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PubMed2004

Local extinction and recolonization, species effective population size, and modern human origins.

A primary objection from a population genetics perspective to a multiregional model of modern human origins is that the model posits a large census size, whereas genetic data suggest a small effective population size. The relationship between census size and effective size is complex, but arguments based on an island model of migration show that if the effective population size reflects the number of breeding individuals and the effects of population subdivision, then an effective population size of 10,000 is inconsistent with the census size of 500,000 to 1,000,000 that has been suggested by archeological evidence. However, these models have ignored the effects of population extinction and recolonization, which increase the expected variance among demes and reduce the inbreeding effective population size. Using models developed for population extinction and recolonization, we show that a large census size consistent with the multiregional model can be reconciled with an effective population size of 10,000, but genetic variation among demes must be high, reflecting low interdeme migration rates and a colonization process that involves a small number of colonists or kin-structured colonization. Ethnographic and archeological evidence is insufficient to determine whether such demographic conditions existed among Pleistocene human populations, and further work needs to be done. More realistic models that incorporate isolation by distance and heterogeneity in extinction rates and effective deme sizes also need to be developed. However, if true, a process of population extinction and recolonization has interesting implications for human demographic history.

Animals↗
PubMed2007

Fragile external phenotype of modern human proximal femur in comparison with medieval bone.

UNLABELLED: Proximal femur macroanatomy of 118 medieval and 67 contemporary adults, 84 contemporary elderly, and 48 contemporary hip fracture cases was evaluated. Within approximately 1000 years, the femoral neck axis has become longer, and its cross-section has become proportionally smaller and more oval in shape. These changes in the present external phenotype alone account for approximately 50% higher fall-induced stress compared with the medieval situation. INTRODUCTION: Bones, as whole skeletal structures, adapt to mechanical stresses they customarily experience. Because the present, mechanized lifestyle apparently deprives our skeletons of vigorous, habitual physical exertion, we studied whether the proximal femur phenotype has evolved vulnerable to fragility fractures by time. MATERIALS AND METHODS: Proximal femur macroanatomy of 118 medieval and 67 contemporary adults, 84 contemporary elderly, and 48 contemporary hip fracture cases was evaluated. Using direct measurements of external bone dimensions and geometric properties, we estimated the fall-induced stress as an index of hip fragility. RESULTS: Within approximately 1000 years, the femoral axis length has become substantially longer (analysis of covariance, body height adjusted, p < 0.001), whereas the neck circumference has not increased. The macroanatomy was found similar between the contemporary adult and elderly groups. In hip fracture cases, however, the femoral axis length was further lengthened (p < 0.001), but the circumference was somewhat smaller (p = 0.001). Consequently, the estimated fall-induced stress can be approximately 1.5-fold today compared with the medieval times (p < 0.001), and the secular trend seemed to be worse in women (sex-time interaction, p = 0.001). CONCLUSIONS: The modern, relatively slender phenotype of the proximal femur alone seems to increase the fall-induced stress considerably, and when this phenotype coincides the osteoporotic, internally deteriorated femoral neck structure, fracture risk is imminent. This mechanically compromised external phenotype underscores the importance of timely strengthening of the skeleton and its regular maintenance throughout life.

Adaptation, Physiological↗
PubMedDate not supplied

Modernizing the FDA: an incremental revolution.

The U.S. Food and Drug Administration (FDA) is responsible for protecting consumers from unsafe or ineffective drugs and medical devices. The agency's role is defined by a growing and increasingly complex set of statutes, which reflect Congress's desires, on the one hand, to prevent product hazards and, on the other, to expedite FDA review and approval of promising new medical technologies. Congress's latest attempt to calibrate regulation to achieve these goals, the 1997 Food and Drug Administration Modernization Act, endorses certain of the FDA's own innovations and changes in the agency's ways of doing business.

Drug Approval↗
PubMedDate not supplied

E-prescribing and the medicare modernization act of 2003.

Provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 are intended to foster electronic prescribing by requiring standards for interoperability and by permitting third parties to offset implementation costs. Although physicians have been slow to embrace e-prescribing, adoption may increase in 2006, when a new tide of pharmacy messages will arrive from patients entering multi-tier drug coverage under Medicare. However, the e-prescribing systems selected may lack the advanced features needed to improve patient safety and chronic disease control. To optimize the return on Medicare drug spending, the government should consider additional incentives to spur the uptake of more advanced systems.

Drug Prescriptions↗
PubMed2004

Quality as a system property: section 646 of the Medicare Modernization Act.

