Mid Thirties Research Articles

The enduring effect of scientific interest on trust in climate scientists in the United States

People who distrust scientists are more likely to reject scientific consensus, and are more likely to support politicians who are sceptical of scientific research1. Consequently, boosting Americans’ trust in scientists is a central goal of science communication2. However, while previous research has identified several correlates of distrust in climate scientists3 and scientists more broadly4, far less is known about potential long-term influences taking root in young adulthood. This omission is notable, as previous research suggests that attitudes towards science formulated in pre-teenage years play a key role in shaping attitudes in adulthood5. Using data from the Longitudinal Study of American Youth, I find that interest in science at age 12–14 years is associated with increased trust in climate scientists in adulthood (mid thirties), irrespective of Americans’ political ideology. The enduring and bipartisan effects of scientific interest at young ages suggest a potential direction for future efforts to boost mass trust in climate scientists. Analysis of longitudinal survey data shows that interest in science at age 12–14 years is associated with increased trust in climate scientists in adulthood (mid thirties) in the United States, irrespective of political ideology.

Trajectories of Cigarette Smoking Beginning in Adolescence Predict Insomnia in the Mid Thirties

ABSTRACTBackground: Insomnia is increasingly recognized as a public health concern in modern society. Insomnia diagnoses appear to be increasing and are associated with poor health outcomes. They may cost $100 billion annually in health services. Objective: Given the adverse consequences of insomnia such as cardiovascular disease, diabetes, and depression, the present study was designed to examine the relationship of the trajectories of earlier cigarette smoking and later insomnia. The ultimate goal is to reduce the prevalence of insomnia. Methods: 674 participants (53% African Americans, 47% Puerto Ricans, 60% females) were surveyed at 6 points in time. We employed the growth mixture model to obtain the trajectories of cigarette smoking from age 14 to 32. We used logistic regression analyses to examine the associations between the trajectories of smoking and insomnia. Results: Males were less likely to have insomnia than females (Adjusted odds ratio: AOR = 0.34, p < .05). A higher Bayesian posterior probability (BPP) for the chronic smoking trajectory group (AOR = 2.69, p < .05) and for the moderate smoking trajectory group (AOR = 5.33, p < .01) was associated with an increased likelihood of having insomnia at age 36 compared with the BPP of the no or low smoking trajectory group. Conclusions: Prevention and treatment programs for individuals who suffer from insomnia should be implemented in parallel with programs for smoking cessation. From a public health perspective, our longitudinal study that examined the association between earlier smoking trajectories and later insomnia suggests that treatments designed to reduce or cease smoking may lessen the occurrence of symptoms of insomnia.

WHEN YOUR HEART IS AFLUTTER AND YOU'RE WEAK AT THE KNEES: A CASE REPORT

A 49 year old gentleman presented to Neurology with a 10 year history of deteriorating mobility. He described an evolving bilateral foot drop from his mid–thirties, with progressive symptoms affecting...

High-Pressure Injection Injuries in the Hand

High-pressure injection injury to the hand and upper extremity is a rare but very serious clinical entity. The objective of this article was to review the current available literature and highlight important topics. A PubMed literature search was undertaken with the terms "high pressure injection injuries," "injection injuries," "finger injection injuries," and other related terms. Articles were reviewed with specific attention to clinical presentation, treatment, outcome, and prognostic variables. Most of the available literature included case studies, case series, retrospective cohorts, and literature reviews. The most common presentation of a high-pressure injection injury is a puncture wound on the nondominant index finger of a working class man in his mid thirties. Important factors at presentation include the time of injury and type and pressure of material injected. Initial treatment should include tetanus prophylaxis, broad-spectrum antibiotics, and urgent consultation with a hand surgeon. Injections with air, gas, or small amounts of veterinary vaccines can usually be managed with observation and serial examinations if there is not concern for compartment syndrome. Injections with other liquid materials typically require emergent surgical débridement, with the best outcomes occurring when treated within 6 hours. A wide surgical irrigation and débridement of necrotic tissues should be performed under general or regional anesthesia. Organic and caustic materials are associated with a higher amputation rate, and decreasing the time from injury to surgery improves the prognosis. High-pressure injection injuries to the hand can result in permanent impairment. Proper diagnosis and urgent treatment are essential for a good outcome.

