San Francisco Research Articles

Disparities in Injury Mortality Between Uganda and the United States: Comparative Analysis of a Neglected Disease

BackgroundThe burden of global injury-related deaths predominantly affects developing countries, which have little infrastructure to evaluate these disparities. We describe injury-related mortality patterns in Kampala, Uganda and compare them with data from the United States and San Francisco (SF), California.MethodsWe created a database in Kampala of deaths recorded by the City Mortuary, the Mulago Hospital Mortuary, and the Uganda Ministry of Health from July to December 2007. We analyzed the rate and odds ratios and compared them to data from the U.S. Centers for Disease Control and Prevention and the California Department of Public Health.ResultsIn Kampala, 25% of all deaths were due to injuries (812/3303) versus 6% in SF and 7% in the United States. The odds of dying of injury in Kampala were 5.0 times higher than in SF and 4.2 times higher than in the United States. Age-standardized death rates indicate a 93% greater risk of dying from injury in Kampala than in SF. The mean age was lower in Kampala than in SF (29 vs. 44 years). The adult injury death rate (rate ratio, or RR) was higher in Kampala than in SF (2.3) or the United States (1.5). Head/neck injury was reported in 65% of injury deaths in Kampala compared to 34% in SF [odds ratio (OR) 3.7] and 28% in the US (OR 4.8).ConclusionsUrban injury-related mortality is significantly higher in Uganda than in the United States. Injury preferentially affects adults in the prime of their economically productive years. These findings serve as a call for stronger injury prevention and control policies in Uganda.

Sources of mercury to San Francisco Bay surface sediment as revealed by mercury stable isotopes

Mercury (Hg) concentrations and isotopic compositions were examined in shallow-water surface sediment (0–2 cm) from San Francisco (SF) Bay to determine the extent to which historic Hg mining contributes to current Hg contamination in SF Bay, and to assess the use of Hg isotopes to trace sources of contamination in estuaries. Inter-tidal and wetland sediment had total Hg (Hg T) concentrations ranging from 161 to 1529 ng/g with no simple gradients of spatial variation. In contrast, inter-tidal and wetland sediment displayed a geographic gradient of δ 202Hg values, ranging from −0.30‰ in the southern-most part of SF Bay (draining the New Almaden Hg District) to −0.99‰ in the northern-most part of SF Bay near the Sacramento–San Joaquin River Delta. Similar to SF Bay inter-tidal sediment, surface sediment from the Alviso Slough channel draining into South SF Bay had a δ 202Hg value of −0.29‰, while surface sediment from the Cosumnes River and Sacramento–San Joaquin River Delta draining into north SF Bay had lower average δ 202Hg values of −0.90‰ and −0.75‰, respectively. This isotopic trend suggests that Hg-contaminated sediment from the New Almaden Hg District mixes with Hg-contaminated sediment from a low δ 202Hg source north of SF Bay. Tailings and thermally decomposed ore (calcine) from the New Idria Hg mine in the California Coast Range had average δ 202Hg values of −0.37 and +0.03‰, respectively, showing that Hg calcination fractionates Hg isotopes resulting in Hg contamination from Hg(II) mine waste products with higher δ 202Hg values than metallic Hg(0) produced from Hg mines. Thus, there is evidence for at least two distinct isotopic signals for Hg contamination in SF Bay: Hg associated with calcine waste materials at Hg mines in the Coast Range, such as New Almaden and New Idria; and Hg(0) produced from these mines and used in placer gold mines and/or in other industrial processes in the Sierra Nevada region and SF Bay area.

