bluuebunny/crossref_metadata_2025 huggingface dataset:
Practical Grading System for Evaluating Cisplatin Ototoxicity in Children
Authors: Chang Kay W. , Chinosornvatana Nina
Published: March 2010

Purpose

We present a new ototoxicity grading system that has clearly defined and frequency-specific audiometric criteria. The purpose of this study was to validate this grading system by assessing its correspondence to audiology treatment recommendations and comparing it with the currently utilized Common Terminology Criteria for Adverse Events (CTCAE).

Patients and Methods

A retrospective chart review was conducted using audiologic, demographic, and clinical data from 134 children receiving 149 courses of chemotherapy consisting of cisplatin and/or carboplatin. Pure-tone audiograms were evaluated using both our proposed grading criteria and the CTCAE criteria. The resulting grades were then compared with charted audiologic interventions and a number of clinical parameters to assess the clinical validity of the grading scale.

Results

Chang grade 2a or higher predicted audiologic intervention. Although both the Chang and CTCAE ototoxicity grades were significantly related to audiologist recommendations for assistive devices such as hearing aids and/or frequency modulated systems (P < .0001), the Chang scale was more specific, with the CTCAE scale diverging from clinical recommendation at higher grades. As expected, patients receiving cisplatin had more severe hearing loss with concurrent carboplatin administration, radiation therapy exposure, younger age, smaller body-surface area, longer treatment exposure, and more severe disease.

Conclusion

This grading system provides robust and clinically useful criteria to represent clinical hearing loss induced by ototoxicity with regard to the impact on speech and language and the need for assistive hearing devices. It is both more specific and more sensitive than the traditional CTCAE criteria for identifying clinically significant ototoxicity.
Employment Among Survivors of Lung Cancer and Colorectal Cancer
Authors: Earle Craig C. , Chretien Yves , Morris Carl , Ayanian John Z. , Keating Nancy L. , Polgreen Linnea A. , Wallace Robert , Ganz Patricia A. , Weeks Jane C.
Published: March 2010

Purpose

To identify the frequency of and factors associated with changes in employment among cancer survivors.

Methods

This prospective cohort study took place in the context of the population-based Cancer Care Outcomes Research and Surveillance Consortium. Patients with nonmetastatic lung or colorectal cancer who survived approximately 15 months after diagnosis without cancer recurrence provided their self-reported employment status, employment experiences, and changes in insurance coverage at 4 and 15 months after diagnosis. Multiple logistic regression was used to relate sociodemographic and disease factors to the probability of labor force departure.

Results

Among 2,422 eligible patients, employment declined from 3% to 31% over the 15 months after cancer was diagnosed. Labor force departures attributable to cancer occurred in 17% of those employed at baseline. Factors associated with significantly higher rates of labor force departure were lung versus colon cancer, stage III versus I or II disease, lower educational and income levels, and, among colorectal patients, older age. Married women were significantly more likely than unmarried women to leave the workforce. Only 2% of patients lacked health insurance during the study period.

Conclusion

Most employed patients with nonmetastatic lung or colorectal cancer return to work, but approximately one sixth of patients leave the workforce, particularly those with worse prognoses or lower socioeconomic status. Potential economic effects must be considered in management decisions about cancer.
Outcomes of Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Proposal for Patient Selection
Authors: Satoh Toyomi , Hatae Masayuki , Watanabe Yoh , Yaegashi Nobuo , Ishiko Osamu , Kodama Shoji , Yamaguchi Satoshi , Ochiai Kazunori , Takano Masashi , Yokota Harushige , Kawakami Yosuke , Nishimura Sadako , Ogishima Daiki , Nakagawa Shunsuke , Kobayashi Hiroaki , Shiozawa Tanri , Nakanishi Toru , Kamura Toshiharu , Konishi Ikuo , Yoshikawa Hiroyuki
Published: March 2010

Purpose

The objective of this study was to assess clinical outcomes and fertility in patients treated conservatively for unilateral stage I invasive epithelial ovarian cancer (EOC).

Patients and Methods

A multi-institutional retrospective investigation was undertaken to identify patients with unilateral stage I EOC treated with fertility-sparing surgery. Favorable histology was defined as grade 1 or grade 2 adenocarcinoma, excluding clear cell histology.

Results

A total of 211 patients (stage IA, n = 126; stage IC, n = 85) were identified from 30 institutions. Median duration of follow-up was 78 months. Five-year overall survival and recurrence-free survival were 100% and 97.8% for stage IA and favorable histology (n = 108), 100% and 100% for stage IA and clear cell histology (n = 15), 100% and 33.3% for stage IA and grade 3 (n = 3), 96.9% and 92.1% for stage IC and favorable histology (n = 67), 93.3% and 66.0% for stage IC and clear cell histology (n = 15), and 66.7% and 66.7% for stage IC and grade 3 (n = 3). Forty-five (53.6%) of 84 patients who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 56 healthy children.

