Authors Mention Research Articles

Ocular Pseudoexfoliation Syndrome and Life Span: Act 2

Ocular Pseudoexfoliation Syndrome and Life Span: Act 2

Herd immunity and the herd severity effect

Vaccination reduces morbidity and mortality by making infections and related diseases less common. A natural conclusion might be that breakthrough cases of vaccine-preventable disease would also become less severe. However, the opposite seems to be true for diseases that are more severe when acquired after childhood, according to the study by Nina Fefferman and Elena Naumova 1 Fefferman NH Naumova EN Dangers of vaccine refusal near the herd immunity threshold: a modelling study. Lancet Infect Dis. 2015; (published online May 15.)http://dx.doi.org/10.1016/S1473-3099(15)00053-5 PubMed Google Scholar published in The Lancet Infectious Diseases. Their finding is somewhat counterintuitive: higher vaccination rates that approach herd immunity levels mean that fewer people overall get sick, but those who get sick might have much more severe illnesses than in previous generations. As the authors mention, vaccines not only protect those who accept them, but they can also make health outcomes worse for those who do not. The occurence underlying Fefferman and Naumova's model deserves a name, perhaps the herd severity effect. Dangers of vaccine refusal near the herd immunity threshold: a modelling studyAs vaccination makes preventable illness rarer, for some diseases, it also increases the expected severity of each case. Because estimates of case risks rely on data for severity generated during a pre-vaccine era they underestimate negative outcomes in the modern post-vaccine epidemiological landscape. Physicians and parents should understand when making decisions about their children's health and safety that remaining unvaccinated in a predominantly vaccine-protected community exposes their children to the most severe possible outcomes for many preventable diseases. Full-Text PDF

Exhaustion or fatigability may not only be cardiac but also myopathic.

To the Editor, With interest, we read the article by Yaksh et al. about a patient with left ventricular hypertrabeculation/noncompaction and Wolff–Parkinson–White syndrome who also manifested with ventricular tachycardia. We have the following comments and concerns. The patient described is not the first adult with noncompaction who also presented with Wolff–Parkinson–White syndrome. In a previous report, one of the two noncompaction patients from the same family had pre-excitation on electrocardiography [1]. The combination of noncompaction and pre-excitation was also reported in two adult Chinese patients [2]. Additionally, Wolff–Parkinson–White syndrome was described by Moceri et al. and Brembilla-Perrot et al. in a single patient each [3, 4]. In a study of 86 noncompaction patients, Wolff–Parkinson–White syndrome was found in two of them [5]. The authors mention that noncompaction was first described by Engberding et al. [6]. Engberding et al. were indeed the first to recognize and describe this unclassified cardiomyopathy on echocardiography, but there are indications that noncompaction had been described earlier, as indicated in the paper by Feldt et al. in 1969 [7]. Noncompaction is not only associated with electrocardiographic abnormalities such as right bundle branch block, supraventricular tachycardia, or ventricular tachycardia, but any type of electrocardiographic abnormality may be observed in these patients including atrial fibrillation, atrioventricular block, left bundle branch block, or QT prolongation [5]. Easy fatigability or exhaustion may not only be a cardiac symptom but may also be a clinical manifestation of a neuromuscular disorder, frequently associated with noncompaction [8]. Was the patient investigated for neuromuscular disorders by a neurologist? Did she present with any other feature of a neuromuscular disorder, such as muscle weakness, wasting, reduced tendon reflexes, muscle aching, muscle cramping, double vision, or ptosis? Not only symptomatic patients are investigated for noncompaction but also asymptomatic patients, as reported in a number of cases and family studies. Occasionally noncompaction is found in asymptomatic relatives of symptomatic noncompaction cases. In a family study of 25 relatives of noncompaction patients, asymptomatic noncompaction was detected in four of these relatives [9]. Surprisingly, the authors mention in the discussion that atrial fibrillation could have been the cause of ventricular tachycardia in their patient [6]. Did the patient receive oral anticoagulation in addition to ablation and implantable cardioverter defibrillator implantation as a prophylactic measure? It is essential to put noncompaction patients on oral anticoagulation as soon as atrial fibrillation or heart failure has been documented. How often did the implantable cardioverter defibrillator discharge during follow-up and which was the arrhythmia that caused the implantable cardioverter defibrillator to react? In the introduction the authors mention that the clinical presentation of noncompaction includes heart failure, thromboembolic events, or arrhythmias [6]. However, noncompaction patients may present with other cardiac manifestations, particularly if noncompaction is associated with functional or morphological abnormalities in addition to noncompaction (non-isolated noncompaction) [10]. Overall, there is a need to thoroughly investigate and describe noncompaction patients, to screen noncompaction patients for neuromuscular disorders or chromosomal abnormalities, and to screen other family members for noncompaction. For clarification of the pathogenetic background of noncompaction, it is useful to search for any genetic abnormality that may explain the occurrence of noncompaction.

