bluuebunny/crossref_metadata_2025 huggingface dataset:
Generational Cohorts, Age at Arrival, and Access to Health Services among Asian and Latino Immigrant Adults
Authors: Kao Dennis T.
Published: May 2009

Recent immigrant assimilation literature has highlighted the tremendous heterogeneity that exists within foreign-born and U.S.-born second generation populations—and thus, the importance of a broader generational cohort framework that encompasses nativity, immigrant generation, age at arrival, and parental nativity. Using data from the 2003 California Health Interview Survey, this paper examines generational cohort differences in access to health services among Asian and Latino immigrant adults. Results showed that immigrants arriving in the U.S. as children had better access to services, one exception being middle-aged and older Asians. Individuals arriving in the U.S. as adults were significantly less likely than the third-and-later generation to have a usual source of care, and also had fewer physician visits. Across all cohorts, Latinos fared worse than both Asians and Whites. This study highlights the value of a generational cohort framework—specifically, the importance of age at arrival—in examining health access among immigrants.
Point-of-Sale Marketing of Tobacco Products: Taking Advantage of the Socially Disadvantaged?
Authors: John Robert , Cheney Marshall K. , Azad M. Raihan
Published: May 2009

With increasing regulation of tobacco industry marketing practices, point-of-sale advertising has become an important channel for promoting tobacco products. One hundred and ten convenience stores in Oklahoma County were surveyed for tobacco-related advertising. There were significantly more point-of-sale tobacco advertisements in low-income and minority neighborhoods than in better educated, higher-income, predominantly White neighborhoods. Storeowners or managers were also interviewed to determine who has decision-making power regarding store signage and placement, and to elicit perceptions of industry tactics. Contracts with tobacco companies leave storeowners with little or no control over promotion of tobacco products within their store, and many are unaware of the implications of the tobacco industry point-of-sale practices. Local ordinances that regulated outdoor signage reduced outdoor tobacco advertisements, as well as tobacco signage and promotions within the store. Policy change, rather than education targeting storeowners, is recommended as the most effective strategy for reducing point-of-sale tobacco advertising.
Providing Access to Specialty Care for Severely Disabled Institutional Residents: An Academic Health Center Telemedicine Model
Authors: Morrow Jay B. , Goetz Lance L. , Marcee Alice K. , Snell Laura E. , Kowalske Karen J. , Roaten Shelley P.
Published: May 2009

The UT Southwestern Virtual Wound Care Clinic provides care to disabled institutional residents in an urban setting. The program offers flexible financial mechanisms for residents of the facility to access specialty care. Telemedicine improves quality-of-life and reduces costs by minimizing patient transportation. The exchange of clinical knowledge benefits both parties.
Why Do Some Health Centers Provide More Enabling Services Than Others?
Authors: Wells Rebecca , Punekar Rajeshwari S. , Vasey Joseph
Published: May 2009

Enabling services (such as outreach, transportation, case management, and discharge planning) play a critical role in improving care for vulnerable populations. However, these services are generally not covered by third party payers, making them a challenge for safety net providers that are themselves often financially strained. The study reported here identified organizational and patient population characteristics associated with enabling services provided by community health centers funded by the Health Resources and Services Administration (HRSA). Lagged regressions on 2003–2004 data from HRSA’s Uniform Data System (n=841) indicated that health centers with more managed care contracts and larger staffs provided both broader scopes of enabling services and higher volumes of these services. Grant revenue was negatively associated with the volume of enabling services; however, net revenue was positively associated with service volume. There were several positive associations between indicators of patient need and the scope and volume of enabling services.
Transnational Messages: What Teachers Can Learn from Understanding Students’ Lives in Transnational Social Spaces
Authors: Brittain Carmina
Published: May 2009

This study investigates how comments that Mexican nationals made about U.S. schools influenced Mexican immigrant adolescents’ perceptions of and experiences in U.S. schools. I investigated the diffusion of this information at three specific points in time—prior to immigration, upon entry to the U.S., and after a few years of living in the U.S. and attending schools here. By sharing information across borders, these Mexican immigrant students and their co-nationals formed a transnational social space, where immigrant children established and maintained productive ties between their country of origin and their receiving country. The themes that these transnational messages revealed included issues of cost of education, concerns with academic quality, value of the English language, social struggles, and racial confrontations in U.S. schools. This article also addresses how U.S. teachers can develop a teaching agenda that addresses the concerns revealed by these transnational messages.
The Politics of Organic Phylogeny: The Art of Parenting and Surviving as Transnational Multilingual Latino Indigenous Immigrants in the U.S.
Authors: Machado-Casas Margarita
Published: May 2009

This three-year qualitative research study took place in a new immigrant-receiving community in North Carolina. Utilizing narrative analysis, it explores how Mexican, Salvadoran, and Guatemalan immigrants of indigenous backgrounds use language as a survival tool to move in and out of transnational social spaces. In addition, it explores the ways in which parents transmit funds of knowledge (Moll, 1992) to their undocumented youth to prepare them for adult life as children of Latino indigenous immigrants in the U.S.. This article examines the implications of transnational cultural and linguistic spaces and its effects and implications for children of multilingual families. It also raises questions about the ways multilingualism affects border mobility and transnationality as well as how undocumented families use multilingualism as a transnational bridge to facilitate their children’s survival in a hostile U.S. environment while schools remain indifferent and unaware of such issues.
Alph, the Sacred River, Ran: Geographical Subterfuge in Pindar Olympian 1.20
Authors: Griffith R. Drew
Published: May 2009

