The Emotionality Activity Sociability Temperament Survey: Factor analysis and temporal stability in a longitudinal cohort

We investigated Buss and Plomin’s Emotionality Activity Sociability (EAS) Temperament Survey for Children, used to assess temperament. Temperament is believed to comprise stable traits that change little over time. We examined stability of EAS temperament in the Avon Longitudinal Study of Parents and Children, in which 7429 mothers completed the EAS when their children were 3, 5 and 6 years old. Factor analysis was conducted at each time point, and stability over time was assessed using correlation and mixed effects regression modelling, accounting for differences within and between individuals. A four-factor model provided the best fit, with 19–20 of the 20 items loading onto the dimensions predicted by Buss and Plomin. Test–retest correlations ranged from 0.52–0.64 (3–5 years), 0.59–0.74 (5–6 years) and 0.46–0.58 (3–6 years). Mixed effects regression modelling suggested good stability over time: differences between, rather than within, individuals accounted for between 69% and 82% of the variance. This study demonstrates the stability of temperament over time, a vital pre-requisite to investigating childhood temperament as a predictor of outcomes.     

Composition and magnetic character of nanometre-size Cu precipitates in reactor pressure vessel steels: Implications for nuclear power plant lifetime extension

The sensitivity of positrons to nanometre-size Cu precipitates in Fe alloys has enabled us to apply a novel spin-polarized element-specific method to probe the composition and magnetic character of the precipitates responsible for reactor pressure vessel (RPV) steel embrittlement. The results clearly show that the precipitates are non-magnetic and place an upper limit of about 10at% on their Fe content. The practical implication of this result is that the Cu precipitate contribution to RPV steel embrittlement saturates is not expected to contribute further during lifetime extension. Our study demonstrates that polarized positrons can be used as a powerful probe of the magnetic character of nanoscale materials, even those embedded in a strongly magnetic host.     

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.     

Mediate Auscultation, the Stethoscope, and the “Autopsy of the Living”: Medicine's Acoustic Culture

The practice of mediate auscultation—listening to the body through a stethoscope—was at the center of new articulations of medical thought and practice in the 19th century. During that period, the stethoscope became the hallmark of medical modernity. This article offers a detailed examination of the work of RTH Laennec and other important writings on the stethoscope in order to argue for the centrality of a distinctive orientation toward listening in modern medicine. The development of mediate auscultation applied medical and scientific reason to listening, just as a particular practice of hearing the body became integral to everyday functioning of medicine. Mediate auscultation was thus an artifact of a new approach to reason and the senses, one based in a scientific mindset and a logic of mediation.     

The 9th annual INDUS-EM 2013 Emergency Medicine Summit, “Principles,Practices, and Patients,” a level one international meeting,Kerala University of Health Sciences and Jubilee Mission Medical College and Research Institute,Thrissur, Kerala,India, October 23–27, 2013

INDUS-EM is India’s only level one conference imparting and exchanging quality knowledge in acute care. Specifically, in general and specialized emergency care and training in trauma, burns, cardiac, stroke, environmental and disaster medicine. It provides a series of exchanges regarding academic development and implementation of training tools related to developing future academic faculty and residents in Emergency Medicine in India. The INDUS-EM leadership and board of directors invited scholars from multiple institutions to participate in this advanced educational symposium that was held in Thrissur, Kerala in October 2013.     

Communication adjustment of patients with a laryngectomy in Turkey: analysis by type of surgery and mode of speech

Previous studies have routinely shown that individuals with a laryngectomy (IWL) have a decreased quality of life (QoL). However, the questionnaires frequently used are not specifically designed for persons with laryngeal cancer and may not reflect the issues of most concern to IWL. The purpose of this study was to investigate (1) the overall communication adjustment of IWL in Turkey, (2) the differences in communication adjustment among types of surgery for the treatment of laryngeal cancer, and (3) the differences in communication adjustment among types of speech following treatment for laryngeal cancer. Fifty-two patients (50 males and two females) who underwent surgical treatment for laryngeal cancer (i.e. total, supraglottic, frontolateral, vertical, supracricoid) and were being seen for follow-up care were recruited from an ENT clinic in Bursa, Turkey. Patients were provided with a written translation of the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) which yielded information on three subscales (General, Environment, and Attitude) and a Total score. Kruskall-Wallis and Wilcoxon signed ranks nonparametric tests of significance showed that overall adjustment was within the well-adjusted range for all types of surgery and modes of speech with two exceptions: Mean scores for supracricoid laryngectomy with cricohyoidopexy (28.5) and esophageal speech (29.3) were both within the poorly adjusted range on the Environment subscale [lowest mean score?=?8.7 (supraglottic)]. Total mean scores ranged from 19.8 (supraglottic) to 49.9 (esophageal speech). Mean scores of the General subscale ranged from 4.0 (electrolaryngeal speech) to 7.7 (tracheoesophageal speech). Mean scores of the Attitude subscale ranged from 6.2 (supraglottic) to 19 (electrolaryngeal). Results of the Kruskall-Wallis test also showed a significant difference between type of surgery for the Environment subscale (p?=?0.003), the Attitude subscale (p?=?0.039), and the Total score (p?=?0.007). The results suggest that overall, IWL in Turkey are well-adjusted to their new voice. However, results also showed that certain conservation surgeries (i.e. supraglottic, frontolateral, vertical) yielded more favorable outcomes than either supracricoid laryngectomy or speech following total laryngectomy. This finding is most likely related to the amount of tissue preserved following conservation surgery, in particular the preservation of the vocal folds.