bluuebunny/crossref_metadata_2025 huggingface dataset:
A Bridge-Vehicle Interaction Based Experimental Investigation of Damage Evolution
Authors: Pakrashi Vikram , O'Connor Alan , Basu Biswajit
Published: November 2009

This article presents an experimental monitoring of the evolution of a crack in a beam using beam-vehicle interaction response signals for identification of progressively increasing crack-depth ratios. The beam is traversed by a two-axle model vehicle providing excitation in the time domain for the various extents of damage. The response of the beam in the time domain during the period of forced vibration is measured using strain gages. A consistent evolution of damage has been demonstrated in terms of the maxima values of the measured responses. The corresponding distortions of wavelet coefficients of the measured strain data due to the presence of various levels of damage have been identified. The evolution of the phase space and the wavelet transformed phase spaces have been evaluated with damage evolution. The wavelet transformed phase spaces for the undamaged and the damaged cases are observed to be distinctly different at high scales. The importance of denoising of the acquired data and the importance of vehicle configuration has been illustrated. This study presents a basis for a general model free damage assessment and structural health monitoring framework. The study presented is particularly useful in the context of continuous online bridge health monitoring, since the data necessary for analysis can be obtained from the operating condition of the bridge and the structure does not need be closed down.
Review Article: Anemia post—lung transplantation: mechanisms and approach to diagnosis
Authors: Modrykamien Ariel
Published: November 2009

Anemia is a common complication in post-lung transplant recipients. Although its mechanism is often multifactorial, clinicians should investigate an eventual underlying explanation to provide the best care. Among the reasons for anemia in lung transplant recipients, blood loss should be thought within the first few days after surgery. Later on, immune-mediated mechanisms, microangiopathic hemolytic anemia and reduction in red blood cell production mediated by viruses, drugs and infiltrative disorders prevail. This article reviews the mechanisms of anemia in post—lung transplant patients and provides an algorithm towards its approach.
Not So Fast, My Friend: Biases in College Football Polls
Authors: Witte Mark David , Mirabile McDonald Paul
Published: November 2009

The national championship game in Division IA football is selected in part by voters. Are the voters biased? Examining all weekly rankings from 2004 to 2008, the authors find the following results. Voters in the USA Today (Coaches’) Poll tend to rank their team’s recent opponents 4.3 places higher than the average voting coach and rank the recent opponents of their alma mater 3.2 places higher. Additionally, both coaches and sports media (AP Poll) overassess teams who play in certain Bowl Championship Series (BCS) conferences relative to non-BCS conferences and reward ‘‘running up the score’’ by voting teams with high offensive output above their peers.
Returns to Stardom: Evidence From U.S. Major League Soccer
Authors: Kuethe Todd H. , Motamed Mesbah
Published: November 2009

This study examines the wage determination of professional soccer players in the U.S. Major League Soccer (MLS). In particular, the authors focus on the superstar effects of the league’s top athletes. Given the structure of the league, the MLS-designated player rule and all-star game participation provide unique measures of superstar status unattainable in existing studies. We find evidence of a superstar premium both on average and among the league’s top earners.
A Comparison of Superficial and Deep Bacterial Presence in Open Fractures of the Lower Extremities
Authors: Ako-Nai A.K. , Ikem I.C. , Daniel F.V. , Ojo D.O. , Oginni L.M.
Published: November 2009

This open prospective study compared the bacterial flora of superficial and deep-wound biopsies and swabs over a 2-year period in 4 different samples cultured from open fracture wounds at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Samples were taken from 47 patients with factures graded according to Gustilo and Anderson’s classification as grade 1 (2.1%), grade II (29.8%), grade IIIA (36.2%), and grade IIIB (31%). A total of 248 samples were cultured using standard techniques. The incidence of open fracture wounds was 78.7% in male patients and 21.3% in female patients. Tibia fractures constituted 66.1%. A total of 203 bacterial isolates were cultured from 248 samples. Gram-negative bacteria constituted 53.2% of isolates, with Escherichia coli being predominant (12.8%). Staphylococcus aureus were the predominant Gram-positive cocci (15.3%), and Staphylococcus epidermidis (13.3%) may be considered to be the major source of open fracture wound contamination. The bacterial species cultured from superficial and deep-wound swabs and biopsies were similar. Resistance to antimicrobials was high for penicillins (amoxicillin and cloxacillin), with values of 68.6% and 58.3%, respectively, for superficial bacterial species and 58.2% and 31.9%, respectively, for deep-wound biopsies.
The Use of a Dermal Substitute (Integra) to Preserve Maximal Foot Length in a Diabetic Foot Wound With Bone and Tendon Exposure Following Urgent Surgical Debridement for an Acute Infection
Authors: Clerici Giacomo , Caminiti Maurizio , Curci Vincenzo , Quarantiello Antonella , Faglia Ezio
Published: November 2009