Pindare, dans Olympique 1, ode écrite en l'honneur de Hiéron de Syracuse, raconte le mythe de Pélops. Le poète lie le héros et le tyran en mentionnant à deux reprises que l'Alphée, rivière coulant à Olympie, emprunte une voie souterraine pour s'unir à la source syracusaine d'Aréthuse. Pindare ou le choeur auraient-ils chanté l'ode devant Aréthuse? Sinon pourquoi commencer le poème avec les mots ἄριϲτον μὲν ὕδωρ.
Physician-Assisted Suicide in Antiquity
Authors: Harms Paul J.
Published: May 2009

Le suicide assisté était, pense-t-on, une pratique courante des médecins de l'Antiquité. Nous remettons en question cette assertion, car elle repose sur une interprétation erronée d'un texte d'Arateus de Cappadoce et de deux passages du Corpus hippocratique. En effet, parce que ces auteurs s'insurgent contre cette pratique, les modernes en déduisent qu'elle était courante. Il nous semble cependant que ces passages relèvent plutôt du souci de protéger la réputation de guérisseur attribuée aux médecins. Notre interprétation s'accorde davantage avec ce que nous connaissons par ailleurs de la médecine ancienne et de la forte compétitivité de ce milieu.
Hadrian, Yourcenar, Syme
Authors: Bradley Keith
Published: May 2009

Dans les conférences Bryce de 1984, Ronald Syme fit une critique du célèbre roman de Marguerite Yourcenar, Les Mémoires d'Hadrien . Une étude de ce texte révèle les liens entre l'historien et la romancière.
Alexander, Elephants and Gaugamela
Authors: Charles Michael B.
Published: May 2009

Il est généralement admis que la première rencontre entre l'Occident et les éléphants de guerre se produisit à Gaugamèles. Or, que l'armée d'Alexandre ait réellement affronté ces animaux au cours de la bataille reste fort douteux, car la Vulgate ne confirme pas le récit d'Arrien, selon lequel quinze éléphants des Indes figuraient sur la ligne de front de Darius. Nous proposons d'abord une revue critique de la recherche à ce sujet et soutenons qu'en général le récit de l'Anabase d'Arrien reste exact. Néanmoins, nous avançons que l'utilisation offensive de ces animaux contre les troupes d'Alexandre est invraisemblable. En effet, les généraux perses n'avaient que très peu d'expérience de cette arme de guerre qu'était l'éléphant.
An Introduction to British Library MS Lansdowne 380
Authors: Sewright Kathleen
Published: May 2009

The manuscript London, British Library, Lansdowne 380 has long been known to students of the poetry of Charles d’Orléans. It contains a version of the poetic collection that the Duke wrote during his twenty-five years as a captive in England following the Battle of Agincourt, the French poetry that Martin Le France referred to as “le livre qu’il fit en Inglant.” Assumed for nearly a century to have been produced in France for French consumption, Lansdowne 380 has never been studied in detail. Until this present study, there has never been but a cursory inventory of its contents, probably because it is a confusing mix of Latin and French liturgical, moralistic and didactic texts, medical recipes and treatises, courtesy texts, “historical” poems, astrological texts, and a variety of courtly poems, including sixty fifteenth-century French secular chanson texts. These chanson texts, most of which were set to music, reveal that the repertory of song that was known to the owner of the manuscript most likely reflects musical activity at the court of either Antoine or Jean de Croy, vassals of the duke of Burgundy, Philippe Le Bon.

The confusion is only superficial, however, as a close examination of its contents shows that the volume was compiled for the use of a young, unmarried woman who had recently learned how to read. The compilation was to serve as a primary tool of her education, with the religious and moralistic items included to insure that she was molded into a devout Christian, while a broad range of secular literature guaranteed a proper cultural upbringing for her, as well.

Further investigation has revealed that the manuscript was probably compiled in London, and was intended for Elizabeth Kingston, resident of Bristol or the surrounding area, who was the wife of William Kingston, courtier and body man to Henry VIII. Lansdowne 380 is thus a witness to continuing English interest during the fifteenth century in various types of French literature, notably the French secular chanson and the poetry of Charles d’Orléans, and it is a significant source of information regarding the education of women during the late Middle Ages.
Delusions, Certainty, and the Background
Authors: Rhodes John , Gipps Richard G. T.
Published: May 2009

Abstract:
Cognitive psychologists have recently identified alterations in perception and reasoning that contribute to the formation and maintenance of beliefs that happen to be delusional. Clinically significant delusions, however, are often deeply unusual. An account of their formation and maintenance must explain not merely how someone can come to hold false or uncommon beliefs, but also how someone can arrive at beliefs that seem profoundly improbable and even bizarre. This paper uses the philosophical concepts of the Bedrock and the Background to provide an account of that foundational, nonrepresentational, non–rule-governed, dispositional structure of everyday understanding that underpins both our perception and our reasoning. The central claim is that the formation and maintenance of delusions becomes intelligible once they are seen to reflect disturbances to this foundational dispositional structure. Different dimensions of the Background are described along with the delusions that might follow from distortions to these dimensions. We challenge the assumption of much recent cognitive psychological theorizing that delusions can be understood as explanations of unusual experiences or as the product of hasty reasoning. Finally, the implications of the theory for the therapy of the delusional patient are briefly discussed.
Introduction and Scaling-up of Emergency Contraception: Lessons Learned from Three Regions
Authors: Fernández-Cerdeño Araceli , Vernon Ricardo , Hossain Sharif , Keesbury Jill , Khan M.E.
Published: May 2009

