Archive for August 2013
In an analysis of a procedure used to help prevent common duct injury during gallbladder removal surgery, use of radiologic examination of the ducts during gallbladder surgery was not associated with a reduced risk of common duct injury, according to a study in the August 28 issue of JAMA.
Biliary anatomy misidentification during gallbladder removal can result in injury to the common hepatic duct or common bile duct. Common duct injuries cause significant short and long-term morbidity including major operations, multiple hospitalizations, and biliary strictures. Elimination of common duct injury is desirable, but it has remained stubbornly present with rates ranging from 0.3 percent to 0.5 percent, according to information. When routinely used, intra-operative cholangiography is thought to prevent common duct injury. However, controversy exists regarding the effectiveness of routine use in the prevention of common duct injury.
Kristin M. Sheffield, Ph.D., and Taylor S. Riall, M.D., Ph.D., of the University of Texas Medical Branch, Galveston, and colleagues investigated the association between intraoperative cholangiography use during cholecystectomy and common duct injury, using instrumental variable analysis, an effective way to overcome unmeasured confounding, that is to say, factors influencing outcomes not found in the database. The researchers identified Medicare beneficiaries from Texas Medicare claims data who underwent inpatient or outpatient cholecystectomy for conditions including biliary colic or biliary dyskinesia, acute cholecystitis, or chronic cholecystitis. The percentage of intraoperative cholangiography use at the hospital and by surgeon was the instrumental variables. Patients with claims for common duct repair operations within 1 year of cholecystectomy were considered as having major common duct injury.
In a logistic regression model controlling for patient, surgeon, and hospital characteristics, the odds of common duct injury for cholecystectomies performed without intraoperative cholangiography were increased compared with those performed with it. When confounding was controlled with instrumental variable analysis, the association between cholecystectomy performed without intraoperative cholangiography and duct injury was no longer significant.
Significant controversy exists regarding the role of intraoperative cholangiography in the prevention of common duct injury during cholecystectomy. Previous population-based studies using data from Medicare claims, hospital discharge records, and national inpatient registries report nearly 2-fold higher rates of injury in cholecystectomies performed without intraoperative cholangiography. In the present study using Texas Medicare claims data, the association between intraoperative cholangiography and common duct injury was highly sensitive to the analytic method used.
Failure to account for potentially confounding variables not routinely captured in administrative databases has a major effect on the interpretation of the findings. Intraoperative cholangiography was not associated with significant reduction in common duct injury using instrumental variable analysis. Instrumental variable analysis balances unmeasured confounding variables to better align risk factors in comparator groups. With better control for unmeasured confounding variables, intraoperative cholangiography was no longer associated with common duct injury. Based on these results, routine intraoperative cholangiography should not be advocated as means for preventing common duct injury.
While this report does not definitively close the door on routine intraoperative cholangiography use, use of directed attention to an important clinical debate by using a new approach to revisit the outcomes of intraoperative cholangiography using observational data. While the true effect of intraoperative cholangiography on the safety of laparoscopic cholecystectomy remains controversial, this study undoubtedly reinvigorates the discussion.
- The difference between science-based medicine and CAM (sciencebasedmedicine.org)
Diabetes is associated with an elevated risk of coronary heart disease. Studies suggest that the genetic factors predisposing to excess cardiovascular risk may be different in diabetic and non-diabetic individuals. It becomes imperative to identify genetic determinants of coronary heart disease that are specific to patients with diabetes. Towards this end, studying independent sets of coronary heart disease cases and coronary heart disease-negative controls and follow up could reveal common genetic variants occurring throughout the genome.
Coronary heart disease is defined as fatal or nonfatal myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, or angiographic evidence of significant stenosis of the coronary arteries.
A variant on chromosome 1q25 is consistently associated with coronary heart disease risk among diabetics, with risk allele frequencies of 0.733. There is no association between this variant and coronary heart disease in non-diabetic patients indicating a significant gene × diabetes interaction on coronary heart disease risk. Compared with protective allele homozygotes, rs10911021 risk allele homozygotes are characterized by a 32% decrease in the expression of the neighboring glutamate-ammonia ligase (GLUL) gene in human endothelial cells. A decreased ratio between plasma levels of γ-glutamyl cycle intermediates pyroglutamic and glutamic acid is also found in risk allele homozygotes.
