Book Review: Gut Feminism

Review of Gut Feminism by Elizabeth A. Wilson. Duke University Press, 2015

Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement

Background There has been ongoing controversy as to whether prosthesis-patient mismatch (PPM, defined as indexed effective orifice area (EOAI) <0.85 m(2)/cm(2)) influences mortality after aortic valve replacement (AVR). In most studies, PPM is anticipated by reference tables based on mean EOAs as opposed to individual assessment. These reference values may not reflect the actual in vivo EOAI and hence, the presence or absence of PPM may be based on false assumptions. Objective To assess the impact of small prosthesis EOA on survival after aortic valve replacement AVR. Methods 645 patients had undergone an AVR between 2000 and 2007 entered the study. All patients underwent transthoracic echocardiography for determination of the actual EOAI within 6 months postoperatively. In order to predict time from surgery to death a proportional hazards model for competing risks (cardiac death vs death from other causes) was used. EOAI was entered as a continuous variable. Results PPM occurred in 40% of the patients. After a median follow-up of 2.35 years, 92.1% of the patients were alive. The final Cox regression model showed a significantly increased risk for cardiac death among patients with a smaller EOAI (HR=0.32, p=0.022). The effect of EOAI on the 2-5 year mortality risk was demonstrated by risk plots. Conclusions In contrast to previous studies these EOAI values were obtained through postoperative echocardiography, substantially improving the accuracy of measurement, and the EOAI was modelled as a continuous variable. There was a significantly improved survival for larger EOAIs following AVR. Strategies to avoid PPM should become paramount during AVR

MRI evidence for altered venous drainage and intracranial compliance in mild traumatic brain injury.

To compare venous drainage patterns and associated intracranial hydrodynamics between subjects who experienced mild traumatic brain injury (mTBI) and age- and gender-matched controls. Thirty adult subjects (15 with mTBI and 15 age- and gender-matched controls) were investigated using a 3T MR scanner. Time since trauma was 0.5 to 29 years (mean 11.4 years). A 2D-time-of-flight MR-venography of the upper neck was performed to visualize the cervical venous vasculature. Cerebral venous drainage through primary and secondary channels, and intracranial compliance index and pressure were derived using cine-phase contrast imaging of the cerebral arterial inflow, venous outflow, and the craniospinal CSF flow. The intracranial compliance index is the defined as the ratio of maximal intracranial volume and pressure changes during the cardiac cycle. MR estimated ICP was then obtained through the inverse relationship between compliance and ICP. Compared to the controls, subjects with mTBI demonstrated a significantly smaller percentage of venous outflow through internal jugular veins (60.9±21% vs. controls: 76.8±10%; p = 0.01) compensated by an increased drainage through secondary veins (12.3±10.9% vs. 5.5±3.3%; p<0.03). Mean intracranial compliance index was significantly lower in the mTBI cohort (5.8±1.4 vs. controls 8.4±1.9; p<0.0007). Consequently, MR estimate of intracranial pressure was significantly higher in the mTBI cohort (12.5±2.9 mmHg vs. 8.8±2.0 mmHg; p<0.0007). mTBI is associated with increased venous drainage through secondary pathways. This reflects higher outflow impedance, which may explain the finding of reduced intracranial compliance. These results suggest that hemodynamic and hydrodynamic changes following mTBI persist even in the absence of clinical symptoms and abnormal findings in conventional MR imaging

Creating Civically Motivated Science Students: Why is it Important to Teach Civics in Science Education?

Only three of the State of Ohio American Government standards address the teaching of civic responsibility, suggesting that these standards somewhat overlook this very important aspect of education. However, both research in the field and the current state of global affairs suggest that we should be teaching students not only more ways in which they can be successfully civically engaged, but also that we should be teaching civic engagement in our science classrooms. This article identifies the relationship between civic activism and science education while addressing the contemporary world issues that intensify the need to merge both this sect of social studies and scientific disciplines.

Speak for Your Self: Psychoanalysis, Autotheory, and the Plural Self

In this article, I explore the status of the self in autotheory, bringing Freud’s The Interpretation of Dreams together with autotheory’s most popular text, Maggie Nelson’s The Argonauts, to consider the movement in contemporary autotheory away from the split subject and toward of what I call a “plural self.” Reading Freud’s The Interpretation of Dreams as a species, avant la lettre, of autotheory, I chart how Freud’s writing challenged the coherence of the self and introduced the now critically embraced theory of the split subject. While this theory has long been a favored tool for enabling critiques of the self, I claim that recent versions of autotheory have deliberately dispensed with the deconstructed split subject in order instead to construct a plural self. Reading The Argonauts, I consider how this plural self is motivated by a principally ethico-political desire to (re)imagine the self relationally, where self and other are reconfigured as collaborative and cumulative. Ultimately, this article asks what promise for relational solidarity a notion of the plural self holds, and where this promise might find its limit

Beyond Repair: Interpretation, Reparation, and Melanie Klein's Clinical Play Technique

