bluuebunny/crossref_metadata_2025 huggingface dataset:
Positive affect as a predictor of lower risk of functional decline in community‐dwelling elderly in Japan
Authors: Hirosaki Mayumi , Ishimoto Yasuko , Kasahara Yoriko , Konno Akiko , Kimura Yumi , Fukutomi Eriko , Chen Wenling , Nakatsuka Masahiro , Fujisawa Michiko , Sakamoto Ryota , Ishine Masayuki , Okumiya Kiyohito , Otsuka Kuniaki , Wada Taizo , Matsubayashi Kozo
Published: December 2012

Aim

To investigate whether positive affect independently predicts a lower risk of functional decline among community‐dwelling older Japanese.

Methods

A 2‐year prospective study was carried out among 505 residents of Tosa Town aged 65 years and older without disability in carrying out basic activities of daily living (BADL) at baseline. Positive and negative affect was measured using the 15‐item Geriatric Depression Scale, which includes items that reflect positive affect, as well as items that reflect negative affect. Information on functional ability, sociodemographic factors and medical conditions was obtained using a self‐administered questionnaire.

Results

A total of 72 (14.3%) participants reported a decline in BADL at the 2‐year follow up. The sum‐score of the positive items was significantly associated with a lower risk of functional decline (OR 0.78, 95% CI 0.64–0.97), after controlling for potential confounding factors. Of the five positive items, three items (feeling satisfied with life OR 0.49, 95% CI 0.25–0.95; feeling happy most of the time OR 0.50, 95% CI 0.25–0.99; and feeling full of energy OR 0.46, 95% CI 0.22–0.95) were significantly associated with functional decline after adjusting for confounders. These associations were also independent of negative affect. In contrast, none of the negative items predicted functional decline after controlling for confounding factors.

Conclusions

Positive psychological well‐being, specifically the feeling of satisfaction with life, happiness and energy, might have a favorable effect on the maintenance of functional ability, regardless of negative affect. Geriatr Gerontol Int 2013; 13: 1051–1058.
Proteosomal degradation of naturally recurring R260C missense and exon‐IV deletion mutants of factor XIII A‐subunit expressed in mammalian cells
Authors: Zhang W. G. , Souri M. , Ichinose A.
Published: December 2012

Congenital factor XIII (FXIII) deficiency is a severe bleeding disorder. We previously identified an Arg260Cys missense mutation and an exon‐IV deletion in patients' A subunit genes, F13A. To characterize the molecular/cellular basis of this disease, we expressed a wild type and these mutant A subunits in baby hamster kidney (BHK) cells. The mutant proteins were expressed less efficiently than the wild type. These mutants gradually decreased inside BHK cells, whereas the wild type remained largely unchanged. The decline/decrease in these mutants was completely blocked/restored by a potent proteasome inhibitor, MG‐132. This was consistent with the prediction by molecular modelling that the mutant molecules would lose the native structure of wild‐type molecule, leading to their instability and degeneration and ultimately to degradation. These mutants might have significantly altered conformations, resulting in the rapid degradation by the proteasome inside the synthesizing cells, and ultimately leading to FXIII deficiency.
Human Studies in the Pathophysiology of Migraine: Genetics and Functional Neuroimaging
Authors: Cutrer F. Michael , Smith Jonathan H.
Published: December 2012

The expansion of technologies available for the study of migraine pathophysiology has evolved greatly over the last 15 years. Two areas of rapid progress are investigations focusing on the genetics of migraine and others utilizing novel functional neuroimaging techniques. Genetic studies are increasingly focusing on sporadic migraine and the utilization of unbiased searches of the human genome to identify novel variants associated with disease susceptibility. At the same time, neuroimaging studies have provided novel insights into the altered neuronal and network dynamics of the migrainous brain. These 2 parallel approaches provide complementary insights into the complexity and heterogeneity of migraine.
The Evolution of a Migraine Attack – A Review of Recent Evidence
Authors: Charles Andrew
Published: December 2012

A migraine attack is an extraordinarily complex brain event that takes place over hours to days. This review focuses on recent human studies that shed light on the evolution of a migraine attack. It begins with a constellation of premonitory symptoms that are associated with activation of the hypothalamus and may involve the neurotransmitter dopamine. Even in the premonitory phase, patients experience sensitivity to sensory stimuli, indicating that central sensitization is a primary phenomenon. The migraine attack progresses to a phase that in some patients includes aura, which involves changes in cortical function, blood flow, and neurovascular coupling. The aura phase overlaps with the headache phase, which is associated with further changes in blood flow and function of the brainstem, thalamus, hypothalamus, and cortex. Serotonin receptors, nitric oxide, calcitonin gene‐related peptide, pituitary adenylate cyclase‐activating polypeptide, and prostanoids are demonstrated specific chemical mediators of migraine based on therapeutic and triggered migraine studies. A number of migraine symptoms persist beyond resolution of headache into a postdromal phase, accompanied by persistent blood flow changes in several brain regions. Although these phases of migraine have substantial temporal, neurochemical, and anatomical overlap, each represents an important window onto the pathophysiology of migraine as well as a target for therapeutic intervention. A comprehensive approach to migraine requires an understanding of the entire range of mechanisms and resultant symptoms that occur throughout the evolution of an attack.
Utility of computed tomography fusion imaging for the evaluation of the ablative margin of radiofrequency ablation for hepatocellular carcinoma and the correlation to local tumor progression
Authors: Makino Yuki , Imai Yasuharu , Igura Takumi , Hori Masatoshi , Fukuda Kazuto , Sawai Yoshiyuki , Kogita Sachiyo , Ohama Hideko , Matsumoto Yasushi , Nakahara Masanori , Zushi Shinichiro , Kurokawa Masanori , Isotani Keisuke , Takamura Manabu , Fujita Norihiko , Murakami Takamichi
Published: December 2012

Aim

To demonstrate the usefulness of the computed tomography (CT) fusion imaging for the evaluation of treatment effect of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).

