bluuebunny/crossref_metadata_2025 huggingface dataset:
First detection of human astrovirus in gastroenteritis outbreak in Hungary
Authors: Pankovics Péter , Boros Ákos , Rovács Melinda , Nagy Erika , Krisztián Erika , Vollain Mária , Reuter Gábor
Published: December 2010

Human astroviruses are one of the known pathogens of gastroenteritis in infants, children and rarely in elderly. It causes 4.2-7.3% of the sporadic gastroenteritis cases with diarrhea and vomiting in children. The etiological role of astrovirus has not been confirmed yet in outbreaks of gastroenteritis in Hungary. Aims: The first description of the detection and molecular epidemiology of astrovirus in outbreaks of gastroenteritis in Hungary. Materials and methods: Stool samples originated from Komárom-Esztergom County, from a day-care center (nursery) where a gastroenteritis outbreak occurred in June, 2010. Astrovirus was detected by RT-PCR methods. The nucleotide sequence of the nearly complete genome was sequenced. Clinical and epidemiological data were collected by epidemiological investigation. Results: Out of the 29 exposed persons (24 children and 5 adults) 7 (24.1%) children had gastroenteritis with diarrhea, and vomiting in one case, in the period of June 4-15, 2010. Bacterial pathogens, rotavirus, adenovirus and norovirus were not detected, but genotype 1 astrovirus could be identified in 3 (42.8%) stool samples (HQ398856). The nucleotide sequence of the astrovirus ORF1a/ORF1b/ORF2/3’UTR regions was determined. The source of the outbreak was presumably the firstly recognized ill child and the virus was spread by fecal-oral route with direct contact in the children community. Conclusions: Epidemiologic and clinical characteristics of the astrovirus outbreak in the nursery are described in details to prove that the possible etiological role of astroviruses in viral gastroenteritis which should not forget in order after rotaviruses, caliciviruses (norovirus and sapovirus) and enteric adenoviruses. Orv. Hetil., 2011, 152, 45–50.
Innovative education: introduction of clinical simulation-based training at the Faculty of Health Sciences, Semmelweis University, Hungary
Authors: Csóka Mária , Deutsch Tibor
Published: December 2010

In Hungary, Faculty of Health Sciences at Semmelweis University was the first institution to introduce patient simulation-based practical training of non-physician professionals. Before introducing this novel educational methodology, students could only practice particular examinations and interventions on demonstration tools. Using the simulator they can also follow and analyze the effects of the interventions that have been made. The high fidelity, adult Human Patients Emergency Care Simulator (HPS-ECS, Medical Education Technologies Incorporation, Sarasota, Florida, USA) is particularly suitable for acquiring skills related to the management of various emergency situations. The 180 cm and 34 kg mannequin which can operate in lying and sitting positions has both respiration and circulation which can be examined the same way as in a living person. It is capable to produce several physical and clinical signs such as respiration with chest movement, electric cardiac activity, palpable pulse, and measurable blood pressure. In addition, it can also exhibit blinking, swelling of the tongue and whole-body trembling while intestinal, cardiac and pulmonary sounds can equally be examined. The high fidelity simulator allows various interventions including monitoring, oxygen therapy, bladder catheterization, gastric tube insertion, injection, infusion and transfusion therapy to be practiced as part of complex patient management. Diagnostic instruments such as ECG recorder, sphygmomanometer, pulse-oxymeter can be attached to the simulator which can also respond to different medical interventions such as intubation, defibrillation, pacing, liquid supplementing, and blood transfusion. The mannequin’s physiological response can be followed up and monitored over time to assess whether the selected intervention has been proven adequate to achieve the desired outcome. Authors provide a short overview of the possible applications of clinical simulation for education and training in health sciences, and present how patient simulator has been embedded in various practical courses as part of different curriculum designed for different health care specialties. Orv. Hetil., 2011, 152, 27–33.
Possible Association of New‐Onset Seizure with the H1N1 Influenza Vaccine
Authors: Kaako Ahmad , Kolade Victor O.
Published: December 2010

Since the introduction of the H1N1 influenza vaccine in the wake of the 2009 H1N1 influenza pandemic, many serious and nonserious adverse events related to the vaccine have been reported. We describe a 59‐year‐old African‐American man with severe chronic heart failure and chronic obstructive pulmonary disease who experienced a new‐onset, generalized tonic‐clonic seizure less than 1 hour after receiving the H1N1 vaccine. He had never experienced any reactions to previous seasonal influenza vaccines. His medical history, physical examination, and targeted investigations revealed no evidence of other potential etiologies for his seizure. After this event, the patient, who was discharged without anticonvulsant therapy, remained seizure free for the next 10 months. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship (score of 4) between the patient's seizure and the receipt of the H1N1 vaccine. This is the first case report, to our knowledge, to suggest a possible association between the H1N1 influenza vaccine and seizure. The mechanism of the association is unclear. Further case series may clarify the nature of the association.
Measuring Diabetes Care in the National Interdisciplinary Primary Care Practice‐Based Research Network (NIPC‐PBRN)
Authors: Dickerson Lori M. , Ables Adrienne Z. , Everett Charles J. , Mainous Arch G. , McCutcheon Allison M. , Bazaldua Oralia V. , Weber Cynthia A. , Carter Barry L. ,   National Interdisciplinary Primary Care Practice‐Based Research Network
Published: December 2010

Study Objective. To assess diabetes care in a network of primary care practices that include pharmacist support by using a scoring system designed for the National Committee for Quality Assurance (NCQA) Diabetes Recognition Program (DRP) measures.