In this report, the authors present the case of a 62-year-old female patient who was admitted to our hospital with an acute deep foot infection. The patient was taken immediately to the operating room where she underwent surgical debridement to completely remove all infected tissues; at the end of this first surgical step, all 5 metatarsal bones remained exposed dorsally. Once eradication of infection was completed, we had to decide whether to perform a transmetatarsal amputation at proximal levels, which would have allowed healing by first intention but would have left the patient with a smaller foot stump, or amputation at more distal levels followed by coverage of healthy tendon and bone tissues with a dermal regeneration template (Integra, Integra Life Sciences Corporation, Plainsboro, NJ), which would have preserved the foot stump length and allowed better walking. We opted for the second choice, and the use of a dermal template actually enabled our patient to maintain a considerable foot stump length, much longer than would have resulted from an amputation with immediate primary closure.
Detecting Aerobic Bacterial Diversity in Patients With Diabetic Foot Wounds Using ERIC-PCR: A Preliminary Communication
Authors: Singh Surya K. , Gupta K. , Tiwari S. , Shahi Shailesh K. , Kumar S. , Kumar A. , Gupta Sanjeev K.
Published: November 2009

The polymicrobial nature of diabetic foot infection is a reflection of the immune compromised state of the host.The methods of microbial identification based on colony morphology and biochemical characteristics have limitations as they may not differentiate the diverse microorganisms that infect foot wounds. The aim of the present study was to find out the bacterial diversity in diabetic foot infections at genetic level by finger printing, that is, ERIC-PCR (enterobacterial repetitive intergenic consensus -polymerase chain reaction). Nine patients with infected diabetic foot ulcers were recruited to the study. Pus and tissue samples were collected from the wound site. Aerobic bacteria were isolated employing standard microbiological culture methods and their genetic variability was analyzed using the ERIC-PCR. Sensitivity test for these isolates against commonly used antibiotics were performed using disc diffusion method. The standard microbiological culture technique yielded 38 morphotypes of bacteria and their genetic diversity was confirmed by ERIC-PCR assay. Analysis of the similarity index using NTSYSpc 2.1 software revealed 34 types of banding pattern among these isolates. Based on the similarity index these isolates were divided into 7 groups. As many as 8 types of aerobic bacterial isolates were detected from a single patient using the above technique compared with 2 on routine culture analysis. Genetically diverse isolates showed differential sensitivity pattern against commonly used antibiotics in the assay. The observed diversity at genetic level is attributed to variable sensitivity pattern of these isolates against the class of antibiotics. A molecular technique such as ERIC-PCR is a more sensitive detection method than conventional techniques, the potential of which needs to be fully understood.
A cost-effectiveness analysis of subject recruitment strategies in the HIPAA era: results from a colorectal cancer screening adherence trial
Authors: Schroy Paul C , Glick Julie T , Robinson Patricia , Lydotes Maria A , Heeren Timothy C , Prout Marianne , Davidson Peter , Wong John B
Published: November 2009

Background Changes in regulatory standards that restrict use of identifiable health information can reduce patient recruitment to clinical trials and increase recruitment costs.

Purpose To compare subject accrual rates and costs of three recruitment strategies that comply with new regulatory standards within the context of a clinical trial evaluating the impact of shared decision-making on colorectal cancer screening adherence.

Methods Sequential cohorts of English-speaking, average-risk patients due for colorectal cancer screening were allocated to one of three recruitment strategies: (1) a provider-initiated electronic ‘opt-in’ referral (Click) method; (2) a provider-mediated ‘opt-in’ referral letter (Letter) method; and (3) an investigator-initiated direct contact ‘opt-out’ (Call) method.

Results During distinct 6-month recruitment periods between March 2005 and April 2006, 100 potential subjects were identified using the Click method, 847 by the Letter method, and 758 by the Call method. After excluding ineligible prescreened patients, accrual rates were higher for the Call method (188 of 531 [35.4%]) than either the Click (12 of 72 [16.7%]; p = 0.002) or Letter (17 of 816 [2.1%]; p < 0.001) methods. The average cost per patient enrolled for the Call ($156) method was competitive with the Click ($129) and substantially lower than the Letter ($1967) methods; the Call method was least expensive if combined with automated patient identification ($99). Data extrapolation suggest it would take 2.4 years at an overall cost of $138,518 to recruit a target sample of 900 patients by the Call method, 40.5 years at $62,419 for the Click method and 27.9 years at $1,737,757 for the Letter method.

Limitations The study was nonrandomized and findings may not be generalizable to other research settings.

Conclusion The investigator-initiated direct contact ‘opt-out’ strategy is significantly more cost-effective and feasible than provider-initiated and provider-mediated ‘opt-in’ strategies for patient recruitment to clinical trials. Clinical Trials 2009; 6: 597—609. http://ctj.sagepub.com
Involving American Indians and medically underserved rural populations in cancer clinical trials
Authors: Guadagnolo B A , Petereit Daniel G , Helbig Petra , Koop David , Kussman Patricia , Fox Dunn Emily , Patnaik Asha
Published: November 2009

Purpose To assess cancer clinical trial recruitment and reasons for nonaccrual among a rural, medically underserved population served by a community-based cancer care center.

Methods We prospectively tracked clinical trial enrollment incidence among all new patients presenting at the Rapid City Regional Cancer Care Institute. Evaluating physicians completed questionnaires for each patient regarding clinical trial enrollment status and primary reasons for nonenrollment. Patients who identified as American Indian were referred to a program where patients were assisted in navigating the medical system by trained, culturally competent staff.