Emergency contraception (EC) has been around for decades, but the first serious introduction and scale-up efforts started in the mid 1990’s. This paper reviews programmatic experiences that sought to expand access to emergency contraceptive pills (ECP) in Africa, Asia and Latin America over the last decade. This multiregional review identifies the individual phases of the introductory processes as well as facilitators and barriers to successful scale-up of ECP service provision. Characteristics of successful projects included conduction of multi-sector diagnostic assessments; careful consideration of legal and policy issues; collaborative advocacy and technical assistance for inclusion in public family planning programs by national and international institutions; as well as attention to programmatic areas such as capacity-building, supply-chain and awareness-raising. Lessons learned from varied developing country experiences are discussed as is the need for increased attention to evaluating and disseminating project results.
The Social Dimension of Health in Morocco
Authors: Yaakoubd Abdel-Ilah
Published: May 2009

In this paper we intend to demonstrate the close links between social and spatial inequalities, on one hand and the health conditions and access to health services, on the other hand. Although the available statistics on the social aspects of health in Morocco is still not of a satisfactory level, the analysis we were able to carry out did lead to some interesting results. The constant and complex interrelationship between social and spatial factors and the scale of resulting inequalities in terms of health is one of the most fundamental conclusions. The heavy weight of gender-based relations on health of Moroccan women in specific contexts is another. The excessive vulnerability of women and children’s health to the social conditions that characterize their daily existence is another noteworthy conclusion. The critical role played by poverty, lack of education, isolation and remoteness of basic health facilities in conditioning the health status and opportunities to access to medical care for these categories of population in the event of illness can be added to the list of important conclusions reached in this study.
Geographic Ancestry and Mortality from Ischemic Heart Disease: Evidence from the Finnish Population Register
Authors: Saarela Jan , Finnäs Fjalar
Published: May 2009

This paper uses the Finnish longitudinal population register to study mortality risks from ischemic heart disease (IHD) for people aged 65–79 years in the period 1981–2004. In spite of substantial reductions in IHD mortality over time, regional differences within Finland have remained practically the same. Having controlled for a number of significant socio-demographic factors, we find geographic ancestry as proxied by people’s birth region and ethnic group to be a strong predictor of IHD mortality. This interrelation is further confirmed by observing death rates in Finns who live abroad. Reasons behind the mortality variation should be sought in circumstances that operate before or at early childhood. In light of recent advances in medical and genetic research, and the population development of Finland, there are strong reasons to believe that patterns observed in these large-scale population data reflect geographic clustering of genetic susceptibility for IHD.
Migration of Ethnic Groups within Cordoba Province (Argentina) during Political Crises Following the Colonial Period
Authors: Colantonio Sonia E. , Fuster Vicente
Published: May 2009

This paper analyzes the composition and pattern of migration within Cordoba province during the period of the Argentinean wars of independence. Studied are the two largest ethnic groups (Spanish and Mixed) using information provided by the census of 1813. Correlations between migration estimates are analyzed. The results obtained indicate that migrants were predominately males, the rest consisting of women and children. Movement took place generally from town to distant localities and the proportion of Spanish and Mixed migrants entering both areas was similar. Men, women and children migrated in comparable numbers, thus suggesting a family migration pattern. Correlation between the proportions of migrants among geographic units indicates equivalent patterns of men, women and children as well as ethno-social categories (Spanish or Mixed). One of the main factors determining migration could be the political and economic instability of Cordoba following the Colonial Period.
Charles Williams and the Companions of the Co-inherence
Authors: Newman Barbara
Published: May 2009

This article assesses the legacy of Charles Williams as an esoteric Christian teacher. Best known as a friend of C. S. Lewis and J. R. R. Tolkien, Williams was also a prolific writer, a practicing Rosicrucian, and a lay spiritual director. Focusing on his central doctrine of co-inherence and corresponding prayer technique known as “substituted love,” the essay examines his novels, poetry, and theological writings as well as his practice of spiritual direction, asking how his ideas were influenced by his familiarity with ritual magic. It also explores the informal religious order he founded, the Companions of the Co-inherence.
Glyphosate Weed Control Enhancement with Ammonium Sulfate and Commercial Water Conditioning Agents
Authors: Peterson Dallas E. , Thompson Curtis R.
Published: May 2009

