‘And how long have you been sick?’: The discursive construction of symptom duration during acute general practice visits and its implications for ‘doctorability’

2015 ◽  
Vol 27 (3) ◽  
pp. 330-349 ◽  
Author(s):  
Søren Beck Nielsen
Keyword(s):  
General Practice ◽  
Interaction Analysis ◽  
Symptom Duration ◽  
Discursive Construction ◽  
Shared Understanding ◽  
Duration Of Symptoms ◽  
Problem Presentation ◽  
Long Time ◽  
Huge Impact ◽  
The Subject

This study uses Conversation Analysis to investigate how doctors and patients talk about the duration of patients’ symptoms during acute general practice consultations in Denmark. Both parties treat it important to address and reach shared understanding about this issue, and it is the subject of much clarification and negotiation. Mentioning the duration of symptoms may be patient-initiated from the very outset of the consultation, as part of the problem presentation, or doctor-solicited in the subsequent interaction. Analysis reveals that in both cases, patients use concepts that stress relative duration as part of efforts to legitimise their visits. Legitimisation by such means is most evident in connection with doctor-solicited mention of duration of symptoms. Patients treat doctors’ questions as preferring an answer, which confirms that they have been sick for a long time. Overall, the study provides insight about the huge impact that discussions about time have for conversational organisation during consultations. It also shows how a shared understanding of the duration of symptoms is treated as a precondition for medical decisions and entitlements.

An Adaptive and Learning System for Feedback-Controlled Evoked Response Studies

1981 ◽  
Vol 20 (03) ◽  
pp. 169-173
Author(s):  
J. Wagner ◽  
G. Pfurtscheixer
Keyword(s):  
Brain Activity ◽  
Evoked Response ◽  
Learning System ◽  
Time Interval ◽  
Electrical Brain Activity ◽  
Long Time ◽  
The Subject ◽  
Eeg Power ◽  
Stimulation System ◽  
Background Eeg

The shape, latency and amplitude of changes in electrical brain activity related to a stimulus (Evoked Potential) depend both on the stimulus parameters and on the background EEG at the time of stimulation. An adaptive, learnable stimulation system is introduced, whereby the subject is stimulated (e.g. with light), whenever the EEG power is subthreshold and minimal. Additionally, the system is conceived in such a way that a certain number of stimuli could be given within a particular time interval. Related to this time criterion, the threshold specific for each subject is calculated at the beginning of the experiment (preprocessing) and adapted to the EEG power during the processing mode because of long-time fluctuations and trends in the EEG. The process of adaptation is directed by a table which contains the necessary correction numbers for the threshold. Experiences of the stimulation system are reflected in an automatic correction of this table. Because the corrected and improved table is stored after each experiment and is used as the starting table for the next experiment, the system >learns<. The system introduced here can be used both for evoked response studies and for alpha-feedback experiments.

The Phantom Defense: America's Pursuit of the Star Wars Illusion. By Craig Eisendrath, Melvin A. Goodman, and Gerald E. Marsh. Westport, CT: Praeger, 2001. 216p. $24.95. Ballistic Missile Defense and the Future of American Security: Agendas, Perceptions, Technology, and Policy. By Roger Handberg. Praeger, 2001. 264p. $62.00. Rockets' Red Glare: Missile Defenses and the Future of World Politics. Edited by James J. Wirtz and Jeffrey A. Larsen. Boulder, CO: Westview, 2001. 368p. $28.50.

2002 ◽  
Vol 96 (4) ◽  
pp. 879-880
Author(s):  
David Goldfischer
Keyword(s):  
World Politics ◽  
Ballistic Missile ◽  
Missile Defense ◽  
Star Wars ◽  
Technological Context ◽  
The Future ◽  
Ballistic Missile Defense ◽  
Long Time ◽  
Strategic Defense ◽  
The Subject

