bluuebunny/crossref_metadata_2025 huggingface dataset:
Breast Cancer Incidence Rates in U.S. Women Are No Longer Declining
Authors: DeSantis Carol , Howlader Nadia , Cronin Kathleen A. , Jemal Ahmedin
Published: May 2011

Background: Several publications reported breast cancer incidence rates continued to decrease among white women, following the decline of about 7% from 2002 to 2003. However, none of these reports exclusively examined the trend after 2003. In this paper, we examined breast cancer incidence rates among non-Hispanic (NH) white women from 2003 to 2007 to determine whether the decrease in breast cancer incidence rates indeed persisted through 2007. In addition, we present breast cancer incidence trends for NH black and Hispanic women and postmenopausal hormone use for all three racial/ethnic groups.

Methods: Breast cancer incidence rates were calculated by race/ethnicity, age and ER status using data from the Surveillance, Epidemiology, and End Results (SEER) 12 registries for 2000 to 2007. Prevalence of postmenopausal hormone use was calculated using National Health Interview Survey data from 2000, 2005, and 2008.

Results: From 2003 to 2007, overall breast cancer incidence rates did not change significantly among NH white women in any age group. However, rates increased (2.7% per year) for ER+ breast cancers in ages 40 to 49, and decreased for ER− breast cancers in ages 40 to 49 and 60 to 69. Similarly, overall breast cancer incidence rates did not change significantly for black and Hispanic women. Hormone use continued to decrease from 2005 to 2008 in all groups, although the decreases were smaller compared to those from 2000 to 2005.

Conclusions: The sharp decline in breast cancer incidence rates that occurred from 2002 to 2003 among NH white women did not continue through 2007.

Impact: Further studies are needed to better understand the recent breast cancer trends. Cancer Epidemiol Biomarkers Prev; 20(5); 733–9. ©2011 AACR.
No Association between Telomere Length in Peripheral Blood Leukocytes and the Risk of Nonmelanoma Skin Cancer
Authors: Liang Geyu , Qureshi Abrar A. , Guo Qun , De Vivo Immaculata , Han Jiali
Published: May 2011

Background: Recent reports have shown that telomere length was associated with the risk of various cancers, but the results have been inconsistent.

Methods: We prospectively evaluated the association of telomere length in peripheral blood leukocytes with the risk of skin squamous cell carcinoma (SCC) in 241 cases and 241 controls within the Health Professionals Follow-up Study (HPFS), and the risk of skin basal cell carcinoma (BCC) in 623 cases and 1,943 controls within the Nurses' Health Study (NHS).

Results: No significant association was observed between telomere length and risk of SCC (longest quartile vs. shortest quartile, OR = 1.09, 95%CI: 0.62–1.93, P = 0.81). Null findings were also observed between telomere length and risk of BCC in 2 independent sets (OR = 0.96, 95%CI: 0.49–1.87, P = 0.83; and OR = 0.91, 95%CI: 0.66–1.25, P = 0.39).

Conclusion: We found no evidence that telomere length in peripheral blood leukocytes was associated with risk of nonmelanoma skin cancer.

Impact: Our prospective study suggests that telomere length in peripheral blood leukocytes is less likely to play a substantial role in nonmelanoma skin cancer development. Cancer Epidemiol Biomarkers Prev; 20(5); 1043–5. ©2011 AACR.
Rotating Night Shift Work and Risk of Ovarian Cancer
Authors: Poole Elizabeth M. , Schernhammer Eva S. , Tworoger Shelley S.
Published: May 2011

Background: Night shift work has been associated with higher risks of breast and endometrial cancer, but few studies have evaluated associations with other reproductive cancers.

Methods: We examined the association between rotating night shift work and risk of ovarian cancer during 20 years of follow-up in 181,548 women participating in two large cohort studies, the Nurses' Health Study (NHS) and NHSII. Number of years of rotating night shift work was queried in 1988 for NHS and in 1989, 1991, 1993, 2001, and 2005 for NHSII. We used Cox proportional hazards regression to model HRs and 95% CIs of ovarian cancer for each shift work category (1–2, 3–5, 6–9, 10–14, 15–19, and 20+ years).

Results: We confirmed 718 incident cases of ovarian cancer over 2,974,672 person-years of follow-up. Rotating shift work was not associated with ovarian cancer risk in either cohort individually. Combining both cohorts, compared with women without any night work, the HR for 15 to 19 years of rotating night shift work was 1.28 (95% CI: 0.84–1.94) and for 20+ years 0.80 (95% CI: 0.51–1.23).

Conclusions: In this large prospective study, there was no association between duration of rotating night shift work and risk of ovarian cancer.

Impact: Although associated with other cancers, night shift work does not appear to be associated with increased risk of ovarian cancer. However, further exploration of the association between melatonin and risk of ovarian cancer is warranted. Cancer Epidemiol Biomarkers Prev; 20(5); 934–8. ©2011 AACR.
Intratumoral Administration of TLR4 Agonist Absorbed into a Cellular Vector Improves Antitumor Responses
Authors: Davis Meghan B. , Vasquez-Dunddel David , Fu Juan , Albesiano Emilia , Pardoll Drew , Kim Young J.
Published: May 2011

Purpose: Because toll-like receptor (TLR) agonists have been well characterized as dendritic cell (DC) activators, we hypothesized that the admixture of TLR4 agonist into a cellular vector could improve the antitumor response in vivo.