Results Between September 2006 and January 2008, 891 new cancer patients were evaluated. Seventy-eight patients (9%; 95% confidence intervals, 7—11%) were enrolled on a clinical treatment trial. For 73% (95% confidence intervals, 69—75%) of patients (646 of 891) lack of relevant protocol availability or protocol inclusion criteria restrictiveness was the reason for nonenrollment. Only 45 (5%; 95% confidence intervals, 4—7%) patients refused enrollment on a trial. Of the 78 enrolled on a trial, 6 (8%; 95% confidence intervals, 3—16%) were American Indian. Three additional American Indian patients were enrolled under a nontreatment cancer control trial, bringing the total percentage enrolled of the 94 American Indians who presented to the clinic to 10% (95% confidence intervals, 5—17%).

Limitations Eligibility rates were unable to be calculated and cross validation of the number in the cohort via registries or ICD-9 codes was not performed.

Conclusion Clinical trial participation in this medically underserved population was low overall, but approximately 3-fold higher than reported national accrual rates. Lack of availability of protocols for common cancer sites as well as stringent protocol inclusion criteria were the primary obstacles to clinical trial enrollment. Targeted interventions using a Patient Navigation program were used to engage AI patients and may have resulted in higher clinical trial enrollment among this racial/ethnic group. Clinical Trials 2009; 6: 610—617. http://ctj.sagepub.com
Satisfactory cross-cultural validity of the ACTG symptom distress module in HIV-1-infected antiretroviral-naive patients
Authors: Regnault Antoine , Marfatia Shalaka , Louie Michael , Mear Isabelle , Meunier Juliette , Viala-Danten Muriel
Published: November 2009

Background Multinational clinical trials commonly include different language versions of patient-reported outcomes (PRO) instruments without considering the question of their cross-cultural validity. The inclusion of a PRO instrument, the Adult AIDS Clinical Trial Group Symptom Distress Module (SDM), in an multinational clinical trial in HIV-1 antiretroviral-naive patients offered an opportunity to explore the methods to assess cross-cultural validity of PRO instruments in the context of clinical trials.

Purpose To assess the cross-cultural validity of the SDM across seven cultural groups in the setting of a multinational HIV clinical trial.

Methods Twenty-five language versions of the SDM were included in a Phase IIb/III trial comparing maraviroc with efavirenz (each in combination with zidovudine/ lamivudine) conducted in 12 countries to assess symptoms perceived by HIV-1-infected antiretroviral-naive patients. Differential item functioning (DIF) detection and the STATIS method were combined in a pragmatic approach to assess the cross-cultural validity of the SDM using pre-antiretroviral treatment data from 759 patients.

Results Statistically significant DIF between cultural groups was observed for four items: fatigue; fevers; anxiety; and headache. However, examination of these items by linguists did not lead to meaningful explanations for the statistical differences. With the STATIS approach, the Bantu and European Germanic groups were the furthest from the Occidental English group.

Limitations The assessment of cross-cultural validity had to be performed on some very small samples and on data aggregated by cultural groups, which suggests the need for a cautious interpretation of the results.

Conclusions Given the heterogeneity of cultures considered, the absence of meaningful explanations for statistically significant differences between cultural groups supports the cross-cultural validity of the SDM versions included in this trial. Thus, this study demonstrated that it is feasible to conduct assessment of crosscultural validity of PRO instruments using data collected in the setting of multinational clinical trials. Clinical Trials 2009; 6: 574—584. http://ctj.sagepub.com
Drugs and Symbolic Pollution: The Work of Cultural Logic in the Russian Press
Authors: Meylakhs Peter
Published: November 2009

This article is devoted to analysis of the ‘media drug wave’ that occurred in Russia at the end of the 1990s. Following a general description of the coverage of the drug problem by the Russian press, the article sets out to explore some reasons that may help to explain the extremely negative attitude of the media and the overwhelming majority of the Russian population to drugs and drug users. Drawing on the cultural theory of risk, it is argued that such an attitude cannot be explained in rational terms of the negative consequences for the health and security of members of society; rather, drugs and drug users are perceived to be symbolic polluters of society. Cultural codes of purity and pollution can help clarify several key themes that inform political and public debates around drugs in Russia. The social context (rise of ‘Russian neomoralism’) in which the drug problem was constructed is outlined.
Rethinking Difficult Pasts: Bloody Sunday (1972) as a Case Study
Authors: Conway Brian
Published: November 2009

The sociological literature on collective memory puts forward fragmented and multivocal commemorations as two dominant ways of responding to difficult pasts. This article argues that there is room for improvement in these models by specifying the conditions under which a controversial past can be remembered initially in a fragmented way and, with greater temporal distance from the original event, can evolve into a more consensual form of commemoration in which the past is seized upon as a resource to advance the politics of reconciliation between two opposing identity groups in an unsettled society. An evolving political climate, active memory choreography, and the usability of the past in the present all help account for this. The empirical evidence to support this theoretical claim comes from a long-range, historical study of the case of Bloody Sunday (1972).
Iterative pruning PCA improves resolution of highly structured populations
Authors: Intarapanich Apichart , Shaw Philip J , Assawamakin Anunchai , Wangkumhang Pongsakorn , Ngamphiw Chumpol , Chaichoompu Kridsadakorn , Piriyapongsa Jittima , Tongsima Sissades
Published: November 2009

Background

Non-random patterns of genetic variation exist among individuals in a population owing to a variety of evolutionary factors. Therefore, populations are structured into genetically distinct subpopulations. As genotypic datasets become ever larger, it is increasingly difficult to correctly estimate the number of subpopulations and assign individuals to them. The computationally efficient non-parametric, chiefly Principal Components Analysis (PCA)-based methods are thus becoming increasingly relied upon for population structure analysis. Current PCA-based methods can accurately detect structure; however, the accuracy in resolving subpopulations and assigning individuals to them is wanting. When subpopulations are closely related to one another, they overlap in PCA space and appear as a conglomerate. This problem is exacerbated when some subpopulations in the dataset are genetically far removed from others. We propose a novel PCA-based framework which addresses this shortcoming.

