bluuebunny/crossref_metadata_2025 huggingface dataset:
Real time quantification in plasma of human telomerase reverse transcriptase (hTERT) mRNA in patients with colorectal cancer
Authors: Lledó S. M. , Garcia‐Granero E. , Dasí F. , Ripoli R. , García S. A. , Cervantes A. , Aliño S. F.
Published: June 2004

Background  Increased telomerase activity can be found in almost 90% of colorectal tumours. We aim to describe the preliminary results for quantification in plasma of hTERT mRNA in colorectal cancer patients.

Materials and methods  Fifty patients undergoing surgery for colorectal cancer and a control group of 50 healthy volunteers were prospectively studied. Pre‐operative venous blood samples were taken from all cancer patients and volunteers. Plasma hTERT expression was determined from peripheral blood based on real‐time quantitative RT‐PCR (qRT‐PCR) method normalized to the amount of RNA input using 18S rRNA gene expression. Plasma pre‐operative CEA levels were also determined.

Results  Median values for normalized hTERT (hTERTN) gene expression were higher in colorectal cancer patients (11.62, range 0.23–47.67) than healthy volunteers (0.29, range 0.00–4.63) (P < 0.001). Individual data showed that 82% of colorectal cancer patients had hTERTN expression values superior to the maximum value observed in the control group. Sensitivity and specificity of the assay for colorectal cancer detection were 98% and 64%, respectively. No significant differences in hTERTN expression between gender or with age (P > 0.05). No significant correlation was found between hTERTN expression and CEA values (Spearman's rank test = 0.136, P = 0.348).

Conclusions  These results show that detection of mRNA based on the qRT‐PCR of the telomerase hTERTN gene in plasma clearly differentiates between healthy and colorectal cancer patients and that hTERTN can be detected and quantified in plasma. This opens up a new field as a noninvasive blood test for colorectal cancer diagnosis.
Stoma formation for functional bowel disease
Authors: Harris R. P. , Daly K. J. , Jones L. S. , Kiff E. S.
Published: June 2004

Objective  To assess the results of stoma formation for functional bowel disease.

Methods  A retrospective study of the indications for and complications of stoma formation in this group. A quality of life questionnaire was sent to the group.

Results  A very small proportion of patients with functional bowel disease have a stoma formed (< 1%). Stoma formation is often associated with problems requiring further operations. Their QOL is reported as poor and is improved upon by stoma formation. Most patients with a temporary stoma elected to keep it rather than suffer their previous problems.

Conclusion  Some patients with functional bowel disease can be successfully managed by stoma formation. Their treatment is difficult, emotionally demanding and labour‐intensive.
‘Paper Clinics’– a model for improving delivery of outpatient colorectal services
Authors: Porrett T. R. C. , Lunniss P. J.
Published: June 2004

Objectives  The overburdening of colorectal out‐patient clinics necessarily leads to delays in time from referral to consultation and subsequent clinic attendance. This study aimed to ascertain the feasibility of ‘paper clinic’ follow‐up rather than all patients receiving a routine follow‐up appointment following investigation. A more efficient outpatient follow‐up process should reduce unnecessary follow‐up, thereby facilitating the speedy investigation and diagnosis of patients through changes in clinic profiles.

Methods  From August 2001 all patients seen in the outpatient clinic of one (part time) Consultant colorectal surgeon, who required investigation, were prospectively recorded on a ‘paper clinic’ form. These patients were given the necessary test request forms but were not given a further outpatient appointment. The results of the investigations were reviewed, together with the patients' medical records at a formal fortnightly ‘paper clinic’ session carried out by the Consultant and Nurse Consultant, and a treatment plan derived. Patients then followed one of 5 follow‐up pathways and were notified in writing with a copy to their GP.

Results  During a 24‐month period a total of 897 patients were reviewed using the ‘paper clinic’ follow‐up system. Of these, 285 (31.8%) patients were discharged without further follow‐up. In a given 3‐month period when the clinic was well established, 152 patients were reviewed, of whom 27% were discharged from follow‐up, 17% received SOS appointments, 13% required further investigation (and consequently were returned to ‘paper clinic’ follow‐up), and 7% received Nurse led follow‐up. In this 3‐month period 64% of patients reviewed by ‘paper clinic’ follow‐up did not return to Surgical Outpatient's and 12% received a Surgical Outpatient appointment for review.

