Hot off the presses! Jan 28 LANCET

The Jan 28 issue of the LANCET is now up on Pubget (About LANCET): if you're at a subscribing institution, just click the link in the latest link at the home page. (Note you'll only be able to get all the PDFs in the issue if your institution subscribes to Pubget.)

Latest Articles Include:

• Religion, organ transplantation, and the definition of death
  - LANCET 377(9762):271 (2011)
  
• Bad decisions for global health
  - LANCET 377(9762):272 (2011)
  
• Has artemisinin resistance spread already?
  - LANCET 377(9762):272 (2011)
  
• Big publishers cut access to journals in poor countries
  - LANCET 377(9762):273-276 (2011)
  
• Augmented CPR: rescue after the ResQ trial
  - LANCET 377(9762):276-278 (2011)
  
• Initial combination antihypertensives: let's ACCELERATE
  - LANCET 377(9762):278-279 (2011)
  
• Time to TEAM: exemestane, or tamoxifen then exemestane?
  - LANCET 377(9762):280-281 (2011)
  
• Checking for plagiarism, duplicate publication, and text recycling
  - LANCET 377(9762):281-282 (2011)
  
• Voting begins for paper of the year 2010
  - LANCET 377(9762):282-283 (2011)
  
• Offline: binayaksen.com
  - LANCET 377(9762):284 (2011)
  
• Science Media Centres go global
  - LANCET 377(9762):285 (2011)
  
• Discrimination against people with HIV persists in China
  - LANCET 377(9762):286-287 (2011)
  
• UK's biomedical research institute gets green light
  - LANCET 377(9762):288 (2011)
  
• Richard Dadd—painting from his mind's eye
  - LANCET 377(9762):289 (2011)
  
• Killing smoking
  - LANCET 377(9762):290 (2011)
  
• Rethy Chhem: from war-torn Cambodia to the IAEA
  - LANCET 377(9762):291 (2011)
  
• American resurrection and the 1788 New York doctors' riot
  - LANCET 377(9762):292-293 (2011)
  
• Gunnar Stickler
  - LANCET 377(9762):294 (2011)
  
• India's Janani Suraksha Yojana: further review needed
  - LANCET 377(9762):295-296 (2011)
  
• India's Janani Suraksha Yojana: further review needed – Authors' reply
  - LANCET 377(9762):296-297 (2011)
  
• Double-dose clopidogrel in patients undergoing PCI for ACS
  - LANCET 377(9762):297 (2011)
  
• Double-dose clopidogrel in patients undergoing PCI for ACS
  - LANCET 377(9762):297 (2011)
  
• Double-dose clopidogrel in patients undergoing PCI for ACS – Authors' reply
  - LANCET 377(9762):298 (2011)
  
• Watch out for the even eviler cousin—sorbitol-fermenting E coli O157
  - LANCET 377(9762):298-299 (2011)
  
• Disseminating Japan's immunisation policy to the world
  - LANCET 377(9762):299 (2011)
  
• Chilean miners: raising awareness of the plight of miners worldwide
  - LANCET 377(9762):299-300 (2011)
  
• From paedophilia to gerontophilia
  - LANCET 377(9762):300 (2011)
  
• Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial
  - LANCET 377(9762):301-311 (2011)
  Background Active compression-decompression cardiopulmonary resuscitation (CPR) with decreased intrathoracic pressure in the decompression phase can lead to improved haemodynamics compared with standard CPR. We aimed to assess effectiveness and safety of this intervention on survival with favourable neurological function after out-of-hospital cardiac arrest. Methods In our randomised trial of 46 emergency medical service agencies (serving 2·3 million people) in urban, suburban, and rural areas of the USA, we assessed outcomes for patients with out-of-hospital cardiac arrest according to Utstein guidelines. We provisionally enrolled patients to receive standard CPR or active compression-decompression CPR with augmented negative intrathoracic pressure (via an impedance-threshold device) with a computer-generated block randomisation weekly schedule in a one-to-one ratio. Adults (presumed age or age ≥18 years) who had a non-traumatic arrest of presumed cardiac cause and met initial and final selection criteria received designated CPR and were included in the final analyses. The primary endpoint was survival to hospital discharge with favourable neurological function (modified Rankin scale score of ≤3). All investigators apart from initial rescuers were masked to treatment group assignment. This trial is registered with ClinicalTrials.g! ov, number NCT00189423. Findings 2470 provisionally enrolled patients were randomly allocated to treatment groups. 813 (68%) of 1201 patients assigned to the standard CPR group (controls) and 840 (66%) of 1269 assigned to intervention CPR received designated CPR and were included in the final analyses. 47 (6%) of 813 controls survived to hospital discharge with favourable neurological function compared with 75 (9%) of 840 patients in the intervention group (odds ratio 1·58, 95% CI 1·07–2·36; p=0·019]. 74 (9%) of 840 patients survived to 1 year in the intervention group compared with 48 (6%) of 813 controls (p=0·03), with equivalent cognitive skills, disability ratings, and emotional-psychological statuses in both groups. The overall major adverse event rate did not differ between groups, but more patients had pulmonary oedema in the intervention group (94 [11%] of 840) than did controls (62 [7%] of 813; p=0·015). Interpretation On the basis of our findings showing increased effectiveness and generalisability of the study intervention, active compression-decompression CPR with augmentation of negative intrathoracic pressure should be considered as an alternative to standard CPR to increase long-term survival after cardiac arrest. Funding US National Institutes of Health grant R44-HL065851-03, Advanced Circulatory Systems.
• Aliskiren and the calcium channel blocker amlodipine combination as an initial treatment strategy for hypertension control (ACCELERATE): a randomised, parallel-group trial
  - LANCET 377(9762):312-320 (2011)
  Background Short-term studies have suggested that the use of initial combination therapy for the control of blood pressure improves early effectiveness. We tested whether a combination of aliskiren and amlodipine is superior to each monotherapy in early control of blood pressure without excess of adverse events, and if initial control by monotherapy impairs subsequent control by combination therapy. Methods We did a double-blind, randomised, parallel-group, superiority trial at 146 primary and secondary care sites in ten countries, with enrolment from Nov 28, 2008, to July 15, 2009. Patients eligible for enrolment had essential hypertension, were aged 18 years or older, and had systolic blood pressure between 150 and 180 mm Hg. Patients were randomly assigned (1:1:2) to treatment with 150 mg aliskiren plus placebo, 5 mg amlodipine plus placebo, or 150 mg aliskiren plus 5 mg amlodipine. Random assignment was through a central interactive voice response system and treatment allocation was masked from the patients. From 16–32 weeks, all patients received combination therapy with 300 mg aliskiren plus 10 mg amlodipine. Our primary endpoints, assessed on an intention-to-treat basis (ie, in patients who received the allocated treatment), were the adjusted mean reduction in systolic blood pressure from baseline over 8 to 24 weeks, and then the final reduction at 24 weeks. This trial! is registered with ClinicalTrials.gov, number NCT00797862. Findings 318 patients were randomly assigned to aliskiren, 316 to amlodipine, and 620 to aliskiren plus amlodipine. 315 patients initially allocated to aliskiren, 315 allocated to amlodipine, and 617 allocated to aliskiren plus amlodipine were available for analysis. Patients given initial combination therapy had a 6·5 mm Hg (95% CI 5·3 to 7·7) greater reduction in mean systolic blood pressure than the monotherapy groups (p<0·0001). At 24 weeks, when all patients were on combination treatment, the difference was 1·4 mm Hg (95% CI −0·05 to 2·9; p=0·059). Adverse events caused withdrawal of 85 patients (14%) from the initial aliskiren plus amlodipine group, 45 (14%) from the aliskiren group, and 58 (18%) from the amlodipine group. Adverse events were peripheral oedema, hypotension, or orthostatic hypotension. Interpretation We believe that routine initial reduction in blood pressure (>150 mm Hg) with a combination such as aliskiren plus amlodipine can be recommended. Funding Novartis Pharma AG.
• Adjuvant tamoxifen and exemestane in early breast cancer (TEAM): a randomised phase 3 trial
  - LANCET 377(9762):321-331 (2011)
  Background Aromatase inhibitors improved disease-free survival compared with tamoxifen when given as an initial adjuvant treatment or after 2–3 years of tamoxifen to postmenopausal women with hormone-receptor-positive breast cancer. We therefore compared the long-term effects of exemestane monotherapy with sequential treatment (tamoxifen followed by exemestane). Methods The Tamoxifen Exemestane Adjuvant Multinational (TEAM) phase 3 trial was conducted in hospitals in nine countries. Postmenopausal women (median age 64 years, range 35–96) with hormone-receptor-positive breast cancer were randomly assigned in a 1:1 ratio to open-label exemestane (25 mg once a day, orally) alone or following tamoxifen (20 mg once a day, orally) for 5 years. Randomisation was by use of a computer-generated random permuted block method. The primary endpoint was disease-free survival (DFS) at 5 years. Main analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, NCT00279448, NCT00032136, and NCT00036270; NTR 267; Ethics Commission Trial 27/2001; and UMIN, C000000057. Findings 9779 patients were assigned to sequential treatment (n=4875) or exemestane alone (n=4904), and 4868 and 4898 were analysed by intention to treat, respectively. 4154 (85%) patients in the sequential group and 4186 (86%) in the exemestane alone group were disease free at 5 years (hazard ratio 0·97, 95% CI 0·88–1·08; p=0·60). In the safety analysis, sequential treatment was associated with a higher incidence of gynaecological symptoms (942 [20%] of 4814 vs 523 [11%] of 4852), venous thrombosis (99 [2%] vs 47 [1%]), and endometrial abnormalities (191 [4%] vs 19 [<1%]) than was exemestane alone. Musculoskeletal adverse events (2448 [50%] vs 2133 [44%]), hypertension (303 [6%] vs 219 [5%]), and hyperlipidaemia (230 [5%] vs 136 [3%]) were reported more frequently with exemestane alone. Interpretation Treatment regimens of exemestane alone or after tamoxifen might be judged to be appropriate options for postmenopausal women with hormone-receptor-positive early breast cancer. Funding Pfizer.
• Reproductive health, and child health and nutrition in India: meeting the challenge
  - LANCET 377(9762):332-349 (2011)
  India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in in! stitutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to create awareness and change health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda needs political commitment of the highest order and the development of a people's movement.
• An essay on a topic of international health importance
  - LANCET 377(9762):350-351 (2011)
  
• Family paralysis
  - LANCET 377(9762):352 (2011)