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Aims: Averaged measurements, but not the progression based on multiple assessments of carotid intima-media thickness, (cIMT) are predictive of cardiovascular disease (CVD) events in individuals. Whether this is true for conventional risk factors is unclear.
Methods and results: An individual participant meta-analysis was used to associate the annualised progression of systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol with future cardiovascular disease risk in 13 prospective cohort studies of the PROG-IMT collaboration (n = 34,072). Follow-up data included information on a combined cardiovascular disease endpoint of myocardial infarction, stroke, or vascular death. In secondary analyses, annualised progression was replaced with average. Log hazard ratios per standard deviation difference were pooled across studies by a random effects meta-analysis. In primary analysis, the annualised progression of total cholesterol was marginally related to a higher cardiovascular disease risk (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.00 to 1.07). The annualised progression of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol was not associated with future cardiovascular disease risk. In secondary analysis, average systolic blood pressure (HR 1.20 95% CI 1.11 to 1.29) and low-density lipoprotein cholesterol (HR 1.09, 95% CI 1.02 to 1.16) were related to a greater, while high-density lipoprotein cholesterol (HR 0.92, 95% CI 0.88 to 0.97) was related to a lower risk of future cardiovascular disease events.
Conclusion: Averaged measurements of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol displayed significant linear relationships with the risk of future cardiovascular disease events. However, there was no clear association between the annualised progression of these conventional risk factors in individuals with the risk of future clinical endpoints.
The article reports three simulation studies conducted to find out whether the effect of a time limit for testing impairs model fit in investigations of structural validity, whether the representation of the assumed source of the effect prevents impairment of model fit and whether it is possible to identify and discriminate this method effect from another method effect. Omissions due to the time limit for testing were not considered as missing data but as information on the participants’ processing speed. In simulated data the presence of a time-limit effect impaired comparative fit index and nonnormed fit index whereas normed chi-square, root mean square error of approximation, and standardized root mean square residual indicated good model fit. The explicit consideration of the effect due to the time limit by an additional component of the model improved model fit. Effect-specific assumptions included in the model of measurement enabled the discrimination of the effect due to the time limit from another possible method effect.
Uncertainty is a central theme in the illness experiences of older cancer patients throughout their illness trajectory. Mishel’s popular theory on uncertainty during illness approaches uncertainty as an outcome and is characterized by the patient’s inability to find meaning in illness events. This study used the concepts of liminality and subjunctivity to explore uncertainty throughout the illness trajectory of cancer patients. We interviewed 18 older (age range = 57–92 years) patients with breast cancer or gastro-intestinal cancer 3 to 4 years post diagnosis. Our analysis is based on the QUAGOL guide that draws on elements of grounded theory such as constant comparison. We found that liminality and subjunctivity provide a useful frame for understanding uncertainty with a specific focus on its productive potential and meaning making. Health care professionals should be open to acquiring a complete picture of patients’ diverse and dynamic experiences of uncertainty in the different stages of their illness trajectory.
Purpose: Sarcopenia, defined as a loss of muscle mass and quality, has been associated with impaired oncological outcome and treatment toxicities in several malignancies. However, its role in anal squamous cell carcinoma (ASCC) remains less well explored.
Methods/Materials: Planning CT scans were used to measure cross-sectional skeletal muscle area (SMA) to calculate the skeletal muscle index (SMI). The association of sarcopenia with clinical and treatment-related parameters, and toxicity was assessed in 114 patients with ASCC that underwent standard 5-Fluorouracil/Mitomycin C chemoradiotherapy (CRT). The prognostic impact of sarcopenia on local relapse-free survival (LRFS), disease-free survival (DFS), and overall survival was examined using a Cox regression analysis.
Results: 29 (25.4%) patients had sarcopenia. Patients with sarcopenia had lower baseline hemoglobin levels (p = 0.002), worse Karnofsky Performance Status (p = 0.001) lower BMI (p < 0.001), and a significantly lower body surface area (p = 0.03), and lower incidence of involved lymph nodes (p = 0.03). Regarding acute toxicity, sarcopenia was associated with a significantly higher incidence of ≥grade 3leukopenia (OR: 3.5; 95% CI: 1.6–7.5, p = 0.007) and ≥grade 3 thrombopenia (OR: 5.1; 95% CI: 1.3–21, p = 0.018) after CRT. Despite higher hematologic toxicity in sarcopenic patients, total treatment time was similar between patients with and without sarcopenia (median 44 vs 45 days, p = 0.95). There was no significant prognostic impact of sarcopenia on either LRFS, DFS, or OS.
