La lectura de la hagiografía en inglés antiguo de Juliana, teniendo en cuenta las diferencias con una versión latina anterior, nos permite ver cómo el autor del poema inglés utiliza recursos de la ...narrativa épica germánica, que habrían resultado familiares para su público. A partir de ellos se desarrolla un proceso doble de presentar una mirada crítica sobre los valores heroicos tradicionales y sobre las religiones paganas. El tipo heroico será diferente, ya que el heroísmo no será representado necesariamente por el guerrero con más fuerza física sino por los ryhtfremmendra (righteous people), los godes cempan (guerreros de Dios). Analizaremos, entonces, los recursos narrativos mediante los cuales el autor busca atraer a su audiencia y que el relato, lejano temporal y espacialmente para ella, resulte más cercano y así funcione como ejemplo con la mayor eficacia posible.
La lectura de la hagiografía en inglés antiguo de Juliana, teniendo en cuenta las diferencias con una versión latina anterior, nos permite ver cómo el autor del poema inglés utiliza recursos de la ...narrativa épica germánica, que habrían resultado familiares para su público. A partir de ellos se desarrolla un proceso doble de presentar una mirada crítica sobre los valores heroicos tradicionales y sobre las religiones paganas. El tipo heroico será diferente, ya que el heroísmo no será representado necesariamente por el guerrero con más fuerza física sino por los ryhtfremmendra (righteous people), los godes cempan (guerreros de Dios). Analizaremos, entonces, los recursos narrativos mediante los cuales el autor busca atraer a su audiencia y que el relato, lejano temporal y espacialmente para ella, resulte más cercano y así funcione como ejemplo con la mayor eficacia posible.
Few studies examine whether and how parental attitudes towards genetic testing change over time. In this study we interviewed parents of 14 children with newly identified hearing loss at two time ...points: after referral to genetics and 1 year later. Qualitative analyses of parental narratives indicate that parental attitudes did not change significantly over this time. Parents who perceived genetic testing to be useful continued to value it after testing, while parents who did not perceive it as being useful for their child's future held the same view a year later. The only parents who changed their views regarding the usefulness of genetic testing for hearing loss were those who reported that their children underwent significant changes in their hearing loss or were faced with other life threatening conditions. Parents were also often unaware of the role of the genetic counselor and how genetic counseling could help address many of their lingering questions and concerns. These emergent themes indicate the need for geneticists and genetic counselors to be aware of and sensitized to the questions and attitudes that bring parents to a genetic evaluation, as well as the reasons why parents may not follow up with genetic testing for hearing loss when recommended.
To determine the rate of ophthalmologic anomalies among patients with syndromic and nonsyndromic, congenital sensorineural hearing loss (SNHL) to assess the need for comprehensive ophthalmologic ...evaluation in these children.
Retrospective medical chart review of children with SNHL who underwent comprehensive evaluation by pediatric ophthalmologists and geneticists.
Tertiary care pediatric hospital.
Seventy-seven patients with SNHL.
Degree of hearing loss (HL) and presence of ophthalmologic and genetic disorders.
The overall rate of ophthalmologic disorders was 32% (25 of 77 patients). When children with multisystem genetic disorders known to be related to visual loss were excluded, the rate fell to 23% (12 of 53 vs 13 of 24; P = .006). There was no statistically significant difference in the degree of HL between patients with and without eye disorders (mean SD, 46.5 29.9 vs 49.1 32.3 dB HL; P = .75). Patients with eye disorders were significantly more likely to have a multisystem genetic disorder (13 of 25 52% vs 11 of 52 21%; P = .006). No patients with ocular abnormalities had isolated otologic disorders, but 9 of 52 (17%) of those patients without ocular abnormalities did.
Comprehensive ophthalmologic examination revealed a rate of ophthalmologic disorders in children with SNHL in the lower end of the previously reported rates of 31% to 61%. Children with nonsyndromic SNHL have an approximately 2- to 3-fold increase in ocular abnormalities compared with the general pediatric population. Ophthalmologic and genetic consultations are warranted in patients with congenital SNHL.
Obesity at breast cancer (BC) diagnosis has been associated with poor outcome, although the magnitude of effect in different BC subtypes is uncertain. We report on the association of obesity or ...overweight at diagnosis of nonmetastatic BC with disease-free (DFS) and overall survival (OS) in the following defined subtypes: hormone receptor positive/HER2 negative (HR+HER2-), HER2 positive (HER2+), and triple negative (TNBC).
We searched MEDLINE, EMBASE, and COCHRANE databases up to January 1, 2019. Study eligibility was performed independently by 2 authors. Studies reporting hazard ratios (HRs) of OS and/or DFS for obesity or overweight in BC subtypes were included. The pooled hazard ratio was computed and weighted using generic inverse variance and random effects models.
Twenty-seven studies were included. Obese compared with nonobese women had worse DFS in all subtypes: the hazard ratios were 1.26 (95% confidence interval CI = 1.13 to 1.41, P < .001) for HR+HER2- BC, 1.16 (95% CI = 1.06 to 1.26, P < .001) for HER2+ BC, and 1.17 (95% CI = 1.06 to 1.29, P = .001) for TNBC. OS was also worse in obese vs nonobese women (HR+HER2- BC HR = 1.39, 95% CI = 1.20 to 1.62, P < .001; HER2+ BC HR = 1.18, 95% CI = 1.05 to 1.33, P = .006; and TNBC HR = 1.32, 95% CI = 1.13 to 1.53, P < .001). As opposed to obesity, overweight was not associated with either DFS or OS in HER2+ BC (HR = 1.02, 95% CI = 0.81 to 1.28, P = .85; and HR = 0.96, 95% CI = 0.76 to 1.21, P = .99, respectively) or TNBC (HR = 1.04, 95% CI = 0.93 to 1.18, P = .49; and HR = 1.08, 95% CI = 0.81 to 1.44, P = .17), respectively. In HR+HER2- BC, being overweight was associated with worse OS (HR = 1.14, 95% CI = 1.07 to 1.22, P < .001).
Obesity was associated with modestly worse DFS and OS in all BC subtypes.
To investigate patterns of prognostic associations over time of insulin- and obesity-related variables measured at diagnosis of early breast cancer (BC), focusing on whether the prognostic ...associations with distant recurrence and death changed over time.
Five hundred thirty-five nondiabetic women with T1-3, N0-1, M0 invasive BC diagnosed from 1989 to 1996 were included in the study. Insulin-related variables included fasting insulin, Homeostasis Model Assessment, C-peptide, and glucose. Obesity-related variables included weight, body mass index (BMI), waist and hip circumference, and leptin. Correlations were examined using the Pearson correlation coefficient and prognostic associations using the Cox model.
There was evidence that associations of baseline insulin-related variables with distant recurrence and death were not constant over time; univariable adverse prognostic associations were significant only during the first 5 years (eg, insulin quartile 4 v 1: hazard ratio HR, 2.32; 95% CI, 1.39 to 3.86; P < .001 for distant disease-free survival DDFS; and HR, 2.85; 95% CI, 1.48 to 5.50; P = .002 for overall survival OS, with little attenuation of this pattern in multivariable analyses). In contrast, obesity-related variables (BMI, weight, leptin) exerted significant adverse univariable associations that were constant over time (eg, BMI quartile 4 v 2: HR, 1.40; 95% CI, 1.07 to 1.82 for DDFS; P = .014; and HR, 1.50; 95% CI, 1.16 to 1.93; P < .001 for OS); prognostic associations of leptin remained significant in multivariable analyses.
Baseline insulin- and obesity-related variables exert different patterns of prognostic associations over time in early BC.
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