Upper-mantle seismic structure beneath SE and Central Brazil from P- and S-wave regional traveltime tomography

SUMMARY We present models for the upper-mantle velocity structure beneath SE and Central Brazil using independent tomographic inversions of P- and S-wave relative arrival-time residuals (including core phases) from teleseismic earthquakes. The events were recorded by a total of 92 stations deployed through different projects, institutions and time periods during the years 1992–2004. Our results show correlations with the main tectonic structures and reveal new anomalies not yet observed in previous works. All interpretations are based on robust anomalies, which appear in the different inversions for P- and S-waves. The resolution is variable through our study volume and has been analyzed through different theoretical test inversions. High-velocity anomalies are observed in the western portion of the Sao Francisco Craton, supporting the hypothesis that this Craton was part of a major Neoproterozoic plate (San Franciscan Plate). Low-velocity anomalies beneath the Tocantins Province (mainly fold belts between the Amazon and Sao Francisco Cratons) are interpreted as due to lithospheric thinning, which is consistent with the good correlation between intraplate seismicity and low-velocity anomalies in this region. Our results show that the basement of the Parana Basin is formed by several blocks, separated by suture zones, according to model of Milani & Ramos. The slab of the Nazca Plate can be observed as a high-velocity anomaly beneath the Parana Basin, between the depths of 700 and 1200 km. Further, we confirm the low-velocity anomaly in the NE area of the Parana Basin which has been interpreted by VanDecar et al. as a fossil conduct of the Tristan da Cunha Plume related to the Parana flood basalt eruptions during the opening of the South Atlantic.

Estimating alcohol-related premature mortality in San Francisco: use of population-attributable fractions from the global burden of disease study.

BackgroundIn recent years, national and global mortality data have been characterized in terms of well-established risk factors. In this regard, alcohol consumption has been called the third leading "actual cause of death" (modifiable behavioral risk factor) in the United States, after tobacco use and the combination of poor diet and physical inactivity. Globally and in various regions of the world, alcohol use has been established as a leading contributor to the overall burden of disease and as a major determinant of health disparities, but, to our knowledge, no one has characterized alcohol-related harm in such broad terms at the local level. We asked how alcohol-related premature mortality in San Francisco, measured in years of life lost (YLLs), compares with other well-known causes of premature mortality, such as ischemic heart disease or HIV/AIDS.MethodsWe applied sex- and cause-specific population-attributable fractions (PAFs) of years of life lost (YLLs) from the Global Burden of Disease Study to 17 comparable outcomes among San Francisco males and females during 2004-2007. We did this in three ways: Method 1 assumed that all San Franciscans drink like populations in developed economies. These estimates were limited to alcohol-related harm. Method 2 modified these estimates by including several beneficial effects. Method 3 assumed that Latino and Asian San Franciscans drink alcohol like populations in the global regions related to their ethnicity.ResultsBy any of these three methods, alcohol-related premature mortality accounts for roughly a tenth of all YLLs among males. Alcohol-related YLLs among males are comparable to YLLs for leading causes such as ischemic heart disease and HIV/AIDS, in some instances exceeding them. Latino and black males bear a disproportionate burden of harm. Among females, for whom estimates differed more by method and were smaller than those for males, alcohol-related YLLs are comparable to leading causes which rank somewhere between fifth and fourteenth.ConclusionsAlcohol consumption is a major contributor to premature mortality in San Francisco, especially among males. Interventions to avert alcohol-related harm in San Francisco should be taken at the population level and deserve the same attention that is given to other major risk factors, such as smoking or obesity.

A Tale of Two Counties: Bereavement in Socio-Demographically Diverse Places

The "Living After Loss" study was designed to test the effectiveness of the dual process model (DPM) of coping with bereavement. In order to obtain a larger and more diverse sample we studied 328 recently widowed men and women (61%) age 50+ in two counties, Salt Lake (n=197) and San Francisco (n=131) in two states, Utah and California. This paper does not report on the effects of the intervention but focuses on a comparison of the bereaved spouses/partners in these two cites. First, the only socio-demographic differences we found between those in SF and SL were that those in San Francisco were more racially, ethnically and religiously diverse, higher in education, had slightly fewer years in their relationship to the deceased and were two weeks longer in their grief process. Second, there were far more similarities than differences between SF and SL regarding nearly all of the study variables. Third, we found that those in SF had more positive qualitative features in their friendship support networks and that for bereaved in both counties, we found strong associations with having highly supportive friend-based networks and more positive bereavement adjustments (especially experiencing lower levels of loneliness and depression). Limitations and suggestions for future research are described.