Cultural traits and stock market development: an empirical analysis

Purpose – During recent times, the stock market has emerged as a major financial institution of an economy. Yet, cross-country differences, in size and role of stock market, persist. The purpose of this paper is to investigate the correlation between cultural traits and the development of the stock market in a country. Considering multiple dimensions of culture, identified in the literature by Hofstede (1980/2001) and World Value Survey, the authors construct the hypotheses: trust, a key cultural trait, should positively influence stock market development; uncertainty avoidance, Hofstede’s cultural dimension should negatively influence the development of the stock market; and individualism, an alternate cultural dimension of Hofstede’s measures, should be positively correlated with stock market development. The cross-country empirical analysis supports the hypotheses. The results hold for multiple measures of stock market development. Design/methodology/approach – This paper investigates the correlation between various cultural traits and the development of the stock market in a country. Specifically, the authors consider three different cultural trait measures. The authors consider a cross-sectional analysis of an extensive number of countries. While all explanatory variables of interest are considered over the period 2000-2007, the authors consider 2008 figures for the dependent variables of interest, financial development. Ordinary least squares is considered as the benchmark specification. Robust regression has been considered as part of robustness analysis. The authors mention throughout the paper that the results stress on significant association between the variables, only. Findings – The empirical results support the hypotheses. The first measure, trust, is positively associated with stock market development of a nation. Statistically, for one standard deviation rise in trust (1 SD=37.5), stock market capitalization will go up between 11 and 19 percentage points. Uncertainty avoidance, the second measure is negatively correlated and statistically, the impact is much greater. Finally, the third measure, individualism, is positively correlated with stock market development. Statistically, for one SD rise in individualism (SD=23.9), stock market capitalization will rise by 23 percentage points. Originality/value – Existing literature has stressed the role of cultural traits – trust, uncertainty avoidance, individualism – in the promotion of entrepreneurship, innovation and growth. Since most startups need to raise capital in order to implement their new ideas, cross-country heterogeneity in the strength of capital markets may lead to important differences in entrepreneurship and productivity growth across economies (Greenwood and Jovanovic, 1990; Jayaratne and Strahan, 1996; Levine, 1997; Beck et al., 2000; Guiso et al., 2004). Yet, the link between stock market development and cultural traits has not been established in the literature. This paper aims to fill this missing link.

Combined double tarsal wedge osteotomy and transcuneiform osteotomy for correction of resistant club foot deformity (the bean-shaped foot).

I read with interest the article “Combined double tarsal wedge osteotomy and transcuneiform osteotomy for correction of resistant club foot deformity (the bean-shaped foot) by Elgeidi and Abulsaad [1]. I would, however, like to draw attention to some errors in their description of the double osteotomy technique. In their article the authors mention that the procedure described by Jawish [2] in his 1994 article was the sole opening wedge osteotomy of the first cuneiform technique. This is not correct, and in fact in this article the author describes a single medial osteotomy for the foot with primus varus, as well as a double osteotomy for feet with resistant metatarsus adductus observed in the clubfoot and Z-shaped-foot. To quote part of the abstract of Jawish’s [2] article: “in resistant metatarsus adductus, closed wedge osteotomy of the cuboid has been added to correct the varus deformity of the fore foot, it allows lateral swing of the fore foot: the bone excised from the cuboid is use to stabilize medial osteotomy”. In the same paragraph of the article of Elgeidi and Abulsaad [1], the authors report that McHale and Lenhart [3] were the first to describe, in 1991, the double osteotomy (opening of the cuneiform and closing of the cuboid). Again, this is incorrect: the double osteotomy technique was first performed by Jawish and colleagues in Paris (Hopital Enfants-Malades), and their description of the technique was published in Chirurgie Orthopedique (a French-language journal) in 1990 [4]. The double osteotomy technique described by Jawish and colleagues in 1990 was performed to correct the resistant adduction of the forefoot in the Z-shaped foot and was performed exactly as cited in 1991 by McHale and Lenhart for forefoot adduction in club foot. The technique is mentioned in the abstract of the 1990 article [4], and illustrations of the double osteotomy are provided in the article itself, with follow-up (Fig. 1). Fig. 1 (Boy DEL...Stephane) a At 12 years old, the patient had a Z-shaped foot grade 4 with no initial treatment. He has metatarsus adductus and lateral deviation of the anterior tarse, with deformities of the first cuneiform and the cuboid. ... To summarize, the double osteotomy of the cuneiform and the cuboid is a technique reported in 1990 by Jawish et al. [4], developed by these authors in the Department of Pediatric Orthopaedics of Hopital Enfants-Malades (Paris) to treat resistant adduction of forefoot. The article published in 1994 by the first author reported the application of the same technique in a series of children with multiple causes of forefoot deformities.