Two Shining Souls: Jane Addams, Leo Tolstoy, and the Quest for Global Peace by James Cracraft (review)

SEER, 91, 4, OCTOBER 2013 876 heraldry and with granting privileged social and political roles to professors, while politicians continued to sabotage learning by underfunding primary schools. The intellectuals and writers of the time also had a responsibility for this situation. The literary polemics of the 1880s showed their concern for their profession’s autonomy and their social compassion, but failed to make the two concerns meet, a failure that may have had considerable effects for at least decades. Admirably balanced in its critical use of sources, perfectly mature in discussing a difficult topic, Drace-Francis’s book is an exceptionally insightful and stimulating analysis of emergent Romanian modernity and a model for future approaches to the early period of South-East European modern culture. Alexandru Ioan Cuza University, Iaşi Doris Mironescu Cracraft, James. Two Shining Souls: Jane Addams, Leo Tolstoy, and the Quest for Global Peace. Lanham, MD, Boulder, CO, New York, Toronto and Plymouth, 2012. xvi + 179 pp. Illustrations. Notes. Bibliography. Index. $59.99: £37.95. In Two Shining Souls: Jane Addams, Leo Tolstoy, and the Quest for Global Peace, James Cracraft, Professor of History Emeritus at the University of Illinois, Chicago, uses a meeting between two international figures in 1896 as the organizing principle to address their comparative philosophies and histories. Today, the Nobel Peace Prize winning Addams is little remembered outside of academic circles, while Tolstoi remains a beloved and widely recognized literary giant. At the end of the nineteenth century, Addams was one of Tolstoi’s many adoring fans. She travelled to Russia to visit one of her inspirations, which she recounts in Twenty Years at Hull-House (1910). Tolstoi maintained an absolute position on pacifism as well as extreme solidarity with manual labourers. Similarly, Addams was a pacifist who lived among the poor in Chicago. However, the meeting was not one of mutual admiration. Tolstoi criticized Addams’s absentee land ownership and her dress as excessive in light of the needs of the poor. Addams left the exchange determined to take Tolstoi’s call for bread labour seriously. For Tolstoi, the meeting was not noteworthy enough to mention in his biography. Cracraft situates the meeting at the intersection of two kindred but methodologically different approaches to social philosophy. Tolstoi was a brilliant uncompromising Russian idealist in his late sixties. Addams was an American pragmatic activist in her mid thirties. Intriguingly, Cracraft introduces the reader to an interlocutor present at the meeting, Aylmer Maude, who was Tolstoi’s biographer, editor and translator. Maude helped make the meeting possible and subsequently published an article describing the events. After being a staunch defender of Tolstoyism, Maude was affected by the REVIEWS 877 meeting, recognizing that Addams’s approach integrated a care for individuals that moved beyond ideological rules of action. He describes Tolstoi’s version of non-resistance as ‘a rule of conduct forbidding the use of physical force, and involving a variety of wide-reaching conclusions: disapproval of all governments, police, voting, property, public law, etc. Non-resistance, as practiced by Miss Addams, is something else. It is an attitude of mind, and not a rigid rule’ (p. 64). Skilfully crafted, Two Shining Souls brings the events surrounding the meeting alive — providing the right balance between sufficient detail to give the events texture and tangibility and offering the sweep of history to present context and meaning. The work is accessible to the non-historian but also engages in scholarly analysis of Addams and Tolstoi. I strongly recommend the work to anyone interested in these figures or the on-going struggle for world peace. The following critiques are in the realm of nuance and do not diminish this reviewer’s overall enthusiasm for the book. Cracraft’s appraisal of Addams comes in the form consistent with biographers prior to the 1990s. For example, Cracraft praises her activism but diminishes her intellectual contribution: ‘Nor was she a thinker to be ranked with such American contemporaries as William James or John Dewey, despite tentative efforts to the contrary’ (p. 149). This statement overlooks the scholarship of the last twenty years that has demonstrated how Addams’s thinking influenced both James and Dewey and how it makes an independent...

The Last Contribution of Hemophiliacs to Blood Coagulation: Atherosclerosis Is Not Prevented by Hypocoagulability

