bluuebunny/crossref_metadata_2025 huggingface dataset:
Who’s in control? Teachers from five countries share perspectives on power dynamics in the learning environment
Authors: Lovorn Michael , Sunal Cynthia Szymanski , Christensen Lois McFadyen , Sunal Dennis W , Shwery Craig
Published: April 2012

This article explores perspectives and strands of thought among teachers from five countries about power dynamics in learning environments, perspectives on power of dominant cultures and impacts of power on concepts of citizenship and social justice. Discourses revealed teachers have some understanding of how power impacts teaching and learning, how language empowers/disempowers students and how teachers and students use their power. Teachers’ and students’ perceptions of power in the learning environment likely shape educational experiences for all stakeholders. Effective empowerment, particularly of students, requires recognition of these and other factors.
Turkish university students’ hopes and fears about travel to the west
Authors: Brown Lorraine , Aktas Gurhan
Published: April 2012

The aim of this article is to explore the perceptions and attitudes of Turkish university students about to embark on a European exchange trip. This qualitative study sheds light on their hopes and fears about travelling to and living for a period of three months in a western country. The article shows how participants shared common aspirations for their trip to be self-developmental and culturally educational. However, it also reveals a high degree of trepidation about their immersion, as Muslim students, in a country in the developed western world. This study thereby makes an important contribution to the international education literature in its identification of concern in students resulting from the current tension between Islam and the west and from perceived discrimination over economic status. The important link between macro forces and the micro experience is revealed.
Primary and secondary prevention of cardiovascular disease in diabetes with aspirin
Authors: Schnell Oliver , Erbach Michael , Hummel Michael
Published: April 2012

Diabetes is associated with an increased cardiovascular risk. The role for aspirin in diabetes is of high clinical interest. Guidelines recommend that primary prevention of cardiovascular disease (CVD) in diabetes with aspirin should be based on the individual risk for CVD. New mechanistic studies suggest that enhanced platelet turnover may partly contribute to the fact the primary prevention studies found unequivocal results in diabetes. There is initial evidence that a potential future modification of dosages in diabetes may counteract the enhancement in platelet turnover in diabetes. The use of aspirin in diabetic patients for secondary prevention of CVD is supported by key evidence. The aim of the review is to present recent studies on aspirin for prevention of CVD in diabetes and to highlight its role also in view of new mechanistic and clinical studies with aspirin. Novel aspects of aspirin, e.g. its potential role for the prevention of cancer, are also presented.
Signal Characteristics of Intraventricular Electrodes Recordings in Human Epilepsy
Authors: Shih Jerry J. , Rodin Ernst , Gupta Vivek , Wharen Robert E.
Published: April 2012

The case of a patient with intractable temporal lobe seizures and inadvertent unilateral intraventricular depth electrode placement is presented. The resting electroencephalograph (EEG) showed marked amplitude differences between the intraventricular electrode on the left and the parenchymal electrode on the right. All recorded seizures originated on the left side and in spite of its intraventricular location, frequency power spectra during the early ictal phase showed a marked increase in power for all frequency bands in the left depth electrode, exceeding that on the right. Analysis with Brain Electrical Source Analysis (BESA) software demonstrated marked ictal baseline shifts which were initially limited to the left side but changed to the right during clinical secondary generalization. In the immediate postictal state, all, except for infraslow, frequencies were markedly reduced in power. We conclude that intraventricular depth electrode contacts placed adjacent to the hippocampal structure can record interictal and ictal activity for all frequency bands, albeit at reduced amplitudes. Furthermore, infraslow activity can provide supplementary information about the epileptogenic zone.
Mid-Latency Auditory Evoked Potentials in 2 Meditative States
Authors: Telles Shirley , Raghavendra Bhat Ramachandra , Naveen Kalkuni Visweswaraiah , Manjunath Nandi Krishnamurthy , Subramanya Pailoor
Published: April 2012

Mid-latency auditory evoked potentials (MLAEPs) were assessed in 60 participants during 4 mental states described in traditional yoga texts. These 4 mental states are random thinking, nonmeditative-focused thinking, meditative focusing, and meditation. Assessments were made before (5 minutes), during (20 minutes), and after (5 minutes) each of the 4 states, on 4 separate days. There were prolonged latencies of 2 MLAEPs components, the Na and Pa waves during meditation ( P < .05, post hoc analyses following analysis of variance [ANOVA]), suggesting that auditory information transmission at the level of the medial geniculate and primary auditory cortex (ie, the neural generators corresponding to the Na and Pa waves) was delayed. Hence, meditation influenced MLAEPs, while meditative focusing did not.
Enhanced Active Segment Selection for Single-Trial EEG Classification
Authors: Hsu Wei-Yen
Published: April 2012

In this study, an electroencephalogram (EEG) analysis system is proposed for single-trial classification of both motor imagery (MI) and finger-lifting EEG data. Applying event-related brain potential (ERP) data acquired from the sensorimotor cortices, the system mainly consists of three procedures; enhanced active segment selection, feature extraction, and classification. In addition to the original use of continuous wavelet transform (CWT) and Student 2-sample t statistics, the two-dimensional (2D) anisotropic Gaussian filter further refines the selection of active segments. The multiresolution fractal features are then extracted from wavelet data by using proposed modified fractal dimension. Finally, the support vector machine (SVM) is used for classification. Compared to original active segment selection, with several popular features and classifier on both the MI and finger-lifting data from 2 data sets, the results indicate that the proposed method is promising in EEG classification.
Competing failure analysis in non-repairable binary systems subject to functional dependence
Authors: Xing Liudong , Wang Chaonan , Levitin Gregory
Published: April 2012