Methodical cube a projektové nástroje jako inovativní přístup k modelování podnikových procesů

The article deals with problem of business processes modelling. It presents basic theoretical concepts and proposals how to use various methods of business processes modelling for various levels and attributes of these processes through created methodical cube. The methodical cube is of process model (or map) creation as well as innovative tool in process management. The objective of this article is to create basis for business processes optimization and for improving their performance through the three aspects methodology required for business processes modelling and design. The authors mention project approach to process modelling. They use an analysis of problems (so-called tree of problems) and analysis of goals (so-called tree of goals) as project tools, which should be applied before process modelling. These tools help process manager to understand potential problems and find goals for making a good process map or model.

Methodical Ways of Enhancement of Personal Communicative Competence as a Social Constant at the Innovative University

The article presents the specifics of personal communicative competence as a social constant and its place among other social constants. The authors define personal communicative competence as the basic on effort he professional competence, a meaningful and essential constant. The ways of enhancement of a bachelor’s communicative competence in “Russian Language. Literature”, “Russian language. History” at the pedagogical college are studied. The paper presents a complex of special tasks, suggested to the students in the course of such subjects as “Pedagogical rhetoric”, “Theory and methodic of teaching Russian” and others. The authors mention some peculiarities of methodical workshops as an educational technology and a classes conducting format, which lets one improve methodical and communicative competence of a future teacher. The principles of the theoretical analyses of communicative situations components at a methodic workshop class are demonstrated by the example of professionally oriented texts critique.

Comment on “Second-Hand Smoking among Intermediate and Secondary School Students in Madinah, Saudi Arabia”

I read the article titled “Second-Hand Smoking among Intermediate and Secondary School Students in Madinah, Saudi Arabia” by Al-Zalabani et al. [1], with curiosity. Authors' efforts are admirable. This study provides valuable information for the evidence based fine tuning of present smoking legislation in the study area. However, the following issues and concerns need to be addressed. Knowledge about harmful effects of smoking from family or school (yes versus no) and belief in the negative effects of second-hand smoking (yes versus no) have been considered as independent variables in this study. What questions were asked and which criteria were used to classify the study participant as “knowledgeable about the harmful effects smoking” and “believer in negative effects of second-hand smoking”? This should have been explicitly mentioned to avoid ambiguity. The estimated prevalence of second-hand smoking exposure among the studied adolescents at home, outside households, and overall exposure should have been reported with 95% confidence intervals [2]. In Table 1, authors have repeatedly mentioned P value as “0.00”. SPSS, by default setting, displays P value as zero if it extends beyond 3 decimal points (i.e., P = 0.0000002 would be displayed as P = 0.00). Practically, the value of P cannot be zero and hence, I would suggest to report it as P < 0.0001. Authors have included all the independent variables in regression model and associations are expressed as adjusted OR with 95% confidence intervals. However, adequacy of the applied binary logistic regression model is not mentioned. Failure to do so may lead to misleading or incorrect inferences. Although the study sample was large, a word about R2 (explaining the variance in the outcome variable) of the applied regression model would have been more affirmative. In the discussion, authors should have given logical explanations about how the significant correlates in regression analysis are associated with second-hand smoking exposure. For example, why boys (versus girls) and those who do not stay with parents are more likely to be exposed to second-hand smoking? Intuitive epidemiological reasoning of the aforesaid, keeping the sociocultural background in mind, would have been more informative and interesting. In conclusion, authors mention that, in Moslem communities, mosques appeared to have a crucial role in raising the awareness of youth and their families not only on the harmful effect of smoking, but also on religion's stance on this habit. Such recommendation is to be endorsed; however, it must be supported by proper reference/s. An additional limitation stating that not all the observed associations infer causality due to cross-sectional study design should have been mentioned. Nonetheless, I must applaud the authors for investigating an important public health problem on a large scale.

Comment on "Effects of Yoga on Utero-Fetal-Placental Circulation in High-Risk Pregnancy: A Randomized Controlled Trial".

I read the paper titled “Effects of Yoga on Utero-Fetal-Placental Circulation in High-Risk Pregnancy: A Randomized Controlled Trial” by A. Rakhshani et al. [1] with a great interest. Authors' efforts are highly commendable. The strength of this study, apart from those mentioned by the authors, is the objectiveness of the key outcomes for yoga intervention. However, the following issues and concerns need to be addressed. Authors mention that the “sample profile matched closely that of the Bengaluru metropolitan population” which is considered as one of the strengths of the study. I feel that it has to be justified with proper reference/s as the analyzed sample size was too small (n = 53, Table 2). In fact, the issue of smaller sample size has been mentioned in the limitation. Authors have used outcome measures such as fetal biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight (Table 3). However, maternal hemoglobin, anemia status, physical activity, dietary, and iron-folate/other supplement intake have an effect on all these fetal parameters [2]. These are the potential confounders in this study and they must have been addressed. Nonetheless, this study highlights the need of higher level of evidence to assess the effect of yoga on maternal and fetal outcomes.

