Subclinical thyroid dysfunction and the risk of stroke: a systematic review and meta-analysis

Subclinical thyroid dysfunction has been associated with coronary heart disease, but the risk of stroke is unclear. Our aim is to combine the evidence on the association between subclinical thyroid dysfunction and the risk of stroke in prospective cohort studies. We searched Medline (OvidSP), Embase, Web-of-Science, Pubmed Publisher, Cochrane and Google Scholar from inception to November 2013 using a cohort filter, but without language restriction or other limitations. Reference lists of articles were searched. Two independent reviewers screened articles according to pre-specified criteria and selected prospective cohort studies with baseline thyroid function measurements and assessment of stroke outcomes. Data were derived using a standardized data extraction form. Quality was assessed according to previously defined quality indicators by two independent reviewers. We pooled the outcomes using a random-effects model. Of 2,274 articles screened, six cohort studies, including 11,309 participants with 665 stroke events, met the criteria. Four of six studies provided information on subclinical hyperthyroidism including a total of 6,029 participants and five on subclinical hypothyroidism (n = 10,118). The pooled hazard ratio (HR) was 1.08 (95 % CI 0.87-1.34) for subclinical hypothyroidism (I (2) of 0 %) and 1.17 (95 % CI 0.54-2.56) for subclinical hyperthyroidism (I (2) of 67 %) compared to euthyroidism. Subgroup analyses yielded similar results. Our systematic review provides no evidence supporting an increased risk for stroke associated with subclinical thyroid dysfunction. However, the available literature is insufficient and larger datasets are needed to perform extended analyses. Also, there were insufficient events to exclude clinically significant risk from subclinical hyperthyroidism, and more data are required for subgroup analyses.

Comparison of noninferiority margins reported in protocols and publications showed incomplete and inconsistent reporting.

OBJECTIVES To compare noninferiority margins defined in study protocols and trial registry records with margins reported in subsequent publications. STUDY DESIGN AND SETTING Comparison of protocols of noninferiority trials submitted 2001 to 2005 to ethics committees in Switzerland and The Netherlands with corresponding publications and registry records. We searched MEDLINE via PubMed, the Cochrane Controlled Trials Register (Cochrane Library issue 01/2012), and Google Scholar in September 2013 to identify published reports, and the International Clinical Trials Registry Platform of the World Health Organization in March 2013 to identify registry records. Two readers recorded the noninferiority margin and other data using a standardized data-abstraction form. RESULTS The margin was identical in study protocol and publication in 43 (80%) of 54 pairs of study protocols and articles. In the remaining pairs, reporting was inconsistent (five pairs, 9%), or the noninferiority margin was either not reported in the publication (five pairs, 9%) or not defined in the study protocol (one pair). The confidence interval or the exact P-value required to judge whether the result was compatible with noninferior, inferior, or superior efficacy was reported in 43 (80%) publications. Complete and consistent reporting of both noninferiority margin and confidence interval (or exact P-value) was present in 39 (72%) protocol-publication pairs. Twenty-nine trials (54%) were registered in trial registries, but only one registry record included the noninferiority margin. CONCLUSION The reporting of noninferiority margins was incomplete and inconsistent with study protocols in a substantial proportion of published trials, and margins were rarely reported in trial registries.

Der Spinozismus im Jüdenthumb, oder, Die von dem heütigen Jüdenthumb und dessen Geheimen Kabbala vergötterte Welt : an Mose Germano sonsten Johan Peter Speeth ...

