Chicago Experience Research Articles

Urban Experience in Chicago: Hull-House and Its Neighborhoods, 1889-1963, http://www.uic.edu/jaddams/hull/urbanexp/. Created by Rima Lunin Schultz, Ellen Skerret, and Sarah Hoadley. Maintained by the Jane Addams and Jane Addams Hull-House Museum, http://www.uic.edu/jaddams/hull/. Created and maintained by the Jane Addams

No history of the U.S. settlement house movement is complete without a discussion of the social activist Jane Addams and Hull House. And no location was more affected by Addams and Hull House than Chicago, where the thirteen-building complex served a densely populated, ethnically diverse neighborhood on the city's Near West Side. Two Web sites hosted by the University of Illinois at Chicago offer a complex and satisfying portrayal of Addams and of Hull House in its local urban context. Together they provide a richer understanding of Hull House's significance in past and present Chicago. Urban Experience in Chicago offers scholars, teachers, and students a wealth of resources, including primary sources, maps, images, interpretive essays, and a section on teachers' materials. An introductory page to the site acts as a textual site map and introduces the five major content sections: “Historical Narrative,” “Timeline,” “Images,” “Geography,” and “Teachers' Resources.” A “Search...

Radiation-induced thyroid cancer: The Chicago experience

IN 1901 KARL WILHELM ROENTGEN, a physics professor at Wurzburg, Germany, received the first Nobel Prize in physics for the discovery of x-rays in experiments, which began 6 years earlier in 1895. The invisible cathode rays generated were found to cause a fluorescence on a barium platinocyanide screen and, surprisingly, to outline the bones of his wife’s hand on this photographic film (Fig 1). By 1896, radiographs were being taken for clinical purposes and their diagnostic possibilities were quickly exploited. Bone films, chest x-rays, and even barium studies of the gastrointestinal tract were quickly tried. Roentgen found that prolonged exposure to x-rays produced burns and ulcerations of the skin, hair loss, and dermatitis. These effects were turned into therapy to burn off moles and to treat acne, hemangiomas, skin tuberculosis, and many other benign skin lesions. At about the same time (1891), Maria Sklodowska left Warsaw to study at the Sorbonne. She married fellow scientist Pierre Curie. Her work on uranium led to the discovery of polonium and radium, a substance 900 times more radioactive than uranium. Uranium, polonium, and radium released rays like x-rays that penetrated matter. Madame Curie and a colleague accidentally burned themselves when carrying vials of radium in their pockets. In 1901, Pierre Curie did so purposely by strapping some radium to his arm. By 1904, it was demonstrated that radium rays destroyed

Remission Status and Performance Status, but Not Cytogenetic Risk Group, Are Associated with Outcome After Reduced Intensity Conditioning (RIC) and Allogeneic Hematopoietic Cell Transplantation (HCT) for Therapy-Related Myeloid Neoplasms (t-MN): Results of the University of Chicago Experience.

Abstract 3395Poster Board III-283Therapy-related myeloid neoplasms (t-MN) are associated with unfavorable cytogenetics, drug resistance, and poor outcomes. For appropriate candidates, allogeneic HCT is the most likely curative therapy. We, and others, have shown that outcomes from HCT using RIC regimens are comparable to standard myeloablative conditioning regimens for high-risk patients with myeloid neoplasms. Few studies have focused on transplant outcomes for pts with t-MN. Therefore, we reviewed outcomes of 46 pts (median age 51; range, 25-71) with t-MN who underwent HCT at the University of Chicago between 3/89 and 1/09. Eleven had presented with < 20% marrow blasts, and 35 had > 20% blasts. Prior malignancies included Hodgkin lymphoma (n = 9), NHL (n = 9), CLL (n = 2), ALL (n = 2), APL (n = 1), and solid tumors (n = 19). Four pts had non-malignant prior diseases (SLE, Crohns disease, heart transplant, kidney transplant), but had received cytotoxic therapy. Since 2001, 37 pts received RIC transplants, whereas 9 earlier pts received myeloablative conditioning. Overall survival (OS) at day 100, 1 yr, and 2 yrs was 63% (95%CI, 49-77%), 40% (95%CI, 25-55%), and 34% (95%CI, 19-49%), respectively. Disease status at transplant was highly predictive of outcome (p = 0.03), with those pts in CR (n = 12) at the time of transplant exhibiting a 2 yr OS of 69% (95% CI, 38-100%) versus those with persistent disease (n = 34) exhibiting a 2 yr OS of 24% (95% CI, 8-40) (see figure below). ECOG performance status (PS) of 0 and 1 (n = 32) had similar outcomes, while no pts with a PS of 2 (n= 4) were alive at 2 years. Neither patient age (>50) nor donor source (related [n = 28] vs unrelated [n = 18]) had a significant impact on outcome (p= 0.73 and 0.07, respectively). Interestingly, cytogenetic subset did not affect outcome; 2 yr OS was 35% (95%CI, 9-61%) for those with intermediate (n = 15) and 31% (95%CI, 12-50%) for those with poor-risk (n = 30) cytogenetics. Only one patient in the group had a good-risk cytogenetic pattern. RIC was associated with a 2 yr OS of 38% (95%CI, 18-58%), while ablative regimens resulted in a 2 yr OS of 21% (95% CI, 0-43%) (p = 0.04). Since RIC transplants were performed more recently, improvements in supportive care may have affected outcomes. These data represent one of the largest series reported on transplant outcome for t-MN. We conclude that RIC followed by related or unrelated donor HCT should be considered for pts with t-MN, regardless of cytogenetic abnormalities. The results for pts transplanted in remission are encouraging with 2 yr OS of 69%. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