As Michael O'Hanlon concludes in his excellent contribution to Rockets' Red Glare: “We should…get used to the debate over ballistic missile defenses. It has been around a long time, and no final resolution is imminent” (p. 132). In one sense, a review of these three recent books makes clear that many analysts had grown a bit too used to positioning themselves in terms of the 1972 ABM Treaty. Preoccupied with arguments over whether the treaty should be preserved, modified, or rewritten in light of a changing strategic and technological context, no one seemed to have anticipated that President George W. Bush would simply withdraw from it, invoking Article XV's provision that either party could withdraw if “extraordinary events related to the subject matter of this Treaty have jeopardized its supreme interests.” Even many strategic defense supporters who deemed the treaty obsolete (as Robert Joseph persuasively maintains in his contribution to Rockets' Red Glare) generally believed that it should only—and would only—be scrapped if negotiations over U.S.-proposed changes broke down. (“The Bush Administration,” surmises O'Hanlon, “will surely try very hard to amend it before going to such an extreme”) (p. 112). In the event, the president's team disavowed even the word “negotiation,” saying they were willing only to “consult” the Russians regarding the treaty's impending demise.

scholarly journals POS1120 PRESENCE OF TOPHI IS ASSOCIATED WITH A RAPID DECLINE IN THE RENAL FUNCTION IN PATIENTS WITH GOUT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 839.1-839
Author(s):  
Y. J. Oh ◽  
K. W. Moon
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Clinical Characteristics ◽  
Multivariate Logistic Regression Analysis ◽  
Joint Involvement ◽  
Rapid Decline ◽  
Symptom Duration ◽  
Tophaceous Gout ◽  
Duration Of Symptoms ◽  
Increased Risk

Background:Gout is the most common inflammatory arthritis resulting from a chronic deposition of MSU crystals in the joints and other soft tissues. After the process of repeated tissue damage and repair due to gout, tophi could be formed around the affected joints. Intra-articular tophi may sometimes result in bone destruction, joint deformities, and dysfunction which can adversely affect the patient’s quality of life. Furthermore, early-onset tophaceous gout patients are more likely to develop renal dysfunction, however, few studies have investigated if the presence of tophi is related with the progression of renal dysfunction in gout patients.Objectives:We aimed to compare clinical characteristics of patients with and without tophi at the time of the diagnosis of gout and investigate the effect of tophi on the renal function in gout patients.Methods:Data of 257 patients who were first diagnosed with gout at the Kangwon National University Hospital from January 2012 to December 2018 were retrospectively studied. Patients were divided into 2 groups according to the presence of tophi at the diagnosis. We compared clinical characteristics and the progression of renal dysfunction between the two groups.Results:Of all patients, 66 (25.5%) initially presented with tophi. Patients with tophi were older, had a longer duration of symptoms, and had a higher prevalence of multiple joint involvement than those without tophi. The decline in the eGFR was more prominent in patients with tophi than in those without (-4.8±14.5 ml/min/1.73m2vs. -0.7±11.9 ml/min/1.73m2, respectively; P=0.039). In multivariate logistic regression analysis, a prolonged symptom duration (odds ratio [OR], 1.010; 95% confidence interval [CI], 1.004–1.017; P=0.001) and multiple joint involvement (OR, 3.027; 95% CI, 1.831–5.004; P<0.001) were significantly associated with increased risk of formation of tophi. The presence of tophi was significantly associated with a rapid decline in the eGFR (β=-0.141; P=0.035).Conclusion:A prolonged symptom duration and multiple joint involvement were independent risk factors for tophi as the presenting symptom in gout patients. The presence of tophi was associated with a declining renal function. Therefore, an early diagnosis and active treatment are important in tophaceous gout.References:[1]Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol 2014;26:186-91.[2]Liu F, Du GL, Song N, Ma YT, Li XM, Gao XM, et al. Hyperuricemia and its association with adiposity and dyslipidemia in Northwest China: results from cardiovascular risk survey in Xinjiang (CRS 2008-2012). Lipids Health Dis 2020;19:58.[3]Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet 2016;388:2039-52.[4]Ruoff G, Edwards NL. Overview of Serum Uric Acid Treatment Targets in Gout: Why Less Than 6 mg/dL? Postgrad Med 2016;128:706-15.[5]Bieber A, Schlesinger N, Fawaz A, Mader R. Chronic tophaceous gout as the first manifestation of gout in two cases and a review of the literature. Semin Arthritis Rheum 2018;47:843-8.Disclosure of Interests:None declared.

scholarly journals 1501. Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED): Updates from Year 2 of multi-site trial