Experimental Design: Granulocyte macrophage colony stimulating factor secreting whole cell tumor cell vector (GVAX) was formulated with lipopolysaccharide (LPS), a TLR4 agonist, and its intratumoral therapeutic efficacy was tested in three different murine models. We utilized immunohistochemistry, fluorescence-activated cell sorting, enzyme-linked immunosorbent spot (ELISPOT), and in vivo CTL analysis to assess both local innate immune responses within the tumor tissue as well as the downstream generation of antitumor T-cell responses.

Results: Intratumoral treatment of LPS-absorbed GVAX showed efficacy in improving an antitumor response in vivo in comparison with GVAX alone. Improved antitumor efficacy of this novel admixture was not present in TLR4 signaling impaired mice. In the CT26 model, 40% to 60% of the mice showed regression of the transplanted tumor. When rechallenged with CT26 tumor cells, these mice proved to be immunized against the tumor. Tumors treated with TLR4 agonist–absorbed GVAX showed increased infiltrating CD4 and CD8 T cells as well as increased numbers of CD86+ cells in the tumor tissue. Draining lymph nodes from the treated mice had enhanced number of activated CD86+, MHCII+, and CD80+ DCs in comparison with GVAX alone and mock-treated groups. ELISPOT assay and in vivo CTL assay showed increased numbers of CTLs specific for the AH1 tumor antigen in mice treated with LPS-absorbed GVAX.

Conclusion: TLR4 on antigen-presenting cells in the tumor microenvironment may be targeted by using cell-based vectors for improved antitumor response in vivo. Clin Cancer Res; 17(12); 3984–92. ©2011 AACR.
Gene Expression following Exposure to Celecoxib in Humans: Pathways of Inflammation and Carcinogenesis Are Activated in Tumors but Not Normal Tissues
Authors: Sagiv Eyal , Sheffer Michal , Kazanov Diana , Shapira Shiran , Naumov Inna , Kraus Sarah , Domany Eytan , Arber Nadir
Published: May 2011

Background: The Cox-2 inhibitor, celecoxib (Pfizer Inc., N.Y., USA), is a promising chemopreventive agent [Arber et al.: N Engl J Med 2006;355:885–895; Bertagnolli et al.: N Engl J Med 2006;355:873–884]. This study aims to explore its mechanism by defining changes in gene expression between neoplastic and normal tissue samples before and after treatment. Methods: Patients with documented colorectal neoplasia in screening colonoscopy, destined to undergo surgical colectomy, were randomized for treatment with celecoxib (n = 11; 400 mg/day) or placebo (n = 3) for 30 days. Tissue samples were taken from the tumor and from normal adjacent mucosa during both colonoscopy and surgery. RNA was extracted and analyzed using Affymetrix Genechip®. Results: 687 genes differentiated tumor samples before and after treatment, among which 310 genes did not show the same differential expression in the placebo group or normal samples. These genes were significantly related to pathways of cell cycle regulation and inflammation, and of note was the TGF-β pathway, which held a strong association with the list of genes formerly found to be associated with the colorectal cancer expression profile in microarray analyses, as summarized in a meta-analysis by Cardoso et al. [Biochim Biophys Acta 2007;1775:103–137]. Conclusions: Celecoxib selectively affects genes and pathways involved in inflammation and malignant transformation in tumor but not normal tissues, this may assist in the development of safer and more effective chemopreventive agents.
The 3Ns Chromosome of Psathyrostachys huashanica Carries the Gene(s) Underlying Wheat Stripe Rust Resistance
Authors: Wang Y. , Yu K. , Xie Q. , Kang H. , Lin L. , Fan X. , Sha L. , Zhang H. , Zhou Y.
Published: May 2011

Stripe rust (Puccinia striiformis tritici (Pst)) is one of the most destructive diseases of wheat in the world. Exploiting and utilizing stripe rust resistance genes of wild species has become an essential strategy for resistance breeding. Psathyrostachyshuashanica Keng ex Kuo is a wild species in Triticeae that has been used for wheat improvement because of its high resistance or immunity to stripe rust. In this study, 9 wheat-P. huashanica addition lines were characterized by Giemsa C-banding, genomic in situ hybridization (GISH), and disease resistance evaluation. Giemsa C-banding and GISH demonstrated that lines 163-5, 165-1, 183-5, 240-3, and 240-4 are P. huashanica 3Ns chromosome monosomic addition lines; lines 183-1 and 183-20 are P. huashanica 3Ns chromosome disomic addition lines; line 165-20 is a P. huashanica 3Ns and 4Ns chromosomes double disomic addition line, and line 219-1 is a P. huashanica 1Ns and 3Ns/5A chromosomes double disomic addition-substitution line. All these addition lines with P. huashanica 3Ns chromosome(s) expressed high resistance or immunity to stripe rust. By comparing the series of wheat-P. huashanica chromosome addition lines, we concluded that the P. huashanica 3Ns chromosome carries the gene(s) for resistance or immunity to stripe rust. These addition lines can be used as a donor source of novel stripe rust resistance to wheat breeding programs.
A Population-Based Survey of Cognitive Performance in a Sicilian Elderly Community
Authors: Ragonese Paolo , Aridon Paolo , D’Amelio Marco , Aiello Fabio , Antonietta Mazzola Maria , Realmuto Sabrina , Salemi Giuseppe , Savettieri Giovanni
Published: May 2011

