177 research outputs found
'The CASE of the Author'
Get PDFExamining the intersections between medicine and literature in the eighteenth century, this article argues that Scottish physician George Cheyne\u27s celebrated "CASE of the Author" (1733) adopts the literary inheritance of the spiritual autobiography as a means of establishing narrative authority and of structuring the clinical record of one man\u27s experiences in health and illness. In tracing his own "Progress" from physical ruin to "perfect Health," Cheyne invokes the authorities of medical science and clinical objectivity. However, the language, structure, and ethos are those of the spiritual autobiography, in which a reflecting author, looking back upon the apparently random and disconnected events of his past, reads "God\u27s plot" for his life. Reading the symptoms of his own ill health and emergent recovery as symbols provided by "the Author of Nature," the reflecting Cheyne discovers an intelligible providential plot by which to interpret the raw data of his own clinical observations
Dyspnea or Cheyne–Stokes respiration associated with Ticagrelor?
No full textA 65-year-old, 85-kg, 182-cm man (author PB), known for ischemic heart disease with surgical revascularization in 2005, was admitted for non-ST-segment elevation myocardial infarction. At the end of successful right coronary artery stenting, Ticagrelor, a reversible inhibitor of P2Y12 receptor, was added to Aspirin. Five hours later, the patient had dyspnea and Cheyne–Stokes respiration (CSR) which was difficult to repress while awake. At home, his spouse recorded on a portable phone the abnormal pattern of periodic breathing during sleep, with apneas lasting up to 21 s. CSR disappeared during daytime over the next few weeks, but the patient kept complaining of dyspnea when going upstairs. [...
Density of a Reintroduced Population of Bornean Orangutans (Pongo pygmaeus) in Pristine and Disturbed Forest Areas, Sungai Wain Protection Forest, East Kalimantan, Indonesia
Get PDFSungai Wain Protection Forest is among the final extant primary lowland coastal forests remaining in East Kalimantan (Fredriksson and Nijman, 2004). From 1992-1997 82 formerly captive Bornean orangutans (Pongo pygmaeus) were released in Sungai Wain Protection Forest through the Wanariset Orangutan Reintroduction Project (Russon and Susilo, 1999). Forest fires burned approximately 60% of the reserve in 1998 (Fredriksson and Nijman, 2004). An extensive nest census conducted in 1998 produced an estimate of 13-17 orangutans remaining in Sungai Wain Protection Forest (Russon and Susilo, 1999). Very little research has been conducted on this reintroduced population of orangutans since the 1998 nest survey. In this study, a new nest survey will be conducted in order to produce a current estimate of orangutan densities in Sungai Wain Protection Forest.
Orangutan density estimates in the primary forest area will be compared to densities in areas of forest
which have been disturbed by fires
Age-related macular degeneration in people with diabetes mellitus: prevalence, incidence, and determinants
No full textTitle: Age-related macular degeneration in people with diabetes mellitus: prevalence, incidence, and determinants.
Background: There were limited epidemiology data of age-related macular degeneration (AMD) prevalence and incidence in people with diabetes and its determinants, including the effect of DR and diabetes medication, to the incidence and progression of AMD. Fundus photographic image from DR screening is reported to be reliable to detect AMD. In the UK, the universal photographic screening programme for DR in diabetes provided sufficient data of medical record to understand the risk and protective factors that affect the development and progression of the disease whilst also provided an opportunity to identify other retinal pathologies such as AMD.
Methods: Of 10,336 people aged ≥50 years who attended the Liverpool Diabetic Eye Screening Programme (LDESP) in 2011 and were enrolled in the Individualised Screening for Diabetic Retinopathy (ISDR) study, I selected randomly 2,600 cohort who had gradable retinal photographs (N=2589) to grade for AMD and used these data to measure the prevalence of AMD in diabetes. Excluding 466 cohort who did not attend the LDESP in 5-year or ungradeable/unavailable images of both eyes, retinal photographs of 2123 cohort were graded for AMD to study the five-year incidence and progression. Retinal photographic grading was performed following the modified Age-Related Eye Disease Study (AREDS) grading system for each eye. Twenty percent of all the images that were used in this study were subjected to quality grading reassurance that was completed separately by a senior AMD grader at Liverpool Ophthalmic Reading Centre. A multivariable logistic regression model was used to assess the association of multiple factors, including anti diabetes medication metformin and AMD incidence and progression. Multiple imputation (MI) applied in multivariable logistic regression was used to handle missing data.