Molecular Epidemiology of Syphilis—San Francisco, 2004-2007

We describe the molecular epidemiology of syphilis in San Francisco (SF) using Treponema pallidum specimens obtained from patients examined at the SF municipal sexually transmitted diseases clinic during 2004-2007. Of 69 specimens, 52 (75%) were subtype 14d9. Single subtype predominance might reflect a closely linked sexual network in SF.

Survival and Prognostic Factors of Pancreatic Cancer Patients Diagnosed from 1995–1999 in the San Francisco Bay Area: A Populationbased Study with Active Follow-Up

S (ACE) AEP Vol. 20, No. 9 September 2010: 691–724 698 data and CHIS self-report data. PAMF rates were sex and age standardized to the CHIS population. RESULTS: PAMF and CHIS rates were similar for men (77% vs. 79%) and women (76 vs. 78%) and those over (84% vs. 86%) and under (73% vs. 75%) 65 years of age. In nearly every racial/ethnic subgroup, PAMF and CHIS rates were comparable and not statistically significantly different. CONCLUSION: CRC screening rates based on clinical records in a geographically limited healthcare organization were comparable to those obtained from a statewide selfreport survey inCalifornia. This suggests that self-report bias in CHIS may be minimal with regard to CRC everscreening in sex-, age-, and racial/ethnic subgroups. It also suggests that PAMF screening rates reflect screening rates in the general population in California. P21 SURVIVAL AND PROGNOSTIC FACTORS OF PANCREATIC CANCER PATIENTS DIAGNOSED FROM 1995–1999 IN THE SAN FRANCISCO BAY AREA: A POPULATIONBASED STUDY WITH ACTIVE FOLLOW-UP Z Gong, EA Holly, PM Bracci, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA PURPOSE: Pancreatic cancer is one of the most fatal cancers in the U.S with a 5-year relative survival rate !5% based on cancer registry data. For a more complete assessment of pancreatic cancer survival in the population, we conducted active patient follow-up in our large populationbased study of pancreatic cancer to compute overall survival rates and assess survival associated with demographic and prognostic clinical factors. METHODS: Active follow-up was used to determine vital status and survival for 1,961 pancreatic cancer patients identified as part of our population-based case-control study. Survival rates were compared across subgroups of patients using Kaplan-Meier methods. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for survival associated with demographics, tumor characteristics and treatment. RESULTS: The overall 5-year relative survival rate of the 1,961 patients was 1.7% with a median survival of 3.9 months. The 5-year survival rate was greater in patients who were younger (!50 years: 9.6%), diagnosed with localized disease (9.4%), had well-differentiated tumors (6.4%), and had had surgical resection (10.9%). Shorter survival was associated with older age at diagnosis (HR for age 80+ yrs: 2.1; 95% CI, 1.6–2.6), male sex (HR, 1.1; 95% CI, 1.0–1.2), distant/metastatic disease at diagnosis (HR, 2.0; 95% CI, 1.6–2.5), and poorly differentiated tumors (HR, 1.5; 95% CI, 1.2–1.9). Longer survival was observed for Asian/Pacific Islanders (relative to non-Hispanic whites) (HR, 0.75; 95% CI, 0.65–0.87) and patients who received any active treatment regardless of tumor stage at diagnosis (HR ranged: 0.40–0.80). CONCLUSIONS: Using active follow-up methods resulting in !1% of patients lost to follow-up, results from our large population-based study show that an overall survival rate for pancreatic cancer patients is lower than that reported in cancer registry data. RESULTS: suggest that pancreatic cancer survival rates have changed little over time, and that early detection and improved treatment strategies are needed to improve prognosis for this deadly disease. P22 INNATE IMMUNITY GENES AND RISK OF ACUTE LYMPHOBLASTIC LEUKEMIA K Bartley, L-I Hsu, A Chokkalingam, J Wiemels, L Barcellos, C Metayer, P Buffler, School of Public Health, University of California, Berkeley, Berkeley, CA PURPOSE: Childhood acute lymphoblastic leukemia (ALL) may be impacted by abnormal responses to microbial challenges due to poor immune priming in childhood. The purpose of this analysis is to determine the association of ALL with single nucleotide polymorphisms (SNPs) in innate immunity genes, which may play a role in immune development. METHODS: Among 377 childhood ALL cases and 448 controls, single SNP statistical analyses were conducted using unconditional logistic regression, assuming a logadditive inheritance model, for 27 genes. Multi SNP analyses were conducted using haplotype sliding windows, with blocks of 2–5 SNPs. Gene-gene interactions were assessed using logic regression and cross validation methods. All models were adjusted for sex, age, race and Hispanic status. RESULTS: Among the 143 SNPs, 6 individual SNPs in 5 genes (CCL8, CX3CR1, CXCL12, FASLG, ITGB1) were significantly associated with childhood ALL (p ! 0.05), but did not remain significant after adjustment for multiple testing. Haplotype analyses revealed regions of interest near the 3’ end of both CXCL12 and CX3CR1; however, no statistically significant gene–gene interactions were identified using logic regression methods. CONCLUSIONS:While the results of this analysis do not generally support a role for innate immunity genes in the development of ALL, regions of interest identified in the CXCL12 and CX3CR1 genes should be further explored to identify specific functional SNPs.

