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PubMed2026

Characteristics of children with ureteroceles presenting for urological evaluation in the modern medical era.

INTRODUCTION: Historically, children with ureteroceles presented symptomatically and were managed surgically. It is unclear if this changed in the modern medical era of prenatal imaging and shared decision making. We aimed to describe the presentation and management of ureteroceles during initial urological evaluation of children in the era of widespread prenatal ultrasonography. PATIENTS AND METHODS: We retrospectively reviewed records of children (<18 years old [yo]) initially evaluated at our center with a ureterocele (2011-2020). We analyzed demographics, renal anatomy, initial presentation for evaluation, and initial management with non-parametric statistics. Febrile urinary tract infections (fUTIs, ≥ 38 °C) were classified as 1) urosepsis (positive urine culture admitted to pediatric intensive care), 2) documented (positive urine culture) or 3) family-reported. RESULTS: We identified 188 children (65% female). Median age at presentation was 1.2 months old (mo) (IQR 18 days-4.4 mo). Antenatally-detected congenital anomalies of the kidney and urinary tract (aCAKUT) were noted in 143 (76%) children with a confirmed postnatal diagnosis of ureterocele. Overall, 129/188 (69%) children presented without symptoms and 59 (31%) presented with symptoms. fUTI was the most common symptomatic presentation (46/188, 24%): urosepsis (6 children), documented (30), and family-reported (10). Children with aCAKUT presented earlier than those without aCAKUT (27 days vs. 1.6 yo, p < 0.0001). They were also less likely to present with symptoms (11% vs. 96%, p < 0.0001), including fUTIs (7% vs. 78%, p < 0.0001). In total, 108 children (57%) were initially managed with transurethral incision, 73 (39%) were observed, and 7 (4%) had reconstructive surgery. Asymptomatic children with aCAKUT (42%) and symptomatic children without aCAKUT (37%) were more likely to be observed than symptomatic children with aCAKUT (7%, p = 0.02). Among 143 children with aCAKUT, those on antibiotic prophylaxis were less likely to present with a history of a fUTI compared to those not on prophylaxis (4/106 vs. 6/37, 4% vs. 16%, p = 0.02). COMMENT: We present a large observational study describing clinical and anatomical characteristics of children presenting with ureteroceles in a medical era of ubiquitous prenatal ultrasonography. Our retrospective study was limited by incomplete documentation of all antenatal ultrasonography and adherence with antibiotic prophylaxis. Long-term clinical outcomes will be the focus of future work. CONCLUSION: In contrast to historical cohorts, most children presented to urologists with asymptomatic ureteroceles diagnosed with aCAKUT. Most children without aCAKUT presented with a fUTI. Overall, 39% of children were initially observed, indicating an increased use of observation in the modern medical era.

Humans↗

PubMed2005

The dynamic range of biologic functions and variation of many environmental cues may be declining in the modern age: implications for diseases and therapeutics.

We hypothesize that declining dynamic range and variation of environmental cues may contribute to health dysfunctions, and that judicious expansion of biologic dynamic ranges may be beneficial. Three disparate examples involving the endocrine, autonomic, and musculoskeletal systems are discussed. Daytime sheltering, optical shading, and nighttime use of artificial light may reduce circadian luminal variation. The resulting melatonin alterations may contribute to systemic dysfunctions. Loss of temporal variation of other hormones may contribute to biologic dysfunctions, especially those involving the hypothalamic-pituitary axis. Reduced variation of physical exertion, environmental stressors, and thermal gradients that characterize modern lifestyles may reduce the autonomic dynamic range resulting in lowered heart rate variability and a myriad of systemic dysfunctions. The health benefits of activities such as exercise, meditation, acupuncture, coitus, and laughter may operate through increasing autonomic variability. Reduced physical exertion also accounts for declining dynamic range of musculoskeletal function. The resulting muscle atrophy, fat infiltration, and sarcomere shortening may not only have deleterious local effects, but may also be involved in systemic metabolic dysfunctions such as insulin resistance. The extent to which our endogenous systems rely on environmental variation for self-tuning and the impact that under-utilization of compensatory mechanisms has on biologic function are not well understood. Modern therapeutic approaches generally result in reversion to the mean of physiologic functions and may buffer against variation. For example, beta-blockers are given to reduce adrenergic excess, insulin to treat insulin insufficiency, serotonin-reuptake inhibitors for depression, and refractive lenses for myopia. By undermining the demand for native compensatory functions, such therapeutic strategies may actually impair future ability to respond to biologic disequilibria. Generalizing from these observations, we anticipate benefits of therapeutic and lifestyle approaches that expand, rather than reduce, the dynamic range of many biologic experiences.

