bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of sarcoidosis in Japan
Authors: Morimoto T. , Azuma A. , Abe S. , Usuki J. , Kudoh S. , Sugisaki K. , Oritsu M. , Nukiwa T.
Published: October 2007

The present study was designed to identify recent clinical phenotypes using the National Epidemiological Survey and to compare findings with those of previous surveys in Japan.

Pathologically confirmed sarcoidosis cases newly diagnosed in 2004 were eligible for the present study. Disease parameters were recorded and compared.

A total of 1,027 patients were enrolled from a cluster encompassing 79.4% of the entire Japanese population. The study participants consisted of 364 males and 663 females, providing an average incidence rate of 1.01 per 100,000 inhabitants (0.73 for males and 1.28 for females). The age-specific incidence rate displayed a biphasic pattern in the whole patient population and in the females. The male incidence rates peaked in the 20–34-yr-old group. A second peak for 50–60-yr-old females showed a higher incidence than the first younger peak. Patients with abnormalities in eyes, skin and cardiac laboratory findings accounted for 54.8, 35.4 and 23.0% of cases, respectively. The female/male incidence ratio was increased, and the frequency of eye and skin involvement and cardiac abnormality was higher than in previous surveys conducted in Japan.

In conclusion, the data obtained in the present study differ from those of other countries and showed changes in sarcoidosis clinical phenotypes compared with previous studies in Japan.
Cirrhosis-induced defects in innate pulmonary defenses against Streptococcus pneumoniae
Authors: Propst-Graham Katie L , Preheim Laurel C , Vander Top Elizabeth A , Snitily Mary U , Gentry-Nielsen Martha J
Published: October 2007

Background

The risk of mortality from pneumonia caused byStreptococcus pneumoniaeis increased in patients with cirrhosis. However, the specific pneumococcal virulence factors and host immune defects responsible for this finding have not been clearly established. This study used a cirrhotic rat model of pneumococcal pneumonia to identify defect(s) in innate pulmonary defenses in the cirrhotic host and to determine the impact of the pneumococcal toxin pneumolysin on these defenses in the setting of severe cirrhosis.

Results

No cirrhosis-associated defects in mucociliary clearance of pneumococci were found in these studies, but early intrapulmonary killing of the organisms before the arrival of neutrophils was significantly impaired. This defect was exacerbated by pneumolysin production in cirrhotic but not in control rats. Neutrophil-mediated killing of a particularly virulent type 3 pneumococcal strain also was significantly diminished within the lungs of cirrhotic rats with ascites. Levels of lysozyme and complement component C3 were both significantly reduced in bronchoalveolar lavage fluid from cirrhotic rats. Finally, complement deposition was reduced on the surface of pneumococci recovered from the lungs of cirrhotic rats in comparison to organisms recovered from the lungs of control animals.

Conclusion

Increased mortality from pneumococcal pneumonia in this cirrhotic host is related to defects in both early pre-neutrophil- and later neutrophil-mediated pulmonary killing of the organisms. The fact that pneumolysin production impaired pre-neutrophil-mediated pneumococcal killing in cirrhotic but not control rats suggests that pneumolysin may be particularly detrimental to this defense mechanism in the severely cirrhotic host. The decrease in neutrophil-mediated killing of pneumococci within the lungs of the cirrhotic host is related to insufficient deposition of host proteins such as complement C3 on their surfaces. Pneumolysin likely plays a role in complement consumption within the lungs. Our studies, however, were unable to determine whether pneumolysin more negatively impacted this defense mechanism in cirrhotic than in control rats. These findings contribute to our understanding of the defects in innate pulmonary defenses that lead to increased mortality from pneumococcal pneumonia in the severely cirrhotic host. They also suggest that pneumolysin may be a particularly potent pneumococcal virulence factor in the setting of cirrhosis.
The CORONIS Trial. International study of caesarean section surgical techniques: a randomised fractional, factorial trial
Authors:   The CORONIS Trial Collaborative Group
Published: October 2007

Background

Caesarean section is one of the most commonly performed operations on women throughout the world. Rates have increased in recent years – about 20–25% in many developed countries. Rates in other parts of the world vary widely.

A variety of surgical techniques for all elements of the caesarean section operation are in use. Many have not yet been rigorously evaluated in randomised controlled trials, and it is not known whether any are associated with better outcomes for women and babies. Because huge numbers of women undergo caesarean section, even small differences in post-operative morbidity rates between techniques could translate into improved health for substantial numbers of women, and significant cost savings.

Design

CORONIS is a multicentre, fractional, factorial randomised controlled trial and will be conducted in centres in Argentina, Ghana, India, Kenya, Pakistan and Sudan.

Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision.