Risk and Protective Factors of Alcohol Use Disorders among Filipino Americans: Location of Residence Matters

Background: Despite the growing number of Asian Americans (AA) in the United States, research on alcohol abuse in this population is sparse. Although AA have few alcohol use disorders (AUD) as an aggregate group, within-group variations in AUD need to be explored among specific ethnic groups in this population. Objectives: This study compared correlates of 12-month prevalence of AUD between Filipino Americans who currently drink alcohol and live in San Francisco (SF) or Honolulu. Methods: Data from the 1998–1999 Filipino American Community Epidemiological Survey (N = 537) were used to test two hypotheses: 1) current drinkers in SF and Honolulu will differ in the characteristics and prevalence of AUD and 2) current drinkers in SF and Honolulu do not share the same protective and risk factors of AUD. Results: Current drinkers from the two regions substantially differed in age, years of education, age at first drink, religiosity, ethnic identity, psychological distress, the nativity status, as well as the prevalence of AUD. Logistic regression models revealed that AUD risk factors were different for SF current drinkers (higher psychological distress, U.S.-born, and lower religiosity) compared to Honolulu drinkers (more years of education and lower emotional support). Conclusion: Filipino American drinkers living in SF and Honolulu have different risk and protective factors for AUD. Health professionals need to be aware of this difference when screening for factors associated with AUD among Filipino Americans. Scientific Significance: The current study revealed the importance of socioenvironmental context (location of residence) in predicting AUD among an Asian ethnic group.

Pharmacy Participation in Non-Prescription Syringe Sales in Los Angeles and San Francisco Counties, 2007

Increasing sterile syringe access for injection drug users (IDUs) is one way to prevent HIV and hepatitis C virus (HCV) transmission in this population. In 2005, California Senate Bill 1159 allowed counties to adopt the Disease Prevention Demonstration Project (DPDP). Where enacted, the DPDP allows pharmacies that register with the county to sell up to ten syringes to adults without a prescription. In the current study, we describe pharmacy participation in nonprescription syringe sales (NPSS) in two counties in California and examine factors associated with NPSS. Telephone and in-person interviews were conducted in Los Angeles (LA) and San Francisco (SF) with 238 pharmacies in 2007 (n = 67 in SF; n = 171 in LA). Quantitative survey items captured pharmacy registration with the county, pharmacy policies/practices, episodes and conditions of NPSS and refusals to sell, potential negative consequences of NPSS, and staff attitudes regarding HIV and HCV prevention for IDUs. Overall, 42% of pharmacies reported NPSS (28% in LA and 81% in SF), although only 34% had registered with the county (17% in LA and 76% in SF). Many pharmacies required proof of a medical condition (80% in LA and 30% in SF) and refused NPSS if the customer was a suspected IDU (74% in LA, 33% in SF). Few negative consequences of NPSS were reported. In multivariate logistic regression analysis, we found that the odds of NPSS were significantly higher among pharmacists who thought syringe access was important for preventing HIV among IDUs [adjusted odds ratio (AOR) = 2.95; 95% confidence interval (CI) = 1.10–7.92], were chain pharmacies (AOR = 12.5; 95% CI = 4.55–33.33), and were located in SF (AOR = 4.88; 95% CI = 1.94–12.28). These results suggest that NPSS were influenced by pharmacists’ perception. NPSS might be increased through greater educational efforts directed at pharmacists, particularly those in non-chain pharmacies.

