bluuebunny/crossref_metadata_2025 huggingface dataset:
Verification of numerical model to predict microstructure of austenitic stainless steel weld metal using synchrotron radiation and trans varestraint testing
Authors: Osuki T. , Yonemura M. , Ogawa K. , Komizo Y. , Terasaki H.
Published: February 2006

A numerical model to predict the microstructure of austenitic stainless steel weld metal is proposed, and spatially resolved X-ray diffraction measurements using synchrotron radiation have been carried out for Fe–20Cr–(9·8–14·4)Ni weld metals, quenched in liquid Sn, to verify the validity of the numerical model. X-ray diffraction analysis of Fe–20Cr–11·5Ni quenched weld metal, solidifying in the ferritic–austenitic mode, showed that the secondary γ phase crystallised in a eutectic growth mode down to a temperature drop of 6 K from the initiation of solidification. Also, from X-ray diffraction analysis of Fe–20Cr–12·7Ni quenched weld metal, which solidified in the austenitic–ferritic mode, it was found that the secondary δ phase crystallised in a eutectic growth mode within the temperature drop range between 15 and 21 K from the initiation of solidification. The crystallisation temperatures predicted by the numerical model for secondary γ and δ phases in Fe–20Cr–11·5Ni and Fe–20Cr–12·7Ni weld metals agreed with experimental data. Furthermore, it was found that the effect of Ni content on the solidification cracking susceptibility of Fe–20Cr–(9·8–14·4)Ni weld metal, determined via trans varestraint testing, agreed with the results calculated using the model. These agreements support the validity of the developed numerical model.
Grain refinement and high performance of titanium alloy joint using arc-ultrasonic gas tungsten arc welding
Authors: He L.-B. , Li L.-M. , Hao H.-W. , Wu M.-S. , Zhou R.-L.
Published: February 2006

Arc-ultrasonic welding technology is one approach for refining the grain structure in titanium alloy welds. This paper reports work in which welds were produced in an α-β titanium alloy under a variety of conditions, including conventional gas tungsten arc welding (GTAW) and arc-ultrasonic GTAW. The results show that arc-ultrasonic energy refined β grain structure in the weld metal, and improved the fatigue life of weld joints. Ultrasonic energy enhances fluid flow, reduces temperature gradients, and causes a continual high frequency oscillation in the welding pool. These effects are believed to be responsible for refining the solidification structure and improving the performance of titanium weld joints.
Optimising pulsed current TIG welding parameters to refine the fusion zone
Authors: Ravisankar V. , Balasubramanian V.
Published: February 2006

The use of pulsed current parameters has been found to improve the mechanical properties of high strength Al–Zn–Mg–Cu welds compared to those of continuous current welds. This is due to grain refinement occurring in the fusion zone. In this investigation an attempt has been made to optimise pulsed current TIG welding parameters to attain maximum grain refinement in high strength AA 7075 aluminium alloy using statistical tools such as design of experiments, response table, and analysis of variance techniques.
Influence of carbon, manganese and nickel on microstructure and properties of strong steel weld metals: Part 1 – Effect of nickel content
Authors: Keehan E. , Karlsson L. , Andrén H.-O.
Published: February 2006

The effects of increasing the nickel content from 3 to 7 or 9 wt-% were investigated in high strength steel weld metals with 2 wt-% manganese. Nickel additions were beneficial to strength but detrimental to impact toughness. Significant segregation of nickel and manganese to interdendritic regions was observed at the two higher nickel contents. In these weld metals a mainly martensitic microstructure developed at interdendritic regions, whereas bainite was found at dendrite core regions. The microstructural inhomogeneity was due to segregation and the accompanying stabilisation of austenite in solute enriched regions to lower transformation temperatures. With 3 wt-% nickel the microstructure was found to be more homogeneous, with mainly bainite forming. The decrease in impact toughness with increasing nickel content was mainly attributed to the formation of coarse grained coalesced bainite.
Feedability of wires during metal active gas welding
Authors: Shimizu H. , Itoh K. , Masaie N. , Kurokawa T. , Ushio M.
Published: February 2006

Feedability of welding wire is controlled by sliding contacts between the contact tube and wire surface. In achieving stable arc discharge, it is very important that feeding speed of the wire does not deviate from the constant speed derived from average welding current. Temperature of the contact tube, current branching, voltage drop, and contact resistance of the sliding contact were measured during welding of Cu coated and non-Cu coated solid wires. For Cu coated solid wire, the sliding contacts can be in either the solid or liquid state, depending on welding current. Conversely, for non-Cu coated solid wire, the sliding contacts are in the liquid state regardless of welding current. Discontinuity of solidification at the sliding contacts causes feeding resistance of the welding wire. The shear strength of a ‘bridge’ solidified at the sliding contact is about 4·5 N, and this force is amplified in the conduit liner by a factor of about 10.
Neural network model of heat and fluid flow in gas metal arc fillet welding based on genetic algorithm and conjugate gradient optimisation
Authors: Kumar A. , DebRoy T.
Published: February 2006

