Web Posting Research Articles

The Modified Barium Swallow Study and Esophageal Screening: A Survey of Clinical Practice Patterns

Modified barium swallow study (MBSS) is a videofluoroscopic evaluation of oropharyngeal swallowing. Views of esophageal bolus flow during MBSS are permitted under speech-language pathology practice guidelines. However, controversy exists over its implementation. Poor consensus and limited practice guidance may lead to clinical practice variations. Aims of the investigation were to (a) describe current practice patterns of speech-language pathologist visualizing bolus flow through the esophagus during the MBSS, (b) understand areas of variation when incorporating esophageal visualization during the MBSS, and (c) determine clinicians' willingness to modify MBSS procedures to include esophageal imaging. A web-based survey (Qualtrics XM) consisting of 26 questions was distributed via web posting and e-mail to members of the American Speech-Language-Hearing Association Special Interest Group 13 and Dysphagia Café. The survey was open for 3 months. Descriptive and associative statistics were completed. Field-testing was performed prior to dissemination of the survey to address content validity. A total of 321 individuals participated; 265 responses were used for analysis. Ninety-three percent of respondents viewed the esophagus during the MBSS. Twelve percent followed to the proximal esophagus, 15% to the mid esophagus, 66% to the lower esophagus, and 6% to varied levels. Variability was also reported in contrast type, volume administered, and nomenclature used. Interestingly, few people (3.61%) disagreed that esophageal visualization should be performed during MBSS. Speech-language pathology respondents in this study visualize contrast flow through the esophagus and are enthusiastic about expanding the standard MBSS. However, results of the survey demonstrate a lack of uniformity in assessment practices. Unfortunately, this may impact the diagnostic accuracy and clinical utility when adding esophageal visualization to the MBSS. This study highlights the need for a standardized protocol and identifies current barriers and controversies that may prevent expanding the MBSS to more comprehensively evaluate individuals with dysphagia.

Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline

This clinical practice guideline addresses the diagnosis and treatment of primary adrenal insufficiency. The Task Force included a chair, selected by The Clinical Guidelines Subcommittee of the Endocrine Society, eight additional clinicians experienced with the disease, a methodologist, and a medical writer. The co-sponsoring associations (European Society of Endocrinology and the American Association for Clinical Chemistry) had participating members. The Task Force received no corporate funding or remuneration in connection with this review. This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to determine the strength of recommendations and the quality of evidence. The evidence used to formulate recommendations was derived from two commissioned systematic reviews as well as other published systematic reviews and studies identified by the Task Force. The guideline was reviewed and approved sequentially by the Endocrine Society's Clinical Guidelines Subcommittee and Clinical Affairs Core Committee, members responding to a web posting, and the Endocrine Society Council. At each stage, the Task Force incorporated changes in response to written comments. We recommend diagnostic tests for the exclusion of primary adrenal insufficiency in all patients with indicative clinical symptoms or signs. In particular, we suggest a low diagnostic (and therapeutic) threshold in acutely ill patients, as well as in patients with predisposing factors. This is also recommended for pregnant women with unexplained persistent nausea, fatigue, and hypotension. We recommend a short corticotropin test (250 μg) as the "gold standard" diagnostic tool to establish the diagnosis. If a short corticotropin test is not possible in the first instance, we recommend an initial screening procedure comprising the measurement of morning plasma ACTH and cortisol levels. Diagnosis of the underlying cause should include a validated assay of autoantibodies against 21-hydroxylase. In autoantibody-negative individuals, other causes should be sought. We recommend once-daily fludrocortisone (median, 0.1 mg) and hydrocortisone (15-25 mg/d) or cortisone acetate replacement (20-35 mg/d) applied in two to three daily doses in adults. In children, hydrocortisone (∼8 mg/m(2)/d) is recommended. Patients should be educated about stress dosing and equipped with a steroid card and glucocorticoid preparation for parenteral emergency administration. Follow-up should aim at monitoring appropriate dosing of corticosteroids and associated autoimmune diseases, particularly autoimmune thyroid disease.

