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1. Substance, Element, Quality, Mixture: Galen’s Physics and His Hippocratic Inheritance

Author

Robert James Hankinson

Subjects
substance, element, quality, mixture, matter, form, History of Greece, DF10-951
Abstract

Galen insists that Hippocrates, in Nature of Man, adopts and argues for a physics in which not only the four fundamental qualities, hot, cold, dry and wet, but also the four basic elements, are taken to be fundamental to the constitution of all material things. He does so because he thinks that such a physics is in fact the right one. The main purpose of this paper is to examine why Galen thinks that not only the fundamental qualities, and a material stuff for them to be instantiated in, is conceptually required for any adequate physics, but also why a commitment to actual elements, conceived of as those material bodies which most fully instantiated the causally basic qualities, is also required. I examine the sources of Galen’s views on material interaction as they derive from their Aristotelian (and to a lesser extent Stoic) forebears, and conclude, ultimately, that Galen’s claim that precise conceptual analysis demands the postulation of actual elements, conceived as the bodies which maximally instantiate the four fundamental qualities, even though no such pure element is ever actually distilled, is in fact unwarranted.

Published
2017
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2. Persistent incisional pain after noncardiac surgery : an international prospective cohort study

Author

Sadeesh Srinathan, Wojciech Szczeklik, Philip J. Devereaux, Paul J. Jackson, Shirley Pettit, Michael J. Jacka, James Hankinson, Alparslan Turan, Daniel I. Sessler, Jason W. Busse, James S. Khan, Chew Yin Wang, D. Norman Buckley, Harsha Shanthanna, Ignacio Garutti, Ian Gilron, Michael McGillion, Carmen Fernández-Riveira, James Paul, Matthew T. V. Chan, and Pilar Paniagua

Subjects
Male, medicine.medical_specialty, Internationality, Surgical Wound, Analgesic, Lower risk, Cohort Studies, Coronary artery disease, Internal medicine, Humans, Medicine, Prospective Studies, Prospective cohort study, Aged, Pain, Postoperative, business.industry, Incidence (epidemiology), Chronic pain, Perioperative, Middle Aged, medicine.disease, Anesthesiology and Pain Medicine, Female, Chronic Pain, business, Follow-Up Studies, Cohort study
Abstract

Background The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain. Methods This was a secondary analysis of an international prospective cohort study from 2012 to 2014. This study included patients who were 45 yr of age or older who underwent major inpatient noncardiac surgery. Data were collected perioperatively and at 1 yr after surgery to assess for the development of persistent incisional pain (pain present around incision at 1 yr after surgery). Results Among 14,831 patients, 495 (3.3%; 95% CI, 3.1 to 3.6) reported persistent incisional pain at 1 yr, with an average pain intensity of 3.6 ± 2.5 (0 to 10 numeric rating scale), with 35% and 14% reporting moderate and severe pain intensities, respectively. More than half of patients with persistent pain reported needing analgesic medications, and 85% reported interference with daily activities (denominator = 495 in the above proportions). Risk factors for persistent pain included female sex (P = 0.007), Asian ethnicity (P < 0.001), surgery for fracture (P < 0.001), history of chronic pain (P < 0.001), coronary artery disease (P < 0.001), history of tobacco use (P = 0.048), postoperative patient-controlled analgesia (P < 0.001), postoperative continuous nerve block (P = 0.010), insulin initiation within 24 h of surgery (P < 0.001), and withholding nonsteroidal anti-inflammatory medication or cyclooxygenase-2 inhibitors on the day of surgery (P = 0.029 and P < 0.001, respectively). Older age (P < 0.001), endoscopic surgery (P = 0.005), and South Asian (P < 0.001), Native American/Australian (P = 0.004), and Latin/Hispanic ethnicities (P < 0.001) were associated with a lower risk of persistent pain. Conclusions Persistent incisional pain is a common complication of inpatient noncardiac surgery, occurring in approximately 1 in 30 adults. It results in significant morbidity, interferes with daily living, and is associated with persistent analgesic consumption. Certain demographics, ethnicities, and perioperative practices are associated with increased risk of persistent pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Published
2021