Design. Retrospective medical record review.

Data Source. Subset of the National Interdisciplinary Primary Care Practice‐Based Research Network (NIPC‐PBRN).

Patients. A total of 1309 adults who were seen at 17 practices for an outpatient diabetes mellitus visit between January 1 and June 30, 2008.

Measurements and Main Results. Patient demographic data and NCQA DRP process and outcome measures (hemoglobin A1c [A1C], blood pressure, and low‐density lipoprotein cholesterol [LDL] level measurements; eye and foot examinations; nephropathy assessment; and smoking status and cessation advice or treatment) were recorded. Points for each measure were compiled, and practices achieving a sufficient score for NCQA recognition (≥ 75.0 points) were identified. Pharmacists were also surveyed regarding their services, participation in quality improvement initiatives, use of electronic medical records, and methods of data extraction. The relationships between DRP measures and quality improvement activities, pharmacist involvement in diabetes care, and use of electronic medical records were analyzed. The DRP outcome measures were satisfactory: mean ± SD A1C 7.6% ± 1.9%, LDL level 99.1 ± 35.1 mg/dl, and systolic and diastolic blood pressures 130.2 ± 18.1 and 74.4 ± 10.8 mm Hg, respectively. Five practices (29%) achieved a sufficient score for NCQA recognition. No significant relationships were noted between DRP measures and participation in quality improvement, type of clinical pharmacy services, or use of electronic medical records (p>0.05). In a regression analysis, only electronic medical record use was significantly related to DRP measures (p=0.02).

Conclusion. Diabetes care in the NIPC‐PBRN appears satisfactory, but improvements are necessary if NCQA recognition is the goal. Use of electronic medical records was associated with better DRP measures.
Nebulizer Delivery of Micafungin Aerosols
Authors: Alexander Barbara D. , Winkler Thomas P. , Shi Shuai , Ashley Elizabeth S. Dodds , Dr. Anthony J. Hickey Ph.D.
Published: December 2010

Study Objectives. To determine the optimal nebulization system for aerosolizing micafungin and to further assess the physiochemical properties of aerosolized micafungin.

Design. In vitro experiment.

Setting. University research center.

Nebulizers. Pari LC Star, Hudson Updraft, Small Volume Nebulizer, and Aeroclipse II.

Measurements and Main Results. Using a commercially available cascade impactor, the four nebulizers were tested for their ability to deliver micafungin to the lungs. Mass median aerodynamic diameter (MMAD) and fine particle fraction (FPF) percent less than 3.3 μm (FPF3.3) and less than 5.8 μm (FPF5.8) were determined during two sampling periods for each of three trials of all nebulizers. The mean ± standard error of the mean MMAD for the nebulizers ranged from 1.93 ± 0.09 to 2.49 ± 0.25 μm; FPF3.3 and FPF5.8 were approximately 50% and 90%, respectively, for all nebulizers.

Conclusion. Although all nebulizers appeared acceptable to deliver micafungin to the lungs, the Pari LC Star had the smallest MMAD and highest FPF3.3 and FPF5.8. These properties of the Pari LC Star should result in greater delivery of the aerosol to the lungs. Additional research on pulmonary delivery and clinical tolerability is warranted.
Heart Failure Caused by Molecularly Targeted Therapies for Cancer
Authors: Jarkowski Anthony , Glode Ashley E. , Spangenthal Edward J. , Wong Michael K. K.
Published: December 2010

Cancer therapeutics is undergoing a revolution with the advent of new drugs that can selectively target molecules responsible for carcinogenesis and tumor growth. The type and mechanism of these targeting drugs vary. Some are small molecules that specifically target a binding site on a receptor or signal transduction molecule. Antibodies have been engineered to bind to the receptors or the corresponding ligands that mediate a critical cancer activity. In almost all cases, the intent is to inhibit or shut down a specific molecular pathway. Unprecedented activity against the cancer is seen without overt traditional toxicities such as alopecia, nausea and/or vomiting, and cytopenias. Unfortunately, an increase in toxicity has now become evident as more experience accumulates with the use of these drugs. In some cases, unexpected cardiotoxicities have arisen when these new drugs have been added to more conventional chemotherapies. Heart failure is the unfortunate manifestation for many of these toxicities. We outline the scope of this problem and examine the mechanisms of drug‐induced heart failure. The distinctive signs and symptoms specific to each drug are described, and the diagnosis and treatment of the condition are discussed. Our aim is to allow the practitioner to recognize the unusual manifestations of heart failure in this setting in order to make a timely diagnosis and begin appropriate treatment measures.
Valvular Heart Disease: A Primer for the Clinical Pharmacist
Authors: Bungard Tammy J. , Sonnenberg Brian
Published: December 2010

