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Subject: Commentary: Call me on my mobile phone...or better not?--a look at the INTERPHONE study results -- Saracci and Samet 39 (3): 695 -- International Journal of Epidemiology
Date: Mon, 31 May 2010 18:40:38 +0200
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<P><!-- <rdf:RDF xmlns=3D"http://creativecommons.org/ns#" =
xmlns:rdf=3D"http://www.w3.org/1999/02/22-rdf-syntax-ns#">=0A=
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<permits rdf:resource=3D"http://creativecommons.org/ns#DerivativeWorks"/>=0A=
</License>=0A=
<item rdf:about=3D"">=0A=
<title>Commentary: Call me on my mobile phone...or better not?--a look =
at the INTERPHONE study results</title>=0A=
<dc:title>Commentary: Call me on my mobile phone...or better not?--a =
look at the INTERPHONE study results</dc:title>=0A=
<dc:creator>Saracci, Rodolfo</dc:creator>=0A=
<dc:creator>Samet, Jonathan</dc:creator>=0A=
<dc:identifier>10.1093/ije/dyq082</dc:identifier>=0A=
<dc:source>International Journal of Epidemiology 2010, 3:695</dc:source>=0A=
<dc:date>2010-06-01</dc:date>=0A=
<prism:publicationName>International Journal of =
Epidemiology</prism:publicationName>=0A=
<prism:publicationDate>2010-06-01</prism:publicationDate>=0A=
<prism:volume>39</prism:volume>=0A=
<prism:number>3</prism:number>=0A=
<prism:section>Theme: Cancer</prism:section>=0A=
<prism:startingPage>695</prism:startingPage>=0A=
</item>=0A=
</rdf:RDF> --><FONT=20
size=3D-1><A =
href=3D"http://ije.oxfordjournals.org/misc/terms.shtml">Published by=20
Oxford University Press on behalf of the International Epidemiological=20
Association =A9 The Author 2010; all rights reserved.<BR>This is an Open =
Access=20
article distributed under the terms of the Creative Commons Attribution=20
Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/) =
which=20
permits unrestricted non-commercial use, distribution, and reproduction =
in any=20
medium, provided the original work is properly cited. </A></FONT><BR>
<H2>Commentary: Call me on my mobile phone...or better not?=97a look at =
the=20
INTERPHONE study results</H2><STRONG></NOBR><NOBR>Rodolfo=20
Saracci<SUP>1</SUP><SUP>,*</SUP></NOBR> and <NOBR>Jonathan=20
Samet<SUP>2</SUP></NOBR> </STRONG>
<P><FONT size=3D-1><SUP>1</SUP>Istituto di Fisiologia Clinica (IFC), =
National=20
Research Council, Pisa, Italy and <SUP>2</SUP>University of Southern =
California,=20
Department of Preventive Medicine and USC Institute for Global Health, =
Los=20
Angeles, CA, USA </FONT>
<P><FONT size=3D-1>*Corresponding author. IFC-National Research Council, =
Via=20
Trieste 41, 56100, Pisa, Italy. E-mail: <SPAN=20
id=3Dem0>saracci{at}hotmail.com</SPAN>
<SCRIPT type=3Dtext/javascript><!--=0A=
 var u =3D "saracci", d =3D "hotmail.com"; =
document.getElementById("em0").innerHTML =3D '<a href=3D"mailto:' + u + =
'@' + d + '">' + u + '@' + d + '<\/a>'//--></SCRIPT>
</FONT>
<P><STRONG>Accepted</STRONG> 12 April 2010
<P>Mobile phone (cell phone) use is increasing extraordinarily<SUP>=20
</SUP>rapidly worldwide. There are now 4.6 billion mobile phone =
subscribers<SUP>=20
</SUP>worldwide.<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B1"><SUP>=
1</SUP></A>=20
In many low- and middle-income countries use of<SUP> </SUP>cell phones =
has made=20
communications possible in vast areas lacking<SUP> </SUP>cable =
connections.=20
Increasingly, in high-income countries, cell<SUP> </SUP>phones have =
replaced=20
=91land lines=92 for personal telecommunications.<SUP> </SUP>Users of =
mobile phones=20
are exposed to electromagnetic radiation,<SUP> </SUP>which has long been =

hypothesized to have adverse health effects,<SUP> </SUP>including =
increased risk=20
of cancer.<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B2"><SUP>=
2</SUP></A><SUP>,</SUP><A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B3"><SUP>=
3</SUP></A>=20
Research on biological<SUP> </SUP>mechanisms of cellular and tissue =
injury by=20
electromagnetic<SUP> </SUP>radiation has been inconclusive, and =
consequently=20
epidemiological<SUP> </SUP>studies have been the principal source of =
evidence on=20
potential<SUP> </SUP>health risks of mobile phone use. Brain tumours =
have been=20
of<SUP> </SUP>particular concern because the electromagnetic radiation=20
generated<SUP> </SUP>by mobile phones passes through the brain when the =
phones=20
are<SUP> </SUP>used without a hands-free device. To date, findings of=20
diverse<SUP> </SUP>studies on mobile phone use and brain tumour risk =
have=20
been<SUP> </SUP>reported with mixed findings, but with no clear =
indication=20
of<SUP> </SUP>increased risk for cancer.<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B4"><SUP>=
4</SUP></A><SUP>,</SUP><A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B5"><SUP>=
5</SUP></A>=20
To provide needed evidence on<SUP> </SUP>the potential risk of brain =
cancer=20
associated with mobile phone<SUP> </SUP>use, the International Agency =
for=20
Research on Cancer (IARC)<SUP> </SUP>initiated a multi-centre =
case=96control=20
study, the INTERPHONE<SUP> </SUP>study, in 1998=9699.<SUP> </SUP>
<P>A much awaited report from this large international study on<SUP>=20
</SUP>mobile phone use and brain tumours is published in this issue<SUP> =