Although numerical calculations of heat transfer and fluid flow can provide detailed insights into welding processes and welded materials, these calculations are complex and unsuitable in situations where rapid calculations are needed. A recourse is to train and validate a neural network, using results from a well tested heat and fluid flow model to significantly expedite calculations and ensure that the computed results conform to the basic laws of conservation of mass, momentum and energy. Seven feedforward neural networks were developed for gas metal arc (GMA) fillet welding, one each for predicting penetration, leg length, throat, weld pool length, cooling time between 800°C and 500°C, maximum velocity and peak temperature in the weld pool. Each model considered 22 inputs that included all the welding variables, such as current, voltage, welding speed, wire radius, wire feed rate, arc efficiency, arc radius, power distribution, and material properties such as thermal conductivity, specific heat and temperature coefficient of surface tension. The weights in the neural network models were calculated using the conjugate gradient (CG) method and by a hybrid optimisation scheme involving the CG method and a genetic algorithm (GA). The neural network produced by the hybrid optimisation model produced better results than the networks based on the CG method with various sets of randomised initial weights. The CG method alone was unable to find the best optimal weights for achieving low errors. The hybrid optimisation scheme helped in finding optimal weights through a global search, as evidenced by good agreement between all the outputs from the neural networks and the corresponding results from the heat and fluid flow model.
Coupled effect of heat input and beam oscillation on mechanical properties of alloy 718 electron beam weldments
Authors: Sivaprasad K. , Raman S. G. S. , Murthy C. V. S. , Reddy G. M.
Published: February 2006

Autogenous full penetration electron beam welds were made on alloy 718 with and without beam oscillation technique. Weldments were subjected to two types of post-weld heat treatments: direct aging (DA) and solution treatment at 980°C followed by aging (STA). When the welds were prepared using different heat inputs in the welding processes with and without beam oscillation, the influence of beam oscillation could not be studied in isolation but the coupled effect of heat input and beam oscillation was studied. Laves particles were finer in size and lower in amount in unoscillated welds compared with those in beam oscillated welds subjected to DA condition. δ phase needles were observed around Laves particles in the welds subjected to STA condition. The amount of Laves particles was less and that of δ phase was more in unoscillated welds compared with those in beam oscillated welds subjected to STA condition. Unoscillated weldments exhibited longer fatigue lives compared with beam oscillated weldments in both DA and STA conditions owing to less amount of Laves in the former. Weldments in STA condition had longer lives compared with those in DA condition. The role of δ phase needles in fatigue life could not be identified.
Low-dose inhaled and nasal corticosteroid use and the risk of cataracts
Authors: Ernst P. , Baltzan M. , Deschênes J. , Suissa S.
Published: February 2006

Orally inhaled corticosteroid use has been convincingly linked to an increase in the risk of cataracts, although the risk at lower doses in common use remains uncertain. The potential risk of cataracts with the use of nasal corticosteroids is unknown.

A matched nested case–control analysis was performed in a population-based cohort of elderly people who had been dispensed medications for airway disease, as identified through a universal drug benefit plan.

Inhaled corticosteroid use was associated with a dose-related increase in both the risk of all cataracts and severe cataracts requiring extraction, and the increase in risk of severe cataracts was apparent even at daily doses of ≤500 μg. An excess risk with nasal corticosteroids was not apparent for severe cataracts.

It is concluded that, among the elderly, even low doses of inhaled corticosteroids are associated with a small but significant excess risk of cataracts requiring extraction. Such an excess risk was not observed with nasal corticosteroids.
Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care
Authors: Erbes R. , Oettel K. , Raffenberg M. , Mauch H. , Schmidt-Ioanas M. , Lode H.
Published: February 2006

Severe tuberculosis (TB) requiring intensive care unit (ICU) care is rare but commonly known to be of markedly bad prognosis. The present study aimed to describe this condition and to determine the mortality rate and risk factors associated with mortality.

Patients with confirmed TB admitted to ICU between 1990 and 2001 were retrospectively identified and enrolled. Clinical, radiological and bacteriological data at admission and during hospital stay were recorded. A multivariate analysis was performed to identify the predictive factors for mortality.

A total of 58 TB patients (12 females, mean age 48 yrs) admitted to ICU were included. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission was 13.1±5.6 and 22 of 58 (37.9%) patients required mechanical ventilation. The in-hospital mortality was 15 of 58 (25.9%); 13 (22.4%) patients died in the ICU. The mean survival of patients who died was 53.6 days (range 1–229), with 50% of the patients dying within the first 32 days. The factors independently associated with mortality were: acute renal failure, need for mechanical ventilation, chronic pancreatitis, sepsis, acute respiratory distress syndrome, and nosocomial pneumonia.

These data indicate a high mortality of patients with tuberculosis requiring intensive care unit care and identifies new independently associated risk factors.
Cost–utility analysis of chemotherapy in symptomatic advanced nonsmall cell lung cancer
Authors: Dooms C. A. , Lievens Y. N. , Vansteenkiste J. F.
Published: February 2006

When using chemotherapy in patients with a short life expectancy, outcomes such as symptom improvement or clinical benefit receive increasing attention. Outcomes of subjective benefit to the patient can be rated as a utility in order to perform health economic analyses and comparisons with other treatment conditions. A cost–utility analysis has been performed alongside a prospective randomised clinical trial comparing single agent gemcitabine to cisplatin-based chemotherapy in symptomatic advanced nonsmall cell lung cancer patients.

Global quality of life as well as resource utilisation data were collected during first-line chemotherapy for both treatment arms. Incremental costs, utilities and cost–utility ratio were calculated.