Five comparisons will be carried out in one trial, using a 2 × 2 × 2 × 2 × 2 fractional factorial design. This design has rarely been used, but is appropriate for the evaluation of several procedures which will be used together in clinical practice. The interventions are:

• Blunt versus sharp abdominal entry

• Exteriorisation of the uterus for repair versus intra-abdominal repair

• Single versus double layer closure of the uterus

• Closure versus non-closure of the peritoneum (pelvic and parietal)

• Chromic catgut versus Polyglactin-910 for uterine repair

The primary outcome is death or maternal infectious morbidity (one or more of the following: antibiotic use for maternal febrile morbidity during postnatal hospital stay, antibiotic use for endometritis, wound infection or peritonitis) or further operative procedures; or blood transfusion.

The sample size required is 15,000 women in total; at least 7,586 women in each comparison.

Discussion

Improvements in health from optimising caesarean section techniques are likely to be more significant in developing countries, because the rates of postoperative morbidity in these countries tend to be higher. More women could therefore benefit from improvements in techniques.

Trial registration

The CORONIS Trial is registered in the Current Controlled Trials registry. ISCRTN31089967.
Clinical implications of metastatic lymph node ratio in gastric cancer
Authors: Liu Caigang , Lu Ping , Lu Yang , Xu Huimian , Wang Shubao , Chen Junqing
Published: October 2007

Background

The 5-year survival rate in patients with gastric cancer is still poor, and lymph node metastasis is considered one of the most important prognostic factors. However, there are controversies in the classification of lymph node metastasis in gastric cancer. This study was carried out to investigate whether the metastatic lymph node ratio is a reliable classification of lymph node metastasis in gastric cancer in Chinese.

Methods

224 cases with gastric cancer with more than D1 dissection were retrospectively reviewed. The association between the total number of resected lymph nodes and the number of metastatic lymph nodes was determined. The prognostic value of the metastastic node ratio, defined as the ratio of the number of metastatic lymph nodes over the total number of resected lymph nodes, and the pN classification was assessed.

Results

The number of metastatic lymph node increased with the number of total resected lymph nodes. A Cox regression revealed that the metastatic node ratio, the number of metastatic nodes, histological type, and histological growth pattern independently influenced prognosis. The 5-year survival rates were 78%, 61%, 25%, 0% in cases with a metastastic node ratio of 0%, > 0% but < 40%, 40–80%, > 80%, respectively (P< 0.001), and were 78%, 62%, 38%, 0% in cases with gastric cancer histologically classified as pN0, pN1, pN2, pN3, respectively (P< 0.001).

Conclusion

The metastatic lymph node ratio is a simple and useful independent prognostic factor. It may obviate possible confounding factors that are related to stage migration, and should be considered as an important component in the lymph node category.
Multiscale computational analysis of Xenopus laevis morphogenesis reveals key insights of systems-level behavior
Authors: Robertson Scott H , Smith Chris K , Langhans Anna L , McLinden Sara E , Oberhardt Matthew A , Jakab Karoly R , Dzamba Bette , DeSimone Douglas W , Papin Jason A , Peirce Shayn M
Published: October 2007

Background

Tissue morphogenesis is a complex process whereby tissue structures self-assemble by the aggregate behaviors of independently acting cells responding to both intracellular and extracellular cues in their environment. During embryonic development, morphogenesis is particularly important for organizing cells into tissues, and although key regulatory events of this process are well studied in isolation, a number of important systems-level questions remain unanswered. This is due, in part, to a lack of integrative tools that enable the coupling of biological phenomena across spatial and temporal scales. Here, we present a new computational framework that integrates intracellular signaling information with multi-cell behaviors in the context of a spatially heterogeneous tissue environment.

Results

We have developed a computational simulation of mesendoderm migration in the Xenopus laevis explant model, which is a well studied biological model of tissue morphogenesis that recapitulates many features of this process during development in humans. The simulation couples, via a JAVA interface, an ordinary differential equation-based mass action kinetics model to compute intracellular Wnt/β-catenin signaling with an agent-based model of mesendoderm migration across a fibronectin extracellular matrix substrate. The emergent cell behaviors in the simulation suggest the following properties of the system: maintaining the integrity of cell-to-cell contact signals is necessary for preventing fractionation of cells as they move, contact with the Fn substrate and the existence of a Fn gradient provides an extracellular feedback loop that governs migration speed, the incorporation of polarity signals is required for cells to migrate in the same direction, and a delicate balance of integrin and cadherin interactions is needed to reproduce experimentally observed migratory behaviors.

