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Showing papers by "University of Washington published in 1997"


Journal ArticleDOI
TL;DR: In this article, the authors identify a robust, recurring pattern of ocean-atmosphere climate variability centered over the midlatitude North Pacific basin over the past century, the amplitude of this climate pattern has varied irregularly at interannual-to-interdecadal timescales.
Abstract: Evidence gleaned from the instrumental record of climate data identifies a robust, recurring pattern of ocean–atmosphere climate variability centered over the midlatitude North Pacific basin. Over the past century, the amplitude of this climate pattern has varied irregularly at interannual-to-interdecadal timescales. There is evidence of reversals in the prevailing polarity of the oscillation occurring around 1925, 1947, and 1977; the last two reversals correspond to dramatic shifts in salmon production regimes in the North Pacific Ocean. This climate pattern also affects coastal sea and continental surface air temperatures, as well as streamflow in major west coast river systems, from Alaska to California.

6,719 citations


Journal ArticleDOI
TL;DR: In this article, Naiman et al. pointed out that harnessing of streams and rivers comes at great cost: Many rivers no longer support socially valued native species or sustain healthy ecosystems that provide important goods and services.
Abstract: H umans have long been fascinated by the dynamism of free-flowing waters. Yet we have expended great effort to tame rivers for transportation, water supply, flood control, agriculture, and power generation. It is now recognized that harnessing of streams and rivers comes at great cost: Many rivers no longer support socially valued native species or sustain healthy ecosystems that provide important goods and services (Naiman et al. 1995, NRC 1992).

5,799 citations


Journal ArticleDOI
TL;DR: In this paper, an expression for the equilibrium free energy difference between two configurations of a system, in terms of an ensemble of finite-time measurements of the work performed in parametrically switching from one configuration to the other, is derived.
Abstract: An expression is derived for the equilibrium free energy difference between two configurations of a system, in terms of an ensemble of finite-time measurements of the work performed in parametrically switching from one configuration to the other. Two well-known identities emerge as limiting cases of this result.

4,496 citations


Journal ArticleDOI
TL;DR: Obese children under three years of age without obese parents are at low risk for obesity in adulthood, but among older children, obesity is an increasingly important predictor of adult obesity, regardless of whether the parents are obese.
Abstract: Background Childhood obesity increases the risk of obesity in adulthood, but how parental obesity affects the chances of a child's becoming an obese adult is unknown. We investigated the risk of obesity in young adulthood associated with both obesity in childhood and obesity in one or both parents. Methods Height and weight measurements were abstracted from the records of 854 subjects born at a health maintenance organization in Washington State between 1965 and 1971. Their parents' medical records were also reviewed. Childhood obesity was defined as a body-mass index at or above the 85th percentile for age and sex, and obesity in adulthood as a mean body-mass index at or above 27.8 for men and 27.3 for women. Results In young adulthood (defined as 21 to 29 years of age), 135 subjects (16 percent) were obese. Among those who were obese during childhood, the chance of obesity in adulthood ranged from 8 percent for 1- or 2-year-olds without obese parents to 79 percent for 10-to-14-year-olds with at least on...

3,994 citations


Journal ArticleDOI
22 Oct 1997-JAMA
TL;DR: The APOE∈4 allele represents a major risk factor for AD in all ethnic groups studied, across all ages between 40 and 90 years, and in both men and women.
Abstract: Objective. —To examine more closely the association between apolipoprotein E (APOE) genotype and Alzheimer disease (AD) by age and sex in populations of various ethnic and racial denominations. Data Sources. —Forty research teams contributed data onAPOEgenotype, sex, age at disease onset, and ethnic background for 5930 patients who met criteria for probable or definite AD and 8607 controls without dementia who were recruited from clinical, community, and brain bank sources. Main Outcome Measures. —Odds ratios (ORs) and 95% confidence intervals (Cls) for AD, adjusted for age and study and stratified by major ethnic group (Caucasian, African American, Hispanic, and Japanese) and source, were computed forAPOEgenotypes ∈2/∈2,∈2/∈3,∈2/∈4,∈3/∈4 and ∈4/∈4 relative to the ∈3/∈3 group. The influence of age and sex on the OR for each genotype was assessed using logistic regression procedures. Results. —Among Caucasian subjects from clinic- or autopsy-based studies, the risk of AD was significantly increased for people with genotypes ∈2/∈4 (OR=2.6, 95% Cl=1.6-4.0), ∈3/∈4 (OR=3.2, 95% Cl=2.8-3.8), and ∈4/∈4 (OR=14.9, 95% CI=10.8-20.6); whereas, the ORs were decreased for people with genotypes ∈2/∈2 (OR=0.6, 95% Cl=0.2-2.0) and ∈2/∈3 (OR=0.6, 95% Cl=0.5-0.8). TheAPOE∈4-AD association was weaker among African Americans and Hispanics, but there was significant heterogeneity in ORs among studies of African Americans (P Conclusions. —TheAPOE∈4 allele represents a major risk factor for AD in all ethnic groups studied, across all ages between 40 and 90 years, and in both men and women. The association betweenAPOE∈4 and AD in African Americans requires clarification, and the attenuated effect ofAPOE∈4 in Hispanics should be investigated further.

