The revised Bethesda guidelines: extent of utilization in a university hospital medical center with a cancer genetics program

<p>Abstract</p> <p>Background</p> <p>In 1996, the National Cancer Institute hosted an international workshop to develop criteria to identify patients with colorectal cancer who should be offered microsatellite instability (MSI) testing due to an increased risk for Hereditary Nonpolyposis Colorectal Cancer (HNPCC). These criteria were further modified in 2004 and became known as the revised Bethesda Guidelines. Our study aimed to retrospectively evaluate the percentage of patients diagnosed with HNPCC tumors in 2004 who met revised Bethesda criteria for MSI testing, who were referred for genetic counseling within our institution.</p> <p>Methods</p> <p>All HNPCC tumors diagnosed in 2004 were identified by accessing CoPath, an internal database. Both the Tumor Registry and patients' electronic medical records were accessed to collect all relevant family history information. The list of patients who met at least one of the revised Bethesda criteria, who were candidates for MSI testing, was then cross-referenced with the database of patients referred for genetic counseling within our institution.</p> <p>Results</p> <p>A total of 380 HNPCC-associated tumors were diagnosed at our institution during 2004 of which 41 (10.7%) met at least one of the revised Bethesda criteria. Eight (19.5%) of these patients were referred for cancer genetic counseling of which 2 (25%) were seen by a genetics professional. Ultimately, only 4.9% of patients eligible for MSI testing in 2004 were seen for genetic counseling.</p> <p>Conclusion</p> <p>This retrospective study identified a number of barriers, both internal and external, which hindered the identification of individuals with HNPCC, thus limiting the ability to appropriately manage these high risk families.</p

Washed by the Gulf Stream: The historic and geographic relation of Irish and Caribbean literature

This project examines the historic and geographic relation between Irish and Caribbean literature. It takes the definition of the Caribbean as a meta-archipelago from Antonio Benitez-Rojo and links this extensive and diverse length of islands with a seemingly monolithic culture at the opposite edge of the North Atlantic. The first chapter examines the historic contexts of the Irish in the Caribbean. The second chapter concerns Irish Big House novels and Caribbean Plantation novels such as Somerville and Ross\u27 The Big House of Inver and Rhys\u27 Wide Sargasso Sea. These texts reveal lapses in historic memory and a geographic identification with the feminine, i.e. the colonizer\u27s (as male) forced insemination of Ireland and the Caribbean (as symbolic feminine space). The third chapter finds that both Joyce and Walcott embrace what Edouard Glissant terms errantry, the temptation to go against the root. Specifically, Joyce and Walcott chart movements in a multiplicity of directions. They do not write directly against colonialism or empire but instead chart labyrinthine courses within their works symbolic of the complex positioning of colonial subjects. The use of the sea as metaphor in both Ulysses and Omeros becomes a striking realization of this errantry. Finally, the last chapter suggests that recent memoirs from both island cultures join ideas of nation with diseased bodies

Washed by the Gulf Stream: The historic and geographic relation of Irish and Caribbean literature

This project examines the historic and geographic relation between Irish and Caribbean literature. It takes the definition of the Caribbean as a meta-archipelago from Antonio Benitez-Rojo and links this extensive and diverse length of islands with a seemingly monolithic culture at the opposite edge of the North Atlantic. The first chapter examines the historic contexts of the Irish in the Caribbean. The second chapter concerns Irish Big House novels and Caribbean Plantation novels such as Somerville and Ross\u27 The Big House of Inver and Rhys\u27 Wide Sargasso Sea. These texts reveal lapses in historic memory and a geographic identification with the feminine, i.e. the colonizer\u27s (as male) forced insemination of Ireland and the Caribbean (as symbolic feminine space). The third chapter finds that both Joyce and Walcott embrace what Edouard Glissant terms errantry, the temptation to go against the root. Specifically, Joyce and Walcott chart movements in a multiplicity of directions. They do not write directly against colonialism or empire but instead chart labyrinthine courses within their works symbolic of the complex positioning of colonial subjects. The use of the sea as metaphor in both Ulysses and Omeros becomes a striking realization of this errantry. Finally, the last chapter suggests that recent memoirs from both island cultures join ideas of nation with diseased bodies