Conclusion

Our computational framework couples two different spatial scales in biology: intracellular with multicellular. In our simulation, events at one scale have quantitative and dynamic impact on events at the other scale. This integration enables the testing and identification of key systems-level hypotheses regarding how signaling proteins affect overall tissue-level behavior during morphogenesis in an experimentally verifiable system. Applications of this approach extend to the study of tissue patterning processes that occur during adulthood and disease, such as tumorgenesis and atherogenesis.
Cartilage markers and their association with cartilage loss on magnetic resonance imaging in knee osteoarthritis: the Boston Osteoarthritis Knee Study
Authors: Hunter David J , Li Jiang , LaValley Michael , Bauer Doug C , Nevitt Michael , DeGroot Jeroen , Poole Robin , Eyre David , Guermazi Ali , Gale Dan , Felson David T
Published: October 2007

We used data from a longitudinal observation study to determine whether markers of cartilage turnover could serve as predictors of cartilage loss on magnetic resonance imaging (MRI). We conducted a study of data from the Boston Osteoarthritis of the Knee Study (BOKS), a completed natural history study of knee osteoarthritis (OA). All subjects in the study met American College of Rheumatology criteria for knee OA. Baseline and follow-up knee magnetic resonance images were scored for cartilage loss by means of the WORMS (Whole Organ Magnetic Resonance Imaging Score) semiquantitative grading scheme. Within the BOKS population, 80 subjects who experienced cartilage loss and 80 subjects who did not were selected for the purposes of this nested case control study. We assessed the baseline levels of cartilage degradation and synthesis products by means of assays for type I and II cleavage by collagenases (Col2:3/4Cshort or C1,2C), type II cleavage only with Col2:3/4Clongmono (C2C), type II synthesis (C-propeptide), the C-telopeptide of type II (Col2CTx), aggrecan 846 epitope, and cartilage oligomeric matrix protein (COMP). We performed a logistic regression to examine the relation of levels of each biomarker to the risk of cartilage loss in any knee. All analyses were adjusted for gender, age, and body mass index (BMI); results stratified by gender gave similar results. One hundred thirty-seven patients with symptomatic knee OA were assessed. At baseline, the mean (standard deviation) age was 67 (9) years and 54% were male. Seventy-six percent of the subjects had radiographic tibiofemoral OA (Kellgren & Lawrence grade of greater than or equal to 2) and the remainder had patellofemoral OA. With the exception of COMP, none of the other biomarkers was a statistically significant predictor of cartilage loss. For a 1-unit increase in COMP, the odds of cartilage loss increased 6.09 times (95% confidence interval [CI] 1.34 to 27.67). After the analysis of COMP was adjusted for age, gender, and BMI, the risk for cartilage loss was 6.35 (95% CI 1.36 to 29.65). Among subjects with symptomatic knee OA, a single measurement of increased COMP predicted subsequent cartilage loss on MRI. The other biochemical markers of cartilage synthesis and degradation do not facilitate prediction of cartilage loss. With the exception of COMP, if changes in cartilage turnover in patients with symptomatic knee OA are associated with cartilage loss, they do not appear to affect systemic biomarker levels.
Surprising complexity of the ancestral apoptosis network
Authors: Zmasek Christian M , Zhang Qing , Ye Yuzhen , Godzik Adam
Published: October 2007

Background

Apoptosis, one of the main types of programmed cell death, is regulated and performed by a complex protein network. Studies in model organisms, mostly in the nematode Caenorhabditis elegans, identified a relatively simple apoptotic network consisting of only a few proteins. However, analysis of several recently sequenced invertebrate genomes, ranging from the cnidarian sea anemone Nematostella vectensis, representing one of the morphologically simplest metazoans, to the deuterostomes sea urchin and amphioxus, contradicts the current paradigm of a simple ancestral network that expanded in vertebrates.

Results

Here we show that the apoptosome-forming CED-4/Apaf-1 protein, present in single copy in vertebrate, nematode, and insect genomes, had multiple paralogs in the cnidarian-bilaterian ancestor. Different members of this ancestral Apaf-1 family led to the extant proteins in nematodes/insects and in deuterostomes, explaining significant functional differences between proteins that until now were believed to be orthologous. Similarly, the evolution of the Bcl-2 and caspase protein families appears surprisingly complex and apparently included significant gene loss in nematodes and insects and expansions in deuterostomes.

Conclusion

The emerging picture of the evolution of the apoptosis network is one of a succession of lineage-specific expansions and losses, which combined with the limited number of 'apoptotic' protein families, resulted in apparent similarities between networks in different organisms that mask an underlying complex evolutionary history. Similar results are beginning to surface for other regulatory networks, contradicting the intuitive notion that regulatory networks evolved in a linear way, from simple to complex.
Definitive hematopoiesis initiates through a committed erythromyeloid progenitor in the zebrafish embryo
Authors: Bertrand Julien Y. , Kim Albert D. , Violette Emily P. , Stachura David L. , Cisson Jennifer L. , Traver David
Published: October 2007