Offen et al. Respond

LETTERS SMOKING AND TOBACCO USE WITHIN THE DEPARTMENT OF VETERANS AFFAIRS Offen et al. provide an insightful review of the complexity of enacting tobacco control policy at the federal level, as seen in their case study of the efforts by the US Department of Veterans Affairs (VA) to adopt a smoking ban in VA medical facilities in the early 1990s. 1 As the authors indicated, tobacco use among the US military has traditionally been higher than among the civilian population. 1 In recent years, however, the VA has made great strides in reducing the rate of smoking among veterans served. For veterans enrolled in the VA health care system in 2011, the proportion of smokers was 19.7%, 2 comparable to the 19.0% reported for the United States as a whole in 2011. 3 Although federal law still requires that VA health care facilities provide areas where pa- tients can smoke, 1 progress has been made in reducing exposure to secondhand smoke for both veterans and VA employees. In citing a 2005 VA survey on smoking and tobacco use cessation within the VA, the authors incorrectly stated that one quarter of 783 smoking sites reported by VA facilities were indoors. 1 In fact, Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www. editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at men6@nyu.edu. all 783 smoking sites were outdoor smoking areas or shelters. 4 The 2005 survey actually reported that 36 out of 158 VA facilities (23%) still had an indoor smoking area somewhere at the facility, mainly in nursing homes and in- patient psychiatric units. 4 Although still far from ideal, by 2009 this number had dropped to 19 facilities; 88% had complete indoor smoke-free policies in place. 5 In referring to military and veteran facilities, it is important to note that the Department of Defense (DoD) and the VA are distinct federal executive branch agencies. Their vari- ous policies and initiatives are independent of each other, reflecting the differences in their populations and missions. Thus, in de- scribing the VA tobacco control efforts as a pattern of “advance and retreat,” the authors incorrectly attribute DoD policies and initia- tives to the VA. 1,6 The article they cited discusses DoD initiatives only, not the VA or VA policies. 6 This misperception that the two departments operate as a single unit is not uncommon, but it is one that must be avoided in future studies. j Kim Hamlett-Berry, PhD Dana E. Christofferson, PhD Richard A. Martinello, MD About the Authors The authors are with the Veterans Health Administration, US Department of Veterans Affairs, Washington, DC. Correspondence should be sent to Kim Hamlett-Berry, PhD, Department of Veterans Affairs, 810 Vermont Avenue (10P3B), Washington, DC 20640 (e-mail: kim.hamlett@va. gov). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted April 3, 2013. doi:10.2105/AJPH.2013.301375 Note. The authors certify that there is no financial conflict of interest with any financial organization with interest in the subject matter discussed in the letter. The views expressed here represent those of the authors and not necessarily those of the US Department of Veterans Affairs. Contributors K. Hamlett-Berry and D. E. Christofferson drafted the letter. R. A. Martinello supervised the overall writing and edited the final version. July 2013, Vol 103, No. 7 | American Journal of Public Health Acknowledgments The authors thank Richard Kaslow, MD, for his insightful comments.

College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference on Good Laboratory Practices in Gynecologic Cytology: Background, Rationale, and Organization

Gynecologic cytopathology is a heavily regulated field, with Clinical Laboratory Improvement Amendments of 1988 mandating the collection of many quality metrics. There is a lack of consensus regarding methods to collect, monitor, and benchmark these data and how these data should be used in a quality assurance program. Furthermore, the introduction of human papilloma virus testing and proficiency testing has provided more data to monitor. To determine good laboratory practices in quality assurance of gynecologic cytopathology. Data were collected through a written survey consisting of 98 questions submitted to 1245 Clinical Laboratory Improvement Amendments-licensed or Department of Defense laboratories. There were 541 usable responses. Additional input was sought through a Web posting of results and questions on the College of American Pathologists Web site. Four senior authors who authored the survey and 28 cytopathologists and cytotechnologists were assigned to 5 working groups to analyze data and present statements on good laboratory practices in gynecologic cytopathology at the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference. Ninety-eight attendees at the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference discussed and voted on good laboratory practice statements to obtain consensus. This paper describes the rationale, background, process, and strengths and limitations of a series of papers that summarize good laboratory practice statements in quality assurance in gynecologic cytopathology.