3. Myocardial Injury after Noncardiac Surgery

Author

Pierre Coriat, Patricia Cruz, Bogusz Kaczmarek, Gabriel Cusati, Wendy Lim, Saeed Darvish-Kazim, Rupert Pearse, Finlay A. McAlister, Cheryl Ramballi, Robert C M Stephens, R.M. Pearse, Jeff Weitz, Germán Málaga, Alexander Y. Fu, Eleanor McAlees, Alberto Varela, Maria Palencia, James Zacharias, Ryan J. J. Amadeo, Bruce M Biccard, Janet Woods, Catherine M. Clase, Patrick S Finnegan, Laura Gallego Paredes, Alistair Hall, Mariana Vargas Furtado, Alben Sigamani, José Villamor, Alex Torborg, Maria De Los Angeles Lazo, Tony Gin, Pavel S Roshanov, Carmen Fernández, Andrea Kurz, Hertzel C. Gerstein, Stephen Li, R.N. Rodseth, P. Naidoo, Mitchell Winemaker, Parminder Raina, Gordon Y.S. Choi, Lalita Afzal, Richard Mizera, Sean M. Bagshaw, Marta Januszewska, Yannick LeManach, Sultana Furruqh, Robert J. Sapsford, Peter Lovrics, B M Biccard, Cecilia Martínez, Faisal Siddiqui, J. Mooney, Carisi Anne Polanczyk, Ina Ismiarti Shariffuddin, Mark Crowther, Elizabeth Ling, Adrià Font, Mark Soth, Maria Stella Chaparro, Maria José Membrillo, Ekaterina Popova, Denis Monneret, Richard P. Whitlock, Amit Garg, Andrew Archbold, Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (Vision) Investigators, M Leuwer, Vincent W. Lee, Zhuo Sun, Patricia Piñeiro, César A. Jardim, Clare D. Ramsey, Krit Panjasawatwong, James Paul, David W. Gibson, Philip St John, Peter Nagele, Jose Amalth do Espirirto Santo, Pablo Alonso-Coello, Jacek Musial, Jacques G. Tittley, Fernando Botto, Georges Daas, Hou Yee Lai, Ana Gutierrez del Arroyo, Edmunds Reineks, Martin Leuwer, Clive Kearon, Jane Blood, Mari Luz Maestre, Neesh Pannu, Marta De Antonio, Ameen Patel, Aida Rotta-Rotta, Noorjahan Haneem Md Hashim, Amal Bessissow, Hélio Penna Guimarães, Norman Buckley, Mateusz Kózka, Maria José Ferré, Gerard Urrútia, Lydia C.W. Lit, Matthew T. V. Chan, Philip J. Devereaux, Ushananthini Ki, Jesús Alvarez García, Shaveta Mala, Juan Carlos Villar, Andrew McKay, Silvia Moreira Ayub Ferreira, Angeles de Miguel, Gordon H. Guyatt, David Orozco, A. Rushton, Michael J Jacka, Holger J Schünemann, Diane Heels-Ansdell, Guillaume Paré, Stephen Hill, Amit X Garg, Hooman Honar, Pervez Sultan, Miquel Santaló, Zubin Punthakee, Sihe Wang, Katia R. M. Leite, Holger Schünemann, Hilary P Grocott, Aram Shahinyan, Sebastian Ribas, Jackie Bosch, Amanda Smith, Giovanna Luratibuse, Joseph Cherian, Maciej Chwała, Heather McDonald, Rey R. Acedillo, Manuel Muñoz, Sally Benton, Michael Walsh, Vikas Tandon, Shirley Pettit, Javier D Loza-Herrera, Paul M. O'Bryne, Joanne Fletcher, Richard Halliwell, Clara K Chow, Jacek Górka, Michelle M. Graham, Alvaro Castañeda, Ainslie Hildebrand, Patrick Magloire, Skarlett Vásquez, Gareth L Ackland, P. George, Sergio Mazzadi, Susannah Howard, Simon J. Howell, Rubeshan Naidoo, William Orovan, Megan Kalin, Anna Reyes, Anthony Adili, Frederick A. Spencer, Laurel Thorlacius, Jehonathan H. Pinthus, Michaela Lobley, Justin DeBeer, Theroshnie Kisten, Dean Gopalan, John W. Eikelboom, Eliana Vieira Santucci, Derek R. Townsend, Raúl Gonzalez, Tomas VanHelder, Sean McMurtry, Susana Díaz, Catherine Royer, Hussein Cassimjee, James D. Douketis, Ahsun Khan, V Vasanthan, Chew Yin Wang, Sadeesh Srinathan, A. Wahab Undok, Deven Reddy, Paola Muti, Paul Jackson, Javier Ganame, Danielle MacNeil, Pilar Paniagua, Graham S. Hillis, Wojciech Szczeklik, Azim S. Gangji, Stephen D. Walter, Andrew Worster, Matthew B. McQueen, Sadeesh K Srinathan, Otavio Berwanger, Cameron Egan, Aine Mugabi, Neil MacDonald, Erica Aranha Suzumura, Matthew J. McQueen, Reitze N. Rodseth, Maria Del Barrio, Peter A. Kavsak, Cristina Ibanez Esteve, David Szalay, Olga L. Cortés, Fidel Reyes, John Whittle, Gracie Ong, Troy S. Wildes, Ngan N. Lam, Karen Raymer, C. Williams, G.L. Ackland, Enrico Vizza, Salim Yusuf, Wan Azman Ahmad, Radhika Dhanpal, Barbara Sokołowska, David Cain, Andre Lamy, Alexandre Biasi Cavalcanti, Marko Mrkobrada, James Hankinson, Emmanuelle Duceppe, Julian Scott, Maria Tiboni, Tomasz Mrowiecki, Vanessa Valderrama-Victoria, Paweł Iwaszczuk, Robert Sapsford, Andrew Wragg, Atiya Faruqui, Edyta Niebrzegowska, Mohit Bhandari, Teresa Del Castillo, Jean Pierre Goarin, Marko Simunovic, Omid Salehian, Smitha Almeida, Ingeborg Welters, Lehana Thabane, D.L. Skinner, Tej Sheth, Alvin S.B. Tan, Ignacio Garutti, Daniel I. Sessler, Sabu Thomas, Sarah D. McDonald, Trevor W R Lee, Marzida Mansor, Julian H. Barth, Nikki Dewhirst, Xavier Pelaez, Valsa Abraham, Jill Rudkowski, Sanjit S. Jolly, Azad Hassan Abdul Razack, Marcin Raczek, Duane J. Funk, Deborah J. Cook, Martin O'Donnell, and Denis Xavier