Lesiones orales como factores de riesgo de enfermedades sistémicas

Los problemas en la salud oral influyen en la condición general del individuo. El diagnóstico clínico de la enfermedad oral puede dar idea de la causa y el pronóstico, sin embargo no refleja directamente el nivel de alteración en el individuo. En algunas personas las enfermedades orales indican un factor de riesgo pero que no son de por vida, ni tan severos que deshabiliten sus capacidades, sin embargo sus consecuencias pueden impactar en la vida diaria en diferentes grados y provocar la percepción de incapacidad alterando el desenvolvimiento psicosocial. Diversos autores mencionan signos orales como factor de riesgo de enfermedades sistémicas. Patologias del canal radicular como lugar de brote de actinomicosis sistémica. Tambien se describe a la ulceración crónica del paladar duro donde se presenta el signo de tuberculosis pulmonar no diagnosticada, asi mismo la sífilis secundaria es inicialmente diagnosticada por lesiones orales. Otros autores sost ienen que el Sarcoma de Ewing primario envuelve al hueso de la cabeza y el cuello antes de repercutir sistemicamente. Tambien se describe que el Citomegalovirus en mucosal oral es una de las primeras manifestaciones del SIDA. Asi mismo se dice que la exposición hematógena a los estreptococos orales ha sido reconocido como potencial factor iniciador de la endocarditis bacteriana. La infección ha sido reconocida como factor de riesgo para la aterogénesis y los eventos trombóticos. Se encontró asociación significativa entre el componente periodontal del índice dental y la isquemia cerebrovascular. Hay lesiones orales que son factores de riesgo para desarrrollar una enfermedad sistémica. La osteodistrofia renal y los cambios en el tejido oseo son consecuencia de la insuficiencia renal. Los cambios en el hueso alveolar asociados a la osteodistrofia renal son similares a los hallados en el hiperparatiroidismo primario e incluyen pérdida generalizada de densidad ósea, adelgazamiento de la cortical de los huesos y pérdida total o parcial de la lámina dura.

Principles and Practice of Mechanical Ventilation, Third Edition

Evolution, refinement, innovation. The iron lung, assist-control ventilation, intelligent control ventilation. We have come a long way in the field of mechanical ventilation as we have evolved from old methods, continue to refine known methods, and look to innovate new ones.Dr. Tobin’s Principles and Practice of Mechanical Ventilation is a classic text that continues to provide practitioners of today the most comprehensive reference to mechanical ventilation, with updates of new knowledge and advances. The third edition follows the second edition since 2006. The most obvious change is the addition of color, which gives graphs and tables more definition and pictures more character. The book has 68 chapters organized into 15 sections. Each chapter, in a broad sense, is organized into “principles” and “practice,” as promised by the book title. The “principles” portion of each chapter includes topics such as basic physiology, mechanisms, and rationale. The “practice” portion of each chapter includes topics such as indications, comparison of modes, and clinical relevance. Many chapters also have a section on unknowns and future perspectives, which are important points, especially in a comprehensive medical text that will certainly have its contrarians. The organization among chapters gives the reader a consistency that facilitates readability.The early part of the book provides a historical perspective of mechanical ventilation. This is followed by the physical science of mechanical ventilation and the design of ventilators. A third of the book is dedicated to the various methods of ventilation, from conventional to nonconventional. In addition, topics cover how mechanical ventilation pertains to different clinical settings, physiologic effects, and airway management. This is followed by a patient-centric approach focusing on complications, monitoring, and management of ventilator-supported patients. The final section covers adjunctive therapies and the ethics and economics of mechanical ventilation.The textbook is best viewed in the hardcover form. However, for less cumbersome transport, the text is available online through Access Anesthesiology® on the McGraw-Hill Medical site, and an electronic book version is also available for portable devices.The list of authors is an impressive collection of experts from around the world who conduct research and are active in societies in addition to their clinical duties. Every chapter is thoroughly researched and up-to-date. The expert minds give the reader a window into their thinking. Many authors mention ongoing or recently completed research and clinical trials, and the new evidence will undoubtedly be presented in the next edition.Overall, the book is well organized and easy to read. The chapters can be read separately if you are exploring a topic or the book can be read continuously for comprehension of all the topics. The chapters contain references to other chapters where needed, so repetition is limited. Specifically, as with the earlier edition, the tone of the book is set early in the “Indications for Mechanical Ventilation” chapter. In a clinical sense, the authors of the chapter want to convey the importance of pathophysiologic concepts, applying knowledge and experience, and then making clinical decisions based on the all of the previous. This premise is followed throughout that book. Background and data are presented first, and reader is guided into the decision-making process.For anesthesiologist, the book provides a perioperative bridge to the world of mechanical ventilation usually found in critical care settings. With this text, an anesthesiologist can become familiar with methods available on anesthesia ventilators. Other methods of ventilation may be worth reading about because many of the technologies found in the intensive care unit ventilator have crossed over to the current anesthesia ventilator. The editor has brought back a chapter on “Mechanical Ventilation during General Anesthesia,” and it is worth reading. Other interesting chapters for the anesthesiologists include an updated chapter on “Complications of Translaryngeal Intubation” and a rewritten chapter on “Complications Associated with Mechanical Ventilation.”For critical care physicians or respiratory care practitioners, the book is an invaluable reference for all aspects of mechanical ventilation. The book with the basic principles and practical everyday management issues of ventilators and patients is a must have in all libraries. New chapters, with topics ranging from the complex, such as the neurally adjusted ventilator assist mode and extracorporeal life support for cardiopulmonary failure, to the simplest, such as airway secretions and suctioning, show how comprehensive the book continues to be. The book is “the definitive guide” to mechanical ventilation and is likely to continue to be “the definitive guide” for future generations.