Conclusion

Our data confirm that fertility-sparing surgery is a safe treatment for stage IA patients with favorable histology and suggest that stage IA patients with clear cell histology and stage IC patients with favorable histology can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy.
TI-CE High-Dose Chemotherapy for Patients With Previously Treated Germ Cell Tumors: Results and Prognostic Factor Analysis
Authors: Feldman Darren R. , Sheinfeld Joel , Bajorin Dean F. , Fischer Patricia , Turkula Stefan , Ishill Nicole , Patil Sujata , Bains Manjit , Reich Lilian M. , Bosl George J. , Motzer Robert J.
Published: March 2010

Purpose

We previously reported a dose-finding and phase II trial of the TI-CE regimen (paclitaxel [T] plus ifosfamide [I] followed by high-dose carboplatin [C] plus etoposide [E] with stem-cell support) in germ cell tumor (GCT) patients predicted to have a poor prognosis with conventional-dose salvage therapy. We now report the efficacy of TI-CE with prognostic factors for disease-free survival (DFS) and overall survival (OS) in our full data set of 107 patients.

Patients and Methods

Eligible patients had advanced GCTs with progressive disease following chemotherapy and unfavorable prognostic features (extragonadal primary site, incomplete response [IR] to first-line therapy, or relapse/IR to ifosfamide-cisplatin–based conventional-dose salvage). Univariate and multivariate analyses (MVAs) of prognostic factors were performed. The predictive ability of the Einhorn and Beyer prognostic models was assessed.

Results

Most patients were platinum refractory and had an IR to first-line chemotherapy. There were 54 (5%) complete and eight (8%) partial responses with negative markers; 5-year DFS was 47% and OS was 52% (median follow-up, 61 months). No relapses occurred after 2 years. Five (24%) of 21 primary mediastinal nonseminomatous GCTs are continuously disease free. On MVA, primary mediastinal site (P < .001), two or more lines of prior therapy (P < .001), baseline human chorionic gonadotropin ≥ 1,000 U/L (P = .01), and lung metastases (P = .02) significantly predicted adverse DFS. Poor-risk patients did worse than good- or intermediate-risk patients according to both Beyer (P < .002) and Einhorn (P < .05) models.

Conclusion

TI-CE is effective salvage therapy for GCT patients with poor prognostic features. Mediastinal primary site and two or more lines of prior therapy were most predictive of adverse DFS. Beyer and Einhorn models can assist in predicting outcome.
Comparison of Two Neoadjuvant Chemoradiotherapy Regimens for Locally Advanced Rectal Cancer: Results of the Phase III Trial ACCORD 12/0405-Prodige 2
Authors: Gérard Jean-Pierre , Azria David , Gourgou-Bourgade Sophie , Martel-Laffay Isabelle , Hennequin Christophe , Etienne Pierre-Luc , Vendrely Véronique , François Eric , de La Roche Guy , Bouché Olivier , Mirabel Xavier , Denis Bernard , Mineur Laurent , Berdah Jean-François , Mahé Marc André , Bécouarn Yves , Dupuis Olivier , Lledo Gérard , Montoto-Grillot Christine , Conroy Thierry
Published: March 2010

Purpose

Neoadjuvant chemoradiotherapy is considered a standard approach for T3-4 M0 rectal cancer. In this situation, we compared neoadjuvant radiotherapy plus capecitabine with dose-intensified radiotherapy plus capecitabine and oxaliplatin.

Patients and Methods

We randomly assigned patients to receive 5 weeks of treatment with radiotherapy 45 Gy/25 fractions with concurrent capecitabine 800 mg/m2 twice daily 5 days per week (Cap 45) or radiotherapy 50 Gy/25 fractions with capecitabine 800 mg/m2 twice daily 5 days per week and oxaliplatin 50 mg/m2 once weekly (Capox 50). The primary end point was complete sterilization of the operative specimen (ypCR).

Results

Five hundred ninety-eight patients were randomly assigned to receive Cap 45 (n = 299) or Capox 50 (n = 299). More preoperative grade 3 to 4 toxicity occurred in the Capox 50 group (25 v 1%; P < .001). Surgery was performed in 98% of patients in both groups. There were no differences between groups in the rate of conservative surgery (75%) or postoperative deaths at 60 days (0.3%). The ypCR rate was 13.9% with Cap 45 and 19.2% with Capox 50 (P = .09). When ypCR was combined with yp few residual cells, the rate was respectively 28.9% with Cap 45 and 39.4% with Capox 50 (P = .008). The rate of positive circumferential rectal margins (between 0 and 2 mm) was 19.3% with Cap 45 and 9.9% with Capox 50 (P = .02).

Conclusion

The benefit of oxaliplatin was not demonstrated and this drug should not be used with concurrent irradiation. Cap 50 merits investigation for T3-4 rectal cancers.
Clinical Scoring System to Predict Hepatocellular Carcinoma in Chronic Hepatitis B Carriers
Authors: Wong Vincent Wai-Sun , Chan Stephen Lam , Mo Frankie , Chan Tung-Ching , Loong Herbert Ho-Fung , Wong Grace Lai-Hung , Lui Yanni Yan-Ni , Chan Anthony Tak-Cheung , Sung Joseph Jao-Yiu , Yeo Winnie , Chan Henry Lik-Yuen , Mok Tony Shu-Kam
Published: March 2010

Purpose

Hepatitis B virus (HBV) infection is an important etiology for hepatocellular carcinoma (HCC). We aim to develop a simple clinical score in predicting the risk of HCC among HBV carriers.