Results

A novel population structure analysis algorithm called iterative pruning PCA (ipPCA) was developed which assigns individuals to subpopulations and infers the total number of subpopulations present. Genotypic data from simulated and real population datasets with different degrees of structure were analyzed. For datasets with simple structures, the subpopulation assignments of individuals made by ipPCA were largely consistent with the STRUCTURE, BAPS and AWclust algorithms. On the other hand, highly structured populations containing many closely related subpopulations could be accurately resolved only by ipPCA, and not by other methods.

Conclusion

The algorithm is computationally efficient and not constrained by the dataset complexity. This systematic subpopulation assignment approach removes the need for prior population labels, which could be advantageous when cryptic stratification is encountered in datasets containing individuals otherwise assumed to belong to a homogenous population.
The effects of corn silk on glycaemic metabolism
Authors: Guo Jianyou , Liu Tongjun , Han Linna , Liu Yongmei
Published: November 2009

Background

Corn silk contains proteins, vitamins, carbohydrates, Ca, K, Mg and Na salts, fixed and volatile oils, steroids such as sitosterol and stigmasterol, alkaloids, saponins, tannins, and flavonoids. Base on folk remedies, corn silk has been used as an oral antidiabetic agent in China for decades. However, the hypoglycemic activity of it has not yet been understood in terms of modern pharmacological concepts. The purpose of this study is to investigate the effects of corn silk on glycaemic metabolism.

Methods

Alloxan and adrenalin induced hyperglycemic mice were used in the study. The effects of corn silk on blood glucose, glycohemoglobin (HbA1c), insulin secretion, damaged pancreatic β-cells, hepatic glycogen and gluconeogenesis in hyperglycemic mice were studied respectively.

Results

After the mice were orally administered with corn silk extract, the blood glucose and the HbA1c were significantly decreased in alloxan-induced hyperglycemic mice (p < 0.05, p < 0.01, respectively), while the level of insulin secretionn was markedly elevated in alloxa-induced hyperglycemic mice (p < 0.05). The alloxan-damaged pancreatic β-cells of the mice were partly recovered gradually after the mice were administered with corn silk extract 15 days later. Also, the body weight of the alloxan-induced hyperglycemic mice was increased gradually. However, ascension of blood glucose induced by adrenalin and gluconeogenesis induced by L-alanine were not inhibited by corn silk extract treatment (p > 0.05). Although corn silk extract increased the level of hepatic glycogen in the alloxan-induced hyperglycemic mice, there was no significant difference between them and that of the control group(p > 0.05).

Conclusion

Corn silk extract markedly reduced hyperglycemia in alloxan-induced diabetic mice. The action of corn silk extract on glycaemic metabolism is not via increasing glycogen and inhibiting gluconeogenesis but through increasing insulin level as well as recovering the injured β-cells. The results suggest that corn silk extract may be used as a hypoglycemic food or medicine for hyperglycemic people in terms of this modern pharmacological study.
Foreskin trapped by zipper: a case report
Authors: Arrabal-Polo Miguel Angel , Arias-Santiago Salvador A , Giron-Prieto Maria Sierra , Arrabal-Martin Miguel
Published: November 2009

We present an 84 year-old-male patient with foreskin trapped by his zipper. After several failed attempts with scissors, screwdriver and others we practise an elliptic incision to resolve the problem. Foreskin injuries are frequent in children but are rare in adult men. There are some techniques described for solving the problem using scissors, screwdriver, traction and surgery.
Specific sublingual immunotherapy with peach LTP (Pru p 3). One year treatment: a case report
Authors: Pereira Celso , Bartolomé Borja , Asturias Juan Andrés , Ibarrola Iñaki , Tavares Beatriz , Loureiro Graça , Machado Daniel , Chieira Celso
Published: November 2009

Introduction

Food allergy is an increasing problem with limited therapeutic approaches apart from to the eviction diet.

Case presentation

A 40-year-old female patient with food allergy symptoms was polysensitized to almost all vegetable food since the age of 36; the onset of symptoms was during pregnancy. The allergological study demonstrated positive skin prick tests (SPT) to nuts, legumes, cereals, spices, several fresh fruits including peach, and other groups of vegetable foods however, it was negative to common aeroallergens. Serum specific IgE levels were negative (<0.35 kU/L) to profilin and carbohydrate determinants, but positive to Pru p 3 (3.5 kU/L). Positive double-blind placebo-controlled food challenge to peach confirmed the allergic disease. She received specific sublingual immunotherapy with native Pru p 3 at a concentration of 40 μg/ml with 5 administrations per week and a cumulative dose of 200 μg of nPru p 3 per month. After an ultra-rush build-up phase concluded in one day she continued therapy during a year with 5 administrations per week. The clinical evolution and laboratory studies demonstrated an early reduction on SPT reactions with no relevant changes on serum specific IgE, IgG, IgG1and IgG4to Pru p 3 during the immunotherapy period. The challenge test was negative 4 months after the beginning of the SLIT. Regarding clinical response she markedly improved after the first month of treatment, and by the 3th month she had no major vegetable dietary restrictions, except for nuts and pepper.

