Pesquisa | SciELO

ABSTRACT The objective of this study was to evaluate the effect of intronic single nucleotide polymorphisms (SNP) on temperament traits in a Brahman cattle population. The SNP located in CACNG4, EXOC4, NRXN3, and SLC9A4 candidate genes were genotyped in 250 animals with temperament records of exit velocity, pen score, and temperament score. Rs3423464051:G>A in the CACNG4 gene was associated with exit velocity and temperament score. An in silico analysis of the five intronic SNP showed that alternative alleles of CACNG4-rs3423464051, EXOC4-rs109393235, and SLC9A4-rs109722627 SNP could alter branch point sites during splicing, while a protein–protein interaction network analysis demonstrated a GRIA2 gene-mediated interaction between CACNG4 and NRXN3. The present results support previously reported evidence regarding bovine temperament-related candidate genes, particularly CACNG4, which is a confirmed candidate gene in need of more detailed analyses to reveal its role in temperament-related traits.

https://doi.org/10.37496/rbz5220220057

Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report
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Zaikos, Thomas Dimitrios

; Yousem, David M.

; Troncoso, Juan C.

; Nix, James Stephen

Autopsy and Case Reports

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2023, Volume 13 elocation e2023448

Resumo: En | Texto: En | PDF: En

ABSTRACT Internal watershed infarcts (IWIs) occur at the junction of the deep and superficial perforating arterial branches of the cerebrum. Despite documentation in the radiology literature, IWIs are rarely encountered at the time of autopsy. Here, we report the case of a 59-year-old incarcerated male who was brought to the emergency department after being found unresponsive on the floor of his jail cell. Initial examination and imaging demonstrated right-sided hemiplegia, aphasia, right facial droop, and severe stenosis of the left middle cerebral artery, respectively. Repeat imaging 4 days after admission and 26 days before death demonstrated advanced stenosis of the intracranial, communicating segment of the right internal carotid artery, a large acute infarct in the right posterior cerebral artery territory, and bilateral deep white matter ischemic changes with a right-sided “rosary-like” pattern of injury that is typical of IWIs. Postmortem gross examination showed that the right deep white matter lesion had progressed to a confluent, “cigar-shaped” subacute IWI involving the right corona radiata. This is the first well-documented case of an IWI with radiologic imaging and photographic gross pathology correlation. This case uniquely highlights a rarely encountered lesion at the time of autopsy and provides an excellent visual representation of internal watershed neuroanatomy.

https://doi.org/10.4322/acr.2023.448

Seers who unmask illusion - In conversation with Thomas Merton and Henri J.M. Nouwen
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Langerman, Peter David

; Marchinkowski, George W

Stellenbosch Theological Journal

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2023, Volume 9 Nº 1 Páginas 1 - 24

Resumo: En | Texto: En | PDF: En

As humanity seeks to redefine its relationships with technology, the earth and ultimate reality, the mystics can assist in discerning a way forward. How can we live at peace in a rapidly changing and technologically advancing world? Will these redefined relationships facilitate human flourishing or cause alienation? Twentieth century mystics Thomas Merton and Henri J. M. Nouwen believed that the conversation began with confronting illusion. The illusions human beings construct begin in the Self (with the false personas we create) but extend to the collectives we relate to. Merton and Nouwen were mystics and social critics, from a starting point of contemplation, representing 'Christ, the challenger and disturber of human illusion.' This article seeks to showcase their contribution while outlining some spiritual practices seekers might adopt to navigate our complex and constantly transforming milieu.

https://doi.org/10.17570/stj.2023.v9n1.at2

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility
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Cohen, Erin Rachel

; Dable, Cortney Lee

; Iglesias, Thomas

; Singh, Eshita

; Ma, Ruixuan

; Rosow, David Edward

International Archives of Otorhinolaryngology

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Dez 2022, Volume 26 Nº 4 Páginas 524 - 532

