bluuebunny/crossref_metadata_2025 huggingface dataset:
Acquisition of Cross-Ethnic Friends by Recent Immigrants in Canada: A Longitudinal Approach
Authors: Martinovic Borja , van Tubergen Frank , Maas Ineke
Published: June 2011

This paper examines the development of inter-ethnic friendships between immigrants and Canadians. It uses longitudinal data from three waves of the Canadian LSIC survey, in which newly arrived immigrants were followed during the first 4 years of settlement. It is found that pre-migration characteristics play an important role in the development of inter-ethnic friendships: immigrants who arrive at a younger age and for economic reasons, as well as those who are highly educated and have a cross-ethnic partner at the moment of arrival, establish more inter-ethnic friendships over time. In addition, post-migration characteristics affect the formation of inter-ethnic friendships. Such friendships are more common among immigrants who embrace Canadian traditions and acquire the host-country language, as well as among those who work in international settings and inhabit ethnically mixed neighborhoods. The effects of pre-migration characteristics are partially mediated by post-migration characteristics. Our findings point out that economic, cultural, and spatial integration are all conducive to inter-ethnic friendships.
Common Variable Immunodeficiency Associated with Hepatosplenic T-Cell Lymphoma Mimicking Juvenile Systemic Lupus Erythematosus
Authors: Jesus A. A. , Jacob C. M. A. , Silva C. A. , Dorna M. , Pastorino A. C. , Carneiro-Sampaio M.
Published: June 2011

Common variable immunodeficiency (CVID) is a heterogeneous disorder with susceptibility to infections, autoimmune manifestations, and cancer. To our knowledge, CIVD with T-cell lymphoma mimicking juvenile systemic lupus erythematosus (JSLE) was not described in the literature, and one case was reported herein. An 8-year-old female was admitted in our Pediatric Immunology Unit with a clinical history of hypogammaglobulinemia, recurrent upper respiratory infections, and pneumonias. She had a marked decrease of three serum immunoglobulin isotypes, and the diagnosis of CVID was established. At the age of 17 years, she presented with oral ulceration, nonerosive arthritis, nephritis, serositis, cytopenia, positive antiphospholipid antibodies, and positive antinuclear antibody fulfilling the American College of Rheumatology (ACR) criteria for SLE. She was treated with intravenous methylprednisolone for three consecutive days, and intravenous immunoglobulin, and maintenance therapy of chloroquine, azathioprine and prednisone 40 mg/day. Two months later, she died of septic shock secondary to acute pneumonia. The necropsy showed hepatosplenic T-cell lymphoma with diffuse involvement of bone marrow, spleen, liver, and lungs. The lymphoma cells were positive for CD3 immunostaining and negative for CD20 and lysozyme. In conclusion, the association of CVID and hepatosplenic T-cell lymphoma may simulate JSLE diagnosis.
Hidden Periodicity and Chaos in the Sequence of Prime Numbers
Authors: Bershadskii A.
Published: June 2011

Logarithmic gaps have been used in order to find a periodic component of the sequence of prime numbers, hidden by a random noise (stochastic or chaotic). It is shown that multiplicative nature of the noise is the main reason for the successful application of the logarithmic gaps transforming the multiplicative noise into an additive one. A relation of this phenomenon to spontaneous neuron activity and to chaotic brain computations has been discussed.
Individual Rac GTPases Mediate Aspects of Prostate Cancer Cell and Bone Marrow Endothelial Cell Interactions
Authors: Chatterjee Moumita , Sequeira Linda , Jenkins-Kabaila Mashariki , Dubyk Cara W. , Pathak Surabhi , van Golen Kenneth L.
Published: June 2011

The Rho GTPases organize the actin cytoskeleton and are involved in cancer metastasis. Previously, we demonstrated that RhoC GTPase was required for PC-3 prostate cancer cell invasion. Targeted down-regulation of RhoC led to sustained activation of Rac1 GTPase and morphological, molecular and phenotypic changes reminiscent of epithelial to mesenchymal transition. We also reported that Rac1 is required for PC-3 cell diapedesis across a bone marrow endothelial cell layer. In the current study, we queried whether Rac3 and RhoG GTPases also have a role in prostate tumor cell diapedesis. Using specific siRNAs we demonstrate roles for each protein in PC-3 and C4-2 cell adhesion and diapedesis. We have shown that the chemokine CCL2 induces tumor cell diapedesis via Rac1 activation. Here we find that RhoG partially contributes to CCL2-induced tumor cell diapedesis. We also find that Rac1 GTPase mediates tight binding of prostate cancer cells to bone marrow endothelial cells and promotes retraction of endothelial cells required for tumor cell diapedesis. Finally, Rac1 leads to β1 integrin activation, suggesting a mechanism that Rac1 can mediate tight binding with endothelial cells. Together, our data suggest that Rac1 GTPase is key mediator of prostate cancer cell-bone marrow endothelial cell interactions.
Examination of the Association between Insufficient Sleep and Cardiovascular Disease and Diabetes by Race/Ethnicity
Authors: Vishnu Abhishek , Shankar Anoop , Kalidindi Sita
Published: June 2011

