Discernible Reason Research Articles

Development of a new approach using an artificial neural network for estimating oil formation volume factor at bubble point pressure of Egyptian crude oil

Understanding the phase behavior and volumetric changes of reservoir fluids throughout the extent of reservoir lifetime are crucially required for effective-commercial oil recoveries. Ideally, reservoir fluid properties are experimentally measured by laboratory experiments known as PVT tests nonetheless, these tests are prohibitive, time-consuming, and required to restrict sampling and transporting procedures. For these discernible reasons, several modeling approaches have been developed. By reviewing the literature, one crucial obstacle that encounters field applicability of most extant models is the selection of input variables. Moreover, a great percentage of extant models employ the results of lengthy experimental tests such as differential gas solubility or even the sample’s chemical composition. Replicability of models’ results using different datasets is also one of the main challenges when employing AI models. Frequently, inadequate descriptions for AI models have been provided in many studies which limits their utility. The inadequate description includes the analysis of ANN model weights and biases besides, the final mathematical model. In this study, a rigorous ANN model with its mathematical model has been implemented to predict oil formation volume factors based on 600 compiled datasets from Egyptian oilfields.A detailed comparison between widely used empirical correlations and the proposed new ANN model is provided in this study. Statistical and graphical analysis depicted the outstanding performance of the new model with R2 = 0.974, ARE = −0.0017%, and AARE = 2.13%. The ANN model provides remarkable sustainable performance compared to local Egyptian empirical correlations and all the other global models.

Investigation of photo-electrochemical response of iron oxide/mixed-phase titanium oxide heterojunction toward possible solar energy conversion

Photocatalysts are part of key strategies to enable green fuel. Photocatalysis and water splitting could be a promising solution to challenges associated with the intermittent nature of sunlight as a huge energy source on Earth. In this study, photo-electrochemical performance and behavior of mixed-phase titanium oxide and iron oxide heterojunction (Ti-TiOx (High-voltage)-FeOx electrode) are compared to the photo-electrochemical performance and behavior of titanium oxide nanotubes with the rutile phase and iron oxide heterojunction (TiOx-nanotubes (H2SO4/KF)-FeOx electrode). The results of photo-electrochemical experiments show that the application of stabilization potential and the presence/absence of dissolved oxygen could not be considered as significant factors affecting the photo-electrochemical properties of the Ti-TiOx (High-voltage)-FeOx and TiOx-nanotubes (H2SO4/KF)-FeOx electrodes. The Ti-TiOx (High-voltage)-FeOx electrode shows an anodic photo-electrochemical response in wavelengths shorter than 530 nm and cathodic photo-electrochemical response in wavelengths longer than 530 nm. However, the Ti-nanotubes (H2SO4/KF)-FeOx electrode consistently exhibits the anodic photo-electrochemical response. Both of the prepared heterojunctions are further characterized through Scanning Electron Microscopy, Energy-dispersive X-ray Spectroscopy, Diffuse Reflectance UV–Vis Spectroscopy, X-ray Diffraction, and Attenuated Total Reflectance Spectroscopy methods. These experiments show that despite different morphologies observed in SEM imaging data, the deposited iron oxide layers on both mixed-phase titanium oxide and titanium oxide nanotubes share the same hematite phase structure. However, only iron oxide electro-deposited on the surface of the mixed-phase titanium oxide, which contains both anatase and rutile phases, with vacant sites of oxygen, exhibits un-expected anodic and cathodic photo-electrochemical responses. Furthermore, according to the results of the characterization and photo-electrochemical investigations, the different chemical environment of mixed-phase titanium oxide, and the possible formation of different types of heterojunction structures in mixed-phase titanium oxide and iron oxide, in contrast to the titanium oxide nanotubes and iron oxide, might be considered the possible discernible reasons for the observed different photo-electrochemical responses. This paper sheds new light on photo-electrochemistry of iron oxide/mixed-phase titanium oxide heterojunction for possible solar energy conversion.

