bluuebunny/crossref_metadata_2025 huggingface dataset:
In Search of a Mère-Patrie: the forgotten mother in the works of Djura and Maryse Condé
Authors: Frederick Patricia
Published: October 2006

The renowned feminist theorist, Luce Irigaray, in her writings on feminine genealogies, states that the question for the Western philosopher is how to recover a buried feminine darkness, how to 'remember the forgotten mother'. In a number of works by Djura, a North-African Kabyle singer
and storyteller known by her first name alone, and those of Maryse Condé, celebrated novelist, playwright and prolific writer from Guadeloupe, we find in the minds of the protagonists this desire to recover the 'forgotten mother' intimately linked to a quest to return to a homeland.
The object of this study is to consider this quest for a 'mère-patrie' in texts that treat the theme of motherhood from vastly different cultural perspectives. Both of these authors explore diverse manifestations of this quest and treat such themes as imposed geographic exile, the postcolonial
condition, selfactualization, and the recovery of a lost cultural and linguistic identity.
'L'Europe s'est effacée, voici l'Asie': un Français entre l'est et l'ouest et entre deux femmes fantasmées dans Ameenah (1935), le 'roman mauricien' de Clément Charoux
Authors: Bukoree Rishy , Magedera Ian H.
Published: October 2006

Charoux uses the geographical situation of the island between East (India) and West (France) to explore a clash of cultures. Yet, here, both the colonized Indian Other (Ameenah, the sugar plantation worker) and French identity are fantasized (Thérèse, Delettre's French
fiancée). The love-triangle is short-lived, Delettre's own anchor points in his French culture come loose and he chooses Ameenah, attempting to forge a new bi-cultural identity for her; but in 1912 the result is abject pidgin (positive créolisation will arrive in the1970s). However,
the novel concentrates on the heroic but doomed attempt by the couple to openly mix cultures, thereby transcending the social norms of more conservative French colonists and 'anglo-saxons' (p. 200).
Women and boundaries in the fiction of Mouloud Feraoun
Authors: Poole Sara
Published: October 2006

The fiction of Algerian writer and novelist Mouloud Feraoun (191362) tends to have been overshadowed by that of his contemporaries, the latter being seen as more engags at a time when Algeria needed strong literary statements. Fifty years on, this essay seeks to reappraise his novels
in the light of, specifically, his treatment of women. The initial, and then more recent, critical reception of his works is briefly examined. It is then argued that his portrayal of female characters presents their situation, and the constraints placed upon them, as indicative of what he
saw as repressive in Kabyle culture (thus woman functions as symbol of that culture). But it is also suggested that these portraits, and in particular the evocation of female friendships, function in a sense as revolutionary literary symbols at a troubled time, in that Feraoun also uses woman,
cast positively, as example of what that culture can aspire to.
Clin d'il: intertextuality in Ben Jelloun's Les Yeux baisss
Authors: Vogl Mary B
Published: October 2006

This essay examines how Ben Jelloun creates a multi-layered intertextuality in his novel Les Yeux baisss that parallels the critical work of Julia Kristeva. Ben Jelloun transposes sign systems so that the novel becomes the site and the catalyst for a reflexive meditation on the
nature of fiction, the process of writing, and the use of language. Just as the main character embodies the fractured life of an emigrant, the prose incarnates a kind of double writing with multiple sub- and intertexts. Considering this novel through the lens of that multi-layered intertextuality
allows for deeper and more pointed revelations of its richness.
On ne nat pas francophone, nomade et mditerranenne, on le devient: N'zid de Malika Mokaddem
Authors: Martin Florence
Published: October 2006

In her latest novel, N'zid, Malika Mokeddem narrates the sea journey of a female protagonist, Nora, an amnesiac who is struggling to (re)gain self-knowledge. This solitary journey on the Mediterranean, however, turns into a project on a larger scale for the author. She sketches the
figure of a francophone, multilingual, multicultural female character - who embraces all of her cultures (whether native or adopted) - who has refashioned a new marine form of nomadism out of the now defunct Saharan one, and who is aware of her own identity as deeply Mediterranean in the most
inclusive (and almost ancient) sense of the term. The article explores these three dimensions of Nora, providing illuminating models for displaced North African women writers and characters as autonomous agents. This conforms to no previously established model, unhampered by frontiers, and,
rather than victims, freely navigates from Bhabha's interstice to Deleuze's sleek space.
The EEC, the Franco regime, and the Socialist group in the European Parliament, 196277
Authors: Anaya Pilar Ortuo
Published: October 2006

In February 1962 Spain made its first approach to the EEC and applied for EEC membership. Eight years later, in June 1970, the EEC signed a Preferential Trade Agreement with Spain, something far short of what it had sought. The nature of the Franco regime was the main obstacle in the
way of full integration into Europe, which was finally achieved in 1986. This article examines the response of the Socialists in the European Parliament to the Spanish approach to the EEC between 1962 to 1977. The first part will consider the years 196270, from the first Spanish application
to the EEC up to the signing of the Preferential Trade Agreement. The Spanish application was challenged on several occasions by the Socialist group, most notably by the intervention of Willi Birkelbach in 1962. The second part will cover the period 197077, up to the first democratic elections
in Spain. Although the European Parliament did not have the power to decide on enlargement of the EEC, the Socialist members in particular used it as a forum to criticise the Franco regime's lack of democratic and civil rights credentials for membership.
Destino ou Futuro sobre a interpretao acadmica do discurso nacional de Eduardo Loureno
Authors: Larsen Ingemai
Published: October 2006

