What makes a medical intervention invasive?

The classification of medical interventions as either invasive or non-invasive is commonly regarded to be morally important. On the most commonly endorsed account of invasiveness, a medical intervention is invasive if and only if it involves either breaking the skin ('incision') or inserting an object into the body ('insertion'). Building on recent discussions of the concept of invasiveness, we show that this standard account fails to capture three aspects of existing usage of the concept of invasiveness in relation to medical interventions-namely, (1) usage implying that invasiveness comes in degrees, (2) that the invasiveness of an intervention can depend on the characteristics of the salient alternative interventions, and (3) that medical interventions can be invasive in non-physical ways. We then offer the beginnings of a revised account that, we argue, is able to capture a wider range of existing usage. Central to our account is a distinction between two properties: basic invasiveness and threshold invasiveness We end by assessing what the standard account gets right, and what more needs to be done to complete our schematic account

Passenger Age and Gender Effects on Adult Driver Fatal Crash Rate

Driver behavior and crash rates vary with the presence of passengers but the details of this relationship are not well understood. The literature generally does not take into account the characteristics of passengers, yet effects on crashes may vary dramatically with passenger age and gender. This study estimated the amount of exposure (driving miles) done by various driver age/gender categories with various combinations of passengers. Statistical imputation techniques were used to derive travel estimates for various pairings using data from the 2001 National Household Travel Survey. Crash frequencies for every pairing were obtained from the Fatality Analysis Reporting System and were used to compute fatal crash rates (per 10 million trip miles). The findings reported here focus on adult (21 and older) drivers. The results show that drivers of a given type (age/gender group) show dramatically different crash rates as a function of passenger type. Some passenger types are associated with fatal crash rates higher than that with no passenger, while other passenger types are associated with lower crash rates. The details of this relationship depend to some degree on driver characteristics. Crash rates for different driver age/gender groups overlap substantially based on the passenger, so that the “best” and “worst” driver groups are passenger-specific. For adult male drivers, female passengers are generally associated with lower crash rates. For male drivers, there is a higher crash rate with a male passenger of a given age than with a female passenger of the same age, even for child passengers

The metabolic syndrome adds utility to the prediction of mortality over its components: The Vietnam Experience Study

Background\ud The metabolic syndrome increases mortality risk. However, as “non-affected” individuals may still have up to two risk factors, the utility of using three or more components to identify the syndrome, and its predictive advantage over individual components have yet to be determined.\ud \ud Methods\ud Participants, male Vietnam-era veterans (n = 4265) from the USA, were followed-up from 1985/1986 for 14.7 years (61,498 person-years), and all-cause and cardiovascular disease deaths collated. Cox's proportional-hazards regression was used to assess the effect of the metabolic syndrome and its components on mortality adjusting for a wide range of potential confounders.\ud \ud Results\ud At baseline, 752 participants (17.9%) were identified as having metabolic syndrome. There were 231 (5.5%) deaths from all-causes, with 60 from cardiovascular disease. After adjustment for a range of covariates, the metabolic syndrome increased the risk of all-cause, HR 2.03, 95%CI 1.52, 2.71, and cardiovascular disease mortality, HR 1.92, 95%CI 1.10, 3.36. Risk increased dose-dependently with increasing numbers of components. The increased risk from possessing only one or two components was not statistically significant. The adjusted risk for four or more components was greater than for only three components for both all-cause, HR 2.30, 95%CI 1.45, 3.66 vs. HR 1.70, 95%CI 1.11, 2.61, and cardiovascular disease mortality, HR 3.34, 95%CI 1.19, 9.37 vs. HR 2.81, 95%CI 1.07, 7.35. The syndrome was more informative than the individual components for all-cause mortality, but could not be assessed for cardiovascular disease mortality due to multicollinearity. Hyperglycaemia was the individual strongest parameter associated with mortality.\ud \u

Caffeine-induced synaptic potentiation in hippocampal CA2 neurons

Caffeine enhances cognition, but even high non-physiological doses have modest effects on synapses. A 1 adenosine receptors (A 1 Rs) are antagonized by caffeine and are most highly enriched in hippocampal CA2, which has not been studied in this context. We found that physiological doses of caffeine in vivo or A 1 R antagonists in vitro induced robust, long-lasting potentiation of synaptic transmission in rat CA2 without affecting other regions of the hippocampus