Redundancy, Noisy Signaling, and Semantic inflation: Studying the Patterns of Self‐Destruction in Complex Systems

AbstractAcross the natural and social world, some fairly advanced and apparently robust systems destroy themselves without discernible reason, function, or purpose. Whereas such and similar cases have been discussed within specific branches of scholarships, the attempts to propose and test a general theory of self‐destruction in complex systems remain, to our knowledge, a thing of the future. To move in this direction, we suggest that the conflicts between explicit stratification, thorough functional differentiation and tacit segmentation within complex systems, are likely to provoke their unintended self‐annihilation. Furthermore, we hypothesize that whenever such systems collapse, it is the circular co‐dependency of noisy signaling, redundancy, and semantic inflation that sets self‐destructive mechanisms in motion. We illustrate our preliminary findings with examples from social, natural, and artificial life; reexamine autoimmunity as a popular model of systemic self‐destruction; and indicate potential avenues of empirical research aimed at supporting, qualifying or disproving the underlying hypothesis.

Binocular vision and image location before Kepler

Kepler’s 1604 Optics (Ad Vitellionem Paralipomena) proposed among many other things a new way of locating the place of the image under reflection or refraction. He rejected the “perspectivist” method that had been used through antiquity and the Middle Ages, whereby the image was located on the perpendicular between the object and the mirror (the “cathetus”). Kepler faulted the method for requiring a metaphysical commitment to the action of final causes in optics: the notion that the image was at that place because it was best or appropriate for it to be there, and for no other discernible reason. Kepler’s new theory relied on binocular vision and depth perception to determine the location of the image. No final causes were required, and he showed that the image would in general not be found on the cathetus. According to modern scholarship, Kepler’s theory was part of his revolutionary transformation of the science of optics, and his abandonment of perspectivist optics; as a consequence, the theory of binocular vision is also thought to be original with him. This article demonstrates that the very same theory of binocular image location was set out by Giovanni Battista Benedetti some twenty years earlier, and his writings on this subject may have been Kepler’s unacknowledged source for his own theory. Furthermore, another mathematician, Simon Stevin, developed much the same theory at the same time as Kepler and, it seems, independently of either Benedetti or Kepler. The discovery of these other binocular theories, especially Benedetti’s, requires us to recognize that Kepler’s revolution (if it can be called that) emerged out of a wider dissatisfaction with the foundations of perspectivist optics, which other lesser-known opticians resolved in much the same way that Kepler did.

'Forever Young'-Testosterone replacement therapy: a blockbuster drug despite flabby evidence and broken promises.

In the last decade, testosterone replacement therapy (TRT) has been increasingly prescribed to treat a controversial condition known as 'late-onset hypogonadism (LOH)'. This syndrome is diagnosed in men who, for no discernible reason other than older age, obesity or ill health have serum testosterone concentrations below the normal range for healthy young men and report one or more of the following symptoms: muscle weakness or wasting, mood, behaviour and cognition-related symptoms and sexual function or libido impairment. However, recent evidence has demonstrated that testosterone drugs do not substantially ameliorate these symptoms and, more worryingly, that their long-term use may be associated with severe adverse effects (i.e. increased risk of prostate cancer, stroke and myocardial infarction, worsening of benign prostatic hyperplasia symptoms and testicular atrophy). Nonetheless, testosterone drugs have exhibited extraordinary commercial success and their pharmaceutical sales are steadily rising. Behind this apparently unjustifiable trend there are deliberate, well designed direct and indirect pharmaceutical marketing initiatives that exploit the conviction rooted in contemporary society that testosterone can reverse the effects of ageing and ensure social accomplishment. Commercial mechanisms have laid the foundation for disease mongering of LOH and also have resulted a considerable expansion of the indications for treatment. This promotion model deserves particular attention since it is applicable to any drug with a purportedly favourable risk-benefit ratio not supported by evidence.

