Yellow Nail Syndrome: Report of Two Cases and a Brief Review of the Current Literature

Yellow Nail Syndrome (YNS) is a rare, and probably misdiagnosed, condition. It must be considered in middle-aged patients with unexplained chronic respiratory manifestations, lymphedema and nail abnormalities. We present two cases of undiagnosed YNS until the current admissions, despite several years of investigation. The authors wish to draw attention to this syndrome, of which diagnosis is clinical and of exclusion.

Politics and protestant Lordship in North East Scotland during the reign of James VI: The life of George Keith, fourth Earl Marischal, 1554-1623

George Keith, fourth Earl Marischal is a case study of long-term, quietly successful and stable lordship through the reign of James VI. Marischal’s life provides a wholly underrepresented perspective on this era, where the study of rebellious and notorious characters has dominated. He is also a counter-example to the notion of a general crisis among the European nobility, at least in the Scottish context, as well as to the notion of a ‘conservative’ or ‘Catholic’ north east. In 1580 George inherited the richest earldom in Scotland, with a geographical extent stretching along the east coast from Caithness to East Lothian. His family came to be this wealthy as a long term consequence of the Battle of Flodden (1513) where a branch of the family, the Inverugie Keiths had been killed. The heiress of this branch was married to the third earl and this had concentrated a large number of lands, and consequently wealth, in the hands of the earls. This had, however, also significantly decreased the number of members and hence power of the Keith kindred. The third earl’s conversion to Protestantism in 1544 and later his adherence to the King’s Party during the Marian Civil War forced the Keiths into direct confrontation with their neighbours in the north east, the Gordons (led by the Earls of Huntly), a Catholic family and supporters of the Queen’s Party. Although this feud was settled for a time at the end of the war, the political turmoil caused by a succession of short-lived factional regimes in the early part of the personal reign of James VI (c.1578-1585) led the new (fourth) Earl Marischal into direct confrontation with the new (sixth) Earl of Huntly. Marischal was outclassed, outmanoeuvred and outgunned at both court and in the locality in this feud, suffering considerably. However, Huntly’s over-ambition in wider court politics meant that Marischal was able to join various coalitions against his rival, until Huntly was exiled in 1595. Marischal also came into conflict briefly with Chancellor John Maitland of Thirlestane as a consequence of Marischal’s diplomatic mission to Denmark in 1589-1590, but was again outmatched politically and briefly imprisoned. Both of these feuds reveal Marischal to be relatively cautious and reactionary, and both reveal the limitations of his power. Elsewhere, the study of Marischal’s activities in the centre of Scottish politics reveal him to be unambitious. He was ready to serve King James, the two men having a healthy working relationship, but Marischal showed no ambition as a courtier, to woo the king’s favour or patronage, instead delegating interaction with the monarch to his kinsmen. Likewise, in government, Marischal rarely attended any of the committees he was entitled to attend, such as the Privy Council, although he did keep a keen eye on the land market and the business conducted under the Great Seal. Although personally devout and a committed Protestant, the study of Marischal’s interaction with the national Kirk and the parishes of which he was patron reveal that he was at times a negligent patron and exercised his right of ministerial presentation as lordly, not godly patronage. The notion of a ‘conservative North East’ is, however, rejected. Where Marischal was politically weak at court and weak in terms of force in the locality, we see him pursuing sideways approaches to dealing with this. Thus he was keen to build up his general influence in the north and in particular with the burgh of Aberdeen (one result of this being the creation of Marischal College in 1593), pursued disputes through increasing use of legal methods rather than bloodfeud (thus exploiting his wealth and compensating for his relative lack of force) and developed a sophisticated system of maritime infrastructure, ultimately expressed through the creating of the burghs of Peterhead and Stonehaven. Although his close family caused him a number of problems over his lifetime, he was able to pass on a stable and enlarged lordship to his son in 1623.