Conclusion  ‘Paper clinic’ follow‐up is an effective and feasible follow‐up alternative, resulting in a major decrease in outpatient follow‐up burden. This has allowed the redesign of the outpatient clinic profile allowing for an increase in new urgent slots, and more rapid clinic follow up review of those patients who need it. Re‐design and rationalization of existing services can result in considerable service improvement. Expanding clinics should not be considered the only option when faced with capacity and demand issues.
Acute compartment syndrome of the legs after colorectal surgery
Authors: Schofield P. F. , Grace R. H.
Published: June 2004

This review considers the causes, diagnosis and management of compartment syndrome affecting the legs after colorectal surgery.
Stochastic efficiency analysis with risk aversion bounds: a simplified approach
Authors: Hardaker J. Brian , Richardson James W. , Lien Gudbrand , Schumann Keith D.
Published: June 2004

A method of stochastic dominance analysis with respect to a function (SDRF) is described and illustrated. The method, called stochastic efficiency with respect to a function (SERF), orders a set of risky alternatives in terms of certainty equivalents for a specified range of attitudes to risk. It can be applied for conforming utility functions with risk attitudes defined by corresponding ranges of absolute, relative or partial risk aversion coefficients. Unlike conventional SDRF, SERF involves comparing each alternative with all the other alternatives simultaneously, not pairwise, and hence can produce a smaller efficient set than that found by simple pairwise SDRF over the same range of risk attitudes. Moreover, the method can be implemented in a simple spreadsheet with no special software needed.
Three facts about marijuana prices*
Authors: Clements Kenneth W.
Published: June 2004

Australians are among the largest consumers of marijuana in the world, and estimates show that their expenditure on marijuana is approximately twice that on wine. In the present paper, the evolution of Australian marijuana prices over the last decade is analysed, and a decline in real terms by almost 40 per cent is shown. This decline is far above that experienced by most agricultural products. Why has this occurred and what are the implications? One possible reason is the adoption of hydroponic growing techniques that have enhanced productivity and lowered costs and prices. Another reason is that laws have become softer and penalties reduced. Patterns in prices are found that divide the country into three broad regions: (i) Sydney, where prices are highest; (ii) Melbourne and Canberra, which have somewhat lower prices; and (iii) everywhere else, where marijuana is cheapest. An exploratory analysis indicates the extent to which the price declines have stimulated marijuana consumption and inhibited the consumption of a substitute product, alcohol.
Measuring the economic inefficiency of Nepalese rice farms using data envelopment analysis
Authors: Dhungana Basanta R. , Nuthall Peter L. , Nartea Gilbert V.
Published: June 2004

A data envelopment analysis of a sample of 76 Nepalese rice farmers reveals average relative economic, allocative, technical, pure technical and scale inefficiencies as 34, 13, 24, 18 and 7 per cent, respectively. The significant variations in the level of inefficiency across sample farms are attributed to the variations in the ‘use intensities’ of resources such as seed, labour, fertilisers and mechanical power. In addition, a second stage Tobit regression shows the variation is also related to farm‐specific attributes such as the farmers’ level of risk attitude, the farm manager's gender, age, education and family labour endowment. Based on the empirical findings, policy implications and development strategies for improving efficiency of Nepalese rice farms are briefly discussed.
Drought policy: a graphical analysis*
Authors: Quiggin John , Chambers Robert G.
Published: June 2004

The standard approach to modelling production under uncertainty has relied on the concept of the stochastic production function. In the present paper, it is argued that a state‐contingent production model is more flexible and realistic. The model is applied to the problem of drought policy.
Technological and financial approaches to risk management in agriculture: an integrated approach*
Authors: Chambers Robert G. , Quiggin John
Published: June 2004

In the present paper, risk‐management problems where farmers manage risk both through production decisions and through the use of market‐based and informal risk‐management mechanisms are considered. It is shown that many of these problems share a common structure, and that a unified and informative treatment of a broad spectrum of risk‐management tools is possible within a cost‐minimisation framework, under minimal conditions on their objective functions. Fundamental results are derived that apply regardless of the producer's preference towards risks, using only the no‐arbitrage condition that agricultural producers never forego any opportunity to lower costs without lowering returns.
Consequences of European Union Enlargement for Spain
Authors: Turrión Jaime , Velázquez Francisco J.
Published: June 2004

This article analyses the effects that EU Eastern enlargement will have on the Spanish economy. As opposed to the widespread belief that the major impact on Spain will stem from the reduction of Community funds received, the impact on two real variables is also analysed here, namely trade and foreign direct investment, and evidence is offered of the restructuring of economic activity in the enlarged Europe and its effects on the Spanish economy. In addition, the competition for Spain of the new partners in the Community market is also examined. One of the most noteworthy results is that the competition of the new members of the European market is becoming stronger, as they have a commercial structure that is becoming more and more similar to Spain's and with a greater technological content. This phenomenon appears to be the outcome of the activity of the multinationals, which are re‐organising their activity and transferring part of their production to Central Europe to capitalise on the cost advantages of the new members and their more strategic geographical situation. Furthermore, evidence is put forward that, if the criteria for eligibility for the Structural and Cohesion Funds are not altered, Spain will be one of the countries in which the budgetary situation will deteriorate most in the post‐enlargement EU.
EU Enlargement and the Portuguese Economy
Authors: Crespo Nuno , Fontoura Maria Paula , Barry Frank
Published: June 2004

The main focus of the present paper is on the emerging and likely future trade effects of enlargement. Though our particular concern is with Portugal, we set the scene by comparing the trade structures of the 10 countries of Central and Eastern Europe (i.e. the eight CEE accession states plus Bulgaria and Romania) – including an analysis of the individual cases of the Czech Republic, Hungary and Poland – with those of the EU15 as a whole, and with those of the 4 EU cohesion countries.