Conclusion

These results demonstrate the excellent efficacy and safety of sublingual specific protein immunotherapy developed according to the patient specific sensitivity profile to Pru p3.
Early loosening and secondary dislocation due to a broken trochanteric osteotomy wire following a Charnley total hip arthroplasty: a case report
Authors: Shahin Yousef , Choudhary Rakesh , Al-Naser Saeed , Mullins Mark
Published: November 2009

We report a case of interposition of a broken trochanteric wire in the hip joint. This caused early wear of the prosthesis and dislocation of the Charnley total hip arthroplasty. The patient was treated with a revision total hip arthroplasty. This rare complication should be taken into consideration when performing a trochanteric osteotomy fixation with wiring in Charnley total hip arthroplasty.
Human Prion disease with a T188K mutation in Chinese: a case report
Authors: Shi Qi , Gao Chen , Zhou Wei , Zhang Bao-Yun , Tian Chan , Chen Jian-Ming , Jiang Hui-Ying , Han Jun , Dong Xiao-Ping
Published: November 2009

Inherited Prion diseases are characterized by mutations in the PRNP gene predispose to disease by causing the expression of abnormal PrP protein. We report a 58-year-old Chinese female with mutation in codon 188 (T188K) of the PRNP gene, while the codon 129 was a methionine homozygous genotype. The patient displayed 4-year long slowly progressive sleeping disturbance and rapid exacerbation of neurological status after other neurological manifestations appeared. Cerebral spinal fluid 14-3-3 protein was positive.
A humeral shaft fracture complicated with anterior shoulder dislocation in a young male treated with modified Intramedullary nailing prior to reduction: a case report
Authors: Kazakos Konstantinos , Paraschou Stamatis , Lasanianos Nikolaos G , Verettas Dionysios , Lyras Dimitrios N
Published: November 2009

Introduction

Anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills.

Case presentation

A 33 years old male sustained a work accident. Radiographs showed an anterior dislocation of the shoulder with a transverse fracture of the middle third of the humeral shaft on the same side. The dislocation proved to be irreducible in the setting of the fracture humerus. Thus, stabilization of the shaft fracture was successfully applied with an intramedullary nail and a small antirotational plate prior to the reduction. The patient recovered full function of the shoulder.

Conclusion

Performing primary intramedullary nailing of the humeral shaft fracture before manipulation of the joint resulted to an excellent outcome.
Prognosis of Women With Metastatic Breast Cancer by HER2 Status and Trastuzumab Treatment: An Institutional-Based Review
Authors: Dawood Shaheenah , Broglio Kristine , Buzdar Aman U. , Hortobagyi Gabriel N. , Giordano Sharon H.
Published: November 2009

Purpose

The purpose of this study was to determine whether trastuzumab improves prognosis of women with metastatic human epidermal growth factor receptor 2 (HER2)/neu –positive breast cancer beyond that of women with HER2/neu-negative disease.

Patients and Methods

Two thousand ninety-one women with metastatic breast cancer diagnosed from 1991 to 2007, with known HER2/neu status and who had not received trastuzumab in the adjuvant setting, were identified. Disease was classified into the following three groups: HER2/neu negative, HER2/neu positive without first-line trastuzumab treatment, and HER2/neu positive with first-line trastuzumab treatment. Overall survival (OS) was estimated using the Kaplan-Meier product-limit method and compared between groups with the log-rank test. Cox proportional hazards models were used to determine associations between OS and HER2/neu status after controlling for patient characteristics.

Results

One hundred eighteen patients (5.6%) had HER2/neu-positive disease without trastuzumab treatment, 191 (9.1%) had HER2/neu-positive disease and received trastuzumab treatment, and 1,782 (85.3%) had HER2/neu-negative disease. Median-follow-up was 16.9 months. One-year survival rates among patients with HER2/neu-negative disease, HER2/neu-positive disease and trastuzumab treatment, and HER2/neu-positive disease and no trastuzumab treatment were 75.1% (95% CI, 72.9% to 77.2%), 86.6% (95% CI, 80.8% to 90.8%), and 70.2% (95% CI, 60.3% to 78.1%), respectively. In a multivariable model, women with HER2/neu-positive disease who received trastuzumab had a 44% reduction in the risk of death compared with women with HER2/neu-negative disease (hazard ratio [HR] = 0.56; 95% CI, 0.45 to 0.69; P < .0001). This HR varied with time and was significant for the first 24 months and not significant after 24 months.

Conclusion

Our results show that women with HER2/neu-positive disease who received trastuzumab had improved prognosis compared with women with HER2/neu-negative disease.
Phase I Clinical and Pharmacokinetic Study of Oral Sapacitabine in Patients With Acute Leukemia and Myelodysplastic Syndrome
Authors: Kantarjian Hagop , Garcia-Manero Guillermo , O'Brien Susan , Faderl Stefan , Ravandi Farhad , Westwood Robert , Green Simon R. , Chiao Judy H. , Boone Patricia A. , Cortes Jorge , Plunkett William
Published: November 2009

Purpose

Sapacitabine is an oral deoxycytidine nucleoside analog with a unique mechanism of action that is different from cytarabine.

