The social cognition of medical knowledge, with special reference to childhood epilepsy

This paper arose out of an engagement in medical communication courses at a Gulf university. It deploys a theoretical framework derived from a (critical) sociocognitive approach to discourse analysis in order to investigate three aspects of medical discourse relating to childhood epilepsy: the cognitive processes that are entailed in relating different types of medical knowledge to their communicative context; the types of medical knowledge that are constituted in the three different text types analysed; and the relationship between these different types of medical knowledge and the discursive features of each text type. The paper argues that there is a cognitive dimension to the human experience of understanding and talking about one specialized from of medical knowledge. It recommends that texts be studied in medical communication courses not just in terms of their discrete formal features but also critically, in terms of the knowledge which they produce, transmit and reproduce

ON THE EXPRESSIVE POWER OF THE RELATIONAL MODEL: A DATABASE DESIGNER\u27S POINT OF VIEW

The purpose of this paper is to introduce a framework for assessing the expressive power of data models and to apply this framework to the relational model of data. From a designer\u27s point of view, a data model such as the relational model should not only be formally defined and easy to understand, but should also provide a powerful set of constructs to model real-world phenomena. The expressive power of a data model, defined as the degree to which its constructs match with constructs encountered in reality, can be judged by two complementary principles: the interpretation principle and the representation principle. It is asserted that database designers attempt to minimize the number of ad hoc database constraints, and that a data model faithful to the two principles supports this design strategy. Subsequently, this constraint minimization strategy is used to assess the expressive power of a particular data model, i.e., the relational data model. The authors take the position that the expressive power of the relational model is not optimal, due to a lack of adherence to both the interpretation principle and the representation principle. The paper amplifies this position by means of a number of examples, all based on publications by Codd and Date

Biogeomorphology in the field: bedforms and species, a mystic relationship

Fine-scale seabed mapping (Owenia fusiformis, and the razor clam Ensis directus) occur near bedload convergence zones resulting from a mutually evasive flood- and ebb-dominant channel system. Such zones are at the end of the channels, hence also fine grained sediments, food and larvae are trapped. The combination of the coarser-grained bedload with thedeposition of fines is indeed the optimum for a lot of suspension and detritus feeders. Still, highest abundances occur at the fringes of such a system where stress levels are intermediate. Hypotheses were successfully tested along the Dutch coastal zone. Those insights are important to assess changes in seafloor integrity and hydrographic conditions

Evaluation of Treatment Thresholds for Unconjugated Hyperbilirubinemia in Preterm Infants:Effects on Serum Bilirubin and on Hearing Loss?

Background: Severe unconjugated hyperbilirubinemia may cause deafness. In the Netherlands, 25% lower total serum bilirubin (TSB) treatment thresholds were recently implemented for preterm infants.Objective: To determine the rate of hearing loss in jaundiced preterms treated at high or at low TSB thresholds.Design/Methods: In this retrospective study conducted at two neonatal intensive care units in the Netherlands, we included preterms (gestational age 35 dB).Results: There were 479 patients in the high and 144 in the low threshold group. Both groups had similar gestational ages (29.5 weeks) and birth weights (1300 g). Mean and mean peak TSB levels were significantly lower after the implementation of the novel thresholds: 152 +/- 43 mu mol/L and 212 +/- 52 mu mol/L versus 131 +/- 37 mu mol/L and 188 +/- 46 mu mol/L for the high versus low thresholds, respectively (PConclusions: Implementation of lower treatment thresholds resulted in reduced mean and peak TSB levels. The incidence of hearing impairment in preterms with a gestational age</p

Discordance between Adolescents and Parents in Functional Somatic Symptom Reports:Sex Differences and Future Symptom Prevalence

