Turning points for perpetrators of intimate partner violence

Understanding why and how perpetrators of intimate partner violence (IPV) change their behavior is an important goal for both policy development and clinical practice. In this study, the authors investigated the concept of "turning points" for perpetrators of IPV by conducting a systematic review of qualitative studies that investigated the factors, situations, and attitudes that facilitated perpetrators' decisions to change their abusive behavior. Two literature databases were searched and six studies were found that met the inclusion criteria for the systematic review. Most included participants from batterer intervention programs (BIPs). The data indicate that community, group, and individual processes all contribute to perpetrators' turning points and behavioral change. These include identifying key incidents that precede change, taking responsibility for past behavior, learning new skills, and developing relationships within and outside of the BIP. By using a qualitative systematic review, the authors were able to generate a more complete understanding of the catalysts for and process of change in these individuals. Further research, combining quantitative and qualitative approaches, will be helpful in the modification of existing BIPs and the development of new interventions to reduce IPV.     

Neurodevelopmental outcome in high-risk preterm infants treated with inhaled nitric oxide

Inhaled nitric oxide (iNO) is used to treat preterm infants with hypoxaemic respiratory failure. In this study we describe the long-term survival and neurodevelopmental status of high-risk preterm infants enrolled into a randomized controlled trial of iNO therapy. Information regarding long-term outcome was available for all 25 children enrolled in the original trial who survived until discharge from hospital. Formal, blinded, developmental assessment and neurological examinations were performed in 21 out of 22 children still alive at 30 mo of age, corrected for prematurity. No significant differences were found in long-term mortality (12/20 vs 8/22, RR 1.65, 95% CI 0.87-3.3), neurodevelopmental delay (4/7 vs 9/14, RR 0.89, 95% CI 0.37-1.75), severe neurodisability (0/7 vs 5/14, p = 0.12) or cerebral palsy (0/7 vs 2/14, p = 0.53) between iNO-treated and control infants. CONCLUSION: In this study there was no evidence of a significant effect on either survival or long-term neurodevelopmental status in infants treated with iNO.     

杂交技术在法洛四联症中的应用

目的:总结杂交技术镶嵌治疗儿童法洛四联症(TOF)的经验。方法:外科术前介入治疗:3例有巨大体肺侧支(APCAs)的重症TOF在根治术前予以侧支血管堵塞术。外科术后镶嵌治疗:6例TOF根治术后残余分流,其中4例残余膜周部室间隔缺损,1例残余左室右房通道室间隔缺损,1例残余房间隔缺损,分别予以经导管残余心脏缺损封堵术。结果:3例有巨大APCAs的重症TOF在根治术前予以侧支血管堵塞术后随即进行外科手术,皆获得满意效果。6例TOF根治术后残余分流者行经导管封堵术封堵成功,随访无残余分流及心脏瓣膜异常,未出现心律失常。结论:杂交技术镶嵌治疗伴有巨大APCAs及术后存在残余分流的TOF安全、有效。     

Electric field and stimulating influence generated by deep brain stimulation of the subthalamic nucleus.

OBJECTIVE: The goal of this project was to develop a quantitative understanding of the volume of axonal tissue directly activated by deep brain stimulation (DBS) of the subthalamic nucleus (STN). METHODS: The 3-dimensionally inhomogeneous and anisotropic tissue medium surrounding DBS electrodes complicates our understanding of the electric field and tissue response generated by the stimulation. We developed finite element computer models to address the effects of DBS in a homogeneous isotropic medium, and a medium with tissue conductivity properties derived from human diffusion tensor magnetic resonance data. The second difference of the potential distribution generated in the tissue medium was used as a predictor of the volume of tissue supra-threshold for axonal activation. RESULTS: The model predicts that clinically effective stimulation parameters (-3 V; 0.1 ms; 150 Hz) result in activation of large diameter (5.7 microm) myelinated axons over a volume that spreads outside the borders of the STN. The shape of the activation volume was dependent on the strong dorsal-ventral anisotropy of the internal capsule, and the moderate anterior-posterior anisotropy of the region around zona incerta. CONCLUSIONS: Small deviations ( approximately 1 mm) in the electrode position within STN can substantially alter the shape of the activation volume as well as its spread to neighboring structures. SIGNIFICANCE: STN DBS represents an effective treatment for medically refractory movement disorders such as Parkinson's disease. However, stimulation induced side effects such as tetanic muscle contraction, speech disturbance and ocular deviation are not uncommon. Quantitative characterization of the spread of stimulation will aid in the development of techniques to maximize the efficacy of DBS.     