</SUP>of the <I>IJE</I>.<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>=20
A number of previous papers cited in the article<SUP> </SUP>reported =
only=20
partial findings from components of the multicentre<SUP> </SUP>study,=20
heightening expectations on what the full data set would<SUP> =
</SUP>eventually=20
show. The component studies were relatively underpowered,<SUP> </SUP>but =
they=20
exhibited a rather consistent and baffling <I>reduced</I><SUP> =
</SUP>risk among=20
cell phone users. We now have the complete results<SUP> </SUP>and the=20
researchers' interpretation of them. The INTERPHONE<SUP> =
</SUP>investigators=20
conclude that =91There were suggestions of<SUP> </SUP>an increased risk =
of glioma,=20
and much less of meningioma, at<SUP> </SUP>the highest exposure levels, =
for=20
ipsilateral exposures and,<SUP> </SUP>for glioma, for tumours in the =
temporal=20
lobe. However, biases<SUP> </SUP>and errors limit the strength of the =
conclusion=20
we can draw<SUP> </SUP>from these analyses and prevent a causal=20
interpretation=92.<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>=20
This statement, as with a similar one (=91...these biases<SUP> </SUP>and =
errors=20
prevent a causal interpretation of the results.=92)<SUP> </SUP>at the =
end of the=20
Appendix 2 of the article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>=20
added during the<SUP> </SUP>editorial process of revision, is both =
elegant and=20
oracular.<SUP> </SUP>Similar to any oracle it tolerates diametrically =
opposite=20
readings.<SUP> </SUP>If more weight is given to the first sentence, a=20
conclusion<SUP> </SUP>is reached in favour of an increased risk, albeit =
not=20
definitively<SUP> </SUP>manifest yet, from intensive use of mobile =
phones.=20
Giving more<SUP> </SUP>weight to the second sentence leads to the =
conclusion=20
that there<SUP> </SUP>are enough sources of errors in the study to =
dismiss the=20
apparent<SUP> </SUP>elevated risks as not real. With equal weight to the =
two=20
sentences,<SUP> </SUP>any conclusion hangs in the balance.<SUP> </SUP>
<P>Is there any way out of this ambivalence? INTERPHONE is the<SUP>=20
</SUP>largest study yet carried out and published on mobile phone<SUP> =
</SUP>use=20
and cancer. It includes 2409 cases of meningioma, 2708 cases<SUP> =
</SUP>of=20
glioma and two series of, respectively, 2662 and 2972 controls<SUP>=20
</SUP>matched by age, sex and region of residence. With the =
coordination<SUP>=20
</SUP>of IARC it has mobilized investigators in multiple centres =
within<SUP>=20
</SUP>13 countries =91 ... to determine whether mobile phone use<SUP>=20
</SUP>increases the risk of [brain] tumours and, specifically, =
whether<SUP>=20
</SUP>radiofrequency energy emitted by mobile phones is =
tumorigenic=92.<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A><SUP>=20
</SUP>
<P>Certainly this is the question that scientists, people and =
public<SUP>=20
</SUP>health decision-makers have in mind, as they seek assurance<SUP>=20
</SUP>that mobile phone use is safe and not a cause of brain =
tumours.<SUP>=20
</SUP>As defined by Lowrance,<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B7"><SUP>=
7</SUP></A>=20
=91a thing is safe if its risks<SUP> </SUP>are judged to be =
acceptable=92. This=20
definition implies<SUP> </SUP>a need for quantification of risk, the =
role of=20
epidemiological<SUP> </SUP>research and a judgement of its acceptability =
in=20
individual<SUP> </SUP>and societal contexts. The risk of main interest =
is=20
lifelong<SUP> </SUP>use, possibly beginning in childhood=97a pattern of=20
exposure<SUP> </SUP>that cannot yet be studied. The now testable =
scientific=20
question<SUP> </SUP>and that addressed by the INTERPHONE study is =
whether=20
mobile<SUP> </SUP>phones increase the risk of brain tumours within the =
first=20
10=9615<SUP> </SUP>years of use, a question much less liable to generate =

unwarranted<SUP> </SUP>expectations about the evidence that the =
INTERPHONE study=20
could<SUP> </SUP>actually deliver. In high-income countries, mobile =
phone=20
use<SUP> </SUP>began in the 1980s but was not widely prevalent until the =

mid-1990s.<SUP> </SUP>The cancer cases in the study were diagnosed =
between 2000=20
and<SUP> </SUP>2004. As a consequence, &lt;5% (110/2409) of the =
meningioma<SUP>=20
</SUP>cases and &lt;9% (252/2972) of the glioma cases occurred =
&gt;10<SUP>=20
</SUP>years since start of mobile phone use. None of the today's=20
established<SUP> </SUP>carcinogens, including tobacco, could have been =
firmly=20
identified<SUP> </SUP>as increasing risk in the first 10 years or so =
since first=20
exposure.<SUP> </SUP>Ionizing radiation is a recognized cause of brain =
tumours=20
but<SUP> </SUP>except for rare instances the radiation induced cases =
occur<SUP>=20
</SUP>on average after 10=9620 years since the time of first =
exposure.<SUP>=20
</SUP>INTERPHONE shares with all studies previously carried out on<SUP>=20
</SUP>mobile phones and cancer the inherent limitation that it can<SUP>=20
</SUP>investigate only a short period of observation since first =
exposure;<SUP>=20
</SUP>the distribution of exposure is brief and truncated leaving<SUP>=20
</SUP>limited incubation time for an exposure-related cancer to =
develop.<SUP>=20
</SUP>Hence observing no increase in risk would be reassuring but<SUP>=20
</SUP>only to a limited extent.<SUP> </SUP>
<P>As a multi-centric study, INTERPHONE has, however, the potential<SUP> =

</SUP>advantage of incorporating simultaneous replication, if there<SUP> =

</SUP>is no methodological heterogeneity across the centres. =
Consistency<SUP>=20
</SUP>of results among centres, a key element for drawing causal=20
inferences,<SUP> </SUP>can be immediately examined, rather than awaiting =
the=20
accumulation<SUP> </SUP>of results from successive and separate studies. =

Overall, a<SUP> </SUP>consistent inter-country pattern of replicated =
reduced=20
risk<SUP> </SUP>for both meningioma and glioma is shown in Table 6 of=20
Appendix<SUP> </SUP>1 of the INTERPHONE article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>,=20
whereas Table 2 of the article<SUP> </SUP>shows an equally consistent =
pattern of=20
reduced risks for different<SUP> </SUP>metrics of exposure (regular use =
vs never=20
regular use, cumulative<SUP> </SUP>call time, cumulative number of =
calls) with=20
only three odds<SUP> </SUP>ratios (ORs) out of 50 above 1. These results =
are=20
also in line<SUP> </SUP>with the detailed findings already published in =
separate=20
reports,<SUP> </SUP>involving nearly half of the cancer cases, from some =
of=20
the<SUP> </SUP>participating countries. On the null hypothesis that =
there=20
is<SUP> </SUP>no association between mobile phone use and brain cancer, =
ORs<SUP>=20
</SUP>fluctuating randomly above and below 1 would be expected, =
whereas<SUP>=20
</SUP>the observed patterns of reduced risks, on average of the =
order<SUP>=20
</SUP>of 30%, would have a tiny probability of occurring just by =
chance.<SUP>=20
</SUP>Having ruled out chance and the possibility of a protective<SUP>=20
</SUP>effect=97absent any supporting biological evidence=97less<SUP> =
</SUP>plausible=20
than the possibility of bias from a variety of sources,<SUP> </SUP>bias =
stands=20
as the most likely explanation of the observed results.<SUP> </SUP>As =
already=20
noted,<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B8"><SUP>=
8</SUP></A>=20
this interpretation carries the uncomfortable<SUP> </SUP>consequence =
that the=20
interpretation of <I>any</I> result of the study<SUP> </SUP>becomes =
problematic,=20
unless the sources of bias are identified<SUP> </SUP>and their =
consequences=20
quantified.<SUP> </SUP>
<P>The authors have carefully pursued bias as an explanation of<SUP> =
</SUP>their=20
findings via several routes. Confronted with a participation<SUP> =
</SUP>rate=20
appreciably lower among controls (average for centres:<SUP> </SUP>53%) =
than=20
among cases (averages of 78% for meningioma and 64%<SUP> </SUP>for =
glioma), they=20
asked a sample of participants (cases in 9<SUP> </SUP>centres, controls =
in 11=20
centres) who had refused the full interview<SUP> </SUP>to respond to a =
brief=20
questionnaire. Among both cases and controls,<SUP> =
</SUP>non-participants=20
reported a lower lifetime prevalence of mobile<SUP> </SUP>phone use than =