Background. We examined the association between insufficient rest/sleep and cardiovascular disease or diabetes mellitus separately among non-Hispanic whites, non-Hispanic blacks, Hispanic Americans, and other races in a contemporary sample of US adults.Methods. Multiethnic, nationally representative, cross-sectional survey (2008 BRFSS) participants who were >20 years of age (n=369, 217; 50% women). Self-reported insufficient rest/sleep in the previous month was categorized into: zero, 1–13, 14–29, and all 30 days. Outcomes were: (1) any CVD, (2) coronary artery disease (CHD), (3) stroke, and (4) diabetes mellitus.Results.Insufficient rest/sleep was found to be positively associated with (1) any CVD, (2) CHD, and (3) stroke among all race-ethnicities. In contrast, insufficient rest/sleep was positively associated with diabetes mellitus in all race-ethnicities except non-Hispanic blacks. The odds ratio of diabetes association with insufficient rest/sleep for all 30 days was 1.37 (1.26–1.48) among non-Hispanic whites, 1.11 (0.90–1.36) among non-Hispanic blacks, 1.88 (1.46–2.42) among Hispanic Americans, and 1.48 (1.10–2.00) among other race/ethnicities.Conclusion. In a multiethnic sample of US adults, perceived insufficient rest/sleep was associated with CVD, among all race-ethnicities. However, the association between insufficient rest/sleep and diabetes mellitus was present among all race-ethnicities except non-Hispanic blacks.
Cytotoxicity of Environmentally Relevant Concentrations of Aluminum in Murine Thymocytes and Lymphocytes
Authors: Kamalov Jamal , Carpenter David O. , Birman Irina
Published: June 2011

The effects of low concentrations of aluminum chloride on thymocytes and lymphocytes acutely dissociated from young mice were studied using flow cytometry with a DNA-binding dye. We demonstrate a rapid and dose-dependent injury in murine thymocytes and lymphocytes resulting from exposure to aluminum, as indicated by an increase in the entry into the cell of the DNA-binding dye, propidium iodine. A 60-minute exposure to 10 μM AlCl3caused damage of about 5% of thymocytes, while 50% were injured after 10 minutes at 20 μM. Nearly all thymocytes showed evidence of damage at 30 μM AlCl3after only 5 minutes of incubation. In lymphocytes, injury was observed at 15 μM AlCl3and less than 50% of cells were injured after a 60-minute exposure to 20 μM. Injury only rarely proceeded to rapid cell death and was associated with cell swelling. These results suggest that aluminum has cytotoxic effects on cells of the immune system.
Application of Functional Link Artificial Neural Network for Prediction of Machinery Noise in Opencast Mines
Authors: Nanda Santosh Kumar , Tripathy Debi Prasad
Published: June 2011

Functional link-based neural network models were applied to predict opencast mining machineries noise. The paper analyzes the prediction capabilities of functional link neural network based noise prediction models vis-à-vis existing statistical models. In order to find the actual noise status in opencast mines, some of the popular noise prediction models, for example, ISO-9613-2, CONCAWE, VDI, and ENM, have been applied in mining and allied industries to predict the machineries noise by considering various attenuation factors. Functional link artificial neural network (FLANN), polynomial perceptron network (PPN), and Legendre neural network (LeNN) were used to predict the machinery noise in opencast mines. The case study is based on data collected from an opencast coal mine of Orissa, India. From the present investigations, it could be concluded that the FLANN model give better noise prediction than the PPN and LeNN model.
VCG with Communities on Random Ad Hoc Networks
Authors: Ercal Gunes , Izhak-Ratzin Rafit , Majumdar Rupak , Meyerson Adam
Published: June 2011

We study game-theoretic mechanisms for routing in wireless ad hoc networks. Our major results include a combination of theoretical bounds and extensive simulations, showing that VCG-based routing in wireless ad-hoc networks exhibits small frugality ratio with high probability. Game-theoretic mechanisms capture the noncooperative and selfish behavior of nodes in a resource-constrained environment. There have been some recent proposals to use these mechanisms (in particular VCG) for routing in wireless ad-hoc networks, and some frugality bounds are known when the connectivity graph is essentially complete. We are the first to show frugality bounds for random geometric graphs, a well-known model for ad-hoc wireless connectivity. In addition, we generalize the model of agent behavior by allowing sets of nodes to form communities to maximize total profit. We are the first to analyze the performance of VCG under such a community model. While some recent truthful protocols for the traditional (individual) agent model have improved upon the frugality of VCG by selecting paths to minimize not only the cost but the overpayment, we show that extending such protocols to the community model requires solving NP-complete problems which are provably hard to approximate.
Cerebrospinal Fluid Biomarkers for Alzheimer’s Disease: The Present and the Future
Authors: Ghidoni Roberta , Benussi Luisa , Paterlini Anna , Albertini Valentina , Binetti Giuliano , Emanuele Enzo
Published: June 2011