Methods

Eighty‐five patients with 94 HCC with complete ablation judged on conventional side‐by‐side interpretation of pre‐RFA and post‐RFA CT at the time of RFA were included in this retrospective study. CT data was retrospectively used to create fusion images of pre‐RFA and post‐RFA CT using automatic rigid registration and manual correction referring to intrahepatic structures and hepatic contours around a tumor. Clinical factors including a minimal ablative margin (MAM) measured on fusion images were examined to prove risk factors for local tumor progression (LTP).

Results

LTP was observed in 13 (13.8%) tumors with a median follow up of 21.0 months (range, 2–75). The mean MAM on the fusion image was 1.4 ± 3.1 mm and 23 tumors (24.5%) were judged to be protruding from the ablation zone. Multivariate analysis revealed that protruding from the ablation zone was the only significant factor for LTP (hazard ratio, 7.09; 95% confidential interval, 2.26–22.3; P < 0.001).

Conclusion

Some HCC were assessed as incomplete ablation on the CT fusion images, although considered completely ablated on side‐by‐side images at the time of treatment, and incomplete ablation was revealed to be the only independent risk factor for LTP. The CT fusion imaging enables quantitative and accurate evaluation of treatment effect of RFA.
The effect of endodontic procedures on apical crack initiation and propagation ex vivo
Authors: Adorno C. G. , Yoshioka T. , Jindan P. , Kobayashi C. , Suda H.
Published: December 2012

Aim

To evaluate the potential effects of endodontic procedures (instrumentation and filling) on crack initiation and propagation in apical dentine.

Methodology

Forty extracted single‐rooted premolars with two canals were selected, 1.5 mm of the apex was ground perpendicular to the long axis of the tooth and the surface polished. The specimens were divided into 4 groups. The buccal canals of groups A, B and C were enlarged to size 40 with manual K‐files. Group A was filled with gutta‐percha using lateral condensation and vertical compaction without sealer. Group B was filled with the same method as group A except only lateral condensation was used. Group C was left unfilled, while group D was left unprepared and unfilled. Images of the resected surface were taken after resection (baseline), after canal preparation, after filling and after 4‐week storage. The images were then inspected for cracks originating from the canal.

Results

A significant effect of preparation on crack initiation (P < 0.05) and no significant effect of filling (P > 0.05) or 4‐week storage on crack initiation (P > 0.05) was found (logistic regression). Fisher's exact test revealed a significant effect of filling on crack propagation (P < 0.05) and no effect of 4‐week storage on crack propagation (P > 0.05).

Conclusions

Root canal procedures can potentially initiate and propagate cracks from within the root canal in the apical region.
Interaction of adjuvant androgen deprivation therapy with patient comorbidity status on overall survival after radical prostatectomy for high‐risk prostate cancer
Authors: Linder Brian J , Boorjian Stephen A , Umbreit Eric C , Carlson Rachel E , Rangel Laureano J , Bergstralh Eric J , Karnes R Jeffrey
Published: December 2012

Background

To evaluate the impact of adjuvant hormonal therapy after radical prostatectomy on overall survival in high‐risk prostate cancer patients, stratified by comorbidity status.

Methods

We identified 1247 patients who underwent radical prostatectomy from 1988 to 2004 for high‐risk prostate cancer, as defined by National Comprehensive Cancer Network classification. Comorbidity status was stratified by Charlson Comorbidity Index as 0, 1 or >2, as well as by the presence or absence of cardiovascular disease. Overall survival was estimated by the Kaplan–Meier method, and compared within each comorbidity category/adjuvant hormonal therapy strata with the log–rank test.

Results

Median patient age was 65 years, and the median postoperative follow up was 11.2 years. In total, 419 patients (34%) received adjuvant hormonal therapy. The distribution of Charlson Comorbidity Index was 0, 1 and ≥2 in 861 (69%), 244 (20%) and 142 (11%) patients, respectively. The 10‐year overall survival for patients who received adjuvant hormonal therapy versus those who did not was 75% versus 82% (P = 0.54) for patients with Charlson Comorbidity Index = 0, 72% versus 76% (P = 0.83) with Charlson Comorbidity Index = 1, and 70% versus 68% (P = 0.33) with Charlson Comorbidity Index ≥2. Meanwhile, 155 (12%) patients had cardiovascular disease, and the 10‐year overall survival for patients with cardiovascular disease who received adjuvant hormonal therapy was 72%, compared with 76% without adjuvant hormonal therapy (P = 0.97). On multivariate analysis, receipt of adjuvant hormonal therapy was not associated with non‐prostate cancer mortality (P = 0.24).