Valvular heart disease is a commonly encountered clinical condition that is not taught in most undergraduate and graduate pharmacy programs, leaving the practicing pharmacist without basic knowledge to expand on and subsequently apply to direct patient care. Unlike other areas of cardiology in which thousands of patients are recruited in many well‐designed randomized clinical trials, data assessing treatments for valvular heart disease are limited and often consist of retrospective case series or observations. Our goal is to provide a basic overview of chronic valvular heart disease, with emphasis on describing the common conditions requiring surgery and the available options, as well as common pharmacologic therapies used in this patient population. Anomalies in valves can be broadly classified as stenosis and regurgitation. Depending on the valve and the type of anomaly, the impact on the cardiovascular system will vary. Understanding the hemodynamic consequences of aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation is imperative to effectively counsel patients surrounding disease progression and self‐monitoring, use of vasodilators, and prophylaxis for endocarditis and rheumatic fever. Further, patient characteristics factored into the choice of implanting either a bioprosthetic (tissue) or prosthetic (metal) valve encompass patient choice, life expectancy, and willingness or ability to accept lifelong anticoagulation therapy. The evolution of metal valves has resulted in newer generations under clinical study that have more laminar flow (minimizing interaction with blood products) and improved pyrolytic carbon (minimizing infection and interaction with blood products). Although antithrombotic therapy with warfarin is now mandatory in North America for all patients receiving metal valves, research is ongoing to assess the need with the most recent generation of valves.
Biostatistical Applications in Epidemiology
Authors: Kier Karen L.
Published: December 2010

Understanding the application of statistical methods is an essential component in the process of evaluating the medical literature. Statistical methods can differ when evaluating randomized controlled clinical trials (experimental design) compared with observational study designs such as cohort or case‐control. A review of common statistical concepts includes variables, measures of central tendency, and measures of dispersion. Other methods include sensitivity, specificity, and predictive value. Observational study designs often include relative risk, odds ratios, relative risk reduction, attributable risk, number needed to treat, and forest plots. A critical component of drug literature evaluation is the understanding of the proper use of parametric and nonparametric statistical tests. Common parametric tests and their nonparametric equivalents are discussed.
Current Therapies for Chronic Hepatitis C
Authors: Ferguson McKenzie C.
Published: December 2010

Hepatitis C virus affects more than 180 million people worldwide and as many as 4 million people in the United States. Given that most patients are asymptomatic until late in the disease progression, diagnostic screening and evaluation should be performed in patients who display high‐risk behaviors associated with acquisition of hepatitis C. Chronic hepatitis C is associated with cirrhosis, hepatic failure, and death; therefore, treatment is aimed at reducing these complications, as well as improving quality of life and minimizing adverse effects. The American Association for the Study of Liver Diseases Practice Guidelines on the Diagnosis, Management, and Treatment of Hepatitis C represent the gold standard for guidance on the management of hepatitis C. Standard treatment for hepatitis C is peginterferon alfa in combination with ribavirin. Currently, two pegylated interferon products are approved by the U.S. Food and Drug Administration for the treatment of hepatitis C. The duration of therapy with peginterferon and ribavirin is dictated by viral genotype and virologic response. Additional therapies are under investigation for treatment of chronic hepatitis C and show early promise of comparative efficacy and fewer adverse effects. Special considerations in certain populations, including patients coinfected with human immunodeficiency virus, those with end‐stage renal disease, injection drug users, pregnant women, and pediatric patients, should guide treatment decisions.
Deathbed Visions from India: A Study of Family Observations in Northern Kerala
Authors: Muthumana Sandhya P. , Kumari Meena , Kellehear Allan , Kumar Suresh , Moosa Feroze
Published: December 2010

This is an interview-based study of 104 families and their observations of the last weeks and days of a dying family member. Forty families reported “unusual experiences and behaviors” from the dying person in their last period of life. Thirty of these dying persons displayed behavior consistent with deathbed visions—interacting or speaking with deceased relatives, mostly their dead parents. There were six cases of reported premonitions of death and five possible confusional states with one patient reported to have had both a deathbed vision and confusional experiences. Socio-demographic factors such as gender, age, occupation, or cause and place of death were not found to be significant. Hindu patients appeared to be more likely than Muslim patients to report these experiences. Use of opiates (or not) did not appear to influence reports. The findings are discussed with reference to past studies of deathbed visions as well as their implications for the future pastoral care of dying people and their families.
Motivation for Research Participation among People Bereaved by Suicide
Authors: Dyregrov Kari , Dieserud Gudrun , Straiton Melanie , Rasmussen Mette Lyberg , Hjelmeland Heidi , Knizek Birthe Loa , Leenaars Antoon A.
Published: December 2010

