Wednesday, November 30, 2011

NEJM Audio Summary - Nov 24, 2011

Excerpted Script
"Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice" by Lawrence Appel from Johns Hopkins University, Baltimore, Maryland. This trial showed that two types of behavioral interventions, one based on remote, call-center support and the other on in-person support, resulted in significant weight loss among obese patients.  At baseline, the mean body-mass index for all participants was 36.6, and the mean weight was 103.8 kg. At 24 months, the mean change in weight from baseline was −0.8 kg in the control group, −4.6 kg in the group receiving remote support only, and −5.1 kg in the group receiving in-person support. The percentage of participants who lost 5% or more of their initial weight was 18.8% in the control group, 38.2% in the group receiving remote support only, and 41.4% in the group receiving in-person support. In two behavioral interventions, one delivered with in-person support and the other delivered remotely, without face-to-face contact between participants and weight-loss coaches, obese patients achieved and sustained clinically significant weight loss over a period of 24 months.
"A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice" by Thomas Wadden, from the University of Pennsylvania, Philadelphia. This trial compared three weight-loss interventions (usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling) in primary care practice. Of the 390 participants, 86% completed the 2-year trial, at which time, the mean weight loss with usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling was 1.7, 2.9, and 4.6 kg, respectively. Initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively. Enhanced lifestyle counseling was superior to usual care on both these measures of success, with no other significant differences among the groups. The benefits of enhanced lifestyle counseling remained even after participants given the weight loss medication, sibutramine were excluded from the analyses. Enhanced weight-loss counseling helps about one third of obese patients achieve long-term, clinically meaningful weight loss. In editorial Susan Yanovski, from National Institute of Health, Bethesda, Maryland, writes that both these studies provide evidence that PCPs can deliver safe and effective weight-loss interventions in primary care settings. Whether patients would be willing to pay for these therapies, or insurers would be willing to reimburse for them, is not known. Some patients will require additional treatments such as medications or bariatric surgery as an adjunct to, but not a replacement for, lifestyle interventions. Continued research on ways to enhance patients' adherence to long-term lifestyle changes should improve the reach and effectiveness of behavioral treatments for obesity in primary care settings. (457 words /214 sec = 128 wpm)