“In principio omnes errant hemophiliacs”. In the past, all bleeding patients were considered as hemophiliacs. Quick demonstrated in the mid thirties that hemophiliacs had a normal prothrombin time (P.T.). This allowed the first distinction of “bleeding patients” in two groups, some with a normal P.T. and some with a prolonged P.T. [1]. Only in 1947, “hemophilia” could be suspected to comprise two different diseases, when Pawlowski in Argentina showed the correction of the defect after mixing the plasmas of two patients known to have hemophilia, thereby suggesting the existence of two types of defect [2]. This was independently confirmed later on by Aggeler et al in the U.S.A. and in England by the Oxford Group in 1952 [3, 4]. Since that time the contribution of hemophilic patients to the understanding of blood coagulation was astonishing and could be summarized along the following lines, without the presumption to be complete: 1). Cryoprecipitates corrected Hemophilia A but not, or very little the hemophilia B defect [5]. 2). Immunological studies on hemophilia A and B have opened new horizons on VWD and demonstrated the existence of hemophilia variants with cross reacting material (CRM) [6, 7]. These studies were then instrumental in the classification of other clotting defects, especially, FX and F VII defects [8]. 3). A hemophilia B variant, hemophilia BM, showed a prolonged prothrombin time when a reagent containing ox-brain thomboplastin was used in the assay system [9]. This opened new horizons in prothrombin complex diseases with regard to their reactivity towards tissue thromploplastins of different origin [10]. 4). Another peculiar contribution was the observation that, in a special type of hemophilia B (Hemophilia B Leyden) there was a variable correction of the defect as the patients aged [11]. This cast light on the androgen-dependent maturation of FIX at the hepatocyte level. 5). Hemophilia patients payed heavily for our delays and faults in the developing of safe concentrates. The pain, sacrifice and the size of the cemetery of hemophiliacs has still to be properly acknowledged and described. 6). Synoviectomy carried out in hemophiliacs in an attempt to impede or delay the occurrence of the arthropathy has considerably spurred the use of this procedure in several orthopedic diseases [12]. 7). The development in some patients of antibodies after replacement therapy has opened important lines of investigation in the genetic control of immunological mechanisms. 8). The widespread treatment of HIV and hepatitis B and C in hemophilia patients has supplied valuable information for the management of these infections even in non-bleeding subjects. 9). The role of liver transplantation in the management of hemophilia is still disputed. However some success has been obtained even by the live donor transplant [13-15]. 10). The status of genetic therapy of hemophilia is still open and very controversial but hemophiliacs have given a contribution even to this field [16, 17]. They represent, at least on theoretical grounds, ideal subjects for gene therapy [16]. Now, hemophiliacs supply us with a new important information. They have shown that atherosclerosis’ may occur in them as in normal persons [18, 19]. Old studies had suggested that the clotting defect could exercise a protection against atherosclerosis. They were wrong. Now it is known that this is not the case. A new medical field has been opened. How to treat hemophilia patients with atherosclerosis and its complications, notably acute coronary syndromes. So, after so many contributions, another major contribution has emerged. Thanks to the improved overall care and to the safety of replacement therapy, the hemophilia population has aged and with age , age related problems have appeared [19, 20]. The demonstration that atherosclerosis may occur in patients with hemophilia and with other congenital coagulation disorders is an event of great importance in blood coagulation. It indicates that hypocoagulability does not prevent the aging of the arteries, namely the formation of fatty streaks or plaques in the intima of the arteries. The focus on the pathogenesis of atherosclerosis must rest therefore on lipids (mainly cholesterol) and inflammation. Congenital hypocoagulability may still protect from atherothrombosis which refers to the formation of a thrombus on fissured on ulcerated plaques. However an arterial occlusion may occur without the formation of a thrombus. This may explain at least part of the myocardial infarctions (M.I.) seen in patients with Hemophilia and other clotting disorders. Autopsy and coronographic data indicate that atherosclerotic streaks and plaques are always present, sometimes complicated by the formation of a thrombus [21, 22]. Manuscript accepted for publication May 27, 2013

The Physician as Storyteller &amp; Poet: Quick Writes from East Bay Writers’ Workshops

One weekend day during my medical internship at Lincoln Hospital in the South Bronx, probably a Saturday, I received an admission. She was a woman in her mid thirties, well known to the medical service, with chronic renal failure. Every few weeks she would come into the emergency room with fluid retention and elevated potassium, and we would hustle around to get her to the ICU where we could initiate peritoneal dialysis. Our ICU had 7 beds for our indigent population of 350,000 and it was shared by all of the services: Medicine, Peds, Surgery, OB. There was never a free bed, so finding a bed for one patient always required a lot of negotiation and weight-throwing. To make it worse, she came at around shift change when it is always difficult to get anyone moved in or out of a bed. I have never been very good at weight-throwing and having started my career as an orderly and scrub nurse, I am very uncomfortable about “yelling” at the staff, which was what was required. Before I could get my patient into the ICU, place the catheter, and start the dialysis, she had a cardiac arrest and died. I took the full load of her death onto my shoulders. How had I let this woman die leaving her children (two, or three as I now remember) motherless? I had failed when my colleagues had succeeded and why couldn't I have been more forceful and aggressive? I went home the next day in a dark mood. I felt as if I was a harmful, dangerous person who had no business becoming a doctor. I thought about throwing myself under a bus or at least breaking my leg on a lamppost. It was all I could do to come in to rounds on Monday. I had to tell my team my story and how I had let them down. Our attending physician, who was also our nephrologist, listened patiently to my tale of failure then calmly told me that I had not killed the patient. The attending reassured me that the patient was killed by her kidney disease and a social system whose best solution was prolonged dialysis. She also reassured me that she would be happy to yell at the staff, if I ever needed help with that in the future.

