Editorial note: The indications for coronary arterial bypass grafting

Mechanisms coupling the absorption of solutes and water in the proximal nephron

Journal of Cutaneous PathologyVolume 6, Issue 4 p. 329-331 Capillary Hemangioma Leopoldo F. Montes, Leopoldo F. Montes Laboratory of Dermatopathology, Department of Dermatology, University of Alabama in Birmingham, Medical Center, Birmingham, Alabama 35294.Search for more papers by this authorWalter H. Wilborn, Walter H. Wilborn Department of Anatomy, College of Medicine, University of South Alabama, Mobile, Alabama 36688, U.S.A.Search for more papers by this author Leopoldo F. Montes, Leopoldo F. Montes Laboratory of Dermatopathology, Department of Dermatology, University of Alabama in Birmingham, Medical Center, Birmingham, Alabama 35294.Search for more papers by this authorWalter H. Wilborn, Walter H. Wilborn Department of Anatomy, College of Medicine, University of South Alabama, Mobile, Alabama 36688, U.S.A.Search for more papers by this author First published: August 1979 https://doi.org/10.1111/j.1600-0560.1979.tb01142.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume6, Issue4August 1979Pages 329-331 RelatedInformation

Clinical and pathologic characteristics of melanoma were compared among 1647 clinical Stage I patients treated at the University of Alabama in Birmingham (USA) and The University of Sydney (Australia) between 1955 and 1980 to determine what changes occurred over a quarter century. Over this period, the number of patients treated annually has increased substantially. There was a steady increase in the proportion of patients presenting with localized disease (clinical Stage I). Melanomas became thinner, less invasive, less ulcerative and thus more curable. They also exhibited more of a radial growth phase. The median thickness of melanomas decreased in Australia from 2.5 mm prior to 1960 to 1.1 mm during the period 1976 to 1980, while in Alabama it has decreased from 3.3 to 1.4 mm. There was a significant increase in melanomas located on the trunk in males and a corresponding decrease in male head and neck melanomas. No significant change in the site distribution was observed for any major anatomical area on female patients. There were minimal differences in the incidence of both clinical and pathologic parameters among melanoma patients in Alabama, USA and in New South Wales, Australia even when accounting for their year of diagnosis. Long-term survival rates in patients with localized disease were found to increase slightly during the 25 year time frame of this analysis. The changes that have occurred are likely due to earlier diagnosis and changes in the biological nature of the disease.

Background: Race and neighborhood socioeconomic disadvantage are linked to worse health outcomes in heart failure, but studies have not specifically focused on patients with heart failure with preserved ejection fraction (HFpEF). Research Question: Is race associated with all-cause mortality among patients with HFpEF and does the area-level poverty moderate this association? Methods: ICD diagnostic codes for HFpEF were used to identify patients with first hospitalizations for HFpEF in University of Alabama in Birmingham (UAB) Medicine EHR data from 2017-2023. Demographics, comorbidities, and laboratory data were extracted at admission. Patient zip codes were merged with Census zip code poverty data. All-cause mortality was ascertained in the EHR. Multivariable-adjusted Cox proportional hazard models examined the association between race and all-cause mortality and interaction between race and zip-level poverty ratio, dichotomized at the median. Results: Between 2017-2023, 14,043 adults had a first hospitalization for HFpEF at UAB; 37% were African American (AA), 58% white, 4.5% from other race/ethnicities. Half resided in high poverty areas (19% of area residents with income below the median poverty level). Compared to whites, AA adults with HFpEF were more likely to be younger, women, reside in high-poverty areas, and have hypertension, diabetes, obesity, worse kidney function and higher brain-natriuretic peptide at admission (Table). Over a median follow-up of 2.7 years [IQR: 0.9-4.9 years], there were 3,747 deaths; 2146 (26.2%) among whites, 1447 (27.8%) among AAs, and 154 (24.3%) among other ethnicities. AA adults had increased all-cause mortality compared to whites, with an adjusted HR 1.14 [95% CI: 1.06-1.23, p=0.001]. The race* poverty interaction p-value was 0.02, indicating that the association between race and all-cause mortality was significantly more pronounced among those residing in higher poverty areas (Table). This was not observed for AA adults in lower poverty areas or for other ethnicities. Conclusion: In this study, AA patients with HFpEF, residing in high poverty areas, had higher all-cause mortality rates compared to white patients. No racial differences in mortality were observed in lower poverty areas.