This paper considers competing failure propagation and isolation effects in the reliability analysis of systems with functional dependence, where the failure of some trigger component causes other components (referred to as dependent components) to become inaccessible or isolated from the system. A propagated failure originating from a dependent component could affect other parts of the system and thus cause the entire system to fail. However, if the trigger component fails first, the propagation of the dependent component failure can be prevented and thus it cannot affect the function of the rest of the system. In other words, propagated failures originating from dependent components in systems with functional dependence can have different consequences due to their competition with the failure of the trigger component in the time domain. This paper suggests a combinatorial method to address such competing failure behavior in the reliability analysis of non-repairable binary-state systems. Different from the work reported in the literature that assumes local and propagated failures of a component being mutually exclusive, the proposed method is applicable to independent and dependent local and propagated component failures. The system reliability analysis results for all the three cases (mutually exclusive, independent and dependent) are compared through a case study. The proposed method is verified through comparison with Markov-based methods.
The Role of Telemedicine in Treating the Critically Ill
Authors: Marcin James P. , Marcin Meghann , Sadorra Candace , Dharmar Madan
Published: April 2012

Telemedicine use has been increasing exponentially and is expected to become a common tool in remote emergency departments, inpatient wards, and ICUs for acute care. Telemedicine involves real-time, live interactive high-definition video and audio communication that allows critical care physicians to have a virtual presence at the bedside of any critically ill patient. There is increasing data to support new care models that incorporate telemedicine in caring for the critically ill, resulting in higher care quality; more efficient resource use with improved cost-effectiveness; and higher patient, family, and remote provider satisfaction. As further research is conducted, the best use of telemedicine will be better defined and will result in increased access to critical care expertise to a larger population of patients requiring ICU services.
Mouse background and IVIG dosage are critical in establishing the role of inhibitory Fcγ receptor for the amelioration of experimental ITP
Authors: Leontyev Danila , Katsman Yulia , Branch Donald R.
Published: April 2012

A recognized paradigm for the therapeutic action of intravenous immunoglobulin (IVIG) in immune thrombocytopenia (ITP) involves up-regulation of the inhibitory Fcγ receptor (FcγRIIB) in splenic macrophages. However, published data have indicated that opposing results are obtained when using FcγRIIB-deficient mice on different strain backgrounds. Herein we show BALB/c FcγRIIB−/− and wild-type, with or without spleens, all recover ITP with similar dynamics after IVIG (1 g/kg) treatment; however, this was not the case for C57BL/6 (B6) FcγRIIB−/−. In investigating this conundrum, we found that wild-type B6 mice are much less sensitive than BALB/c to IVIG-mediated amelioration of ITP, requiring approximately 2- to 2.5-fold more IVIG than BALB/c. When using 2.5 g/kg IVIG in FcγRIIB−/− B6 mice, amelioration of ITP was as in wild-type in all animals. Our findings led us to the conclusion that different strains of mice respond differently to IVIG and that FcγRIIB plays no role in the mechanism of effect of IVIG in experimental ITP.
Clinical features and outcome of multiple primary malignancies involving hepatocellular carcinoma: A long-term follow-up study
Authors: Zeng Qing-An , Qiu Jiliang , Zou Ruhai , Li Yijie , Li Shengping , Li Binkui , Huang Pinzhu , Hong Jian , Zheng Yun , Lao Xiangming , Yuan Yunfei
Published: April 2012

Background

The prolonged survival of individuals diagnosed with cancer has led to an increase in the number of secondary primary malignancies. We undertook to perform a definitive study to characterize and predict prognosis of multiple primary malignancies (MPM) involving hepatocellular carcinoma (HCC), due to the scarcity of such reports.

Methods

Clinicopathological data were analyzed for 68 MPM patients involving HCC, with 35 (target group) underwent curative liver resection. Additional 140 HCC-alone patients with hepatectomy were selected randomly during the same period as the control group.

Results

Of the 68 patients with extrahepatic primary malignancies (EHPM), 22 were diagnosed synchronously with HCC, and 46 metachronously. The most frequent EHPM was nasophargeal carcinoma, followed by colorectal and lung cancer. Univariate analysis demonstrated that synchronous (P = 0.008) and non-radical treatment for EHPM (P < 0.001) were significant risk factors associated with poorer overall survival (OS). While, Cox modeling revealed that the treatment modality for EHPM, but not the synchronous/metachronous determinant, was an independent factor for OS, and that therapeutic option for HCC was an independent factor for HCC-specific OS. Moreover, no HCC-specific overall and recurrence-free survival benefit were observed in the control group when compared with that of the target group (P = 0.607, P = 0.131, respectively).

Conclusions

Curative treatment is an independent predictive factor for OS and HCC-specific OS, and should been taken into account both for synchronous and metachronous patients. MPM patients involving HCC should not be excluded from radical resection for HCC.
Geo-mapping of time trends in childhood caries risk a method for assessment of preventive care
Authors: Strömberg Ulf , Holmn Anders , Magnusson Kerstin , Twetman Svante
Published: April 2012

Background

Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time. The aim of this study was to develop the geo-map concept, addressing time trends in caries risk, and demonstrate the novel approach by analyzing epidemiological data from preschool residents in the region of Halland, Sweden.

