a Crime as a Result of Misinformation from a Young, but Not Elderly, Adult Co-Witness

PubMed Central

Thorley, Craig

2015-01-01

This study examined whether or not exposing an eyewitness to a co-witness statement that incorrectly blames an innocent bystander for a crime can increase the likelihood of the eyewitness subsequently blaming the innocent bystander for the crime. It also examined whether or not the perceived age of the co-witness influences this effect. Participant eyewitnesses first watched a video of a crime featuring a perpetrator and an innocent bystander. They then read one of six bogus co-witness statements about the crime. All were presented as having been written by a female co-witness and they differed in terms of her age (young adult or elderly) and who she blamed for the crime (the perpetrator, the innocent bystander, or nobody). One week later the participants were asked who committed the crime. When the young adult co-witness had blamed the innocent bystander just over 40% of participants subsequently did the same. Few participants (less than 8%) in the other conditions subsequently blamed the innocent bystander. The elderly co-witness was also rated as less credible, less competent, and less accurate than the younger co-witness suggesting eyewitnesses were less likely to be influenced by her incorrect statement as they perceived her to be a less reliable source of information. The applied implications of these findings are discussed. PMID:26230523

Blame Conformity: Innocent Bystanders Can Be Blamed for a Crime as a Result of Misinformation from a Young, but Not Elderly, Adult Co-Witness.

PubMed

Thorley, Craig

2015-01-01

This study examined whether or not exposing an eyewitness to a co-witness statement that incorrectly blames an innocent bystander for a crime can increase the likelihood of the eyewitness subsequently blaming the innocent bystander for the crime. It also examined whether or not the perceived age of the co-witness influences this effect. Participant eyewitnesses first watched a video of a crime featuring a perpetrator and an innocent bystander. They then read one of six bogus co-witness statements about the crime. All were presented as having been written by a female co-witness and they differed in terms of her age (young adult or elderly) and who she blamed for the crime (the perpetrator, the innocent bystander, or nobody). One week later the participants were asked who committed the crime. When the young adult co-witness had blamed the innocent bystander just over 40% of participants subsequently did the same. Few participants (less than 8%) in the other conditions subsequently blamed the innocent bystander. The elderly co-witness was also rated as less credible, less competent, and less accurate than the younger co-witness suggesting eyewitnesses were less likely to be influenced by her incorrect statement as they perceived her to be a less reliable source of information. The applied implications of these findings are discussed.

Analysis of the pathological severity degree of aortic stenosis (AS) and mitral stenosis (MS) using the discrete wavelet transform (DWT).

PubMed

Meziani, F; Debbal, S M; Atbi, A

2013-01-01

The heart is the principal organ that circulates blood. In normal conditions it produces four sounds for each cardiac cycle. However, most often only two sounds appear essential: S1 and S2. Two other sounds: S3 and S4, with lower amplitude than S1 or S2, appear occasionally in the cardiac cycle by the effect of disease or age. The presence of abnormal sounds in one cardiac cycle provide valuable information on various diseases. The aortic stenosis (AS), as being a valvular pathology, is characterized by a systolic murmur due to a narrowing of the aortic valve. The mitral stenosis (MS) is characterized by a diastolic murmur due to a reduction in the mitral valve. Early screening of these diseases is necessary; it's done by a simple technique known as: phonocardiography. Analysis of phonocardiograms signals using signal processing techniques can provide for clinicians useful information considered as a platform for significant decisions in their medical diagnosis. In this work two types of diseases were studied: aortic stenosis (AS) and mitral stenosis (MS). Each one presents six different cases. The application of the discrete wavelet transform (DWT) to analyse pathological severity of the (AS and MS was presented. Then, the calculation of various parameters was performed for each patient. This study examines the possibility of using the DWT in the analysis of pathological severity of AS and MS.

White Innocence and Mexican Americans as Perpetrators in the School-to-Prison Pipeline

ERIC Educational Resources Information Center

Orozco, Richard

2013-01-01

This essay discusses white innocence as a mechanism that may contribute to perceptions of Mexican Americans as perpetrators. These perceptions are crucial to ways teachers and administrators respond to student actions as the initial steps in the school-to-prison pipeline. Specifically, this work reviews the rhetoric of white innocence in a high…

Brilliance of a Fire: Innocence, Experience and the Theory of Childhood

ERIC Educational Resources Information Center

Davis, Robert A.

2011-01-01

This essay offers an extensive rehabilitation and reappraisal of the concept of childhood innocence as a means of testing the boundaries of some prevailing constructions of childhood. It excavates in detail some of the lost histories of innocence in order to show that these are more diverse and more complex than established and pejorative…

Eyewitness identification evidence and innocence risk.

PubMed

Clark, Steven E; Godfrey, Ryan D

2009-02-01

It is well known that the frailties of human memory and vulnerability to suggestion lead to eyewitness identification errors. However, variations in different aspects of the eyewitnessing conditions produce different kinds of errors that are related to wrongful convictions in very different ways. We present a review of the eyewitness identification literature, organized around underlying cognitive mechanisms, memory, similarity, and decision processes, assessing the effects on both correct and mistaken identification. In addition, we calculate a conditional probability we call innocence risk, which is the probability that the suspect is innocent, given that the suspect was identified. Assessment of innocence risk is critical to the theoretical development of eyewitness identification research, as well as to legal decision making and policy evaluation. Our review shows a complex relationship between misidentification and innocence risk, sheds light on some areas of controversy, and suggests that some issues thought to be resolved are in need of additional research.

Echocardiographic Screening of Rheumatic Heart Disease in American Samoa.

PubMed

Huang, Jennifer H; Favazza, Michael; Legg, Arthur; Holmes, Kathryn W; Armsby, Laurie; Eliapo-Unutoa, Ipuniuesea; Pilgrim, Thomas; Madriago, Erin J

2018-01-01

While rheumatic heart disease (RHD) is a treatable disease nearly eradicated in the United States, it remains the most common form of acquired heart disease in the developing world. This study used echocardiographic screening to determine the prevalence of RHD in children in American Samoa. Screening took place at a subset of local schools. Private schools were recruited and public schools underwent cluster randomization based on population density. We collected survey information and performed a limited physical examination and echocardiogram using the World Heart Federation protocol for consented school children aged 5-18 years old. Of 2200 students from two private high schools and two public primary schools, 1058 subjects consented and were screened. Overall, 133 (12.9%) children were identified as having either definite (3.5%) or borderline (9.4%) RHD. Of the patients with definitive RHD, 28 subjects had abnormal mitral valves with pathologic regurgitation, three mitral stenosis, three abnormal aortic valves with pathologic regurgitation, and seven borderline mitral and aortic valve disease. Of the subjects with borderline disease, 77 had pathologic mitral regurgitation, 12 pathologic aortic regurgitation, and 7 at least two features of mitral valve disease without pathologic regurgitation or stenosis. Rheumatic heart disease remains a major cause of morbidity and mortality worldwide. The prevalence of RHD in American Samoa (12.9%) is to date the highest reported in the world literature. Echocardiographic screening of school children is feasible, while reliance on murmur and Jones criteria is not helpful in identifying children with RHD.

Echocardiography findings in clinically confirmed congenital rubella syndrome cases seen at the University of Port Harcourt Teaching Hospital, Nigeria.

PubMed

Otaigbe, B E; Tabansi, P N; Agbedey, G O

2012-01-01

Congenital rubella syndrome (CRS) is known to affect thousands of children in the developing world because rubella vaccination is not available routinely in most of these countries. Among its many manifestations only congenital heart disease is life threatening. This study was undertaken to ascertain the cases of echocardiographic determined congenital heart disease in clinically confirmed CRS cases. Data of patients with clinically confirmed CRS seen over a period of 5 years in the Paediatric cardiology clinic of the University of Port Harcourt Teaching Hospital was retrieved and analysed. Seven cases (2.8 % of total cardiac cases) were seen. 6 (85.7%) cases had at least one murmur on auscultation. Patent ductus arteriosus was the commonest cardiac defect seen either in isolation or incombination with a VSD or ASD. Only one child had no cardiac defect. 4 (57.1%) of them had been admitted for heart failure at least once and 2 (28.6 %) were on anti-failure regimen, one of whom had cardiac surgery one month ago. In view of the fact that 6 (85.7%) of the patients with CRS had at least one congenital heart defect, we advocate routine echocardiography on patients with CRS to ensure early treatment and reduce mortality and morbidity.We also advocate that rubella vaccination be given routinely in developing countries.

Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals

PubMed Central

Chambers, John; Kabir, Saleha; Cajeat, Eric

2014-01-01

Background Heart disease is difficult to detect clinically and it has been suggested that echocardiography should be available to all patients with possible cardiac symptoms or signs. Aim To analyse the results of 2 years of open access echocardiography for the frequency of structural heart disease according to request. Design and setting Retrospective database analysis in a teaching hospital open access echocardiography service. Method Reports of all open access transthoracic echocardiograms between January 2011 and December 2012 were categorised as normal, having minor abnormalities, or significant abnormalities according to the indication. Results There were 2343 open access echocardiograms performed and there were significant abnormalities in 29%, predominantly valve disease (n = 304, 13%), LV systolic dysfunction (n = 179, 8%), aortic dilatation (n = 80, 3%), or pulmonary hypertension (n = 91, 4%). If echocardiography had been targeted at a high-risk group, 267 with valve disease would have been detected (compared to 127 with murmur alone) and 139 with LV systolic dysfunction (compared to 91 with suspected heart failure alone). Most GP practices requested fewer than 10 studies, but 6 practices requested over 70 studies. Conclusion Open access echocardiograms are often abnormal but structural disease may not be suspected from the clinical request. Uptake by individual practices is patchy. A targeted expansion of echocardiography in patients with a high likelihood of disease is therefore likely to increase the detection of clinically important pathology. PMID:24567615

Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals.

PubMed

Chambers, John; Kabir, Saleha; Cajeat, Eric

2014-02-01

Heart disease is difficult to detect clinically and it has been suggested that echocardiography should be available to all patients with possible cardiac symptoms or signs. To analyse the results of 2 years of open access echocardiography for the frequency of structural heart disease according to request. Retrospective database analysis in a teaching hospital open access echocardiography service. Reports of all open access transthoracic echocardiograms between January 2011 and December 2012 were categorised as normal, having minor abnormalities, or significant abnormalities according to the indication. There were 2343 open access echocardiograms performed and there were significant abnormalities in 29%, predominantly valve disease (n = 304, 13%), LV systolic dysfunction (n = 179, 8%), aortic dilatation (n = 80, 3%), or pulmonary hypertension (n = 91, 4%). If echocardiography had been targeted at a high-risk group, 267 with valve disease would have been detected (compared to 127 with murmur alone) and 139 with LV systolic dysfunction (compared to 91 with suspected heart failure alone). Most GP practices requested fewer than 10 studies, but 6 practices requested over 70 studies. Open access echocardiograms are often abnormal but structural disease may not be suspected from the clinical request. Uptake by individual practices is patchy. A targeted expansion of echocardiography in patients with a high likelihood of disease is therefore likely to increase the detection of clinically important pathology.

Trauma, innocence and the core complex of dissociation.

PubMed

Kalsched, Donald E

2017-09-01

Trauma survivors often lament that they have lost their innocence or lost their souls and that something vulnerable and whole about themselves has been 'broken' or annihilated. Yet when the psychotherapeutic relationship begins, and symbolic material from dreams and the transference emerges, discernible patterns become apparent, indicating that a core of innocence and vitality has not been totally lost or annihilated. On the contrary, it has been 'saved' by dissociation and its system of inner objects and their protective and/or persecutory narrative 'scripts' or 'schemas'. The dissociative system splits off a wounded, orphaned 'child' in the psyche and clinging to this 'child' is a penumbra of innocence that apparently must be preserved at all costs. Unfortunately the costs of preservation are high because such encapsulated innocence becomes malignant, and the inner world turns perverse and destructive. Only when the wounded, orphaned, and innocent part of the personality is allowed to suffer experience again - this time with the promise of a new outcome - can true healing of trauma occur. How to facilitate this authentic suffering in the face of powerful resistances thrown up by the 'system', will be the focus of this paper. © 2017, The Society of Analytical Psychology.

Evaluation of platelet function in dogs with cardiac disease using the PFA-100 platelet function analyzer.

PubMed

Clancey, Noel; Burton, Shelley; Horney, Barbara; Mackenzie, Allan; Nicastro, Andrea; Côté, Etienne

2009-09-01

Cardiac disease has the potential to alter platelet function in dogs. Evaluation of platelet function using the PFA-100 analyzer in dogs of multiple breeds and with a broad range of cardiac conditions would help clarify the effect of cardiac disease on platelets. The objective of this study was to assess differences in closure time (CT) in dogs with cardiac disease associated with murmurs, when compared with that of healthy dogs. Thirty-nine dogs with cardiac murmurs and turbulent blood flow as determined echocardiographically were included in the study. The dogs represented 23 different breeds. Dogs with murmurs were further divided into those with atrioventricular valvular insufficiency (n=23) and subaortic stenosis (n=9). Fifty-eight clinically healthy dogs were used as controls. CTs were determined in duplicate on a PFA-100 analyzer using collagen/ADP cartridges. Compared with CTs in the control group (mean+/-SD, 57.6+/-5.9 seconds; median, 56.5 seconds; reference interval, 48.0-77.0 seconds), dogs with valvular insufficiency (mean+/-SD, 81.9+/-26.3 seconds; median, 78.0 seconds; range, 52.5-187 seconds), subaortic stenosis (71.4+/-16.5 seconds; median, 66.0 seconds; range, 51.5-95.0 seconds), and all dogs with murmurs combined (79.6+/-24.1 seconds; median, 74.0 seconds; range, 48.0-187 seconds) had significantly prolonged CTs (P<.01). The PFA-100 analyzer is useful in detecting platelet function defects in dogs with cardiac murmurs, most notably those caused by mitral and/or tricuspid valvular insufficiency or subaortic stenosis. The form of turbulent blood flow does not appear to be an important factor in platelet hypofunction in these forms of cardiac disease.

Predictors of postnatal complications and congenital cardiac diseases in infants of mothers with pregestational and gestational diabetes.

PubMed

Demirpençe, Savaş; Demirpençe, Banu İnce; Meşe, Timur; Arslanoğlu, Sertaç; Tavlı, Vedide; Çalkavur, Şebnem; Olukman, Özgür; Firuzan, Ali Rıza

2014-12-01

In this study, we aimed to evaluate the postnatal problems of infants of mothers with pregestational and gestational diabetes and the clinical properties of infants who were found to have congenital cardiac disease. We retrospectively examined the records of 337 newborns who were followed up with a diagnosis of infant of diabetic mother between January 2010 and January 2012 in our Neonatology Unit. The demographic data of the diabetic mothers and their babies, the postnatal problems of the babies of diabetic mothers and congenital heart diseases found on transthoracic echocardiography were examined. The patients were classified as group A, B and C in accordance with the recommendations of The American Congress of Obstetricians and Gynecologists (ACOG) according to the type of diabetes. The most common postnatal problems included hyperbilirubinemia, respiratory distress, hypoglycemia and hypocalcemia. The rate of congenital heart disease was found be 17.3% in group A, 50% in group B and 9% in group C. No correlation was found between congenital heart disease and gender, multiple pregnancy, diabetes type, diet treatment, use of oral antidiabetic drugs and drug usage. A positive significant correlation was found between congenital heart disease and genetic disease, murmur, cyanosis and presence of gestational hypertension. It was shown that use of insulin, genetic disease and presence of gestational diabetes increased the risk of congenital heart disease. In our study, the overall incidence of congenital heart disease was found to be 24% in infants of diabetic mothers. It should be kept in mind that it is important to investigate the infants of mothers with pregestational and gestational diabetes in terms of the risk of congenital heart disease.

Treatment of patent ductus arteriosus by the use of an Amplatz canine ductal occluder device

PubMed Central

White, Pam

2009-01-01

A 7-month-old female, spayed border collie was referred to the Ontario Veterinary College due to a continuous murmur noted by the referring veterinarian prior to ovariohysterectomy. Auscultation confirmed a grade VI/VI continuous murmur. An echocardiogram confirmed patent ductus arteriosus (PDA). An Amplatz canine ductal occluder device was successfully placed for occlusion of blood flow though the ductus. PMID:19436449

Path length entropy analysis of diastolic heart sounds.

PubMed

Griffel, Benjamin; Zia, Mohammad K; Fridman, Vladamir; Saponieri, Cesare; Semmlow, John L

2013-09-01

Early detection of coronary artery disease (CAD) using the acoustic approach, a noninvasive and cost-effective method, would greatly improve the outcome of CAD patients. To detect CAD, we analyze diastolic sounds for possible CAD murmurs. We observed diastolic sounds to exhibit 1/f structure and developed a new method, path length entropy (PLE) and a scaled version (SPLE), to characterize this structure to improve CAD detection. We compare SPLE results to Hurst exponent, Sample entropy and Multiscale entropy for distinguishing between normal and CAD patients. SPLE achieved a sensitivity-specificity of 80%-81%, the best of the tested methods. However, PLE and SPLE are not sufficient to prove nonlinearity, and evaluation using surrogate data suggests that our cardiovascular sound recordings do not contain significant nonlinear properties. Copyright © 2013 Elsevier Ltd. All rights reserved.

Infective endocarditis of the aortic valve in a Border collie dog with patent ductus arteriosus

PubMed Central

AOKI, Takuma; SUNAHARA, Hiroshi; SUGIMOTO, Keisuke; ITO, Tetsuro; KANAI, Eiichi; FUJII, Yoko

2014-01-01

Infective endocarditis (IE) in dogs with cardiac shunts has not been reported previously. However, we encountered a dog with concurrent patent ductus arteriosus (PDA) and IE. The dog was a 1-year-old, 13.9-kg female Border collie and presented with anorexia, weight loss, pyrexia (40.4°C) and lameness. A continuous murmur with maximal intensity over the left heart base (Levine 5/6) was detected on auscultation. Echocardiography revealed a PDA and severe aortic stenosis (AS) caused by aortic-valve vegetative lesions. Corynebacterium spp. and Bacillus subtilis were isolated from blood cultures. The dog responded to aggressive antibiotic therapy, and the PDA was subsequently surgically corrected. After a series of treatments, the dog showed long-term improvement in clinical status. PMID:25391395

Infective endocarditis of the aortic valve in a Border collie dog with patent ductus arteriosus.

PubMed

Aoki, Takuma; Sunahara, Hiroshi; Sugimoto, Keisuke; Ito, Tetsuro; Kanai, Eiichi; Fujii, Yoko

2015-03-01

Infective endocarditis (IE) in dogs with cardiac shunts has not been reported previously. However, we encountered a dog with concurrent patent ductus arteriosus (PDA) and IE. The dog was a 1-year-old, 13.9-kg female Border collie and presented with anorexia, weight loss, pyrexia (40.4 °C) and lameness. A continuous murmur with maximal intensity over the left heart base (Levine 5/6) was detected on auscultation. Echocardiography revealed a PDA and severe aortic stenosis (AS) caused by aortic-valve vegetative lesions. Corynebacterium spp. and Bacillus subtilis were isolated from blood cultures. The dog responded to aggressive antibiotic therapy, and the PDA was subsequently surgically corrected. After a series of treatments, the dog showed long-term improvement in clinical status.

Partial anomalous pulmonary venous connection with suspected pulmonary hypertension in a cat.

PubMed

Nicolson, Geoff; Daley, Michael; Makara, Mariano; Beijerink, Niek

2015-12-01

Partial anomalous pulmonary venous connection has previously been reported in the dog, but never in a cat. A 14-month-old Devon Rex cat was presented for echocardiography to evaluate a heart murmur noticed during a routine examination. The pertinent finding was right-sided cardiomegaly in the absence of an atrial septal defect or tricuspid regurgitation; pulmonary hypertension was suspected. A thoracic computed tomographic angiography study identified a partial anomalous pulmonary venous connection with the lobar veins of the left caudal, right middle, right caudal and accessory lung lobes draining into the caudal vena cava. The resultant volume overload is an easily overlooked differential diagnosis for right-sided cardiac enlargement. This is the first such report of this anomaly in a cat. Copyright © 2015 Elsevier B.V. All rights reserved.

Path Length Entropy Analysis of Diastolic Heart Sounds

PubMed Central

Griffel, B.; Zia, M. K.; Fridman, V.; Saponieri, C.; Semmlow, J. L.

2013-01-01

Early detection of coronary artery disease (CAD) using the acoustic approach, a noninvasive and cost-effective method, would greatly improve the outcome of CAD patients. To detect CAD, we analyze diastolic sounds for possible CAD murmurs. We observed diastolic sounds to exhibit 1/f structure and developed a new method, path length entropy (PLE) and a scaled version (SPLE), to characterize this structure to improve CAD detection. We compare SPLE results to Hurst exponent, Sample entropy and Multi-scale entropy for distinguishing between normal and CAD patients. SPLE achieved a sensitivity-specificity of 80%–81%, the best of the tested methods. However, PLE and SPLE are not sufficient to prove nonlinearity, and evaluation using surrogate data suggests that our cardiovascular sound recordings do not contain significant nonlinear properties. PMID:23930808

Saphenous vein graft aneurysm fistula formation causing right heart failure: an unusual presentation.

PubMed

Boon, K J; Arshad, M A; Singh, H; Lainchbury, J G; Blake, J W H

2015-11-01

Saphenous vein graft aneurysm (SVG) formation after coronary artery bypass grafting is a rare complication of the surgery. We present a case of a 68-year-old man with an unusual presentation of such an aneurysm. Thirty-four years after his initial bypass surgery, the patient presented with a fistula formation into his right atrium from a vein graft aneurysm. Late aneurysm formation is thought to occur secondary to atherosclerotic degeneration of the SVG with background hypertension and dyslipidaemia accelerating the process. Diagnostic modalities used to investigate SVG aneurysms include computed tomography, transthoracic echocardiogram, magnetic resonance imaging and cardiac catheterisation. Aneurysms with fistula formation historically require aggressive surgical intervention. Resection of the aneurysm with subsequent revascularisation if required is the surgical norm. SVG aneurysm with fistula formation into a cardiac chamber is a rare complication of coronary artery bypass grafting (CABG), which can occur with atypical presenting symptoms. Physicians should keep in mind the possibility of this occurring in post-CABG patients presenting with heart failure and a new murmur. © 2015 Royal Australasian College of Physicians.

Spectrum of heart diseases in children: an echocardiographic study of 1,666 subjects in a pediatric hospital, Yaounde, Cameroon.

PubMed

Chelo, David; Nguefack, Félicitée; Menanga, Alain P; Ngo Um, Suzanne; Gody, Jean C; Tatah, Sandra A; Koki Ndombo, Paul O

2016-02-01

Children's health programs in Sub-Saharan Africa have always been oriented primarily to infectious diseases and malnutrition. We are witnessing in the early 21(st) century an epidemiological transition marked by the decline of old diseases and the identification of new diseases including heart disease. Therefore, it is necessary to describe the spectrum of these diseases in order to better prepare health workers to these new challenges. We conducted a cross-sectional study focused on heart disease diagnosed by echocardiography in children seen from January 2006 to December 2014 in a pediatric hospital of Yaounde. We collected socio-demographic data and the types of heart disease from registers, patients files as well as the electronic database of echocardiographic records. A total of 2,235 patients underwent echocardiographic examination during the study period including 1,666 subjects with heart disease. Congenital cardiopathies were found in 1,230 (73.8%) patients and acquired abnormalities in 429 (25.8%). Seven children (0.4%) had a combination of both types. Congenital heart defects (CHD) were dominated by ventricular septal defect (VSD). Acquired heart disease was mostly rheumatic valvulopathies. Dyspnea on exertion was the most frequent presenting complaint (87.6%). Discovery of a heart murmur was the principal clinical finding on physical examination (81.4%). The median age was 9 months for congenital heart disease and 132 months for acquired heart disease. As infectious diseases recede and the diagnostic facilities are improving, pediatric heart diseases occupy a more important position in the spectrum of pediatric diseases in our context. However, the ability to evoke the diagnosis remains unsatisfactory by the majority of health personnel and therefore needs to be improved. Apart from congenital heart diseases, the impact of acquired heart diseases, rheumatic valvulopathy being the highest ranking, is remarkable in pediatrics. Awareness of health personnel for better management of child tonsillitis is more than ever a necessity. This preventive attitude of rheumatic heart disease is the main attitude available in our disadvantaged economic environment.

Tetralogy of Fallot and pheochromocytoma in a situs inversus totalis: An unusual association

PubMed Central

Tapia-Orihuela, Rubén Kevin Arnold; Huaringa-Marcelo, Jorge; Loja-Oropeza, David

2016-01-01

Introduction: Situs inversus totalis is an uncommon anomaly which exist a complete transposition of organs and it’s occasionally associated with congenital heart diseases, such as tetralogy of fallot. Pheochromocytoma is a rare neuroendocrine tumor with an annual incidence of 2-8 cases per million people and for years has been studied its relationship with the hypoxic pathway. Case Report: A 29 year old male with a history of tetralogy of fallot corrected at 10 years and situs inversus totalis. He was admitted to hospital with a progressive story of four months of constipation, palpitations, headache, dyspnea and sweating. Physical examination revealed a thinned man with peripheral cyanosis, clubbing and signs of decompensated congestive heart failure as hepatomegaly, legs edema, multifocal systodiastolic murmurs, abdominal distension and jugular venous distention. The echocardiogram shows severe right ventricular dysfunction and severe pulmonary hypertension. Furthermore, abdominal computed tomography shows right adrenal mass. Elevated metanephrines and catecholamines confirmed the diagnosis of pheochromocytoma. Surgical removal is decided and preoperative management begins with alpha-adrenergic blockade, however the patient had a hemodynamic decompensation with an unfavorable evolution. Discussion: In conclusion, there are few reports of cyanotic congenital heart disease with pheochromocytoma. Several studies show a significant association between both of them due to chronic hypoxia leads sustained hyperresponsiveness in adrenal medulla and it would cause the tumor. Special preoperative management of pheochromocytoma is recommended when there underlying heart disease and congestive heart failure. We present the first international report of tetralogy of fallot and pheochromocytoma in a patient with situs inversus totalis. PMID:27777699

Tetralogy of Fallot and pheochromocytoma in a situs inversus totalis: An unusual association.

PubMed

Tapia-Orihuela, Rubén Kevin Arnold; Huaringa-Marcelo, Jorge; Loja-Oropeza, David

2016-01-01

Introduction: Situs inversus totalis is an uncommon anomaly which exist a complete transposition of organs and it's occasionally associated with congenital heart diseases, such as tetralogy of fallot. Pheochromocytoma is a rare neuroendocrine tumor with an annual incidence of 2-8 cases per million people and for years has been studied its relationship with the hypoxic pathway. Case Report: A 29 year old male with a history of tetralogy of fallot corrected at 10 years and situs inversus totalis. He was admitted to hospital with a progressive story of four months of constipation, palpitations, headache, dyspnea and sweating. Physical examination revealed a thinned man with peripheral cyanosis, clubbing and signs of decompensated congestive heart failure as hepatomegaly, legs edema, multifocal systodiastolic murmurs, abdominal distension and jugular venous distention. The echocardiogram shows severe right ventricular dysfunction and severe pulmonary hypertension. Furthermore, abdominal computed tomography shows right adrenal mass. Elevated metanephrines and catecholamines confirmed the diagnosis of pheochromocytoma. Surgical removal is decided and preoperative management begins with alpha-adrenergic blockade, however the patient had a hemodynamic decompensation with an unfavorable evolution. Discussion: In conclusion, there are few reports of cyanotic congenital heart disease with pheochromocytoma. Several studies show a significant association between both of them due to chronic hypoxia leads sustained hyperresponsiveness in adrenal medulla and it would cause the tumor. Special preoperative management of pheochromocytoma is recommended when there underlying heart disease and congestive heart failure. We present the first international report of tetralogy of fallot and pheochromocytoma in a patient with situs inversus totalis.

Asymptomatic heart valve dysfunction in healthy middle-aged companion dogs and its implications for cardiac aging.

PubMed

Urfer, Silvan R; Kaeberlein, Tammi L; Mailheau, Susan; Bergman, Philip J; Creevy, Kate E; Promislow, Daniel E L; Kaeberlein, Matt

2017-02-01

Heart disease is the leading cause of death in the USA, accounting for about one in every four deaths. Age is the greatest risk factor for heart disease in both people and dogs; however, heart disease is generally not considered as a major cause of morbidity or mortality in dogs. As part of the preliminary selection process for a veterinary clinical trial, 40 companion dogs with no history of cardiac pathology that were at least 6 years old and weighed at least 18 kg underwent a cardiac screening using Doppler echocardiography. Eleven dogs from this cohort were diagnosed with valvular regurgitation by echocardiography, and seven of these cases were of sufficient severity to warrant exclusion from the clinical trial. In only one case was a heart murmur detected by auscultation. Serum alkaline phosphatase levels were significantly higher in the dogs with moderate to severe valvular regurgitation compared to the rest of the cohort. These observations suggest that asymptomatic degenerative valvular disease detectable by echocardiography, but not by a standard veterinary exam including auscultation, may be present in a significant fraction of middle-aged companion dogs, indicating a previously underappreciated similarity between human and canine aging. Further, these data suggest that companion dogs may be a particularly useful animal model for understanding mechanisms of age-related degenerative valve disease and for developing and testing interventions to ameliorate cardiac disease. Future studies should address whether dogs with asymptomatic valve disease are at higher risk for subsequent morbidity or early death.

Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE.

PubMed

Compostella, Leonida; Compostella, Caterina; Russo, Nicola; Setzu, Tiziana; Iliceto, Sabino; Bellotto, Fabio

2017-09-01

During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.

Elevated resting heart rate in heart transplant recipients: innocent bystander or adverse prognostic indicator?

PubMed

Wachter, S Blake; McCandless, Sean P; Gilbert, Edward M; Stoddard, Gregory J; Kfoury, Abdallah G; Reid, Bruce B; McKellar, Stephen H; Nativi-Nicolau, Jose; Saidi, Abdulfattah; Barney, Jacob; McCreath, Lauren; Koliopoulou, Antigone; Wright, Spencer E; Fang, James C; Stehlik, Josef; Selzman, Craig H; Drakos, Stavros G

2015-09-01

The elevated baseline heart rate (HR) of a heart transplant recipient has previously been considered inconsequential. However, we hypothesized that a resting HR above 100 beats per minute (bpm) may be associated with morbidity and mortality. The U.T.A.H. Cardiac Transplant Program studied patients who received a heart transplant between 2000 and 2011. Outpatient HR values for each patient were averaged during the first year post-transplant. The study cohort was divided into two groups: the tachycardic (TC) (HR > 100 bpm) and the non-TC group (HR ≤ 100 bpm) in which mortality, incidence of rejection, and cardiac allograft vasculopathy were compared. Three hundred and ten patients were included as follows: 73 in the TC and 237 in the non-TC group. The TC group had a higher risk of a 10-yr all-cause mortality (p = 0.004) and cardiovascular mortality (p = 0.044). After adjustment for donor and recipient characteristics in multivariable logistic regression analysis, the hazard ratio was 3.9, (p = 0.03, CI: 1.2-13.2) and 2.6 (p = 0.02, CI: 1.2-5.5) for cardiovascular mortality and all-cause mortality, respectively. Heart transplant recipients with elevated resting HR appear to have higher mortality than those with lower resting HR. Whether pharmacologically lowering the HR would result in better outcomes warrants further investigation. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Emotion, cognitive load and learning outcomes during simulation training.

PubMed

Fraser, Kristin; Ma, Irene; Teteris, Elise; Baxter, Heather; Wright, Bruce; McLaughlin, Kevin

2012-11-01

Simulation training has emerged as an effective way to complement clinical training of medical students. Yet outcomes from simulation training must be considered suboptimal when 25-30% of students fail to recognise a cardiac murmur on which they were trained 1 hour previously. There are several possible explanations for failure to improve following simulation training, which include the impact of heightened emotions on learning and cognitive overload caused by interactivity with high-fidelity simulators. This study was conducted to assess emotion during simulation training and to explore the relationships between emotion and cognitive load, and diagnostic performance. We trained 84 Year 1 medical students on a scenario of chest pain caused by symptomatic aortic stenosis. After training, students were asked to rate their emotional state and cognitive load. We then provided training on a dyspnoea scenario before asking participants to diagnose the murmur in which they had been trained (aortic stenosis) and a novel murmur (mitral regurgitation). We used factor analysis to identify the principal components of emotion, and then studied the associations between these components of emotion and cognitive load and diagnostic performance. We identified two principal components of emotion, which we felt represented invigoration and tranquillity. Both of these were associated with cognitive load with adjusted regression coefficients of 0.63 (95% confidence interval [CI] 0.28-0.99; p = 0.001) and - 0.44 (95% CI - 0.77 to - 0.10; p = 0.009), respectively. We found a significant negative association between cognitive load and the odds of subsequently identifying the trained murmur (odds ratio 0.27, 95% CI 0.11-0.67; p = 0.004). We found that increased invigoration and reduced tranquillity during simulation training were associated with increased cognitive load, and that the likelihood of correctly identifying a trained murmur declined with increasing cognitive load. Further studies are needed to evaluate the impact on performance of strategies to alter emotion and cognitive load during simulation training. © Blackwell Publishing Ltd 2012.

Visualization of traumatic tricuspid insufficiency by three-dimensional echocardiography.

PubMed

Nishimura, Kazuhisa; Okayama, Hideki; Inoue, Katsuji; Saito, Makoto; Nagai, Takayuki; Suzuki, Jun; Ogimoto, Akiyoshi; Ohtsuka, Tomoaki; Higaki, Jitsuo

2010-01-01

A 19-year-old male was admitted to the emergency room of our hospital after a motor vehicle accident. During his first physical examination, a holosystolic murmur was heard at the fourth left parasternal border. Transthoracic echocardiography showed severe tricuspid insufficiency, but the cause of tricuspid insufficiency was unclear. Therefore, three-dimensional echocardiography was performed and demonstrated flail anterior, posterior and septal leaflets of the tricuspid valve. The diagnosis was tricuspid insufficiency due to papillary muscle rupture secondary to chest blunt trauma. Surgical repair of the tricuspid valve was performed in this patient. After surgery, the signs and symptoms of right ventricular heart failure were relieved. In this case, three-dimensional echocardiography was very useful for the evaluation of spatial destruction of the tricuspid valve and papillary muscle. 2009 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Successful medical management of a case of Austrian syndrome-an uncommon entity in the modern antibiotic era: a case report.

PubMed

Rahim, Muhammad Abdur; Zaman, Shahana; Haque, Hasna Fahmima; Afroze, Samira Rahat; Uddin, Khwaja Nazim

2017-09-06

Austrian syndrome-the combination of meningitis, pneumonia and infective endocarditis due to Streptococcus pneumoniae infection, is a rare entity. In literature only a few hundreds of cases are reported but surprisingly we did not find any report on Austrian syndrome in or from Bangladesh. We report the case history of a middle aged Bangladeshi diabetic man, who had fever, cough, shortness of breath and altered mentation. He had tachycardia, bi-basal lung crepitations, new cardiac murmurs and meningism. Diagnostic work-up revealed Austrian syndrome. Because of the rarity of the condition, this case is reported. A case of pneumococcal pneumonia or meningitis should raise suspicion of concomitant endocarditis and Austrian syndrome, specially if there is heart failure, as early recognition and treatment may appear life-saving.

Cardiac Auscultation Using Smartphones: Pilot Study.

PubMed

Kang, Si-Hyuck; Joe, Byunggill; Yoon, Yeonyee; Cho, Goo-Yeong; Shin, Insik; Suh, Jung-Won

2018-02-28

Cardiac auscultation is a cost-effective, noninvasive screening tool that can provide information about cardiovascular hemodynamics and disease. However, with advances in imaging and laboratory tests, the importance of cardiac auscultation is less appreciated in clinical practice. The widespread use of smartphones provides opportunities for nonmedical expert users to perform self-examination before hospital visits. The objective of our study was to assess the feasibility of cardiac auscultation using smartphones with no add-on devices for use at the prehospital stage. We performed a pilot study of patients with normal and pathologic heart sounds. Heart sounds were recorded on the skin of the chest wall using 3 smartphones: the Samsung Galaxy S5 and Galaxy S6, and the LG G3. Recorded heart sounds were processed and classified by a diagnostic algorithm using convolutional neural networks. We assessed diagnostic accuracy, as well as sensitivity, specificity, and predictive values. A total of 46 participants underwent heart sound recording. After audio file processing, 30 of 46 (65%) heart sounds were proven interpretable. Atrial fibrillation and diastolic murmur were significantly associated with failure to acquire interpretable heart sounds. The diagnostic algorithm classified the heart sounds into the correct category with high accuracy: Galaxy S5, 90% (95% CI 73%-98%); Galaxy S6, 87% (95% CI 69%-96%); and LG G3, 90% (95% CI 73%-98%). Sensitivity, specificity, positive predictive value, and negative predictive value were also acceptable for the 3 devices. Cardiac auscultation using smartphones was feasible. Discrimination using convolutional neural networks yielded high diagnostic accuracy. However, using the built-in microphones alone, the acquisition of reproducible and interpretable heart sounds was still a major challenge. ClinicalTrials.gov NCT03273803; https://clinicaltrials.gov/ct2/show/NCT03273803 (Archived by WebCite at http://www.webcitation.org/6x6g1fHIu). ©Si-Hyuck Kang, Byunggill Joe, Yeonyee Yoon, Goo-Yeong Cho, Insik Shin, Jung-Won Suh. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 28.02.2018.