The Happiness-Suicide Paradox

FEDERAL RESERVE BANK OF SAN FRANCISCO WORKING PAPER SERIES Working Paper 2010-30 http://www.frbsf.org/publications/economics/papers/2010/wp10-30bk.pdf The views in this paper are solely the responsibility of the authors and should not be interpreted as reflecting the views of the Federal Reserve Bank of San Francisco or the Board of Governors of the Federal Reserve System.

A Model for Determining Ground Delay Program Parameters Using a Probabilistic Forecast of Stratus Clearing

An approach is presented for using the probabilistic forecast of stratus clearing time at San Francisco (SFO) to achieve more efficient Ground Delay Programs (GDPs) by determining optimal GDP parameters. Given a probabilistic forecast, we use a simulation-based approach to generate all possible stratus clearing times for each discrete GDP end time and geographic scope under consideration. Various key measures are evaluated such as unnecessary ground delay if the GDP ends later than stratus clearing and the risk of airborne holding at the end of the GDP if the GDP ends earlier than stratus clearing. An objective function that includes each of the key metrics captures the cost of each scenario under consideration, and the optimal GDP parameters can then be selected. Initial results show reductions of 29% for unnecessary issued ground delay and reductions of 39% for unnecessarily delayed flights over the SFO GDPs during the stratus seasons in 2006 and 2007. Preparations are currently in progress to conduct a field evaluation of the model during the stratus season in 2010, with model enhancements that include the arrival rate in the selection of the recommended GDP parameters.

San Francisco to Silicon Valley, California, Instant Ridesharing with Transfer Hub

A concept of operations is provided for an innovative instant ridesharing service to exploit the large San Francisco (SF) Bay Area major employer commuter flow from SF to Silicon Valley in California. Although the concept of filling empty seats in cars seems obvious, 15 previous dynamic or instant ridesharing pilot programs have failed to develop critical mass. The proposed service differs from past attempts because (a) it targets a large commuter flow vector rather than a two-dimensional area and results in a higher probability of ride matches; (b) it uses a midcommute transfer hub to further increase ride matching probabilities; (c) it offers a viable business model that provides $40 per day per commuter cost savings to Silicon Valley employers; (d) it uses psychological persuasion principles to obtain higher participant commitment; (e) it uses daily financial incentives to motivate participants; and (f) through extensive participant training, it emphasizes immediate high system utilization on the first day of operation.

Intravitreal Bevacizumab vs Sub-Tenon Triamcinolone Acetonide for Choroidal Neovascularization Attributable to Pathologic Myopia

To compare the visual outcomes of intravitreal bevacizumab (Avastin; Genentech Inc, South San Franciso, California, USA) and sub-Tenon triamcinolone acetonide (TA) for choroidal neovascularization attributable to pathologic myopia (mCNV). Retrospective, comparative, interventional case series. Fifty-four consecutive eyes of 53 patients with mCNV treated with either sub-Tenon TA or intravitreal bevacizumab in an institutional setting were included. Twenty eyes were treated with sub-Tenon TA and 34 eyes were treated with intravitreal bevacizumab. The main outcome measures included best-corrected visual acuity (BCVA) 12 months after the initial injection and logarithm of the minimum angle of resolution gain from baseline compared with analysis of covariance (ANCOVA). At 12 months, the BCVA improved by 1.9 lines in the intravitreal bevacizumab group and worsened by 0.3 lines in the sub-Tenon TA group. Thus, the intravitreal bevacizumab group had significantly greater visual improvement than the sub-Tenon TA group (P < .01). Statistical analysis (ANCOVA) revealed that age (P = .01), pretreatment BCVA (P < .01), and the treatment choice (intravitreal bevacizumab or sub-Tenon TA; P < .01) correlated significantly with the BCVA and the BCVA gain at 12 months. The refractive error was of borderline significance (P = .06). Although this study is limited because of its retrospective nature, intravitreal bevacizumab seems to result in a more favorable visual outcome than sub-Tenon TA in the treatment of mCNV. Patient age, the BCVA before treatment, and the refractive error must be considered to initiate the treatment.