Shifting sites of blood cell production during development is common across widely divergent phyla. In zebrafish, like other vertebrates, hematopoietic development has been roughly divided into two waves, termed primitive and definitive. Primitive hematopoiesis is characterized by the generation of embryonic erythrocytes in the intermediate cell mass and a distinct population of macrophages that arises from cephalic mesoderm. Based on previous gene expression studies, definitive hematopoiesis has been suggested to begin with the generation of presumptive hematopoietic stem cells (HSCs) along the dorsal aorta that express c-myb and runx1. Here we show, using a combination of gene expression analyses, prospective isolation approaches,transplantation, and in vivo lineage-tracing experiments, that definitive hematopoiesis initiates through committed erythromyeloid progenitors (EMPs) in the posterior blood island (PBI) that arise independently of HSCs. EMPs isolated by coexpression of fluorescent transgenes driven by the lmo2and gata1 promoters exhibit an immature, blastic morphology and express only erythroid and myeloid genes. Transplanted EMPs home to the PBI,show limited proliferative potential, and do not seed subsequent hematopoietic sites such as the thymus or pronephros. In vivo fate-mapping studies similarly demonstrate that EMPs possess only transient proliferative potential, with differentiated progeny remaining largely within caudal hematopoietic tissue. Additional fate mapping of mesodermal derivatives in mid-somitogenesis embryos suggests that EMPs are born directly in the PBI. These studies provide phenotypic and functional analyses of the first hematopoietic progenitors in the zebrafish embryo and demonstrate that definitive hematopoiesis proceeds through two distinct waves during embryonic development.
Single-molecule mechanical unfolding and folding of a pseudoknot in human telomerase RNA
Authors: Chen Gang , Wen Jin-Der , Tinoco Ignacio
Published: October 2007

RNA unfolding and folding reactions in physiological conditions can be facilitated by mechanical force one molecule at a time. By using force-measuring optical tweezers, we studied the mechanical unfolding and folding of a hairpin-type pseudoknot in human telomerase RNA in a near-physiological solution, and at room temperature. Discrete two-state folding transitions of the pseudoknot are seen at ∼10 and ∼5 piconewtons (pN), with ensemble rate constants of ∼0.1 sec−1, by stepwise force–drop experiments. Folding studies of the isolated 5′-hairpin construct suggested that the 5′-hairpin within the pseudoknot forms first, followed by formation of the 3′-stem. Stepwise formation of the pseudoknot structure at low forces are in contrast with the one-step unfolding at high forces of ∼46 pN, at an average rate of ∼0.05 sec−1. In the constant-force folding trajectories at ∼10 pN and ∼5 pN, transient formation of nonnative structures were observed, which is direct experimental evidence that folding of both the hairpin and pseudoknot takes complex pathways. Possible nonnative structures and folding pathways are discussed.
Hip dysplasia and the torn acetabular labrum
Authors: Haene R. A. , Bradley M. , Villar R. N.
Published: October 2007

The epidemiological data and intra-operative findings from 260 consecutive arthroscopically-diagnosed acetabular labral tears seen over a ten-year period were analysed. Radiographs of 128 of these patients were assessed for dysplasia using established radiological parameters. Patients with acetabular dysplasia were then compared against those without in order to identify any differences in gender, age, the side of the tear, the pattern of the tear, the number of quadrants involved, the quadrant preference and the prevalence of intra-articular comorbidity. Dysplasia was found in 46% (59 of 128) of the hips. No significant differences existed between the dysplastic and non-dysplastic subgroups as regards gender distribution, the side of the lesion, the number of quadrants involved or the distribution of tears among the quadrants. However, tears associated with dysplasia were diagnosed in an older age group, had a different pattern and were associated with a much higher prevalence of osteoarthritis.
Does the upper femoral epiphysis slip or rotate?
Authors: Tayton K.
Published: October 2007

Although much has been published on the causes of slipped upper femoral epiphysis and the results of treatment, little attention has been given to the mechanism of the slip. This study presents the results of the analysis of 13 adolescent femora, and the attempts to reproduce the radiological appearances of a typical slip. The mean age of the skeletons was 13 years (11 to 15). It was found that the internal bony architecture in the zone of the growth plate was such that a slip of the epiphysis on the metaphysis (in the normal meaning of the word slip) could not take place, largely relating to the presence of a tubercle of bone projecting down from the epiphysis. The only way that the appearance of a typical slipped upper femoral epiphysis could be reproduced was by rotating the epiphysis posteromedially on the metaphysis. The presence and size of this peg-like tubercle was shown radiologically by CT scanning in one pair of intact adolescent femurs.
Supports and filtrations in algebraic geometry and modular representation theory
Authors: Balmer Paul
Published: October 2007

Working with tensor triangulated categories, we prove two theorems relative to supports and then discuss their incarnations in algebraic geometry and in modular representation theory. First, we show that an indecomposable object has connected support. Then we consider the filtrations by dimension or codimension of the support and prove that the associated subquotients decompose as sums of local terms.
Central sets and a non-commutative Roth theorem
Authors: Bergelson V. (Vitaly) , McCutcheon Randall
Published: October 2007

In 1952 K. Roth showed that any subset of N having positive upper density contains arithmetic progressions of length 3, a result E. Szemer´edi extended to progressions of arbitrary length in 1975. An approach involving multiple recurrence for measure preserving systems developed by H. Furstenberg led to extensions to linear configurations in more general groups while demonstrating families of such configurations to be large in various senses. Using ultrafilter techniques for doing ergodic theory without averaging, we prove a version of Roth's theorem, in its ergodic-theoretic formulation, for general countable groups G. A combinatorial consequence, valid in amenable groups, is the presence of many configurations of the form {(a, b), (ag, b), (ag, bg)} in positive density subsets of G × G. Here "many" implies in particular "central* in the variable g".
Eisenstein series on loop groups: Maass-Selberg relations 3
Authors: Garland Howard
Published: October 2007