Patients and Methods

We first evaluated 1,005 patients and found that the following five factors independently predicted HCC development: age, albumin, bilirubin, HBV DNA, and cirrhosis. These variables were used to construct a prediction score ranging from 0 to 44.5. The score was validated in another prospective cohort of 424 patients.

Results

During a median follow-up of 10 years, 105 patients (10.%) in the training cohort and 45 patients (10.6%) in the validation cohort developed HCC. Cutoff values of 5 and 20 best discriminated HCC risk. By applying the cutoff value of 5, the score excluded future HCC development with high accuracy (negative predictive value = 97.8% and 97.3% in the training and validation cohorts, respectively). In the validation cohort, the 5-year HCC-free survival rates were 98.3%, 90.5%, and 78.9% in the low-, medium-, and high-risk groups, respectively. The hazard ratios for HCC in the medium- and high-risk groups were 12.8 and 14.6, respectively.

Conclusion

A simple prediction score constructed from routine clinical and laboratory parameters is accurate in predicting HCC development in HBV carriers. Future prospective validation is warranted.
Early Overnutrition Results in Early-Onset Arcuate Leptin Resistance and Increased Sensitivity to High-Fat Diet
Authors: Glavas Maria M. , Kirigiti Melissa A. , Xiao Xiao Q. , Enriori Pablo J. , Fisher Sarah K. , Evans Anne E. , Grayson Bernadette E. , Cowley Michael A. , Smith M. Susan , Grove Kevin L.
Published: March 2010

Childhood obesity increases the risk of adult obesity and diabetes, suggesting that early overnutrition permanently programs altered energy and glucose homeostasis. In the present studies, we used a mouse model to investigate whether early overnutrition increases susceptibility to obesity and insulin resistance in response to a high-fat diet (HFD). Litters from Swiss Webster dams were culled to three [chronic postnatal overnutrition (CPO)] or 10 (control) pups and then weaned onto standard chow at postnatal day (P) 23. At 6 wk of age, a subset of mice was placed on HFD, and glucose and insulin tolerance were examined at 16–17 wk of age. Leptin sensitivity was determined by hypothalamic phosphorylated signal transducer and activator of transcription-3 immunoreactivity at P16 and adulthood after ip leptin. CPO mice exhibited accelerated body weight gain and hyperleptinemia during the preweaning period but only a slightly heavier body weight and normal glucose tolerance in adulthood on standard chow diet. Importantly, CPO mice exhibited significant leptin resistance in the arcuate nucleus, demonstrated by reduced activation of phospho-signal transducer and activator of transcription-3, as early as P16 and throughout life, despite normalized leptin levels. In response to HFD, CPO but not control mice displayed insulin resistance in response to an insulin tolerance test. In conclusion, CPO mice exhibited early and persistent leptin resistance in the arcuate nucleus and, in response to HFD, rapid development of obesity and insulin resistance. These studies suggest that early overnutrition can permanently alter energy homeostasis and significantly increase susceptibility to obesity and insulin resistance.
Functional Significance of Nuclear Estrogen Receptor Subtypes in the Liver of Goldfish
Authors: Nelson Erik R. , Habibi Hamid R.
Published: March 2010

Estrogens work by binding to and activating specific estrogen receptors (ERs). Although mammals have two major nuclear ER subtypes (ERα and ERβ), three subtypes have been shown in teleost fish (ERα, ERβ-I, and ERβ-II). 17β-Estradiol stimulates the production of an egg yolk precursor protein (vitellogenin) in the liver of oviparous species, including the goldfish. However, the functional involvement of the ER subtypes in this process is not fully understood. Here, using primary goldfish hepatocytes, we test the hypothesis that all three ER subtypes are functionally involved in the liver of goldfish by using RNA interference to specifically knock-down the different ER subtypes. The results suggest that ERα is induced by estradiol through activation of the ERβ subtypes. This induction serves to sensitize the liver to further stimulation by estradiol. The knock-down results were supported by use of ER subtype specific antagonists. Sensitization by up-regulation of ERα is likely to be important for seasonal spawners such as goldfish, to bring about a change from somatic growth to reproductive development, and vitellogenesis. The novel data presented in this study provide strong support for the hypothesis that the goldfish ER subtypes play functional roles in the regulation of vitellogenin and ERα and provide a framework for the better understanding of ER signaling in fish and other vertebrates.
Electronic Literature as World Literature; or, The Universality of Writing under Constraint
Authors: Tabbi Joseph
Published: March 2010