The University of Chicago experience with pediatric robotic-assisted laparoscopic augmentation-ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA)

Acharya, Sujeet S. MD; Zagaja, Gregory P. MD; Shalhav, Arieh L. MD; Gundeti, Mohan S. MBBS Author Information

Wasting Away: Chicago’s Declining Core

The University of Chicago met widespread national opposition ten years ago after it instituted a new, less demanding core curriculum to make way for more electives. It was part of a plan to make the curriculum significantly less demanding in order to attract more students and improve the school’s bottom line in a time of putative budget deficits. In 2009, when the university is in a truly dire financial situation, the current president’s plans to meet its needs include no such curricular initiative. In the late 1990s, however, then-president Hugo Sonnenschein apparently was arguing that prospective students at the margin, those who were industrious enough to choose Chicago but who wanted more time for non-academic “fun” than the traditional Chicago experience allowed for, would be persuaded to apply for admission. There were other arguments for changing the core, too, such as the vapid “change is inevitable; the disciplines are changing; let’s change with the times,” and the more noble idea that shaking things up would inspire the weaker core courses to improve or else face the chopping block. The immediate results of the curriculum debates, however, betrayed the primary impetus Acad. Quest. (2009) 22:298–313 DOI 10.1007/s12129-009-9119-5

The University of Chicago Experience with Pediatric Robotic Assisted Laparoscopic Augmentation Ileocystoplasty and Mitrofanoff Appendicovesicostomy

Purpose To the best of our knowledge we present the first series of complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA) in a pediatric population. Material and Methods From February to July 2008, five patients with spina bifida and neurogenic bladder were selected to undergo RALIMA by a single surgeon at the University of Chicago Medical Center. All had constipation, day and night-time incontinence, with recurrent urinary tract infection (UTI), and failed attempts at anticholinergic therapy and clean intermittent catheterization. Urodynamics showed all had low capacity bladders with poor compliance and high leak point pressures. Pre-operative bowel preparation was not performed. Mean follow-up was six months. Results One patient required conversion to open ileal augmentation due to kyphoscoliosis, adhesions and failure to progress, while another underwent augmentation ileocystoplasty without appendicovesicostomy. Of the patients who had robotic augmentation ileocystoplasty, average age was 9.75 years (range 8-11 years). Average operative time was 8.5 hours (range 6-11 hours). There were no intra-operative complications. One patient had a wound infection after surgery. Post-operatively, patients only required oral analgesia for 24-36 hours, were started on liquid diet on average after 7.5 hours (range 6-10 hours), on regular diet after 24 hours (range 12-36 hours), and were discharged home within 6 days. Post-operatively, all patients demonstrated no leak on follow-up cystogram, and were catheterizing per apendicovesicostomy (3 patients by six weeks) or urethra (1 patient at 4 weeks). All patients now have day and night-time continence with no UTIs, and bladder capacity between 250-450 mL. Conclusions While longer follow-up is necessary to see if these results are durable, this series demonstrates that RALIMA is a safe, feasible and effective procedure in the short term with the possible added benefits of shorter recovery time and analgesia.