Creating a Medical Home in the San Francisco Department of Public Health

Patients with a medical home tend to fare better. One of the first steps toward establishing a medical home is to create panels by designating a clinic responsible for each patient. In 2006, we defined active clinic panels (all patients assigned to a clinic and seen there for one or more outpatient medical visits during the past 2 years) for the San Francisco Department of Public Health's 13 community- and four public hospital-based primary care clinics and began automatically assigning previously unassigned patients to clinics based on utilization. In 2007, we created a Web-based user interface for managing panels from within the electronic medical record. Providers and medical directors can now view and verify their panels and link to patient demographic and utilization data. Through April 2008, 14 508 patients have been auto-assigned to a clinic; on average 320 patients were assigned monthly. A total of 82,637 primary care patients were on a clinic panel, and 73.6 percent of them were active. Patient demographics, panel size, and productivity vary considerably by clinic. By establishing active panels and providing Web-based access to panel data, we can systematically assign patients a clinical home; enable providers to manage their panels; accurately measure utilization, capacity, and productivity; assess patient characteristics; and generate clinical quality indicators based on an accurate denominator. These management tools will allow us to set policies and work toward our goal of establishing a medical home for San Franciscans who rely on publicly funded care.

Lessons from history: coastal cities and natural disaster

PurposeThis paper aims to connect the history of San Francisco's urban development, particularly the use of artificial fill along the coast, with the city's seismic history in order to explore whether San Franciscans have learned from recurrent natural disasters.Design/methodology/approachThe paper uses historical analysis of primary sources, particularly scientific reports related to the 1906 and 1989 earthquakes. The theoretical approach draws on environmental history and natural disaster studies.FindingsSan Franciscans failed to learn lessons from earthquakes in 1868 and 1906. After the 1989 earthquake, experts reported that much of the damage had been predictable. Both policymakers and laypeople were surprised to discover the extent of scientific knowledge, given the poor preparation and outcomes.Research limitations/implicationsThe brief treatment by no means represents a thorough review of the literature; the paper is intended to be provocative rather than comprehensive.Practical implicationsThe paper suggests that coastal residents need to develop a new paradigm for viewing environmental change, including natural disasters, as an inherent element of dynamic coastal ecosystems. This mindset would help cities to better prepare for both future disasters and more gradual change to coastal landscapes, such as that likely to occur as a result of global climate change.Originality/valueThe study connects insights from the discipline of history to those of the earthquake sciences. It seeks to disseminate concepts from environmental history, such as the unnaturalness of natural disasters and the relationship of cities to nature, to an audience of policymakers and scientists.

P53 and its influence in adenocarcinoma stomach

e15685 Background: Gastric cancer is the second most common cause of the malignancy in the world after lung cancer. Various pathogenesis have been given for the adenocarcinoma, like mutation in the E-catherin gene, amplification of COX-2, HGF/ SF, VEGF; deletion of FHIT, APC, p53 but none have provided a definite target for treatment. Methods: This is a immunohistochemical prospective experiment study done on 76 cases of Gastric Adenocarcinoma.The location of the tumors were recorded as in the proximal stomach (fundus and body) and distal stomach (antrum, prepylorus, and pylorus). PAb1801 clonewas obtained from the ZYMED LABORATRIES, San Franscisco. A standardised immunohistochemical method was followed in this study. Results: p53 mutations were seen 41 out of 76 cases(53.95%). And 23 out of 41(56.09%) cases of p53 expression of the total mutated cases expressed p53 100%. 20 out of 36 cases (55.55%) of age below 60 yrs and 21 out of 40 cases (52.55%) of age above 60 yrs were p53 positive. 33 out of 60 (55%)of the males and 8 out of 16 (50%) females were reported of having gastric adenocarcinoma with p53expression. The histology of the tissue samples from the gastric adenocarcinoma patients had following relationship with the p53 immunoreactivity, 20 out of 37 cases(54.05%) of the well differentiated,7 out of 17 cases (41.18% )of the moderately differentiated, and and 13 out of 21 cases(61.90%) of the poorly differentiated gastric adenocarcinoma showed positive immunoreactivity. 15 out of 33 cases (45.45%)were localized to the proximal stomach and 30 out of 52 cases (57.69%)were localized to the distal stomach. 52.63 % of the non-mucinous type of gastric adenocarcinoma showed positive p53 immunoreactivity. Conclusions: The TP53 mutation is slightly more common in males than females, with greater occurrence in the late years of life. The mutation is more marked in the poorly differentiated gastric adenocarcinoma. The antral, pylorus,and the prepyloric parts of the stomach( the distal stomach) are more prone for mutated p53 induced adenocarcinoma. No significant financial relationships to disclose.