The aim of this article is to analyse Eduardo Loureno's contribution to the ongoing debate on Portuguese National Identity and to assess the extent to which his national discourse gives rise to opposing readings. The first part will examine the basis of the polarized discussion between
functionalists and essentialists. The second part demonstrates that in so far as Loureno's national discourse is highly conventional it must, as argued by Boaventura de Sousa Santos among others, be considered parallel to the mythologized discourse of Aantnio Quadros. However, using parameters
such as motivation and the scientific paradigm, this comparison is not at all valid. What complicates the reading and thus the reception of Loureno is his making use of certain linguistic devices which are easily associated with the essentialists' discourse; this aspect is dealt with in the
conclusion.
Portuguese musical comedies from the 1940s and 1950s and the transatlantic connection
Authors: Shaw Lisa
Published: October 2006

This article examines the broad patterns established by the first sound films produced in Portugal. Against the backdrop of the Salazar regime, it focuses in particular on the so-called comdia portuguesa, a cinematic tradition that proliferated in the 1930s and 1940s. It analyses in
detail a paradigmatic example of this tradition, O ptio das cantigas/The Courtyard of Songs (1942). By the 1950s the conventions of these comedy films were hackneyed and yet they continued to be reproduced. This article studies two films from this era, namely Os trs da vida airada/The Fun-loving
Three (1952) and O cantor e a bailarina/The Singer and the Dancer (1959). Particular attention is paid to how these later examples of the musical comedy borrowed from both Brazilian and Hollywood musicals in order to create a celebration of pan-Lusitanian identity.
Seeing double? The remaking of Alejandro's Amenbar's Abre los ojos as Cameron Crowe's Vanilla Sky
Authors: White Anne M
Published: October 2006

This article begins by examining in general terms the remaking of European films by Hollywood and considers the reasons for the growth in this cultural phenomenon. It goes onto argue that analysis of this process has much to tell us about intertextuality: how texts are read and transformed.
Focusing on Vanilla Sky (US 2002), the Hollywood remake by Cameron Crowe of Alejandro Amenbar's film, Abre los ojos (Spain 1997), it explores the similarities and differences between the two films. In addition, it also considers the extent to which a filmic remake like Vanilla Sky might be
read as a self-conscious reflection on the processes which are at the very heart of intertextuality as we understand it.
The Climate Change Agenda: from Rio to Jo'burg and Beyond
Authors: Dunn Seth , Flavin Christopher
Published: October 2006

This paper addresses issues relating to the centrality of climate change to sustainable development; the challenges envisaged in implementing climate change agreements; and prospects for moving the climate change agenda forward. It shows how the science, technology, economics, policy,
business, and politics of climate change have evolved in the decade since Rio, and argues that these developments, taken together, make the climate challenge in 2002 fundamentally different from that in 1992. The Kyoto Protocol is seen as a challenge to global action on climate change, and
the 2002 Johannesburg World Summit as an opportunity for making Kyoto work.
Reading masculinities in Claire Denis's Chocolat
Authors: Hayward Susan
Published: October 2006

This paper comes in three parts. First, a framing and focusing of Claire Denis' film Chocolat/Chocolate (1988), including a brief synopsis of the film. Second, a summary of Denis' stated purpose in making the film and what we can read from that in relation to the film itself and the
construction of subjectivity. Third and finally, an investigation of the construction of masculinity as it concerns the main male protagonist, Prote the black manservant also referred to in the film as le boy.
L q-solutions to the Cosserat spectrum in bounded and exterior domains
Authors: Weyers Stephan
Published: September 2006

If

λ = 1 is an eigenvalue of infinite multiplicity and λ = 2 is an accumulation point of eigenvalues of finite multiplicity. For the
The weak Lq-Cosserat spectrum for the first boundary value problem in the half-space. Applications to Stokes' and Lamé's system
Authors: Simader Christian G.
Published: September 2006

In the upper half-space
Efficacy and Safety of Tacrolimus Ointment Treatment for up to 4 Years in Patients With Atopic Dermatitis
Authors: Spergel Jonathan M.
Published: September 2006

Purpose of the Study.

This study was designed to evaluate the long-term safety and efficacy of 0.1% tacrolimus ointment in adult and pediatric patients with atopic dermatitis (AD).

Study Population.

A total of 408 adult and 391 pediatric patients with moderate-to-severe AD who had participated in a previous clinical trial of tacrolimus ointments. The pediatric patients were from 2 to 15 years of age (185 patients aged 2–6 years, and 206 patients aged 7–15 years), and 93.5% of the patients had severe AD.

Methods.

Tacrolimus ointment 0.1% was applied twice daily either intermittently or continuously to the affected areas. Efficacy and safety assessments included percent body surface area affected, Eczema Area and Severity Index score, individual signs of AD, and the incidence of adverse events. Patients were treated for a range of 1 to 1186 days (median: 982 days). A total of 37.5% of the patients in the study were treated for >3 years.

Results.