New localities Gasteromycetes near Busko Zdrój

The authors mention new localities of three, rare species of &lt;i&gt;Gasteromycetes&lt;/i&gt; in Poland, connected with xerothermic vegetation.

Social neuroscience in psychiatry: of obvious relevance.

Cacioppo et al 1 make the important point that the study of normal and abnormal social behavior is essential in the understanding of mental disorders. Indeed, it is hard to imagine a mental disorder that does not involve, or lead to, abnormalities in social interaction. One could even say that one of the hallmarks of mental illness is that social interactions are affected. Obviously, and as argued by many, the human species is a social species and therefore its brain is developed to support social activities. The paper provides three examples of psychiatric disorders where abnormalities in social functioning are involved: major depressive disorder, antisocial personality and hypoactive sexual desire disorder. However, the relationship between abnormal social activities and these three disorders may be quite dissimilar. One could argue that in major depression the abnormalities in social interactions are secondary to the disease and may therefore be important in treatment and rehabilitation but not as important in understanding the etiology of the illness 2. In contrast, antisocial personality disorder is characterized at its core by abnormal social interaction, where the abnormality may be lifelong and of a developmental nature. Finally, hypoactive sexual desire disorder may lead to social interaction abnormalities, but these may not be the cause of the illness. The authors mention, but do not address in detail, two other mental disorders where abnormal social interaction, specifically impaired social cognition, may be a root cause of the illness: autism 3 and schizophrenia 4. Emotional and cognitive dysfunctions are the core clinical features of schizophrenia 5. Moreover, it has been argued that impairments in emotion recognition and theory of mind (ToM) may even trump the value of general cognition and symptoms in explaining outcome in schizophrenia 6. In healthy individuals, social cognition has been extensively studied using functional and structural imaging, and a network of brain regions subserving it has been identified 7. In short, the processing of facial expressions depends critically on the amygdala and the orbitofrontal cortex, whereas in mentalizing tasks, such as ToM, the medial and orbitofrontal cortex is critical 8. In schizophrenia, functional neuroimaging studies have consistently demonstrated reduced activity of the amygdala during processing of facial emotions compared to healthy controls 9, and reduced activation of the prefrontal cortex (PFC) has been related to impaired performance on ToM tasks. Indeed, a recent meta-analysis of functional imaging studies, comprising 450 schizophrenia patients and 422 healthy controls, has shown reduced amygdala and PFC activity in social cognition in schizophrenia 10. In contrast to the numerous functional neuroimaging studies in schizophrenia, only few structural imaging studies have investigated the relationship between abnormalities of the amygdala and PFC and social cognitive deficits seen in patients. So far, samples have been small (between 16 and 38 patients), and the influence of IQ and symptomatology has often been disregarded. We recently completed a study where we investigated whether social cognitive deficits in patients with schizophrenia are related to gray matter volume abnormalities of the amygdala and PFC. We assessed facial emotion recognition and ToM in 166 patients with schizophrenia and 134 healthy controls, and magnetic resonance imaging brain scans were acquired. Preliminary results suggest that reduced PFC, but not amygdala, gray matter volume is associated with social cognitive deficits in schizophrenia 11. Thus, anatomical abnormalities in schizophrenia may in part be related to social cognitive dysfunction. Whether this is specific to schizophrenia or these anatomical changes are also observed in other disorders characterized by social deficits remains to be studied. All in all, Cacioppo et al's paper makes a very important and compelling case that social neuroscience should be integrated into psychiatry and may make important contributions in understanding the etiology and sequelae of mental disorders. However, there is a lot of pioneering work that needs to be done to start understanding the role of this important human aspect in the etiology and course of psychiatric illness.

