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The literature fails to reflect general agreement over the nature of the services and procedures provided by bioethicists, and the training and core competencies this work requires. If bioethicists are to define their activities in a consistent way, it makes sense to look for common ground in shared communities of practice. We report results of a survey of the services and procedures among bioethicists affiliated with the University of Toronto Joint Centre for Bioethics (JCB). This is the largest group of bioethicists working in healthcare organizations in Canada. The results suggest there are many common services and procedures of JCB bioethicists. This survey can serve as a baseline for further exploration of the work of JCB bioethicists. Common practices exist with respect to the domains of practice, individual reporting relationships, service availability within business hours and the education and training of the bioethicist. [ABSTRACT FROM AUTHOR]

Background: Diverticulitis is a common indication for surgical emergency room admission, often leading to abdominal computed tomography (CT) scanning for both diagnosis and staging. C-reactive protein (CRP) has been identified as a useful biomarker of inflammation. Aspirin and corticosteroids are known to down-regulate CRP production. In this study, we evaluated the usefulness of CRP as a biomarker for complicated diverticulitis and specifically in patients on anti-inflammatory medications: aspirin and corticosteroids. Methods: We analyzed the medical records of patients diagnosed at one medical center during a two-year period, with left-sided diverticulitis, according to clinical data and CT scan. Disease severity was assessed by the Hinchey score using the radiological findings detected by CT. Results: A total of 295 patients were included in the study. Two hundred and forty-three (82 %) were classified with uncomplicated (Hinchey 1a) and 52 (18 %) with complicated disease (Hinchey > 1a). Mean CRP levels were 133.5 and 63.5 mg/ml for those with complicated and uncomplicated disease, respectively ( p < 0.001), and 139 and 60 mg/ml, respectively ( p < 0.001) in the subgroup of patients taking aspirin ( n = 61). For 14 patients on corticosteroid treatment, the difference in mean CRP levels for complicated and uncomplicated disease was not statistically significant. CRP > 90 mg/ml had 88 % sensitivity and 75 % specificity for complicated disease. Conclusions: The CRP level distinguished between complicated and uncomplicated disease among left-sided diverticulitis patients including those taking aspirin, but not among those on corticosteroid treatment. [ABSTRACT FROM AUTHOR]

Background: Perioperative blood transfusion has been associated with a poor prognosis in patients undergoing surgery for colorectal cancer. The aim of this study was to evaluate risk factors for blood transfusion and its impact on long-term outcome exclusively in patients undergoing laparoscopic surgery for curable colorectal cancer. Methods: Data were retrieved from a prospectively collected database of patients who underwent laparoscopic surgery for curable colorectal cancer over a 6-year period. Long-term data were collected from our outpatient clinic and personal contact when necessary. Results: Two hundred and one patients underwent laparoscopic surgery for curable colorectal cancer (stage I-III). Sixty-eight (33.8 %) received blood transfusions during or after surgery. These patients were typically older, had lower preoperative hemoglobin levels, had a more advanced cancer, had a higher Charlson score, had a higher rate of complications and had a higher conversion rate. Kaplan-Meier overall survival analysis was significantly worse in patients who received blood transfusions ( P = 0.004). Decreased disease-free survival was also observed in transfused patients; however, this did not reach statistical significance ( P = 0.21). A multivariate analysis revealed that transfusion was not an independent risk factor for decreased overall and disease-free survival. The Charlson score was the only independent risk factor for overall survival (OR = 2.1, P = 0.002). Independent factors affecting disease-free survival were stage of disease, Charlson score and, to a lesser degree, age and body mass index. Conclusions: Perioperative blood transfusion is associated with decreased long-term survival in patients undergoing laparoscopic resection for colorectal cancer. However, this association apparently reflects the poorer medical condition of patients requiring surgery and not a causative relationship. [ABSTRACT FROM AUTHOR]

Background: Doppler ultrasonography enables accurate identification of the terminal branches of the superior rectal artery prior to hemorrhoidal artery ligation (HAL). However, since the positions of these branches have been found to be relatively constant, the question arises as to the necessity of ultrasonography for their identification. The aim of the current study was to examine the positions of all arteries identified and ligated during the HAL procedure. Methods: We recorded the position of all arteries located and ligated in 135 consecutive patients who underwent the HAL procedure during the years 2003 to 2006. Results: In all patients, 6-8 terminal arterial branches were located above the dentate line. In 102 (76 %) patients, terminal branches were located in all 6 of the odd-numbered clock positions around the anus (1, 3, 5, 7, 9, and 11 o'clock in the lithotomy position). If we had ligated arteries only at these odd-numbered clock positions, without using Doppler ultrasonography, we would have located all the arteries in 96 (71 %) of our patients. Conclusions: The number and location of arterial branches of the superior rectal artery are relatively constant. Nevertheless, if, Doppler ultrasonography had not been performed and, ligation in the HAL procedure had been at the odd-numbered clock positions only, then at least one artery would have been missed in 29 % of our patients. [ABSTRACT FROM AUTHOR]