Living Donor Kidney Transplantation Across Positive Crossmatch: The University of Illinois at Chicago Experience

To increase living donation for kidney transplantation, we investigated desensitization of recipients with positive crossmatch against a potential living donor. Between June 2001 and March 2007, 57 consecutive sensitized candidates for kidney transplantation, with crossmatch positive potential living donors, were treated with various desensitization protocols. All patients received plasmapheresis every other day with intravenous immune globulin 100 mg/kg starting 1 week before the scheduled transplant. Postoperatively, the recipients continued to receive every other day plasmapheresis with intravenous immune globulin for the initial week. Immunosuppression therapy consisted of induction with thymoglobulin and a combination of tacrolimus, mycophenolate, and corticosteroids. Six patients failed to convert with pretransplant immunomodulation and were not transplanted; 51 underwent live donor kidney transplant. Mean follow-up was 23 months and 36 patients have more than 1-year follow-up. One-year patient and graft survivals were 95% and 93%, respectively. There were 25 episodes of biopsy-proven or clinically presumed rejection in 22 patients in the first year. Of the 17 biopsy-proven episodes, 12 were antibody-mediated rejection and five were acute cellular rejection. Of the patients with antibody-mediated rejection (biopsy proven or empiric), two patients (12%) lost their graft by 1 year. The median modification of diet in renal disease at 6 and 12 months was 55 mL/min (range 9-104 mL/min) and 48 mL/min (range 8-99), respectively. Despite increased rejection rates, graft and patient survivals indicate that desensitization of positive crossmatch patients is a reasonable alternative for a sensitized patient who could potentially wait 10 or more years for a suitable cadaveric kidney.

An analysis of police responses to gangs in Chicago

In response to Chicago’s well‐documented gang problem, the Chicago Police Department (CPD) established its first specialized gang unit in 1967. In the ensuing decades, the CPD reorganized its core gang unit several times and expanded its anti‐gang response through numerous supporting restructuring efforts. The Chicago experience indicates that reorganization can positively and negatively influence the relative effectiveness of the police response to gangs. As such, the lessons for police departments are twofold: be careful when restructuring, particularly when adapting for reasons not tied to the actual gang problem; but reorganize whenever necessary to address rising gang violence.

Teaching &amp; Learning Guide for: Literature, Social Science, and the Development of American Migration Narratives in the Twentieth Century

Teaching &amp; Learning Guide for: Literature, Social Science, and the Development of American Migration Narratives in the Twentieth Century

Using respondent-driven sampling for behavioural surveillance: Response to Scott

s r s t e v p f s In a recent article, Dr. Scott raised ethical questions bout respondent-driven sampling, or RDS (Scott, 2008). r. Scott used data he collected in Chicago, Illinois in 2005 t the time that the National HIV Behavioural Surveillance ystem amongst injecting drug users (NHBS-IDU), sponored by the Centers for Disease Control and Prevention CDC), was being conducted. He asserted that RDS invites, f not promotes, violation of federal guidelines governing he protection of human research subjects and that the RDS esign generally, and the NHBS implementation specifially, resulted in data of questionable quality. CDC places he highest priority on human subjects protection and the thics of surveillance and research. We therefore comment n Dr. Scott’s article and then describe CDC plans for the ext NHBS-IDU cycle. Because NHBS uses a standard proocol in all sites (Lansky et al., 2007), we describe operations enerally, with details about the Chicago experience where elevant. Numerous controls for the protection of participants n research and surveillance activities are fundamental spects of the RDS method (Semaan, Santibanez, Garfein, eckathorn, & DesJarlais, 2008) and many were specifically sed in NHBS-IDU. The controls described below were put n place to assure the ethical conduct of NHBS-IDU. We isagree with Dr. Scott that “RDS assigns the lion’s share f responsibility for ethical conduct. . . to the human subjects

Urban experience in Chicago: Hull-House and its neighborhoods, 1889-1963

Urban experience in Chicago: Hull-House and its neighborhoods, 1889-1963

1–30 Defining Negative Margins in DCIS Patients Treated With Breast Conservation Therapy: The University of Chicago Experience

1–30 Defining Negative Margins in DCIS Patients Treated With Breast Conservation Therapy: The University of Chicago Experience

Government Account for Relief in Occupied Area

Government Account for Relief in Occupied Area

Urban experience in Chicago: Hull-House and its neighborhoods, 1889-1963

Urban experience in Chicago: Hull-House and its neighborhoods, 1889-1963

Defining Negative Margins in DCIS Patients Treated with Breast Conservation Therapy: The University of Chicago Experience