Subjects
medicine.medical_specialty, biology, Troponin T, business.industry, Hazard ratio, Infarction, Perioperative, medicine.disease, Troponin, Surgery, Anesthesiology and Pain Medicine, Internal medicine, medicine, biology.protein, Cardiology, Myocardial infarction, Prospective cohort study, business, Cohort study
Abstract

Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study’s four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS. Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated “abnormal” laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria. Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors’ diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96–5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6–41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom. Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Published
2014
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4. Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

Author

Fernando, Botto, Pablo, Alonso-Coello, Matthew T V, Chan, Juan Carlos, Villar, Denis, Xavier, Sadeesh, Srinathan, Gordon, Guyatt, Patricia, Cruz, Michelle, Graham, C Y, Wang, Otavio, Berwanger, Rupert M, Pearse, Bruce M, Biccard, Valsa, Abraham, German, Malaga, Graham S, Hillis, Reitze N, Rodseth, Deborah, Cook, Carisi A, Polanczyk, Wojciech, Szczeklik, Daniel I, Sessler, Tej, Sheth, Gareth L, Ackland, Martin, Leuwer, Amit X, Garg, Yannick, Lemanach, Shirley, Pettit, Diane, Heels-Ansdell, Giovanna, Luratibuse, Michael, Walsh, Robert, Sapsford, Holger J, Schünemann, Andrea, Kurz, Sabu, Thomas, Marko, Mrkobrada, Lehana, Thabane, Hertzel, Gerstein, Pilar, Paniagua, Peter, Nagele, Parminder, Raina, Salim, Yusuf, P J, Devereaux, Matthew J, McQueen, Mohit, Bhandari, Jackie, Bosch, Norman, Buckley, Clara K, Chow, Richard, Halliwell, Stephen, Li, Vincent W, Lee, John, Mooney, Mariana V, Furtado, Erica, Suzumura, Eliana, Santucci, Katia, Leite, Jose Amalth do Espirirto, Santo, Cesar A P, Jardim, Alexandre Biasi, Cavalcanti, Helio Penna, Guimaraes, Michael J, Jacka, Finlay, McAlister, Sean, McMurtry, Derek, Townsend, Neesh, Pannu, Sean, Bagshaw, Amal, Bessissow, Emmanuelle, Duceppe, John, Eikelboom, Javier, Ganame, James, Hankinson, Stephen, Hill, Sanjit, Jolly, Andre, Lamy, Elizabeth, Ling, Patrick, Magloire, Guillaume, Pare, Deven, Reddy, David, Szalay, Jacques, Tittley, Jeff, Weitz, Richard, Whitlock, Saeed, Darvish-Kazim, Justin, Debeer, Peter, Kavsak, Clive, Kearon, Richard, Mizera, Martin, O'Donnell, Matthew, McQueen, Jehonathan, Pinthus, Sebastian, Ribas, Marko, Simunovic, Vikas, Tandon, Tomas, Vanhelder, Mitchell, Winemaker, Sarah, McDonald, Paul, O'Bryne, Ameen, Patel, James, Paul, Zubin, Punthakee, Karen, Raymer, Omid, Salehian, Fred, Spencer, Stephen, Walter, Andrew, Worster, Anthony, Adili, Catherine, Clase, Mark, Crowther, James, Douketis, Azim, Gangji, Paul, Jackson, Wendy, Lim, Peter, Lovrics, Sergio, Mazzadi, William, Orovan, Jill, Rudkowski, Mark, Soth, Maria, Tiboni, Rey, Acedillo, Amit, Garg, Ainslie, Hildebrand, Ngan, Lam, Danielle, Macneil, Pavel S, Roshanov, Sadeesh K, Srinathan, Clare, Ramsey, Philip St, John, Laurel, Thorlacius, Faisal S, Siddiqui, Hilary P, Grocott, Andrew, McKay, Trevor W R, Lee, Ryan, Amadeo, Duane, Funk, Heather, McDonald, James, Zacharias, Olga Lucía, Cortés, Maria Stella, Chaparro, Skarlett, Vásquez, Alvaro, Castañeda, Silvia, Ferreira, Pierre, Coriat, Denis, Monneret, Jean Pierre, Goarin, Cristina