In this paper we prove the Maass-Selberg relations for the inner product of truncated, pseudo Eisenstein series. One can then extract the Maass-Selberg relations for truncated Eisenstein series themselves from those for truncated pseudo-Eisenstein series—a task which we shall complete in a subsequent paper.
Tight contact structures on some small Seifert fibered 3-manifolds
Authors: Ghiggini Paolo , Lisca Paolo , Stipsicz András
Published: October 2007

We classify tight contact structures on the small Seifert fibered 3-manifolds M(−1; r1, r2, r3) with ri ∈ (0, 1) ∩ Q and r1, r2 ≥ ½ . The result is obtained by combining convex surface theory with computations of contact Ozsváth–Szabó invariants. We also show that some of the tight contact structures on the manifolds considered are nonfillable, justifying the use of Heegaard Floer theory.
Beta-elements and divided congruences
Authors: Hornbostel Jens , Naumann Niko
Published: October 2007

The f-invariant is an injective homomorphism from the 2-line of the Adams-Novikov spectral sequence to a group which is closely related to divided congruences of elliptic modular forms. We compute the f-invariant for two infinite families of β-elements and explain the relation of the arithmetic of divided congruences with the Kervaire invariant one problem.
Stable relative Bessel distributions on GL(n) over a quadratic extension
Authors: Offen Omer
Published: October 2007

We study regularized periods of Eisenstein series over unitary groups. They play an important role in the study of unitary periods of cusp forms. A stabilization is used to express the periods in terms of L-functions. Thanks to recent developments of Jacquet and Lapid, we obtain certain Bessel identities that generalize identities obtained by Lapid-Rogawski. These identities are applied in "Compact unitary periods" by Lapid and Offen.
The sharp bound for the Hilbert transform on weighted Lebesgue spaces in terms of the classical A p characteristic
Authors: Petermichl S
Published: October 2007

We show that the norm of the Hilbert transform as an operator in the weighted space (ω) for 2 ≤ p p characteristic of ω. This result is sharp. We also prove a bilinear imbedding theorem with simple conditions.
Formulaic Composition in the Blues: A View from the Field
Authors: Evans David
Published: October 2007

Recent publications by Robert Springer and Michael Taft have brought renewed attention to the subject of the formula in blues lyrics. This article critiques these works. Drawing insights from the author's fieldwork in the blues tradition, it agrees with Springer that a blues formula can be a half-line, whole line, or couplet unit and suggests that the blues formula should be understood, as Parry and Lord understood the oral epic formula, to be a lexical rather than semantic unit. The author offers a method of structural analysis of highly formulaic blues texts and discusses the relationships of folk blues to commercially recorded blues.
"Witty House Name": Visual Expression, Interpretive Practice, and Uneven Agency in a Midwestern College Town
Authors: LaDousa Chaise
Published: October 2007

Many students living in a college town located in the Midwest of the United States have put up large signs on the houses in which they reside. The signs' messages such as "Hangover Here," "Crammed Inn," and "Syc-a-College" create puns drawing on multiple domains of meaning from student or local life, including locations, institutions, and popular film or music titles. This article considers the different meanings and purposes of house signs as envisioned by different groups of residents of named houses in order to explore the contours of agency involved in house sign activity. Interviews with residents of named houses reveal that some groups' interpretive desires are salient to all residents of named houses, regardless of what they understand their house sign to do, while the interpretive desires of others are thwarted. Thus, this article argues that agency is mediated by house sign activity in uneven ways and, more broadly, uses the college house sign phenomenon to shed new light on the ways in which agency is mediated by language.
The Cave-Dwellers' Treasure: Folktales, Morality, and Gender in a Nahua Community in Mexico
Authors: Raby Dominique
Published: October 2007

In Nahua communities, both men and women may act as storytellers, but female storytellers are fewer and perform in more intimate contexts. As a result, there is to date no analysis of female Nahua storytelling. In this article, the author compares two cognate folktales and underlines how each storyteller, a woman and a man, deal with essential concepts related to morality and supernatural beings. Recent studies on women's folklore point out that women's discourse often takes place in a private context and uses ambiguity as an expressive strategy; this ambiguity, in turn, is linked to the immorality or illegitimacy attributed to women's words by many societies. The Nahua case, however, suggests that Nahua female storytellers, although performing privately, prefer a discourse that stresses themes of morality, while some publicly renowned male storytellers may express ambiguous and amoral feelings. Ultimately, this disparity can be tied to the ambivalent opinion Nahuas hold toward the Hispanic world and to recent changes in female identity.
Unruly Tales: Ideology, Anxiety, and the Regulation of Genre
Authors: Schacker Jennifer
Published: October 2007