A single-nucleotide polymorphism (rs10911021) is identified that is significantly associated with coronary heart disease among persons with diabetes but not in those without diabetes and is functionally related to glutamic acid metabolism, suggesting a mechanistic link.
Credits: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
Breathe in the mountain air and gaze out over expansive grounds glistening and dewy from the sunrise. Observe silence during breakfast hours. How one can manage with our friends together without talking and laughing … impossible! We might not make it through the next 15 minutes. We work around noise all day. Isn’t silence what we want? Why do we always have to talk anyway?
Hold the food on tongue a bit longer and notice the flavors in a refreshing way. During this time don’t converse, read or watch TV. You can feel the textures and the tastes fill the taste buds. Silence overflows from body, mind and soul as if it were always there; as if it was always your way of being. Just notice the view of the sky, mountains and valleys, our own mind-chatter and to-do lists rest blissfully now. Pure silence while eating with friends feels amazing. Many feel discomfort in silence, especially when with friends.
I wonder what we are all always chatting about! What level of our most authentic selves is being covered up because we so rarely sit together in silence? What levels of anxiety are we frequently releasing and soothing, back and forth, among one another? Which silly jokes can go left unsaid here and there to let in a little more truth in silence?
By sitting in silence, alone or with others, we give the brain a rest and allow our deepest selves to just be. We move and behave differently in the world when we are coming from a place of simply being. We are scared of the feelings that come up in silence. We feel uncomfortable in our insecurities and our fears. We live in a society filled with distractions to choose from. Happy thoughts fill us in silence. Sadness, nervousness and fear also fill us in silence. When we sit as conscious observers of our own feelings, we are allowing our whole selves to just be, without judgment. We are awake and peaceful. Tranquility fills us in silence. Enter the silence of your deepest self and truest self will ease into you.
To feel wholeness and connectedness from silence, choose one meal a day that you will eat in complete silence, without any distractions. Allow thoughts, to-do lists and feelings to pass by like logs floating away, down a river. Simply observe what comes up and allow it to pass on by. Plan to walk in silence from one point to another, and then back again. Observe any uncomfortable feelings that emerge, and observe how you feel once you have eased into your own silence.
When something really exciting or positive happens in life or work, stay in that place of blissful silence before telling others about it. Stay with the feelings you have about this positive occurrence. Bring your happy energy into your day, knowing you will tell the good news once you are ready. Observe when you are eating, shopping, watching TV or engaging in other behaviors for the purpose of distraction. Be the compassionate mother to yourself, and allow all of your feelings to be without judgment.
To most of us, silence only comes when we close our eyes and turn in for the night. Even when we are listening, our minds churn an inner dialogue; like, we are deciding what we will say next, contemplating the way the speaker’s mouth is moving, thinking about what is for lunch. A healthy fix of silence, whether it is a week-long retreat or a few, simple moments focusing on the breath could do miracles.
In many eastern traditions, observing silence is an integral practice. Not speaking and turning inward is thought to bring peace, clarity and spiritual purity. In the west, even during secular events, moments of silence is practiced to respect and reflect. In our hyper-connected, buzzing world where there is a constant soundtrack to our lives; be it a whizzing car, the bark of a dog or the low hum of a computer at work, you’ll have to seek silence deliberately in order to reap its benefits. Your relationship with quiet and the act of restoring could improve your skills when it comes to work, friendships and happiness.
Creative types swear by silence. It is a stark reminder of the difference between what is worth saying and what isn’t. It is the perfect editor for the creative soul. Creativity is a side effect of meditation. In silence, we gain perspective on what matters, and can more comfortably do away with the non-essentials. When you spend time just being present and observing your breath, thoughts, feelings, and moment-to-moment experience, we start to realize how trivial most of our daily worries really are. In the midst of the daily grind, one can let go of the small stuff, and keep the big picture in view.
Silence is therapeutic. We need silence for sanity. The level of noise that we live with really closes us down. We have very little peace and quiet. Silence is not just no noise; silence is peace and quiet and peace and quiet is beautiful. When we find peace and quiet, we think clearly, feel clearly and the body rejuvenates itself. We don’t know what to do with the free time that quiet offers. Our lives are busy and structured. The healing process needs a simple figuring out of how we want to spend our afternoon without distraction to fall back on.