Virginia Woolf: A Portrait by Viviane Forrester

Reviewed by: Virginia Woolf: A Portrait by Viviane Forrester Drew Patrick Shannon Viviane Forrester. Virginia Woolf: A Portrait. Trans. Jody Gladding. New York: Columbia UP, 2015. 247 pp. While a biography may be free in some ways to break certain narrative rules—one can always begin with the subject's death, for instance—in general it must follow a chronology, introduce its subject to readers unfamiliar with the material, and situate its subject in a historical context. Such rules may not apply to literary portraiture, a form that can show its subject at skewed angles, in odd colors, and with clearly visible brushstrokes. The late Viviane Forrester has produced something much in the latter vein in Virginia Woolf: A Portrait. First published in France, it won the 2009 Goncourt Prize for biography and appears now in an English translation by Jody Gladding. Based almost entirely on primary sources, the book assumes a certain degree of knowledge of Virginia Woolf on the reader's part and proposes to delve deeply into Woolf's psyche to rescue her from what Forrester sees as the unsavory influences of the people who surrounded her. But, as with any portrait, the book reveals perhaps more about its author than its subject. Arranged in five parts, Forrester's book argues for the concept of Virginia "alone" and aims to present her as a gallant, misunderstood figure in need of a much more focused depiction (3). But then Forrester somewhat oddly examines Woolf in light of the major figures and events in her life: her husband Leonard; her family and her childhood in Hyde Park Gate, Kensington; her sister Vanessa Bell; the other members of the Bloomsbury Group and the writers Katherine Mansfield and Vita Sackville-West; and, finally, death itself. Forrester's writing attempts to follow the model set by Woolf in some of the autobiographical writings that appear in Moments of Being as well as the witty, urbane, conversational tone set by Woolf in her best essays and in A Room of One's Own. There are many rhetorical questions scattered throughout the text, most of which ask the reader to ponder how Woolf herself fits into the swirling mix of personalities and often unpleasant events. "What is the weight of a life?" and "What entangled Virginia?" (3), Forrester asks; she provides a running commentary on the length of time it will take before Woolf drowns herself in the River Ouse. While there are moments of elegance—indeed, of poetry—in Forrester's prose, at times the sentences appear clotted and dense and verb tenses often shift from past to present for no discernible reason; sentence fragments and single words stand alone, as if to shock the reader into stillness. One assumes that Gladding reproduced this as accurately as possible from Forrester's original French. The effect, while sometimes beautiful, quickly becomes tiring and cloying. [End Page 597] More problematic than style is Forrester's stance on the other figures in Woolf's life and, ultimately, on Woolf herself. By the fourth page of the book, Forrester launches into an attack on both Leonard Woolf and Quentin Bell; the former is accused of marrying Virginia solely for personal gain (he hated life in colonial Ceylon, and Virginia, requiring much care, could serve as a reason to return to Britain) and the latter is attacked for having produced a two-volume biography of his aunt that simply perpetuated the myths of sexual coldness put forth by Leonard. Bell in particular is attacked relentlessly; he is mentioned over twenty times in the text, typically with condescension if not outright contempt. (Forrester appears to have had issues with Bell since their joint 1973 appearance on a radio program she was producing on—as she puts it—"guess who?" [19].) Troublingly, many of Forrester's arguments about Bell were current in the mid-to late 1970s, and many of the same points were made much more clearly and effectively by Ellen Hawkes Rogat in her 1974 essay "The Virgin in the Bell Biography." Many of Forrester's contentions about Leonard Woolf, Vanessa Bell, Quentin Bell, Leslie and Julia Stephen, the Duckworth brothers and their sexual misconduct, and the other...