Resumo: En | Texto: En | PDF: En

Abstract Introduction Iatrogenic bilateral vocal fold immobility (BVFI) often arises from posterior glottic stenosis (PGS) after endotracheal intubation, whereby posterior commissure mucosal disruption leads to fibrosis and ankylosis of the cricoarytenoid joints. Sequelae can be devastating, resulting in dyspnea, stridor, and death due to asphyxiation. Objectives We sought to review features associated with PGS to better understand how to prevent this condition. A secondary aim is to analyze factors correlating to tracheostomy dependence. Methods Charts from January 2010 to November 2020 were retrospectively reviewed, and adult patients with the diagnosis of BVFI after intubation were included. Data on comorbidities, duration of intubation, laryngoscopy, and decannulation status was analyzed. Results Out of the 68 patients included in the present study, 60.3% were male, and the mean duration of intubation 14.3 ± 8.5 days. A total of 94% of the patients were intubated for at least 7 days, diabetic, and/or obese. Although association with prolonged intubation >7 days was not significant (p = 0.064), complete BVFI on fiberoptic exam (n = 47) was significantly associated with tracheostomy dependence both in the entire cohort (p = 0.036) and in the 56 patients with tracheostomy (p = 0.0086). Patients without cardiovascular disease (CVD) were less likely to be tracheostomy dependent compared with those with CVD (odds ratio [OR]: 0.23 [0.053–0.79]; p = 0.028). Conclusions We identified duration of intubation, DM, and obesity as potential risk factors for PGS. Complete immobility and CVD were significantly associated with tracheostomy dependence. Our findings may have important implications for earlier tracheostomy in high-risk intubated patients, as well as for closer monitoring of disease progression and earlier intervention in those predisposed to tracheostomy dependence.

https://doi.org/10.1055/s-0041-1741435

Robotic-assisted nephrectomy with level II IVC thrombectomy using Rummel Tourniquets
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Pulford, Christopher

; Keating, Kevin

; Rohloff, Matthew

; Peifer, David

; Eames, Richard

; Shakuri-Rad, Jaschar

; Maatman, Thomas

International braz j urol

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Jan 2022, Volume 48 Nº 1 Páginas 196 - 197

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Inferior vena cava (IVC) invasion from renal cell carcinoma (RCC) occurs at a rate of 4-10% (1). IVC thrombectomy (IVC-TE) can be an open procedure because of the need for handling of the IVC (2). The first reported series of robotic management of IVC-TE started in 2011 for the management of Level I - II thrombi with subsequent case reports in recent years (2-5). Materials and Methods: The following is a patient in his 50’s with no significant medical history. Magnetic resonance imaging and IR venogram were performed preoperatively. The tumor was clinical stage T3b with a 4.3cm inferior vena cava thrombus. The patient underwent robotic assisted nephrectomy and IVC-TE. Rummel tourniquets were used for the contralateral kidney and the IVC. The tourniquets were created using vessel loops, a 24 French foley catheter and hem-o-lock clips. Results: The patient tolerated the surgical procedure well with no intraoperative complications. Total surgical time was 274 min with 200 minutes of console time and 22 minutes of IVC occlusion. Total blood loss in the surgery was 850cc. The patient was discharged from the hospital on post-operative day 3 without any complications. The final pathology of the specimen was pT3b clear cell renal cell carcinoma Fuhrman grade 2. The patient followed up post-operatively at both four months and six months without disease recurrence. The patient continues annual follow-up with no recurrence. Conclusions: Surgeon experience is a key factor in radical nephrectomy with thrombectomy as patients have a reported 50-65% survival rate after IVC-TE (4).

https://doi.org/10.1590/s1677-5538.ibju.2021.0393

Moralidad y legitimidad en la teoría crítica de Jürgen Habermas: normatividad, reconocimiento y solidaridad
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Martínez, David

Izquierdas

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2022, Volume 51 elocation 14

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract: According to Jürgen Habermas, his theory of legitimacy is independent of morality. To justify this statement, he resorts to immanent arguments based on the historic development of modern society. However, the incorporation of the principle of discourse can be seen in the sense that legitimacy is not freed from morality of the Kantian tradition. This return of Kant opens the space for Hegelian objections. One of them is elaborated by James Finlayson, who argues that the problem in Habermas is that he reconstructs a notion of normative validity that incorporates Thomas Nagel's distinction between agent-neutral interests and agent-relative interests. The inclusion of this distinction would be problematic, as it would imply a split that would make the agent-neutral interests of morality and the agent-relative interests of empirical subjects irreconcilable. This article argues that the objection can be answered from Habermas based on the concepts of recognition and solidarity. However, these concepts are incompatible with Nagel's distinction, so the latter must be rejected.