Per patient, an incremental cost of \#8364;1,522 was obtained for gemcitabine compared to cisplatin–vindesine, mainly as a consequence of the direct cost of the cytotoxic drugs. When combined with utilities, this resulted in an incremental cost–utility ratio for gemcitabine of \#8364;13,836 per quality-adjusted life year gained.

In conclusion, although the least expensive strategy is cisplatin–vindesine, the greater clinical benefit of gemcitabine, resulting in an acceptable incremental cost–utility ratio as compared with other healthcare interventions, balances its higher cost. The gains in subjective outcome achieved with palliative chemotherapy are critical from both a clinical and a health economic point of view.
High diagnostic accuracy of NT-proBNP for cardiac origin of pleural effusions
Authors: Kolditz M. , Halank M. , Schiemanck C. S. , Schmeisser A. , Höffken G.
Published: February 2006

A prospective study was performed to evaluate the diagnostic accuracy of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels, measured simultaneously in serum and pleural fluid, in identifying pleural effusions due to heart failure.

Pleural fluid and serum samples from all patients presenting for thoracentesis between April 2004 and May 2005 were simultaneously collected. The discriminative properties of NT-proBNP levels in identifying pleural effusions due to heart failure were determined by receiver operating characteristic curve analysis and compared to the diagnostic value of finding a transudate by Light's criteria.

Ninety-three patients were evaluated, 27% with cardiac effusion and 73% with exudative effusions of various cause. Levels of NT-proBNP in pleural fluid and serum correlated closely. Serum and pleural fluid NT-proBNP levels were significantly elevated in patients with cardiac effusion. With a cut-off value of 4,000 ng·L−1, NT-proBNP levels in pleural fluid and serum displayed comparably high diagnostic accuracies of 92 and 91%, respectively. All patients misclassified by Light's criteria were correctly identified by measuring NT-proBNP levels.

N-terminal-pro-B-type natriuretic peptide levels in either pleural fluid or serum showed a high diagnostic accuracy compared to traditional criteria. Thus measuring N-terminal-pro-B-type natriuretic peptide is a valuable additional diagnostic tool for the detection or exclusion of cardiac origin of pleural effusions.
Predictors of success and failure in pulmonary rehabilitation
Authors: Garrod R. , Marshall J. , Barley E. , Jones P. W.
Published: February 2006

The purpose of the present study was to identify prognostic features of chronic obstructive pulmonary disease (COPD) associated with success or failure in pulmonary rehabilitation. Patients were stratified according to the Medical Research Council (MRC) dyspnoea score.

A total of 74 stable COPD patients (mean±sdage 68±10 yrs), 21 MRC dyspnoea score grade 1/2, 29 grade 3/4 and 24 grade 5, with a mean forced expiratory volume in one second of 1.1±0.6 L, attended for rehabilitation. Assessments consisted of the following: quadriceps torque, 6-minute walking distance (6MWD), Brief Assessment Depression Cards and St George's Respiratory Questionnaire (SGRQ). Predictors of drop-out and of response (a change in SGRQ of four points or 6MWD of 54 m) were tested using binary logistic regression.

In total, 51 patients completed the study. Of these, 39 (77%) showed a clinically significant benefit in either 6MWD or SGRQ. Baseline variables were poor predictors of response in each case. Significant differences were seen between MRC dyspnoea score groups for change in 6MWD and SGRQ Score. Only grade 1/2 and 3/4 patients improved. Depression was a risk factor for subject drop-out compared with nondepressed patients.

Baseline state is a poor predictor of response to rehabilitation, although Medical Research Council dyspnoea score grade 5 patients showed smaller magnitudes of improvement than patients with less severe Medical Research Council dyspnoea score grades. Risk of drop-out is significantly greater in depressed compared with nondepressed patients.
Systemic lupus erythematosus with concurrent protein-losing enteropathy and primary sclerosing cholangitis: a unique association
Authors: Oh D CT , Ng T M , Ho J , Leong K P
Published: February 2006

We describe a 24-year old male patient with systemic lupus erythematosus (SLE) with the gastrointestinal manifestations of protein-losing enteropathy (PLE) and primary sclerosing cholangitis (PSC). He presented with periorbital, scrotal and lower limb oedema. PLE was diagnosed because of hypoalbuminaemia together with an elevation of alpha-1-antitrypsin stool clearance and absence of proteinuria. PSC was diagnosed on the basis of an elevated serum alkaline phosphatase and lymphocytic and fibrous cholangitis. His disease was also complicated by neuropsychiatric lupus and hypogonadism. All the manifestations of SLE resolved with systemic corticosteroids and pulsed cyclophosphamide treatment. This case report documents the unusual association of SLE with PLE and PSC, and this relationship suggests that autoimmunity underlie the pathogenesis of these conditions.
Mycoplasma pneumonia with antiphospholipid antibodies and a cardiac thrombus
Authors: Bakshi M , Khemani C , Vishwanathan V , Anand R K , Khubchandani R P
Published: February 2006

A case is reported of a four-year old child with mycoplasma pueumonia with a left atrial thrombus secondary to aPL antibodies. He was anticoagulated and the thrombus resolved in six months.
Renal outcomes in children with lupus and a family history of autoimmune disease
Authors: Apenteng T , Kaplan B , Meyers K
Published: February 2006