문화유산기관의 협업을 통한 교육서비스 개발에 관한 연구 - 기록관·도서관·박물관을 중심으로 -

기록관·도서관·박물관은 각자가 다루는 자원은 다르지만 서비스 부문에서는 여러 공통점을 지니고 있다. 특히 교육 분야에서는 다양한 자료와 관점을 아우르는 통합적인 서비스가 필요하기 때문에 향후 각 문화유산기관들은 효율적인 교육서비스를 제공하기 위해 서로 협력할 필요가 있다. 이에 본 연구에서는 협력의 필요성을 제고하고, 국외와 국내에서 문화유산기관이 협력하여 서비스를 제공한 사례를 분석했다. 특히 각 기관에서 이루어지는 교육서비스의 현황을 분석함으로써 그 공통점과 특화된 영역을 제시하여 향후 교육서비스 모형을 개발할 때 참고할 수 있도록 설명하고자 했다. 이러한 분석을 바탕으로 국내에서 문화유산기관의 협력을 활성화시키기 위한 방안을 제시하고, ADDIE모형을 적용한 개발 프로세스를 통해 교육서비스 모형을 제시했다.

La codépendance : nouvel outil clinique ou flou conceptuel ? Une revue de la littérature

The goal of this literature review is to introduce, present and analyze the clinical phenomenon that is codependency. It will present explanatory models, measurement tools and therapeutic strategies, before introducing a critical analysis of this concept and its use. Codependency is an entity defined by several major symptoms such as denial, hyper-control, emotional repression, compulsions, self-neglect and a difficulty setting healthy boundaries. It is evaluated with a valid and reliable tool, called the Codependency Assessment Tool (CODAT). On a therapeutic level, specialists underline the importance of a pre-therapeutic diagnosis and the development of targeted therapeutic strategies. They also emphasize the benefits of combined individual and group therapy. On a collective level, 12 step programs, such as Al-Anon and Codependents Anonymous, offer support groups adapted to these symptoms although they insist on certain limits that must be understood. Despite an interest for this concept because of its clinical usefulness and its resonance with certain patients that suffer from it, certain authors mention conceptual flaws and insufficient empirical data. Thus, exploratory research concerning this phenomenon and its effects must continue.

Investigation of publication bias in meta-analyses of diagnostic test accuracy: a meta-epidemiological study.

BackgroundThe validity of a meta-analysis can be understood better in light of the possible impact of publication bias. The majority of the methods to investigate publication bias in terms of small study-effects are developed for meta-analyses of intervention studies, leaving authors of diagnostic test accuracy (DTA) systematic reviews with limited guidance. The aim of this study was to evaluate if and how publication bias was assessed in meta-analyses of DTA, and to compare the results of various statistical methods used to assess publication bias.MethodsA systematic search was initiated to identify DTA reviews with a meta-analysis published between September 2011 and January 2012. We extracted all information about publication bias from the reviews and the two-by-two tables. Existing statistical methods for the detection of publication bias were applied on data from the included studies.ResultsOut of 1,335 references, 114 reviews could be included. Publication bias was explicitly mentioned in 75 reviews (65.8%) and 47 of these had performed statistical methods to investigate publication bias in terms of small study-effects: 6 by drawing funnel plots, 16 by statistical testing and 25 by applying both methods. The applied tests were Egger’s test (n = 18), Deeks’ test (n = 12), Begg’s test (n = 5), both the Egger and Begg tests (n = 4), and other tests (n = 2). Our own comparison of the results of Begg’s, Egger’s and Deeks’ test for 92 meta-analyses indicated that up to 34% of the results did not correspond with one another.ConclusionsThe majority of DTA review authors mention or investigate publication bias. They mainly use suboptimal methods like the Begg and Egger tests that are not developed for DTA meta-analyses. Our comparison of the Begg, Egger and Deeks tests indicated that these tests do give different results and thus are not interchangeable. Deeks’ test is recommended for DTA meta-analyses and should be preferred.

Comments on: Queueing models for the analysis of communication systems

In the article, authors restrict their attention to the class of discrete-time single-server queueing models useful for performance analysis of communication systems. This is quite natural because the leader of the author’s group professor Herwig Bruneel has the great experience in analysis of discrete-time queues, see his book Bruneel and Kim (1993) published twenty years ago and an impressive amount of journal and conference papers published by the authors after this book. As the authors mention, queueing models in discrete-time are very appropriate to describe traffic and congestion phenomena in digital communication systems, since these models reflect in a natural way the synchronous nature of modern transmission systems, whereby time is segmented into intervals (“slots”) of fixed length and information packets are transmitted at slot boundaries only, i.e., at a discrete sequence of time points.