Resumen: Según Jürgen Habermas su teoría de la legitimidad es independiente de la moralidad. Para justificar esta afirmación recurre a argumentos inmanentes sustentados en el desarrollo histórico de la sociedad moderna. Sin embargo, la incorporación del principio de discurso puede leerse en el sentido de que la legitimidad no está liberada de la moralidad propia de la tradición kantiana. Este retorno de un componente kantiano abre el espacio a objeciones de tipo hegelianas. Una de ellas es elaborada por James Finlayson, quien argumenta que el problema en Habermas es que reconstruye una noción de validez normativa que incorpora la distinción de Thomas Nagel entre intereses agente-neutrales e intereses agente-relativos. La inclusión de esta distinción sería problemática pues supondría una escisión que haría irreconciliables los intereses agente-neutrales de la moralidad y los intereses agente-relativos de los sujetos empíricos. Este artículo sostiene que la objeción se puede responder desde Habermas a partir de los conceptos de reconocimiento y solidaridad. Sin embargo, estos conceptos son incompatibles con la distinción de Nagel, por lo cual esta última debe ser rechazada.

Saúde Cardiovascular e Fibrilação ou Flutter Atrial: Um Estudo Transversal do ELSA-Brasil
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Santos, Itamar S.

; Lotufo, Paulo A.

; Goulart, Alessandra C.

; Brant, Luisa C. C.

; Pinto Filho, Marcelo M

; Pereira, Alexandre C.

; Barreto, Sandhi M.

; Ribeiro, Antonio L. P.

; Thomas, G Neil

; Lip, Gregory Y. H.

; Bensenor, Isabela M.

; Arasalingam, Ajini

; Beane, Abi

; Bensenor, Isabela M

; Brocklehurst, Peter

; Cheng, Kar Keung

; El-Bouri, Wahbi

; Feng, Mei

; Goulart, Alessandra C

; Greenfield, Sheila

; Guo, Yutao

; Guruparan, Mahesan

; Gusso, Gustavo

; Gooden, Tiffany E

; Haniffa, Rashan

; Humphreys, Lindsey

; Jolly, Kate

; Jowett, Sue

; Kumarendran, Balachandran

; Lancashire, Emma

; Lane, Deirdre A

; Li, Xuewen

; Lip (Co-PI), Gregory Y.H.

; Li, Yan-guang

; Lobban, Trudie

; Lotufo, Paulo A

; Manseki-Holland, Semira

; Moore, David J

; Nirantharakumar, Krishnarajah

; Olmos, Rodrigo D

; Paschoal, Elisabete

; Pirasanth, Paskaran

; Powsiga, Uruthirakumar

; Romagnolli, Carla

; Santos, Itamar S

; Shantsila, Alena

; Sheron, Vethanayagam Antony

; Shribavan, Kanesamoorthy

; Szmigin, Isabelle

; Subaschandren, Kumaran

; Surenthirakumaran, Rajendra

; Tai, Meihui

; Neil Thomas (Co-PI), G

; Varella, Ana C

; Wang, Hao

; Wang, Jingya

; Zhang, Hui

; Zhong, Jiaoyue

Arquivos Brasileiros de Cardiologia

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2022, Nº ahead

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A associação entre o status de saúde cardiovascular ideal ( ideal cardiovascular health ( ICVH) e diagnóstico de fibrilação ou flutter atrial (FFA) foi menos estudado em comparação a outras doenças cardiovasculares. Objetivos Analisar a associação entre o diagnóstico de FFA e métricas e escores de ICVH no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos Este estudo analisou dados de 13141 participantes com dados completos. Os traçados eletrocardiográficos foram codificados de acordo com o Sistema de Minnesota, em um centro de leitura centralizado. As métricas do ICVH (dieta, atividade física, índice de massa corporal, tabagismo, glicemia de jeju, e colesterol total) e escores do ICVH foram calculados conforme proposto pela American Heart Association . Modelos de regressão logística bruta e ajustada foram construídos para analisar associações de métricas e escores do ICVH com diagnóstico de FFA. O nível de significância foi estabelecido em 0,05. Resultados A idade mediana da amostra foi de 55 anos, e 54,4% eram mulheres. Nos modelos ajustados, os escores de ICVH não apresentaram associação significativa com diagnóstico de FFA prevalente [odds ratio (OR):0,96; intervalo de confiança de 95% (IC95%):0,80-1,16; p=0,70). Perfis de pressão arterial ideal (OR:0,33; IC95%:0,1-0,74; p=0,007) e colesterol total ideal (OR:1,88; IC95%:1,19-2,98; p=0,007) foram significativamente associados com o diagnóstico de FFA. Conclusões Não foram identificadas associações significativas entre escores de ICVH global e diagnóstico de FFA após ajuste multivariado em nossas análises, devido, ao menos em parte, às associações antagônicas da FFA com métricas de pressão arterial e de colesterol total do ICVH. Nossos resultados sugerem que estimar a prevenção da FFA por meio de escore de ICVH global pode não ser adequado, e as métricas do ICVH devem ser consideradas separadamente.