The elimination of trade barriers between incumbents and accession states will have two trade‐related effects on EU incumbents: an increase in bilateral flows with the CEEC and a shift effect as the CEEC displace some incumbent exports to EU markets. The first effect is likely to be strongest for those incumbents for which there is a strong overlap between their export structure and the import structure of the CEEC. Portugal emerges as one of the economies with the least overlap.

The displacement effect, we conclude, is likely to be particularly strong in the case of Portugal, given the high degree of similarity between Portuguese exports and those of the CEEC. Portugal appears to be ‘being squeezed from below’ in that, for the majority of its traditional export sectors, the CEEC became progressively more competitive during the second half of the 1990's.

Portuguese specialisation was increasingly confined to low‐technology, low‐added‐value sectors with declining demand, as strong FDI inflows to the CEEC led to an increasing preponderance of more dynamic sectors in their export structures. Thus, Portugal is also being squeezed from above. This suggests that there may be substantial industrial disruption, in response to which labour‐market flexibility and dynamic entrepreneurial response is crucial. Intersectoral mobility is generally easier the more highly educated the workforce – an indicator on which Portugal scores poorly. The Portuguese labour market, however, displays a high degree of flexibility, consistent with its long lasting low rate of unemployment. Continued flexibility will help minimise these likely adjustment costs.

Besides the trade and industry effects, other topics considered in the paper include the implications of enlargement for Portugal's ability to attract FDI, the likely consequences for Portugal of inward migration from the CEEC to the EU, and the implications of enlargement for Portugal's budgetary relations with the rest of the EU.
Prospects for Ireland in an Enlarged EU
Authors: Barry Frank
Published: June 2004

The CEEC share of Irish exports has grown fivefold since transition began, with export sales expanding in all sectors. Even at current income levels there remains scope for a further doubling of exports, and trade will grow even more substantially if accession facilitates the CEEC in converging more rapidly on EU living standards.

Most analyses predict that the EU15 sectors that face the greatest threats of enlargement‐induced disruption are Food and Textiles, Clothing and Footwear. In the case of Irish Food Processing, however, the prognosis of the present paper is positive since Irish agricultural output differs quite strongly from that of the CEE economies. The adjustment costs associated with industrial dispution, furthermore, are highest in economies with rigid labour markets, whereas the flexibility of the Irish labour market seems to have improved substantially over the last decade or so.

Outward FDI from Ireland has grown strongly over the Celtic Tiger era, and Irish multinational firms have been reasonably active in acquiring companies in their sectors in Cental and Eastern Europe. The main worry for Ireland is that the more successful accession states may divert FDI inflows away from Ireland. Micro‐level analysis of the conditions pertaining in some of Ireland's most important foreign‐dominated sectors – information technology, pharma‐chem and instrument engineering – suggests that these threats may be overstated. The leading CEE economies, rather than drawing FDI away from Ireland, may instead contribute to the further development of EU‐wide production networks, making the networks themselves more competitive as global players.

The net cost to Ireland of agreements already reached on the financing of enlargement is quite manageable. The cost to Ireland would escalate dramatically, however, if costs and benefits were to be redistributed within the EU in line with current income levels, entailing a substantial transformation of the CAP transfer mechanism.
The Motor Industry in an Enlarged EU
Authors: Rhys D. Garel
Published: June 2004

The motor industry in the ‘First Fifteen’ EU makes an enormous contribution to its economic prosperity. This is manifest in the scale of employment, output, investment, international trade and technological change. The enlargement of the EU will see the full integration of the auto sector in the accession countries with the activities in the West to reinforce its already massive scale. The nature of optimum size and the importance of economies of scale creates a bias to bigness in vehicle manufacture. Hence, the auto industry in the accession countries consists largely of the local operations of transnational companies. As car demand is income elastic the level of sales in the accession countries is relatively small but as the economies expand the potential is enormous. This, together with non‐scaler advantages such as low wage rates, has attracted considerable investment by vehicle firms in the last fifteen years into the accession countries. Various tariff reduction agreements have meant that integration of the East Central European motor industry with Western operations has pre‐dated the current formal enlargement of the EU. The countries that have done particularly well in attracting automotive investment have been Poland, the Czech Republic and, particularly, Slovakia. The recent history of the auto sector in the accession countries has not been without its problems. The collapse of the command economies saw disruption in the market and the decline of the local indigenous car makers. Subsequently this was more than offset by new inward investment. There has been no revival of the local commercial vehicle industry and further restructuring can be expected. The long‐term survival of the auto component sector in the accession countries will depend on how the sector responds to the competitive challenges of free trade and enlargement. However, there are signs that significant high value‐added activities such as vehicle design and development, will be sustainable in East Central Europe. The motor industry in the accession countries will face its own challenges, not least the tendency of the industry to anticipate formal integration. This time it will mean expansion into Eastern Europe. Hence, whilst the location of vehicle plants in the accession countries challenges the traditional centres of manufacture in the West, including ‘the periphery’, in turn they must be alert to even newer competition elsewhere.
Enlargement and the European Geography of the Information Technology Sector
Authors: Barry Frank , Curran Declan
Published: June 2004

The information technology sector in Europe, comprising the production of computer hardware and software, is disproportionately located on the continent's western periphery. The vast bulk of computers sold in Europe in the 1990s were assembled either in Ireland or Scotland, while Ireland also accounted for over 40 per cent of all packaged software and 60 per cent of all business software sold in Europe. As the sector in both these locations is largely foreign owned, the question arises as to whether EU enlargement might impact on the geography of the sector by diverting information technology FDI from the western to the new eastern periphery. This issue is explored in the present paper by analysis of five individual sub‐segments: computer assembly and electronic components, R&D, mass‐market packaged software and the remainder of the software sector.