Drawing on nineteenth-century writings about the "fairy tale" or "popular tale," this article explores ideologies of genre—specifically, tacit assumptions regarding generic coherence, stability, and transparency. The history of the fairy tale in England was marked by semiotic, linguistic, and cultural border crossings, including seventeenth-century French literary tales adapted to various forms of English print and theater culture and the transformation of field-based collections into popular folklore books. Early delineations of the "real traditional fairy tale" attempted to regulate the boundaries of an emergent discipline and a genre undergoing some radical reevaluation. These constructions were intertwined with anxieties about a number of binary oppositions, including the domestic and the foreign, the oral and the written, male and female, adult and child, and art and commerce. Although such statements sought to contain and regulate the production and reception of the fairy tale as a popular genre, to the exclusion of literary contes de fées, they tell only a partial story. I propose that the rowdy, bawdy, and satirical stage genre of English pantomime suggests an alternate and frequently overlooked medium for the transmission of fairy tales during these formative decades in the history of folklore studies.
What Many Transgender Activists Don't Want You to Know: and why you should know it anyway
Authors: Bailey J. Michael , Triea Kiira
Published: October 2007

Currently the predominant cultural understanding of male-to-female transsexualism is that all male-to-female (MtF) transsexuals are, essentially, women trapped in men's bodies. This understanding has little scientific basis, however, and is inconsistent with clinical observations. Ray Blanchard has shown that there are two distinct subtypes of MtF transsexuals. Members of one subtype, homosexual transsexuals, are best understood as a type of homosexual male. The other subtype, autogynephilic transsexuals, are motivated by the erotic desire to become women. The persistence of the predominant cultural understanding, while explicable, is damaging to science and to many transsexuals.
The New Israeli Law on the Care of the Terminally Ill: conceptual innovations waiting for implementation
Authors: Barilan Y. Michael
Published: October 2007

Israel has recently enacted a law on the care of terminally ill patients. This law, the Patient Nearing Death Act, is the first of its kind in the world. The law divides terminally ill patients—upon their own wishes—into two separate groups: "those who wish their lives be prolonged," and those who do not. Doctors will have to abide by elaborate advanced directives and take into account various sources of information on the presumed wishes of the patient. The law sanctions discontinuation of mechanical ventilation should it become a "cyclical" rather than "continuous" therapy, a provision that has implications for the use of the already available paraPAC ventilators. The law exposes gaps in modern Judaism between the religious law and the attitudes of the observant population with regard to medical ethics.
The Role of Scientists in the Beginning-of-Life Debate: a 25-year retrospective
Authors: Caplan Arthur L , Marino Thomas A
Published: October 2007

This article examines scientific testimony given during the past 25 years surrounding the issue of when life begins. Although the biological facts were presented clearly, the moral and philosophical issues proved to be problematic. Often those in government tried to use science to substantiate their own philosophical beliefs. Scientists need to present facts to society and to political leaders as clearly and as dispassionately as possible in order to continue to help the public understand complicated biological processes. Scientists also need to help ensure that science is not misused or misinterpreted to justify moral, theological, or philosophical beliefs.
Ethical Problems with the Mental Health Evaluation Standards of Care for Adult Gender Variant Prospective Patients
Authors: Hale C. Jacob
Published: October 2007

The World Professional Association for Transgender Health's "Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons" (SOC) set forth standards clinicians must meet to ensure ethical care of adequate quality. The SOC also set requirements gender variant prospective patients must meet to receive medical interventions to change their sexual characteristics to those more typical for the sex to which they were not assigned at birth. One such requirement is that mental health professionals must ascertain that prospective patients have met the SOC's eligibility and readiness criteria. This article raises two objections to this requirement: ethically obligatory considerations of the overall balance of potential harms and benefits tell against it, and it violates the principle of respect for autonomy. This requirement treats gender variant prospective patients who request medical intervention as different in kind, not merely degree, from other patient populations, as it [End Page 491] constructs the very request as a phenomenon of incapacity. This is ethically indefensible in and of itself, but it is especially pernicious in a sociocultural and political context that already denies gender variant people full moral status.
Putting Concerns about Nature in Context: the case of agricultural biotechnology
Authors: Kaebnick Gregory E
Published: October 2007

Concerns about nature are playing increasingly prominent roles in a variety of social debates, including medical biotechnology, environmental protection, and agricultural biotechnology. These concerns are often simply rejected as incoherent: critics argue that there is no good account for how natural states of affairs can have moral value, and that the concept of "nature" is too multifarious and vague to be deployed in moral argument anyway. When these concerns are defended, they are frequently formulated as strong claims that make implausible ontological commitments and that ignore the linkages between these different debates. Agricultural biotechnology provides an especially challenging case study for evaluating concerns about nature. I offer a qualified defense that recognizes these concerns as conceptually linked, attends to social context at appropriate points, and overcomes the charges of incoherence. This defense supports a restrained treatment of concerns about nature in public policy: public policy can neither endorse nor dismiss them. In the case of agricultural biotechnology, this stance probably mandates some form of labeling.
Becoming What We Love: autogynephilic transsexualism conceptualized as an expression of romantic love
Authors: Lawrence Anne A
Published: October 2007