Genetic factors play an important role in systemic lupus erythematosus (SLE) susceptibility and development of lupus nephritis (LN). The significance, however, of a positive family history of autoimmune disease on renal outcome in SLE patients is unknown. This retrospective study of 64 children with LN investigates whether children with LN and a family history of AID (autoimmune disease; 34 patients) had worse renal outcomes when compared with children who did not have a family history (26 patients) of AID. In four patients the family history was unknown. The primary endpoint was doubling of serum creatinine (sCr) and the secondary endpoint was requiring dialysis or transplant (ESRD). Demographic variables for family history + versus mean age in years (range) at onset of LN were 13.5 (7.4-15.9) versus 13.2 (6.4-19.7); female 26: 34 (76%) versus 24: 26 (92%), P = 0.097; race Black 23 (68%), Caucasian 7 (21%), Asian 1 (2%), Hispanic 3(9%) versus Black 14 (54%), Caucasian 6 (23%), Asian 2 (8%), Hispanic 4 (15%). Three patients died (1.6%); sCr doubled in 6/34 (17.6%) versus 2/26 (7.7%), P = 0.45, followed for 2.8 years (0.8-5.8) and 1.8 years (1.8-1.9), respectively, P = 0.24; sCr doubled plus ESRD in 10/34 (29%) versus 6/26 (23%), P = 0.77, followed for 2.7 years (0.8-5.8) and 2.0 years (0.7-4.1) respectively, P = 0.29. In the family history + group, more Black versus non-Black patients doubled their sCr or reached ESRD, 8/23 (35%) versus 2/11 (18%), P = 0.44. More males and Black patients with LN had a positive family history for AID and were more likely to double their sCr or reach ESRD. These results suggest that a family history of AID impacts on renal outcome in children with SLE.
Association of glomerular podocytopathy and nephrotic proteinuria in mesangial lupus nephritis
Authors: Han T S , Schwartz M M , Lewis E J
Published: February 2006

We investigated a series of patients with systemic lupus erythematosus (SLE), who had sparse subepithelial and mesangial immune deposits. Our goal was to determine structure: function correlation. We examined whether proteinuria correlated with either capillary wall immune aggregate formation or abnormal podocyte morphology. Renal biopsies from patients with sparse (two or fewer subepithelial or intramembranous electron dense deposits per glomerular capillary loop) immune deposits and podocyte effacement were studied. Patients fulfilled criteria for the diagnosis of SLE. Cases were excluded if the biopsy showed endocapillary proliferation or necrosis. Eighteen biopsies were studied, five from patients with nephrotic range proteinuria (≥3 g/day) and 13 from patients with non-nephrotic proteinuria (<3 g/day). The five nephrotic patients had a mean foot process effacement of 48% ± 39% (range 10-100%). Thirteen non-nephrotic patients had a mean foot process effacement of 11.7% ± 8% (range 0-20%). The only distinguishing morphologic finding associated with nephrotic range proteinuria was diffuse foot process effacement. No correlation between subepithelial deposits and proteinuria was observed. There were no other histologic differences between the nephrotic and non-nephrotic patients. Among these patients, the nephrotic syndrome appears best correlated with podocytopathy rather than subepithelial electron dense deposits, mesangial deposits, or mesangial hypercellularity.
Neuromyelitis optica (Devic’s syndrome) as first manifestation of systemic lupus erythematosus
Authors: Jacobi C , Stingele K , Kretz R , Hartmann M , Storch-Hagenlocher B , Breitbart A , Wildemann B
Published: February 2006

Neurologic symptoms rarely occur as presenting feature of systemic lupus erythematosus (SLE). We describe a 37-year old woman who presented with several episodes of transverse myelitis and optic neuritis. Clinical, radiologic and laboratory findings were compatible with neuromyelitis optica (NMO). Seven years after disease onset clinical and laboratory findings were diagnostic for SLE. This case illustrates that NMO may represent a first manifestation of SLE for many years.
Efficacy of cyclosporin-A in the long-term management of thrombocytopenia associated with systemic lupus erythematosus
Authors: Quartuccio L , Sacco S , Franzolini N , Perin A , Ferraccioli G , De Vita S
Published: February 2006

Thrombocytopenia frequently complicates systemic lupus erythematosus (SLE), and its long-term management may be problematic. Intravenous immunoglobulins and high doses of steroids are often effective as induction therapy, but thrombocytopenia frequently relapses during steroid tapering. Several immunosuppressive agents have been evaluated as induction or maintenance therapy in small series or in case reports. We describe six consecutive unselected SLE patients where cyclosporin-A (CyA) was effective and safe in the long-term management of thrombocytopenia and allowed steroid tapering. One relapse occurred during CyA reduction and responded to CyA dose adjustment. Steroids could be stopped in three out of six patients, and were maintained at very low doses in the remaining patients. CyA was stopped in one patient after one year of treatment, without relapse at month 11+ from discontinuation. No severe side effects were documented. Overall, these data suggest that CyA may prove to be an effective and safe therapeutic option for SLE-related thrombocytopenia.
Oxidized low-density lipoprotein and β2-glycoprotein I in patients with systemic lupus erythematosus and increased carotid intima-media thickness: implications in autoimmune-mediated atherosclerosis
Authors: Lopez L R , Salazar-Paramo M , Palafox-Sanchez C , Hurley B L , Matsuura E , Garcia-De La Torre I
Published: February 2006