Methods

The study population consisted of 9,973 (2006) and 10,927 (2010) children between 3 to 6years of age (~77% of the eligible population) from whom caries data were obtained. Reported dmfs>0 for a child was considered as the primary caries outcome. Each study individual was geo-coded with respect to his/her residence parish (66 parishes in the region). Smoothed caries risk geo-maps, along with corresponding statistical certainty geo-maps, were produced by using the free software Rapid Inquiry Facility and the ESRI ArcGIS system. Parish-level socioeconomic data were available.

Results

The overall proportion of caries-free (dmfs=0) children improved from 84.0% in 2006 to 88.6% in 2010. The ratio of maximum and minimum (parish-level) smoothed relative risks (SmRRs) increased from 1.76/0.44=4.0 in 2006 to 2.37/0.33=7.2 in 2010, which indicated an increased geographical polarization of early childhood caries in the population. Eight parishes showed evidential, positional changes in caries risk between 2006 and 2010; their corresponding SmRRs and statistical certainty ranks changed markedly. No considerable parallel changes in parish-level socioeconomic characteristics were seen during the same time period.

Conclusion

Geo-maps based on caries risk can be used to monitor changes in caries risk over time. Thus, geo-mapping offers a convenient tool for evaluating the effectiveness of tailored health promotion and preventive care in child populations.
Influence of the relative composition of trace elements and vitamins in physicochemical stability of total parenteral nutrition formulations for neonatal use
Authors: Lobo Bianca W , da Veiga Venício F , Cabral Lúcio M , Michel Ricardo C , Volpato Nádia M , de Sousa Valéria P
Published: April 2012

Objective

The present study aimed to evaluate the influence of the relative composition of trace elements and vitamins in physicochemical stability of neonatal parenteral nutrition.

Material and methods

Three formulations for neonatal administration were selected; the main variable was the presence of trace elements and vitamins. The analyses where carried out immediately after preparation and at 24 h, 48 h, 72 h and 7 days after preparation. Three methods were selected to determine globule size: light obscuration, dynamic light scattering and optical microscopy. Complementary evaluation including visual inspection, determination of pH and osmolarity, peroxide levels and measurements of zeta potential were also performed.

Results

There was an observable alteration in color and phase separation in the PN stored at 25°C and 40°C. Neither globule size pattern, nor any other physicochemical characteristic evaluated appeared to be considerably altered in any of the analyzed formulations even after 7 days of storage at 5°C. Globule size in all the PN studied was consistent with the established limit, below 500 nm by DLS measurement, and PFAT5 was below 0.05% under all storage temperatures.

Conclusion

Concomitant presence of trace elements and vitamins in the same neonatal formulation did not alter the evaluated aspects of stability.
The cytotoxicity of polycationic iron oxide nanoparticles: Common endpoint assays and alternative approaches for improved understanding of cellular response mechanism
Authors: Hoskins Clare , Cuschieri Alfred , Wang Lijun
Published: April 2012

Background

Iron oxide magnetic nanoparticles (MNP's) have an increasing number of biomedical applications. As such in vitro characterisation is essential to ensure the bio-safety of these particles. Little is known on the cellular interaction or effect on membrane integrity upon exposure to these MNPs. Here we synthesised Fe3O4 and surface coated with poly(ethylenimine) (PEI) and poly(ethylene glycol) (PEG) to achieve particles of varying surface positive charges and used them as model MNP's to evaluate the relative utility and limitations of cellular assays commonly applied for nanotoxicity assessment. An alternative approach, atomic force microscopy (AFM), was explored for the analysis of membrane structure and cell morphology upon interacting with the MNPs. The particles were tested in vitro on human SH-SY5Y, MCF-7 and U937 cell lines for reactive oxygen species (ROS) production and lipid peroxidation (LPO), LDH leakage and their overall cytotoxic effect. These results were compared with AFM topography imaging carried out on fixed cell lines.

Results

Successful particle synthesis and coating were characterised using FTIR, PCS, TEM and ICP. The particle size from TEM was 30 nm (−16.9 mV) which increased to 40 nm (+55.6 mV) upon coating with PEI and subsequently 50 nm (+31.2 mV) with PEG coating. Both particles showed excellent stability not only at neutral pH but also in acidic environment of pH 4.6 in the presence of sodium citrate. The higher surface charge MNP-PEI resulted in increased cytotoxic effect and ROS production on all cell lines compared with the MNP-PEI-PEG. In general the effect on the cell membrane integrity was observed only in SH-SY5Y and MCF-7 cells by MNP-PEI determined by LDH leakage and LPO production. AFM topography images showed consistently that both the highly charged MNP-PEI and the less charged MNP-PEI-PEG caused cell morphology changes possibly due to membrane disruption and cytoskeleton remodelling.