The Art and Science of Happiness

The Art and Science of Happiness Saara Myrene Raappana (bio) Make Yourself Happy Eleni Sikelianos Coffee House Press www.coffeehousepress.org/shop/make-yourself-happy/ 168Pages; Print, $18.00 Often called an experimental poet, Eleni Sikelianos recently said in an interview with Numero Cinq that “‘Experimental’ is kind of a stand-in word for a number of things, one of which might be writing that creates meanings as it makes itself.” Sikelianos’s twelfth book, Make Yourself Happy, dwells in meanings and their making: the meanings of happiness and extinction, how to live and how to read, the world and extinction. Allusive and whimsical, meandering and laser-focused, apocalyptic and optimistic, Make Yourself Happy takes the imperative “you” of its title seriously, relying upon the reader to complete the text by getting lost in and puzzling through it. The first section is a series of poems called “Make Yourself Happy”: “This is the poem that will tell you / how to live.” Then it wanders through the sprawling and minute details of daily attempts to “make yourself happy”: “you’ll eat a croissant / to make yourself happy”; “an animal sound will / make yourself happy;” “See leaves in the gutters and salted butter that stands in a bright / circle of light like a small giraffe…to make yourself happy;” “I’m giving away my belongings / in language to make myself happy.” Happiness comes from sunlight and bread and meat, from language and buying small “fancy” things. But elsewhere, the poems contradict themselves: I shall do nothing fancy to make myself happy. Help! I dwell here because I do not dwell among the dead. But sunlight is lethal to some, so shall I make a golden ring that replicates itself or build a golden hour from which is banished grief to make the hour so roundly happy? What makes one person happy “is lethal to some,” and a speaker buys something fancy to make herself happy later eschews fanciness. Here, happiness is defined by, or in opposition to, hand surgeries and childhood memories, family members swimming in sparkling pools or floundering in heroin addiction. Make Yourself Happy’s happiness [End Page 26] is complicated, mercurial, and personal. It’s also political: In “Juan, Juan,” the speaker says, “I was gone and when I came back / you’d voted for all the wrong politicians!” Now happiness seems synonymous with good planning: These people, for example, forgetting to make themselves happy built the entryway but forgot to build the building used up all the wood & coal & sky & ice & light Now ¿Dónde viviremos? The answer to “Where will we live?” is, at turns, optimistic (“Every beautiful bird is in Texas”), nostalgic (“We…panhandled enough money to buy some Hostess Pies, a Heath Bar and a Coke, 1976 or 5”), and foreboding (“I take / a twisted bone for home.”). That “twisted bone” might have been pulled from any of the extinct species that are the subjects the second section, “How to Assemble the Animal Globe.” This section traverses each continent by describing animals that disappeared at the hands of hunters or industrialization—or for no discernible reason. Part ode, part elegy, and part resurrection spell, this heavily annotated section seems to comment, in part, on the unintended consequences of the pursuit of certain kinds of (un)happiness—whether the “Atlas Bear (used for sport in Roman Empire, the last one shot c. 1879)” or the last Steller’s Sea Cow, “killed for its excellent meat.” But despite its subject matter, “How to Assemble the Animal Globe” isn’t just about doom. This section’s antepenultimate poem is a list of Lazarus species—taxa that reappeared after a period of disappearance from the fossil record. This poem’s facing page is the first of four interspersed pages printed with segments of a paper globe—each segment covered in names of extinct animals—to be cut out, folded, and assembled. The book is, again, directing the reader to action. Imperatives abound throughout the book, actually, whether they’re as overt as the book’s title or gentle as the texts many allusions—Shakespeare to Black Elk to Homer to C. D. Wright, as well as...

Philosophy and Shi͑ism: Two Sides of the Same Coin?

It is often argued that there is an intimate connection between Islamic philosophy and Shii culture. It is certainly true that most Islamic philosophers were Shii, and parts of the Shii world appear to be far more sympathetic to philosophical enquiry than is the case in a Sunni environment. An explanation of this could be that most Islamic philosophers are from the Persian cultural sphere, which became Shii, and those national origins and not the doctrinal divide could be the relevant factor. It could also be that since some of the Sunni world became antagonistic to philosophy, enthusiasm for it was a potent way to oppose that world. Finally, it is sometimes argued that Shiism is particularly close to mysticism and so to philosophy, but this is difficult to accept since all kinds of Muslims have been attracted to taṣawwuf and the latter does not seem to be linked with any particular doctrinal division in Islam. The conclusion is that there is no discernible reason for the apparent fact that philosophy is more integrated in the Shia as compared with the Sunni world.

Dissatisfied patients after total knee arthroplasty

Background and purpose — In 2003, an enquiry by the Swedish Knee Arthroplasty Register (SKAR) 2–7 years after total knee arthroplasty (TKA) revealed patients who were dissatisfied with the outcome of their surgery but who had not been revised. 6 years later, we examined the dissatisfied patients in one Swedish county and a matched group of very satisfied patients.Patients and methods — 118 TKAs in 114 patients, all of whom had had their surgery between 1996 and 2001, were examined in 2009–2010. 55 patients (with 58 TKAs) had stated in 2003 that they were dissatisfied with their knees and 59 (with 60 TKAs) had stated that they were very satisfied with their knees. The patients were examined clinically and radiographically, and performed functional tests consisting of the 6-minute walk and chair-stand test. All the patients filled out a visual analog scale (VAS, 0–100 mm) regarding knee pain and also the Hospital and Anxiety and Depression scale (HAD).Results — Mean VAS score for knee pain differed by 30 mm in favor of the very satisfied group (p < 0.001). 23 of the 55 patients in the dissatisfied group and 6 of 59 patients in the very satisfied group suffered from anxiety and/or depression (p = 0.001). Mean range of motion was 11 degrees better in the very satisfied group (p < 0.001). The groups were similar with regard to clinical examination, physical performance testing, and radiography.Interpretation — The patients who reported poor response after TKA continued to be unhappy after 8–13 years, as demonstrated by VAS pain and HAD, despite the absence of a discernible objective reason for revision.