The Essentials of Narrative: A Synthesis of the West and the East

This is a study on the nature of narrative in light of a narratological theory inspired by a comparison of narratives in the West and the East, and which tries to reach a deeper understanding of narratives in their particular cultural milieus as well as the nature of narrative per se. The macroscopic structure which the subject itself demands gives coherence to the study of elements which do not solely belong to narrative texts but nevertheless are essential for a text to function as a narrative. The essentials under investigation are the narrator's perspective (which gives a narrative its internal structure), language (which both enables and affects the formation of narrative), and the notion of genre (which plays a crucial role in the interpretation of narrative). These elements were selected after a consideration of theorles postulated by Erich Auerbach, Northrop Frye, Fredric Jameson and Mikhail Bakhtin, as well as of the key properties of narrative as traditionally treated in Chinese scholarship on narrative. After the initial chapter, each chapter consists of a theoretical discussion on the main topic, followed by an analysis of a particular aspect of the subject as revealed in an American novel and in a Chinese novel. These subjects in elude the internal structure of narrative, fictionalization, the objectivity of language and the diversity of voices, the potentiality of language and the elosure of narrative, plot and the ordering of a narrative, and fragmentarity and the perceiving of a narrative. In theoretical discussions, the essay challenges theories proposed by Wayne Booth, Michel Foucault, Umberto Eco, Stanley Fish, Roman Jakobson, Jacques Derrida, Jonathan Culler and Tzvetan Todorov. The major texts discussed are Henry James's The Portrait of a Lady, Luo Guanzhong's Three Kingdoms, William Faulkner's Absalom. Absalom!, Cao Xueqin's Dream of the Red Chamber. Edgar Allan Poe's "Ligeia," and Liu E's The Travels of Laocan. The central idea of the research is to question such assumptions as made by Anthony Burgess in his article on the novel in The Encyelopaedia Britannica (15th ed) that "novelists, being neither poets nor philosophers, rarely originate modes of thinking and expression."

Bilateral Chylothorax Secondary to Retrosternal Goitre: a Case Report and Review of the Literature

Chylothorax is characterized by an accumulation of lymphatic fluid in the pleural cavity due to damage to the thoracic duct. The aetiology can be traumatic or non-traumatic. Goitre is a rare cause of chylothorax with only eight cases previously described in the literature including only one case causing a bilateral chylothorax. This report describes a patient with bilateral chylothorax secondary to substernal goitre, which was successfully treated, and discusses this very rare case in light of the available literature.

Acute Cholecystitis as a Complication After Colonoscopy: A Case Report and Literature Review

Acute cholecystitis after colonoscopy is a rare event, with less than 10 cases described in the literature. We report the case of a male patient with silent gallstones who underwent colonoscopy for follow-up of his Crohn’s disease. The colonoscopy revealed erosions in the terminal ileum, from which biopsies were taken. A sessile polyp 4 mm in diameter at the recto-sigmoid junction was also removed. Less than 24 h after the colonoscopy, the patient complained of upper right quadrant pain, nausea and vomiting. Based on the clinical findings, laboratory data and ultrasonography, we diagnosed acute cholecystitis and excluded any complication after the colonoscopy. Laparoscopic cholecystectomy was performed and the patient was discharged.

Gender and East Asian Welfare States: from Confucianism to Gender Equality

How can we understand the gender logic underpinning the welfare states/systems of East Asia? Does the comparative literature, which has largely been concerned with western Welfare states, whether in The Three Worlds of Welfare Capitalism (Esping-Andersen 1990), or in gender-based analysis of the male breadwinner model (Lewis 1992, 2001, 2006), have anything to offer in understanding the gender assumptions underpinning East Asian welfare states? Are the welfare systems of East Asian countries distinctive, with Confucian assumptions hidden beneath the surface commitment to gender equality? We will use the (mainly western) comparative literature, but argue that Confucian influences remain important, with strong assumptions of family, market and voluntary sector responsibility rather than state responsibility, strong expectations of women’s obligations, without compensating rights, a hierarchy of gender and age, and a highly distinctive, vertical family structure, in which women are subject to parents-in-law. In rapidly changing economies, these social characteristics are changing too. But they still put powerful pressures on women to conform to expectations about care, while weakening their rights to security and support. Nowhere do welfare states’ promises bring gender equality in practice. Even in Scandinavian countries women earn less, care more, and have less power than men. We shall compare East Asian countries (Japan, Korea, Taiwan where possible) with some Western ones, to argue that some major comparative data (e.g. OECD) show the extreme situation of women in these countries. Some fine new qualitative studies give us a close insight into the experience of mothers, including lone and married mothers, which help us to understand how far the gender assumptions of welfare states are from Scandinavia’s dual earner model. There are signs of change in society as well as in economy, and room for optimism that women’s involvement in social movements and academic enquiry may be challenging Confucian gender hierarchies.