Management of ductal carcinoma in situ (DCIS) has been evolving and the majority of women are now being treated with breast-conserving surgery and radiation therapy (i.e. breast conservation therapy [BCT]). Controversies still exist regarding the histologic features and margin status that are associated with local recurrence. The goal of this study was to review our institution's experience in patients diagnosed with DCIS and treated with BCT to determine pathologic features that can predict local recurrence, with particular emphasis on the final surgical margin status. We analyzed 103 consecutive patients with DCIS who were treated with BCT between 1986 and 2000. The slides were reviewed to determine the final margin status, type of DCIS, size of DCIS, nuclear grade, presence of necrosis and calcification, and volume of excised specimen. Margins were considered positive when DCIS touched or was transected at an inked margin. Negative margins were further categorized as close (less than 1 mm), 1--5 mm, and more than 5 mm. The size of the DCIS was determined based on either the maximal dimension on a slide or from the number of consecutive slides containing DCIS. Morphology and immunohistochemical profiles of the recurrent DCIS cases were compared with original DCIS. All patients were treated uniformly with external beam radiation therapy to the entire breast (median dose 46 Gy) with a boost to the tumor bed (median dose 14 Gy). The median follow-up was 63 months (range 7--191 months). The actuarial 5-year local control rate was 89%. The median time to local recurrence was 55 months. There were 13 local recurrences, of which 9 recurred as pure DCIS and 4 as invasive ductal carcinomas. Univariate analysis showed a significant association with local recurrence for positive margin (p=0.008), high nuclear grade (p=0.02), and young age at diagnosis (p=0.03). If margins were negative, the 5-year local control was 93%, as compared to 69% if margins were positive. A multivariate analysis showed that early age at diagnosis, positive margin status, and high nuclear grade were independently associated with local recurrence. The morphology and immunohistochemical stains of all nine recurrent DCIS were similar to those of the original DCIS. Breast conservation can be achieved with excellent local control by obtaining microscopically negative margins as strictly defined by DCIS not touching the inked surgical margins, and postoperative radiation that includes boost therapy to the tumor bed.

Getting it the Second Time Around: Student Classroom Experience in Chicago's Summer Bridge Program

Increased use of high-stakes testing has been accompanied by an expansion of summer school programming. Few investigations focus on student experience within these programs. Using multiple methods, we examined how low-performing students attending the Chicago Public Schools’ Summer Bridge program perceived their summer learning environments. Students reported substantial increases in academic press and personalism between the school year and summer. Qualitative analysis revealed that over half of the students characterized their experience as substantively better in the summer than in the school year. They particularly focused on exposure to new content, increased attention from teachers, and an improved classroom climate that helped in the mastery of material.

Getting it the Second Time Around: Student Classroom Experience in Chicago's Summer Bridge Program

Increased use of high-stakes testing has been accompanied by an expansion of summer school programming. Few investigations focus on student experience within these programs. Using multiple methods, we examined how low-performing students attending the Chicago Public Schools’ Summer Bridge program perceived their summer learning environments. Students reported substantial increases in academic press and personalism between the school year and summer. Qualitative analysis revealed that over half of the students characterized their experience as substantively better in the summer than in the school year. They particularly focused on exposure to new content, increased attention from teachers, and an improved classroom climate that helped in the mastery of material.

Understanding the French 2003 Heat Wave Experience: Beyond the heat, a Multi‐Layered Challenge

The 2003 heat wave killed nearly 15,000 people in France. It was a stealth killer. “We did not notice anything”, as the Minister of Health declared to the Parliamentary Commission. It is of crucial importance to understand the keys to this collective failure, which has much in common with the Chicago experience in 1995 –the lessons of which had not been grasped nor learned.A four‐layered challenge explains the fiasco. The emergency challenge, which is not the realm of bureaucracies outside the “9/11” bodies. The crisis management challenge, largely documented since the 80s and the 90s, but still poorly known by most organisations, in France and elsewhere. The unconventional crisis challenge, emerging more and more today with “outside‐of‐the‐box” scenarios – and for which very few are ready to prepare, in any country in the world. The “texture” challenge, when the whole fabric of our complex systems (rather than just some specific segment) is suddenly deeply affected — an entirely new front‐line in the crisis world, which urges to switch from a mechanical or an architectural to a more “biological” approach to read, seize, and handle emerging csrises.The 2003 heat fiasco compels us to prepare for far more than climate‐related crises. It calls for a fresh and bold look at our crisis paradigms. As General Foch said: “Gunfire kills, but so do outdated visions”.