Monday, November 28, 2011

LinuxMint 12 "Lisa" にインストールした12のソフト

LinuxMint 12 "Lisa"をインストールして環境整備が整ったので、その感想と忘備録を記しておく。ubuntuのunityのインターフェイスは世界的に不評を買ったらしく、DistroWatchでも、ランキング首位をLinuxMintに譲ってしまった。そのLinuxMintが新しいバージョンをリリースしたのを機会にちょっと浮気心を出してしまったわけだ。結論から言うと、「見目麗しいが痛い目に合う」ってこと。Gnome3とMintMenuの共存で使いやすくなっているわけだが、日本語環境の不備をGoogleで調べながら解決する手間を惜しむ方は手を出さないほうが良さそう。まずは、インストール画面で日本語を選ばせながら、インストール後設定をしなければ、日本語入力ができないというのには、愕然。ソフトに拘りがない人は、DVD版をインストールすれば、ひと通りメジャーなソフトは入っているので弄る必要はないのだが、拘りのソフトを入れようとすると、コマンドを叩く必要が出てくる。日本語周りが不安定なようで、一時、豆腐になってしまった場面にも出くわした。なんやかんや下のソフトの環境を整えるのに丸一日を費やしてしまった。
  1. Google Chrome: ソフトウェアの管理でインストールできる。
  2. mozc: Google日本語入力。これもソフトウェアの管理からインストール。
  3. Dropbox: ソフトウェアの管理からインストール。
  4. PlayItSlowly + gPodder: いずれもソフトウェアの管理からインストール。連携には、gPodderの設定に"playitslowly %f"と入れておく
  5. Mendeley: debファイルをダウンロードして、ダウンロードフォルダを開き、右クリックで「端末の中に開く」を選択、"sudo dpkg -i mendeley...."のオマジナイ。
  6. R + RStudio + EZR on R Commander: Rは、ソフトウェアの管理からインストール。RStudioは、上記Mendeleyと同じ要領で。EZR on R Commanderは本来Win/Mac向けで、別記事で書いておいたほうがいいのかもしれない。簡単に述べると、Macと同じ手順を踏んで、EZRsetupOSX.zipを解凍してできるpkgファイルをunpkgで展開したもののうち、Rcmdr-menus.txt、StatMedOSX.R、Rcmdr.moの3つのファイルを適当に配置したら、起動しました!
  7. Gephi + Sun-java-6-jre: Gephiは0.8βから日本語に対応しましたが、インストール直後は、全て豆腐。一時は、諦めて英語で使うことにしようかと日和りましたが、自分が訳した責任もあるので、長時間格闘しました。Java環境が原因と気づくのにしばらくかかり、こちらを大いに参考にさせて頂きました。
  8. Quarry + GnuGo: デフォルトではゲームが入ってないのが、LinuxMintの隠れた美点。ちょっと一区切りに始めたソリティアに嵌ってしまうこともありません。しかし、全くお遊びがないのも寂しいので囲碁環境をと。原りょう氏の沢崎シリーズの主人公のごとく、大竹美学の片鱗に触れましょうか。
  9. AdobeAir + プリントマジック: ここ数年、年賀状は、この環境で作成してきた。公式にLinux版の開発中止が発表されたが、次のリンクでまだダウンロードできる模様。今年で最後かな。
  10. MuseScore: 無料の WYSIWYG 楽譜作成ソフトウェアです。作曲を嗜むわけではありませんが、サイトからいろんな曲の楽譜をダウンロードして演奏させると楽しいです。ソフトウェアの管理でインストールできる。
  11. Evolution: 知らないうちにGmailやGoogleカレンダーとの相性が良くなっていたようで、ソフトウェアの管理でインストール。
  12. zsh: "sudo apt-get install zsh"でインストール。「漢のzsh

Saturday, November 19, 2011

NEJM Audio Summary - Nov 17, 2011

Excerpted Script
"Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors"
by Markus Juonala from University of Turku, Turku University Hospital, Finland.
In four prospective cohort studies, obese adults who were overweight or obese in childhood had increased rates of cardiovascular risk factors. Subjects with consistently high adiposity status from childhood to adulthood, as compared with persons who had a normal BMI as children and were nonobese as adults, had an increased risk of type 2 diabetes (relative risk, 5.4), hypertension (relative risk, 2.7), elevated low-density lipoprotein cholesterol levels (relative risk, 1.8), reduced high-density lipoprotein cholesterol levels (relative risk, 2.1), elevated triglyceride levels (relative risk, 3.0), and carotid-artery atherosclerosis (increased intima–media thickness of the carotid artery) (relative risk, 1.7) . Persons who were overweight or obese during childhood but were nonobese as adults had risks of the outcomes that were similar to those of persons who had a normal BMI consistently from childhood to adulthood. Overweight or obese children who were obese as adults had increased risks of type 2 diabetes, hypertension, dyslipidemia, and carotid-artery atherosclerosis. The risks of these outcomes among overweight or obese children who became nonobese by adulthood were similar to those among persons who were never obese.
Albert Rocchini, from  C.S. Mott Children's Hospital, Ann Arbor, Michigan, writes in editorials, that the authors found that, over an interval of almost 25 years, only 15% of subjects who were of normal weight as children were obese as adults, whereas 65% of those who were overweight or obese as children and 82% of those who were obese as children were obese as adults. These figures suggest that targeting interventions for obesity prevention and treatment specifically to children who are at high risk for becoming obese will prove to be a more valuable and more cost-effective strategy than targeting these interventions to whole populations of children. (317 words / 150 sec = 127 wpm)
Refered Blog