Background: The global burden of neurodegenerative diseases is increasing. Previous studies reported differences related to age, gender and socioeconomic status. We calculated the cognitive performances of a Sicilian population aged 65 years or older, by means of a door-to-door population-based survey in Bagheria city, Sicily. Methods: A door-to-door survey was carried out in the city of Bagheria, Sicily (prevalence day September 30, 2006). A cohort of 2,200 persons was randomly stratified, obtaining a 25% sample of the whole population. Cognitive function was assessed by Mini Mental State Examination (MMSE). Percentile distributions by age, gender, education and working activity were calculated. Regression models were used to analyze the relationship between the investigated variables and cognitive performance. Results: A total of 1,837 persons agreed to participate (1,062 women and 775 men). Distribution of MMSE showed a highly significant inverse linear trend related to the increasing age (p < 0.0001) and to the degree of education (p < 0.0001), both in men and women. We observed a significant association between higher education and a better cognitive performance (OR 6.91; CI 3.24–14.76) and an inverse association between manual kind of occupation versus not manual and a poorer cognitive status (OR 0.82; CI 0.67–0.997). Height was associated with decreased cognitive performances in women (OR = 1.03; CI = 1.01–1.05) but not in men (OR = 0.997; CI = 0.993–1.002). Conclusions: These findings provide a feature of cognitive performances in Sicily, measured by MMSE scores in individuals aged 65 years or older.
Genetic Compensation Abilities of Aegilopsspeltoides Chromosomes for Homoeologous B-Genome Chromosomes of Polyploid Wheat in Disomic S(B) Chromosome Substitution Lines
Authors: Friebe B. , Qi L.L. , Liu C. , Gill B.S.
Published: May 2011

The S genome of Aegilops speltoides is closely related to the B and G genomes of polyploid wheats. However, little work has been reported on the genetic relationships between the S-genome and B-genome chromosomes of polyploid wheat. Here, we report the isolation of a set of disomic substitutions (DS) of S-genome chromosomes for the B-genome chromosomes and their effects on gametophytic and sporophytic development. Ae. speltoides chromosomes were identified by their distinct C-banding and fluorescence in situ hybridization patterns with the Ae. speltoides-derived clone pGc1R-1. Although no large structural differences between S-genome and B-genome chromosomes exist, significant differences in gametophytic compensation were observed for chromosomes 1S, 3S, 5S and 6S. Similarly, chromosomes 1S, 2S, 4S, 5S and 6S affected certain aspects of sporophytic development in relation to spike morphology, fertility and meiotic pairing. The DS5S(5B) had disturbed meiosis with univalents/multivalents and suffered chromosome elimination in the germ tissues leading to haploid spikes in 50% of the plants. The effect of the Ph1 gene on meiosis is well known, and these results provide evidence for the role of Ph1 in the maintenance of polyploid genome integrity. These and other data are discussed in relation to the structural and functional differentiation of S- and B-genome chromosomes and the practical utility of the stocks in wheat improvement.
Gamma Knife Radiosurgery for Central Neurocytoma: Retrospective Analysis of Fourteen Cases with a Median Follow-Up Period of Sixty-Five Months
Authors: Chen Meng-Chao , Pan David Hung-Chi , Chung Wen-Yuh , Liu Kang-Du , Yen Yu-Shu , Chen Ming-Teh , Wong Tai-Tong , Shih Yang-Hsin , Wu Hsiu-Mei , Guo Wan-Yuo , Shiau Cheng-Ying , Wang Ling-Wei , Lin Chii-Wann
Published: May 2011

Object: Central neurocytoma (CN) is considered to be a benign neuronal tumor with possible atypical behavior. Microsurgery, radiation therapy (RT) and radiosurgery all have been used in treating this rare disease during the past decade. In this study, the authors present the experience with gamma knife radiosurgery (GKRS) on 14 patients with CN during a median follow-up period of 65 months and document the safety and efficacy of GKRS in the treatment of CN. Methods: Between November 1997 and December 2009, 14 patients pathologically diagnosed with CN were treated with GKRS. Follow-up magnetic resonance imaging (MRI) was performed at 6-month intervals. Tumor volume and adverse radiation effects (ARE) were documented to evaluate tumor response to GKRS. The Karnofsky Performance Scale (KPS) and neurological status were used to assess clinical outcome. The mean radiation dose prescribed to the tumor margin was 12.1 Gy (ranging from 11 to 13 Gy). The mean tumor volume was 19.6 ml (ranging from 3.5 to 48.9 ml). The mean follow-up period was 70 months (ranging from 30 to 140 months), and the median follow-up period was 65 months. Results: Tumor shrinkage was found in all patients at the final MRI follow-up. The mean volume reduction was 69% (ranging from 47 to 87%). No tumor progression, ARE or radiation-related toxicity developed in any of the cases. The KPS scores of all patients were the same or had increased, and the neurological functions were all stable without deterioration at the final follow-up. Conclusion: In our observations, GKRS was found to be an effective and safe alternative as adjuvant therapy for pathology-confirmed CN. The tumor volume and functional outcome can be controlled with a favorable result in long-term observation. Compared with RT and microsurgery, GKRS plays an important role in the treatment of CN as a minimally invasive technique with low morbidity. Regular long-term MRI follow-up should be mandatory to document the tumor response and possible recurrence. Multicenter consortia should be considered for further investigation and evaluation of GKRS for such a rare tumor.
Molecular Cytogenetic Analysis of a Gliosarcoma with Osseous Metaplasia
Authors: Dahlback H.S.S. , Gorunova L. , Micci F. , Scheie D. , Brandal P. , Meling T.R. , Heim S.
Published: May 2011