Improvements in efficacy parameters were observed within 1 week of treatment and continued for the duration of the study. Common adverse events included skin burning, pruritus, skin infection, skin erythema, flu-like symptoms, and headache. The incidence of adverse events, including cutaneous infections, did not increase with time on treatment.

Conclusion.

Tacrolimus ointment therapy is a rapidly effective and safe treatment for the management of AD in pediatric and adult patients for up to 4 years.

Reviewer Comments.

This study shows no long-term adverse effects of this topical calcineurin inhibitor in the treatment of AD. Most patients had >2½ years of treatment without increase in the number or incidence of infections. If these drugs were systemically immunosuppressive, the number of cutaneous or systemic infections would have been expected to increase.
The Influence of Pulmonary Function Testing on the Management of Asthma in Children
Authors: Kaplan Michael S.
Published: September 2006

Purpose of the Study.

Seventy-five percent of the asthma care in the United States is provided by primary care generalists. The National Asthma Education and Prevention Program guidelines recommend spirometry to assess management once the peak flow has stabilized. The purpose of this study was to assess how pulmonary-function tests (PFTs) performed during a patient encounter influence management decisions beyond the history and physical examination alone.

Study Population.

A total of 367 asthmatic patients were enrolled during their visit to a pediatric pulmonary clinic. The patients were 4 to 18 years old (mean: 10.4 years), and 60% were male. Patients were excluded if PFTs could not be performed on them, if they had a pulmonary diagnosis other than asthma, or if they had used albuterol within 4 hours.

Methods.

History of asthma symptoms was obtained, and a physical examination was performed. Spirometry was performed before the provider assessment. Peak expiratory flow rate (PEF) was also obtained. The results of the PFTs were not known to the provider at the time of the assessment and initial decision-making. The provider then reviewed the spirometry results and revised the initial recommendations if necessary. Changes in management were analyzed with respect to demographic data and spirometry. The diagnostic accuracy of PEF to detect abnormal lung function was determined.

Results.

Eight percent of the patients had mild intermittent asthma, 21% mild persistent asthma, 57% moderate persistent asthma, and 14% severe persistent asthma. Spirometry results were normal in 55% of the visits. Abnormal spirometry occurred equally in boys and girls. Sixty percent of the abnormal results were new compared with previous baseline measurements. The likelihood of an abnormal PFT increased with increasing severity classification. Ten percent of those in the group with mild intermittent asthma had abnormal PFTs, compared with 74% of those with severe persistent asthma. PFT results changed management in 15% of the visits. When spirometry did not change the treatment, the providers were more likely to have already decided to maintain therapy (58%). When spirometry did change treatment, providers were more likely to increase medications (75%). PEF was moderately inaccurate in detecting abnormal spirometry.

Conclusions.

In a clinical setting, even asthma care experts tended to overestimate the degree of asthma control as measured by airway obstruction. Spirometry results in this study were just as likely to be abnormal in patients with a normal history and physical examination.

Reviewer Comments.

The next logical question is: Does decision-making enhanced by spirometry result in better outcomes such as decreased symptoms, improved functioning and sleep, fewer exacerbations requiring steroid rescue, and less use of urgent asthma care services? When assessing asthma control, one should always consider comorbidities and adherence issues before stepping up therapy.
Mutations in TNFRSF13B Encoding TACI Are Associated With Common Variable Immunodeficiency in Humans
Authors: Bonilla Francisco A.
Published: September 2006

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Purpose of the Studies.

To search for mutations of TACI (transmembrane activator and calcium modulator and cyclophilin ligand interactor; also TNFRSF13B) in patients with common variable immunodeficiency (CVID) and immunoglobulin A deficiency (IGAD).

Study Populations.

Salzer et al screened 162 unrelated individuals with CVID. Castigli et al studied 19 unrelated individuals with CVID and 16 with IGAD. Healthy individuals (100 and 50, respectively) served as controls.

Methods.

Genomic DNA from patients was subjected to reverse transcription and polymerase chain reaction sequencing analysis of the 5 exons of the gene encoding TACI. Binding of mutant TACI to ligands and stimulation of immunoglobulin production in vitro with TACI agonists in patients was also studied.

Results.

Salzer et al identified 13 individuals with CVID who had mutations in TACI. Castigli et al identified 4 individuals with CVID and 1 with IGAD and TACI mutations. None of the 150 controls studied had any of the identified TACI mutations. Interestingly, TACI mutations could cause disease in both the heterozygous and homozygous conditions. Patients’ cells had diminished binding to TACI ligands and showed diminished responses (immunoglobulin production) to TACI agonists in vitro. The clinical characteristics of the patients included hypogammaglobulinemia and impaired antibody responses, recurrent bacterial sinopulmonary infections, autoimmune disease (anemia, thyroiditis, positive antinuclear antibody), lymphoproliferative disease, and malignancy (B-cell lymphoma, gastric carcinoma).

Conclusions.

Approximately 8% to 20% of patients with severe combined immunodeficiency or IGAD may have heterozygous or homozygous mutation in TACI. This genetic alteration should be sought in patients with these disorders.

Reviewer Comments.