Few studies directly address vulnerable populations' motivation for participating in research. Often motives are expressed spontaneously and typically given post-interview. This article investigates motivation for research participation among informants who have been bereaved by suicide. Informants were specifically asked for their motivation either prior to, or directly after the interview. Four categories of motivations were identified: 1) Helping Others, 2) Venting, 3) Insight, and 4) Just Because. Sixty percent of informants gave more than one motivation. The majority was altruistically motivated; they hoped that by taking part they could play a role in helping to prevent suicide, improving services for the bereaved or moving research forward. Close family members were more likely to be motivated by a desire to help others than more distant family members. Findings are discussed in the context of suicide-related bereavements. Information about research participation as beneficial to others should be given parallel to that of possible strain.
A Qualitative Study of Attitudes toward Suicide and Suicide Prevention among Psychology Students in Ghana
Authors: Knizek Birthe Loa , Akotia Charity Sylvia , Hjelmeland Heidi
Published: December 2010

The purpose of the present study was to investigate attitudes toward suicide and suicide prevention among psychology students in Ghana by means of a qualitative analysis of open-ended questions about causes of suicide and how suicide best can be prevented. The students mainly saw the causes as intra-personal and almost all of them believed that suicide can be prevented. The results indicated a huge impact of religion on the attitudes toward suicide as well as some lack of distinction between their religious and professional roles and responsibilities.
Internal Connections and Conversations: The Internalized other Interview in Bereavement Work
Authors: Moules Nancy J.
Published: December 2010

Much of the work of grief lies in the ways the bereaved learn to maintain connection to the deceased in their lives, while living alongside the physical absence of them. The theory of an Internalized Other Interview is that we carry within ourselves impressions, memories, beliefs, assessments, doctrines, and codes of those who have shaped our lives through relationship. This internalized community of commentators is active in our lives on a day-to-day basis, but when someone dies, their active voice in the dialogue is shifted to a perceived inactivity. However, I argue that, despite the physical absence of the other, the voice continues to resonate and interact in our formation of our worlds. How our loved ones live on inside us influences who we are in the world and in our bereavement. As a result of our research and clinical work, I have come to believe that the active interviewing of the deceased person as internalized in the bereaved can have powerful and healing effects. In this article, I share the results of the research related to this intervention, describe the history located in Internalized Other Interviewing, and offer a transcription of an Internalized Other Interview with a young man and his family who recently lost both his brother and father.
Impact of Voting Advice Applications (VAAs) on Voter Turnout and Their Potential Use for Civic Education
Authors: Fivaz Jan , Nadig Giorgio
Published: December 2010

A low level of voter turnout and a certain alienation of citizens from politics are well‐known challenges to many modern democracies. At the same time a special type of political website called Voting Advice Applications (VAAs) attracts millions of voters all over Europe. They offer voters a new approach for choosing candidates or political parties to vote for. VAAs seem to be particularly popular among young voters. In this article we try to assess whether these tools have the potential to increase voter turnout and whether they could be used to improve civic educational programs. We do this based on data from Switzerland and the Swiss VAA smartvote.
Anonymity in a World of Digital Books: Google Books, Privacy, and the Freedom to Read
Authors: Jones Elisabeth A. , Janes Joseph W.
Published: December 2010

With its Books project, Google has made an unprecedented effort to aggregate a comprehensive public‐access collection of the world's books. If successful, Google's collection would become the world's largest and most broadly accessible public book collection—indeed, project leaders have frequently spoken of their desire to create a “universal library” (Toobin 2007). Still, the Google “library” would differ from established contexts for the provision of free, public access to reading materials—like public libraries—along several policy‐related dimensions, of which perhaps the most glaring is its treatment of reader privacy. This paper teases out the specific differences in reader privacy protections between the American public library and Google Books, and what those differences might mean for the values and goals that such contexts have historically embodied. Our analysis is structured by Helen Nissenbaum's “contextual integrity decision heuristic” (2009), which focuses on revealing changes in informational norms and transmission principles between prevailing and novel settings and practices. Based on this analysis, we recommend a two‐pronged approach to alleviating the threats to reader privacy posed by Google Books: both data policy modifications within Google itself and inscription of privacy protections for online reading into federal or international law.
Of States and Borders on the Internet: The Role of Domain Name Extensions in Expressions of Nationalism Online in Kazakhstan
Authors: Shklovski Irina , Struthers David M.
Published: December 2010

The space of the Internet is often described as easy to traverse with no regard for national borders. Yet few have considered what such easy border crossings on the Internet might mean to the ordinary people actually doing the traversing. Our qualitative study of regular Internet users in Kazakhstan shows that the naming of a state‐controlled space on the Internet, through the use of country code top‐level domain names (ccTLDs), does in fact matter to the average user. People are aware of national boundary traversals as they navigate the Internet. Respondents in our study identified their activity on the Internet as happening within or outside the space of the state to which they felt allegiance and belonging. National borders are demarcated on the Internet through naming via ccTLDs and can result in individual expressions of various types of nationalism online. We find that ccTLDs are not just symbolic markers but have real meaning and their importance increases in locations where notions of statehood are in flux.
Medical Refugees and the Future of Health Tourism
Authors: Amodeo Joseph
Published: December 2010