participants. Since the participation rate among<SUP> </SUP>controls was =
lower=20
than among cases, this pattern of response<SUP> </SUP>to the request for =

participation introduces a lower frequency<SUP> </SUP>of regular phone =
users=20
among controls than among cases. Extrapolating<SUP> </SUP>the findings =
from this=20
sample to the whole study population,<SUP> </SUP>the researchers =
estimated<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A><SUP>,</SUP><A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B9"><SUP>=
9</SUP></A>=20
that this selective non-participation<SUP> </SUP>bias may have led to a=20
reduction in the ORs for regular use<SUP> </SUP>of 5=9615%, potentially =
accounting=20
for most of the bias<SUP> </SUP>observed (Table 2 of the article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>)=20
for meningioma [21%, 95 %<SUP> </SUP>confidence interval (CI) 9=9632] =
and glioma=20
(19%, 95% CI<SUP> </SUP>6=9630). A substantiated downward and =
generalized bias=20
implies<SUP> </SUP>that any observed increase in risk would be=20
underestimated,<SUP> </SUP>independent of statistical significance. If =
this bias=20
extends<SUP> </SUP>to those with the highest exposure, then an increased =
risk=20
has<SUP> </SUP>been observed in spite of this downward bias. In the top=20
decile<SUP> </SUP>of cumulative call time, the most comprehensive metric =
of=20
exposure,<SUP> </SUP>the observed and probably underestimated ORs are =
1.15 for=20
meningioma<SUP> </SUP>and 1.40 for glioma (Table 2 of the article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>).=20
People in the<SUP> </SUP>top decile used a mobile phone for a total of =
<IMG=20
alt=3D&#8805; src=3D"http://ije.oxfordjournals.org/math/ge.gif" =
border=3D0>1640 h,=20
still<SUP> </SUP>not a very intensive use by today's pattern: spread =
over=20
10<SUP> </SUP>years, the lower limit of this category is about half an =
hour<SUP>=20
</SUP>per day. Sensitivity analyses (bottom part of Table 4 of =
Appendix<SUP>=20
</SUP>1 of the article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>)=20
show that the increased ORs are fairly consistent<SUP> </SUP>among =
countries.=20
They appear further increased (Table 5: 1.45<SUP> </SUP>for meningioma =
and 1.96=20
for glioma) when the participant reported<SUP> </SUP>using the phone on =
the same=20
side of the tumour, yet the systematically<SUP> </SUP>higher ORs for =
ipsilateral=20
vs controlateral use, even at low<SUP> </SUP>levels of exposure, points =
to=20
reporting bias and casts doubt<SUP> </SUP>on this latter result.<SUP> =
</SUP>
<P>A second approach to bias investigation and correction is =
presented<SUP>=20
</SUP>in Appendix 2 of the INTERPHONE article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>.=20
To avoid the problem<SUP> </SUP>of a lower frequency of regular users =
among=20
controls (arising<SUP> </SUP>from non-participation), ORs were =
calculated taking=20
the lowest<SUP> </SUP>levels of regular use as the reference category =
rather=20
than<SUP> </SUP>non-regular use. This approach has been often employed =
in=20
occupational<SUP> </SUP>epidemiology when risk is compared between =
people at=20
various<SUP> </SUP>level of exposure rather than between exposed and=20
non-exposed<SUP> </SUP>subjects, the latter being regarded as an =
entirely=20
different<SUP> </SUP>group. The table in Appendix 2 of the article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>=20
shows that the<SUP> </SUP>ORs for meningioma are only slightly changed =
(cf.=20
Table 2 of<SUP> </SUP>the article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>),=20
whereas those for gliomas are now mostly close<SUP> </SUP>to (and above) =
1; the=20
OR for the top decile of cumulative call<SUP> </SUP>time has increased =
from 1.40=20
to 1.82. The direction of these<SUP> </SUP>corrections, the size of =
which may be=20
questionable (as discussed<SUP> </SUP>in Appendix 2 of the article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>)=20
speaks again in favour of a contribution<SUP> </SUP>of non-participation =
bias to=20
the observed low ORs. A further<SUP> </SUP>reason for the downward bias =
may,=20
however, lie in a different<SUP> </SUP>direction, briefly mentioned in =
Appendix=20
2 of the article<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B6"><SUP>=
6</SUP></A>.<SUP>=20
</SUP>Low risks have been a recurrent feature not only of the =
INTERPHONE<SUP>=20
</SUP>study, but also of other studies of mobile phones and brain<SUP>=20
</SUP>tumours, including a nationwide cohort study<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B10"><SUP=
>10</SUP></A>=20
in which non-participation<SUP> </SUP>was not an issue. Major clinical=20
manifestations of brain tumours<SUP> </SUP>may not be long lasting but =
lesser=20
symptoms, including occasional<SUP> </SUP>seizures, may develop over =
several=20
years before diagnosis, as<SUP> </SUP>indicated by findings of increased =
risk of=20
brain tumours in<SUP> </SUP>people with a hospital discharge diagnosis =
of=20
epilepsy <IMG alt=3D&#8805; =
src=3D"http://ije.oxfordjournals.org/math/ge.gif" border=3D0>8=20
years<SUP> </SUP>earlier, the risk progressively increasing as the =
interval=20
between<SUP> </SUP>epilepsy and tumour diagnosis becomes shorter.<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B11"><SUP=
>11</SUP></A>=20
In addition,<SUP> </SUP>a nationwide cohort study using the same =
database as the=20
cohort<SUP> </SUP>brain cancer investigation<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B12"><SUP=
>12</SUP></A>=20
found reduced hospitalization rates<SUP> </SUP>among mobile phone users =
for a=20
variety of central nervous system<SUP> </SUP>diagnoses (Alzheimer=92s =
disease,=20
vascular dementia, other<SUP> </SUP>dementia, Parkinson=92s disease and =
epilepsy)=20
for time periods<SUP> </SUP>up to 10 years after starting phone use. One =