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Background: Doppler-guided hemorrhoidal artery ligation (DGHAL) was described as lower risk and a less painful alternative to hemorrhoidectomy. We report our experience and 5-year follow-up with this procedure. Methods: Between May 2003 and December 2004, 100 patients with symptomatic Grade II or III hemorrhoids underwent ultrasound identification and ligation of 6-8 terminal branches of the superior rectal artery above the dentate line by a single surgeon using local, regional, or general anesthesia. There were 42 men and 58 women (mean age 42 years, median duration of symptoms 6/3 years). A 10-point visual analog scale was used for postoperative pain scoring. Surgical and functional outcome was assessed at 6 weeks and 3 and 12 months after surgery, with long-term follow-up by a telephone questionnaire at 5 years after the procedure. Results: The mean operative time was 19 min. Local anal block combined with intravenous sedation ( n = 93) or general or spinal ( n = 7) anesthesia was used. Only 5 patients were hospitalized overnight. There was no urinary retention, bleeding, or mortality in the immediate postoperative period. The mean pain score decreased from 2.1 at 2 h postoperatively to 1.3 on the first postoperative day. All patients had complete functional recovery by the third postoperative day. Ninety-six patients completed 12 months of follow-up. Eighty-five of these patients (89%) remained asymptomatic at 12 months, though this number dropped to 67/92 (73%) at 5 years. Conclusions: Long-term follow-up confirms the effectiveness of the DGHAL procedure for treatment for Grade II hemorrhoids. The DGHAL procedure alone seems less effective for Grade III hemorrhoids. [ABSTRACT FROM AUTHOR]

Background: Lymph node ratio (LNR: the ratio of metastatic to total retrieved nodes) has shown prognostic significance in several tumors. Its role in patients with colorectal cancer submitted to laparoscopic resection is still not clearly defined. The aim of this study was to evaluate the impact of LNR on long-term outcome in patients undergoing curative laparoscopic resection. Methods: Patients' data were retrieved from our prospective in-hospital collected data of patients that underwent laparoscopic surgery for curable colorectal cancer over a 6-year period. Long-term data were collected from our outpatient's clinic data and personal contact when necessary. Results: Two hundred and five patients underwent laparoscopic resection for curable colorectal cancer in the study period. Sixty-five patients were node positive. Receiver operating characteristic (ROC) analysis selected 0.13 as the best LNR cutoff value in this group. Kaplan-Meier 5-year survival analysis revealed a significant decrease in overall and disease-free survival in patients with an LNR above 0.13. Long-term outcome of patients with an LNR below 0.13 was similar to node-negative stage II patients. Conclusions: The lymph node ratio is a valuable prognostic factor in node-positive colon cancer patients undergoing laparoscopic resection. Patients with an LNR below 0.13 have the same long-term outcome as stage II node-negative patients. The laparoscopic approach presents the same trends in terms of overall survival and disease-free survival as conventional open access when LNR is considered. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the long-term results, early and late complication rates, and overall satisfaction of patients with grade III hemorrhoids treated by stapled hemorrhoidopexy (SH) or Doppler-guided hemorrhoidal artery ligation (DGHAL). Methods: Operative and follow-up patients' data were prospectively collected for patients undergoing either SH or DGHAL by a single surgeon during a 2-year period. A retrospective comparison between patients' outcome operated by one of the two methods was made based on this data. Clinical data on postoperative pain, analgesic requirements, time to first bowel movement and functional recovery were collected at five postoperative follow-up visits (1 and 6 weeks, 6, 12, and 18 months). Data on patient satisfaction, recurrence of hemorrhoidal symptoms and further treatments were obtained by a standardized questionnaire that was conducted during the last visit 18 months postoperatively. Results: A total of 63 patients underwent SH (aged 52 ± 3.2 years) and 51 patients underwent DGHAL (aged 50 ± 7.3 years). DGHAL patients experienced less postoperative pain as scored by pain during bowel movement (2.1 ± 1.4 vs. 5.5 ± 1.9 for SH), and required fewer analgesics postoperatively. Hospital stay, time to first bowel movement, and complete functional recovery were also significantly shorter for the DGHAL patients. Nine DGHAL patients (18%) suffered from persistent bleeding or prolapses and required additional treatment compared with 2 (3%) patients in the SH group. SH patients reported greater satisfaction compared with DGHAL patients at 1 year postoperatively. Conclusion: Both SH and DGHAL are safe procedures and have similar effectiveness for treating grade III hemorrhoids. DGHAL is less painful and provides earlier functional recovery, but is associated with higher recurrence rates and lower satisfaction rates compared with SH. [ABSTRACT FROM AUTHOR]

Objective:The purpose of this study is to examine the results of repeat lumbar puncture in infants with initial positive cerebrospinal fluid (CSF) cultures in order to determine the clinical characteristics and outcomes of infants with repeat positive cultures.Study Design:Cohort study of infants with an initial positive CSF culture undergoing repeat lumbar puncture between 1997 and 2004 at 150 neonatal intensive care units managed by the Pediatrix Medical group. We compared the clinical outcomes of infants with repeat positive cultures and infants with repeat negative cultures.Result:We identified 118 infants with repeat CSF cultures. Of these, 26 infants had repeat positive cultures. A higher proportion with repeat positive cultures died compared with those with repeat negative cultures, 6/23 (26%) vs. 6/81 (7%), respectively (P=0.02).Conclusion:Among infants with a positive CSF culture, a repeat positive CSF culture is common. The presence of a second positive culture is associated with increased mortality. [ABSTRACT FROM AUTHOR]