Electronic literature is not just a “thing” or a “medium” or even a body of “works” in various “genres.” It is not poetry, fiction, hypertext, gaming, codework, or some new admixture of all these practices. E-literature is, arguably, an emerging cultural form, as much a collective creation of terms, keywords, genres, structures, and institutions as it is the production of new literary objects. The ideas of cybervisionaries Paul Otlet, Vannevar Bush, and Ted Nelson, foundational to the electronic storage, recovery, and processing of texts, go beyond practical insights and can be seen to participate in a long-standing ambition to construct a world literature in the sense put forward by David Damrosch (2003: 5): “not an infinite ungraspable canon of works but rather a mode of circulation and of reading... that is applicable to individual works as to bodies of material.” The model for such constructions may be not the global literary commerce envisioned by Goethe and adopted by Karl Marx, not the romantic tradition of poets as world legislators, and not the current model of a “world republic of letters.” The model adopted in this essay, rather, is the literary practice of writing under constraint, developed long before the Internet but suited to its computational impositions and gamelike literary presentations. Instead of a canon of works preserved solely by the power of institutions, the essay presents a freestanding network of authors as precursors to, and models for, this potential world literature, namely, the Oulipo.
Antebellum AI: “Maelzel's Chess-Player” and Poe's Reverse Constraints
Authors: Grimstad Paul
Published: March 2010

In his essay “The Philosophy of Composition” (1846), Edgar Allan Poe describes how he composed his lyric poem “The Raven” by following a series of predetermined steps. My essay shows how Poe's description of composition as rule following both has suggestive affinities with and significantly alters the Oulipian understanding of constraints as axioms that precede composition. Looking closely at Poe's earlier essay “Maelzel's Chess-Player” (1836) and the way it anticipates more recent debates in artificial intelligence, I show how Poe's (1984d [1846]: 13) constraint, as stated in “The Philosophy of Composition,” “I prefer commencing with the consideration of an effect,” is a matter of concealing a decade of experimentation in previous magazine essays with the effect of a poetry-making algorithm.
Cancer Patients' Experiences of Using Complementary Therapies: Polarization and Integration
Authors: Smithson Janet , Paterson Charlotte , Britten Nicky , Evans Maggie , Lewith George
Published: March 2010

Objective

The use of complementary therapies by people with cancer is commonplace. In a recent synthesis of 26 qualitative studies of patients' experiences of complementary therapy use after a diagnosis of cancer, the emergent theme of ‘polarization’ was the most notable barrier to a positive experience of complementary therapies. In this paper, we explore the two synthesis concepts of ‘polarization’ and ‘integration’, and their relationship to health service policies and guidelines on integrated services.

Methods

A systematic literature search and a meta-ethnography to synthesize key concepts.

Results

The majority of patients who used complementary therapies after a diagnosis of cancer wanted to be certain that the therapies were not interfering with their conventional cancer treatment. They valued the therapies in wider terms including: taking ‘a niche of control’, relieving symptoms, improving wellbeing, and promoting reconnection and social interaction. The emergent theme of ‘polarization’ suggested that conventional physicians who are perceived to be poorly informed or negative about complementary approaches induce patient anxiety, safety concerns, and difficulties in access. They may compromise their therapeutic relationship and, rarely, they may trigger patients to abandon conventional medicine altogether. In contrast, integrated advice and/or services were highly valued by patients, although some patients preferred their complementary health care to be provided in a non-medicalized environment.

Conclusions

Our findings suggest that the current polarized situation is unhelpful to patients, detrimental to therapeutic relationships and may occasionally be dangerous. They indicate that complementary therapies, in a supportive role, should be integrated into mainstream cancer care.
Decision-Focused Transformation of Additive Value Models to Improve Communication
Authors: Dees Robert A. , Dabkowski Matthew F. , Parnell Gregory S.
Published: March 2010

When using multiobjective decision analysis with an additive value/utility model, we may define local ranges of the value measures that are bounded by the set of alternatives, or we can define global ranges of the value measures that are bounded by our preferences for some future set of alternatives. Local value models use the full value space defined by the alternatives to distinguish between the alternatives. Global value models may identify new objectives and may help us develop better alternatives, but the alternatives do not usually span the full global value space. We present a mathematical transformation of a global value model's single-dimensional value functions and swing weights to a decision-focused value model using the global value, alternative scores, and transformation equations. When the transformation is appropriate, the decision-focused value model can provide useful distinctions to better communicate the trade-offs between alternatives. We prove that the transformation preserves the rank ordering of the alternatives, and we discuss the appropriate conditions for use.
Environmental Uncertainty and IT Infrastructure Governance: A Curvilinear Relationship
Authors: Xue Ling , Ray Gautam , Gu Bin
Published: March 2010