Ibanez, Esteve, Catherine, Royer, Georges, Daas, Gordon Y S, Choi, Tony, Gin, Lydia C W, Lit, Alben, Sigamani, Atiya, Faruqui, Radhika, Dhanpal, Smitha, Almeida, Joseph, Cherian, Sultana, Furruqh, Lalita, Afzal, Preetha, George, Shaveta, Mala, Holger, Schünemann, Paola, Muti, Enrico, Vizza, G S Y, Ong, Marzida, Mansor, Alvin S B, Tan, Ina I, Shariffuddin, V, Vasanthan, N H M, Hashim, A Wahab, Undok, Ushananthini, Ki, Hou Yee, Lai, Wan Azman, Ahmad, Azad H A, Razack, Vanessa, Valderrama-Victoria, Javier D, Loza-Herrera, Maria, De Los Angeles Lazo, Aida, Rotta-Rotta, Barbara, Sokolowska, Jacek, Musial, Jacek, Gorka, Pawel, Iwaszczuk, Mateusz, Kozka, Maciej, Chwala, Marcin, Raczek, Tomasz, Mrowiecki, Bogusz, Kaczmarek, Bruce, Biccard, Hussein, Cassimjee, Dean, Gopalan, Theroshnie, Kisten, Aine, Mugabi, Prebashini, Naidoo, Rubeshan, Naidoo, Reitze, Rodseth, David, Skinner, Alex, Torborg, Gerard, Urrutia, Mari Luz, Maestre, Miquel, Santaló, Raúl, Gonzalez, Adrià, Font, Cecilia, Martínez, Xavier, Pelaez, Marta, De Antonio, Jose Marcial, Villamor, Jesús Alvarez, García, Maria José, Ferré, Ekaterina, Popova, Ignacio, Garutti, Carmen, Fernández, Maria, Palencia, Susana, Díaz, Teresa, Del Castillo, Alberto, Varela, Angeles, de Miguel, Manuel, Muñoz, Patricia, Piñeiro, Gabriel, Cusati, Maria, Del Barrio, Maria José, Membrillo, David, Orozco, Fidel, Reyes, Robert J, Sapsford, Julian, Barth, Julian, Scott, Alistair, Hall, Simon, Howell, Michaela, Lobley, Janet, Woods, Susannah, Howard, Joanne, Fletcher, Nikki, Dewhirst, C, Williams, A, Rushton, I, Welters, M, Leuwer, Rupert, Pearse, Gareth, Ackland, Ahsun, Khan, Edyta, Niebrzegowska, Sally, Benton, Andrew, Wragg, Andrew, Archbold, Amanda, Smith, Eleanor, McAlees, Cheryl, Ramballi, Neil, Macdonald, Marta, Januszewska, Robert, Stephens, Anna, Reyes, Laura Gallego, Paredes, Pervez, Sultan, David, Cain, John, Whittle, Ana Gutierrez, Del Arroyo, Zhuo, Sun, Patrick S, Finnegan, Cameron, Egan, Hooman, Honar, Aram, Shahinyan, Krit, Panjasawatwong, Alexander Y, Fu, Sihe, Wang, Edmunds, Reineks, Jane, Blood, Megan, Kalin, David, Gibson, and Troy, Wildes

Subjects
Male, Myocardial Ischemia, surgical technique, Article, Cohort Studies, Age Distribution, Postoperative Complications, Troponin T, Humans, preoperative care, human, Prospective Studies, outcome assessment, Aged, Hardware_MEMORYSTRUCTURES, troponin T, ComputingMilieux_THECOMPUTINGPROFESSION, predictive value, Research Diagnostic Criteria, heart muscle injury, Middle Aged, Prognosis, major clinical study, mortality, clinical feature, Patient Outcome Assessment, peroperative complication, priority journal, Surgical Procedures, Operative, prognosis, purl.org/pe-repo/ocde/ford#3.02.09 [https]
Abstract

Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS. Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated abnormal laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria. Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors' diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96-5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6-41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom. Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Published
2014

5. The growth of medical empiricism

Author

Robert James Hankinson

Subjects
media_common.quotation_subject, Philosophy, medicine, Pyrrhonism, Dissection (medical), Empiricism, medicine.disease, Causality, Epistemology, Skepticism, media_common
Published
1995
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