The paper deems it likely that computer assembly operations will continue the shift seen in recent years from Ireland and Scotland to Central and Eastern Europe. The production of electronic components such as microchips represents a growing share of activity in most EU locations as well as in the CEE countries. Analysis suggests that this pattern of geographically‐dispersed growth will resume once the consequences of the collapse of the high‐tech bubble are played out.

The distribution of R&D activity across Europe and globally is also considered unlikely to be much affected by enlargement. As for software, as long as localisation activities remain important, Ireland – the EU location in which most of this activity is carried out – seems set to be able to compete strongly, given the attractiveness of its English‐language environment and other attributes to the young continental Europeans upon which this activity relies. Most software services remain largely non‐tradable however. This sector will grow in the accession states as computer penetration rates converge on the EU average, but without displacing activity from the incumbent EU member states. For firms already competing in the tradable niche software segment, on the other hand, enlargement cannot but be beneficial because of its impact on the size of the market into which they sell.
Enlargement and the Textiles, Clothing and Footwear Industry
Authors: Hanzl‐Weiß Doris
Published: June 2004

The textiles, clothing and footwear (TCF) industry is a labour intensive industry, strongly determined by globalization and easy relocation to low‐cost countries. Hence also in the European Union this industry is relatively more important in the low‐wage regions of the EU‐Southern periphery. With the envisaged enlargement, however, these countries fear a further shift of the sector to Central and Eastern Europe as these countries still have a comparative advantage in terms of low labour costs. The present article investigates whether this fear is justified, looking at three main aspects: first at the position and history of the TCF sector in the European Union and its role in the EU periphery, second at the sector in the Central and Eastern accession countries, and third at gobalization issues. The second aspect is dealt with in great detail, as development trends in the Central and East European countries are important and telling. Much has happened during the 15‐year (and more) period between the collapse of communism and the EU membership in this region, most important the integration to the EU by the means of trade, in particular outward processing trade. These developments mainly seem to determine future trends in an enlarged Europe. Overall however, future prospects have to be seen in a global context, strongly influencing the sector via changes in global trade policies.
Old Testament and Church Ministries in Two Ecumenical Dialogues
Authors: Mueller, SJ Joseph G.
Published: June 2004

Abstract:  To understand any church institution as founded by Jesus, one must take account of its relationship to his work of bringing the Old Testament revelation and its institutions to their eschatological realization. A sample of the work of recent ecumenical dialogues (BEM and the international Lutheran– Roman Catholic document on church and justification) shows that their discussions of church institutions have failed to do this adequately. This failure has complicated the efforts at unity to which these dialogues intend to contribute. Attention to the Old Testament roots of church institutions can help ecumenical ecclesiology to focus better on some important issues.
The Dialectic of Divine Love: Pannenberg's Hegelian Trinitarianism
Authors: Min Anselm K.
Published: June 2004

Abstract:  In this study of Pannenberg's social trinitarianism, I first present his Hegelian‐dialectical approach to the problem of the unity and plurality in God, highlighting his many innovations, such as the mutual reciprocity of the divine persons, the mutual mediation of the divine essence and the three persons, the essence as self‐manifestation and a force field, the Holy Spirit as the divine essence, which is love. Second, I discuss serious reservations about some of the consequences of these innovations, such as the monarchy of the Spirit, the elevation of the divine essence as an entity above the three persons, the failure to explain the specificity and equality of each person, and others.
Did Christ have a Fallen Human Nature?
Authors: Crisp Oliver
Published: June 2004

Abstract:  Recently, it has become common to claim that the human nature assumed by the Son was ‘fallen’, although sinless. This seems a difficult thing to say with a traditional understanding of original sin. This article explores this difficulty, proposes a possible solution, and then shows that the solution proposed also faces logical difficulties. The article thus argues that it is not possible to make logical sense of the notion that Christ's humanity was fallen.
A Community of Love? Jesus as the Body of God and Robert Jenson's Trinitarian Thought
Authors: Burgess Andrew
Published: June 2004

Abstract:  This article is a critical engagement with Robert Jenson's trinitarian thought as shaped by his description of Jesus as the body of God. Jenson develops his doctrine of God's personhood using a phenomenology of spirit and body, subjectivity and objectivity, with an emphasis on the incarnation as the event in which God takes on embodiment and thereby becomes a personal agent. However, it is shown that Jenson's construction prevents proper development of the threeness of God, and that his thought finally implies modalism. In particular, Jenson's attempt to describe the internal relations of God as ‘mutual, loving, converse’ founders on his overdeveloped phenomenology of personhood.
New Perspectives on an Old Debate: Friedrich Schleiermacher's Essay on Election
Authors: Gockel Matthias
Published: June 2004