About the Contributors

The following list of titles was compiled by the Library Journal List Committee of the Reference and Adult Services Division, American Library Association. Committee members include Larry Earl Bone, Memphis Public Library and Information Center, Chairman; Lynn Cochran, Free Library of Philadelphia, Pennsylvania; Carl T. Cox, University of Tennessee, Knoxville; Laurel Grotzinger, Western Michigan University, Kalamazoo; John Larsen, Columbia University, New York, New York; Wilbur McGill, Enoch Pratt Free Library, Baltimore, Maryland; Mary Jean Nottviet, Iowa City, Iowa; Lelia B. Saunders, Arlington County Department of Libraries, Virginia; Paul Spence, University of Alabama in Birmingham. The 63 titles on this list represent in the opinion of the Committee, a selection of outstanding reference books published in 1973 and late 1972 for small and medium‐sized public and college libraries.

Prognostic histopathological factors in malignant melanoma

Unstable angina pectoris: A comparison of the costs of medical and surgical treatment

A driamycin (ADR; doxorubicin HCl), is a potent anthracycline chemotherapeutic agent that is effective against a wide range of human malignancies, such as leukemias, lymphomas, and many solid tumors. For many malignancies (eg, breast cancer, lymphoma), it is the most effective single agent. The use of ADR has been limited, however, by the development of a dose-dependent cardiomyopathy induced by this antineoplastic agent. The overall incidence of clinical cardiotoxicity for patients treated with ADR is approximately 2%, with the incidence of congestive heart failure increasing to 10% at 500 mg/m and to over 40% at 700 mg/m. The cardiac-specific injury of ADR is usually irreversible, although aggressive support for a low cardiac output may reverse the dysfunction in some patients. Nevertheless, once ADR-induced heart failure has been diagnosed, the prognosis is poor; mortality varies from 30 to 60%. It is also noteworthy that various other commonly used antineoplastic agents, cyclophosphamide, 5-fluorouracil, paclitaxel, streptozotocin, bevacizumab (Avastin), etoposide, bleomycin, tamoxifen, and trastuzumab (Herceptin), as well as radiation therapy, which is commonly used as an adjuvant to lumpectomy, are also cardiotoxic, although different mechanisms may be involved. Therefore, the development of sensitive methods for early detection of drugor radiation-induced cardiotoxicity in individual patients could greatly facilitate the management of a wide range of neoplastic diseases. Development of ADR-induced cardiomyopathy is dose dependent and cumulative. To reduce the incidence of cardiotoxicity, limiting treatment with this agent to a total lifetime dose of ADR of 550 mg/m is recommended. However, the individual response to ADR is highly variable, and bolus administration of up to 900 mg/m has been reported without evidence of heart failure; up to 1,500 mg/m has been administered by continuous infusion without evidence of cardiotoxicity. In some patients, drug resistance, rather than toxicity, is dose limiting; in other instances, restriction of ADR therapy to the recommended guidelines may lead to the premature discontinuation of treatment in patients who might otherwise benefit from higher doses. Conversely, some patients may be highly sensitive to ADR, experiencing toxicity at doses that are lower than the recommended limit. Patients with cardiac disorders or with previous radiation therapy to the mediastinum are generally excluded from ADR treatment protocols. It has also been reported that in some pediatric cases, for which treatment with ADR was well within the recommended limit, congestive heart failure developed several years after treatment. Consequently, the availability of a sensitive, noninvasive method for assessing the early onset of ADR cardiomyopathy in the individual patient would have a significant clinical impact. At the present time, there does not appear to be any effective method for predicting which patients will develop ADR-induced heart failure or for sensitively detecting its onset at a very early stage, when administration can effectively be discontinued or useful treatment for cardiomyopathy can be initiated. Current methods of assessing cardiotoxicity are limited to measurement of cardiac function by radionuclide ventriculography (RNV), echocardiography, and detection of tissue damage by percutaneous endomyocardial biopsy. RNV is not particularly sensitive for detecting early damage as assessed by endomyocardial biopsy scores. In combination with exercise, RNV sensitivity improves, but at the expense of specificity. Artifactual errors of 5% or more in ejection fraction measurements are common. Therefore, it has been recommended that a combination of RNV or echocardiography and biopsy examinations be employed in the From the Department of Radiology, University of Pennsylvania, Philadelphia, PA; Department of Radiology, University of Florida, Miami, FL; and Division of Cardiovascular Disease, Department of Medicine, University of Alabama in Birmingham, Birmingham, AL.