Alzheimer’s disease (AD) is the major cause of dementia in the elderly. The biochemical changes that precede AD may be present up to 20 years before the clinical manifestation of the disease. The translational development of AD biomarkers may be theoretically achieved via two different strategies: the first strategy can be defined as ‘knowledge-based’ (deductive method), while the second one is a hypothesis-generating ‘unbiased’ approach (inductive strategy). The ‘knowledge-based’ approach relies on a direct understanding of the neuropathological processes that underlie the development of AD. In contrast, the ‘unbiased’ approach involves the use of modern techniques including proteomics and bioinformatics that allow unbiased investigations of numerous putative markers that may be informative with regard to AD. Cerebrospinal fluid (CSF) dosage of neuropathological AD-associated proteins has already been incorporated into the neurochemical diagnosis of AD, attesting the relevance of translational research. In the last few years, biomarker discovery research has successfully utilized genomics and proteomics for the identification of several promising molecular markers for AD. In the present article, we discuss the present state of the art and the future challenges in the search of CSF biomarkers for AD.
Previous Chemoembolization Response after Transcatheter Arterial Chemoembolization (TACE) Can Predict the Anti-Tumor Effect of Subsequent TACE with Miriplatin in Patients with Recurrent Hepatocellular Carcinoma
Authors: Imai Norihiro , Ikeda Kenji , Seko Yuya , Kawamura Yusuke , Sezaki Hitomi , Hosaka Tetsuya , Akuta Norio , Kobayashi Masahiro , Saitoh Satoshi , Suzuki Fumitaka , Suzuki Yoshiyuki , Arase Yasuji , Kumada Hiromitsu
Published: June 2011

Aim: The purpose of this retrospective study was to evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) with miriplatin in patients with unresectable hepatocellular carcinoma (HCC). Methods: From 2007 to 2010, 122 consecutive patients with unresectable HCC were treated by TACE with miriplatin-lipiodol suspension in our institute. Twenty-two patients (18%) had a solitary nodule and 100 patients (82%) had multiple nodules. Ninety-eight patients (80%) had a history of TACE. Results: Thirty-five of the 122 treated patients (29%) showed complete response (CR). And no serious complications were observed. Patients who had shown CR after previous TACE (pre-CR) were significantly more likely to show CR in the current study compared with patients who had shown less successful responses after previous TACE (56 vs. 20%, p = 0.003). Multivariate analysis revealed that response after previous TACE (pre-CR, risk ratio: 4.76; p = 0.035), tumor multiplicity (solitary, risk ratio: 9.69; p = 0.003), and injection artery (peripheral to segmental hepatic artery, risk ratio: 5.28;p = 0.040) were significant independent predictors associated with CR after TACE using miriplatin. Conclusion: In repetition of TACE treatment, switching the TACE agent from epirubicin or cisplatin to miriplatin offered a favorable treatment effect, especially in patients who had shown a CR after previous TACE.
Efficacy and Safety of Two Analogs of L-Carnitine on Rats Made Insulin Resistant by a High-Fructose Diet
Authors: Gómez-Solís Antonieta , De la Cruz-Cordero Ricardo , Avalos-Soriano Anaguiven , Duarte-Vázquez Miguel Angel , Reyes-Esparza Jorge , Rodríguez-Fragoso Lourdes
Published: June 2011

Aim: To evaluate the efficacy and safety of 2 analogs of L-carnitine on rats made insulin resistant by a high-fructose diet. Methods: Using rats made insulin resistant by a high-fructose diet, we investigated the impact of 2 analogs of L-carnitine (25 mg/kg) and L-carnitine (250 mg/kg) on glucose, triglycerides and cholesterol blood levels, and liver glycogen. We also evaluated the safety of both analogs by the assessment of some biochemical and hematological parameters, a histological analysis and a study of embryotoxicity. Results: Both analogs reduced the levels of triglycerides in the liver and plasma, but only analog 2 reduced the cholesterol levels in insulin-resistant rats. No changes were observed in glycogen content. Safety evaluations revealed alterations in blood lymphocytes and embryotoxicity data. Conclusion: This study demonstrated that the 2 analogs maintain the pharmacological properties of L-carnitine but have a different efficacy, potency and toxicity.
Effects of HMG-CoA Reductase Inhibitors on the Pharmacokinetics of Losartan and Its Main Metabolite EXP-3174 in Rats: Possible Role of CYP3A4 and P-gp Inhibition by HMG-CoA Reductase Inhibitors
Authors: Yang Si-Hyung , Choi Jun-Shik , Choi Dong-Hyun
Published: June 2011

The present study was designed to investigate the effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (atorvastatin, pravastatin, simvastatin) on the pharmacokinetics of losartan and its active metabolite EXP-3174 in rats. Pharmacokinetic parameters of losartan and EXP-3174 in rats were determined after oral and intravenous administration of losartan (9 mg/kg) without and with HMG-CoA reductase inhibitors (1 mg/kg). The effect of HMG-CoA reductase inhibitors on P-gp and cytochrome (CYP) 3A4 activity were also evaluated. Atorvastatin, pravastatin and simvastatin inhibited CYP3A4 activities with IC50 values of 48.0, 14.1 and 3.10 µmol/l, respectively. Simvastatin (1–10 µmol/l) enhanced the cellular uptake of rhodamine-123 in a concentration-dependent manner. The area under the plasma concentration-time curve (AUC0–∞) and the peak plasma concentration of losartan were significantly (p < 0.05) increased by 59.6 and 45.8%, respectively, by simvastatin compared to those of control. The total body clearance (CL/F) of losartan after oral administration with simvastatin was significantly decreased (by 34.8%) compared to that of controls. Consequently, the absolute bioavailability (F) of losartan after oral administration with simvastatin was significantly increased by 59.4% compared to that of control. The metabolite-parent AUC ratio was significantly decreased by 25.7%, suggesting that metabolism of losartan was inhibited by simvastatin. In conclusion, the enhanced bioavailability of losartan might be mainly due to inhibition of P-gp in the small intestine and CYP3A subfamily-mediated metabolism of losartan in the small intestine and/or liver and to reduction of the CL/F of losartan by simvastatin.
Dermocosmetics for Dry Skin: A New Role for Botanical Extracts
Authors: Casetti F. , Wölfle U. , Gehring W. , Schempp C.M.
Published: June 2011

