The good funeral: toward an understanding of funeral participation and satisfaction.

This study posits a model of funeral satisfaction in which religiosity predicts general funeral attitudes, which predict levels and types of funeral participation, mediating the relationship between attitudes and satisfaction in a particular bereavement context. Over a thousand respondents rated their attitudes toward funerals in general and evaluated the most recent funeral they had actually attended. The resulting model indicated that religiosity and favorable attitudes, when enacted through participation and involvement, tend to predict funeral satisfaction, in combination with favorable comparisons, and when the deceased was close and the death unexpected or tragic. Evaluations of the funeral, in turn, independently influence a person's general attitudes about funerals. Theoretical and practical implications for understanding funerals and bereavement are explored.

Accuracy of liver-specific magnetic resonance imaging as a predictor of chemotherapy-associated hepatic cellular injury prior to liver resection.

BACKGROUND/AIMS: To evaluate the diagnostic precision of chemical-shift imaging MRI and ferucarbotran-enhanced MRI for hepatic parenchymal injury prior to hepatic resection for colorectal metastases. METHODS: Preoperative MRI criteria were used to score 37 patients with colorectal liver metastases by two independent radiologists, blinded to outcomes, for signal drop-out on chemical-shift imaging MRI and ferucarbotran uptake and compared to blinded standardized histopathological endpoints of steatosis, steatohepatitis and sinusoidal dilatation. Sensitivity, specificity, predictive values and the area under the receiver operating characteristic curve (AUC) were calculated for the MRI sequences. RESULTS: On histology, severe steatosis, steatohepatitis and sinusoidal dilation were evident in 6 (16.2%), 4 (10.8%) and 9 (24.3%) patients respectively. Chemical-shift imaging MRI had a positive predictive value (PPV) of 100% for severe steatosis, 80% for steatohepatitis and zero for sinusoidal dilatation, with an AUC of 1.0, 0.99 and 0.36 respectively. Ferucarbotran-enhanced MRI had a 100% PPV for the detection of severe sinusoidal dilatation, with an AUC of 0.61. CONCLUSIONS: This study demonstrates that liver-specific MRI can accurately predict the severity of pre-existing hepatic injury. Moreover, it may play a key role in planning the timing and extent of chemotherapy and hepatic resection for colorectal metastases.

The association between subjective and clinical indicators of health in prospective Vietnamese migrants.

We conducted a cross-sectional survey of 1669 prospective Vietnamese migrants who had applied to migrate to Australia to describe the association between self-reported health status and several commonly used clinical indicators of health among prospective Vietnamese migrants. Participants were recruited from the International Organization for Migration's standardised medical screening program.' We found that clinical indicators of health are related to self-reported health status among prospective Vietnamese migrants. Self-reported health status, which was assessed using a modified version of the Short Form-36 health survey, was significantly associated with clinical indicators of health, including the number of body system abnormalities identified during medical screening, evidence of tuberculosis on chest radiograph, and self-reported weight loss over the previous six months. These findings support the validity of self-reported health status assessment among prospective migrants, although the assessment of subjective indicators of health during compulsory medical screening may be limited by reporting bias.

Results of tuberculosis screening in applicants for migration in Vietnam and Cambodia.

SETTING: Pre-migration medical screening programmes in Ho Chi Minh City, Vietnam and Phnom Penh, Cambodia. OBJECTIVE: To compare the rates of newly diagnosed bacteriologically confirmed tuberculosis (TB) in a cohort of migration applicants in Vietnam and Cambodia with current estimates of the TB burden in these countries. DESIGN: Interviews and medical screening of 5108 Vietnamese and 910 Cambodian migration applicants who applied for an Australian visa. RESULTS: On initial testing, the rate of bacteriologically confirmed TB among the Vietnamese cohort was 157 per 100,000 population compared to 989/100,000 among the Cambodian cohort. When cases detected during follow-up testing were included, the rate in the Vietnamese cohort was 489/100,000 compared to 1209/100,000 in the Cambodian cohort. CONCLUSIONS: Although it has been suggested that the rate of newly diagnosed bacteriologically confirmed TB among migration applicants would underestimate the prevalence of TB in the Vietnamese and Cambodian populations, the rates found were substantially higher than current point estimates of the prevalence of TB, particularly for Vietnam. Our findings suggest that current published estimates of the tuberculosis burden in Vietnam and Cambodia may be conservative.

