After hMSH2 and hMLH1- what next? Analysis of three-generational, population-based, early-onset colorectal cancer families

The aim of our study was to examine the role of genetic factors on early-onset colorectal cancer after excluding the impact of germline mutations in the two major mismatch repair genes. A total of 131 incident probands, under 45 years at diagnosis of a first primary colorectal cancer selected from the Victorian Cancer Registry, and their first-and second-degree relatives, were interviewed. Germline DNA from all 12 probands with a family history meeting the modified Amsterdam Criteria for Hereditary Non-Polyposis Colorectal Cancer (HNPCC) and a random sample of 31 of the remaining probands was screened for mutations in hMSH2 and<i> hMLH1 via manual sequencing. Germline mutations were identified in 6 of the 131 probands (5%), all from the "HNPCC" families. Of the remaining 125 probands, 51 (41%) reported at least one first-or second-degree relative with colorectal cancer with an excess of colorectal cancer in first-degree relatives (SMR = 2.7, 95% CI = 1.7-4.1, p < 0.001). The lifetime risk to age 70 for first-degree relatives was 8.0% (5.0-12.8%), compared to the Victorian population risk of 3.2% (p = 0.01). The best fitting major gene model was a recessively-inherited risk of 98% to age 70 (95% CI = 24-100%) carried by 0.17% of the population and would explain 15% of all colorectal cancer in cases with a diagnosis before age 45. Early-onset colorectal cancer is strongly familial even after excluding families found to be segregating a mutation in either of the 2 major mismatch repair genes. There is evidence for a role of yet to be identified genes associated with a high recessively-inherited risk of colorectal cancer.

Words Between Worlds: Portal Fantasy as Dialogic in Gaiman and Miéville

Step through the looking-glass and where do you go? Inherently, every text exposes the reader to other worlds. However, the fantastic, like no other mode, not only exposes, but explores, explains, and employs other worlds (and how we enter them) to question what is real and unreal, possible and impossible.Using Farah Mendelsohn’s (2008) examination of portal fantasy, this paper argues that when you step into another world you leave something behind and bring something back. This Bakhtinian dialogic will then frame an analysis of Neil Gaiman’s American Gods (2001) and China Miéville’s The City and the City (2009) which explore notions of organic subjectivity, reader expectations, and if gaps actually exist between textual and extra-textual, real and unreal.These atypical, self- reflexive, satirical portal fantasies express how writers position readers (not unlike their protagonists) in alternative conceptual realms, disturbing the everyday, the commonplace realities we often take for granted. As such, both texts and the discursive strategies they use ask: what do we see, or, as may be the case, un-see? Significantly, this paper suggests that, via self-conscious world-building, portal fantasies allow reader and writer the opportunity to inhabit those spaces between textual, ideological, generic, metaphorical, irrational, fantastic worlds.

Association between participation in outpatient cardiac rehabilitation and self-reported receipt of lifestyle advice from a healthcare provider: results of a population-based cross-sectional survey

We test the hypothesis that the odds of self-reported receipt of lifestyle advice from a health care provider will be lower among outpatient cardiac rehabilitation (OCR) nonattendees and nonreferred patients compared to OCR attendees. Logistic regression was used to analyse cross-sectional data provided by 65% (4971/7678) of patients aged 20 to 84 years discharged from public hospitals with a diagnosis indicating eligibility for OCR between 2002 and 2007. Among respondents, 71% (3518) and 55% (2724) recalled advice regarding physical activity and diet, respectively, while 88% (592/674) of smokers recalled quit advice. OCR attendance was low: 36% (1764) of respondents reported attending OCR, 11% (552) did not attend following referral, and 45% (2217) did not recall being invited. The odds of recalling advice regarding physical activity and diet were significantly lower among OCR nonattendees compared to attendees (OR 0.34, 95% CI 0.21, 0.56 and OR 0.33, 95% CI 0.25, 0.44, resp.) and among nonreferred respondents compared to OCR attendees (OR 0.10, 95% CI 0.07, 0.15 and OR 0.17, 95% CI 0.14, 0.22, resp.). Patients hospitalised for coronary heart disease should be referred to OCR or a suitable alternative to improve recall of lifestyle advice that will reduce the risk of further coronary events.