The increasing prevalence of male-to-female (MtF) transsexualism in Western countries is largely due to the growing number of MtF transsexuals who have a history of sexual arousal with cross-dressing or cross-gender fantasy. Ray Blanchard proposed that these transsexuals have a paraphilia he called autogynephilia, which is the propensity to be sexually aroused by the thought or image of oneself as female. Autogynephilia defines a transsexual typology and provides a theory of transsexual motivation, in that Blanchard proposed that MtF transsexuals are either sexually attracted exclusively to men (homosexual) or are sexually attracted primarily to the thought or image of themselves as female (autogynephilic), and that autogynephilic transsexuals seek sex reassignment to actualize their autogynephilic desires. Despite growing professional acceptance, Blanchard's formulation is rejected by some MtF transsexuals as inconsistent with their experience. This rejection, I argue, results largely from the misconception that autogynephilia is a purely erotic phenomenon. Autogynephilia can more accurately be conceptualized as a type of sexual orientation and as a variety of romantic love, involving both erotic and affectional or attachment-based elements. This broader conception of autogynephilia addresses many of the objections to Blanchard's theory and is consistent with a variety of clinical observations concerning autogynephilic MtF transsexualism.
Infant Mortality Decline in the Late 19th and Early 20th Centuries: the role of market milk
Authors: Lee Kwang-Sun
Published: October 2007

Starting in the late 19th and early 20th centuries, a precipitous decline in infant mortality was observed in the United States. Economic growth, improved nutrition, new sanitary measures, and advances in knowledge about infant care all contributed to this decline in infant mortality. Little is known, however, about how these individual factors affected disease-specific components of infant mortality over time. Systematic review of historical data suggests that cleaning the market milk supply was the single most important contributor to this decline in both diarrheal and overall infant mortality, and that this development played a far more important role than family income, other sanitary measures, or medical intervention.
Divergence or Disorder?: the politics of naming intersex
Authors: Reis Elizabeth
Published: October 2007

The conditions once known under the umbrella terms intersex and hermaphroditism are now generally being called disorders of sex development in medical settings. The terms might seem synonymous, but in fact there are significant differences with controversial consequences. Hermaphroditism, an older term that can still be found in many medical writings, is vague, demeaning, and sensationalistic, conjuring mythic images of monsters and freaks. In the 1990s, activists advocated intersex to describe discordance between the multiple components of sex anatomy, but that word alienated many parents of affected children, as it suggests a self-conscious alternative gender identity and sexuality. Disorders of sex development also refers to intersex, but it deemphasizes the identity politics and sexual connotations associated with intersex, avoids the degradation associated with hermaphrodite, and instead highlights the underlying genetic or endocrine factors that cause prenatal sex development to take an unusual path. I argue that using disorder is problematic, because it implies medical conditions in need of repair, when some intersex anatomies, though atypical, do not necessarily need surgical or hormonal correction. I advocate a less pathologizing new term, divergence of sex development, that might reduce some of the conflict over nomenclature and satisfy intersex people, their parents, and their doctors.
What Can the Samoan "Fa'afafine" Teach Us about the Western Concept of Gender Identity Disorder in Childhood?
Authors: Vasey Paul L , Bartlett Nancy H
Published: October 2007

This article examines whether gender identity disorder in childhood (GIDC) constitutes a mental disorder as outlined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR). Data were collected in Samoa, a culture that is characterized by a high degree of social tolerance towards feminine males who are known locally as fa'afafine. The study location was chosen because, unlike Western locales, it afforded the opportunity to examine whether gender-atypical behavior, gender-atypical identity, and sex-atypical identity, in and of themselves, cause distress in sex/gender variant individuals, while simultaneously controlling for the confounding effects of extreme societal intolerance towards such individuals. Because of our focus on the DSM-IV-TR's diagnosis of GIDC, we were specifically interested in ascertaining whether adult fa'afafine recalled a strong and persistent cross-gender identification in childhood, a sense of inappropriateness in the male-typical gender role, a discomfort with their sex, or distress associated with any of the above. In addition, we sought to determine whether parental encouragement or discouragement of cross-gender behaviors influence feelings of distress in relation to the behaviors in question. Based on the cross-cultural information presented here, we conclude that the diagnostic category of GIDC should not occur in its current form in future editions of the DSM, as there is no compelling evidence that cross-gender behaviors or identities, in and of themselves, cause distress in the individual.
Modern-Day Eunuchs: motivations for and consequences of contemporary castration
Authors: Wassersug Richard J , Johnson Thomas W
Published: October 2007