Abstract Background The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. Objective To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05. Results The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15–0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19–2.98; p=0.007) profiles were significantly associated with AFF diagnosis. Conclusions No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.

https://doi.org/10.36660/abc.20210970

How we do it: robotic-assisted distal ureterectomy with ureteral reimplantation
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Pulford, Christopher

; Keating, Kevin

; Rohloff, Matthew

; Peifer, David

; Eames, Richard

; Maatman, Thomas

International braz j urol

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Dez 2021, Volume 47 Nº 6 Páginas 1277 - 1278

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: High risk upper tract urothelial carcinoma (UTUC) is typically managed with radical nephroureterectomy, however, renal preservation can be attempted when UTUC is localized to the distal ureter in the presence of chronic kidney disease (1–3). Distal ureterectomy is typically managed with a ureteral reimplantation and psoas hitch in order to maintain urothelial continuity, to avoid comprising the contralateral ureter, and reducing risk of chronic urinary tract infections and electrolyte abnormalities (4). We present our case of distal ureteral UTUC managed robotically with a distal ureterectomy with ureteral reimplantation. Technique and Follow-Up: Initially, an Orandi needle on a resectoscope circumscribed the left ureteral orifice. Next, robotically, the retroperitoneum was exposed and a left sided pelvic lymphadenectomy was completed. The left ureter was mobilized and the diseased ureteral segment was transected. The mobilized bladder was sutured to psoas fascia. After a cystotomy, the ureter was re-anastomosed to the bladder. The patient was discharged on postoperative day three and re-evaluated one week later with a cystogram. Final pathology was downgraded to non-invasive low-grade papillary urothelial carcinoma with negative lymph nodes and margins. Conclusion: High risk UTUC localized to the distal ureter in the setting of chronic kidney disease can be managed with a distal ureterectomy (3). Robotic distal ureterectomy with ureteral reimplantation can be assisted by an Orandi needle to achieve negative margins. Utilizing a robotic technique can offer challenges with the ureteral spatulation and reanastomosis (5–7). By fixating the ureter to the bladder prior to reanastomosis, our technique offers a solution for these difficulties.

https://doi.org/10.1590/s1677-5538.ibju.2021.0207 65 downloads

Clínica y política de la palabra en el psicoanálisis
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Orozco Guzmán, Mario

; Pavón-Cuéllar, David

Andamios

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Dez 2021, Volume 18 Nº 47 Páginas 469 - 492

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

Resumen El presente artículo discierne y examina ciertos aspectos políticos de la palabra que se consideran cruciales en la clínica psicoanalítica. El tema es abordado primero a través de los casos de histeria en los que se origina el psicoanálisis y luego en otros momentos del desarrollo del trabajo de Freud, como los correspondientes a la Interpretación y de los sueños y a la Psicología de las masas y análisis del yo, entre otros. Se discute la potencialidad liberadora de la palabra, su relación con el poder, con la represión y la censura, y su función trivalente para inhibir la violencia, para incitarla o para reparar sus efectos deletéreos. La ruta prosigue con el papel de la palabra en episodios de microhistoria habitados por un silencio mortífero. Finalmente se replantea y redimensiona el análisis de Freud y Bullit sobre la personalidad del presidente norteamericano Thomas Woodrow Wilson para mostrar los efectos de un caso de total asimilación de lo político a la palabra.