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S752-S753
Author(s):  
Stephanie A Richard ◽  
Timothy Burgess ◽  
Timothy Burgess ◽  
Limone Collins ◽  
Rhonda Colombo ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Clinic Visit ◽  
Vaccine Effectiveness ◽  
Symptom Duration ◽  
Blood Draw ◽  
Duration Of Symptoms ◽  
Nasal Swabs ◽  
Second Year ◽  
Military Facilities ◽  
Pragmatic Assessment

Abstract Background Despite nearly universal influenza vaccination for active duty military personnel, breakthrough influenza infections occur. We are reporting on the second year of the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED), comparing three FDA-licensed influenza vaccine types (egg-based, cell -based, and recombinant) to assess differences in immunogenicity and effectiveness. Methods Participants in the second year of PAIVED were enrolled from Oct 2019 through Jan 2020 at 9 military facilities. Participants received weekly inquiries about influenza-like-illnesses (ILI) experienced in the past week, and if the participant reported having a cough or sore throat and a) muscle/body aches or fatigue and/or b) being feverish or having chills, they were scheduled for a clinic visit. During this visit, a blood sample and a nasal swab were collected, as well as information about symptom duration and severity. A second (convalescent) visit was conducted approximately 4 weeks later, which involved collecting additional information about the duration of symptoms and illness burden, as well as a second blood draw. Due to the COVID-19 pandemic, acute and convalescent visits were disrupted at most sites in March and April due to COVID-19 precautions. Results PAIVED year 2 enrolled 5,892 participants who completed demographic forms (Table 1). Among those who reported any ILIs, most reported one ILI (1,345), while 264 reported two ILIs, and 42 reported three ILIs. Nasal swabs were processed from 273 ILIs at four sites (Fig 1), and 14 cases of influenza were identified thus far. The median duration of ILIs was ten days, with a median of three days of limited activity, and two days with fever. Nine individuals were hospitalized. Table 1. Demographic characteristics of individuals enrolled in PAIVED 2019/20 Figure 1. Lab results as of 5/15 (N=273 samples) Conclusion Over 25% of participants reported an ILI, and 5% of the nasal swabs that have been tested thus far have been positive for influenza. While most samples have not yet been analyzed, we have identified some breakthrough cases of influenza among vaccinated participants. Planned analyses include comparative vaccine effectiveness in order to inform future vaccine purchasing decisions. Disclaimer Disclosures All Authors: No reported disclosures

scholarly journals 508. Biomarker elevation during COVID-19: Differences between ambulatory and hospitalized individuals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S319-S320
Author(s):  
Paul W Blair ◽  
Charlotte Lanteri ◽  
Deborah Striegel ◽  
Brian Agan ◽  
Ryan C Maves ◽  
...  
Keyword(s):  
Principal Component Analysis ◽  
Negative Binomial ◽  
Principal Component ◽  
Component Analysis ◽  
Ambulatory Setting ◽  
Level Of Care ◽  
Symptom Duration ◽  
Duration Of Symptoms ◽  
Course Of Illness ◽  
D Dimer

Abstract Background While the majority of illness due to COVID-19 does not require hospitalization, little has been described about the host inflammatory response in the ambulatory setting. Differences in the levels of inflammatory signaling proteins between outpatient and hospitalized populations could identify key maladaptive immune responses during COVID-19. Methods Samples were collected from 76 participants (41% female, mean 46.8 years of age) enrolled at five military treatment facilities between March 20, 2020 and June 17, 2020 in an ongoing prospective COVID-19 cohort. This analysis was restricted to those with positive SARS-CoV-2 (severe acute respiratory syndrome–coronavirus 2) RT-PCR testing and included hospitalized (N=29; 10 requiring an ICU stay) and non-hospitalized (N=43) participants. Severity markers (IL6, D-dimer, procalcitonin, ferritin, ICAM-1, IL5, lipocalin, RAGE, TNFR, VEGFA, IFNγ, IL1β) were measured in plasma (mg/dL) using the Ella immunoassay and natural log transformed. Univariate negative binomial regression was performed to determine relative risk of hospitalization. Using the full marker panel, we performed a Principal Component Analysis (PCA) to determine directions of maximal variance in the data. Pearson’s correlation coefficient was determined between analytes and each axis. Results Participants requiring ambulatory-, hospital-, and ICU-level care had samples collected at 44.0 (IQR: 35.0–51.0), 40.0 (13.0–51.0), and 47.5 (21.0–54.0) days, respectively. Higher unadjusted levels of IL6, D-dimer, procalcitonin, or ferritin were each associated with hospitalization (Table 1). The PCA showed a separation along axes between level of care and duration of symptoms (Fig 1). While significant correlations were noted with a number of biomarkers, PC1 most correlated with TNFR1 (r=0.88) and PC2 most correlated with IL6Ra (r=0.95). PC1 axis variation accounted for 36.5% of variance and the PC2 axis accounted for 20.0% of variance. Figure 1. Principal Component Analysis (PCA) of biomarkers by level of care and symptom duration. Conclusion TNFR1 and IL6Ra levels correlated with differences in the proinflammatory states between hospitalized and non-hospitalized individuals including time points late in the course of illness. Further analysis of these preliminary findings is needed to evaluate for differences by stages of illness. Disclosures All Authors: No reported disclosures