Dry skin is associated with a disturbed skin barrier and reduced formation of epidermal proteins and lipids. During recent years, skin-barrier-reinforcing properties of some botanical compounds have been described. Searching the PubMed database revealed 9 botanical extracts that specifically improve skin barrier and/or promote keratinocyte differentiation in vivo after topical application. The topical application of Aloe vera (leaf gel), Betula alba (birch bark extract), Helianthus annuus (sunflower oleodistillate), Hypericum perforatum (St. John’s wort extract), Lithospermum erythrorhizon (root extract), Piptadenia colubrina (angico-branco extract) and Simarouba amara (bitter wood extract) increased skin hydration, reduced the transepidermal water loss, or promoted keratinocyte differentiation in humans in vivo. The topical application of Rubia cordifolia root extract and rose oil obtained from Rosa spp. flowers stimulated keratinocyte differentiation in mouse models. The underlying mechanisms of these effects are discussed. It is concluded that some botanical compounds display skin-barrier-reinforcing properties that may be used in dermocosmetics for dry skin. However, more investigations on the mode of action and more vehicle-controlled studies are required.
Skin Disinfection by Plasma-Tissue Interaction: Comparison of the Effectivity of Tissue-Tolerable Plasma and a Standard Antiseptic
Authors: Lademann O. , Kramer A. , Richter H. , Patzelt A. , Meinke M.C. , Czaika V. , Weltmann K.-D. , Hartmann B. , Koch S.
Published: June 2011

Wound healing disorders frequently occur due to biofilm formation on wound surfaces requiring conscientious wound hygiene. Often, the application of conventional liquid antiseptics is not sufficient and sustainable as (1) the borders and the surrounding of chronic wounds frequently consist of sclerotic skin, impeding an effectual penetration of these products, and (2) the hair follicles representing the reservoir for bacterial recolonization of skin surfaces are not affected. Recently, it has been reported that tissue-tolerable plasma (TTP), which is used at a temperature range between 35 and 45°C, likewise has disinfecting properties. In the present study, the effectivity of TTP and a standard liquid antiseptic was compared in vitro on porcine skin. The results revealed that TTP was able to reduce the bacterial load by 94%, although the application of the liquid antiseptic remained superior as it reduced the bacteria by almost 99%. For in vivo application, however, TTP offers several advantages. On the one hand, TTP enables the treatment of sclerotic skin as well, and on the other hand, a sustainable disinfection can be realized as, obviously, also the follicular reservoir is affected by TTP.
“When you take thing out the earth and you en’t put nothing back”: Nature, Form and the Metabolic Rift in Jan Carew’s Black Midas
Authors: Niblett Michael
Published: June 2011

This article examines Jan Carew’s 1958 novel Black Midas and its mediation of the environmental legacies of the colonial penetration of Guyana. I suggest that the ecological changes wrought by the forcible integration of the Caribbean into the capitalist world-system constitute a “trauma” that, like the traumas of slavery and the decimation of the indigenous peoples, haunts literary texts from the region. The article focuses in particular on the impact of what John Bellamy Foster, following Marx, calls the metabolic rift — the rupture in the interaction between human beings and the earth caused by the antagonistic relationship capitalism sets up between town and country, or metropole and colony. I argue that the generic discontinuities and formal quirks of Carew’s novel can be read as mediating the structural limits to development imposed by ecological imperialism and the metabolic rift, the dynamics of which imprint themselves on the aesthetics of the text.
Metaphysician: Trying to Read Peter Goldsworthy’s Prescription
Authors: Henricksen Noel
Published: June 2011

As a medical practitioner, Peter Goldsworthy has been confronted, all too frequently, with human suffering, morbidity and mortality: he wrestles with their existential meaning in his poetry, essays and stories. Death, in Goldsworthy’s works, is ubiquitous: it becomes an engine for tension between belief and scepticism, for contention between the legacy of his childhood Methodism and his professional grounding in scientific method. Goldsworthy describes incidents and presents arguments which explore the feasibility that we are not ephemeral but potentially eternal: séances and hoped-for hauntings; near-death experiences … explained physiologically; cloned Tasmanian tigers, and a doctor’s self-insemination with the DNA of Jesus; God-centred science fiction, and a convincing postulate for resurrection expressed in the language of mathematics and quantum mechanics. Detached and irreverent, Goldsworthy dissects and analyses, but avoids circumscription or dogmatism. He desires, at best, some proof that there is a dimension beyond the physical; he feels some sadness that a scientific mind is deprived of a certainty of the metaphysical; and he expresses hope that “perhaps, just perhaps …”.
Ghosts of Irish Famine in J. G. Farrell’s The Siege of Krishnapur
Authors: Johnson Alan
Published: June 2011