Silence is a catalyst for focus. We have all felt the need for library-quiet when struggling to concentrate, but being in quiet, takes practice. Being quiet can make one thoughtful. In silence, we can hear our soul speak. Without the surface noise, the insignificant chatter will default to mute. It is often the quiet ones who out-produce everyone else. Silence can make one a better listener. We are losing our listening skill. There is plenty to be distracted by, and as a result our skill to really pay attention is weak. Listening is access to understanding. Just three minutes a day of silence is a wonderful exercise to reset your ears and to recalibrate so that you can hear the quiet again. If you can’t get absolute silence, then go for quiet and that is absolutely fine.
Listening is one of the most difficult skills on this planet. It is very hard to stop mind from wandering. There are lots of reasons why it is so hard for us to be silent. We can always tell when someone is not giving you their complete attention. Practicing quiet, whether through retreat, meditation or just a few minutes unplugged, can prepare you as a professional and a friend to really hear.
Romans 8:28 tell us that all things work together for good, for those that love God and are the called according to His purposes. So everyday I wake up thinking I trust in God no matter what may come my way. Things do happen for a reason. We know that all things work together for good to those who love God, to those who are the called according to His purpose.” Our hope at Bible or Not is that our readers come to know that God is on His throne, that he loves His people, and that He has a plan and purpose for each one of us. To everything there is a season, and whether you are in the spring, summer, fall or winter of life; whether you are in a time of plenty or want; or a time of joy or sorrow; things do happen for a reason and you can trust that God will see you through.
You’ve heard it thousands of times: “Don’t worry; everything will work out just fine.” It is the eternal optimism that is borne not in the crucible of reality but in the wishful thinking of the American dream, of Hollywood make-believe, or of a nave Pollyanna outlook. All of us know it isn’t completely true. We know of children who were cut down by cancer or drunk drivers, of drug addicts who came from good homes, of family men who lost their jobs, of soldiers who returned from battle with one less limb. We know of countless tragedies and needless suffering, yet we repeat the myth to our children without blinking an eye: “Don’t worry; everything will work out just fine.”
This sentiment is not new; it did not start in modern times. Ancient Greeks and Romans uttered something similar to their children, knowing that their words were hollow. The apostle Paul also said something like this. The difference is that Paul did not write a sanguine blank check; he conditioned his sentiment with important qualifiers, and he defined the ‘good’ as other than comfort and wealth.
In real estate it is said that there are three fundamental principles one must follow when buying a house: location, location, and location. In interpreting scripture, there are also three fundamental principles: context, context, and context. Romans 8:28 is no exception to this rule. If we look at it in its context, we will understand its intent. The overall context of Romans 8:28 is one in which Paul addresses living by the power of the Spirit in the midst of suffering and pain. Paul was no stranger to suffering; his several near-death experiences, beatings, imprisonments, and persecutions were enough to eradicate any Pollyannaism that might have lurked in his heart. In the immediate context within the verse itself—Paul expresses prerequisites for the good to take place: “we know that all things work together for good for those who love God, who are called according to His purpose.” Paul is not giving this promise to all people, but only to those “who love God, who are called according to His purpose.”
Those who love God are, in this context, Christians, because they are called according to God’s purpose: the ‘called’ are also the ‘justified’ who will be ‘glorified’. Some take the present participle ‘who love’ as a temporal condition, as if to say, “As long as you love God, things work out; but whenever you are not loving God, things do not work out for your good.” This interpretation, however, is unlikely. First, the tense in this construction is most likely a gnomic present, indicating a characteristic rather than a temporal condition. Second, the following verses (29-30) speak of our conformity to Christ, our glorification, as the inevitable outcome of those who love God and that is not dependent on how much we love God but on the finished work of Christ on the cross. Paul concludes this chapter by making explicit that nothing can separate us from the love of God and by implication that would include even our temporary lapses in our love for the Savior.
What is the good is defined for us, initially at least, in verse 29, one of the forgotten verses of scripture: “because those whom he foreknew he also predestined to be conformed to the image of his Son that his Son would be the firstborn among many brothers and sisters”. The good is not our comfort, wealth, or health. It is conformity to Christ! This good is then fully defined in the next verse: “And those He predestined, he also called; and those He called, He also justified; and those He justified, He also glorified”. Ultimately, all things work together to bring each Christian into conformity to Christ, to bring each Christian to glory. So certain is Paul that this will take place that he speaks of our glorification in the past tense! He uses what is called the “proleptic aorist,” a device in Greek when an author is indicating that “it’s as good as done.” Not only this, but no one is lost between predestination and glorification. Paul does not say “some of those” or even “most of those” when describing each stage of the salvation journey. From predestination to glorification, he uses the simple “those.” No one misses the boat along the way.