Animals↗

PubMed2006

The busy shall inherit the earth: the evolution from 'hard work' to 'busyness' in modern science and society.

Although 'hard work' and 'busyness' are somewhat similar terms, there seem to be significant differences in the way that they are used. While hard work has always been a feature of complex societies, modern society can be seen as evolving toward being dominated by jobs characterized by busyness. Busyness refers to multi-tasking - having many sequential jobs to perform and switching frequently between them on an externally-imposed schedule. Traditionally, the individual gifts of a successful scientist were mainly in terms of knowledge, theoretical or technical aptitude. But nowadays the successful scientist is often one who has been promoted from hard-work to busyness: an expert in synthesizing a sufficient degree of scientific ability with a broad range of managerial and political skills. It is psychologically tough to be busy, because busyness is a consequence of human beings being constrained by the functioning of abstract social systems. In a complex modern organization, individual psychology is subordinated to inflexible programs of being in specific places at specific times doing specific things - this is both tricky to do well and demanding to do at all. Since people are paid (mainly) to do difficult but necessary things they would prefer not to do, busyness has become a major reason why people are paid a premium salary. In the long-term, many straightforward jobs will be analyzed and routinized out of existence, with the narrowly-skilled worker being replaced by teams, machines or computers. But busy jobs are hard to eliminate because they are those in which it is optimal for a variety of disparate and unpredictable tasks to be done by a single person. Consequently, those individuals who can cope with, even thrive-upon, busyness are becoming indispensable. In future 'the busy shall inherit the earth' (or, at least, the most powerful and highest paid jobs), not just in science but in all major social domains.

Employment↗

PubMed2004

Midwifery practice and the crisis of modernity: implications for the role of the midwife.

Almost since its inception, the concept of modernity was found to display tensions between its emancipatory potential to liberate the human subject from the manacles of tradition, and the application of reason to co-ordinate and control the natural world through scientific knowledge. This paper presents a qualitative analysis of in-depth interviews with 12 midwives about their role in the Irish maternity services and argues that, in a period of late modernity, these tensions continue to manifest themselves in the context of the midwife's role. Although the contemporary period is marked by a loss of faith in scientific truths, widely contested obstetric knowledge and practices continue to exercise mastery over nature while undermining a central feature of the midwife's role-the liberation of the autonomous subject. Drawing on the theory of communicative action developed by the critical theorist Jürgen Habermas, it is argued that the midwife's role in facilitating the autonomous choices of women through communicative action is impeded by the colonization of the lifeworld of labour and childbirth by the technocratic system of obstetrics. Although participants reported that their role involved empowering women and facilitating choices through dialogue congruent with communicative action, data also suggested that participants used strategic communication with clients aimed at achieving particular ends. The use of strategic communication was linked to the way in which the midwife's role is determined to a large extent by the practices and protocols of obstetrics, and also to the notion of client passivity. The instrumental rationality of obstetrics is linked to an outcome orientation to power and money, and a political economy perspective of medicine. It appears that communicative action between midwives and obstetricians is important in bringing about structural changes to facilitate the conditions for communicative action between midwives and their clients.

Clinical Competence↗

PubMed2006

Adolf Remane (1898-1976) and his views on systematics, homology and the Modern Synthesis.