Cardiac Auscultation Using Smartphones: Pilot Study

PubMed Central

Kang, Si-Hyuck; Joe, Byunggill; Yoon, Yeonyee; Cho, Goo-Yeong; Shin, Insik

2018-01-01

Background Cardiac auscultation is a cost-effective, noninvasive screening tool that can provide information about cardiovascular hemodynamics and disease. However, with advances in imaging and laboratory tests, the importance of cardiac auscultation is less appreciated in clinical practice. The widespread use of smartphones provides opportunities for nonmedical expert users to perform self-examination before hospital visits. Objective The objective of our study was to assess the feasibility of cardiac auscultation using smartphones with no add-on devices for use at the prehospital stage. Methods We performed a pilot study of patients with normal and pathologic heart sounds. Heart sounds were recorded on the skin of the chest wall using 3 smartphones: the Samsung Galaxy S5 and Galaxy S6, and the LG G3. Recorded heart sounds were processed and classified by a diagnostic algorithm using convolutional neural networks. We assessed diagnostic accuracy, as well as sensitivity, specificity, and predictive values. Results A total of 46 participants underwent heart sound recording. After audio file processing, 30 of 46 (65%) heart sounds were proven interpretable. Atrial fibrillation and diastolic murmur were significantly associated with failure to acquire interpretable heart sounds. The diagnostic algorithm classified the heart sounds into the correct category with high accuracy: Galaxy S5, 90% (95% CI 73%-98%); Galaxy S6, 87% (95% CI 69%-96%); and LG G3, 90% (95% CI 73%-98%). Sensitivity, specificity, positive predictive value, and negative predictive value were also acceptable for the 3 devices. Conclusions Cardiac auscultation using smartphones was feasible. Discrimination using convolutional neural networks yielded high diagnostic accuracy. However, using the built-in microphones alone, the acquisition of reproducible and interpretable heart sounds was still a major challenge. Trial Registration ClinicalTrials.gov NCT03273803; https://clinicaltrials.gov/ct2/show/NCT03273803 (Archived by WebCite at http://www.webcitation.org/6x6g1fHIu) PMID:29490899

Mitochondria in cancer: not just innocent bystanders.

PubMed

Frezza, Christian; Gottlieb, Eyal

2009-02-01

The first half of the 20th century produced substantial breakthroughs in bioenergetics and mitochondria research. During that time, Otto Warburg observed abnormally high glycolysis and lactate production in oxygenated cancer cells, leading him to suggest that defects in mitochondrial functions are at the heart of malignant cell transformation. Warburg's hypothesis profoundly influenced the present perception of cancer metabolism, positioning what is termed aerobic glycolysis in the mainstream of clinical oncology. While some of his ideas stood the test of time, they also frequently generated misconceptions regarding the biochemical mechanisms of cell transformation. This review examines experimental evidence which supports or refutes the Warburg effect and discusses the possible advantages conferred on cancer cells by 'metabolic transformation'.

Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes

PubMed Central

Høyte, Henning; Jensen, Torstein; Gjesdal, Knut

2005-01-01

Background To determine whether the use of an electronic, sensor based stethoscope affects the cardiac auscultation skills of undergraduate medical students. Methods Forty eight third year medical students were randomized to use either an electronic stethoscope, or a conventional acoustic stethoscope during clinical auscultation training. After a training period of four months, cardiac auscultation skills were evaluated using four patients with different cardiac murmurs. Two experienced cardiologists determined correct answers. The students completed a questionnaire for each patient. The thirteen questions were weighted according to their relative importance, and a correct answer was credited from one to six points. Results No difference in mean score was found between the two groups (p = 0.65). Grading and characterisation of murmurs and, if present, report of non existing murmurs were also rated. None of these yielded any significant differences between the groups. Conclusion Whether an electronic or a conventional stethoscope was used during training and testing did not affect the students' performance on a cardiac auscultation test. PMID:15882458

The (Un)reliability of Alibi Corroborators: Failure to Recognize Faces of Briefly Encountered Strangers Puts Innocent Suspects at Risk.

PubMed

Charman, Steve D; Reyes, Andrea; Villalba, Daniella K; Evans, Jacqueline R

2017-01-01

Some innocent suspects rely on the memory of strangers to corroborate their alibis. However, no research has examined whether such potential alibi corroborators can accurately recognize an innocent suspect with whom they previously interacted. We developed a novel alibi corroboration paradigm in which undergraduate students (representing innocent suspects who would later provide an alibi) interacted with naïve university employees (representing potential alibi corroborators). Each student briefly interacted with a different naïve university employee (n = 60), and were also each yoked to a different employee with whom they did not interact (n = 60). Employees were presented 24 hours later with either a single photograph of the student or a six-person array containing a photograph of the student and were asked if they recognized anyone. The majority of employees failed to make a correct recognition of the student. False recognitions, however, were rare. Students exhibited overconfidence that they would be recognized. Findings imply that innocent suspects who rely on strangers to corroborate their alibis may be at risk. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The penology of racial innocence: the erasure of racism in the study and practice of punishment.

PubMed

Murakawa, Naomi; Beckett, Katherine

2010-01-01

In post–civil rights America, the ascendance of “law-and-order” politics and “postracial” ideology have given rise to what we call the penology of racial innocence. The penology of racial innocence is a framework for assessing the role of race in penal policies and institutions, one that begins with the presumption that criminal justice is innocent of racial power until proven otherwise. Countervailing sociolegal changes render this framework particularly problematic. On the one hand, the definition of racism has contracted in antidiscrimination law and in many social scientific studies of criminal justice, so that racism is defined narrowly as intentional and causally discrete harm. On the other hand, criminal justice institutions have expanded to affect historically unprecedented numbers of people of color, with penal policies broadening in ways that render the identification of racial intent and causation especially difficult. Analyses employing the penology of racial innocence examine the ever-expanding criminal justice system with limited definitions of racism, ultimately contributing to the erasure of racial power. Both racism and criminal justice operate in systemic and serpentine ways; our conceptual tools and methods, therefore, need to be equally systemic and capacious.

Are nonparticipants in prosocial behavior merely innocent bystanders?

PubMed

Anker, Ashley E; Feeley, Thomas Hugh

2011-01-01

Latané and Darley's (1970) bystander intervention theory was used to model individuals' participation in two prosocial behaviors (organ donation, green living). It is argued that nonparticipants in prosocial helping are innocent bystanders who likely fail to notice the need, do not interpret the cause as an emergency, do not accept responsibility for the need to help, and have little knowledge on how to help. Data in study 1 (n = 494) indicate support for the proposed innocent bystander path model (notice event → interpret event as emergency → accept responsibility → knowledge of how to help) in organ donation. Study 2 (n = 519) replicated the model in the context of green living and additionally found a direct path from noticing the event to knowledge of how to help. Implications of framing nonparticipation in prosocial behaviors as innocent bystander effects are discussed in context of campaign communication.

Left ventricular inflow tract obstruction secondary to a myxoma in a dog.

PubMed

Fernandez-del Palacio, M Josefa; Sanchez, Joaquin; Talavera, Jesus; Martínez, Carlos

2011-01-01

This is the first description of a left ventricular inflow tract obstruction secondary to a myxoma in a dog. A 4 yr old, male fox terrier presented with a 1 mo history of cough and exercise intolerance. Expiratory dyspnea, pulmonary crackles, irregular cardiac rhythm, and a grade 4/6 pansystolic cardiac murmur over the left cardiac apex were the most important features on physical examination. The electrocardiogram revealed atrial fibrillation. Thoracic radiographs showed left-sided cardiac enlargement and mild pulmonary edema, especially in the hilar area. Two-dimensional transthoracic echocardiography showed severe left atrial dilation and a homogenous, echodense mass involving both leaflets of the mitral valve and the posteromedial papillary muscle, inducing mitral stenosis. Spectral Doppler echocardiography was consistent with severe left ventricular inflow tract obstruction secondary to a mass. Therapy for congestive heart failure was prescribed. Follow-up examinations of the dog 1 mo, 2 mo, and 6 mo after diagnosis showed an improvement in clinical signs, but similar echocardiographic features. Eleven months after diagnosis, the dog was euthanized at the owner's request because of recurrent congestive heart failure. The postmortem examination showed the cardiac tumor was consistent with a myxoma.

A simulator-based study of in-flight auscultation.

PubMed

Tourtier, Jean-Pierre; Libert, Nicolas; Clapson, Patrick; Dubourdieu, Stéphane; Jost, Daniel; Tazarourte, Karim; Astaud, Cécil-Emmanuel; Debien, Bruno; Auroy, Yves

2014-04-01

The use of a stethoscope is essential to the delivery of continuous, supportive en route care during aeromedical evacuations. We compared the capability of 2 stethoscopes (electronic, Litmann 3000; conventional, Litmann Cardiology III) at detecting pathologic heart and lung sounds, aboard a C135, a medical transport aircraft. Sounds were mimicked using a mannequin-based simulator SimMan. Five practitioners examined the mannequin during a fly, with a variety of abnormalities as follows: crackles, wheezing, right and left lung silence, as well as systolic, diastolic, and Austin-Flint murmur. The comparison for diagnosis assessed (correct or wrong) between using the electronic and conventional stethoscopes were performed as a McNemar test. A total of 70 evaluations were performed. For cardiac sounds, diagnosis was right in 0/15 and 4/15 auscultations, respectively, with conventional and electronic stethoscopes (McNemar test, P = 0.13). For lung sounds, right diagnosis was found with conventional stethoscope in 10/20 auscultations versus 18/20 with electronic stethoscope (P = 0.013). Flight practitioners involved in aeromedical evacuation on C135 plane are more able to practice lung auscultation on a mannequin with this amplified stethoscope than with the traditional one. No benefit was found for heart sounds.

Hemolysis, myopathy, and cardiac disease associated with hereditary phosphofructokinase deficiency in two Whippets

PubMed Central

Gerber, Karen; Harvey, John W.; D'Agorne, Sara; Wood, Jonathan; Giger, Urs

2009-01-01

Two male castrated Whippet littermates were presented at 1 year of age for pallor, tachycardia, systolic heart murmur, dark yellow to orange feces, intermittent lethargy, pigmenturia, and muscle shivering or cramping after exercise. Persistent macrocytic hypochromic anemia with marked reticulocytosis and metarubricytosis was found when CBC results were compared with reference values for Whippets. Increased serum creatine kinase activity and hyperkalemia also were sometimes present over the 4-year period of evaluation. Progressively increasing serum concentrations of N-terminal prohormone brain natriuretic peptide suggested cardiac disease. Erythrocytes from the whippets were less osmotically fragile but more alkaline fragile than those from control dogs. Erythrocyte phosphofructokinase (PFK) activities and 2,3-diphosphoglycerate concentrations were decreased. Restriction enzyme-based DNA test screening and DNA sequencing revealed the same mutation in the muscle-PFK gene of the Whippets as seen in English Springer Spaniel dogs with PFK deficiency. This is the first report of PFK deficiency in Whippet dogs. In addition to causing hemolysis and exertional myopathy, heart disease may be a prominent clinical component of PFK deficiency in this breed and has not been previously recognized in PFK-deficient English Springer Spaniels. PMID:19228357

Pregnancy Outcome of Abnormal Nuchal Translucency: A Systematic Review

PubMed Central

Roozbeh, Nasibeh; Azizi, Maryam

2017-01-01

Introduction Nuchal Translucency (NT) is the sonographic form of subcutaneous gathering of liquid behind the foetal neck in the first trimester of pregnancy. There is association of increased NT with chromosomal and non-chromosomal abnormalities. Aim The purpose of this systemic review was to review the pregnancy outcome of abnormal nuchal translucency. Materials and Methods The present systematic review was conducted by searching English language articles from sources such as International Medical Sciences, Medline, Web of science, Scopus, Google Scholar, PubMed, Index Copernicus, DOAJ, EBSCO-CINAHL. Persian articles were searched from Iranmedex and SID sources. Related key words were “outcome”, “pregnancy”, “abnormal”, and “Nuchal Translucency” (NT). All, randomized, descriptive, analytic-descriptive, case control study conducted during 1997-2015 were included. Results Including duplicate articles, 95 related articles were found. After reviewing article titles, 30 unrelated article and abstracts were removed, and 65 articles were evaluated of which 30 articles were duplicate. Finally 22 articles were selected for final analysis. Exclusion criteria were, case studies and reports and quasi experimental designs. This evaluation has optioned negative relationship between nuchal translucency and pregnancy result. Rate of cardiac, chromosomal and other defects are correlated with increased NT≥2.5mm. Cardiac disease which were associated to the increased NT are heart murmur, systolic organic murmur, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), tricuspid valve insufficiency and pulmonary valve insufficiency, Inferior Vena Cava (IVC) and Patent Ductus Arteriosus (PDA). The most common problems that related with increased NT were allergic symptoms. Conclusion According to this systematic review, increased NT is associated with various foetal defects. To verify the presence of malformations, birth defect consultations with a perinatologist and additional tests are required. PMID:28511453

Pregnancy Outcome of Abnormal Nuchal Translucency: A Systematic Review.

PubMed

Roozbeh, Nasibeh; Azizi, Maryam; Darvish, Leili

2017-03-01

Nuchal Translucency (NT) is the sonographic form of subcutaneous gathering of liquid behind the foetal neck in the first trimester of pregnancy. There is association of increased NT with chromosomal and non-chromosomal abnormalities. The purpose of this systemic review was to review the pregnancy outcome of abnormal nuchal translucency. The present systematic review was conducted by searching English language articles from sources such as International Medical Sciences, Medline, Web of science, Scopus, Google Scholar, PubMed, Index Copernicus, DOAJ, EBSCO-CINAHL. Persian articles were searched from Iranmedex and SID sources. Related key words were "outcome", "pregnancy", "abnormal", and "Nuchal Translucency" (NT). All, randomized, descriptive, analytic-descriptive, case control study conducted during 1997-2015 were included. Including duplicate articles, 95 related articles were found. After reviewing article titles, 30 unrelated article and abstracts were removed, and 65 articles were evaluated of which 30 articles were duplicate. Finally 22 articles were selected for final analysis. Exclusion criteria were, case studies and reports and quasi experimental designs. This evaluation has optioned negative relationship between nuchal translucency and pregnancy result. Rate of cardiac, chromosomal and other defects are correlated with increased NT≥2.5mm. Cardiac disease which were associated to the increased NT are heart murmur, systolic organic murmur, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), tricuspid valve insufficiency and pulmonary valve insufficiency, Inferior Vena Cava (IVC) and Patent Ductus Arteriosus (PDA). The most common problems that related with increased NT were allergic symptoms. According to this systematic review, increased NT is associated with various foetal defects. To verify the presence of malformations, birth defect consultations with a perinatologist and additional tests are required.

World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease—an evidence-based guideline

PubMed Central

Reményi, Bo; Wilson, Nigel; Steer, Andrew; Ferreira, Beatriz; Kado, Joseph; Kumar, Krishna; Lawrenson, John; Maguire, Graeme; Marijon, Eloi; Mirabel, Mariana; Mocumbi, Ana Olga; Mota, Cleonice; Paar, John; Saxena, Anita; Scheel, Janet; Stirling, John; Viali, Satupaitea; Balekundri, Vijayalakshmi I.; Wheaton, Gavin; Zühlke, Liesl; Carapetis, Jonathan

2017-01-01

Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: ‘definite RHD’, ‘borderline RHD’, and ‘normal’. Four subcategories of ‘definite RHD’ and three subcategories of ‘borderline RHD’ exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control. PMID:22371105

Heart valve disease associated with treatment with ergot-derived dopamine agonists: a clinical and echocardiographic study of patients with Parkinson's disease.

PubMed

Rasmussen, V G; Poulsen, S H; Dupont, E; Østergaard, K; Safikhany, G; Egeblad, H

2008-01-01

To elucidate the association between treatment with ergot-derived dopamine agonists (EDDA) and valvular abnormalities amongst patients with idiopathic Parkinson's disease (IPD) and secondly, to analyse the yield of clinical screening for valvular heart disease. A cross-sectional controlled study. The cohort of IPD patients treated in the outpatient clinic, Department of Neurology, Aarhus University Hospital, Denmark. A total of 138 IPD patients [median age 64 (39-87) years, 62% men] treated with either EDDA (n = 85) or non-EDDA (n = 53) for at least 6 months. Interventions. Patients were screened for valvular heart disease by clinical means and by examiner-blinded echocardiography. Main outcome measure was valvular regurgitation revealed by echocardiography. Severe aortic regurgitation (n = 4) or moderate aortic (n = 12), mitral (n = 3) or tricuspidal valve regurgitation (n = 5) was found in 22 EDDA patients (25.9%). Two patients had coexistent moderate mitral and tricuspid valvular regurgitation. Two non-EDDA patients had moderate valve insufficiency (3.8%, P < 0.05). The adjusted relative risk for at least moderate valve insufficiency in the EDDA patients was 7.2% (P < 0.05). The sensitivity of detecting at least moderate valvular disease by cardiac murmur, dyspnoea, or the heart failure marker NT-proBNP (natriuretic peptide) was 62% for the neurologists and 93% for the cardiologist but with equally low specificity (30-35%). EDDA was associated with a clinically important and statistically significant risk of at least moderate valve regurgitation. Clinical screening for valve disease was inadequate and it seems advisable to offer EDDA patients control with echocardiography.

World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline.

PubMed

Reményi, Bo; Wilson, Nigel; Steer, Andrew; Ferreira, Beatriz; Kado, Joseph; Kumar, Krishna; Lawrenson, John; Maguire, Graeme; Marijon, Eloi; Mirabel, Mariana; Mocumbi, Ana Olga; Mota, Cleonice; Paar, John; Saxena, Anita; Scheel, Janet; Stirling, John; Viali, Satupaitea; Balekundri, Vijayalakshmi I; Wheaton, Gavin; Zühlke, Liesl; Carapetis, Jonathan

2012-02-28

Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control.

Delayed innocent bystander cell death following hypoxia in Caenorhabditis elegans

PubMed Central

Sun, C-L; Kim, E; Crowder, C M

2014-01-01

After hypoxia, cells may die immediately or have a protracted course, living or dying depending on an incompletely understood set of cell autonomous and nonautonomous factors. In stroke, for example, some neurons are thought to die from direct hypoxic injury by cell autonomous primary mechanisms, whereas other so called innocent bystander neurons die from factors released from the primarily injured cells. A major limitation in identifying these factors is the inability of current in vivo models to selectively target a set of cells for hypoxic injury so that the primarily injured cells and the innocent bystanders are clearly delineated. In order to develop such a model, we generated transgenic Caenorhabditis elegans strains where 2–3% of somatic cells were made selectively sensitive to hypoxia. This was accomplished by cell type-specific wild-type rescue in either pharyngeal myocytes or GABAergic neurons of a hypoxia resistance-producing translation factor mutation. Surprisingly, hypoxic targeting of these relatively small subsets of non-essential cells produced widespread innocent bystander cell injury, behavioral dysfunction and eventual organismal death. The hypoxic injury phenotypes of the myocyte or neuron sensitized strains were virtually identical. Using this model, we show that the C. elegans insulin receptor/FOXO transcription factor pathway improves survival when activated only after hypoxic injury and blocks innocent bystander death. PMID:24317200

Delayed innocent bystander cell death following hypoxia in Caenorhabditis elegans.

PubMed

Sun, C-L; Kim, E; Crowder, C M

2014-04-01

After hypoxia, cells may die immediately or have a protracted course, living or dying depending on an incompletely understood set of cell autonomous and nonautonomous factors. In stroke, for example, some neurons are thought to die from direct hypoxic injury by cell autonomous primary mechanisms, whereas other so called innocent bystander neurons die from factors released from the primarily injured cells. A major limitation in identifying these factors is the inability of current in vivo models to selectively target a set of cells for hypoxic injury so that the primarily injured cells and the innocent bystanders are clearly delineated. In order to develop such a model, we generated transgenic Caenorhabditis elegans strains where 2-3% of somatic cells were made selectively sensitive to hypoxia. This was accomplished by cell type-specific wild-type rescue in either pharyngeal myocytes or GABAergic neurons of a hypoxia resistance-producing translation factor mutation. Surprisingly, hypoxic targeting of these relatively small subsets of non-essential cells produced widespread innocent bystander cell injury, behavioral dysfunction and eventual organismal death. The hypoxic injury phenotypes of the myocyte or neuron sensitized strains were virtually identical. Using this model, we show that the C. elegans insulin receptor/FOXO transcription factor pathway improves survival when activated only after hypoxic injury and blocks innocent bystander death.

A case of an unexplained eosinophilic myocarditis in a dog.

PubMed

Keeshen, T P; Chalkley, M; Stauthammer, C

2016-09-01

An 8-year-old spayed female Munsterlander was evaluated for a chronic low grade fever and a two month history of exercise intolerance. On physical examination, tachycardia and a grade II/VI right systolic heart murmur were detected. Echocardiography revealed marked thickening of the atrial and ventricular walls with mixed echogenicity and concentric hypertrophy of the left and right ventricles and equivocal systolic dysfunction. Serum cardiac troponin I level was markedly elevated. Endomyocardial biopsy was attempted; however, the patient arrested during the procedure and resuscitation was unsuccessful. Post-mortem examination revealed severe, chronic atrial and ventricular eosinophilic myocarditis associated with marked interstitial fibrosis. Serological testing, histopathology and immunohistochemistry staining did not reveal an underlying infectious agent or neoplasm. To our knowledge, this is the first reported case of primary eosinophilic myocarditis in the absence of a peripheral eosinophilia and multi-organ eosinophilic inflammation in a dog. Published by Elsevier B.V.

VENTRICULAR SEPTAL DEFECT IN A CRAB-EATING FOX (CERDOCYON THOUS).

PubMed

Sousa, Marlos Gonçalves; de Córdova, Fabiano Mendes; Ramos, Adriano Tony; Viana, Eduardo Borges; de Castro Conti, Laura Monteiro

2016-06-01

Congenital heart diseases are not commonly diagnosed in wild animals. It is not surprising that few reports exist in the literature, so that prevalence of these anomalies is unknown in wild species. We report a case of a ventricular septal defect documented in a free-ranging crab-eating fox (Cerdocyon thous). This animal presented with rapid, labored breathing, and on physical examination, pulmonary crackles and a holosystolic murmur were auscultated. The echocardiogram with Doppler showed discontinuity of the dorsal section of the ventricular septum, which allowed a turbulent systolic flow to move from the left to the right ventricle. The postmortem examination confirmed the absence of a dorsal connection between the septum and the atrioventricular junction, and pronounced left ventricular myocardial dilation was observed on histopathology. To the authors' knowledge, this is the first report of a perimembranous ventricular septal defect in a crab-eating fox.

Traumatic ventricular septal defect following a stab wound to the chest.

PubMed

Ito, Hideki; Saito, Shunei; Miyahara, Ken; Takemura, Haruki; Sawaki, Sadanari; Matsuura, Akio

2009-03-01

A 51-year-old man who had been suffering from depression stabbed himself in the chest with an ice pick. At presentation, an ice pick lodged in the left fifth intercostal space was moving synchronously with his heartbeat. Echocardiography revealed that the tip was penetrating the anterior wall of the right ventricle. Because the patient was tamponading, an emergency operation was carried out. The ice pick was removed following the establishment of a cardiopulmonary bypass and pericardiotomy. The perforation of the right ventricle was closed with a pledget-reinforced mattress stitch. On postoperative day 12, a holosystolic murmur was detected on auscultation. Transthoracic echocardiography revealed a ventricular septal defect 5 mm in diameter located near the apex. The pulmonary-tosystemic flow ratio was 1.1 by echocardiographic measurement. No sign of heart failure was present. Although it was agreed to manage the ventricular septal defect conservatively, careful echocardiographic follow-up is mandatory.

Air embolism after central venous catheterization.

PubMed

Kashuk, J L; Penn, I

1984-09-01

Air embolism--the most dangerous complication of central venous catheterization--may occur in several ways. The most frequent is from disconnection of the catheter from the related intravenous tubing. An embolism may present with a sucking sound, tachypnea, air hunger, wheezing, hypotension and a "mill wheel" murmur. A later manifestation is severe pulmonary edema. In a review of 24 patients, the mortality was 50 per cent. Among the survivors, five (42 per cent) had neurologic damage. Immediate treatment includes placing the patient in the left lateral and Trendelenberg positions, administration of oxygen and aspiration of air from the heart. Cardiac massage and emergency cardiopulmonary bypass may be necessary. Most instances can be prevented by inserting the cannula with the patient in the Trendelenberg position, occluding the cannula hub except briefly while the catheter is inserted, fixation of the catheter hub to its connections and occlusive dressing over the track after removal of the catheter.

Why Confessions Trump Innocence

ERIC Educational Resources Information Center

Kassin, Saul M.

2012-01-01

As illustrated by the story of Amanda Knox and many others wrongfully convicted, false confessions often trump factual innocence. Focusing on consequences, recent research suggests that confessions are powerfully persuasive as a matter of logic and common sense; that many false confessions contain richly detailed narratives and accurate crime…

Blaming for a better future: future orientation and associated intolerance of personal uncertainty lead to harsher reactions toward innocent victims.

PubMed

Bal, Michèlle; van den Bos, Kees

2012-07-01

People are often encouraged to focus on the future and strive for long-term goals. This noted, the authors argue that this future orientation is associated with intolerance of personal uncertainty, as people usually cannot be certain that their efforts will pay off. To be able to tolerate personal uncertainty, people adhere strongly to the belief in a just world, paradoxically resulting in harsher reactions toward innocent victims. In three experiments, the authors show that a future orientation indeed leads to more negative evaluations of an innocent victim (Study 1), enhances intolerance of personal uncertainty (Study 2), and that experiencing personal uncertainty leads to more negative evaluations of a victim (Study 3). So, while a future orientation enables people to strive for long-term goals, it also leads them to be harsher toward innocent victims. One underlying mechanism causing these reactions is intolerance of personal uncertainty, associated with a future orientation.

A defense of compulsory vaccination.

PubMed

Flanigan, Jessica

2014-03-01

Vaccine refusal harms and risks harming innocent bystanders. People are not entitled to harm innocents or to impose deadly risks on others, so in these cases there is nothing to be said for the right to refuse vaccination. Compulsory vaccination is therefore justified because non-vaccination can rightly be prohibited, just as other kinds of harmful and risky conduct are rightly prohibited. I develop an analogy to random gunfire to illustrate this point. Vaccine refusal, I argue, is morally similar to firing a weapon into the air and endangering innocent bystanders. By re-framing vaccine refusal as harmful and reckless conduct my aim is to shift the focus of the vaccine debate from non-vaccinators' religious and refusal rights to everyone else's rights against being infected with contagious illnesses. Religious freedom and rights of informed consent do not entitle non-vaccinators to harm innocent bystanders, and so coercive vaccination requirements are permissible for the sake of the potential victims of the anti-vaccine movement.

Innocent Until Proven Guilty

ERIC Educational Resources Information Center

Case, Catherine; Whitaker, Douglas

2016-01-01

In the criminal justice system, defendants accused of a crime are presumed innocent until proven guilty. Statistical inference in any context is built on an analogous principle: The null hypothesis--often a hypothesis of "no difference" or "no effect"--is presumed true unless there is sufficient evidence against it. In this…

"Listening Silence" and Its Discursive Effects

ERIC Educational Resources Information Center

Applebaum, Barbara

2016-01-01

While researchers have studied how white silence protects white innocence and white ignorance, in this essay Barbara Applebaum explores a form of white silence that she refers to as "listening silence" in which silence protects white innocence but does not necessarily promote resistance to learning. White listening silence can appear to…

Preschoolers' Understanding of Lies and Innocent and Negligent Mistakes.

ERIC Educational Resources Information Center

Siegal, Michael; Peterson, Candida C.

1998-01-01

Examined preschoolers' ability to distinguish innocent and negligent mistakes from lies. Found that, when asked to identify a mistake or lie about a food's contact with contaminants and identify a bystander's reaction, children distinguished mistakes from lies; they could also discriminate between lies and both negligent mistakes that generate…

Evaluation of Dietary Intakes, Body Composition, and Cardiometabolic Parameters in Adolescent Team Sports Elite Athletes: A Cross-sectional Study.

PubMed

Hosseinzadeh, Javad; Maghsoudi, Zahra; Abbasi, Behnood; Daneshvar, Pooya; Hojjati, Atefeh; Ghiasvand, Reza

2017-01-01

Nutritional intake is an important issue in adolescent athletes. Proper athletes' performance is a multifactorial outcome of good training, body composition, and nutritional status. The aim of the present study was to assess nutritional status, body composition, and cardiometabolic factors in adolescent elite athlete's province of Isfahan, Iran. In this cross-sectional study, 100 adolescent elite athletes from volleyball, basketball, and soccer teams were selected for the study. Demographic, anthropometric, and cardiometabolic parameters were assessed. Nutritional intakes of participants were recorded using three 24-h recall questioners. Thirty-four female athletes and 66 male athletes participated in this study. Body mass index had not significantly different between the sexes. Energy, protein, carbohydrate, iron, and fat intakes were significantly higher in male athletes ( P = 0.02), but calcium and folic acid intakes were not significantly different between the sexes, and Vitamin D intake was significantly higher in females ( P = 0.01). Systolic and diastolic blood pressure was significantly higher in males ( P = 0.04) and heart rate had not significantly different between the sexes ( P = 0.09). Heart murmurs and heart sounds in the majority of participants were normal. All the evaluated anthropometric and cardiometabolic parameters were in normal range in the majority of participants. The results showed that dietary intake in these athletes is approximately normal but micronutrients intake status in these athletes needs to be investigated further and longer.

Evaluation of Dietary Intakes, Body Composition, and Cardiometabolic Parameters in Adolescent Team Sports Elite Athletes: A Cross-sectional Study

PubMed Central

Hosseinzadeh, Javad; Maghsoudi, Zahra; Abbasi, Behnood; Daneshvar, Pooya; Hojjati, Atefeh; Ghiasvand, Reza

2017-01-01

Background: Nutritional intake is an important issue in adolescent athletes. Proper athletes’ performance is a multifactorial outcome of good training, body composition, and nutritional status. The aim of the present study was to assess nutritional status, body composition, and cardiometabolic factors in adolescent elite athlete's province of Isfahan, Iran. Materials and Methods: In this cross-sectional study, 100 adolescent elite athletes from volleyball, basketball, and soccer teams were selected for the study. Demographic, anthropometric, and cardiometabolic parameters were assessed. Nutritional intakes of participants were recorded using three 24-h recall questioners. Results: Thirty-four female athletes and 66 male athletes participated in this study. Body mass index had not significantly different between the sexes. Energy, protein, carbohydrate, iron, and fat intakes were significantly higher in male athletes (P = 0.02), but calcium and folic acid intakes were not significantly different between the sexes, and Vitamin D intake was significantly higher in females (P = 0.01). Systolic and diastolic blood pressure was significantly higher in males (P = 0.04) and heart rate had not significantly different between the sexes (P = 0.09). Heart murmurs and heart sounds in the majority of participants were normal. Conclusion: All the evaluated anthropometric and cardiometabolic parameters were in normal range in the majority of participants. The results showed that dietary intake in these athletes is approximately normal but micronutrients intake status in these athletes needs to be investigated further and longer. PMID:28904935

Pulmonary artery dissection in eight dogs with patent ductus arteriosus.

PubMed

Scansen, Brian A; Simpson, Elaine M; López-Alvarez, Jordi; Thomas, William P; Bright, Janice M; Eason, Bryan D; Rush, John E; Dukes-McEwan, Joanna; Green, Henry W; Cunningham, Suzanne M; Visser, Lance C; Kent, Agnieszka M; Schober, Karsten E

2015-06-01

To describe a series of dogs with pulmonary artery dissection and patent ductus arteriosus (PDA). Eight dogs. Retrospective case series. Pulmonary artery dissection was diagnosed in 8 dogs, 3 were Weimaraners. Four dogs presented in left-sided congestive heart failure, 4 presented for murmur evaluation and without clinical signs, and 1 presented in right-sided congestive heart failure. In 7 dogs the dissection was first documented concurrent with a diagnosis of uncorrected PDA. In the other dog, with pulmonary valve stenosis and PDA, the dissection was observed on autopsy examination 17 months after balloon pulmonary valvuloplasty and ductal closure. Median age at presentation for the 7 dogs with antemortem diagnosis of pulmonary artery dissection was 3.5 years (range, 1.5-4 years). Three dogs had the PDA surgically ligated, 2 dogs did not undergo PDA closure, 1 dog failed transcatheter occlusion of the PDA with subsequent surgical ligation, 1 dog underwent successful transcatheter device occlusion of the PDA, and 1 dog had the PDA closed by transcatheter coil delivery 17 months prior to the diagnosis of pulmonary artery dissection. The 2 dogs that did not have the PDA closed died 1 and 3 years after diagnosis due to heart failure. Pulmonary artery dissection is a potential complication of PDA in dogs, the Weimaraner breed may be at increased risk, presentation is often in mature dogs, and closure of the PDA can be performed and appears to improve outcome. Copyright © 2014 Elsevier B.V. All rights reserved.

Regularities in eyewitness identification.

PubMed

Clark, Steven E; Howell, Ryan T; Davey, Sherrie L

2008-06-01

What do eyewitness identification experiments typically show? We address this question through a meta-analysis of 94 comparisons between target-present and target-absent lineups. The analyses showed that: (a) correct identifications and correct-nonidentifications were uncorrelated, (b) suspect identifications were more diagnostic with respect to the suspect's guilt or innocence than any other response, (c) nonidentifications were diagnostic of the suspect's innocence, (d) the diagnosticity of foil identifications depended on lineup composition, and (e) don't know responses were nondiagnostic with respect to guilt or innocence. Results of diagnosticity analyses for simultaneous and sequential lineups varied for full-sample versus direct-comparison analyses. Diagnosticity patterns also varied as a function of lineup composition. Theoretical, forensic, and legal implications are discussed.

Duration of daily TV/screen watching with cardiovascular, respiratory, mental and psychiatric health: Scottish Health Survey, 2012-2013.

PubMed

Shiue, Ivy

2015-01-01

The link of duration of TV and/or screen watching and chronic health conditions by subtypes is unclear. Therefore, the relationship between TV and/or screen watching hours and cardiovascular, respiratory, mental and psychiatric health and well-being (happiness) was assessed in an independent population-based survey to identify correlations of various hours with health conditions. Data was retrieved from the Scottish Health Survey, 2012-2013. Information on demographics, lifestyle factors, self-reported health conditions and TV and/or screen watching duration in both Scottish adults and children was collected by annual household interviews. Chi-square test and survey weighted logistic and multi-nominal modelling were performed. 5527 (57.0%) Scottish adults aged 16-99 watched TV and/or screen daily for 3 + h on average. There was a trend toward more hypertension, angina, stroke, diabetes, chronic obstructive pulmonary disease and poor self-rated health and mental health. Reporting watching TV and/or screen for 4 + h, for 5 + h and for 8 + h was associated with higher rates of heart attack, heart murmur or other heart troubles and abnormal heart rhythms, respectively. 414 (20.7%) Scottish children aged 4-12 watched TV and/or screen for 3h or more. They tended to have poor self-rated health and life difficulties perceived as emotional and behavioural problems. There were associations between various hours of TV and/or screen watching (3+h) and poor health observed both in Scottish adults and children. Future educational and public health programmes minimising TV and/or screen watching in order to protect cardiovascular, respiratory, mental and psychiatric health might be considered. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Redefining the Legacy of Mina Shaughnessy: A Critique of the Politics of Linguistic Innocence.

ERIC Educational Resources Information Center

Lu, Min-zhan

1991-01-01

Argues that Mina Shaughnessy's view of language as a politically innocent vehicle of meaning overlooks basic writers' need to confront the dissonance they experience between academic and other discourses. Suggests educators need to abandon the limitations of the essentialist view of language informing their pedagogy. (KEH)

Youths' Displaced Aggression against in- and Out-Group Peers: An Experimental Examination

ERIC Educational Resources Information Center

Reijntjes, Albert; Thomaes, Sander; Kamphuis, Jan H.; Bushman, Brad J.; Reitz, Ellen; Telch, Michael J.

2013-01-01

People often displace their anger and aggression against innocent targets, sometimes called scapegoats. Tragic historic events suggest that members of ethnic minority out-groups may be especially likely to be innocent targets. The current experiment examined displaced aggression of Dutch youths against Dutch in-group peers versus Moroccan…

"Suited to Their Needs": White Innocence as a Vestige of Segregation

ERIC Educational Resources Information Center

Orozco, Richard; Jaime Diaz, Jesus

2016-01-01

Discourses that supported de jure segregated schools often invoked White innocence in the form of altruistic motivations. These same invocations are found in more contemporary school policy discourses. The authors of this article argue, based on the concept of intertextuality of discourse, the existence of contemporary schooling policies as…

Failing left ventricle to ascending aorta conduit-Hybrid implantation of a melody valve and NuMed covered stent.

PubMed

Gössl, Mario; Johnson, Jonathan N; Hagler, Donald J

2014-04-01

We present the case of a 36-year-old woman with increasing shortness of breath, a new 3/4 diastolic murmur, and a complex history of LV outflow tract obstruction. She has undergone multiple surgeries including the replacement of her old LV apex to ascending aorta conduit with a 20-mm Gore-Tex tube graft, addition of a 24-mm homograft sutured between the conduit and the LV apex, and insertion of a 21-mm Freestyle porcine valve conduit between the Gore-Tex tube graft and allograft at age 23. The current assessment showed a failing Freestyle conduit prosthesis leading to left heart decompensation. Due to substantial surgical risk, the patient underwent successful implantation of a Melody valve into the Gore-Tex tube and exclusion of the failing Freestyle bioprosthesis with a NuMed CP stent in a hybrid procedure. The case nicely illustrates the collaborative potential of cardiovascular surgeons and interventional cardiologists in the new arena of a hybrid operating room. Complex hybrid procedures like the current one, especially those including percutaneous placements of valves, offer therapeutic options for patients that are otherwise too high risk for conventional open heart surgery. Copyright © 2013 Wiley Periodicals, Inc.