SHRINE: Enabling Nationally Scalable Multi-Site Disease Studies

Results of medical research studies are often contradictory or cannot be reproduced. One reason is that there may not be enough patient subjects available for observation for a long enough time period. Another reason is that patient populations may vary considerably with respect to geographic and demographic boundaries thus limiting how broadly the results apply. Even when similar patient populations are pooled together from multiple locations, differences in medical treatment and record systems can limit which outcome measures can be commonly analyzed. In total, these differences in medical research settings can lead to differing conclusions or can even prevent some studies from starting. We thus sought to create a patient research system that could aggregate as many patient observations as possible from a large number of hospitals in a uniform way. We call this system the ‘Shared Health Research Information Network’, with the following properties: (1) reuse electronic health data from everyday clinical care for research purposes, (2) respect patient privacy and hospital autonomy, (3) aggregate patient populations across many hospitals to achieve statistically significant sample sizes that can be validated independently of a single research setting, (4) harmonize the observation facts recorded at each institution such that queries can be made across many hospitals in parallel, (5) scale to regional and national collaborations. The purpose of this report is to provide open source software for multi-site clinical studies and to report on early uses of this application. At this time SHRINE implementations have been used for multi-site studies of autism co-morbidity, juvenile idiopathic arthritis, peripartum cardiomyopathy, colorectal cancer, diabetes, and others. The wide range of study objectives and growing adoption suggest that SHRINE may be applicable beyond the research uses and participating hospitals named in this report

Quantum chaos in a deformable billiard: Applications to quantum dots

We perform a detailed numerical study of energy-level and wavefunction statistics of a deformable quantum billiard focusing on properties relevant to semiconductor quantum dots. We consider the family of Robnik billiards generated by simple conformal maps of the unit disk; the shape of this family of billiards may be varied continuously at fixed area by tuning the parameters of the map. The classical dynamics of these billiards is well-understood and this allows us to study the quantum properties of subfamilies which span the transition from integrability to chaos as well as families at approximately constant degree of chaoticity (Kolmogorov entropy). In the regime of hard chaos we find that the statistical properties of interest are well-described by random-matrix theory and completely insensitive to the particular shape of the dot. However in the nearly-integrable regime non-universal behavior is found. Specifically, the level-width distribution is well-described by the predicted $\chi^2$ distribution both in the presence and absence of magnetic flux when the system is fully chaotic; however it departs substantially from this behavior in the mixed regime. The chaotic behavior corroborates the previously predicted behavior of the peak-height distribution for deformed quantum dots. We also investigate the energy-level correlation functions which are found to agree well with the behavior calculated for quasi-zero-dimensional disordered systems.Comment: 25 pages (revtex 3.0). 16 figures are available by mail or fax upon request at [email protected]

“It’s my dream to work with Olympic athletes”: Neophyte sport psychologists’ expectations and initial experiences regarding service delivery

We examined trainee practitioners' initial experiences of applied sport psychology practice. Semi-structured interviews (4) were conducted over 6 months with 7 full-time MSc students before, during, and after the applied sport psychology module, when they were working with clients. Participants also kept reflective diaries over an 8-week period whilst working with clients. Findings included: (a) motivations and expectations of an ASP practice career, (b) perceptions of service delivery, (c) emotional demands, and (d) pivotal experiences. Findings extend previous literature on the initial stages of practitioner development, providing micro-level detail on aspects of the intense development process during this pivotal perio

Myelination generates aberrant ultrastructure that is resolved by microglia

To enable rapid propagation of action potentials, axons are ensheathed by myelin, a multilayered insulating membrane formed by oligodendrocytes. Most of the myelin is generated early in development, resulting in the generation of long-lasting stable membrane structures. Here, we explored structural and dynamic changes in central nervous system myelin during development. To achieve this, we performed an ultrastructural analysis of mouse optic nerves by serial block face scanning electron microscopy (SBF-SEM) and confocal time-lapse imaging in the zebrafish spinal cord. We found that myelin undergoes extensive ultrastructural changes during early postnatal development. Myelin degeneration profiles were engulfed and phagocytosed by microglia using exposed phosphatidylserine as one eat me signal. In contrast, retractions of entire myelin sheaths occurred independently of microglia and involved uptake of myelin by the oligodendrocyte itself. Our findings show that the generation of myelin early in development is an inaccurate process associated with aberrant ultrastructural features that require substantial refinement. Djannatian et al. show by ultrastructural analysis of mouse optic nerves and in vivo imaging of zebrafish spinal cords that developmental myelination is an error-prone process and microglia contribute to the removal of aberrant structures. This may be an important mechanism to generate properly functioning myelin