Results: The age-standardised prevalence of early, intermediate, and late AMD was 13.8%, 4.4%, and 0.9%, respectively. Prevalence of any AMD were consistently increased with increasing age (crude OR 1.06, 95%CI 1.05-1.07, p<0.001). These results persisted in multivariable logistic regression of complete record analysis and MI to missing data (both OR 1.05, 95%CI 1.05-1.07, p<0.001). The presence of any DR was associated with reduced risk of any AMD in multivariable logistic regression (complete record: OR 0.70, 95% CI 0.51-0.97, p=0.03; MI: 0.78, 0.61-0.99, p=0.04). The age-standardised incidence of early, intermediate, early-intermediate, and late AMD was 11.6%, 10.3%, 16.4%, and 2.9%, respectively. The progression from early/intermediate to late AMD was 8.4%. In multivariable logistic regression analysis, increasing age was associated with increased odds of incidence of early-intermediate (OR 1.03; 95%CI: 1.01-1.05, p=0.002), intermediate (1.05, 1.03-1.07, p<0.001), late (1.19, 1.14-1.24, p<0.001), and any AMD (1.03, 1.02-1.05, p<0.001). Likewise, increasing age was related to progression to late AMD (1.14, 1.09-1.19, p<0.001). No significant evidence of association was identified between the presence of any DR or diabetes control at baseline with AMD incidence and progression in final model of multivariable logistic regression (p0.05). Metformin use lowered the odds of intermediate AMD incidence consistently in multivariable logistic regression model (complete record: OR 0.63, 95%CI 0.43-0.92, p=0.02; MI: 0.66, 0.48-0.91, p=0.01). The interobserver agreement kappa statistic for AMD severity level was more than 0.7 in both eyes of the baseline and follow-up images.
Conclusions: I found that detecting and grading AMD during routine DR screening is feasible and reliable, indicated by good interobserver agreement in my study. Inconsistent comparison of prevalence, incidence, and progression of AMD with selected reference studies was observed. Due to differences in follow-up period, age ranges, grading categories, demographic, and methodologies between studies, cautious interpretation is warranted. Inconsistent association between presence of any DR and any AMD in cross-sectional and follow-up analysis were observed in my study. Ultimately, there is no straight-forward explanation for these conflicting results. Metformin use suggested to be protective to incidence of intermediate stage of AMD and warrant further observational studies in other population settings as foundational knowledge for potential randomised controlled clinical trial
Disability Studies Reads the Romance
No full textAs the most popular of the popular genres, romance novels are an important site of investigation for cultural disability studies, a field concerned with the effects that representations of disability have on the world. The article explores the productive potentials of a dialogue between cultural disability studies and popular romance studies. With a focus on selected novels by Mary Balogh, a bestselling author of historical romance, the argument is that the frequent use of disabled characters, and the way in which those characters are depicted, positions all disabled characters as potential romantic actants, and encourages readers to reflect critically upon how they conceptualize disability
Control theory prediction of resolved Cheyne-Stokes respiration in heart failure
Get PDFCheyne-Stokes respiration (CSR) foretells deleterious outcomes in patients with heart failure. Currently, the size of therapeutic intervention is not guided by the patient's underlying pathophysiology. In theory, the intervention needed to resolve CSR, as a control system instability (loop gain >1), can be predicted knowing the baseline loop gain and how much it falls with therapy. In 12 patients with heart failure, we administered an inspiratory carbon dioxide fraction of 1-3% during CSR (n=95 interventions) as a means to reduce loop gain. We estimated the loop gain on therapy (LGtherapy), using the baseline loop gain (using hyperpnoea length/cycle length) and its expected reduction (18% per 1% inspired carbon dioxide), and tested the specific hypothesis that LGtherapy predicts CSR persistence (LGtherapy >1) versus resolution (LGtherapy <1). As predicted, when LGtherapy >1.0, CSR continued during therapy in 23 out of 25 (92%) trials. A borderline loop gain zone (0.8<LGtherapy<1) yielded an unpredictable outcome, while LGtherapy <0.8 consistently yielded CSR resolution (37 out of 37 trials). A threshold of LGtherapy=0.9 determined outcome in 76 out of 95 (80%) trials. We establish proof-of-concept that control theory provides predictive insight into CSR resolution in heart failure. Thus, we now have a means to calculate the size of interventions needed to ameliorate CSR on a patient-by-patient basis.</p