The number of retrieved lymph nodes in colorectal cancer resection may have an impact on staging and survival. Examination of at least 12 nodes has become a quality measure for adequate surgical practice. To evaluate the impact of the number of retrieved lymph nodes in laparoscopic colorectal surgery for cancer on node-negative patients’ survival. Evaluation of our prospective in-hospital collected data of patients that underwent laparoscopic surgery for curable colorectal cancer over a 5-year period. Long-term data were collected from our outpatient’s clinic data and personal contact when necessary. During a 5-year period since September 2003,173 patients were operated laparoscopically for curable colorectal cancer. Of the 117 patients who were node negative, 85 node-negative patients (72%) had 12 or more evaluated lymph nodes (mean, 18.3 + 2.4), while 32 node-negative patients had less than 12 (mean, 8.3 + 6.2). Patients with fewer than 12 nodes evaluated had significantly more left-sided tumors, while patients with 12 nodes or more had more right-sided tumors. A comparison of 5-year disease free and overall Kaplan–Meier survival curves revealed no statistically significant difference between the two groups. Evaluation of less than 12 nodes may not necessarily impact patients’ survival in node-negative patients undergoing laparoscopic resection for curable colorectal cancer. A lower number of nodes may be sufficient. [ABSTRACT FROM AUTHOR]

Analyses for value assignment in the renewal Standard Reference Materials® SRM 1598a Animal Serum and SRM 1577c Bovine Liver included extensive characterization by neutron activation analysis (NAA). Conventional instrumental NAA procedures were complemented by pre-irradiation chemical separations for the determination of Al, V, Mn, and Cu, radiochemical separations for the determination of Ag, As, Cd, Cr, Cu, Mo, Sb, and Se, and the use of (anti-) coincidence gamma-ray spectrometry systems for the instrumental determination of Ag, Cr, and Hg. The previous materials, SRMs 1598, 1577, and 1577b, were analyzed together with the new materials for quality control. [ABSTRACT FROM AUTHOR]

Germline mutations in two major susceptibility genes, BRCA1 and BRCA2, account for nearly 20% of familial breast cancers. A majority of the remaining genetic factors involved in heritable breast cancer susceptibility are, however, unknown. Recently, a new BRCA1-interacting protein, receptor associated protein 80 (RAP80), was identified. RAP80 plays an important role in BRCA1-mediated DNA damage responses (DDRs) by recruiting BRCA1 to DNA double-strand breaks (DSBs). A comprehensive screening of DNA from affected index cases of 112 BRCA1/BRCA2 mutation-negative Finnish breast cancer families revealed altogether 10 alterations in RAP80, one of which, c.241-243delGAA, resulted in a single glutamic acid deletion at residue 81 in a highly conserved region of ubiquitin interaction motif 1. The resultant delE81 protein product displayed significantly reduced ubiquitin binding and DSB localization. Expression of the RAP80 delE81 allele impaired both BRCA1 and ABRA1 DSB recruitment, thus compromising BRCA1-mediated DDR signaling. Compared with wild-type RAP80, expression of the delE81 allele was associated with a significant increase in cytogenetically detectable chromosomal aberrations, particularly chromatid breaks. Although evidently quite rare, these results suggest that critical constitutional mutations in RAP80 abrogate DDR function and may be involved in genetic predisposition to cancer.Oncogene (2009) 28, 1843–1852; doi:10.1038/onc.2009.33; published online 23 March 2009 [ABSTRACT FROM AUTHOR]

The National Institute of Standards and Technology (NIST) is preparing a freeze-dried powdered bovine liver tissue Standard Reference Material (SRM) to replace SRM 1577b Bovine Liver as the stock of this material was exhausted during 2006. Like the original SRM 1577 issued in 1972, this renewal focuses on the key elements for diagnostic, nutritional, and toxicological measurements that are important to medical, veterinary, and environmental sciences investigations. NIST’s approach for value assignment included extensive characterization by neutron activation analysis (NAA). Difficulties in the determination of some elements present at very low levels were overcome by use of radiochemical separations. Twentyone elements were characterized in SRM 1577c by NAA. The previous materials, SRM 1577 and 1577b, served as quality control. [ABSTRACT FROM AUTHOR]

This paper describes some highlights from the author’s efforts to improve neutron activation analysis (NAA) detection limits through development and optimization of radiochemical separations, as well as to improve the overall accuracy of NAA measurements by identifying, quantifying and reducing measurement biases and uncertainties. Efforts to demonstrate the metrological basis of NAA, and to establish it as a “Primary Method of Measurement” will be discussed. [ABSTRACT FROM AUTHOR]

A previous study on the determination of carbon, nitrogen, and phosphorus in cattail using cold neutron prompt gamma activation analysis (CNPGAA) demonstrates that the results of numerous cattail samples showed favorable comparison to results from an elemental analyzer (EA) for C and N. However, the results for P overestimated the results from a UV-VIS spectrophotometer because of the interference of chlorine existing in cattail collected from an estuarine environment. To compare to CNPGAA, a method for the determination of C, N, and P in cattail using thermal neutron prompt gamma activation analysis (TNPGAA) has been developed in the TNPGAA facility at the National Institute of Standards and Technology (NIST) and evaluated through the analysis of standard reference materials (SRMs). [ABSTRACT FROM AUTHOR]