Multiresolution wavelet analysis of the body surface ECG before and after angioplasty

Electrocardiographic recordings of patients with coronary artery stenosis, made before and after angioplasty, were analyzed by the multiresolution wavelet transform (MRWT) technique. The MRWT decomposes the signal of interest into its coarse and detail components at successively finer scales. MRWT was carried out on different leads in order to compare the P-QRS-T complex from recordings made before with those made after percutaneous transluminal coronary angioplasty (PTCA). ECG signals before and after successful PTCA procedures show distinctive changes at certain scales, thus helping to identify whether the procedure has been successful. In six patients who underwent right coronary artery PTCA, varying levels of reperfusion were achieved, and the changes in the detail components of ECG were shown to correlate with the successful reperfusion. The detail components at scales 5 and 6, corresponding approximately to the frequencies in the range of 2.3–8.3 Hz, are shown to be the most sensitive to ischemia-reperfusion changes (p<0.05). The same conclusion was reached by synthesizing the post-PTCA signals from pre-PTCA signals with the help of these detail components. For on-line monitoring a vector plot, analogous to vector cardiogram, of the two most sensitive MRWT detail components is proposed. Thus, multiresolution analysis of ECG may be useful as a monitoring and diagnostic tool during angioplasty procedures.     

Electrical stimulation of cardiac myocytes

The influence of nonuniform cell shape and field orientation on the field stimulation thresholds of cardiac myocytes was studied both experimentally and computationally. The percent change in excitation threshold, which was studied with patch clamp technique, was found to be 182±83.1% (mean ±SD) higher when the electric field (EF) was parallel to the transverse cell axisversus the longitudinal axis (p<0.0006). On reversing the polarity of the applied EF, the percentage change in threshold was observed to increase by 98.9±71.0% (p<0.0002), implying asymmetry of the stimulation threshold of isolated myocytes. Finite element models were made to investigate the distribution of the transmembrane potential of these experimentally studied myocytes. A typical cell model showed that the maximum transmembrane potential induced on opposite ends of the cell was 39.1 mV and −46.5 mV for longitudinal field (aligned with the long axis of the cell), but was 40.5 mV and −44.8 mV for transverse field (aligned with the short axis of the cell). More significantly, it was found that the maximum transmembrane potential occurred at discrete points or “hot spots” on the cell membrane. It is hypothesized that the depolarization of the cell initiates at the hot spot and then spreads over the entire cell. The different excitation thresholds for different polarities of the applied EF can be explained by the different maximum induced at the opposite ends of the cell.     

Investigation of the effects of ischemic preconditioning on the HRV response to transient global ischemia using linear and nonlinear methods

Ischemic preconditioning (IP) has been used as a strategy to prevent cell death in various organs, including the brain and the heart. Investigation of the effects of ischemic preconditioning mostly employed models with reduced complexity, such as cell cultures, tissue slices or perfused organ preparations. Although such models can provide valuable insight into the protective mechanism of preconditioning, the functional (re)organization of the control mechanisms at the level of the living organism cannot be assessed. The purpose of the present animal model study was to evaluate the effect of global ischemic preconditioning on the heart rate variability (HRV) response to the asphyxia insult. The data consisted of 4 h RR interval measurements recorded in five preconditioned and five non-preconditioned Wistar rats. Using linear (time and frequency domain) and nonlinear (approximate entropy and parameters of Poincare plots) measures, we evaluated the dynamic time course of the HRV response to the asphyxia insult and the effect of preconditioning on the autonomic neurocardiac control. Both the linear and nonlinear parameters indicate a faster recovery of the baseline HRV corresponding to the preconditioned groups, though only the spectral analysis identifies a statistically significant difference between the two groups. For the preconditioned group, at about 90 min after the asphyxic insult, the autonomic neural balance (measured by LF/HF ratio) appears fully recovered. The small variation of the rest of the parameters indicates the necessity of further investigation including the design of a larger study with a higher statistical power. Our results show for the first time that global ischemic preconditioning influences the HRV response to the asphyxia injury. The neuroprotective effect of preconditioning translates into a faster recovery of the basal HRV and the autonomic modulation of the heart.     

Low tuberculosis notification in mountainous Vietnam is not due to low case detection: a cross-sectional survey

Background  

Studies show that tuberculosis notification declines with increasing altitude. This can be due to declining incidence or declining case detection. In Vietnam notification rates of new smear-positive tuberculosis in the central mountainous provinces (26/100,000 population) are considerably lower than in Vietnam in general (69/100,000 population). In order to clarify whether this is explained by low incidence or low case detection, we aimed to assess the prevalence of new smear-positive tuberculosis among adults with prolonged cough in three mountainous provinces in central Vietnam.