Progressive subretinal fibrosis and blindness in patients with multifocal granulomatous chorioretinitis

Since women with a first-degree relative with breast cancer are at increased risk for breast cancer, it is of special importance that they adhere to early detection programs. In this study, women with (389) and without (3295) a family history of breast cancer were compared with respect to risk perception, breast cancer anxiety, and early detection behavior. Special attention was paid to the role of knowing that family history is a breast cancer risk factor. It was found that 46% of "family history positives" did not know that their risk was increased by their family history. Still, family history positives had increased risk perception; our results suggest that this was partly caused by their knowing they belonged to a risk group and partly by their having experienced the disease at close range. Although family history positives had higher risk perceptions, no differences in early detection behavior were found. This could not be attributed to high anxiety levels. Implications for health education are discussed.     

Estimation of the Bivariate Stable Spectral Representation by theProjection Method

A method of estimating the spectral representation of a generalized bivariatestable distribution is presented, based on a series of maximum likelihood (ML)estimates of the stable parameters of univariate projections of the data. Thecorresponding stable spectral density is obtained by solving a quadraticprogram. The proposed method avoids the often arduous task of computing themultivariate stable density, relying instead on the standard univariate stabledensity. The paper applies this projection procedure, under the simplifyingassumption of symmetry, to simulated data as well as to foreign exchangereturn data, with favorable results. Kanter projection coefficients governingconditional expectations are computed from the estimated spectral density. For the simulated data these compare well to their known true values.     

Is team training in briefings for surgical teams feasible in simulation?

We developed a module for surgical team training using briefings in simulated crisis scenarios and here we report preliminary findings. Nine surgical teams (34 trainees) participated in a pre-training simulation, followed by an interactive workshop on briefing and checklists, and then a post-training simulation. Both technical and non-technical skills were assessed via observation during simulations by expert trainers who provided feedback on performances at the end of simulation. Trainees also reported their attitudes to briefings and evaluated the training. Pre-training attitudes to briefing were positive, some of which improved post-training and trainees’ evaluation of the training was positive. Surgeons’ technical skill improved significantly post-training, but their decision-making skill was rated lower than other non-technical skills, compared to other trainees. The training did not appear to greatly improve non-technical skill performance. Training surgical teams in simulation is feasible but much more work is needed on measurement development and training strategy to confirm its efficacy and utility.     

The renal factor in the post-traumatic "fluid overload" syndrome

Hypervolemia with hypertension often occurs 36-72 hours following massive blood and fluid replacement for hypovolemic shock. This syndrome of "fluid overload" has been attributed to the rapid intravascular flux of previously sequestered fluid in patients with impaired diuresis. This hypothesis was tested in 35 injured patients who received a mean of 9.3 L of blood and 17.4 L of salt during resucitation. The renal parameters measured soon after resuscitation included: 1) renal clearance of inulin (GFR), para-amino hippurate (ERPF), milliosmoles, sodium, and free water; 2) inulin space, renal vascular resistance (RVR), O2 consumption, renin, renal blood flow (RBF), and response to furosemide. Eighteen patients developed hypertension, hypervolemia, and respiratory insufficiency. When compared to the 17 normovolemic, non-hypertensive patients, the 18 hypervolemic patients had significantly increased RVR, with a significant decrease in RBF despite an increase in plasma volume and cardiac output. Furosemide produced less diuresis and natriuresis in the hypertensive patients. The balance between hypovolemia and "fluid overload" seemed percarious in the hypertensive patients. Peripheral renin and catecholamine levels were normal in both groups. Patients with post-traumatic "fluid overload" appear to have a combination of hypervolemia, respiratory insufficiency, hypertension, increased cardiac output, decreased extracellular fluid space, and decreased renal perfusion. These findings suggest that decreased interstitial fluid space compliance rather than "fluid overload" is the underlying factor leading to respiratory insufficiency. The therapeutic aspects of these findings are discussed.     

Psychosomatic disease and the problem of causation

Despite its impressive rate of growth in the past decades, an increasing amount if dissatisfaction with the area of psychosomatic medicine is reflected in recent literature. The discipline's failures relate to concepts of pathogenesis and therapeutic application of research findings. These failures are explained as a necessary consequence of the philosophical tenet of mind-body dualism which underlies medical theory. It is urged that advocates of psychosomatic medicine give the concept of "holism" meaning at the most fundamental level by establishing a rational basis for theory, or else forsake this line of research for others which yield causal relationships conductive to effective therapy.     

Effectiveness of cationically modified cellulose polymers for dewatering algae

A method to flocculate algal cultures of Chlamydomonas reinhardtii using four different industrially produced polymers is presented. Starting with a 1 wt% stock polymer solution, flocculation times less than 60 min were observed for 0.1 to 0.6 g polymer per L of algae culture, while control samples took greater than 1400 min to flocculate. Cell counts showed that 99% of the cells were flocculated using the polymers compared to 73% for the control. Finally, the flocculation process was successful at both 5 and 40 mL batch sizes for one polymer; therefore, the method is efficient, effective and may be scalable.