Assessment of cardiovascular disease in the donkey: clinical, echocardiographic and pathological observations.

PubMed

Roberts, S L; Dukes-McEwan, J

2016-10-15

The Donkey Sanctuary (DS) owns 3500-4000 donkeys, estimated to be about 35 per cent of the UK population. Although postmortem surveys suggest a high prevalence of cardiovascular disease in donkeys, there is sparse clinical information about cardiovascular examination findings and echocardiographic findings in health and disease. In this cross-sectional study, auscultation findings were recorded, and in a subset of donkeys, echocardiography was used to screen for structural and functional cardiac disease. 202 donkeys were examined; 117 geldings and 85 females. Heart sounds S1 and S2 were detected in all donkeys, but none had audible S3. S4 was detected in nine (4.5 per cent; significantly older than those without S4; P<0.001). A heart murmur was detected in four donkeys. Echocardiography identified these to be due to a ventricular septal defect in one, and aortic regurgitation in three. An additional 43 donkeys had echocardiography. A further 10 donkeys were identified to have aortic insufficiency, but no other valvular regurgitation. 76/202 donkeys subsequently underwent postmortem examination. Three showed degenerative aortic valve changes. One donkey had nodular lesions in the intima of proximal aorta and sinus of Valsalva. Histopathology showed multifocal chronic nodular eosinophilic arteritis, consistent with verminous arteritis. The DS pathology database identified other similar cases. British Veterinary Association.

Morbidity of Chagas heart disease in the microregion of Rio Negro, Amazonian Brazil: a case-control study

PubMed Central

Coura, José Rodrigues; Viñas, Pedro Albajar; Brum-Soares, Lucia Maria; de Sousa, Andréa Silvestre; Xavier, Sérgio Salles

2013-01-01

A case-control study on the morbidity of Chagas heart disease was carried out in the municipality of Barcelos in the microregion of the Rio Negro, state of Amazonas. One hundred and six individuals, who were serologically positive for Trypanosoma cruzi infection, as confirmed by at least two techniques with different principles, were matched according to age and sex with an equal number of seronegative individuals. The cases and controls were evaluated using an epidemiological questionnaire and clinical, electrocardiograph and echocardiograph examinations. In the seroepidemiological evaluation, 62% of the interviewees recognised triatomines and most of them confirmed that they had seen these insects in the piassava plantations of the riverside communities of the Negro River tributaries. Of the seropositive patients, 25.8% affirmed that they had been stung by the triatomines and 11.7% denied having been stung. The principal clinical manifestations of the seropositive individuals were palpitations, chest pain and dyspnoea upon effort. Cardiac auscultation revealed extrasystoles, bradycardia and systolic murmurs. The electrocardiographic alterations were ventricular extrasystoles, left and right bundle branch block, atrioventricular block and primary T wave alterations. The echocardiogram was altered in 22.6% of the seropositive individuals and in 8.5% of the seronegative individuals. PMID:24402153

Gonococcal endocarditis in a 47-year-old Japanese man.

PubMed

Ito, Hiroshi; Miyazaki, Shinichi; Ozeki, Takaya; Matsuo, Masaki; Branch, Joel; Fujita, Yoshiro; Marui, Nobuyuki

2014-01-01

A 47-year-old sexually active Japanese man was admitted with a persistent fever and weight loss. A physical examination revealed a cardiac murmur. A transthoracic echocardiogram was nondiagnostic, although blood cultures grew Neisseria gonorrhoeae. Gonococcal endocarditis was diagnosed based on the modified Duke criteria. The administration of antimicrobial therapy resulted in an adequate initial resolution; however, two months after completing the therapy, the patient developed cardiac failure. Severe aortic regurgitation was identified, and the patient underwent emergent aortic valve replacement. Despite the rarity of gonococcal endocarditis, this disease should nevertheless be considered in patients presenting with a fever, cardiac murmur and a consistent sexual history.

A Compromise and Resist World Feminism Analysis of the Age of innocence

ERIC Educational Resources Information Center

Yang, Hongyan

2016-01-01

Edith Wharton (1862-1937), a Pulitzer Prize winner, is a distinguished female novelist at the turn of the nineteenth and twentieth centuries. Her work "The Age of Innocence" contributes much to the formation of a female literary tradition. Wharton's subversion of male discourse can be well traced in her novel "The Age of…

Justice for All

ERIC Educational Resources Information Center

Ruffins, Paul

2011-01-01

The first Innocence Project (IP) was founded in 1992 by attorneys Barry C. Scheck and Peter J. Neufeld at Yeshiva University's Benjamin N. Cardozo School of Law. The original goal was to free people whose innocence could be proven using DNA. So far, IPs have helped free nearly 300 men and women who had served an average of 13 years for crimes they…

Moral Dilemmas and Moral Rules

ERIC Educational Resources Information Center

Nichols, Shaun; Mallon, Ron

2006-01-01

Recent work shows an important asymmetry in lay intuitions about moral dilemmas. Most people think it is permissible to divert a train so that it will kill one innocent person instead of five, but most people think that it is not permissible to push a stranger in front of a train to save five innocents. We argue that recent emotion-based…

Personal Responsibility and Behavioral Disengagement in Innocent Bystanders during Classroom Management Events: The Moderating Effect of Teacher Aggressive Tendencies

ERIC Educational Resources Information Center

Montuoro, Paul; Lewis, Ramon

2018-01-01

Recent studies have shown that student behavioral engagement is malleable. For example, these studies have reported that students who feel emotionally supported by their teachers experience higher levels of behavioral engagement. The authors contributed to this research by investigating behavioral disengagement among innocent bystanders during…

Safety, Risk, and Recovery: Women and Men as Parents in Contemporary American Fiction. Working Paper No. 179.

ERIC Educational Resources Information Center

Gullette, Margaret Morganroth

In contemporary American fiction, children are still dying. On the scale of innocence and guilt, there is a complete range, in 13 contemporary novels studied, from cases where the parents are clearly "innocent," to cases where they are clearly guilty. The novels are not about the children but instead are about the fictional midlife…

Southeast Asia Report. No. 1316

DTIC Science & Technology

1983-07-25

28 Columnist Urges Consideration for Innocent (A. Battala; BULLETIN TODAY, 18 Jun 83) 29 Four Rebel Priests ’Disowned’ by Church Superiors...THAILAND Columnist Sees Declining U.S. Interest in Southeast Asia (Trairat; DAILY NEWS, 27 May 83) 58 Editorial Discusses Indochina Trade, Asks...cash from the municipal treasury vault. CSO: 4200/663 28 PHILIPPINES COLUMNIST URGES CONSIDERATION FOR INNOCENT Manila BULLETIN TODAY in

Recovery from Cyclophosphamide Overdose in a Dog.

PubMed

Finlay, Jessica Renee; Wyatt, Kenneth; North, Courtney

An adult female spayed dog was evaluated after inadvertently receiving a total dose of 1,750 mg oral cyclophosphamide, equivalent to 2,303 mg/m 2 , over 21 days (days -21 to 0). Nine days after the last dose of cyclophosphamide (day +9), the dog was evaluated at Perth Veterinary Specialists. Physical examination revealed mucosal pallor, a grade 2/6 systolic heart murmur, and severe hemorrhagic cystitis. Severe nonregenerative pancytopenia was detected on hematology. Broad spectrum antibiotics, two fresh whole blood transfusions, granulocyte colony stimulating factor, and tranexamic acid were administered. Five days after presentation (day +14), the peripheral neutrophil count had recovered, and by 12 days (day +21) the complete blood count was near normal. A second episode of thrombocytopenia (day +51) was managed with vincristine, prednisolone, and melatonin. The dog made a complete recovery with no long-term complications at the time of writing. To the author's knowledge, this is the highest inadvertently administered dose of cyclophosphamide to result in complete recovery.

Three-dimensional imaging of redundant Chiari's network prolapsing into right ventricle.

PubMed

Betrián Blasco, Pedro; Sarrat Torres, Rebeca; Pijuan Domènech, Maria Antonia; Marimón Blanch, Cristina; Pérez Herrera, Verónica; Girona Comas, Josep

2008-02-01

An asymptomatic 1-month-old girl was studied in another institution because of the presence of a cardiac murmur, and referred to our center for further evaluation as a result of tricuspid valve abnormalities detected in the echocardiographic study. Echocardiography revealed a very redundant, thin, freely mobile structure in the right atrium, moving rapidly in (systole) and out (diastole) of the right ventricle through the tricuspid orifice. It arose from near the border of the inferior vena cava and attached to the atrial wall close to the coronary sinus ostium, suggesting an unusually prominent Chiari's network. Three-dimensional imaging allowed definition of the structure in all the planes and dimensions, and the relationship of the structure with right atrium and ventricle. Chiari's network is an embryonic remnant present in 2% to 3% of the population. The identification of a Chiari's network is important because the widely mobile structure within the right atrium can be confused with other entities, such as right heart vegetation, flail tricuspid leaflet, ruptured chordae tendinae, or a thrombus.

Ovarian hemangiosarcoma in an orange-winged Amazon parrot (Amazona amazonica).

PubMed

Mickley, Kimberly; Buote, Melanie; Kiupel, Matti; Graham, Jennifer; Orcutt, Connie

2009-03-01

A 25-year-old intact female orange-winged Amazon parrot (Amazona amazonica) presented for a 2-week history of straining to defecate, lethargy, open-beak breathing, decreased vocalization, and ruffled feathers. On physical examination, the parrot had a heart murmur, increased air sac and lung sounds, open-beak breathing, increased respiratory rate and effort, and coelomic distension. An ultrasound revealed intracoelomic fluid, and hemorrhagic fluid was aspirated from the coelom. Cytologic analysis indicated hemocoelom. Pericardial effusion was observed during the sonogram, and pericardiocentesis was performed. The bird was euthanatized upon the owner's request because of a poor prognosis. At necropsy, several masses that involved the ovary and oviduct were observed, as well as a thickened pericardium and a thickened, fibrinous epicardium. Results of a histopathologic examination of the masses that involved the reproductive tract revealed ovarian hemangiosarcoma, which was confirmed by immunohistochemical staining. To our knowledge, ovarian hemangiosarcoma has not been reported in a psittacine species, nor has immunohistochemistry confirmed ovarian hemangiosarcoma in avian species, specifically in an orange-winged Amazon parrot.

Iliopsoas abscess as a complication of tunneled jugular vein catheterization in a hemodialysis patient.

PubMed

Hsiao, Po-Jen; Tsai, Ming-Hsien; Leu, Jyh-Gang; Fang, Yu-Wei

2015-04-01

Iliopsoas abscess is a rare complication in hemodialysis patients that is mainly due to adjacent catheterization, local acupuncture, discitis, and bacteremia. Herein, we report a 47-year-old woman undergoing regular hemodialysis via a catheter in the internal jugular vein who presented with low back pain and dyspnea. A heart murmur suggested the presence of catheter-related endocarditis, and this was confirmed by an echocardiogram and a blood culture of methicillin-resistant Staphylococcus aureus. A computed tomography indicated a pulmonary embolism and an incidental finding of iliopsoas abscess. Following surgical intervention and intravenous daptomycin, the patient experienced full recovery and a return to usual activities. This case indicates that an iliopsoas abscess can be related to a jugular vein catheter, which is apparently facilitated by infective endocarditis. The possibility of iliopsoas abscess should be considered when a hemodialysis patient presents with severe low back pain, even when there is no history of adjacent mechanical intervention. © 2014 International Society for Hemodialysis.

Ureaplasma parvum causing life-threatening disease in a susceptible patient.

PubMed

Korytny, Alexander; Nasser, Roni; Geffen, Yuval; Friedman, Tom; Paul, Mical; Ghanem-Zoubi, Nesrin

2017-08-16

A 56-year-old man with lymphoma developed orchitis followed by septic arthritis of his right glenohumeral joint. Synovial fluid cultures were negative but PCR amplification test was positive for Ureaplasmaparvum. The patient was treated with doxycycline. Two and a half years later, the patient presented with shortness of breath and grade III/IV diastolic murmur on auscultation. Echocardiography revealed severely dilated left heart chambers, severe aortic regurgitation and several mobile masses on the aortic valve cusps suspected to be vegetations. He underwent valve replacement; valve tissue culture was negative but the 16S rRNA gene amplification test was positive for U. parvum He was treated again with doxycycline. In an outpatient follow-up 1 year and 3 months later, the patient was doing well. Repeated echocardiography showed normal aortic prosthesis function. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eftekhari, F.; Yousefzadeh, D.K.

Two cases of primary infantile hyperparathyroidism (PIH) are reported. In both cases the diagnosis was initially suspected from chest radiographs which were obtained to assess the etiology of fever and respiratory distress in one case and heart murmur in another. The first case responded well to subtotal parathyroidectomy. The second case had many unique features. (1) She never became overtly symptomatic. (2) She displayed a constellation of findings that are not yet emphasized. (3) Her indisputable radiographic findings of hyperparathyroidism vanished spontaneously by two months of age, whereas her biochemical alterations have persisted up to now, 2 1/2 years aftermore » birth. (4) Three members of her family have subclinical hyperparathyroidism (elevated serum parathormone, hypercalcemia, and hypophosphatemia). Our review of 19 more cases showed that PIH has no specific clinical symptoms and/or signs. Of the laboratory findings, hypercalcemia was most consistantly encountered. The radiographic findings, although not identical to those described in hyperparathyroid adults, had the greatest diagnostic specificity. The disorder carried a grave prognosis if not diagnosed promptly and managed surgically.« less

Comparison of systemic health conditions between African American and Caucasian complete denture patients.

PubMed

Szylkowska, Ewelina; Kaste, Linda M; Schreiner, Joseph; Gordon, Sara C; Lee, Damian J

2014-07-01

To compare prevalence of systemic health conditions (SHC) between African American and Caucasian edentulous patients presenting for complete dentures (CD) at an urban dental school. The study included patients presenting for CD 1/1-12/31/2010, ages 20 to 64 years, and either African American or Caucasian. Covariates included: age group, gender, employment status, Medicaid status, smoking history, and alcohol consumption. SHC included at least one of the following: arthritis, asthma, cancer, diabetes, emphysema, heart attack, heart murmur, heart surgery, hypertension, or stroke. The group (n = 88) was 44.3% African American, 65.9% ≥50, 45.5% male, 22.7% employed, and 67.0% with at least one SHC. African Americans were older (p = 0.001) and more likely to have one or more SHC (p = 0.011). Patients with at least one SHC were older (p = 0.018) and more likely female (p = 0.012). The total sample logistic regression model assessing SHC yielded only gender as statistically significant (males < OR 0.32, 95% CI 0.11 to 0.92). Caucasian males were less likely to have SHC (OR 0.17, 95% CI 0.04 to 0.77), and Caucasians ≥50 were more likely (OR 5.36, 95% CI 1.19 to 24.08). African Americans yielded no significant associations. Among selected completely edentulous denture patients at an urban dental school, two out of three patients had at least one SHC. This exploratory study suggests there may be health status differences between African American and Caucasian patients in this setting, calling for further study. © 2014 by the American College of Prosthodontists.

Comparison of traditional and sensor-based electronic stethoscopes in beagle dogs.

PubMed

Szilvási, Viktória; Vörös, Károly; Manczur, Ferenc; Reiczigel, Jenő; Novák, István; Máthé, Akos; Fekete, Dániel

2013-03-01

The objective of this study was to compare the auscultatory findings using traditional and electronic sensor-based stethoscopes. Thirty-three adult healthy Beagles (20 females, 13 males, mean age: 4.8 years, range 1.4-8 years) were auscultated by four investigators with different experiences (INVEST-1, -2, -3 and -4) independently with both stethoscopes. Final cardiological diagnoses were established by echocardiography. Mitral murmurs were heard with both stethoscopes by all investigators and echocardiography revealed mild mitral valve insufficiency in 7 dogs (21%, 4 females, 3 males). The statistical sensitivity (Se) in recognising cardiac murmurs proved to be 82% using the traditional stethoscope and 75% using the electronic one in the mean of the four examiners, whilst statistical specificity (Sp) was 99% by the traditional and 100% by the electronic stethoscope. The means of the auscultatory sensitivity differences between the two stethoscopes were 0.36 on the left and 0.59 on the right hemithorax, demonstrating an advantage for the electronic stethoscope being more obvious above the right hemithorax (P = 0.0340). The electronic stethoscope proved to be superior to the traditional one in excluding cardiac murmurs and especially in auscultation over the right hemithorax. Mitral valve disease was relatively common in this clinically healthy research Beagle population.

Thomas Merton Goes to Class: Pedagogy on the Borders of the Short Story

ERIC Educational Resources Information Center

Callaghan, Michael J.

2011-01-01

Our thesis is more finely tuned to Thomas Merton (1915-68) the writer, more specifically, the poet/artist/writer and thinker. These are the components of the "Merton" voice. Merton senses the quality of innocence as the "sine qua non" of the poet or writer's vocation: "His art depends on an ingrained innocence which he would lose in business, in…

The Culture of Peace and the Prevention of Terrorism from the Perspectives of Islamic Education and the United Nations

ERIC Educational Resources Information Center

Mawajdeh, Baker S.; Talhouni, Mansour H.; Rashaydeh, Mohammad S.; Hussein, Izdihar J.

2017-01-01

Terrorism is an unfamiliar phenomenon to the Islamic religion and it is in opposition to its doctrine. It leads to the loss of innocent lives, destruction of properties, spreading rumors, terrorizing the innocents and destabilization. All this makes fighting and preventing the phenomenon of terrorism the duty of all human beings. This study aimed…

Tissue-Resident Lymphocytes in Solid Organ Transplantation: Innocent Passengers or the Key to Organ Transplant Survival?

PubMed

Prosser, Amy C; Kallies, Axel; Lucas, Michaela

2018-03-01

Short-term outcomes of solid organ transplantation have improved dramatically over the past several decades; however, long-term survival has remained static over the same period, and chronic rejection remains a major cause of graft failure. The importance of donor, or "passenger," lymphocytes to the induction of tolerance to allografts was recognized in the 1990s, but their precise contribution to graft acceptance or rejection has not been elucidated. Recently, specialized populations of tissue-resident lymphocytes in nonlymphoid organs have been described. These lymphocytes include tissue-resident memory T cells, regulatory T cells, γδ T cells, invariant natural killer T cells, and innate lymphoid cells. These cells reside in commonly transplanted solid organs, including the liver, kidneys, heart, and lung; however, their contribution to graft acceptance or rejection has not been examined in detail. Similarly, it is unclear whether tissue-resident cells derived from the pool of recipient-derived lymphocytes play a specific role in transplantation biology. This review summarizes the evidence for the roles of tissue-resident lymphocytes in transplant immunology, focussing on their features, functions, and relevance for solid organ transplantation, with specific reference to liver, kidney, heart, and lung transplantation.

Uncontrolled pneumonia in a 49-year-old white man.

PubMed

Taghizadeh, Farnoush; Raghuwanshi M, Raghuraj S

2014-01-01

A 49-year-old white man. Shortness of breath, fever, and ongoing unintended weight loss. The patient had arrived at the emergency department of a hospital in St. Augustine, Florida with coughing and progressive shortness of breath. He reported that he had been experiencing these symptoms for the past 6 weeks. He was examined by his primary physician, who had prescribed him a course of antibiotics and treated him on an outpatient basis. The patient reported no improvement in his symptoms at present, despite the antibiotics. He mentioned that he had traveled to St. Augustine, Florida approximately 10 days previously. Medical personnel in the emergency department subsequently performed a chest x-ray on the patient, as well as computed tomography (CT) scanning of his lymphadenopathy. MEDICAL AND FAMILY HISTORY: Positive for hypertension, diabetes mellitus, and osteoporosis. He reported that he has chewed 2 packs of chewing tobacco per day for the past 30 years, occasionally drinks alcohol, and is a nonsmoker with no known allergies. Noncontributory. Noncontributory. The patient exhibited mild respiratory distress; however, he was awake, alert, and oriented, with a temperature of 37.3°C. He also exhibited poor respiratory effort with diffuse expiratory rhonchi. His heart rate and heart rhythm were regular, with no murmurs, gallops, or rubs. His bowel sounds were positive; he exhibited no organomegaly and no cyanosis, clubbing, or edema of his extremities.

[Broad ischemic stroke revealing infective endocarditis in a young patient: about a case].

PubMed

Ravelosaona, Fanomezantsoa Noella; Razafimahefa, Julien; Randrianasolo, Rahamefy Odilon; Rakotoarimanana, Solofonirina; Tehindrazanarivelo, Djacoba Alain

2016-01-01

Broad ischemic stroke is mainly due to a cardiac embolus or to an atheromatous plaque. In young subjects, one of the main causes of ischemic stroke (broad ischemic stroke in particolar) is embolic heart disease including infective endocarditis. Infective endocarditis is a contraindication against the anticoagulant therapy (which is indicated for the treatment of embolic heart disease complicated by ischemic stroke). One neurologic complications of infective endocarditis is ischemic stroke which often occurs in multiple sites. We here report the case of a 44-year old man with afebrile acute onset of severe left hemiplegia associated with a sistolic mitral murmur, who had fever in hospital on day 5 with no other obvious source of infection present. Brain CT scan showed full broad ischaemic stroke of the right middle cerebral artery territory and doppler ultrasound, performed after stroke onset, showed infective endocarditis affecting the small mitral valve. He was treated with 4 weeks of antibiotic therapy without anticoagulant therapy ; evolution was marked by the disappearance of mitral valve vegetations and by movement sequelae involving the left side of the body. In practical terms, our problem was the onset of the fever which didn't accompany or pre-exist patient's deficit, leading us to the misdiagnosis of ischemic stroke of cardioembolic origin. This case study underlines the importance of doppler ultrasound, in the diagnosis of all broad ischemic strokes, especially superficial, before starting anticoagulant therapy.

Legal Implications of the Use of Biometrics as a Tool to Fight the Global War on Terrorism

DTIC Science & Technology

2008-06-13

suspects, thwarting their plan to terrorize innocent citizens. A biometric identification system would certainly present law enforcement officials...with a powerful tool for the identification of known or suspected terrorists and other criminals, however, the system must adhere to the laws...terrorize innocent citizens. A biometric identification system would certainly present law enforcement officials with a powerful tool for the

The impact of multiple show-ups on eyewitness decision-making and innocence risk.

PubMed

Smith, Andrew M; Bertrand, Michelle; Lindsay, R C L; Kalmet, Natalie; Grossman, Deborah; Provenzano, Daniel

2014-09-01

If an eyewitness rejects a show-up, police may respond by finding a new suspect and conducting a second show-up with the same eyewitness. Police may continue finding suspects and conducting show-ups until the eyewitness makes an identification (Study 1). Relatively low criterion-setting eyewitnesses filter themselves out of the multiple show-ups procedure by choosing the first suspect with whom they are presented (Studies 2 and 3). Accordingly, response bias was more stringent on the second show-up when compared with the first, but became no more stringent with additional show-ups. Despite this stringent shift in response bias, innocence risk increased with additional show-ups, as false alarms cumulate (Studies 2 and 3). Although unbiased show-up instructions decreased innocent suspect identifications, the numbers were still discouraging (Study 4). Given the high number of innocent suspects who would be mistakenly identified through the use of multiple show-up procedures, using such identifications as evidence of guilt is questionable. Although evidence of guilt is limited to identifications from a single show-up, practical constraints might sometimes require police to use additional show-ups. Accordingly, we propose a stronger partition between evidentiary and investigative procedures. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Perspective: Innocence and due diligence: managing unfounded allegations of scientific misconduct.

PubMed

Goldenring, James R

2010-03-01

While the incidence of fraud in science is well documented, issues related to the establishment of innocence in cases of fallacious allegations remain unaddressed. In this article, the author uses his own experience to examine issues that arise when investigators are falsely accused of scientific fraud. Investigators must understand the processes in place to protect themselves against false accusations. The present system takes a position of guilty until proven innocent, a concept that is antithetical to American principles of jurisprudence. Yet this stance is acceptable as a requirement for membership in the scientific community, more reflective of the rules within a guild organization. The necessity for proof of innocence by members of the scientific community carries obligations that transcend normal legal assumptions. Scientists must safeguard their reputations by organizing and maintaining all original image files and data relevant to publications and grant proposals. Investigators must be able to provide clear documentation rapidly whenever concerns are raised during the review process. Moreover, peer-reviewed journals must be diligent not only in the identification of fraud but also in providing rapid due process for adjudication of allegations. The success of the scientific guild rules of conduct lies in the practice of due diligence by both scientists and journal editors in questions of scientific misconduct.

Innocence, Protection and Failure: Bringing the Child Subject to the Centre of the Politics of the Family. A Response to Cristyn Davies and Kerry Robinson

ERIC Educational Resources Information Center

Hopkins, Lucy

2013-01-01

In response to Davies and Robinson's article looking at how queer families are positioned and position themselves in relation to neoliberalism, this article brings the child to the centre of the debate to examine how reading the child subject in terms of discourses of innocence and protection might work to maintain the hegemony of the…

The Diversification of Mexican Transnational Criminal Organizations and its Effects on Spillover Violence in the United States

DTIC Science & Technology

2013-06-14

would require the determination of “innocent.” This definition presumes that violence against illegal immigrants , often the victims of violence on...Canada, Chile , the Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, South Korea, Luxembourg...illegal immigrants being smuggled into the U.S., Mexican or U.S. citizens working with the cartels or their innocent family members, and those that

Unfair Lineups Make Witnesses More Likely to Confuse Innocent and Guilty Suspects.

PubMed

Colloff, Melissa F; Wade, Kimberley A; Strange, Deryn

2016-09-01

Eyewitness-identification studies have focused on the idea that unfair lineups (i.e., ones in which the police suspect stands out) make witnesses more willing to identify the police suspect. We examined whether unfair lineups also influence subjects' ability to distinguish between innocent and guilty suspects and their ability to judge the accuracy of their identification. In a single experiment (N = 8,925), we compared three fair-lineup techniques used by the police with unfair lineups in which we did nothing to prevent distinctive suspects from standing out. Compared with the fair lineups, doing nothing not only increased subjects' willingness to identify the suspect but also markedly impaired subjects' ability to distinguish between innocent and guilty suspects. Accuracy was also reduced at every level of confidence. These results advance theory on witnesses' identification performance and have important practical implications for how police should construct lineups when suspects have distinctive features. © The Author(s) 2016.

Protecting the Innocence of Youth: Moral Sanctity Values Underlie Censorship From Young Children.

PubMed

Anderson, Rajen A; Masicampo, E J

2017-11-01

Three studies examined the relationship between people's moral values (drawing on moral foundations theory) and their willingness to censor immoral acts from children. Results revealed that diverse moral values did not predict censorship judgments. It was not the case that participants who valued loyalty and authority, respectively, sought to censor depictions of disloyal and disobedient acts. Rather, censorship intentions were predicted by a single moral value-sanctity. The more people valued sanctity, the more willing they were to censor from children, regardless of the types of violations depicted (impurity, disloyalty, disobedience, etc.). Furthermore, people who valued sanctity objected to indecent exposure only to apparently innocent and pure children-those who were relatively young and who had not been previously exposed to immoral acts. These data suggest that sanctity, purity, and the preservation of innocence underlie intentions to censor from young children.

Murmur from a bullet: Old lesion, new treatment.

PubMed

Neves, David; Bettencourt, Nuno; Braga, Pedro; Gama, Vasco

2015-06-01

Aortic disease can be highly variable in terms of lesion morphology, clinical presentation and etiology. We present the case of a young man who suffered a gunshot injury at the age of 12, resulting in paraplegia. Later a murmur was detected and at age 25 a pseudoaneurysm was diagnosed, with fistulization to the left pulmonary artery. Given his good functional status, he was initially managed by a conservative strategy, with regular follow-up. At age 35 left ventricular dilatation was observed with tachycardia and systolic dysfunction, and he was referred for transcatheter aortic valve replacement. Currently, at age 41, he is well in cardiovascular terms, with a good procedural result and professionally active. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Incidence of mitral valve prolapse in one hundred clinically stable newborn baby girls: an echocardiographic study.

PubMed

Chandraratna, P A; Vlahovich, G; Kong, Y; Wilson, D

1979-09-01

Clinical and echocardiographic examinations were performed on 100 clinically stable, newborn baby girls. Mitral valve prolapse was noted on the echocardiograms of seven babies. Three subjects had systolic clicks, two of whom had systolic murmurs following the click. The four other babies who had echocardiographic evidence of mitral valve prolapse had no abnormal auscultatory signs. Of the 93 babies without evidence of mitral prolapse, 91 had normal echocardiograms and auscultatory features; one was noted to have a murmur consistent with a ventricular septal defect, and another had an eccentric aortic valve on the echocardiogram which was suggestive of a bicuspid aortic valve. Serial studies on our group of subjects will yield useful information regarding the natural history of mitral valve prolapse.

Patent ductus arteriosus associated with congenital anomaly of coronary artery.

PubMed

Maleki, Majid; Azizian, Nassrin; Esmaeilzadeh, Maryam; Moradi, Bahieh

2013-11-01

We reported a case of patent ductus arteriosus (PDA) with congenital anomaly of coronary arteries as abnormal origin of right coronary artery (RCA) and left coronary artery (LCA) from a single ostium of the right coronary sinus. A 21-year-old man referred to our institution for evaluation of cardiac murmur. He has suffered from palpitation and atypical chest pain for three months. On physical examination, a continuous murmur was heard in the second left parasternal space. Transthoracic echocardiography showed normal left and right ventricular size and systolic function (LVEF = 55%). Main pulmonary artery (PA) and left pulmonary artery (LPA) branch were considerably dilated. Considering normal coronary flow, lack of clinical evidence of myocardial ischemia and echocardiography findings, patient underwent surgical closure of PDA via left thoracotomy and after five days discharged uneventfully.

Increased NT-proANP predicts risk of congestive heart failure in Cavalier King Charles spaniels with mitral regurgitation caused by myxomatous valve disease.

PubMed

Eriksson, Anders S; Häggström, Jens; Pedersen, Henrik Duelund; Hansson, Kerstin; Järvinen, Anna-Kaisa; Haukka, Jari; Kvart, Clarence

2014-09-01

To evaluate the predictive value of plasma N-terminal pro-atrial natriuretic peptide (NT-proANP) and nitric oxide end-products (NOx) as markers for progression of mitral regurgitation caused by myxomatous mitral valve disease. Seventy-eight privately owned Cavalier King Charles spaniels with naturally occurring myxomatous mitral valve disease. Prospective longitudinal study comprising 312 measurements over a 4.5 year period. Clinical values were recorded, NT-proANP concentrations were measured by radioimmunoassay, and NOx were analyzed colorimetrically. To predict congestive heart failure (CHF), Cox proportional hazards models with time-varying covariates were constructed. The hazard ratio for NT-proANP (per 1000 pmol/l increase) to predict future CHF was 6.7 (95% confidence interval, 3.6-12.5; p < 0.001). The median time to CHF for dogs with NT-proANP levels >1000 pmol/l was 11 months (95% confidence interval, 5.6-12.6 months), compared to 54 months (46 - infinity) for dogs with concentrations ≤ 1000 pmol/l (p < 0.001). Due to intra- and inter-individual variability, most corresponding analyses for NOx were insignificant but dogs reaching CHF had a lower mean NOx concentration than dogs not reaching CHF (23 vs. 28 μmol/l, p = 0.016). Risk of CHF increased with increase in heart rate (>130 beats per minute) and grade of murmur (≥ 3/6). The risk of CHF due to mitral regurgitation is increased in dogs with blood NT-proANP concentrations above 1000 pmol/l. Measurement of NT-proANP can be a valuable tool to identify dogs that may develop CHF within months. Copyright © 2014 Elsevier B.V. All rights reserved.

Trends in pediatric echocardiography and the yield for congenital heart disease in a major cardiac referral hospital in Cameroon.

PubMed

Nkoke, Clovis; Balti, Eric; Menanga, Alain; Dzudie, Anastase; Lekoubou, Alain; Kingue, Samuel; Kengne, Andre Pascal

2017-01-01

Congenital heart disease (CHD) is a common condition in children in Sub-Saharan Africa (SSA), where it is associated with poor outcomes. Diagnosis of CHD in SSA depends essentially on echocardiography, which is available only in few urban referral centers. Our aim was to assess time changes in the pattern of referral for pediatric echocardiography and the subsequent diagnosis of structural CHD in a major SSA city. All pediatric echocardiography performed between 2004 and 2013 at the echocardiography laboratory of the Yaounde General Hospital were reviewed. The primary indication of the study and the presence of structural CHD were recorded. Between 2004 and 2013, 9,390 echocardiograms were performed and 834 (8.9%) children aged 1 day to 15 years underwent echocardiography at the center, and 227 (27.2%) cases of definite structural CHD were diagnosed, with 123 (54.2%) in boys. The most frequent indications for echocardiography were heart murmurs (40%) and the suspicion of CHD (37.4%). The commonest CHD was ventricular septal defect (VSD) (30%) with tetralogy of Fallot being the most frequent cyanotic heart lesion (5.3%). The proportion of pediatric echocardiography decreased from 13.3% in 2004-2005 to 6.1% in 2012-2013 (P=0.001) but not in a linear fashion (P=0.072 for linear trend).The diagnosis of structural CHD increased from 25.1% in 2004-2005 to 27.1% in 2012-2013. This increase however was non-significant (P=0.523) and did not follow a linear trend (P=0.230). The pattern of referral for pediatric echocardiography at this center has changed over time, but diagnosis of structural CHD has remained the same. Improving access to this diagnostic procedure and subsequent treatment of diagnosed CHD will help improving the outcome of the disease in this setting.

Should learners reason one step at a time? A randomised trial of two diagnostic scheme designs.

PubMed

Blissett, Sarah; Morrison, Deric; McCarty, David; Sibbald, Matthew

2017-04-01

Making a diagnosis can be difficult for learners as they must integrate multiple clinical variables. Diagnostic schemes can help learners with this complex task. A diagnostic scheme is an algorithm that organises possible diagnoses by assigning signs or symptoms (e.g. systolic murmur) to groups of similar diagnoses (e.g. aortic stenosis and aortic sclerosis) and provides distinguishing features to help discriminate between similar diagnoses (e.g. carotid pulse). The current literature does not identify whether scheme layouts should guide learners to reason one step at a time in a terminally branching scheme or weigh multiple variables simultaneously in a hybrid scheme. We compared diagnostic accuracy, perceptual errors and cognitive load using two scheme layouts for cardiac auscultation. Focused on the task of identifying murmurs on Harvey, a cardiopulmonary simulator, 86 internal medicine residents used two scheme layouts. The terminally branching scheme organised the information into single variable decisions. The hybrid scheme combined single variable decisions with a chart integrating multiple distinguishing features. Using a crossover design, participants completed one set of murmurs (diastolic or systolic) with either the terminally branching or the hybrid scheme. The second set of murmurs was completed with the other scheme. A repeated measures manova was performed to compare diagnostic accuracy, perceptual errors and cognitive load between the scheme layouts. There was a main effect of the scheme layout (Wilks' λ = 0.841, F 3,80 = 5.1, p = 0.003). Use of a terminally branching scheme was associated with increased diagnostic accuracy (65 versus 53%, p = 0.02), fewer perceptual errors (0.61 versus 0.98 errors, p = 0.001) and lower cognitive load (3.1 versus 3.5/7, p = 0.023). The terminally branching scheme was associated with improved diagnostic accuracy, fewer perceptual errors and lower cognitive load, suggesting that terminally branching schemes are effective for improving diagnostic accuracy. These findings can inform the design of schemes and other clinical decision aids. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Simulation-guided cardiac auscultation improves medical students' clinical skills: the Pavia pilot experience.

PubMed

Perlini, Stefano; Salinaro, Francesco; Santalucia, Paola; Musca, Francesco

2014-03-01

Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p < 0.001 vs. baseline). Rather unexpectedly, before the tutorial, the performance of VI-year students and of residents was not significantly different from their III-year colleagues, since the two groups correctly identified 14.2 and 16.2 % of the diagnoses, respectively. After the tutorial, the VI-year students and the residents also improved their overall performance (to 73.1 and 76.1 %, respectively; p < 0.001 for both when compared to before the tutorial). The persistence of this capability after 3 years was remarkable, since the 85 students who repeated the test without any further exposure to the 10-h teaching session with Harvey(©) correctly identified 68.4 % of the possible cardiac diagnoses (p < 0.001 vs. baseline). These data underscore the importance of clinical training in order to improve auscultation skills in our academic setting, prompting to redesign teaching curricula. Simulation-based cardiac auscultation should be considered as the "missing link" between formal lecturing and bedside teaching of heart sounds and murmurs.

Congenital cardiac disease in dogs.

PubMed

McCaw, D; Aronson, E

1984-07-01

Pulmonic stenosis is caused by a malformed pulmonic valve, stricture of the right ventricular outflow tract or stricture of the pulmonary artery. English Bulldogs, Beagles, Samoyeds, Fox Terriers and Chihuahuas are predisposed. Clinical signs in severely affected dogs include exercise intolerance, stunting, dyspnea, syncope and ascites. Auscultation reveals a high-frequency, crescendo-decrescendo murmur during systole, loudest over the left side of the thorax, near the sternal cardiac border. An ECG may reveal a right-axis deviation of greater than 120 degrees, S waves in leads I, II and III, deep S waves in CV6LL, CV6LU and V10, Q waves deeper than 0.5 mv in leads II, III and AVF, and positive T waves in lead V10. Plain film LAT thoracic radiographs reveal an elevated carina, increased sternal contact of the heart, loss of the cranial cardiac waist and a widened cardiac silhouette, with normal pulmonary vasculature. A DV projection reveals an inverted "D" shape of the right ventricle and a pulmonary artery bulge. A nonselective angiocardiogram reveals poststenotic dilation of the main pulmonary artery. Treatment involves surgical correction of the stenosis.