The Essence of Giving—A Transplant Story

The Essence of Giving—A Transplant Story Andy Heath I think I’ve always believed in giving of myself to serve others. Looking back, I’m a little surprised that personality trait didn’t lead me to becoming a firefighter, police officer or even pursue a career in the military. Instead, I was a professional singer, a cruise director on luxury ships and had recently begun a new career as a financial advisor with a major brokerage firm before volunteering to become a liver donor. Through a sales contest early in my new career, I won a two–year coaching program that gathered for three–day training weekends every quarter in New York City. Between weekends, we were matched with daily partners, adding to the continuity and accountability. Twenty–two strangers began and a close–knit group of friends graduated. Initially, I expected the purpose of the program was to help us grow our careers, but ultimately it became a vehicle to build and live a life of higher significance. One of my daily partners was Mike—a strong, thoughtful and caring man in his mid–thirties. Mike was married with three young children and already a successful financial advisor. We were a year into our coaching program before he told the group he was suffering from primary sclerosing cholangitis. At some point he would need a liver transplant. Meanwhile, his disease left him susceptible to contracting cancer. I don’t recall how I first learned about living liver donation. It seemed almost miraculous—and a solution to Mike’s problem. Best of all, it was something I could do. Without discussing the subject with my wife first, I asked Mike to consider me as a possible donor. I was extremely healthy and fit. I never smoked and didn’t drink. I was sure I had the healthiest 39–year–old liver he could ever find. And if donating part of my liver could give my friend a chance for his kids to get to know their father—this father—well, that was worthwhile. A transplant was Mike’s opportunity for a second chance at life. And it was my opportunity to live without regret. It was impossible to not try. My offer was sincere, but was immediately dismissed as Mike confided that several family members were waiting in line as potential donors. Months later, after no family members were found to be compatible, I received a phone call from Mike asking if I was still serious about my offer. This time, I went immediately to my wife and told her what I wanted to try. She never hesitated and never wavered in her support. Much later, Tammy told me that the look in my eyes and the conviction in my voice was enough to convince her of my resolve and that she would support me. I selfishly never asked or fully understood her concern and worry for me. I think we both looked at this opportunity as a higher calling in my life. This was one of those moments that allows you to make a real difference. But, the recipient was also someone Tammy had never met. We lived in Kansas City and Mike’s family lived in Pennsylvania. It was clearly time for introductions. Tammy joined me as we traveled to Pennsylvania for donor compatibility testing. Mike’s insurance covered the testing for two potential donors and that limit had already been reached by family members. To go forward with my testing required a $25,000 deposit to be paid to the hospital which would be reimbursed by the insurance company if we went through with the surgery. When word of our plans spread to our coaching [End Page 14] group, they quickly rallied and sent $25,000 to Mike within a matter of days. Incredible. Following four days of extensive tests and psychological interviews, I was pronounced to be a perfect, textbook candidate. To this day I don’t know why, but I did very little research of the surgical procedure and the risks involved. Looking back, I believe I had confidently decided I was meant to do this. I felt I could see my life decisions...

John Mackay: Silver King in the Gilded Age (review)

2010Book Reviews415 Texas. These pioneers helped found communities and served proudly during the Texas Revolution and Civil War. However, by the late 1 860s the two families were clearly organized in opposition to one another. Parsons remains uncertain as to what exact incident spawned the feud. It could have been the killing of Daniel Chisholm by the Taylors or the deadi ofa Taylor relative at the hands ofa posse led by Bill Sutton. Moving on from those incidents, Parsons proceeds chronologically and presents an image of bloody and lawless Reconstruction Texas. The Taylors, often categorized as cattle thieves, come off as oppressed citizens within Parsons's work. Creed Taylor, the generally recognized leader of the Taylor family, is described by Parsons as a "Texas hero" (81). The Suttons do not appear quite as favorably as it is clear throughout the text that Parsons believes they were generally corrupt officials bent on personal retribution. Instead of curbing the violence, Parsons argues that Sutton affiliates Captain Charles S. Bell and John Jackson Marshall "Jack" Helm initiated a "reign of terror" (62) across Texas characterized by large numbers of fugitives—often Taylor men—being killed during supposed escape attempts. In the end, it is difficult to entirely agree with Parsons's attempts to rehabilitate the Taylors due, in part, to his reliance uponJohn Wesley Hardin's self-serving and Taylor-praising autobiography. Hardin, drawn into an alliance with the Taylor family out of allegiance to his cousins, played his part in the violence that consumed DeWitt, Gonzales, Karnes, and Bastrop counties, until he decided to relocate to Florida, most likely to avoid capture and prosecution for murder. When authorities finally apprehended Hardin in 1877, the feud was winding down with Parsons stating that it officially ended with an 1899 pardon of one feudist. Parsons's account of the feud highlights the individual personalities of the feudists while also providing a plausible description of how life in Reconstruction Texas resembled "in many respects a continuation of the declared war" (257). The usefulness of Parsons's text lies in its accounts of deadly gunplay that serve not only to titillate but to reinforce the interpretation ofa Reconstruction Texas ruled by brute force and not force of law. Rice UniversityRobin Sager John Mackay: Silver King in the Gilded Age. By Michael J. Makley. (Reno: University of Nevada Press, 2009. Pp. 284. Illustrations, notes, bibliography, index. ISBN 9780874177701, $34.95 cloth.) John Mackay was a man almost bigger than life. This biography offers us insights into the man and his times as the exploitation of the Comstock Lode was turned into a symbol of wealth and excess. He presided over an environmental disaster twenty-five miles east of the high ridge of the Sierra Nevada during a time of intense human exploitation and corrupt business dealings. However, in this interesting book diat contains a wealth of local detail, Mackay emerges as an almost heroic figure. Born in 1831, he emigrated from Ireland in 1840 with his parents and lived as a boy in New York City. In 1851 he arrived in the gold fields along the American 416 Southwestern Historical QuarterlyJanuary River and then moved on to Sierra County. In 1 859 word of the Comstock discoveries lured him to that site. Mackay married the widow Louise Bryant when he was in his mid thirties. It was a lifelong but largely long distance relationship since she chose Paris and London as her principal domiciles. During the course of the marriage he was sued at least once by a woman after a failed relationship. The author shows Mackay's struggles with local cartels and banking interests that exploited small-scale mine operators while depicting the growth of his own business. As an inquiring reader I would like to know more about Mackay's financing and where it came from, if it did not come from the same sources as the others . At the highest levels Mackay interfaced with New York financiers including J. P. Morgan, but no analysis of that relationship is offered. In die later phases of his career he expanded into the transoceanic cable and land communications industries. This would have meant competition, cooperation, or both...