Abstract:  This article analyses Schleiermacher's essay on election, which has not received the attention it deserves. I argue that it presents a significant advance in the debate about unconditional grace and the relation between redemption and predestination. While Schleiermacher defends the Augustinian‐Calvinist view of election, he criticizes the ideas of double predestination and eternal damnation (for the unbelievers). Thus, he wants to provide a new basis for Lutherans and Calvinists to settle or, at least, reconsider their longstanding controversy over the matter. After the publication of the essay in 1819, Schleiermacher's doctrine of election remained unchanged, except for minor modifications.
Transnational Families: Memories and Narratives
Authors: Chamberlain Mary , Leydesdorff Selma
Published: June 2004

This introduction to a special issue of the journal explores not only the role of memory and narratives in understanding gender and transnational families, but suggests how such families use and understand their memories to construct coherent narratives of the self and kin. In common with renewed thinking about the multifaceted nature of migration, the complexities of the process, and the continuing dialogue that migration establishes between the old and the new, the past and the present, those who engage with oral history/life story methods are increasingly aware that such data provide a ‘value added’ to rich empirical detail. These methods reveal the use of memory and its role in the continuing emotional adjustments in which most transnational experience is embroiled. They show how the multi‐layering of memory, language and narratives are indicators of the ways in which culture shapes recall and recounting. Families themselves become sites of belonging, part of the imaginary unity through which a transnational family may seek its identity. Equally, oral histories can tease out ways in which gender differences impact on, or are impacted by, transnational lives. The introduction situates the subsequent articles within a brief overview of oral history and migration.
Celebrating Ourselves: The Family Reunion Rituals of African‐Caribbean Transnational Families
Authors: Sutton Constance R.
Published: June 2004

In the past decade, family reunions have become an important ritualized event among Afro‐Caribbean transnational migrants. Dispersed across a large number of North Atlantic countries, Afro‐Caribbeans have turned to organizing events specifically designed to reunite kinfolk. The rituals constitute a celebration of family as a distinct social group with a kin‐based, lineage‐like identity. Re‐creating kin ties among those spread across different nations and transmitting kin‐based connections to their offspring are the main incentives for holding these rituals. In this article I describe three different recent family reunions, one held in Barbados, one in Grenada, and one in Trinidad and Barbados. I analyse the specific forms these rituals take, relate their differences from the social positioning of the core members of the kin groups and discuss the signifying practices of the reunions for maintaining Caribbean family connections in the diaspora. Finally, I raise questions about how the kin‐based identities constructed in the reunion rituals intersect with race/class, ethnic and national identities.
Soa's Version: Ironic Form and Content in The Self‐Account of A Transnational métisse Narrator
Authors: Walsh Andrew
Published: June 2004

In this article I explore the links between the form and content of narratives collected from a young Malagasy/French woman, named Soa, who has recently moved from Madagascar to France. Soa's self‐account is riddled with stories that point out the ambiguities inherent in her experience of life as a woman with feet, and obligations, in two worlds at once. Rather than indicating her confusion or uncertainty, it is argued here that these stories, and the form in which they are presented, indicate the sort of ironic stance that may well be the prerogative of transnational, millionétisse narrators like Soa.
The Quest for Family and The Mobility of Modernity in Narratives of Postwar British Emigration
Authors: Hammerton James
Published: June 2004

In this article I focus on ways in which the postwar generation of British migrants to Canada and Australia construct their stories as epic struggles with family themes of both loss and triumph at the centre. While, during the postwar years, there is among some migrants evidence of the emergence of a more adaptable, sojourning ‘mobility of modernity’, most life stories told by the migrants suggest a more traditional pattern in which family themes dominate. In these narratives postwar migrants structure their accounts along traditional ‘epic story’ lines reminiscent of Oscar Handlin's long superseded thesis about dislocation in the old country, alienation in the new and ultimate triumph over material and cultural obstacles. But the ‘epic’ quality of these stories is deeply attached to family themes; the disruption of family networks and attempts to rescue the old or create new ones are central to the way the migration experience determines the structuring of life memories. The very act of migration focuses attention on its impact on kinship. The predominantly urban, nuclear family form of postwar British migration does contrast sharply with more traditional rural patterns based on extended family movements and ‘chain migration’. But British migrants' emphasis on the ‘quest for family’ and the refashioning of migrant identity in their narratives underlines the coexistence of traditional themes within countervailing trends towards the mobility of modernity.
Recycled Odyssey: Creating Transnational Families in The Greek Diaspora
Authors: Panagakos Anastasia N.
Published: June 2004