befunden und widerleget von Johann Georg Wachter

The Inverted Phantom Giant

In his famous children’s book, “Jim Button and Luke the Engine Driver”, Michael Ende describes a curious character: A phantom giant. Clothed in rags and with a long beard, the phantom giant appears enormous from far away, but shrinks to normal size as one gets closer. Most people avoid the poor creature, but the ones that dare approach it encounter a gentle, lonely being called Mr. Tur Tur. Chemical ecology is just the opposite of Mr. Tur Tur: A phantom dwarf. Or, in other words, an inverted phantom giant. From a distance, chemical ecology appears like a slightly odd, marginal section of biology and chemistry. But, as the interested scholar approaches, it starts growing and very quickly reaches gigantic dimensions, because all life is explained by chemistry, and all biological chemistry is guided by ecological principles. Herein lies the difficulty with chemical ecology: As it is not perceived well by biologists and chemists, few approach it to understand its significance, and the ones that do find themselves in front of a giant that defies their attempts to define and contain it. This is where the Journal of Chemical Ecology comes in: It invites us to take a closer look at an underestimated discipline and supports us to explore it and deal with its multidimensionality through the promotion of knowledge and methods. These services are unique and make the journal stand out of the crowd of scientific journals. Writing children’s books has become difficult in the era of information technology. And, so has the job of the Journal of Chemical Ecology. Young scientists gather information through accessible, dynamic websites and social platforms. They want articles that are available through a single mouse click, anywhere, anytime. They prefer advanced interactive hypertext protocols over clumsy pdf files. They care about transparency, non-profit and open access just as much as about traditional journal properties. In my view, reaching “the kids” is the major challenge of the Journal over the next years. Promoting an inverted phantom giant in the 21st century requires a combination of high-quality information and boosted visibility. In Michael Ende’s book, Jim and Luke follow exactly this strategy with Mr. Tur Tur: They become friends and offer him a job as a living lighthouse to protect their small island. They combine a quality relationship with high visibility, et voilà, the story ends well! I am looking forward to seeing if the Journal of Chemical Ecology will follow a similar path to reach the next generation of biologists and chemists. If yes, there is a good chance that in 40 years from now, somebody will write a laudation and refer to another famous book by Michael Ende: “The Neverending Story”.

The Lord of Heaven in the Inner Chambers: Jesuits, Women, and Domestic Christianity (ca. 1580-1690)

The study focuses on gender norms and practices in Chinese Christian communities established by Jesuit missionary activity during the long seventeenth century. It analyzes how European and Chinese gender norms and practices affected each other in the context of the Sino-Western cultural contact initiated by the missionaries. The thesis consists of two parts. First, it analyzes the ways in which European Jesuits engaged with Chinese gender relations in the course of their mission in China. The study demonstrates that the Jesuits’ adoption of the Chinese scholar-gentry’s habitus entailed a partial adaptation to Confucian gender norms. The latter placed great emphasis on gender segregation and therefore discouraged direct communication between missionaries and Chinese women. This resulted in the emergence of organizational and devotional arrangements of Christian communities specific to China. Second, the study discusses Chinese Christian women's religious culture that emerged in the absence of a strong missionary presence among female devotees. It points out that Chinese Christian women created their own ritual culture and religious sociability in the domestic context, and that they actively took part in shaping Chinese Christianity as masters of domestic rituals.

Collecting the Painted Netherlands: The Art Collection of Ernest of Austria in Brussels

The (art) collection of Archduke Ernest of Austria (1553-1595) is widely unknown when it comes to early-modern Habsburg collections. Ernest, younger brother of Emperor Rudolf II (b. 1552) and educated at the Madrid court, was appointed Governor-General of the Netherlands by King Philip II of Spain, his uncle, in summer 1593. Ernest relocated his court from Vienna to Brussels in early 1594 and was welcomed there with lavish festivities: the traditional Blijde Inkomst, Joyous Entry, of the new sovereign. Unfortunately, the archduke died in February 1595 after residing in Brussels for a mere thirteen months. This investigation aims to shed new light on the archduke and his short-lived collecting ambitions in the Low Countries, taking into account that he had the mercantile and artistic metropolis Antwerp in his immediate reach. I argue, that his collecting ambitions can be traced back to one specific occasion: Ernest’s Joyous Entry into Antwerp in June 1594. There the archduke received a series of six paintings of Pieter Bruegel the Elder (1525/30-1569) known as The Months (painted in 1565), hanging today in separate locations in Vienna, New York and Prague. These works of art triggered Ernest’s collecting ambitions and prompted him to focus mainly on works of art and artefacts manufactured at or traded within the Netherlands during the last eight months of his lifetime. Additionally, it will be shown that the archduke was inspired by the paintings’ motifs and therefore concentrated on acquiring works of art depicting nature and landscape scenes from the 1560s and 1590s. On the basis of the archduke’s recently published account book (Kassabuch) and of the partially published inventory of his belongings, it becomes clear that Ernest of Austria must be seen in line with the better-known Habsburg collectors and that his specific collection of “the painted Netherlands” can be linked directly to his self-fashioning as a rightful sovereign of the Low Countries.

Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review.