Fathers Who Kill Their Children: An Analysis of the Literature

Roughly half of filicidal acts are committed by fathers, though the majority of the literature focuses on maternal filicide. This paper reviews the existing literature on paternal filicide with the goal of identifying characteristics common among these fathers. Fathers who killed their children were, on average, in their mid thirties. The mean age of their victims was five. They may have multiple victims. Sons and daughters were killed in equal numbers. Reasons included death related to abuse, mental illness (including psychosis and depression), and revenge against a spouse. The method often involved wounding violence. Suicide following the act occurred frequently. After being tried for their crimes, filicidal fathers were more frequently incarcerated than hospitalized. Given the range of those capable of this act, mental health professionals must be alert to the possibility of filicide in a variety of fathers. Considering this risk, clinicians should inquire about thoughts of harming children, partners, and themselves.

The psychiatric intensive care unit: A prospective survey of patient demographics and outcomes at seven English PICUs

Background: Psychiatric intensive care units (PICUs) have become a standard part of UK mental health services. They treat patients who may be very unwell and who are usually compulsorily detained. There is little published data about the clinical activity of such units to provide an evidence base for clinical governance.Aim: To describe the socio-demographic characteristics, mental state and outcome of treatment for 332 patients admitted consecutively to seven English PICUs.Method: Prospective, multi-centre case note analysis.Results: PICU patients were predominantly Caucasian males, in their mid thirties, with complex needs and chronic psychotic illness often complicated by substance misuse. Most were admitted because of perceived risk of violence to others. Whilst most admissions appeared to be broadly in line with Department of Health guidelines some patients experienced an excessive length of PICU stay. Patients from particular BME groups were over-represented.Conclusions: PICUs appear to deliver effective treatment but are not always the least restrictive environment as envisaged by the Department of Health. Further work is needed to evaluate treatment interventions and develop valid measures of quality of care.

Body mass index: impact on IVF success appears age-related

The objective of this study was to examine the effect of BMI on IVF outcomes. This was a retrospective analysis of all patients undergoing IVF from 1st January 2005 to 1st March 2006 in a large private practice using a single IVF laboratory. The patients underwent standard protocols for controlled ovarian hyperstimulation and embryology parameters. The main outcome measure was clinical pregnancy rate. A total of 2167 fresh, non-donor IVF cycles were queried, but to minimize bias, only the first treatment cycle for each patient was analyzed (n = 1273). The data were examined by multiple regression models that included BMI and Age as main effects plus a BMI x Age interaction. When examined as a main effect, BMI did not appear to have a major effect on IVF outcome, but there was a significant BMI x Age interaction. At younger ages, a high BMI had a pronounced negative influence on fertility, but this effect diminished as the patient age increased. Clinical pregnancy rates decreased with increasing BMI and increasing Age. In younger patients undergoing IVF, BMI has a significant negative impact on fertility that diminishes as patients reach their mid thirties. After Age 36, BMI has a minimal impact on fertility.

