A Mobile Colonoscopic Unit for Lynch Syndrome: Trends in Surveillance Uptake and Patient Experiences of Screening in a Developing Country

The Genetic and Endoscopic Surveillance Clinic is an annual outreach service offering accessible colonoscopic surveillance to known families with Lynch syndrome living in remote areas of the Western and Northern Cape Province of South Africa. Unfortunately attendance at this outreach clinic has been declining over several years and fewer than a quarter of participants, attending for surveillance, have been adherent with all their recommended screening appointments. Concerns exist for non-adherent individuals as screening can prevent colorectal cancer by removing the precancerous lesion or enabling the treatment of a malignancy at an early stage. This study explored the experience of surveillance from both the non-adherers’ and adherers’ perspectives and identified unique factors affecting attendance at the outreach clinic. Rates of compliance are calculated for 191 mutation-positive cases of Lynch syndrome, using strict attendance criteria, and compared to figures obtained from self-reported attendance. Non-compliance was under-reported and compliance was exaggerated when basing data on self-reported adherence to recommendations. Specific characteristics of the outreach clinic affecting compliance are identified and recommendations are made to facilitate improvements to the service. These improvements can result in increased compliance with screening regimens and ultimately reduce cancer-related mortality.     

Death‐contemplation and contemplative living: Socrates and the Katha Upanishad

This paper seeks to argue that Socrates’ thought on the connection between death‐contemplation and genuine philosophising as reported in Plato's Phaedo, is comparable in many ways to the insight on the same connection contained in the Katha Upanishad. While refraining from a general comparison of the Platonic and the Upanishadic systems, the paper attempts to show, through an original exposition of Phaedo as well as the Katha Upanishad, that both these classics emphasise the value of death‐contemplation for a thoughtful and fundamental assessment of human existence, which is but a genuine task of philosophy.     

After justification: Toward a Dalit public Lutheran theology

The aim of this article is to construct a “Dalit public Lutheran theology” as an “after‐justification” conversation, which drafts an agenda for the future of Lutheran theology in the twenty‐first century. In moving toward that construction, I first briefly explain Dalit theology, public theology, and Lutheran theology and shall discuss the rationale for a Dalit public Lutheran theology. From there I propose that Lutheran theology needs to take a contextual, post‐colonial and subaltern turn. Then I discuss the contours of Dalit public Lutheran theology by discussing one of the pivotal doctrine of Luther, “justification by grace through faith,” by engaging in a Dalit public discourse and propose “hospitality by love” as what comes after justification. Finally, I bring out the relevance of such a theology for our present‐day context. The method I employ in this article is subaltern methodology, which is to “read from below” or “read against the grain.” “After justification” is understood as “beyond” the understanding of doctrine of justification, as a forward‐looking public theological understanding of justification, where it finds fecundity and validity.     

Thinking graphically: Connecting vision and cognition during graph comprehension

Task analytic theories of graph comprehension account for the perceptual and conceptual processes required to extract specific information from graphs. Comparatively, the processes underlying information integration have received less attention. We propose a new framework for information integration that highlights visual integration and cognitive integration. During visual integration, pattern recognition processes are used to form visual clusters of information; these visual clusters are then used to reason about the graph during cognitive integration. In 3 experiments, the processes required to extract specific information and to integrate information were examined by collecting verbal protocol and eye movement data. Results supported the task analytic theories for specific information extraction and the processes of visual and cognitive integration for integrative questions. Further, the integrative processes scaled up as graph complexity increased, highlighting the importance of these processes for integration in more complex graphs. Finally, based on this framework, design principles to improve both visual and cognitive integration are described.     

Influence of precipitation of intermetallics on Young's modulus in nickel and zirconium base alloys

The influence of precipitation of intermetallic phases on changes in Young's modulus in nickel and zirconium base alloys is discussed. This study shows clearly for the first time that the change in the modulus due to precipitation of intermetallic phases in these alloys is essentially governed by the change in the modulus of the matrix due to removal of precipitation forming elements, and not by the modulus of the precipitated intermetallics or the matrix/intermetallic interface.     

Semantic clustering as a neuropsychological predictor for amnestic-MCI

ABSTRACT

Recent research has demonstrated that patients with Alzheimer's disease (AD) show deficits in semantic processing when compared to cognitively healthy individuals. This difference is thought to be attributed to losses in higher cortical systems that are predominantly associated with executive functioning. The first aim of the study will be to determine if differences in semantic clustering can accurately differentiate patients with amnestic mild cognitive impairment (aMCI) from cognitively normal (CN) individuals. The second aim will be to determine the extent to which semantic processing might be associated with executive functions. Data from 202 (134 CN, 68 aMCI) participants were analyzed to quantify differences in semantic clustering ratios on the HVLT-R. Study participants ages ranged from 51 to 87 with education ranging from 6 to 20 years. ANCOVA revealed statistically significant differences on semantic clustering ratios (p < .001). Moderate correlations between semantic clustering Category Fluency Test (r = .45) were also found. Statistically significant group differences were also present on Trails-B and WAIS-R Digit Symbol performance (p < .001). Overall, these data indicate that deficits in semantic clustering are present in aMCI patients.     