Glyphosate herbicide labels generally recommend addition of ammonium sulfate (AMS) to the spray solution, which often improves weed control, especially when mixed with hard water. AMS in solution disassociates, and the sulfate binds with cations in the spray solution, preventing the development of glyphosate-cation complexes that tend to have lower absorption into plant leaves. In addition, the ammonium ion can associate with the glyphosate molecule, which helps facilitate glyphosate absorption into the leaf. The recommended AMS rate is 1–2 % w/w, and AMS is available in both dry and liquid formulations. Applicators generally find AMS inconvenient to use because of the high use rate and handling issues. Several companies are marketing low-rate water conditioner products to be used as an alternative to AMS with glyphosate. Pesticide applicators like the convenience of low-rate water conditioners, but performance of these products has been inconsistent. Field experiments were conducted near Manhattan, KS, from 2005 to 2008 to compare the efficacy of glyphosate with AMS and various commercial water conditioners on velvetleaf, sorghum, corn, and sunflower. Each experiment consisted of a sublethal (0.31 or 0.43 kg ae/ha) dose of glyphosate applied in combination with the recommended application rate of each adjuvant. Water hardness, environmental conditions, and plant growth stages varied by experiment. Control of all assay species with glyphosate was enhanced by the addition of AMS, unless control was near complete in the absence of AMS. Commercial water conditioner products that included an AMS component at the equivalent rate of 1 % w/w gave equal or slightly better control than glyphosate plus 1 % w/w AMS. Commercial water conditioners that did not provide an equivalent amount of AMS gave less control than glyphosate with 1 % or 2 % w/w AMS and were often no better than glyphosate alone for the low-rate products.
Reliability Life Prediction of VFD by Constant Temperature Stress Accelerated Life Tests and Maximum Likelihood Estimation
Authors: Zhang Jian-Ping , Wang Rui-Tao
Published: May 2009

In order to obtain the life information of vacuum fluorescent display (VFD) in a short time, four constant stress accelerated life tests (CSALT) are conducted with the cathode temperature increased. Lognormal function is applied for describing the life distribution of VFD. Assuming an Arrhenius model, the lognormal parameters are computed by using the maximum likelihood estimation. Furthermore, a self-developed software is employed in predicting the VFD life. The statistical analysis of the results indicates that the test design of CSALT is correct and feasible, that the average life of VFD is over 30,000 h, and that the life-stress relationship satisfies linear Arrhenius equation completely. The precise accelerated parameter is shown to be particularly useful to predict the VFD life within shorter time. Thus, this work provides significant guidelines to help engineers make decisions in design and manufacturing strategy from the aspect of reliability life.
Prediction of Cushion Performance Less Than One Inch Thick
Authors: Daum Matthew , Batt Gregory
Published: May 2009

An important tool packaging engineers use when designing cushions to protect products from shock is the cushion curve. Cushion curves show deceleration values along the vertical axis versus the static loading (weight divided by bearing area) along the horizontal axis for a given thickness of cushion material and given drop height. Commercially available cushion curves display a thickness of one inch and greater. However, many times packaging engineers design packages with cushions less than one inch thick. This leaves the packaging engineer to either guess deceleration levels below one inch thick by trial and error, or to extrapolate from existing cushion curve data. The purpose of this study was to determine if using existing cushion curve information would accurately predict deceleration values below one inch thick. To do this, a procedure was developed comparing information collected from expanded polystyrene cushion samples greater than one inch thick (correlating to existing cushion curves) compared to information collected from samples less than one inch thick. The comparison looked for difference between the datasets. It was found that in fact there was a statistical difference, meaning existing cushion curves should not be used to predict deceleration values for cushion thicknesses below one inch.
Successful use of weekly pegvisomant administration in patients with acromegaly
Authors: Higham C E , Thomas J D J , Bidlingmaier M , Drake W M , Trainer P J
Published: May 2009

Context

Clinical trials using 80 mg once weekly pegvisomant (pegV) in active acromegaly led to a 30% fall in serum IGF1. Subsequent studies demonstrated that daily administration of up to 40 mg/day achieved an IGF1 within reference range in 97% of patients. PegV has a half-life of >70 h suggesting weekly dosing may be possible but using higher doses than in the initial trials.

Objective

To determine the efficacy of weekly dosing of pegV.

Design

A two center, open-label prospective study in patients with acromegaly converted from a stable daily dose of pegV (median dose 15 mg daily (range 10–20 mg od), IGF1 normal for 3 months prior to inclusion) to twice-weekly (week 0–16) followed by once-weekly (week 16–32) administration.

Results

Seven patients (4M, age 57±7 years, 6/7 prior transsphenoidal surgery, 7/7 prior radiotherapy) were recruited. Six patients completed the twice-weekly and five patients both the twice-weekly and once-weekly administration. Headaches led to two patient withdrawals at 0+24 weeks. Mean pre-dose serum IGF1 levels remained stable with the different administration regimens (IGF1 baseline 145±39 ng/ml, twice-weekly 124±39 ng/ml and once-weekly 127±22 ng/ml) and all values were within age adjusted IGF1 reference range. PegV dose was reduced in two patients and five opted to continue weekly administration at trial termination. Safety and quality of life parameters remained stable.

Conclusions

Twice and once-weekly administration of pegV is effective in controlling serum IGF1 levels in acromegaly and although not formally assessed, continuation of weekly dosing in five patients at study conclusion suggests patient preference for this regimen.
Distal gastric bypass surgery for the treatment of hypothalamic obesity after childhood craniopharyngioma
Authors: Schultes Bernd , Ernst Barbara , Schmid Florian , Thurnheer Martin
Published: May 2009

Context

Obesity resulting from damage to the hypothalamus, i.e. hypothalamic obesity, is a severe condition that currently lacks any effective evidence-based therapy.

Objective

Our goal was to describe the course of hypothalamic obesity in a craniopharyngioma patient treated with distal gastric bypass surgery and to outline distinct aspects of multidisciplinary case management.