Hideous Love: The Story of the Girl Who Wrote by Stephanie Hemphill (review)

Reviewed by: Hideous Love: The Story of the Girl Who Wrote by Stephanie Hemphill Karen Coats Hemphill, Stephanie Hideous Love: The Story of the Girl Who Wrote Frankenstein. Balzer + Bray, 2013 [320p] Trade ed. ISBN 978-0-06-185331-9 $17.99 E-book ed. ISBN 978-0-06-220923-8 $9.99 Reviewed from galleys M Gr. 7-10 Mary Shelley’s well-documented life was marked by passion, scandal, travel, and loss. Her devotion to the married Percy Bysshe Shelley is legendary; when she ran away with him, she endured estrangement from her beloved father as well as repeated dalliances on her lover’s part while her own heart remained faithful. In this poetic biography, Hemphill adheres faithfully to the events of the lives of the famous pair, relating their travels, Mary’s suspicions of Percy’s unfaithfulness and her jealousy toward her half-sister, who traveled with them, the births of their four children and deaths of three, the writing and revisions of Frankenstein and Mary’s other novels, the couple’s attempts to forge intellectual community and outrun scandal, the exploits of Byron, and finally, the death and funeral of Mary’s beloved Shelley—all in under a decade. Unfortunately, only a few of the individual poems in this verse novel, written in a first-person impression of Mary’s voice, come close to conveying any sort of emotion; instead, Mary relates her feelings in affectless, workmanlike sentences with no discernible reason for the line breaks. For the most part, the language is stiff and halting, with intrusive and ill-fitting similes and diction [End Page 156] that is difficult to resolve even into readable prose, let alone evocative strains of poetry. The wooden, prosaic tone of the poetry is particularly disappointing in contrast with Mary Shelley’s vivid and emotional writing. Hemphill’s faithfulness to Shelley’s life is the work’s saving grace, as it provides readers a focused way to imagine how difficult living under the principles of free love was for Mary, as well as the compromises culture required of a woman of genius during the time period. End matter includes an author’s note, a character list, a bibliography of Mary Shelley’s writing, and suggestions for further reading. Copyright © 2013 The Board of Trustees of the University of Illinois

How health visitors can offer advice on calming a crying baby

It is common for babies to cry, to varying degrees. Some parents will be better able to cope with infant crying than others. A ‘normal crying curve’ has been observed, in which infant crying increases after birth until around week eight, when it stabilizes and then decreases over the following weeks ( Barr, 1990 ). There may be no discernible reason for this type of crying, and health visitors should reassure parents that it is normal and support them to cope with it. However, there are potential causes of crying to consider, such as gastrointestinal problems, allergy or other illness. There is a link between excessive crying and postnatal depression; although it is unclear which is the cause and which the effect, it is worth noting that health visitors may wish to screen for postnatal depression in cases of extreme crying. It is also important that health visitors remember that crying can be a risk factor, as the safety of the baby must always be paramount.

Some mothers do ‘ave’ em

Many newborn babies suffer from colic; others have reflux which causes them distress. And some just scream for no discernible reason. This month, Ruth Donnelly tells her own story of struggling to cope with her newborn baby's screaming and explains how her local health visiting team helped her to keep her cool in a very trying situation.

A modified three-dose protocol for colonization of the canine urinary tract with the asymptomatic bacteriuria Escherichia coli strain 83972

Establishment of asymptomatic bacteriuria is a novel alternative to antimicrobial therapy for management of recurrent bacterial urinary tract infection in humans and may also be useful for dogs if it can be shown that colonization of the canine bladder can be achieved. A three-dose protocol for Escherichia coli strain 83972 inoculation was developed to attempt induction of persistent bacteriuria in healthy dogs. A previous study using a single inoculation colonized dogs for no longer than 10 days and multi-dose protocols have been used to establish persistent bacteriuria in human patients. Three doses of approximately 109E. coli 83972 bacteria were introduced into the bladder of eight healthy female dogs over 24h via an indwelling sterile urinary catheter. Three additional dogs were sham-inoculated.Duration of colonization ranged from 1 to 28 days (median 2 days) with no discernible reason for the prolonged colonization in one dog. Multi-dose inoculation of healthy dogs was not obviously superior to our previous use of single-dose inoculation apart from one dog remaining colonized for 28 days following the three-dose inoculation protocol.