Conclusions

Adjuvant hormonal therapy after radical prostatectomy for high‐risk prostate cancer does not increase non‐prostate cancer mortality, even among patients with multiple comorbidities. Additional studies are warranted to determine optimal multimodal treatment approach for high‐risk patients.
Standard and saturation transrectal prostate biopsy techniques are equally accurate among prostate cancer active surveillance candidates
Authors: Linder Brian J , Frank Igor , Umbreit Eric C , Shimko Mark S , Fernández Nicolás , Rangel Laureano J , Karnes R Jeffrey
Published: December 2012

Objectives

To examine the ability of standard and saturation transrectal prostate biopsy techniques to predict appropriate candidates for active surveillance.

Methods

Between 2005 and 2007, 500 consecutive patients underwent transrectal ultrasound‐guided biopsy by a standard template (12 cores) or saturation template (≥18 cores, median 27 cores), with subsequent radical prostatectomy. Using the criteria of Gleason score ≤6, clinical stage T1 or T2a, prostate‐specific antigen <10 and ≤33% of cores involved, 218 patients were potential candidates for active surveillance. Pathology results from the prostatectomy specimens were used to determine the accuracy of each biopsy technique. Biochemical failure after prostatectomy was evaluated using logistic and Cox proportional hazards regression.

Results

A standard biopsy was carried out for 124 patients and saturation biopsy for 94 patients. There was no statistically significant difference between the groups in terms of median age (P = 0.14), preoperative prostate‐specific antigen (P = 0.52) and clinical stage (P = 0.23). Similar rates of Gleason score ≥7 at the time of radical prostatectomy were found, with 14% for standard biopsy and 15% for saturation biopsy (P = 0.70). Upstaging was shown in two standard biopsy patients (1.6%) and no saturation biopsy patients (P = 0.62). A multivariate analysis adjusting for prior prostate biopsy, preoperative prostate‐specific antigen and clinical stage showed no difference in the rate of upgrading based on biopsy technique (P = 0.26). During follow up, 5‐year biochemical failure‐free survival estimates were not significantly different (P = 0.11).

Conclusions

In men with prostate cancer, standard and saturation transrectal prostate biopsies techniques are equally predictive of candidates for active surveillance.
Perceptions from the front line: Professional identity in mental health nursing
Authors: Hercelinskyj Gylo , Cruickshank Mary , Brown Peter , Phillips Brian
Published: December 2012

In the context of a growing population of people experiencing mental illness worldwide, mental health nurses are a crucial workforce. Their recruitment and retention, however, is in decline. Drawing on qualitative data obtained from interviews with mental health nurses (MHN) in Victoria, Australia, the paper employs a range of concepts from role theory to explore professional identity within mental health nursing. The data highlight three key issues in relation to the future recruitment and retention of MHN: (i) the ambiguity of the MHN role; (ii) the weak definition and lack of understanding of the scope of the MHN role by nursing students; and (iii) a lack of communication about MHN as a profession to a wider audience. These findings indicate three avenues through which recruitment and retention in mental health nursing could be improved: (i) public communication; (ii) training and educating of the next generation of MHN; and (iii) more accurately defining the role of the MHN.
The dynamics of infection and the persistence of immunity to A(H1N1)pdm09 virus in Israel
Authors: Weil Merav , Shohat Tamar , Bromberg Michal , Bassal Ravit , Dichtiar Rita , Mandelboim Michal , Sofer Danit , Cohen Dani , Mendelson Ella
Published: December 2012

Background

Influenza virus A(H1N1)pdm09 first appeared in Israel in late April 2009, disappeared in mid‐March 2010, and reappeared in late October 2010. Symptoms were mostly mild without need for medical care.

Objectives

To provide targets for future pandemic preparedness and response by evaluating the dynamics and cumulative incidence of A(H1N1)pdm09 infection, the virus‐specific seroprevalence (HI antibody titer >1:40) at the height of the pandemic, during its decline and thereafter.

Methods

A cross‐sectional seroepidemiological study was conducted on 6911 serum samples collected before, during, and after the pandemic.

Results

Cumulative incidence of infection derived from the differences between post‐ and pre‐pandemic seroprevalence was 54·1%, 32·9%, 22·9%, 14·8%, and 6·3% in age‐groups 0–9, 10–19, 20–49, 50–79, and ≥80 years, respectively, and 28·5% for all age‐groups combined. Vaccination could have contributed at the most 4·6% to the post‐pandemic population seroprevalence. High pre‐pandemic immune response (47·4%) found in a cohort aged 15–18 year was strongly associated with birth years 1990–1993. Morbidity began to decline in mid‐November 2009 at 32·8% population seroprevalence (45% in ages 0–19 year) and stopped in March 2010 at 43·4% population seroprevalence in February 2010 (70% in ages 0–19 year). Between February and September 2010, seroprevalence declined by 12·2% allowing virus recirculation from October 2010.