What can exploratory modelling tell us about the ecobiology of European sea bass ( Dicentrarchus labrax ): a comprehensive overview

European sea bass, Dicentrarchus labrax, is a highly valuable species in Europe, both for aquaculture in the Mediterranean Sea and for commercial and recreational fisheries in the North East Atlantic Ocean. Subjected to increasing fishing pressure, the wild population has recently experienced significant recruitment fluctuation as well as a northward extension of its distribution area in the North Sea. While the nature of the ecological and/or physiological processes involved remains unresolved, ontogenetic habitat shifts and adult site fidelity could increase the species’ vulnerability to climate change and overfishing. As managers look for expert information to propose management scenarios leading to sustainable exploitation, exploratory modelling appears to be a cost-efficient approach to enhance the understanding of recruitment dynamics and the spatio-temporal scales over which fish populations function. A conceptual modelling framework and its specific data requirements are discussed to tackle some sound ecological questions regarding this species. We consequently provide an updated review of current knowledge on bass population structure, biology and ecology. This paper will hence be particularly valuable to develop spatially-explicit models of European sea bass dynamics under environmental and anthropogenic forcing. Knowledge gaps requiring further research efforts are also reported.

New worlds and new churches: The Orthodox Church(es) and the European Union

The Orthodox church(es) share a common commitment to the unity of dogma and spirituality. There is, however, no doctrinal formulation that comes close to a form of political theology at a pan-Orthodox level. This means that the Orthodox churches’ attitude towards the European Union (EU) is driven by their ecclesial diversity and by complex inter-ecclesial relations. More fundamentally they share a fragmented and plural, theological objection to the very ideas of Europe and the West. This has been further complicated by the emergence of a substantial Orthodox diaspora from Eastern Europe, Russia, and the Middle East living across the breadth of the European continent. Consequently the ecclesial identity and self-perception of the autocephalous Orthodox churches is changing. These churches are becoming increasingly transnational and extra-territorial. With this, their perception of Europe and the West, as seen through the eyes of their diaspora communities, is altering from “threat” to “home” (Makrides and Uffelmann, 2003). The growing diaspora will not only impact the Christian demographics of Europe but will also transform the Eastern Churches’ view of Europe and the EU (Leustean, 2009; 2011; 2013; 2014a; 2014b).

Dyslipidemia and blood lipid levels in patients tratied in primary care centers in east SAN JOSE

Dyslipidemia, i.e. high levels of blood lipids (cholesterol and triglycerides), is strongly related to cardiovascular disease (CVD). In order to reduce the risk of CVD at any moment in a person ́s life, it is crucial to know his/her –and the population’s– lipid profile. The aim of this study was to assess the (statistical) indicators of blood lipids and the prevalence of dyslipidemia in patients treated in the Integral Health Attention Program from Universidad de Costa Rica. A descriptive study was conducted including 10,044 patients aged 20 to 65 years, who were tested for a blood lipid profile in 2006. A total of 2,969 (29.6%) male and 7,075 (70.4%) female patients took part in the study, with an average age of 43.5 years. General averages for blood lipids were: 203.3 mg/dl for total cholesterol, 50.1 mg/dl for HDL, 120.1 mg/dl for LDL, and 165.6 mg/dl for triglycerides. Prevalence of 17.2% was determined for hypercholesterolemia (≥240 mg/dl), as well as 21.3% for low HDL levels (<40 mg/dl), 11.9% for high LDL levels (≥160 mg/dl), and 26.3% for high triglyceride levels (≥200 mg/dl). Women showed higher overall levels of dyslipidemia than men. Based on health areas, no significant differences were found in general lipid levels by age or sex. Results indicate that the general prevalence of dyslipidemia is close to half the rate reported in worldwide literature and lower than results reported in Costa Rican studies. However, general averages exceeded optimal levels for each blood lipid; consequently, it is important to develop health interventions oriented to reduce the impact of dyslipidemia in the studied population.