Abstract This article discerns and examines certain political aspects of speech that are considered crucial in the psychoanalytic clinic. The subject is approached first through the cases of hysteria in which psychoanalysis originates and then in other moments of the development of Freud’s work, such as those corresponding to Interpretation of dreams and to Group Psychology and Analysis of the Ego, among others. The liberating potential of speech, its relationship with power, with repression and censorship, and its trivalent function to inhibit violence, to incite it or to repair its deleterious effects are discussed. The route continues with the role of speech in episodes of microhistory inhabited by a deadly silence. Finally, Freud and Bullit’s analysis of the personality of the American President Thomas Woodrow Wilson is reconsidered and re-dimensioned to show the effects of a case of total assimilation of the political to speech.

https://doi.org/10.29092/uacm.v18i47.885 30 downloads

10.

Ensayo sobre las utilidades
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Ricardo, David

El trimestre económico

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Set 2021, Volume 88 Nº 351 Páginas 895 - 920

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Through this text, David Ricardo opens a discussion about the ideas of Thomas Malthus on the theories of the capital increase and the type of profits, applied to the economic processes in agriculture and to the context of Great Britain of 1814-1815 regarding the economic policies that were being carried out to regulate the grain trade. In this way, he reflects on the relationships and dynamics between capital and profits.

Resumen Mediante este texto, David Ricardo abre una discusión acerca de las ideas de Thomas Malthus sobre las teorías del aumento de capital y el tipo de utilidades, las cuales se aplicaron a los procesos económicos en la agricultura y al contexto de la Gran Bretaña de 1814-1815 respecto de las políticas económicas que se estaban llevando a cabo para regular el comercio de los cereales. De esta manera, reflexiona sobre las relaciones y las dinámicas dadas entre capital y utilidades.

https://doi.org/10.20430/ete.v88i351.1304 73 downloads

11.

Establishing targets for advanced HIV disease: A call to action
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Meya, David B.

; Tugume, Lillian

; Nabitaka, Vennie

; Namuwenge, Proscovia

; Phiri, Sam

; Oladele, Rita

; Jibrin, Bilkisu

; Mobolaji-Bello, Mojisola

; Kanyama, Cecilia

; Maokola, Werner

; Mfinanga, Sayoki

; Katureebe, Cordelia

; Amamilo, Ikechukwu

; Ngwatu, Brian

; Jarvis, Joseph N.

; Harrison, Thomas S.

; Shroufi, Amir

; Rajasingham, Radha

; Boulware, David

; Govender, Nelesh P.

; Loyse, Angela

Southern African Journal of HIV Medicine

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2021, Volume 22 Nº 1 Páginas 1 - 5

Resumo: En | Texto: En | PDF: En

The World Health Organization (WHO) has published a guideline for the management of individuals with advanced HIV disease (AHD) to reduce HIV-related deaths. The guideline consists of a package of recommendations including interventions to prevent, diagnose and treat common opportunistic infections, including tuberculosis (TB), cryptococcosis and severe bacterial infections, along with rapid initiation of antiretroviral treatment and enhanced adherence support. Currently no clear targets exist for these key interventions. Emerging programmatic data from Uganda, Tanzania and Nigeria suggest that an estimated 80% of eligible people continue to miss the recommended cryptococcal or TB testing, highlighting the remaining challenges to the effective implementation of WHO-recommended AHD packages of care in real-world resource-limited settings. The absence of mortality indicators for the leading causes of HIV-related deaths, because of the lack of mechanisms to ascertain cause of death, has had a negative impact on establishing interventions to reduce mortality. We suggest that setting 95-95-95 targets for CD4 testing, cryptococcal antigen and TB testing, and treatment that are aligned to the WHO AHD package of care would be a step in the right direction to achieving the greater goal of the WHO End TB strategy and the proposed new strategy to end cryptococcal meningitis deaths. However, these targets will only be achieved if there is healthcare worker training, expanded access to bedside point-of-care diagnostics for hospitalised patients and those in outpatient care who meet the criteria for AHD, and health systems strengthening to minimise delays in initiating the WHO-recommended therapies for TB and cryptococcal disease.

https://doi.org/10.4102/sajhivmed.v22i1.1266 25 downloads

12.