This essay argues that Anglo-Irish author J. G. Farrell’s 1973 Booker Prize-winning novel, in emphasizing the starvation of besieged Britishers during the so-called Mutiny of 1857, implicitly recalls the starvation of the Irish during the Great Famine of the 1840s. The potency of this tropological trace enables Farrell to satirize imperialism and, in the 1970s, imperial nostalgia, more effectively. By outlining the historical link between tropes of Irish figures and Indian rebels, and by highlighting Farrell’s echo of these tropes, the essay shows that the novel’s descriptions of food and hunger, for example, establish an unstated correspondence between these near-contemporaneous events that exposes the vacuity of imperialism and imperial nostalgia.
History and Narrative: The Use of the Sublime in Tash Aw’s Fiction
Authors: Sim Wai-chew
Published: June 2011

This essay synthesizes the work of Raymond Williams and Hayden White with a view to investigating the use of the sublime in two novels written by Malaysian author Tash Aw. It argues that, as a mode of historical emplotment, the sublime draws together the aesthetic and the political. In Aw’s texts it is used to enact experiential goals, to create “structures of feeling” that register the continuity between individual and group experience. Such usage prompts a consideration of the eventual irruptions of the collective will seen especially in anti-colonial and revolutionary contexts. By threading their plots through commonplace experiences of love and friendship and through encounters with “real-life” historical figures (Lai Teck, Sukarno), Aw’s texts provide structures of feeling which seek to alter our conceptual geography. While they promote considerations that derive in part from the politics of recognition, they also help to underwrite an internationalism worthy of the name.
Narrating “Dark” India in Londonstani and The White Tiger: Sustaining Identity in the Diaspora
Authors: Goh Robbie B. H.
Published: June 2011

In Indian Anglophone writing up to about the 1990s, a romantic narrative strand, working in parallel with a metafictional “encyclopaedic” form in other texts of the period, reflects a more hopeful and positive attitude towards Indian society, and an implicit confidence in its potential redemption. Many later works by Indian diasporic writers show a much more negative and critical attitude to India, catalysed by persisting socio-political problems such as corruption and communal violence. This “dark turn” in Indian Anglophone writing is very clearly seen in works such as Aravind Adiga’s The White Tiger and Gautam Malkani’s Londonstani, which seem to allow little or no possibility for India’s social problems to be resolved, and indeed make that irresolvable violence and confusion their particular theme. Yet in a way this “dark” India ironically becomes the means of a distinct cultural focus, a narrative mode of engagement with the homeland that, irrespective of its negative social view, is a means of sustaining cultural identity within the homogenizing and deterritorializing forces of globalization.
Navigating between Worlds: Ben Okri’s Abiku Child and the Oshogbo School of Art
Authors: Smalligan Laura M.
Published: June 2011

The figure of the abiku , a spirit child who dies before reaching maturity but is given the opportunity to be born again and again, has been used by Nigeria’s writers to represent the possibility of renewal and rebirth for their postcolonial nation. This article will suggest that the abiku in Ben Okri’s novel The Famished Road departs from this standard usage. Okri’s abiku instead embodies a desire for the people of Nigeria to be able to navigate between two seemingly opposed worlds: the secular, commercialized world of Western modernism and the spiritual world founded on Yoruba culture and belief. This literary appropriation of the abiku figure in Okri’s novel finds a parallel in the visual art of the Oshogbo School of Art, particularly in the work of Muraina Oyelami, Rufus Ogundele and Bisi Fabunmi.
Systematic review of the role of alternative application routes for opioid treatment for moderate to severe cancer pain: An EPCRC opioid guidelines project
Authors: Radbruch Lukas , Trottenberg Peter , Elsner Frank , Kaasa Stein , Caraceni Augusto
Published: June 2011

The European Palliative Care Research Collaboration is updating the EAPC recommendations on opioids in cancer pain management. A systematic literature search on Medline on the use of alternative routes for opioid application identified 242 papers, with 72 publications included in the final evaluation. Two or more alternative routes of opioid application were compared in 18 papers with a total of 674 patients. The best evidence base was available for the subcutaneous route. A comparison of subcutaneous and intravenous routes found no differences, confirming both routes as feasible, effective and safe. Efficacy and safety of the rectal route was comparable to the parenteral route. The side effect profile seemed to be very similar for the subcutaneous, intravenous, rectal or transdermal routes. Local side effects were reported for rectal application as well as for subcutaneous and transdermal administration. In conclusion, the systematic review found good evidence that subcutaneous administration of morphine or other opioids is an effective alternative for cancer patients if oral treatment is not possible. However, for a number of patients intravenous, rectal or transdermal therapy will offer a good alternative to the subcutaneous route. The review found no significant differences in efficacy or side effects between the alternative application routes.
Opioids for the management of breakthrough cancer pain in adults: A systematic review undertaken as part of an EPCRC opioid guidelines project
Authors: Zeppetella Giovambattista
Published: June 2011