Conclusions

Our findings indicate that common in vitro cell endpoint assays do not give detailed and complete information on cellular state and it is essential to explore novel approaches and carry out more in-depth studies to elucidate cellular response mechanism to magnetic nanoparticles.
Carbon nanotube counter electrode for high-efficient fibrous dye-sensitized solar cells
Authors: Huang Shuqing , Sun Huicheng , Huang Xiaoming , Zhang Quanxin , Li Dongmei , Luo Yanhong , Meng Qingbo
Published: April 2012

High-efficient fibrous dye-sensitized solar cell with carbon nanotube (CNT) thin films as counter electrodes has been reported. The CNT films were fabricated by coating CNT paste or spraying CNT suspension solution on Ti wires. A fluorine tin oxide-coated CNT underlayer was used to improve the adherence of the CNT layer on Ti substrate for sprayed samples. The charge transfer catalytic behavior of fibrous CNT/Ti counter electrodes to the iodide/triiodide redox pair was carefully studied by electrochemical impedance and current-voltage measurement. The catalytic activity can be enhanced by increasing the amount of CNT loading on substrate. Both the efficiencies of fibrous dye-sensitized solar cells using paste coated and sprayed CNT films as counter electrodes are comparative to that using Pt wires, indicating the feasibility of CNT/Ti wires as fibrous counter electrode for superseding Pt wires.
Aging, cancer, and cancer vaccines
Authors: Mazzola Paolo , Radhi Saba , Mirandola Leonardo , Annoni Giorgio , Jenkins Marjorie , Cobos Everardo , Chiriva-Internati Maurizio
Published: April 2012

World population has experienced continuous growth since 1400 A.D. Current projections show a continued increase - but a steady decline in the population growth rate - with the number expected to reach between 8 and 10.5 billion people within 40 years. The elderly population is rapidly rising: in 1950 there were 205 million people aged 60 or older, while in 2000 there were 606 million. By 2050, the global population aged 60 or over is projected to expand by more than three times, reaching nearly 2 billion people [1]. Most cancers are age-related diseases: in the US, 50% of all malignancies occur in people aged 65-95. 60% of all cancers are expected to be diagnosed in elderly patients by 2020 [2]. Further, cancer-related mortality increases with age: 70% of all malignancy-related deaths are registered in people aged 65 years or older [3]. Here we introduce the microscopic aspects of aging, the pro-inflammatory phenotype of the elderly, and the changes related to immunosenescence. Then we deal with cancer disease and its development, the difficulty of treatment administration in the geriatric population, and the importance of a comprehensive geriatric assessment. Finally, we aim to analyze the complex interactions of aging with cancer and cancer vaccinology, and the importance of this last approach as a complementary therapy to different levels of prevention and treatment. Cancer vaccines, in fact, should at present be recommended in association to a stronger cancer prevention and conventional therapies (surgery, chemotherapy, radiation therapy), both for curative and palliative intent, in order to reduce morbidity and mortality associated to cancer progression.
Uncertainty in techno-economic estimates of cellulosic ethanol production due to experimental measurement uncertainty
Authors: Vicari Kristin J , Tallam Sai Sandeep , Shatova Tatyana , Joo Koh Kang , Scarlata Christopher J , Humbird David , Wolfrum Edward J , Beckham Gregg T
Published: April 2012

Background

Cost-effective production of lignocellulosic biofuels remains a major financial and technical challenge at the industrial scale. A critical tool in biofuels process development is the techno-economic (TE) model, which calculates biofuel production costs using a process model and an economic model. The process model solves mass and energy balances for each unit, and the economic model estimates capital and operating costs from the process model based on economic assumptions. The process model inputs include experimental data on the feedstock composition and intermediate product yields for each unit. These experimental yield data are calculated from primary measurements. Uncertainty in these primary measurements is propagated to the calculated yields, to the process model, and ultimately to the economic model. Thus, outputs of the TE model have a minimum uncertainty associated with the uncertainty in the primary measurements.

Results

We calculate the uncertainty in the Minimum Ethanol Selling Price (MESP) estimate for lignocellulosic ethanol production via a biochemical conversion process: dilute sulfuric acid pretreatment of corn stover followed by enzymatic hydrolysis and co-fermentation of the resulting sugars to ethanol. We perform a sensitivity analysis on the TE model and identify the feedstock composition and conversion yields from three unit operations (xylose from pretreatment, glucose from enzymatic hydrolysis, and ethanol from fermentation) as the most important variables. The uncertainty in the pretreatment xylose yield arises from multiple measurements, whereas the glucose and ethanol yields from enzymatic hydrolysis and fermentation, respectively, are dominated by a single measurement: the fraction of insoluble solids (fIS) in the biomass slurries.

Conclusions

We calculate a $0.15/gal uncertainty in MESP from the TE model due to uncertainties in primary measurements. This result sets a lower bound on the error bars of the TE model predictions. This analysis highlights the primary measurements that merit further development to reduce the uncertainty associated with their use in TE models. While we develop and apply this mathematical framework to a specific biorefinery scenario here, this analysis can be readily adapted to other types of biorefining processes and provides a general framework for propagating uncertainty due to analytical measurements through a TE model.
Analysis of 777 cases with obstruction of the ureter or extrahepatic bile duct by ultrasonography after normal saline retention enema
Authors: Tang Chong , Wu Xuegang , Fan Qiuhong , Deng Zhensheng
Published: April 2012

Background

Conventional transabdominal ultrasound usually fails to visualize parts of the ureter or extrahepatic bile duct covered by bowel gas. In this study, we propose a new method for gaining acoustic access to the ureters and extrahepatic bile duct to help determine the nature of obstruction to these structures when conventional transabdominal ultrasound fails.