explanation is<SUP> </SUP>that mobile phone users may be a healthy group =
showing=20
a =91healthy<SUP> </SUP>user effect=92 but a more likely one is that =
people=20
with<SUP> </SUP>prodromal manifestations of neurological disease make =
less=20
use<SUP> </SUP>of mobile phones. Along with non-participation this=20
selection<SUP> </SUP>bias may also contribute to the downward bias in =
the=20
INTERPHONE<SUP> </SUP>study.<SUP> </SUP>
<P>We commend the INTERPHONE investigators for a rigorously =
implemented<SUP>=20
</SUP>protocol and the careful exploration of bias. INTERPHONE =
clearly<SUP>=20
</SUP>demonstrates that epidemiological research has to give major<SUP>=20
</SUP>emphasis to bias prevention and control. For the time being,<SUP>=20
</SUP>INTERPHONE's findings, interpreted in the context of prior =
studies,<SUP>=20
</SUP>tells us that the question as to whether mobile phone use =
increases<SUP>=20
</SUP>risk for brain cancers remains open. Given the relatively =
short<SUP>=20
</SUP>time of observation since first exposure and the acknowledged<SUP> =

</SUP>biases we simply do not know the answer to this question. =
Some<SUP>=20
</SUP>may interpret the results differently and most who have been<SUP>=20
</SUP>awaiting the results of the INTERPHONE study will be =
disappointed<SUP>=20
</SUP>by its mixed findings. Those upholding a precautionary =
approach<SUP>=20
</SUP>to the extent and manner of use of mobile phones may find =
some<SUP>=20
</SUP>support in the elevated risks noted in subjects with the =
highest<SUP>=20
</SUP>exposures.<SUP> </SUP>
<P>Not surprisingly, we end by calling for more research, given<SUP> =
</SUP>the=20
increasingly ubiquitous use of mobile phones, rising use<SUP> </SUP>by =
children=20
and the indication from some studies, including<SUP> </SUP>the =
INTERPHONE study,=20
that mobile phone use may increase risk<SUP> </SUP>for brain tumours. =
One=20
possibility to minimize selection and<SUP> </SUP>information biases, =
proposed=20
previously by Rothman,<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B13"><SUP=
>13</SUP></A>=20
would<SUP> </SUP>track cohorts of mobile phone users with exposures=20
documented<SUP> </SUP>via company records and outcomes ascertained =
through=20
record<SUP> </SUP>linkage with cancer registries. Large cohorts would be =

required<SUP> </SUP>to investigate adult brain cancers that have an =
incidence=20
rate<SUP> </SUP>in the order of 10 per 100 000 person-years but the=20
advantage<SUP> </SUP>is that once established a cohort can be repeatedly =

followed<SUP> </SUP>up in time, updating exposure measurements in cases =
and a=20
random<SUP> </SUP>control sample. This type of investigation overcomes =
the=20
problem<SUP> </SUP>of case=96control studies conducted when not enough =
time<SUP>=20
</SUP>has elapsed since first exposure to make possible the =
emergence<SUP>=20
</SUP>of long latency adverse health effects. This approach was =
blocked<SUP>=20
</SUP>in the USA through litigation.<A=20
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#B14"><SUP=
>14</SUP></A>=20
Another possibility would be<SUP> </SUP>periodic replication of =
multi-centric=20
case=96control studies,<SUP> </SUP>comparable with the INTERPHONE study =
in design,=20
although the<SUP> </SUP>potential for bias would likely remain.<SUP> =
</SUP>
<P>Fortunately, high-quality cancer registries are in place in<SUP> =
</SUP>many=20
countries around the world and descriptive patterns of<SUP> </SUP>brain =
tumour=20
occurrence can be monitored through careful and<SUP> </SUP>ongoing =
analyses to=20
detect changes suggestive of increased risk<SUP> </SUP>from mobile phone =

use.<SUP> </SUP>
<P>The tired refrain =91more research is needed=92 fully<SUP> =
</SUP>applies in this=20
instance: without more research the public's<SUP> </SUP>question about =
the=20
acceptability of cancer risk from mobile<SUP> </SUP>phones will remain=20
unanswered.<SUP> </SUP>
<P><A name=3DSEC1><!-- null --></A><BR clear=3Dright>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%" bgColor=3D#e1e1e1>
  <TBODY>
  <TR>
    <TD vAlign=3Dcenter align=3Dleft width=3D"5%" bgColor=3D#ffffff><IMG =
height=3D21=20
      alt=3D" " hspace=3D5 =
src=3D"http://ije.oxfordjournals.org/icons/toc/rarrow.gif"=20
      width=3D10></TD>
    <TH vAlign=3Dcenter align=3Dleft width=3D"95%"><FONT =
size=3D+2>&nbsp;&nbsp;=20
      Funding </FONT></TH></TR></TBODY></TABLE>
<TABLE cellPadding=3D5 align=3Dright border=3D1>
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT size=3D-1><A=20
      =
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#top"><IMG=
=20
      height=3D9 alt=3D" " hspace=3D5=20
      src=3D"http://ije.oxfordjournals.org/icons/toc/uarrow.gif" =
width=3D11=20
      border=3D0>Top<BR></A><IMG height=3D9 alt=3D" " hspace=3D5=20
      src=3D"http://ije.oxfordjournals.org/icons/toc/dot.gif" width=3D11 =