3,825 citations


Book ChapterDOI
TL;DR: Raster3D is discussed, which is a suite of programs for molecular graphics, which must compromise the quality of rendered images to achieve rendering speeds high enough for useful interactive manipulation of three-dimensional objects.
Abstract: Publisher Summary This chapter discusses Raster3D, which is a suite of programs for molecular graphics. Crystallographers were among the first and most avid consumers of graphics workstations. Rapid advances in computer hardware, and particularly in the power of specialized computer graphics boards, have led to successive generations of personal workstations with ever more impressive capabilities for interactive molecular graphics. For many years, it was standard practice in crystallography laboratories to prepare figures by photographing directly from the workstation screen. No matter how beautiful the image on the screen, however, this approach suffers from several intrinsic limitations. Among these is the inherent limitation imposed by the effective resolution of the screen. Use of the graphics hardware in a workstation to generate images for later presentation can also impose other limitations. Designers of workstation hardware must compromise the quality of rendered images to achieve rendering speeds high enough for useful interactive manipulation of three-dimensional objects.

3,735 citations


Journal ArticleDOI
TL;DR: In this article, the authors provide evidence that firms manage reported earnings to avoid earnings decreases and losses and find evidence that two components of earnings, cash flow from operations and changes in working capital, are used to achieve increases in earnings.

3,645 citations


Journal ArticleDOI
TL;DR: Riparian zones possess an unusually diverse array of species and environmental processes as discussed by the authors, related to variable flood regimes, geographically unique channel processes, altitudinal climate shifts, and upland influences on the fluvial corridor.
Abstract: Riparian zones possess an unusually diverse array of species and environmental processes. The ecological diversity is related to variable flood regimes, geographically unique channel processes, altitudinal climate shifts, and upland influences on the fluvial corridor. The resulting dynamic environment supports a variety of life-history strategies, biogeochemical cycles and rates, and organisms adapted to disturbance regimes over broad spatial and temporal scales. Innovations in riparian zone management have been effective in ameliorating many ecological issues related to land use and environmental quality. Riparian zones play essential roles in water and landscape planning, in restoration of aquatic systems, and in catalyzing institutional and societal cooperation for these efforts.

2,502 citations


Journal ArticleDOI
TL;DR: In this paper, the authors compare the structure of the interannual variability associated with the ENSO cycle and documents its time history back to 1900, using the leading EOFs of the SST anomaly and anomaly deviation fields in various domains and the associated expansion coefficient (or principal component) time series, which are used to construct global regression maps of SST, sea level pressure (SLP), and a number of related variables.
Abstract: A number of recent studies have reported an ENSO-like EOF mode in the global sea surface temperature (SST) field, whose time variability is marked by an abrupt change toward a warmer tropical eastern Pacific and a colder extratropical central North Pacific in 1976‐77. The present study compares this pattern with the structure of the interannual variability associated with the ENSO cycle and documents its time history back to 1900. The analysis is primarily based on the leading EOFs of the SST anomaly and ‘‘anomaly deviation’’ fields in various domains and the associated expansion coefficient (or principal component) time series, which are used to construct global regression maps of SST, sea level pressure (SLP), and a number of related variables. The use of ‘‘anomaly deviations’’ (i.e., departures of local SST anomalies from the concurrent global-mean SST anomaly) reduces the influence of global-mean SST trends upon the structure of the EOFs and their expansion coefficient time series. An important auxiliary time series used in this study is a ‘‘Southern Oscillation index’’ based on marine surface observations. By means of several different analysis techniques, the time variability of the leading EOF of the global SST field is separated into two components: one identified with the ‘‘ENSO cycle-related’’ variability on the interannual timescale, and the other a linearly independent ‘‘residual’’ comprising all the interdecadal variability in the record. The two components exhibit rather similar spatial signatures in the global SST, SLP, and wind stress fields. The SST signature in the residual variability is less equatorially confined in the eastern Pacific and it is relatively more prominent over the extratropical North Pacific. The corresponding SLP signature is also stronger over the extratropical North Pacific, and its counterpart in the cold season 500-mb height field more closely resembles the PNA pattern. The amplitude time series of the ENSO-like pattern in the residual variability reflects the above-mentioned shift in 1976‐77, as well as a number of other prominent features, including a shift of opposite polarity during the 1940s.