A primeira tradução de o leão e a joia, de Wole Soyinka, para o português do Brasil : análise descritiva da oralidade

Dissertação (mestrado)—Universidade de Brasília, Instituto de Letras, Departamento de Línguas Estrangeiras e Tradução, Programa de Pós-Graduação em Estudos da Tradução, 2016.

Clinical communication and adverse health events: literature review

Abstract Health institutions have an increased risk of occurrence of errors due to their diversity, specificity and volume of services, representing a great concern for health professionals whose main function is to protect the health and lives of their patients. We intend to identify a body of evidence, that shows what the most common adverse events are and what adverse events potentially arise from clinical miscommunications. An integrative literature review using the keywords "Adverse Events", "Patient Safety", "Communication". An inquiry was made on databases PubMed, Web of Science, Scielo and CINAHL, in articles published between January 2010 and March 2016, available in Portuguese and English. Of the 216 articles that emerged were selected eight articles that answered the research questions: what are the most common adverse events that have their origin in communication errors? Analyzing the selected studies, it appears that the most common adverse events arise in the context of obstetrics and pediatrics, in surgical contexts, in the continuity of care and related medication. Patient safety should be seen as a key component of quality in health care, with good management of the risk of fundamental error for the promotion of this security. The knowledge and understanding that communication failures are one of the main factors contributing to the occurrence of errors in the context of health care, allows the subsequent development of strategies to improve this process and thus ensure safer healthcare.

Literature review and update of lower limb neural mobilization

Summarize the available literature descriptions of neural mobilization (NM) techniques and neural provocation tests (NPT) for the Lower Limb (LL). Compilation of data was performed in May 2016 using MEDLINE data base, Google Scholar and the library of the European University of Madrid. After application of inclusion/exclusion criterions 5 books and 14 journal publications where found to be of interest and used during data extraction.Results: a list of 8 different LLNM techniques are applied in a rhythmic alternating oscillatory cycle fashion, starting in the initial position from where the therapist proceeds to move the limb in order to achieve a final position. LL NPTs are useful tools for differential diagnose and selecting the proper LLNM procedure. There is no consensus about the time frame of repetition intervals or amount of tensile strength during NPT never the less it is found to normally be performed at a rate of 2-4 seconds per complete cycle of movement, during 1-5 minutes, 3-5 times a week. LLNM treatment techniques all thou increasingly popular in clinical practice are found to be frugally described and lack proper standardization in regards to therapeutic dosification.

Methodology used in studies reporting chronic kidney disease prevalence : a systematic literature review

BACKGROUND: Many publications report the prevalence of chronic kidney disease (CKD) in the general population. Comparisons across studies are hampered as CKD prevalence estimations are influenced by study population characteristics and laboratory methods. METHODS: For this systematic review, two researchers independently searched PubMed, MEDLINE and EMBASE to identify all original research articles that were published between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European adult general population. Data on study methodology and reporting of CKD prevalence results were independently extracted by two researchers. RESULTS: We identified 82 eligible publications and included 48 publications of individual studies for the data extraction. There was considerable variation in population sample selection. The majority of studies did not report the sampling frame used, and the response ranged from 10 to 87%. With regard to the assessment of kidney function, 67% used a Jaffe assay, whereas 13% used the enzymatic assay for creatinine determination. Isotope dilution mass spectrometry calibration was used in 29%. The CKD-EPI (52%) and MDRD (75%) equations were most often used to estimate glomerular filtration rate (GFR). CKD was defined as estimated GFR (eGFR) <60 mL/min/1.73 m(2) in 92% of studies. Urinary markers of CKD were assessed in 60% of the studies. CKD prevalence was reported by sex and age strata in 54 and 50% of the studies, respectively. In publications with a primary objective of reporting CKD prevalence, 39% reported a 95% confidence interval. CONCLUSIONS: The findings from this systematic review showed considerable variation in methods for sampling the general population and assessment of kidney function across studies reporting CKD prevalence. These results are utilized to provide recommendations to help optimize both the design and the reporting of future CKD prevalence studies, which will enhance comparability of study results.