      border=3D0><FONT color=3D#464c53>Funding</FONT><BR><A=20
      =
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#BIBL"><IM=
G=20
      height=3D9 alt=3D" " hspace=3D5=20
      src=3D"http://ije.oxfordjournals.org/icons/toc/darrow.gif" =
width=3D11=20
      =
border=3D0>References<BR></A></FONT></TH></TR></TBODY></TABLE>&nbsp;<BR>F=
unding to=20
pay the Open Access publication charges for this<SUP> </SUP>article was =
provided=20
in equal parts by the European Educational<SUP> </SUP>Programme in =
Epidemiology=20
and the University of South California.<SUP> </SUP>
<P><B>Conflict of interest:</B> Rodolfo Saracci is Visiting =
Scientist<SUP>=20
</SUP>with the Education and Training section of the International<SUP>=20
</SUP>Agency for Research on Cancer, Lyon and a member of the =
Scientific<SUP>=20
</SUP>Advisory Committee of IMIM-CREAL, Barcelona. Jonathan Samet<SUP> =
</SUP>is=20
also a member of the Scientific Advisory Committee of IMIM-CREAL,<SUP>=20
</SUP>Barcelona.<SUP> </SUP>
<P><A name=3DBIBL><!-- null --></A><BR clear=3Dright>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%" bgColor=3D#e1e1e1>
  <TBODY>
  <TR>
    <TD vAlign=3Dcenter align=3Dleft width=3D"5%" bgColor=3D#ffffff><IMG =
height=3D21=20
      alt=3D" " hspace=3D5 =
src=3D"http://ije.oxfordjournals.org/icons/toc/rarrow.gif"=20
      width=3D10></TD>
    <TH vAlign=3Dcenter align=3Dleft width=3D"95%"><FONT =
size=3D+2>&nbsp;&nbsp;=20
      References </FONT></TH></TR></TBODY></TABLE>
<TABLE cellPadding=3D5 align=3Dright border=3D1>
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT size=3D-1><A=20
      =
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#top"><IMG=
=20
      height=3D9 alt=3D" " hspace=3D5=20
      src=3D"http://ije.oxfordjournals.org/icons/toc/uarrow.gif" =
width=3D11=20
      border=3D0>Top<BR></A><A=20
      =
href=3D"http://ije.oxfordjournals.org/cgi/content/full/39/3/695#SEC1"><IM=
G=20
      height=3D9 alt=3D" " hspace=3D5=20
      src=3D"http://ije.oxfordjournals.org/icons/toc/uarrow.gif" =
width=3D11=20
      border=3D0>Funding<BR></A><IMG height=3D9 alt=3D" " hspace=3D5=20
      src=3D"http://ije.oxfordjournals.org/icons/toc/dot.gif" width=3D11 =

      border=3D0><FONT=20
color=3D#464c53>References</FONT><BR></FONT></TH></TR></TBODY></TABLE>&nb=
sp;<BR><A=20
name=3DB1><!-- null --></A><SUP>1</SUP> International Telecommunication =
Union.=20
Measuring the Information Society (2010) Geneva: International =
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<P><A name=3DB2><!-- null --></A><SUP>2</SUP> International Agency for =
Research on=20
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Electric and Magnetic Fields. IARC Monograph 80 (2002) Lyon: =
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<P><A name=3DB3><!-- null --></A><SUP>3</SUP> National Research Council. =
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<P><A name=3DB4><!-- null --></A><SUP>4</SUP> Ahlbom A, Feychting M, =
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<P><A name=3DB5><!-- null --></A><SUP>5</SUP> Khurana VG, Teo C, Kundi =
M, Hardell=20
L, Carlberg M. Cell phones and brain tumors: a review including the =
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<P><A name=3DB6><!-- null --></A><SUP>6</SUP> The INTERPHONE Study =
Group. Brain=20
tumours risk in relation to mobile telephone use: results of the =
INTERPHONE=20
international case-control study. Int J Epidemiol (2010) =
39:675=96694.<!-- HIGHWIRE ID=3D"39:3:695:6" --><A=20
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nalCode=3Dintjepid&amp;resid=3D39/3/675"><NOBR>[Abstract/<FONT=20
color=3D#cc0000>Free</FONT>&nbsp;Full&nbsp;Text]</NOBR></A><!-- =
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<P><A name=3DB7><!-- null --></A><SUP>7</SUP> Lowrance WW. Of Acceptable =
Risk:=20
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<P><A name=3DB8><!-- null --></A><SUP>8</SUP> Saracci R, Pearce N. =
Commentary:=20
observational studies may conceal a weakly elevated risk under the =
appearance of=20
consistently reduced risks. Int J Epidemiol (2008) 37:1313=9615.<!-- =
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<P><A name=3DB9><!-- null --></A><SUP>9</SUP> Vrijheid M, Richardson L, =
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BK, et al. Quantifying the impact of selection bias caused by =
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in a case-control study of mobile phone use. Ann Epidemiol (2009) =
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16%2Fj.annepidem.2008.10.006&amp;link_type=3DDOI">[CrossRef]</A><A=20
href=3D"http://ije.oxfordjournals.org/cgi/external_ref?access_num=3D00026=
1933200005&amp;link_type=3DISI">[Web=20
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<P><A name=3DB10><!-- null --></A><SUP>10</SUP> Sch=FCz J, Jacobsen R, =
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nalCode=3Djnci&amp;resid=3D98/23/1707"><NOBR>[Abstract/<FONT=20
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and law.=20
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nalCode=3Dsci&amp;resid=3D294/5546/1440"><NOBR>[<FONT=20
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function tickbox_change(tickbox) {
  var name=3Dtickbox.name;
  var value=3Dtickbox.value;
  var checked=3Dtickbox.checked;
  switch(name) {
  	case "Archive": tick_archive_x[value]=3Dchecked; break;
	case "Year"   : tick_year_x[value]=3Dchecked; break;
	case "Status" : tick_status_x[value]=3Dchecked;
  }
  filter();
}

function archive_line(id, archives, year_joined, status) {
  line_count++;
  line_id[line_count]=3Did;
  line_archives[line_count]=3Darchives;
  line_year_joined[line_count]=3Dyear_joined;
  line_status[line_count]=3Dstatus;
}

//Site help page
var helpC =3D new Array();
var helpQ =3D new Array();
var helpA =3D new Array();
var helpK =3D new Array();
var xmlDoc;

function loadXML() {
try //Internet Explorer
  {
  xmlDoc=3Dnew ActiveXObject("Microsoft.XMLDOM");
  }
catch(e)
  {
  try //Firefox, Mozilla, Opera, etc.
    {
    xmlDoc=3Ddocument.implementation.createDocument("","",null);
    }
  catch(e)
    {
    alert(e.message);
    return;
    }
  }
  xmlDoc.async=3Dfalse;
  xmlDoc.load("/resource/xml/qa.xml");
  var i=3D0;
  for(var c=3D0; c<xmlDoc.getElementsByTagName("category").length; c++) =
{
    var category=3DxmlDoc.getElementsByTagName("category")[c];
	for(var q=3D0; q<category.getElementsByTagName("question").length; q++) =
{
      var question=3Dcategory.getElementsByTagName("question")[q];
	  =
helpC[helpC.length]=3Dcategory.getElementsByTagName("title")[0].childNode=
s[0].nodeValue;
	  =
helpQ[helpQ.length]=3Dquestion.getElementsByTagName("text")[0].childNodes=
[0].nodeValue
	  try {
	  helpK[helpK.length]=3D" =
"+question.getElementsByTagName("text")[0].childNodes[0].nodeValue+
	    " =
"+question.getElementsByTagName("keywords")[0].childNodes[0].nodeValue+" =
";
	  } catch(e) {}
	  =
helpA[helpA.length]=3Dquestion.getElementsByTagName("answer")[0].childNod=
es[0].nodeValue;
	}
  }
}