2,409 citations


Journal ArticleDOI
TL;DR: An analysis of tumor/patient characteristics and treatment variables in previous Radiation Therapy Oncology Group (RTOG) brain metastases studies was considered necessary to fully evaluate the benefit of these new interventions.
Abstract: Promising results from new approaches such as radiosurgery or stereotactic radiosurgery of brain metastases have recently been reported. Are these results due to the therapy alone or can the results be attributed in part to patient selection? An analysis of tumor/patient characteristics and treatment variables in previous RTOG brain metastases studies was considered necessary to fully evaluate the benefit of these new interventions.

2,330 citations


Journal ArticleDOI
TL;DR: In this article, the authors compare several methods of estimating Bayes factors when it is possible to simulate observations from the posterior distributions, via Markov chain Monte Carlo or other techniques, provided that each posterior distribution is well behaved in the sense of having a single dominant mode.
Abstract: The Bayes factor is a ratio of two posterior normalizing constants, which may be difficult to compute. We compare several methods of estimating Bayes factors when it is possible to simulate observations from the posterior distributions, via Markov chain Monte Carlo or other techniques. The methods that we study are all easily applied without consideration of special features of the problem, provided that each posterior distribution is well behaved in the sense of having a single dominant mode. We consider a simulated version of Laplace's method, a simulated version of Bartlett correction, importance sampling, and a reciprocal importance sampling technique. We also introduce local volume corrections for each of these. In addition, we apply the bridge sampling method of Meng and Wong. We find that a simulated version of Laplace's method, with local volume correction, furnishes an accurate approximation that is especially useful when likelihood function evaluations are costly. A simple bridge sampli...

Journal ArticleDOI
TL;DR: In this article, a classification of channel-reach morphology in mountain drainage basins synthesizes stream morphologies into seven distinct reach types: colluvial, bedrock, and five alluvial channel types (cascade, step pool, plane bed, pool rime and dune ripple).
Abstract: A classification of channel-reach morphology in mountain drainage basins synthesizes stream morphologies into seven distinct reach types: colluvial, bedrock, and five alluvial channel types (cascade, step pool , plane bed, pool rime, and dune ripple). Coupling reach-level channel processes with the spatial arrangement of reach morphologies, their links to hillslope processes, and external forcing by confinement, ripar­ ian vegetation, and woody debris defines a process-based framework within which to assess channel condition and response potential in mountain drainage basins. Field investigations demonstrate character­ istic slope, grain size, shear stress, and roughness ranges for different reach types, observations consistent with our hypothesis that alluvial channel morphologies reflect specific roughness configurations ad­ justed to the relative magnitudes of sediment supply and transport ca­ pacity. Steep alluvial channels (cascade and step pool) have high ratios of transport capacity to sediment supply and are resilient to changes in discharge and sediment supply, whereas low-gradient alluvial channels (pool rime and dune ripple) have lower transport capacity to supply ra­ tios and thus exhibit significant and prolonged response to changes in sediment supply and discharge. General differences in the ratio of transport capacity to supply between channel types allow aggregation of reaches into source, transport, and response segments, the spatial distribution of which provides a watershed-level conceptual model linking reach morphology and channel processes. These two scales of channel network classification define a framework within which to in­ vestigate spatial and temporal patterns of channel response in moun­ tain drainage basins.

Journal ArticleDOI
TL;DR: In this article, the prevalence of aortic sclerosis and stenosis in the elderly and to identify clinical factors associated with degenerative aortric valve disease were determined using stepwise logistic regression analysis.