Cardiomyopathy in captive African hedgehogs (Atelerix albiventris).

PubMed

Raymond, J T; Garner, M M

2000-09-01

From 1994 to 1999, 16 captive African hedgehogs (Atelerix albiventris), from among 42 necropsy cases, were diagnosed with cardiomyopathy. The incidence of cardiomyopathy in this study population was 38%. Fourteen of 16 hedgehogs with cardiomyopathy were males and all hedgehogs were adult (>1 year old). Nine hedgehogs exhibited 1 or more of the following clinical signs before death: heart murmur, lethargy, icterus, moist rales, anorexia, dyspnea, dehydration, and weight loss. The remaining 7 hedgehogs died without premonitory clinical signs. Gross findings were cardiomegaly (6 cases), hepatomegaly (5 cases), pulmonary edema (5 cases), pulmonary congestion (4 cases), hydrothorax (3 cases), pulmonary infarct (1 case), renal infarcts (1 case), ascites (1 case), and 5 cases showed no changes. Histologic lesions were found mainly within the left ventricular myocardium and consisted primarily of myodegeneration, myonecrosis, atrophy, hypertrophy, and disarray of myofibers. All hedgehogs with cardiomyopathy had myocardial fibrosis, myocardial edema, or both. Other common histopathologic findings were acute and chronic passive congestion of the lungs, acute passive congestion of the liver, renal tubular necrosis, vascular thrombosis, splenic extramedullary hematopoiesis, and hepatic lipidosis. This is the first report of cardiomyopathy in African hedgehogs.

Terror management and attributions of blame to innocent victims: reconciling compassionate and defensive responses.

PubMed

Hirschberger, Gilad

2006-11-01

In this article, 4 studies test the hypothesis that reminders of personal death bias the normative attribution process and increase the motivation to blame severely injured, innocent victims. In Studies 1 and 2, primes of death led to greater attributions of blame to severely injured victims but did not significantly influence attributions of blame to either mildly injured victims or negatively portrayed others. In Study 3, primes of death led to greater attributions of blame to victims of circumstance but did not influence attributions of blame to victims who were explicitly responsible for their condition. In Study 4, innocent victims who were severely injured elicited more death-related cognitions than did victims who were responsible for their condition or who were only mildly injured. These findings indicate that the predictions of normative models of attribution may be moderated, and even overturned, when observers are reminded of their personal death such that defensive needs override rational inferential processes.

Actual innocence: is death different?

PubMed

Acker, James R

2009-01-01

Supreme Court jurisprudence relies heavily on the premise that "death is different" from other criminal sanctions, and that capital cases entail commensurately demanding standards of reliability. Although invoked most frequently with respect to sentencing, both precedent and logic suggest that heightened reliability applies as well to guilt determination in capital trials. Nevertheless, recurrent and highly visible wrongful convictions in capital cases have affected public opinion, contributed to a precipitous decline in new death sentences, and led to calls for reforms designed to guard against the risk of executing innocent persons. This article examines the implications of the "death is different" doctrine for the problem of wrongful convictions in both capital and non-capital cases. It argues that innovations designed to enhance reliability in the special context of death-penalty prosecutions are important in their own right, but relevant new safeguards also should extend to criminal cases generally, where innocent people are similarly at risk and wrongful convictions are far more prevalent. (c) 2009 John Wiley & Sons, Ltd.

Antibiotics prescription in Nigerian dental healthcare services.

PubMed

Azodo, C C; Ojehanon, P I

2014-09-01

Inappropriate antibiotics prescription in dental healthcare delivery that may result in the emergence of antibiotic-resistant bacteria, is a worldwide concern. The objective of the study was to determine the antibiotics knowledge and prescription patterns among dentists in Nigeria. A total of 160 questionnaires were distributed to dentists attending continuing education courses organized by two organizations in Southern and Northern parts of Nigeria. Data analysis was done using SPSS version 17.0. A total of 146 questionnaires were returned, properly filled, out of 160 questionnaires, giving an overall response rate 91.3%. The clinical factors predominantly influenced the choice of therapeutic antibiotics among the respondents. In this study, the most commonly prescribed antibiotics among the respondents was a combination of amoxicillin and metronidazole. Of the respondents, 136 (93.2%) of them considered antibiotic resistance as a major problem in Nigeria and 102 (69.9%) have experienced antibiotics resistance in dental practice. The major reported conditions for prophylactic antibiotics among the respondents were diabetic mellitus, HIV/AIDS, history of rheumatic fever, other heart anomalies presenting with heart murmur and presence of prosthetic hip. The knowledge of adverse effects of antibiotics was greatest for tooth discoloration which is related to tetracycline. Data from this study revealed the most commonly prescribed antibiotics as a combination of amoxicillin and metronidazole. There existed gaps in prophylactic antibiotic prescription, consideration in the choice of therapeutic antibiotics and knowledge of adverse effects of antibiotics among the studied dentists.

Suspect filler similarity in eyewitness lineups: a literature review and a novel methodology.

PubMed

Fitzgerald, Ryan J; Oriet, Chris; Price, Heather L

2015-02-01

Eyewitness lineups typically contain a suspect (guilty or innocent) and fillers (known innocents). The degree to which fillers should resemble the suspect is a complex issue that has yet to be resolved. Previously, researchers have voiced concern that eyewitnesses would be unable to identify their target from a lineup containing highly similar fillers; however, our literature review suggests highly similar fillers have only rarely been shown to have this effect. To further examine the effect of highly similar fillers on lineup responses, we used morphing software to create fillers of moderately high and very high similarity to the suspect. When the culprit was in the lineup, a higher correct identification rate was observed in moderately high similarity lineups than in very high similarity lineups. When the culprit was absent, similarity did not yield a significant effect on innocent suspect misidentification rates. However, the correct rejection rate in the moderately high similarity lineup was 20% higher than in the very high similarity lineup. When choosing rates were controlled by calculating identification probabilities for only those who made a selection from the lineup, culprit identification rates as well as innocent suspect misidentification rates were significantly higher in the moderately high similarity lineup than in the very high similarity lineup. Thus, very high similarity fillers yielded costs and benefits. Although our research suggests that selecting the most similar fillers available may adversely affect correct identification rates, we recommend additional research using fillers obtained from police databases to corroborate our findings.

DoS detection in IEEE 802.11 with the presence of hidden nodes

PubMed Central

Soryal, Joseph; Liu, Xijie; Saadawi, Tarek

2013-01-01

The paper presents a novel technique to detect Denial of Service (DoS) attacks applied by misbehaving nodes in wireless networks with the presence of hidden nodes employing the widely used IEEE 802.11 Distributed Coordination Function (DCF) protocols described in the IEEE standard [1]. Attacker nodes alter the IEEE 802.11 DCF firmware to illicitly capture the channel via elevating the probability of the average number of packets transmitted successfully using up the bandwidth share of the innocent nodes that follow the protocol standards. We obtained the theoretical network throughput by solving two-dimensional Markov Chain model as described by Bianchi [2], and Liu and Saadawi [3] to determine the channel capacity. We validated the results obtained via the theoretical computations with the results obtained by OPNET simulator [4] to define the baseline for the average attainable throughput in the channel under standard conditions where all nodes follow the standards. The main goal of the DoS attacker is to prevent the innocent nodes from accessing the channel and by capturing the channel’s bandwidth. In addition, the attacker strives to appear as an innocent node that follows the standards. The protocol resides in every node to enable each node to police other nodes in its immediate wireless coverage area. All innocent nodes are able to detect and identify the DoS attacker in its wireless coverage area. We applied the protocol to two Physical Layer technologies: Direct Sequence Spread Spectrum (DSSS) and Frequency Hopping Spread Spectrum (FHSS) and the results are presented to validate the algorithm. PMID:25685510

DoS detection in IEEE 802.11 with the presence of hidden nodes.

PubMed

Soryal, Joseph; Liu, Xijie; Saadawi, Tarek

2014-07-01

The paper presents a novel technique to detect Denial of Service (DoS) attacks applied by misbehaving nodes in wireless networks with the presence of hidden nodes employing the widely used IEEE 802.11 Distributed Coordination Function (DCF) protocols described in the IEEE standard [1]. Attacker nodes alter the IEEE 802.11 DCF firmware to illicitly capture the channel via elevating the probability of the average number of packets transmitted successfully using up the bandwidth share of the innocent nodes that follow the protocol standards. We obtained the theoretical network throughput by solving two-dimensional Markov Chain model as described by Bianchi [2], and Liu and Saadawi [3] to determine the channel capacity. We validated the results obtained via the theoretical computations with the results obtained by OPNET simulator [4] to define the baseline for the average attainable throughput in the channel under standard conditions where all nodes follow the standards. The main goal of the DoS attacker is to prevent the innocent nodes from accessing the channel and by capturing the channel's bandwidth. In addition, the attacker strives to appear as an innocent node that follows the standards. The protocol resides in every node to enable each node to police other nodes in its immediate wireless coverage area. All innocent nodes are able to detect and identify the DoS attacker in its wireless coverage area. We applied the protocol to two Physical Layer technologies: Direct Sequence Spread Spectrum (DSSS) and Frequency Hopping Spread Spectrum (FHSS) and the results are presented to validate the algorithm.

Redox non-innocent bis(2,6-diimine-pyridine) ligand-iron complexes as anolytes for flow battery applications.

PubMed

Duarte, Gabriel M; Braun, Jason D; Giesbrecht, Patrick K; Herbert, David E

2017-12-21

Diiminepyridines are a well-known class of "non-innocent" ligands that confer additional redox activity to coordination complexes beyond metal-centred oxidation/reduction. Here, we demonstrate that metal coordination complexes (MCCs) of diiminepyridine (DIP) ligands with iron are suitable anolytes for redox-flow battery applications, with enhanced capacitance and stability compared with bipyridine analogs, and access to storage of up to 1.6 electron equivalents. Substitution of the ligand is shown to be a key factor in the cycling stability and performance of MCCs based on DIP ligands, opening the door to further optimization.

2010 Aerospace Medical Certification Statistical Handbook

DTIC Science & Technology

2012-02-01

type, hysterical- dissociative type, phobic, neurasthenic, depersonalization, hypochondriacal, adjustment disorder and other neurosis 12,178 2.03...Murmur – includes functional or physiological 10,301 1.72 Traumatic brain injury, concussion, amnesia , coma (30 minutes or more), loss of memory 10,197

Acute resolution of pulmonary alveolar infiltrates in 10 dogs with pulmonary hypertension treated with sildenafil citrate: 2005-2014.

PubMed

Kellihan, Heidi B; Waller, Kenneth R; Pinkos, Alyssa; Steinberg, Howard; Bates, Melissa L

2015-09-01

To describe clinical canine patients with naturally occurring pulmonary hypertension and radiographic pulmonary alveolar infiltrates before and after treatment with sildenafil. Ten client-owned dogs. A retrospective analysis of dogs with echocardiographically-determined pulmonary hypertension and pulmonary alveolar infiltrates on thoracic radiographs was performed before (PRE) and after (POST) sildenafil therapy. Clinical scores, pulmonary alveolar infiltrate scores and tricuspid regurgitation gradients were analyzed PRE and POST sildenafil. Pulmonary alveolar infiltrates associated with pulmonary hypertension developed in a diffusely patchy distribution (10/10). Sixty percent of dogs had a suspected diagnosis of interstitial pulmonary fibrosis as the etiology of pulmonary hypertension. Median PRE clinical score was 4 (range: 3-4) compared to POST score of 0 (0-2) (p = 0.005). Median alveolar infiltrate score PRE was 10 (5-12) compared to POST score of 4 (0-6) (p = 0.006). Median tricuspid regurgitation gradient PRE was 83 mmHg (57-196) compared to 55 mmHg POST (33-151) (p = 0.002). A subset of dogs with moderate to severe pulmonary hypertension present with diffuse, patchy alveolar infiltrates consistent with non-cardiogenic pulmonary edema. The typical clinical presentation is acute dyspnea and syncope, often in conjunction with heart murmurs suggestive of valvular insufficiency. This constellation of signs may lead to an initial misdiagnosis of congestive heart failure or pneumonia; however, these dogs clinically and radiographically improve with the initiation of sildenafil. Copyright © 2015 Elsevier B.V. All rights reserved.

Anatomic, histopathologic, and echocardiographic features in a dog with an atypical pulmonary valve stenosis with a fibrous band of tissue and a patent ductus arteriosus.

PubMed

Yoon, Hakyoung; Kim, Jaehwan; Nahm, Sang-Soep; Eom, Kidong

2017-07-11

Congenital pulmonary valve stenosis and patent ductus arteriosus are common congenital heart defects in dogs. However, concurrence of atypical pulmonary valve stenosis and patent ductus arteriosus is uncommon. This report describes the anatomic, histopathologic, and echocardiographic features in a dog with concomitant pulmonary valve stenosis and patent ductus arteriosus with atypical pulmonary valve dysplasia that included a fibrous band of tissue. A 1.5-year-old intact female Chihuahua dog weighing 3.3 kg presented with a continuous grade VI cardiac murmur, poor exercise tolerance, and an intermittent cough. Echocardiography indicated pulmonary valve stenosis, a thickened dysplastic valve without annular hypoplasia, and a type IIA patent ductus arteriosus. The pulmonary valve was thick line-shaped in systole and dome-shaped towards the right ventricular outflow tract in diastole. The dog suffered a fatal cardiac arrest during an attempted balloon pulmonary valvuloplasty. Necropsy revealed pulmonary valve dysplasia, commissural fusion, and incomplete opening and closing of the pulmonary valve because of a fibrous band of tissue causing adhesion between the right ventricular outflow tract and the dysplastic intermediate cusp of the valve. A fibrous band of tissue between the right ventricular outflow track and the pulmonary valve should be considered as a cause of pulmonary valve stenosis. Pulmonary valve stenosis and patent ductus arteriosus can have conflicting effects on diastolic and systolic dysfunction, respectively. Therefore, beta-blockers should always be used carefully, particularly in patients with a heart defect where there is concern about left ventricular systolic function.

Trisomy 15 mosaicism and uniparental disomy (UPD) in a liveborn infant

DOE Office of Scientific and Technical Information (OSTI.GOV)

Milunsky, J.M.; Wyandt, H.E.; Amos, J.A.

We describe a liveborn infant with UPD in association with trisomy 15 mosaicism. Third trimester amniocentesis was performed for suspected IUGR. Results revealed 46,XX/47,XX,+15. The infant initially had respiratory distress and fed poorly. Symmetrical growth retardation, craniofacial dysmorphism, excess nuchal folds, a heart murmur, hypermobile joints, minor limb abnormalities, absent spontaneous movement and an abnormal cry were noted. Further study showed complex heart defects, including VSD and PDA, a left choroid plexus cyst, 13 ribs bilaterally, abnormal optic discs, abnormal visual evoked potentials and abnormal auditory brain stem responses. The infant died at 6 weeks of life from cardio-respiratory complications.more » Blood chromosomes were normal, 46,XX in 100 cells. Parental blood chromosomes were normal. Skin biopsy revealed 46,XX/47,XX,+15 in 40/50 (80%) cells as did autopsy lung tissue. Molecular analysis of the infant`s blood revealed maternal uniparental heterodisomy for chromosome 15 in the 46,XX cell line. Microsatellite analysis demonstrated that the extra chromosome originated from a maternal meiosis I nondisjunction. To our knowledge, this is the first liveborn infant with mosaic trisomy 15 and UPD in the diploid cells. Trisomy 15, heretofore, has been regarded as nonviable, even in mosaic form. While maternal UPD is associated with the Prader-Willi syndrome phenotype, mosaicism for trisomy 15 has been reported only when confined to the placenta. UPD in this case generally complicated prediction of the phenotype and raises the question whether all cases with UPD 15 should have more than one tissue studied to determine undetected trisomy 15.« less

Hepatic Cyst Compressing The Right Atrial and Ventricular Inflow Tract: An Uncommon Cardiac Complication.

PubMed

Panchal, Maulik; Alansari, Ahmed; Wallack, Marc; Visco, Ferdinand; Williams, Susan; Sy, Alexander M

2018-01-01

Commonly reported complications of hepatic cysts are spontaneous hemorrhage, rupture into the peritoneal cavity, infection and compression of the biliary tree however cardiac complications are not commonly reported. We are presenting a case of a large liver cyst presenting with right atrial and ventricular inflow tract impingement resulting in cardiac symptoms. A 68 year-old Hispanic female presented with one month of fatigue and shortness of breath after household work and walking less than one block, right upper quadrant pain and weight loss. She had history of multiple hepatic cysts for more than 12 years, well-controlled diabetes and hypertension. Examination of the heart revealed tachycardia with regular heart sounds. There were no murmurs. She had tenderness in her right upper quadrant on palpation and an enlarged smooth liver. Rest of physical examination was unremarkable. CT scan of the abdomen showed multiple non-enhancing liver cysts in both lobes, with the largest measuring 12 x 15 x 17 cm which was significantly increased from her baseline of 7 x 8 x 10 cm in 2003. Echocardiogram showed normal left ventricular ejection fraction, grade 1 diastolic dysfunction and a hepatic cyst impinging RA and RV inflow tract. She had successful laparoscopic enucleation of liver cyst and subsequent relief from tachycardia, fatigue and shortness of breath. In conclusion, this case illustrates that hepatic cysts may become symptomatic after remaining quiescent for an extended period. They may present with unusual symptoms and clinicians should be mindful of rare complications, such as in this case.

The UK National DNA Database: Implementation of the Protection of Freedoms Act 2012.

PubMed

Amankwaa, Aaron Opoku; McCartney, Carole

2018-03-01

In 2008, the European Court of Human Rights, in S and Marper v the United Kingdom, ruled that a retention regime that permits the indefinite retention of DNA records of both convicted and non-convicted ("innocent") individuals is disproportionate. The court noted that there was inadequate evidence to justify the retention of DNA records of the innocent. Since the Marper ruling, the laws governing the taking, use, and retention of forensic DNA in England and Wales have changed with the enactment of the Protection of Freedoms Act 2012 (PoFA). This Act, put briefly, permits the indefinite retention of DNA profiles of most convicted individuals and temporal retention for some first-time convicted minors and innocent individuals on the National DNA Database (NDNAD). The PoFA regime was implemented in October 2013. This paper examines ten post-implementation reports of the NDNAD Strategy Board (3), the NDNAD Ethics Group (3) and the Office of the Biometrics Commissioner (OBC) (4). Overall, the reports highlight a considerable improvement in the performance of the database, with a current match rate of 63.3%. Further, the new regime has strengthened the genetic privacy protection of UK citizens. The OBC reports detail implementation challenges ranging from technical, legal and procedural issues to sufficient understanding of the requirements of PoFA by police forces. Risks highlighted in these reports include the deletion of some "retainable" profiles, which could potentially lead to future crimes going undetected. A further risk is the illegal retention of some profiles from innocent individuals, which may lead to privacy issues and legal challenges. In conclusion, the PoFA regime appears to be working well, however, critical research is still needed to evaluate its overall efficacy compared to other retention regimes. Copyright © 2018 Elsevier B.V. All rights reserved.

Redox-Active vs Redox-Innocent: A Comparison of Uranium Complexes Containing Diamine Ligands.

PubMed

Pattenaude, Scott A; Mullane, Kimberly C; Schelter, Eric J; Ferrier, Maryline G; Stein, Benjamin W; Bone, Sharon E; Lezama Pacheco, Juan S; Kozimor, Stosh A; Fanwick, Phillip E; Zeller, Matthias; Bart, Suzanne C

2018-05-11

Uranium complexes ( Mes DAE) 2 U(THF) (1-DAE) and Cp 2 U( Mes DAE) (2-DAE) ( Mes DAE = [ArN-CH 2 CH 2 -NAr]; Ar = 2,4,6-trimethylphenyl (Mes)), bearing redox-innocent diamide ligands, have been synthesized and characterized for a full comparison with previously published, redox-active diimine complexes, ( Mes DAB Me ) 2 U(THF) (1-DAB) and Cp 2 U( Mes DAB Me ) (2-DAB) ( Mes DAB Me = [ArN═C(Me)C(Me)═NAr]; Ar = Mes). These redox-innocent analogues maintain an analogous steric environment to their redox-active ligand counterparts to facilitate a study aimed at determining the differing electronic behavior around the uranium center. Structural analysis by X-ray crystallography showed 1-DAE and 2-DAE have a structural environment very similar to 1-DAB and 2-DAB, respectively. The main difference occurs with coordination of the ene-backbone to the uranium center in the latter species. Electronic absorption spectroscopy reveals these new DAE complexes are nearly identical to each other. X-ray absorption spectroscopy suggests all four species contain +4 uranium ions. The data also indicates that there is an electronic difference between the bis(diamide)-THF uranium complexes as opposed to those that only contain one diamide and two cyclopentadienyl rings. Finally, magnetic measurements reveal that all complexes display temperature-dependent behavior consistent with uranium(IV) ions that do not include ligand radicals. Overall, this study determines that there is no significant bonding difference between the redox-innocent and redox-active ligand frameworks on uranium. Furthermore, there are no data to suggest covalent bonding character using the latter ligand framework on uranium, despite what is known for transition metals.

The single lineup paradigm: A new way to manipulate target presence in eyewitness identification experiments.

PubMed

Oriet, Chris; Fitzgerald, Ryan J

2018-02-01

The suspect in eyewitness lineups may be guilty or innocent. These possibilities are traditionally simulated in eyewitness identification studies using a dual-lineup paradigm: All witnesses observe the same perpetrator and then receive one of two lineups. In this paradigm, the suspect's guilt is manipulated by including the perpetrator in one lineup and an innocent suspect in the other. The lineup is then filled with people matched to either the suspect (resulting in different fillers in perpetrator-present and perpetrator-absent lineups) or to the perpetrator (resulting in the same fillers in each lineup). An inescapable feature of the dual-lineup paradigm is that the perpetrator-present and perpetrator-absent lineups differ not only in the suspect's guilt, but also in their composition. Here, we describe a single-lineup paradigm: Subjects observe one of two perpetrators and then all subjects receive the same lineup containing one of the perpetrators. This alternative paradigm allows manipulation of the suspect's guilt without changing the lineup's composition. In three experiments, we applied the single-lineup paradigm to explore suspect-filler similarity and consistently found that increasing similarity reduced perpetrator identifications but did little to prevent innocent suspect misidentifications. Conversely, when fillers were matched to the perpetrator using a dual-lineup paradigm, increasing similarity reduced identification of perpetrators and innocent suspects. This finding suggests that the effect of filler similarity may depend on the person to whom the fillers are matched. We suggest that the single-lineup paradigm is a more ecologically valid and better controlled approach to creating suspect-matched lineups in laboratory investigations of eyewitness memory than existing procedures. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Bedside cardiac examination: constancy in a sea of change.

PubMed

Richardson, T R; Moody, J M

2000-11-01

The general trend in the recent literature has been to highlight the difficulties and shortcomings of the physical examination and to attribute these difficulties to deficiencies in training rather than to intrinsic weaknesses in auscultation itself. The call is for better training. Given the advice of the authors mentioned above, individual training may be warranted at the postgraduate level and in the large community of practicing internists and cardiologists. Although not proven, it is likely that individual training with computer technology, audiotape instruction, or simulator technology such as described in the following paragraphs would be effective at improving bedside clinical diagnosis and cost-effective patient care in the postgraduate, continuing medical education setting. The advances in auscultation during the last few years have been more incremental than fundamental. There is ongoing research into the mechanism of production of S3 and S4, and mathematical modeling techniques have recently been used with some success in evaluating the vibrations of S3 and S4 as forced, damped oscillations of a viscoelastic system. Analysis of sound energy with the technique of spectral waveform analysis, which investigates the frequency content of sound signals, has been used for many years in the study of cardiovascular sound. By the use of various methods of mathematical analysis, investigators have found potentially useful information in spectral sound patterns of prosthetic valves, murmur characteristics, and even potentially hemodynamic information from heart sounds. Despite the mathematical advances, there are still disturbing drawbacks to some of the analytic techniques, such as the production of mathematical terms containing "negative energy." Although the potential of obtaining significant clinical information from spectral analysis of heart sound recordings is attractive, the clinical usefulness of such techniques remains virtually nonexistent. Similar to the recent advances in auscultation, the technical advances in the design of the stethoscope have also been more incremental than fundamental. There are at least 3 recently introduced electronic stethoscopes that have the capability of amplification and filtration and that claim noise reduction. Because their introduction is recent, no information is available in the peer-review literature regarding their clinical performance; therefore their place in the clinical arena remains to be elucidated--perhaps a boon for patient care providers with specific hearing defects and perhaps useful in noisy clinical environments. Peer-review literature has not shown clear superiority of one type of acoustic stethoscope over another. The teaching of auscultation has been an area of recognized importance in patient care since the inception of auscultation as a medical art. Attempts to facilitate practitioner learning in the performance and interpretation of auscultation have advanced through the decades limited only by the technical infrastructure of the day. The availability of recorded heart sounds and murmurs appeared shortly after the availability of recording and playback devices, with first vinyl and later tape recordings. In 1974, technology was employed to create a virtual patient named "Harvey," an engineered cardiology patient simulator that reproduces many of the physical findings of the cardiology examination. Later, with the advent of commercially available CD-ROM devices, newer, better-integrated teaching devices have been developed, some of them outstanding in their clarity and quality. Despite the obvious value of such instructional aids that are best used in the individual setting, there is evidence that the classroom is still of significant value in teaching auscultation. However, nowhere else in the practice of medicine is a mentor approach more valuable than in learning auscultation. (ABSTRACT TRUNCATED)

Approach to chest pain and acute myocardial infarction.

PubMed

Pandie, S; Hellenberg, D; Hellig, F; Ntsekhe, M

2016-03-01

Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers are key components of an effective chest pain assessment. The first priority is excluding serious chest pain syndromes, namely acute coronary syndromes (ACSs), aortic dissection, pulmonary embolism, cardiac tamponade and tension pneumothorax. On history, the mnemonic SOCRATES (Site Onset Character Radiation Association Time Exacerbating/relieving factor and Severity) helps differentiate cardiac from non-cardiac pain. On examination, evaluation of vital signs, evidence of murmurs, rubs, heart failure, tension pneumothoraces and chest infections are important. A 12-lead ECG should be interpreted within 10 minutes of first medical contact, specifically to identify ST elevation myocardial infarction (STEMI). High-sensitivity troponins improve the rapid rule-out of myocardial infarction (MI) and confirmation of non-ST elevation MI (NSTEMI). ACS (STEMI and NSTEMI/unstable anginapectoris (UAP)) result from acute destabilisation of coronary atheroma with resultant complete (STEMI) or subtotal (NSTEMI/UAP) thrombotic coronary occlusion. The management of STEMI patients includes providing urgent reperfusion: primary percutaneous coronary intervention(PPCI) if available, deliverable within 60 - 120 minutes, and fibrinolysis if PPCI is not available. Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), anticoagulation (heparin or low-molecular-weight heparin) and cardiac monitoring.

Epidermal mechano-acoustic sensing electronics for cardiovascular diagnostics and human-machine interfaces.

PubMed

Liu, Yuhao; Norton, James J S; Qazi, Raza; Zou, Zhanan; Ammann, Kaitlyn R; Liu, Hank; Yan, Lingqing; Tran, Phat L; Jang, Kyung-In; Lee, Jung Woo; Zhang, Douglas; Kilian, Kristopher A; Jung, Sung Hee; Bretl, Timothy; Xiao, Jianliang; Slepian, Marvin J; Huang, Yonggang; Jeong, Jae-Woong; Rogers, John A

2016-11-01

Physiological mechano-acoustic signals, often with frequencies and intensities that are beyond those associated with the audible range, provide information of great clinical utility. Stethoscopes and digital accelerometers in conventional packages can capture some relevant data, but neither is suitable for use in a continuous, wearable mode, and both have shortcomings associated with mechanical transduction of signals through the skin. We report a soft, conformal class of device configured specifically for mechano-acoustic recording from the skin, capable of being used on nearly any part of the body, in forms that maximize detectable signals and allow for multimodal operation, such as electrophysiological recording. Experimental and computational studies highlight the key roles of low effective modulus and low areal mass density for effective operation in this type of measurement mode on the skin. Demonstrations involving seismocardiography and heart murmur detection in a series of cardiac patients illustrate utility in advanced clinical diagnostics. Monitoring of pump thrombosis in ventricular assist devices provides an example in characterization of mechanical implants. Speech recognition and human-machine interfaces represent additional demonstrated applications. These and other possibilities suggest broad-ranging uses for soft, skin-integrated digital technologies that can capture human body acoustics.

[A case of lupus myocarditis and nephritis with transient foramen jugular syndrome].

PubMed

Kohro-Kawata, J; Nakamura, H; Yamamoto, T; Fukuta, S; Matsuzaki, M

1997-10-01

A 46-year-old man was admitted to our clinic because of acute heart failure. Six years before admission he was pointed out cardiomegary and hematuria. One year later, he was diagnosed as having jugular foramen syndrome. On admission, he had a fever and dyspnea. Pansystolic blowing murmur was audible at the apex. The chest ratio on his chest X-ray was 52.5%. An electrocardiogram showed left ventricular hypertrophy. An echocardiogram showed marked dilatation and severe dysfunction of left ventricle. Radionuclide scanning with technetium 99 m pyrophosphate identified inflammatory change in the apex. Myocardial biopsy showed fibrotic degeneration and IgG deposits in myocardium. Blood examination showed anemia, lymphopenia. positive anti-nuclear antibody (1000 times, shaggy pattern), positive anti ds-DNA antibody and hypocomplementemia. Furthermore, proteinuria was pointed out. Renal biopsy showed focal segmental glomerulonephritis with active necrotizing lesion (type III nephritis). Lupus myocarditis and nephritis was diagnosed. After prednisolone (80 mg/day) was administered. left ventricular function and hypocomplementemia improved. The ACE inhibitor was also used for proteinuria. In spite of a little amount of blood transfusion, he showed hepatic hemosiderosis. We suspect that the cause of hemosiderosis was related chronic inflammation of active lupus. It was treated with Erythropoietin.

'Caterpillar right ventricle': unusual manifestation of a rare disease.

PubMed

Kalliath, Suneesh; Rajesh, Gopalan Nair

2017-01-01

A 66-year-old man presented with abdominal distension and pedal oedema for the past 10 years. He had history of right heart failure on several occasions in the past, and one of these admissions prompted referral to a cardiac specialist. On examination, he had markedly elevated jugular venous pressure with prominent 'y-descent', a tricuspid regurgitation murmur, gross ascites and pedal oedema. A full blood count, routine biochemical screen and serum bicarbonate levels were normal. Right ventricular angiogram revealed a 'caterpillar'-like aneurysm of the right ventricle (RV) apex (figure 1 arrow) with a dilated right ventricular outflow tract and significant tricuspid regurgitation with a dilated right atrium (see online supplementary video 1). Figure 1 A cine angiographic frame of the right ventricle in posteroanterior view, showing a 'caterpillar'-like right ventricle aneurysm (arrow). 10.1136/heartasia-2017-010957.supp3Supplementary file 3. On the basis of the clinical and right ventriculography features, what is the most likely diagnosis for this patient?Arrhythmogenic right ventricular cardiomyopathy (ARVC)Right ventricular endomyocardial fibrosis (RV-EMF) with an RV aneurysmCardiac sarcoidosisCongenital diverticulum of the right ventricle.

Sternal Cleft Associated with Cantrell's Pentalogy in a German Shepherd Dog.

PubMed

Benlloch-Gonzalez, Manuel; Poncet, Cyrill

2015-01-01

A 5 mo old male German shepherd dog weighing 15.5 kg was presented with an abdominal wall hernia and exercise intolerance. Physical examination showed a grade II/VI systolic heart murmur and an area of cutaneous atrophy overlying a midline supraumbilical wall defect. Thoracic radiography, computed tomography, and ultrasound examination revealed a congenital caudal sternal cleft, a supraumbilical diastasis rectus, and a patent ductus arteriosus. Exploratory surgery confirmed defects of the pars sternalis of the diaphragm and caudoventral pericardium and a persistent left cranial vena cava. Those findings were compatible with Cantrell's pentalogy. Surgical treatment included ligation of the patent ductus arteriosus through the sternal cleft, diaphragmatic reconstruction with paracostal extension of the diaphragmatic defect, pericardial and linea alba appositional reconstruction, and primary approximation of the sternal halves. Growth and exercise activity were normal 10 mo after surgery. The discovery of a midline cranial abdominal wall, pericardial, diaphragmatic, or sternal defect should prompt a thorough examination to rule out any possible associated syndrome. Cantrell's pentalogy presents various degrees of expression and is rare in dogs. Management involves early surgical repair of congenital anomalies to protect the visceral structures. The prognosis in dogs with mild forms of the syndrome is encouraging.

Endocarditis in adults with bacterial meningitis.

PubMed

Lucas, Marjolein J; Brouwer, Matthijs C; van der Ende, Arie; van de Beek, Diederik

2013-05-21

Endocarditis may precede or complicate bacterial meningitis, but the incidence and impact of endocarditis in bacterial meningitis are unknown. We assessed the incidence and clinical characteristics of patients with meningitis and endocarditis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012. Endocarditis was identified in 24 of 1025 episodes (2%) of bacterial meningitis. Cultures yielded Streptococcus pneumoniae in 13 patients, Staphylococcus aureus in 8 patients, and Streptococcus agalactiae, Streptococcus pyogenes, and Streptococcus salivarius in 1 patient each. Clues leading to the diagnosis of endocarditis were cardiac murmurs, persistent or recurrent fever, a history of heart valve disease, and S aureus as the causative pathogen of bacterial meningitis. Treatment consisted of prolonged antibiotic therapy in all patients and surgical valve replacement in 10 patients (42%). Two patients were treated with oral anticoagulants, and both developed life-threatening intracerebral hemorrhage. Systemic (70%) and neurological (54%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (63%). Seven of 24 patients (29%) with meningitis and endocarditis died. Endocarditis is an uncommon coexisting condition in bacterial meningitis but is associated with a high rate of unfavorable outcome.

Increased mitral valve regurgitation and myocardial hypertrophy in two dogs with long-term pimobendan therapy.

PubMed

Tissier, R; Chetboul, V; Moraillon, R; Nicolle, A; Carlos, C; Enriquez, B; Pouchelon, J-L

2005-01-01

The aim of this article is to describe original adverse effects in two dogs chronically treated with the inodilator pimobendan. We report a German shepherd (i.e., dog 1) and a poodle (i.e., dog 2) that were referred to our cardiology unit after receiving pimobendan for 10 and 5 mo, respectively. In both dogs, conventional echo-Doppler examination demonstrated mitral valve regurgitation and myocardial hypertrophy. Tissue Doppler imaging (TDI) was performed in the first case and revealed an abnormal relaxation phase. After the first examination, pimobendan administration was stopped in both cases and dogs were re-examined 3 and 1 mo later, respectively. Mitral valve regurgitation assessed by echocardiography decreased in both dogs, and the systolic heart murmur disappeared in dog 1. Importantly, most echocardiographic and TDI parameters tended to normalize in dog 1, suggesting, at least partial reversal of both myocardial hypertrophy and relaxation abnormality produced during inodilator therapy. This is the first report to describe an increase in mitral regurgitation under clinical conditions in dogs treated with pimobendan. We also suggest that pimobendan may induce ventricular hypertrophy. However, prospective studies are needed to confirm this observation.

Epidermal mechano-acoustic sensing electronics for cardiovascular diagnostics and human-machine interfaces

PubMed Central

Liu, Yuhao; Norton, James J. S.; Qazi, Raza; Zou, Zhanan; Ammann, Kaitlyn R.; Liu, Hank; Yan, Lingqing; Tran, Phat L.; Jang, Kyung-In; Lee, Jung Woo; Zhang, Douglas; Kilian, Kristopher A.; Jung, Sung Hee; Bretl, Timothy; Xiao, Jianliang; Slepian, Marvin J.; Huang, Yonggang; Jeong, Jae-Woong; Rogers, John A.

2016-01-01

Physiological mechano-acoustic signals, often with frequencies and intensities that are beyond those associated with the audible range, provide information of great clinical utility. Stethoscopes and digital accelerometers in conventional packages can capture some relevant data, but neither is suitable for use in a continuous, wearable mode, and both have shortcomings associated with mechanical transduction of signals through the skin. We report a soft, conformal class of device configured specifically for mechano-acoustic recording from the skin, capable of being used on nearly any part of the body, in forms that maximize detectable signals and allow for multimodal operation, such as electrophysiological recording. Experimental and computational studies highlight the key roles of low effective modulus and low areal mass density for effective operation in this type of measurement mode on the skin. Demonstrations involving seismocardiography and heart murmur detection in a series of cardiac patients illustrate utility in advanced clinical diagnostics. Monitoring of pump thrombosis in ventricular assist devices provides an example in characterization of mechanical implants. Speech recognition and human-machine interfaces represent additional demonstrated applications. These and other possibilities suggest broad-ranging uses for soft, skin-integrated digital technologies that can capture human body acoustics. PMID:28138529

Prevalence of mitral valve regurgitation in 79 asymptomatic Norfolk terriers.

PubMed

Bodegård-Westling, A; Tidholm, A; Häggström, J

2017-04-01

To determine the prevalence of mitral valve regurgitation (MR) in asymptomatic Swedish Norfolk terriers. Seventy-nine privately owned Norfolk terriers. A prospective observational study was conducted where dogs were recruited via the Swedish Norfolk terrier club. All dogs were examined using the same protocol including physical examination and Doppler echocardiography. Fifteen dogs (19%) had a murmur at the time of the examination. A total of 35 dogs (44%) had MR, including 23 dogs (29%) with both MR and tricuspid valve regurgitation and 12 dogs (15%) with MR only, identified on Doppler echocardiography. In addition, 7 dogs (9%) had tricuspid valve regurgitation only. The prevalence of MR increased with increasing age (p < 0.0001). Mitral valve regurgitation is common in asymptomatic Norfolk terriers with and without murmurs and the prevalence increases with age. The impact of MR in this breed on survival remains to be elucidated by a longitudinal study. Copyright © 2017 Elsevier B.V. All rights reserved.

