Many commentators have contrasted the way that sociability is theorized in the writings of Mary Astell and Damaris Masham, emphasizing the extent to which Masham is more interested in embodied, worldly existence. I argue, by contrast, that Astell's own interest in imagining a constitutively relational individual emerges once we pay attention to her use of religious texts and tropes. To explore the relevance of Astell's Christianity, I emphasize both how Astell's Christianity shapes her view of the individual's relation to society and how Masham's contrasting views can be analyzed through the lens of her charge that Astell is an “enthusiast.” In late seventeenth-century England, “enthusiasm” was a term of abuse that, commentators have recently argued, could function polemically to dismiss those deemed either excessively social or antisocial. By accusing Astell of enthusiasm, I claim, Masham seeks to marginalize the relational self that Astell imagines and to promote a more instrumental view of social ties. I suggest some aspects of Astell's thought that may have struck contemporaries as “enthusiastic” and contrast her vision of the self with Masham's more hedonistic subject. I conclude that, although each woman differently configures the relation between self and society, they share a desire to imagine autonomy within a relational framework.
Monday, April 30, 2012
Chronic rhinosinusitis symptoms and computed tomography staging: improved correlation by incorporating radiographic density
Abstract
Background:
Traditional methods for staging of chronic rhinosinusitis (CRS) by computed tomography (CT) have not proven to be predictive of subjective reports of patients' symptoms. An objective measure of CRS severity that correlates well with patients' symptoms, particularly if available from CT data, would be a valuable tool in assessment of disease status and outcomes after surgery.
Methods:
Retrospective chart review of CRS patients with symptom data from the Rhinosinusitis Symptom Inventory (RSI) and objective data from a sinus CT scan. CRS disease severity on CT imaging was measured according to the traditional Lund-Mackay scoring, as well as by raw measures of the densities of sinus opacities (in Hounsfield units [HU]) and density-weighted Lund-Mackay scoring. These data were related to symptom severity scores using a multivariate regression model.
Results:
There was no significant correlation between either raw density values of sinus opacities or weighted Lund-Mackay scores with facial or total symptom scores. Oropharyngeal symptoms scores were negatively correlated with the sum of “average HU” values (p = 0.036, β = −1.120) but were positively correlated with the sum of “maximum HU” values (p = 0.047, β = 1.221). There was a significant negative correlation between the systemic symptoms score and mean of “average HU” values (p = 0.010, β = −0.272). Finally, there was a positive correlation between “maximum HU” value-weighted Lund-Mackay score with nasal symptom scores (p = 0.016, β = 0.241), systemic symptom scores (p = 0.008, β = 0.605), and total symptom scores (p = 0.078, β = 0.179).
Conclusion:
Incorporation of radiographic characteristics of sinus opacification with Lund-Mackay scores offers greater predictive power of patients' subjective symptom severity. © 2012 ARS-AAOA, LLC.
Toward a Postcolonial, Posthumanist Feminist Theory: Centralizing Race and Culture in Feminist Work on Nonhuman Animals
Posthumanist feminist theory has been instrumental in demonstrating the salience of gender and sexism in structuring human–animal relationships and in revealing the connections between the oppression of women and of nonhuman animals. Despite the richness of feminist posthumanist theorizations it has been suggested that their influence in contemporary animal ethics has been muted. This marginalization of feminist work—here, in its posthumanist version—is a systemic issue within theory and needs to be remedied. At the same time, the limits of posthumanist feminist theory must also be addressed. Although posthumanist feminist theory has generated a sophisticated body of work analyzing how gendered and sexist discourses and practices subordinate women and animals alike, its imprint in producing intersectional analyses of animal issues is considerably weaker. This leaves theorists vulnerable to charges of essentialism, ethnocentrism, and elitism despite best intentions to avoid such effects and despite commitments to uproot all forms of oppression. Gender-focused accounts also preclude understanding of the importance of race and culture in structuring species-based oppression. To counter these undesirable pragmatic and conceptual developments, posthumanist feminist theory needs to engender feminist accounts that centralize the structural axes of race and culture.