CVID and IGAD are among the most prevalent humoral immunodeficiencies at all ages. These studies represent important descriptions of defined mutations in patients with CVID and IGAD occurring in a significant fraction of these patients in 2 relatively genetically disparate populations. The ability to clearly define the underlying cause of disease in these patients will immediately lead to greater accuracy and confidence in diagnosis, earlier and more aggressive therapy, and, hopefully, improved outcomes.
Titrating Steroids on Exhaled Nitric Oxide in Children With Asthma: A Randomized, Controlled Trial
Authors: Kelso John M.
Published: September 2006

Purpose of the Study.

To evaluate whether titrating inhaled corticosteroids (ICSs) on the fraction of nitric oxide in exhaled air (FeNO) improves asthma management in children.

Study Population.

A total of 85 children (aged 6–18 years) with asthma who had been using ICSs at a constant dose for at least 3 months.

Methods.

Children were randomly allocated to 1 of 2 groups stratified for baseline FeNO and dose of ICSs. In one group, ICS doses were determined by FeNO and symptoms according to an algorithm; in the other group, only symptoms influenced ICS dosing. The study duration was 12 months, with 5 visits at 3-month intervals. FeNO was measured at each visit, and the ICS dose was then adapted to FeNO and/or symptom scores that were recorded during the previous 2 weeks.

Results.

The cumulative ICS dose was not different between groups. Within the FeNO group, no significant change in FeNO was found, whereas in the symptom group there was a significant increase in FeNO (P = .035). In the FeNO group, hyperresponsiveness improved more than in the symptom group (2.5 vs 1.1 methacholine doubling dose; P = .04). Eight prednisone courses were prescribed for 7 patients in the FeNO group versus 18 courses in 10 patients in the symptom group, but this difference was not statistically significant (P = .60). There was no difference between groups in forced expiratory volume in 1 second (FEV1) or symptom scores.

Conclusion.

In children with asthma, 1 year of steroid titration on FeNO did not result in higher steroid doses and did improve airway hyperresponsiveness and inflammation.

Reviewer Comments.

I am still not sure what to make of eNO. If monitoring FeNO and making treatment decisions on the basis of the values leads to better asthma outcomes, then it would be a useful tool. Because the FeNO group did not end up receiving a higher cumulative ICS dose, we have to assume that they got more when they needed it and less when they did not. However, the clinical results seem inconsistent. I suppose it is a good thing to have a higher methacholine PD20 (the dose provoking a 20% fall in FEV1) and a lower FeNO, but I would have been happier to see a difference in FEV1 and symptom scores, or if the difference in the number of episodes requiring prednisone courses had been statistically significant. Although I am not sure that I can share the authors’ conclusion that “the time has come to introduce FeNO in to the routine assessment of children with asthma,” I believe we should pay attention to future studies on FeNO monitoring and clinical asthma outcomes.
Pediatric Hypereosinophilic Syndrome (HES) Differs From Adult HES
Authors: James John
Published: September 2006

Purpose of the Study.

To highlight specific differences between pediatric and adult patients with hypereosinophilic syndrome (HES).

Study Population.

The case report involved a 15-year-old male who presented with abdominal pain, diarrhea, and a 10-lb weight loss. Colonoscopy revealed colitis. A nonproductive cough, night sweats, and a diffuse pruritic, papular rash developed. His initial absolute eosinophil count was 1890/mm3 (reference: <400/mm3), which increased to 52 000/mm3. Additional laboratory studies included: immunoglobulin E, 8561 U/mL (7–110 U/mL); alkaline phosphatase, 1149 U/mL (reference: 50–280 U/mL); γ-glutamyl transpeptidase, 193 (reference: 0–50 U/mL); and serum tryptase, 4.7 μg/L (reference: 1.9–13.5 μg/L). Ultrasound of the liver revealed an abnormal parenchymal pattern with dilated bile ducts. Molecular analysis of the patient’s peripheral blood for the Fip1-like-1 platelet-derived growth factor receptor α chain (FIP1L1-PDGFRA) fusion tyrosine kinase associated with HES in adults was negative. Open lung biopsy revealed patchy interstitial and intra-alveolar inflammation with a predominance of eosinophils. A skin biopsy showed acute neutrophilic folliculitis with perivascular dermatitis with eosinophils. Bone marrow biopsy demonstrated a hypercellular marrow with predominantly eosinophils, which is consistent with idiopathic HES.

Methods.

The investigators compared this case report of pediatric HES and additional published cases of pediatric and adult patients with HES.

Results.

Pediatric HES has only a slight male predominance (55.3% male vs 44.7% female), whereas adult HES is reported to be more common among males than females, with a ratio of 9 to 1. In adults, the frequencies of symptoms found on presentation are: fatigue (26%), cough (24%), dyspnea (16%), rash (12%), and fever (12%). Fever (58.8%), arthralgias (23%), and rash (23.5%) were more common in pediatric cases. As with adults, involvement of the cardiovascular system is the major source of morbidity and mortality. Pediatric HES is commonly associated with chromosomal abnormalities, and in ∼40% of the cases, it has been associated with acute leukemia. As opposed to the vast majority of adult HES cases, no pediatric case with the FIP1L1-PDGFRA fusion gene has been reported.

Conclusion.

There are several distinct features of pediatric, compared with adult, HES.

Reviewer Comments.