Methods

The normal saline retention enema method, that is, using normal saline-filled colons to gain acoustic access to the bilateral ureters and extrahepatic bile duct and detecting the lesions with transabdominal ultrasonic diagnostic apparatus, was applied to 777 patients with obstructive lesions, including 603 with hydroureter and 174 with dilated common bile duct, which were not visualized by conventional ultrasonography. The follow-up data of all the patients were collected to verify the results obtained by this method.

Results

Of the 755 patients who successfully finished the examination after normal saline retention enema (the success rate of the enema is about 98%), the nature of obstruction in 718 patients was determined (the visualizing rate is approximately 95%), including 533 with ureteral calculus, 23 with ureteral stricture, 129 with extrahepatic bile duct calculus, and 33 with common bile duct tumor.

Conclusions

Colons filled fully with normal saline can surely give acoustic access to the bilateral ureters and extrahepatic bile duct so as to determine the nature of obstruction of these structures when conventional transabdominal ultrasound fails.
In vivo breast cancer characterization imaging using two monoclonal antibodies activatably labeled with near infrared fluorophores
Authors: Sano Kohei , Mitsunaga Makoto , Nakajima Takahito , Choyke Peter L , Kobayashi Hisataka
Published: April 2012

Introduction

The gene expression profiles of cancer cells are closely related to their aggressiveness and metastatic potential. Antibody-based immunohistochemistry (IHC) of tissue specimens is a common method of identifying expressed proteins in cancer cells and increasingly inform treatment decisions. Molecular imaging is a potential method of performing similar IHC studies in vivo without the requirement for biopsy or tumor excision. To date, antibody-based imaging has been limited by high background levels related to slow clearance, making such imaging practical. However, optically activatable imaging agents, which are only fluorescent when bound to their cognate receptor, open the possibility of doing in vivo multi-color IHC.

Methods

We describe the use of activatable, near infrared fluorescence-labeled AlexaFluor680 (Alexa680) conjugated panitumumab (Pan) targeted against human epidermal growth factor receptor (EGFR) (Pan-Alexa680) and Indocyanine Green (ICG) conjugated trastuzumab (Tra) targeted against human epidermal growth factor receptor type 2 (HER2) (Tra-ICG) were synthesized and evaluated in cells in vitro and in an orthotopic breast cancer mouse model in vivo.

Results

Pan-Alexa680 (self-quenched; SQ) and Tra-ICG were initially quenched but demonstrated a 5.2- and 50-fold dequenching capacity under detergent treatment, respectively. In vitro microscopy and flow cytometry using MDA-MB-468 (EGFR+/HER2-) and 3T3/HER2 cells (EGFR-/HER2+), demonstrated specific fluorescence signal for each cell type based on binding to Pan-Alexa680(SQ) or Tra-ICG. An in vivo imaging study employing a cocktail of Pan-Alexa680(SQ) and Tra-ICG (each 50 μg) was injected into mice with orthotopic MDA-MB-468 and 3T3/HER2 tumors in the breast. Each probe visualized only the target-specific breast tumor.

Conclusions

Multi-color target-specific fluorescence breast cancer imaging can be achieved in vivo by employing two activatable fluorescent probes administered as a cocktail. The images allowed us to see a specific receptor expression in each breast tumor without post-image processing.
Cancer-Related Fatigue in Women With Breast Cancer: Outcomes of a 5-Year Prospective Cohort Study
Authors: Goldstein David , Bennett Barbara K. , Webber Kate , Boyle Fran , de Souza Paul L. , Wilcken Nicholas R.C. , Scott Elizabeth M. , Toppler Ruth , Murie Penelope , O'Malley Linda , McCourt Junie , Friedlander Michael , Hickie Ian B. , Lloyd Andrew R.
Published: April 2012

Purpose

Prolonged and disabling fatigue is prevalent after cancer treatment, but the early natural history of cancer-related fatigue (CRF) has not been systematically examined to document consistent presence of symptoms. Hence, relationships to cancer, surgery, and adjuvant therapy are unclear.

Patients and Methods

A prospective cohort study of women receiving adjuvant treatment for early-stage breast cancer was conducted. Women (n = 218) were enrolled after surgery and observed at end treatment and at 1, 3, 6, 9, and 12 months as well as 5 years. Structured interviews and self-report questionnaires were used to record physical and psychologic health as well as disability and health care utilization. Patients with CRF persisting for 6 months were assessed to exclude alternative medical and psychiatric causes of fatigue. Predictors of persistent fatigue, mood disturbance, and health care utilization were sought by logistic regression.

Results

The case rate for CRF was 24% (n = 51) postsurgery and 31% (n = 69) at end of treatment; it became persistent in 11% (n = 24) at 6 months and 6% (n = 12) at 12 months. At each time point, approximately one third of the patients had comorbid mood disturbance. Persistent CRF was predicted by tumor size but not demographic, psychologic, surgical, or hematologic parameters. CRF was associated with significant disability and health care utilization.