Using Patients to Promote Evidence-Based Prescribing

Billions of dollars are spent each year on drugs with unproven clinical effectiveness and limited safety records. Sales of ezetimibe totaled over $4 billion per year in 2010 despite little evidence of benefit on meaningful clinical outcomes as a substitute or adjunct to statin therapy.1 Millions of people were early adopters of rofecoxib (Vioxx) and rosiglitazone (Avandia), only to see these drugs withdrawn or restricted due to safety concerns. What can be done to increase rational prescribing? In this issue of the Archives, Schwartz and Woloshin report on a patient-oriented approach to promote use of drugs with proven clinical benefit and a well-established track record of safety.2 In a survey of 2,944 adults, they presented 2 highly-simplified case scenarios. The first case involved the choice between 2 hypothetical lipid-lowering drugs. Both drugs have identical safety profiles, but drug A has a proven clinical benefit – reducing heart attacks – while drug B has only been shown to lower cholesterol. Participants were randomized into three groups: (1) receiving only the above information, (2) receiving the information plus a brief warning highlighting that it is not known whether drug B improves clinical outcomes, or (3) the information, warning, and a directive statement to “ask for a drug shown to reduce heart attacks.” When asked which drug they would prefer, 59% of participants in the information-only group chose the drug with evidence of clinical benefit. In contrast, 71% of participants in each of the 2 warning groups chose this drug. The authors obtained similar results from a second scenario that focused on favoring drugs with a long established track record of safety. As with the first scenario, the 2 warning groups were more likely to choose the better (in this case, older) drug, with 34% of participants in the information-only group selecting the older drug vs. 53% in each of the warning groups. What can this warning-based approach teach us about improving prescribing? It depends on whether one sees the study results as a glass half-empty or half-full. On the positive side, a simple warning improved patient decision-making. On the other hand, seemingly irrational decisions persisted to a striking degree. One in three participants preferred a drug with no evidence of clinical benefit despite explicit instructions to ask for a drug known to confer benefit (and no discernible reason to favor the inferior drug). In the second scenario, half of participants chose a newer heartburn drug despite explicit directions to ask for a drug for a longer track record of safety. It’s not only patients who make such illogical decisions. Physicians are equally well-established in our proclivity to favor new, relatively untested medications and to prescribe contrary to guidelines.3 These contrasting perspectives highlight the challenges and opportunities to use Schwartz and Woloshin’s findings to improve care. Simply adding warnings to patient educational materials is unlikely to meaningfully increase rational prescribing. Other influences on prescribing are strong, physicians are often unaware of the evidence basis for drugs they prescribe, and educational interventions alone typically have minimal impact on behaviors.4-6 Nonetheless, giving patients warnings and instructions may be of substantial value if we also provide them the tools to help them successfully advocate for their own care. Such patient activation programs can dovetail with other system-based approaches that align the incentives of patients and physicians toward evidence-based care. For example, a recent study used letters, financial incentives, and phone calls to encourage patients with hypertension to discuss thiazide diuretics with their physician.7 The approach was highly successful in increasing the number of patients taking thiazides, and was welcomed by patients and physicians alike because both felt that it served their interests. Similarly, other work has shown that outcomes in older adults transitioning from hospital to home can be substantially improved by coaching patients about how to talk with their doctors and advocate for themselves.8 Many physicians have first-hand experience with situations where highly engaged patients (or their caregivers) identified an error, potential treatment, or other opportunity to improve care that would otherwise have been missed. We work within a health care environment whose complexity and incentives makes it difficult to consistently provide the care to which we aspire. We are thus well-served by being open to approaches that build the patient-physician partnership to improve quality of care. These efforts need to be paired with systems improvements that promote high-quality prescribing, help physicians respond to patient questions, and align the incentives of patients, physicians, and health care systems. Patient activation programs are a valuable tool to provide better care. We should take full advantage.