During the past seven years, several states within the US have enacted regulations that limit the amounts of selected non-nutritive elements in fertilizers. Internationally, several countries, including Japan, China, and Australia, and the European Union also limit the amount of selected elements in fertilizers. The elements of interest include As, Cd, Co, Cr, Cu, Hg, Mo, Ni, Pb, Se, and Zn. Fertilizer manufacturers and state regulatory authorities, faced with meeting and verifying these limits, need to develop analytical methods for determination of the elements of concern and to validate results obtained using these methods. Until now, there were no certified reference materials available with certified mass fraction values for all elements of interest in a blended, multi-nutrient fertilizer matrix. A new standard reference material (SRM) 695 trace elements in multi-nutrient fertilizer, has been developed to help meet these needs. SRM 695 has recently been issued with certified mass fraction values for seventeen elements, reference values for an additional five elements, and information values for two elements. The certificate of analysis includes an addendum listing percentage recovery for eight of these elements, determined using an acid-extraction inductively-coupled plasma optical-emission spectrometry (ICP–OES) method recently developed and tested by members of the Association of American Plant Food Control Officials. [ABSTRACT FROM AUTHOR]

This paper describes the use of cold-neutron prompt-gamma activation analysis (CNPGAA) to determine carbon, nitrogen, and phosphorus in the aquatic plant Typha domingensis, commonly known as cattail, during spring and fall seasons. According to studies of the Florida Everglades, cattail replaces sawgrass as a result of nutrient enrichment from farm water runoff. Nutrient enrichment, especially phosphorus, in sediment and the water column can lead to undesirable expansion. Early signs of this expansion are apparent in the Apalachicola River floodplain near Apalachicola, Florida, USA. This research project is designed to use cattails as biomonitors of nutrient enrichment in the lower Apalachicola River floodplain. Determination of carbon, nitrogen, and phosphorus in cattail using cold neutron prompt-gamma activation has been developed in our previous studies at the CNPGAA facility at the National Institute of Standards and Technology (NIST), USA. The results of numerous field samples, collected from the study area during spring and fall seasons in 2002, will be presented in this paper. [ABSTRACT FROM AUTHOR]

The basic assumptions of activation analysis are that the induced radioactivity is proportional to the amount of analyte, and that the quantity of radioactivity can be related simply to the number of counts observed. Quantitative measurement of activity (and of its uncertainty) is not always simple, especially when accuracy better than a few percent is sought. Recent work with 77Ge and 76As has demonstrated that the accuracy of half-lives in the literature is sometimes insufficient. Despite these and other problems, quantitative understanding and documentation of uncertainties can be accomplished, providing demonstrable quality assurance and supporting claims of traceability to the Système International. [ABSTRACT FROM AUTHOR]

The determination of arsenic at natural levels in biological materials remains difficult. Many analytical techniques cannot detect the low levels present in typical biological tissues and other techniques suffer from interferences. This paper reviews uses of neutron activation analysis (NAA) at NIST to determine nanogram amounts of arsenic in biological reference materials with radiochemical (RNAA) or instrumental (INAA) procedures. INAA is compromised by high activities from 24Na, 82Br, and 32P that may be formed during irradiation of biological tissues, and result in detection limits as high as 0.1 mg. Lower detection limits have been achieved using state-of-the-art gamma-ray spectrometry systems in INAA and a variety of procedures in RNAA. These techniques and procedures were applied recently at NIST to the determination of arsenic in urine, nutritional supplements, and total diet samples. [ABSTRACT FROM AUTHOR]

Two prompt gamma-ray activation analysis (PGAA) facilities at the NIST Center for Neutron Research have been used routinely to perform elemental analyses of a variety of materials. Results from these analyses are usually expressed as mass fraction values with expanded uncertainties. The expanded uncertainty consists of the combined uncertainty multiplied by the appropriate coverage factor (k) required to achieve a 95% confidence interval. The combined uncertainty includes the uncertainties associated with preparation, irradiation, and γ-ray spectrometry of samples and standards, and corrections for γ-rays from the background or blanks where necessary. To determine the combined uncertainty, each component of uncertainty associated with each variable and constant in the basic measurement equation is evaluated. In this paper we present the PGAA measurement equation, a description of the potential sources of uncertainty for each component of the equation, and three examples of uncertainty evaluation. The examples are for determination of H in standard reference material (SRM) 2454, hydrogen in titanium alloy using the cold neutron PGAA facility, Cd in SRM 2702 Inorganics in Marine Sediment using the original thermal neutron PGAA facility, and N in SRM 3244 Ephedra-Containing Protein Powder using the recently designed thermal neutron PGAA facility. [ABSTRACT FROM AUTHOR]

A method for the determination of carbon, nitrogen, and phosphorus in cattail using cold neutron prompt-gamma activation analysis (CNPGAA) has been developed and evaluated through the analysis of standard reference materials (SRM). After extensive preparation, approximately 400 mg cattail samples from the lower Apalachicola River floodplain were irradiated in the CNPGAA facility at the National Institute of Standards and Technology (NIST). The results of numerous field samples and two standard reference materials using the nuclear method show favorable comparison to results obtained by a CHNS/O analyzer. [ABSTRACT FROM AUTHOR]

