The Epicurean Parasite: Horace, Satires 1.1-3

We have learned a great deal in recent years about reading Horace\u27s satires; there is now widespread agreement that the speaker of the satires is himself a character within them, a persona. Such a persona may be most effective when it has obvious connections with its creator, but that fact does not preclude the exaggeration of reality, or even its complete inversion. For Horace the implications of this approach are exciting: instead of a poet discoursing with cheerful earnestness on morality, on poetry and on his daily life, we have a fictional character, whom we do not have to take seriously at all.The three diatribe satires present us with a character so absurd that they have been taken, I think rightly, as parodies. Although the poems were once appreciated as effective moralising sermons, even their admirers found it hard to justify the lack of intellectual coherence, to say nothing of the astonishing vulgarity of the second satire. As parodies, however, the poems are wonderfully successful. The speaker trots out a series of banalities: ‘people should be content with who they are’; ‘people should not go to extremes’; ‘people should be consistent’. But he invariably gets distracted, goes off on tangential rants, and makes a fool of himself. The moralist of the first three satires is, to put it bluntly, a jerk

Segmental infantile hemangioma and concomitant hypertension in three African American neonates

We present three African American infants with segmental, ulcerated infantile hemangiomas and concomitant, persistent hypertension. When treated with beta-blocker therapy, the hemangiomas decreased in size and the ulcerations resolved, but there was no impact on the elevated blood pressure in one of our patients. We failed to identify any associations between infantile hemangioma and hypertension in the literature

Early-Life Height Attainment in Cystic Fibrosis Is Associated with Pulmonary Function at Age 6 Years

Rationale: In contrast to the well-described association between early-life weight for age, body mass index (BMI), and later lung disease in people with cystic fibrosis (CF), the relationship between height-for-age (HFA) percentiles and respiratory morbidity is not as well-studied. We hypothesized that changes in HFA in children with CF in the first 6 years of life would be associated with pulmonary function at the age of 6–7 years. Objectives: To determine if an association exists between changes in HFA in early life and pulmonary function in school-aged children with CF. Methods: We performed a retrospective longitudinal cohort study of children with CF followed in the CF Foundation Patient Registry who were born between 2003 and 2010, had CF diagnosed before the age of 2 years, and were followed through at least the age of 7 years. Changes in annualized HFA were classified into mutually exclusive categories. Multivariable analysis of covariance models were used to test for an association between the percent-predicted forced expiratory volume in 1 second (FEV1) at the age of 6–7 years and height-trajectory categories. Results: There were 5,388 eligible children in the CF Foundation Patient Registry. The median (interquartile range) HFA at the age of 6–7 years was in the 39.5th (17.2th–64.9th) percentile. The mean (95% confidence interval) FEV1% predicted at the age of 6–7 years was 95.6% (95.1–96.1%). In a multivariable regression model, the mean (95% confidence interval) FEV1% predicted was higher for children with HFA that was always above the 50th percentile (97.8% [96.3–99.4%]) than for children whose height had been below the 50th percentile for at least 1 year and increased by ≥10 percentile points (95.1% [93.7–96.6%]), was stable (94.3% [92.8–95.7%]), or decreased by ≥10 percentile points (95.7% [94.2–97.3%]). The association between HFA categories and FEV1% predicted was not affected by adding the mean annualized BMI percentile at the age of 6–7 years to the regression model. Among those with HFA that decreased by ≥10 percentile points, there was a correlation between the nadir annualized HFA percentile and the FEV1% predicted at the age of 6–7 years. Conclusions: Children with CF with HFA that is always above the 50th percentile have the highest pulmonary function at the age of 6–7 years. Maintaining a BMI above the 50th percentile remains an important achievable goal for children with CF but is not the sole marker that should be examined in evaluating nutrition

Efficacy and safety of Creon® 24,000 in subjects with exocrine pancreatic insufficiency due to cystic fibrosis

AbstractBackgroundPancreatic enzyme replacement therapy is critical for adequate nutrition in cystic fibrosis (CF) patients with exocrine pancreatic insufficiency (EPI).MethodsThis was a double-blind, randomised, placebo-controlled, two-period crossover study assessing efficacy and safety of Creon 24,000-unit capsules in CF subjects ≥12years with EPI. Patients were randomised to one of two 5-day sequences, Creon/placebo or placebo/Creon (target dose, 4000 lipase units/g fat). Primary outcome was the coefficient of fat absorption (CFA); secondary outcomes were coefficient of nitrogen absorption (CNA), symptoms, and safety.ResultsThirty-two subjects were randomised. Mean CFA and CNA were significantly greater with Creon than placebo (CFA, 88.6% vs. 49.6%; CNA, 85.1% vs. 49.9%; p<0.001 for both). Symptoms were improved and fewer treatment-emergent adverse events were reported with Creon than placebo. One patient discontinued for weight loss unrelated to study drug.ConclusionsThis study demonstrated Creon was effective in treating EPI due to CF and was safe and well tolerated