Functional somatic symptoms, i.e., physical complaints that cannot be sufficiently explained by an objectifiable biomedical abnormality, become increasingly more prevalent in girls than in boys during adolescence. Both parents and adolescents report more functional somatic symptoms in girls, but their reports correspond only limitedly. It remains unknown whether parent-adolescent discordance contributes to the higher symptom prevalence in girls. This study investigated parent-adolescent discordance in reported functional somatic symptoms throughout adolescence, examined the longitudinal association of parent-adolescent discordance with symptom prevalence in early adulthood and focused on sex differences in these processes. Participants included 2229 adolescents (50.7% female) from four assessments (age 11 to 22 years) of the TRAILS population cohort. Parents and adolescents reported significantly more symptoms in girls than in boys during adolescence. Variance analyses showed that throughout adolescence, parents reported fewer symptoms than girls self-reported and more than boys self-reported. Regression analyses using standardized difference scores showed that lower parent-report than self-report was positively associated with symptom prevalence in early adulthood. Polynomial regression analyses revealed no significant interaction between parent-reported and adolescent self-reported symptoms. Associations did not differ between boys and girls. The findings show that lower parent-reported than self-reported symptoms predict future symptom prevalence in both sexes, but this discordance was more observed in girls. The higher functional somatic symptom prevalence in girls might be partly explained by parental underestimation of symptoms.</p

COMPARE LAAO: Rationale and design of the randomized controlled trial "COMPARing Effectiveness and safety of Left Atrial Appendage Occlusion to standard of care for atrial fibrillation patients at high stroke risk and ineligible to use oral anticoagulation therapy"

Contains fulltext : 252137.pdf (Publisher’s version ) (Open Access)BACKGROUND: Left atrial appendage occlusion (LAAO) provides an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). In patients with a long-term or permanent contraindication for OAC randomized controlled trial (RCT) data is lacking. STUDY OBJECTIVES: To assess the efficacy and safety of LAAO in AF patients who are ineligible to use OAC. The co-primary efficacy endpoint is (1) time to first occurrence of stroke (ischemic, hemorrhagic, or undetermined) and (2) time to first occurrence of the composite of stroke, transient ischemic attack (TIA), and systemic embolism (SE). The primary safety endpoint is the 30-day rate of peri-procedural complications. STUDY DESIGN: This is a multicenter, investigator-initiated, open-label, blinded endpoint (PROBE), superiority-driven RCT. Patients with AF, a CHA₂DS₂-VASc score ≥2 for men and ≥3 for women and a long-term or permanent contraindication for OAC will be randomized in a 2:1 fashion to the device- or control arm. Patients in the device arm will undergo percutaneous LAAO and will receive post-procedural dual antiplatelet therapy (DAPT) per protocol, while those in the control arm will continue their current treatment consisting of no antithrombotic therapy or (D)APT as deemed appropriate by the primary responsible physician. In this endpoint-driven trial design, assuming a 50% lower stroke risk of LAAO compared to conservative treatment, 609 patients will be followed for a minimum of 1 and a maximum of 5 years. Cost-effectiveness and budget impact analyses will be performed to allow decision-making on reimbursement of LAAO for the target population in the Netherlands. SUMMARY: The COMPARE LAAO trial will investigate the clinical superiority in preventing thromboembolic events and cost-effectiveness of LAAO in AF patients with a high thromboembolic risk and a contraindication for OAC use. NCT TRIAL NUMBER: NCT04676880

Interaction of ballistic quasiparticles and vortex configurations in superfluid He3-B

The vortex line density of turbulent superfluid He3-B at very low temperature is deduced by detecting the shadow of ballistic quasiparticles which are Andreev reflected by quantized vortices. Until now the measured total shadow has been interpreted as the sum of shadows arising from interactions of a single quasiparticle with a single vortex. By integrating numerically the quasi-classical Hamiltonian equations of motion of ballistic quasiparticles in the presence of nontrivial but relatively simple vortex systems (such as vortex-vortex and vortex-antivortex pairs and small clusters of vortices) we show that partial screening can take place, and the total shadow is not necessarily the sum of the shadows. We have also found that it is possible that, upon impinging on complex vortex configurations, quasiparticles experience multiple reflections, which can be classical, Andreev, or both.Comment: To appear in Phys Rev