Patient and methods

A 29-year-old man, who had undergone craniopharyngioma resection at the age of 8, was referred to our Interdisciplinary Obesity Centre with a body mass index (BMI) of 52.0 kg/m2, type 2 diabetes and obstructive sleep apnoea syndrome (OSAS). After careful preoperative preparation, including the adjustment of hormone substitution therapy for panhypopituitarism, nutritional counselling and a supervised exercise program, he underwent a distal gastric bypass operation.

Results

Eighteen months after the operation the patient's BMI had decreased to 31.9 kg/m2, type 2 diabetes was in complete remission, and OSAS appeared to be improved. Also, feelings of hunger were markedly reduced after the operation. A standard regimen of supplements successfully prevented any severe nutritional deficiencies. After weight loss, the dose of hydrocortisone could be distinctly reduced without any signs of adrenal insufficiency while GH substitution had to be markedly increased to achieve normal IGF1 levels.

Conclusions

Our case demonstrates that within a multidisciplinary team approach, a distal gastric bypass operation can be a safe and highly effective therapy for patients with hypothalamic obesity. Also, our findings hint at an effect of gastric bypass surgery on hunger and eating behaviour that may not essentially rely on hypothalamic mechanisms.
Kinase Mutations and Efficacy of Imatinib in Korean Patients with Advanced Gastrointestinal Stromal Tumors
Authors: Kim Tae Won , Ryu Min-Hee , Lee Heungnam , Sym Sun Jin , Lee Jae-Lyun , Chang Heung Moon , Park Young Suk , Lee Kyung Hee , Kang Won Ki , Shin Dong Bok , Bang Yung-Jue , Lee Jung Shin , Kang Yoon-Koo
Published: May 2009

Purpose.

This study analyzed the relationship between treatment outcome and kinase mutational status in Korean patients with advanced gastrointestinal stromal tumors (GISTs).

Experimental Design.

Clinical data were collected from 113 consecutive patients with metastatic or unresectable GISTs treated with imatinib from June 2001 through June 2005 at five institutions in Korea. KIT exons 9, 11, 13, and 17 and PDGFRA exons 12 and 18 were examined.

Results.

The median patient age was 57 years (range, 31–82 years). The overall response rate was 67.2%. KIT mutations were found in exon 11 (n = 92, 81.4%) and exon 9 (n = 10, 8.8%). One patient had a PDGFRA exon 18 mutation. The overall mutation rate was 91.2%. Response rates were 68.4%, 50.0%, and 80.0% in patients with KIT exon 11 mutations, KIT exon 9 mutations, and no kinase mutations, respectively. With a median follow-up of 49.0 months, the median progression-free survival (PFS) time was 42.0 months and median overall survival (OS) time was not reached. PFS and OS times did not differ significantly according to KIT genotype.

Conclusion.

This study was unable to find an association between KIT mutational status and clinical outcome of imatinib in Korean patients with advanced GISTs. There was a trend toward better outcomes for patients with wild-type KIT or exon 11 mutations compared with exon 9 mutations, although this was not statistically significant. Compared with previous studies in western populations, these results suggest that ethnic differences may influence the relationship between KIT genotype and clinical outcome to imatinib.
High Incidence of Hypocalcemia and Serum Creatinine Increase in Patients with Bone Metastases Treated with Zoledronic Acid
Authors: Zuradelli Monica , Masci Giovanna , Biancofiore Giuseppe , Gullo Giuseppe , Scorsetti Marta , Navarria Pierina , Tancioni Flavio , Berlusconi Marco , Giordano Laura , Santoro Armando
Published: May 2009

Background.

Zoledronic acid belongs to the new generation of bisphosphonates with demonstrated clinical benefit for the treatment of bone metastases from different kinds of neoplasms. Hypocalcemia and serum creatinine elevation are expected adverse events during this therapy. The monitoring of serum calcium and creatinine is therefore recommended. The primary aim of this study was to establish the actual incidence of hypocalcemia and serum creatinine elevation during treatment with zoledronic acid. Skeletal-related events and side effects were also assessed.

Methods.

Serum creatinine and calcium levels were evaluated in 240 consecutive patients (83 males, 157 females; mean age, 62 years) with metastatic bone lesions from different solid tumors treated with zoledronic acid.

Results.

Overall, 93 of 240 patients (38.8%) developed hypocalcemia, which was grade (G)1 in 45 patients (48.4%), G2 in 37 patients (39.8%), G3 in 10 patients (10.8%), and G4 in one patient (1.1%). The median time to occurrence of hypocalcemia (any grade) was 2.3 months after the beginning of the treatment (range, 0–34.9 months).

Increased serum creatinine was observed in 33 of 240 patients (13.7%), of whom 19 had G1 (57.6%), 11 had G2 (33.3%), and three had G3 (9.1%). The median time to serum creatinine increase (for any grade) was 4.7 months (range, 0–29.2 months).

Conclusions.

Our analysis shows a high incidence of hypocalcemia and increased serum creatinine level during treatment with zoledronic acid. These results strongly support the need for accurate monitoring of plasma calcium and creatinine levels.
Neuroendocrine Tumors of the Pancreas
Authors: Ehehalt Florian , Saeger Hans D. , Schmidt C. Max , Grützmann Robert
Published: May 2009

Learning Objectives

Assess the basic aspects of PNET tumor biology, pathogenesis, and classification. Explain the epidemiology and evaluate the prognosis of PNET patients. Engage in rational clinical management of PNETs.