The Medicare Trustees' 2004 report indicates that the Part A Hospital Insurance trust fund will be exhausted by 2019. Medicare's sustainable growth rate (SGR) formula for physician reimbursement is widely recognized as being flawed; if it is not reformed, it may result in reduced access to physician services for beneficiaries. MedPAC proposes an alternative to the SGR formula that involves explicit consideration of Medicare program objectives and ensures that payments for physician services be adequate to maintain access. Section 646 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 may provide answers regarding providing high-quality care in fee-for-service Medicare.

Medicare↗
PubMed2001

Digital echocardiography: its role in modern medical practice.

Digital echocardiography has evolved rapidly during the last decade, and the all-digital echocardiographic laboratory has just reached the threshold of reality. This review article explains what this transition means for the modern medical practice and concisely presents what a digital echocardiogram is, the technical aspects of digital image acquisition and processing, and the advantages and limitations of digital echocardiography vs analog echocardiography. This review should serve as a useful source of information for the general cardiologist not working closely with digital echocardiography, as well as a resource for the noncardiologist.

Echocardiography↗
PubMed2006

Posterior prolapse: an important entity even in the modern age of the pars flaccida approach to lap-band placement.

BACKGROUND: The most prevalent long-term complications in patients who undergo laparoscopic adjustable gastric band (LAGB) surgery are pouch dilatation and gastric prolapse (slippage). Gastric prolapse can be divided into the anterior and posterior variety. Posterior prolapse is thought to be specific to the perigastric approach due to a lack of posterior band fixation. We report a series of 3 patients out of 1,104 who underwent LAGB placement using the pars flaccida approach and developed a posterior prolapse. METHODS: Between March 2002 and December 2005, 1,104 patients underwent LAGB insertion using the pars flaccida approach at our institution. 3 patients (0.27%) developed posterior prolapse requiring reoperation. RESULTS: All 3 patients presented with similar complaints, including solid food intolerance, gastroesophageal reflux and/or regurgitation. Although identical to those reported with anterior prolapse, diagnosis was definitively made with barium video esophagogram. All patients were treated with reoperation, but band replacement was impossible in 2 of the 3 cases secondary to extensive adhesion formation. CONCLUSION: The finding of 3 patients who experienced posterior prolapse, despite using the pars flaccida approach, highlights the fact that this complication although diminished, has not been eliminated as previously thought. We describe the presentation, work-up, and management of this rare but important entity in the modern era of LAGB.

Adult↗
PubMed2006

From traditional Ayurvedic medicine to modern medicine: identification of therapeutic targets for suppression of inflammation and cancer.

Cancer is a hyperproliferative disorder that involves transformation, dysregulation of apoptosis, proliferation, invasion, angiogenesis and metastasis. Extensive research during the last 30 years has revealed much about the biology of cancer. Drugs used to treat most cancers are those that can block cell signalling, including growth factor signalling (e.g., epidermal growth factor); prostaglandin production (e.g., COX-2); inflammation (e.g., inflammatory cytokines: NF-kappaB, TNF, IL-1, IL-6, chemokines); drug resistance gene products (e.g., multi-drug resistance); cell cycle proteins (e.g., cyclin D1 and cyclin E); angiogenesis (e.g., vascular endothelial growth factor); invasion (e.g., matrix metalloproteinases); antiapoptosis (e.g., bcl-2, bcl-X(L), XIAP, survivin, FLIP); and cellular proliferation (e.g., c-myc, AP-1, growth factors). Numerous reports have suggested that Ayurvedic plants and their components mediate their effects by modulating several of these recently identified therapeutic targets. However, Ayurvedic medicine requires rediscovery in light of our current knowledge of allopathic (modern) medicine. The focus of this review is to elucidate the Ayurvedic concept of cancer, including its classification, causes, pathogenesis and prevention; surgical removal of tumours; herbal remedies; dietary modifications; and spiritual treatments.

Animals↗
PubMed2001

The practice of Modern Group Psychotherapy: working with past trauma in the present.

Modern Group Psychotherapy offers specific techniques for aiding the pre-oedipal patient to speak, connect, and achieve emotional growth. This article illustrates the use of such therapeutic group tools as joining, mirroring, bridging, contact functioning, the object-oriented question, the insulation barrier, and transient identification, through case vignettes. It demonstrates how such techniques protect fragile egos and assist them on their journey to maturity. Emphasis is placed on the creative components of countertransference as a valuable supplement in patient treatment. The power of the group as an agent for change is portrayed.

Countertransference↗
PubMed2001

Dante's Divine Comedy revisited: what can modern psychoanalysts learn from a medieval "psychoanalysis"?