PRM77 Mapping the Meanings of Words Patients Use to Describe Their Pain

To identify the meaning of descriptors patients use to describe the quality and severity of their pain by mapping word clusters that patients identify as synonyms for the same pain sensation. Subjects were recruited by web posting and telephone screening. Those self-reporting active treatment for Migraine or Low Back Pain (LBP) were scheduled for in-person interviews using card sort exercises with 93 different pain descriptors to identify those each subject commonly used to describe the pain associated with their condition, and to identify pairs of descriptors that describe the same pain. Network maps that diagrammed patient identified equivalences between descriptors were created for each condition using Netdraw (Borgatti 2002) and then compared. Subjects ranged between 19 and 70 years (mean age of 41). The majority (73%) was female, 65% were working full or part time, and 59% were Caucasian. Migraine patients identified more descriptive synonyms to describe their pain (10% of all identified synonym pairs) than the LBP group (6%). For the Migraine group, most words used synonymously formed a single large cluster of connections. For the LBP group two main clusters of descriptors emerged, differentiating low-intensity and high-intensity pain. Patients in both groups tended to identify STIFFNESS-TIGHT, ACHING-HURTING, RADIATING-SHOOTING and PULSATING-PULSING-THROBBING as synonymous. LBP patients also associated RADIATING with movement (SPREADING/PENETRATING) and thermal (HOT) descriptors, while Migraine patients tended to use it interchangeably with PIERCING. Migraine patients described TIGHT as equivalent with SQUEEZING/CRUSHING, while LBP patients associated it with PULLING/TENSION. For LBP patients, SPREADING was closely associated with PENETRATING/RADIATING/SHOOTING, while for Migraine patients it was linked closely to THROBBING/GNAWING/FLASHING. While some descriptors were used to convey a more consistent meaning across groups, other descriptors demonstrated condition-specific meaning. These findings emphasize the importance of context of use when using pain as a study endpoint.

Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline

The aim was to develop clinical practice guidelines on hypertriglyceridemia. The Task Force included a chair selected by The Endocrine Society Clinical Guidelines Subcommittee (CGS), five additional experts in the field, and a methodologist. The authors received no corporate funding or remuneration. Consensus was guided by systematic reviews of evidence, e-mail discussion, conference calls, and one in-person meeting. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage, the Task Force incorporated changes in response to written comments. The Task Force recommends that the diagnosis of hypertriglyceridemia be based on fasting levels, that mild and moderate hypertriglyceridemia (triglycerides of 150-999 mg/dl) be diagnosed to aid in the evaluation of cardiovascular risk, and that severe and very severe hypertriglyceridemia (triglycerides of > 1000 mg/dl) be considered a risk for pancreatitis. The Task Force also recommends that patients with hypertriglyceridemia be evaluated for secondary causes of hyperlipidemia and that subjects with primary hypertriglyceridemia be evaluated for family history of dyslipidemia and cardiovascular disease. The Task Force recommends that the treatment goal in patients with moderate hypertriglyceridemia be a non-high-density lipoprotein cholesterol level in agreement with National Cholesterol Education Program Adult Treatment Panel guidelines. The initial treatment should be lifestyle therapy; a combination of diet modification and drug therapy may also be considered. In patients with severe or very severe hypertriglyceridemia, a fibrate should be used as a first-line agent.

The Multisite Translational Community Trial and Community-Based Participatory Research: A Failure to Communicate?