Journal ArticleDOI
TL;DR: In this paper, the authors consider the problem of accounting for model uncertainty in linear regression models and propose two alternative approaches: the Occam's window approach and the Markov chain Monte Carlo approach.
Abstract: We consider the problem of accounting for model uncertainty in linear regression models. Conditioning on a single selected model ignores model uncertainty, and thus leads to the underestimation of uncertainty when making inferences about quantities of interest. A Bayesian solution to this problem involves averaging over all possible models (i.e., combinations of predictors) when making inferences about quantities of interest. This approach is often not practical. In this article we offer two alternative approaches. First, we describe an ad hoc procedure, “Occam's window,” which indicates a small set of models over which a model average can be computed. Second, we describe a Markov chain Monte Carlo approach that directly approximates the exact solution. In the presence of model uncertainty, both of these model averaging procedures provide better predictive performance than any single model that might reasonably have been selected. In the extreme case where there are many candidate predictors but ...

Journal ArticleDOI
01 Jun 1997-Geology
TL;DR: The most prominent Holocene climatic event in Greenland ice-core proxies, with approximately half the amplitude of the Younger Dryas, occurred ∼8000 to 8400 yr ago.
Abstract: The most prominent Holocene climatic event in Greenland ice-core proxies, with approximately half the amplitude of the Younger Dryas, occurred ∼8000 to 8400 yr ago. This Holocene event affected regions well beyond the North Atlantic basin, as shown by synchronous increases in windblown chemical indicators together with a significant decrease in methane. Widespread proxy records from the tropics to the north polar regions show a short-lived cool, dry, or windy event of similar age. The spatial pattern of terrestrial and marine changes is similar to that of the Younger Dryas event, suggesting a role for North Atlantic thermohaline circulation. Possible forcings identified thus far for this Holocene event are small, consistent with recent model results indicating high sensitivity and strong linkages in the climatic system.

Journal ArticleDOI
TL;DR: In this paper, a model of cash management is developed and used to identify a sample of cash-rich firms, and the acquisition behavior of these firms is examined for evidence of free cash flow-related behavior.
Abstract: The acquisition behavior of cash-rich firms is examined for evidence of free cash flow-related behavior. A model of cash management is developed and used to identify a sample of cash-rich firms. The model provides a benchmark "normal" level of cash reserves based on industry characteristics and dynamic cash management over time. Cash-rich firms are found to be more likely to begin acquisitions, increase current acquisition spending, and engage in large acquisitions than the rest of the population of firms. In a multivariate setting, cash- richness is a strong predictor of acquisition likelihood, even controlling for sales growth and stock price performance. Additional tests support the free cash flow hypothesis over a hypothesis in which managers optimally stockpile cash before an acquisition. Among cash- rich firms, the decision to spend the cash on an acquisition rather than pay it out is strongly related to how well the agency conflict between managers and owners is controlled. Further, the abnormal return from an acquisition announcement is decreasing in the deviation of a firm's cash reserves from its predicted optimal level. Cash-rich firms are more likely to make diversifying acquisitions and their targets are less likely to attract other bidders. Overall, the evidence supports the explanatory power of the free cash flow hypothesis for the investment decisions of cash-rich firms.

Journal ArticleDOI
TL;DR: A new tool, called Eraser, is described, for dynamically detecting data races in lock-based multithreaded programs, which uses binary rewriting techniques to monitor every shared-monory reference and verify that consistent locking behavior is observed.
Abstract: Multithreaded programming is difficult and error prone. It is easy to make a mistake in synchronization that produces a data race, yet it can be extremely hard to locate this mistake during debugging. This article describes a new tool, called Eraser, for dynamically detecting data races in lock-based multithreaded programs. Eraser uses binary rewriting techniques to monitor every shared-monory reference and verify that consistent locking behavior is observed. We present several case studies, including undergraduate coursework and a multithreaded Web search engine, that demonstrate the effectiveness of this approach.

Journal ArticleDOI
14 Nov 1997-Science
TL;DR: The wild-type Caenorhabditis elegans nematode ages rapidly, undergoing development, senescence, and death in less than 3 weeks, while mutants with reduced activity of the gene daf-2, a homolog of the insulin and insulin-like growth factor receptors, age more slowly than normal and live more than twice as long.
Abstract: The wild-type Caenorhabditis elegans nematode ages rapidly, undergoing development, senescence, and death in less than 3 weeks. In contrast, mutants with reduced activity of the gene daf-2, a homolog of the insulin and insulin-like growth factor receptors, age more slowly than normal and live more than twice as long. These mutants are active and fully fertile and have normal metabolic rates. The life-span extension caused by daf-2 mutations requires the activity of the gene daf-16. daf-16 appears to play a unique role in life-span regulation and encodes a member of the hepatocyte nuclear factor 3 (HNF-3)/forkhead family of transcriptional regulators. In humans, insulin down-regulates the expression of certain genes by antagonizing the activity of HNF-3, raising the possibility that aspects of this regulatory system have been conserved.