When we read Rom 8:28 in its context we can give a positive answer to the questions of pain and suffering in the world. We may see nothing good come of misery and disaster in this world, but this world is not all of reality. There is an ‘until’; there is a place beyond the horizon of what our senses can apprehend, and it is more real and more lasting than what we experience in this mortal shell. God is using the present, even the miserable present, to conform us to the image of his Son. If we define the good as only what we can see in this life, then we have missed the whole point of this text, as Paul says earlier in the same chapter, “For I consider that our present sufferings cannot even be compared to the glory that will be revealed to us”. Western Christians—especially American Christians—are prone to pervert texts such as Rom 8:28. If our lives are comfortable, if we have wealth, good health, that is fine and well. But it is not the good that Paul had in mind, and it is not the goal of the Christian life.
If you think you’re hearing the word empathy everywhere, you’re right. It is now on the lips of scientists and business leaders, education experts and political activists. Empathy is not just a way to extend the boundaries of our moral universe. According to new research, it is a habit we can cultivate to improve the quality of our own lives. Empathy is the ability to step into the shoes of another person, aiming to understand their feelings and perspectives and to use that understanding to guide our actions. That makes it different from kindness or pity. This is not to be confused with: one should treat others as one would like others to treat oneself.
There is a revolutionary shift in the science of how we understand human nature. The old view that we are essentially self-interested creatures is being nudged firmly to one side by evidence that we are also homo empathicus, wired for empathy, social cooperation, and mutual aid. Over the last decade, neuroscientists have identified a 10-section empathy circuit in our brains which, if damaged, can curtail our ability to understand what other people are feeling. Evolutionary biologists have shown that we are social animals who have naturally evolved to care for each other, just like our primate cousins. Psychologists have revealed that we are primed for empathy by strong attachment relationships in the first two years of life.
The empathy does not stop developing in childhood. We can nurture its growth throughout our lives and we can use it as a radical force for social transformation. Research in sociology, psychology, history and studies of empathic personalities reveals how we can make empathy an attitude and a part of our daily lives, and thus improve the lives of everyone around us. Without empathy, human beings are lonely and disconnected creatures. An old philosophical question asks: Is there any such thing as a selfless act? Cynics answer no, because any apparently selfless act is always tacitly showing off what good people we are. Even if no one else knows about the act, the good feeling you get yourself from helping someone else means a selfless act is never really entirely selfless. But perhaps cynics will be impressed by recent neuroscientific studies which demonstrate in the living mind the enormous human capacity for empathy.
In an experiment, participants were first put in functional magnetic resonance imaging machine and shown a series of ‘X’s and ‘O’s on a screen. The ‘X’s indicated there was a 17% chance they would get a mild electric shock through the ankle, while the ‘O’s indicated they were safe for the moment. The scan of participants’ brains showed that when there was a chance they were about to receive a shock, the parts of the brain that are involved in threat response became more active. This is expected.
The correlation between self and friend is remarkably similar. The finding shows the brain’s remarkable capacity to model self to others; that people close to us become a part of ourselves, and that is not just metaphor or poetry, it is very real. Literally, we are under threat when a friend is under threat, but not so when a stranger is under threat. So the brain scanner could ‘see’ people empathizing with their friends, but can it see whether this empathy does any good? That’s what was examined in a previous study with a similar procedure—except this time participants were husband and wife.
When people held their spouse’s hand, as opposed to that of a stranger, the threat response regions of the brain were significantly less active than otherwise. The better the marital relationship, the greater the positive effect of holding hands with their partners. Subsequent studies showed that the other person only needs to be in the room for the threat response regions to quieten the mind. We all know from personal experience how gut-wrenching it is to watch the suffering of someone we love. We all know that, when we are suffering ourselves, it is better to have someone around that we love. But it is fascinating to see these fundamental aspects of what makes us human occurring right there, deep in the living mind.
Highly empathic people have an insatiable curiosity about strangers. They will talk to the person sitting next to them on the bus, having retained that natural inquisitiveness we all had as children, but which society is so good at beating out of us. They find other people more interesting than themselves but are not out to interrogate them, respecting the advice do not be an examiner, be the interested inquirer.
