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August 4, 2005  Vol. 353 No. 5

Perspective
441-444

The demand for organs remains far greater than the supply. During the past year, writes Dr. Robert Steinbrook, a passionate controversy has developed about the public solicitation of organs, which takes place over the Internet, on billboards, and through ...

444-446

Today, almost half of all kidney donors in the United States are living. Dr. Robert Truog explains that organ donation by living donors presents a unique ethical dilemma, in that physicians must risk the life of a healthy person to save or improve the ...

447-449

Nowadays, the risks — both physical and emotional — associated with kidney donation are more completely understood than they were in the early years of transplantation. Dr. Julie Ingelfinger writes that donating a kidney is sufficiently safe that the ...

Original Articles
451-459

In 2003 and 2004, routine testing of blood donations for West Nile virus RNA in the United States led to the identification of 540 positive donations, of which 67 percent were IgM-negative and most likely to be infectious. The rates of positive donations decreased from 1.49 per 10,000 in 2003 to 0.44 per 10,000 in 2004.

460-467

In 2003, nucleic acid amplification screening of 677,603 blood donations for West Nile virus with the use of “minipools” of 16 samples led to the identification of 1 positive donation for every 3703 analyzed (0.027 percent). In 2004, a strategy of testing individual donations in selected regions led to a 32 percent increase in the identification of donations with West Nile virus.

468-475

Exercise capacity is a predictor of the risk of death among both women and men. Whereas there are extensive data on expected functional capacity for age among men, normative values for women have not been well established. In a study of 5721 asymptomatic women who underwent symptom-limited exercise testing, a nomogram was developed to compare a woman's exercise performance with levels predicted for age.

476-486

About 1 of 10 night-shift workers suffers from severe excessive sleepiness on the job. This realization has led to the development of specific diagnostic criteria for people affected with shift-work sleep disorder. In this multicenter study, patients meeting this case definition were treated with placebo or modafinil. Although there was a significant improvement in laboratory measures of sleep, treated patients were still quite sleepy.

Review Articles
487-497

    The full benefit of many effective medications will be achieved only if patients adhere to prescribed treatment regimens. Unfortunately, applying terms such as “noncompliant” and “nonadherent” to patients who do not consume every pill at the desired time can stigmatize them in their future relationships with health care providers. This article on medication adherence (or compliance) reviews strategies to assess and enhance this important aspect of patient care.

    498-507
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    An expert examination of the blood smear can identify errors, establish a diagnosis, or lead to a useful fortuitous finding. An atlas of instructive blood smears is included as a set of slides.

    Images in Clinical Medicine
    508
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    This 40-year-old man presented with a four-day history of pain in the left upper quadrant, accompanied by fatigue, fever, sweating, and sore throat.

    Clinical Problem-Solving
    509-514

      A 44-year-old woman came to the emergency department because of pain in her right thigh shortly after she had a minor fall. A right femoral-neck fracture was diagnosed, and she was admitted to the orthopedic ward to await surgery. Six months before hospitalization, limb pain had developed, which became progressively worse. The patient also reported a weight loss of 30 kg and fatigue.

      Editorials
      516-517

      In 2002, just three years after its appearance in the Western Hemisphere, West Nile virus caused the largest outbreak of arboviral encephalitis ever recorded in the United States.1 Epidemiologic investigations that year revealed that West Nile virus could ...

      517-519

        Cardiorespiratory fitness, as measured by a number of relatively simple and inexpensive clinical maneuvers, provides strong and independent prognostic information about the overall risk of illness and death, especially that from cardiovascular causes. ...

        519-521

        As many as 20 percent of workers in industrialized nations are shift workers — in other words, people who work either at night or on rotating shifts.1 Shift-work sleep disorder, defined as a primary complaint of insomnia or excessive sleepiness temporally ...

        Clinical Implications of Basic Research
        522-523

        The aggrecanases — enzymes that break down cartilage — are attractive candidates as drug targets. Studies of two mouse models implicate a single aggrecanase as a mediator of the erosion of cartilage in osteoarthritis.

        Correspondence
        524-525

        To the Editor: Hampel and colleagues (May 5 issue)1 suggest that a universal screening program for the detection of microsatellite instability in patients with colorectal cancer is feasible and probably desirable. However, it will not be inexpensive. We ...

        525-528

        To the Editor: Long-term antichlamydial antibiotic therapy did not alter the risk of cardiac events among patients with stable coronary disease, as reported by Grayston et al.,1 or after an acute coronary syndrome, as reported by Cannon et al.2 (April 21 ...

        528-529

        To the Editor: In their study, Ito and colleagues (May 12 issue)1 observed reductions in both the activity and expression of histone deacetylases (HDACs), especially HDAC2, in patients with chronic obstructive pulmonary disease (COPD). In addition, the ...

        529-530

        To the Editor: The elegant work presented by Feldman et al. (May 5 issue)1 shows that point mutations in codon 137 of the V2 vasopressin receptor (V2R) can result in either a loss-of-function mutation (R137H, which is associated with congenital ...

        530-532
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        To the Editor: Two articles in the April 7 issue (Fridkin et al.1 and Miller et al.2) deal with the subject of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection. Fridkin et al. found that 6 percent of cases of MRSA infection ...

        532-533

        To the Editor: The emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is of great concern.1,2 USA300, the predominant epidemic clone in numerous outbreaks in closed communities in the United States,2 is also increasingly ...

        Book Reviews
        534-535

        In war, truth is the first casualty.

        — Aeschylus (525–456 B.C.)

        Severe acute respiratory syndrome (SARS) is the plague of the new millennium. The disease has caused tremendous social, economic, and political disruptions worldwide. In his book, Thomas ...

        535

        In 1793, a massive epidemic of yellow fever terrorized Philadelphia. Frustrated by fruitless trials of sundry remedies, Dr. Benjamin Rush finally hit on a putative cure: plentiful bloodletting and purging with the use of the potent laxatives calomel and ...

        536

        Traditionally, efforts to reduce the spread of human immunodeficiency virus (HIV) in the United States and elsewhere have focused on people who are at risk for becoming infected owing to their drug use or sexual behavior. The conceptual question has been, ...