Conclusion: This is the largest study to assess the impact of sarcopenia on toxicity and oncological outcome in patients with ASCC. Increased clinician awareness of higher hematological toxicity risk is needed for sarcopenic patients with ASCC undergoing CRT to facilitate closer monitoring of side effects and earlier introduction of supportive measures. Further prospective studies are needed to elucidate the prognostic role and impact of sarcopenia on CRT-related toxicity in ASCC.
This paper aims at reconstructing the development and role of German neurology between 1840 and 1940. Therefore a couple of original sources as well as selected material form the scattered secondary literature were assessed and reviewed. Since the middle of the nineteenth century, an intricate process of separation from internal medicine and psychiatry gradually led to forming a self-conscious community of German neurologists. While Moritz Heinrich Romberg had constructed a cognitive basis for neurology, scientific founders such as Wilhelm Erb, Carl Wernicke, Alois Alzheimer, Hermann Oppenheim, Max Nonne, and many others established the new discipline within modern medicine. In 1891, the first generation of “pure” neurologists succeeded in founding the German Journal for Neurology (Deutsche Zeitschrift für Nervenheilkunde) followed by an autonomous professional organisation, the Society of German Neurologists (Gesellschaft Deutscher Nervenärzte) in 1907. A variety of external factors, however, hampered the institutional evolution and thus the implementation of chairs and departments remained quite modest. In 1935, only 2 years after the National Socialists had seized power, the regulatory merger with the psychiatristsʼ society caused the cautious attempts of German neurologists for autonomy to end in complete failure. The imprisonment, murder and expulsion of neuroscientists declared as Jewish or non-Aryan caused profound changes in neurology, medicine, academic life, and health care in general. Further historical research is needed to reconstruct in detail the involvement of German neurologists in racial-hygienic and eugenic research as well as the institutional and scientific development of German neurology after World War II.
Wer waren die Literaturwissenschaftler, die bei der Gründung 1914 an die Universität Frankfurt am Main berufen wurden, die das akademische Leben der Stadt Frankfurt in der Weimarer Republik mitprägten, die nach 1933 in Frankfurt weiterhin Literaturwissenschaft betrieben oder die vertrieben wurden? Ein zweisemestriges interdisziplinäres Lehrforschungsseminar am Fachbereich 10 (Neuere Philologien) hat anlässlich des Jubiläums zum 100-jährigen Bestehen der Universität im Jahr 2014 Antworten auf diese Fragen gesucht. Das Ergebnis ist eine virtuelle Ausstellung mit 20 Porträts (Goethe Universität Frankfurt am Main, 2017). Diese Ausstellung war jedoch nur ein Teil einer Reihe von Veranstaltungen, die sich im Jubiläumsjahr der Frankfurter Universität mit den Literaturwissenschaften in Frankfurt befassten.
Les trois auteurs et voyageurs étudiés dans cet article (Albert Londres, André Gide, Michel Leiris) ont prêté leurs voix à l’anticolonialisme. Ils ont critiqué les effets du colonialisme européen en Afrique noire de la fin des années 1920 au début des années 1930. Toutefois, pour des raisons diverses allant d’aspects institutionnels aux sensibilités personnelles, leur engagement ne paraissait pas tout à fait le bienvenu, d’où leur hésitation à placer la parole politique au premier plan et à assumer le rôle d’intellectuel engagé. Ils ont alors justifié leur démarche par l’expérience personnelle et singulière du voyage et par l’urgence du sujet de leurs récits. Les formes littéraires qui en résultent (grand reportage, journal intime de voyage, journal ethnographique) ont profondément modernisé le genre du récit de voyage dans un moment critique de son évolution.
Built to colonize
(2019)
The extensive scholarship devoted to the congruence of mass-elite policy preferences lacks consensus about the meaning, comparison, and measurement across political settings. This makes comparisons difficult and raises obstacles to advancing the debates. This symposium aims to identify the diversity of methodological choices and to reflect systematically on several key choices of particular importance in understanding the congruence. The contributions to the symposium compare and contrast how several types of measurement fare in diverse political contexts in Eastern Europe, Latin America, North Africa, and East Asia, and what we can learn from those methodological choices.