INTRODUCTION Investigations of the dynamic function of female pelvic floor muscles (PFM) help us to understand the pathophysiology of stress urinary incontinence (SUI). Displacement measurements of PFM give insight into muscle activation and thus help to improve rehabilitation strategies. This systematic review (PROSPERO 2013: CRD42013006409) was performed to summarise the current evidence for PFM displacement during voluntary and involuntary activation in continent and incontinent women. METHODS MEDLINE, EMBASE, Cochrane and SPORTDiscus databases were searched using selected terminology reflecting the PICO approach. Screening of Google Scholar and congress abstracts added to further information. Original articles investigating PFM displacement were included if they reported on at least one of the aims of the review, e.g., method, test position, test activity, direction and quantification of displacement, as well as the comparison between continent and incontinent women. Titles and abstracts were screened by two reviewers. The papers included were reviewed by two individuals to ascertain whether they fulfilled the inclusion criteria and data were extracted on outcome parameters. RESULTS Forty-two predominantly observational studies fulfilled the inclusion criteria. A variety of measurement methods and calculations of displacement was presented. The sample was heterogeneous concerning age, parity and continence status. Test positions and test activities varied among the studies. CONCLUSIONS The findings summarise the present knowledge of PFM displacement, but still lack deeper comprehension of the SUI pathomechanism of involuntary, reflexive activation during functional activities. We therefore propose that future investigations focus on PFM dynamics during fast and stressful impact tasks.

Breastfeeding-Associated Hypernatremia: A Systematic Review of the Literature.

There are increasing reports on hypernatremia, a potentially devastating condition, in exclusively breastfed newborn infants. Our purposes were to describe the clinical features of the condition and identify the risk factors for it. We performed a review of the existing literature in the National Library of Medicine database and in the search engine Google Scholar. A total of 115 reports were included in the final analysis. Breastfeeding-associated neonatal hypernatremia was recognized in infants who were ≤ 21 days of age and had ≥ 10% weight loss of birth weight. Cesarean delivery, primiparity, breast anomalies or breastfeeding problems, excessive prepregnancy maternal weight, delayed first breastfeeding, lack of previous breastfeeding experience, and low maternal education level were significantly associated with breastfeeding-associated hypernatremia. In addition to excessive weight loss (≥ 10%), the following clinical findings were observed: poor feeding, poor hydration state, jaundice, excessive body temperature, irritability or lethargy, decreased urine output, and epileptic seizures. In conclusion, the present survey of the literature identifies the following risk factors for breastfeeding-associated neonatal hypernatremia: cesarean delivery, primiparity, breastfeeding problems, excessive maternal body weight, delayed breastfeeding, lack of previous breastfeeding experience, and low maternal education level.

Do multiple true-false items beat the commonly used one-best-answers questions regarding to the Ottawa Criteria for Good Assessment? Results of a literature review

Background: Multiple True-False-Items (MTF-Items) might offer some advantages compared to one-best-answer-questions (TypeA) as they allow more than one correct answer and may better represent clinical decisions. However, in medical education assessment MTF-Items are seldom used. Summary of Work: With this literature review existing findings on MTF-items and on TypeA were compared along the Ottawa Criteria for Good Assessment, i.e. (1) reproducibility, (2) feasibility, (3) validity, (4) acceptance, (5) educational effect, (6) catalytic effects, and (7) equivalence. We conducted a literature research on ERIC and Google Scholar including papers from the years 1935 to 2014. We used the search terms “multiple true-false”, “true-false”, “true/false”, and “Kprim” combined with “exam”, “test”, and “assessment”. Summary of Results: We included 29 out of 33 studies. Four of them were carried out in the medical field Compared to TypeA, MTF-Items are associated with (1) higher reproducibility (2) lower feasibility (3) similar validity (4) higher acceptance (5) higher educational effect (6) no studies on catalytic effects or (7) equivalence. Discussion and Conclusions: While studies show overall good characteristics of MTF items according to the Ottawa criteria, this type of question seems to be rather seldom used. One reason might be the reported lower feasibility. Overall the literature base is still weak. Furthermore, only 14 % of literature is from the medical domain. Further studies to better understand the characteristics of MTF-Items in the medical domain are warranted. Take-home messages: Overall the literature base is weak and therefore further studies are needed. Existing studies show that: MTF-Items show higher reliability, acceptance and educational effect; MTF-Items are more difficult to produce