Oxidative stress and LDL modification (oxLDL) are early pro-atherogenic events. OxLDL binds β2GPI producing immunogenic oxLDL/β2GPI complexes. Antibodies to these complexes have been associated with arterial thrombosis in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Circulating oxLDL/β2GPI complexes, IgG and IgM antibodies to these complexes were measured by ELISA in 30 SLE patients asymptomatic for cardiovascular disease (mean age 31 years) and 27 age/sex matched healthy controls. Carotid intima-media thickness (IMT) was measured by ultrasound in all patients and controls. Forty-seven percent of SLE presented plaques (median IMT of 0.65 ± 0.12 mm) while only 7% of the controls had plaques (median IMT of 0.50 ± 0.04 mm, P < 0.001). Median optical density (OD450nm) for oxLDL/β2GPI complexes in SLE was 0.244 ± 0.07, higher than controls (0.174 ± 0.09, P < 0.001). Median OD for IgG anti-oxLDL/β2GPI antibodies was also higher in SLE (0.297 ± 0.26) compared to controls (0.194 ± 0.07, P < 0.001) while the median OD for IgM antibodies in SLE (0.444 ± 0.46) was not different than controls (0.326 ± 0.22, P = 0.267). There was no correlation between IMT and oxLDL/β2GPI complexes, IgG or IgM antibodies, possibly reflecting the complex interrelationship between these serologic elements and tissue factors in the arterial wall. These results support the hypothesis that oxLDL/β2GPI complexes and IgG (not IgM) anti-oxLDL/β2GPI antibodies contribute to the development of autoimmune-mediated atherosclerosis
Identification in Administrative Databases of Women Dying of Breast Cancer
Authors: Gagnon Bruno , Mayo Nancy E. , Laurin Carroll , Hanley James A. , McDonald Neil
Published: February 2006

Purpose

Palliative care is an essential component of cancer care, and population-based research is needed to monitor its impact. Administrative databases are the cornerstone of health services research. Their limitation is that cause of death is not sufficient to readily classify decedents as terminally ill for the study of the health services they received at the end of life. The study purpose is to develop and test the validity of an algorithm allowing the classification of the decedents as dying of breast cancer (BC), using administrative data.

Methods

Validation was carried out through a chart review of 119 BC decedents extracted from hospital-based databases. This algorithm was applied to 3,384 deceased women with BC representative of the whole population. The effect of the classification by the algorithm was illustrated by the shift in the distributions of age and place of death.

Results

The validation showed a sensitivity of 95%, a specificity of 89%, a positive predictive value of 98%, and negative predictive value of 77% for the classification of women dying of BC. Of the 3,384 decedents, 2,293 were classified as dying of, and 1,091 as not dying of BC. Women dying of BC were younger, died less often at home (6.9% v 17.9%), and in chronic care institutions (4.1% v 14.8%), and more often in acute-care beds (69.9% v 57.1%).

Conclusion

This novel way to classify decedents is conceptually based and empirically validated through chart review and impact on distribution of age and place of death.
White Matter Anisotropy in Post-Treatment Childhood Cancer Survivors: Preliminary Evidence of Association With Neurocognitive Function
Authors: Khong Pek-Lan , Leung Lucullus H.T. , Fung Amy S.M. , Fong Daniel Y.T. , Qiu Deqiang , Kwong Dora L.W. , Ooi Gaik-Cheng , McAlanon Grainne , Cao Guang , Chan Godfrey C.F.
Published: February 2006

Purpose

We aim to determine if the loss of white matter fractional anisotropy (FA), measured by diffusion tensor magnetic resonance imaging (DTI), in post-treatment childhood medulloblastoma (MED) and acute lymphoblastic leukemia (ALL) survivors correlate with intelligence quotient (IQ) scores.

Materials and Methods

MED and ALL survivors (n = 30; 20 male, 10 female; age range, 6.0 to 22.1 years; mean, 13.1 years) were recruited for DTI and IQ tests. In this cross-sectional study, age-matched normal control (n = 55; 32 male, 23 female; age range, 6.0 to 23 years; mean, 12.1 years) DTI was obtained to compute percentage difference in white matter FA (ΔFA%) for each patient compared with the age-matched control group. Multivariate regression analysis was performed to determine the relationships between ΔFA%, age at treatment, irradiation dose, time interval from treatment, and full-scale IQ (FSIQ), verbal IQ (VIQ), and performance IQ (PIQ). Receiver operating characteristics curves were used to determine the best ΔFA% cutoffs for predicting FSIQ, VIQ, and PIQ of less than 85.

Results

ΔFA% had a significant effect on FSIQ (adjusted r2 = 0.439; P < .001), VIQ (adjusted r2 = 0.237; P = .028), and PIQ (adjusted r2 = 0.491; P < .001) after adjusting for the effects of age at treatment, irradiation dose, and time interval from treatment. The best ΔFA% value to predict less than 85 scores in FSIQ, VIQ, and PIQ was −3.3% with specificities of 100% and sensitivities ranging from 77.8% to 87.5%.

Conclusion

Our preliminary findings suggest that white matter FA may be a clinically useful biomarker for the assessment of treatment-related neurotoxicity in post-treatment childhood cancer survivors.
Stability of Parental Understanding of Random Assignment in Childhood Leukemia Trials: An Empirical Examination of Informed Consent
Authors: Greenley Rachel Neff , Drotar Dennis , Zyzanski Stephen J. , Kodish Eric
Published: February 2006

Purpose

To examine stability versus change in parental understanding of random assignment in randomized clinical trials (RCTs) for pediatric leukemia and to identify factors associated with changes in understanding.