Extant research considers the IT governance choice to be a trade-off between the cost-efficiency of centralization and the responsiveness provided by local information processing. This view predicts that firms tend to decentralize IT governance in more uncertain environments. We investigate this issue by studying the relationship between environmental uncertainty and IT infrastructure governance in a sample of business units from Fortune 1000 companies. The key proposition in this paper is that the relationship between environmental uncertainty and decentralization in IT infrastructure governance is best characterized as a curvilinear relationship. That is, when environmental uncertainty increases from low to high, firms tend to first decentralize their IT infrastructure decisions to the business units to enhance their responsiveness; and then centralize their IT infrastructure decisions to the headquarters as uncertainty increases further, to achieve the benefits of coordination and to mitigate the potential agency problem in uncertain environments. Moreover, the study proposes that business unrelatedness between business units and their headquarters moderates the curvilinear relationship between environmental uncertainty and IT infrastructure governance. We find that both the propositions are supported by the data.
Putting Yourself in the Picture: An Evaluation of Virtual Model Technology as an Online Shopping Tool
Authors: Smith Stephen P. , Johnston Robert B. , Howard Steve
Published: March 2010

The electronic gulf between shoppers and products makes evaluating a physical product on offer at an e-store a potentially problematic activity. We propose that the outcome of the product evaluation task is determined by the fit between the type of information provided and the type of information sought by the consumer and that this, in turn, influences a consumer's attitude toward an e-store. An experiment to compare the impact of one type of advanced evaluation support technology, the virtual model, with a more basic online catalog, is then described. Results indicate that virtual models are potentially valuable when a customer is concerned with self-image and considerably less valuable when concerned with functionality. In more general terms, variation in end-user attitudes toward the object of the task (evaluative attitude) influenced how informed consumers felt about a product when using different technologies. Feeling informed, in turn, had a strong effect on consumer attitudes toward the store. Our results highlight two important issues for online stores: (1) a consumer's information requirements depend on his or her attitude to a product rather than product attributes; and (2) meeting or not meeting these information requirements affects perceptions of the store. Business success in this context therefore appears to hinge on addressing the specific functional and image-related information needs of customers rather than simply providing more interactivity or technical functionality.
A Paradigm Shift: Quality Management and PMETB – The Approach of a School of Surgery
Authors: Bradburn M , Kendall S , Young A , Sher L
Published: March 2010

In 2003, UK legislation established a new regulatory body to develop a single, unifying framework for postgraduate medical and dental education and training: the Postgraduate Medical Education and Training Board (PMETB). This new independent statutory organisation came into being on 30 September 2005 and set about a systematic examination of existing practice, as well as asking all 57 recognised specialties to submit formal curricula to them for approval. This review of practice translated into a policy document entitled Generic standards for training (April 2006), later updated in July 2008. In December 2008 the Joint Committee on Surgical Training (JCST) published a surgical version of this, the JCST Standards for Surgical Training.
Revalidation – an update
Authors: Bishop Karl
Published: March 2010

In February 2009 the General Dental Council (GDC) updated its open consultation document on the proposals for revalidation (http://www.gdc-uk.org/Our+current+reforms/Revalidation). The GDC has made it clear that there will be only one standard for nonspecialists and this will be that required for full registration. Presumably for specialists the standards will be those for entry on to the specialist lists. In addition, the GDC states that it intends revalidation to be proportionate in the area of the clinical practice of the registrant and that individuals will only have to undertake a single revalidation process.
Can I cut it? / A foundation for surgical training
Authors: Harvey Nick , Young Alexander
Published: March 2010

In general doctors are a politician's dream: hard-working and intelligent but conformist. Yes, we are akin to clever sheep. We tend to be easily steered by barking managers and politicians and continue to try our best no matter what pen we find ourselves in. At most we muster a bleat of objection but not in unison. Clever? Or just foolish enough to be shepherded into any corner?
Whistle While you Work
Authors: Wolthuizen Catherine
Published: March 2010

It seems that barely a month goes by without whistleblowing in the NHS hitting the headlines. Stories such as the nurse struck off for filming patients undercover, staff unable to speak up about poor standards of care at Mid Staffordshire NHS Foundation Trust and the Liverpool consultant forced to sign a gagging clause have all attracted the media spotlight. But when the attention has moved on to other scandals a more fundamental tale emerges: the need for clear guidance so that medical and healthcare professionals feel able to speak up about risks they observe at the earliest possible opportunity. In this article, we discuss whistleblowing in the NHS; describe what Public Concern at Work is doing to help organisations get it right; and set out a brief guide to the relevant law.
Mentoring dental professionals
Authors: Worker Charlotte , Hunter Sally
Published: March 2010

Mentoring has become an increasingly valuable skill in dentistry. Professionals working in primary dental care often face challenging decisions in relative isolation about the care of their patients and their own professional development. Pressures come from many different directions, including those resulting from the sheer range of career choices, changing arrangements for delivery of primary care and uncertainty around future commitment to funding. Above all there is the desire to live up to the professional vision of service, standards and quality that led many to become members of a person-centred profession in the first place.
The Lost Generation: Impact of the 56-hour EWTD on Current Surgical Training
Authors: Chalmers CR , Joshi S , Bentley PG , Boyle NH
Published: March 2010