Improving residency training with the help of multisource feedback: Generation of a model of influencing factors

Background: Feedback is considered to be one of the most important drivers of learning. One form of structured feedback used in medical settings is multisource feedback (MSF). This feedback technique provides the opportunity to gain a differentiated view on a doctor’s performance from several perspectives using a questionnaire and a facilitating conversation, in which learning goals are formulated. While many studies have been conducted on the validity, reliability and feasibility of the instrument, little is known about the impact of factors that might influence the effects of MSF on clinical performance. Summary of Work: To study under which circumstances MSF is most effective, we performed a literature review on Google Scholar with focus on MSF and feedback in general. Main key-words were: MSF, multi-source-feedback, multi source feedback, and feedback each combined with influencing/ hindering/ facilitating factors, effective, effectiveness, doctors-intraining, and surgery. Summary of Results: Based on the literature, we developed a preliminary model of facilitating factors. This model includes five main factors influencing MSF: questionnaire, doctor-in-training, group of raters, facilitating supervisor, and facilitating conversation. Discussion and Conclusions: Especially the following points that might influence MSF have not yet been sufficiently studied: facilitating conversation with the supervisor, individual aspects of doctors-in-training, and the causal relations between influencing factors. Overall there are only very few studies focusing on the impact of MSF on actual and long-term performance. We developed a preliminary model of hindering and facilitating factors on MSF. Further studies are needed to better understand under which circumstances MSF is most effective. Take-home messages: The preliminary model might help to guide further studies on how to implement MSF to use it at its full potential.

The Process of Starting a Business

Many students are inspired to start their own business venture after taking some courses in school or simply just taking an idea and turning it into a business. The beginning process is usually most difficult in terms of establishing a functioning business, getting the right connections, and avoiding discouragement to follow through with the business. That is why many businesses fall into the categories of starting, failing along the process, or failing to get started. There is a lot to be learned from the process of starting a business venture. In addressing this issue, some of the questions this research study aims to explore and study are how people go about their new venture efforts? Second, what steps they undertake? Third, from whom do they get information? And fourth, how do they use that information? This study will seek a variety of insights that can help answer these questions and improve our understanding of why some businesses fail, succeed, or never get started.

Production Streamlining through Design, Implementation, and Analysis of Lean Manufacturing Methods

Through the correct implementation of lean manufacturing methods, a company can greatly improve their business. Over a period of three months at TTM Technologies, I utilized my knowledge to fix existing problems ans streamline production. In addition, other trouble areas in their production process were discovered and proper lean methods were used to address them. TTM Technologies saw many changed in the right direction over this time period.

The Effects of a Physical Activity Intervention on the way Elementary School Girls Play

The rates of childhood and adolescent obesity in the United States have been increasing steadily. American youth continue to eat more (increase energy intake) and reduce physical activity (decrease energy expenditure) resulting in increased body weight and body fatness. One way to help reduce body weight in children is to increase physical activity. The purpose of this study was to determine if an age appropriate before-school physical activity intervention would be successful in increasing energy expenditure, intensity of activity, and behavioral approaches in overweight girls. The subjects were recruited from Parker Memorial School in Tolland, Connecticut, and two testing periods occurred over an eight week period. Video recordings of each physical activity session were analyzed to determine energy expenditure, exercise intensity, and behaviors during exercise. Data was evaluated for normal distribution, and paired t-tests were used to determine statistical significance. This study showed that the age appropriate before school physical activity intervention was able to increase energy expenditure and exercise intensity and have a positive effect on behavioral approaches in overweight girls.

Building Steprelationships: Emerging Adult Stepchildrens' Perceptions and Experiences of their Stepparents

A grounded theory study was conducted with ten (7 female, 3 male) emerging-adults in stepfamilies to examine their perceptions and experiences of their stepparents, and what factors influence the development and maintenance of these steprelationships. Three primary categories emerged from the data: (1) Stepchildrens' perceptions of their stepparents presence in their lives, including both physical closeness and physical and emotional involvement (2) The perceived level of authenticity within the steprelationship, and (3) The level of clout stepchildren afforded to their stepparents' position within their lives and families. Additional factors found to influence the levels of presence, authenticity, and clout were stepchildrens' emotional maturity, cultural background, relationships with their biological parents, and feelings regarding the use and acquisition of money.