Conclusion

CRF is common but generally runs a self-limiting course. Much of the previously reported high rates of persistent CRF may be attributable to factors unrelated to the cancer or its treatment.
Prevention of Pegfilgrastim-Induced Bone Pain: A Phase III Double-Blind Placebo-Controlled Randomized Clinical Trial of the University of Rochester Cancer Center Clinical Community Oncology Program Research Base
Authors: Kirshner Jeffrey J. , Heckler Charles E. , Janelsins Michelle C. , Dakhil Shaker R. , Hopkins Judith O. , Coles Charlotte , Morrow Gary R.
Published: April 2012

Purpose

Pegfilgrastim-induced bone pain is a significant clinical problem that may result in discontinuation of pegfilgrastim and lead to less effective chemotherapy dosing. Interventions for pegfilgrastim-induced bone pain are needed.

Patients and Methods

The University of Rochester Cancer Center Clinical Community Oncology Program Research Base randomly assigned 510 patients at 17 sites to receive either naproxen (500 mg two times per day) or placebo on the day of pegfilgrastim administration, continuing for 5 to 8 days after pegfilgrastim. Patients recorded pain severity (using a scale of 0 to 10) and duration in daily diaries. The primary outcome measure was the area under the curve (AUC) for pain for days 1 through 5. Secondary outcome measures included the identification of risk factors for the development of pain and response to naproxen.

Results

Patients' mean age was 55.6 years and 86% were female. Sixty-eight percent of patients had breast cancer and 10% had lung cancer. Pain reached its peak at 3 days for both groups. The mean AUC for pain was 7.71 for the placebo group and 6.04 for the naproxen group (P = .037). Naproxen reduced maximum pain from 3.40 to 2.59 (P = .005). Naproxen also reduced overall pain incidence from 71.3% to 61.1% (P = .020) and duration from 2.40 to 1.92 days (P = .009). The reduction in severe pain (> 5 on a scale of 1 to 10) from 27.0% to 19.2% was also significant (P = .048). Risk factors could not be identified to predict incidence, severity, or ability to prevent pegfilgrastim-induced bone pain.

Conclusion

Our phase III randomized placebo-controlled clinical trial demonstrated that naproxen at a dose of 500 mg twice per day is effective in reducing the incidence and severity of pegfilgrastim-induced bone pain.
Toward Patient-Centered Cancer Care: Patient Perceptions of Problematic Events, Impact, and Response
Authors: Mazor Kathleen M. , Roblin Douglas W. , Greene Sarah M. , Lemay Celeste A. , Firneno Cassandra L. , Calvi Josephine , Prouty Carolyn D. , Horner Kathryn , Gallagher Thomas H.
Published: April 2012

Purpose

Cancer treatments are complex, involving multiple clinicians, toxic therapies, and uncertain outcomes. Consequently, patients are vulnerable when breakdowns in care occur. This study explored cancer patients' perceptions of preventable, harmful events; the impact of these events; and interactions with clinicians after such events.

Patients and Methods

In-depth telephone interviews were conducted with cancer patients from three clinical sites. Patients were eligible if they believed: something “went wrong” during their cancer care; the event could have been prevented; and the event caused, or could have caused, significant harm. Interviews focused on patients' perceptions of the event, its impact, and clinicians' responses to the event.

Results

Ninety-three of 416 patients queried believed something had gone wrong in their care that was preventable and caused or could have caused harm. Seventy-eight patients completed interviews. Of those interviewed, 28% described a problem with medical care, such as a delay in diagnosis or treatment; 47% described a communication problem, including problems with information exchange or manner; and 24% described problems with both medical care and communication. Perceived harms included physical and emotional harm, disruption of life, effect on family members, damaged physician-patient relationship, and financial expense. Few clinicians initiated discussion of the problematic events. Most patients did not formally report their concerns.

Conclusion

Cancer patients who believe they experienced a preventable, harmful event during their cancer diagnosis or care often do not formally report their concerns. Systems are needed to encourage patients to report such events and to help physicians and health care systems respond effectively.
High Frequency of Germline SUFU Mutations in Children With Desmoplastic/Nodular Medulloblastoma Younger Than 3 Years of Age
Authors: Brugières Laurence , Remenieras Audrey , Pierron Gaëlle , Varlet Pascale , Forget Sébastien , Byrde Véronique , Bombled Johny , Puget Stéphanie , Caron Olivier , Dufour Christelle , Delattre Olivier , Bressac-de Paillerets Brigitte , Grill Jacques
Published: April 2012

Purpose

Germline mutations of the SUFU gene have been shown to be associated with genetic predisposition to medulloblastoma, mainly in families with multiple cases of medulloblastoma and/or in patients with symptoms similar to those of Gorlin syndrome. To evaluate the contribution of these mutations to the genesis of sporadic medulloblastomas, we screened a series of unselected patients with medulloblastoma for germline SUFU mutations.

Patients and Methods

A complete mutational analysis of the SUFU gene was performed on genomic DNA in all 131 consecutive patients treated for medulloblastoma in the pediatrics department of the Institut Gustave Roussy between 1972 and 2009 and for whom a blood sample was available.

Results

We identified eight germline mutations of the SUFU gene: one large genomic duplication and seven point mutations. Mutations were identified in three of three individuals with medulloblastoma with extensive nodularity, four of 20 with desmoplastic/nodular medulloblastomas, and one of 108 with other subtypes. All eight patients were younger than 3 years of age at diagnosis. The mutations were inherited from the healthy father in four of six patient cases in which the parents accepted genetic testing; de novo mutations accounted for the other two patient cases. Associated events were macrocrania in six patients, hypertelorism in three patients, and multiple basal cell carcinomas in the radiation field after age 18 years in one patient.