The usual management of cancer related breakthrough pain is with supplemental doses of analgesics (commonly opioids) at a dose proportional to the total around-the-clock opioid dose. The aim of this review, undertaken as part of a European Palliative Care Research Collaborative (EPCRC) project, to update the EAPC guidelines on opioid analgesics in cancer pain was to determine the evidence for the utility of opioids in the management of breakthrough pain in patients with cancer. Randomized controlled trials of opioids used as rescue medication were identified using electronic search strategies. Outcome measures sought were reduction in pain intensity measured by an appropriate scale, adverse effects, attrition, and patient satisfaction. The date of the final search was 31 July 2009. Eight studies (790 patients) met the inclusion criteria. Most studies investigated rescue medication delivery via the buccal or nasal transmucosal routes. Intravenous morphine has been compared with the transmucosal route and the two found to be effective. The oral route has not been formally tested although found to be an inferior comparator in one study. Most studies showed no meaningful relationship between the effective dose of transmucosal opioid and the around-the-clock scheduled medication or the previous rescue medication, although one study found a fixed proportion of either intravenous morphine or transmucosal fentanyl to be efficacious.
Spinal opioids in adult patients with cancer pain: A systematic review: A European Palliative Care Research Collaborative (EPCRC) Opioid Guidelines Project
Authors: Kurita Geana Paula , Kaasa Stein , Sjøgren Per
Published: June 2011

Background: A systematic review, undertaken according to an initiative to revise European Association for Palliative Care guidelines on the use of opioids for cancer pain, which aimed to analyse analgesic efficacy and side effects of spinal opioids in adult cancer patients previously treated with systemic opioids.

Methods: Search strategy elaborated with MeSH terms and words related to cancer, palliative care, pain, spinal route and opioids. PubMed, Embase and Cochrane assessed in Nov 2009. Studies were analysed and classified according to quality of evidence and strength of recommendation.

Results: Out of 2939 abstracts, 44 articles were selected (nine randomized controlled trials (RCTs), two non-randomized cohort studies, 28 uncontrolled prospective studies, and five case series). Relief of pain and/or side effects were reported in 42 articles; however, there were few studies of high quality design (RCTs) and these studies had methodological limitations that reduced their quality of evidence to very low.

Conclusion: There are few RCTs and these are of very low quality. As a result, they provide weak recommendation for using spinal opioids in adult cancer patients. Further studies are clearly needed.
Starting Step III opioids for moderate to severe pain in cancer patients: Dose titration: A systematic review
Authors: Klepstad Pål , Kaasa Stein , Borchgrevink Petter C
Published: June 2011

The European Association for Palliative Care recommendation for starting morphine for cancer pain is dose titration with immediate release (IR) oral morphine given every 4 h with additionally doses for breakthrough pain. As part of a EU 6th framework programme to revise the guidelines we review the evidence regarding starting treatment and dose titration of opioids in adult patients with moderate to severe cancer pain. Relevant papers were identified though a systematic search in Medline for papers published until the end of 2009. We identified 15 relevant papers. Thirteen papers were descriptive papers reporting the results from starting treatment with oral morphine (six studies), starting treatment with intravenous morphine (two studies) and starting treatment with transdermal fentanyl (four studies). All treatment strategies resulted in acceptable pain control and were well tolerated. Two randomized controlled trials were identified. One study compared starting opioid treatment with intravenous morphine versus IR oral morphine and one study compared IR oral morphine versus sustained release oral morphine.
A systematic review of combination step III opioid therapy in cancer pain: An EPCRC opioid guideline project
Authors: Fallon Marie T , Laird Barry JA
Published: June 2011

Background: The use of combinations of opioids is a common clinical practice; however, this is not advocated by the World Health Organization (WHO) analgesic ladder. As opioid combination therapy becomes used increasingly, a review of the evidence on this practice was conducted.

Aims: To carry out a systematic review of the use of strong opioids in combination in cancer pain.

Methods: The following databases were searched electronically: Embase (1980–2010 week 2), Medline (1950–2010 week 1) and the Cochrane Database of Systematic Reviews (fourth quarter 2009). Only strong opioids as defined by the WHO ladder and full opioid agonists were examined. Only studies conducted in human, adult patients with chronic cancer pain were eligible. Studies must have contained data on efficacy and/or side effects in the key point. Appraisal was conducted using predetermined criteria set by the EAPC guideline development group. All potential papers were reviewed independently by both authors.

Results: In total 596 articles were retrieved resulting in only two eligible studies, which were rated as grade C and grade D evidence. These examined morphine in combination with oxycodone or fentanyl/methadone.

Conclusion: Only a weak recommendation can be used to support combination opioid therapy. This recommendation is also based on the caveat that the desirable effects of combination opioid therapy is outweighed by any disadvantages that this would confer. Prospective randomized trials are needed to clarify the benefits and safety of combination opioid therapy.
Evidence-based medicine: What is the evidence that it has made a difference?
Authors: McQuay Henry
Published: June 2011

Evidence-based medicine (EBM) has, over the past 20 years, made us all more critical in our thinking about the efficacy and safety of interventions. This is evident in the higher standards of our spoken and written work, formal and informal, and in our approach to the subject. The downside has been the coincidence of the squeeze on healthcare funding with the emergence of the EBM ideas – it has been all too easy to misuse the tools of EBM to deny patients access to treatment, and this, together with the off-putting political correctness of the EBM approach in some quarters, has made clinicians uneasy.

