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The title "Atrial Septal Defects Accelerate Pulmonary Hypertension Diagnoses in Premature Infants" reflects an important clinical observation linking congenital heart defects with the early development of a life-threatening condition in neonates.
Here’s a detailed summary and analysis:
🧠 Understanding the Core Concepts
✅ Atrial Septal Defect (ASD):
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A congenital heart defect where there is an opening in the atrial septum, allowing blood to flow between the left and right atria.
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In preterm infants, this can result in left-to-right shunting, increasing pulmonary blood flow.
✅ Pulmonary Hypertension (PH):
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A condition where the pulmonary arteries have abnormally high pressure, making it harder for the heart to pump blood through the lungs.
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In premature infants, PH is associated with bronchopulmonary dysplasia (BPD) and chronic lung disease, but cardiac shunting can worsen or precipitate it.
📌 Key Findings (Implied by the Title):
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Presence of an ASD leads to earlier diagnosis of PH in preterm infants.
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Suggests that increased pulmonary blood flow from the ASD may exacerbate or unmask PH earlier than it would appear otherwise.
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ASD may serve as a pathophysiologic amplifier in the already vulnerable pulmonary circulation of preterm neonates.
🔬 Clinical Implications:
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Monitoring & Screening:
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Preterm infants with ASDs should be closely monitored for signs of PH using echocardiography.
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Routine screening for PH might be considered earlier in this group.
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Timing of Intervention:
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May support earlier closure (surgical or device-based) of significant ASDs in high-risk preemies to reduce pulmonary vascular load.
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Must balance risks of intervention versus benefits, especially in fragile infants.
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Prognostic Marker:
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ASD presence might be a risk factor or marker for earlier PH development — useful for stratifying patient risk.
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Interdisciplinary Care:
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Management should involve neonatology, cardiology, and pulmonology teams for coordinated care and decision-making.
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📚 If You’re Writing or Presenting on This:
You could structure a discussion or slide presentation like this:
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Background: Prematurity, PH, and CHD links
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Mechanism: ASD → L→R shunt → ↑ pulmonary blood flow → endothelial injury → PH
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Evidence/Data: (Insert data from study if available)
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Clinical Impacts
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Future Directions: Need for prospective studies, optimal timing of ASD closure
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SC OF STORYTELLING
There are many things that attract and hold the attention of brains. Storytellers engage a number of neural processes that evolved for a variety of reasons and are waiting to be played like instruments in an orchestra: moral outrage, unexpected change, status play, specificity, curiosity, and so on. By understanding them, we can more easily create stories that are gripping, profound, emotional and original.
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All was confusion in the Oblonskys’ house. The wife had found out that the husband was having an affair with their former French governess and had announced to the husband that she could not live in the same house with him. (Leo Tolstoy, Anna Karenina – sentences two and three.) In life, most of the unexpected changes we react to will turn out to be of no importance: the bang was just a lorry door; it wasn’t your name, it was a mother calling for her child. So you slip back into reverie and the world, once more, becomes a smear of motion and noise. But, every now and then, that change matters. It forces us to act. This is when story begins.
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Information gaps create gnawing levels of curiosity in the readers of Agatha Christie and the viewers of Prime Suspect, stories in which they’re (1) posed a puzzle; (2) exposed to a sequence of events with an anticipated but unknown resolution; (3) surprised by red herrings, and (4) tantalised by the fact that someone knows whodunnit, and how, but we don’t
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The only thing we’ll ever really know are those electrical pulses that are sent up by our senses. Our storytelling brain uses those pulses to create the colourful set in which to play out our lives. It populates that set with a cast of actors with goals and personalities, and finds plots for us to follow. Even sleep is no barrier to the brain’s story-making processes. Dreams feel real because they’re made of the same hallucinated neural models we live inside when awake. The sights are the same, the smells are the same, objects feel the same to the touch. Craziness happens partly because the fact-checking senses are offline, and partly because the brain has to make sense of chaotic bursts of neural activity that are the result of our state of temporary paralysis. It explains this confusion as it explains everything: by roughing together a model of the world and magicking it into a cause-and-effect story.