Letters to the editor referring to a recent Journal article are encouragedup to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www.editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at men6@nyu.edu. [ABSTRACT FROM AUTHOR]

Mathematical Models for Social Impacts of the ModernTechnology Developments

Rapid developments of modern technology have impacted the lives of all peoples. In this paper, we discuss a few mathematical models for estimating social impacts of such developments on today's society. In particular, we consider the impacts in the area of communication. Mathematical models for estimating those impacts are discussed, numerical procedures to implement these models are mentioned, and simulated data are used to illustrate the applications of these models. Index Terms—Technology development, social impact, communication, mathematical models. I. I NTRODUCTION Today's world is in the era of rapid developments of modern technologies. New ideas, new designs, new applications, and new devices pop up every day. The impacts of such developments on our societies are broad and huge. The technology developments have changed our lives in many aspects. For example, how many people are still regularly writing letters to their families and friends today? Not many! At some point in our lives, emails and phone calls were replacing letters. Now, text messaging, online chatting, and social web (such as Facebook) posting have started replacing emails and phone calls. In this paper, we discuss a few mathematical models for estimating the social impacts of technology developments in the area of communication. Markov chain models are used to estimate the long term trend of the impacts in those areas, entropy models are used to estimate the diversity of the impacts on different groups of people, and χ 2 tests are used to estimate the homogeneity of impacts on different groups of people. Numerical procedures to implement these models are mentioned and simulated data are used to illustrate the applications of these models. These models are ready to be applied by sociologists once they have real world data available. II. M ARKOV C HAIN M ODELS FOR L ONG T ERM T RENDS In this section, we consider the long term trends of the social impacts of technology developments in the areas of communication and education. In a later section, we will use a dynamical system model to estimate the trend of the impacts in the career options. Take the area of communication to start with. Let's consider three basic ways of communication: by regular mail, by email or telephone, by text messaging, online chatting, and social web posting. Let us categorize people in three groups: Group A contains those who still use regular mails a lot (either for social purposes or for paying bills) and also use emails and phones a lot, but barely use the newest technology such as text messaging, online chatting, or social web posting; Group B contains those who rarely use regular mails for social purposes but only for paying bills. They mainly use emails and phone calls for social communications, and they have started to try the text messaging, online chatting and social web posting; Group C contains those who are tech advanced. They rarely use regular mails now. Sometimes they use emails and telephones, but they prefer to use the newest online technology for all the social communications, plus paying their bills. When time goes by, the technology is getting more and more affordable and user-friendly, and accordingly we see more and more people leaning to the use of technology. So, what would happen in long run? Would we ever need post offices in the future? Let us discuss the use of Markov chain models in estimating the long term trend. Let us start illustrating this model with an example. Suppose a survey is made at the beginning of each year to find out the percentages of our population in each of the three groups. Each survey will show a status vector

Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline

We developed clinical practice guidelines for congenital adrenal hyperplasia (CAH). The Task Force included a chair, selected by The Endocrine Society Clinical Guidelines Subcommittee (CGS), ten additional clinicians experienced in treating CAH, a methodologist, and a medical writer. Additional experts were also consulted. The authors received no corporate funding or remuneration. Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage, the Task Force incorporated changes in response to written comments. We recommend universal newborn screening for severe steroid 21-hydroxylase deficiency followed by confirmatory tests. We recommend that prenatal treatment of CAH continue to be regarded as experimental. The diagnosis rests on clinical and hormonal data; genotyping is reserved for equivocal cases and genetic counseling. Glucocorticoid dosage should be minimized to avoid iatrogenic Cushing's syndrome. Mineralocorticoids and, in infants, supplemental sodium are recommended in classic CAH patients. We recommend against the routine use of experimental therapies to promote growth and delay puberty; we suggest patients avoid adrenalectomy. Surgical guidelines emphasize early single-stage genital repair for severely virilized girls, performed by experienced surgeons. Clinicians should consider patients' quality of life, consulting mental health professionals as appropriate. At the transition to adulthood, we recommend monitoring for potential complications of CAH. Finally, we recommend judicious use of medication during pregnancy and in symptomatic patients with nonclassic CAH.