Conclusion

These data indicate that germline SUFU mutations were responsible for a high proportion of desmoplastic medulloblastoma in children younger than 3 years of age. Genetic testing should be offered to all children diagnosed with sonic hedgehog–driven medulloblastoma at a young age.
CCK-Induced Reduction of Food Intake and Hindbrain MAPK Signaling Are Mediated by NMDA Receptor Activation
Authors: Campos Carlos A. , Wright Jason S. , Czaja Krzysztof , Ritter Robert C.
Published: April 2012

The dorsal vagal complex of the hindbrain, including the nucleus of the solitary tract (NTS), receives neural and humoral afferents that contribute to the process of satiation. The gut peptide, cholecystokinin (CCK), promotes satiation by activating gastrointestinal vagal afferents that synapse in the NTS. Previously, we demonstrated that hindbrain administration of N-methyl-d-aspartate (NMDA)-type glutamate receptor antagonists attenuate reduction of food intake after ip CCK-8 injection, indicating that these receptors play a necessary role in control of food intake by CCK. However, the signaling pathways through which hindbrain NMDA receptors contribute to CCK-induced reduction of food intake have not been investigated. Here we report CCK increases phospho-ERK1/2 in NTS neurons and in identified vagal afferent endings in the NTS. CCK-evoked phospho-ERK1/2 in the NTS was attenuated in rats pretreated with capsaicin and was abolished by systemic injection of a CCK1 receptor antagonist, indicating that phosphorylation of ERK1/2 occurs in and is mediated by gastrointestinal vagal afferents. Fourth ventricle injection of a competitive NMDA receptor antagonist, prevented CCK-induced phosphorylation of ERK1/2 in hindbrain neurons and in vagal afferent endings, as did direct inhibition of MAPK kinase. Finally, fourth ventricle administration of either a MAPK kinase inhibitor or NMDA receptor antagonist prevented the reduction of food intake by CCK. We conclude that activation of NMDA receptors in the hindbrain is necessary for CCK-induced ERK1/2 phosphorylation in the NTS and consequent reduction of food intake.
Arcuate Kisspeptin/Neurokinin B/Dynorphin (KNDy) Neurons Mediate the Estrogen Suppression of Gonadotropin Secretion and Body Weight
Authors: Mittelman-Smith Melinda A. , Williams Hemalini , Krajewski-Hall Sally J. , Lai Josephine , Ciofi Philippe , McMullen Nathaniel T. , Rance Naomi E.
Published: April 2012

Estrogen withdrawal increases gonadotropin secretion and body weight, but the critical cell populations mediating these effects are not well understood. Recent studies have focused on a subpopulation of hypothalamic arcuate neurons that coexpress estrogen receptor α, neurokinin 3 receptor (NK3R), kisspeptin, neurokinin B, and dynorphin for the regulation of reproduction. To investigate the function of kisspeptin/neurokinin B/dynorphin (KNDy) neurons, a novel method was developed to ablate these cells using a selective NK3R agonist conjugated to the ribosome-inactivating toxin, saporin (NK3-SAP). Stereotaxic injections of NK3-SAP in the arcuate nucleus ablated KNDy neurons, as demonstrated by the near-complete loss of NK3R, NKB, and kisspeptin-immunoreactive (ir) neurons and depletion of the majority of arcuate dynorphin-ir neurons. Selectivity was demonstrated by the preservation of proopiomelanocortin, neuropeptide Y, and GnRH-ir elements in the arcuate nucleus and median eminence. In control rats, ovariectomy (OVX) markedly increased serum LH, FSH, and body weight, and these parameters were subsequently decreased by treatment with 17β-estradiol. KNDy neuron ablation prevented the rise in serum LH after OVX and attenuated the rise in serum FSH. KNDy neuron ablation did not completely block the suppressive effects of E2 on gonadotropin secretion, a finding consistent with redundant pathways for estrogen negative feedback. However, regardless of estrogen status, KNDy-ablated rats had lower levels of serum gonadotropins compared with controls. Surprisingly, KNDy neuron ablation prevented the dramatic effects of OVX and 17β-estradiol (E2) replacement on body weight and abdominal girth. These data provide evidence that arcuate KNDy neurons are essential for tonic gonadotropin secretion, the rise in LH after removal of E2, and the E2 modulation of body weight.
Decidual Endovascular Trophoblast Invasion in Women with Polycystic Ovary Syndrome: An Experimental Case-Control Study
Authors: Palomba Stefano , Russo Tiziana , Falbo Angela , Di Cello Annalisa , Amendola Giuseppina , Mazza Rosa , Tolino Achille , Zullo Fulvio , Tucci Luigi , La Sala Giovanni Battista
Published: April 2012

Context:

Previous experimental and clinical data suggest impaired decidual trophoblast invasion in patients with polycystic ovarian syndrome (PCOS).

Objective:

The objective of the study was to test the hypothesis that decidual endovascular trophoblast invasion in pregnant patients with PCOS is impaired and to clarify the potential mechanisms involved.

Design:

This was an experimental case-control study.

Setting:

The study was conducted at the academic Departments of Obstetrics and Gynecology and the Unit of Pathology (Italy).

Patients:

Forty-five pregnant subjects screened from a wide population of women waiting for legal pregnancy termination were included in the final analysis. Specifically, 15 pregnant patients with PCOS were enrolled as cases and another 30 age- and body mass index (BMI)-matched healthy pregnant women without any feature of PCOS were enrolled as the controls.