Adolf Remane was primarily a morphologist and systematist. In 1952, he published an influential book on the foundations of systematics and phylogenetics in which he advocated homology as the central concept of morphology and the basis of the natural system and discussed criteria serving to discriminate homology from homoplasy in great detail. During the decades when the Modern Synthesis of evolution was created, he repeatedly commented on and criticised the synthetic theory of evolution, which he never fully accepted. Remane disapproved of idealistic morphology and was strongly opposed to Lamarckian, saltationist and orthogenetic theories of evolution. Yet, while appreciating the synthetic theory's validity in the realm of speciation and microevolution, he rejected the claim that the current genetic knowledge was sufficient to explain complex morphological transformations on the basis of random mutations and selection. Instead, he seems to have favoured mutation pressure as the most important factor in macroevolution. Nevertheless, the sometimes vicious disputes between Remane and the adherents of the Modern Synthesis may at least partly have been brought about by personal factors rather than by scientific differences.

Animals↗

PubMed2005

Early corticosteroid withdrawal under modern immunosuppression in renal transplantation: multivariate analysis of risk factors for acute rejection.

UNLABELLED: Early corticosteroid withdrawal has been shown to be effective in low-risk patient populations in a number of US and European multicenter trials. However, patient populations traditionally considered to be at high risk for acute rejection (eg, African Americans, repeat transplant recipients, sensitized patients) are usually excluded from these trials. Since our initial experience with early withdrawal almost 10 years ago, we have included high-immunologic-risk patients. We have accumulated enough high-risk patients with early withdrawal to allow the first multivariate analysis of risk factors for acute rejection in early withdrawal under modern immunosuppression. METHODS: Early withdrawal was performed under prospective IRB-approved protocols. Statistical analysis included chi square test and logistic regression. All rejection episodes were biopsy proven and graded by Banff 1997 criteria. RESULTS: A total of 164 patients underwent early withdrawal: 82% had at least one mismatched DR antigen, 17% had delayed graft function, 33% were African American, and 18% were repeat transplant recipients. Multivariate analysis of risk factors for acute rejection indicated that two factors induced a statistically significant alteration in acute rejection risk: repeat transplant recipients (4.3-fold increased risk) and thymoglobulin induction (0.30 risk (ie, 70% reduction in risk compared to patients not receiving thymoglobulin induction). Sensitized recipients and African Americans were also at increased risk but did not quite reach statistical significance. These data strongly support the use of T-cell depleting antibody induction therapy in high-risk patients undergoing early withdrawal under modern immunosuppression.

Adrenal Cortex Hormones↗

PubMed2006

Modern acoustic emission technique and its application in aviation industry.

This paper proposes the concept of modern acoustic emission (MAE) technique and describes its application in aviation industry. Modern AE is characterized by the combination of AE parameter and waveform analysis based on the understanding of AE source mechanism, the property of sound wave propagation and the interaction between sound wave and the medium in which the sound wave is propagating. Another feature of MAE is characterized by the application of so-called fully digital AE apparatus with low noise, high speed of data transmission and accurate AE source locating capability. MAE is merely an imagination without the realization of the advanced fully digital AE instrument. The application of MAE in monitoring the conditions of aircraft structures during a fatigue test was taken as an example for showing the important role played by AE. Roles of AE in the evaluation of (environment-related) corrosion damage of aircraft were also presented.

Journal Article↗

PubMed2007

A pioneer in the development of modern ultrasound: Robert William Boyle (1883-1955).

Robert William Boyle was one of the pioneers in the development and application of ultrasound. His remarkable career has not been previously traced in any depth, nor have his contributions, especially those during WWI, been carefully described. In collaboration with Lord Rutherford, his work on the development of ultrasound methods for submarine detection paralleled those in France under Paul Langevin (1872-1946), who many consider to be the father of modern ultrasound. This biographic account of Boyle's life focuses on his ultrasound research contributions, particularly the developments during WWI and those in the 10 years after. Evidence is presented that his pioneering research, along with that of Langevin, provided much of the foundation for modern ultrasound developments. Although this paper is partially based on somewhat dispersed biographic information performed by others, original letters and research papers, in addition to records and verbal accounts provided by relatives, have been used and consulted.