Calculations and analysis of cross sections required for argon charge exchange recombination spectroscopy

A large set of calculations has been carried out providing a basis for diagnostics of fusion plasmas through emission resulting from radiative de-excitation following charge transfer between hydrogen and highly charged argon ions, so-called argon charge exchange recombination spectroscopy. These results have been obtained using the classical trajectory Monte Carlo (CTMC) method to treat charge transfer to states with principal quantum numbers up to 30 or more. Nine collision energies between 13.3333 and 250 keV/u pertinent to neutral beam injection have been considered for Arq+ (q = 15–18) colliding with atomic hydrogen in both the ground and metastable states. Atomic orbital close coupling calculations have also been undertaken in order to provide a fully quantum mechanical test of the CTMC results for Ar18+ + H(1s) collisions. The results of the calculations are discussed here and the full set of data is made available through a web posting.

Clinical and genetic factors associated with lipoprotein-associated phospholipase A 2 in the Framingham Heart Study

Objective To conduct an investigation of clinical and genetic correlates of lipoprotein-associated phospholipase (Lp-PLA 2) activity and mass in a large community-based cohort. Higher circulating Lp-PLA 2 predicts cardiovascular disease risk, but sources of inter-individual variability are incompletely understood. Methods We conducted stepwise regression of clinical correlates of Lp-PLA 2 in four Framingham Heart Study cohorts ( n = 8185; mean age 50 ± 14 years, 53.8% women, 9.8% ethnic/racial minority cohort). We also conducted heritability and linkage analyses in Offspring and Generation 3 cohorts ( n = 6945). In Offspring cohort participants we performed association analyses ( n = 1535 unrelated) with 1943 common tagging SNPs in 233 inflammatory candidate genes. Results Sixteen clinical variables explained 57% of the variability in Lp-PLA 2 activity; covariates associated with Lp-PLA 2 mass were similar but only explained 27% of the variability. Multivariable-adjusted heritability estimates for Lp-PLA 2 activity and mass were 41% and 25%, respectively. A linkage peak was observed for Lp-PLA 2 activity (chromosome 6, LOD score 2.4). None of the SNPs achieved experiment-wide statistical significance, though 12 had q values <0.50, and hence we expect at least 50% of these associations to be true positives. The strongest multivariable-association with Lp-PLA 2 activity was found for MEF2A (rs2033547; nominal p = 3.20 × 10 −4); SNP rs1051931 in PLA2G7 was nominally associated ( p = 1.26 × 10 −3). The most significant association to Lp-PLA 2 mass was in VEGFC (rs10520358, p = 9.14 × 10 −4). Conclusions Cardiovascular risk factors and genetic variation contribute to variability in Lp-PLA 2 activity and mass. Our genetic association analyses need replication, which will be facilitated by web posting of our genetic association results.

ASSESSMENT OF THE EFFECTS OF SOCIAL SUPPORT ON ADOLESCENTS WITH PARENTS WITH HIV/AIDS

Letters to the editor referring to a recentJournal article are encouraged up to 3months after the article’s appearance. Bysubmitting a letter to the editor, the authorgives permission for its publication in theJournal. Letters should not duplicate materialbeing published or submitted elsewhere. Theeditors reserve the right to edit and abridgeletters and to publish responses.Text is limited to 400 words and 10 refer-ences. Submit online at www.ajph.org forimmediate Web posting, or at submit.ajph.orgfor later print publication. Online responsesare automatically considered for printpublication. Queries should be addressed tothe Editor-in-Chief, Mary E. Northridge, PhD,MPH, at men11@columbia.edu.

The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline

The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome. The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments. After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.