Conclusions

Our study provides targets for controlling future influenza pandemics in Israel. Vaccination should focus on the younger age‐groups (0–19 year) which played a key role in transmission of the A(H1N1)pdm09 due to lack of background immunity (ages 0–9 year) and high exposure rates (ages 10–19 year).
Reconstructing a lost tradition: the philosophy of medical education in an age of reform
Authors: Martin Christopher
Published: December 2012

Context  At the 100th anniversary of Abraham Flexner’s landmark report on medical education, critical reassessment of the direction of medical education reform evinced valuable interdisciplinary contributions from biomedicine, sociology, psychology and education theory. However, to date, philosophy has been absent from the discussion despite its long standing contribution to studies on education in other professions.

Methods  This discussion paper examines how the philosophical tradition can contribute to scholarship in medical education. It begins with an explanation of the scholarly tradition of philosophy of education and its role in thinking in education more generally. It then makes links between this tradition and the context of medical education in the Flexner era of education reform. The paper then argues that this tradition is necessary to the understanding of medical education reform post‐Flexner and that doctors must benefit from an education derived from this tradition in order to be able to carry out their work.

Discussion  These foundations are characterised as a hidden, but always present, tradition in medical education. Two ways in which this ‘lost tradition’ can inform medical education theory and practice are identified: firstly, by the establishment of a public canon of medical education texts that express such a tradition, and, secondly, by the incorporation of a variety of ‘signature pedagogies’ exemplary of liberal education.
From sick role to practices of health and illness
Authors: Frank Arthur W
Published: December 2012

Context Health care research generally, and medical education research specifically, make increasingly sophisticated use of social science methods, but these methods are often detached from the theories that are the substantive core of the social sciences. Enhanced understanding of theory is especially valuable for gaining a broader perspective on how issues in medical education reflect the social processes that contextualise them.

Methods This article reviews five social science theories, emphasising their relevance to medical education, beginning with the emergence of the sociology of health and illness in the 1950s, with Talcott Parsons’ concept of the ‘sick role’. Four turning points since Parsons are then discussed with reference to the theory developed by, respectively, Harold Garfinkel, Michel Foucault and Pierre Bourdieu, and what is called the ‘narrative or dialogical turn’. In considering these, the author argues for a theory‐grounded research that relates specific problems to what Max Weber called the ‘fate of our times’.

Conclusions The conclusion considers how medical education research can critique the reproduction of a discourse of scarcity in health care, rather than participating in this discourse and legitimating the disciplinary techniques that it renders self‐evident.
Narrative, emotion and action: analysing ‘most memorable’ professionalism dilemmas
Authors: Rees Charlotte E , Monrouxe Lynn V , McDonald Laura A
Published: December 2012

OBJECTIVES Although previous studies have explored medical learners’‘most memorable’ experiences, these have typically focused on patient deaths or mistakes. Drawing on multiple theoretical perspectives to understand the interplay between narrative, emotion and action, this paper aims to explore thewhatsandhowsof written narratives of most memorable professionalism dilemmas: what types of dilemma are most memorable? When and where do they take place? How do students act? What characteristics relate to these dilemmas? How are dilemmas narrated?

METHODS A total of 680 students from 29 of 32 UK medical schools provided a written narrative of their most memorable dilemma as part of their responses to an online questionnaire exploring the impact of professionalism dilemmas on moral distress. We employed quantitative thematic and discourse analysis of all narratives using Linguistic Inquiry Word Count software (liwc) and conducted a narrative analysis of one exemplar.

RESULTS The most common themes across all narratives concerned dilemmas that related to issues of patient care with reference to the actions of health care professionals or students, student abuse, and consent and intimate examination. A total of 41.1% of experiences had occurred over 6 months previously and 80.1% had taken place in hospital settings. Overall, 54.9% of narrators reported having done something in the face of their dilemma, although only 13.2% described taking obvious or direct action. Numerous characteristics were related to most memorable dilemmas (e.g. narratives citing intimate examinations were more likely to take place in surgical settings). A total of 92.6% of narratives included negative emotion talk and numerous significant relationships emerged between types of emotion talk and most memorable dilemmas (e.g. more anger talk in abuse narratives). Our narrative analysis of one exemplar illustrates the richness of emotion talk and more subtle devices to establish emotional tone.

DISCUSSION Findings extend previous research into issues related to professionalism by exploring relationships between narrative, emotion and action in the context of written narratives of most memorable dilemmas. We encourage medical educators to help students construct coherent and emotionally integrated narratives to make sense of negative professionalism dilemmas.
Discourse(s) of emotion within medical education: the ever‐present absence
Authors: McNaughton Nancy
Published: December 2012

Context Emotion in medical education rests between the idealised and the invisible, sitting uneasily at the intersection between objective fact and subjective values. Examining the different ways in which emotion is theorised within medical education is important for a number of reasons. Most significant is the possibility that ideas about emotion can inform a broader understanding of issues related to competency and professionalism.

Objectives The current paper provides an overview of three prevailing discourses of emotion in medical education and the ways in which they activate particular professional expectations about emotion in practice.

Methods A Foucauldian critical discourse analysis of the medical education literature was carried out. Keywords, phrases and metaphors related to emotion were examined for their effects in shaping medical socialisation processes.