How Far Scientific is Snakebite Prevention and First Aid Treatment in School Textbook?

2019 ◽  
Vol 31 (1) ◽  
pp. 39-40
Author(s):  
Faiha Fairouz ◽  
Rumana Rashid ◽  
Abdullah Abu Sayeed
Keyword(s):  
Health Problem ◽  
Rural Areas ◽  
Elementary Science ◽  
First Aid ◽  
Primary Treatment ◽  
National Guidelines ◽  
Long Time ◽  
Class Viii ◽  
The Subject ◽  
School Books

Background: Snakebite is an old health problem in rural areas. In Bangladesh, the snakebite issue is included in school syllabus, in curriculum since long time, so that people can take/get immediate first aid treatment and can prevent snakebite. The success of snakebite treatment depends more on providing first aid treatment immediately after snakebite by learning and by sending the patients quickly to hospital. Snakebite is a preventable health problem indeed. If it can be prevented the rate of snakebite will also decrease. In the recently published snake bite management Guideline by WHO it has been targeted to reduce 50% of mortality & disability due to snakebite by 2030.1 Methods: a. The snakebite topic or issue has been thoroughly reviewed in the secondary and higher secondary school books. b. National Guidelines on snakebite in providing/ giving first aid treatment has been reviewed.2 c. The correlation between the topic to learn the subject and the national guidelines have been reviewed and given taken into account. d. The similarity or correlation between the national guidelines and the topic in the prevention of snakebite in the book have been observed & reviewed. It was a descriptive/narrative research study. Results: In the book of class IV in Primary and Secondary level students, ‘Elementary Science, (‘Prathomiik Bigghan’) page no. 86 and in book of class VIII Home Science (‘Gharjhastha Biggan’) page no. 16 the Snakebite issue/topic is mentioned.2,3 There are 22 information on the first aid/primary treatment of Snakebite among which 5 (five) are nonscientific rather harmful. (Table & Picture) Bangladesh J Medicine Jan 2020; 31(1) : 39-40

Latins and Greeks in Debate over Purgatory, 1230–1439

1984 ◽  
Vol 35 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Robert Ombres
Keyword(s):  
Thirteenth Century ◽  
Long Time ◽  
The Subject ◽  
The Common ◽  
Common Agenda

By the 1230s Latins and Greeks were riot short of issues for debate or polemic, but the topic of purgatory did have a novel feel about it. The doctrine seems to emerge on the common agenda fairly suddenly, finding no place, for example, in the wide-ranging list of 104 points of divergence drawn up by the Byzantine prelate, Constantine Stilbès, in the wake of the cruel sack of Constantinople by the Latins in 1204. The subject did, however, establish itself as a hardy perennial, and it is proposed to trace its main ramifications up to the death of Emperor Michael viii in 1282, and then to concentrate on the Council of Ferrara–Florence (1438–9). Without a doubt the debates and the constant attempts at reunion were not conducted in isolation from wider cultural, political and military considerations, the kind of considerations that in 1400 would lead the Byzantine emperor to journey as far as England. But here the emphasis will fall on the theological aspects. Moreover, there were also in play forces of inertia, ignorance and mutual incomprehension difficult to assess rationally. The thirteenth-century friar, Humbert of Romans O.P., in discussing what would make for reunion with the Greeks noted how a schism might be continued simply because it had existed for a long time, just like the feud between Guelf and Ghibelline.

