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Objective: In the field of thoracoabdominal aortic aneurysm (TAAA) open surgical repair (OSR), some preoperative characteristics are established risk factors for adverse outcomes, whereas others are supposed to be relevant, but their role still need to be defined; among them, the presence of "shaggy aorta" (SA), an extensive and irregular atheroma within the aorta. The aim of this study is to report the results of a single-center large cohort of patients treated with OSR for TAAA with SA, comparing the outcomes with patients affected by TAAA without SA, and analyzing the impact of the scores for SA on the outcomes., Methods: All consecutive patients receiving OSR for TAAA between 2012 and 2021 were retrospectively analyzed. Clinical data from patients with degenerative TAAA were included and analyzed for preoperative characteristics and postoperative outcomes; patients with ruptured TAAA, and patients with aortic dissection were excluded from the analysis. Patients with degenerative aortic aneurysm, thrombus measurement in non-aneurysmal aortic segments (≤40 mm), atheroma thickness ≥5 mm, and finger-like thrombus projection were included in the SA group, whereas the others were included in the non-shaggy aorta group (NSA group). The SA group and NSA group were compared using a propensity-matched comparison. Preoperative computed tomography scans of patients in the SA group were also stratified according to SA grading scores., Results: A total of 58 patients with SA were identified (male, n = 43 [74.1%], mean age 70.1 ± 7.8 years) among 497 patients with TAAA treated with open surgical repair. After propensity matching, there were 57 patients in the SA group and 57 in the NSA group with correction of all differences in baseline characteristics. Patients in the SA group presented significantly higher in-hospital mortality (SA group, 14.0% vs NSA group, 3.5%; P = .047), postoperative acute renal failure (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease [RIFLE], 3-5) (SA group, 21.1% vs NSA group, 5.3%; P = .013), and postoperative embolization (SA group, 28.1% vs NSA group, 8.8%; P = .008). Spinal cord ischemia and stroke rate were not significantly influenced by the presence of SA. In the SA group, 16 patients (27.6%) with end-organ embolization were compared with 42 patients (72.4%) without a documented embolization considering the grade of aortic "shagginess" and no significant difference was identified (P = .546)., Conclusions: Despite a better knowledge of the SA disease, new classifications, and intraoperative adjuncts, TAAA patients with SA treated with OSR have worse postoperative outcomes if compared with patients without SA. The presence of SA is a risk factor itself, whereas the grade of "shagginess" seems not to impact on postoperative outcomes., (Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

A staged endovascular strategy was used to treat the aneurysmal evolution of the aortic island including intercostal arteries reimplanted in a loop-graft, following thoraco-abdominal aortic open repair in a young patient diagnosed with Marfan syndrome. First, selective coil embolization of patent intercostal arteries was performed in 2 separate sessions, to minimize the risk of spinal cord ischaemia. Then, the aneurysm was successfully excluded occluding the loop graft with 2 PTFE-membrane vascular plugs., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Integrating people's values and perceptions into planning is essential for the successful management of natural resources. However, successful implementation of natural resources management decisions on the ground is a complex task, which requires a comprehensive understanding of a system's social and ecological linkages. This paper investigates the relationship between sense of place and people's attitudes towards their natural environment. Sense of place contributes towards shaping peoples' beliefs, values and commitments. Here, we set out to explore how these theoretical contributions can be operationalized for natural resources management planning in the Great Barrier Reef region of Australia. We hypothesise that the region's diverse range of natural resources, conservation values and management pressures might be reflected in people's attachment to place. To tests this proposition, variables capturing socio-demographics, personal wellbeing and a potential for sense of place were collected via mail-out survey of 372 residents of the region, and tested for relationships using multivariate regression and redundancy orientation analyses. Results indicate that place of residence within the region, involvement in community activities, country of birth and the length of time respondents lived in the region are important determinants of the values assigned to factors related to the natural environment. This type of information is readily available from National Census and thus could be incorporated into the planning of community engagement strategies early in the natural resources management planning process. A better understanding of the characteristics that allow sense of place meanings to develop can facilitate a better understanding of people's perceptions towards environmental and biodiversity issues. We suggest that the insights gained from this study can benefit environmental decision making and planning in the Great Barrier Reef region; and that sense of place is a concept worthy of further investigation elsewhere., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The acquisition of cognitive, sensory-motor and social emotional functions depend on a proper development of the Central Nervous System (CNS). This set of functions, known as intelligence, allows a better adaptation to the environment. In the last decades, an increase in the average of intelligence has been reported. However, such an increase cannot be observed in an equivalent way in economically and social underprivileged regions. Children from those regions are in great risk of being affected by mental retardation or impaired cognitive development. In later life they will, probably, be unable to transform and improve themselves and their communities, perpetuating the poverty of the region. Therefore, knowledge of factors involved in CNS development is a matter of health closely related to social improvement. Malnutrition throughout pregnancy and breastfeeding is clearly identifiable as a cause of damage in CNS development. Vitamin B1 (Thiamine) is a micronutrient important to the growth and maturity of the CNS. Thiamine shortcoming may affect 50% of pregnant women. Thiamine function in cerebral development is still not well known. There is a gap in the literature regarding systematical research about the blood thiamine concentration throughout the periods of gestation and breastfeeding. These studies are relevant in populations with a high level of nutritional vulnerability, because in a follow up offspring cognitive exam they could reveal if the maternal thiamine deficiency is related to child CNS impairment. This paper introduce the hypothesis that thiamine shortcoming during pregnancy and breastfeeding is directly related to cognitive impairment of child. Data about the neurophysiological role of thiamine, consequences of its shortcoming in experimental models, populations under the risk of thiamine shortcoming are presented. The hypothesis that maternal thiamine shortcoming causes damage related to child cognitive development needs to be considered. Thus, thiamine shortcoming during gestation and breastfeeding and its effects on children must be studied in many populations in order to know the magnitude of the problem and to indicate actions to overcome it., (Copyright © 2012. Published by Elsevier Ltd.)