Predictors of tuberculin reactivity among prospective Vietnamese migrants: the effect of smoking.

We investigated the prevalence and predictors of positive tuberculin skin test (TST) results among prospective Vietnamese migrants. We interviewed and medically screened 1395 Vietnamese people aged over 15 years who had applied to migrate to Australia. Approximately 44% of applicants had an induration of 10 mm or more, and 18.6% had an induration of 15 mm or more. A positive tuberculin skin test at 5 mm, 10 mm and 15 mm of induration cut-points was significantly associated with age (OR 1.01-1.02 per year) and duration of smoking (OR 1.03-1.12 per year). Smoking appears to be an important factor associated with increased susceptibility to mycobacterial infection. It is not yet clear whether the increased tuberculin reactivity associated with smoking reflects an increased risk of tuberculosis among these migrants.

Paclitaxel and gemcitabine chemotherapy for advanced transitional-cell carcinoma of the urothelial tract: a phase II trial of the Minnie pearl cancer research network.

PURPOSE: To evaluate the toxicity and efficacy of combination chemotherapy with paclitaxel and gemcitabine in patients with advanced transitional-cell carcinoma of the urothelial tract. PATIENTS AND METHODS: Fifty-four patients with advanced unresectable urothelial carcinoma entered this multi-centered, community-based, phase II trial between May 1997 and December 1999. All patients were treated with paclitaxel 200 mg/m(2) by 1-hour intravenous (IV) infusion on day 1 and gemcitabine 1,000 mg/m(2) IV on days 1, 8, and 15; courses were repeated every 21 days. Patients who had objective response or stable disease continued treatment for six courses. RESULTS: Twenty-nine of 54 patients (54%; 95% confidence interval, 40% to 67%) had major responses to treatment, including 7% complete responses. With a median follow-up of 24 months, 16 patients (30%) remain alive and nine (17%) are progression-free. The median survival for the entire group was 14.4 months; 1- and 2-year actuarial survival rates were 57% and 25%, respectively. Seven (47%) of 15 patients previously treated with platinum-based chemotherapy responded to paclitaxel/gemcitabine. Grade 3/4 toxicity was primarily hematologic, including leukopenia (46%), thrombocytopenia (13%), and anemia (28%). Ten patients (19%) required hospitalization for neutropenia and fever, and one patient had treatment-related septic death. CONCLUSION: The combination of paclitaxel and gemcitabine is active and well tolerated in the first- or second-line treatment of patients with advanced transitional-cell carcinoma of the urothelial tract. Response rate and duration compare favorably with those produced by other active, first-line regimens. This regimen should be further evaluated in phase II and III studies, as well as in patients with compromised renal function.

Heterologous expression and properties of the gamma-subunit of the Fe-only hydrogenase from Thermotoga maritima.