function searchHelp() {
  var keywords=3Ddocument.getElementById("keywords").value;
  if(keywords.length>0) {
    var keyword=3Dkeywords.split(" ");
	//score keyword search results;
    var scores =3D new Array();
	var qid =3D new Array();
	for(var qa=3D0; qa<helpK.length; qa++) {
	   scores[qa]=3D0;
	   for(var k=3D0; k<keyword.length; k++) {
              if(keyword[k].length > 3) {
	         if(helpK[qa].toLowerCase().match(keyword[k])) {
		  scores[qa]+=3D1;
		  qid[qa]=3Dqa;
	 	 }
              }
	   }
	}
	//sort results by score
	for(var s1=3D0; s1<scores.length; s1++) {
	  for(var s2=3D0; s2<scores.length; s2++) {
	    if(scores[s1]>scores[s2]) {
	      var temp_score=3Dscores[s1];
		  var temp_qid=3Dqid[s1];
		  scores[s1]=3Dscores[s2];
		  qid[s1]=3Dqid[s2];
		  scores[s2]=3Dtemp_score;
		  qid[s2]=3Dtemp_qid;
		}
	  }
	}
	//build results and display
	var results=3D"";
	for(var qa=3D0; qa<(qid.length<10 ? qid.length : 9); qa++) {
	  if(scores[qa]>0) {
	    results+=3D"<p><strong><a =
href=3D\"javascript:toggle('q"+qa+"');\">"+helpQ[qid[qa]]+"</a></strong><=
br />";
		results+=3D'<div id=3D"q'+qa+'" =
style=3D"display:none">'+helpA[qid[qa]]+'<br /><br /></div></p>';
	  }
	}
	if(results=3D=3D0) {=20
	  results=3D"<p>We didn't find any answers for your question.</p>";
	}
	results+=3D"<p>Can't find what you're looking for? <a =
href=3D\"javascript:show('contact');\">Contact us</a></p>";
	document.getElementById("qa_results").innerHTML=3Dresults;
  }
}

function categoryList() {
  var lastVal=3D"";
  for(var c=3D0; c<helpC.length; c++) {
    if(helpC[c]!=3DlastVal) {
	  document.write("<option =
value=3D\""+helpC[c]+"\">"+helpC[c]+"</option>");
	  lastVal=3DhelpC[c];
	}
  }
}

function browseQuestions(question) {
  var results=3D"";
  if(question!=3D"...") {
	for(var c=3D0; c<helpC.length; c++) {
	  if(helpC[c]=3D=3Dquestion) {
	    results+=3D"<p><strong><a =
href=3D\"javascript:toggle('b"+c+"');\">"+helpQ[c]+"</a></strong><br =
/>";
		results+=3D'<div id=3D"b'+c+'" style=3D"display:none">'+helpA[c]+'<br =
/><br /></div></p>';
	  }
	}
  }
  document.getElementById("browse_results").innerHTML=3Dresults;
}

function toggle(divID) {
  var e=3Ddocument.getElementById(divID);
  e.style.display=3D(e.style.display=3D=3D"none"?"block":"none");
}

function show(tab) {
  var showhideTabs =3D new Array("ask", "browse", "contact");
  for(var a=3D0; a<showhideTabs.length; a++) {
    =
document.getElementById(showhideTabs[a]).style.display=3D(tab=3D=3Dshowhi=
deTabs[a]?"block":"none");
  }
}
------=_NextPart_000_0039_01CB00F0.C37273C0
Content-Type: application/octet-stream
Content-Transfer-Encoding: quoted-printable
Content-Location: http://ije.oxfordjournals.org/javascript/ajax/xmlhttprequest.js