Successful and safe treatment of hemangioma with oral propranolol in a single institution

PurposeDramatic improvement of hemangioma to propranolol has been recently reported; however, details on dose and duration of treatment, potential risks, and monitoring have not been determined. The objective of this study is to describe and analyze the use of propranolol as a first-line treatment or as a single therapy in management of complicated hemangioma.MethodsA retrospective chart review of eight patients diagnosed with hemangioma and treated with propranolol in Kangbuk Samsung Hospital from February 2010 to April 2011 was performed.ResultsEight patients with hemangioma with functional impairment, cosmetic disfigurement, or rapid growth were treated with propranolol. Five patients had solitary facial hemangioma. The mean age of symptoms at onset was 5 weeks. The median age for starting propranolol treatment was 5.5 months. Propranolol at 2 mg/kg/day was finally administered in divided doses with a gradual increase. Significant regression was observed in seven patients, and shrinkage in size, softening in consistency, and decrease in redness were evident within 4 weeks. Among them, six patients were still taking propranolol, and one patient had stopped after 12 months. Other one patient did not show significant improvement with satisfactory result after 3 months of propranolol use. Treatment with propranolol was well tolerated and had few side effects. No rebound growth was observed in any of the patients.ConclusionWe observed that use of propranolol was very effective in treatment of hemangioma without obvious adverse effects or relapse

Management of infantile hemangiomas during the COVID pandemic

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.The COVID‐19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves long‐term outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of IH via telemedicine. FDA/EMA‐approved monitoring guidelines, clinical practice guidelines, and relevant, up‐to‐date publications regarding initiation and monitoring of beta‐blocker therapy were used to inform the recommendations. Clinical decision‐making guidelines about when telehealth is an appropriate alternative to in‐office visits, including medication initiation, dosage changes, and ongoing evaluation, are included. The importance of communication with caregivers in the context of telemedicine is discussed, and online resources for both hemangioma education and propranolol therapy are provided

2016 ACR-EULAR adult dermatomyositis and polymyositis and juvenile dermatomyositis response criteria-methodological aspects

Objective. The objective was to describe the methodology used to develop new response criteria for adult DM/PM and JDM. Methods. Patient profiles from prospective natural history data and clinical trials were rated by myositis specialists to develop consensus gold-standard ratings of minimal, moderate and major improvement. Experts completed a survey regarding clinically meaningful improvement in the core set measures (CSM) and a conjoint-analysis survey (using 1000Minds software) to derive relative weights of CSM and candidate definitions. Six types of candidate definitions for response criteria were derived using survey results, logistic regression, conjoint analysis, application of conjoint-analysis weights to CSM and published definitions. Sensitivity, specificity and area under the curve were defined for candidate criteria using consensus patient profile data, and selected definitions were validated using clinical trial data. Results. Myositis specialists defined the degree of clinically meaningful improvement in CSM for minimal, moderate and major improvement. The conjoint-analysis survey established the relative weights of CSM, with muscle strength and Physician Global Activity as most important. Many candidate definitions showed excellent sensitivity, specificity and area under the curve in the consensus profiles. Trial validation showed that a number of candidate criteria differentiated between treatment groups. Top candidate criteria definitions were presented at the consensus conference. Conclusion. Consensus methodology, with definitions tested on patient profiles and validated using clinical trials, led to 18 definitions for adult PM/DM and 14 for JDM as excellent candidates for consideration in the final consensus on new response criteria for myositis

Will Scotland's oil and gas contracting industry survive the ending of the Petroleum Revenue Tax?

In the March 1993 budget the Chancellor of the Exchequer proposed the phasing out of the Petroleum Revenue Tax. All fields receiving development assent after March 1993 will now pay no tax apart from Corporation Tax at 33%. PRT for existing fields is reduced from 75% to 50%. At the same time companies will no longer be able to offset exploration and appraisal expenditure in one field against tax liabilities accruing from other fields in the North Sea (some form of transitional relief will be available till 1995). The changes are seen in general to be prejudicial to an industry already finding it difficult to cope with declining real oil prices in an ageing oil province with internationally high production costs. The specific focus of this article is the impact which any such decline will have on the contracting and supply industry which has grown up to service North Sea oil production

Studies on protein synthesis by the mucosa of the fallopian tube

SIGLEAvailable from British Library Document Supply Centre- DSC:DXN1128 / BLDSC - British Library Document Supply CentreGBUnited Kingdo