Intervention:

Interventions included the collection of trophoblastic and decidual tissue at the 12th week of gestation.

Main Outcome Measures:

Clinical, ultrasonographic, and biochemical data as well as the histological analysis of decidual endovascular trophoblast invasion.

Results:

The rate of implantation site vessels with endovascular trophoblast invasion (ratio between total number of implantation site vessels and total number of vessels with endovascular trophoblast invasion) and the extent of endovascular trophoblast invasion (proportion between immunoreactive areas to cytokeratin 7 and to CD34) were significantly lower in patients with PCOS compared with healthy non-PCOS controls. Endovascular trophoblast invasion data were significantly and indirectly related to the markers of insulin resistance and testosterone concentrations in PCOS patients.

Conclusions:

Pregnant patients with PCOS patients have impaired decidual trophoblast invasion. Further studies are needed to evaluate the exact mechanisms through which insulin resistance and hyperandrogenemia exert this effect.
Beneficial Effects of Growth Hormone Treatment on Cognition in Children with Prader-Willi Syndrome: A Randomized Controlled Trial and Longitudinal Study
Authors: Siemensma Elbrich P. C. , Tummers-de Lind van Wijngaarden Roderick F. A. , Festen Dederieke A. M. , Troeman Zyrhea C. E. , van Alfen-van der Velden A. A. E. M. (Janielle) , Otten Barto J. , Rotteveel Joost , Odink Roelof J. H. , Bindels-de Heus G. C. B. (Karen) , van Leeuwen Mariette , Haring Danny A. J. P. , Oostdijk Wilma , Bocca Gianni , Mieke Houdijk E. C. A. , van Trotsenburg A. S. Paul , Hoorweg-Nijman J. J. Gera , van Wieringen Hester , Vreuls René C. F. M. , Jira Petr E. , Schroor Eelco J. , van Pinxteren-Nagler Evelyn , Willem Pilon Jan , Lunshof L. (Bert) , Hokken-Koelega Anita C. S.
Published: April 2012

Background:

Knowledge about the effects of GH treatment on cognitive functioning in children with Prader-Willi syndrome (PWS) is limited.

Methods:

Fifty prepubertal children aged 3.5 to 14 yr were studied in a randomized controlled GH trial during 2 yr, followed by a longitudinal study during 4 yr of GH treatment. Cognitive functioning was measured biennially by short forms of the WPPSI-R or WISC-R, depending on age. Total IQ (TIQ) score was estimated based on two subtest scores.

Results:

During the randomized controlled trial, mean sd scores of all subtests and mean TIQ score remained similar compared to baseline in GH-treated children with PWS, whereas in untreated controls mean subtest sd scores and mean TIQ score decreased and became lower compared to baseline. This decline was significant for the Similarities (P = 0.04) and Vocabulary (P = 0.03) subtests. After 4 yr of GH treatment, mean sd scores on the Similarities and Block design subtests were significantly higher than at baseline (P = 0.01 and P = 0.03, respectively), and scores on Vocabulary and TIQ remained similar compared to baseline. At baseline, children with a maternal uniparental disomy had a significantly lower score on the Block design subtest (P = 0.01) but a larger increment on this subtest during 4 yr of GH treatment than children with a deletion. Lower baseline scores correlated significantly with higher increases in Similarities (P = 0.04) and Block design (P < 0.0001) sd scores.

Conclusions:

Our study shows that GH treatment prevents deterioration of certain cognitive skills in children with PWS on the short term and significantly improves abstract reasoning and visuospatial skills during 4 yr of GH treatment. Furthermore, children with a greater deficit had more benefit from GH treatment.
Maps and the Teaching of Latin American History
Authors: Dym Jordana , Offen Karl
Published: April 2012

Historical maps deserve a place in the college classroom as primary sources. Since the 1980s, scholarship has shown how maps can be analyzed and interpreted to reveal something not only about the peoples, spaces, and times they portray but also about the societies that create, consume, and contest them. Over the last decade, the maps themselves have become increasingly accessible, as important research libraries and archives digitize their holdings. Yet these graphic texts are not yet staples of college curricula or documentary readers. This essay provides a brief overview of recent research in the history of cartography and presents two examples of map discussion modules for the Latin American history classroom: a demonstration of US neocolonialism, resource extraction, and social change in late nineteenth-century eastern Nicaragua, and a case of urban planning and ideas of order in colonial Mexico City.
Migration and Labor in the Americas: Praxis, Knowledge, and Nations
Authors: Craib Raymond , Overmyer-Velázquez Mark
Published: April 2012

This article examines the conceptualization, development, and implementation of two related courses on the lives and labors of migrants in the United States. Both courses focus on the histories and hemispheric experiences of migrant workers, within and between the United States, Latin America, and the Spanish Caribbean. The courses are used as a means to think more broadly about what it means to teach courses on Latin America in the twenty-first-century context of the transnational turn in scholarship, the debates over immigration and its reform, concerns over the future of labor organizing, and efforts to seek social justice. Drawing on the work of Paulo Freire in Pedagogy of the Oppressed, students in the seminars engage in praxis and work to deconstruct four interrelated and seemingly fixed binaries: structure and agency, theory and practice, classroom and outside world, and teacher and student.