The Great Barrier Reef (GBR) provides a globally significant demonstration of the effectiveness of large-scale networks of marine reserves in contributing to integrated, adaptive management. Comprehensive review of available evidence shows major, rapid benefits of no-take areas for targeted fish and sharks, in both reef and nonreef habitats, with potential benefits for fisheries as well as biodiversity conservation. Large, mobile species like sharks benefit less than smaller, site-attached fish. Critically, reserves also appear to benefit overall ecosystem health and resilience: outbreaks of coral-eating, crown-of-thorns starfish appear less frequent on no-take reefs, which consequently have higher abundance of coral, the very foundation of reef ecosystems. Effective marine reserves require regular review of compliance: fish abundances in no-entry zones suggest that even no-take zones may be significantly depleted due to poaching. Spatial analyses comparing zoning with seabed biodiversity or dugong distributions illustrate significant benefits from application of best-practice conservation principles in data-poor situations. Increases in the marine reserve network in 2004 affected fishers, but preliminary economic analysis suggests considerable net benefits, in terms of protecting environmental and tourism values. Relative to the revenue generated by reef tourism, current expenditure on protection is minor. Recent implementation of an Outlook Report provides regular, formal review of environmental condition and management and links to policy responses, key aspects of adaptive management. Given the major threat posed by climate change, the expanded network of marine reserves provides a critical and cost-effective contribution to enhancing the resilience of the Great Barrier Reef.

Background: It has not been determined whether biochemical or psychological variables predict clinical response and toxicity to Li(+) treatment., Methods: From 30 Li(+)-treated bipolar patients, we measured biochemical variables in red blood cells (RBCs) that encompassed the cell membrane abnormality and the Li(+)/Mg(2+) competition mechanism. Psychiatric measures of depression, mania, and side effects of Li(+) toxicity were correlated with these biochemical variables. Physician classification of Li(+) response and toxicity for each patient were used for determining whether significant differences in biochemical variables and psychiatric measures existed between full and partial responders, and as well as toxic and non-toxic Li(+)-treated bipolar patients., Results: Serum [Li(+)] ([Li(+)]e), the ratio of intracellular RBC to serum Li(+), [Li(+)]i/[Li(+)]e, and phosphatidylcholine shared moderate proportions of variance (10-15%) with several of the psychiatric measures. Physician assessment of full response was predicted by higher levels of [Li(+)]e and lower scores on the Hamilton Slowing subscale (95.6% accuracy), whereas higher lithium-binding constants and higher Hamilton total scores perfectly predicted physician classification of partial response. Higher scores on Hamilton Slowing subscale and General Side Effects (GSE) scale were strongly predictive of physician classified Li(+) toxicity (80% accuracy), whereas lower levels of [Li(+)]e and lower scores on the Hamilton Symptom Severity subscale perfectly predicted physician rated non-toxicity in these patients., Conclusions: We found distinct [Li(+)]e levels that predict response and/or toxicity. Specifically, when [Li(+)]e was in the range of 0.93-1.42 mM, full response without toxicity was predicted; higher values predicted toxicity; lower values predicted partial response.