This article compares the motivations for, and responses to, castration between two groups of males: prostate cancer patients and voluntary modern-day eunuchs with castration paraphilias or other emasculating obsessions. Prostate cancer patients are distressed by the side effects of androgen deprivation and typically strive to hide or deny the effects of castration. In contrast, most voluntary eunuchs are pleased with the results of their emasculations. Despite a suggested association of androgen deprivation with depression, voluntary eunuchs appear to function well, both psychologically and socially. Motivation, rather than physiology, appears to account for these different responses to androgen deprivation.
Risk of Wrist Fracture in Women Is Heritable and Is Influenced by Genes That Are Largely Independent of Those Influencing BMD
Authors: Andrew Toby , Antioniades Leto , Scurrah Katrina J , MacGregor Alex J , Spector Tim D
Published: October 2007

Using a classical twin design study, we estimated the genetic contribution to liability of wrist fracture in women to be statistically and clinically significant. BMD is highly heritable, but statistical models showed very little overlap of shared genes between the two traits.

Introduction: Studies have observed contradictory evidence for genetic effects influencing the outcome of osteoporotic fracture, in part because of the methodological problems involved in analyzing age-related “censored” outcomes. Although a shared genetic etiology is often assumed between fracture and low BMD, this has not been shown to be the case.

Materials and Methods: In a study of 6570 white healthy female volunteer twins between 18 and 80 years of age, we identified and validated 220 nontraumatic wrist fracture cases. From this we estimated the population prevalence, case-wise twin concordance, heritability in liability to wrist fracture (WF), and the genetic contribution to WFs controlling for age by analyzing the survival outcome using generalized linear mixed models implemented in Winbugs software. We included forearm BMD as a co-variate in some of the models to test whether there is a shared genetic etiology between WFs and BMD.

Results: The prevalence of WFs in women was estimated to be 3.3% with a case-wise concordance in monozygotic twins of 0.28 and 0.11 in dizygotic twins. The additive polygenic heritability in liability was ∼54%, and a significant genetic etiology was confirmed by analyzing WFs as a survival outcome. The magnitude of the genetic influence on risk of WFs reduced very little when BMD was included as a co-variate in the survival analysis model.

Conclusions: There is an important genetic contribution to the risk of WFs, but for the most part, these genes are unlikely to play a direct etiological role in the development of low BMD. If these results are confirmed for other sites, fracture and low BMD will have their own specific genetic risk factors that are unlikely to be shared between the two traits. This has important clinical and research implications.
Association Between Self-Reported Prior Wrist Fractures and Risk of Subsequent Hip and Radiographic Vertebral Fractures in Older Women: A Prospective Study
Authors: Schousboe John T , Fink Howard A , Taylor Brent C , Stone Katie L , Hillier Teresa A , Nevitt Michael C , Ensrud Kristine E
Published: October 2007

In this large prospective cohort study of elderly women, the relationships between prior wrist fracture and incident hip and radiographic vertebral fractures were significantly attenuated when adjusted for BMD. This study suggests that BMD thresholds for drug therapy to prevent osteoporotic fracture should be only modestly adjusted in those with prior wrist fracture compared with those without prior wrist fracture. Validation of such an approach would require intervention trials in patients with prior wrist fracture.

Introduction: Prior wrist fracture has been identified as a risk factor for incident hip and vertebral fractures and proposed as a criterion for determining who should be offered drug therapy to prevent osteoporotic fracture, even if their hip BMD T score is > −2.5. Previously published studies of the relationships between prior wrist fracture and incident hip and vertebral fractures did not adjust for BMD.

Materials and Methods: We ascertained prior history of wrist fracture since age 50, measured calcaneal and hip BMD, and performed lateral spine films in a cohort of 9704 elderly community-dwelling women, and then followed them prospectively for incident vertebral and hip fractures. Incident vertebral fractures were defined by morphometry using lateral spine radiography at the first examination and an average of 3.7 years later. Incident hip fractures were confirmed with radiographic reports over a mean follow-up period of 10.1 years.

Results: Prior wrist fracture was associated with an age-adjusted 72% increased odds of incident radiographic vertebral fracture (odds ratio [OR], 1.72; 95% CI, 1.31–2.25). After adjustment for calcaneal BMD, the association of prior wrist fracture with incident radiographic vertebral fracture was attenuated (OR, 1.39; 95% CI, 1.05–1.83). Prior wrist fracture was also associated with an age-adjusted 43% excess rate of incident hip fracture (hazards ratio [HR], 1.43; 95% CI, 1.17–1.74). After adjustment for hip BMD, the association of prior wrist fracture with rate of incident hip fracture was no longer statistically significant (HR, 1.12; 95% CI, 0.92–1.38).

Conclusion: In elderly women, prior wrist fracture is a risk factor for radiographic vertebral fracture independent of BMD. The association between prior wrist fracture and incident hip fracture is largely explained by hip BMD. Modest adjustment of BMD drug treatment thresholds for prevention of osteoporotic fractures in those with prior wrist fracture compared with those without prior wrist fracture may be reasonable, but validation of such an approach would require intervention trials in patients with prior wrist fracture.