Is there a role for vaccine-based therapy in recurrent glioblastoma?

Bloch et al. recently reported on phase II trial results with the heat-shock protein peptide complex-96 (HSPPC-96) vaccine in patients with recurrent glioblastoma (GBM).1 An editorial by Sampson et al., which generally promoted this line of investigation in GBM,2 accompanied the article. Several comments regarding the HSPPC-96 vaccine trial seem warranted. Firstly, the trial required all patients to undergo a complete or near-complete tumor resection confirmed by early postresection MRI. The requirement of minimal residual disease in the current vaccine trial recapitulates a similar paradigm in stem cell transplantation for hematologic malignancies, which is that immunologic-based anticancer therapy requires minimal tumor burden for maximum effectiveness. The eligibility requirement of complete resection necessarily limits the vaccine approach to a small subset of patients with recurrent GBM that is likely to be fewer than 15% of all patients with recurrent disease. Additionally, based on data reported by Bloch, nearly 30% of eligible patients were unable to receive treatment for a variety of reasons, predominantly insufficient tissue being acquired at the time of surgery (wherein vaccine could not be produced) and early disease progression following resective surgery. Consequently, no more than 10% of patients with recurrent GBM may be eligible for HSPPC-96 vaccine-based therapy, a factor that limits the generalizability of HSP-vaccine therapy in this setting. The necessity of a 1-month postresection interval before commencing vaccine therapy presumably reflects the time required to manufacture a tumor-specific vaccine. The difficulties with this lengthy pretreatment window following resective surgery were reflected in the 20% of patients whose disease progressed during the time period when their HSPPC-96 vaccine was being manufactured. Lastly, the survival outcomes in the current study do not appear significantly better than those seen with conventional salvage therapy for recurrent GBM utilizing, for example, lomustine or bevacizumab.3,4 Although a median progression-free survival of 19 weeks was reported, inspection of the Kaplan-Meier survival curve indicates that only 20% of patients were progression free at 6 months (the usual benchmark for determining efficacy in recurrent GBM).5 A 20% 6-month progression-free survival is not significantly different than that reported for other phase II trials in recurrent GBM. Not clear from the current trial is the emphasis on overall survival (median, 42 weeks), which likely reflects postvaccine salvage therapy. Bloch did not enumerate therapy prior to HSP vaccine and, importantly, data were not provided on postvaccine salvage therapy, thereby confounding interpretation of the current study. Furthermore, the 9 patients in whom vaccine was generated, but who progressed before receiving the vaccine, were excluded from the intent-to-treat survival analysis. These comments are not meant to diminish the significant efforts of the HSPPC-96 vaccine trial group but rather to generate discussion regarding the role of vaccine-based immunotherapy in the treatment of recurrent GBM. As the authors mention, this phase II study serves as a platform for the recently opened randomized phase II trial comparing HSPPC-96 vaccine with or without bevacizumab to bevacizumab only. This trial and the Celldex REACT trial (bevacizumab with or without the EGFRviii peptide vaccine) will determine whether vaccine-based therapies are efficacious in recurrent GBM.

The role of low intracranial pressure in the development of glaucoma in patients with Alzheimer's disease