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Humans have an extraordinary gift for reading and understanding the minds of other people. In order to control our environment of humans, we have to be able to predict how they’re going to behave. The importance and complexity of human behaviour means we have an insatiable curiosity about it. Storytellers exploit both these mechanisms and this curiosity; the stories they tell are a deep investigation into the ever-fascinating whys of what people do.
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But these neural activations aren’t limited to mere descriptions of appearance. When we detect the glass of wine, other associations also flash into being: bitter-sweet flavours; vineyards; grapes; French culture; dark marks on white carpets; your road-trip to the Barossa Valley; the last time you got drunk and made a fool of yourself; the first time you got drunk and made a fool of yourself; the breath of the woman who attacked you. These associations have powerful effects on our perception. Research shows that when we drink wine our beliefs about its quality and price change our actual experience of its taste. The way food is described has a similar effect
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There’s a chance you’ve been made aware of these processes when, in a crowded room, you’ve suddenly heard someone in a distant corner speaking your name. This experience suggests the brain’s been monitoring myriad conversations and has decided to alert you to the one that might prove salient to your wellbeing. It’s constructing your story for you: sifting through the confusion of information that surrounds you, and showing you only what counts. This use of narrative to simplify the complex is also true of memory. Human memory is ‘episodic’ (we tend to experience our messy pasts as a highly simplified sequences of causes and effects) and ‘autobiographical’ (those connected episodes are imbued with personal and moral meaning).
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But all storytellers, no matter who their intended audience, should beware of over-tightening their narratives. While it’s dangerous to leave readers feeling confused and abandoned, it’s just as risky to over-explain. Causes and effects should be shown rather than told; suggested rather than explained. If they’re not, curiosity will be extinguished and readers and viewers will become bored
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These ‘big five’ personality traits aren’t switches – we’re not one thing or the other. Rather, they’re dials, with us having more or less of each trait, our particular highs and lows combining to form our own peculiar self. Personality has a powerful influence over our theory of control. Different personalities have different go-to tactics for controlling the environment of people. When unexpected change threatens, some are more likely to jump to aggression and violence, some charm, some flirtation, others will argue or withdraw or become infantile or try to negotiate for consensus or become Machiavellian or dishonest, resorting to threat, bribery or con.
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Compare this pushy, freedom-loving self to the one that emerged in the East. The undulating and fertile landscape in Ancient China was perfect for large groupish endeavours. Getting by would have probably meant being a part of a sizeable wheat-or rice-growing community or working on a huge irrigation project. The best way of controlling the world, in that place, was ensuring the group, rather than the individual, was successful. That meant keeping your head down and being a team player. This collective theory of control led to a collective ideal of self. In the Analects, Confucius is recorded as describing ‘the superior man’ as one who ‘does not boast of himself’, preferring instead the ‘concealment of his virtue’. He ‘cultivates a friendly harmony’ and ‘lets the states of equilibrium and harmony exist in perfection’. He could hardly be more different than the pushy Westerner emerging seven thousand kilometres away.
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Because our models make up our actual experience of reality, it’s little wonder that any evidence which suggests they are wrong is profoundly unsettling. ‘Things are experienced as pleasurable because they are familiar,’ writes Wexler, ‘while the loss of the familiar produces stress, unhappiness and dysfunction.’ We’re so used to our aggressive model defending responses – they’re such an ordinary part of being alive – we become inured to their strangeness. Why do we dislike people we disagree with? Why do we feel emotionally repulsed by them?
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Who was Charles Foster Kane really? That was the challenge that editor Rawlston made to his staff of storytellers at the beginning of Citizen Kane. Was he the man his old friend perceived: self-interested, delusional, desperate for approval and attention? Or was he the person his own hero making brain told him he was: brave, generous and selfless?
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