Enteropathogenic Escherichia coli: foe or innocent bystander?

PubMed Central

Hu, Jia; Torres, Alfredo G.

2015-01-01

Enteropathogenic Escherichia coli (EPEC) remain one the most important pathogens infecting children and they are one of the main causes of persistent diarrhea worldwide. Historically, typical EPEC (tEPEC), defined as those isolates with the attaching and effacement (A/E) genotype (eae+), which possess bfpA+ and lack the stx- genes are found strongly associated with diarrheal cases. However, occurrence of atypical EPEC (aEPEC; eae+ bfpA- stx-) in diarrheal and asymptomatic hosts has made investigators question the role of these pathogens in human disease. Current epidemiological data is helping answering the question whether EPEC is mainly a foe or an innocent bystander during infection. PMID:25726041

Strategic Interviewing to Detect Deception: Cues to Deception across Repeated Interviews

PubMed Central

Masip, Jaume; Blandón-Gitlin, Iris; Martínez, Carmen; Herrero, Carmen; Ibabe, Izaskun

2016-01-01

Previous deception research on repeated interviews found that liars are not less consistent than truth tellers, presumably because liars use a “repeat strategy” to be consistent across interviews. The goal of this study was to design an interview procedure to overcome this strategy. Innocent participants (truth tellers) and guilty participants (liars) had to convince an interviewer that they had performed several innocent activities rather than committing a mock crime. The interview focused on the innocent activities (alibi), contained specific central and peripheral questions, and was repeated after 1 week without forewarning. Cognitive load was increased by asking participants to reply quickly. The liars’ answers in replying to both central and peripheral questions were significantly less accurate, less consistent, and more evasive than the truth tellers’ answers. Logistic regression analyses yielded classification rates ranging from around 70% (with consistency as the predictor variable), 85% (with evasive answers as the predictor variable), to over 90% (with an improved measure of consistency that incorporated evasive answers as the predictor variable, as well as with response accuracy as the predictor variable). These classification rates were higher than the interviewers’ accuracy rate (54%). PMID:27847493

Lineup composition, suspect position, and the sequential lineup advantage.

PubMed

Carlson, Curt A; Gronlund, Scott D; Clark, Steven E

2008-06-01

N. M. Steblay, J. Dysart, S. Fulero, and R. C. L. Lindsay (2001) argued that sequential lineups reduce the likelihood of mistaken eyewitness identification. Experiment 1 replicated the design of R. C. L. Lindsay and G. L. Wells (1985), the first study to show the sequential lineup advantage. However, the innocent suspect was chosen at a lower rate in the simultaneous lineup, and no sequential lineup advantage was found. This led the authors to hypothesize that protection from a sequential lineup might emerge only when an innocent suspect stands out from the other lineup members. In Experiment 2, participants viewed a simultaneous or sequential lineup with either the guilty suspect or 1 of 3 innocent suspects. Lineup fairness was varied to influence the degree to which a suspect stood out. A sequential lineup advantage was found only for the unfair lineups. Additional analyses of suspect position in the sequential lineups showed an increase in the diagnosticity of suspect identifications as the suspect was placed later in the sequential lineup. These results suggest that the sequential lineup advantage is dependent on lineup composition and suspect position. (c) 2008 APA, all rights reserved

The effect of exposure to multiple lineups on face identification accuracy.

PubMed

Hinz, T; Pezdek, K

2001-04-01

This study examines the conditions under which an intervening lineup affects identification accuracy on a subsequent lineup. One hundred and sixty adults observed a photograph of one target individual for 60 s. One week later, they viewed an intervening target-absent lineup and were asked to identify the target individual. Two days later, participants were shown one of three 6-person lineups that included a different photograph of the target face (present or absent), a foil face from the intervening lineup (present or absent), plus additional foil faces. The hit rate was higher when the foil face from the intervening lineup was absent from the test lineup and the false alarm rate was greater when the target face was absent from the test lineup. The results suggest that simply being exposed to an innocent suspect in an intervening lineup, whether that innocent suspect is identified by the witness or not, increases the probability of misidentifying the innocent suspect and decreases the probability of correctly identifying the true perpetrator in a subsequent test lineup. The implications of these findings both for police lineup procedures and for the interpretation of lineup results in the courtroom are discussed.

Memory Errors in Alibi Generation: How an Alibi Can Turn Against Us.

PubMed

Crozier, William E; Strange, Deryn; Loftus, Elizabeth F

2017-01-01

Alibis play a critical role in the criminal justice system. Yet research on the process of alibi generation and evaluation is still nascent. Indeed, similar to other widely investigated psychological phenomena in the legal system - such as false confessions, historical claims of abuse, and eyewitness memory - the basic assumptions underlying alibi generation and evaluation require closer empirical scrutiny. To date, the majority of alibi research investigates the social psychological aspects of the process. We argue that applying our understanding of basic human memory is critical to a complete understanding of the alibi process. Specifically, we challenge the use of alibi inconsistency as an indication of guilt by outlining the "cascading effects" that can put innocents at risk for conviction. We discuss how normal encoding and storage processes can pose problems at retrieval, particularly for innocent suspects that can result in alibi inconsistencies over time. Those inconsistencies are typically misunderstood as intentional deception, first by law enforcement, affecting the investigation, then by prosecutors affecting prosecution decisions, and finally by juries, ultimately affecting guilt judgments. Put differently, despite the universal nature of memory inconsistencies, a single error can produce a cascading effect, rendering an innocent individual's alibi, ironically, proof of guilt. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

The impact of fillers on lineup performance.

PubMed

Wetmore, Stacy A; McAdoo, Ryan M; Gronlund, Scott D; Neuschatz, Jeffrey S

2017-01-01

Filler siphoning theory posits that the presence of fillers (known innocents) in a lineup protects an innocent suspect from being chosen by siphoning choices away from that innocent suspect. This mechanism has been proposed as an explanation for why simultaneous lineups (viewing all lineup members at once) induces better performance than showups (one-person identification procedures). We implemented filler siphoning in a computational model (WITNESS, Clark, Applied Cognitive Psychology 17:629-654, 2003), and explored the impact of the number of fillers (lineup size) and filler quality on simultaneous and sequential lineups (viewing lineups members in sequence), and compared both to showups. In limited situations, we found that filler siphoning can produce a simultaneous lineup performance advantage, but one that is insufficient in magnitude to explain empirical data. However, the magnitude of the empirical simultaneous lineup advantage can be approximated once criterial variability is added to the model. But this modification works by negatively impacting showups rather than promoting more filler siphoning. In sequential lineups, fillers were found to harm performance. Filler siphoning fails to clarify the relationship between simultaneous lineups and sequential lineups or showups. By incorporating constructs like filler siphoning and criterial variability into a computational model, and trying to approximate empirical data, we can sort through explanations of eyewitness decision-making, a prerequisite for policy recommendations.

Electroreduction of CO 2 Catalyzed by a Heterogenized Zn–Porphyrin Complex with a Redox-Innocent Metal Center

DOE PAGES

Wu, Yueshen; Jiang, Jianbing; Weng, Zhe; ...

2017-07-26

Transition-metal-based molecular complexes are a class of catalyst materials for electrochemical CO 2 reduction to CO that can be rationally designed to deliver high catalytic performance. One common mechanistic feature of these electrocatalysts developed thus far is an electrogenerated reduced metal center associated with catalytic CO 2 reduction. Here in this paper, we report a heterogenized zinc–porphyrin complex (zinc(II) 5,10,15,20-tetramesitylporphyrin) as an electrocatalyst that delivers a turnover frequency as high as 14.4 site –1 s –1 and a Faradaic efficiency as high as 95% for CO 2 electroreduction to CO at -1.7 V vs the standard hydrogen electrode in anmore » organic/water mixed electrolyte. While the Zn center is critical to the observed catalysis, in situ and operando X-ray absorption spectroscopic studies reveal that it is redox-innocent throughout the potential range. Cyclic voltammetry indicates that the porphyrin ligand may act as a redox mediator. Chemical reduction of the zinc–porphyrin complex further confirms that the reduction is ligand-based and the reduced species can react with CO 2. This represents the first example of a transition-metal complex for CO 2 electroreduction catalysis with its metal center being redox-innocent under working conditions.« less

Electroreduction of CO2 Catalyzed by a Heterogenized Zn–Porphyrin Complex with a Redox-Innocent Metal Center

PubMed Central

2017-01-01

Transition-metal-based molecular complexes are a class of catalyst materials for electrochemical CO2 reduction to CO that can be rationally designed to deliver high catalytic performance. One common mechanistic feature of these electrocatalysts developed thus far is an electrogenerated reduced metal center associated with catalytic CO2 reduction. Here we report a heterogenized zinc–porphyrin complex (zinc(II) 5,10,15,20-tetramesitylporphyrin) as an electrocatalyst that delivers a turnover frequency as high as 14.4 site–1 s–1 and a Faradaic efficiency as high as 95% for CO2 electroreduction to CO at −1.7 V vs the standard hydrogen electrode in an organic/water mixed electrolyte. While the Zn center is critical to the observed catalysis, in situ and operando X-ray absorption spectroscopic studies reveal that it is redox-innocent throughout the potential range. Cyclic voltammetry indicates that the porphyrin ligand may act as a redox mediator. Chemical reduction of the zinc–porphyrin complex further confirms that the reduction is ligand-based and the reduced species can react with CO2. This represents the first example of a transition-metal complex for CO2 electroreduction catalysis with its metal center being redox-innocent under working conditions. PMID:28852698

Electroreduction of CO 2 Catalyzed by a Heterogenized Zn–Porphyrin Complex with a Redox-Innocent Metal Center

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Yueshen; Jiang, Jianbing; Weng, Zhe

Transition-metal-based molecular complexes are a class of catalyst materials for electrochemical CO 2 reduction to CO that can be rationally designed to deliver high catalytic performance. One common mechanistic feature of these electrocatalysts developed thus far is an electrogenerated reduced metal center associated with catalytic CO 2 reduction. Here in this paper, we report a heterogenized zinc–porphyrin complex (zinc(II) 5,10,15,20-tetramesitylporphyrin) as an electrocatalyst that delivers a turnover frequency as high as 14.4 site –1 s –1 and a Faradaic efficiency as high as 95% for CO 2 electroreduction to CO at -1.7 V vs the standard hydrogen electrode in anmore » organic/water mixed electrolyte. While the Zn center is critical to the observed catalysis, in situ and operando X-ray absorption spectroscopic studies reveal that it is redox-innocent throughout the potential range. Cyclic voltammetry indicates that the porphyrin ligand may act as a redox mediator. Chemical reduction of the zinc–porphyrin complex further confirms that the reduction is ligand-based and the reduced species can react with CO 2. This represents the first example of a transition-metal complex for CO 2 electroreduction catalysis with its metal center being redox-innocent under working conditions.« less

Electroreduction of CO 2 Catalyzed by a Heterogenized Zn–Porphyrin Complex with a Redox-Innocent Metal Center

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Yueshen; Jiang, Jianbing; Weng, Zhe

Transition-metal-based molecular complexes are a class of catalyst materials for electrochemical CO2 reduction to CO that can be rationally designed to deliver high catalytic performance. One common mechanistic feature of these electrocatalysts developed thus far is an electrogenerated reduced metal center associated with catalytic CO2 reduction. Here we report a heterogenized zinc–porphyrin complex (zinc(II) 5,10,15,20-tetramesitylporphyrin) as an electrocatalyst that delivers a turnover frequency as high as 14.4 site–1 s–1 and a Faradaic efficiency as high as 95% for CO2 electroreduction to CO at -1.7 V vs the standard hydrogen electrode in an organic/water mixed electrolyte. While the Zn center ismore » critical to the observed catalysis, in situ and operando X-ray absorption spectroscopic studies reveal that it is redox-innocent throughout the potential range. Cyclic voltammetry indicates that the porphyrin ligand may act as a redox mediator. Chemical reduction of the zinc–porphyrin complex further confirms that the reduction is ligand-based and the reduced species can react with CO2. This represents the first example of a transition-metal complex for CO2 electroreduction catalysis with its metal center being redox-innocent under working conditions.« less

Outcomes of borderline rheumatic heart disease: A prospective cohort study.

PubMed

Bertaina, Geneviève; Rouchon, Bernard; Huon, Bertrand; Guillot, Nina; Robillard, Corinne; Noël, Baptiste; Nadra, Marie; Tribouilloy, Christophe; Marijon, Eloi; Jouven, Xavier; Mirabel, Mariana

2017-02-01

The advent of systematic screening for rheumatic heart disease (RHD) by echocardiography in endemic regions has led to a new entity: borderline RHD. The pathogenicity and natural history of borderline RHD needs to be addressed. The aim of this study was to assess the outcomes of children detected by echocardiography as having borderline RHD. Schoolchildren in 4th grade (i.e., aged 9-10years) who were prospectively echo-screened for RHD (2012-2014) in Nouméa, New Caledonia, were asked to participate. Children with borderline RHD according to consistent independent review by two cardiologists were included and followed-up in 2015. Among the 8684 schoolchildren screened, 49 were diagnosed with borderline RHD according to the Cardiologist clinically involved in the child's management plan. After independent review by two cardiologists, 25 children were consistently diagnosed with borderline RHD and included in the follow-up study. Overall, inter-observer agreement was moderate with diagnostic kappa values of 0.63 (95% CI 0.45-0.78). After a median follow-up of 23months (IQR (20.5-33.0), 15 children (60.0%) had stability of valvular lesions, 8 (32.0%) had normal findings according to the WHF criteria. Two children (8.0%) had definite RHD on the follow-up echocardiogram, but no clinical events or audible pathological murmur during the study period. No factor could be identified as prognostic of either stability or progression. Borderline RHD diagnosed by systematic screening in high-risk populations remains mostly unchanged at 2years follow-up. Diagnosis of borderline RHD may require two reviewers for consistency. Copyright © 2016. Published by Elsevier Ireland Ltd.

Thyrotoxic Valvulopathy: Case Report and Review of the Literature

PubMed Central

Pierre, Keniel; Gadde, Sushee; Omar, Bassam; Awan, G. Mustafa; Malozzi, Christopher

2017-01-01

We report a 42-year-old female who was admitted for abdominal pain, and also endorsed dyspnea, fatigue and chronic palpitations. Past medical history included asthma, patent ductus arteriosus repaired in childhood and ill-defined thyroid disease. Physical examination revealed blood pressure of 136/88 mm Hg and heart rate of 149 beats per minute. Cardiovascular exam revealed an irregularly irregular rhythm, and pulmonary exam revealed mild expiratory wheezing. Abdomen was tender. Electrocardiogram revealed atrial fibrillation with rapid ventricular response which responded to intravenous diltiazem. Labs revealed TSH of < 0.1 mU/L and free T4 of 2.82 ng/dL, a positive TSH-receptor and thyroid peroxidase antibodies suggesting Grave’s thyrotoxicosis. A transthoracic echocardiogram reported an ejection fraction of 55-60%, with mild to moderate mitral regurgitation (MR) and moderate to severe tricuspid regurgitation (TR) and dilated right heart chambers. Pulmonary artery systolic pressure was 52 mm Hg. Transesophageal echocardiogram revealed a myxomatous tricuspid valve with thickening and malcoaptation of the leaflets and moderate to severe TR, mild to moderate MR with mild thickening of the mitral valve leaflets. Abdominal ultrasound revealed wall thickening of the gall bladder concerning for acute cholecystitis. She underwent laparoscopic cholecystectomy and was discharged in stable condition on methimazole for her thyroid disease, and on oral diltiazem for rate control and anticoagulation for atrial fibrillation. Follow-up visit with her cardiologist few months later documented absence of cardiac symptoms, and no murmurs were reported on physical examination. This case underscores the importance of maintaining a high index of suspicion for hyperthyroidism when faced with significant newly diagnosed pulmonary hypertension and TR, as treatment of the thyroid abnormalities can reverse these cardiac findings. PMID:28725332

Clinical and anatomical observations of a two-headed lamb.

PubMed

Fisher, K R; Partlow, G D; Walker, A F

1986-04-01

The clinical and anatomical features of a live-born diprosopic lamb are described. There are no complete anatomical analyses of two-faced lambs in the literature despite the frequency of conjoined twinning in sheep. The lamb had two heads fused in the occipital region. Each head had two eyes. The pinnae of the medial ears were fused. Caudal to the neck the lamb appeared grossly normal. The lamb was unable to raise its heads or stand. Both heads showed synchronous sucking motions and cranial reflexes were present. Nystagmus, strabismus, and limb incoordination were present. The respiratory and heart rates were elevated. There was a grade IV murmur over the left heart base and a palpable thrill on the left side. Each head possessed a normal nasopharynx, oropharynx, and tongue. There was a singular laryngopharnyx and esophagus although the hyoid apparatus was partially duplicated. The cranial and cervical musculature reflected the head duplications. The aortic trunk emerged from the right ventricle just to the right of the conus arteriosus. A ventricular septal defect, patent foramen ovale, and ductus arteriosus were present along with malformed atrioventricular valves. Brainstem fusion began at the cranial medulla oblongata between cranial nerves IX and XII. The cerebella were separate but small. The ventromedial structures from each medulla oblongata were compressed into an extraneous midline remnant of tissue which extended caudally to the level of T2. The clinical signs therefore reflected the anatomical anomalies. A possible etiology for this diprosopus might be the presence early in development of an excessively large block of chordamesoderm. This would allow for the formation of two head folds and hence two "heads."

Cardiac evaluation of clinically healthy captive maned wolves (Chrysocyon brachyurus).

PubMed

Estrada, Amara H; Gerlach, Trevor J; Schmidt, Mandi K; Siegal-Willott, Jessica L; Atkins, Adrienne L; Van Gilder, James; Citino, Scott B; Padilla, Luis R

2009-09-01

The objective of this project was to determine radiographic vertebral heart sizes and electrocardiographic (ECG) and echocardiographic measurements in healthy anesthetized maned wolves (Chrysocyon brachyurus). The wolves, housed at the White Oak Conservation and Smithsonian National Zoo Conservation and Research Centers, were being anesthetized for annual examinations. Cardiac auscultation, thoracic radiographs, a standard 6-lead ECG, and echocardiography were performed on the wolves while they were under general anesthesia. Thirteen maned wolves were evaluated: five males and eight females. Mean age was 6.4 +/- 4.4 years (range, 2-13 years). Mean weight was 26 +/- 2.95 kg (range, 22-32 kg). Low-grade systolic murmurs were auscultated in three of 13 maned wolves. Evaluation of ECGs revealed a sinus rhythm, with a QRS morphology, and mean electrical axis similar to domestic canines. Radiographic evaluation revealed a mean vertebral heart size of 8.27 +/- 0.48 (range, 7.9-8.6). In addition, the cardiac silhouette was seen to elongate, with an increase in sternal contact in older wolves. Echocardiography showed that mitral valve degenerative changes and insufficiency is likely common in older wolves. Visualization of physiologic regurgitation across the mitral and pulmonary valves was common in wolves of all ages. Left ventricular measurements were similar to those reported for healthy dogs, and several variables correlated well with body weight. Two wolves were found to have one to three heartworms in the right pulmonary artery, and degenerative mitral valve disease was determined in maned wolves older than 6 years of age. All of the wolves in this study were on heartworm preventative and tested negative for heartworm antigen at their annual examinations. The results of this study provide reference information for use in the cardiac evaluation of anesthetized maned wolves.

Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report.

PubMed

Pallangyo, Pedro; Lyimo, Frederick; Bhalia, Smita; Makungu, Hilda; Nyangasa, Bashir; Lwakatare, Flora; Suranyi, Pal; Janabi, Mohamed

2017-07-19

Pulmonary artery aneurysms constitute <1% of aneurysms occurring in the thoracic cavity. Congenital cardiac defects are responsible for the majority (>50%) of cases, however, pulmonary artery aneurysm is a rare sequelae of pulmonary tuberculosis reported in about 5% of patients with chronic cavitary tuberculosis on autopsy. The natural history of this potentially fatal condition remains poorly understood and guidelines for optimal management are controversial. A 24-year-old man, a nursing student of African descent, was referred to us from an up-country regional hospital with a 4-week history of recurrent episodes of breathlessness, awareness of heartbeats and coughing blood 3 weeks after completing a 6-month course of anti-tuberculosis drugs. A physical examination revealed conjuctival and palmar pallor but there were no stigmata of connective tissue disorders, systemic vasculitides or congenital heart disease. An examination of the cardiovascular system revealed accentuated second heart sound (S 2 ) with early diastolic (grade 1/6) and holosystolic (grade 2/6) murmurs at the pulmonic and tricuspid areas respectively. Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia. A chest radiograph revealed bilateral ovoid-shaped perihilar opacities while a computed tomography scan showed bilateral multiple pulmonary artery pseudoaneurysms with surrounding hematoma together with adjacent cystic changes, consolidations, and tree-in-bud appearance. Our patient refused to undergo surgery and died of aneurismal rupture after 9 days of hospitalization. The presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm. Furthermore, despite of its rarity, early recognition and timely surgical intervention of pulmonary artery aneurysm is crucial to reducing morbidity and preventing the attributed mortality.

[Clinical and genetic study of an infant with Alagille syndrome: identification of a novel chromosomal interstitial deletion including JAG1 gene].

PubMed

Li, Hua; Liu, Jia-Jia; Deng, Mei; Guo, Li; Cheng, Ying; Song, Yuan-Zong

2017-10-01

Alagille syndrome (ALGS) is an autosomal dominant disease affecting multiple systems including the liver, heart, skeleton, eyes, kidneys and face. This paper reports the clinical and genetic features of an infant with this disease. A 3-month-and-10-day-old female infant was referred to the hospital with jaundiced skin and sclera for 3 months. Physical examination revealed wide forehead and micromandible. A systolic murmur of grade 3-4/6 was heard between the 2th and 3th intercostal spaces on the left side of the sternum. The abdomen was distended, and the liver palpable 3 cm under the right subcostal margin with a medium texture. Serum biochemistry analysis revealed abnormal liver function indices, with markedly elevated bilirubin (predominantly direct bilirubin), total bile acids (TBA) and gamma-glutamyl transpeptidase (GGT). Atrial septal defect and pulmonary stenosis were detected on echocardiography. Next generation sequencing detected entire deletion of the JAG1 gene, and then chromosomal microarray analysis revealed a novel interstitial deletion of 3.0 Mb in size on chr20p12.3p12.2, involving JAG1 gene. The child had special facial features, heart malformations, and cholestasis, and based on the genetic findings, ALGS was definitively diagnosed. Thereafter, symptomatic and supportive treatment was introduced. Thus far, the infant had been followed up till his age of 11 months. The hyperbilirubinemia got improved, but GGT and TBA were persistently elevated, and the long-term outcome needs to be observed. This study extended the JAG1 mutation spectrum, and provided laboratory evidences for the diagnosis and treatment of the patient, and for the genetic counseling and prenatal diagnosis in the family.

[Patent ductus arteriosus in the dog: a retrospective study of clinical presentation, diagnostics and comparison of interventional techniques in 102 dogs (2003-2011)].

PubMed

Meijer, M; Beijerink, N J

2012-06-01

A left-to-right shunting patent ductus arteriosus (PDA) is a common congenital heart defect in dogs. If it is left uncorrected, life expectancy in most cases is decreased due to the development of left-sided congestive heart failure. The aim of this study was to describe the dogs diagnosed with PDA in the Utrecht University Companion Animal Clinic from 2003 to 2011. The medical records of 102 patients were retrieved, and the clinical presentation and outcome of PDA closure by surgical ligation or transarterial catheter occlusion (TCO) were reviewed. In the TCO group, the result of coiling was compared with the placement of an Amplatz Canine Duct Occluder (ACDO). A predisposition to PDA was found in the German Brak, Stabyhoun, and Schapendoes. Dogs treated with surgical ligation were significantly older and heavier than those treated with TCO; within the TCO group, dogs treated with ACDO were significantly older and heavier The initial success rate (complete disappearance of the audible murmur in a patient that survived the procedure) was not significantly different between the different treatment modalities. Major complications were more common with surgical ligation, but the incidence of minor complications was not significantly different. There was no diference in survival between dogs treated with surgical ligation and dogs treated with TCO. This study shows a previously unreported predisposition to PDA in certain breeds. Both surgical ligation and TCO are suitable techniques for PDA closure, although major complications were more common with surgical ligation. ACDO appears to be the method with the least complications and thus can be considered the safest method.

The effects of smoothies on enamel erosion: an in situ study.

PubMed

Ali, Hanein; Tahmassebi, Jinous F

2014-05-01

To measure, in vitro, the pH and titratable acidity (TA) of various soft drinks and to assess the erosive effect of smoothies using an in situ model. The in vitro phase of this study included measuring the inherent pH of six different commercially available smoothies, diet coke, and citric acid 0.3% (positive control) using a pH meter. The TA was determined by titration with NaOH. In the second part of the study, an in situ model was used. An upper removable appliance capable of retaining two enamel slabs was constructed and worn by 14 volunteers. The drinks under test were Innocent(®) strawberries and banana smoothie and citric acid. Volunteers were instructed to dip the appliance in the test solutions extra-orally five times daily for 2 min each time for 21 days. Measurements of enamel loss were made by surface profilometry and microhardness. Diet Coke was found to be the most acidic drink (pH 2.61), whereas Innocent(®) mangoes and passion fruit smoothie showed to be the least (pH 3.9). With regard to TA, Innocent(®) blackberries, strawberries, and blackcurrant smoothie had the highest TA requiring 10.8 mol of NaOH to reach pH 7.0, whereas citric acid required only 3.1 mol of NaOH to reach the same pH value. Surface profilometry and microhardness testing revealed that citric acid caused a statistically significantly greater tooth surface loss compared with smoothie after 21-day pH cycling protocol. Smoothies are acidic and have high TA levels. Innocent(®) strawberries and banana smoothie had an erosive potential to the teeth. However, its erosive effect was significantly less compared with citric acid after 21-day pH cycling protocol using an in situ model. © 2013 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

From a Roar to a Murmur: Virginia's History & Social Science Standards, 1995-2009

ERIC Educational Resources Information Center

van Hover, Stephanie; Hicks, David; Stoddard, Jeremy; Lisanti, Melissa

2010-01-01

The authors trace the development and implementation of Virginia's History and Social Science standards-based accountability system from 1995 to 2009. They frame the study within an examination of the political ideologies that influence policy realization and unpack the relationship between ideological and epistemological beliefs about the nature…

Double-blind photo lineups using actual eyewitnesses: an experimental test of a sequential versus simultaneous lineup procedure.

PubMed

Wells, Gary L; Steblay, Nancy K; Dysart, Jennifer E

2015-02-01

Eyewitnesses (494) to actual crimes in 4 police jurisdictions were randomly assigned to view simultaneous or sequential photo lineups using laptop computers and double-blind administration. The sequential procedure used in the field experiment mimicked how it is conducted in actual practice (e.g., using a continuation rule, witness does not know how many photos are to be viewed, witnesses resolve any multiple identifications), which is not how most lab experiments have tested the sequential lineup. No significant differences emerged in rates of identifying lineup suspects (25% overall) but the sequential procedure produced a significantly lower rate (11%) of identifying known-innocent lineup fillers than did the simultaneous procedure (18%). The simultaneous/sequential pattern did not significantly interact with estimator variables and no lineup-position effects were observed for either the simultaneous or sequential procedures. Rates of nonidentification were not significantly different for simultaneous and sequential but nonidentifiers from the sequential procedure were more likely to use the "not sure" response option than were nonidentifiers from the simultaneous procedure. Among witnesses who made an identification, 36% (41% of simultaneous and 32% of sequential) identified a known-innocent filler rather than a suspect, indicating that eyewitness performance overall was very poor. The results suggest that the sequential procedure that is used in the field reduces the identification of known-innocent fillers, but the differences are relatively small.

Responsibility, guilt, and decision under risk.

PubMed

Mancini, Francesco; Gangemi, Amelia

2003-12-01

We hypothesize that individuals' choices (risk-seeking/risk-aversion) depend on moral values and, in particular, on how subjects evaluate themselves as guilty or as victims of a wrong rather than on the descriptions of the outcomes as given in the options and evaluated accordingly as gains or losses (framing effect). People who evaluate themselves as victims are expected to show a risk-seeking preference (context of innocence). People who evaluate themselves as guilty are expected to show a risk-averse preference (context of guilt). Responses of 232 participants to a decision problem were compared in four different conditions involving two-story formats (innocence/guilt) and two-question-options formats (gain/loss). Regardless of the format of the question options, the story format appears to be an important determinant of individuals' preferences.

Stop Punishing Innocent Taxpayers Act

THOMAS, 113th Congress

Rep. Buchanan, Vern [R-FL-16

2014-04-28

House - 06/09/2014 Referred to the Subcommittee on Regulatory Reform, Commercial And Antitrust Law. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

31 CFR 101.8 - Discretion of the Secretary.

Code of Federal Regulations, 2010 CFR

2010-07-01

... FORFEITURE OF COUNTERFEIT GOLD COINS § 101.8 Discretion of the Secretary. The Secretary of the Treasury... not convinced that the petitoner was an innocent purchaser or holder without knowledge that the gold...

Announcements

NASA Astrophysics Data System (ADS)

1997-10-01

NSF-Course and Curriculum Development Program Call for Award Nominations Gordon Conference- Innocations in College Chemistry Teaching Summer Opportunity for Students High School Chemistry Day ACS Satellite TV Seminars Wanted - Newletter Editor ACS Abstract Deadline Call for Award Nominations

43 CFR 9239.6-1 - Turpentine.

Code of Federal Regulations, 2011 CFR

2011-10-01

... will be as follows: (a) Innocent trespass. Value of the gum and injury done to the trees. United States v. Taylor (35 Fed. 484). (b) Willful trespass. Value of the product manufactured from the crude...

43 CFR 9239.6-1 - Turpentine.

Code of Federal Regulations, 2014 CFR

2014-10-01

... will be as follows: (a) Innocent trespass. Value of the gum and injury done to the trees. United States v. Taylor (35 Fed. 484). (b) Willful trespass. Value of the product manufactured from the crude...

43 CFR 9239.6-1 - Turpentine.

Code of Federal Regulations, 2012 CFR

2012-10-01

... will be as follows: (a) Innocent trespass. Value of the gum and injury done to the trees. United States v. Taylor (35 Fed. 484). (b) Willful trespass. Value of the product manufactured from the crude...

43 CFR 9239.6-1 - Turpentine.

Code of Federal Regulations, 2013 CFR

2013-10-01

... will be as follows: (a) Innocent trespass. Value of the gum and injury done to the trees. United States v. Taylor (35 Fed. 484). (b) Willful trespass. Value of the product manufactured from the crude...

Fetal microchimeric cells in autoimmune thyroid diseases: harmful, beneficial or innocent for the thyroid gland?

PubMed

Lepez, Trees; Vandewoestyne, Mado; Deforce, Dieter

2013-01-01

Autoimmune thyroid diseases (AITD) show a female predominance, with an increased incidence in the years following parturition. Fetal microchimerism has been suggested to play a role in the pathogenesis of AITD. However, only the presence of fetal microchimeric cells in blood and in the thyroid gland of these patients has been proven, but not an actual active role in AITD. Is fetal microchimerism harmful for the thyroid gland by initiating a Graft versus Host reaction (GvHR) or being the target of a Host versus Graft reaction (HvGR)? Is fetal microchimerism beneficial for the thyroid gland by being a part of tissue repair or are fetal cells just innocent bystanders in the process of autoimmunity? This review explores every hypothesis concerning the role of fetal microchimerism in AITD.

Investigating true and false confessions within a novel experimental paradigm.

PubMed

Russano, Melissa B; Meissner, Christian A; Narchet, Fadia M; Kassin, Saul M

2005-06-01

The primary goal of the current study was to develop a novel experimental paradigm with which to study the influence of psychologically based interrogation techniques on the likelihood of true and false confessions. The paradigm involves guilty and innocent participants being accused of intentionally breaking an experimental rule, or "cheating." In the first demonstration of this paradigm, we explored the influence of two common police interrogation tactics: minimization and an explicit offer of leniency, or a "deal." Results indicated that guilty persons were more likely to confess than innocent persons, and that the use of minimization and the offer of a deal increased the rate of both true and false confessions. Police investigators are encouraged to avoid interrogation techniques that imply or directly promise leniency, as they appear to reduce the diagnostic value of any confession that is elicited.

Scalable interrogation: Eliciting human pheromone responses to deception in a security interview setting.

PubMed

Stedmon, Alex W; Eachus, Peter; Baillie, Les; Tallis, Huw; Donkor, Richard; Edlin-White, Robert; Bracewell, Robert

2015-03-01

Individuals trying to conceal knowledge from interrogators are likely to experience raised levels of stress that can manifest itself across biological, physiological, psychological and behavioural factors, providing an opportunity for detection. Using established research paradigms an innovative scalable interrogation was designed in which participants were given a 'token' that represented information they had to conceal from interviewers. A control group did not receive a token and therefore did not have to deceive the investigators. The aim of this investigation was to examine differences between deceivers and truth-tellers across the four factors by collecting data for cortisol levels, sweat samples, heart-rate, respiration, skin temperature, subjective stress ratings and video and audio recordings. The results provided an integrated understanding of responses to interrogation by those actively concealing information and those acting innocently. Of particular importance, the results also suggest, for the first time in an interrogation setting, that stressed individuals may secrete a volatile steroid based marker that could be used for stand-off detection. The findings are discussed in relation to developing a scalable interrogation protocol for future research in this area. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

10. Elevation of iconostas at Chapel of St. Sergius of ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

10. Elevation of iconostas at Chapel of St. Sergius of Radonezh; Elevation of iconostas at Chapel of St. Innocent of Irkutsk - Holy Ascension Russian Orthodox Church, Unalaska Island, Unalaska, Aleutian Islands, AK

29 CFR 417.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... a reasonable time following such hearing, a decision is reached as to the guilt or innocence of the... organization whose interests are or may be affected by a proceeding. (f) Court means the district court of the...

Transformations in Mid-Life.

ERIC Educational Resources Information Center

Gould, Roger L.

1979-01-01

Between the ages of thirty-five and fifty, adults become engrossed in questioning the meaning of work, marriage, and life itself. In the process, they must confront long-held false beliefs in their own immortality, safety, and innocence. (Author)

30 CFR 281.47 - Cancellation of leases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... cause serious harm or damage to life (including fish and other aquatic life), to property, to any... partners to exercise due diligence, the innocent parties shall have the right to seek damages for such loss...

30 CFR 282.15 - Cancellation of leases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... lease would probably cause serious harm or damage to life (including fish and other aquatic life), to... due to the failure of one or more partners to exercise due diligence, the innocent parties shall have...

12 CFR 622.82 - Decision of the Board.

Code of Federal Regulations, 2010 CFR

2010-01-01

... representative. (c) Guilt not an issue. In deciding upon any suspension of prohibition by notice, the ultimate question of the guilt or innocence of the individual with respect to the criminal charge that is...

The paediatrician and cardiac auscultation

PubMed Central

Roy, Douglas L

2003-01-01

The cardiac auscultation (CA) skills of paediatric residents and office-based paediatricians have recently been shown to be suboptimal. CA is known to have a high degree of specificity and sensitivity, and is inexpensive. New teaching aids and availability of surrogate patient heart sounds and murmurs now allow most physicians to acquire CA skills. These teaching aids should be available in all medical schools and in all postgraduate paediatric training programs. While the relationship between musicality and CA skill has not been proven, the author assumes this relationship to be valid. Specific learning objectives in CA should be established. Recognizing that the current trend is away from clinical examinations, students frequently are unaware that a CA learning deficit exists. Therefore, students’ CA skills should be evaluated before medical school graduation and at the Royal College of Physicians and Surgeons specialty examination. Students with amusia (inability to distinguish pitch of sound) should be identified and consideration should be given to directing them away from a clinical specialty in which CA is important. Further study is required in the physiology of learning of CA. Appropriate action by medical school and paediatric postgraduate program directors and the Royal College will effect a higher standard of patient care by increasing CA skills, resulting in a more financially efficient system – something everyone is trying to achieve in these times of increasing medical care costs. PMID:20019823

Audit of cardiac pathology detection using a criteria-based perioperative echocardiography service.

PubMed

Faris, J G; Hartley, K; Fuller, C M; Langston, R B; Royse, C F; Veltman, M G

2012-07-01

Transthoracic echocardiography is often used to screen patients prior to non-cardiac surgery to detect conditions associated with perioperative haemodynamic compromise and to stratify risk. However, anaesthetists' use of echocardiography is quite variable. A consortium led by the American College of Cardiology Foundation has developed appropriate use criteria for echocardiography. At Joondalup Hospital in Western Australia, we have used these criteria to order echocardiographic studies in patients attending our anaesthetic pre-admission clinic. We undertook this audit to determine the incidence of significant echocardiographic findings using this approach. In a 22-month period, 606 transthoracic echocardiographic studies were performed. This represented 8.7% of clinic attendees and 1.7% of all surgical patients. In about two-thirds of the patients, the indication for echocardiography was identified on the basis of a telephone screening questionnaire. The most common indications were poor exercise tolerance (27.4%), ischaemic heart disease (20.9%) and cardiac murmurs (16.3%). Over 26% of patients studied had significant cardiac pathology (i.e. moderate or severe echocardiographic findings), most importantly moderate or severe aortic stenosis (8.6%), poor left ventricular function (7.1%), a regional wall motion abnormality (4.3%) or moderate or severe mitral regurgitation (4.1%). Using appropriate use criteria to guide ordering transthoracic echocardiography studies led to a high detection rate of clinically important cardiac pathology in our perioperative service.