Gliosarcoma, a rare glioblastoma variant, is composed of a glial and a mesenchymal component. Though the mesenchymal portion most commonly resembles a fibrosarcoma, other differentiation patterns have been observed. We present the first genomic characterisation (karyotyping followed by FISH and array comparative genomic hybridisation analysis) of a gliosarcoma with osseous metaplasia. In addition to chromosomal changes often found in gliomas (+7,–10,–13, and –22), the tumour cells also harboured a hitherto unknown t(3;21)(q13∼21;q21∼22).
Epidemiology of Charcot-Marie-Tooth Disease in the Population of Belgrade, Serbia
Authors: Mladenovic J. , Milic Rasic V. , Keckarevic Markovic M. , Romac S. , Todorovic S. , Rakocevic Stojanovic V. , Kisic Tepavcevic D. , Hofman A. , Pekmezovic T.
Published: May 2011

Background: The aim of this study was to determine prevalence and 15-year survival in Charcot-Marie-Tooth disease (CMT). Methods: The study covers the period from 1 January 1988 to 31 December 2007 in the territory of Belgrade. Data on a number of CMT-affected persons and their basic demographic characteristics as well as data on the disease were collected from medical records. Data on the course and outcome of the disease were obtained through direct contact with patients, their families and their physicians. Results: We registered 161 patients with CMT in the population of Belgrade. The most frequent type was CMT1. The crude prevalence of CMT disease in the Belgrade population on 31 December 2007 was 9.7/100,000 for all subtypes, 7.1/100,000 for CMT1, and 2.3/100,000 for CMT2. Gender-specific prevalence was 11.2/100,000 for males and 8.3/100,000 for females. The highest age-specific prevalence was registered in the oldest age group (75+ years; 19.1/100,000), and the lowest one in patients aged 5–14 years (5.0/100,000). The cumulative probability of 15-year survival for CMT patients in Belgrade was 85.6 ± 7.8% (44.9 ± 31.8% for males and 98.2 ± 1.8% for females). Conclusions: The prevalence of CMT found in Belgrade is similar to the prevalence registered in Southern European countries.
Interaction of high-molecular-weight kininogen with endothelial cell binding proteins suPAR, gC1qR and cytokeratin 1 determined by Surface Plasmon Resonance (BiaCore)
Authors: Ghebrehiwet Berhane , Joseph Kusumam , Kao Alice , Bdeir Khalil , Cines Douglas , Pixley Robin , Espinola Ricardo , Colman Robert
Published: May 2011

The physiologic activation of the plasma kallikrein-kinin system requires the assembly of its constituents on a cell membrane. High-molecular-weight kininogen (HK) and cleaved HK (HKa) both interact with at least three endothelial cell binding proteins: urokinase plasminogen activator receptor (uPAR), globular C1q receptor (gC1qR,) and cytokeratin 1 (CK1). The affinity of HK and HKa for endothelial cells are KD=7–52 nM. The contribution of each protein is unknown. We examined the direct binding of HK and HKa to the soluble extracellular form of uPAR (suPAR), gC1qR and CK1 using surface plasmon resonance. Each binding protein linked to a CM-5 chip and the association, dissociation and KD (equilibrium constant) were measured. The interaction of HK and HKa with each binding protein was zinc-dependent. The affinity for HK and HKa was gC1qR>CK1>suPAR, indicating that gC1qR is dominant for binding. The affinity for HKa compared to HK was the same for gC1qR, 2.6-fold tighter for CK1 but 53-fold tighter for suPAR. Complex between binding proteins was only observed between gC1qR and CK1 indicating that a binary CK1-gC1qR complex can form independently of kininogen. Although suPAR has the weakest affinity of the three binding proteins, it is the only one that distinguished between HK and HKa. This finding indicates that uPAR may be a key membrane binding protein for differential binding and signalling between the cleaved and uncleaved forms of kininogen. The role of CK1 and gC1qR may be to initially bind HK to the membrane surface before productive cleavage to HKa.
New oral anticoagulants in venous thromboembolism prophylaxis in orthopaedic patients: Are they really better?
Authors: Huo Michael
Published: May 2011

Prophylaxis against venous thromboembolism (VTE) is considered standard of care. Appropriate chemoprophylaxis for VTE has been mandated by the United States government agencies and consumer groups. However, controversies exist regarding the most clinically relevant and safe chemoprophylaxis protocols in patients undergoing joint replacement surgery. Thus, this paper reviews the clinical efficacy and safety of newer oral anticoagulants. A literature search was performed for oral anticoagulants in advanced stages of development using PubMed and abstracts from thrombosis meetings. Most clinical trial data have demonstrated equal or superior efficacy in venographic endpoints in comparison to low-molecular-weight heparins (LMWH). However, bleeding complications have been reported to occur with oral anticoagulants as frequently as or more frequently than with LMWH. Other potential complications reported include liver enzyme elevation and cardiac irregularities. It remains to be established whether newer oral anticoagulants will be better alternatives to the current standard-ofcare in real-life medical clinical practice.
Aspirin failure in patients presenting with acute cerebrovascular ischaemia
Authors: Halawani Saeed H. M. , Williams David J. P. , Webster John , Greaves Michael , Ford Isobel
Published: May 2011