I realize after having gone over this material that I have done a sort of deconstruction of Dante's Divine Comedy which putatively attempts to raise the human vision to transcendent heights and to focus love on the love of God, but which along the way indulges in the very human aspects of pity, compassion, music, poetry, and the other arts, as well as reason and puzzlement. In this sense the poem is also an exposition of the value of the higher human faculties, which contrasts at times rather vividly with the apparently harsh autocratic fates that are assigned to some characters--who do not seem quite deserving of what is inflicted upon them. Here we have a collision between absolute faith in the judgment of God and human reason and compassion which sometimes seems to be unable to justify these judgments. In spite of the fact that Dante is trying to adhere to orthodox theology throughout, it is clear that his poetic soul has great difficulty in avoiding the depiction of characters for whom he has a secret sympathy. The central point of this study of The Divine Comedy is to emphasize how Dante, almost in spite of himself, expressed empathy and understanding for a variety of unfortunates either in the Inferno or in the Purgatorio. Virgil even scolds him for his compassion, arguing that God's justice is always correct and if God is angry at someone and punishes him or her, Dante should also be angry and not compassionate. Dante tries, but he cannot quite manage to do it. Translated into modern terminology, we can learn from this report of a medieval "psychoanalysis" an important lesson in our clinical work. Rigid adherence to rules such as those Freud himself proclaimed (although he never followed them), for instance in his famous demand that one be always opaque to the patient, and/or rigid adherence to one or another psychoanalytic theory, must be understood as a form of countertransference, a character flaw in the analyst. Each case demands its own approach and its own form or forms or channels of understanding, just as Dante offers us in The Divine Comedy. It is because he offers such a perspective almost in spite of himself that his poem transcends the medieval mind and becomes relevant to all ages and cultures. As a rule of thumb, when one finds one's instinctual convictions about how to proceed in conflict with one's theories and set of rules, something is wrong. It is with the greatest trepidation that a well-analysed psychoanalyst should force him- or herself to ignore an instinctual or intuitive feeling of how to respond to a patient because it conflicts with some theoretical principles or official rules of procedure. Such a conflict is a call for further self-analysis, consultation with colleagues, and creative solutions.

Humans↗
PubMed1999

Imagined lives, suffering, and the work of culture: the embodied discourses of conflict in modern Tibet.

This article explores the cultural epidemiology of rlung ("loong") disorder among Tibetans living in the cities and towns of the modern Chinese state of Tibet. Rlung, glossed as air or wind, is the most important of the three humors of the classical Tibetan ethnomedical system. Considered by Tibetans to be contingent upon multiple social, emotional, and religious phenomena, rlung disorders are fertile ground for the development of etiological discourses that incorporate the social and political crises that are part of the rapidly changing Tibetan plateau. In this essay I locate rlung disorder in a confluence of Tibetan ethnomedical constructions of the mind-body-universe linkage, in which rlung stands as the chief symbolic mediator, with ethnic conflict, rapid economic development, and the localization of global debates over Tibetan suffering and human rights.

Adult↗
PubMed2004

Linkage disequilibrium mapping of yield and yield stability in modern spring barley cultivars.

Associations between markers and complex quantitative traits were investigated in a collection of 146 modern two-row spring barley cultivars, representing the current commercial germ plasm in Europe. Using 236 AFLP markers, associations between markers were found for markers as far apart as 10 cM. Subsequently, for the 146 cultivars the complex traits mean yield, adaptability (Finlay-Wilkinson slope), and stability (deviations from regression) were estimated from the analysis of variety trial data. Regression of those traits on individual marker data disclosed marker-trait associations for mean yield and yield stability. Support for identified associations was obtained from association profiles, i.e., from plots of P-values against chromosome positions. In addition, many of the associated markers were located in regions where earlier QTL were found for yield and yield components. To study the oligogenic genetic base of the traits in more detail, multiple linear regression of the traits on markers was carried out, using stepwise selection. By this procedure, 18-20 markers that accounted for 40-58% of the variation were selected. Our results indicate that association mapping approaches can be a viable alternative to classical QTL approaches based on crosses between inbred lines, especially for complex traits with costly measurements.

Bayes Theorem↗
PubMed2006

Socioeconomic impact of modern multidisciplinary management of retinoblastoma.