Patients and Methods

To define the dose-limiting toxicities (DLT) and maximum-tolerated dose (MTD) of sapacitabine given orally twice daily for 7 days every 3 to 4 weeks, or twice daily for 3 days for 2 weeks (days 1 through 3 and days 8 through 10) every 3 to 4 weeks, in refractory-relapse acute leukemia and myelodysplastic syndrome (MDS). A total of 47 patients were treated in the phase I study that used a classical 3 + 3 design. Sapacitabine was escalated from 75 to 375 mg twice daily for 7 days (n = 35) and from 375 to 475 mg twice daily for 3 days on days 1 through 3 and days 8 through 10.

Results

The DLTs with both schedules were gastrointestinal. The MTDs were 375 mg twice daily for 7 days and 425 mg twice daily for 3 days on days 1 through 3 and days 8 through 10. The recommended phase II single-agent dose schedules were 325 mg twice daily for 7 days and 425 mg twice daily for 3 days on days 1 through 3 and days 8 through 10. Responses were observed in 13 patients (28%); four were complete responses, and nine were marrow complete responses.

Conclusion

Sapacitabine is a new, safely administered, oral deoxycytidine analog that has encouraging activity in leukemia and MDS. Phase II studies are ongoing.
Vagrancy and Comparative Racialization in Huckleberry Finn and “Three Vagabonds of Trinidad”
Authors: Hsu Hsuan L.
Published: November 2009

Hsu's essay argues that the racially differentiated experiences of mobility depicted in Huckleberry Finn are informed by a range of vagrancy laws that restricted access to public spaces. Such legal constraints on mobility were deployed throughout the South and West to control the mobility of African Americans, Native Americans, and Chinese immigrants. Post-Reconstruction practices such as convict lease and the enforcement of vagrancy laws help account for Huck and Jim's divergent experiences of mobility and captivity as they travel downriver in Twain's novel. Racially differentiated restrictions on vagrancy also connect Huckleberry Finn to a range of literary intertexts, including Twain's own Tom Sawyer and “Goldsmith's Friend Abroad Again.” In “Three Vagabonds of Trinidad,” Bret Harte revises the Jackson's Island episode of Huckleberry Finn by presenting a provisional friendship between a Native American, a Chinese boy, and an adventurous white boy that develops in Humboldt County, California. Read together, these texts demonstrate how racial stereotypes colluded with the policing of public and private spaces to reproduce racial hierarchies in the wake of Emancipation. At the same time, they make visible potential cross-racial affiliations between different groups undergoing disparate but comparable experiences of displacement, exile, and imprisonment.
The Visual Art of Invisible Man: Ellison's Portrait of Blackness
Authors: Hill Lena M.
Published: November 2009

Hill examines how art theory and plastic art objects facilitate Ellison's presentation of African American consciousness in Invisible Man. When considered alongside manuscripts of the novel in addition to letters and other archival material, the published text emerges as heavily invested in visual constructs. Ellison's work with visual media ranged from an apprenticeship with Richmond Barthé to his life-long work as a photographer. Tracing the development of his aesthetic back to his friendship with Richard Wright and Romare Bearden, Hill argues that Ellison's metaphor of invisibility evolves from the confluence of these relationships together with his appreciation for the ways that visual art portrays black interiority. Crucial moments in the novel, including the narrator's college experiences, interactions with women, Harlem work for the Brotherhood, and unpublished episodes related to his time at Mary's boarding house, accrue new meaning when considered in light of Ellison's broader investment in visual culture. Ultimately, Ellison creates a relationship between narrative and visuality that redefines simplistic perspectives on African American identity. As the titular Invisible Man grows from uncritically admiring traditional images of power to understanding complicated visual presentations of blackness, he learns to value the complexity of African American cultural existence. Like Ellison's investment in jazz and blues, his deployment of visual art infuses his writing with an authenticity and authority reflective of the sophisticated black literary technique he champions for the remainder of his career.
Shiite Peasants and a New Nation in Colonial Lebanon: The Intifada of Bint Jubayl, 1936
Authors: Abisaab Malek
Published: November 2009

Studies on colonial Lebanon explain social change and the engagement with the state from the perspective of the rural landed elites and urban notables. Lebanon is usually investigated as a place for exhibiting or reconciling diverse sectarian cultures that ultimately develop a Libanist or Arabist national identity of some sort. Studies on Lebanon have rarely attended to the voices from below, or class and provincial engagements with colonialism. My article focuses on Shiite peasants and rural workers in the south struggling against a wide range of dislocations and civil disruptions brought by colonialism and the nascent Lebanese nation-state. The article also explores the connections among sectarian dynamics, colonial discipline, and peasant militancy. Shiite peasants used tools of collective organization, bargaining, and revolts against the French and drew critical alliances with a sector of the landed notables and religious intellectuals. The peasants were less amenable to Libanist national projections and not readily mobilized on the basis of a Shiite sectarian identity. Rather, their demands in the petitions they sent to the French and the slogans they raised during the revolts reflected suspicion of nationalist politics and a concern for local economic empowerment and political representation.
Stable Sulfenyl Iodide Bearing a Primary Alkyl Steric Protection Group with a Cavity-shaped Framework
Authors: Sase Shohei , Aoki Yohei , Abe Noriaki , Goto Kei
Published: November 2009