Aspirin is the most commonly used antiplatelet drug for prevention of ischaemic stroke. In order to determine the prevalence and nature of aspirin failure, we studied 51 adults admitted with suspected ischaemic stroke and already prescribed daily aspirin. Within 48 hours (h) of onset, blood and urine samples were collected to assess platelet aggregation, activation and aspirin response by a range of methods. All tests were then repeated on a second sample taken 24 h after witnessed administration of 75 mg or 150 mg aspirin. At entry to the study, incomplete response to aspirin, measured by arachidonic acid (AA)-stimulated platelet aggregation, was found in 43% of patients. Following in-hospital aspirin administration, there was a significant decrease in AA-aggregation (p=0.001) suggesting poor adherence to therapy prior to admission. However, residual aggregation (10–15%) persisted in 11 subjects – suggesting alternative causes. In incomplete responders on admission, platelet aggregation with adenosine diphosphate (ADP) was significantly higher compared with responders (p<0.05) but there were no significant differences in collagen aggregation, platelet fibrinogen binding or P-selectin expression, plasma von Willebrand factor, fibrinogen, high-sensitivity C-reactive protein, or the urinary metabolite, 11-dehydro-TxB2. Incomplete platelet inhibition is common around the time of acute cerebrovascular ischaemic events in patients prescribed aspirin. Up to 50% of these observations appear due to incomplete adherence to aspirin therapy. Intervention studies are required to determine the clinical relevance of measured platelet response to aspirin in terms of outcome, and the effectiveness of improved pharmacotherapy for stroke prevention.
Higher mortality rate in patients hospitalised for acute pulmonary embolism during weekends
Authors: Imberti Davide , Ageno Walter , Dentali Francesco , Manfredini Roberto , Gallerani Massimo
Published: May 2011

The management of acute pulmonary embolism (PE) is often challenging and requires specific medical expertise, diagnostic techniques and therapeutic options that may not be available in all hospitals throughout the entire week. The aim of our study was to evaluate whether or not an association exists between weekday or weekend admission and mortality for patients hospitalised with acute PE. Using routinely collected hospital administrative data, we examined patients discharged with a diagnosis of PE from the hospitals of the Emilia- Romagna Region in Italy (January 1999-December 2009). The risk of inhospital death was calculated for admissions at the weekend and compared to weekday admissions. Of a total of 26,560 PEs, 6,788 (25.6%) had been admitted during weekends. PE admissions were most frequent on Mondays (15.8%) and less frequent on Saturdays and Sun- days/holidays (12.8%) (p<0.001). Weekend admissions were associated with significantly higher rates of in-hospital mortality than weekday admissions (28% vs. 24.8%) (p<0.001). The risk of weekend admission and in-hospital mortality was higher after adjusting for sender, hospital characteristics, and the Charlson co-morbidity index. In conclusion, hospitalisation for PE on weekends seems to be associated with a significantly higher mortality rate than on weekdays. Further research is needed to investigate the reasons for this observed difference in mortality in order to try and implement future strategies that ensure an adequate level of care throughout the entire week.
Impact of the type of centre on management of AF patients: Surprising evidence for differences in antithrombotic therapy decisions
Authors: Gerth Andrea , Limbourg Tobias , Lewalter Thorsten , Goette Andreas , Wegscheider Karl , Treszl Andras , Meinertz Thomas , Oeff Michael , Ravens Ursula , Breithardt Günter , Steinbeck Gerhard , Kirchhof Paulus , Nabauer Michael ,   the AFNET
Published: May 2011

Atrial fibrillation (AF) patients may receive treatment from specialists or from general medicine physicians representing different levels of care within a structured health care system. This “choice” is influenced by patient flow within a health care system, patient preference, and individual access to health care resources. We analysed how the postgraduate training and work environment of treating physicians affects management decisions in AF patients. Patient characteristics and treatment decisions were analysed at the time of enrolment into the registry of the German Atrial Fibrillation NETwork (AFNET). A total of 9,577 patients were enrolled from 2004 to 2006 in 191 German centres that belonged to the following four levels of care: 13 tertiary care centres (TCC) enrolled 3,795 patients (39.6%), 58 district hospitals (DH) enrolled 2,339 patients (24.4%), 62 office-based cardiologists (OC) enrolled 2,640 patients (27.6%), and 58 general practitioners or internists (GP) enrolled 803 patients (8.4%). Patients with new-onset AF were often treated in DH. TCC treated younger patients who more often presented with paroxysmal AF. Older patients and patients in permanent AF more often received outpatient care. Consistent with recommendations, younger patients and patients with non-permanent AF received rhythm control therapy more often. In addition, the type of centre affected the decision for rhythm control. Stroke risk was similar between centre types (mean CHADS2 scores 1.6 –1.9). TCC (68.8%) and OC (73.6%) administered adequate antithrombotic therapy more often than DH (55.1%) or GP (52.0%, p<0.001 between groups). Upon multivariate analysis, enrolment by TCC or OC was associated with a 1.60 (1.20–2.12, p=0.001) fold chance for adequate antithrombotic treatment. This difference between centre types was consistent irrespective of the type of stroke risk estimation (ESC 2001 guidelines, CHADS2 score), and also consistent when the recently suggested CHA2DS2-VASc score was used to estimate stroke risk. In conclusion, management decisions in AF are influenced by the education and clinical background of treating physicians in Germany. Inpatients receive more rhythm control therapy. Adequate antithrombotic therapy is more often administered in specialist (cardiologist) centres.
Early Repolarization Pattern in Competitive Athletes
Authors: Noseworthy Peter A. , Weiner Rory , Kim Jonathan , Keelara Varsha , Wang Francis , Berkstresser Brant , Wood Malissa J. , Wang Thomas J. , Picard Michael H. , Hutter Adolph M. , Newton-Cheh Christopher , Baggish Aaron L.
Published: May 2011

Background—

Inferior lead early repolarization pattern (ERP) recently has been associated with sudden cardiac death. Although ERP is common among athletes, prevalence, ECG lead distribution, clinical characteristics, and effects of physical training remain uncertain. We sought to examine the nonanterior ERP in competitive athletes.