The reform of specialist surgical training – the New Deal (1991), the Calman report (1993) and the implementation of the European Working Time Directive (EWTD, 1998) – has resulted in shorter training periods with reduced working hours. The Calman reform aimed to improve and structure training with regular assessment and supervision whereas the New Deal and the EWTD have concentrated predominantly on a reduction in hours. The adoption of full or partial shift work to provide surgical cover at night compliant to a 56-hour working week, as stipulated by phase one of the EWTD, has resulted in daytime hospital attendance for surgical trainees of an average three days per week despite almost universal acknowledgement of the limited training opportunities available at night.
Everyone has an Agenda but the Media Control the Timeframe
Authors: Lander Anthony
Published: March 2010

In late 2008 I was Clinical Lead for General Surgery and Urology at the Children's Hospital in Birmingham (BCH) and was Vice-chair of the senior medical and dental staff committee. Our hospital provides local, regional and some supra-regional services for children covering all medical and surgical specialties. The hospital is well loved by patients and parents and we thought we had good relationships with the media. Of course no organisation is perfect and we all have something we wish to see improved. For staff the hospital easily passed the test: 'would you want your own child treated here?'
Conceptions of learning and approaches to studying among White and ethnic minority students in distance education
Authors: Richardson John T. E.
Published: March 2010

Background. The attainment of White students at UK institutions of higher education tends to be higher than that of students from other ethnic groups, but the causes of this are unclear.

Aims. This study compared White students and students from other ethnic groups in their conceptions of learning, their approaches to studying, and their academic attainment.

Sample. A stratified sample of 1,146 White students and 1,146 students from other ethnic groups taking courses by distance learning with the UK Open University.

Methods. The Mental Models section of the Inventory of Learning Styles and the Revised Approaches to Studying Inventory were administered in a postal survey.

Results. The students' questionnaire scores were contaminated by response bias, which varied across different ethnic groups. When adjusted to control for response bias, the scores on the two questionnaires shared 37.2% of their variance and made a significant contribution to predicting the students' attainment. White students were more likely to exhibit a meaning‐directed learning pattern, whereas Asian and Black students were more likely to exhibit a reproduction‐directed learning pattern. However, the variation in attainment across different ethnic groups remained significant when their questionnaire scores and prior qualifications were taken into account.

Conclusions. There is a strong relationship between students' conceptions of learning and their approaches to studying, and variations in conceptions of learning in different ethnic groups give rise to variations in approaches to studying. However, factors other than prior qualifications and conceptions of learning are responsible for variation in attainment across different ethnic groups.
Ideology and Total War. Military Intellectuals and the Analysis of the Spanish
Civil War in Britain, 1936–1943
Authors: Searle Alaric
Published: March 2010

The recent historical interest in the analysis of the lessons of the Spanish Civil War by the European powers has tended to focus very strongly on the tactical experiences and the study of new military technology. This has led to the implied assumption that much of this analysis took place within a closed, professional military environment. In the case of Britain, however, the military debate on the lessons and significance of the civil war was conducted in a much more public fashion than in many other countries. For this reason, and due to the considerable political controversy over the official government policy of non-intervention, ideology played a significant role in the analyses of the unfolding military drama in Spain. This article considers the way in which ideology affected military interpretations of the conflict – and the employment of these analyses for ideological purposes – by examining the public debate, the reaction of British intelligence and the views of four "military intellectuals" who commented on the conflict in newspaper articles, books, and in memoranda written for military intelligence
Nachrichten aus der Forschung
Authors: Bange Oliver , Potempa Harald , Wienand Christiane , Vuletic Alexandar-S.
Published: March 2010

Oliver Bange/Harald Potempa: "Imperialkriege - gestern und heute?" 50. Internationale Tagung für Militärgeschichte (ITMG), Potsdam, 19. Juni bis 1. Juli 2009

Christiane Wienand: Kriegsenden, Nachkriegsordnungen und Militärreformen im 19. und 20. Jahrhundert, Potsdam, 26./27. Februar 2009

Aleksandar-S. Vuletic: "Die Kamera als Waffe". Propagandabilder des Zweiten Weltkrieges. Symposium der Deutschen Kinemathek - Museum für Film und Fernsehen in Berlin, 24. bis 26. September 2009
Position Paper: Rapid responses to steroids: current status and future prospects
Authors: Wendler Alexandra , Baldi Elisabetta , Harvey Brian J , Nadal Angel , Norman Anthony , Wehling Martin
Published: March 2010

Steroids exert their actions through several pathways. The classical genomic pathway, which involves binding of steroids to receptors and subsequent modulation of gene expression, is well characterized. Besides this, rapid actions of steroids have been shown to exist. Since 30 years, research on rapid actions of steroids is an emerging field of science. Today, rapid effects of steroids are well established, and are shown to exist for every type of steroid. The classical steroid receptors have been shown to be involved in rapid actions, but there is also strong evidence that unrelated structures mediate these rapid effects. Despite increasing knowledge about the mechanisms and structures which mediate these actions, there is still no unanimous acceptance of this category. This article briefly reviews the history of the field including current controversies and challenges. It is not meant as a broad review of literature, but should increase the awareness of the endocrinology society for rapid responses to steroids. As members of the organizing committee of the VI International Meeting on Rapid Responses to Steroid Hormones 2009, we propose a research agenda focusing on the identification of new receptoral structures and the identification of mechanisms of actions at physiological steroid concentrations. Additionally, efforts for the propagation of translational studies, which should finally lead to clinical benefit in the area of rapid steroid action research, should be intensified.
The Influence of Horizontal Gene Transfer on the Mean Fitness of Unicellular Populations in Static Environments
Authors: Raz Yoav , Tannenbaum Emmanuel
Published: March 2010