Background. Complete excision is the preferred treatment for pilonidal sinus disease. We describe a new technique of excision and tension–free primary closure of pilonidal sinus disease, combined with application of fibrin glue in order to obliterate the dead space and to promote wound healing. Methods. A curved incision of the carried out, 2–3 cm lateral to the opening of the sinus, done under general or spinal anesthesia, and a thick flap was created by undercutting the medial edge and advancing it across the midline. The sinus was completely excised with all of its extensions. The flap was then sutured back to its original place by several interrupted monofilament mattress sutures. Then, 2–4 ml of fibrin glue was injected through the original pilonidal sinus opening to the sinus bed in order to obliterate the dead space. Results. Thirty patients with pilonidal sinus disease were treated by this technique. In four patients, there was a temporary purulent discharge through the opening of the sinus, and there were no other complications. The mean period for returning to daily activities and to work for patients was 11 days (SD=6 days). No infection or recurrent disease was noticed during the follow–up period (23±3 months). Conclusions. Complete excision with tensionfree closure with fibrin glue application may be a useful technique for the treatment of pilonidal sinus disease. [ABSTRACT FROM AUTHOR]

Objective: To determine whether exposure during pregnancy to two types of lozenges used for treatment of sore throat [Kalgaron (Rafa Laboratories, Jerusalem, Israel) or Strepsils (Boots Healthcare International, Nottingham, UK)] was associated with an increased risk of malformations, spontaneous abortions or decreased birthweight. Design: Prospective, controlled, observational study. Study participants: The study group included 54 women who received Kalgaron or Strepsils during the first trimester of pregnancy. The control group included 54 women exposed to non-teratogenic drugs. Results: The rate of major malformations in the study group (3.84%) did not differ from that of the control group (3.92%) [p = 0.98; relative risk 0.98, 95% confidence interval 0.14 to 6.7]. The rate of minor malformations in the study group (1.92%) did not differ statistically from that of the control group (0%) [p = 0.32]. There were also no statistically significant differences in birthweight, rate of live births and rate of spontaneous abortions among the two groups. Conclusions: The use of Kalgaron or Strepsils during pregnancy was not associated with an increased risk of malformations, spontaneous abortions or decreased birthweight. However, larger studies are needed to confirm the safety of these medications during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between cumulative lifetime exposure to diagnostic radiation and the risk of multiple myeloma using data from a large, multi-center, population-based case-control study.Methods: Study subjects included a total of 540 cases with newly diagnosed multiple myeloma and 1998 frequency-matched population controls living in three areas of the United States (Georgia, Michigan, New Jersey). Information on exposure to diagnostic X-rays was obtained by personal interview.Results: No association was found between case-control status and the total number of reported diagnostic X-rays of any type (odds ratio (OR) for 20 or more compared to less than 5 X-rays = 0.9, 95% confidence interval (95% CI) = 0.7-1.2). There was no evidence of an excess risk of multiple myeloma among individuals who reported exposure to 10 or more diagnostic X-rays that impart a relatively high radiation dose to the bone marrow, as compared to individuals reporting no such exposures (OR 0.7, 95% CI 0.4-1.3).Conclusions: These data suggest that exposure to diagnostic X-rays has a negligible impact, if any, on risk of developing multiple myeloma. [ABSTRACT FROM AUTHOR]

Objectives: To explore whether dietary factors contribute to the risk of multiple myeloma and the two-fold higher incidence among blacks compared to whites in the United States.Methods: Data from a food-frequency questionnaire were analyzed for 346 white and 193 black subjects with multiple myeloma, and 1086 white and 903 black controls who participated in a population-based case-control study of multiple myeloma in three areas of the United States.Results: Elevated risks were associated with obese vs. normal weight (OR = 1.9, 95% confidence interval (CI) = 1.2-3.1 for whites and OR = 1.5, 95% CI = 0.9-2.4 for blacks), while the frequency of obesity was greater for black than white controls. Reduced risks were related to frequent intake of cruciferous vegetables (OR = 0.7, 95% CI = 0.6-0.99) and fish (OR = 0.7, 95% CI = 0.5-0.9) in both races combined, and to vitamin C supplements in whites (OR = 0.6, 95% CI = 0.5-0.9) and blacks (OR = 0.8, 95% CI = 0.5-1.4), with the frequency of vitamin supplement use being greater for white than black controls. However, frequent intake of vitamin C from food and supplements combined was associated with a protective effect in whites (OR = 0.6, 95% CI = 0.4-0.9), but not blacks (OR = 1.2, 95% CI = 0.8-2.1).Conclusions: The greater use of vitamin C supplements by whites and the higher frequency of obesity among blacks may explain part of the higher incidence of multiple myeloma among blacks compared to whites in the United States. In addition, the increasing prevalence of obesity may have contributed to the upward trend in the incidence of multiple myeloma during recent decades. [ABSTRACT FROM AUTHOR]

Standard reference material (SRM) 2134 Arsenic Implant in Silicon was produced at the National Institute of Standards and Technology (NIST) as a calibrant for secondary ion mass spectrometry. Instrumental neutron activation analysis was used as a primary method for certification of the arsenic implanted dose. A complete evaluation of all sources of uncertainty yielded an expanded relative uncertainty for the mean value of this SRM to be 0.38% at approximately the 95% level of confidence. No evidence indicating significant heterogeneity among samples was observed. [ABSTRACT FROM AUTHOR]