Methods and Results—

ERP was assessed in a cross-sectional cohort of collegiate athletes (n=879). The relationship between ERP and cardiac structure were then examined in a longitudinal subgroup (n=146) before and after a 90-day period of exercise training. ERP was defined as J-point elevation ≥0.1 mV in at least 2 leads within a nonanterior territory (inferior [II, III, aVF] or lateral territory [I, aVL, V4-V6]). Nonanterior ERP was present in 25.1% (221/879) of athletes, including the inferior subtype in 3.8% (33/879). Exercise training led to significant increases in the prevalence of ERP and the inferior subtype, but there were no associations between ERP and echocardiographic measures of left ventricular remodeling. In a multivariable model, ERP was associated with black race (odds ratio [OR], 5.84; 95% CI, 3.54 to 9.61;
P
<0.001), increased QRS voltage (OR, 2.08; 95% CI, 1.71 to 2.52;
P
<0.001), and slower heart rate (OR, 1.54; 95% CI, 1.26 to 1.87;
P
<0.001).

Conclusions—

Nonanterior ERP, including the inferior subtype, is common and has strong clinical associations among competitive athletes. The finding of increased ERP prevalence after intense physical training establishes a strong association between exercise and ERP.
The Community Climate System Model Version 4
Authors: Gent Peter R. , Danabasoglu Gokhan , Donner Leo J. , Holland Marika M. , Hunke Elizabeth C. , Jayne Steve R. , Lawrence David M. , Neale Richard B. , Rasch Philip J. , Vertenstein Mariana , Worley Patrick H. , Yang Zong-Liang , Zhang Minghua
Published: May 2011

The fourth version of the Community Climate System Model (CCSM4) was recently completed and released to the climate community. This paper describes developments to all CCSM components, and documents fully coupled preindustrial control runs compared to the previous version, CCSM3. Using the standard atmosphere and land resolution of 1° results in the sea surface temperature biases in the major upwelling regions being comparable to the 1.4°-resolution CCSM3. Two changes to the deep convection scheme in the atmosphere component result in CCSM4 producing El Niño–Southern Oscillation variability with a much more realistic frequency distribution than in CCSM3, although the amplitude is too large compared to observations. These changes also improve the Madden–Julian oscillation and the frequency distribution of tropical precipitation. A new overflow parameterization in the ocean component leads to an improved simulation of the Gulf Stream path and the North Atlantic Ocean meridional overturning circulation. Changes to the CCSM4 land component lead to a much improved annual cycle of water storage, especially in the tropics. The CCSM4 sea ice component uses much more realistic albedos than CCSM3, and for several reasons the Arctic sea ice concentration is improved in CCSM4. An ensemble of twentieth-century simulations produces a good match to the observed September Arctic sea ice extent from 1979 to 2005. The CCSM4 ensemble mean increase in globally averaged surface temperature between 1850 and 2005 is larger than the observed increase by about 0.4°C. This is consistent with the fact that CCSM4 does not include a representation of the indirect effects of aerosols, although other factors may come into play. The CCSM4 still has significant biases, such as the mean precipitation distribution in the tropical Pacific Ocean, too much low cloud in the Arctic, and the latitudinal distributions of shortwave and longwave cloud forcings.
Deep Atmospheric Response to the Spring Kuroshio over the East China Sea*
Authors: Xu Haiming , Xu Mimi , Xie Shang-Ping , Wang Yuqing
Published: May 2011

The atmospheric response to the spring Kuroshio Front over the East China Sea is investigated using a suite of high-resolution satellite data and a regional atmospheric model. The atmospheric response appears to extend beyond the marine atmospheric boundary layer, with frequent occurrence of cumulus convection.

In spring, Quick Scatterometer (QuikSCAT) wind speed shows a clear effect of sea surface temperature (SST), with high (low) wind speed observed over the warm (cold) tongue. This in-phase relationship between SST and surface wind speed is indicative of SST influence on the atmosphere. Wind convergence is found on the warmer flank of the Kuroshio Front, accompanied by a narrow rainband. The analysis of satellite-borne radar measurements indicates that deep convection appears over the Kuroshio warm tongue in the spring season, with enhanced convective precipitation, frequent occurrence of cumulus convection, and increased precipitation (cloud) tops in altitude. These deep convective activities along the Kuroshio warm tongue are further supported by enhanced lightning flash rate observed by satellite and atmospheric heating estimated by a Japanese reanalysis.

The Weather Research and Forecasting (WRF) model is used to investigate the precipitation response to the spring Kuroshio SST front over the East China Sea. Forced by observed SST [control (CTL)], the model well simulates a narrow band of precipitation, high wind speed, and surface wind convergence that closely follows the Kuroshio warm current, consistent with satellite observations. This narrow rainband completely disappears in the model when the SST front is removed by horizontally smoothed SST (SmSST). The results show that it is convective precipitation that is sensitive to the Kuroshio SST front. A case study for an eastward-moving extratropical cyclone indicates that convective precipitation increases its intensity and duration in the CTL run compared to the SmSST run. Local enhancement of upward sensible and latent heat fluxes and convective instability in the lower atmosphere are the key to anchoring the narrow band of convective precipitation that closely follows the Kuroshio.
Comparing Law-Making Activities in a Quasi-Federal System of Government
Authors: Bonafont Laura Chaqués , Palau Roqué Anna M.
Published: May 2011