Most of the published information on the HES has focused on adult patients. This report compares a pediatric case report of HES and a review of published pediatric cases of this condition to adult patients with this syndrome. This is an insightful clinical report that should be useful in the overall workup of pediatric patients who present with dramatic eosinophilia (>1500/mm3) for >6 months’ duration without other known causes of eosinophilia and who have evidence of organ involvement that might be attributable to HES.
Breast-feeding Reduces the Risk for Childhood Eczema
Authors: Nowak-Wegrzyn Anna
Published: September 2006

Purpose of the Study.

To investigate the effect of breastfeeding in various phenotypes of eczema.

Study Population.

A birth cohort of 4089 children followed up to 4 years of age.

Methods.

Data on breastfeeding, allergic symptoms, and potential confounders were obtained from questionnaires when the children were 2 months and 1, 2, and 4 years old. At 4 years, blood allergen-specific immunoglobulin E was analyzed. Children with symptoms of eczema and asthma during the period of breastfeeding were excluded in most analyses on risk assessment of eczema and asthma, respectively, to avoid disease-related modification of exposure.

Results.

Exclusive breastfeeding for ≥4 months reduced the risk for eczema at the age of 4 years (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.63–0.96) irrespective of combination with asthma, sensitization to common allergens, or parental allergic disease. This decreased risk was most evident for children with onset of eczema during the first 2 years persisting to 4 years (OR: 0.59; 95% CI: 0.45–0.77). Among children with early-onset eczema, irrespective of persistency, followed by late onset of asthma or early-onset asthma, irrespective of persistency, followed by late-onset eczema to 4 years, a protective effect of breastfeeding was also seen (OR: 0.48; 95% CI: 0.30–0.76).

Conclusions.

Breastfeeding ≥4 months reduces the risk for eczema and asthma to 4 years of age.

Reviewer Comments.

Many studies to date have shown that breastfeeding confers a protective effect against early atopic diseases including eczema. This is yet another argument to support breastfeeding.
Patterns of Quick-Relief and Long-term Controller Medication Use in Pediatric Asthma
Authors: James John
Published: September 2006

Purpose of the Study.

To simultaneously examine adherence to long-term controller and quick-relief medications and to contrast patterns of medication use in children with asthma.

Study Population.

There were 75 children aged 8 to 16 years diagnosed with persistent asthma and prescribed quick-relief and long-term medications by metered-dose inhaler. Participants were a subsample of a larger adherence study.

Methods.

This was a cross-sectional, 1-month follow-up study. The primary outcome measure was adherence to both medications as measured by electronic monitoring devices. A classification framework for contrasting adherence patterns between medication classes was developed to identify cases for individual analysis.

Results.

High levels of nonadherence to long-term controller medications (median: 46% of prescribed doses taken) and variable patterns of quick-relief medication use (range: 0–251 doses over the month) were documented, but consistent relationships between patterns of medication use across both classes were not found. Individual cases identified by the classification scheme illustrated the complexity and clinical utility of contrasting adherence patterns.

Conclusions.

Monitoring long-term controller medication adherence may be more predictive of morbidity than quick-relief medication use except in outlier cases, in which monitoring both medication types may be valuable for clinical and empirical purposes.

Reviewer Comments.

Medication adherence has long been identified as a key factor in overall asthma outcome. For example, self-reporting quick-relief and long-term controller medication use, canister weighing, pharmacy records, and electronic monitoring have all been used to assess medication adherence. Of these methods, electronic monitoring, which is the most costly and technologically complex, is generally accepted as the most accurate method for monitoring adherence. Inadequate daily medication adherence has been widely documented in patients with asthma and has been linked to morbidity and increased health care costs. Although it was not surprising that nonadherence to long-term controller medications was common in this investigation, it was very interesting that no statistically significant relationship was found between adherence with quick-relief and long-term controller medication classes. For example, the investigators’ hypothesis that quick-relief and long-term controller medication use would demonstrate an inverse relationship (eg, higher long-term controller medication use corresponding to lower reliance on quick-relief medications) was not confirmed. The investigators suggest that novel strategies to enhance appropriate medication use, such as better tracking the use of long-term controller medications and providing feedback regarding actual use, may be effective in improving adherence in asthma patients.
Emergence of Drug Resistant HIV-1 After Intrapartum Administration of Single-Dose Nevirapine Is Substantially Underestimated
Authors: Church Joseph A.
Published: September 2006

Purpose of the Study.

An inexpensive, effective regimen to prevent perinatal HIV transmission in the developing world is highly desirable. Nevirapine, a nonnucleoside reverse transcriptase inhibitor, seems to provide such an intervention. However, drug-resistance mutations have been identified in up to 40% of women shortly after they received a single intrapartum nevirapine dose as part of a transmission-prevention strategy. This study was undertaken to reexamine the incidence of drug-resistant HIV-1 after single-dose nevirapine.

Study Population.

Fifty South African women infected with HIV subtype C.

Methods.

Sensitive, real-time polymerase chain reaction assays were sequentially performed for nonnucleoside reverse transcriptase inhibitor–resistance mutation, K103N and Y181C.

Results.

Resistance mutations emerged in 65% of women after a single dose of nevirapine.

Conclusions.

Single-dose nevirapine as used in the developing world for prevention of perinatal HIV transmission results in the development of resistance mutations in a very high percentage of women who receive this intervention.