Journal ArticleDOI
TL;DR: The effects of multiple sequence information and different types of conformational constraints on the overall performance of the method are investigated, and the ability of a variety of recently developed scoring functions to recognize the native-like conformations in the ensembles of simulated structures are investigated.

Journal ArticleDOI
TL;DR: In this paper, the structural, electronic and chemisorptive properties of ultrathin metal films on clean and well-defined oxide surfaces have been characterized using a variety of surface science techniques.

Journal ArticleDOI
TL;DR: In this article, a gauge-invariant decomposition of the nucleon spin into quark helicity, quark orbital, and gluon contributions is proposed, and the total quark contribution is measured through virtual Compton scattering in a special kinematic region where single quark scattering dominates.
Abstract: I introduce a gauge-invariant decomposition of the nucleon spin into quark helicity, quark orbital, and gluon contributions. The total quark (and hence the quark orbital) contribution is shown to be measurable through virtual Compton scattering in a special kinematic region where single quark scattering dominates. This deeply virtual Compton scattering has much potential to unravel the quark and gluon structure of the nucleon.

Proceedings ArticleDOI
01 Oct 1997
TL;DR: Eraser as mentioned in this paper uses binary rewriting techniques to monitor every shared memory reference and verify that consistent locking behavior is observed in lock-based multi-threaded programs, which can be used to detect data races.
Abstract: Multi-threaded programming is difficult and error prone. It is easy to make a mistake in synchronization that produces a data race, yet it can be extremely hard to locate this mistake during debugging. This paper describes a new tool, called Eraser, for dynamically detecting data races in lock-based multi-threaded programs. Eraser uses binary rewriting techniques to monitor every shared memory reference and verify that consistent locking behavior is observed. We present several case studies, including undergraduate coursework and a multi-threaded Web search engine, that demonstrate the effectiveness of this approach.

Journal ArticleDOI
TL;DR: The incidence of AF in older adults may be higher than estimated by previous population studies and left atrial size appears to be an important risk factor, and the control of blood pressure and glucose may be important in preventing the development of AF.
Abstract: Background This study aimed to describe the incidence of atrial fibrillation (AF) among older adults during 3 years of follow-up. Methods and Results In this cohort study, 5201 adults ≥65 years old were examined annually on four occasions between June 1989 and May 1993. At baseline, participants answered questionnaires and underwent a detailed examination that included carotid ultrasound, pulmonary function tests, ECG, and echocardiography. Subjects with a pacemaker or AF at baseline (n=357) were excluded. New cases of AF were identified from three sources: (1) annual self-reports, (2) annual ECGs, and (3) hospital discharge diagnoses. Cox proportional-hazards models were used to assess baseline risk factors as predictors of incident AF. Among 4844 participants, 304 developed a first episode of AF during an average follow-up of 3.28 years, for an incidence of 19.2 per 1000 person-years. The onset was strongly associated with age, male sex, and the presence of clinical cardiovascular disease. For men 65 to...

Journal ArticleDOI
TL;DR: In this article, the authors focus on the transport and transformations of land-derived organic matter in the ocean, highlighting recent research on the patterns and processes involved in the degradation of terrestrial organic matter.

Journal ArticleDOI
TL;DR: In this article, the vacuum stress between closely spaced conducting surfaces, due to the modification of the zero-point fluctuations of the electromagnetic field, has been conclusively demonstrated using an electromechanical system based on a torsion pendulum.
Abstract: The vacuum stress between closely spaced conducting surfaces, due to the modification of the zero-point fluctuations of the electromagnetic field, has been conclusively demonstrated. The measurement employed an electromechanical system based on a torsion pendulum. Agreement with theory at the level of 5% is obtained.

Journal ArticleDOI
TL;DR: This work determined that high level expression of PPARγ in colon warrants further study in view of the well established role of fatty acid and arachidonic acid derivatives in colonic disease and its promoters and tissue-specific expression were functionally characterized.