In this article the authors develop a new approach to the study of policy dynamics in a quasi-federal system of government. The goal is to contribute to previous research on comparative federalism by analyzing the variations of issue attention between levels of government and across four regional governments—Andalusia, Catalonia, Galicia, and the Basque Country. To do so the authors follow the policy dynamics approach, developing a comparative and empirical analysis about issue attention across time, territories, and policy subsystems. The analysis relies on an extensive database, created following the methodology of the Comparative Agendas Project, which includes all laws passed from the early 1980s to present. The results indicate that legislative agendas have become increasingly diverse since the 1990s, and this is partly explained by party preferences and the type of government.
Branding a Rising China: An Analysis of Beijing’s National Image Management in the Age of China’s Rise
Authors: Sheng Ding
Published: May 2011

National image is not only a channel to wield a state’s national power, but also an important national power resource. It has become critically important for China as it tries to rise in a relatively favorable international environment. Following a theoretical discussion on national image management in international relations and a historical review of China’s national image management, this article examines China’s strengths and weaknesses in its national image management. On the one hand, China’s national image benefits from its strong commitment to cultural diplomacy, effective employment of information and communication technologies in international broadcasting, and close connections with the Chinese diaspora around the world. On the other hand, China’s national image management is constrained by such hurdles as weak political credibility, reviving popular nationalism, and various missteps in its foreign policies. This study concludes that China’s national image management will remain an uphill battle in the long run.
Age Matters
Authors: Rosenfeld Richard , Rojek Jeff , Decker Scott
Published: May 2011

Prior research on police searches of motorists has consistently found that Black drivers are more likely to be searched than White drivers. The authors argue that race differences in police searches depend on the driver’s age. In logistic regression and propensity-score matching analyses of St. Louis police traffic stops, the authors find that young Black males are subjected to discretionary searches at higher rates than are young White males. By contrast, among drivers age 30 and older, Black males are no more likely, and in some analyses are less likely, than White males to be subjected to a discretionary search. The study findings are consistent with studies of young Black males’ negative experience with and attitudes toward the police. If replicated in future research, however, the findings suggest that it may be difficult to prove that police searches of young Black males result primarily from racial bias or unlawful discrimination.
Countercyclical Macroprudential Tools
Authors: Saurina Jesús
Published: May 2011

Risk-sensitive capital requirements, such as those established in Basel 2/3, and loan loss provisions based on incurred losses or on short-horizon expected losses, increase procyclicality in the banking system. They could, therefore, contribute to fuelling credit bubbles in good times, as rising risks are not properly covered either with capital or provisions, and credit crunches in bad times, as requirements are sharply increased to compensate for the former undercapitalisation and under-provisioning, and banks respond by cutting credit to households and firms. This paper shows that the procyclicality of current and envisaged capital requirements and loan loss provisions is a serious concern. But, at the same time, it can be dealt with using countercyclical macroprudential tools, first, by smoothing minimum capital requirements using a very simple and intuitive formula based on GDP growth and, secondly, by using forward-looking provisions such as the Spanish dynamic provisions, a working macroprudential mechanism for more than a decade and a full lending cycle.
Application of the Optimal Design Approach to Improve a Pretransplant Drug Dose Finding Design for Ciclosporin
Authors: Hennig Stefanie , Nyberg Joakim , Fanta Samuel , Backman Janne T. , Hoppu Kalle , Hooker Andrew C. , Karlsson Mats O.
Published: May 2011

A time and sampling intensive pretransplant test dose design was to be reduced, but at the same time optimized so that there was no loss in the precision of predicting the individual pharmacokinetic (PK) estimates of posttransplant dosing. The following variables were optimized simultaneously: sampling times, ciclosporin dose, time of second dose, infusion duration, and administration order, using a published ciclosporin population PK model as prior information. The original design was reduced from 22 samples to 6 samples/patient and both doses (intravenous oral) were administered within 8 hours. Compared with the prior information given by the published ciclosporin population PK model, the expected standard deviations (SDs) of the individual parameters for clearance and bioavailability could be reduced by, on average, 40% under the optimized sparse designs. The gain of performing the original rich design compared with the optimal reduced design, considering the standard errors of the parameter estimates, was found to be minimal. This application demonstrates, in a practical clinical scenario, how optimal design techniques may be used to improve diagnostic procedures given available software and methods.
Music of the Future: Italian Theatres and the European Experience of Modernity between Unification and World War One
Authors: Körner Axel
Published: May 2011

This article challenges the common idea of Italy’s obsession with Italian music, and with Verdi in particular, an image which supports stereotypes of Italians as narrowly focused on their own national culture, mentally sealed off from what is happening outside the peninsula. Starting from an analysis of the frequently rather mixed or even negative reception of Verdi’s music in Italy, the article outlines the general crisis which affected Italian opera after Unification. One of the responses to this crisis was a remarkable internationalization of the repertoire on the Italian stages. Taking music and opera as an example, the article demonstrates the extent to which Italy articulated its experience of modernity and nation building through a transnational exchange of ideas and a generous reception of European culture.
Unmet needs of severely affected multiple sclerosis patients: The health professionals’ view
Authors: Golla Heidrun , Galushko Maren , Pfaff Holger , Voltz Raymond
Published: May 2011

Background: Research has only started recently to specifically concentrate on the group of patients severely affected by multiple sclerosis (MS).

Aim: The aim of this study was to assess the perception on patients’ unmet needs by healthcare professionals.

Methods: Focus groups and expert interviews were recorded, transcribed verbatim and analysed by qualitative content analysis.