/*=0A=
=0A=
Cross-Browser XMLHttpRequest v1.2=0A=
=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=
=3D=3D=3D=3D=3D=3D=3D=3D=0A=
=0A=
Emulate Gecko 'XMLHttpRequest()' functionality in IE and Opera. Opera =
requires=0A=
the Sun Java Runtime Environment <http://www.java.com/>.=0A=
=0A=
by Andrew Gregory=0A=
http://www.scss.com.au/family/andrew/webdesign/xmlhttprequest/=0A=
=0A=
This work is licensed under the Creative Commons Attribution License. To =
view a=0A=
copy of this license, visit =
http://creativecommons.org/licenses/by-sa/2.5/ or=0A=
send a letter to Creative Commons, 559 Nathan Abbott Way, Stanford, =
California=0A=
94305, USA.=0A=
=0A=
Attribution: Leave my name and web address in this script intact.=0A=
=0A=
Not Supported in Opera=0A=
----------------------=0A=
* user/password authentication=0A=
* responseXML data member=0A=
=0A=
Not Fully Supported in Opera=0A=
----------------------------=0A=
* async requests=0A=
* abort()=0A=
* getAllResponseHeaders(), getAllResponseHeader(header)=0A=
=0A=
*/=0A=
// IE support=0A=
if (window.ActiveXObject && !window.XMLHttpRequest) {=0A=
  window.XMLHttpRequest =3D function() {=0A=
    var msxmls =3D new Array(=0A=
      'Msxml2.XMLHTTP.5.0',=0A=
      'Msxml2.XMLHTTP.4.0',=0A=
      'Msxml2.XMLHTTP.3.0',=0A=
      'Msxml2.XMLHTTP',=0A=
      'Microsoft.XMLHTTP');=0A=
    for (var i =3D 0; i < msxmls.length; i++) {=0A=
      try {=0A=
        return new ActiveXObject(msxmls[i]);=0A=
      } catch (e) {=0A=
      }=0A=
    }=0A=
    return null;=0A=
  };=0A=
}=0A=
// Gecko support=0A=
/* ;-) */=0A=
// Opera support=0A=
if (window.opera && !window.XMLHttpRequest) {=0A=
  window.XMLHttpRequest =3D function() {=0A=
    this.readyState =3D 0; // =
0=3Duninitialized,1=3Dloading,2=3Dloaded,3=3Dinteractive,4=3Dcomplete=0A=
    this.status =3D 0; // HTTP status codes=0A=
    this.statusText =3D '';=0A=
    this._headers =3D [];=0A=
    this._aborted =3D false;=0A=
    this._async =3D true;=0A=
    this._defaultCharset =3D 'ISO-8859-1';=0A=
    this._getCharset =3D function() {=0A=
      var charset =3D _defaultCharset;=0A=
      var contentType =3D =
this.getResponseHeader('Content-type').toUpperCase();=0A=
      val =3D contentType.indexOf('CHARSET=3D');=0A=
      if (val !=3D -1) {=0A=
        charset =3D contentType.substring(val);=0A=
      }=0A=
      val =3D charset.indexOf(';');=0A=
      if (val !=3D -1) {=0A=
        charset =3D charset.substring(0, val);=0A=
      }=0A=
      val =3D charset.indexOf(',');=0A=
      if (val !=3D -1) {=0A=
        charset =3D charset.substring(0, val);=0A=
      }=0A=
      return charset;=0A=
    };=0A=
    this.abort =3D function() {=0A=
      this._aborted =3D true;=0A=
    };=0A=
    this.getAllResponseHeaders =3D function() {=0A=
      return this.getAllResponseHeader('*');=0A=
    };=0A=
    this.getAllResponseHeader =3D function(header) {=0A=
      var ret =3D '';=0A=
      for (var i =3D 0; i < this._headers.length; i++) {=0A=
        if (header =3D=3D '*' || this._headers[i].h =3D=3D header) {=0A=
          ret +=3D this._headers[i].h + ': ' + this._headers[i].v + '\n';=0A=
        }=0A=
      }=0A=
      return ret;=0A=
    };=0A=
    this.getResponseHeader =3D function(header) {=0A=
      var ret =3D getAllResponseHeader(header);=0A=
      var i =3D ret.indexOf('\n');=0A=
      if (i !=3D -1) {=0A=
        ret =3D ret.substring(0, i);=0A=
      }=0A=
      return ret;=0A=
    };=0A=
    this.setRequestHeader =3D function(header, value) {=0A=
      this._headers[this._headers.length] =3D {h:header, v:value};=0A=
    };=0A=
    this.open =3D function(method, url, async, user, password) {=0A=
      this.method =3D method;=0A=
      this.url =3D url;=0A=
      this._async =3D true;=0A=
      this._aborted =3D false;=0A=
      this._headers =3D [];=0A=
      if (arguments.length >=3D 3) {=0A=
        this._async =3D async;=0A=
      }=0A=
      if (arguments.length > 3) {=0A=
        opera.postError('XMLHttpRequest.open() - user/password not =
supported');=0A=
      }=0A=
      this.readyState =3D 1;=0A=
      if (this.onreadystatechange) {=0A=
        this.onreadystatechange();=0A=
      }=0A=
    };=0A=
    this.send =3D function(data) {=0A=
      if (!navigator.javaEnabled()) {=0A=
        alert("XMLHttpRequest.send() - Java must be installed and =
enabled.");=0A=
        return;=0A=
      }=0A=
      if (this._async) {=0A=
        setTimeout(this._sendasync, 0, this, data);=0A=
        // this is not really asynchronous and won't execute until the =
current=0A=
        // execution context ends=0A=
      } else {=0A=
        this._sendsync(data);=0A=
      }=0A=
    }=0A=
    this._sendasync =3D function(req, data) {=0A=
      if (!req._aborted) {=0A=
        req._sendsync(data);=0A=
      }=0A=
    };=0A=
    this._sendsync =3D function(data) {=0A=
      this.readyState =3D 2;=0A=
      if (this.onreadystatechange) {=0A=
        this.onreadystatechange();=0A=
      }=0A=
      // open connection=0A=
      var url =3D new java.net.URL(new =
java.net.URL(window.location.href), this.url);=0A=
      var conn =3D url.openConnection();=0A=
      for (var i =3D 0; i < this._headers.length; i++) {=0A=
        conn.setRequestProperty(this._headers[i].h, this._headers[i].v);=0A=
      }=0A=
      this._headers =3D [];=0A=
      if (this.method =3D=3D 'POST') {=0A=
        // POST data=0A=
        conn.setDoOutput(true);=0A=
        var wr =3D new =
java.io.OutputStreamWriter(conn.getOutputStream(), this._getCharset());=0A=
        wr.write(data);=0A=
        wr.flush();=0A=
        wr.close();=0A=
      }=0A=
      // read response headers=0A=
      // NOTE: the getHeaderField() methods always return nulls for me :(=0A=
      var gotContentEncoding =3D false;=0A=
      var gotContentLength =3D false;=0A=
      var gotContentType =3D false;=0A=
      var gotDate =3D false;=0A=
      var gotExpiration =3D false;=0A=
      var gotLastModified =3D false;=0A=
      for (var i =3D 0; ; i++) {=0A=
        var hdrName =3D conn.getHeaderFieldKey(i);=0A=
        var hdrValue =3D conn.getHeaderField(i);=0A=
        if (hdrName =3D=3D null && hdrValue =3D=3D null) {=0A=
          break;=0A=
        }=0A=
        if (hdrName !=3D null) {=0A=
          this._headers[this._headers.length] =3D {h:hdrName, =
v:hdrValue};=0A=
          switch (hdrName.toLowerCase()) {=0A=
            case 'content-encoding': gotContentEncoding =3D true; break;=0A=
            case 'content-length'  : gotContentLength   =3D true; break;=0A=
            case 'content-type'    : gotContentType     =3D true; break;=0A=
            case 'date'            : gotDate            =3D true; break;=0A=
            case 'expires'         : gotExpiration      =3D true; break;=0A=
            case 'last-modified'   : gotLastModified    =3D true; break;=0A=
          }=0A=
        }=0A=
      }=0A=
      // try to fill in any missing header information=0A=
      var val;=0A=
      val =3D conn.getContentEncoding();=0A=
      if (val !=3D null && !gotContentEncoding) =
this._headers[this._headers.length] =3D {h:'Content-encoding', v:val};=0A=
      val =3D conn.getContentLength();=0A=
      if (val !=3D -1 && !gotContentLength) =
this._headers[this._headers.length] =3D {h:'Content-length', v:val};=0A=
      val =3D conn.getContentType();=0A=
      if (val !=3D null && !gotContentType) =
this._headers[this._headers.length] =3D {h:'Content-type', v:val};=0A=
      val =3D conn.getDate();=0A=
      if (val !=3D 0 && !gotDate) this._headers[this._headers.length] =
=3D {h:'Date', v:(new Date(val)).toUTCString()};=0A=
      val =3D conn.getExpiration();=0A=
      if (val !=3D 0 && !gotExpiration) =
this._headers[this._headers.length] =3D {h:'Expires', v:(new =
Date(val)).toUTCString()};=0A=
      val =3D conn.getLastModified();=0A=
      if (val !=3D 0 && !gotLastModified) =
this._headers[this._headers.length] =3D {h:'Last-modified', v:(new =
Date(val)).toUTCString()};=0A=
      // read response data=0A=
      var reqdata =3D '';=0A=
      var stream =3D conn.getInputStream();=0A=
      if (stream) {=0A=
        var reader =3D new java.io.BufferedReader(new =
java.io.InputStreamReader(stream, this._getCharset()));=0A=
        var line;=0A=
        while ((line =3D reader.readLine()) !=3D null) {=0A=
          if (this.readyState =3D=3D 2) {=0A=
            this.readyState =3D 3;=0A=
            if (this.onreadystatechange) {=0A=
              this.onreadystatechange();=0A=
            }=0A=
          }=0A=
          reqdata +=3D line + '\n';=0A=
        }=0A=
        reader.close();=0A=
        this.status =3D 200;=0A=
        this.statusText =3D 'OK';=0A=
        this.responseText =3D reqdata;=0A=
        this.readyState =3D 4;=0A=
        if (this.onreadystatechange) {=0A=
          this.onreadystatechange();=0A=
        }=0A=
        if (this.onload) {=0A=
          this.onload();=0A=
        }=0A=
      } else {=0A=
        // error=0A=
        this.status =3D 404;=0A=
        this.statusText =3D 'Not Found';=0A=
        this.responseText =3D '';=0A=
        this.readyState =3D 4;=0A=
        if (this.onreadystatechange) {=0A=
          this.onreadystatechange();=0A=
        }=0A=
        if (this.onerror) {=0A=
          this.onerror();=0A=
        }=0A=
      }=0A=
    };=0A=
  };=0A=
}=0A=
// ActiveXObject emulation=0A=
if (!window.ActiveXObject && window.XMLHttpRequest) {=0A=
  window.ActiveXObject =3D function(type) {=0A=
    switch (type.toLowerCase()) {=0A=
      case 'microsoft.xmlhttp':=0A=
      case 'msxml2.xmlhttp':=0A=
      case 'msxml2.xmlhttp.3.0':=0A=
      case 'msxml2.xmlhttp.4.0':=0A=
      case 'msxml2.xmlhttp.5.0':=0A=
        return new XMLHttpRequest();=0A=
    }=0A=
    return null;=0A=
  };=0A=
}=0A=