Metrology systems are being established by various countries for the worldwide comparability of data related to trade, industrial products, health, and the environment. This has in turn led to an increased interest in methods that have the highest possible accuracy and precision. The relevance of instrumental neutron activation analysis (INAA) for metrological science has been evaluated. It is concluded that INAA is a suitable technique for method validation, proficiency testing, development of reference materials and reference methods. Moreover, it is concluded that INAA may comply with the CCQM definition of a definitive or primary ratio method provided that the uncertainty in the results is reduced to much lower levels compared to those currently encountered in most NAA laboratories. [ABSTRACT FROM AUTHOR]

A population-based case-control study was carried out among 981 men (479 black, 502 white) with pathologically confirmed prostate cancer and 1315 controls (594 black, 721 white). In-person interviews elicited information on sexual behaviour and other potential risk factors for prostate cancer. Blood was drawn for serologic studies in a subset of the cases (n = 276) and controls (n = 295). Prostate cancer risk was increased among men who reported a history of gonorrhoea or syphilis (odds ratio (OR) = 1.6; 95% confidence internal (CI) 1.2-2.1) or showed serological evidence of syphilis (MHA-TP) (OR = 1.8; 95% CI 1.0-3.5). Patterns of risk for gonorrhoea and syphilis were similar for blacks (OR = 1.7; 95% CI 1.2-2.2) and whites (OR = 1.6; 95% CI 0.8-3.2). Risks increased with increasing occurrences of gonorrhoea, rising to OR = 3.3 (95% CI 1.4-7.8) among subjects with three or more events (Ptrend = 0.0005). Frequent sexual encounters with prostitutes and failure to use condoms were also associated with increased risk. Syphilis, gonorrhoea, sex with prostitutes and unprotected sexual intercourse may be indicators of contact with a sexually transmissible factor that increases the risk of prostate cancer. [ABSTRACT FROM AUTHOR]

Objectives: To investigate dietary factors for squamous cell esophageal cancer and whether these factors may contribute to the five-fold higher incidence of this cancer in the black versus white population of the United States.Methods: Data from a food frequency questionnaire were analyzed for 114 white men and 219 black men with squamous cell esophageal cancer, and 681 white and 557 black male controls from three areas of the United States who participated in a population-based case-control study of esophageal cancer.Results: Protective effects were associated with intake of raw fruits and vegetables (odds ratio for high versus low consumers = 0.3 in both white and black men) and use of vitamin supplements (especially vitamin C; odds ratio for high versus low consumers = 0.4 in both races), with the frequency of consumption of raw fruits and vegetables and vitamin supplements being greater for white than black controls. In addition, elevated risks were associated with high versus low intake of red meat (OR = 2.7 for blacks and 1.5 for whites) and processed meat (OR = 1.6 for blacks and 1.7 for whites), with the levels of consumption being greater for black than white controls.Conclusions: In the United States, these dietary factors may contribute in part to the much higher incidence of squamous cell esophageal cancer among black compared to white men. [ABSTRACT FROM AUTHOR]

In a population-based case-control study of pancreatic cancer conducted in three areas of the USA, 484 cases and 2099 controls were interviewed to evaluate the aetiologic role of several medical conditions/interventions, including diabetes mellitus, cholecystectomy, ulcer/gastrectomy and allergic states. We also evaluated risk associated with family history of cancer. Our findings support previous studies indicating that diabetes is a risk factor for pancreatic cancer, as well as a possible complication of the tumour. A significant positive trend in risk with increasing years prior to diagnosis of pancreatic cancer was apparent (P-value for test of trend = 0.016), with diabetics diagnosed at least 10 years prior to diagnosis having a significant 50% increased risk. Those treated with insulin had risks similar to those not treated with insulin (odds ratio (OR) = 1.6 and 1.5 respectively), and no trend in risk was associated with increasing duration of insulin treatment. Cholecystectomy also appeared to be a risk factor, as well as a consequence of the malignancy. Subjects with a cholecystectomy at least 20 years prior to the diagnosis of pancreatic cancer experienced a 70% increased risk, which was marginally significant. In contrast, subjects with a history of duodenal or gastric ulcer had little or no elevated risk (OR = 1.2; confidence interval = 0.9-1.6). Those treated by gastrectomy had the same risk as those not receiving surgery, providing little support for the hypothesis that gastrectomy is a risk factor for pancreatic cancer. A significant 40% reduced risk was associated with hay fever, a non-significant 50% decreased risk with allergies to animals, and a non-significant 40% reduced risk with allergies to dust/moulds. These associations, however, may be due to chance since no risk reductions were apparent for asthma or several other types of allergies. In addition, we observed significantly increased risks for subjects reporting a first-degree relative with cancers of the pancreas (OR = 3.2), colon (OR = 1.7) or ovary (OR = 5.3) and non-significantly increased risks for cancers of the endometrium (OR = 1.5) or breast (OR = 1.3). The pattern is consistent with the familial predisposition reported for pancreatic cancer and with the array of tumours associated with hereditary non-polyposis colon cancer. [ABSTRACT FROM AUTHOR]