Broad-scale mapping of seafloor habitats in the north-east Atlantic using existing environmental data

If marine management policies and actions are to achieve long-term sustainable use and management of the marine environment and its resources, they need to be informed by data giving the spatial distribution of seafloor habitats over large areas. Broad-scale seafloor habitat mapping is an approachwhich has the benefit of producing maps covering large extents at a reasonable cost. This approach was first investigated by Roff et al. (2003), who, acknowledging that benthic communities are strongly influenced by the physical characteristics of the seafloor, proposed overlaying mapped physical variables using a geographic information system (GIS) to produce an integrated map of the physical characteristics of the seafloor. In Europe the method was adapted to the marine section of the EUNIS (European Nature Information System) classification of habitat types under the MESH project, andwas applied at an operational level in 2011 under the EUSeaMap project. The present study compiled GIS layers for fundamental physical parameters in the northeast Atlantic, including (i) bathymetry, (ii) substrate type, (iii) light penetration depth and (iv) exposure to near-seafloor currents andwave action. Based on analyses of biological occurrences, significant thresholds were fine-tuned for each of the abiotic layers and later used in multi-criteria raster algebra for the integration of the layers into a seafloor habitat map. The final result was a harmonised broad-scale seafloor habitat map with a 250 m pixel size covering four extensive areas, i.e. Ireland, the Bay of Biscay, the Iberian Peninsula and the Azores. The map provided the first comprehensive perception of habitat spatial distribution for the Iberian Peninsula and the Azores, and fed into the initiative for a pan- European map initiated by the EUSeaMap project for Baltic, North, Celtic and Mediterranean seas.

Valor diagnóstico del pepsinógeno i/ii como biomarcador de lesiones pre-malignas y malignas gástricas: revisión sistemática

Antecedentes: El cáncer gástrico se diagnostica tardíamente. Sólo en países como Corea y Japón existen políticas de tamizaje, que se justificarían en cualquier país con alta prevalencia de cáncer gástrico como Colombia o Chile. El análisis del pepsinógeno sérico se ha propuesto para el diagnóstico de lesiones premalignas y malignas gástricas, por lo cual se pretende revisar sistemáticamente en la literatura el valor diagnóstico del cociente pepsinógeno I/II como marcador de lesiones premalignas y malignas gástricas. Metodología: Se revisó la literatura hasta septiembre del 2016 con palabras claves lesiones malignas, premalignas gástricas y pepsinógeno en las bases de datos PubMed, OVID, EMBASE, EBSCO, LILACS, OPENGRAY y Dialnet, artículos de prueba diagnóstica que evaluaran el cociente pepsinógeno I/II en relación con los hallazgos histológicos. Resultados: Se incluyeron 21 artículos conun total de 20601 pacientes, que demuestranuna sensibilidad entre13.7% - 91.2%, una especificidad entre 38.5% - 100%, un Valor Predictivo Positivo entre 6.3% - 100% y un Valor Predictivo Negativo entre 33.3% - 98.8%del cociente pepsinógeno I/II en relación con el diagnósticode lesiones premalignas y malignas gástricas. Conclusiones: Los valores del cociente pepsinógeno I/II disminuidos se relacionan con la presencia delesiones premalignas y malignas gástricas.Dado que tiene mejor especificidad que sensibilidad, en cuanto prueba para tamizaje, sería útil para la selección de pacientes que se beneficiaríande la EVDA. Se requieren más estudios de prueba diagnóstica para validar un punto de corte específico que pueda ser utilizado como valor estándar.