Results: Unmet needs were identified in four main categories (‘support from family/friends’; ‘healthcare services’; ‘managing everyday life’; ‘maintaining biographical continuity’). Whereas physicians assessed most unmet needs in the category ‘healthcare services’, nurses and social workers focussed on unmet needs in the categories ‘support from family/friends’ and ‘maintaining biographical continuity’. Although the study focused on unmet needs of patients, professionals also voiced their unmet needs when caring for these patients. The group of professionals identified more subcategories than patients and included unmet needs of relatives.

Conclusion: Adding professionals’ perspective to that of patients is essential to gain a holistic view on patients’ unmet needs and to further optimize their care. The perspective of palliative care might contribute to meet unmet needs of severely affected MS patients.
Dying cancer patients’ own opinions on euthanasia: An expression of autonomy? A qualitative study
Authors: Karlsson Marit , Milberg Anna , Strang Peter
Published: May 2011

Introduction: Deliberations on euthanasia are mostly theoretical, and often lack first-hand perspectives of the affected persons.

Method: Sixty-six patients suffering from cancer in a palliative phase were interviewed about their perspectives of euthanasia in relation to autonomy. The interviews were transcribed verbatim and analysed using qualitative content analysis with no predetermined categories.

Results: The informants expressed different positions on euthanasia, ranging from support to opposition, but the majority were undecided due to the complexity of the problem. The informants’ perspectives on euthanasia in relation to autonomy focused on decision making, being affected by (1) power and (2) trust. Legalization of euthanasia was perceived as either (a) increasing patient autonomy by patient empowerment, or (b) decreasing patient autonomy by increasing the medical power of the health care staff, which could be frightening. The informants experienced dependence on others, and expressed various levels of trust in others’ intentions, ranging from full trust to complete mistrust.

Conclusions: Dying cancer patients perceive that they cannot feel completely independent, which affects true autonomous decision making. Further, when considering legalization of euthanasia, the perspectives of patients fearing the effects of legalization should also be taken into account, not only those of patients opting for it.
Subclinical abnormalities in workers with continuous low-level toluene exposure
Authors: Shih Hsu-Tzu , Yu Chin-Lin , Wu Ming-Tsang , Liu Chiu-Shong , Tsai Chon-Haw , Hung Dong-Zong , Wu Chun-Shing , Kuo Hisen-Wen
Published: May 2011

Short-term exposure to a high concentration (TWA > 100 ppm) of toluene can cause hepatotocixity and neurotoxicity in humans. Data on the effects of exposure to low levels of toluene, however, are controversial. In addition, few studies on the effects of toluene exposure on the autonomic nervous system have been conducted. Urine samples from 34 male factory workers in Taiwan who were exposed to low levels of toluene either intermittently (n = 13) or continuously (n = 21) were taken on a Monday morning after a 2-day hiatus and at the end of the workweek on Friday evening. Urinary hippuric acid levels were measured using high-performance liquid chromatography (HPLC). A complete blood work-up was also performed for each subject. The prevalence and severity of neurotoxic symptoms were investigated by a self-reported questionnaire, a neuropsychiatric battery, and sympathetic and peripheral nerve function tests. The mean value of urinary hippuric acid corrected for creatinine (Cr) was 0.34 ± 0.18 g/g Cr on Monday morning and 0.43 ± 0.26 g/g Cr on Friday evening. The difference in the mean value of urinary hippuric acid between the two periods (p < 0.01) and the odds ratio of impairment of sympathetic (OR = 4.13, p = 0.11) and peripheral nerves (OR = 6.94, p = 0.074) were higher in workers continuously exposed to toluene. In addition, workers who were continuously exposed to toluene had a lower mean platelet count (216 ± 41 × 106 /µL) than workers who were intermittently exposed (252 ± 40 × 106/µL), (p = 0.018). Furthermore, there was a positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 0.35-0.66, p < 0.05) in all workers. These data suggest that continuous exposure to low levels of toluene may be associated with sympathetic and peripheral nerve dysfunction and sub-clinical hematological damage. Further research needs to be carried out regarding how chronic exposure to low-levels of toluene affects workers.
The neuroprotective role of boric acid on aluminum chloride-induced neurotoxicity
Authors: Çolak Suat , Geyikoğlu Fatime , Keles Osman Nuri , Türkez Hasan , Topal Ahmet , Unal Bünyami
Published: May 2011

This study was designed to investigate the qualitative and quantitative changes in brain tissue following aluminum chloride (AlCl3) administration and to determine whether boric acid (BA) has a protective effect against brain damage induced by AlCl 3. For this aim, Sprague-Dawley rats were randomly separated into eight groups: (1) control, (2) AlCl3 (5 mg/kg/day), (3, 4 and 5) BA (3.25, 36 and 58.5 mg/kg/day), (6, 7 and 8) AlCl3 (5 mg/kg/day) plus BA (3.25, 36 and 58.5 mg/kg/day). After the animals were killed, the total numbers of neuron in the brain of all groups were determined using an unbiased stereological analysis. In addition to the stereological analysis, all brains were examined histopathologically by using light and electron microscopy. The stereological and histopathological results indicated a high damage of the rat brain tissues in the AlCl3 and AlCl3 + high dose BA (36 and 58.5) treatment groups. However, protective effects on neuron were observed in the AlCl3 + low dose BA (3.25) group when compared other AlCl3 groups. Our stereological and histopathological findings show that low-dose BA, as a proteasome inhibitor, can decrease the adverse effects of AlCl3 on the cerebral cortex.