Health tourism presents American policymakers with a perplexing situation, which requires an examination of the implications of such tourism on trade and economics, especially when considering the role of the General Agreement on Trade in Services (GATS). Currently, the issue of health tourism, or the means by which consumers seek health services abroad, and its policy implications has yet to gain the attention of policymakers in the United States and the international community. By reviewing existing literature and relevant international treaties, it becomes apparent that the expanding popularity of health tourism necessitates exploring the potential implications of health tourism. Further, in assessing its impact, policymakers must examine questions related to quality, performance, and accountability of those facilities hosting health tourists.
Do People Support Sin Taxes? A Population Survey of Attitudes
Authors: Brezis Mayer , Marans Rachel
Published: December 2010

Background: The rising costs of healthcare and the recognition that many chronic diseases are preventable by healthy lifestyles have led to inquiry about economic incentives for modifying behavior. The present work explored people's attitudes towards a differential health insurance premium based on lifestyle. Methods: A random dial telephone survey of the Israeli population assessed the degree of agreement with a policy of differential taxing on health insurance premium with a discount for individuals maintaining a healthy lifestyle, such as non‐smoking or regular exercise. Results: A majority (66%) of respondents expressed support for a policy of differential taxing. Support was high across all sectors of society, including Arab Israelis (92%), Russians (71%), orthodox religious individuals (78%), persons with low education (72%) or low income (69%), smokers (51%), and sedentary people (65%). Conclusion: A large majority of the population supports differential health insurance premiums according to lifestyle.
Policy Adoption of the Special Design (SD) Provision in the State Children's Health Insurance Program
Authors: Park Sang‐Chul , Lee Se‐Jin , Lee Keon‐Hyung
Published: December 2010

Introduction: Political partisanship and institutional arrangement can influence a state's decision to include special provisions (e.g., a premium assistance program, an enrollee buy‐in program, coverage expansion and health services initiatives) in the State Children's Health Insurance Program (SCHIP). Methods: Four published sources of data on SCHIP for 2005 were subjected to a logistic regression analysis to investigate the political and practical relationships. Results: The logistic regression analysis reveals that a Democratic governor and dominance in both the upper and lower legislative bodies combined with the existence of a SCHIP increase the likelihood that special design features will be adopted. Conclusion: Democratic political dominance in United States favors expanded SCHIP. States with more limited income eligibility are less likely to adopt special design provisions. The dominance of liberal ideology in politics, an increased organizational flexibility and the existing scope of beneficiaries provide the conditions for addressing a new children's health policy in international countries.
A Preliminary Assessment of Chlamydia and Gonnorhea Infections in the U.S.A. Communities Neighboring Military Installations
Authors: Koizumi Naoru , Nicogossian Arnauld , Patel Amit , Kloc Michelle
Published: December 2010

Sexually transmitted infections (STIs) among U.S. military personnel and neighboring communities prior, during, and after deployment are a threat to military readiness and community health. This pilot study used data from the Virginia Department of Health. Geographic and spatial pattern analysis of two STIs, Chlamydia trachomatis and Neisseria gonorrhoeae, were conducted. Of special interest was the STI spread patterns correlated with locations of military staging bases, in the aftermath of September 11, 2001. Higher prevalence rates of STIs were found in the counties contiguous to military installations.
Ulipristal Acetate: A New Emergency Contraceptive that is Safe and More Effective than Levonorgestrel
Authors: Fine Paul M
Published: December 2010

Ulipristal acetate (UPA), a selective progesterone receptor modulator, when taken as a single 30-mg dose, is safe and effective for emergency contraception up to 5 days (120 h) following unprotected intercourse. This indication has been approved in Europe since May 2009 and was approved by the US FDA in August 2010. The older progesterone-only emergency contraceptive, levonorgestrel (LNG), is approved only up to 72 h after unprotected intercourse. UPA is effective in delaying or inhibiting ovulation, even if taken 24 to 48 h prior to expected ovulation, a time when LNG is no longer effective. A recent meta-analysis of two randomized clinical trials showed UPA to have a pregnancy risk 42% lower than LNG up to 72 h, and 65% lower in the first 24 h following unprotected intercourse. In a randomized trial enrolling women up to 5 days after unprotected intercourse, significantly more pregnancies were prevented with UPA than with LNG when taken beyond 72 h.
The Epidemiology of Breast Cancer: An Up-to-Date Synopsis and Suggestions for the Future
Authors: Ciatto Stefano
Published: December 2010

Breast Cancer Epidemiology provides a comprehensive, and the most up-to-date review of what is known about how, when and why breast cancer happens. The most interesting feature of this book is that it does not necessarily stop at what is firmly known, based on definitive controlled evidence, but it dares to provide a deep insight into what is likely and what might be, including scenarios (e.g., screening), which are still being developed and are yet to be fully understood.
The Prevention of Cervical Cancer in Africa
Authors: Fiander AN
Published: December 2010

