Perspectives on the Missiological Legacy of Martin Luther and the Protestant Reformation

Upon the occasion of the 500th anniversary Martin Luther’s publication of his 95 theses, this composite article brings together five perspectives on the missiological legacy of the reformer and the subsequent Protestant Reformation. The blend of voices makes clear that Luther and the subsequent Protestant Reformation do not have a simple missiological legacy but rather various legacies: theological, ecclesiological, political, and practical; some of which co-exist, and even collide, in the same ecclesiastical community. The scandalous legacy of a splintered and splintering church remains. Yet, demonstrations of mutual recognition, reciprocal respect, and genuine fellowship can be found in certain missiological circles

Creating functional autogenous vascular access in older patients

ObjectiveArteriovenous fistulas (AVFs) are the preferred choice for hemodialysis vascular access (AV access); however, there is debate over the utility of AVFs in older patients, particularly concerning access maturation and functionality. We reviewed our AV access experience in patients ≥65 years of age.MethodsWe analyzed consecutive AV access patients ≥65 years old with access operations between March 2003 and December 2009. All patients had ultrasound vessel mapping. In addition to overall outcomes review, the data for patients ≥65 years old were stratified into three 10-year increments by age for further analysis. We compared functional patency data for our older patients with those of our non-elderly patients aged 21 to 64 years treated during the same time period.ResultsFour hundred sixty-one consecutive AV access patients new to our practice were included in this study. Ages were 65 to 94 years (mean, 73 years). Two hundred thirty-six (51.2%) were female, 276 (59.9%) patients were diabetic, and 103 (22.3%) were obese. One hundred seven (23.2%) patients had previous access operations. Radiocephalic AVFs were constructed in 29 (6.3%) patients, 99 (21.5%) patients had brachial artery inflow AVFs, 330 (71.6%) had proximal radial artery AVFs, and three were based on the femoral artery. Transposition AVFs were used in 124 (26.9%) patients. No grafts were used for AV access in any patient during the study period. Time to AVF use was 0.5 to 6 months (mean, 1.5 months). Primary, primary assisted, and cumulative patency for patients aged 65 to 94 years were 59.9%, 93.7%, and 96.9% at 12 months and 45.3%, 90.1%, and 94.6% at 24 months, respectively. Follow-up was 1.5 to 77 months (mean, 17.0 months). Subgroup age stratification (65-74 [n = 268], 75-84 [n = 167], 85-94 [n = 26] years) found no statistical difference in functional access outcomes. Primary, primary assisted, and cumulative patency rates were not statistically different in the elderly and non-elderly populations (P = .29, .27, and .37, respectively). One hundred fifty-six patients died during the study period, 1.3 to 61 months (mean, 20 months) after access creation. No deaths were related to access operations.ConclusionsAVFs are feasible and offer functional and timely AV access in older patients. There was no difference in functional access outcomes for older patients with subgroup age stratification. AVF patency rates were not statistically different in the elderly and non-elderly populations. Cumulative AVF patency for patients ≥65 years of age was 96.9% at 12 months and 94.6% at 24 months

Brachial vein transposition arteriovenous fistulas for hemodialysis access

BackgroundAn arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, offering lower morbidity, mortality, and cost compared with grafts or catheters. Patients with a difficult access extremity have often lost all superficial veins, and even basilic veins may be obliterated. We have used brachial vein transposition AVFs (BVT-AVFs) in these challenging patients and review our experience in this report.MethodsThe study reviewed consecutive patients in whom BVT-AVFs were created from September 2006 to March 2009. Most BVT-AVFs were created in staged procedures, with the second-stage transposition operations completed 4 to 6 weeks after the first-stage AVF operation. A single-stage BVT-AVF was created when the brachial vein diameter was ≥6 mm.ResultsWe identified 58 BVT-AVF procedures, comprising 41 women (71.0%), 28 diabetic patients (48.3%), and 29 (50.0%) had previous access surgery. The operation was completed in two stages in 45 operations (77.6%) and was a primary transposition in 13 patients. However, five of these were secondary AVFs with previous distal AV grafts or AVFs placed elsewhere; effectively, late staged procedures. Follow-up was a mean of 11 months (range, 2.0-31.7 months). Primary patency, primary-assisted patency, and cumulative (secondary) patency were 52.0%, 84.9%, and 92.4% at 12 months and 46.2%, 75.5%, and 92.4% at 24 months, respectively. Harvesting the brachial vein was tedious and more difficult than harvesting other superficial veins. No prosthetic grafts were used.ConclusionBVT-AVFs provide a suitable option for autogenous access when the basilic vein is absent in patients with difficult access extremities. Most patients required intervention for access maturation or maintenance. Most BVT-AVFs were created with staged procedures. Cumulative (secondary) patency was 92.4% at 24 months