Trastuzumab (Herceptin)-associated cardiomyopathy presented as new onset of complete left bundle-branch block mimicking acute coronary syndrome: a case report and literature review.

PubMed

Tu, Chung-Ming; Chu, Kai-Ming; Yang, Shin-Ping; Cheng, Shu-Mung; Wang, Wen-Been

2009-09-01

Trastuzumab (Herceptin) is well documented in reducing suffering and mortality from breast cancer. The clinically most important side effect of Herceptin is cardiotoxicity, which is reported in 2.6% to 4.5% of patients receiving trastuzumab alone and in as many as 27% of patients when trastuzumab is combined with an anthracycline in metastatic disease. We reported the case of a 50-year-old woman who presented to our emergency department (ED) because of chest pain and shortness of breath. On physical examination, holosystolic murmur over apex could be heard. Pulmonary and abdominal examinations were unremarkable. Twelve-lead electrocardiography showed sinus tachycardia and new onset of complete left bundle-branch block. Emergent transthoracic echocardiography revealed generalized hypokinesia of left ventricle and akinesia over interventricular septum and apex. She subsequently underwent immediate coronary angiography that revealed normal coronary angiography, and left ventriculogram revealed generalized hypokinesia with severe left ventricle dysfunction with ejection fraction of 33%. During right heart catheterization and endomyocardial biopsy, cardiac tamponade developed and was successfully relieved by pericardial window. She was discharged event-free 3 weeks later with conservative treatment. Although new onset of complete left bundle-branch block in a patient with chest pain may be acute coronary syndrome, careful review of medicine history is mandatory to avoid unnecessary procedure and complications.

Remainder Wheels and Group Theory

ERIC Educational Resources Information Center

Brenton, Lawrence

2008-01-01

Why should prospective elementary and high school teachers study group theory in college? This paper examines applications of abstract algebra to the familiar algorithm for converting fractions to repeating decimals, revealing ideas of surprising substance beneath an innocent facade.

"Typical Clinton: brazen it out".

PubMed

Upchurch, C M; O'Connell, D C

2000-07-01

Ten excerpts of both President Clinton's Grand Jury Testimony of August 17, 1998 and of each of two interviews with Hillary Rodham Clinton (Today Show, January 27, 1998; Good Morning America, January 28, 1998) were analyzed. In all of them, the topic under discussion was the President's insistence on his innocence in the Lewinsky case. Comparisons between the President and First Lady revealed long and short within-speaker pauses, respectively. His replies to questions average more than twice the length of hers. Comparisons were also made with other speech genres, including modern presidential inaugural rhetoric. In particular, President Clinton's statement of his innocence at the conclusion of an educational press conference on January 26, 1998 and his prepared statement at the beginning of his Grand Jury Testimony were found to vary notably from all the other corpora. Both are characterized by several of Ekman's (1985, p. 286) behavioral cues for the detection of deception.

The Non-innocent Phenalenyl Unit: An Electronic Nest to Modulate the Catalytic Activity in Hydroamination Reaction

PubMed Central

Mukherjee, Arup; Sen, Tamal K.; Ghorai, Pradip Kr; Mandal, Swadhin K.

2013-01-01

The phenalenyl unit has played intriguing role in different fields of research spanning from chemistry, material chemistry to device physics acting as key electronic reservoir which has not only led to the best organic single component conductor but also created the spin memory device of next generation. Now we show the non-innocent behaviour of phenalenyl unit in modulating the catalytic behaviour in a homogeneous organic transformation. The present study establishes that the cationic state of phenalenyl unit can act as an organic Lewis acceptor unit to influence the catalytic outcome of intermolecular hydroamination reaction of carbodiimides. For the present study, we utilized organoaluminum complexes of phenalenyl ligands in which the phenalenyl unit maintains the closed shell electronic state. The DFT calculation reveals that the energy of LUMO of the catalyst is mainly controlled by phenalenyl ligands which in turn determines the outcome of the catalysis. PMID:24084653

Biliary stricture due to neuroma after an innocent blunt abdominal trauma.

PubMed

Katsinelos, P; Dimiropoulos, S; Galanis, I; Tsolkas, P; Paroutoglu, G; Arvaniti, M; Katsiba, D; Baltaglannis, S; Pilpilidis, I; Papagiannis, A; Vaslliadis, I

2002-10-01

A traumatic neuroma of the biliary tract is rarely associated with biliary obstruction. However, when it arises in the common bile duct (CBD) and is associated with obstructive jaundice, it is difficult to distinguish it from bile duct cancer. We describe a patient who developed obstructive jaundice and itching, due to CBD stricture, 8 years after innocent blunt abdominal trauma. The stricture was resected and hepatico-jejunal anastomosis was performed. Histological examination revealed a traumatic neuroma and a fibrous scar around the common bile duct. Symptoms disappeared following surgical removal of the lesion. Blunt abdominal injury may cause the late onset of a fibrous scar and traumatic neuroma in the common bile duct. To our knowledge, a traumatic neuroma of the biliary tract after blunt abdominal trauma has not been reported previously. We review the clinical picture of this relatively rare problem, along with its diagnosis, pathogenesis and treatment.

Diagnosis, imaging and clinical management of aortic coarctation.

PubMed

Dijkema, Elles J; Leiner, Tim; Grotenhuis, Heynric B

2017-08-01

Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Despite echocardiographic screening, prenatal diagnosis of C o A remains difficult. Most patients with CoA present in infancy with absent, delayed or reduced femoral pulses, a supine arm-leg blood pressure gradient (> 20 mm Hg), or a murmur due to rapid blood flow across the CoA or associated lesions (BAV). Transthoracic echocardiography is the primary imaging modality for suspected CoA. However, cardiac magnetic resonance imaging is the preferred advanced imaging modality for non-invasive diagnosis and follow-up of CoA. Adequate and timely diagnosis of CoA is crucial for good prognosis, as early treatment is associated with lower risks of long-term morbidity and mortality. Numerous surgical and transcatheter treatment strategies have been reported for CoA. Surgical resection is the treatment of choice in neonates, infants and young children. In older children (> 25 kg) and adults, transcatheter treatment is the treatment of choice. In the current era, patients with CoA continue to have a reduced life expectancy and an increased risk of cardiovascular sequelae later in life, despite adequate relief of the aortic stenosis. Intensive and adequate follow-up of the left ventricular function, valvular function, blood pressure and the anatomy of the heart and the aorta are , therefore, critical in the management of CoA. This review provides an overview of the current state-of-the-art clinical diagnosis, diagnostic imaging algori thms, treatment and follow-up of patients with CoA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Large left circumflex coronary artery with a fistula to superior vena cava: Diagnosis by echocardiography.

PubMed

Liu, Yunqi; Liu, Yanqiu; Xiong, Mai; Li, Hanzhao; Liu, Donghong; Zhang, Xi

2017-04-01

The left circumflex coronary artery associated with a fistula to superior vena cava is a rare entity. We describe a 7-year-old girl who presented with a cardiac murmur and was diagnosed with a coronary artery fistula between the left circumflex artery and superior vena cava by echocardiography. The surgical occlusion of the fistula was successful. © 2017, Wiley Periodicals, Inc.

Verification of intravenous catheter placement by auscultation--a simple, noninvasive technique.

PubMed

Lehavi, Amit; Rudich, Utay; Schechtman, Moshe; Katz, Yeshayahu Shai

2014-01-01

Verification of proper placement of an intravenous catheter may not always be simple. We evaluated the auscultation technique for this purpose. Twenty healthy volunteers were randomized for 18G catheter inserted intravenously either in the right (12) or left arm (8), and subcutaneously in the opposite arm. A standard stethoscope was placed over an area approximately 3 cm proximal to the tip of the catheter in the presumed direction of the vein to grade on a 0-6 scale the murmur heard by rapidly injecting 2 mL of NaCl 0.9% solution. The auscultation was evaluated by a blinded staff anesthesiologist. All 20 intravenous injection were evaluated as flow murmurs, and were graded an average 5.65 (±0.98), whereas all 20 subcutaneous injections were evaluated as either crackles or no sound, and were graded an average 2.00 (±1.38), without negative results. Sensitivity was calculated as 95%. Specificity and Kappa could not be calculated due to an empty false-positive group. Being simple, handy and noninvasive, we recommend to use the auscultation technique for verification of the proper placement of an intravenous catheter when uncertain of its position. Data obtained in our limited sample of healthy subjects need to be confirmed in the clinical setting.

33 CFR 137.80 - Commonly known or reasonably ascertainable information about the facility and the real property...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 137.80 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.80...

33 CFR 137.80 - Commonly known or reasonably ascertainable information about the facility and the real property...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 137.80 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.80...

33 CFR 137.80 - Commonly known or reasonably ascertainable information about the facility and the real property...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 137.80 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.80...

33 CFR 137.80 - Commonly known or reasonably ascertainable information about the facility and the real property...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 137.80 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.80...

33 CFR 137.80 - Commonly known or reasonably ascertainable information about the facility and the real property...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 137.80 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.80...

The Almanac.

ERIC Educational Resources Information Center

Cole, Robert A.

1983-01-01

Modern revolutions, in all of their historical varieties and doctrines, perplex many of us. In the hopes of providing some elements for profitable reflection, 23 quotes from famous sources are provided. For example; "Every act of rebelling expresses a nostalgia for innocence" (Albert Camus). (NW)

Hiding Crimes in Cyberspace (PREPRINT)

DTIC Science & Technology

1999-07-01

enforcement agencies have encountered encrypted e-mail and files in investigations of pedophiles and child pornography, including the FBI’s Innocent Images...for sexually assaulting minors and distributing child pornography (Akdeniz). The priest was part of an international pedophile ring that

75 FR 20893 - National Day of Service and Remembrance for Victims and Survivors of Terrorism, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-21

... Nation, and the human spirit. Terrorists prey on the innocent and vulnerable, and have nothing to offer..., and acts of community service in memory of the victims and survivors of terrorism worldwide. IN...

Sexuality

ERIC Educational Resources Information Center

Matthews, Corinne

2018-01-01

Sexuality is both everywhere and nowhere in children's literature since it collides with an ideology of childhood innocence that works to erase childhood sexuality altogether. Debates about identity, self-expression, the boundary between childhood and adulthood--and attempts to police that boundary--often center on sexuality. Anxiety around…

Utility of the Physical Examination in Detecting Pulmonary Hypertension. A Mixed Methods Study

PubMed Central

Colman, Rebecca; Whittingham, Heather; Tomlinson, George; Granton, John

2014-01-01

Introduction Patients with pulmonary hypertension (PH) often present with a variety of physical findings reflecting a volume or pressure overloaded right ventricle (RV). However, there is no consensus regarding the diagnostic utility of the physical examination in PH. Methods We conducted a systematic review of publications that evaluated the clinical examination and diagnosis of PH using MEDLINE (1946–2013) and EMBASE (1947–2013). We also prospectively evaluated the diagnostic utility of the physical examination findings. Patients who underwent right cardiac catheterization for any reason were recruited. After informed consent, participants were examined by 6 physicians (3 “specialists” and 3 “generalists”) who were unaware of the results of the patient's hemodynamics. Each examiner independently assessed patients for the presence of a RV lift, loud P2, jugular venous distension (JVD), tricuspid insufficiency murmur and right-sided 4th heart sound at rest and during a slow inspiration. A global rating (scale of 1–5) of the likelihood that the patient had pulmonary hypertension was provided by each examiner. Results 31 articles that assessed the physical examination in PH were included in the final analysis. There was heterogeneity amongst the studies and many did not include control data. The sign most associated with PH in the literature was a loud pulmonic component of the second heart sound (P2). In our prospective study physical examination was performed on 52 subjects (25 met criteria for PH; mPAP ≥25 mmHg). The physical sign with the highest likelihood ratio (LR) was a loud P2 on inspiration with a LR +ve 1.9, 95% CrI [1.2, 3.1] when data from all examiners was analyzed together. Results from the specialist examiners had higher diagnostic utility; a loud P2 on inspiration was associated with a positive LR of 3.2, 95% CrI [1.5, 6.2] and a right sided S4 on inspiration had a LR +ve 4.7, 95% CI [1.0, 15.6]. No aspect of the physical exam, could consistently rule out PH (negative LRs 0.7–1.3). Conclusions The presence of a loud P2 or audible right-sided 4th heart sound are associated with PH. However the physical examination is unreliable for determining the presence of PH. PMID:25343585

Utility of the physical examination in detecting pulmonary hypertension. A mixed methods study.

PubMed

Colman, Rebecca; Whittingham, Heather; Tomlinson, George; Granton, John

2014-01-01

Patients with pulmonary hypertension (PH) often present with a variety of physical findings reflecting a volume or pressure overloaded right ventricle (RV). However, there is no consensus regarding the diagnostic utility of the physical examination in PH. We conducted a systematic review of publications that evaluated the clinical examination and diagnosis of PH using MEDLINE (1946-2013) and EMBASE (1947-2013). We also prospectively evaluated the diagnostic utility of the physical examination findings. Patients who underwent right cardiac catheterization for any reason were recruited. After informed consent, participants were examined by 6 physicians (3 "specialists" and 3 "generalists") who were unaware of the results of the patient's hemodynamics. Each examiner independently assessed patients for the presence of a RV lift, loud P2, jugular venous distension (JVD), tricuspid insufficiency murmur and right-sided 4th heart sound at rest and during a slow inspiration. A global rating (scale of 1-5) of the likelihood that the patient had pulmonary hypertension was provided by each examiner. 31 articles that assessed the physical examination in PH were included in the final analysis. There was heterogeneity amongst the studies and many did not include control data. The sign most associated with PH in the literature was a loud pulmonic component of the second heart sound (P2). In our prospective study physical examination was performed on 52 subjects (25 met criteria for PH; mPAP ≥ 25 mmHg). The physical sign with the highest likelihood ratio (LR) was a loud P2 on inspiration with a LR +ve 1.9, 95% CrI [1.2, 3.1] when data from all examiners was analyzed together. Results from the specialist examiners had higher diagnostic utility; a loud P2 on inspiration was associated with a positive LR of 3.2, 95% CrI [1.5, 6.2] and a right sided S4 on inspiration had a LR +ve 4.7, 95% CI [1.0, 15.6]. No aspect of the physical exam, could consistently rule out PH (negative LRs 0.7-1.3). The presence of a loud P2 or audible right-sided 4th heart sound are associated with PH. However the physical examination is unreliable for determining the presence of PH.

Patent ductus arteriosus in an adult amur leopard (Panthera pardus orientalis).

PubMed

Douay, Guillaume; Drut, Amandine; Ribas, Thibault; Gomis, David; Graille, Mélanie; Lemberger, Karin; Bublot, Isabelle

2013-03-01

A clinically healthy 16-yr-old female leopard (Panthera pardus orientalis) was diagnosed with a patent ductus arteriosus on echocardiography and later confirmed on necropsy A murmur was heard on auscultation during a routine examination, and the congenital defect was an incidental finding. The animal had been asymptomatic its entire life. This deformity is rarely observed in nondomestic felids and may be asymptomatic, as has been described in domestic cats.

Must Children Testify in Grown-Up Courtrooms?

ERIC Educational Resources Information Center

Myers, John E. B.

1993-01-01

The demands of the American justice system make testimony difficult for children, yet the presumption of innocence and the rights of the accused are so important that society is justified in asking even young children to endure the stress of the witness stand. (MDM)

Design principles in telescope development: invariance, innocence, and the costs

NASA Astrophysics Data System (ADS)

Steinbach, Manfred

1997-03-01

Instrument design is, for the most part, a battle against errors and costs. Passive methods of error damping are in many cases effective and inexpensive. This paper shows examples of error minimization in our design of telescopes, instrumentation and evaluation instruments.

Admiral Arleigh Burke: A Study in Strategic Leadership

DTIC Science & Technology

2004-06-17

leadership than the first two years. 1John N. Horrocks Jr., “The Art , Science , and Innocence...Demetracopoulos, Elias P. “Muzzling Admiral Burke.” Proceedings 126, no. 1 (January 2000): 64-68. Horrocks, John N., Jr. “The Art , Science , and

Integrated Nanoscale Nanowire Correlated Electronic Nanosensing Technology (INNOCENT)

DTIC Science & Technology

2006-06-01

out by characterizing the response of a 7 device to two different but structurally similar viruses, paramyxovirus and influenza A using nanowire devices...modified with antibodies specific for influenza A. Delivery of a solution containing paramyxovirus exhibited only short duration conductance changes

40 CFR 312.1 - Purpose, applicability, scope and disclosure obligations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Purpose, applicability, scope and disclosure obligations. 312.1 Section 312.1 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS INNOCENT LANDOWNERS...

Scaffolding Proteins: Not Such Innocent Bystanders

PubMed Central

Smith, F. Donelson; Scott, John D.

2014-01-01

Sequential transfer of information from one enzyme to the next within the confines of a protein kinase scaffold enhances signal transduction. Though frequently considered to be inert organizational elements, two recent reports implicate kinase-scaffolding proteins as active participants in signal relay. PMID:23787043

A resolution supporting peace, security, and innocent civilians affected by conflict in Yemen.

THOMAS, 111th Congress

Sen. Cardin, Benjamin L. [D-MD

2009-11-05

Senate - 12/04/2009 Resolution agreed to in Senate without amendment and with a preamble by Unanimous Consent. (All Actions) Tracker: This bill has the status Agreed to in SenateHere are the steps for Status of Legislation:

Nature and Nationhood: Danish Perspectives

ERIC Educational Resources Information Center

Schnack, Karsten

2009-01-01

In this paper, I shall discuss Danish perspectives on nature, showing the interdependence of conceptions of "nature" and "nationhood" in the formations of a particular cultural community. Nature, thus construed, is never innocent of culture and cannot therefore simply be "restored" to some pristine, pre-lapsarian…

Sanitizing "Indians" in America's Thanksgiving Story

ERIC Educational Resources Information Center

Adare-Tasiwoopa ápi, Sierra; Adams-Campbell, Melissa

2016-01-01

Children's books about the Thanksgiving holiday offer a superlative example of America's supposedly innocent interactions with "Indians." In this essay, we describe how representations of "Indians" in children's Thanksgiving books are often used to promote a Manifest Destiny ideology, we correct basic "facts" about…

Paradise Lost.

ERIC Educational Resources Information Center

Ruenzel, David

1996-01-01

Though kindergarten was originally intended to be innocent and provide children with rich experiences, it is now more like a mini-first grade, with tremendous pressures for students to achieve academically. It is important for children to find kindergarten pleasurable because it is a bridge to their future in education. (SM)

33 CFR 137.35 - Inquiries by an environmental professional.

Code of Federal Regulations, 2011 CFR

2011-07-01

... professional. 137.35 Section 137.35 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND...: STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and... the specific qualifications based on education, training, and experience to assess the nature, history...

33 CFR 137.35 - Inquiries by an environmental professional.

Code of Federal Regulations, 2013 CFR

2013-07-01

... professional. 137.35 Section 137.35 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND...: STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and... the specific qualifications based on education, training, and experience to assess the nature, history...

33 CFR 137.85 - The degree of obviousness of the presence or likely presence of oil at the facility and the real...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL... INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.85 The degree of obviousness of the presence or...

33 CFR 137.85 - The degree of obviousness of the presence or likely presence of oil at the facility and the real...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL... INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.85 The degree of obviousness of the presence or...

33 CFR 137.85 - The degree of obviousness of the presence or likely presence of oil at the facility and the real...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL... INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.85 The degree of obviousness of the presence or...

33 CFR 137.85 - The degree of obviousness of the presence or likely presence of oil at the facility and the real...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL... INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.85 The degree of obviousness of the presence or...

33 CFR 137.85 - The degree of obviousness of the presence or likely presence of oil at the facility and the real...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL... INNOCENT LAND-OWNER DEFENSE Standards and Practices § 137.85 The degree of obviousness of the presence or...

40 CFR 312.25 - Searches for recorded environmental cleanup liens.

Code of Federal Regulations, 2010 CFR

2010-07-01

... cleanup liens. 312.25 Section 312.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS INNOCENT LANDOWNERS, STANDARDS FOR... cleanup liens. (a) All appropriate inquiries must include a search for the existence of environmental...

33 CFR 151.2015 - Is a vessel in innocent passage exempt from the mandatory requirements?

Code of Federal Regulations, 2010 CFR

2010-07-01

... mandatory requirements? A foreign vessel merely traversing the territorial sea of the U.S. (i.e., not entering or departing a U.S. port, or not navigating the internal waters of the U.S.) is exempt from the...

33 CFR 151.2015 - Is a vessel in innocent passage exempt from the mandatory requirements?

Code of Federal Regulations, 2011 CFR

2011-07-01

... mandatory requirements? A foreign vessel merely traversing the territorial sea of the U.S. (i.e., not entering or departing a U.S. port, or not navigating the internal waters of the U.S.) is exempt from the...

Recursive Averaging

ERIC Educational Resources Information Center

Smith, Scott G.

2015-01-01

In this article, Scott Smith presents an innocent problem (Problem 12 of the May 2001 Calendar from "Mathematics Teacher" ("MT" May 2001, vol. 94, no. 5, p. 384) that was transformed by several timely "what if?" questions into a rewarding investigation of some interesting mathematics. These investigations led to two…

From Wisdom to Innocence: Passing on the Knowledge of the Night Sky

NASA Technical Reports Server (NTRS)

Shope, R.

1996-01-01

Memorable learning can happen when the whole family shares the thrill of discovery together. The fascination of the night sky presents a perfect opportunity for gifted parents and children to experience the tradition of passing on knowledge from generation to generation.

Interventions Highlighting Hypocrisy Reduce Collective Blame of Muslims for Individual Acts of Violence and Assuage Anti-Muslim Hostility.

PubMed

Bruneau, Emile; Kteily, Nour; Falk, Emily

2018-03-01

Collectively blaming groups for the actions of individuals can license vicarious retribution. Acts of terrorism by Muslim extremists against innocents, and the spikes in anti-Muslim hate crimes against innocent Muslims that follow, suggest that reciprocal bouts of collective blame can spark cycles of violence. How can this cycle be short-circuited? After establishing a link between collective blame of Muslims and anti-Muslim attitudes and behavior, we used an "interventions tournament" to identify a successful intervention (among many that failed). The "winning" intervention reduced collective blame of Muslims by highlighting hypocrisy in the ways individuals collectively blame Muslims-but not other groups (White Americans, Christians)-for individual group members' actions. After replicating the effect in an independent sample, we demonstrate that a novel interactive activity that isolates the psychological mechanism amplifies the effectiveness of the collective blame hypocrisy intervention and results in downstream reductions in anti-Muslim attitudes and anti-Muslim behavior.

The impact of prior knowledge from participant instructions in a mock crime P300 Concealed Information Test.

PubMed

Winograd, Michael R; Rosenfeld, J Peter

2014-12-01

In P300-Concealed Information Tests used with mock crime scenarios, the amount of detail revealed to a participant prior to the commission of the mock crime can have a serious impact on a study's validity. We predicted that exposure to crime details through instructions would bias detection rates toward enhanced sensitivity. In a 2 × 2 factorial design, participants were either informed (through mock crime instructions) or naïve as to the identity of a to-be-stolen item, and then either committed (guilty) or did not commit (innocent) the crime. Results showed that prior knowledge of the stolen item was sufficient to cause 69% of innocent-informed participants to be incorrectly classified as guilty. Further, we found a trend toward enhanced detection rate for guilty-informed participants over guilty-naïve participants. Results suggest that revealing details to participants through instructions biases detection rates in the P300-CIT toward enhanced sensitivity. Copyright © 2014 Elsevier B.V. All rights reserved.

Nurses and national socialism--a moral dilemma: one historical example of a route to euthanasia.

PubMed

Hoskins, Sylvia Anne

2005-01-01

If euthanasia were to be made legal in other countries apart from The Netherlands and Belgium, nurses would be faced with ethical dilemmas that could impact on their professional accountability and their personal moral beliefs. As a part of history has demonstrated, the introduction of the practice of euthanasia could also significantly change the relationship between nurses and patients. In Germany between 1940 and 1945, in response to a government directive, nurses participated in the practice of euthanasia and as a result many innocent German people were killed by what were considered to be 'mercy deaths'. It is important to try and understand the moral thinking and examine the complex issues at this historical junction that led German nurses to participate in the killing of thousands of innocent people. Such reflection may help to stimulate an awareness of the moral issues that nurses in the twenty-first century could confront if euthanasia were to be made legal in their own country. This has implications for future nursing practice.

Unsettling care: Troubling transnational itineraries of care in feminist health practices.

PubMed

Murphy, Michelle

2015-10-01

Responding to the call by Maria Puig de la Bellacasa for Science and Technology Studies to take up 'matters of care', this article cautions against equating care with positive feelings and, in contrast, argues for the importance of grappling with the non-innocent histories in which the politics of care already circulates, particularly in transnational couplings of feminism and health. The article highlights these histories by tracing multiple versions of the politics of care in a select set of feminist engagements with the pap smear and cervical cancer. Drawing on postcolonial and indigenous feminist commitments, as well as amplifying Donna Haraway's call to 'stay with the trouble', the article seeks to disturb hegemonic histories and arrangements of race, colonialism, and political economy, while simultaneously valuing divergent multi-local itineraries as relevant to technoscientific matters of care. This call for a politics of 'unsettling' care strives to stir up and put into motion what is sedimented, while embracing the generativity of discomfort, critique, and non-innocence.

Interventions Highlighting Hypocrisy Reduce Collective Blame of Muslims for Individual Acts of Violence and Assuage Anti-Muslim Hostility

PubMed Central

Bruneau, Emile; Kteily, Nour; Falk, Emily

2017-01-01

Collectively blaming groups for the actions of individuals can license vicarious retribution. Acts of terrorism by Muslim extremists against innocents, and the spikes in anti-Muslim hate crimes against innocent Muslims that follow, suggest that reciprocal bouts of collective blame can spark cycles of violence. How can this cycle be short-circuited? After establishing a link between collective blame of Muslims and anti-Muslim attitudes and behavior, we used an “interventions tournament” to identify a successful intervention (among many that failed). The “winning” intervention reduced collective blame of Muslims by highlighting hypocrisy in the ways individuals collectively blame Muslims—but not other groups (White Americans, Christians)—for individual group members’ actions. After replicating the effect in an independent sample, we demonstrate that a novel interactive activity that isolates the psychological mechanism amplifies the effectiveness of the collective blame hypocrisy intervention and results in downstream reductions in anti-Muslim attitudes and anti-Muslim behavior. PMID:29251246

Redox non-innocence permits catalytic nitrene carbonylation by (dadi)Ti=NAd (Ad = adamantyl)

DOE PAGES

Heins, Spencer P.; Wolczanski, Peter T.; Cundari, Thomas R.; ...

2017-03-06

Application of the diamide, diimine {–CH=N(1,2-C 6H 4)N(2,6- iPr 2-C 6H 3)} 2 m ((dadi) m) ligand to titanium provided adducts (dadi)TiL x (1-L x; L x = THF, PMe 2Ph, (CNMe) 2), which possess the redox formulation [(dadi) 4-]Ti(IV)L x, and 22 πe - (4n + 2). Related complexes containing titanium-ligand multiple bonds, (dadi)Ti=X (2=X; X = O, NAd), exhibit a different dadi redox state, [(dadi) 2-]Ti(IV)X, consistent with 20 πe - (4n). The Redox Non-Innocence (RNI) displayed by dadi m impedes binding by CO, and permits catalytic conversion of AdN 3 + CO to AdNCO + N 2.more » Kinetics measurements support carbonylation of 2=NAd as the rate determining step. Finally, structural and computational evidence for the observed RNI is provided.« less

[Whipple's disease endocarditis: report of 5 cases and review of the literature].

PubMed

Aïouaz, H; Célard, M; Puget, M; Vandenesch, F; Mercusot, A; Fenollar, F; Delahaye, F; Obadia, J F; Tebib, J; Rousset, H

2005-10-01

Endocarditic lesions (infectious endocarditis) associated with Whipple's disease are exceptional. We report five cases from the cardiovascular and pneumologic hospital Louis Pradel in Lyon. We have collected all cases of Tropheryma whipplei endocarditis diagnosed between 1995 and 2004. Five men with a mean age of 53 years at time of diagnosis. The symptoms were essentially cardiovascular: murmur, embolism in 3 cases, and heart failure secondary to valvular insufficiency in 2 cases. The valvular involvement, double in 3 cases, was more often aortic. Vegetations were present in all patients and valvular destruction sometimes very important. A low grade fever was present in 4 cases, associated with weight loss in 2 cases. The only extra-cardiac symptoms were arthralgias or arthritis in all cases, considered in 3 patients as seronegative rheumatoid arthritis, B27+ spondylarthritis, and psoriasic arthritis. Their was no other clinical manifestations of Whipple's disease, particularly digestive, ocular, neurologic or adenopathy, and duodenal biopsies secondarily performed in 4 cases were non contributive. This differs from literature as an extra-cardiac location was identified in 11 out of 17 cases. The diagnosis was obtained by histology and PCR on the cardiac valves, as all the patients underwent surgery. The evolution was favourable with a prolonged antibiotic therapy. These report confirms the existence of endocarditic forms of the Whipple's disease, in which the single extra-cardiac manifestation is rheumatologic, and reminds us the usefulness of histology and PCR on the cardiac valves at the time of valvular surgery.

Retrospective analysis of co-occurrence of congenital aortic stenosis and pulmonary artery stenosis in dogs.

PubMed

Kander, M; Pasławska, U; Staszczyk, M; Cepiel, A; Pasławski, R; Mazur, G; Noszczyk-Nowak, A

2015-01-01

The study has focused on the retrospective analysis of cases of coexisting congenital aortic stenosis (AS) and pulmonary artery stenosis (PS) in dogs. The research included 5463 dogs which were referred for cardiological examination (including clinical examination, ECG and echocardiography) between 2004 and 2014. Aortic stenosis and PS stenosis were detected in 31 dogs. This complex defect was the most commonly diagnosed in Boxers - 7 dogs, other breeds were represented by: 4 cross-breed dogs, 2 Bichon Maltais, 3 Miniature Pinschers, 2 Bernese Mountain Dogs, 2 French Bulldogs, and individuals of following breeds: Bichon Frise, Bull Terrier, Czech Wolfdog, German Shepherd, Hairless Chinese Crested Dog, Miniature Schnauzer, Pug, Rottweiler, Samoyed, West Highland White Terrier and Yorkshire Terrier. In all the dogs, the murmurs could be heard, graded from 2 to 5 (on a scale of 1-6). Besides, in 9 cases other congenital defects were diagnosed: patent ductus arteriosus, mitral valve dysplasia, pulmonary or aortic valve regurgitation, tricuspid valve dysplasia, ventricular or atrial septal defect. The majority of the dogs suffered from pulmonary valvular stenosis (1 dog had supravalvular pulmonary artery stenosis) and subvalvular aortic stenosis (2 dogs had valvular aortic stenosis). Conclusions and clinical relevance - co-occurrence of AS and PS is the most common complex congenital heart defect. Boxer breed was predisposed to this complex defect. It was found that coexisting AS and PS is more common in male dogs and the degree of PS and AS was mostly similar.

Desensitization to ceftaroline in a patient with multiple medication hypersensitivity reactions.

PubMed

Jones, Justin M; Richter, Lisa M; Alonto, Augusto; Leedahl, David D

2015-02-01

The case of a patient with multiple medication hypersensitivity reactions and a methicillin-resistant Staphylococcus aureus (MRSA) infection who underwent desensitization to ceftaroline is reported. A 32-year-old Caucasian woman with asthma, gastroesophageal reflux disease, heart murmur, and major depression was admitted for MRSA cellulitis with a subcutaneous abscess along the left sternomanubrial joint and clavicular osteomyelitis secondary to port placement after gastric bypass surgery. The patient had an extensive history of hypersensitivity reactions. Pertinent documented allergies were as follows: penicillin (anaphylaxis), daptomycin (anaphylaxis), vancomycin (hives), linezolid (hives), ertapenem (rash), ciprofloxacin (rash), and tigecycline (rash). The patient also reported previous reactions to aztreonam (unknown) and gentamicin (hives). The pharmacy was consulted to develop a desensitization protocol for ceftaroline. The desensitization protocol used three serial dilutions of ceftaroline to make 14 sequential infusions with escalating doses. Intramuscular epinephrine, i.v. diphenhydramine, and i.v. methylprednisolone were ordered as needed for the development of immediate hypersensitivity reactions during or after administration of ceftaroline. The cumulative dose (574.94 mg) was administered intravenously over 225 minutes with no breakthrough symptoms reported during or after the desensitization protocol. Ceftaroline fosamil 600 mg i.v. every 12 hours was continued for six weeks. Desensitization to ceftaroline was conducted for a patient with extensive history of hypersensitivity reactions to other drugs, including penicillin-induced anaphylaxis. Desensitization and subsequent treatment with full doses of ceftaroline were accomplished without apparent adverse effects. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Clinical severity score system in dogs with degenerative mitral valve disease.

PubMed

López-Alvarez, J; Elliott, J; Pfeiffer, D; Chang, Y-M; Mattin, M; Moonarmart, W; Hezzell, M J; Boswood, A

2015-01-01

Several risk factors already have been determined for dogs with degenerative mitral valve disease (DMVD). Risk factors often have been considered in isolation and have not always taken into account additional information provided by the history and physical examination (PE). Data obtained from history and PE of dogs with DMVD provide prognostic information and can be used for risk stratification. Client-owned dogs (n = 244) with DMVD recruited from first opinion practice. Prospective longitudinal follow-up of dogs with DMVD. History and PE data were obtained at 6-month intervals and analyzed with time-dependent Cox models to derive relative risk of cardiac death. Independent hazard ratios were used to derive a clinical severity score (CSS), the prognostic value of which was evaluated by analyzing the median survival times for different risk groups and ROC analysis. Analysis of the progression of CSS over time also was undertaken. History of cough, exercise intolerance, decreased appetite, breathlessness (difficulty breathing) and syncope with PE findings of heart murmur intensity louder than III/VI and absence of respiratory sinus arrhythmia were independently associated with outcome and allowed development of the CSS. Clinical severity score distinguished groups of dogs with significantly different outcomes. Routinely obtained clinical findings allow risk stratification of dogs with DMVD. Results of ancillary diagnostic tests may be complementary to history and PE findings and always should be interpreted in conjunction with these findings. Copyright © 2015 by the American College of Veterinary Internal Medicine.

Proximal dup(10q): Case report and literature review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barritt, J.A.; Teague, K.E.; Bodurtha, J.N.

We report a case of a proximal dir dup(10q) in a female with multiple congenital anomalies. During infancy she was noted to gave growth retardation, microcephaly, microphthalmia, coloboma, a long, beaked nose, posteriorly rotated ears with simple helices, full bowed lips, widely-spaced nipples, broad first toes, hypermobile and proximally placed thumbs, a heart murmur, PDA, and coarctation of the aorta. Additional findings at age 13 included a full columella, short philtrum, thin limbs, bilateral blindness, and mental retardation, as well as continued growth retardation. Her medical history included precocious puberty at age 8 and a diagnosis of hyperactivity. Using FISHmore » with multiple probes combined with GTG-banding, the aberrant chromosome was determined to be a dir dup(10)(q21{r_arrow}q22). Parental chromosomes were normal and the family history was unremarkable. The parental origin of the dir dup(10) is being assessed using DNA markers. Five similar cases of proximal dup(10q) have been reported previously. Consistent characteristics include low birth weight, developmental and psychomotor delay, growth retardation, and microcephaly. Also found in most cases were short prominent philtrum, bowed mouth, PDA, thin limbs, coloboma, micropthalmia, deep set eyes, and other ocular anomalies. Our case is unique in that she has a long, beaked nose, precocious puberty, and hyperactivity. Future studies such as this, using molecular cytogenetic techniques to better define the chromatin involved in proximal dup(10q), may lead to its recognition as a distinct clinical phenotype.« less

Subaortic membrane in an adult patient with coronary artery disease.

PubMed

Okutan, Huseyin; Kutsal, Ali

2005-01-01

A case of subaortic membrane with coronary artery disease in a 48-year-old man is described. He was referred to our hospital for cardiac murmur, which was discovered on routine clinical examination. He had no significant past medical history apart from dizziness while exercising. Subaortic membrane was totally excised; left internal thoracic artery was anastomosed to left anterior descending artery by end-to-side technique. The postoperative 2-year course of the patient was uneventful.

Yield of Echocardiogram and Predictors of Positive Yield in Pediatric Patients: A Study in an Urban, Community-Based Outpatient Pediatric Cardiology Clinic.

PubMed

Billa, Ramya Deepthi; Szpunar, Susan; Zeinali, Lida; Anne, Premchand

2018-01-01

The yield of outpatient echocardiograms varies based on the indication for the echocardiogram and the age of the patient. The purpose of this study was to determine the cumulative yield of outpatient echocardiograms by age group and reason for the test. A secondary aim was to determine the predictors of a positive echocardiogram in an outpatient cardiology clinic at a large community teaching hospital. We retrospectively reviewed the charts of 891 patients who had a first-time echocardiogram between 2011 and 2015. Positive yield was defined as echocardiographic findings that explained the reason for the echocardiogram. The overall positive yield was 8.2%. Children between birth and 3 months of age had the highest yield (34.2%), and children between 12 and 18 years of age had the lowest yield (1%). Patients with murmurs (18.1%) had the highest yield compared with patients with other signs or symptoms. By age group and reason, the highest yields were as follows: 0 to 3 months of age, murmur (39.2%); 4 to 11 months of age, >1 symptom (50%); and 1 to 5 years of age, shortness of breath (66.7%). Based on our study, the overall yield of echocardiograms in the outpatient pediatric setting is low. Age and symptoms should be considered before ordering an echocardiogram.