Colorectal Cancer Screening in Patients with a Positive Family History: An Analysis of Screening Referral Patterns and Reasons for Non-Adherence to National Guidelines

Background: ASGE guidelines recommend the use of colonoscopic screening and initiation of colorectal cancer (CRC) screening at an earlier age for patients at elevated risk for CRC because of a positive family history. Currently, there are no data on referral patterns for screening in such high-risk patients. From anecdotal experience, we believe that many such patients are being referred by their primary care providers at an inappropriately late age. Our study had two objectives: (1) To assess if patients with a family history are being appropriately referred for screening; (2) To uncover possible reasons for non-adherence in those patients not in compliance with guidelines. Methods: We retrospectively reviewed the most recent 161 screening colonoscopies performed at Virginia Mason Clinic involving patients with a family history of CRC in a first-degree relative. For each patient, two independent reviewers abstracted detailed family and CRC screening history data from our comprehensive electronic medical records system. Based on the abstracted information, we determined whether each patient had been referred for screening in accordance with ASGE guidelines. For non-adherent patients, we then tried to find possible reasons that could explain non-adherence. Results: Out of 161 patients referred for screening, 103 (64%) had not been compliant with guidelines. Specifically, 92 (57%) had delayed initiation of screening (i.e. screening was started at an age much later than that recommended by the guidelines), 5 (3%) had premature initiation of screening, and 6 (4%) had screening with the wrong modality. Of cases involving delayed screening initiation, in 15 (16%) the patient was not under primary care at the time screening was supposed to have started, in 3 (3%) the patient refused screening despite recommendations by primary care, and in 26 (28%) the patient was older than the recommended age by the time CRC was discovered in their relatives (usually siblings). The remaining patients exhibited no discernible reason for delayed initiation of screening. Conclusions: Because our study included only patients with a family history of CRC referred for screening colonoscopy instead of all patients with a family history in the Virginia Mason system, the strikingly high proportion of patients with delayed initiation of screening implies inappropriate referral patterns from primary care, as opposed to unwillingness to undergo screening on the part of the patients. Although some cases demonstrate mitigating reasons for non-adherence to guidelines, our results strongly suggest inadequate knowledge of CRC screening guidelines in primary care providers.

Analysis of long-term dependence phenomenon in Benue River flow process and its hypothesis testing

In this paper, the long-term dependence phenomenon (the Hurst Effect) which characterizes hydrological and other geophysical times series is studied. The long-term memory is analysed for both daily and monthly streamflow series of the Benue River at Makurdi, Nigeria by using heuristic methods and testing specifically the null hypothesis of short-term memory in the monthly flow series. Results obtained by applying heuristic procedures indicated that there may be the presence of long-term memory component in mean daily flow series but there is no discernible reason to suspect the presence in both average monthly and maximum monthly flow series (extreme event). Hypothesis testing was conducted by using original and modified versions of rescaled range statistic. When the modified rescaled range, which accounts for short-term memory in the series, is used, the null hypothesis is accepted for both the average monthly and maximum monthly flow series, indicating little or no probable presence of long-term memory in the series. An identical conclusion is also arrived at when second null hypothesis for independence of the monthly flow series is tested. Therefore, apart from the mean daily flow series, there is little evidence of long-term dependence in the Benue River streamflow series at Makurdi. However, considering the limited length of data used, the results are inconclusive.

Household, Women and Christianities in Late Antiquity and the Middle Ages (review)