Clinicians have to make decisions about therapy for the individual patient. Ideally this is guided by the best available evidence and their experience. EBM can guide one as to the population efficacy and safety of a particular intervention, but as we all know few patients are average. That guidance can only be given if there is adequate evidence, and the difficulty with guidance about symptom control is often the paucity of evidence of sufficient quality to yield credible guidance. Palliative care is often a ‘complex intervention’, and here EBM struggles to untangle which components, if any, of the complex interventions are important. The trial and review methodologies for complex intervention are wanting. Tom Chalmers, a grandfather of the EBM movement, argued late in his career that the most important function of the EBM approach was to frame the research agenda. This we think is correct. The process of systematic review of a topic throws up the deficits in trial methods and the lacunae in the data, and this then can show the way forward.
The second step of the analgesic ladder and oral tramadol in the treatment of mild to moderate cancer pain: A systematic review
Authors: Tassinari Davide , Drudi Fabrizio , Rosati Marta , Tombesi Paola , Sartori Sergio , Maltoni Marco
Published: June 2011

Background: To analyse the evidence supporting the widespread use of modified analgesic ladders or oral tramadol as alternatives to codeine/paracetamol for mild to moderate cancer pain.

Methods: A systematic review of the literature was independently performed by two authors. The level of evidence and risk/benefit ratio were assessed in all the selected trials. A comprehensive analysis of the level of evidence, risk/benefit ratio and strength of the recommendations was carried out. The analysis was performed using the GRADE system.

Results: Eighteen papers were included into the analysis. The level of evidence was low or very low for all the trials, and as a result the risk/benefit ratio was uncertain. Likewise, the strength of the final recommendations was considered weak negative for either the use of modified analgesic ladders (by-passing the second step of the World Health Organization (WHO) analgesic ladder) or the use of oral tramadol as an alternative to codeine/paracetamol in the second step of the WHO analgesic ladder.

Conclusions: Data supporting the role of modified two-step analgesic ladders or oral tramadol as an alternative to codeine/paracetamol are insufficient to recommend their routine use in cancer patients with mild to moderate cancer pain.
Conversion ratios for opioid switching in the treatment of cancer pain: a systematic review
Authors: Mercadante Sebastiano , Caraceni Augusto
Published: June 2011

In this paper we describe the results of a systematic search of the literature on conversion ratios during opioid switching. This is part of a project of the European Palliative Care Research Collaboration to update the European Association for Palliative Care recommendations for the use of opioid analgesics in the treatment of cancer pain. Studies were eligible for inclusion if they involved adult patients with chronic cancer pain, contained data on opioid conversion ratios, were prospective and were written in English. Thirty-one studies were identified and included. The majority of the studies had methodological flaws and were not designed to explore or demonstrate equianalgesic dose data. However, the data allow some recommendations to be made that could be helpful to clinicians for whom there are few reliable experimental data on which to base dosing guidelines. Switching to transdermal fentanyl (TDfe) or buprenorphine (TDbu) is an option for patients with stable, controlled pain. Reliable and consistent studies show a ratio of 100 : 1 between oral morphine (ORmo) and TDfe. A ratio of 75 : 1 between ORmo and TDbu may be appropriate, but the supporting evidence here is much less robust. Data are relatively consistent to support a conversion ratio between ORmo and oral hydromorphone (ORhy) of 5 : 1. Despite some limitations, there is evidence to support the use of an approximate conversion ratio of ORmo:oral oxycodone (ORox) of 1.5 : 1. The conversion between ORox and ORhy is estimated to be 1 : 4. When switching from different opioids to methadone the conversion ratio is highly variable, ranging from 5 : 1 to 10 : 1 and much higher in some studies. The derived ratios are influenced by several factors, including the reasons for switching and previous opioid doses. An individual treatment decision and strict monitoring is recommended for patients considered at risk.
Space-time, Event and Expression in Early Tamil Texts
Authors: Ganesh K.N.
Published: June 2011

Much attention has been paid to the compositions of early Tamil bards that have been compiled and reproduced as Akam and Puram texts. Several studies on the early Tamil texts have appeared from linguistic, cultural and historical perspectives, which have helped to provide valuable insights into structural and processual aspects of early Tamil society. Studies of Tinai and Turai have been central to such efforts. Arguments regarding Tinai as representative of social evolution have given way to efforts at understanding Tinai in terms of material culture and forms of ecological adaptation. The thematic character of turai has provided valuable insights into the processes at work within the social formations of early Tamilakam. The present article attempts to analyse one text of crucial importance to the discussion. Tolkappiyam is primarily a text on Tamil language and grammar, but its significance in understanding the society of early Tamils has long been recognised. It is also known that Porulatikaram in Tolkappiyam goes far beyond the conventional linguistic treatises in dealing with social processes. However, the text is not merely an exercise in social linguistics, but provides a comprehensive methodology in understanding early Tamil texts. The article argues that the methodology involves historical categories of space and time and formation of events that constitute the basis of literary expressions. It is argued that the context of introduction of these categories signifies major transformation in early Tamil society, which makes the composition of Tolkappiyam representative of changing social order.
Kṛimilā
Authors: Kumar Anil
Published: June 2011