In this article we aim to draw attention to the burden of cervical cancer in Africa for reproductive health and review strategies for prevention, including appropriate noncytology-based cervical screening and prophylactic human papillomavirus vaccination. We consider the heavy burden of disease attributable to human papillomavirus infection borne by developing countries, particularly in Africa. Following identification of the human papillomavirus as the infectious etiological agent and elucidation of the long natural history of cervical neoplasia, cervical cancer is now one of the most preventable of all cancers. Opportunities for primary prevention by prophylactic vaccination and secondary prevention by appropriate cervical screening are discussed, together with the importance of population coverage. Qualitative work on attitudes towards cervical cancer prevention, education needs, the creation of an environment for informed choice and uptake are essential aspects of effective prevention programs. Cervical cancer poses a huge health burden in Africa. It is a disease that is eminently preventable given political will, the availability of affordable vaccines, appropriate cervical screening and access to cheap, point-of-care human papillomavirus testing. There are a number of unanswered questions for the prevention of cervical cancer and a need for demonstration projects to address these and further develop prevention strategies.
Preoperative Evaluation of Adnexal Masses
Authors: Miller Rachel Ware , van Nagell John R
Published: December 2010

Evaluation of: Daemen A, Valentin L, Fruscio R et al.: Improving the preoperative classification of adnexal masses as benign or malignant by second stage tests. Ultrasound Obstet. Gynecol. (2010) (Epub ahead of print). This is a large multicenter trial designed to determine the efficacy of second stage diagnostic testing when the primary diagnostic test has provided an uncertain diagnosis of a benign or malignant adnexal mass. Women with adnexal masses were evaluated using ultrasonography. Clinical and ultrasonographic data were employed to determine the risk of malignancy using 11 statistical models and their performance was evaluated based on histologic findings at surgery. Overall, the ultrasound examiner's subjective evaluation had the highest area under the curve and specificity, with respect to diagnostic performance. Of the mathematical models evaluated, LR1 performed the best, with an area under the curve of 0.95, a sensitivity of 92% and a specificity of 84%. The accuracy of subjective evaluation did not improve with the addition of any second stage test. If the LR1 model was used as the primary diagnostic test, the addition of subjective evaluation as a secondary test was found to be beneficial.
Menopause and Mental Well-Being: Timing of Symptoms and Timing of Hormone Treatment
Authors: Pluchino Nicola , Bucci Fiorella , Cela Vito , Cubeddu Alessandra , Genazzani Andrea Riccardo
Published: December 2010

In the aftermath of the Women's Health Initiative studies, both the clinical and basic science communities had to sort out divergent results among experimental findings, observational data and randomized controlled trials in order to establish a shared analysis. The scientific community formally debates the role of different HRT formulations, hormone doses, time of treatment initiation since the menopause and the age of treated women. Basic scientists demonstrated that the multiple neuroprotective effects of estrogen on brain cells may induce a differential biological response according to the time of treatment. Progesterone (but not all synthetic progestins) also has pivotal neuroactive functions in animal models of reproductive aging. Additionally, epidemiological surveys provide information regarding the detrimental role of hypogonadism on mental well-being. The present article briefly summarizes current evidence supporting the neuroactive role of estrogen, with reference to the clinical finding sustaining the intriguing hypothesis of the early female brain senescence as a highly responsive period to estrogen treatment.
Hypoactive Sexual Desire Disorder and Current Pharmacotherapeutic Options in Women
Authors: Palacios Santiago
Published: December 2010

Hypoactive Sexual Desire Disorder (HSDD) is the most common female sexual dysfunction. The diagnosis of HSDD requires the existence of personal distress or interpersonal difficulties associated with low sexual desire, that cannot be explained by any other psychiatric affection and that is not exclusively due to a disease or substance. HSDD can have a serious effect on emotional wellbeing and interpersonal relationships, and it occurs in premenopausal and postmenopausal women. The Decreased Sexual Desire Screener is a shortened diagnostic method designed to help doctors who are not specialized in female sexual dysfunction to diagnose acquired HSDD in women. There is evidence that treatment with androgens or with estrogens is effective in HSDD; however, important unanswered questions still exist. Presently, new therapeutic strategies to combat HSDD are being researched, including novel methods of testosterone provision and drugs that act upon the CNS.
A New TNM Classification for Breast Cancer to Meet the Demands of the Present and the Challenges of the Future
Authors: Zurrida Stefano , Veronesi Umberto
Published: December 2010

In this article we will describe our proposed changes to the breast cancer tumor node metastasis (TNM) classification which, while retaining TNM structure to ensure backwards compatibility, will render it more useful and better able to accommodate future developments. We propose changing T to specify exact tumor size (a tumor of pathological diameter 1.7 cm would be pT1.7); changing N to specify the number of metastatic lymph nodes over the total number removed (e.g., pN5/21); adding suffixes to M to indicate metastatic site; removing in situ neoplasms from the classification, since they are not carcinomas and are incapable of metastasizing; and removing the terms ‘infiltrating’ and ‘invasive’ since they are redundant. Finally, we would include hormone receptor, HER2, and other biological indicators of prognosis, as they are verified, in a placeholder system appended to the TNM. These proposals shift the emphasis from the quantity of tumor present to the quality of the cancer.
The Current Status of Lymphadenectomy in the Management of Endometrial Cancer
Authors: Creasman WT
Published: December 2010