Methods

Eighty-four parents of children diagnosed with acute lymphoblastic leukemia or acute myeloid leukemia who were enrolled onto a pediatric leukemia RCT at one of six US children's hospitals participated. Parents were interviewed twice, once within 48 hours after the Informed Consent Conference (ICC; time 1 [T1]) and again 6 months later (time 2 [T2]). Interviews focused on parental understanding of key components of the RCT, including random assignment. Interviews were audiotaped, transcribed, and later analyzed.

Results

Changes in understanding of random assignment occurred in 19% of parents, with 17% of parents deteriorating in understanding from T1 to T2. Forty-nine percent of parents failed to understand random assignment at both times. Factors associated with understanding at both times included majority ethnicity, high socioeconomic status, parental reading of consent document, and presence of a nurse during the ICC. Physician discussion of specific components of the RCT was also associated with understanding at both times. Female caregivers and parents of low socioeconomic status were overrepresented among those who showed decay in understanding from T1 to T2.

Conclusion

Parents showed little gain in understanding over time. Factors that predicted understanding at diagnosis as well as sustained understanding over time may be important intervention targets. Attention to both modifiable and nonmodifiable barriers is important for clinical practice.
Racial Differences in Trust and Lung Cancer Patients' Perceptions of Physician Communication
Authors: Gordon Howard S. , Street Richard L. , Sharf Barbara F. , Kelly P. Adam , Souchek Julianne
Published: February 2006

Purpose

Black patients report lower trust in physicians than white patients, but this difference is poorly studied. We examined whether racial differences in patient trust are associated with physician-patient communication about lung cancer treatment.

Patients and Methods

Data were obtained for 103 patients (22% black and 78% white) visiting thoracic surgery or oncology clinics in a large Southern Veterans Affairs hospital for initial treatment recommendation for suspicious pulmonary nodules or lung cancer. Questionnaires were used to determine patients' perceptions of the quality of the physicians' communication and were used to assess patients' previsit and postvisit trust in physician and trust in health care system. Patients responded on a 10-point scale.

Results

Previsit trust in physician was statistically similar in black and white patients (mean score, 8.2 v 8.3, respectively; P = .80), but black patients had lower postvisit trust in physician than white patients (8.0 v 9.3, respectively; P = .02). Black patients, compared with white patients, judged the physicians' communication as less informative (7.3 v 8.5, respectively; P = .03), less supportive (8.1 v 9.3, respectively; P = .03), and less partnering (6.4 v 8.2, respectively; P = .001). In mixed linear regression analysis, controlling for clustering of patients by physician, patients' perceptions of physicians' communication were statistically significant (P < .005) predictors of postvisit trust, although patient race, previsit trust, and patient and visit characteristics were not significant (P > .05) predictors.

Conclusion

Perceptions that physician communication was less supportive, less partnering, and less informative accounted for black patients' lower trust in physicians. Our findings raise concern that black patients may have lower trust in their physicians in part because of poorer physician-patient communication.
Community-Based Use of Chemotherapy and Hormonal Therapy for Early-Stage Breast Cancer: 1987-2000
Authors: Harlan Linda C. , Clegg Limin X. , Abrams Jeffrey , Stevens Jennifer L. , Ballard-Barbash Rachel
Published: February 2006

Purpose

We describe trends in the use of chemotherapy and hormonal therapy by nodal and estrogen receptor (ER) status in women with early-stage breast cancer.

Methods

Cases were randomly sampled from the population-based Surveillance, Epidemiology and End Results (SEER) program and physician verified treatment was examined. A total of 9,481 women, aged 20 years and older, diagnosed with early-stage breast cancer in 1987 to 1991, 1995, and 2000 were included in the study.

Results

The use of chemotherapy plus tamoxifen increased between 1995 and 2000 for women with node-negative, ER-positive breast cancer ≥ 1 cm (8% to 21%). Nearly 23% of women with node-negative and ER-positive tumors ≥ 1 cm received no adjuvant therapy. The use of chemotherapy alone increased to nearly 60% in women with node-negative, ER-negative tumors ≥ 1 cm (48% to 59%). However, in 2000, 16% of women with node-positive and ER-negative tumors received no adjuvant therapy and an additional 6% received tamoxifen alone. The influence of age can clearly be seen. Chemotherapy is given much less often in women 70 years or older.

Conclusion

The results from SEER areas across the United States suggest that physicians quickly responded to publications and guidelines regarding breast cancer therapy. The lack of definitive findings from clinical trials on the use of adjuvant therapy in women 70 years and older may explain the lower use in this group of women.
Anthracyclines Cause Endothelial Injury in Pediatric Cancer Patients: A Pilot Study
Authors: Chow Amy Y. , Chin Clifford , Dahl Gary , Rosenthal David N.
Published: February 2006

Purpose

The vascular endothelium plays a central role in the regulation of arterial vasomotor tone, releasing nitric oxide for vasodilation. Endothelial-dependent vasodilation can be assessed in vivo, using high resolution ultrasound to measure changes in diameter of the brachial artery. Animal studies have demonstrated that anthracyclines can damage the endothelium and impair the vasodilatory response of arteries; however, there are no comparable data in humans. This is a pilot study assessing endothelial toxicity from anthracyclines in pediatric cancer patients.