To evaluate whether the fivefold greater incidence rate of squamous-cell esophageal cancer in Black compared with White men is due to type of alcoholic beverage consumed or to other qualitative differences in alcohol consumption, we conducted a population-based case-control study with 373 males diagnosed with squamous-cell esophageal cancer (124 Whites and 249 Blacks) and 1,364 male controls (750 Whites and 614 Blacks) from three geographic areas in the United States. Included were all histologically confirmed cases newly diagnosed from 1 August 1986 through 30 April 1989, among White and Black men aged 30 to 79 years. Risks varied to some extent according to type of alcohol used, with beer a stronger contributor in Whites, and wine and liquor stronger contributors in Blacks. However, most of the differences in the odds ratios by type of alcohol and race were eliminated after controlling for average weekly amount of total alcohol consumed. Thus, while alcohol use in all forms is an important risk factor for squamous-cell esophageal cancer in Whites and Blacks, type of alcoholic beverage used does not appear to account for the racial differences in incidence. [ABSTRACT FROM AUTHOR]

In the United States, the incidence rates of multiple myeloma in Blacks are more than twice those in Whites, but the etiology of this cancer is poorly understood. A population-based case-control interview study of 571 subjects (365 White, 206 Black) with multiple myeloma and 2,122 controls (1,155 White, 967 Black) living in three areas of the United States (Georgia, Michigan, New Jersey) offered the opportunity to investigate the relationship with smoking and alcohol drinking and to evaluate whether these factors might contribute to the excess risk of multiple myeloma in Blacks. For Blacks and Whites of either gender, there were no significantly elevated risks associated with ever use of cigarettes or alcoholic beverages and no consistent patterns with either intensity or duration of use. These data support previous studies indicating that smoking and drinking are not related causally to the risk of multiple myeloma, and thus cannot account for the racial disparity in incidence rates. [ABSTRACT FROM AUTHOR]

Environmental tobacco smoke (ETS) has been classified as a human lung carcinogen by the United States Environmental Protection Agency (EPA), based both on the chemical similarity of sidestream and mainstream smoke and on slightly higher lung cancer risk in never-smokers whose spouses smoke compared with those married to nonsmokers. We evaluated the relation between ETS and lung cancer prospectively in the US, among 114,286 female and 19,549 male never-smokers, married to smokers, compared with about 77,000 female and 77,000 male never-smokers whose spouses did not smoke. Multivariate analyses, based on 247 lung cancer deaths, controlled for age, race, diet, and occupation. Dose-response analyses were restricted to 92,222 women whose husbands provided complete information on cigarette smoking and date of marriage. Lung cancer death rates, adjusted for other factors, were 20 percent higher among women whose husbands ever smoked during the current marriage than among those married to never-smokers (relative risk [RR] = 1.2, 95 percent confidence interval [CI] = 0.8-1.6). For never-smoking men whose wives smoked, the RR was 1.1 (CI = 0.6-1.8). Risk among women was similar or higher when the husband continued to smoke (RR = 1.2, CI = 0.8-1.8), or smoked 40 or more cigarettes per day (RR = 1.9, CI = 1.0-3.6), but did not increase with years of marriage to a smoker. Most CIs included the null. Although generally not statistically significant, these results agree with the EPA summary estimate that spousal smoking increases lung cancer risk by about 20 percent in never-smoking women. Even large prospective studies have limited statistical power to measure precisely the risk from ETS. [ABSTRACT FROM AUTHOR]

Objective: To identify from the literature and clinical experience a rational approach to management of fibroadenomas of the breast.Method: Recent literature on detection, diagnosis, and natural history of fibroadenomas was reviewed. Experience with over 4,000 women evaluated in the breast clinic at the Tel-Aviv Medical Center contributed to the management strategies suggested by review of the literature.Results: Fibroadenomas of the breast are common, accounting for 50% of all breast biopsies performed. Physical examination, sonography, and fine needle aspiration are effective in distinguishing fibroadenomas from breast cancer. Transformation from fibroadenoma to cancer is rare; regression or resolution is frequent, supporting conservative approaches to follow-up and management.Conclusion: Age-based algorithms that allow for conservative management and that limit excision to patients whose fibroadenomas fail to regress are presented. [ABSTRACT FROM AUTHOR]

Objective: To measure the prevalence of current drinking and potential problem drinking in an inner-city ambulatory care setting, using the CAGE questionnaire.Design: Survey of patients attending ambulatory care clinics, using structured personal interviews.Setting: Three ambulatory care clinics serving an indigent, predominantly black population of metropolitan Atlanta: a general medical appointment clinic, a walk-in clinic, and a neighborhood primary care clinic.Patients/participants: Patients over the age of 18 who attended one of the above clinics on a day when interviewers were available and who were estimated to have more than a 45-minute wait prior to seeing their health provider.Interventions: None.Measurements and Main Results: 15.3% of subjects had CAGE scores greater than or equal to 2 (95% CI 12.2, 19.0). A CAGE score of greater than or equal to 2 was almost three times more common in men than in women, 26.7% vs. 9.5%. Only 8.6% (95% CI 6.3, 11.7) of subjects reported drinking greater than or equal to 2 drinks per day. These findings suggest that problem drinking may affect as many as one in six people seeking care in inner-city ambulatory care clinics and provide support for the use of screening instruments such as the CAGE questionnaire for improved sensitivity in detecting alcoholism in these practice settings. [ABSTRACT FROM AUTHOR]