The Hospital's Role in Improving Survival of Patients With Out-of-Hospital Cardiac Arrest
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Unfortunately, in spite of recurring updated guidelines, survival of patients with OHCA had been unchanged for decades. Recently, new approaches to patients with OHCA during the community and prehospital phases of therapy for cardiac arrest have resulted in a dramatic improvement in survival. Further improvement in survival has resulted from hospitals designated as Cardiac Receiving Centers. These centers are committed to the treatment of post-cardiac arrest syndrome by providing 24/7 therapeutic mild hypothermia, urgent cardiac catheterization and percutaneous coronary intervention, evidence-based termination of resuscitation protocols that limit premature withdrawal of care, protocol to address organ donation, commitment of cardiocerebral resuscitation training in their community, and a commitment and proven ability of data collection to assure that instituted changes result in improved survival. This newer aspect of hospital practice is an aspect that needs to be embraced by either becoming a Cardiac Receiving Center or partnering with other hospitals that can provide this critically important service. Clin. Cardiol. 2012 doi: 10.1002/clc.21992
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Discovery, Synthesis, and in vitro Evaluation of West Nile Virus Protease Inhibitors Based on the 9,10-Dihydro-3H,4aH-1,3,9,10a-tetraazaphenanthren-4-one Scaffold
Abstract
West Nile virus (WNV), a member of the Flaviviridae family, is a mosquito-borne pathogen that causes a great number of human infections each year. Neither vaccines nor antiviral therapies are currently available for human use. In this study, a WNV NS2B–NS3 protease inhibitor with a 9,10-dihydro-3H,4aH-1,3,9,10a-tetraazaphenanthren-4-one scaffold was identified by screening a small library of non-peptidic compounds. This initial hit was optimized by solution-phase synthesis and screening of a focused library of compounds bearing this scaffold. This led to the identification of a novel, uncompetitive inhibitor (1a40, IC50=5.41±0.45 μM) of WNV NS2B–NS3 protease. Molecular docking of this chiral compound onto the WNV protease indicates that the S enantiomer of 1a40 appears to interfere with the productive interactions between the NS2B cofactor and the NS3 protease domain; (S)-1a40 is a preferred isomer for inhibition of WNV NS3 protease.
Running cofactor interference: In vitro assays with West Nile virus (WNV) NS2B–NS3 protease resulted in the discovery of 9,10-dihydro-3H,4aH-1,3,9,10a-tetraazaphenanthren-4-ones as a new class of inhibitors of this enzyme. Optimization of the lead compound led to an uncompetitive WNV NS2B–NS3 inhibitor with an IC50 value of 5.41±0.45 μM.
Brain-derived neurotrophic factor as a regulator of systemic and brain energy metabolism and cardiovascular health
Overweight sedentary individuals are at increased risk for cardiovascular disease, diabetes, and some neurological disorders. Beneficial effects of dietary energy restriction (DER) and exercise on brain structural plasticity and behaviors have been demonstrated in animal models of aging and acute (stroke and trauma) and chronic (Alzheimer's and Parkinson's diseases) neurological disorders. The findings described later, and evolutionary considerations, suggest brain-derived neurotrophic factor (BDNF) plays a critical role in the integration and optimization of behavioral and metabolic responses to environments with limited energy resources and intense competition. In particular, BDNF signaling mediates adaptive responses of the central, autonomic, and peripheral nervous systems from exercise and DER. In the hypothalamus, BDNF inhibits food intake and increases energy expenditure. By promoting synaptic plasticity and neurogenesis in the hippocampus, BDNF mediates exercise- and DER-induced improvements in cognitive function and neuroprotection. DER improves cardiovascular stress adaptation by a mechanism involving enhancement of brainstem cholinergic activity. Collectively, findings reviewed in this paper provide a rationale for targeting BDNF signaling for novel therapeutic interventions in a range of metabolic and neurological disorders.
Evidence-Based Postoperative Pain Management After Laparoscopic Colorectal Surgery
Abstract
Aim: The aim of this systematic review was to evaluate the available literature on the management of pain after laparoscopic colorectal surgery.
Method: Randomized studies, published in English between January 1995 and July 2011, assessing analgesic and anesthetic interventions in adults undergoing laparoscopic colorectal surgery, and reporting pain scores, were retrieved from the EMBASE and MEDLINE databases. Efficacy and adverse effects of analgesic techniques was assessed. The recommendations were based on procedure-specific evidence from a systematic review and supplementary transferable evidence from other relevant procedures.