October 22, 2013Dear Editor,We read with great interest the paper by Janssen et al. (2013)entitled ‘The vast complexityof primaryopen angle glaucoma: Dis-ease genes, risks, molecular mechanisms and pathobiology.’ Theauthors deserve appreciation for their very informative reviewarticle.However,wewishtomakeacommentconcerningtheirdis-cussion of the potential role of intracranial pressure (ICP) in Alz-heimer’s disease (AD) and glaucoma.In the last section of their paper, Janssen and colleaguesdiscuss the potential relation between primary open angle glau-coma (POAG) and AD. As the authors mention, several studieshave found an increase in the occurrence of glaucoma in AD pa-tients. The authors state: “In our view, POAG damage could becaused by the net pressure over the optic disk, involving boththe aqueous humor pressure of the eye and cerebrospinal fluid(CSF) pressure of the brain, as described above. Also, CSF pressurechanges have been described in AD (Silverberg et al., 2006).Could these pressure changes underlie a relationship betweenPOAG and AD, and at the same time explain the apparently con-flicting association studies?” Further, the authors state: “We hy-pothesize that there is a strong association between normalpressure glaucoma and late AD, since both disease stages,following the ‘net pressure on the optic disk hypothesis’,arecharacterized by one single disease mechanism: an abnormallylow ICP.”Janssen et al. (2013) thus hypothesize that low ICP may play arole in the association between glaucoma and AD. We fully agreewith the authors since our group has previously presented this hy-pothesisforthefirsttime(Wostynetal.,2008,2009a).Intwoofourearlier manuscripts published in 2008 (Wostyn et al., 2008) and2009 (Wostyn et al., 2009a), we proposed low ICP occurring inAD as a factor leading to increased risk of glaucoma. Evidence forthishypothesiswasgainedfromCSFpressuremeasurementstudiesin AD patients and patients with glaucoma. The finding of a highoccurrence of reduced CSF pressure among patients with AD(Silverberg et al., 2006; Wostyn et al., 2009b) could be linked tothe high rate of reported comorbidity between AD and glaucoma(Bayer et al., 2002; Tamura et al., 2006), since it has been shownthat CSF pressure is lower in patients with glaucoma (Berdahlet al., 2008a, 2008b; Ren et al., 2010). This could result in anabnormally high trans-lamina cribrosa pressure difference andlead to glaucomatous damage. Given this previously advanced hy-pothesis, it was a great surprise when Janssen et al. (2013) recentlyhypothesized about the potential role of low ICP in glaucoma andAD without citing our earlier work (Wostyn et al., 2008, 2009a)or making clear the relevant precedents. The authors did cite oneof our papers, one largely focused on the high occurrence rate ofglaucoma among patients with normal pressure hydrocephalus(Wostyn et al., 2010), but this paper has no direct relevance tothe above hypothesis.Sincerely yours,Peter Wostyn, MDVeva De Groot, MD, PhDDebby Van Dam, PhDKurt Audenaert, MD, PhDPeter Paul De Deyn, MD, PhDReferences

Intracuff pressures in ProSeal and Supreme airways

AnaesthesiaVolume 69, Issue 2 p. 183-183 CorrespondenceFree Access Intracuff pressures in ProSeal and Supreme airways A. Philip, A. Philip [email protected] Leicester Royal Infirmary, Leicester, UKSearch for more papers by this authorV. Kaushik, V. Kaushik Leicester Royal Infirmary, Leicester, UKSearch for more papers by this authorM. Mushambi, M. Mushambi Leicester Royal Infirmary, Leicester, UKSearch for more papers by this author A. Philip, A. Philip [email protected] Leicester Royal Infirmary, Leicester, UKSearch for more papers by this authorV. Kaushik, V. Kaushik Leicester Royal Infirmary, Leicester, UKSearch for more papers by this authorM. Mushambi, M. Mushambi Leicester Royal Infirmary, Leicester, UKSearch for more papers by this author First published: 20 January 2014 https://doi.org/10.1111/anae.12569Citations: 1 No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesiacorrespondence.com. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat We read with interest the article by Anand et al. 1 comparing intracuff pressures between the ProSeal® and Supreme® laryngeal mask airways (LMAs) and should like the authors to clarify some issues that are not clear in their article: Did the authors standardise tidal volumes and peak airway pressures for all their patients? The authors mention that the initial intracuff readings were 60 cmH20 in both groups. Were the cuffs intentionally inflated to that value? If so, the authors chose to inflate the cuffs to the upper limit of the manufacturers' recommendations, which is usually unnecessary since an adequate seal can be achieved at lower cuff pressures. Silicone cuff-based ProSeal LMAs are re-used after sterilisation. Did the authors factor this into their standardisation, i.e. a ProSeal LMA that has been sterilised 30 times will presumably allow more diffusion of nitrous oxide than one that has been sterilised, say, 10 times or less? In Zhang et al.'s study 2, referred to by Anand and colleagues in their study, oropharyngeal leak pressure was determined by closing the expiratory valve at a fixed gas flow of 3 l.min−1 and noting the pressure in the circuit at which an audible leak is heard over the mouth. It is not clear how Anand et al. checked the oropharyngeal leak pressure; was it using a similar method? Anand et al. recommend that cuff pressure should be monitored when ProSeal LMAs are used during general anaesthesia involving nitrous oxide. Recommendations to monitor cuff pressures in LMAs should apply to all LMAs, and not just to ProSeal LMAs. References 1Anand LK, Singh M, Kapoor D, Goel N. Intracuff pressure comparison between ProSeal® and Supreme® laryngeal mask airways. Anaesthesia 2013; 68: 1202– 3. 2Zhang L, Seet E, Mehta V, et al. Oropharyngeal leak pressure with the laryngeal mask airway supreme™ at different intracuff pressures: a randomized controlled trial. Canadian Journal of Anesthesia 2011; 58: 624– 9. Citing Literature Volume69, Issue2February 2014Pages 183-183 ReferencesRelatedInformation