Individualised variable-interval risk-based screening for sight-threatening diabetic retinopathy: the Liverpool risk calculation engine
No full textAims/hypothesis: individualised variable-interval risk-based screening offers better targeting and improved cost-effectiveness in screening for diabetic retinopathy. We developed a generalisable risk calculation engine (RCE) to assign personalised intervals linked to local population characteristics, and explored differences in assignment compared with current practice. Methods: data from 5 years of photographic screening and primary care for people with diabetes, screen negative at the first of > 1 episode, were combined in a purpose-built near-real-time warehouse. Covariates were selected from a dataset created using mixed qualitative/quantitative methods. Markov modelling predicted progression to screen-positive (referable diabetic retinopathy) against the local cohort history. Retinopathy grade informed baseline risk and multiple imputation dealt with missing data. Acceptable intervals (6, 12, 24 months) and risk threshold (2.5%) were established with patients and professional end users.Results: data were from 11,806 people with diabetes (46,525 episodes, 388 screen-positive). Covariates with sufficient predictive value were: duration of known disease, HbA1c, age, systolic BP and total cholesterol. Corrected AUC (95% CIs) were: 6 months 0.88 (0.83, 0.93), 12 months 0.90 (0.87, 0.93) and 24 months 0.91 (0.87, 0.94). Sensitivities/specificities for a 2.5% risk were: 6 months 0.61, 0.93, 12 months 0.67, 0.90 and 24 months 0.82, 0.81. Implementing individualised RCE-based intervals would reduce the proportion of people becoming screen-positive before the allocated screening date by > 50% and the number of episodes by 30%. Conclusions/interpretation: the Liverpool RCE shows sufficient performance for a local introduction into practice before wider implementation, subject to external validation. This approach offers potential enhancements of screening in improved local applicability, targeting and cost-effectiveness.</p
sj-pdf-6-jrs-10.1177_01410768231182389 - Supplemental material for COVID-19 risk mitigation in reopening mass cultural events: population-based observational study for the UK Events Research Programme in Liverpool City Region
No full textSupplemental material, sj-pdf-6-jrs-10.1177_01410768231182389 for COVID-19 risk mitigation in reopening mass cultural events: population-based observational study for the UK Events Research Programme in Liverpool City Region by Girvan Burnside, Christopher P Cheyne, Gary Leeming, Michael Humann, Alistair Darby, Mark A Green, Alexander Crozier, Simon Maskell, Kay O’Halloran, Elena Musi, Elinor Carmi, Naila Khan, Debra Fisher, Rhiannon Corcoran, Jake Dunning, W John Edmunds, Kukatharmini Tharmaratnam, David M Hughes, Liora Malki-Epshtein, Malcolm Cook, Ben M Roberts, Eileen Gallagher, Kate Howell, Meera Chand, Robin Kemp, Matthew Boulter, Tom Fowler, Malcolm G Semple, Emer Coffey, Matt Ashton, The COVID-19 Genomics UK (COG-UK) ConsortiumMarta García-Fiñana and Iain E Buchan in Journal of the Royal Society of Medicine</p
sj-pdf-2-jrs-10.1177_01410768231182389 - Supplemental material for COVID-19 risk mitigation in reopening mass cultural events: population-based observational study for the UK Events Research Programme in Liverpool City Region
No full textSupplemental material, sj-pdf-2-jrs-10.1177_01410768231182389 for COVID-19 risk mitigation in reopening mass cultural events: population-based observational study for the UK Events Research Programme in Liverpool City Region by Girvan Burnside, Christopher P Cheyne, Gary Leeming, Michael Humann, Alistair Darby, Mark A Green, Alexander Crozier, Simon Maskell, Kay O’Halloran, Elena Musi, Elinor Carmi, Naila Khan, Debra Fisher, Rhiannon Corcoran, Jake Dunning, W John Edmunds, Kukatharmini Tharmaratnam, David M Hughes, Liora Malki-Epshtein, Malcolm Cook, Ben M Roberts, Eileen Gallagher, Kate Howell, Meera Chand, Robin Kemp, Matthew Boulter, Tom Fowler, Malcolm G Semple, Emer Coffey, Matt Ashton, The COVID-19 Genomics UK (COG-UK) Consortium, Marta García-Fiñana and Iain E Buchan in Journal of the Royal Society of Medicine</p
- …