Fitness training for cardiorespiratory conditioning after traumatic brain injury

Cardiorespiratory deconditioning is a common sequelae after traumatic brain injury (TBI). Clinically, fitness training is implemented to address this impairment, however this intervention has not been subject to rigorous review. The primary objective was to evaluate whether fitness training improves cardiorespiratory fitness in people who have sustained a TBI. We searched ten electronic databases (Cochrane Injuries Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; PubMed (MEDLINE); CINAHL; AMED; SPORTDiscus; PsycINFO; PEDro and PsycBITE) and two clinical trials registers (TrialsCentral and Current Controlled Trials). The last search was August 2007. In addition we screened reference lists from included studies and contacted trialists to identify further studies. Randomised controlled studies with TBI participants were eligible if they compared an exercise programme incorporating cardiorespiratory fitness training to usual care, a non-exercise intervention or no intervention. Two authors independently screened the search output, extracted data and assessed quality. All trialists were contacted for additional information. Mean difference and 95% confidence intervals (CI) were calculated for continuous data and risk difference or odds ratio and 95% CI were calculated for dichotomous data. Data were pooled when there were sufficient studies with clinical and statistical homogeneity. Six studies, incorporating 303 participants, were included. The participants were primarily males, in their mid thirties who had sustained a severe TBI. The studies were clinically diverse with regard to the interventions, time post-injury and the outcome measures used; therefore, the primary outcome could not be pooled. Three of the six studies indirectly assessed change in cardiorespiratory fitness after fitness training using the peak power output obtained during cycle ergometry (either at volitional fatigue or at a predetermined endpoint, that is, a percentage of predicted heart rate maximum). Cardiorespiratory fitness was improved after fitness training in one study (mean difference 59 watts, 95% CI 24 to 94), whilst there was no significant improvement in the other two studies. Four of the six studies had no drop-outs from their intervention group and no adverse events were reported in any study. There is insufficient evidence to draw any definitive conclusions about the effects of fitness training on cardiorespiratory fitness. Whilst it appears to be a safe and accepted intervention for people with TBI, more adequately powered and well-designed studies are required to determine the effects across a range of outcome measures.

Cramér vs. Cramér. On Cramér's probabilistic model for primes

In the 1930's Cramer created a probabilistic model for primes. He applied his model to express a very deep conjecture about large differences between consecutive primes. The general belief was for a period of 50 years that the model reflects the true behaviour of primes when applied to proper problems. It was a great surprise therefore when Helmut Maier discovered in 1985 that the model gives wrong predictions for the distribution of primes in short intervals. In the paper we analyse this phenomen, and describe a simpler proof of Maier's theorem which uses only tools available at the mid thirties. We present further a completely different contradiction between the model and the reality. Additionally, we show that, unlike to the contradiction discovered by Maier, this new contradiction would be present in essentially all Cramer type models using independent random variables.

A Reevaluation of The "Face Behind the Knife"

A Reevaluation of "The Face behind the Knife" Joseph Musso (bio) Click for larger view View full resolution Figure 1. The known, circa 1832–33 portrait of Col. James Bowie purchased at the 2001 Butterfields Auction by the Texas State Preservation Board and the Texas Historical Commission. Photograph by Joseph Musso, 1984. [End Page 362] In the January 2006 edition of the Southwestern Historical Quarterly, Mr. Don Arp Jr. came to some flawed conclusions in his article titled "The Face behind the Knife: A Study of the James Bowie Portrait Purchased by the Texas Historical Commission and the State Preservation Board." In his attempt to examine the origins of the known portrait of James Bowie, Mr. Arp explored the possibility that another portrait, supposedly signed by the noted American artist Alfred Jacob Miller, and now being offered for sale at the Alexander Gallery in New York City, is also a portrait [End Page 363] of James Bowie but depicts him later in life. Mr. Arp argues that this second portrait was done from descriptions provided by family and friends nine to ten months after Bowie's death in 1836. Regrettably, this latter portrait has been previously well documented as an "unsigned" portrait of Jim's older brother, Rezin. Rezin was two and a half years older than Jim. The known portrait of James Bowie, purchased by the Texas Historical Commission, shows a man in his mid thirties with hair. The documented, once unsigned portrait of Rezin, suggests a man in his mid to late thirties who was completely bald. Instead of comparing this latter portrait to a another known miniature portrait and also a larger charcoal portrait of Rezin, both of which show him to be completely bald, Mr. Arp used a computer program to remove the hair on the known portrait of Jim. In so doing Mr. Arp obviously hoped that there would be enough resemblance between the two portraits to advance his argument that this alleged Miller portrait is really an older depiction of Jim. At the same time, Mr. Arp also dismisses an article and the facts contained therein written by this author about the known portrait of James Bowie in the December 1982 Alamo News as being "under-researched."1 Click for larger view View full resolution Figure 2. The known, circa 1838 miniature portrait of Col. Rezin Pleasants Bowie that was sold at the 2001 Butterfields Auction. Photograph by Joseph Musso, 1984. [End Page 364] Click for larger view View full resolution Figure 3. The known, charcoal portrait of Col. Rezin Pleasants Bowie that was sold at the 2001 Butterfields Auction. Photograph by Joseph Musso, 1984. However, when one considers that the known, unsigned portrait of James Bowie sold for $321,875.00 at the June 26, 2001, Butterfields Auction and two known, unsigned portraits of Rezin Bowie, an oil painted miniature on ivory and a larger charcoal portrait, sold for only $40,625.00 and $2,350.00 respectively at the same auction, the need for accuracy on this subject is imperative.2 Fortunately, history has provided enough evidence to prove to all concerned that this latter painting depicting a bald-headed man is not an older portrait of Jim, but rather a younger portrait of Rezin. Furthermore, it was documented as such, as far back as on Tuesday, July 12, 1836, when The New York Herald wrote a negative story on Rezin. Titled, "The Bowie Knife" and spelling his name phonetically as Reson, it accurately described this portrait, reading in part: That kind of knife was the production of Reson Bowie, a brother of James—one of a desperate daredevil family, who have been the terror and the proverb of the whole South-west. Do you wish to see his likeness and the formidable, terrible weapon which [End Page 365] his bloodthirsty ingenuity contrived? Go to Bishop's barroom in New Orleans—there hangs his portrait. A brown and swarthy creature, with hard face, stern cold eye and firm lip, open bosom, and the blood-chilling knife in his clenched hand. If you wish to see the original, there he is at Donaldsonville, on the Mississippi, half blind and yet a terror, breathing...