In this article I explore the types of transnational families forged by Greek Canadian women through cycles of migration between Canada and Greece. The focus is on how transmigrant women search for a spouse and heterosexual lifestyle embodied within a seemingly ‘authentic’ Greek experience. This recycled odyssey in which the women negotiate systems of gender and ethnic identification between two different social milieux highlights how parental guidance, class tensions and representations of gender and sexuality (re)form the Greek transnational family. These conflicts, and their resolutions, indicate how the ties of transnational families are negotiated to accommodate competing notions of sexuality, femininity, filial piety, parental investment and economic responsibility. Such cases are poorly documented since it is assumed that ‘white’ ethnic groups in North America are more assimilated. However, given the forces that drive transnationalism — such as global capital, cheap travel, telecommunications and European integration — belonging to an imagined community has different implications than it did in the past.
‘Aprendemos A Convivir’: Conjugal Relations, Co‐parenting, and Family Life Among Ecuadorian Transnational Migrants in New York and The Ecuadorian Andes
Authors: Pribilsky Jason
Published: June 2004

The aim of this article is to examine conjugal relations, co‐parenting and family life among Ecuadorian transnational migrants in New York and the Azuayo‐ Cañari highlands of Ecuador. It counters two commonly‐held views of transmigration. Officials and academics often stress the negative impacts of male migration to the USA, arguing that it leads to spousal abandonment. In addition, studies of gender in transnational relationships generally concentrate on women's experiences and lack a more nuanced understanding of men's lives in migration. Based on interviews with both male migrants in New York and women in Ecuador, this research focuses instead on how intact couples work to redefine roles, relationships and family life; how they learn to live side‐by‐side (aprender a convivir). The article begins with an account of men's adjustment to single life in the city, which is then juxtaposed to women's experiences in the sending villages. The main section presents a narrative of one couple, revealing how they handle remittances, communication, child‐raising and their own relationship. Their experiences highlight the tensions and problems faced by young couples starting to form their own autonomous households in a setting increasingly different from that of previous generations. But, despite hardships, such couples often state that their relationship improved after migration.
Off‐Label Prescribing of Drugs in Specialty Headache Practice
Authors: Loder Elizabeth W. , Biondi David M.
Published: June 2004

Objective.—To assess the extent of off‐label prescribing in specialty headache practice.

Methods.—A prospective record was kept of all prescriptions written during a 30‐day period in a tertiary care headache program affiliated with two teaching hospitals. Each drug was categorized as “on‐label,” defined as approved by the FDA for a headache or general pain indication, and used in accordance with label instructions, or “off‐label,” defined as any use of a drug not covered in the FDA‐approved package insert.

Results.—A total of 379 prescriptions were written during a 30‐day period. One hundred and seventy‐eight prescriptions (47%) met the criteria for off‐label use. In all, 23 categories of off‐label treatment were prescribed during the study, but just 4 accounted for over half of all off‐label prescriptions: newer antiepileptic drugs such as topiramate and lamotrigine (each accounted for n = 26, 15% of off‐label prescriptions), newer antidepressants, especially venlafaxine (n = 27; 15% of off‐label prescriptions), and botulinum toxin type A (n = 13; 7% of off‐label prescriptions).

Two hundred and one prescriptions met criteria for on‐label use. The largest percentages of prescriptions written for approved, on‐label indications were for triptans (n = 74; 37% of on‐label prescriptions), and nonsteroidal anti‐inflammatory drugs (n = 64; 32% of on‐label prescriptions).

Conclusions.—Off‐label prescribing is common in the specialty management of headache conditions. We conclude that it is within the current standard of care, and an integral part of practice, to use off‐label medications in the treatment of complex headache conditions.
Severe Vascular Events in Migraine Patients
Authors: Velentgas Priscilla , Cole J. Alexander , Mo Jingping , Sikes Carolyn R. , Walker Alexander M.
Published: June 2004

Objective.—To estimate rates of vascular events in relation to dispensing of triptans and ergot alkaloids among migraineurs, and to compare these rates with those of nonmigraineurs.

Context.—It has been speculated that the use of triptans or ergot alkaloid drugs might increase risk of ischemic events through vasoconstriction.

Design.—A retrospective cohort study of 130,411 migraineurs and 130,411 age‐, sex‐, and health plan‐matched nonmigraineurs who were members of UnitedHealthcare during 1995 through 1999. The data source for this study was Ingenix's research database containing pharmacy and medical claims for UnitedHealthcare members, and the National Death Index.

Main Outcome Measures.—Incidence of cardiovascular and cerebrovascular events and mortality.

Results.—Migraineurs and nonmigraineurs had identical rates of myocardial infarction: 1.4 per 1000 person‐years. Migraineurs were 67% more likely to suffer a stroke than nonmigraineurs (adjusted relative risk [RR] 1.67, 95% confidence interval [CI] 1.31–2.13), and had higher rates of unstable angina and transient ischemic attacks. There was no increase in risk of myocardial infarction with current (adjusted RR 0.80, 95% CI 0.58–1.11) or recent (adjusted RR 1.15, 95% CI 0.71–1.87) triptan use. Neither current (adjusted RR 0.90, 95% CI 0.64–1.26) nor recent (adjusted RR 0.84, 95% CI 0.46–1.55) triptan use was associated with risk of stroke. Current users of ergot alkaloids were somewhat more likely to have a stroke than other migraineurs (adjusted RR 1.49, 95% CI 0.93–2.41), but there was no dose‐response relationship.