This We Remember: Consuming Representation via the Web Posting of War Photographs

Consumers are increasingly searching for beautiful memories. Memory is not solely the work of the mind retrieving a “true” past. People represent their unique past to (re)construct their identity and seek social links with others who share the remembered events. Through visual analysis of the web posting of war photographs by Vietnam veterans, this paper explores how people consume representations in remembering, reconstructing identities and building a mnemonic community. The analysis suggests that individual remembering is nested within collective remembering. A conceptual framework viewing remembering as mediated action helps to explain how consumers use representations in remembering. This process is carried out not only by individuals but also by cultural institutions. American Vietnam veterans use consumer products including private photographs, movies, books, travel trips and the Internet as tools to assist in the on‐going process of remembering. They add their own voice into the social representation system to create representations that further express who they are and to connect with their community. The constructed memory shapes consumers' present. This in turn modifies their representation of their pasts which become involved in changing the larger social representation system.

A 10-year history of lung cancer practice guideline development: Process, productivity and impact

17044 Background: CCO's Program in Evidence-based Care at McMaster University, has developed and disseminated clinical guidance documents through provincial DSGs for 10 years. The 37 member Lung DSG includes medical oncologists (17), radiation oncologists (11), thoracic surgeons (4), nurses (2), and a research coordinator. Pathologists (3), community/patient representatives (2), a medical resident and medical sociologist have previously been members. Methods: The LDSG has used the practice guideline (PG) development cycle described by Browman GP et al (JCO 1998; 16(3):1226–31). Results: 31 reports have been published in peer-reviewed journals, including 25 guidelines; all PGs are posted on the CCO website. Topics were initially selected on the basis of known practice variability (chemotherapy for Stage IV NSCLC) or clinical controversy (combined modality therapy for Stage III NSCLC); PGs for single chemotherapy drugs (6) or chemotherapy usage in specific situations (7) have dominated DSG activity; 5 PGs on radiotherapy alone and 3 on RT as part of CMT have been completed; recent PGs have been written for rare tumours (mesothelioma, thymoma) and diagnostic imaging (PET). Initially, PGs were based solely on published RCT evidence. Evidence from publicly accessible abstracts/meeting presentations, and Phase II trials (in the absence of higher quality evidence) is now considered. For rare tumours (thymoma), the DSG has used a Delphi consensus methodology. Knowledge transfer occurs through the DSG meeting process (twice yearly face-to-face; 2–4 teleconferences), practitioner feedback (PF), publications, presentations and web posting. PF using a standardized feedback questionnaire is generally high (59.9%) but varies by PG and discipline; PF is incorporated into final guideline documents. Guideline recommendations for the use of vinorelbine, gemcitabine, taxanes and erlotinib in NSCLC have been successful in securing government funding. No significant financial relationships to disclose.

Beyond open access: open discourse, the next great equalizer

The internet is expanding the realm of scientific publishing to include free and open public debate of published papers. Journals are beginning to support web posting of comments on their published articles and independent organizations are providing centralized web sites for posting comments about any published article. The trend promises to give one and all access to read and contribute to cutting edge scientific criticism and debate.

China Science Foundation Takes Action Against 60 Grantees

BEIJING—As part of a campaign to improve ethical behavior among China's rapidly growing scientific community, the country's leading basic research agency has disclosed the names of three scientists being punished for misconduct. In the past 2 years, some 60 scientists funded by the National Science Foundation of China (NSFC) have been found guilty of misconduct, but the Web posting (nsfc.gov.cn) late last month is the first time that any names or institutions have been identified.

Scientific Publications – Free For All?

One of the most important elements of the Antarctic Treaty is the requirement to provide open and free access to all information collected south of 60° S. For this reason the current focus on making all published science free for everyone strikes a sympathetic cord. Led by various institutions promoting web posting of published material and the Public Library of Science enthusiasts proposing open access through the author-pays model there is a ferment of activity at present around the world to convert scientists and librarians to this new religion.