A primary alkyl steric protection group bearing a cavity-shaped framework, a BpqCH2 group, was developed. A sulfenyl iodide with the BpqCH2 group was successfully synthesized and unambiguously characterized by X-ray crystallographic analysis. The sulfenyl iodide showed remarkable stability both in the solid state and in solution, demonstrating that the BpqCH2 group is promising for kinetic stabilization of primary alkyl substituted reactive species.
Syphilis co-infection does not affect HIV disease progression
Authors: Weintrob A C , Gu W , Qin J , Robertson J , Ganeson A , Crum-Cianflone N F , Landrum M L , Wortmann G W , Follman D , Agan B K
Published: November 2009

HIV and syphilis are often seen as co-infections since they share a common mode of transmission. During episodes of syphilis, CD4 counts transiently decrease and HIV viral loads increase; however, the effect of syphilis co-infection on HIV disease progression (time to AIDS or death) is unclear. We analysed prospectively collected information on 2239 persons with estimated dates of HIV seroconversion (205 [9.2%] with confirmed syphilis and 66 [2.9%] with probable syphilis) in order to determine the effect of syphilis co-infection on HIV disease progression. In multivariate models censored at highly active antiretroviral therapy (HAART) initiation or last visit, adjusting for CD4 count, age, race, gender, and hepatitis B and C status, syphilis (confirmed + probable) was not associated with increased hazard of AIDS or death (hazard ratio 0.99, 95% CI 0.73–1.33). Treating HAART as a time-varying covariate or limiting the analysis to only confirmed syphilis cases did not significantly alter the results. Despite transient changes in CD4 counts and viral loads, syphilis does not appear to affect HIV disease progression.
Introduction to an integrated competence framework for health-care support workers and nurses working in menopause
Authors: McFall Philomena , Abernethy Kathy
Published: November 2009

The evolving role of the menopause nurse is essential to the provision of expert clinical care, and for the education of both patients and health-care professionals. The new Royal College of Nursing integrated competence framework for health-care support workers and nurses working in menopause has been developed to provide specialist guidance and can be used to ensure practice is safe, effective and accountable. It supports acknowledgement for knowledge, skills and competence in their daily roles whilst caring for women at the time of menopause. It aims to ensure consistent standards across all settings whilst increasing the effectiveness of menopause service provision. Using the competences will help nursing staff identify their own level of practice, career plan in a more structured way and pinpoint education and development needs. The framework is a dynamic document that will continuously evolve in light of changes in menopausal healthcare.
Endometriosis: associations with menopause, hormone replacement therapy and cancer
Authors: Palep-Singh Manisha , Gupta Sujata
Published: November 2009

Endometriosis is an estrogen-dependent condition and is characterized by the presence of ectopic endometrial tissue. The pathogenesis of this condition remains an enigma. Endometriosis has well known associations with menopause both in terms of secondary outcomes from medical and surgical therapy in premenopausal women, as well as a natural occurrence/recurrence of the disease in women going through menopause naturally. This review article aims to discuss the current day modalities of management of endometriosis with their pros and cons especially in the context of menopause and cancer.
Menopause, evolution and changing cultures
Authors: Shaw Laurence M A , Shaw Sebastian L J
Published: November 2009

The menopause is an isolated event in a much wider process that was probably an evolutionary adaptation essential for survival in the Pliocene. As a reproductive strategy, it is largely vestigial in the 21st century, part of an era that has seen a doubling of the average human longevity compared with that of the past. This process commences as an accelerated decline in female fertility, usually from the fourth decade of life, culminating in a total cessation of reproductive capacity for those surviving. The 20th and 21st century sees a huge increase in the numbers surviving and the duration of that postreproductive life phase extending for decades. This extended period of what is essentially a hormone deficiency state is a recent phenomenon and by no means part of the natural history of the human individual. It is therefore not surprising to see a postmenopausal increase in the incidence of so many disorders above that expected by age alone. Recent reproductive patterns have seen increases in the birth rate and requests for fertility treatments among women in their late 30s and 40s. Many try for pregnancy but are unsuccessful. The genes that permit later reproduction and hence later menopause are therefore being preferentially selected. Slowly over generations we will expect to see the fertility of future 40 year olds increase and the age of menopause to extend much later into our, now, longer lives.
Smoking predicts incident fractures in elderly men: Mr OS Sweden
Authors: Jutberger Hans , Lorentzon Mattias , Barrett-Connor Elizabeth , Johansson Helena , Kanis John A , Ljunggren Östen , Karlsson Magnus K , Rosengren Björn E , Redlund-Johnell Inga , Orwoll Eric , Ohlsson Claes , Mellström Dan
Published: November 2009