Horizontal gene transfer (HGT) is believed to be a major source of genetic variation, particularly for prokaryotes. It is believed that horizontal gene transfer plays a major role in shaping bacterial genomes and is also believed to be responsible for the relatively rapid dissemination and acquisition of new, adaptive traits across bacterial strains. Despite the importance of horizontal gene transfer as a major source of genetic variation, the bulk of research on theoretical evolutionary dynamics and population genetics has focused on point mutations (sometimes coupled with gene duplication events) as the main engine of genomic change. Here, we seek to specifically model HGT processes in bacterial cells, by developing a mathematical model describing the influence that conjugation-mediated HGT has on the mutation–selection balance in an asexually reproducing population of unicellular, prokaryotic organisms. It is assumed that mutation–selection balance is reached in the presence of a fixed background concentration of antibiotic, to which the population must become resistant to survive. We find that HGT has a nontrivial effect on the mean fitness of the population. However, one of the central results that emerge from our analysis is that, at mutation–selection balance, conjugation-mediated HGT has a slightly deleterious effect on the mean fitness of a population. Therefore, we conclude that HGT does not confer a selection advantage in static environments. Rather, its advantage must lie in its ability to promote faster adaptation in dynamic environments, an interpretation that is consistent with the observation that HGT can be promoted by environmental stresses on a population.
Transformation/Transcription Domain-Associated Protein (TRRAP)-Mediated Regulation of Wee1
Authors: Calonge Teresa M , Eshaghi Majid , Liu Jianhua , Ronai Ze'ev , O'Connell Matthew J
Published: March 2010

The G2 DNA damage checkpoint inhibits Cdc2 and mitotic entry through the dual regulation of Wee1 and Cdc25 by the Chk1 effector kinase. Upregulation of Chk1 by mutation or overexpression bypasses the requirement for upstream regulators or DNA damage to promote a G2 cell cycle arrest. We screened in fission yeast for mutations that rendered cells resistant to overexpressed chk1+. We identified a mutation in tra1, which encodes one of two homologs of transformation/transcription domain-associated protein (TRRAP), an ATM/R-related pseudokinase that scaffolds several histone acetyltransferase (HAT) complexes. Inhibition of histone deacetylases reverts the resistance to overexpressed chk1+, suggesting this phenotype is due to a HAT activity, although expression of checkpoint and cell cycle genes is not greatly affected. Cells with mutant or deleted tra1 activate Chk1 normally and are checkpoint proficient. However, these cells are semi-wee even when overexpressing chk1+ and accumulate inactive Wee1 protein. The changed division response (Cdr) kinases Cdr1 and Cdr2 are negative regulators of Wee1, and we show that they are required for the Tra1-dependent alterations to Wee1 function. This identifies Tra1 as another component controlling the timing of entry into mitosis via Cdc2 activation.
Providing Effective Feedback
Authors: Brodsky Dara , Doherty Elizabeth G.
Published: March 2010

Feedback promotes learning and ensures that trainees achieve predetermined standards. Feedback can be formative or summative. Learners should be encouraged to be self-reflective, and the teacher and learner should work together as allies to maximize the learner's potential. Reviewers should be prepared to respond to defensive reactions and to consider their own biases. This article offers illustrative examples of effective and ineffective feedback.
Neonatal Cardiopulmonary Resuscitation: Critical Hemodynamics
Authors: Wyckoff Myra H.
Published: March 2010

Following asphyxia-induced severe bradycardia or asystole, a critical diastolic blood pressure must be attained during resuscitation to achieve return of spontaneous circulation. Although unknown in asphyxiated neonates, adult ventricular fibrillation models suggest that this critical pressure is approximately 15 to 20 mm Hg. Based on adult model data, chest compressions with coordinated ventilation at a ratio of 3:1 are unlikely to produce a sufficient diastolic blood pressure to achieve return of spontaneous circulation. Other compression-to-ventilation ratios that are potentially more effective at attaining an adequate diastolic blood pressure while maintaining adequate ventilation during neonatal resuscitation should be investigated. In addition, development of strategies to decrease “hands-off time” during newborn cardiac compressions are needed, including further investigation of capnography to guide cardiopulmonary resuscitation efforts rather than stopping to listen every 30 seconds. Administration of intravenous epinephrine often is needed once chest compressions are initiated for rapid achievement of the diastolic blood pressure necessary for a successful resuscitation. However, few data are available to allow determination of the most efficacious/safe epinephrine dosing and route of administration.
Pharmacologic Treatment of Feeding Intolerance in Neonates
Authors: Young Thomas E.
Published: March 2010