Discussion Despite the increasing recognition over the last two decades of emotion as ‘socially constructed’, the view of emotion as individualised is deeply embedded in our language and conceptual frameworks. The discourses that inform our emotion talk and practice as teachers and health care professionals are important to consider for the effects they have on competence and professional identity, as well as on practitioner and patient well‐being. Expanded knowledge of how emotion is ‘put to work’ within medical education can make visible the invisible and unexamined emotion schemas that serve to reproduce problematic professional behaviours. For this discussion, three main discourses of emotion will be identified: a physiological discourse in which emotion is described as located inside the individual as bodily states which are universally experienced; emotion as a form of competence related to skills and abilities, and a socio‐cultural discourse which calls on conceptions from the humanities and social sciences and directs our attention to emotion’s function in social exchanges and its role as a social, political and cultural mediator.
Gender matters in medical education
Authors: Bleakley Alan
Published: December 2012

Context  Women are in the majority in terms of entry to medical schools worldwide and will soon represent the majority of working doctors. This has been termed the ‘feminising’ of medicine. In medical education, such gender issues tend to be restricted to discussions of demographic changes and structural inequalities based on a biological reading of gender. However, in contemporary social sciences, gender theory has moved beyond both biology and demography to include cultural issues of gendered ways of thinking. Can contemporary feminist thought drawn from the social sciences help medical educators to widen their appreciation and understanding of the feminising of medicine?

Discussion  Post‐structuralist feminist critique, drawn from the social sciences, focuses on cultural practices, such as language use, that support a dominant patriarchy. Such a critique is not exclusive to women, but may be described as supporting a tender‐minded approach to practice that is shared by both women and men. The demographic feminising of medicine may have limited effect in terms of changing both medical culture and medical education practices without causing radical change to entrenched cultural habits that are best described as patriarchal. Medical education currently suffers from male biases, such as those imposed by ‘andragogy’, or adult learning theory, and these can be positively challenged through post‐structuralist feminist critique.

Conclusions  Women doctors entering the medical workforce can resist and reformulate the current dominant patriarchy rather than reproducing it, supported by male feminists. Such a feminising of medicine can extend to medical education, but will require an appropriate theoretical framework to make sense of the new territory. The feminising of medical education informed by post‐structuralist frameworks may provide a platform for the democratisation of medical culture and practices, further informing authentic patient‐centred practices of care.
Subarachnoid‐pleural fistula in a child: The cause and treatment
Authors: Karabayir Nalan , Demirkol Demet , Odaman Al Isık , Dolas Ilyas , Sencer Altay
Published: December 2012

Hydrothorax of the cerebrospinal fluid after a subarachnoid‐pleural fistula is a rare condition. Subarachnoid‐pleural fistula may appear after a trauma at the thoracolumbar vertebral column or iatrogenically after thoracotomy. A two years and four months old boy who was operated because of ganglioneuroblastoma was admitted to hospital due to respiratory distress. The chest roentgenogram obtained two months after thoracotomy, showed a pleural effusion at the left side and a chest tube was inserted. The craniospinal magnetic resonance imagining revealed subarachnoid‐pleural fistula and lumbar external cerebrospinal fluid drainage was performed. The chest tube was removed by application of tetracycline between pleural layers. After the patient was discharged, respiratory distress reoccured after 3 weeks and a chest tube was reinserted due to fluid at the left hemithorax. An external lumbar drainage was reapplied. The location of the fistula was determined by craniospinal magnetic resonance imagining and myelography. The fistula was surgically restored by a posterior approach and laminectomy. The cerebrospinal fluid drainage and chest tube was removed three days and seven days after the operation respectively. The patient was discharged at the 13 days after the operation. During periodical outpatient follow up the patient has no symptoms and is neurologically intact. Subarachnoid‐pleural fistulas, usually do not regress spontaneously or respond to conservative methods. Invasive approaches including surgery may be needed to treat patients with subarachnoid‐pleural fistulae.
Acetaminophen administration in a patient with Gilbert's syndrome
Authors: Nakagawa Taku , Mure Takeo , Yusoff Surini , Ono Eiichi , Harahap Indra Sari Kusuma , Morikawa Satoru , Morioka Ichiro , Takeshima Yasuhiro , Nishio Hisahide , Matsuo Masafumi
Published: December 2012

The patient was an 8‐year‐old Japanese girl with Gilbert's syndrome (GS). Based on the DNA analysis, she was homozygous for a T‐to‐G transversion at nucleotide position 1456 in the UGT1A1 gene, leading to the substitution of aspartate for tyrosine at position 486 of the UGT1A1 enzyme. Because this mutation is located in an exon common to UGT1A genes, all the UGT1A enzymes may be affected. It is well‐known that UGT1A1, UGT1A6 and UGT1A9 enzymes glucuronidate acetaminophen. To evaluate acetaminophen tolerance in the patient, serum acetaminophen levels were determined after oral administration of acetaminophen (15 mg/kg). The maximum serum acetaminophen level reached (12.8 µg/mL) was far below the toxic level. The finding suggested that the usual therapeutic dose of acetaminophen is safe for the GS patient. The combination of mutation analysis in UGT1A1 and acetaminophen loading test may be useful to avoid adverse effect in GS patients.
Acute encephalopathy and tubulointerstitial nephritis associated with Yersinia pseudotuberculosis
Authors: Kaito Hiroshi , Kamei Koichi , Ogura Masao , Kikuchi Eriko , Hoshino Hideki , Nakagawa Satoshi , Matsuoka Kentaro , Abe Jun , Ito Shuichi
Published: December 2012