This article is available for continuing medical education credit at CME.TheOncologist.com
Proactive Management of Adverse Events Maintains the Clinical Benefit of Ixabepilone
Authors: Yardley Denise A.
Published: May 2009

Ixabepilone is a novel microtubule-stabilizing agent with clinical efficacy in advanced breast cancer, including patients whose disease has progressed on prior anthracyclines and taxanes. The safety profile of single-agent ixabepilone and combination ixabepilone plus capecitabine therapy is reviewed, outlining the steps to effectively manage and prevent common adverse events. Ixabepilone is generally well tolerated, and importantly, its toxicity profile does not overlap with that of capecitabine. Peripheral sensory neuropathy and neutropenia are the most common toxicities associated with ixabepilone; both can be effectively managed by monitoring patients and then, depending on severity, instituting a treatment delay until recovery and reducing the ixabepilone dose for subsequent treatment cycles. Ixabepilone dose reductions are recommended for most grade 3 events, excluding transient fatigue, arthralgia, and myalgia, whereas treatment discontinuation is recommended for persistent grade 3 neuropathy or any grade 4 nonhematological toxicity. Because ixabepilone exposure is greater in patients with hepatic impairment and those receiving concomitant strong cytochrome P-450 CYP3A4 inhibitors, dose adjustments and restrictions are recommended according to the degree of hepatic impairment, whether ixabepilone is administered alone or in combination with capecitabine, and whether a strong CYP3A4 inhibitor is being coadministered. Patients should be premedicated with oral H1 and H2 antihistamines to prevent hypersensitivity reactions. Unlike taxanes, corticosteroid premedication is not required unless a hypersensitivity reaction occurred during a previous cycle or during treatment with another Cremophor-containing agent. By effectively managing adverse events and taking steps to minimize them, clinicians can ensure that patients derive the maximum benefit from ixabepilone therapy.
Characterization of the angiotensin (AT1b) receptor promoter and its regulation by glucocorticoids
Authors: Bogdarina Irina G , King Peter J , Clark Adrian J L
Published: May 2009

Angiotensin II acts through two pharmacologically distinct receptors known as AT1 and AT2. Duplication of the AT1 receptor in rodents into At1a and b subtypes allows tissue-specific expression of the AT1b in adrenal and pituitary tissue. Adrenal expression of this receptor is increased in the offspring of rat mothers exposed to a low-protein diet and this is associated with the undermethylation of its promoter. This phenomenon is blocked by the inhibition of maternal glucocorticoid synthesis by metyrapone. We have mapped the transcriptional start site of the promoter and demonstrated that a 1.2 kbp fragment upsteam of this site is effective in driving luciferase expression in mouse Y1 cells. A combination of bioinformatic analysis, electrophoretic mobility shift analysis (EMSA), and mutagenesis studies demonstrates: i) the presence of a putative TATA box and CAAT box; ii) the presence of three Sp1 response elements, capable of binding SP1; mutation of any pair of these sites effectively disables this promoter; iii) the presence of four potential glucocorticoid response elements which each bind glucocorticoid receptor in EMSA, although only two confer dexamethasone inhibition on the promoter; iv) the presence of two AP1 sites. Mutagenesis of the distal AP1 site greatly diminishes promoter function but this is also associated with the loss of dexamethasone inhibition. These studies will facilitate an understanding of the mechanisms by which fetal programming leads to long term alterations in gene expression and the development of adult disease.
Changes in Spousal Health Insurance Coverage and Female Labor Supply Decisions
Authors: Kapinos Kandice A.
Published: May 2009

This study examines the changing relationship between spousal health insurance coverage and labor market outcomes for married women over time as healthcare costs have increased. In particular, I investigate how husbands' health insurance coverage offers affect wives' decisions to enter the labor force and work full-time and how this has changed over time. I endeavor to correct for potential biases of these effects by 1) using an instrumental variables model to deal with endogeneity and 2) estimating and netting out likely unobserved heterogeneity biases, such as assortative mating or income effects. Using Current Population Survey data from 1995 to 2005, I find that husbands' employer-provided health insurance coverage has a negative effect on wives' labor supply that has increased (become more negative) over time.
Elevated Triglycerides Correlate With Progression of Diabetic Neuropathy
Authors: Wiggin Timothy D. , Sullivan Kelli A. , Pop-Busui Rodica , Amato Antonino , Sima Anders A.F. , Feldman Eva L.
Published: May 2009

OBJECTIVE

To evaluate mechanisms underlying diabetic neuropathy progression using indexes of sural nerve morphometry obtained from two identical randomized, placebo-controlled clinical trials.

RESEARCH DESIGN AND METHODS

Sural nerve myelinated fiber density (MFD), nerve conduction velocities (NCVs), vibration perception thresholds, clinical symptom scores, and a visual analog scale for pain were analyzed in participants with diabetic neuropathy. A loss of ≥500 fibers/mm2 in sural nerve MFD over 52 weeks was defined as progressing diabetic neuropathy, and a MFD loss of ≤100 fibers/mm2 during the same time interval as nonprogressing diabetic neuropathy. The progressing and nonprogressing cohorts were matched for baseline characteristics using an O'Brien rank-sum and baseline MFD.