What Makes Us Human?

To RSVP or for more information, please call Daniel Leonardich at 415.734.2080 or email sci4life@gladstone.ucsf.edu Science for Life lectures are free with open seating. Parking is available across the street in the UCSF Rutter Center garage. Co-sponsored by San Francisco Conservatory of Music cellist Erin Wang will share with us a brief discussion of “evolution” from baroque through contemporary western music and introduce us to the stylistic and formal elements that changed from one period to the next. Ms. Wang will perform selections from Bach, Mozart, Brahms, and Ligeti Katherine S. Pollard, PhD ASSOCIATE INVESTIGATOR, GLADSTONE INSTITUTE OF CARDIOVASCULAR DISEASE ASSOCIATE PROFESSOR, DEPARTMENT OF EPIDEMIOLOGY AND BIOSTATISTICS UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

San Francisco Knows What Kids–and Their Parents–Want

San Francisco Knows What Kids–and Their Parents–Want

Poet Laureate: San Francisco

Page 16 American Book Review The Beat poems in this book pay homage to Jack Kerouac, Wallace Berman, and Bob Kaufman B O O K R E V I E W S Poet Laureate: San Francisco Rob Johnson All That’s Left Jack Hirschman City Lights Foundation Books http://www.citylights.com 86 pages; paper, $10.95 San Francisco poetry has for fifty years been dogged by its Beat legacy. It’s easy to forget that before Allen Ginsberg howled there and Jack Kerouac bummed his way there that Kenneth Rexroth, Robert Duncan, and Gary Snyder and other important poets were already there and had been for a while. They were so pissed off at the Beat incursion that, at the height of San Francisco’s “Poetry Renaissance” in 1956, they refused to be photographed with Kerouac, Ginsberg, and Gregory Corso for a Mademoiselle magazine spread. They had real differences with the Beats. As a group, for example, the San Franciscans were much more political than the early Beats. Rexroth was an anarchist, and Snyder was a Wobbly. Ginsberg, of course, became a political poet but somewhat later, and you really don’t want to know Kerouac’s politics (like his friend, William S. Burroughs, he was pretty much a Goldwater Republican with a strong anti-communist bent; at any rate, he never wrote what I would call a “political” poem). Corso, was so appalled by the overwhelming pressure to write political poetry in the 1960s that he stopped writing poetry altogether. Instead, he put his energies into being a drug addict: better a drug addict than a political poet, he believed. San Francisco poetry is still of two minds. There’s that impulse towards anarchy and revolution , but there’s also the continued Beat influence that won’t be brought down to the level of simple politics. In Jack Hirschman’s All That’s Left, a book that commemorates his appointment as San Francisco “Poet Laureate,” we see a personification of these two sides of San Francisco poetry—the impulse to change the world through social protest poetry, and the Beat impulse to view the world more personally and also on a spiritual plane. The Beat poems in the book pay homage to Jack Kerouac, Wallace Berman, and Bob Kaufman. The one on Kerouac is fine indeed, and in the following lines, echoes what Norman Mailer said upon first reading Kerouac’s On the Road (1957): “I was thinking, Oh shit, this guy’s done it. He was there, living it, and I was just an intellectual, writing about it.” Hirshman writes, When I was student young one day the Kerouac way suddenly was felt far and near like an eruption of the American moment I’d only been hanging around or talking about or studying about but not living in…. There’s also a lovely homage to a recently deceased street poet named Suzy that’s witty and supple and personal and very beatific: Poetry’s so sad about not being able to be written by her, it’s gone to a corner and won’t come out until she speaks again. Hirschman’s known, however, as a “political” poet, even though I think his real gift is for the kind of verse quoted above. His political poetry, by contrast , brings to mind Marcel Proust’s observation, “A work of art that contains theories is like an object on which the price tag has been left.” In “This House of Hunger,” he trades his poetic muse in for stale and sophomoric protest rhetoric: “Fat Exxon and Bechtel / have billions of bux in them. / What pretty profits to set / before King Death!” “The Kick Arcane” shows the seventy-two-year-old poet and veteran of many civil-rights crusades being cursed by a black woman on a bus and then kicked out the door onto the streets. Now, this might have made a fine subject for a darkly ironic and comic poem, but instead the poet drags out the tired saw that our differences have less to do with skin color than with “class” differences. The aging radical Allen Ginsberg wrote a similar poem about being mugged and losing...