We report the case of a 28‐month‐old boy with encephalopathy and acute tubulointerstitial nephritis possibly associated with Yersinia pseudotuberculosis (Yp) infection. He was transferred to our center because of impairment of renal function and altered consciousness. He had fever for 5 days after recurrent vomiting and diarrhea. Computed tomography scan was normal, but electroencephalogram (EEG) analyses showed generalized slow wave patterns. Continuous hemodialysis was undergone and then his renal function was improved, but altered consciousness persisted. Single photon emission computed tomography (SPECT) revealed abnormally low signals at entire field, which suggested that he was suffered from encephalopathy. Phenobarbital administration and post‐encephalopathy rehabilitation were started, and he recovered in fully premorbid state with normal EEG and SPECT findings on the 33rd hospital day. Various bacterial cultures were negative, but both Yp antibody and Yp‐derived mitogen (YPM) antibody, the antibody of a specific Yp exotoxin, had an extremely high titer. This is the first report of encephalopathy potentially caused by Yp, indicated by the presence of a high Yp and YPM antibody titer.
Endometrial cancer in a 14‐year‐old girl with Cowden syndrome: A case report
Authors: Baker William David , Soisson Andrew Patrick , Dodson Mark Kane
Published: December 2012

The appearance of endometrial cancer in adolescence is uncommon and warrants investigation for an hereditary cancer syndrome. Cowden syndrome is an autosomal dominant cancer syndrome associated with a germline PTEN mutation and increased risk of breast, thyroid, endometrial and colon cancer. In this report we present a case of a 14‐year‐old nulligravid female diagnosed with grade 1 endometrial adenocarcinoma. She subsequently developed fibrocystic breast disease and colon polyps and was diagnosed with Cowden syndrome at age 20. We therefore recommend formal evaluation for Cowden syndrome to be considered when endometrial cancer is diagnosed in adolescence.
Fetal macrosomia in Japanese women
Authors: Morikawa Mamoru , Cho Kazutoshi , Yamada Takashi , Yamada Takahiro , Sato Shoji , Minakami Hisanori
Published: December 2012

Aim

It is unknown how to reduce the number of macrosomic neonates among women without hyperglycemia. The aim of this study was to determine clinically useful risk factors for macrosomic neonates among women without hyperglycemia.

Material and Methods

A retrospective observational study was conducted in 117 680 Japanese women without hyperglycemia who gave birth to singleton infants at 37 weeks of gestation or later. Maternal age, parity, fetal sex, pregnancy length, and maternal body composition were studied as possible candidates for risk factors of macrosomic neonates using multivariate logistic regression analyses. Outcome measures were clinically available independent risk factors for macrosomic neonates weighing 4000 g or more.

Results

A total of 1037 (0.9%) women gave birth to macrosomic neonates. A male fetus (odds ratio [95% confidence interval]: 1.99 [1.75–2.27]), multiparity (1.75 [1.53–1.99]), pregnancy length of 41 weeks or more (4.28 [3.73–4.91]) and six characteristics at or above the 90th percentile values consisting of body height (≥1.65 m: 1.70 [1.45–1.99]), pre‐pregnancy body weight (≥65 kg: 1.47 [1.12–1.93]), pre‐pregnancy body mass index (BMI) (≥25 kg/m2: 1.49 [1.16–1.91]), weight gain during pregnancy (≥15 kg: 2.32 [1.78–3.03]), BMI gain during pregnancy (≥6.0 kg/m2: 1.52 [1.16–2.00]), and body weight at delivery (≥75 kg: 2.57 [2.08–3.17]) were identified as independent risk factors for macrosomia.

Conclusion

Intervention, such as a counseling on dietary habits leading to a lesser net weight gain may be considered among women suspected of having fetal overgrowth.
Prevalence of chromosomal abnormalities in Sri Lankan women with primary amenorrhea
Authors: Samarakoon Lasitha , Sirisena Nirmala D. , Wettasinghe Kalum T. , Kariyawasam Kariyawasam Warnakulathanthrige Jayani C. , Jayasekara Rohan W. , Dissanayake Vajira H. W.
Published: December 2012

Aim

Chromosomal abnormalities are implicated in the etiology of primary amenorrhea. The underlying chromosomal aberrations are varied and regional differences have been reported. The objective of this study is to describe the prevalence of various types of chromosomal abnormalities in Sri Lankan women with primary amenorrhea.

Material and Methods

Medical records of all patients diagnosed with primary amenorrhea referred for cytogenetic analysis to two genetic centers in Sri Lanka from January 2005 to December 2011 were reviewed. Chromosome culture and karyotyping was performed on peripheral blood samples obtained from each patient. Data were analyzed using standard descriptive statistics.