Apparatus is being developed for short irradiation and rapid counting at the NIST Reactor, optimized for accurate neutron activation analysis via activation products ranging in half-life from about 500 ms to 500 s. This facility is designed to irradiate a sample either in a well-thermalized neutron flux at 3·1013 n·cm−2·s−1, or in a higher flux with a larger fast and epithermal component. The design transfer time for a 1-ml rabbit is 500 ms, measured to 10 ms precision. Timing information for both irradiation and counting will be transferred automatically to the activation analysis workstation computer. The γ-ray spectrometer system is selected and tuned for accurate measurement at high and varying counting rates, using loss-free counting (LFC) technology. A detailed calibration and characterization of this system has been performed. Accurate measurement requires that attention be paid to the systematic and random errors to which LFC is subject, but this requirement is minor compared to the advantages of undistorted spectral shape, the ability to solve the decay equations exactly, and the wider useful range of counting rates in the spectrometer system. [ABSTRACT FROM AUTHOR]

We give algorithms to minimize density for VLSI channel-routing problems with terminals that are movable subject to certain constraints. The main cases considered are channels with linear-order constraints, channels with linear-order constraints and separation constraints, channels with movable modules containing fixed terminals, and channels with movable modules and terminals. In each case we improve previous results for running time and space by a factor of L/lg n and L, respectively, where L is the channel length and n is the number of terminals. [ABSTRACT FROM AUTHOR]

In 2005, plumes were detected near the south polar region of Enceladus, a small icy satellite of Saturn. Observations of the south pole revealed large rifts in the crust, informally called ‘tiger stripes’, which exhibit higher temperatures than the surrounding terrain and are probably sources of the observed eruptions. Models of the ultimate interior source for the eruptions are under consideration. Other models of an expanding plume require eruptions from discrete sources, as well as less voluminous eruptions from a more extended source, to match the observations. No physical mechanism that matches the observations has been identified to control these eruptions. Here we report a mechanism in which temporal variations in tidal stress open and close the tiger-stripe rifts, governing the timing of eruptions. During each orbit, every portion of each tiger stripe rift spends about half the time in tension, which allows the rift to open, exposing volatiles, and allowing eruptions. In a complementary process, periodic shear stress along the rifts also generates heat along their lengths, which has the capacity to enhance eruptions. Plume activity is expected to vary periodically, affecting the injection of material into Saturn’s E ring and its formation, evolution and structure. Moreover, the stresses controlling eruptions imply that Enceladus’ icy shell behaves as a thin elastic layer, perhaps only a few tens of kilometres thick. [ABSTRACT FROM AUTHOR]

Presents research which analyzed the orientation and distribution of the surface features of Jupiter's moon Europa to conclude that the satellite has non-synchronous rotation. Europa's orbit; Europa's small forced eccentricity and its causes; Gravity data; Use of data from Galileo spacecraft; Possibility of global subsurface ocean.

The safety of gastrointestinal endoscopy in the immediate postoperative period following partial gastrectomy was assessed in ten dogs. Endoscopy was performed preoperatively and at 1, 2, 3, and 7 days postoperatively. The mean pressures required to perform an adequate endoscopy varied from 17 to 20 mm Hg. Following partial gastrectomy, the abdominal wall was closed with a zipper to facilitate inspection of the gastric anastomosis. No leakage of air or intra-abdominal abscesses were seen following endoscopy. The results of this study suggest that endoscopy can be safely performed in the immediate postgastrectomy period. [ABSTRACT FROM AUTHOR]

The National Institute of Standards and Technology (NIST) has recently introduced several reference materials for organic and inorganic nutrients in food matrices to assist the food industry in complying with nutrition labeling laws; the food industry and other government agencies have collaborated with NIST in this endeavor. Two food-matrix SRMs were issued in 1996: SRM 1544, Fatty Acids and Cholesterol in Frozen Food Composite; and SRM 1846, Infant Formula. Concentration values in SRM 1544 are provided for six fatty acids, cholesterol, and proximates (fat, protein, carbohydrate, etc.). Values are assigned for proximate and caloric content as well as the concentrations of sixteen vitamins and nine minerals and trace elements in SRM 1846. In 1997, NIST expects to issue two additional food-matrix SRMs: SRM 1548a, Typical Diet, and SRM 2383, Baby Food Composite. SRM 1548a will replace SRM 1548, Total Diet, and will have values assigned for proximates, major and minor inorganic nutrients, and toxic trace elements. SRM 2383 will have values assigned for proximates, vitamins, carotenoids, and inorganic nutrients. [ABSTRACT FROM AUTHOR]

We describe the CT and MR findings in a patient diagnosed with tuberous sclerosis after presenting with a hemorrhagic subependymal giant cell astrocytoma (SEGCA). While these tumors are not uncommon in tuberous sclerosis, hemorrhage into them is extremely rare. [ABSTRACT FROM AUTHOR]

Unlabelled: Gentamicin is widely used in paediatric medicine and therapeutic monitoring is mandatory due to the narrow margin of safety. Saliva sampling may be of potential interest, especially in children in whom blood sampling is often difficult. Experience with once daily intravenous administration of aminoglycosides has grown in recent years. Gentamicin levels were measured in serum and saliva of 55 children treated with the drug (5 mg/kg per day), administered intravenously in three different regimens: thrice (n = 19), twice (n = 18), and once daily (n = 18). No correlation was found between serum gentamicin concentrations and saliva levels when the drug was administered twice or thrice daily, however, there was good correlation when the drug was administered once daily (r2 = 0.96, P < 0.0001).Conclusion: In children with uncomplicated infections treated with once daily gentamicin, trough concentrations of the drug can be monitored in saliva. [ABSTRACT FROM AUTHOR]

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