Admissible Christianity : a study of Christian fundamentalism in the writings of James Barr

An attempt to set forth the essential nature of a theology is a notoriously difficult task. This thesis addresses two questions to a contemporary study of fundamentalism. It asks to what extent has James Barr been able to describe the theology of fundamentalism and to what extent his critical analysis of that theology is philosophically valid? The first chapter identifies the inherent difficulties in a phenomenology of fundamentalism and includes an historical survey of the theology of the movement. This chapter is supported by appendix one which identifies the philosophical culture associated with fundamentalist thought. Barr's description of the theological and religious character of fundamentalism is accepted within the identified limitations. The second and third chapters give an account of Barr's theological evaluation of fundamentalism. He argues the fundamentalists espouse an aberrant form of Christianity. Their religion represents a projection onto the biblical text of a religion foreign to the theological character of the Old and New Testaments. This projection is achieved by an intellectually sophisticated hermeneutical procedure. The doctrines of inerrancy, verbal inspiration and infallibility establish an understanding of Christianity which does not represent the essential character of the Christian faith. Fundamentalist hermeneutics, Barr concludes, allows for a theology indigenous neither to the biblical text nor to the Christian tradition. It attempts to afford biblical justification to the doctrines of a human religion extraneous to the biblical text. The fourth chapter considers the philosophical basis of Barr's understanding of the Bible. He takes the idealist view that the biblical text possesses a theological meaning whose boundaries can be delineated and whose essential content defined. This chapter is supported by appendix two which locates Barr's writings on fundamentalism within his wider concerns about the hermeneutical problems raised by the biblical text and the religious authority of the Bible. The penultimate chapter surveys the insights of contemporary literary theory concerning the perception of written texts. The philosophical validity of an idealist view of the biblical text is questioned. Two major conclusions are drawn. Barr's assessment of fundamentalism is philosophically dependent upon his idealist perception of the biblical text. This conclusion leads to the more general conclusion that the biblical text contains no essential description of Christianity but is capable of being read according to a range of theological interpretations some of which are more defensible than others.

Identification of depression in diabetes the efficacy of PHQ-9 and HADS-D

Background
Clinical guidelines advise screening for depression in patients with diabetes. The Patient Health Questionnaire (PHQ-9) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) are commonly used in primary care.

Aim
To compare the efficacy of HADS-D and PHQ-9 in identifying moderate to severe depression among primary care patients with type 2 diabetes.

Design of study
Self-report postal survey, clinical records assessed by GPs.

Setting
Seven metropolitan and rural general practices in Victoria, Australia.

Method
Postal questionnaires were sent to all patients with diabetes on the registers of seven practices in Victoria. A total of 561 completed postal questionnaires were returned, giving a response rate 47%. Surveys included demographic information, and history of diabetes and depression. Participants completed both the PHQ-9 and HADS-D. Clinical data from patient records included glycosylated hemoglobin (HbA1c) levels and medications.

Results
The proportion of the total sample completing HADS-D was 96.8% compared with 82.4% for PHQ-9. Level of education was unrelated to responses on the HADS-D but was related to completion of the PHQ-9. Using complete data (n = 456) from both measures, 40 responders showed HADS-D scores in the moderate to severe range, compared with 103 cases identified by PHQ-9. Only 35 cases were classified in the moderate to severe category by both the PHQ-9 and HADS-D. Items with the highest proportions of positive responses on the PHQ-9 were related to tiredness and sleeping problems and, on the HADS-D, feeling slowed down.

Conclusion
It may be that the items contributing to the higher prevalence of moderate to severe depression using the PHQ-9 are due to diabetes-related symptoms or sleep disorders.

Interview with Dr Ray Anere (d. 2015)

The late Dr Ray Anere was a Papua New Guinean who studied in Australia at the Australian National University in 1982 - 1985. He was awarded an Australian International Development Assistance Bureau (AIDAB) scholarship and completed a Master degree in Arts. He later completed a PhD at Claremont University in California, USA under a Fulbright Scholarship. Dr Anere was a Senior Research Fellow at the National Research Institute in PNG and maintained strong connections with Australia and with the USA. Dr Anere was a member of the PNG USA Alumni Association and the PNG Australia Alumni Association. Dr Anere passed away in April 2015. The interview was conducted in English on 17 December 2014 by Dr Musawe Sinebare and Mr Gande James, both of Pacific Adventist University. This set comprises: an interview recording, a timed summary and a photograph.