Canada↗

PubMed2000

The first modern operating room in America.

The modern OR was a vital addition to aseptic technique and essential to the development of invasive surgery, and many people do not realize that it needed to be "invented." Gustav Neuber, William S. Halsted, Charles McBurney, and others pioneered the necessary changes in practices and the environment to protect the patient from infection. This article presents the history behind the evolvement of the modern OR and discusses changes in the structures of some facilities as awareness increased about the principles of asepsis.

Facility Design and Construction↗

PubMed1999

Dietary intake of modernizing Samoans: implications for risk of cardiovascular disease.

OBJECTIVE: To describe the dietary intake of American and Western Samoans, with emphasis on nutrients conventionally related to risk factors for cardiovascular disease. DESIGN: Cross-sectional dietary survey. Intake estimates were based on 24-hour recall interviews. SUBJECT: Community-based samples of 946 men and women (455 American Samoans, 491 Western Samoans) aged 25 to 55 years. STATISTICAL ANALYSES: Tests of differences in means (t tests) and proportions (chi 2 tests). Correlation and multivariate linear regression analyses were conducted to describe correlates of energy and nutrient intakes. RESULTS: Few differences were noted between the energy and nutrient intakes of men and women, but substantial differences were found between residents of American Samoa and those of the less modernized country of Western Samoa. American Samoans consumed significantly more energy as carbohydrate (47% vs 44%) and protein (18% vs 13%) and less as fat (36% vs 46%) and saturated fat (16% vs 30%). Energy-adjusted intakes of cholesterol and sodium were higher among American Samoans. These differences persisted after adjustment for age, gender, years of education, occupation, and categories of a 10-point material lifestyle score. Samoans in the lowest category of material lifestyle had significantly lower energy-adjusted intakes of protein, cholesterol, and sodium and higher intakes of saturated fat than those in the upper 2 categories. Additional analyses described the contribution of specific foods to the intakes of energy and macronutrients. CONCLUSIONS/APPLICATIONS: The observed energy and nutrient intake patterns are consistent with previously reported levels of obesity and risk factors for cardiovascular disease among Samoans and suggest dietary modification for those at highest risk. Dietetics practitioners who counsel Samoan and other Pacific Islander clients should be aware of these intake patterns, which seem particularly malleable to levels of personal income. More generally, results from this study illustrate that the food choices of certain ethnic groups may be profoundly affected by the process of modernization within a country or by migration to a more economically developed locale.

Adult↗

PubMedDate not supplied

GM polymorphism and the evolutionary history of modern humans.

Present human populations show a complex network of genetic relationships, which reflects mainly their unique origin and their migration and isolation history since the recent creation of modern man. The scrutiny of their genetic characteristics, according to GM polymorphism, shows that the continuity of the genetic variation between populations from neighbouring continents, assured by intermediate world part populations, is against any attempt to divide present human populations into major groups. GM polymorphism analysis also shows three remarkable levels of genetic differentiation, which would have appeared, respectively, within populations of sub-Saharan Africa, Europe and East Asia. The first small groups of people that split from the common ancestral population gave the sub-Saharan Africans. On the other hand, Asians diverged mainly from Europeans and Near East populations during a later period. The confrontation between the phylogeny and the frequency distribution of GM haplotypes shows that the ancestral population of actual South-Arabia people could be a candidate for a common ancestral population. The first major expansions of modern humans were proposed in a hypothetical scenario, which will open a new track in the research of our geographic origin.

Biological Evolution↗

PubMed2000

Enamel thickness and the helicoidal wear plane in modern human mandibular molars.