Successful establishment of enteral feedings is major goal in the treatment of very low-birthweight infants, but functional immaturity of the gastrointestinal tract may hamper such efforts. Prokinetic agents often are used in an attempt to overcome the functional immaturity by speeding up gastric emptying and increasing small intestinal motility. This brief review examines the currently used candidate drugs: erythromycin, metoclopramide, and domperidone, as well as the potential role for prebiotics and probiotics.
Camp Jump Start: Effects of a Residential Summer Weight-Loss Camp for Older Children and Adolescents
Authors: Huelsing Jean , Kanafani Nadim , Mao Jingnan , White Neil H.
Published: March 2010

OBJECTIVE:

Residential weight-loss camps offer an opportunity for overweight and obese children to lose weight in a medically safe, supervised, supportive environment. The purpose of this report is to describe short-term outcomes in 76 children participating in a 4- or 8-week residential weight-loss camp for children and adolescents.

PATIENTS AND METHODS:

The camp program enrolled obese 10- to 18-year-old adolescents. The program consisted of structured and nonstructured physical activities and group educational sessions covering nutrition, physical fitness, and self-esteem. A diet plan of 3 balanced meals and 2 snacks per day was prepared under the supervision of a registered dietitian. Participants had height, weight, and blood pressure measured and performed a 1-mile run at maximum effort on an outdoor track.

RESULTS:

For all campers, statistically significant (P < .0001) reductions were observed for BMI, BMI z score, systolic blood pressure, body weight, and 1-mile run times. Compared with campers in the 4-week session, campers in the 8-week session had greater reductions in BMI, BMI z score, body weight, and systolic blood pressure. Multivariate analysis revealed that gender was a significant predictor for reduction in body weight, BMI, and BMI z score, all of which decreased more in boys than in girls.

CONCLUSIONS:

This report adds to the evidence that residential weight-loss camps are highly effective in improving measures of health and fitness among overweight and obese children and adolescents. Additional study is needed on the long-term effects of such camps in terms of weight maintenance, behavior change, and metabolic and health outcomes.
Predictive Value of Albuminuria in American Indian Youth With or Without Type 2 Diabetes
Authors: Kim Nan Hee , Pavkov Meda E. , Knowler William C. , Hanson Robert L. , Weil E. Jennifer , Curtis Jeffrey M. , Bennett Peter H. , Nelson Robert G.
Published: March 2010

OBJECTIVE:

To examine the prognostic significance of elevated albuminuria in youth with type 2 diabetes.

PATIENTS AND METHODS:

Cross-sectional and prospective studies were conducted on Pima Indian youth aged 5 to 19 years at baseline who were examined between July 1, 1982, and December 31, 2007. Prevalence and sequential changes in the level of microalbuminuria (30 ≤ albumin-to-creatinine ratio [ACR] < 300 mg/g) and macroalbuminuria (ACR ≥ 300 mg/g) and incidence of macroalbuminuria were computed according to the presence or absence of type 2 diabetes.

RESULTS:

The prevalence of microalbuminuria and macroalbuminuria was 6.5% and 0.6% in the 3856 nondiabetic youth and 18.5% and 2.9% in the 103 youth with diabetes, respectively. One hundred forty-one of 187 (75.4%) nondiabetic youth, but only 1 of 14 (7.1%) diabetic youth with an elevated ACR (≥30 mg/g) regressed to an undetectable or normal ACR (<30 mg/g) on subsequent examination. In a subset of 2666 youth with a median follow-up of 8.1 years, 36 nondiabetic and 30 diabetic youth with baseline ACRs of <300 mg/g developed macroalbuminuria. For a given ACR, the incidence of macroalbuminuria was 15.9-fold (95% confidence interval: 11.1–22.6) higher in the diabetic than in the nondiabetic youth.

CONCLUSIONS:

Elevated albuminuria is infrequent and largely transient in nondiabetic youth, but it is relatively frequent and largely persistent in those with diabetes. Microalbuminuria in youth with type 2 diabetes strongly predicts progression to macroalbuminuria, which supports annual screening for albuminuria.
An Evidence-Based Overview of Prenatal Consultation With a Focus on Infants Born at the Limits of Viability
Authors: Griswold Katherine J. , Fanaroff Jonathan M.
Published: March 2010

Before the delivery of a premature infant, a prenatal consultation between parents and physicians provides the opportunity to establish a trusting relationship and create a supportive environment for decision-making concerning neonatal resuscitation. The ideal consult enables physicians to educate parents about preterm delivery and potential outcomes for their infant while providing parents with the time to ask questions and express their values. The uncertainty that surrounds many decisions in the treatment and resuscitation of infants born at the limits of viability creates a situation in which joint responsibility for decision-making between parents and physicians is vital. In this review we examine ethical considerations regarding the resuscitation of infants born at the limits of viability and present the current policies established by the Neonatal Resuscitation Program and the American Academy of Pediatrics. The parental and physician perspectives regarding the consultation experience are presented also. Finally, a model for the prenatal consultation is introduced with suggestions for the incorporation of morbidity and mortality data as well as the structure and approach to discussion with parents with threatened preterm delivery.