Departments of Pediatrics and Microbiology, School of Medicine, University of Alabama in Birmingham, and Children s Hospital, Birmingham, Alabama

*Assistant Professor, Department of Anesthesiology. University of Alabama in Birmingham, University Station, Birmingham, Alabama 35294. Dr. Gooding's Current Address: Department of Anesthesiology, Tulane University, New Orleans, Louisiana. Accepted for publication: April 7, 1977

A prospective study was conducted to evaluate and compare the determinants of dietary zinc intake in black and white low-income pregnant women. The study population consisted of 1298 low-income women (70% Black, 30% White) who received prenatal care at University Hospital at the University of Alabama in Birmingham from 1985 to 1989. Various maternal characteristics were evaluated at the first prenatal visit. Two 24 h recalls were obtained at 18 and 30 wk of gestation to calculate the intakes of dietary zinc and other nutrients. Student's t test, chi2, Pearson correlation coefficients, and multiple regression analyses were used to compare and evaluate the determinants of zinc and other nutrient intakes in Black and White subjects. The mean prepregnancy body mass index and the mean intake of zinc, energy, and all the other nutrients except calcium were significantly higher in Black than in White subjects. There was a significant correlation between zinc and energy intake (r = 0.69, p = 0.001). Age, marital status, parity, socioeconomic status, smoking, and alcohol intake were not significant predictors of zinc or other nutrient intakes. After adjusting for energy intake, race was the only significant predictor of dietary zinc intake. Race and energy intake explained 24% of the variation in zinc intake. Results of this study indicate that after adjusting for other covariates, race and energy intakes are the only predictors of zinc intake in low-income pregnant women.

The importance of better nutrition education in the medical school has become more recognized and emphasized in recent years. In an attempt to fulfill increasing needs for teaching programs, unproven approaches have often been used, thereby risking loss of both effectiveness of instruction and student interest. A retrospective evaluation of a decade of teaching experience at the University of Alabama in Birmingham has resulted in a better understanding of what problems may be encountered in the development of a nutrition education program. From this review, two factors appear to be of critical importance to a successful program: relevance of the course material to medical practice and the presence of a strong, positive role model as a physician-nutritionist. Five other factors that need to be considered, but often receive undue priorities, are also discussed.