OBJECTIVE: Our objective for this study was to examine the impact of the modern management of intraocular retinoblastoma on the patient and the family. METHODS: This study comprises a retrospective, noncomparative case series of 25 consecutive patients with multifocal, intraocular retinoblastoma that was treated with primary systemic chemotherapy. Medical charts were reviewed, and the following data were extracted: patients' age and gender, laterality of disease, and Reese-Ellsworth classification of each eye as well as the number of central venous lines placed, cycles of chemotherapy received, outpatient appointments, examinations under anesthesia, focal therapies administered, computed tomography/MRI, radiation treatments, anesthetic procedures administered, and miles traveled. RESULTS: Twenty patients with bilateral and 5 with unilateral intraocular retinoblastoma (median age: 9.3 months) had 895 outpatient appointments and underwent 698 examinations under anesthesia with 230 focal therapies, 347 days of radiotherapy, 226 computed tomography scans/MRIs, and 38 central venous line placements. A total of 1272 anesthetic procedures (median: 50) were performed with no major complication. In all, patients traveled 822312 miles (median: 22214 miles) to receive their care. The median follow-up was 82 months. CONCLUSIONS: Successful retinoblastoma management requires close surveillance, aggressive consolidation, and numerous anesthetic procedures, all of which the patients and the families must endure. There is a significant impact on the patient, the family, and hospital resources.

Anesthesia, General↗
PubMed1993

[The origin of modern pediatric nursing].

The object of study of this investigations in the knowledge in pediatrics nursing from the institutionalization of the modern nursing beginning from the XIX Century. The knowledge in this study is considered as an instrument from which man apprehends his working object. From an historical perspective nursing is seen as a social articulated practice, as part of a collective process of works, whose purposes are: the control of the disease in the society, based on collective level and the recuperation of the individual working strength. Through the bibliography, we try to identify the characteristics of children's nursing assistance in England, during the XIX Century and the simultaneous movements of the medicinal practice: the social medicine, the clinic medical practice and puericulture. Followed the characteristics of the children's assistance in the United States in the beginning of the century and the theoretical reference in which it is located.

History, 19th Century↗
PubMedDate not supplied

[The fairy tale and modern paternity].

The study presents the interpretation of a hospital delivery from the male's perspective, according to the cultural experiences of the individual, making available the simultaneous discovery of that which conceals and brings out this phenomenon. In seeking answers to the hidden meanings of the paternity process, it points to a literary path of meaning and art: the allegory. The account of the material analyzed is presented in the form of a seemingly ingenuous narrative--a fairy tale--with a symbolic nature and a moral backdrop, using the fable of Charles Perreaut entitled "Little Red Ridding Hood". From this other view, the beauty of the modern world is captured, offering a key for interpretations of the human realities.

Humans↗
PubMed2004

[The role and practices of the curandeiro and saludador in early modern Portuguese society].

This paper will explore the role and practices of magic-using folk healers - curandeiros and saludadores - in early modern Portuguese society. The article will examine the ambivalent place of the folk healer as a figure both central to and marginal in Portuguese popular culture. In considering some of the services offered by unlicensed popular healers and their recourse to the unorthodox magical means inherent in popular curing, the paper will investigate curandeiros and saludadores illicit sources of power. Further, this work will examine the prominence of men as folk healers in southern Portugal during the seventeenth and eighteenth centuries. Finally, by looking at the notoriety of Luso-African folk healers, the paper will assess the importance of race as a factor in the culture of Portuguese magical curing.

History, 17th Century↗
PubMedDate not supplied

[The modern psychiatric institution from an organizational perspective].

The essay analyzes the development of the modern psychiatric institution, represented most importantly by the emergence of the traditional asylum organization. In this type of institution, the process of behavioral control operates upon the same epistemological bases that fostered the bureaucratic model of domination - in other words, in the consonance with the instrumental-rational approach that legitimizes as key principles predictability and efficacy. In contrast, there has been recently been a break with this organizational type, expressed through the anti-asylum and anti-psychiatry movements, chiefly in the form on denunciations and criticisms of the contradictory 'telos' so evident at asylums and, secondarily, in the form of reformist proposals. Lastly, this change in paradigm has moved towards humanizing interactions between actors within the asylum model.

Health Care Reform↗
PubMed2004

The Medicare Prescription Drug, Improvement and Modernization Act and the impact on care of people with chronic illness: benefit design and implementation issues.

The Medicare Prescription Drug Improvement and Modernization Act represents the most far-reaching and one of the most controversial reforms of the Medicare program since its enactment in 1965. The Act ushers in a new Medicare prescription drug benefit, revitalizes Medicare Advantage plans and promotes new approaches to care of Medicare beneficiaries with chronic illness. However, while the Act evidences a commitment to improving the care of beneficiaries with chronic illness, reform may prove elusive. The basic benefit design is daunting in its complexity andfor certain beneficiaries, coverage may be less generous and less comprehensive than currently available coverage. To ensure appropriate transition and treatment for dual eligibles and others with chronic illness, both Congress and the Department of Health and Human Services must be prepared to address a number of important benefit design and operations issues and be willing to make mid-course corrections and adjustment as the process unfolds.

Aged↗