Reviewer Comments.

Although single-dose nevirapine has been successfully implemented as a strategy to prevent perinatal HIV transmission, it is increasingly apparent that the women who are treated with this regimen more often than not develop resistance mutations to nevirapine. The clinical implications are clear: Will nevirapine work for future perinatal interventions for individual women with drug-resistance mutations? Will women with these drug-resistance mutations fail to respond to nevirapine as part of a highly active retroviral therapy intervention when they need treatment for their own HIV disease? In the same issue of The Journal of Infectious Diseases, Flys et al (J Infect Dis. 2005;192:24–29) demonstrated that drug-resistance variants of HIV may persist for >1 year in this situation. In addition, Lee et al (J Infect Dis. 2005;192:1260–1264) showed that women who developed drug-resistant HIV after exposure to single-dose nevirapine shed drug-resistant HIV in their breast milk. This increases the risk of transmission of resistant virus to uninfected infants. Together, these studies demonstrate that single-dose nevirapine, although an effective strategy for reducing maternal-child transmission of HIV, also predisposes treated women to the development of drug-resistant virus as well as the potential for transmitting drug-resistant virus to their infants via breastfeeding.
Recognition, Evaluation, and Treatment of Anaphylaxis in the Child Care Setting
Authors: Skolnick Helen
Published: September 2006

Purpose of the Study.

Although many young children with a history of allergic reactions or anaphylaxis spend considerable time in child care centers, little is known about the centers’ knowledge of, experience with, and capacity to treat anaphylaxis. The purpose of this study was to evaluate the ability of child care centers to recognize, evaluate, and treat anaphylaxis episodes.

Study Population.

Children aged 1 to 6 who attended child care center in the suburbs of Chicago, Illinois.

Methods.

Eighty-five independent child care centers in suburbs of Chicago were selected randomly. They were contacted by telephone and asked to join the study by completing an initial questionnaire about allergic reactions and anaphylaxis. The center directors and teachers were then offered an allergy seminar on anaphylaxis avoidance, recognition, evaluation, and treatment. After the seminar, center directors were given a posttest that included some of the questions from the original questionnaire.

Results.

Of the 85 centers, 44 agreed to participate. Forty-two centers completed the surveys before the seminar and 39 after the seminar. On average, each center had up to 7 children with an identifiable food allergy. The most commonly reported source of education concerning allergies was information provided by the parents. Before the seminar, 24% of child care centers would administer intramuscular epinephrine for a severe allergic reaction. After the seminar, 77% of centers stated they would administer intramuscular epinephrine (P < .001). In addition, center staff significantly improved their knowledge of symptoms of allergic reactions and the correct methods of intramuscular epinephrine administration.

Conclusions.

There is a knowledge deficit in anaphylaxis education at child care centers for children 1 to 6 years old. Intervention with individual education seminars can significantly increase the ability of child care center staff to recognize, evaluate, and treat anaphylaxis.

Reviewer Comments.

Although it is encouraging that the staffs at child care centers seem to be able to learn how to recognize and treat allergic reactions and anaphylaxis, it is at the same time discouraging that such a small percentage would have done so correctly before the seminar. Most child care centers receive their education from discussions with parents. However, studies have shown that only 50% of parents could identify all the critical steps for proper usage of epinephrine. Therefore, I agree with the authors that it is critical that health care professionals become more involved in the education of parents and the staffs of child care centers. In addition, detailed treatment plans should be written to help guide centers in the proper care of allergic reactions.
Depletion of Latent HIV-1 Infection in Vivo: A Proof-of-Concept Study
Authors: Church Joseph A.
Published: September 2006

Purpose of the Study.

Resting CD4+ T cells are a primary reservoir for HIV. In these cells the HIV is in a latent form and not a target of current antiviral agents. The chromatin-remodeling enzyme histone deacetylase 1 (HDAC1) maintains latency of integrated HIV. This study tested the hypothesis that an inhibitor of HDAC1, valproic acid, would result in depletion of latently infected resting CD4+ T cells.

Study Population.

Four human volunteers with HIV receiving highly active antiretroviral therapy.

Methods.

The individual subjects’ antiretroviral therapies were intensified with enfuvirtide, a fusion inhibitor, to minimize the spread of HIV during potential release from latency. The subjects then were treated with oral valproic acid, 500 to 750 mg twice daily, in addition to their antiretroviral therapy, and they were followed for 3 months. Latently infected resting T cells were quantified before and after augmentation of treatment with limiting-dilution culture of resting cells after ex vivo activation.

Results.

The frequency of resting CD4+ T-cell infection was stable before the addition of enfuvirtide and valproic acid but declined thereafter. This decline was significant in 3 or 4 patients, with a mean reduction of 75% in circulating HIV-infected resting CD4+ T cells. There were no complications of the additional treatments except for the expected injection-site reactions to enfuvirtide.

Conclusions.

Combination therapy with an HDAC inhibitor and very potent antiretroviral therapy accelerated the reduction in HIV-infected resting T cells. This suggests a new approach to the management of HIV that eventually may result in clearance of HIV from infected individuals.

Reviewer Comments.