Thursday, November 10, 2011

NEJM Audio Summary - Nov 10, 2011

Excerpted Script
"Glucocorticoids plus N-Acetylcysteine in Severe Alcoholic Hepatitis"
by Eric Nguyen-Khac, from Amiens University Hospital, France.
Mortality among patients with severe acute alcoholic hepatitis is high, even among those treated with glucocorticoids. These authors investigated whether combination therapy with glucocorticoids plus N-acetylcysteine would improve survival. Mortality was not significantly lower in the prednisolone–N-acetylcysteine group than in the prednisolone-only group at 6 months (27% vs. 38%). Mortality was significantly lower at 1 month (8% vs. 24%) but not at 3 months (22% vs. 34%). Death due to the hepatorenal syndrome was less frequent in the prednisolone–N-acetylcysteine group than in the prednisolone-only group at 6 months (9% vs. 22%). Although combination therapy with prednisolone plus N-acetylcysteine increased 1-month survival among patients with severe acute alcoholic hepatitis, 6-month survival, the primary outcome, was not improved. (143 words/77 sec = 111 wpm)

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Wednesday, November 9, 2011

NEJM Audio Summary - Nov 3, 2011

Excerpted Script
"Host and Pathogen Factors for Clostridium difficile Infection and Colonization" by Vivian Loo, from McGill University Health Centre, Montreal, Quebec, Canada.
This study identified host and bacterial factors associated with health care–associated acquisition of Clostrium difficile infection and colonization. Of 4143 patients admitted to the hospitals in Quebec, Montreal, 2.8% and 3.0% had health care–associated C. difficile infection and colonization, respectively. Older age and use of antibiotics and proton-pump inhibitors were significantly associated with health care–associated C. difficile infection. Hospitalization in the previous 2 months; use of chemotherapy, proton-pump inhibitors, and H2 blockers; and antibodies against toxin B were associated with health care–associated C. difficile colonization. Among patients with health care–associated C. difficile infection and those with colonization, 62.7% and 36.1%, respectively, had the North American PFGE type 1 (NAP1) strain. In this study, health care–associated C. difficile infection and colonization were differentially associated with defined host and pathogen variables. The NAP1 strain was predominant among patients with C. difficile infection, whereas asymptomatic patients were more likely to be colonized with other strains. (188 words/ 97sec = 116 wpm)
Refered Blogs

Wednesday, November 2, 2011

NEJM Audio Summary - Oct 27, 2011


Excerpted Script
00:54 | "Small-Airway Obstruction and Emphysema in Chronic Obstructive Pulmonary Disease" by John McDonough from St. Paul's Hospital, Vancouver, British Columbia, Canada. Patients with COPD have increased peripheral airway resistance. Using CT to compare the number of airways measuring 2.0 to 2.5 mm in 78 patients who had various stages of COPD. This study determined whether there was a relationship between small-airway obstruction and emphysematous destruction in COPD. The number of airways measuring 2.0 to 2.5 mm in diameter was reduced in patients with Global Initiative for Chronic Obstructive Lung disease (GOLD) scale stage 1, 2, 3 and 4 disease. MicroCT of isolated samples of lungs removed from patients with GOLD stage 4 disease showed a reduction of 81 to 99.7% in the total cross-sectional area of terminal bronchioles and a reduction of 72 to 89% in the number of terminal bronchioles. A comparison of the number of terminal bronchioles and dimensions at different levels of emphysematous destruction showed that the narrowing and loss of terminal bronchioles preceded emphysematous destruction in COPD. These results show that narrowing and disappearance of small conducting airways before the onset of emphysematous destruction can explain the increased peripheral airway resistance reported in COPD.
02:30 | In EDITORIAL, Wayne Mitzner from Johns Hopkins Bloomberg School of Public Health, Baltimore, writes this study raises key issues related to the timeline of the pathology in COPD, particularly with regard to the interaction between the peripheral airways and parenchyma. Given this uncertainty regarding the pathologic progression, it may be time to think about reconsidering the definition of emphysema. A new definition will clearly need to include more about the involvement of small airways beyond the simple absence of obvious fibrosis. On the basis of the work of McDonough and colleagues, the permanent enlargement of the distal airspaces may serve only as a structural biomarker, being a secondary result of small-airway inflammation and destruction.    (321 words/ 45-201sec = 131wpm) 

  • determine whether
  • relationship between/with
  • analysis/study/patient/result/data show
  • after/with/of/before the onset

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