This article puts clinical child psychoanalysis into conversation with recent debates about critical method in order to question the turn toward so-called “reparative reading” in feminist and queer theory. While Eve Kosofsky Sedgwick’s original call for a new kind of reparative method culled its key terms (“reparative” and “paranoid”) from child psychoanalyst Melanie Klein, the scholars who have adopted reparativity in critical theory pay little attention to Klein’s work. In this article, I take up Klein’s theory of the depressive position and reparativity as she elaborated them in her clinical work with children, particularly her wartime analysis of “Richard” in 1941. Klein interpreted Richard’s play—his clinical “war games”—through her idiomatic vocabulary of “attack” and “repair.” By situating this case and Klein’s larger theory of psychic reparations in the political climate of wartime Europe, I argue that Klein’s writings point to the ethico-political dangers inherent in reparative endeavors, which name the object and narrate its injury and repair according only to the perimeters of one’s own self. From this reading, I propose that there might be a benefit to foregoing the injury/repair framework implicit in reparative agendas—both critical and clinical alike. By returning reparativity to Klein, I therefore aim not to offer a corrective to Sedgwick or to the scholars following her, but rather to interrogate the ethical stakes of all reparative endeavors, be they political, intellectual, or clinical. At the most basic level, then, this article argues that the space of the clinic is an important (and often undervalued) object for the consideration of critical method

Impact of the Specific Mutation in KRAS Codon 12 Mutated Tumors on Treatment Efficacy in Patients with Metastatic Colorectal Cancer Receiving Cetuximab-Based First-Line Therapy: A Pooled Analysis of Three Trials

Purpose: This study investigated the impact of specific mutations in codon 12 of the Kirsten-ras (KRAS) gene on treatment efficacy in patients with metastatic colorectal cancer (mCRC). Patients: Overall, 119 patients bearing a KRAS mutation in codon 12 were evaluated. All patients received cetuximab-based first-line chemotherapy within the Central European Cooperative Oncology Group (CECOG), AIO KRK-0104 or AIO KRK-0306 trials. Results: Patients with KRAS codon 12 mutant mCRC showed a broad range of outcome when treated with cetuximab-based first-line regimens. Patients with tumors bearing a KRAS p.G12D mutation showed a strong trend to a more favorable outcome compared to other mutations (overall survival 23.3 vs. 14-18 months; hazard ratio 0.66, range 0.43-1.03). An interaction model illustrated that KRAS p.G12C was associated with unfavorable outcome when treated with oxaliplatin plus cetuximab. Conclusion: The present analysis suggests that KRAS codon 12 mutation may not represent a homogeneous entity in mCRC when treated with cetuximab-based first-line therapy. Copyright (C) 2012 S. Karger AG, Base

Iron Status and Analysis of Efficacy and Safety of Ferric Carboxymaltose Treatment in Patients with Inflammatory Bowel Disease

Background and Aims:We analyzed iron deficiency and the therapeutic response following intravenous ferric carboxymaltose in a large single-center inflammatory bowel disease (IBD) cohort. Methods: 250 IBD patients were retrospectively analyzed for iron deficiency and iron deficiency anemia. A subgroup was analyzed regarding efficacy and side effects of iron supplementation with ferric carboxymaltose. Results: In the cohort (n = 250), 54.4% of the patients had serum iron levels 60 mu g/dl, 61.6% had ferritin >100 ng/ml, and 90.7% reached Hb >12/13 g/dl at follow-up (p < 0.0001 for all parameters vs. pretreatment values). The most frequent adverse event was a transient increase of liver enzymes with male gender as risk factor (p = 0.008, OR 8.62, 95% CI 1.74-41.66). Conclusions: Iron deficiency and anemia are frequent in IBD patients. Treatment with ferric carboxymaltose is efficious, safe and well tolerated in iron-deficient IBD patients. Copyright (C) 2011 S. Karger AG, Base

Estimating individual treatment effects from responses and a predictive biomarker in a parallel group RCT

When being interested in administering the best of two treatments to an individual patient i, it is necessary to know the individual treatment effects (ITEs) of the considered subjects and the correlation between the possible responses (PRs) for two treatments. When data are generated in a parallel–group design RCT, it is not possible to determine the ITE for a single subject since we only observe two samples from the marginal distributions of these PRs and not the corresponding joint distribution due to the ’Fundamental Problem of Causal Inference’ [Holland, 1986, p. 947]. In this article, we present a counterfactual approach for estimating the joint distribution of two normally distributed responses to two treatments. This joint distribution can be estimated by assuming a normal joint distribution for the PRs and by using a normally distributed baseline biomarker which is defined to be functionally related to the sum of the ITE components. Such a functional relationship is plausible since a biomarker and the sum encode for the same information in a RCT, namely the variation between subjects. As a result of the interpretation of the biomarker as a proxy for the sum of ITE components, the estimation of the joint distribution is subjected to some constraints. These constraints can be framed in the context of linear regressions with regard to the proportions of variances in the responses explained and with regard to the residual variation. As a consequence, a new light is thrown on the presence of treatment–biomarker interactions. We applied our approach to a classical medical data example on exercise and heart rate