Brachial vein transposition arteriovenous fistulas for hemodialysis access

BackgroundAn arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, offering lower morbidity, mortality, and cost compared with grafts or catheters. Patients with a difficult access extremity have often lost all superficial veins, and even basilic veins may be obliterated. We have used brachial vein transposition AVFs (BVT-AVFs) in these challenging patients and review our experience in this report.MethodsThe study reviewed consecutive patients in whom BVT-AVFs were created from September 2006 to March 2009. Most BVT-AVFs were created in staged procedures, with the second-stage transposition operations completed 4 to 6 weeks after the first-stage AVF operation. A single-stage BVT-AVF was created when the brachial vein diameter was ≥6 mm.ResultsWe identified 58 BVT-AVF procedures, comprising 41 women (71.0%), 28 diabetic patients (48.3%), and 29 (50.0%) had previous access surgery. The operation was completed in two stages in 45 operations (77.6%) and was a primary transposition in 13 patients. However, five of these were secondary AVFs with previous distal AV grafts or AVFs placed elsewhere; effectively, late staged procedures. Follow-up was a mean of 11 months (range, 2.0-31.7 months). Primary patency, primary-assisted patency, and cumulative (secondary) patency were 52.0%, 84.9%, and 92.4% at 12 months and 46.2%, 75.5%, and 92.4% at 24 months, respectively. Harvesting the brachial vein was tedious and more difficult than harvesting other superficial veins. No prosthetic grafts were used.ConclusionBVT-AVFs provide a suitable option for autogenous access when the basilic vein is absent in patients with difficult access extremities. Most patients required intervention for access maturation or maintenance. Most BVT-AVFs were created with staged procedures. Cumulative (secondary) patency was 92.4% at 24 months

Velocity at maximal oxygen uptake best predicts 3 km race time in collegiate distance runners

Purpose: There is a lack of scientific investigation into the predictors of 3 km race performance in collegiate distance runners. The purpose of this investigation was to determine what physiological variables best predict 3 km race time in a group of collegiate distance runners. Methods: Twenty-one endurance trained runners (11 men, 10 women) volunteered for this investigation. Running economy (RE) and maximal oxygen uptake (VO2max) testing were conducted within 9 ± 6 days of the race in a single session. All participants ran in a 3 km race at an NCAA sanctioned track meet. Pearson’s product moment correlations were performed between 3 km race time and velocity at VO2max (vVO2max), relative VO2max, RE at 9.7, 11.3, 12.9, and 14.5 km•hr-1 and percent of VO2max. A stepwise multiple regression was performed with 3 km race time as the dependent variable and independent variables of vVO2max, VO2max, RE9.7, RE11.3, RE12.9, RE14.5. Results: The results revealed that vVO2max was the best predictor of 3 km race performance in a heterogeneous group of collegiate distance runners (R2=0.90). For the men, vVO2max remained the best predictor of 3 km race performance (R2=0.49). For the women, the best predictors of 3 km performance were vVO2max and VO2max (R2=0.97). Conclusions: Distance coaches should consider emphasizing vVO2max as a primary factor in training to improve 3 km race performance and conversely, the pace achieved in a 3-km race is a good predictor of vVO2max

Multifactorial Patterns of Gene Expression in Colonic Epithelial Cells Predict Disease Phenotypes in Experimental Colitis

Background— The pathogenesis of inflammatory bowel disease (IBD) is complex and the need to identify molecular biomarkers is critical. Epithelial cells play a central role in maintaining intestinal homeostasis. We previously identified five “signature” biomarkers in colonic epithelial cells (CEC) that are predictive of disease phenotype in Crohn\u27s disease. Here we investigate the ability of CEC biomarkers to define the mechanism and severity of intestinal inflammation. Methods— We analyzed the expression of RelA, A20, pIgR, tumor necrosis factor (TNF), and macrophage inflammatory protein (MIP)-2 in CEC of mice with dextran sodium sulfate (DSS) acute colitis or T-cell-mediated chronic colitis. Factor analysis was used to combine the five biomarkers into two multifactorial principal components (PCs). PC scores for individual mice were correlated with disease severity. Results— For both colitis models, PC1 was strongly weighted toward RelA, A20, and pIgR, and PC2 was strongly weighted toward TNF and MIP-2, while the contributions of other biomarkers varied depending on the etiology of inflammation. Disease severity was correlated with elevated PC2 scores in DSS colitis and reduced PC1 scores in T-cell transfer colitis. Downregulation of pIgR was a common feature observed in both colitis models and was associated with altered cellular localization of pIgR and failure to transport IgA. Conclusions— A multifactorial analysis of epithelial gene expression may be more informative than examining single gene responses in IBD. These results provide insight into the homeostatic and proinflammatory functions of CEC in IBD pathogenesis and suggest that biomarker analysis could be useful for evaluating therapeutic options for IBD patients

Physical and biological variability in the Antarctic Polar Frontal Zone: report on research cruise 103 of the MV SA Agulhas

A detailed hydrographic and biological survey was carried out in the region of the South-west Indian Ridge during April 2002. Hydrographic data revealed that the Andrew Bain Fracture Zone, centred at 30oE, 50oS, functions as an important choke point to the flow of the Antarctic Circumpolar Current, resulting in the convergence of the Antarctic Polar Front (APF) and the southern branch of the Sub-Antarctic Front (SSAF). Total chlorophyll-a concentration and zooplankton biomass were highest at stations occupied in the vicinity of two frontal features represented by the APF and SSAF. These data suggest that the region of the South-west Indian Ridge is an area of elevated biological activity and probably acts as an important offshore feeding area for the top predators on the Prince Edward Islands