Conclusions.—Use of triptans is not associated with increased risk of any ischemic events, including myocardial infarction and stroke, or mortality. Consistent with previous studies, migraineurs in general have an elevated risk of stroke, but not myocardial infarction, compared with nonmigraineurs.
Patterns of Use of Triptans and Reasons for Switching Them in a Tertiary Care Migraine Population
Authors: Sheftell Fred D. , Feleppa Michele , Tepper Stewart J. , Volcy Michel , Rapoport Alan M. , Bigal Marcelo E.
Published: June 2004

Objective.—To assess the reasons for switching triptans within migraine patients presenting to a specialty clinic.

Design and Methods.—We reviewed data of migraineurs who (1) were currently using a triptan as acute treatment medication for migraine, and (2) had previously used at least one other triptan, or a different triptan formulation. All subjects were followed for at least 1 year. For every triptan/formulation used, the reasons for discontinuation were obtained.

Results.—Our sample consisted of 386 patients, 339 of whom (87.8%) were females. Sumatriptan was first used by 349 (90.4%); zolmitriptan, by 238 (61.5%); rizatriptan, by 195 (50.5%); naratriptan, by 137 (35.4%); and almotriptan, by 31 (8.0%). Almotriptan was excluded from this analysis because of our small sample. We found significant differences among those who wanted to try another triptan to see if it would be better in those who first used sumatriptan 25 mg, compared to those first using sumatriptan 50 mg (P= .01), sumatriptan 100 mg (P < .001), sumatriptan nasal spray (NS) (P < .001), sumatriptan subcutaneous (SC) (P < .001), zolmitriptan 5 mg (P < .001), rizatriptan 10 mg (P < .001), and naratriptan (P= .001). Patients using rizatriptan, sumatriptan NS, and sumatriptan SC had significantly lower rates of reporting this answer. Subjects first using naratriptan were less likely to report recurrence than those using sumatriptan 25 mg (P= .004), sumatriptan 50 mg (P= .0005), sumatriptan 100 mg (P= .003), zolmitriptan (P= .02), and rizatriptan (P= .006). Incomplete relief was more frequently reported by those first using sumatriptan 25 mg and naratriptan. Inconsistency was a reason for switching in those initially using sumatriptan NS, sumatriptan 25 mg, and naratriptan and less frequently reported in those using zolmitriptan and sumatriptan SC. Side effects were major factors for those first using sumatriptan 100 mg, NS, and SC, and less for those using naratriptan and sumatriptan 25 mg. From those subjects that initially used sumatriptan SC and were switched to a different triptan or formulation, 19.5% returned to sumatriptan SC; for the other triptans/formulations, the percentages were: sumatriptan 25 mg, 7.8%; sumatriptan 50 mg or 100 mg, 42.3%; sumatriptan NS, 17.7%; zolmitriptan, 17.6%; rizatriptan, 16.5%; naratriptan, 9.4%. For those who used more than three triptans/formulations, the last triptan used was: sumatriptan, 29.5%; zolmitriptan, 31.8%; rizatriptan, 25.0%; naratriptan, 12.5%.

Conclusions.—A variety of treatment attributes are important in determining the reasons involved in switching a triptan. To assess this attributes can provide additional information to supplement the traditional tests of efficacy provided by randomized clinical trials.
Study of Mitochondrial DNA Mutations in Patients With Migraine With Prolonged Aura
Authors: Rozen Todd D. , Shanske Sara , Otaegui David , Lu Jiesheng , Young William B. , Bradley Kathy , DiMauro Salvatore , Silberstein Stephen D.
Published: June 2004

Ten patients with migraine with prolonged aura were studied for the presence of mitochondrial DNA point mutations utilizing DNA isolated from blood and hair samples. We analyzed for nine point mutations reported in patients with MELAS (A3243G, C3256T, T3271C, T3291C, A5814G, T8356C, T9957C, G13513A, and A13514G) and three secondary LHON mutations (T4216C, A4917G, and G13708A). None of the patients tested had any of these mutations in mitochondrial DNA. However, one patient was found to have a tRNA(Gln) A4336G mitochondrial DNA variant. From this study it appears that migraine with prolonged aura is not an oligosymptomatic form of MELAS and is not related to secondary LHON mutations. The significance of the tRNA A4336G variant is unknown.
Chronic Daily Headache: Correlation Between the 2004 and the 1988 International Headache Society Diagnostic Criteria
Authors: Bigal Marcelo E. , Tepper Stewart J. , Sheftell Fred D. , Rapoport Alan M. , Lipton Richard B.
Published: June 2004

Background.—In a previous study, we compared the 1988 International Headache Society (IHS) criteria and the Silberstein‐Lipton criteria (S‐L) in a subspeciality clinic sample of 638 patients with chronic daily headache (CDH) assessed both clinically and with headache diaries. Both systems allowed for the classification of most patients with CDH. The 1988 IHS classification required multiple diagnoses and was more complex to apply.