Reviewed by: Household, Women and Christianities in Late Antiquity and the Middle Ages Pamela O’Neill Mulder-Bakker, Anneke B. and Jocelyn Wogan-Browne, eds. Household, Women and Christianities in Late Antiquity and the Middle Ages (Medieval Women: Texts & Contexts, 14), Turnhout, Brepols, 2005; hardback; pp. 260; R.R.P. €60.00; ISBN 2503517781. This book claims, on its cover, to consider 'the impact of women's householding on the history of the church'. Most of the nine papers struggle to live up to this claim, which should probably be taken as a criticism of the claim, rather than of the papers. They range broadly in time and space, from late antique to late medieval, from Byzantium to Scandinavia, and while most are based in the study of literature, there is some interesting discussion of material culture. The editors provide an introduction in two parts, dividing the collection into two sections. There is no discernible reason for this, since the sections are not separated by period, geography, theme or approach. The introductions raise some interesting threads which can be pursued through the papers. Seven propositions are advanced concerning women, household and Christianity in the late antique and medieval periods, including that the medieval family was more egalitarian and the antique household more patriarchal, that household structures contributed to the shape of church activities, and that the difference between canon and civil law had a significant impact on women's roles and freedoms. Much is made of the 'conclusion' that European Christianity cannot be seen as a 'single monolithic entity or process', a concept which is hardly new to anyone familiar with the early medieval period. This idea gives rise to the unnecessary pluralising of 'Christianity' in the book's title, leaving one to ponder the use of 'household' in the singular. Kate Cooper contributes two papers. The first is an interesting analysis of the contrast between biological and monastic families in the Lives of Melania the Younger, discussing the legalities and practicalities of family duties in the aristocratic Roman milieu alongside the political concerns of the young monastic foundation. Her second paper compares the Handbook for Gregoria, a sixth-century Latin conduct manual, to its contemporary, Ferrandus's Letter to Reginus, with a focus on the image of the miles Christi and its application in household and province as spheres of authority. The conclusion that 'the lay household should hold a central place ... as the elusive but indispensable institution within which the fate of province and empire took shape' (p. 105) is important, but seems to be insufficiently argued in the paper, where household and province are compared, but not considered as in active relationship. [End Page 216] Eva M. Synek's paper on ''Oikos-Ecclesiology' and 'Church Order' in Eastern Christianity' discusses the nature of the early church as household with God as pater familias, and the gradual erosion of this structure as earthly father-figures, specifically bishops, were established. Else Marie Wiberg Pedersen's paper gives an interesting analysis of two monastic texts from Helfta, showing that the monastic community and indeed the wider church were conceived in terms of the household, with Christ as the kitchen and the focus on spiritual nourishment for household members and visitors. In 'The Icon Corner in Medieval Byzantium', Judith Herrin makes a case for women's control of domestic devotion through their roles as first maintainers of the space dedicated to household gods and then commissioners and maintainers of Christian icons and the space they occupied in the household. Her admirable analysis of the literary and sparse archaeological evidence for the use of icons is perhaps not quite sufficient to uphold her suggestion that women were virtually forced to turn to devotion to icons because they were excluded from any other role in the Byzantine church than that of nun. Birgit Sawyer's discussion of women and conversion in Scandinavia draws on the evidence of rune-stones and literature to suggest that Christianity encouraged women to espouse chastity in the face of existing reverence for procreation, and to depart from traditional kin-based arrangements for land-ownership and donate property to the church. This, she suggests, gave rise to misogynistic tendencies...

After the Ball

Academics have argued for decades about whether markets are efficient. This has been a great waste of intellectual resources with no discernible reason other than to funnel research efforts toward ends that lead nowhere. The simple facts discussed in this article make it clear why markets can9t ever be efficient, absent radical changes not only to finance but also to government and politics. Given post-Enron incidents of corporate larceny, it should also be clear that the system cannot and will not be repaired beyond tokenism, unless and until we sever or at least mitigate the connection between politics and economics. While there are scandals in other capitalist countries as well, and some of them with political undertones, no strain of capitalism is as much influenced by the unhealthy symbiosis of money and politics as the American kind. No real reform seems likely in the near future because the three requisites for making the system less dependent on politics—stiff campaign finance laws, efficient enforcement of these laws, and abolition of the lobbying system—seem quite remote. Yet there remain new avenues for academics, the financial industry, and government, avenues that are this side of utopia.

Dissolving the Synoptic Problem Through Film?

Film makers have taken liberties with the Gospels, for discernible narrative reasons. May not Luke have so treated Matthew, freeing us from Q? A comparison with Luke’s (near-) contemporaries such as Josephus, and their improvements on others’ narratives, suggests more apposite questions and a different answer.

Voices in History

Experiences of “hearing voices” nowadays usually count as verbal hallucinations and they indicate serious mental illness. Some are first rank symptoms of schizophrenia, and the mass media, at least in Britain, tend to present them as antecedents of impulsive violence. They are, however, also found in other psychiatric conditions and epidemiological surveys reveal that even individuals with no need of psychiatric help can hear voices, sometimes following bereavement or abuse, but sometimes for no discernible reason. So do these experiences necessarily mean insanity and violence, and must they be thought of as pathogenic hallucinations; or are there other ways to understand them and live with them, and with what consequences?One way to make our thinking more flexible is to turn to history. We find that hearing voices was always an enigmatic experience, and the people who had it were rare. The gallery of voice hearers is, though, distinguished and it includes Galilei, Bunyan and St Teresa. Socrates heard a daemon who guided his actions, but in his time this did not signify madness, nor was it described as a hallucination. Yet in 19th century French psychological medicine the daemon became a hallucination and Socrates was retrospectively diagnosed as mentally ill. This paper examines the controversies which surrounded the experience at different points in history as well as the practice of retrospective psychiatry. The conclusion reached on the basis of the historical materials is that the experience and the ontological status it is ascribed are not trans-cultural or trans-historic but situated both in history and in the contemporary conflicts.