Perception of alternated speech operates similarly in young and older adults with age-normal hearing

When speech is rapidly alternated between the two ears, intelligibility declines as the rate of alternation approaches 3 to 5 switching cycles per second, and then, paradoxically, returns to a good level beyond that point. We tested intelligibility when shadowing was used as a response measure (Experiment 1), when recall was used as a response measure (Experiment 2), and when time-compression was used to vary the speech rate of the presented materials (Experiment 3). In spite of claims that older adults are generally slower in switching attention, younger and older adults did not differ in the critical alternation rates producing minimal intelligibility. We suggest that the point of minimal intelligibility in alternated speech reflects an interaction between (1) the rate of disruption induced by breaking the speech stream between two sound sources, (2) the amount of contextual information per ear, and (3) the size of the silent gaps separating the speech elements that must be perceptually bridged.     

Neurocognitive Functioning in AD/HD,Predominantly Inattentive and Combined Subtypes

The Predominantly Inattentive (PI) and Combined (CB) subtypes of AD/HD differ in cognitive tempo, age of onset, gender ratio, and comorbidity, yet a differentiating endophenotype has not been identified. The aim of this study was to test rigorously diagnosed PI, CB, and typical children on measures selected for their potential to reveal hypothesized differences between the subtypes in specific neurocognitive systems (anterior vs. posterior attentional systems) and processes (arousal vs. activation). Thirty-four CB and 26 PI children meeting full DSM-IV criteria for subtype both in school and at home, without confounding reading disability or emotional disorder, were enrolled along with 20 typically developing children. Neurocognitive functions measured included attention, inhibitory control, working memory, learning, and executive functions. Tasks included the Stroop, Wisconsin Card Sorting Test, Continuous Performance Test (CPT). Buschke Selective Reminding Test, ad the Tower of London (TOL), as well as instruments developed by Posner and Sternberg, and tasks assessing the impact on reaction time of [corrected] varying preparatory intervals and stimulus/response complexity. After co-varying for IQ, subtypes differed primarily on measures of impulsivity during tests of vigilance (CPT) and executive function (TOL), with the CB group showing greater impulsivity than both other groups. In addition, the PI group showed worse performance than CB and control groups on the WISC-III Processing Speed Index. Whether analyzed with or without an IQ co-variate, there was no support in the data for hypothesized differences between subtypes in functioning of the anterior vs. posterior attentional systems, nor in involvement of arousal vs. activation processes. The results indicate that the PI and CB subtypes are best differentiated by ratings, observations and tests of cognitive tempo and behavioral impulsivity. Neuropsychological methods have yet to identify critical neuropsychological [corrected] substrates of these differences.     

Exercise Training for Persons with Alzheimer's Disease and Caregivers: A Review of Dyadic Exercise Interventions

Alzheimer's disease (AD) is the most common form of dementia and the prevalence will increase dramatically in the next decades. Although exercise has shown benefits for people with dementia due to AD as well as their caregivers, the impact of a dyadic exercise intervention including both groups as study participants remains to be determined. The authors review the current clinical evidence for dyadic exercise interventions, which are exercise regimens applied to both the person with dementia and the caregiver. A total of 4 controlled trials were reviewed. This review shows that dyadic exercise interventions are feasible and may produce a positive effect on functional independence and caregiver burden. However, there was insufficient evidence to support a benefit of dyadic exercise intervention on cognitive performance and on behavioral and neuropsychiatric symptoms in participants with dementia due to AD. A dyadic exercise intervention improves functional independence and caregiver burden. However, there is a need for well-designed randomized controlled clinical trials to confirm these benefits and to investigate several important points such as the effects of a dyadic exercise intervention on cognitive and noncognitive outcomes of AD, the optimal intensity of exercise training, and the cost effectiveness of such a program.     

Salesperson ambidexterity and customer satisfaction: examining the role of customer demandingness,adaptive selling,and role conflict

This research investigates the effects of sales-service ambidexterity on salesperson role perceptions, behaviors, and customer satisfaction. Using a business-to-business, salesperson-customer sample, we build and test a model which highlights both the positive and negative consequences of this simultaneous goal pursuit. Specifically, while sales-service ambidexterity positively impacts adaptive selling behaviors, it also increases perceptions of role conflict among salespeople. Customer demandingness moderates these relationships. Taken together, the results provide insights for firms on how to manage their sales force to optimize both sales and service outcomes based on characteristics of their salespeople and customers.