Results

Altogether 338 patients with primary amenorrhea were karyotyped and mean age at testing was 20.5 years. Numerical and structural chromosomal abnormalities were noted in 115 (34.0%) patients which included 45,X Turner syndrome (10.7%), Turner syndrome variants (13.9%), XY females (6.5%), 45,X/46,XY (0.9%), 46,XX/46,XY (0.6%), 47,XXX (0.3%), 47,XX,+ mar (0.3%), 46,X,i(X)(p10) (0.3%), 46,XX with SRY gene translocation on X chromosome (0.3%) and 46,XX,inv(7)(p10;q11.2) (0.3%). Short stature, absent secondary sexual characteristics, neck webbing, cubitus valgus and broad chest with widely spaced nipples were commonly seen in patients with Turner syndrome and variant forms. Neck webbing and absent secondary sexual characteristics were significantly associated with classical Turner syndrome than variant forms.

Conclusion

A considerable proportion of women with primary amenorrhea had chromosomal abnormalities. Mean age at testing was late suggesting delay in referral for karyotyping. Early referral for cytogenetic evaluation is recommended for the identification of underlying chromosomal aberrations in women with primary amenorrhea.
ABCB1/MDR1 gene polymorphism and colorectal cancer risk: a meta‐analysis of case–control studies
Authors: He T. , Mo A. , Zhang K. , Liu L.
Published: December 2012

Aim  ABCB1/MDR1 protein is found in high concentrations on the apical surfaces of colonic epithelial cells. It acts as an efflux pump by transporting toxic endogenous substances, drugs and xenobiotics out of cells. Polymorphisms in the ABCB1/MDR1 gene may either change expression of the ABCB1/MDR1 protein or alter its function, suggesting its possible association with colorectal cancer. Several studies have reported a relationship between ABCB1 gene polymorphisms and colorectal cancer risk, but no consistent conclusion has been reached. We therefore conducted a meta‐analysis to identify any association between the ABCB1 gene and CRC risk.

Method  PubMed, Embase, Google Scholar, Cbmdisc and CNKI were searched for studies on the relationship of ABCB1/MDR1 gene SNPs and the incidence of colorectal cancer. Eligible articles were included for data extraction. The main outcome was the frequency of ABCB1/MDR1 gene SNPs among cases and controls. Comparison of the distribution of SNPs was performed mainly using Review Manager 5.0.

Results  Ten, four and two trials were identified that focussed on the ABCB1 gene SNPs rs1045642, rs2032582 and rs3789243, respectively. A total of 3175 cases and 3715 controls were included. The meta‐analysis, stratified by ethnicity or population source, indicated no association between the ABCB1 gene rs1045642 polymorphism and colorectal cancer risk. However, when the study by Bae et al. was removed from the analysis, there was some evidence to indicate a higher T‐allele frequency in Asian colorectal cancer patients (OR = 1.30, 95% CI: 1.02–1.67, P = 0.03). Neither ABCB1 rs2032582 nor ABCB1 rs3789243 indicated an association with colorectal cancer risk. An increased frequency only of the wild‐type combined allele (rs2032582G/rs1045642C) was found in Caucasian patients (OR = 1.22, 95% CI: 1.03–1.44, P = 0.02).

Conclusion  There is some evidence to indicate an association between ABCB1 rs1045642T and colorectal cancer risk in Asians. Compared with the ABCB1 gene SNPs rs1045642, rs2032582 or rs3789243 alone, combined haplotypes of several SNPs might be a better marker to determine the genetic influence on the susceptibility to colorectal cancer among Caucasians.
Virtue and austerity
Authors: Allmark Peter
Published: December 2012

Virtue ethics is often proposed as a third way in health‐care ethics, that while consequentialism and deontology focus on action guidelines, virtue focuses on character; all three aim to help agents discern morally right action although virtue seems to have least to contribute to political issues, such as austerity. I claim: (1) This is a bad way to characterize virtue ethics. The 20th century renaissance of virtue ethics was first proposed as a response to the difficulty of making sense of ‘moral rightness’ outside a religious context. For Aristotle the right action is that which is practically best; that means best for the agent in order to live a flourishing life. There are no moral considerations besides this. (2) Properly characterized, virtue ethics can contribute to discussion of austerity. A criticism of virtue ethics is that fixed characteristics seem a bad idea in ever‐changing environments; perhaps we should be generous in prosperity, selfish in austerity. Furthermore, empirical evidence suggests that people indeed do change with their environment. However, I argue that virtues concern fixed values not fixed behaviour; the values underlying virtue allow for different behaviour in different circumstances: in austerity, virtues still give the agent the best chance of flourishing. Two questions arise. (a) In austere environments might not injustice help an individual flourish by, say, obtaining material goods? No, because unjust acts undermine the type of society the agent needs for flourishing. (b) What good is virtue to those lacking the other means to flourish? The notion of degrees of flourishing shows that most people would benefit somewhat from virtue. However, in extreme circumstances virtue might harm rather than benefit the agent: such circumstances are to be avoided; virtue ethics thus has a political agenda to enable flourishing. This requires justice, a fortiori when in austerity.
Thinking as a subversive activity: doing philosophy in the corporate university
Authors: Rolfe Gary
Published: December 2012