RESULTS

At 52 weeks, the progressing cohort demonstrated a 25% decrease (P < 0.0001) from baseline in MFD, while the nonprogressing cohort remained unchanged. MFD was not affected by active drug treatment (P = 0.87), diabetes duration (P = 0.48), age (P = 0.11), or BMI (P = 0.30). Among all variables tested, elevated triglycerides and decreased peroneal motor NCV at baseline significantly correlated with loss of MFD at 52 weeks (P = 0.04).

CONCLUSIONS

In this cohort of participants with mild to moderate diabetic neuropathy, elevated triglycerides correlated with MFD loss independent of disease duration, age, diabetes control, or other variables. These data support the evolving concept that hyperlipidemia is instrumental in the progression of diabetic neuropathy.
Effect of Musculoskeletal Pain on Sexuality of Male Adolescents and Adults with Juvenile Idiopathic Arthritis
Authors: de AVILA LIMA SOUZA LILIAN , GALLINARO ANDREA LOPES , ABDO CARMITA HELENA NAJJAR , KOWALSKI SÉRGIO CANDIDO , SUEHIRO RICARDO MAISSE , da SILVA CLÓVIS ARTUR ALMEIDA , GOLDENSTEIN-SCHAINBERG CLÁUDIA
Published: May 2009

Objective.

To develop a questionnaire for the evaluation of sexuality of male patients with juvenile idiopathic arthritis (JIA).

Methods.

A cohort of male patients with rheumatoid factor (RF)-negative polyarticular JIA according to the 2004 revised ILAR criteria and inactive disease was studied. The Health Assessment Questionnaire (HAQ) was applied to all patients. As a control group, 120 age-matched males of the same socioeconomic status were evaluated. A self-administered structured instrument, the Male Sexual Evaluation Questionnaire (MSEQ), was developed by multiprofessional experts to assess sexual life, including satisfaction, practice, and related functional aspects.

Results.

Thirty-two male patients with RF-negative polyarticular JIA [mean age 20.8 ± 3.8 yrs (range 16–26), mean disease duration 15.4 ± 3.6 yrs (range 13–20)] were studied. Mean HAQ score was 1.25 ± 0.67 (range 0.1–2.1). Masturbation was practiced similarly by patients and controls (87.5% vs 91%; p > 0.999), although joint pain was observed in only 2 (7%) patients. Regular sexual intercourse (≥ once/week) was reported by 78% of patients and 62% of controls (p = 0.86). Joint pain during intercourse was more frequent in patients (48% vs 3% in controls; p < 0.001). The mean HAQ score was higher in the 12 patients with joint pain (hips = 3, knees = 5, and hips + knees = 4) during intercourse compared to the 13 patients without joint pain (1.82 ± 0.27 vs 1.43 ± 0.32; p < 0.05). Preserved desire and satisfaction were universal findings for all JIA patients and controls.

Conclusion.

The MSEQ was applicable to this cohort of male patients with RF-negative polyarticular JIA and showed that sexual life is preserved despite longterm disease, morbidity/functional dysfunction, and joint pain.
Efficacy, Safety, and Tolerability of the Cyclooxygenase-Inhibiting Nitric Oxide Donator Naproxcinod in Treating Osteoarthritis of the Hip or Knee
Authors: KARLSSON JON , PIVODIC ALDINA , AGUIRRE DIANA , SCHNITZER THOMAS J.
Published: May 2009

Objective.

Naproxcinod, a cyclooxygenase-inhibiting nitric oxide donator antiinflammatory drug, was evaluated in this phase 2, double-blind, randomized, parallel group study to determine its optimal dose in patients with osteoarthritis (OA).

Methods.

In total 543 patients with OA of the hip or knee were randomized to receive naproxcinod 750 mg once daily (qd), 750 mg twice daily (bid), 1125 mg bid, rofecoxib 25 mg qd, or placebo for 6 weeks. The primary efficacy variable was the within-patient change from baseline to the average of Weeks 4 and 6 in WOMAC™ pain subscale score. Treatment-group differences were compared using ANCOVA with factors for treatment and country, and baseline pain subscale score as a covariate. Safety endpoints included vital signs and adverse events. Treatment-group differences in mean change from baseline to Week 6 in systolic blood pressure (SBP) were compared using an ANCOVA with treatment and country as fixed factors and baseline SBP as covariate.

Results.

All active treatments showed statistically significant reductions in WOMAC pain score compared to placebo (p ≤ 0.02). Naproxcinod was well tolerated. The 750 mg bid dose appeared to have the best balance of benefit versus safety. All 3 naproxcinod doses showed a reduction in SBP, while an increase was shown for rofecoxib. The changes for the naproxcinod groups were statistically significantly better compared to rofecoxib (p ≤ 0.02).

Conclusion.