Curiosity expands our empathy when we talk to people outside our usual social circle, encountering lives and worldviews very different from our own. Curiosity is a key character strength that can enhance life satisfaction. Curiosity is a useful cure for the chronic loneliness afflicting around one in three Americans. Cultivating curiosity requires more than having a brief chat about the weather. Crucially, it tries to understand the world inside the head of the other person. To be curious all it requires is courage.
We all have assumptions about others and use collective labels, for example, “Muslim fundamentalist,” “welfare mom”—that prevent us from appreciating individuality. Being empathic, you challenge your own preconceptions and prejudices by searching for what you share with people rather than what divides.
Highly empathic people expand their empathy by gaining direct experience of other people’s lives, putting into practice the Native American proverb, “Walk a mile in another man’s moccasins before you criticize him.” Empathy does not just make you good; it is good for you, too. All genuine education comes about through experience. To be an empathic conversationalist, one is to master the art of radical listening, an ability to be present to what is really going on within, to the unique feelings and needs a person is experiencing in that very moment. Highly empathic people listen hard to others and do all they can to grasp their emotional state and needs, whether it is a friend who has just been diagnosed with cancer or a spouse who is upset at them for working late yet again.
Just listening is never enough; we are to make ourselves vulnerable. Removing our masks and revealing our feelings to someone is vital for creating a strong empathic bond. Empathy is a two-way street that, at its best, is built upon mutual understanding; an exchange of our most important beliefs and experiences. We typically assume empathy happens at the level of individuals, but highly empathic people know that empathy can also be a mass phenomenon that brings about fundamental social change. Just think of the movements against slavery in the 18th and 19th centuries on both sides of the Atlantic. The abolitionists placed their hope not in sacred texts but human empathy, doing all they could to get people to understand the very real suffering on the plantations and slave ships.
Empathy flowers on a collective scale if its seeds are planted in our children. Canada’s pioneering Roots of Empathy, the world’s most effective empathy teaching program, which has benefited over half a million school kids has unique curriculum centers on an infant, whose development children observe over time in order to learn emotional intelligence and its results include significant decline in playground bullying and higher levels of academic achievement.
Beyond education, the big challenge is figuring out how social networking technology can harness the power of empathy to create mass political action. Twitter may have gotten people onto the streets for Occupy Wall Street and the Arab Spring, but can it convince us to care deeply about the suffering of distant strangers, whether they are drought-stricken farmers in Africa or future generations who will bear the brunt of our carbon-junkie lifestyles? This will only happen if social networks learn to spread not just information, but empathic connection.
Highly empathic people do far more than empathize with the usual suspects. We tend to believe empathy should be reserved for those living on the social margins or who are suffering. This is necessary, but it is hardly enough. We also need to empathize with people whose beliefs we don’t share or who may be enemies in some way. Like impact anthropology that involves submerging oneself to greater or lesser degrees in a sector perceived to be deeply alien, for the explicit purpose of internalizing the rules and inner codes of the system you wish to impact. Gaining access allows one to obtain internal knowledge, and that leads to legitimacy within the system. This leads to an ability to create an impact. By internalizing the rules of a system, you can make it yours and play with it, integrating yourself into the DNA in order to promote mutations. That is a great route to creative disruption and a positive deviance. The reward might be the ability to create a better human relationship. The cost might be the loss of secure beliefs, and a secure identity.
Organizations, too, should be ambitious with their empathic thinking. In an era of rapid technological change, mastering empathy is the key business survival skill because it underpins successful teamwork and leadership. The 20th century was the Age of Introspection, when self-help and therapy culture encouraged us to believe that the best way to understand who we are and how to live was to look inside ourselves. It left us gazing at our own navels. The 21st century should become the Age of Empathy, when we discover ourselves not simply through self-reflection, but by becoming interested in the lives of others. We need empathy to create a new kind of revolution. Not an old-fashioned revolution built on new laws, institutions, or policies, but a radical revolution in human relationships.
- Empathy is an In-Built Quality in Humans (medindia.net)
- Human brains are hardwired for empathy, friendship, study shows (psypost.org)
- Researchers Explain Human’s Ability To Empathize and Form Friendships (hngn.com)
- Study finds that our brains are hardwired for empathy, friendship (medicalnewstoday.com)