Five-Year Risk for Interval-Invasive Second Breast Cancer

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The fabric of Old Belief : staroobriadtsy - traditions of clothmaking, dress, and ritual from the 17th to the 20th century

THESIS 5617.1THESIS 5617.2THESIS 5617.3The theme of this dissertation is the relationship of textiles to Old Belief, a religious minority formed after the raskol or schism in the Russian Orthodox church in 1666/1667. Within this theme I also investigate the structure of Old Believer society and the relationship of religious discipline to the material and symbolic expressions of Old Belief. Using the example of a textile factory still in existence in Moscow as illustration, I explore the progress typical of numerous eighteenth and nineteenth-century Old Believers from weaver to wealthy textile manufacturer. Although it may seem contradictory, in order to identify the reasons for this entrepreneurial success, much of my research was conducted in Old Believer villages in the Altai Mountains of southwestern Siberia in 1996, 1997, and 1999. In these isolated communities, Old Believer society changed at a much slower pace than in urban centres, allowing the researcher a view of Old Believer lifestyle and attitudes maintained in the past. In the six chapters which follow the Introduction, I examine aspects of Russian and Old Believer history as well as ethnographic sources related to Old Belief which shed light on the role of cloth and clothing in Old Believer culture. These chapters aim to: identify the roots of Old Believer attachment to Russian tradition within the conflict which produced the raskol and identify the early adherents of Old Belief. -- survey suggest the crown weaving communities in Russia at the time of the raskol and parallels with Old Believer textile enterprise. -- outline the establishment of sanctuaries of Old Belief where religion and commerce intertwined and where an emphasis on the preservation of traditional crafts encouraged Old Believers to maintain the visual symbols, including ritual textiles, of their religious identity. -- trace the route of Old Believers from these refuges to Siberia and analyse the character of their society in the Altai Mountains, founded at the same time as their co-religionists were establishing textile enterprises in European Russia. -- examine the clothmaking skills maintained in these communities. -- confirm the significance of cloth and clothing as an essential ritual and symbolic element of Old Belief. I conclude that apart from the orderly structure of Old Believer society, attention to traditional crafting skills such as spinning, weaving, and embroidery contributed to Old Believer entrepreneurial success in the textile industry. Their religious belief dictated that Old Believers maintain a lifestyle based on the sanctity of Russian tradition. As a result, in Old Believer communities, where visual symbols were an expression of religious correctness, families maintained and passed on to the next generation an expertise in textile crafts which allowed them to create ritual cloth and clothing. A view of the lifestyle of Old Believers in the Altai, unaffected by urban influence until the early twentieth century, sheds light on the relationship their co-religionists in European Russia had also once had to cloth and clothmaking

The Duration of Zidovudine Benefit in Persons With Asymptomatic HIV Infection: Prolonged Evaluation of Protocol 019 of the AIDS Clinical Trials Group

Objective.—To determine the durability of zidovudine-induced delay in clinical progression of asymptomatic human immunodeficiency virus (HIV) disease and to assess the relationship between this effect and the entry CD4+ cell count.Design and Interventions.—Extended follow-up data from subjects participating in protocol 019 of the AIDS [acquired immunodeficiency syndrome] Clinical Trials Group were examined. Subjects were offered a total daily dose of 500 mg of open-label zidovudine after the unblinding of the original randomized trial in 1989. Original treatment groups included placebo, 500 mg of zidovudine, or 1500 mg of zidovudine daily in divided doses. Three distinct analyses were conducted to assess the duration of zidovudine's effect on progression to AIDS or death: (1) analysis of all follow-up information from all subjects, (2) analysis of all subjects but with follow-up of original placebo-assigned subjects censored at the time open-label zidovudine was initiated, and (3) analysis of the effect of initiating zidovudine in subjects initially assigned to receive placebo.Setting.—University-based and university-affiliated AIDS research clinics participating in AIDS Clinical Trials Group protocol 019.Patients.—A total of 1565 asymptomatic HIV-infected subjects with entry CD4+ cell counts less than 0.50×109/L (500/μL).Main Outcome Measure.—Time to progression to AIDS or death.Results.—During follow-up of up to 4.5 years (mean, 2.6 years), 232 subjects progressed to AIDS or died. In each of the three analyses described herein, zidovudine was associated with a significant (P=.008,.004,.007) decrease in the risk of such progression. However, each of these analyses also indicated a decreasing placebo:zidovudine relative risk with duration of use (P=.002,.08,.04), suggesting a nonpermanent effect. The duration of benefit appeared to be related to entry CD4+ cell count, with greater benefit in those with higher counts at entry. No significant differences in survival were found between those originally randomized to zidovudine or placebo.Conclusions.—Zidovudine at 500 mg/d caused a significant delay in progression to AIDS or death, but its earlier use in asymptomatic disease was not associated with an additional prolongation of survival compared with delayed initiation. The delay in progression diminished over time especially in subjects with entry CD4+ cell counts less than 0.30×109/L (300/μL). Treatment strategies that alter drug regimens before the loss of zidovudine benefit should be explored.(JAMA. 1994;272:437-442

Edoxaban versus warfarin in patients with atrial fibrillation

Contains fulltext : 125374.pdf (publisher's version ) (Open Access)BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 years). The primary efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding. RESULTS: The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority) and 1.61% with low-dose edoxaban (hazard ratio, 1.07; 97.5% CI, 0.87 to 1.31; P=0.005 for noninferiority). In the intention-to-treat analysis, there was a trend favoring high-dose edoxaban versus warfarin (hazard ratio, 0.87; 97.5% CI, 0.73 to 1.04; P=0.08) and an unfavorable trend with low-dose edoxaban versus warfarin (hazard ratio, 1.13; 97.5% CI, 0.96 to 1.34; P=0.10). The annualized rate of major bleeding was 3.43% with warfarin versus 2.75% with high-dose edoxaban (hazard ratio, 0.80; 95% CI, 0.71 to 0.91; P<0.001) and 1.61% with low-dose edoxaban (hazard ratio, 0.47; 95% CI, 0.41 to 0.55; P<0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), and 2.71% (hazard ratio, 0.85; 95% CI, 0.76 to 0.96; P=0.008), and the corresponding rates of the key secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (hazard ratio, 0.87; 95% CI, 0.78 to 0.96; P=0.005), and 4.23% (hazard ratio, 0.95; 95% CI, 0.86 to 1.05; P=0.32). CONCLUSIONS: Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. (Funded by Daiichi Sankyo Pharma Development; ENGAGE AF-TIMI 48 ClinicalTrials.gov number, NCT00781391.)