This study received a fair amount of media coverage at the time it was published. It begs the question, can HIV be cured? A 75% reduction in the resting T-cell reservoir seems impressive. However, this was a very short-term study, and the kinetics and degree to which the resting T-cell reservoir was replenished after discontinuation of valproic acid was not reported. In addition, valproic acid, a widely used anticonvulsant, is potentially highly toxic and has “black-box” warnings for hepatotoxicity, teratogenicity, and pancreatitis. Despite the authors’ optimistic conclusions, “this finding, though not definitive, suggests that new approaches will allow the cure of HIV in the future,” use of the “C word” is likely premature.
Differences in Race, Ethnicity, and Socioeconomic Status in Schoolchildren Dispensed Injectable Epinephrine in 3 Massachusetts School Districts
Authors: Goldsobel Alan B.
Published: September 2006

Purpose of the Study.

To analyze the demographic characteristics of schoolchildren dispensed injectable epinephrine in 3 school districts with widely diverse socioeconomic, racial, and ethnic populations.

Study Population.

Students (prekindergarten to grade 12) from 3 school districts in Massachusetts (n = 21 875) were evaluated. Two of the school districts were affluent, suburban towns outside of Boston (5855 students). The third district (16 020 students) was also a Boston suburb but with a very low per-capita income, with 23% of the school-age population living below the poverty line. The 2 suburban districts were 92% and 95% white, respectively, and the third district was 60% nonwhite.

Methods.

All school districts in Massachusetts are required to report the number of students using daily or as-needed prescription medications to the Department of Public Health. Data were taken from reports filed by school nurses monthly for all students from the 2003–2004 school year for these 3 school districts.

Results.

A total of 181 schoolchildren (0.83%) in the 3 districts were dispensed injectable epinephrine during the school year studied. Diagnoses listed for the prescription of epinephrine included peanut ree nut allergy (65%), stinging-insect allergy (19%), seafood allergy (6%), and egg or dairy allergy (3%). A miscellaneous group (7%) included diagnoses for latex, chocolate, pollen, fruit, cold air, and ibuprofen allergy. Males were more likely to be dispensed epinephrine than females (odds ratio [OR]: 1.44; P < .02). White students were nearly 5 times more likely to have been dispensed epinephrine for peanut and tree nut allergy (OR: 4.5; P < .001) and almost 9 times more likely for stinging-insect allergy (OR: 8.7; P < .001). Seventy-five percent of students dispensed epinephrine for peanut or tree nut allergy were enrolled in prekindergarten through grade 5.

Conclusions.

Significant racial and socioeconomic differences for prescribing self-injectable epinephrine was seen in 3 school districts in Massachusetts.

Reviewer Comments.

This study describes the racial and socioeconomic demographics of children prescribed injectable epinephrine but does not address the reasons for the disparity between affluent and nonaffluent or white and nonwhite populations. This study suggests that minority, socioeconomically disadvantaged students are being either underdiagnosed or undertreated for potential anaphylactic reactions that require epinephrine. Other studies have not shown racial differences in the incidence of food allergies, suggesting that other factors are involved in the lower rate of epinephrine dispensed to disadvantaged minority students.
Exercise-Induced Dyspnea in Children and Adolescents: If Not Asthma Then What?
Authors: Skolnick Helen
Published: September 2006

Purpose of the Study.

Exercise-induced asthma (EIA) is the most commonly recognized cause of exercise-induced dyspnea (EID) in children and adolescents. However, EID in otherwise healthy children and adolescents may have other causes besides asthma. The purpose of this study is to report the outcome of evaluations for EID when other signs and symptoms of asthma were absent or there was no response to previous use of an inhaled β2 agonist.

Study Population.

One hundred forty-two patients, 6 to 21 years old (mean: 14 years), with EID were studied.

Methods.

In this retrospective study, investigators reviewed the results of all exercise tests performed in otherwise healthy patients with EID between 1996 and 2003. Physiologic measures assessed included preexercise and postexercise spirometry with the addition of oxygen uptake, carbon dioxide production, continuous oximetry, and electrocardiogram monitoring during most tests. EIA was diagnosed if treadmill exercise resulted in reproduction of symptoms in association with a decrease in forced expiratory volume in 1 second of at least 15%. Endoscopy was performed if stridor and/or decreased maximal inspiratory flow were present. Criteria were established for restrictive abnormalities, physical conditioning, exercise-induced hyperventilation, and normal physiologic limitation.

Results.

EID was present in the subjects for an average of 30.2 months (range: <1 to 192 months) before evaluation, and in 98 patients the symptoms were attributed to asthma. Symptoms of EID were reproduced during exercise testing in 117 patients. EIA was identified as the cause of EID in only 11 of the 117. Seventy-four demonstrated only normal physiologic exercise limitation; 48 of the 74 had normal-to-high cardiovascular conditioning, and 26 had poor conditioning. Other diagnoses for reproducible EID included restrictive abnormalities in 15, vocal cord dysfunction in 13, laryngomalacia in 2, primary hyperventilation in 1, and supraventricular tachycardia in 1.

Conclusions.

The diagnoses of EIA should be questioned as the etiology of EID in children and adolescents who do not have other symptoms of asthma and who do not respond to pretreatment with a β2 agonist.

Reviewer Comments.