Thermotoga maritima is a hyperthermophilic bacterium that contains a complex, heterotrimeric (alpha(beta)gamma) Fe-only hydrogenase. Sequence analysis indicates that the gene encoding the smallest subunit (gamma), hydC, contains a predicted iron-sulfur cluster binding motif. However, characterization of the native gamma-subunit has been hampered by interference from and the inability to separate intact gamma-subunit from the other two subunits (alpha and beta). To investigate the function and properties of the isolated gamma-subunit, the gene encoding HydG was expressed in Escherichia coli. Two forms of the recombinant protein were obtained with molecular masses of 10 and 18 kDa, respectively. Both contained a single [2Fe-2S] cluster based on metal analysis, EPR and UV-visible spectroscopy. NH2-terminal sequencing revealed that the 10 kDa protein is a truncated form of the intact gamma-subunit and lacks the first 65 amino acid residues. The midpoint potential of the 18 kDa form was -356 mV at pH 7.0 and 25 degrees C, as measured by direct electrochemistry, and was pH dependent with a pK(ox) of 7.5 and a pK(red) of 7.7. The oxidized, recombinant gamma-subunit was stable at 80 degrees C under anaerobic conditions with a half-life greater than 24 h, as judged by the UV-visible spectrum of the [2Fe-2S] cluster. In the presence of air the protein was less stable and denatured with a half-life of approx. 2.5 h. The recombinant gamma-subunit was electron transfer competent and was efficiently reduced by pyruvate ferredoxin oxidoreductase from Pyrococcus furiosus, with a Km of 5microM and a Vmax of 9 U/mg. In contrast, native T. maritima hydrogenase holoenzyme and its separated alpha-subunit were much less effective electron donors for the gamma-subunit, with a V(max) of 0.01 U/mg and 0.1 U/mg, respectively.

Development of a Vietnamese version of the Short form-36 Health Survey.

We aimed to test the psychometric properties of a culturally relevant translation of the medical outcomes study short form-36 health survey (SF-36) with prospective Vietnamese migrants. The translated survey was interviewer-administered to 1610 Vietnamese aged over 15 years who had applied to migrate to Australia. All but two SF-36 items had good discriminant validity, and all eight scales of the Vietnamese version of the SFS-36 had good discriminant validity, which supports the use of SF-36 constructs to assess self-reported health status among Vietnamese migrants. However, the mental health, vitality and bodily pain scales demonstrated low internal consistency. This finding is likely to be a product of the increased diversity among scale items following modifications to improve cultural relevance. Further modifications to improve the internal consistency of these scales are required.

The hyperthermophilic bacterium, Thermotoga maritima, contains an unusually complex iron-hydrogenase: amino acid sequence analyses versus biochemical characterization.

The hyperthermophilic bacterium, Thermotoga maritima, grows up to 90 degrees C by fermenting carbohydrates and it disposes of excess reductant by H(2) production. The H(2)-evolving cytoplasmic hydrogenase of this organism was shown to consist of three different subunits of masses 73 (alpha), 68 (beta) and 19 (gamma) kDa and to contain iron as the only metal. The genes encoding the subunits were clustered in a single operon in the order hydC (gamma), hydB (beta), and hydA (alpha). Sequence analyses indicated that: (a) the enzyme is an Fe-S-cluster-containing flavoprotein which uses NADH as an electron donor; and (b) the catalytic Fe-S cluster resides within the alpha-subunit, which is equivalent to the single subunit that constitutes most mesophilic Fe-hydrogenases. The alpha- and beta-subunits of the purified enzyme were separated by chromatography in the presence of 4 M urea. As predicted, the H(2)-dependent methyl viologen reduction activity of the holoenzyme (45-70 U mg(-1)) was retained in the alpha-subunit (130-160 U mg(-1)) after subunit separation. However, the holoenzyme did not contain flavin and neither it nor the alpha-subunit used NAD(P)(H) or T. maritima ferredoxin as an electron carrier. The holoenzyme, but not the alpha-subunit, reduced anthraquinone-2,6-disulfonate (apparent K(m), 690 microM) with H(2). The EPR properties of the reduced holoenzyme, when compared with those of the separated and reduced subunits, indicate the presence of a catalytic 'H-cluster' and three [4Fe-4S] and one [2Fe-2S] cluster in the alpha-subunit, together with one [4Fe-4S] and two [2Fe-2S] clusters in the beta-subunit. Sequence analyses predict that the alpha-subunit should contain an additional [2Fe-2S] cluster, while the beta-subunit should contain one [2Fe-2S] and three [4Fe-4S] clusters. The latter cluster contents are consistent with the measured Fe contents of about 32, 20 and 14 Fe mol(-1) for the holoenzyme and the alpha- and beta-subunits, respectively. The T. maritima enzyme is the first 'complex' Fe-hydrogenase to be purified and characterized, although the reason for its complexity remains unclear.