In Test, Herbs Equal Western Drugs Against Knee Arthritis

SAN FRANCISCO — Ayurvedic herbal remedies were as effective as celecoxib or glucosamine in managing pain from knee osteoarthritis in a 24-week randomized, double-blind trial of 440 middle-aged patients. Ayurvedic therapy originated in ancient India and is thought to be the precursor to many forms of Asian medicine. Ayurvedic medicine still is practiced in India, where the study was conducted, to treat several chronic disorders. The Indian government funded the study. The rate of adverse effects did not differ significantly between treatments in the study, but fewer side effects were reported with Ayurvedic therapy. “Perhaps it's time to have some of these old drugs rather than newer pharmaceutical drugs” offered to patients with knee osteoarthritis, Arvind Chopra, MD, said at the annual meeting of the American College of Rheumatology. Dr. Chopra and his associates spent years conducting preliminary studies of various Ayurvedic herbs (some in placebo-controlled trials) and standardizing formulations. The herbal drugs for the exploratory studies and the current efficacy-equivalence study were manufactured in one batch. The investigators chose two formulations to compare with celecoxib and glucosamine. Both contained 250 mg of Zingiber officinale (ginger, known in Sanskrit as shanthi), 55 mg of Tinospora cordifolia (heart-leafed moonseed, or guduchi), and 125 mg of Emblica officinale (Indian gooseberry, or amalaki), a combination that had produced the greatest reduction in pain in preliminary studies. They called this formulation OA-01. They added extract of Boswellia serrata (Indian frankincense, or salai guggul), which may augment overall efficacy, and called the second formulation OA-03. The study randomized 110 adults aged 40-70 years with symptomatic knee osteoarthritis to each of four treatment arms: 2,240 mg/day of OA-01; 1,640 mg/day of OA-03; 200 mg/day of celecoxib, or 2 g/day of glucosamine sulfate. Overall, 31% of patients withdrew before the end of the 6-month study, but withdrawal rates did not differ significantly between groups, reported Dr. Chopra, director of the Centre for Rheumatic Diseases, Maharashtra, India He said he has no potential conflicts of interest related to this study. An intent-to-treat analysis of results found equivalent efficacy between the Ayurvedic formulations and the Western drugs according to prespecified definitions of equivalence in three main outcome measures—active pain rated on a Visual Analog Scale (VAS), and validated Indian versions of the Western Ontario and McMaster Osteoarthritis (WOMAC) Index scores for pain and for difficulty. The Ayurvedic remedies showed equivalent efficacy to the Western drugs in each of the main outcome measures. There were some suggestions that the OA-03 therapy had a superior chondroprotective role compared with the other drugs. Random x-rays of knee joint space assessed by investigators blinded to treatment consistently favored the OA-03 group, Dr. Chopra said. Less than 20% of patients reported side effects, all of which were mild and were treated symptomatically, the main one being epigastric pain in 16%-25% of patients. The cohort had a mean age of 56 years, had a median weight of 65 kg, and was 72% female. There continues to be controversy over whether glucosamine has any clinical benefit when used to manage OA.