Patients and Methods

Fourteen control patients and 14 cancer patients (4 to 21 years) were studied. Cancer patients had completed chemotherapy containing no less than 300 mg/m2 of anthracyclines 2 to 60 months before study. Brachial artery diameters were measured at rest and 1 minute after blood pressure cuff occlusion. Brachial artery reactivity (BAR) was calculated as percent change between baseline and after cuff deflation measurements. Results were compared using unpaired, two-tailed t-test.

Results

Baseline characteristics, including age, percentage of females, blood pressure, and resting vessel diameters were similar between the two groups. BAR in the controls averaged 6.7% with a standard deviation (SD) of 3.3%, while BAR in patients receiving anthracyclines averaged 3.8% with an SD of 3.4%, demonstrating a significant decrease (P < .05) in vasomotor reactivity in the treated group.

Conclusion

These results suggest that anthracyclines cause impaired endothelial function, an important and newly recognized toxicity. Since endothelial dysfunction is an early event in atherogenesis, there may be important clinical implications from these findings. Further study is required to confirm these preliminary results in a larger cohort.
Characterization ofBRCA1andBRCA2Mutations in a Large United States Sample
Authors: Chen Sining , Iversen Edwin S. , Friebel Tara , Finkelstein Dianne , Weber Barbara L. , Eisen Andrea , Peterson Leif E. , Schildkraut Joellen M. , Isaacs Claudine , Peshkin Beth N. , Corio Camille , Leondaridis Leoni , Tomlinson Gail , Dutson Debra , Kerber Rich , Amos Christopher I. , Strong Louise C. , Berry Donald A. , Euhus David M. , Parmigiani Giovanni
Published: February 2006

Purpose

An accurate evaluation of the penetrance of BRCA1 and BRCA2 mutations is essential to the identification and clinical management of families at high risk of breast and ovarian cancer. Existing studies have focused on Ashkenazi Jews (AJ) or on families from outside the United States. In this article, we consider the US population using the largest US-based cohort to date of both AJ and non-AJ families.

Methods

We collected 676 AJ families and 1,272 families of other ethnicities through the Cancer Genetics Network. Two hundred eighty-two AJ families were population based, whereas the remainder was collected through counseling clinics. We used a retrospective likelihood approach to correct for bias induced by oversampling of participants with a positive family history. Our approach takes full advantage of detailed family history information and the Mendelian transmission of mutated alleles in the family.

Results

In the US population, the estimated cumulative breast cancer risk at age 70 years was 0.46 (95% CI, 0.39 to 0.54) in BRCA1 carriers and 0.43 (95% CI, 0.36 to 0.51) in BRCA2 carriers, whereas ovarian cancer risk was 0.39 (95% CI, 0.30 to 0.50) in BRCA1 carriers and 0.22 (95% CI, 0.14 to 0.32) in BRCA2 carriers. We also reported the prospective risks of developing cancer for cancer-free carriers in 10-year age intervals. We noted a rapid decrease in the relative risk of breast cancer with age and derived its implication for genetic counseling.

Conclusion

The penetrance of BRCA mutations in the United States is largely consistent with previous studies on Western populations given the large CIs on existing estimates. However, the absolute cumulative risks are on the lower end of the spectrum.
Randomized Phase II Study Comparing Thalidomide With Medroxyprogesterone Acetate in Patients With Metastatic Renal Cell Carcinoma
Authors: Lee Chooi P. , Patel Poulam M. , Selby Peter J. , Hancock Barry W. , Mak Ian , Pyle Lynda , James Maggie G. , Beirne Debbie A. , Steeds Sarah , A'Hern Roger , Gore Martin E. , Eisen Tim
Published: February 2006

Purpose

To investigate escalating doses of thalidomide compared with medroxyprogesterone in patients with metastatic renal cell carcinoma (RCC), who had either progressed after first-line immunotherapy or who were not suitable for immunotherapy.

Patients and Methods

Thalidomide was started at 100 mg/d orally (PO) and escalated by 100 mg/d every 2 weeks to the maximum dose of 400 mg/d. Medroxyprogesterone was given at a fixed dose of 300 mg PO daily.

Results

Sixty patients were entered (thalidomide:medroxyprogesterone = 29:31; median age, 59 [thalidomide], 60 [medroxyprogesterone]; No. of patients assessable for response, 22 [thalidomide], 26 [medroxyprogesterone]). In the thalidomide arm, there was no objective response seen. The best response was SD in three patients lasting 5+, 6+, and 12 months, respectively. All patients in the medroxyprogesterone arm progressed. There was no difference in overall survival between the two arms; median survival in the thalidomide arm was 8.2 months compared with 4.8 months in the medroxyprogesterone arm (P = .62). Hazard ratio was 0.88 (95% CI, 0.67 to 1.94). Median duration of treatment was 73 days (range, 14 to 364 days) in the thalidomide arm, and 84 days (range, 7 to 175 days) in the medroxyprogesterone arm. The high incidence of toxicity in the thalidomide arm, mainly somnolence, constipation, fatigue and paraesthesia, meant that only 30.8% of patients were able to tolerate the maximum dose of 400 mg/d of treatment.