Although asthma is the most common cause of EID, this article demonstrates the important point that not all EID is caused by asthma. Patients who experience EID but not other signs or symptoms of asthma or who do not benefit from pretreatment with an inhaled β2 agonist clearly can benefit from a treadmill test with cardiac and respiratory physiologic monitoring. A large portion of these patients demonstrated normal physiologic limitation associated with reproduction of symptoms. Routine treatment of EID as asthma can lead to both unnecessary medication and frustration on the part of the patients and their families.
Paradoxical CD4+ T-Cell Decline in HIV-Infected Patients With Complete Virus Suppression Taking Tenofovir and Didanosine
Authors: Church Joseph A.
Published: September 2006

Purpose of the Study.

Tenofovir and didanosine are adenosine analogs commonly used in highly active antiretroviral therapy combinations. Although virologically effective, this combination is theoretically associated with pharmacokinetic interactions and increased risks of pancreatitis and hyperglycemia. The study examined the CD4+ T-cell effects of the use of these 2 drugs as part of a highly active antiretroviral therapy regimen.

Methods.

Data from 570 individuals were analyzed retrospectively according to the nucleoside analog “backbone” of protease inhibitor–containing regimens: tenofovir + didanosine in 298 subjects, didanosine in 88, tenofovir in 44, and neither didanosine nor tenofovir in 140.

Results.

Significant CD4+ T-cell declines were noted in patients taking the combination of tenofovir + didanosine relative to all other nucleoside analog combinations including didanosine or tenofovir only. Patients exposed to higher didanosine doses showed a more pronounced CD4+ T-cell decline, and plasma levels of didanosine correlated with the extent of T-cell loss.

Conclusions.

Although patients receiving tenofovir + didanosine–based combinations generally achieved excellent viral suppression, their CD4+ T cells often paradoxically declined. This effect generally progressed over time. It is hypothesized that the use of these 2 agents together results in a condition that metabolically resembles purine nucleoside phosphorylase deficiency, a rare but well-described primary immunodeficiency syndrome.

Reviewer Comments.

Tenofovir and didanosine frequently are the only nucleoside analog agents available to patients with drug-resistant virus. This combination with either a nonnucleoside reverse transcriptase inhibitor or a protease inhibitor is often effective in suppressing virus in patients with limited options. However, the paradoxical decline in T-cell numbers is of great concern. Patients on this regimen must be monitored carefully for this potential complication.
Risk Factors for Atopic Dermatitis in New Zealand Children at 3.5 Years of Age
Authors: Spergel Jonathan M.
Published: September 2006

Purpose of the Study.

To examine factors associated with a diagnosis of atopic dermatitis (AD) at 3.5 years of age, especially factors implicated by the hygiene hypothesis.

Study Population.

There were 871 children enrolled at birth for the Auckland Birthweight Collaborative study, 744 (85.4%) participated at 1 year, and 550 (63.2%) at 3.5 years. AD was diagnosed in 87 (15.8%) children at 3.5 years.

Methods.

The Auckland Birthweight Collaborative study is a case-control study of risk factors for small-for-gestational-age infants. Case subjects were born at term with birth weight at ≤10th percentile; controls were appropriate for gestational age, with birth weight >10th percentile. AD was defined as the presence of an itchy rash in the past 12 months with ≥3 of the following by history: flexural involvement, generally dry skin, atopic disease in parents or siblings, or visible flexural dermatitis by photographic protocol.

Results.

The prevalence of AD did not differ by birth weight. AD at 3.5 years was associated with raised serum immunoglobulin E, wheezing, asthma, rash, or eczema at 1 year. In multivariate analysis adjusting for parental atopy and breastfeeding, AD at 3.5 years was associated with atopic disease in the parents (maternal atopy only [adjusted odds ratio (aOR): 3.83; 95% confidence interval (CI): 1.2–12.2]; paternal atopy only [aOR: 3.6; 95% CI: 1.09–11.75]; both parents atopic [aOR: 6.12; 95% CI: 2.0–18.5]). There was a higher risk of AD with longer duration of breastfeeding (<6 months [aOR: 6.13; 95% CI: 1.5–25.9]; >6 months [aOR: 9.70; 95% CI: 2.5–38.2]) compared with never breastfeeding. AD at 3.5 years had a negative association with cat ownership (aOR: 0.5; 95% CI: 0.2–0.97) but was not associated with owning a dog at 3.5 years, having pets at 1 year, or with older siblings. AD at 3.5 years was not associated with gender, socioeconomic status, maternal smoking, parity, mold exposure, immunizations, BMI, or antibiotic use in the first year of life.

Conclusions.

A personal and a parental history of atopic disease are risk factors for AD at 3.5 years. Duration of breastfeeding was associated with an increased risk of AD. No association was found with factors implicated by the hygiene hypothesis.

Reviewer Comments.

This is one of many studies to look at various risk factors for atopy, here focusing on AD. Similar to other studies, the authors show that family history of atopy is a risk factor for AD. However, compared with other studies, the authors did not find any association with gender, socioeconomic status, environmental risks, or BMI. This discrepancy is probably attributable to differences in populations and different environmental factors. The data on atopy prevention by breastfeeding remain unclear and may be affected by reverse causation (breastfeeding longer in response to observing AD); although this is one of several negative studies, meta-analyses of multiple studies typically show a prevention effect.