The International Gynocologic Cancer Society is a biannual meeting for those multidiscipline physicians who are involved in research and the clinical care of women with a gynecologic cancer. Approximately 3000 physicians from all geographic areas attended and heard presentations covering all aspects of gynecologic cancer.
Gonadal Hormones and Cognitive Aging: A Midlife Perspective
Authors: Henderson Victor W
Published: December 2010

Gonadal steroids affect a variety of brain processes. Cognitive consequences of hormonal changes associated with menopause are of scientific interest and of relevance to public health. Natural menopause is a normal physiological process that can only be directly studied through observational research. Similarly, surgical menopause in humans is rarely directly amenable to experimental research. Causality with respect to cognitive outcomes is, therefore, difficult to infer. Cross-sectional and longitudinal findings from the Melbourne Women's Midlife Health Project, the Study of Women's Health Across the Nation and other midlife cohorts suggest that cognitive consequences of the natural menopausal transition are probably small, at least during midlife and at least for episodic memory, which is a key cognitive domain. The data for episodic memory are the most robust. Midlife episodic memory performance is similar both shortly before and after natural menopause, and serum estradiol concentration in midlife is not associated with episodic memory performance. Effects of natural menopause on other cognitive domains, cognitive consequences of surgical menopause and late-life cognitive consequences of midlife hormonal exposures are less well understood and merit continued study.
Fatty acid composition including trans isomers of Serbian biscuits
Authors: Kravic Snezana , Suturovic Zvonimir , Svarc-Gajic Jaroslava , Stojanovic Zorica , Pucarevic Mira , Nikolic Ivana
Published: December 2010

An experimental study was carried out with the aim of evaluating the quality
of the lipid fraction of Serbian biscuits. Total fat contents of the biscuit
samples ranged between 10.2% and 24.5%. The saturated, cis-monounsaturated
and cis-polyunsaturated fatty acid contents were within the ranges of
18.585.6%, 10.649.9% and 2.713.3% of total fatty acids, respectively. The
content of trans fatty acids (TFA) ranged from 0.0% to 42.5% and the mean
was 10.2%. In a total of 34 investigated samples, 10 of them were found to
be trans - free, 8 contained low level of TFA (under 2%), 4 samples
contained between 2 and 10% of TFA, while 12 samples contained very high
amounts of TFA (12.042.5%). The results obtained showed a considerable
variability in fatty acid composition of biscuits which indicated that
different types of fats and oils were used for production of biscuits in
Serbia.
Iz b''lgaro-sr''bskite knizovni vr''zki prez XIII v
Authors: Velinova Vasja
Published: December 2010

The article examines a cycle of prayers kept in the well known miscellanea of
Priest Dragol from the third quarter of the 13th century (the manuscript is
kept in the Belgrade National Library, signature No. 651), attributed to St.
Sysinnios. The fourteen copies, which have been found until now, are
systematized according to their textual versions. The main result is that
the Miscellanea of Priest Dragol represents a very important moment in the
diffusion of such texts because: 1. it attests the existence of earlier
copies of Sysinnios? prayers both in the Slavonic and Greek traditions; 2.
it offers four different versions of ancient Greek patterns; 3. it should be
considered as the basis of development of the apothropeic literature among
the Slavs.
Reconsidering the Orthodox notated manuscripts from the end of the 12th and 13th century, related to Bulgaria
Authors: Kujumdzieva Svetlana
Published: December 2010

Manuscripts with notation in the restored Bulgarian state, after Byzantine
rule from 1018 to 1187, continued the tradition from former times of being
written in Slavic (old-Bulgarian) and Greek, a bilingual practice that was
established during the time of SS. Cyril and Methodios. The Greek language
did not have an ethnic connotation: it was perceived as the language of the
rich culture of Antiquity and as a liturgical language. Most of the
manuscripts originated from the south-western Bulgarian lands. Those in
Slavic belong to the type of Menaia and Triodia-Pentekostaria; fewer of them
are Oktoechoi. The Menaion, the Triodion-Pentekostarion, and the Oktoechos
all together constitute the book of the Sticherarion. The manuscripts in
Slavic were notated in the Palaeo-Byzantine notation of the archaic
adiastematic type. The musical signs in them could be characterized as
"instructions" for singing: they did not fix the exact pitch of the tone but
only gave the direction of the melody. The manuscripts in Palaeo-Byzantine
notation can be systematized into three groups: manuscripts that were partly
notated in the Palaeo-Byzantine notation of the Coislin and/or the Chartres
type, manuscripts in theta notation, and manuscripts that were fully notated
in Palaeo-Byzantine notation. In the Bulgarian libraries from the period
under consideration, there are also preserved manuscripts in Greek. They are
of the Sticherarion type and were notated in Middle Byzantine notation. The
origins of these Sticheraria are linked to the Bachkovo monastery.
Manuscripts in Slavic notated in Middle Byzantine notation have not been
found and there is no evidence that this notation was adapted to the Slavic
language ? either in Bulgaria, or in any other Slavic Orthodox country.
However, it does not mean that this notation was not known in any one of
them: the Middle Byzantine manuscripts in Greek preserved in the Bulgarian
libraries prove that this notation was known. As a whole, till the end of the
13th century, the manuscripts with notation offer a picture of a very dynamic
musical practice. Various types of notation show the various levels to which
church music developed and functioned: all of the notated manuscripts display
a high professional level; the partly notated manuscripts and these in theta
notation ? indicate an oral level with particular characteristics.
Turnovo: Principles and means of constructing the sacral topography of a medieval Bulgarian capital
Authors: Erdeljan Jelena
Published: December 2010