The academy is in a mess. The cultural theorist Bill Readings claimed that it is in ruins, while the political scientist Michael Oakeshott suggested that it has all but ceased to exist. At the very least, we might argue that the current financial squeeze has distorted the University into a shape that would be all but unrecognizable to Oakeshott and others writing in the 1950s and 1960s. I will begin this paper by tracing the development of the modern Enlightenment University over the past 200 years from its roots in late 18th century Berlin to its current predicament. I will then turn my attention to the introduction during the 1990s of nursing education into the University, and examine the particular difficulties and tensions encountered at the interface between a professional practice and an academic discipline. Finally, I will propose philosophy as a way of dwelling in the ruins of the Enlightenment University and of reconciling the corporate demands of the University with the obligations of the nursing profession.
Capitalism, the state and health care in the age of austerity: a Marxist analysis
Authors: Porter Sam
Published: December 2012

The capacity to provide satisfactory nursing care is being increasingly compromised by current trajectories of healthcare funding and governance. The purpose of this paper is to examine how well Marxist theories of the state and its relationship with capital can explain these trajectories in this period of ever‐increasing austerity. Following a brief history of the current crisis, it examines empirically the effects of the crisis, and of the current trajectory of capitalism in general, upon the funding and organization of the UK and US healthcare systems. The deleterious effect of growing income inequalities to the health of the population is also addressed. Marx's writings on the state and its relation to the capitalist class were fragmentary and historically and geographically specific. From them, we can extract three theoretical variants: the instrumentalist theory of the state, where the state has no autonomy from capital; the abdication theory, whereby capital abstains from direct political power and relies on the state to serve its interests; and the class‐balance theory, whereby the struggle between two opposed classes allows the state to assert itself. Discussion of modern Marxist interpretations includes Poulantzas's abdication theory and Miliband's instrumentalist theory. It is concluded that, despite the pluralism of electoral democracies, the bourgeoisie do have an overweening influence upon the state. The bourgeoisie's ownership of the means of production provides the foundation for its influence because the state is obliged to rely on it to manage the supply of goods and services and the creation of wealth. That power is further reinforced by the infiltration of the bourgeoisie into the organs of state. The level of influence has accelerated rapidly over recent decades. One of the consequences of this has been that healthcare systems have become rich pickings for the evermore confident bourgeoisie.
(Non)words, (non)words, (non)words: evidence for a protolexicon during the first year of life
Authors: Ngon Céline , Martin Andrew , Dupoux Emmanuel , Cabrol Dominique , Dutat Michel , Peperkamp Sharon
Published: December 2012

Previous research with artificial language learning paradigms has shown that infants are sensitive to statistical cues to word boundaries (Saffran, Aslin & Newport, 1996) and that they can use these cues to extract word‐like units (Saffran, 2001). However, it is unknown whether infants use statistical information to construct a receptive lexicon when acquiring their native language. In order to investigate this issue, we rely on the fact that besides real words a statistical algorithm extracts sound sequences that are highly frequent in infant‐directed speech but constitute nonwords. In three experiments, we use a preferential listening paradigm to test French‐learning 11‐month‐old infants' recognition of highly frequent disyllabic sequences from their native language. In Experiments 1 and 2, we use nonword stimuli and find that infants listen longer to high‐frequency than to low‐frequency sequences. In Experiment 3, we compare high‐frequency nonwords to real words in the same frequency range, and find that infants show no preference. Thus, at 11 months, French‐learning infants recognize highly frequent sound sequences from their native language and fail to differentiate between words and nonwords among these sequences. These results are evidence that they have used statistical information to extract word candidates from their input and stored them in a ‘protolexicon’, containing both words and nonwords.
Shrinkage and Penalty Estimators of a Poisson Regression Model
Authors: Hossain Shakhawat , Ahmed Ejaz
Published: December 2012

In this paper we propose Stein‐type shrinkage estimators for the parameter vector of a Poisson regression model when it is suspected that some of the parameters may be restricted to a subspace. We develop the properties of these estimators using the notion of asymptotic distributional risk. The shrinkage estimators are shown to have higher efficiency than the classical estimators for a wide class of models. Furthermore, we consider three different penalty estimators: the LASSO, adaptive LASSO, and SCAD estimators and compare their relative performance with that of the shrinkage estimators. Monte Carlo simulation studies reveal that the shrinkage strategy compares favorably to the use of penalty estimators, in terms of relative mean squared error, when the number of inactive predictors in the model is moderate to large. The shrinkage and penalty strategies are applied to two real data sets to illustrate the usefulness of the procedures in practice.
Confidence Intervals for the Weighted Sum of Two Independent Binomial Proportions
Authors: Decrouez Geoffrey , Robinson Andrew P.
Published: December 2012

Confidence intervals for the difference of two binomial proportions are well known, however, confidence intervals for the weighted sum of two binomial proportions are less studied. We develop and compare seven methods for constructing confidence intervals for the weighted sum of two independent binomial proportions. The interval estimates are constructed by inverting the Wald test, the score test and the Likelihood ratio test. The weights can be negative, so our results generalize those for the difference between two independent proportions. We provide a numerical study that shows that these confidence intervals based on large‐sample approximations perform very well, even when a relatively small amount of data is available. The intervals based on the inversion of the score test showed the best performance. Finally, we show that as for the difference of two binomial proportions, adding four pseudo‐outcomes to the Wald interval for the weighted sum of two binomial proportions improves its coverage significantly, and we provide a justification for this correction.