Helicoid occlusion has long been recognized as a feature characterizing the human dentition and has been viewed as an important morphological marker in the transition from Australopithecus to Homo. The hallmark of helicoidal wear is a buccal wear slope in anterior mandibular molars (and a corresponding lingual slope of wear in anterior maxillary molars) reversing to a flat or lingual-oriented one in posterior mandibular molars. If localized increases in enamel thickness are taken as evidence of an adaptation to increased wear resistance, then data on enamel thickness in unworn molars can be used to assess whether the region of greatest wear changes from anterior to posterior in such a way as to provide evidence for the helicoidal wear plane being a structural feature of the orofacial skeleton. Such a hypothesis was supported in a previous study on enamel thickness in modern human maxillary molars. As maxillary and mandibular precisely interdigitate, it is reasonable to expect that a similar pattern of enamel thickness distribution should be present in mandibular molars. To test this, data on the distribution of enamel thickness across functionally relevant regions of the crown were collected on a sample of twenty-nine completely unworn mandibular molars. Results suggest that enamel thickness increases slightly posteriorly but no evidence exists for morphological changes along the mandibular molar series of modern humans to follow a trend towards providing additional tooth material in areas under greater wear in accordance with a helicoidal wear model. This suggests that the patterning of enamel thickness must be viewed in conjunction with other features, such as the biomechanical behaviour of molars during occlusion and axial molar angulation, to ascertain the precise anatomical determinants of this unique feature of the human dentition.

Biomechanical Phenomena↗

PubMed1990

Retention of lead and cadmium in prehistoric and modern human teeth.

In 5000-year-old premolars from Nubia and in 500-year-old teeth from Greenland, the lead concentrations were very low; modern teeth contained 10-100 times more lead. In contrast, cadmium concentrations varied by 30-fold in the two prehistorical populations; modern-day cadmium levels were in the lower range of this interval. These data suggest that, when compared to preindustrial exposures, the impact of current environmental lead pollution is considerable, while that of cadmium pollution is much less.

Adult↗

PubMedDate not supplied

Florence Nightingale's influence on the development and professionalization of modern nursing in Japan.

This article has summarized the overwhelming sociocultural and geopolitical forces that influenced the development of modern nursing in Japan. The irony of Japanese nursing is that modern nursing, first introduced by navy physicians, served the needs of Japanese military efforts and those of physicians who required others to perform menial hospital chores. Because of the harsh realities of nursing in the battlefields or in hospitals, working as a Kangofu was, and is, not compatible with a traditional family life. Like Nightingale, the majority of active Kangofus, especially the leaders in the profession, are unmarried. The major impact of Nightingale on Japanese nurses has been in her role as a spiritual icon, giving nurses the strength to survive in the face of enormous hardship. The true professionalization of nursing in Japan lies on the horizon, 110 years after Nightingale's work was introduced in Japan and 50 years after Japan became a democratic country. Toward this new vision for nursing, I offer the Hokenfu model rather than the traditional Kangofu model, under which Japanese nurses have suffered oppression and discrimination for a century. In conclusion, Japanese nurses should expand their perspective on their profession and seize the opportunity for reform that now tantalizingly presents itself, not only to best serve their patients but also to fulfill their own potential as respected health professionals-potential that is, as of now, unrealized.

Education, Nursing↗

PubMed2000

Spatial variation of modern pollen in Oregon and southern Washington, USA.

Surface sediments from 95 lakes provide information on the spatial variation of modern pollen spectra in Oregon and southern Washington. Percentages for 13 pollen types were compared within and between vegetation zones to characterize regional patterns of pollen spectra. The percentage data were also compared with climate variables to determine relationships between pollen percentages and regional climate gradients. The composition of modern pollen spectra corresponds well with the distribution of the pollen producers. Most pollen assemblages were generally dominated by Pinus, but those west of the Cascade Range were dominated by Alnus. Low percentages of Pseudotsuga/Larix, Tsuga mertensiana, Abies, and Picea pollen coincided with local occurrence of the trees. The distributions of the pollen data were arranged along gradients of temperature and effective moisture. West of the Cascade Range, Alnus, Tsuga heterophylla, Pseudotsuga/Larix, and Cupressaceae pollen were abundant and correlate well with moderate temperature and high effective moisture. In the shrub-steppe and woodlands east of the Cascade Range, where effective moisture is low, Artemisia, Cupressaceae, and Pinus pollen were dominant. At high elevations, Pinus, T. mertensiana, Abies, and Picea were common pollen types in areas with short growing seasons and high effective moisture. Pollen percentages collected from lake surface sediments, moss polsters, and soils were compared within a number of vegetation types to assess their similarity. The three types of sample yielded similar results for forested areas, but lake sediment samples from upper- and lower-treeline sites captured a more regional picture of the vegetation.