Journal ArticleDOI
TL;DR: Four distinct coding mutations in JAG1 are demonstrated, providing evidence that it is the causal gene for Alagille syndrome, and supporting the hypothesis that haploinsufficiency for this gene is one of the mechanisms causing the Alagile syndrome phenotype.
Abstract: Alagille syndrome is an autosomal dominant disorder characterized by abnormal development of liver, heart, skeleton, eye, face and, less frequently, kidney Analyses of many patients with cytogenetic deletions or rearrangements have mapped the gene to chromosome 20p12, although deletions are found in a relatively small proportion of patients (< 7%) We have mapped the human Jagged1 gene (JAG1), encoding a ligand for the developmentally important Notch transmembrane receptor, to the Alagille syndrome critical region within 20p12 The Notch intercellular signalling pathway has been shown to mediate cell fate decisions during development in invertebrates and vertebrates We demonstrate four distinct coding mutations in JAG1 from four Alagille syndrome families, providing evidence that it is the causal gene for Alagille syndrome All four mutations lie within conserved regions of the gene and cause translational frameshifts, resulting in gross alterations of the protein product Patients with cytogenetically detectable deletions including JAG1 have Alagille syndrome, supporting the hypothesis that haploinsufficiency for this gene is one of the mechanisms causing the Alagille syndrome phenotype

Journal ArticleDOI
TL;DR: In this article, a variety of physical data from lowland streams in western Washington displays the onset of readily observable aquatic-system degradation at a remarkably consistent level of development, typically about ten percent effective impervious area in a watershed.
Abstract: Urbanization of a watershed degrades both the form and the function of the downstream aquatic system, causing changes that can occur rapidly and are very difficult to avoid or correct. A variety of physical data from lowland streams in western Washington displays the onset of readily observable aquatic-system degradation at a remarkably consistent level of development, typically about ten percent effective impervious area in a watershed. Even lower levels of urban development cause significant degradation in sensitive water bodies and a reduced, but less well quantified, level of function throughout the system as a whole. Unfortunately, established methods of mitigating the downstream impacts of urban development may have only limited effectiveness. Using continuous hydrologic modeling we have evaluated detention ponds designed by conventional event methodologies, and our findings demonstrate serious deficiencies in actual pond performance when compared to their design goals. Even with best efforts at mitigation, the sheer magnitude of development activities falling below a level of regulatory concern suggests that increased resource loss will invariably accompany development of a watershed. Without a better understanding of the critical processes that lead to degradation, some downstream aquatic-system damage is probably inevitable without limiting the extent of watershed development itself.

Journal ArticleDOI
TL;DR: In adults with asymptomatic AS, the rate of hemodynamic progression and clinical outcome are predicted by jet velocity, the rates of change inJet velocity, and functional status.
Abstract: Background Only limited data on the rate of hemodynamic progression and predictors of outcome in asymptomatic patients with valvular aortic stenosis (AS) are available. Methods and Results In 123 adults (mean age, 63±16 years) with asymptomatic AS, annual clinical, echocardiographic, and exercise data were obtained prospectively (mean follow-up of 2.5±1.4 years). Aortic jet velocity increased by 0.32±0.34 m/s per year and mean gradient by 7±7 mm Hg per year; valve area decreased by 0.12±0.19 cm2 per year. Kaplan-Meier event-free survival, with end points defined as death (n=8) or aortic valve surgery (n=48), was 93±5% at 1 year, 62±8% at 3 years, and 26±10% at 5 years. Univariate predictors of outcome included baseline jet velocity, mean gradient, valve area, and the rate of increase in jet velocity (all P≤.001) but not age, sex, or cause of AS. Those with an end point had a smaller exercise increase in valve area, blood pressure, and cardiac output and a greater exercise decrease in stroke volume. Multiv...

Journal ArticleDOI
TL;DR: All-trans-retinoic acid as induction or maintenance treatment improves disease-free and overall survival as compared with chemotherapy alone and should be included in the treatment of acute promyelocytic leukemia.
Abstract: Background All-trans-retinoic acid induces complete remission in acute promyelocytic leukemia. However, it is not clear whether induction therapy with all-trans-retinoic acid is superior to chemotherapy alone or whether maintenance treatment with all-trans-retinoic acid improves outcome. Methods Three hundred forty-six patients with previously untreated acute promyelocytic leukemia were randomly assigned to receive all-trans-retinoic acid or daunorubicin plus cytarabine as induction treatment. Patients who had a complete remission received consolidation therapy consisting of one cycle of treatment identical to the induction chemotherapy, then high-dose cytarabine plus daunorubicin. Patients still in complete remission after two cycles of consolidation therapy were then randomly assigned to maintenance treatment with all-trans-retinoic acid or to observation. Results Of the 174 patients treated with chemotherapy, 120 (69 percent) had a complete remission, as did 124 of the 172 (72 percent) given all-trans-...