Conclusion

Thalidomide is not superior to medroxyprogesterone acetate in patients with metastatic RCC. Its risk/benefit ratio does not favor its use in this patient population.
Relationship Between Cisplatin Administration and the Development of Ototoxicity
Authors: Rademaker-Lakhai Jeany M. , Crul Mirjam , Zuur Lot , Baas Paul , Beijnen Jos H. , Simis Yvonne J.W. , van Zandwijk Nico , Schellens Jan H.M.
Published: February 2006

Purpose

To determine the auditory toxicity associated with dose- and schedule- intensive cisplatin/gemcitabine chemotherapy in non–small-cell lung carcinoma patients.

Patients and Methods

Patients were treated with gemcitabine followed by cisplatin according to an interpatient dose-escalation scheme. Patients were randomly assigned to receive treatment once a week for 6 weeks or once every 2 weeks for 4 weeks. The following cohorts of patients were treated with a reversed schedule once every 2 weeks, in which cisplatin was followed by gemcitabine. The dose-intensity of cisplatin was equal in both schedules. Audiometric evaluations were obtained for each ear at several frequencies. Mean hearing loss after cisplatin treatment was computed for each dose level at each tested frequency in each ear at baseline and subsequent follow-up audiometry. Pure tone averages (PTAs) were also calculated. The pharmacokinetics of cisplatin was determined to study the correlation among the maximum drug concentration, the area under the curve of unbound platinum, and the development of ototoxicity.

Results

A total of 328 audiograms were analyzed. At the higher frequencies, a more severe hearing impairment was recorded. Most patients showed a decrease in hearing thresholds at dosages above 60 mg/m2 cisplatin at the higher frequencies. PTAs at 1, 2, and 4 kHz show a mean hearing loss of 19 dB after cisplatin administration at dosages above 90 mg/m2. Threshold shifts at 8 and 12.5 kHz after cisplatin administration were experienced at dosages above 60 mg/m2.

Conclusion

Hearing loss after cisplatin therapy occurs mainly at high frequencies and at cisplatin dosages more than 60 mg/m2. It is more pronounced when cisplatin is given once every 2 weeks.
State of the Art in Research on Equity in Health
Authors: Starfield Barbara
Published: February 2006

This essay provided the introduction to a workshop in Bellagio, Italy, on the subject of translating research into policy for equity in health. The essay first defines equity in a way that facilitates its assessment and monitoring and then summarizes evidence from existing research. Directions for developing policy strategies follow from these principles. The role of health services in influencing the distribution of health in populations is discussed in the special context of primary-care-oriented health systems that are, at the same time, more effective, more efficient, and more equity producing than is the case for specialist-dominated health systems.
Reframing the Racial Disparities Issue for State Governments
Authors: Stone Deborah
Published: February 2006

Although racial and ethnic disparities in health have been on the federal government's agenda since 1985, no policy reforms have significantly reduced disparities. The question arises whether states can effectively address this issue without waiting for solutions from the national government. The purpose of this article is to propose ways of reframing the disparities issue that might give state policy makers more leverage and might strengthen political will to address the issue. I suggest a moral frame based on a concept of distributive justice in which medical care must be distributed according to need. I explain the rationales for such a frame and consider its strategic advantages and disadvantages. In the last section, I suggest some policies based on this framing that are within the power of state legislatures.
State Legislative Activities Related to Elimination of Health Disparities
Authors: Ladenheim Kala , Groman Rachel
Published: February 2006

How have state legislatures acted to address racial and ethnic disparities in health care? This article examines trends over time in state legislation related to disparities in care and access, proposed legislation during one biennial session, and contemporary legislative attitudes and awareness of the issue. The mix of strategies adopted across the states reflects the differing ways that states understand gaps in minority health and changing strategies over time. Historically, California, Florida, and Louisiana (all states with substantial minority populations) have been the most active in dealing with minority health issues through statutes. In the eighteen months of the 2001–2002 legislative session that we studied, the most common bills called for studies of disparities and appropriations for identifiable minority health initiatives. Measures that successfully cleared the legislature include measures related to cultural competence and minority health awareness month. Finally, the article discusses issues and limitations in using legislative action to measure the level of state policy activity with regard to health disparities. To ground the description of trends in disparity legislation, the authors integrated comments by state legislators with a discussion of problems in interpreting legislative activity.
Reducing Racial and Ethnic Health Disparities: Exploring an Outcome-Oriented Agenda for Research and Policy
Authors: Gibbs Brian K. , Nsiah-Jefferson Laurie , McHugh Matthew D. , Trivedi Amal N. , Prothrow-Stith Deborah
Published: February 2006

Eliminating racial and ethnic disparities in health status and health care, a major focus of Healthy People 2010, remains on the national agenda and among the priorities for the administration of President George W. Bush. Even though the elimination of racial and ethnic health disparities challenges the whole nation, individual states are on the front line of many initiatives and are often the focus of important policy efforts. In addition, it is important to focus on states because they are already responsible for much of the health and public health infrastructure, and several states have developed initiatives dating back to the release of Margaret Heckler's report on the gaps in health outcomes by race in 1985. This article makes the case for an outcome-oriented approach and provides a summary of lessons learned based upon preliminary investigations into constructing and applying two indices, the disparity reduction profile to measure effort and the disparity index to measure outcomes.