The aim of this study was to investigate the association between smoking and bone mineral density (BMD) and radiographically verified prevalent vertebral fractures and incident fractures in elderly men. At baseline 3003 men aged 69 to 80 years of age from the Swedish Mr Os Study completed a standard questionnaire concerning smoking habits and had BMD of the hip and spine measured using dual-energy X-ray absorptiometry (DXA); 1412 men had an X-ray of the thoracic- and lumbar spine. Radiologic registers were used to confirm reported new fractures after the baseline visit. At baseline, 8.4% were current smokers. Current smokers had a 6.2% lower BMD at the total hip and a 5.4% lower BMD at the lumbar spine (p < .001). Current smoking remained independently inversely associated with BMD at the hip and lumbar spine after adjusting for age, height, weight, calcium intake, physical activity, and centers as covariates. Prevalent vertebral fractures among current smokers were increased in unadjusted analyses [odds ratio (OR) = 1.90, 95% confidence interval (CI) 1.26–2.87] and after adjustment for lumbar BMD (OR = 1.67, 95% CI 1.09–2.55). Smokers had a high risk for two or more prevalent vertebral fractures (OR = 3.18, 95% CI 1.88–5.36). During the average follow-up of 3.3 years, 209 men sustained an X-ray-verified fracture. Incident fracture risk among smokers was calculated with Cox proportional hazard models. Current smokers had an increased risk of all new fractures [hazard ratio (HR) = 1.76, 95% CI 1.19–2.61]; nonvertebral osteoporotic fractures, defined as humerus, radius, pelvis, and hip fractures (HR = 2.14, 95% CI 1.18–3.88); clinical and X-ray-verified vertebral fractures (HR = 2.53, 95% CI 1.37–4.65); and hip fractures (HR = 3.16, 95% CI 1.44–6.95). After adjustment for BMD, including other covariates, no significant association between smoking and incident fractures was found. Current tobacco smoking in elderly men is associated with low BMD, prevalent vertebral fractures, and incident fractures, especially vertebral and hip fractures. © 2010 American Society for Bone and Mineral Research
Antiretroviral Exposure and Lymphocyte mtDNA Content Among Uninfected Infants of HIV-1-Infected Women
Authors: Aldrovandi Grace M. , Chu Clara , Shearer William T. , Li Daner , Walter Jan , Thompson Bruce , McIntosh Kenneth , Foca Marc , Meyer William A. , Ha Belinda F. , Rich Kenneth C. , Moye Jack
Published: November 2009

OBJECTIVE: Concern for potential adverse effects of antiretroviral (ARV) chemotherapy used to prevent mother-to-child HIV transmission has led the US Public Health Service to recommend long-term follow-up of ARV-exposed children. Nucleoside reverse transcriptase inhibitor ARV agents can inhibit DNA polymerase γ, impairing mitochondrial DNA (mtDNA) synthesis and resulting in depletion or dysfunction.

METHODS: We measured the mtDNA content of stored peripheral blood mononuclear cells (PBMCs) of 411 healthy children who were born to HIV-uninfected women and 213 uninfected infants who were born to HIV-infected women with or without in utero and neonatal ARV exposure. Cryopreserved PBMC mtDNA was quantified by using the Primagen Retina Mitox assay.

RESULTS: Geometric mean PBMC mtDNA levels were lower at birth in infants who were born to HIV-infected women. Among HIV-exposed children, mtDNA levels were lowest in those who were not exposed to ARVs, higher in those with exposure to zidovudine alone, and higher still in those with combination nucleoside reverse transcriptase inhibitor exposure. A similar pattern was observed in the corresponding women. Levels of mtDNA increased during the first 5 years of life in all HIV-exposed children but achieved normal levels only in those with ARV exposure.

CONCLUSIONS: Levels of mtDNA are lower than normal in HIV-exposed children. Contrary to expectation, PBMC mtDNA levels are significantly higher in ARV-exposed, HIV-uninfected infants and their infected mothers compared with ARV-unexposed infants and women. By 5 years, levels of PBMC mtDNA rise to normal concentrations in ARV-exposed children but remain depressed in ARV-unexposed children.
Energy Expenditure for Breastfeeding and Bottle-Feeding Preterm Infants
Authors: Berger Irit , Weintraub Valentin , Dollberg Shaul , Kopolovitz Rozalia , Mandel Dror
Published: November 2009

OBJECTIVE: We hypothesized that resting energy expenditure (REE) would be higher after breastfeeding than after bottle-feeding.

METHODS: Nineteen preterm infants (gestational age: 32 weeks) in stable condition who were nourished entirely with their mothers' breast milk were assigned randomly to feeding either by bottle or at the breast. Each infant served as his or her own control subject. REE was measured for 20 minutes after feeding. Breast milk quantity was evaluated with prefeeding and postfeeding weighing. REE values for bottle-feeding and breastfeeding were compared with paired t tests.

RESULTS: Contrary to our null hypothesis, the group's mean REE values after bottle-feeding and breastfeeding were very similar (284.7 ± 26.8 kJ/kg per day [68.3 ± 6.4 kcal/kg per day] vs 282.6 ± 28.5 kJ/kg per day [67.5 ± 6.8 kcal/kg per day]; not significant). The duration of feeding was significantly longer for breastfeeding than for bottle-feeding (20.1 ± 7.9 vs 7.8 ± 2.9 minutes; P < .0001).

CONCLUSION: There was no significant difference in REE when infants were breastfed versus bottle-fed. Longer feeding times at the breast did not increase REE. We speculate that it is safe to recommend feeding at the breast for infants born at >32 weeks when they can tolerate oral feeding.