This dose-finding study identified naproxcinod 750 mg bid as the upper dose for further therapeutic confirmatory clinical trials. Naproxcinod at all doses decreased mean SBP compared to an increase with rofecoxib.
MRI for breast cancer: Current indications
Authors: Ojeda-Fournier Haydee , Comstock Christopher E
Published: May 2009

Mammography is the only imaging study that has been proven in multiple large randomized trials to decrease breast cancer mortality. Mammography, however, has its limitations and, as such, other modalities that can complement it are being studied. One of these is dynamic contrast-enhanced breast MRI, which has emerged as an important adjunctive modality and is at present the most sensitive modality that we have to evaluate the breast. The American College of Radiology, in its 2004 practice guidelines, has outlined the 12 current indications for breast MRI. This manuscript reviews and provides examples of each of these.
Pictorial review of MRI/CT Scan in congenital temporal bone anomalies, in patients for cochlear implant
Authors: Gupta Santosh S , Maheshwari Shailendra R , Kirtane Milind V , Shrivastav Nitin
Published: May 2009

High-resolution CT scan (HRCT) and MRI are routinely performed prior to cochlear implant surgery. These modalities help assess the status of the inner ear structures. A few patients have significant anomalies, which need to be assessed and understood in detail. We present a pictorial essay of these anomalies and described our HRCT and MRI techniques in patients being imaged prior to surgery.
Pictorial essay: B-scan ultrasonography in ocular abnormalities
Authors: Aironi VD , Gandage SG
Published: May 2009

B-scan ultrasonography (USG) is a simple, noninvasive tool for diagnosing lesions of the posterior segment of the eyeball. Common conditions such as cataract, vitreous degeneration, retinal detachment, ocular trauma, choroidal melanoma, and retinoblastoma can be accurately evaluated with this modality. B-scan USG is cost-effective, which is an important consideration in the rural setting. In addition, it is noninvasive and easily available and the results are reproducible.
Papillary carcinoma arising from a thyroglossal duct cyst
Authors: Smiti S , Mahmood Nabil Sherif
Published: May 2009

This report describes a case of papillary carcinoma arising from a thyroglossal duct cyst (TDC) in a young woman. Imaging showed a heterogeneous cystic lesion at the level of the hyoid, with calcifications and enhancing septae. We compared the USG, CT scan, and MRI findings with those reported previously in literature and we conclude that the presence of a midline cystic lesion with calcification in a young adult should arouse suspicion of papillary carcinoma in a TDC.
Dynamic MRI of the vocal cords using phased-array coils: A feasibility study
Authors: Schlamann Marc , Lehnerdt Götz , Maderwald Stefan , Ladd Susanne
Published: May 2009

Objective: Endoscopy for evaluation of hoarseness is an invasive procedure and the result depends, to a large extent, on the patient′s cooperation. Successful laryngoscopy can also be hampered by unfavourable anatomic conditions, a severely impaired general condition, or severe coagulopathy. We evaluated the feasibility of doing ultra-fast magnetic resonance imaging (MRI), using a recent dedicated coil design and a sequence with inherently high signal-to-noise ratios (SNR), for the detection of motility disorders of the vocal cords. Materials and Methods: Twelve consecutive patients (eight males and four females) in the age range of 24-80 years (mean age 60 years) with persistent hoarseness and presumed vocal cord palsy were included in this blinded prospective study. Two two-element phased-array carotid coils were used for signal reception. The first coronal real-time steady-state free precession (SSFP) sequence was performed during silence (i.e., with no vocal cord motion) and the second while phonating ′heee.′ Qualitative MRI findings were compared with the results of the endoscopic examination. Results: The examination time for setup, patient instruction and positioning, localization scans, and real-time SSFP scans was less than 10 min. Seven patients with laryngoscopically-confirmed unilateral palsy of the vocal cord were correctly identified with MRI. The five remaining patients had hoarseness due to causes other than vocal cord palsy; they showed normal motion of the vocal cords on MRI and endoscopy. Conclusion: Compared to preceding studies, the image quality in this study is supported by excellent SNR (carotid phased-array coils and SSFP sequence with higher SNR if compared to a spoiled gradient-echo sequence or an EPI sequence). Further studies, with larger groups of patients, are necessary to show if this protocol can serve as an alternative to endoscopy in selected cases.
Extraosseous Ewing′s sarcoma / primitive neuroectodermal tumor of the sacral nerve plexus
Authors: Narula MK , Gupta Nishant , Anand Rama , Kapoor Sudhir
Published: May 2009

We report an unusual case of Ewing′s sarcoma / primitive neuroectodermal tumor (PNET) of the sacral nerve plexus in a 9-year-old boy who presented with a soft tissue swelling and severe piercing pain in the lower back region. MRI of the lumbosacral spine showed a lobulated soft tissue mass with clubbed finger-like projections along the path of the sacral nerves, which had caused widening of the spinal canal and the sacral foramina (S2-S4 level). There was presacral extension and posterior scalloping of the sacral vertebrae. Histopathology of the lesion confirmed Ewing′s sarcoma / PNET of the sacral spinal nerve plexus. The patient responded favorably to chemotherapy and radiotherapy, showing clinical and radiological improvement.
Novel lineup methods for improving the performance of older eyewitnesses
Authors: Wilcock Rachel , Bull Ray
Published: May 2009

Previous research shows that older witnesses demonstrate poorer lineup performance compared to younger adults. Two experiments are presented which investigated the effectiveness of pre‐identification procedures aimed to reduce false identifications made by older adults. In experiment one older adults' demonstrated poorer lineup performance compared to younger adults. However, older adults benefited from pre‐lineup questions and a practice lineup prior to viewing a target absent (TA) lineup. In a second experiment, participants in the practice lineup condition made significantly fewer false identifications and more correct rejections on two TA lineups compared to participants in the control condition. On both target present (TP) lineups there was no significant difference in lineup performance between the two conditions. The effect of pre‐identification procedure on self‐reported lineup decision strategy and memory for non‐biased lineup instructions are discussed, as well as future research directions. Copyright © 2009 John Wiley & Sons, Ltd.