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Authors: Sabrina Oebel, Alexander Gotschy, Ingo Paetsch, Cosima Jahnke, Sven Plein, Rolf Gebker, Sandra Hamada, Michael Frick, Jochen von Spiczak, Malgorzata Polacin, Frank Enseleit, Nikolaus Marx, Thomas F. Lüscher, Frank Ruschitzka, Sebastian Kozerke, Hatem Alkadhi and Robert Manka

Abstract

Background

To assess the accuracy of 3D cardiovascular magnetic resonance (CMR) perfusion imaging for the detection of coronary artery disease (CAD) against fractional flow reserve (FFR) and quantitative coronary angiography (QCA) in patients with reduced ejection fraction (EF).

Methods

Out of 447 patients who underwent 3D CMR perfusion imaging (at 1.5 and 3.0 Tesla under adenosine stress and at rest) at 5 European centers, 86 cases with an EF ≤50% were identified (mean age 64±11yrs, 80% male). Significant CAD was defined as a FFR value <0.8 and a QCA >50%. 86 individuals matched for age, gender and major cardiovascular risk factors, were chosen as the control group.

Results

The prevalence of CAD defined by FFR (<0.8) was 59% (EF≤50%) vs. 54% (EF>50%), p=0.4). In relation to FFR, 3D perfusion imaging yielded a sensitivity of 84.5% (95% CI 76.0-90.4) and specificity of 77.3% (95% CI 66.7-85.3). The sensitivity of perfusion imaging was higher in patients with an EF≤50% (90.2% vs. 78.3 %, p=0.1) whereas specificity showed the reverse (62.9% vs. 90.0%, p=0.005) The diagnostic accuracy was comparable in both subgroups (AUC 79.1% vs 83.7%, p=0.25). According to QCA, the prevalence of CAD was 78% vs. 72% (p=0.4). Perfusion imaging yielded a sensitivity and specificity of 82.1% vs. 62.9%, p=0.01 and 79.0% vs. 95.8%, p=0.09 respectively with a high diagnostic accuracy in both subgroups (AUC 82.0% vs. 80.5%).

Conclusion

3D-CMR perfusion imaging yields a high sensitivity and diagnostic accuracy with regards to the detection of significant CAD irrespective of LV systolic function.

Open access

Abstract

This article concentrates on the transformative potential of the Millennial generation within the framework of the political landscapes of the United States, several European countries and Russia. Generational experiences frame the context for the comparative examination of the democratic order and the perspectives for democratic transition. In Western countries, the group is a potentially powerful political force, yet its members do not pursue traditional forms of civic engagement – they are sceptical about institutional forms of participation and have little trust in public authority. Embedded in a youth-marginalization discourse, the public identities of the Millennials are seen rather as a manifestation of the failures of democratic representation, rather than as forms of agency seeking new ways of political expression. The orientations of this distinct group also present a puzzle when the future of authoritarian regimes is discussed: Millennials’ openness to political change is often questioned, despite the prominent role they play in the rise of the opposition forces that gained influence during Vladimir Putin’s third term. Nevertheless, in both contexts, the ongoing generational shift has become an increasingly important area for social-scientific investigation and it is being directly related to broader arguments about the nature of political change.

Open access

ERRATUM: MINITRAE ET NUMINI EIUS

Egy kelta istenség a vulgáris latin Aquincumban

Author: Vágási Tünde
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Abstract

Quality of educational services is highly dependent on competent teachers. Thus, the competency-based framework for teacher education has become an important issue across Europe. This approach in Europe has greatly reflected in the field of adult learning and education. There are five research projects dedicated to identifying competences of adult learning facilitators, involving regional countries or all the Member States of the European Union. Based on the results of the five research projects, this paper has a twofold aim: 1) to describe those research projects and their identified competences for adult learning and 2) to analyse the common competences identified by all the five research projects. The distinct scopes of teacher's competences and teaching competences are offering the framework for analysis. We found ten common competences that are particularly relevant to teaching roles of adult learning facilitators in Europe. Moreover, the analyses revealed that adult learning facilitators need to possess teacher competences that are relevant to institutional administration. Our conclusion is that there are common competences for adult learning facilitators which are relevant to both teaching and teacher competences.

Open access

Abstract

Approaching the process of normal ageing with a health psychology model was an important development in health science. In earlier healing models, questions of old age were either ignored or dealt with only in the context of various diseases. Definitions of the stages of human life have changed and pushed the limits of old age to a higher level. The expanding human life course raises important medical, psychological, and sociological issues. The definition of ageing and the characteristics of normal ageing need to be reconsidered. The cognitive representations of ageing people are a good reflection of how they think about themselves, the world, and the stage of life ahead. The contribution of health psychology as a modern approach to healthy ageing has greatly altered the attitudes of healthcare professionals. The concept of active old age helps to deal with the growing number of elderly people in a new context. In this brief overview of the health psychology approach to normal ageing, we aim to help healthcare professionals better manage the problems in their daily work. In a brief introduction, we review the physical and mental symptoms of ageing. We strive to isolate the normal variants from gerontopsychiatric and neuropsychiatric disorders. While normal ageing does not require clinical attention, psychiatric disorders do, and we briefly describe the therapeutic forms. Psychoeducation, group therapy, and supportive techniques prove to be the most effective.

Open access

Abstract

In this report we show an unusual case of a giant ascending aortic double chambers pseudoaneurysm eroding the sternum. The patient was an asymptomatic 22-year-old man who underwent CT Angiography with ECG gating and who previously underwent aortic valve replacement.

Open access
Authors: Erica Maffei, Francesco Di Pede, Elisabetta Barbieri and Filippo Cademartiri

Abstract

A 50-year-old female with palpitations, dyspnoea and slightly dilated left ventricle at echocardiography was referred to Cardiac CT (CCT) for coronary artery assessment. CCT revealed a large fistula from the left main coronary artery to the right atrium, associated with agenesia of the inferior vena cava.

Open access

Summary

In or. 25 Demosthenes compares Aristogeiton to a watchdog who, instead of defending the sheeps, attacks and tears them to pieces. This picture seems not to be common in Attic rhetoric, but is occurs in Plat. Rep. 416a, where Socrates warns about the danger that the most popular orators, in betrayal of their former task, assault the demos and eventually become tyrants. This platonic passage confers a new meaning to the Demosthenic statement and suggests the possibility that Aristogeiton aimed at tyranny. Hence the nomos, which only can control physis, protects society from the worst human vices (poneria, hybris and anaideia), and represents the most effective defence of democracy.

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Authors: Pierleone Lucatelli, Maurizio Del Monte, Gianluca De Rubeis, Giulia Cundari, Marco Francone, Valeria Panebianco and Carlo Catalano

Abstract

COVID-19 patients suffering sudden worsening of clinical conditions have an atypical peripheral pulmonary arterial obstruction at computed tomography pulmonary angiogram (CTPA), poorly associated to deep venous thrombosis (DVT), suspicious for thrombotic in situ nature rather than embolic.

Open access