Results: Of the 170 randomized studies identified, 12 studies were included. Overall, all approaches including ketorolac, methylprednisolone, intraperitoneal instillation of ropivacaine, intravenous lidocaine infusion, intrathecal morphine, and epidural analgesia improved pain relief, reduced opioid requirements and improved bowel function. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis. The L’abbe plots of the data from the epidural analgesia studies included in this review indicate that the pain scores in the non-epidural groups, although higher than those in the epidural groups, were within an acceptable level (i.e., <4/10).
Conclusion: Infiltration of surgical incisions with local anaesthetic at the end of surgery, systemic steroids, conventional nonsteroidal anti-inflammatory drugs or cyclooxygenase-2-selective inhibitors in combination with paracetamol with opioid used as rescue are recommended. Intravenous lidocaine infusion is recommended, but not as first line of therapy. However, neuraxial blocks (i.e., epidural analgesia and spinal morphine) are not necessary based on high risk:benefit ratio.
© 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Septic shock in a patient infected with Rickettsia sibirica mongolitimonae, Spain
Clin Microbiol Infect
Abstract
In 1996, the first human case of infection by Rickettsia sibirica subsp. mongolitimonae was described in France. Subsequently, other human cases were reported in the same country. The acronym LAR (lymphangitis-associated rickettsiosis) has been proposed to designate this disease because lymphangitis is one of the main clinical manifestations. Later, a few more cases were described in Portugal, South Africa, Egypt, Greece and Spain. We report a case of R. sibirica mongolitimonae infection as a cause of septic shock in a Spanish patient living in La Rioja (northern Spain). In addition, the broad clinical spectrum of this tick-borne disease is discussed.
Clinical impact of HSV-1 detection in the lower respiratory tract from hospitalized adult patients
Clin Microbiol Infect
Abstract
The occurrence and clinical impact of herpes simplex virus (HSV) were evaluated in 342 bronchoalveolar lavage specimens from 237 patients. HSV-1 and HSV-2 were detected in 32.1% and <1% of patients, respectively. A significant difference of HSV-1 prevalence and load was found in relation to admission to intensive care unit, mechanical ventilation and mortality within 28 days; in particular, a viral load ≥105 copies/mL bronchoalveolar lavage fluid was significantly associated with critical features. No association was found with immune status or other characteristics. Nine of 21 (42.9%) cases of ventilator-associated pneumonia were positive for HSV-1, with poor outcome in six.
Changes in problem-based and routine-based healthcare attendance: a comparison of three national dental health surveys
Abstract
Background
Healthcare utilization either may be guided by a preventive orientation leading to regular visits to the doctor, or it may be triggered by impaired health. Using data from three German national surveys, we wanted to examine whether the effects of income on the utilization of dental health services increased over time owing to the considerable decrease in insurance coverage over the years and the increase in higher out-of-pocket costs from patients.
Methods
Data from three national dental health surveys (1989, 1997 and 2005) were used. The data of all respondents aged between 35 and 44 years were available, and the number of caries-free and unrestored healthy teeth was used as outcome.
Results
Over the years, the proportion of routine attenders increased considerably, and the dental health measure used indicates the improvement. The least educated respondents and those with the lowest income profited less than other groups. In spite of higher copayments, the effects of income on the utilization of dental care did not increase over time. Regarding the results of education, a significant effect was only found in the study from 2005. No clear differences between routine- and problem-oriented attenders emerged with respect to the dental health measure chosen.
Conclusions
Material conditions and education had effects on utilization behaviour. Contrary to expectation, increasing copayments did not yield higher effects of income on healthcare utilization.
Is the wait-for-patient-to-come approach suitable for African newcomers to Alberta, Canada?
Abstract
Objectives
A qualitative study was conducted to identify psychosocial barriers to providing and obtaining preventive dental care for preschool children among African recent immigrants.
Methods
Seven focus groups were conducted with 48 mothers of 3- to 5-year-old children from Ethiopian, Eritrean, and Somali communities in Edmonton. Participants had lived in Canada for 5 years or less. Three debriefing interviews were conducted with the community health workers who facilitated the focus groups in participants' first languages. Data analysis consisted of assigning codes, grouping codes into existing or new categories of barriers, grouping identified categories into domains, and organizing categories and domains around a general perspective of psychosocial barriers to prevention of caries.