In a recent course of exploration in the area identified as Kṛimilā Adhiṣṭhāna of early medieval period by D.C. Sircar is near modern town Lakhisarai, a district headquarter of Bihar. It is situated around 125 kilometers east of Patna, the state capital. It is well connected by rail and road; Patna Howrah main line and NH 80 passes through the place. The longitude of city is 86°06′ east and latitude is 25°10′ north. The area around 25–30 square kilometers of the city has large number of historical monuments, particularly Buddhist Stupas and Brahmanical temples. Beglar and Cunningham explored the area and reported the antiquity of the region in 19th century. They have identified existence of Buddhist Stupa and Brahmanical temples in the area. In 1950s and 1960s D.C. Sircar and subsequently R.K Choudhary visited the region and reported few inscriptions of early medieval period. An extensive exploration conducted by me, has revealed many interesting facts undisclosed about the early medieval historiography. There are more than thirty big mounds which are unexcavated lying between Valgudar and Rampur in Lakhisarai district of Bihar. Recent exploration has yielded six image inscriptions and more than 100 Buddhist as well as Brahmanical sculptures. Stylistic analysis of these sculptures suggests us the early medieval dates, and different phases of construction activities. The whole area falls around 30 square kilometers, which has more than thirty mounds, more than twenty ponds and three lakes. Few brick structures over the mounds are exposed due to natural calamities or encroachments by the local people. Overall survey of the area and decipherment of the found inscriptions, suggests us about an existence of a large religious and administrative centre of early medieval eastern India.
Social History through Inscriptions
Authors: Reddy B. Rama Chandra , Natarajan R.
Published: June 2011

Imprecation in epigraphy is cursing individuals who destroy the gift or misappropriate the charitable grant. They vary from simple warnings to severe abuses and thus mirror the then existing society and social values. Initially the rulers issued their inscriptions in the elite Sanskrit language. Slowly from the sixth century onwards the regional language, Telugu, began to replace Sanskrit as the chief epigraphical medium in most parts of the present Andhra Pradesh and the process was near completion by the time of Vijayanagara rulers. The colloquial dialects have their own distinct identities in every region of Andhra Pradesh. Of late the historians try to disseminate information regarding the society and ethics of a particular period by using the contents of the inscriptions. Hence an attempt is made in this direction by studying inscriptions of Cuddapah district, from where the first Telugu stone and copper plate inscriptions appeared. This article assumes potential significance when imprecatory passages of a turbulent region are studied for introspection as there is a paradigm shift in the tone and tenor of these expressions, truly reflecting the erstwhile society.
The Katakarajavamsavali
Authors: Kulke Hermann
Published: June 2011

The Katakarajavamsavali (KRV) is a free Sanskrit rendering of the Madala Panji, Puri’s famous Oriya chronicle. Dated in 1820 and written by an unknown author, it reveals a fascinating ‘biography’, directly linked with the colonial quest for acquiring traditional Indian knowledge. In 1825 it was transferred to the India Office Library at London and remained unnoticed until its rediscovery in 1974 and publication in 1987. In 1820 two British ‘administrators cum historians’, Andrew Stirling, Secretary to the Commissioner at Cuttack, and Colin Mackenzie, Surveyor General of India, met in Orissa and seem to have entrusted ‘a learned Brahmin of Puri’ to write a new and systematic chronicle of Orissa in Sanskrit. A detailed analysis makes it very likely that the author was Jagannath Rajguru who had already been the main informant of Groeme for the compilation of his famous Report on the Jagannath temple in 1805 and who was twice appointed Head Pariksha of the temple. The KRV became the major historical source of A. Stirling’s ‘An Account, Geographical, Statistical, and Historical of Orissa Proper or Cuttack’, published by the Asiatic Society at Calcutta in 1822 as the first ‘modern’ publication on Orissa.
A Bilingual Astrolabe from the Court of Jahāngīr
Authors: Sarma Sreeramula Rajeswara
Published: June 2011

A Mughal astrolabe preserved in the Sampurnanand Sanskrit University at Varanasi is unique in many respects. While almost all the extant Indo-Persian astrolabes emanate from a single family of astrolabe makers of Lahore or are influenced by the products of this family, the present astrolabe differs from the characteristic style of the Lahore family and testifies to the presence of another style of astrolabe-making in the Indian subcontinent. Made by a Brahmin apprentice of a Muslim astrolabe maker at Jahāngīr’s court in Agra, this astrolabe carries legends in Arabic and Sanskrit so that it can be used by Muslim nuzūmis as well as by Hindu jyotiṣīs and is thus a ‘unique testimonial to an intercultural encounter’—to borrow David King’s phrase. This article offers a full technical description of this astrolabe and attempts to situate it in the history of production of Indo-Persian astrolabes on the one hand, and that of Sanskrit astrolabes on the other.
Decay of Village Community and the Decline of Vernacular Education in Bihar and Bengal in the Colonial Era
Authors: Jha Hetukar
Published: June 2011

Indigenous elementary schools were in a flourishing state in thousands of villages of Bihar and Bengal until the early decades of the nineteenth century. They were village institutions, maintained by village people, where their children (belonging to all caste clusters and communities) used to receive education and training relevant to the pursuit of their future occupations. Village community and identity quite effectively operated in many contexts of everyday life. However, the colonial policies in respect of education and land control adversely affected both the village structure and the village institutions of secular (elementary) education. The British legal system and the rise of caste consciousness since the second half of the nineteenth century added fuel to the fire. Gradually, village as the base of secular identity and solidarity became too weak to create and maintain its own institution by the end of the nineteenth century. Simultaneously, the British policy skewed in favour of the filtration theory of education since 1835, it seems, worked to block to a significant extent the entry into the middle classes from below.