Improvements in clinical benefit with vinorelbine in the treatment of hormone-refractory prostate cancer: a phase II trial.

BACKGROUND: Clinical activity is difficult to assess by traditional response endpoints in patients with advanced prostate cancer. We used clinical benefit response to assess the activity of vinorelbine (Navelbine) in patients with hormone-refractory prostate cancer. PATIENTS AND METHODS: Forty-nine men with hormone-refractory prostate cancer received vinorelbine weekly for eight weeks followed by every-other-week dosing. Clinical benefit response was defined by improvement in 1 of the following categories for at least 12 weeks and stable response or better in the other 2: pain index (analgesic consumption and pain intensity), Karnofsky performance status, and tumor status. RESULTS: Of 37 evaluable patients, 14 (39%) achieved clinical benefit for a median duration of 6 months (range 3-24 months). Toxicities consisted primarily of brief neutropenia and mild nausea. CONCLUSION: These findings indicate that vinorelbine is well tolerated in men with hormone-refractory prostate cancer and produces durable clinical benefit as defined by improvement in pain index and performance status.

Chorioamnionitis: is continuation of antibiotic therapy necessary after cesarean section?

OBJECTIVE: Our purpose was to determine whether the continuation of antibiotics postoperatively after cesarean section in patients whose labors were complicated by chorioamnionitis would reduce the incidence of endometritis. STUDY DESIGN: Patients with a clinical diagnosis of chorioamnionitis treated with ampicillin during labor and who required cesarean delivery for obstetric indications received preoperative intravenous clindamycin and gentamicin and were randomized into 2 groups. Group 1 received no scheduled postoperative antibiotics and group 2 continued to receive clindamycin 900 mg every 8 hours and gentamicin 1.5 mg/kg every 8 hours until afebrile for a minimum of 24 hours (temperature

Pharmacokinetic and phase I studies of brequinar (DUP 785; NSC 368390) in combination with cisplatin in patients with advanced malignancies.

Brequinar (DUP 785; NSC 368390) is a quinoline carboxylic acid derivative that inhibits pyrimidine synthesis at the level of dihydro-orotate dehydrogenase and revealed synergy with cisplatin in preclinical models. In this study investigating the pharmacokinetic and toxicity of brequinar in combination with cisplatin, patients were initially treated with weekly brequinar, in combination with an every-three-week administration of cisplatin. Due to toxicity, the schedule was modified to a 28-day cycle with brequinar given on days 1, 8, 15, and cisplatin on day 1. A total of 24 patients (16 male, 8 female; median age 57; median performance status 1) received 69 courses of therapy. Six dose levels were explored, with cisplatin/ brequinar doses, respectively, of 50/500, 50/650, 50/860, 60/860, 75/650, and 75/860 mg/m2. The serum concentration versus time curves for brequinar were biphasic. A comparison of the pharmacokinetic results after the first and third doses of brequinar indicate that the presence of 50, 60, and 75 mg/m2cisplatin did not change the protein binding and the pharmacokinetics of brequinar in any of the three brequinar-dose groups. Total cisplatin plasma pharmacokinetic followed a triphasic-shape curve and unbound cisplatin decayed at a very rapid rate. Since pharmacokinetic parameters for total cisplatin in this study were similar to those reported in the literature, the presence of brequinar is unlikely to alter the pharmacokinetics of cisplatin. Main dose-limiting toxicities included myelosuppression (including neutropenia and thrombocytopenia) and mucositis. Cisplatin/brequinar doses of 50/500, 50/650, 50/860, 60/860, 75/650, and 75/860 mg/m2, were associated with dose limiting toxicity in 0/3, 1/3, 1/3, 1/3, 2/4, 2/5, and 4/6 patients, respectively. This study shows that co-administration of brequinar and cisplatin does not affect the pharmacokinetic properties of either drug and that the MTDs of cisplatin/brequinar combinations are 60/860 mg/m2 or 75/650 mg/m2. From this study, we conclude that full dose of 75 mg/m2 cisplatin (day 1) can be administered with 650 mg/m2 brequinar (days 1, 8 and 15) without significant modifications of individual drug pharmacokinetic parameters.