Objectives.—The aim of this study was to revisit the same database, now comparing the prior classification systems with the new 2004 IHS classification. In contrast with the 1st edition, the 2nd edition includes criteria for chronic migraine (CM), new daily persistent headache (NDPH), and hemicrania continua (HC).

Methods.—We reviewed the clinical records and the headache diaries of 638 patients seen between 1980 and 2001 at a headache center. All patients had primary CDH according to the S‐L criteria.

Results.—Using the S‐L criteria as a reference, of the 158 patients with transformed migraine (TM) without medication overuse, just 9 (5.6%) met 2004 IHS criteria for CM. Most of the subjects were classified using combinations of migraine and CTTH diagnoses, much like the 1988 IHS classification. Similarly, using the new IHS system, just 41/399 (10.2%) subjects with TM with medication overuse were classified as probable CM with probable medication overuse. Most patients with NDPH without overuse were easily classified using the 2004 criteria (95.8%). Regarding NDPH with medication overuse, the diagnostic groups were much like results for the 1st edition. All patients with chronic tension‐type headache (CTTH) and hemicrania continua (HC) according to the S‐L system were easily classified using the 2004 IHS criteria.

Conclusions.—We conclude that the 2004 IHS criteria facilitate the classification of NDPH without medication overuse and HC. For subjects with TM according to the S‐L system, the new IHS criteria are complex to use and require multiple diagnoses. Very few patients with TM in the S‐L system could be classified with a single diagnosis in the 2004 IHS classification. In fact, CM was so rare that it would be virtually impossible to conduct clinical trials of this entity using the 2004 IHS criteria. Clinical trials of this entity should therefore be conducted using the S‐L criteria. Finally, we propose that in the 3rd edition of the IHS classification, the diagnosis of NDPH be revised so as not to exclude migraine features.
Orgasmic Headache With Transient Basilar Artery Vasospasm
Authors: Schlegel Daniel , Cucchiara Brett
Published: June 2004

A 36‐year‐old man without significant past medical history presented with recurrent explosive headache at the time of orgasm. Magnetic resonance angiography showed focal mid‐basilar artery narrowing. Despite receiving no specific therapy, the patient's headaches and vascular narrowing had resolved completely on follow‐up six months later. While a number of pharmacologic agents have been proposed to be of benefit in orgasmic headache, this case suggests that spontaneous resolution may also occur.
Ecosystem Properties and Forest Decline in Contrasting Long-Term Chronosequences
Authors: Wardle David A. , Walker Lawrence R. , Bardgett Richard D.
Published: June 2004

During succession, ecosystem development occurs; but in the long-term absence of catastrophic disturbance, a decline phase eventually follows. We studied six long-term chronosequences, in Australia, Sweden, Alaska, Hawaii, and New Zealand; for each, the decline phase was associated with a reduction in tree basal area and an increase in the substrate nitrogen–to-phosphorus ratio, indicating increasing phosphorus limitation over time. These changes were often associated with reductions in litter decomposition rates, phosphorus release from litter, and biomass and activity of decomposer microbes. Our findings suggest that the maximal biomass phase reached during succession cannot be maintained in the long-term absence of major disturbance, and that similar patterns of decline occur in forested ecosystems spanning the tropical, temperate, and boreal zones.
Total Synthesis of Norzoanthamine
Authors: Miyashita Masaaki , Sasaki Minoru , Hattori Izumi , Sakai Mio , Tanino Keiji
Published: June 2004

Norzoanthamine, an alkaloid isolated from
Zoanthus
sp., can suppress the loss of bone weight and strength in ovariectomized mice. Norzoanthamine derivatives can also strongly inhibit the growth of P-388 murine leukemia cell lines and human platelet aggregation. However, norzoanthamine's densely functionalized complex stereostructure and scarce availability from natural sources have proved a synthetic challenge. We report the stereoselective total synthesis of norzoanthamine in 41 steps, with an overall yield of 3.5% (an average of 92% yield each step).
Calorie Restriction Promotes Mammalian Cell Survival by Inducing the SIRT1 Deacetylase
Authors: Cohen Haim Y. , Miller Christine , Bitterman Kevin J. , Wall Nathan R. , Hekking Brian , Kessler Benedikt , Howitz Konrad T. , Gorospe Myriam , de Cabo Rafael , Sinclair David A.
Published: June 2004

A major cause of aging is thought to result from the cumulative effects of cell loss over time. In yeast, caloric restriction (CR) delays aging by activating the Sir2 deacetylase. Here we show that expression of mammalian Sir2 (SIRT1) is induced in CR rats as well as in human cells that are treated with serum from these animals. Insulin and insulin-like growth factor 1 (IGF-1) attenuated this response. SIRT1 deacetylates the DNA repair factor Ku70, causing it to sequester the proapoptotic factor Bax away from mitochondria, thereby inhibiting stress-induced apoptotic cell death. Thus, CR could extend life-span by inducing SIRT1 expression and promoting the long-term survival of irreplaceable cells.