Glulam connections assembled with screws in different installation angles
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Hanna, David

; Tannert, Thomas

Maderas. Ciencia y tecnología

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2021, Volume 23 elocation 54

Resumo: En | Texto: En | PDF: En

Abstract: Self-tapping screws are the recognized state-of-the-art in fastener technology for timber structures. Combining fasteners of different stiffness, such as self-tapping screws with different installation angles, can be advantageous to simultaneously achieve high connection stiffness and ductility. In this paper, experimental investigations on a total of 65 glued-laminated timber joints assembled with a variety of installation angles including several combinations of self-tapping screws acting axially in withdrawal with self-tapping screws acting laterally are presented. The connection performance was analyzed in terms of the load-carrying capacity, the deformation capacity, the stiffness, and the ductility. The findings demonstrated that joint assemblies with self-tapping screws loaded primarily laterally exhibit low stiffness but high ductility, whereas joint assemblies with self-tapping screws loaded primarily in withdrawal are very stiff but exhibit low ductility. Combining screws in different installation angles created glued-laminated timber connections that combine high stiffness with high ductility. Existing analytical expressions were deemed suitable to estimate load-carrying capacity through simple summation of the different screws’ individual resistances.

https://doi.org/10.4067/s0718-221x2021000100454 320 downloads

13.

¿Cabe un voluntarismo en la explicación psicológica de Tomás de Aquino sobre las causas del mal moral?
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Téllez Maqueo, David E.

Veritas

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Ago 2020, Nº 46 Páginas 135 - 155

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Most of the studies and commentaries on Thomas Aquinas such as those made from the scholastic and neo-scholastic perspective have emphasized the intelectualism of his thought. This intelectualism is based mainly but non exclusively on the ontologicalprimacy of the intellect over the will, on the affirmation that the ignorance is one of the pivotal causes of evil actions, and on the fact that the will tends to follow the judgment of reason. Over the last fifty years, however, this reading has been the object of a critical revision by bringing to light in the texts the value of the will in Ethics and Philosophical Anthropology of Thomas Aquinas. Without the least intention of questioning the presence of intelectualist elements in his works, the aim of this paper is to reflect on some kind of psychological voluntarism in Thomas Aquinas, grounded on the role of the will in realiging the moral evil.

Resumen La mayoría de los comentarios y estudios tradicionales sobre Tomás de Aquino, como los que han predominado en la escolástica y la neoescolástica, se han caracte rizado por el intelectualismo de su pensamiento basado principalmente, aunque no exclusivamente, en la primacía ontológica del intelecto sobre la voluntad; en la afir mación de la ignorancia como una de las causas primordiales del mal actuar, y en la existencia de una facultad como la voluntad que tiende a seguir el juicio de la razón. En los últimos cincuenta años, sin embargo, esta interpretación ha sido revisada crí ticamente poniendo a la luz de los textos el valor de la voluntad en la antropología y la ética de Tomás de Aquino. Sin tratar de negar la presencia de elementos intelec- tualistas en su obra, el objetivo de este trabajo es reflexionar en torno a la existencia de cierto voluntarismo psicológico de santo Tomás con base en el papel que ejerce la voluntad en la realización del mal moral.

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14.

Los biomarcadores cardiacos e inflamatorios se asocian con un empeoramiento en los outcomes renales en pacientes con diabetes mellitus tipo 2: observaciones del estudio SAVOR-TIMI 53
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Zelniker, Thomas A

; Morrow, David A

; Mosenzon, Ofri

; Gurmu, Yared

; Im, Kyungah

; Cahn, Avivit

; Raz, Itamar

; Steg, Philippe Gabriel

; Leiter, Lawrence A

; Braunwald, Eugene

; Bhatt, Deepak L

; Scirica, Benjamin M

Acta bioquímica clínica latinoamericana

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Mar 2020, Volume 54 Nº 1 Páginas 69 - 80