33 CFR 137.50 - Reviews of historical sources of information.

Code of Federal Regulations, 2013 CFR

2013-07-01

... information. 137.50 Section 137.50 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND...: STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and... insurance maps, building department records, chain of title documents, and land use records. (b) Historical...

33 CFR 137.50 - Reviews of historical sources of information.

Code of Federal Regulations, 2014 CFR

2014-07-01

... information. 137.50 Section 137.50 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND...: STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and... insurance maps, building department records, chain of title documents, and land use records. (b) Historical...

33 CFR 137.50 - Reviews of historical sources of information.

Code of Federal Regulations, 2011 CFR

2011-07-01

... information. 137.50 Section 137.50 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND...: STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and... insurance maps, building department records, chain of title documents, and land use records. (b) Historical...

33 CFR 137.50 - Reviews of historical sources of information.

Code of Federal Regulations, 2012 CFR

2012-07-01

... information. 137.50 Section 137.50 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND...: STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and... insurance maps, building department records, chain of title documents, and land use records. (b) Historical...

33 CFR 137.50 - Reviews of historical sources of information.

Code of Federal Regulations, 2010 CFR

2010-07-01

... information. 137.50 Section 137.50 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND...: STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES UNDER THE INNOCENT LAND-OWNER DEFENSE Standards and... insurance maps, building department records, chain of title documents, and land use records. (b) Historical...

38 CFR 4.17a - Misconduct etiology.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Misconduct etiology. 4... RATING DISABILITIES General Policy in Rating § 4.17a Misconduct etiology. A permanent and total... coexistence of misconduct disability when: (a) A veteran, regardless of employment status, also has innocently...

38 CFR 4.17a - Misconduct etiology.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Misconduct etiology. 4... RATING DISABILITIES General Policy in Rating § 4.17a Misconduct etiology. A permanent and total... coexistence of misconduct disability when: (a) A veteran, regardless of employment status, also has innocently...

38 CFR 4.17a - Misconduct etiology.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Misconduct etiology. 4... RATING DISABILITIES General Policy in Rating § 4.17a Misconduct etiology. A permanent and total... coexistence of misconduct disability when: (a) A veteran, regardless of employment status, also has innocently...

38 CFR 4.17a - Misconduct etiology.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Misconduct etiology. 4... RATING DISABILITIES General Policy in Rating § 4.17a Misconduct etiology. A permanent and total... coexistence of misconduct disability when: (a) A veteran, regardless of employment status, also has innocently...

38 CFR 4.17a - Misconduct etiology.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Misconduct etiology. 4... RATING DISABILITIES General Policy in Rating § 4.17a Misconduct etiology. A permanent and total... coexistence of misconduct disability when: (a) A veteran, regardless of employment status, also has innocently...

Digging Up "The Secret Garden": Noble Innocents or Little Savages?

ERIC Educational Resources Information Center

Wilkie, Christine

1997-01-01

Offers a rereading of Frances Hodgson Burnett's "The Secret Garden," finding in it the triumph of Apollonian male rationalism over the Dionysian female cult of nature. Examines images of primitivism and wildness in the book, connecting them to polarities in conceptions of primitivism. (SR)

Anti-Submarine Warfare (ASW) Capability Transformation: Strategy of Response to Effects Based Warfare

DTIC Science & Technology

2011-06-01

the ROK Cheonan destroyer by a probable PRK submarine. Despite the authoritative findings of an International team that forensically examined the...evidence of the sinking implicating PRK , North Korea continues to maintain its innocence and deny any involvement, especially since there is

Multiple Confidence Estimates as Indices of Eyewitness Memory

ERIC Educational Resources Information Center

Sauer, James D.; Brewer, Neil; Weber, Nathan

2008-01-01

Eyewitness identification decisions are vulnerable to various influences on witnesses' decision criteria that contribute to false identifications of innocent suspects and failures to choose perpetrators. An alternative procedure using confidence estimates to assess the degree of match between novel and previously viewed faces was investigated.…

Innocents Abroad: American Students in German Universities, 1810-1870

ERIC Educational Resources Information Center

Diehl, Carl

1976-01-01

Presented is a history of American students in Germany prior to 1870 and an assessment of the influence of these students who returned to the United States to fashion institutions of higher learning and to establish the criteria of higher learning in the humanities. (Author/DB)

Thou Shalt Not Dupe.

ERIC Educational Resources Information Center

Association of Data Processing Service Organizations, Arlington, VA.

The problem of unauthorized computer software duplication impedes the production of upgraded products by software developers, who find thousands of illegal computer program copies have been made by customers who either innocently believe they are doing nothing wrong, or simply choose to ignore the law. Unauthorized duplication and use of software…

Not Such Innocents Abroad?

ERIC Educational Resources Information Center

Schaur, Georg; Watts, Michael

2010-01-01

Little research in economic education has dealt with MBA programs. The authors investigated student performance in a microeconomics/managerial economics course taught in a one-year MBA program at the German International School of Management and Administration in Hanover, Germany, during the 2002-5 academic years. After controlling for other…

Misrepresentation and the Liability of Universities

ERIC Educational Resources Information Center

Katter, Norman

2006-01-01

This article focuses on misrepresentation and the exposure of universities to legal liability for innocent, fraudulent or negligent statements by academics or administrative staff made to students or prospective students. A greater public awareness of consumer rights through media coverage of damage awards, speculative actions by lawyers, and a…

Characterization of Non-Innocent Metal Complexes Using Solid-State NMR Spectroscopy: o-Dioxolene Vanadium Complexes

PubMed Central

Chatterjee, Pabitra B.; Goncharov-Zapata, Olga; Quinn, Laurence L.; Hou, Guangjin; Hamaed, Hiyam; Schurko, Robert W.; Polenova, Tatyana; Crans, Debbie C.

2012-01-01

51V solid-state NMR (SSNMR) studies of a series of non-innocent vanadium(V) catechol complexes have been conducted to evaluate the possibility that 51V NMR observables, quadrupolar and chemical shift anisotropies, and electronic structures of such compounds can be used to characterize these compounds. The vanadium(V) catechol complexes described in these studies have relatively small quadrupolar coupling constants, which cover a surprisingly small range from 3.4 to 4.2 MHz. On the other hand, isotropic 51V NMR chemical shifts cover a wide range from −200 ppm to 400 ppm in solution and from −219 to 530 ppm in the solid state. A linear correlation of 51V NMR isotropic solution and solid-state chemical shifts of complexes containing non-innocent ligands is observed. These experimental results provide the information needed for the application of 51V SSNMR spectroscopy in characterizing the electronic properties of a wide variety of vanadium-containing systems, and in particular those containing non-innocent ligands and that have chemical shifts outside the populated range of −300 ppm to −700 ppm. The studies presented in this report demonstrate that the small quadrupolar couplings covering a narrow range of values reflect the symmetric electronic charge distribution, which is also similar across these complexes. These quadrupolar interaction parameters alone are not sufficient to capture the rich electronic structure of these complexes. In contrast, the chemical shift anisotropy tensor elements accessible from 51V SSNMR experiments are a highly sensitive probe of subtle differences in electronic distribution and orbital occupancy in these compounds. Quantum chemical (DFT) calculations of NMR parameters for [VO(hshed)(Cat)] yield 51V CSA tensor in reasonable agreement with the experimental results, but surprisingly, the calculated quadrupolar coupling constant is significantly greater than the experimental value. The studies demonstrate that substitution of the catechol ligand with electron donating groups results in an increase in the HOMO-LUMO gap and can be directly followed by an upfield shift for the vanadium catechol complex. In contrast, substitution of the catechol ligand with electron withdrawing groups results in a decrease in the HOMO-LUMO gap and can directly be followed by a downfield shift for the complex. The vanadium catechol complexes were used in this work because the 51V is a half-integer quadrupolar nucleus whose NMR observables are highly sensitive to the local environment. However, the results are general and could be extended to other redox active complexes that exhibit similar coordination chemistry as the vanadium catechol complexes. PMID:21842875

Children's Literature: The Great Excluded. Volume Two.

ERIC Educational Resources Information Center

Butler, Francelia, Ed.

This collection of essays is intended to stimulate writing, teaching, and study of children's literature by humanists. Among the included essays are: "Back to Pooh Corner,""Sophisticated Reading for Children,""Medieval Songs of Innocence and Experience,""Milton's 'Comus' as Children's Literature,""Fantasy in a Mythless Age,""Science Fiction and…

Subliminal Messages in Advertising.

ERIC Educational Resources Information Center

Olson, Miles C.

The technique of subliminal information giving has been considerably broadened in recent years so that magazine ads now employ it by carefully hiding images where they are not usually perceived with the conscious eye. In his recent book, "Subliminal Seduction: Ad Media's Manipulation of a Not So Innocent America," Wilson B. Key…

Kids and Cults: Who Joins, and Why.

ERIC Educational Resources Information Center

Swope, George W.

1980-01-01

States that the social conditions that produce cults are favorable today and that those young people who are attracted to cult membership are idealistic, innocent, inquisitive, independent, identity-seeking, insecure, and vulnerable. Suggests that educators can help students be aware of the seriousness of the problems cults can cause. (TJ)

Mapping "Chinese" Christian Schools in Indonesia: Ethnicity, Class and Religion

ERIC Educational Resources Information Center

Hoon, Chang-Yau

2011-01-01

Schools are not "innocent" sites of cultural transmission. They play an active and significant role in transmitting values and inculcating culture. Schools also serve as a site for the maintenance of boundaries and for the construction of identities. Previous studies have recognized the relationship between education and identity.…

Is It True That "Blonds Have More Fun"?

ERIC Educational Resources Information Center

Bonsangue, Martin V.

1992-01-01

Describes the model for decision making used in inferential statistics and real-world applications that parallel the statistical model. Discusses two activities that ask students to write about a personal decision-making experience and create a mock trial in which the class makes the decision of guilt or innocence. (MDH)

Media Incitement: The "Born Innocent" Case.

ERIC Educational Resources Information Center

Stevens, George E.

1979-01-01

Concludes from a review of court cases that recovery of damages from a mass medium for an alleged incitement of antisocial behavior is unlikely under traditional negligence rules, even without a consideration of constitutional questions. Notes that the expense of litigation may cause the media to avoid potentially provocative communication. (GT)

31 CFR 101.2 - Petitions for mitigation.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., DEPARTMENT OF THE TREASURY MITIGATION OF FORFEITURE OF COUNTERFEIT GOLD COINS § 101.2 Petitions for mitigation. (a) Who may file. Any person may petition the Secretary of the Treasury for return of the gold bullion of counterfeit gold coins forfeited to the United States, if: (1) The petitioner innocently...

31 CFR 101.2 - Petitions for mitigation.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., DEPARTMENT OF THE TREASURY MITIGATION OF FORFEITURE OF COUNTERFEIT GOLD COINS § 101.2 Petitions for mitigation. (a) Who may file. Any person may petition the Secretary of the Treasury for return of the gold bullion of counterfeit gold coins forfeited to the United States, if: (1) The petitioner innocently...

31 CFR 101.2 - Petitions for mitigation.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., DEPARTMENT OF THE TREASURY MITIGATION OF FORFEITURE OF COUNTERFEIT GOLD COINS § 101.2 Petitions for mitigation. (a) Who may file. Any person may petition the Secretary of the Treasury for return of the gold bullion of counterfeit gold coins forfeited to the United States, if: (1) The petitioner innocently...

31 CFR 101.2 - Petitions for mitigation.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., DEPARTMENT OF THE TREASURY MITIGATION OF FORFEITURE OF COUNTERFEIT GOLD COINS § 101.2 Petitions for mitigation. (a) Who may file. Any person may petition the Secretary of the Treasury for return of the gold bullion of counterfeit gold coins forfeited to the United States, if: (1) The petitioner innocently...

A Commentary on Mill’s Logic. Book I. Of Names and Propositions.

DTIC Science & Technology

1983-10-01

truth . [’extension and intension’ in Flew (1979)]. The presumption is that manness necessarily implies rationality, but i- only contigently...guilty and inocent ; these are contraries rather than contradictories, since there are things, such as numbers, that are neither guilty nor innocent

Feeling Jumpy: Teaching about HIV/AIDS

ERIC Educational Resources Information Center

Lesko, Nancy; Brotman, Jennie S.; Agarwal, Ruchi; Quackenbush, Jaime Lynn

2010-01-01

Sexuality education and HIV/AIDS education are arenas of strong feelings. Emotions make sexuality and health lessons peculiar, "thrown together" lessons, and emotions stick to "childhood innocence", "growing up too fast" and even "jump" in response to visuals, say a used condom on an elementary school playground or a pregnant sophomore in a…

"Charmer Boys" and "Cream Girls": How Primary School Children Construct Themselves as Heterosexual Subjects through Football

ERIC Educational Resources Information Center

Mayeza, Emmanuel

2018-01-01

South African research on young children's constructions of social identities illuminates the significance of play in the construction of gender identities. However, what remains largely understudied are the children's construction of sexualities through play. The dominant discourse of "childhood innocence" obscures the variegated…

The End of Youth and Innocence

ERIC Educational Resources Information Center

Wilson, Jane

1975-01-01

The changing role of the physical scientist in society is traced from the first atomic bomb explosion in the New Mexican desert in 1945 to the present. Both the good and bad points of the changes brought upon the world by the rapid development of nuclear energy are discussed. (BT)

To Catch a Thief.

ERIC Educational Resources Information Center

Lindsay, R. C. L.

1998-01-01

Describes the differences between normal and sequential lineups and their effects on eyewitnesses to crime. After a staged crime in a college lab, students were shown photographs in either normal lineup style or sequential style. 35% of eyewitnesses shown all photographs at the same time mistakenly picked an innocent person. Only 18% shown…

Mitochondria and aging: innocent bystanders or guilty parties?

PubMed

Tońska, K; Sołyga, A; Bartnik, E

2009-01-01

There are many theories of aging and a number of them encompass the role of mitochondria in this process. Mitochondrial DNA mutations and deletions have been shown to accumulate in many tissues in mammals during aging. However, there is little evidence that these mutations could affect the functioning of aging tissues.

Scaffolding proteins: not such innocent bystanders.

PubMed

Smith, F Donelson; Scott, John D

2013-06-17

Sequential transfer of information from one enzyme to the next within the confines of a protein kinase scaffold enhances signal transduction. Though frequently considered to be inert organizational elements, two recent reports implicate kinase-scaffolding proteins as active participants in signal relay. Copyright © 2013 Elsevier Ltd. All rights reserved.

Explaining Anti-U.S. Military Base Sentiment in South Korea

DTIC Science & Technology

2017-06-01

transition. Thus, Roh dismissed the initial succession plan and assured the public a general vote for the upcoming presidential selection . Upon his...military member was accused of killing an innocent college student at a fast food restaurant in Itawon. Furthermore, the U.S. armored vehicle accident

Viewpoint. America's "Other" Divorce Crisis

ERIC Educational Resources Information Center

Squires, Jim

2004-01-01

Divorce is viewed as a national tragedy, particularly for its impact on young children, who lacked any control over the situation yet were most susceptible to its emotional pain and uncertainty. Children lost the security of a home, predictable routines, and loving family members. Innocent lives were transformed forever, often for the worse.…

Rethinking Children: Power, Pedagogy, and Contemporary Art Education Practices

ERIC Educational Resources Information Center

Ivashkevich, Olga

2012-01-01

Within the modern institution of schooling, educators portray children as lacking in knowledge and maturity and try to restrict their access to the issues that undermine this assumed innocence. Such renditions of children produce hierarchical power relationships in which children's ways of knowing are seen as what Foucault (1980) called…

How Justice System Officials View Wrongful Convictions

ERIC Educational Resources Information Center

Smith, Brad; Zalman, Marvin; Kiger, Angie

2011-01-01

The wrongful conviction of factually innocent people is a growing concern within the United States. Reforms generated by this concern are predicated in part on the views of justice system participants. The authors surveyed judges, police officials, prosecutors, and defense lawyers in Michigan regarding their views of why wrongful convictions…

"Why Are They Bombing Innocent Iraqis?": Political Literacy among Primary Pupils

ERIC Educational Resources Information Center

Maitles, Henry; Deuchar, Ross

2004-01-01

This article presents case studies of political literacy among primary pupils. While researching primary pupils' understanding of "enterprise", the researchers added interviews connecting this concept to the Iraq war. A sample of 10 non-representative Scottish primary schools from seven local education authorities has provided the…

25 CFR 700.519 - Gifts, entertainment and favors.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 2 2011-04-01 2011-04-01 false Gifts, entertainment and favors. 700.519 Section 700.519... Employee Responsibility and Conduct § 700.519 Gifts, entertainment and favors. (a) Acceptance of gratuities, including gifts, entertainment and favors, (no matter how innocently tendered or received) from those who...

25 CFR 700.519 - Gifts, entertainment and favors.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 2 2014-04-01 2014-04-01 false Gifts, entertainment and favors. 700.519 Section 700.519... Employee Responsibility and Conduct § 700.519 Gifts, entertainment and favors. (a) Acceptance of gratuities, including gifts, entertainment and favors, (no matter how innocently tendered or received) from those who...

25 CFR 700.519 - Gifts, entertainment and favors.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 2 2012-04-01 2012-04-01 false Gifts, entertainment and favors. 700.519 Section 700.519... Employee Responsibility and Conduct § 700.519 Gifts, entertainment and favors. (a) Acceptance of gratuities, including gifts, entertainment and favors, (no matter how innocently tendered or received) from those who...

25 CFR 700.519 - Gifts, entertainment and favors.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false Gifts, entertainment and favors. 700.519 Section 700.519... Employee Responsibility and Conduct § 700.519 Gifts, entertainment and favors. (a) Acceptance of gratuities, including gifts, entertainment and favors, (no matter how innocently tendered or received) from those who...

Moments in the Life of a Scientist

NASA Astrophysics Data System (ADS)

Rossi, Bruno

2008-07-01

List of plates; Foreword; Preface; Prehistory; 1. Arcetri (1928-32); 2. Padua, Copenhagen, Manchester; 3. Physics of elementary particles in the Age of Innocence (1939-46); 4. Los Alamos (1943-46); 5. Cosmic rays at MIT (1946- ); 6. Physics in space; Postscript; As for me … Nora Rossi; Index.

Nature by Default in Early Childhood Education for Sustainability

ERIC Educational Resources Information Center

Elliott, Sue; Young, Tracy

2016-01-01

This essay critiques the relevance of historical antecedents about children's play in nature and how these historical and political mechanisms create cultural rovoked by Taylor's (2013) exploration of the pervasive influence of romanticised images of innocent children in nature and our own experiences of never-ending "nice" stories about…

Rethinking Childhood Innocence.

ERIC Educational Resources Information Center

Sychterz, Terre

2002-01-01

Discusses the controversial work of Maurice Sendak, a popular, yet controversial children's author and illustrator. Examines the oral responses of a class of first graders to "We Are All in the Dumps with Jack and Guy," with the purpose of demonstrating that children can act as their own agents in constructing meaning through complex…

Childhood as Rhetoric.

ERIC Educational Resources Information Center

Katriel, Tamar; Nesher, Pearla

1987-01-01

Investigates a news program aimed at children in Israel to determine its functions as a mass media form. Suggests that the content of the news items reflects a culturally derived view of childhood as a golden time of innocence, which conflicts with Israeli children's needs to confront "real world" issues in their politically tense…

Watching the Moon from Tenerife

ERIC Educational Resources Information Center

Baruch, John; Machell, James; Norris, Kath

2005-01-01

"Where does the Sun go at night?" or "Why don't the Australians fall off?" are typical of the innocent questions that children ask. A new "Earth and Beyond" primary science learning programme from the University of Bradford is piloting some exciting ways to engage children with these questions and providing…

Routine (Dis)Order in an Infant School

ERIC Educational Resources Information Center

Bailey, Simon; Thomson, Pat

2009-01-01

Attention deficit hyperactivity disorder (ADHD) is popularly understood to be a condition which resides in the person. In this scenario, the school is an innocent bystander, a container for the "maladjusted child". Drawing on an ethnographic case study of one classroom, the first stage of doctoral research into the production of the…

Tale of an Innocent

ERIC Educational Resources Information Center

Singer, Nicky

2006-01-01

The British novelist Nicky Singer talks about becoming a writer, the role of editors and about who decides what can--and what cannot--be published on either side of the Atlantic. Her three novels explore territory which can make publishers nervous: "Feather Boy" (initiation rites and domestic violence), "Doll" (self-harm) and…

Values of Youth: Messages from the Most Popular Songs of Four Decades.

ERIC Educational Resources Information Center

Ostlund, Deborah R.; Kinnier, Richard T.

1997-01-01

Analyzed the lyrics of the 100 most popular songs in America from the 1950s to the 1980s to assess their value themes. Extracted nine value themes: romantic love, celebration, humanitarianism, antiestablishmentarianism, friendship, patriotism, narcissism, self-esteem, and nostalgia. Romantic love, particularly that of "innocent" young…

A Study to Develop a Methodology Determining the Feasibility of Establishing a Blood Collection Program in an Army Healthcare Facility

DTIC Science & Technology

1985-05-01

minimal. The risk of acquiring syphilis through blood transfusions is so rare that American Association of Blood Bank Standards have dropped the...requirement to test for syphilis , although Federal regulations still require it. Malaria can be effectively screened out by excluding potential donors. 2 9 The...murmur or repair of a congenital defect medical director. Listed below are some does not necessarily disqualify a donor. drugs and medical conditions

Brucella endocarditis: an occupational hazard!

PubMed

Agarwal, Sanjeev Kumar; Rajani, Ali Raza; Hussain, Kosar; Dande, Mangesh Manoharrao

2013-04-22

A young man presented with a 2-month history of fever and malaise. Cardiac auscultation revealed the presence of a diastolic murmur. Subsequently, a cardiac echocardiogram was done, which showed a large vegetation adherent to an anterior mitral leaflet. The blood culture was positive for Brucella species. The patient was given antibiotic therapy for brucellosis and referred for surgery. Brucella endocarditis is one of the rarest, yet most notorious complications of this infection. This condition requires a high degree of clinical suspicion in order to facilitate prompt diagnosis and treatment.

Refining an Automated Transcranial Doppler System for the Detection of Vasospasm after Traumatic Brain Injury

DTIC Science & Technology

2013-09-01

measure blood flow velocity in the MCA and ICA of patients with known vasospasm, as compared to standard TCD run by a trained neurosonographer...a trained neurosonographer. (Q1-Q10 out of 12 quarters) Task 1: Get approval for the human subjects study (Q1-2). This study will involve up to 128...Heinemann; 1999:109–128. 2. Aaslid R, Nornes H. Musical murmurs in human cerebral arteries after subarachnoid hemorrhage. J Neurosurg 1984; 60:32–36

True Aneurysms of the Extracranial Carotid Artery : An Evaluation of Two "Giant Aneurysms" and the Current Literature.

PubMed

Altun, Gokalp; Pulathan, Zerrin; Hemsinli, Dogus

2018-03-01

True extracranial carotid artery aneurysms (ECCAs) are uncommon. Atherosclerosis is the most common etiological factor. Neck pain, a pulsatile mass and murmur at auscultation are the most common symptoms. ECCAs may exhibit severe clinical manifestations due to complications. Cases of rupture can be fatal. There is a risk of distal embolization and stroke in thrombosed cases. We discuss two cases of enlarged ECCA treated surgically in the light of the most recent literature.

[Clinical treatment of infective endocarditis with vegetations in pregnant women and the outcomes of gestation].

PubMed

Chu, L; Zhang, J; Li, Y N; Meng, X; Liu, Y Y

2016-05-25

To investigate the clinical treatment of infective endocarditis with vegetations in pregnant women and the outcomes of the gestation. Nine cases of pregnant women diagnosed as infective endocarditis with vegetations in Beijing Anzhen Hospital, Capital Medical University from January 2001 to October 2015 were enrolled in retrospective analysis. Consultations were held by doctors from department of obstetrics, anesthesiology, cardiology, cardial surgery and extracorporeal circulation to decide the individualized treatment plan for the 9 cases of pregnant women after admissions. Clinical treatments including general treatment, anti-infection treatment, cardiac surgery, and termination of pregnancy surgery were completed through collaboration among related departments. The clinical characters, therapeutic regimens, maternal and neonatal outcomes of the 9 cases were analyzed. (1) Clinical characters: the ages of the 9 cases of pregnant women were from 25 to 36 years old. The onset gestational ages were from 19 to 36 weeks. fever, cough, sputum and progressive anemia were the main symptoms. Patients had cyanosis of lips, could not lie on the back or even be orthopnea, when heart failure happened. Heart murmur was audible and splenomegaly was touched in physical examination. Blood cultures were positive. Basic heart disease types: 7 cases of congenital heart diseases included 2 cases of aortic insufficiency, 1 case of mitral insufficiency, 1 case of patent ductus arteriosus, 1 case of right ventricular outflow tract stenosis and 2 cases of ventricular septal defect.Two cases of rheumatic heart diseases included 1 case of mitral stenosis, 1 case of mitral stenosis after artificial disc changed and jammed. According to endocardial vegetations attached position there were 3 cases of mitral valve vegetations, 2 cases of pulmonary valve vegetations, 3 cases of aortic vegetations and 1 case of right ventricular outflow tract neoplasm. Preoperative heart function classification: 1 case of level Ⅱ, 3 cases of level Ⅲ, 5 cases of level Ⅳ. (2) TREATMENTS: general treatment included oxygen uptake, rest in bed, cardiac strengthen and diuretic therapy, etc. Combined and adequate antibiotics were applied in anti-infection treatment according to drug sensitive test. Nine cases of pregnant women were all performed surgical treatment of heart diseases and removal of the endocardial vegetations. Caesarean sections were performed for 2 cases in second trimester and for 7 cases in last trimester. Cardiac surgery and caesarean section were operated in 6 cases at the same time among 22-34 weeks of pregnancy. Cardiac surgery were respectively operated in 2 cases 11 days and 32 days after the caesarean section at 33, 37 weeks of pregnancy. While Cardiac surgery was operated (at 26 weeks of pregnancy) before the caesarean section (at 37 weeks of pregnancy) in another 1 case. (3) Maternal and neonatal outcomes: 7 cases of pregnant women were rescued successfully, while 2 cases of pregnant women were death. Postoperative heart function classification: 1 case of level Ⅰ, 2 cases of level Ⅱ, 4 cases of level Ⅲ and 2 cases of level Ⅵ. Neonatal survivals were 6 cases including 2case of full-term infants, 4 cases of preterm infants. Stillbirth or neonatal death were 3 cases, which included 2 cases performed caesarean section in second trimester and 1 case of very low weight infant who was given up treatment by family because of severe asphyxia. Followed up periods were from 1 to 7 years with an average time of (2.0±1.6) years. Infants and young children grew and developed well during the period of follow up. The risk is extremely high of pregnancy with infective endocarditis with vegetations. But there is still a way to save the maternal and neonatal life by using a multidisciplinary collaboration formulation and implementation of individualized treatment plan and selecting the appropriate time for heart surgery and the termination of pregnancy.

Who's Afraid of Foucault? History, Theory, and Becoming Subjects

ERIC Educational Resources Information Center

Coloma, Roland Sintos

2011-01-01

This article explores the epistemological innocence of the field of history of education. The author's interrogation of the field's regime of truth and its effects intends to enact what he is conceptualizing as a "self-reflexive historiography," a historiography that attends to the ways in which the field has constituted and turned historians of…

When You Wish upon a Star It Makes a Difference Who You Are: Children's Culture and the Wonderful World of Disney.

ERIC Educational Resources Information Center

Giroux, Henry A.

1995-01-01

The boundaries between entertainment, education, and commercialization collapse through Disney's reach into diverse spheres of everyday life. Disney's "innocence" is a promotional mask covering its aggressive marketing techniques and influence in transforming children into active consumers. Although Disney's films are joyous and…

Beyond Comfort Zones: An Experiment in Medical and Art Education

ERIC Educational Resources Information Center

Auerbach, Kelli; Baruch, Jay M.

2012-01-01

Practicing medicine and creating art are both informed by observation and perception, yet how artists and doctors view the world and their place in it might be quite different. By bringing two populations together--RISD students and Warren Alpert Medical School students--into one experimental course, "No Innocent Eye: Knowledge and…

Group Contagion: The Mailbox Melee

ERIC Educational Resources Information Center

Morse, William C.

2010-01-01

In a group situation, something goes wrong but no individual feels personal responsibility. This is called the "pie" phenomenon because everybody has a piece of the action, but all believe they are innocent. Each contributes to contagion and chaos but all say, "We didn't do nothing." In this article, the author, a pioneer in work with troubled…

Weighing the Cost of Educational Inflation in Undergraduate Medical Education

ERIC Educational Resources Information Center

Cusano, Ronald; Busche, Kevin; Coderre, Sylvain; Woloschuk, Wayne; Chadbolt, Karen; McLaughlin, Kevin

2017-01-01

Despite the fact that the length of medical school training has remained stable for many years, the expectations of graduating medical students (and the schools that train them) continue to increase. In this "Reflection", the authors discuss motives for educational inflation and suggest that these are likely innocent, well-intentioned,…

43 CFR 9239.5-2 - Oil.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF THE INTERIOR TECHNICAL SERVICES (9000) TRESPASS Kinds of Trespass § 9239.5-2 Oil. For oil trespass in a State where there is no State law governing such trespass, the measure of damages will be as follows: (a) Innocent trespass. Value of oil taken, less amount of expense incurred in taking the same. (b...

43 CFR 9239.5-2 - Oil.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF THE INTERIOR TECHNICAL SERVICES (9000) TRESPASS Kinds of Trespass § 9239.5-2 Oil. For oil trespass in a State where there is no State law governing such trespass, the measure of damages will be as follows: (a) Innocent trespass. Value of oil taken, less amount of expense incurred in taking the same. (b...

43 CFR 9239.5-2 - Oil.

Code of Federal Regulations, 2014 CFR

2014-10-01

... OF THE INTERIOR TECHNICAL SERVICES (9000) TRESPASS Kinds of Trespass § 9239.5-2 Oil. For oil trespass in a State where there is no State law governing such trespass, the measure of damages will be as follows: (a) Innocent trespass. Value of oil taken, less amount of expense incurred in taking the same. (b...

43 CFR 9239.5-2 - Oil.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF THE INTERIOR TECHNICAL SERVICES (9000) TRESPASS Kinds of Trespass § 9239.5-2 Oil. For oil trespass in a State where there is no State law governing such trespass, the measure of damages will be as follows: (a) Innocent trespass. Value of oil taken, less amount of expense incurred in taking the same. (b...

Roadside alfalfa: Innocent bystanders or conveyers of genetically-engineered traits?

USDA-ARS?s Scientific Manuscript database

Clumps of alfalfa are a common sight along roads and vacant lots in areas that grow alfalfa for hay or seed. So what role do feral roadside plants play in dispersing transgenes? Is there a risk that transgenic feral plants serve as reservoirs or conduits that might facilitate the movement of transg...

28 CFR 28.23 - Evidence subject to the preservation requirement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim struggled...

28 CFR 28.23 - Evidence subject to the preservation requirement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim struggled...

The Voice of the Innocent: Propaganda and Childhood Testimonies of War

ERIC Educational Resources Information Center

de La Ferrière, Alexis Artaud

2014-01-01

Childhood testimonies have become a familiar component of war reporting and peace advocacy through the publication of children's drawings, oral descriptions of wartime trauma and wartime writing. While such practices have the merit of publicising children's experiences, it is also the case that the selection and distribution of these materials is…

28 CFR 28.23 - Evidence subject to the preservation requirement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim struggled...

28 CFR 28.23 - Evidence subject to the preservation requirement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim struggled...

28 CFR 28.23 - Evidence subject to the preservation requirement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim struggled...

The Changing Experiences of Primary Teachers: Responding to Scenarios Involving Diverse Sexualities

ERIC Educational Resources Information Center

van Leent, Lisa; Ryan, Mary

2016-01-01

Sex education and diverse sexualities are controversial topics within the primary school arena. Concepts of childhood innocence have influenced sex education curriculum, policy development and teaching practices within schools. However, research shows that primary school-aged students are aware of and talk about sexualities. The aim of this…

Contextualising the Sexualisation of Girls Debate: Innocence, Experience and Young Female Sexuality

ERIC Educational Resources Information Center

Kehily, Mary Jane

2012-01-01

This paper aims to contextualise debates on the sexualisation of girls by providing ways of interpreting it from different perspectives--including the perspectives of girls themselves. Asking not "are" girls being prematurely sexualised but "how" can this debate be understood as a feature of time and place and how does it…

How to save lives and reduce injuries : a citizen activist guide to effectively fight drunk driving.

DOT National Transportation Integrated Search

1982-08-01

This guide is designed to teach you the basics of exactly how to get drunk drivers off the roads in enough numbers so that there will, in fact, be significantly fewer innocent people killed and injured where you live. And it only takes one motivated ...

Hypervariable minisatellites: recombinators or innocent bystanders?

PubMed

Jarman, A P; Wells, R A

1989-11-01

It has become apparent in recent years that unexpectedly large numbers of minisatellites exist within the eukaryotic genome. Their use in genetics is well known, but as with any new class of sequence, there is also much speculation about their involvement in a range of biological processes. How much is known of their biology?

Too Calloused to Care: An Experimental Examination of Factors Influencing Youths' Displaced Aggression against Their Peers

ERIC Educational Resources Information Center

Reijntjes, Albert; Kamphuis, Jan H.; Thomaes, Sander; Bushman, Brad J.; Telch, Michael J.

2013-01-01

People often displace their aggression against innocent targets. Notwithstanding the merits of previous research on displaced aggression, critical gaps remain. First, it is unclear whether and how situational and dispositional factors interact to influence displaced aggression. Moreover, it is unclear whether engaging in direct aggression…

Thinking outside Specious Boxes: Constructionist and Post-Structuralist Readings of "Child Sexual Abuse"

ERIC Educational Resources Information Center

Grondin, Anne-Marie

2011-01-01

Contemporary western understandings of "childhood" reflect (adult) cultural projections of children as (sexually) innocent, vulnerable beings. In this paper, I examine how projections of children and their "sexual culture" are maintained and reproduced through child sexual abuse therapy in North America. I argue that such specious frameworks pose…

Bitter Sweets: Mapping Pineapples, Hospitality, and Slavery

ERIC Educational Resources Information Center

Dawson, Julia; Mitchell, Jerry T.

2017-01-01

The objects that represent our material culture--street signs, mascots, symbols etched into stone or printed on stationery--are silent bearers of history: the past tattooed on the present. The meanings given to those objects may change from one social or culture group to another. One seemingly innocent and overlooked example in this vein is the…

Education in Disguise: Sanctioning Sexuality in Elementary School Halloween Celebrations

ERIC Educational Resources Information Center

Boas, Erica Misako

2016-01-01

Halloween as celebrated in US elementary schools provides a rare opportunity to explore the more tangible manifestations of sexuality. A time of celebration, Halloween is perceived as a festive event for children, being both "innocent" and fun. Yet, because it is the one school day where sexuality is on display, sexuality becomes a…

Awareness of Deaf Sign Language and Gang Signs.

ERIC Educational Resources Information Center

Smith, Cynthia; Morgan, Robert L.

There have been increasing incidents of innocent people who use American Sign Language (ASL) or another form of sign language being victimized by gang violence due to misinterpretation of ASL hand formations. ASL is familiar to learners with a variety of disabilities, particularly those in the deaf community. The problem is that gang members have…

"Snapchat," Youth Subjectivities and Sexuality: Disappearing Media and the Discourse of Youth Innocence

ERIC Educational Resources Information Center

Charteris, Jennifer; Gregory, Sue; Masters, Yvonne

2018-01-01

Research on youth subjectivities and disappearing media is still in its infancy. Ephemeral technologies such as Snapchat, Frankly and Wickr offer young people opportunities for discursive agency, harnessing teenage discourses of social positioning. These media facilitate social mobility in teen peer contexts by providing a medium for dynamic and…

Producing Governable Subjects: Images of Childhood Old and New

ERIC Educational Resources Information Center

Smith, Karen

2012-01-01

Conceptions of childhood in terms of "evil" and "innocence" transcend time and culture. These conflicting images are deployed by Chris Jenks as the Dionysian and Apollonian models of childhood to symbolize external and internal forms of control. Drawing on the literature on governmentality this article revisits these models and introduces a…

Wanted: "Real" Children. About Innocence and Nostalgia in a Commodified Childhood

ERIC Educational Resources Information Center

Vanobbergen, Bruno

2004-01-01

Today childhood takes place within a multimedia context where education, marketing and entertainment operate together in one big melting pot. Childhood is commodified, a situation not everybody seems happy with. Due to increasing exposure with violence and sexual activities, for example in children's games, children seem to lose the chance to be…

Child Soldiers and Iconography: Portrayals and (Mis)Representations

ERIC Educational Resources Information Center

Denov, Myriam

2012-01-01

Over the past decade, child soldiers have inundated the popular media. Images of boys armed with AK47s appear ubiquitous, providing a cautionary tale of innocent childhood gone awry. While these representations turn commonly held assumptions of a protected and innocuous childhood on its head, what they conceal is as provocative as what they…

Michigan Sex-Offender Law Has Educators in Uproar

ERIC Educational Resources Information Center

Maxwell, Lesli A.