Results
Barriers to prevention of early childhood caries (ECC) were associated with home-based prevention, early detection, and access to professional care. Barriers to parental prevention were related to health beliefs, knowledge, oral health approach, and skills. Barriers to early detection included perceived role of caregivers and dentists, perceived identity of ECC, ways of detecting cavities, and parental self-efficacy. Access barriers were related to parental knowledge of preventive services, attitudes toward dentists and dental services, English skills, and external constraints concerned dental insurance, social support, time, and transportation.
Conclusions
Preventive interventions should be aimed at assisting primary caregivers with providing and obtaining adequate dental care for their children through enhancing oral health literacy, developing new set of oral health–related skills, reducing environmental constraints, and strengthening their intention of obtaining professional preventive dental services.
Overexpression of RNA helicase p68 protein in cutaneous squamous cell carcinoma
Summary
Background. RNA helicase p68 is a prototypic DEAD-box RNA helicase. Recent studies indicate that p68 plays important role in cancer development and progression. However, the role of p68 protein expression in cutaneous squamous cell carcinoma (SCC) remains unknown.
Aim. To elucidate the expression of p68 protein in cutaneous SCC.
Methods. The level of p68 protein was examined by double immunofluorescent staining in 24 samples of human cutaneous SCC tissue specimens and their adjacent tissues and in 6 normal foreskin samples to compare the expression of p68 with that of Ki-67.
Results. Overexpression of p68 protein was seen in all 24 SCC cases (100%), whereas very low expression of p68 was detected in normal foreskin. Moreover, p68 protein expression was higher in cases of cutaneous SCC with metastasis than in cases without metastasis. Additionally, p68 had a similar expression pattern to that of Ki-67.
Conclusion. The high frequency of p68 expression in cutaneous SCC indicates that p68 might be involved in the development and progression of cutaneous SCC.
Orofacial granulomatosis: three case reports illustrating the spectrum of disease and overlap with Crohn's disease
Summary
We report three cases of orofacial granulomatosis (OFG) to illustrate the spectrum of this disease, and to discuss the appropriate management steps, consider its overlap with Crohn's disease (CD) and raise its awareness among paediatric dermatologists. The term ‘orofacial granulomatosis’ was first used in 1985 to describe granulomas in the orofacial region in the absence of any recognized systemic condition. It is uncommon but becoming increasingly recognized in children. The clinical features of the disease may vary greatly, and often present with subtle changes that can be missed. There is a debate about whether OFG exists as a separate condition or whether it is an oral feature of CD, as some patients go on to develop CD several years later. Identifying those most at risk is important, as ongoing investigations may be necessary. The three cases presented in this series illustrate the range of disease signs and symptoms, and the investigations required.
Characteristics of older and younger patients with suspected paracetamol toxicity
Aim: The aim of this study was to compare the characteristics of older and younger patients with suspected paracetamol toxicity.
Methods: A retrospective audit of the medical records of older (≥65 years, n= 25) and younger (20–30 years, n= 50) patients with a detectable paracetamol level at a Sydney hospital.
Results: Older patients showed a different clinical pattern of suspected paracetamol toxicity and were more likely than younger patients to have multifactorial elevation of liver function tests. Additionally, older age was more likely to be associated with chronic therapeutic paracetamol dosing (71% older, 6% younger, P < 0.001), or with accidental toxic exposure (90% older, 29% younger, P < 0.001), while younger patients were more likely to have a deliberate high-dose exposure (10% older, 71% younger, P < 0.001).
Conclusions: The age-related differences in paracetamol exposure, paracetamol levels and liver function tests described in this population should be considered when ordering and interpreting paracetamol levels.
Calciphylaxis with normal renal function: treated with intravenous sodium thiosulfate
Summary
Calciphylaxis is a rare and potentially life-threatening condition. It is thought to result from arterial calcification causing complete vascular occlusion and subsequent cutaneous infarction. Most often, it is a complication of end-stage renal failure or hyperparathyroidism; without either of these associated conditions, it is extremely rare. We report a case of calciphylaxis in a 58-year-old white British man, who had received long-term oral prednisolone for asthma control, with prophylactic calcium supplementation. There was no history of renal failure, and the patient’s parathyroid function was normal. He was found to be heterozygous for the Factor V Leiden mutation. The acute presentation was seemingly precipitated by an episode of trauma and subsequent compression bandaging. The patient responded promptly to intravenous sodium thiosulfate. To our knowledge, this is the first case with no history of renal failure and normal parathyroid function, precipitated by compression bandaging and with an associated Factor V Leiden mutation.