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Background: Cardiac and renal diseases commonly occur with bidirectional interactions. We hypothesized that cardiac and inflammatory biomarkers may assist in identification of patients with type 2 diabetes mellitus (T2DM) at high risk of worsening renal function. Methods: In this exploratory analysis from SAVOR-TIMI 53, concentrations of high-sensitivity cardiac troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP) were measured in baseline serum samples of 12310 patients. The primary end point for this analysis was a ≥40% decrease in estimated glomerular filtration rate (eGFR) at end of treatment (EOT) at a median of 2.1 years. The relationships between biomarkers and the end point were modeled using adjusted logistic and Cox regression. Results: After multivariable adjustment including baseline renal function, each biomarker was independently associated with an increased risk of ≥40% decrease in eGFR at EOT [Quartile (Q) Q4 vs Q1: hs-TnT adjusted odds ratio (OR), 5.63 (3.49-9.10); NT-proBNP adjusted OR, 3.53 (2.29-5.45); hs-CRP adjusted OR, 1.84 (95% CI, 1.27-2.68); all P values ≤0.001]. Furthermore, each biomarker was independently associated with higher risk of worsening of urinary albumin-to-creatinine ratio (UACR) category (all P values ≤0.002). Sensitivity analyses in patients without heart failure and eGFR >60 mL/min provided similar results. In an adjusted multimarker model, hs- TnT and NT-proBNP remained significantly associated with both renal outcomes (all P values <0.01). Conclusions: hs-TnT, NT-proBNP, and hs-CRP were each associated with worsening of renal function [reduction in eGFR (≥40%) and deterioration in UACR class] in high-risk patients with T2DM. Patients with high cardiac or inflammatory biomarkers should be treated not only for their risk of cardiovascular outcomes but also followed for renal deterioration.

Antecedentes: Las enfermedades cardiaca y renal se manifiestan comunmente con interacciones bidireccionales. Nuestra hipotesis es que los biomarcadores cardiacos e inflamatorios pueden ser utiles en la identificacion de pacientes con diabetes mellitus tipo 2 (DM2) de alto riesgo de deterioro de la funcion renal. Métodos: En el presente analisis exploratorio del estudio SAVOR-TIMI 53, las concentraciones de troponina T cardiaca de alta sensibilidad (TnT-us), propeptido natriuretico cerebral N-terminal (NT-proBNP) y proteina C-reactiva de alta sensibilidad (PCR-us) fueron medidas en muestras basales de suero de 12.310 pacientes. El punto final primario para este analisis fue una disminucion mayor al 40% en la tasa de filtracion glomerular estimada (TFGe) al final del tratamiento (FdT) en una mediana de seguimiento de 2,1 anos. Las relaciones entre los biomarcadores y el punto final se modelaron utilizando regresion logistica ajustada y regresion de Cox. Resultados: Despues de la regresion logistica ajustada, incluyendo la funcion renal basal, cada biomarcador se asocio independientemente con mayor riesgo de una disminucion mayor o igual al 40% en la TFGe al FdT [Cuartil (Q) Q4 vs Q1: cociente de probabilidades (CP) ajustado de TnT-us fue 5,63 (IC 95%, 3,49-9,10); para NTproBNP CP ajustado, 3,53 (IC 95%, 2,29-5,45); OR ajustado para PCR-us, 1,84 (IC 95%, 1,27-2,68); todos los valores con p≤0,001]. Ademas, cada biomarcador se asocio de manera independiente con mayor riesgo de empeoramiento en la categoria de la relacion albumina/ creatinina urinaria (RACu) (p≤0,002 en todos los casos). Los analisis de sensibilidad en pacientes sin insuficiencia cardiaca y TFGe >60 mL/min demostraron resultados similares. En un modelo ajustado de marcadores multiples (multi-marcador), TnT-us y NT-proBNP se mantuvieron significativamente asociados con ambos puntos finales renales (p<0,01 en todos los casos). Conclusiones: TnT-us, NT-proBNP y PCR-us se asociaron con el empeoramiento de la funcion renal [reduccion de la TFGe (≥40%) y deterioro en la categoria de RACu] en pacientes con DM2 de alto riesgo. Los pacientes con biomarcadores cardiacos o inflamatorios elevados deben ser tratados no solo por su riesgo de resultados cardiovasculares, sino tambien monitoreados en cuanto a su deterioro renal.

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15.

Patient acceptance of HIV testing services in rural emergency departments in South Africa
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Rao, Aditi

; Kennedy, Caitlin

; Mda, Pamela

; Quinn, Thomas C.

; Stead, David

; Hansoti, Bhakti

Southern African Journal of HIV Medicine

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2020, Volume 21 Nº 1 Páginas 1 - 9

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BACKGROUND: South Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs. OBJECTIVES: This study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies. METHOD: We conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented. RESULTS: Across sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were 'does not want to know status' (37.6%), 'in too much pain' (34%) and 'does not believe they are at risk' (19.9%). CONCLUSIONS: Despite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs.

https://doi.org/10.4102/sajhivmed.v21i1.1105 652 downloads

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