------=_NextPart_000_0039_01CB00F0.C37273C0
Content-Type: application/octet-stream
Content-Transfer-Encoding: quoted-printable
Content-Location: http://ije.oxfordjournals.org/javascript/ajax/utility.js

/************************************************************************=
*****=0A=
 * javascript/ajax/utility.js=0A=
 *=0A=
 * Utility functions for working with XMLHttpRequest data.=0A=
 *=0A=
 * Copyright 2006 Board of Trustees of the Leland Stanford Junior =
University.=0A=
 =
*************************************************************************=
***/=0A=
=0A=
/*=0A=
 * Copy XML nodes into an HTMLElement. This effectively=0A=
 * clones XML markup which uses XHTML naming conventions=0A=
 * into an HTML DOM.=0A=
 */=0A=
function copy_xml_to_html(src, dst) {=0A=
  if (src.nodeType =3D=3D 1) { /* Node.ELEMENT_NODE */=0A=
    var e =3D document.createElement(src.nodeName);=0A=
    for (var i =3D 0; i < src.childNodes.length; i++) {=0A=
	  copy_xml_to_html(src.childNodes[i], e);=0A=
    }=0A=
    for (var i =3D 0; i < src.attributes.length; i++) {=0A=
      var n =3D src.attributes[i].name;=0A=
      var v =3D unescape_xml_string(src.attributes[i].value);      =0A=
      e.setAttribute(n, v);=0A=
      if (n =3D=3D "class") {=0A=
        e.className =3D v;=0A=
      }=0A=
      else if (n =3D=3D "style") {=0A=
        set_css_style(v, e, "");=0A=
      }=0A=
    }=0A=
    dst.appendChild(e);=0A=
  }=0A=
  else if (src.nodeType =3D=3D 3) { /* Node.TEXT_NODE */=0A=
    dst.appendChild(document.createTextNode(src.nodeValue));=0A=
  }=0A=
}=0A=
=0A=
/* =0A=
 * It is unclear that this is the right thing to be calling=0A=
 * from copy_xml_to_html, but it appears that Safari decides=0A=
 * to convert &amp; to the NCR &#35;, and then encodes that=0A=
 * NCR to &%26%2338;.  So, I'm going to treat the DOM Attr=0A=
 * value as a plain string, and run our XML string input=0A=
 * through the decoding routine below.=0A=
 */=0A=
function unescape_xml_string(s) {=0A=
  return s.replace(/&apos;/g, "'")=0A=
          .replace(/&#39;/g,  "'")=0A=
          .replace(/&quot;/g, "\"")=0A=
          .replace(/&#34;/g,  "\"")=0A=
          .replace(/&gt;/g,   ">")=0A=
          .replace(/&#62;/g,  ">")=0A=
          .replace(/&lt;/g,   "<")=0A=
          .replace(/&#60;/g,  "<")=0A=
          .replace(/&amp;/g,  "&")=0A=
          .replace(/&#38;/g,  "&");=0A=
}=0A=
=0A=
/*=0A=
 * Parse set of CSS rules and apply them to an element.=0A=
 * This is quite horrifying, but I'm unable to determine=0A=
 * how else to handle this with IE 6.  FireFox and other=0A=
 * sane browsers let you simply set the style attribute=0A=
 * or use e.style.setProperty(rule, value, priority),=0A=
 * IE 6 appears to have neither of these capabilities..=0A=
 */=0A=
function set_css_style(css, e, priority) {=0A=
  var rules =3D css.split(";");=0A=
  for (var i =3D 0; i < rules.length; i++) {=0A=
    var nvpair =3D rules[i].split(":");=0A=
    if (nvpair.length =3D=3D 2) {=0A=
      try {=0A=
        var name  =3D nvpair[0]; /* style attribute */=0A=
        var value =3D nvpair[1]; /* attribute value */=0A=
  =0A=
        /*=0A=
         * For each possible style attribute, set the=0A=
         * appropriate style property in the element.=0A=
         */=0A=
        if (name =3D=3D "background") {=0A=
           e.style.background =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-attachment") {=0A=
          e.style.backgroundAttachment =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-color") {=0A=
          e.style.backgroundColor =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-image") {=0A=
          e.style.backgroundImage =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-position") {=0A=
          e.style.backgroundPosition =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-position-x") {=0A=
          e.style.backgroundPositionX =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-position-y") {=0A=
          e.style.backgroundPositionY =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-repeat") {=0A=
          e.style.backgroundRepeat =3D value;=0A=
        }=0A=
        else if (name =3D=3D "behavior") {=0A=
          e.style.behavior =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border") {=0A=
          e.style.border =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-bottom") {=0A=
          e.style.borderBottom =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-bottom-color") {=0A=
          e.style.borderBottomColor =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-bottom-style") {=0A=
          e.style.borderBottomStyle =3D value;=0A=
        }=0A=
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------=_NextPart_000_0039_01CB00F0.C37273C0
Content-Type: application/octet-stream
Content-Transfer-Encoding: quoted-printable
Content-Location: http://ije.oxfordjournals.org/javascript/entrez/callback.js

/************************************************************************=
*****=0A=
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 * Entrez Linking callback to populate content box.=0A=
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University.=0A=
 =
*************************************************************************=
***/=0A=
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/*=0A=
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------=_NextPart_000_0039_01CB00F0.C37273C0--