States Begin to Permit Web Posting for Legal Ads, Public Notices

Editor & Publisher reported recently that many newspapers were adding public notices to the list of those items posted on their Web sites.1 Publishers said they hoped this expansion of services would dissuade state legislatures from changing the laws that require publication of legal notices in newspapers. Although the small circulation newspapers are usually hardest hit by the loss of legal ads during downturns in commercial advertising, the large circulation newspapers report substantial revenue streams from legal notice clients and are eager to retain the system.2Since the late 1990s, many of the larger circulation newspapers created Web sites for posting legal notices as a way of dissuading local government from moving into the venue. Several newspaper group consortia also formed to create Web sites for public notices. A large site is http:/ / publicnoticeads.com used in Arizona, Colorado, Iowa, Louisiana, Mississippi, New Jersey, Ohio, Oklahoma, Oregon and Utah, launched four years ago. Most newspaper publishers were still treating the Web posting as an addition, not a replacement, for newsprint publication in 2002. News organizations did not claim a significant revenue stream from the additional Web postings of legal notices.3Individual state organizations, like Pennsylvania, also are hosting sites for legal notice postings in response to the state legislature inquiries.4 Pennsylvania has traditionally required that legal notices be published in certain, designated newspapers in order to meet the statutory mandate of providing the public with knowledge about government activities.5 And the concerns about the costs and effectiveness of its historical statutory notice practices are not unique to Pennsylvania. Nearly half of the nation's states not only reviewed the venues required for statutory notice, but also made changes in those laws during the past two years. Some legislatures continue to review the necessity of publishing public and legal notices in newsprint. This article reviews the changes that 21 states and the District of Columbia made recently in their legally binding practices for distributing public notice information.BackgroundPublic notice through newspaper publication has served both state and federal government in the United States since the organization of the nation. As early as the first session of the first Congress, the public has been kept informed about government activities through both traditional news stories and legal advertisements in designated newspapers.6 Although newspapers are not the only way to learn about the activities of municipal, state and federal agencies, it has been the single venue specifically identified by all 50 states.7The reasons most often mentioned for posting public or legal notices in newspapers include:* Newspaper accessibility to both the reading public and the government* A relatively inexpensive distribution mechanism with documented subscribership* A relatively stable format for evidence and records.8The key concern now most frequently mentioned is that actual notice may be less certain when newsprint publication of legal notice is the primary means of distribution. Actual notice connotes the warning or alert provided by newspaper publishing must be done so that it communicates pertinent fact by an authorized person about government business to an appropriate constituency.9 Since legislators are now considering other venues for public notice, there are apparently some who believe newspapers are no longer serving that function adequately, though all 50 states and the District of Columbia continue to require newspaper publication as notification for much of the public's business.10Newspaper associations, like American Court & Commercial Newspapers, have frequently devoted national meeting sessions to concerns about legal and public notice requirements.11 The National Newspaper Association compiled several reports during the 1990s about the state laws and the shifting statutory mandates. …

Management of abnormal uterine bleeding by northern, rural and isolated primary care physicians: PART II: What do we need?

BackgroundAbnormal uterine bleeding (AUB) is a common problem that affects one in five women during the pre-menopausal years. It is frequently managed by family physicians, especially in northern, rural and isolated areas where severe shortages of gynecologists exist.MethodsWe surveyed 194 family physicians in northern, rural and isolated areas of Ontario, Canada to determine their educational and resource needs for the management of AUB, with a specific focus on the relevance and feasibility of using clinical practice guidelines (CPGs).ResultsMost physicians surveyed did not use CPGs for the management of AUB because they did not know that such guidelines existed. The majority were interested in further education on the management of AUB through mailed CPGs and locally held training courses. A major theme among respondents was the need for more timely and effective gynecological referrals.ConclusionA one-page diagnostic and treatment algorithm for AUB would be easy to use and would place minimal restrictions on physician autonomy. As the majority of physicians had Internet access, we recommend emailing and web posting in addition to mailing this algorithm. Local, hands-on courses including options for endometrial biopsy training would also be helpful for northern, rural and isolated physicians, many of whom cannot readily take time away from their practices.