Although lithium salts have been used in the treatment and prophylaxis of manic-depressive or bipolar patients for 50 years, the mechanism of the pharmacologic action of Li+ is unknown. Based on activity studies of inhibitory and stimulatory guanine-binding (G) proteins in rat cortical membranes, it was proposed that Li+ inhibition of G-proteins may account for its pharmacologic action. We used the purified alpha subunit of the recombinant inhibitory G-protein, rGialpha1, and found that Li+ at therapeutic levels significantly inhibited the formation of the GDP.AlF4-.rGialpha1 complex. Because our studies were conducted with a purified, metal-reconstituted G-protein rather than with cell membrane suspensions, our Li+ inhibition results lend additional support to the G-protein hypothesis for Li+ action.

Authors focused the undergraduate education at the College of Nursing, University of São Paulo at Ribeirão Preto Campus, through its historical and conceptual mark since its establishment in the 1950's. In the 1980's, a study of curriculum modification originated from a wide process of discussion, culminated in a proposal of formation of generalized nurses and the introduction of a new curriculum in 1989. According to authors' version, the prospectives to nursing education depend on the schools' reflection about the University's role in the reorientation of health services and formation of students aiming at political, scientific and technical competence to actuate at different levels of community health assistance. A new educational model will require a curriculum reorientation and the insertion of schools in the health services as a strategic component of the integration of education with professional practice.

An exploratory study of the research carried out by nurses belonging to the Brazilian Nursing Association from 1985 to 1988 was conducted with following objectives: to analyze the characteristics of the scientific production of nurses; to identify the forms of dissemination of these studies, and to determine the expectations of nurses with respect to the Center of Nursing Studies and Research "Centro de Estudos e Pesquisas em Enfermagem" (CEPEn). Scientific papers, reports of experience, theses and monographs predominated in the production identified. The forms of dissemination most frequently mentioned were scientific events and publication in Brazilian journals. The suggestions presented to CEPEn point at the need of promoting events, courses, research meetings, research dissemination and consulting on projects.

A systematic NMR characterization of various Dy(III) complexes of linear and macrocyclic aminophosphonates as 7Li and 23Na NMR shift reagents for biological systems was undertaken. Their efficacy as shift reagents (SR) was tested under constant aqueous solution ionic strength conditions at pH 7.5 as a function of rho = [SR]/[M+]. Further characterization of the two best SRs, Dy(PcPcP)2(7-) and Dy(DOTP)5-, led to the conclusion that, although quite sensitive to solution pH and the presence of alkali metal ions and Mg2+ and Ca2+, these complexes were stable towards hydrolysis by phosphatases. The lack of precipitation of its solutions in the presence of Ca2+, allowed the choice of Dy(DOTP)5- as the best overall SR for biological studies. Other SRs, like Dy(TTHA)3-, although less sensitive to pH and to divalent ions, require significantly higher concentrations to yield the same shifts, leading to large bulk susceptibility artifacts in perfused tissues and organs.

The present study makes a bibliographic review about the alimentary hygiene of children in the neonatal period. It describes the advantages of maternal milk by attending the basic principles that should govern the children's feeding, the importance of free scheme breast-feeding to emotional development, as well as ventral and right side-lying position and belching to the prevention of accidents.

We have investigated the influence of Li+ on free intracellular Mg2+ concentration in human erythrocytes by 31P NMR and optical absorbance spectroscopies. In red cells loaded with 3 mM intracellular Li+, the chemical shift separation between the alpha- and beta-phosphate resonances of MgATP2- was approx. 0.9 ppm larger than that observed in Li+-free red cells. By analyzing the interaction of each red cell component with Mg2+ and Li+, we found that Mg2+ is displaced in part from MgATP2- upon addition of Li+ and that the released Mg2+ is bound to the red cell membrane causing an overall decrease in free intracellular Mg2+ concentration.