Phase II trial of paclitaxel by 24-hour continuous infusion for relapsed non-Hodgkin's lymphomas: Southwest Oncology Group trial 9246.

PURPOSE: The Southwest Oncology Group (SWOG) recently conducted a multiinstitutional phase II trial to determine the complete response (CR) and partial response (PR) rates, toxicities, and progression-free and overall survivals of patients with relapsed non-Hodgkin's lymphomas (NHLs) treated with a 24-hour continuous infusion of paclitaxel at a dose of 175 mg/m2. PATIENTS AND METHODS: Sixty-six patients with relapsed NHL who had received minimal prior therapy (one prior chemotherapy regimen for intermediate- to high-grade NHL [44 patients] or one or two prior regimens for low-grade NHL [22 patients]) were premedicated with dexamethasone, diphenhydramine, and cimetidine and then treated with continuous intravenous infusion paclitaxel over 24 hours every 21 days. RESULTS: Eleven of 66 patients (17%) achieved rigorously documented objective remissions, including two CRs (3%) and nine PRs (14%). In addition, another five patients (8%) achieved apparent PRs on a single computed tomographic (CT) scan. Responses were brief, lasting a median of 3 months (5 months for indolent lymphomas and 3 months for intermediate- to high-grade lymphomas). Grade 4 or 5 granulocytopenia was the only common serious toxicity, and occurred in 42 of 66 patients (64%). CONCLUSION: Paclitaxel is generally well tolerated when given as a continuous infusion of 175 mg/m2 over 24 hours, despite predictable granulocytopenia. However, single-agent paclitaxel has modest clinical efficacy compared with other available treatments for relapsed NHL.

Interobserver variability in prostate cancer specific survival.

We evaluated the reliability of disease-specific survival (DSS) as an outcome measure in patients with carcinoma of the prostate (CaP). The records of 50 patients had a diagnosis of CaP and had expired were selected from the hospital tumor registry. Records were reviewed by six individuals and each individual was asked to specify cause of death as due to CaP or some other cause. DSS curves were generated based on the determinations of each reviewer. Although the DSS curves were generally parallel, a high degree of variability was seen at various intervals, leading us to conclude that DSS is dependent upon the individual reviewer. Published by Elsevier Science Inc.

Building effective boards by focusing on the system.

Seasoned board members from two dynamic health systems--Centura Health and Crozer-Keystone Health System--point to the CEO's commitment to the system and its mission as the critical element in keeping the board focused.

Reduction of liquefaction hazards by deep soil mixing

One of the most promising technologies for site improvement involves deep soil mixing (DSM), whereby cements and hardening agents are mixed in situ with native soil to increase strength and stiffness properties. this method proved to be effective in stabilizing potentially liquefiable soil at several sites during the Kole earthquake, including the Oriental Hotel, where partial coverage by DSM columns was successful not in controlling lateral spread but in preventing liquefaction. Analytical results compare very favorably with twoo separate sets of centrifuge test data. The analytical model correctly predicts the observed behavior of DSM-reinforced soil at the Oriental Hotel during the Kobe earthquake. DSM is effective in reducing liquefaction potential because it provides reinforcement to restrict shear strain in the soil mass. The proposed analytical approach correctly accounts for observed perfomance and provides a means of assessing the appropriate DSM grid dimensions for effective site improvement. (AU)