2006-01-01

This article discusses a new state law which has stirred up a fierce dispute over privacy rights, as innocent school employees in Michigan have begun learning that they have been misidentified as criminals. The Student Safety Initiative, a series of laws that took effect January 1, required Michigan school districts to obtain criminal-background…

The Future World Champions? Ideals for Upbringing Represented in Contemporary European Advertisements

ERIC Educational Resources Information Center

Gram, Malene

2004-01-01

The general European discourse of childhood presents children as innocent and vulnerable, but within this discourse different images of "the perfect child" exist. In this article ideals for upbringing are studied as they are represented in French, German and Dutch printed advertisements for children's products. The sample consists of 290…

Power and the Power Simulation: Then and Now

ERIC Educational Resources Information Center

Bolman, Lee; Deal, Terrence E.

2017-01-01

Lee Bolman and Terrence Deal think of how much has changed since the era of innocence when they first published "A Simple But Powerful Power Simulation"--before the advent of cell phones, personal computers, the Internet, e-mail, Facebook, and Twitter. So much has changed, and yet the fundamentals of human behavior, social interaction,…

26 CFR 1.6015-5 - Time and manner for requesting relief.

Code of Federal Regulations, 2014 CFR

2014-04-01

... equitable relief under § 1.6015-4, a requesting spouse must file Form 8857, “Request for Innocent Spouse Relief” (or other specified form); submit a written statement containing the same information required on Form 8857, which is signed under penalties of perjury; or submit information in the manner prescribed...

26 CFR 1.6015-5 - Time and manner for requesting relief.

Code of Federal Regulations, 2011 CFR

2011-04-01

... equitable relief under § 1.6015-4, a requesting spouse must file Form 8857, “Request for Innocent Spouse Relief” (or other specified form); submit a written statement containing the same information required on Form 8857, which is signed under penalties of perjury; or submit information in the manner prescribed...

Childhood and Travel Literature.

ERIC Educational Resources Information Center

Espey, David

If children are not present in most travel literature--precisely because the genre has most typically been the domain of solitary male travelers who are escaping domestic obligation, routine, the familiar, and the family--they nevertheless are an integral part of the genre. The traveler is in many ways a child, an innocent abroad. Traveler writers…

"Where Do Babies Come from?" Barriers to Early Sexuality Communication between Parents and Young Children

ERIC Educational Resources Information Center

Stone, Nicole; Ingham, Roger; Gibbins, Katie

2013-01-01

"Where do babies come from?" "Why do boys have willies?" "What does gay mean?" Probably all parents have faced such "innocent" questions from young children, and many have found them challenging to answer. Access to sexuality education at an early age is frequently considered controversial; however, there…

The Media and the Terrorist: Not Innocents, but Both Victims.

ERIC Educational Resources Information Center

Dowling, Ralph E.

Government officials, media critics, and the public at large appear to believe that the media "cause" or strongly motivate acts of terrorism. However, analysis using Kenneth Burke's dramatistic method can explain political terrorism without reference to desire for coverage. Terrorism would occur because of its symbolic value even with no…

Redox non-innocence permits catalytic nitrene carbonylation by (dadi)Ti 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 1111111111111111111111111111111111 1111111111111111111111111111111111 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 1111111111111111111111111111111111 1111111111111111111111111111111111 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 0000000000000000000000000000000000 NAd (Ad = adamantyl).

PubMed

Heins, Spencer P; Wolczanski, Peter T; Cundari, Thomas R; MacMillan, Samantha N

2017-05-01

Application of the diamide, diimine {-CHN(1,2-C 6 H 4 )N(2,6- i Pr 2 -C 6 H 3 )} 2 m ((dadi) m ) ligand to titanium provided adducts (dadi)TiL x ( 1 -L x ; L x = THF, PMe 2 Ph, (CNMe) 2 ), which possess the redox formulation [(dadi) 4- ]Ti(iv)L x , and 22 πe - (4 n + 2). Related complexes containing titanium-ligand multiple bonds, (dadi)TiX ( 2 X; X = O, NAd), exhibit a different dadi redox state, [(dadi) 2- ]Ti(iv)X, consistent with 20 πe - (4 n ). The Redox Non-Innocence (RNI) displayed by dadi m impedes binding by CO, and permits catalytic conversion of AdN 3 + CO to AdNCO + N 2 . Kinetics measurements support carbonylation of 2 NAd as the rate determining step. Structural and computational evidence for the observed RNI is provided.

What do potential jurors know about police interrogation techniques and false confessions?

PubMed

Leo, Richard A; Liu, Brittany

2009-01-01

Psychological police interrogation methods in America inevitably involve some level of pressure and persuasion to achieve their goal of eliciting confessions of guilt from custodial suspects. In this article, we surveyed potential jurors about their perceptions of a range of psychological interrogation techniques, the likelihood that such techniques would elicit a true confession from guilty suspects, and the likelihood that such techniques could elicit a false confession from innocent suspects. Participants recognized that these interrogation techniques may be psychologically coercive and may elicit true confessions, but believed that psychologically coercive interrogation techniques are not likely to elicit false confessions. The findings from this survey study indicate that potential jurors believe that false confessions are both counter- intuitive and unlikely, even in response to psychologically coercive interrogation techniques that have been shown to lead to false confessions from the innocent. This study provides empirical support for the idea that expert witnesses may helpfully inform jurors about the social science research on psychologically coercive interrogation methods and how and why such interrogation techniques can lead to false confessions. (c) 2009 John Wiley & Sons, Ltd.

Adult age differences in unconscious transference: source confusion or identity blending?

PubMed

Perfect, Timothy J; Harris, Lucy J

2003-06-01

Eyewitnesses are known often to falsely identify a familiar but innocent bystander when asked to pick out a perpetrator from a lineup. Such unconscious transference errors have been attributed to either identity confusions at encoding or source retrieval errors. Three experiments contrasted younger and older adults in their susceptibility to such misidentifications. Participants saw photographs of perpetrators, then a series of mug shots of innocent bystanders. A week later, they saw lineups containing bystanders (and others containing perpetrators in Experiment 3) and were asked whether any of the perpetrators were present. When younger faces were used as stimuli (Experiments 1 and 3), older adults showed higher rates of transference errors. When older faces were used as stimuli (Experiments 2 and 3), no such age effects in rates of unconscious transference were apparent. In addition, older adults in Experiment 3 showed an own-age bias effect for correct identification of targets. Unconscious transference errors were found to be due to both source retrieval errors and identity confusions, but age-related increases were found only in the latter.

Cognitive-psychology expertise and the calculation of the probability of a wrongful conviction.

PubMed

Rouder, Jeffrey N; Wixted, John T; Christenfeld, Nicholas J S

2018-05-08

Cognitive psychologists are familiar with how their expertise in understanding human perception, memory, and decision-making is applicable to the justice system. They may be less familiar with how their expertise in statistical decision-making and their comfort working in noisy real-world environments is just as applicable. Here we show how this expertise in ideal-observer models may be leveraged to calculate the probability of guilt of Gary Leiterman, a man convicted of murder on the basis of DNA evidence. We show by common probability theory that Leiterman is likely a victim of a tragic contamination event rather than a murderer. Making any calculation of the probability of guilt necessarily relies on subjective assumptions. The conclusion about Leiterman's innocence is not overly sensitive to the assumptions-the probability of innocence remains high for a wide range of reasonable assumptions. We note that cognitive psychologists may be well suited to make these calculations because as working scientists they may be comfortable with the role a reasonable degree of subjectivity plays in analysis.

Technical-scientific investigations to detect the temporal vicissitudes of the funeral monument of Innocent VIII (Giovanbattista Cibo, 1484-1492), compared with that of Sixtus IV (Francesco della Rovere 1471-1484), both made by Antonio del Pollaiolo.

PubMed

Gabrielli, Nazzareno

2018-04-03

The restoration of the funeral monument of Innocent VIII (Giovan-Battista Cibo, 1484-1492) was executed by Sante Guido with the support of the Knights of Columbus. The praiseworthy intervention aimed at restoring the monument from polluting aerodynamic agents has at the same time enabled a careful study of the work regarding, above all, the authenticity of the current coloring in relation to the original presentation intended by Antonio del Pollaiolo. In particular, an attempt has been made to uncover the historical vicissitudes of the work: from its realization to the present restoration. In this regard, I would like to recall that, as reported by Pasquale Rotondi, the restoration of a work is a very special moment in which it is possible to carry out all the studies aimed at understanding the causes which have determined its state of conservation, as well as, of course, its constituent elements and its implementing methods.

Selecting lineup foils in eyewitness identification experiments: experimental control and real-world simulation.

PubMed

Clark, S E; Tunnicliff, J L

2001-06-01

Experimental research on eyewitness identification follows a standard principle of experimental design. Perpetrator-present and perpetrator-absent lineups are constructed with the same foils, so that the two conditions are identical except for the presence or absence ofthe trueperpetrator ofthe crime. However, this aspect of the design simulates conditions that do not correspond to those of real criminal investigations. Specifically, these conditions can create perp-absent lineups in which the foils are selected based on their similarity to an unknown person--the real perpetrator. Analysis of the similarity relations predicts that when foils for perp-absent lineups are selected based on their match to the perpetrator the false identification rate will be lower than if the foils are selected based on their match to the innocent suspect. This prediction was confirmed in an experiment that compared these two perp-absent lineup conditions. These results suggest that false identification rates in previous experiments would have been higher if the foils had been selected based on their match to the innocent suspect, rather than the absent perpetrator.

Robustness of the sequential lineup advantage.

PubMed

Gronlund, Scott D; Carlson, Curt A; Dailey, Sarah B; Goodsell, Charles A

2009-06-01

A growing movement in the United States and around the world involves promoting the advantages of conducting an eyewitness lineup in a sequential manner. We conducted a large study (N = 2,529) that included 24 comparisons of sequential versus simultaneous lineups. A liberal statistical criterion revealed only 2 significant sequential lineup advantages and 3 significant simultaneous advantages. Both sequential advantages occurred when the good photograph of the guilty suspect or either innocent suspect was in the fifth position in the sequential lineup; all 3 simultaneous advantages occurred when the poorer quality photograph of the guilty suspect or either innocent suspect was in the second position. Adjusting the statistical criterion to control for the multiple tests (.05/24) revealed no significant sequential advantages. Moreover, despite finding more conservative overall choosing for the sequential lineup, no support was found for the proposal that a sequential advantage was due to that conservative criterion shift. Unless lineups with particular characteristics predominate in the real world, there appears to be no strong preference for conducting lineups in either a sequential or a simultaneous manner. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

N200 and P300 as orthogonal and integrable indicators of distinct awareness and recognition processes in memory detection.

PubMed

Hu, Xiaoqing; Pornpattananangkul, Narun; Rosenfeld, J Peter

2013-05-01

In an event-related potential (ERP)-based concealed information test (CIT), we investigated the effect of manipulated awareness of concealed information on the ERPs. Participants either committed a mock crime or not (guilty vs. innocent) before the CIT, and received feedback regarding either specific (high awareness) or general (low awareness) task performance during the CIT. We found that awareness and recognition of the crime-relevant information differentially influenced the frontal-central N200 and parietal P300: Probe elicited a larger N200 than irrelevant only when guilty participants were in the high awareness condition, whereas the P300 was mainly responsive to information recognition. No N200-P300 correlation was found, allowing for a combined measure of both yielding the highest detection efficiency in the high awareness group (AUC = .91). Finally, a color-naming Stroop task following the CIT revealed that guilty participants showed larger interference effects than innocent participants, suggesting that the former expended more attentional resources during the CIT. Copyright © 2013 Society for Psychophysiological Research.

[Embolizing aortic valve endocarditis in the differential diagnosis of thrombotic thrombocytopenic purpura].

PubMed

Thomas, M; Heyll, A; Meckenstock, G; Vogt, M; Aul, C

1992-05-08

A 50-year-old man complained of lumbar pains, lack of energy, dysarthria and ataxic gait. Investigation revealed progressive anaemia (haemoglobin initially 10.5 g/dl, later 6.8 g/dl) and thrombocytopenia (initially 67,000/microliters, later 25,000/microliters). In addition he had unexplained pyrexia of up to 39.8 degrees C. Lactate dehydrogenase was 780 U/l and fragmented red cells were noted in the blood film. Because of suspicion of thrombotic thrombocytopenic purpura, treatment with fresh plasma by infusion was immediately initiated. On the third day of treatment he developed left ventricular failure; auscultation revealed a blowing early diastolic murmur over Erb's point together with a spindle-shaped early diastolic murmur over the right second intercostal space. Computed tomography of the skull showed recent haemorrhage into the left half of the cerebellum and an older right posterior infarct. The abdominal ultrasound scan suggested a haemorrhagic spleen infarct. In view of these findings the diagnosis was revised to embolizing aortic endocarditis with aortic reflux (confirmed by colour Doppler echo-cardiography). Aortic valve replacement was performed immediately, and the patient was treated with gentamycin 80 mg/d and teicoplanin 400 mg/d for four weeks. Postoperatively he was given 12 units of platelet concentrate and the platelet count remained stable thereafter (greater than 100,000/microliters). Splenectomy became necessary because the splenic haematoma increased in size during oral anticoagulant therapy. After a 6 week hospital stay the patient was discharged in good condition.

[Acoustic characteristics of adductor spasmodic dysphonia].

PubMed

Yang, Yang; Wang, Li-Ping

2008-06-01

To explore the acoustic characteristics of adductor spasmodic dysphonia. The acoustic characteristics, including acoustic signal of recorded voice, three-dimensional sonogram patterns and subjective assessment of voice, between 10 patients (7 women, 3 men) with adductor spasmodic dysphonia and 10 healthy volunteers (5 women, 5 men), were compared. The main clinical manifestation of adductor spasmodic dysphonia included the disorders of sound quality, rhyme and fluency. It demonstrated the tension dysphonia when reading, acoustic jitter, momentary fluctuation of frequency and volume, voice squeezing, interruption, voice prolongation, and losing normal chime. Among 10 patients, there were 1 mild dysphonia (abnormal syllable number < 25%), 6 moderate dysphonia (abnormal syllable number 25%-49%), 1 severe dysphonia (abnormal syllable number 50%-74%) and 2 extremely severe dysphonia (abnormal syllable number > or = 75%). The average reading time in 10 patients was 49 s, with reading time extension and aphasia area interruption in acoustic signals, whereas the average reading time in health control group was 30 s, without voice interruption. The aphasia ratio averaged 42%. The respective symptom syllable in different patients demonstrated in the three-dimensional sonogram. There were voice onset time prolongation, irregular, interrupted and even absent vowel formants. The consonant of symptom syllables displayed absence or prolongation of friction murmur in the block-friction murmur occasionally. The acoustic characteristics of adductor spasmodic dysphonia is the disorders of sound quality, rhyme and fluency. The three-dimensional sonogram of the symptom syllables show distinctive changes of proportional vowels or consonant phonemes.

The impact of congenital cardiovascular malformations on the assessment and surgical management of infants with cleft lip and/or palate.

PubMed

Harry, Brian L; TeBockhorst, Seth; Deleyiannis, Frederic W-B

2013-05-01

The purpose of this study was to assess the cardiac evaluation of cleft lip and/or palate patients, characterize their cardiovascular malformations, and determine the impact of cardiovascular malformations on surgical management. A single-institution retrospective study of 329 consecutive cleft patients was performed. Cardiovascular malformations were categorized according to involvement of cardiac septa, vasculature, and valves. Their impact on the need for cardiac surgery, timing of cleft repair, need for subacute bacterial endocarditis (SBE) prophylaxis, and the perioperative experience was evaluated. Ten percent (33/329) of cleft patients had a cardiovascular malformation, and 3% underwent cardiac surgery prior to cleft repair. Malformations of the septa, vasculature, and valves were present in 9%, 6%, and 2% of cleft infants, respectively. Murmur as a sign of structural cardiovascular disease was 79% sensitive and 97% specific. Cleft palate repair was delayed by 2 months in patients with a cardiovascular malformation (P = .001). Subacute bacterial endocarditis prophylaxis was recommended, not recommended, or not specified by cardiology in 18%, 33%, and 48% of cleft patients with a cardiovascular malformation, respectively. Postoperative stay and surgical complications were not associated with cardiovascular malformation. Even in the absence of a murmur, echocardiographic screening should be considered in infants with nonspecific signs of cardiovascular disease. Greater awareness of the guidelines for SBE prophylaxis is needed. Most cleft patients with a cardiovascular malformation do not require cardiac surgery and do not experience an increased rate of complications associated with cleft surgery.

Discrete wavelet-aided delineation of PCG signal events via analysis of an area curve length-based decision statistic.

PubMed

Homaeinezhad, M R; Atyabi, S A; Daneshvar, E; Ghaffari, A; Tahmasebi, M

2010-12-01

The aim of this study is to describe a robust unified framework for segmentation of the phonocardiogram (PCG) signal sounds based on the false-alarm probability (FAP) bounded segmentation of a properly calculated detection measure. To this end, first the original PCG signal is appropriately pre-processed and then, a fixed sample size sliding window is moved on the pre-processed signal. In each slid, the area under the excerpted segment is multiplied by its curve-length to generate the Area Curve Length (ACL) metric to be used as the segmentation decision statistic (DS). Afterwards, histogram parameters of the nonlinearly enhanced DS metric are used for regulation of the α-level Neyman-Pearson classifier for FAP-bounded delineation of the PCG events. The proposed method was applied to all 85 records of Nursing Student Heart Sounds database (NSHSDB) including stenosis, insufficiency, regurgitation, gallop, septal defect, split sound, rumble, murmur, clicks, friction rub and snap disorders with different sampling frequencies. Also, the method was applied to the records obtained from an electronic stethoscope board designed for fulfillment of this study in the presence of high-level power-line noise and external disturbing sounds and as the results, no false positive (FP) or false negative (FN) errors were detected. High noise robustness, acceptable detection-segmentation accuracy of PCG events in various cardiac system conditions, and having no parameters dependency to the acquisition sampling frequency can be mentioned as the principal virtues and abilities of the proposed ACL-based PCG events detection-segmentation algorithm.

Combining simulated patients and simulators: pilot study of hybrid simulation in teaching cardiac auscultation.

PubMed

Friederichs, Hendrik; Weissenstein, Anne; Ligges, Sandra; Möller, David; Becker, Jan C; Marschall, Bernhard

2014-12-01

Auscultation torsos are widely used to teach position-dependent heart sounds and murmurs. To provide a more realistic teaching experience, both whole body auscultation mannequins and torsos have been used in clinical examination skills training at the Medical Faculty of the University of Muenster since the winter term of 2008-2009. This training has since been extended by simulated patients, which are normal, healthy subjects who have undergone attachment of the electronic components of the auscultation mannequins to their chests to mimic pathophysiological conditions ("hybrid models"). The acceptance of this new learning method was examined in the present pilot study. In total, 143 students in their second preclinical year who were participating in auscultation training were randomized into an intervention group (hybrid models) and a control group (auscultation mannequins). One hundred forty-two (99.3%) of these students completed a self-assessment Likert-scale questionnaire regarding different teaching approaches (where 1 = "very poor" to 100 = "very good"). The questionnaire focused on the "value of learning" of different teaching approaches. Direct comparison showed that students evaluated the hybrid models to be significantly more effective than the auscultation mannequins (median: 83 vs. 64, P < 0.001). The cardiac auscultation training was generally assessed positively (median: 88). Additionally, verbal feedback was obtained from simulated patients and tutors (trained students who had successfully passed the course a few semesters earlier). Personal feedback showed high satisfaction from student tutors and simulated patients. Hybrid simulators for teaching cardiac auscultation elucidated positive responses from students, tutors, and simulated patients. Copyright © 2014 The American Physiological Society.

Quantification of mitral valve regurgitation in dogs with degenerative mitral valve disease by use of the proximal isovelocity surface area method.

PubMed

Gouni, Vassiliki; Serres, François J; Pouchelon, Jean-Louis; Tissier, Renaud; Lefebvre, Hervé P; Nicolle, Audrey P; Sampedrano, Carolina Carlos; Chetboul, Valérie

2007-08-01

To determine the within-day and between-day variability of regurgitant fraction (RF) assessed by use of the proximal isovelocity surface area (PISA) method in awake dogs with degenerative mitral valve disease (MVD), measure RF in dogs with MVD, and assess the correlation between RF and several clinical and Doppler echocardiographic variables. Prospective study. 6 MVD-affected dogs with no clinical signs and 67 dogs with MVD of differing severity (International Small Animal Cardiac Health Council [ISACHC] classification). The 6 dogs were used to determine the repeatability and reproducibility of the PISA method, and RF was then assessed in 67 dogs of various ISACHC classes. Mitral valve regurgitation was also assessed from the maximum area of regurgitant jet signal-to-left atrium area (ARJ/LAA) ratio determined via color Doppler echocardiographic mapping. Within- and between-day coefficients of variation of RF were 8% and 11%, respectively. Regurgitation fraction was significantly correlated with ISACHC classification and heart murmur grade and was higher in ISACHC class III dogs (mean +/- SD, 72.8 +/- 9.5%) than class II (57.9 +/- 20.1%) or I (40.7 +/- 19.2%) dogs. Regurgitation fraction and left atriumto-aorta ratio, fractional shortening, systolic pulmonary arterial pressure, and ARJ/LAA ratio were significantly correlated. Results suggested that RF is a repeatable and reproducible variable for noninvasive quantitative evaluation of mitral valve regurgitation in awake dogs. Regurgitation fraction also correlated well with disease severity. It appears that this Doppler echocardiographic index may be useful in longitudinal studies of MVD in dogs.

Population differences in dysmorphic features among children with fetal alcohol spectrum disorders.

PubMed

May, Philip A; Gossage, J Phillip; Smith, Matthew; Tabachnick, Barbara G; Robinson, Luther K; Manning, Melanie; Cecanti, Mauro; Jones, Kenneth Lyons; Khaole, Nathaniel; Buckley, David; Kalberg, Wendy O; Trujillo, Phyllis M; Hoyme, H Eugene

2010-05-01

To examine the variation in significant dysmorphic features in children from 3 different populations with the most dysmorphic forms of fetal alcohol spectrum disorders, fetal alcohol syndrome (FAS), and partial fetal alcohol syndrome (PFAS). Advanced multiple regression techniques are used to determine the discriminating physical features in the diagnosis of FAS and PFAS among children from Northern Plains Indian communities, South Africa, and Italy. Within the range of physical features used to identify children with fetal alcohol spectrum disorders, specifically FAS and PFAS, there is some significant variation in salient diagnostic features from one population to the next. Intraclass correlations in diagnostic features between these 3 populations is 0.20, indicating that about 20% of the variability in dysmorphology core features is associated with location and, therefore, specific racial/ethnic population. The highly significant diagnostic indicators present in each population are identified for the full samples of FAS, PFAS, and normals and also among children with FAS only. A multilevel model for these populations combined indicates that these variables predict dysmorphology unambiguously: small palpebral fissures, narrow vermillion, smooth philtrum, flat nasal bridge, and fifth finger clinodactyly. Long philtrum varies substantially as a predictor in the 3 populations. Predictors not significantly related to fetal alcohol spectrum disorders dysmorphology across the 3 populations are centile of height (except in Italy) strabismus, interpupilary distance, intercanthal distance, and heart murmurs. The dysmorphology associated with FAS and PFAS vary across populations, yet a particular array of common features occurs in each population, which permits a consistent diagnosis across populations.

Long-term follow-up after transvenous single coil embolization of patent ductus arteriosus in dogs.

PubMed

Hildebrandt, N; Schneider, C; Schweigl, T; Schneider, M

2010-01-01

Long-term follow-up studies after interventional therapy of patent ductus arteriosus (PDA) in dogs are rare. Transvenous PDA embolization with a single detachable coil is a highly effective method in patients with an angiographically determined PDA≤4.0 mm. Twenty-eight dogs with an angiographic PDA≤4.0 mm were included. Prospective follow-up study after PDA coil embolization. The median follow-up time was 792 days (range, 2-3, 248 days). The rate of complete closure demonstrated by Doppler color flow was 54% at day 3 after intervention and the final cumulative rate was 71%. The rate of complete closure was significantly different between small and moderately sized PDA over the study period (P<.0001) and finally was 100 and 50%, respectively. In 16 dogs with complete closure, no recanalization was found. Disappearance of the continuous heart murmur was found in 89% after 3 days, and this increased to a final cumulative rate of 96%. Indexed left ventricular internal diameter in diastole (LVDd-I) decreased significantly (P<.0001). In the group with moderately sized PDA, a significant difference (P=.0256) was seen in LVDd-I between patients with and without residual shunt after exclusion of patients with persistent severe mitral valve regurgitation. Long-term follow-up after single coil embolization showed complete closure in all small PDA but a residual shunt with mild hemodynamic consequences was present in half of the moderately sized PDA. Copyright © 2010 by the American College of Veterinary Internal Medicine.

Two congenital coronary abnormalities affecting heart function: anomalous origin of the left coronary artery from the pulmonary artery and congenital left main coronary artery atresia.

PubMed

Xiao, Yanyan; Jin, Mei; Han, Ling; Ding, Wenhong; Zheng, Jianyong; Sun, Chufan; Lyu, Zhenyu

2014-01-01

The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) and congenital left main coronary artery atresia (CLMCA-A) are two kinds of very rare coronary heart diseases which affect heart function profoundly. This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients. From April 1984 to July 2012, in Beijing Anzhen Hospital, 23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A. We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation, diagnosis, and treatments of these two kinds of congenital coronary abnormalities. The 23 patients (13 males and 10 females, aged ranging from 2.5 months to 65 years) identified with ALCAPA were classified into infantile type (age of onset younger than 12 months, 16 cases) and adult type (age of onset older than 12 months, 7 cases). Four patients were diagnosed with CLMCA-A (three males and one female, aged ranging from 3 months to 2 years). The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection, heart failure, dyspnea, feeding intolerance, diaphoresis, and failure to thrive. And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis, dilated cardiomyopathy, and acute myocardial infarction. As for the adult-type ALCAPA, cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease, myocarditis, or patent ductus arteriosus. In ECG examination: Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I, avL, and V4-V6, especially in lead avL. However, ECG of adult-type ALCAPA lacked distinct features. In chest radiography: pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A, while pulmonary artery segment dilation was more common in adult type. In echocardiography, the common features of infantile-type ALCAPA and CLMCA-A included left ventricular enlargement, left ventricular systolic function normal or mildly reduced in CLMCA-A or significantly reduced in ALCAPA, and moderate to large mitral valve. It was performed in 9 of 23 cases of ALCAPA and showed the origin of the dilated right coronary artery (RCA) from the right sinus of the aortic root and absence of LCA origin in angiography. After opacification of RCA, reverse flow in the LCA and pulmonary artery was visualized through coronary artery collateral circulation. Angio was performed in three of the four cases of CLMCA-A and showed left main coronary artery was a blind end, with diameter of only 1.1-2.0 mm. Treatment and prognosis: 21 patients with ALCAPA had cardiac surgery and 6 of them died postoperatively. Fifteen postoperative patients survived without overt symptoms within the follow-up period of 6-166 months (median 17 months). As for treatment of CLMCA-A, four patients took digoxin and diuretics without undergoing cardiac surgery. Their clinical symptoms improved during the close follow-ups. ALCAPA and CLMCA-A are two rare coronary artery abnormalities that affect cardiac function in infants and children. In younger patients with cardiomegaly and heart dysfunction these two congenital coronary diseases should be noticed.

The Fourth R-Revolvers: Principal Perceptions Related to Armed School Personnel and Related Legal Issues

ERIC Educational Resources Information Center

Weiler, Spencer C.; Armenta, Anthony D.

2014-01-01

The United States has experienced several mass killings by firearms in the recent past, but none has stirred the passions of the nation's citizens like the killing of innocent schoolchildren in Newtown, Connecticut. Debates immediately began regarding proposed solutions for making students safer in schools. One recommendation for promoting…

Simple Tips for Helping Students Become Safer, Smarter Social Media Users

ERIC Educational Resources Information Center

Agosto, Denise E.; Abbas, June

2016-01-01

In thinking about teens and online risks, school librarians need to know researchers generally agree that, despite the popular image of pedophiles and criminals lurking online waiting to harm innocent young people, in reality social media use is only about as risky as most everyday social interactions in the offline world (Agosto and Abbas 2013).…

First Battle of Manassas: An End to Innocence. Teaching with Historic Places.

ERIC Educational Resources Information Center

Litterst, Michael

This lesson is based on the National Register of Historic Places registration file, "Manassas National Battlefield Park" and other sources. The lesson could be used in units on the Civil War. Students strengthen their skills of observation and interpretation in the study of history and geography and gain practice in analyzing primary…

Family Support Programs and Incarcerated Parents: Overview of Family Support Programs.

ERIC Educational Resources Information Center

Family Resource Coalition, Chicago, IL.

This fact sheet begins with an overview of family support programs, which includes a discussion of the premises of family support programs and a list of typical program components. The remainder of the fact sheet focuses on support programs for incarcerated parents. The children of incarcerated parents, though innocent of any crime, are often…

Digitizing a Heritage of Faded Memories: A Case Study on Extending Historical Research Capabilities

ERIC Educational Resources Information Center

Branting, Steven D.

2009-01-01

A historical fact is like a fata morgana, "always less than what really happened." Even consensus does not establish truth; otherwise history is merely the version of the past that people agree to accept. The students who participated in the acclaimed 5th Street Cemetery Necrogeographical Study innocently found themselves clashing with…

The Elephant in the Classroom

ERIC Educational Resources Information Center

Brezicki, Colin G.

2012-01-01

For high school teachers these are enigmatic times. Teachers want to prepare students for life in the real world, but balk at teaching them the truth of that world. The recent publication of a corrected "Huckleberry Finn," which replaced the word nigger with slave, touched a nerve. Is the point to safeguard the innocent or to make us feel we are…

Intrafamilial Conflict and Emotional Well-Being: A Population Based Study among Icelandic Adolescents

ERIC Educational Resources Information Center

Gunnlaugsson, Geir; Kristjansson, Alfgeir Logi; Einarsdottir, Jonina; Sigfusdottir, Inga Dora

2011-01-01

Objectives: During intrafamilial conflicts children are often innocent bystanders, caught in the crossfire. In such situations, they are at increased risk to become directly involved in abusive verbal behavior of the perpetrator, and exposed to being shouted or yelled at, threatened, rejected and even physically abused. The present study has two…

The Loss of Innocence: Emotional Costs to Serving as Gatekeepers to the Counseling Profession

ERIC Educational Resources Information Center

Kerl, Stella; Eichler, Margaret

2005-01-01

The practice of gatekeeping within the profession of counseling is well documented in the literature. Counselor educators are charged with the responsibility of serving as gatekeepers for the profession. However, a number of factors inhibit the practice of gatekeeping, including fears of retribution, loss, or damage. At the same time, failure to…

The Speeding Car Design Challenge

ERIC Educational Resources Information Center

Roman, Harry T.

2009-01-01

All too often, one reads about high-speed police chases in pursuit of stolen cars that result in death and injury to people and innocent bystanders. Isn't there another way to accomplish the apprehension of the thieves that does not put people at such great risk? This article presents a classroom challenge to use technology to remotely shutdown…

Decisional Bias as Implicit Moral Judgment

ERIC Educational Resources Information Center

Spring, Toni; Saltzstein, Herbert D.

2017-01-01

Decisional bias (false alarm rate) when judging the guilt/innocence of a suspect is offered as an implicit measure of moral judgment. Combining two data sets, 215 participants, ages 10-12, 13-15, and 16-18 watched the visually identical film involving a person setting a fire, framed either as (1) intentional but not resulting in a fire (BI-NF),…

The Metaphorical Use of Vampire Films in Counseling

ERIC Educational Resources Information Center

Priester, Paul E.

2008-01-01

This article presents the movie "Interview With the Vampire" as an adjunctive resource in counseling. The themes of power, justification of violence, and transformation from innocence to maturity are particularly powerful for adolescent girls. A case study of a 13-year-old girl is presented as an example of how to use a specific film, "Interview…

Disciplining the Practice of Creative Inquiry: The Suppression of Difference in Teacher Education

ERIC Educational Resources Information Center

Edwards, Gail; Blake, Anthony

2007-01-01

In this paper we suggest that the pursuit of ahistorical, universal truths in education is antithetical to creativity, learning and motivation in preservice teachers. We argue that learning to teach is a dynamic process embedded in networks of power in which educational truths are politically "accomplished" rather than innocently discovered. We…

"Kinder than the Dickens": Thoughts on Forgiveness

ERIC Educational Resources Information Center

Showalter, Shirley H.

2007-01-01

The school shootings of October 2006 arrested the world's attention. The contrast of innocence and violence, the mystery of the shooters' motivations, the fact that there were five school shooting in six weeks--all of these were factors, but none can compare to the strength of the families who chose to forgive and their witness under fire. Through…

On the Hegemony of Technical Rationality and the Importance of Distinctions

ERIC Educational Resources Information Center

Varkoy, Oivind

2017-01-01

The point of departure in this article is the hegemony of technical rationality when it comes to the justification of music education. This is considered as an example of uniformity, sameness, and homogeneity, or worse, simplicity and naivety--or even worse, a sweet innocence--regarding understanding and thoughts about life, society, and culture…

Spare the Rod and Save the Child: Observations and Some Positive Recommendations on Child Abuse.

ERIC Educational Resources Information Center

Cass, Elie

1979-01-01

Parents have the right to their children, but their children have a right to live. The Criminal Code should be amended to oblige parents to prove their innocence. If the Crown can establish that the child was beaten when only parents were present, parents should prove they were not responsible. (Author)

A Counter-Intuitive Strategy: Reduce Student Stress by Teaching Current Events

ERIC Educational Resources Information Center

Passe, Jeff

2008-01-01

Should elementary school students be introduced to disturbing current events topics? A common response would be to protect the innocence of young children, allowing them to live their lives relatively free of the troubles that beset the world. But closer examination reveals that the study of current events actually helps to reduce fear and worry.…

Backloading in the Sequential Lineup Prevents Within-Lineup Criterion Shifts that Undermine Eyewitness Identification Performance

ERIC Educational Resources Information Center

Horry, Ruth; Palmer, Matthew A.; Brewer, Neil

2012-01-01

Although the sequential lineup has been proposed as a means of protecting innocent suspects from mistaken identification, little is known about the importance of various aspects of the procedure. One potentially important detail is that witnesses should not know how many people are in the lineup. This is sometimes achieved by…

Lineup Composition, Suspect Position, and the Sequential Lineup Advantage

ERIC Educational Resources Information Center

Carlson, Curt A.; Gronlund, Scott D.; Clark, Steven E.

2008-01-01

N. M. Steblay, J. Dysart, S. Fulero, and R. C. L. Lindsay (2001) argued that sequential lineups reduce the likelihood of mistaken eyewitness identification. Experiment 1 replicated the design of R. C. L. Lindsay and G. L. Wells (1985), the first study to show the sequential lineup advantage. However, the innocent suspect was chosen at a lower rate…

The Role of Experience and Contact in the Recognition of Faces of Own- and Other-Race Persons.

ERIC Educational Resources Information Center

Brigham, John C.; Malpass, Roy S.

1985-01-01

Reviews research which has demonstrated an own-race bias in recognition accuracy. Analyzes the impact of differential recognition on the criminal justice system, focusing on the construction of fair lineups and the likelihood of misidentification of innocent persons. Evaluates several explanations to account for this bias and relates findings to…

FIRE! A Red Flag Tap in Reclaiming Intervention

ERIC Educational Resources Information Center

Bodnar, Brian

2007-01-01

"Red Flag Interventions" address problems which are imported from elsewhere and acted out towards persons who are in effect innocent bystanders. This is commonly seen as students "carry in" problems from the home or street to school, or they "carry over" conflicts from one class to the next. A third variation of Red Flag intervention is when a…

A Bully's Bystanders Are Never Innocent

ERIC Educational Resources Information Center

Coloroso, Barbara

2005-01-01

Though they play the least active role, bystanders are a critical element in bullying. With peers looking on and providing at least tacit support, the bully is no longer acting alone. The bystanders have become allies to the point of magnifying the supposed negative attributes of the target. If the bullying cycle is to be broken, the role of the…

Bystanders not so innocent after all.

PubMed

Batten, Marcel; Ghilardi, Nico

2012-06-29

Interleukin 27 (IL-27) regulates immune responses, including T helper 17 (Th17) cell activity. In this issue of Immunity, Hirahara et al. (2012) demonstrate that IL-27 suppresses Th17 cells in trans through induction of the inhibitory ligand PD-L1 on bystander T cells. Copyright © 2012 Elsevier Inc. All rights reserved.

Rescuing the Soiled Dove: Pop Culture's Influence on a Historical Narrative of Prostitution

ERIC Educational Resources Information Center

Voelkel, Micki; Henehan, Shelli

2018-01-01

American popular culture romanticises relationships between sex workers and their customers; novels, films and television depict prostitutes as innocents in need of rescue by a wealthy or powerful man. Miss Laura's Social Club, a restored Victorian brothel in Fort Smith, Arkansas, USA, functions both as an informal house museum and the visitor…

The Hero's Journey: How Educators Can Transform Schools and Improve Learning.

ERIC Educational Resources Information Center

Brown, John L.; Moffett, Cerylle A.

This book's central theme is that shared vision, purpose, and inquiry, combined with the use of the collective wisdom of myth, legend, and metaphor, can transform a school. The book profiles six phases of the mythic hero's journey from unconscious innocence to ultimate self-awareness. The text is divided into eight chapters. Chapter 1 summarizes…

Resisting Dark Chocolate: A Journey through Racial Identity and Deficit Thinking: A Case Study and Solutions

ERIC Educational Resources Information Center

Trotman Scott, Michelle

2014-01-01

Research indicates that Black children with darker complexions experience more difficulty being accepted by Whites and their Black peers; and they are believed to be less intelligent than White and lighter complexion Black students. It also reveals that the innocence young children have regarding differences between themselves and others do not…