Again on relative clause and subordination in Latin

2014 ◽  
Vol 13 (1) ◽  
Author(s):  
Gualtiero Calboli
Keyword(s):  
Relative Clause ◽  
Syntactic Structure ◽  
Central Point ◽  
Relative Pronoun ◽  
Case Theory ◽  
Nominative Case ◽  
Subordinate Clauses ◽  
Long Time ◽  
The Subject ◽  
The Law

AbstractI started from the relative clause which occurs in Hittite, and in particular with the enclitic position of the relative pronoun. This is connected with the OV position and this position seems to have been prevailing in Hittite and PIE. The syntactic structure usually employed in Hittite between different clauses is the parataxis. Nevertheless, also the hypotaxis begins to be employed and the best occasion to use it was the diptych as suggested by Haudry, though he didn't consider the most natural and usual diptych: the law, where the crime and the sanction build a natural diptych already in old Hittite. Then I used Justus' and Boley's discussion on the structure of Hittite sentence and found a similarity with Latin, namely the use of an animate subject as central point of a sentence. With verbs of action in ancient languages the subject was normally an animate being, whereas also inanimate subject is employed in modern languages. This seems to be the major difference between ancient and modern structure of a sentence, or, better to say, in Hittite and PIE the subject was an animate being and this persisted a long time, and remained as a tendency in Latin, while in following languages and in classical grammar the subject became a simple nominal “entity” to be predicated and precised with verb and other linguistic instruments. A glance has been cast also to pronouns and particles (sometimes linked together) as instruments of linking nominal variants of coordinate or subordinate clauses and to the development of demonstrative/deictic pronouns. Also in ancient case theory a prevailing position was assured to the nominative case, the case of the subject.

MUSEUM OF ARCHEOLOGY AND ETHNOGRAPHY OF THE IEI UFRC RAS: CREATION AND DEVELOPMENT

2021 ◽  
Vol 0 (3) ◽  
pp. 103-112
Author(s):  
R.M. MUKHAMETZYANOVA-DUGGAL ◽  
◽  
D.A. KAMALETDINOV ◽  
Keyword(s):  
Twentieth Century ◽  
Significant Contribution ◽  
Southern Urals ◽  
Project Work ◽  
Ethnographic Research ◽  
Historical Science ◽  
The Southern Urals ◽  
Research Activities ◽  
Long Time ◽  
The Subject

The subject of the research is the experience of creating and functioning of the Museum of Archeology and Ethnography of the R.G. Kuzeev Institute of Ethnological Research of the UFRC RAS (MAE IEI UFRC RAS), which is an integral part of the academic museum network formed in the second half of the twentieth century. For a long time, the museum has been exhibiting objects that demonstrate the results of archaeological and ethnographic research in the field of studying the history and culture of the peoples of the Southern Urals. The purpose of this article is to provide a brief overview of the creation of the museum, to consider its development to date; to analyze the main directions of work and the results of museum activities, as well as to determine the specifics and prospects for the development of museum activities of the IEI of the UFRC RAS. In the course of the research, the names of scientists and specialists who participated in the formation of collections are named, information about the acquisition of museum funds and state accounting of objects is provided, the features of exposition activity are highlighted, the most interesting exhibitions and current work in this direction are noted, the implementation of excursion activities is shown, the results of project work are highlighted and the most significant projects are described. Attention is also paid to the results of research activities based on archaeological and ethnographic funds, since this work makes a significant contribution to the development of historical science.

An Introduction to the History of International Law

1924 ◽  
Vol 18 (2) ◽  
pp. 246-259 ◽  
Author(s):  
Baron S. A. Korff
Keyword(s):  
Nineteenth Century ◽  
International Law ◽  
Ancient World ◽  
Long Time ◽  
History Of ◽  
The Subject ◽  
History Of International Law

For a long time writers on international law took it for granted that the subject of their studies was a relatively recent product of modern civilization, and that the ancient world did not know any system of international law. If we go back to the literature of the nineteenth century, we can find a certain feeling of pride among internationalists that international law was one of the best fruits of our civilization and that it was a system which distinguished us from the ancient barbarians. Some of these writers paid special attention to this question of origins and endeavored to explain why the ancient world never could have had any international law.

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