Case or agr. Just as abstract Case and agr are cover terms for syntactic features with often idiosyncratic morphological realization, thematic roles seem most useful simply as syntactic designations for positions that enter into argument and adjunct relations. This is a good book, not just for its critique of theta theory, but also for the positive contribution of further development of the Decompositional Theory. Although the book is a revised dissertation, it doesn't read like one: the style is engaging and philosophical, and the exemplification is detailed and clear. And while it does not cover every thematic-role-based proposal ever made, the book is nevertheless to be recommended to anyone who has puzzled over the content of thematic roles. [Edwin Battistella, University of Alabama in Birmingham] Psychology of language: An introduction to sentence and discourse processes. By Murray Singer. Hillsdale, NJ: Lawrence Erlbaum, 1990. Pages xi, 308. $24.95. Recent years have seen the emergence of an essentially interdisciplinary, cognitive-science approach to natural language processing, with some of the most fruitful work focusing on discourse structure and processing. Singer's book is intended as an introductory graduate textbook, though it is also suitable as a desk reference for the linguist, cognitive psychologist, or computer scientist with an interest in natural language processing. An introductory graduate textbook must accomplish several purposes: (i) familiarize students with key theoretical concepts; (ii) refer them to the fundamental literature in which those concepts are discussed; (iii) provide them with exemplars that teach them how to apply the concepts insightfully to the data; and (iv) inculcate a sense of relevance that enables students to read professional articles and evaluate their theoretical significance. S's book is probably above average by these standards. Key concepts are clearly if succinctly explained, fundamental articles are cited in each of the relevant disciplines, and examples are frequent and detailed enough to satisfy the most exacting linguist. The book's weaknesses are those endemic to any introductory text: it emphasizes consensus, spending more time summarizing established results than exploring open issues and controversies, and the passages which explain key concepts are often terse, so that the instructor may sometimes wish to assign source articles as background reading. Overall, the book appears to be a valuable introductory textbook for a course in psycholinguistics or discourse processing. It is divided into ten chapters, as follows: Ch. 1, 'Introduction'; Ch. 2, 'Language and meaning: Representing and remembering discourse'; Ch. 3, 'Syntax and parsing processes'; Ch. 4, The role of knowledge in language comprehension'; Ch. 5, 'Understanding coherent discourse'; Ch. 6, Theme'; Ch. 7, 'Inference processes'; Ch. 8, 'Understanding stories'; Ch. 9, 'Question answering and sentence verification'; and Ch. 10, 'Natural language understanding by computers—and people'. One of the noteworthy aspects of the book is its thorough integration of psycholinguistic data with the concepts of discourse analysis, including coherence, the givennew contract, thematic structure, and scripts. [Paul Deane, University of Central Florida.] An essay on grammar-parser relations. By Jan van de Koot. Dordrecht: Foris, 1990. Pp. xii, 152. Paper $24.50. In this monograph, K investigates the possible relations between grammars and parsers. Any theory of the mind that postulates separate 240 LANGUAGE, VOLUME 68, NUMBER 1 (1992) levels of representations raises the question of what relations are possible, justified and beneficial among the several levels. Two such theories are Marr's theory of vision and Chomskyan generative grammar, with their separation of competence from performance. The book under review belongs to the research line of computer modelling of performance started by Parsifal (Mitchell Marcus, A theory of syntactic recognition for natural language, Cambridge, MA: MIT Press, 1980) in the Government-Binding framework. The monograph starts with a critical introduction to the relevant issues. Through extensive quotations from Marr's work (David Marr, Vision, San Francisco, CA: Freeman, 1982) K presents the methodological justification for multileveled theories of cognition. He then proceeds to explore, in the more limited domain of the language faculty, the necessary features of a psychologically real theory of grammar. The arguments that led some scholars to consider transformational grammar not psychologically real are presented and rebutted by the introduction of a more articulated framework for evaluation, which takes into account the separateness of competence grammar, runtime grammar, parsing technique, and evaluation metrics. Although nothing new is added to the debate here, the main issues of a discussion that spans a decade are reviewed clearly and concisely. Ch. 2 is an overview of several proposals in the framework of deterministic parsing. Most notably, the first such parser, Parsifal, is presented in detail. Arguing against some recent criticism of Parsifal's use of look-ahead, K claims that the use of look-ahead to resolve local ambiguities is empirically correct if coupled with the assumption that lexical-semantic information can be used during syntactic processing, when it is needed for disambiguation. K also reviews the formal properties of Parsifal, drawing on other works in the literature to argue that determinism provides a functional explanation of WH-islands at most, and that it is neutral with respect to grammatical formalism. Ch. 3 explores the relation between the Barriers theory (Noam Chomsky, Barriers. Cambridge, MA: MIT Press, 1986) and deterministic parsing. The parsing platform is Parsifal, with alterations and augmentations that link it more tightly to the grammar and make it more accurate empirically. An algorithm for chain formation is proposed here. K discusses its integration in the existing parser and its application to some linguistic facts, such as violations of the Subject and Adjunct Conditions and parasitic gaps. Some interesting ideas are put forth in this chapter, although more extensive exemplification and, if not a real implementation, at least lower-level specifications of the algorithms would have substantiated the proposal more convincingly. The book ends with a number of theoretical investigations of the possible contribution of the theory of performance to the theory of competence. In general, the reader interested in these issues will find in K's book an accurate and critical review of the main issues in the tradition of deterministic parsing, in itself a needed and useful contribution. Because the book is not intended as a review, however, more space should have been devoted to the author's new proposal; interesting ideas, such as those related to the algorithms for chain formation, are not given enough space and detailed description. The book would have also benefited from more careful editing and typesetting. [Paola Merlo. University ofMaryland.] Politically speaking: The pragmatic analysis of political language. By John Wilson. (Language in Society series.) Basil Blackwell, 1990. Pp. 203. Cloth $45.95, paper $16.95. Politically speaking offers an interesting and frequently amusing look at political speech from the perspective of linguistic pragmatics. Unlike Robin Lakoffs Talking power (New York: Basic Books, 1990), it does not investigate political power or even politics in a generic sense; and, unlike Frederick Bowers's Linguistic aspects oflegislative expression (Vancouver: University of British Columbia Press, 1990). it does not examine statutory language. Rather, Wilson explores politicians' utterances in speeches and interviews. Examples from other cultures are used, but mostly the study deals with recent British and American political figures. A notable feature of the book, W's quotations—from Margaret Thatcher's 'We are a grandmother' to Ronald Reagan's '[in England] a criminal with a gun, even if he was arrested for burglary, was tried for first degree murder and hanged if found

DEBRA S. GADDY, RN, MSN, is a clinical nurse specialist in hematology/oncology at the Children's Hospital, University of Alabama in Birmingham.