Neurologie des malformations artérioveineuses cérébrales

Brain arteriovenous malformations (AVMs) constitute a neurovascular disorder that comes to clinical attention mainly in young adults in their mid thirties. Associated symptoms often require neurological treatment for symptomatic seizures (focal or generalized), headaches (episodic or chronic), progressive neurological deficits, or spontaneous AVM rupture leading to intracerebral, intraventricular, and/or subarachnoid hemorrhage. Little data exist in the medical literature regarding the natural history risk of the disease and no controlled studies are available on the risk of invasive AVM treatment (endovascular, neurosurgery, radiotherapy). This review focuses on all aspects of neurological brain AVM management and discusses possible predictors of the natural history risk as well as the benefit and risk of invasive treatment. AVM patient management is ideally based on a trans-disciplinary approach via a neurovascular team of neurologists, neuroradiologists, neurosurgeons, and radiotherapists. A newly diagnosed AVM does not necessarily represent an a priori indication for interventional treatment. The decision in favor or against therapy mainly depends on clinical criteria (ruptured versus unruptured AVM, neurological exam, patient age and co-morbidity, etc.) and the angioarchitecture of the malformation. The ARUBA study is going to be the first randomized clinical trial comparing the risk of invasive treatment versus non-invasive management.

Synovial Chondromatosis in an Elite Cyclist: A Case Report

Doward DA, Troxell ML, Fredericson M. Synovial chondromatosis in an elite cyclist: a case report. Primary synovial chondromatosis is a rare disorder that can present as chronic hip and groin pain. It is characterized by formation of osteocartilaginous nodules arising from the synovium. We report the first case, to our knowledge, of an Olympic-caliber cyclist, in her mid thirties, with primary synovial chondromatosis of the left hip. Clinical examination showed decreased internal rotation, external rotation, forward flexion, and abduction of the left hip. A radiograph of the left hip showed slight hip-joint narrowing centrally. A magnetic resonance imaging arthrogram showed a small anterior labral tear and innumerable small intermediate-intensity filling defects situated diffusely within the joint fluid. Fluoroscopically guided injection of the left hip with local anesthetic and cortisone produced temporary pain relief. Conservative treatment was marginally helpful. Results of a rheumatology workup were unremarkable. Arthroscopic removal of loose bodies and synovectomy were performed. The diagnosis of primary synovial chondromatosis was confirmed by histologic examination. At the 17-month follow-up, our patient was essentially pain free and had returned to her previous athletic activities.