This paper presents the principles and means of constructing the identity and
sacral topography of Trnovo as the capital of the Second Bulgarian Empire
(XII-XIV centuries). The image of Trnovo as the ideal city, one whose fate
is (pre)destined by Divine Providence, is constructed by employing a number
of hierotopic instruments - texts of different genres, reliquary programs
and spatial disposition of churches and monasteries in the city and its
immediate environs as well as on elements of visual culture. This endeavor
relies on the (universal) model of the capital of the Byzantine Empire Constantinople, as well as on that set by Preslav, the capital of the First
Bulgarian Empire.
Power and history in Bulgaria at the end of the 12th and during the 13th century
Authors: Kajmakamova Milijana
Published: December 2010

This study aims to represent the campaign the members of the Assenid dynasty
launched when they started a movement for the restoration and, subsequently the consolidation of the Bulgarian kingdom that was expected to achieve
interaction between power and history. The process started in the late 12th
century, continued during the 13th century, and culminated in 1235 with the
restoration of the Bulgarian patriarchy, thanks to the tsar Ivan Assen II
(1218-1231). The analysis pays close attention to the two major trends which
show the aforementioned interaction: the share of historical records in the
propaganda the Assenids conducted in support of their newly-won power and
the prominence Bulgarian historiography enjoyed during the same period.
Die siedlungsstruktur der region melnik in spatbyzantinischer und osmanischer zeit
Authors: Popovic Mihailo
Published: December 2010

The Byzantine and Old Slavonic charters on the city of Melnik and its
surrounding area for the period between 1216/1259 and 1395 have not been
analysed so far according to the "Central Place Theory". On the one hand
this analysis shows clearly the limits in the localization of toponyms
mentioned in the charters. On the other hand it is possible to discern that
the urban catchment of the city in the Late Byzantine period was not that
spacious as postulated in the secondary literature, but has to be revised on
the basis of the present findings in favor of a spatially limited
catchment.
Pomen Petrovaradina u Ekthesis chronike iz XVI veka
Authors: Stojkovski Boris
Published: December 2010

Ekthesis chronike is a XVI century work written by an anonymous author. This
author or compiler gives some data on our regions as well. The topic of this
work is the part of the chronicle which relates to the Ottoman conquest of
Hungary, especially to the mention of Petrovaradin, i. e. its? siege and
conquest by the Turks in 1526. The data provided by Ekthesis chronike is
analyzed and compared with other contemporary sources, especially Turkish
and Hungarian. Even though it is written in a popular manner and contains
some mistakes, this chronicle is a very interesting source for late
Byzantine history, but also for the period after the fall of Constantinople
and Ottoman conquests during the XVI century.
The authority of the ecumenical patriarch in the Orthodox Church: A historico-canonical analysis
Authors: Vranic Vasilije
Published: December 2010

During the 20th century, the exact role and the scope of jurisdictional
authority of the Ecumenical Patriarch was an object of attention of both
theologians and historians. The problem of defining the Patriarch was
reactualized through the intensification of conciliar negotiations of
Orthodox Churches. The purpose of this article is to demonstrate that the
pretensions of the Ecumenical Patriarch for universal jurisdiction over the
entire Orthodox Diaspora, and the pretensions for the right of final
arbitration in the ecclesial matters of the entire Orthodox communion, do
not have a support in the Orthodox Ecclesiology. This will be argued in a
historical analysis of the relevant prescriptions of the Eastern Orthodox
Canon Law, which will be placed into the context of the history of the
Christian Church, primarily of the Patristic period, since there disciplines
play a vital role in the Orthodox understanding of Ecclesiological
Tradition.
Internally-driven change and feature correspondence in object representation: A key to children's essentialism?
Authors: Haman Maciej
Published: December 2010

Internally-driven change and feature correspondence in object representation: A key to children's essentialism?

Two experiments were run to investigate how preschoolers use the pattern of an object's change as a cue to noticing correlations among the object's subsequent features. Four-year-old children were familiarized with either an internally or externally-driven transformation of an object, and tested for identification of an animation that did not match the familiar sequence of the object's features. In both experiments children in the internal-change group identified the incorrect sequence significantly more quickly than in the external-change condition. These results strongly suggest that perception of internally-driven transformation facilitates the formation of and/or access to a representation of correspondences between subsequent features of an object. The possible role of this mechanism in essentialist thinking is discussed at the end of the paper.