Journal Article↗

PubMed2003

The morphometric relationship of Upper Cave 101 and 103 to modern Homo sapiens.

Since the discovery of the Homo sapiens crania from the Upper Cave of Zhoukoudian in northern China (UC 101, UC 102, and UC 103), no clear consensus has arisen regarding their affinities with modern populations. We use linear craniofacial measurements to compare UC 101 and UC 103 to a worldwide sample of H. sapiens that includes Paleoamericans and Archaic Indians, and employ Mahalanobis distance analysis and associated unweighted, unrestricted canonical variate analysis for the comparisons. Analyses indicate that UC 101 has consistent affinities with Easter Island and European populations, whereas UC 103 has more tenuous similarities with Australo-Melanesian groups. Both fossils exhibit some similarities to certain Paleoamerican and Archaic Indian individuals, but rarely cluster together. Upper Cave 103 is more of an outlier to modern populations than is UC 101. The fossils are not representative of any group to which they have been compared, but may be part of the generalized population that was ancestral to Paleoamericans.

Animals↗

PubMed2000

Human tooth enamel as a record of the comparative lead exposure of prehistoric and modern people.

There is a considerable body of evidence to support the contention that the atmospheric Pb burden is now considerably greater than it was in the remote past. However, as there are a diversity of potential environmental pathways leading to Pb ingestion, it is not clear how atmospheric Pb levels relate to human exposure. It is necessary to establish a baseline for human exposure to Pb from natural sources in the pre-metallurgical past, with which contemporary exposure can be compared. This paper addresses this issue by comparing the Pb content of human dental enamel--an established proxy for Pb exposure--from modern and archaeological, pre-metallurgical individuals using thermal and plasma ionisation mass spectrometry. It is shown that mean Neolithic enamel Pb contents are approximately 0.31 +/- 0.04 ppm. These values are only one order of magnitude lower than previously reported data for the same tissues for modern juveniles, despite an established 400-fold increase in the atmospheric Pb burden. The results suggest that 'natural' exposure to Pb in food and water may have been higher than previously thought, and that the link between atmospheric Pb and human exposure warrants further investigation.

Dental Enamel↗

PubMed1998

The distribution of lead within ancient and modern human teeth: implications for long-term and historical exposure monitoring.

The preservation of lead within human tissue makes it possible to monitor long-term exposure to the element and to model changing sources of lead pollution throughout the lifetime of an individual. Dental tissues have recently been shown to be particularly useful for this purpose. Enamel, for instance, forms at known stages of life and is chemically stable in vivo whereas dentine is remodelled in a predictable fashion. The relative stability of enamel is reflected in its excellent post-mortem preservation. This raises the possibility of using historical or archaeological material to reconstruct long-term trends and establish baseline data relating to exposure among pre-industrial or even prehistoric populations. The use of archaeological material is currently problematic, however, because of the site-specific nature of diagenesis and incomplete understanding of its chemistry, particularly in respect of lead uptake into dental tissue from the burial environment. A detailed study of lead distribution within both ancient and modern human teeth is presented. Conclusions are drawn on the pattern of lead distribution resulting from tissue formation and the manner of its alteration in the burial environment. In particular, attention is drawn to a consistent enrichment of lead within the outer 30 microns of the enamel of both ancient and modern teeth which appears to be unrelated to diagenesis. The implications for current approaches to long-term monitoring and for the reconstruction of historical and archaeological exposure patterns are discussed.

Archaeology↗