Bullous disease of the lung and cannabis smoking: insufficient evidence for a causative link

Cannabis smoking appears on teaching slides as a cause of bullous lung disease and consequent pneumothorax. This seems to have become received wisdom—`A striking feature of cannabis smoking is that it is associated with bullous lung disease in young people'.1 The authors cite a report of four cases.2 The suggestion appears, albeit in more muted terms, with the same citation in a UK Parliamentary memorandum on adverse effects of smoking marijuana on lung health.3 What is the evidence that cannabis smoking causes bullous lung disease and what is its association, directly or indirectly, with pneumothorax? The characteristic clinical condition of acute pneumothorax is of a patient who presents with symptoms of rapid onset and is found to have free air in the pleural space. There is a widely accepted taxonomy.4 Patients presenting acutely are classified as having spontaneous pneumothorax to distinguish them from those caused by trauma (including iatrogenesis from various interventions with needles in the neck vessels, breast, pleura or lung). Spontaneous pneumothorax is then subdivided dichotomously into primary and secondary. Secondary spontaneous pneumothorax includes all of those where the pneumothorax occurs in the presence of any underlying lung disease. It is most frequently seen against a background of the common lung diseases that cause enlargement and weakening of the air spaces such as emphysema and chronic obstructive pulmonary disease. Occasional patients have one or more very large bullae. They are usually distinguished from the patient group with chronic obstructive pulmonary disease and emphysema on the basis of younger age and characteristic radiological findings. Is cannabis a cause of these large bullae? Secondary pneumothorax also occurs in other common diseases such as lung cancer, tuberculosis and lung abscess which may necrose, cavitate and breach the pleura and occasionally present with pneumothorax. There are many much less common diseases such as lymphangioleio-myomatosis, Wegner's granulomatosis, pneumocystis and Langerhans' cell histiocytosis that may present for the first time with pneumothorax. This long and effectively endless list of possible causes is not surprising when one notes that the visceral pleura is thin and vulnerable and arguably any lung disease can result in pneumothorax occasionally.4 Primary spontaneous pneumothorax is the characteristic condition of young people, predominately males (3:1) in their teens to mid thirties (Figure 1). They tend to be tall and lean; a family history is not infrequent. They fall into a well characterized diagnostic frame.5 The words `primary' and `spontaneous' have a tendency to be conflated with idiopathic or of unknown aetiology but there is a very definite pathological lesion. In most cases there are small bullae apparent at the apex of the lung. Now that surgeons can obtain excellent magnified views at video assisted thoracic surgery computerized tomography6,7 and radiologists inspect them with high resolution CT there is no mystery about it. Might cannabis smoking contribute to this group? After all bullae must start small and progress over time to become larger. Figure 1 A consecutive series of 117 cases of pneumothorax managed surgically in Guy's Hospital during 2003. It shows the typical bimodal distribution and that males (darker grey bars) outnumber women in both distributions There is a quite separate way in which cannabis smokers are reported to present with abnormal air in the chest (pneumothorax and/or pneumomediastinum). Instances in case reports are attributed to extreme breath holding, Valsalva, and Muller's manouevres.8-11 This is a form of barotrauma which is a well-recognized cause of pneumothorax in intensive care units. If there is a cause-and-effect relationship between cannabis smoking and acute rupture of previously normal lung air spaces due to extreme pressure change, it falls under the diagnostic heading not of spontaneous but of traumatic pneumothorax. The focus in our investigation was on bullous lung disease in cannabis smokers.

Myelopathy Associated With Melorheostosis: A Case Report

Reznik M, Fried GW. Myelopathy associated with melorheostosis: a case report. A man in his mid thirties presented with lower-extremity weakness and spasticity because of a myelopathy caused by a rare disorder of bone known as melorheostosis. The primary pathology involved was compression of the cord at the cervicothoracic levels by dystrophic osseous formation within the vertebral bodies. Based on a review of existing literature, it was evident that the spine is an uncommon location to find melorheostosis, making this disease entity a unique cause of myelopathy. The patient’s progress was closely observed during his inpatient rehabilitation program, after he underwent spinal decompression surgery. Starting from the level of complete paralysis, he was able to regain functional strength in his legs by the end of his 2-month course. Despite the lack of reported outcomes in cases of myelopathy associated with melorheostosis, our report describes a favorable prognosis with good recovery of both strength and function.

Maternal osteoporosis after prolonged magnesium sulfate tocolysis therapy: A case report

Hung J-W, Tsai M-Y, Yang B-Y, Chen J-F. Maternal osteoporosis after prolonged magnesium sulfate tocolysis therapy: a case report. Tocolysis therapy with magnesium sulfate is known to affect calcium homeostasis. Prolonged infusion of magnesium sulfate (MgSO 4) has been used for the treatment of refractory preterm labor, and has been reported to change maternal calcium homeostasis and possible mineralization. In this case report, we present a woman in her mid thirties who had undergone intravenous MgSO 4 tocolysis therapy, and developed osteoporosis leading to significant morbidity after delivery. The laboratory investigation, including the bone scan, magnetic resonance image, indices of bone turnover, and the results of 2 years of follow-up of bone mineral density, are also reported. This case report supports the existence of a possible association between prolonged intravenous magnesium tocolysis and maternal osteoporosis. To prevent osteoporosis, it is important to avoid a prolonged period of MgSO 4 tocolysis. In cases of prolonged MgSO 4 treatment and bedrest, physicians should be aware of the risk of osteoporosis. The recommended management is also discussed in this report.