Long-term follow-up of nonmyeloablative allogeneic stem cell transplantation for renal cell carcinoma: The University of Chicago Experience

Nonmyeloablative allogeneic stem cell transplantation (NST) has considerable activity in patients with metastatic renal cell carcinoma (RCC), although there are limited long-term follow-up data. Between February 1999 and May 2003, 18 patients with metastatic RCC underwent 19 matched-sibling NSTs after conditioning with fludarabine and cyclophosphamide with tacrolimus and mycophenolate mofetil as post-transplant immunosuppression. Among the four objective responses, all were partial and have relapsed with a median response duration of 609 days (range, 107-926). All responders are alive at a median of 41 months. Median overall survival for the entire cohort was 14 months. There were four early treatment-related deaths and one late treatment-related death. Eight patients died from progressive disease and five (28%) from treatment-related mortality. Stratifying transplant outcome as early death, intermediate (no response, no early death), or response, the combination of pre-treatment anemia and decreased performance status, was associated with adverse outcome (P = 0.015) and reduced survival (HR 5.4, 95% confidence interval of 1.4 to 21, P = 0.007). Responders demonstrated prolonged survival compared to nonresponders (P = 0.002). NST leads to durable responses in a minority of metastatic RCC patients. Appropriate patient selection is paramount. Anemia and decreased performance status may enable risk stratification.

The University of Chicago experience with a reduced intensity allogeneic peripheral blood stem cell transplant preparative regimen using fludarabine, cyclophosphamide, and antithymocyte globulin (ATG) in pts with a hematologic malignancy

6626 Background: Non-myeloablative preparative regimens have been used extensively in alloSCT. We hypothesized that a novel preparative regimen, fludarabine, cyclophosphamide, ATG, could result in hematopoetic engraftment, disease control, and low toxicity. Methods: Patients (pts) received fludarabine 30 mg/m2/d on d –9, -8, -7, -6, -5, cyclophosphamide 2gm/m2/d on day –5, and ATG 10 mg/m2/d on day –5, -4, -3, -2. Stem cells were from full HLA matched sibling donors. GVHD prophylaxis included tacrolimus 0.03 mg/kg/d starting day -4, to reach a level of 5–15ng/ml, and tapered to discontinue by day +90. Mycophenylate mofetil 1mg PO bid was started on day +1 and continued until day +60. T cell subsets were analyzed by flow cytometry, Results: 17 pts were treated on this study from June 1999 to October 2001. (3 AML, 1 MDS, 5NHL, 3 HD, 2MM, 2CLL/SLL, 1CMML) Median age was 60 yrs, (24–67). Pts had a median of 3 prior chemo regimens (0–5), including 5 with a prior autoSCT. Median ECOG PS was 1 (0–1). Median hospitalization was 21d (15–77). Median days to ANC>500 was 14 (0–21) and median days to plt>100 was 13 (0- not reached). Two deaths occurred prior to d100, both due to sepsis (d23, d61). No pt had acute GVHD. 3/17 pts had extensive chronic GVHD (2 liver, 1colon) Median donor chimerism at d30 was 67.5%, at d100 was 75%. Best response: CR 8pts, PR 2pts, SD 3 pts, PD 3pts. One pt died at d21 with RD. Median PFS of pts with SD, PR, or CR was 5.13 mos (2.6 –50+). Three pts had DLI after PD. (1 HD pt had no GVHD, but had PD; 1 NHL pt had grIV gut GVHD, died of sepsis d39 w/RD; 1MM pt had grIII liver GVHD, achieved a CR lasting 2 yrs) Data from T-cell subset analysis is available on 7 / 17 pts. At d33, pts with a CR or PR had more IL2-producingCD8+ (12.02 vs 3.20, p=0.0034), CD4+ (126.64 vs. 38.92, p=0.0294), and CD3+ (138.66 vs 42.11, p=0.02) T cells/μL.Conclusions: This regimen was well tolerated by this older group of heavily pretreated pts, but median donor chimerism was only 75% at d100. The numbers of T cells producing Th1 cytokines at d33 was higher in pts with a good clinical response. No significant financial relationships to disclose.