bluuebunny/crossref_metadata_2025 huggingface dataset:
Avaliação psicossomática no câncer de mama: proposta de articulação entre os níveis individual e familiar
Authors: Filgueiras Maria Stella Tavares , Lisboa Aline Vilhena , Macedo Raphael Modesto de , Paiva Flávia Gomes de , Benfica Tânia Mara Silva , Vasques Vanessa Azevedo
Published: January 2008

Este trabalho constitui um desdobramento da pesquisa "Avaliação psicossomática do risco de adoecimento em mulheres com história familiar de câncer de mama", realizada no Centro de Psicologia Aplicada da Universidade Federal de Juiz de Fora, Minas Gerais, desde 1999. Propõe, neste sentido, uma articulação entre os níveis individual e familiar da avaliação psicossomática do risco de adoecimento nesse tipo de enfermidade. Destaca, nessa direção, a função materna como operador de análise, buscando dar conta de ambos os níveis de avaliação: no nível individual, remetendo à qualidade da internalização da função de continente provida pela mãe; e, no nível familiar, buscando capturar, pelos mecanismos de interfantasmatização, a eficácia do grupo familiar como representante da função materna continente. Baseia-se, para tanto, na Psicossomática Psicanalítica, sobretudo nos estudos da Escola de Psicossomática de Paris sobre o funcionamento mental nas somatizações, e em psicanalistas estudiosos da família, concebida como "corpo materno" e lugar de ancoragem das excitações, conflitos e fantasmas circulantes entre os membros do grupo. A partir do estudo de um dos casos investigados na pesquisa, lança-se mão da Análise de Discurso, tanto nas três entrevistas individuais quanto nas três entrevistas de família. O caso tomado demonstrou ser adequado ao propósito do estudo em questão.
Physical and chemical changes during ripening of blackberry fruits
Authors: Tosun Ilkay , Ustun N. Sule , Tekguler Belkis
Published: January 2008

Blackberry (Rubus L.) is a naturally growing fruit in Anatolia. Consumption of fresh and frozen blackberries has increased in the past few years in Turkey. The aim of this study is to analyze blackberry at three levels of ripeness taking into account some physical and chemical properties (color, dry matter, soluble solids, total sugar, titratable acidity, pH, total phenolics, total anthocyanin, and minerals) in order to understand this behavior during the ripening process. Blackberry fruits were harvested at green, red and ripe (mature) stages. The determination of fruit maturity was based on fruit surface color. The dry matter, total phenolics and Hunter L, b values decreased but soluble solids, total sugar and total anthocyanins increased with maturity. In the early fruit ripening stages, pH decreased, titratable acidity and Hunter a value increased while in the later stages, pH increased, titratable acidity and Hunter a value decreased considerably. Analysis of variance revealed (P < 0.01) differences in these parameters based on ripeness stages. No remarkable changes in potassium, calcium, zinc and manganese concentrations occured during the development of fruits. Differences were observed for magnesium (P < 0.01), iron (P < 0.01) and copper (P < 0.05) during ripening of blackberry.
O atendimento humanizado em unidade pediátrica: percepção do acompanhante da criança hospitalizada
Authors: Faquinello Paula , Higarashi Ieda Harumi , Marcon Sonia Silva
Published: January 2008

Estudo qualitativo desenvolvido com o objetivo de investigar a percepção do acompanhante da criança internada sobre a qualidade do atendimento prestado pela equipe hospitalar no tangente ao aspecto da humanização. Os dados foram coletados em outubro de 2006, junto a 20 acompanhantes (um pai, uma avó e 18 mães), em uma unidade pediátrica de um hospital-escola no Noroeste do Paraná, por meio de entrevista semi-estruturada. Para o tratamento dos dados, empregou-se a técnica do Discurso do Sujeito Coletivo. Conclui-se que para a clientela em questão o atendimento humanizado no hospital está relacionado com a capacidade de abordar o paciente de forma holística e igualitária. As atitudes que conferem um caráter humanizado ao assistir, estão relacionadas com o estilo de comunicação adotado, ao passo que o atendimento não humanizado é traduzido por atitudes que valorizam as regras hospitalares, a falta de atenção e a baixa empatia por parte dos profissionais.
Competência dos enfermeiros em problematizar a realidade do serviço de saúde no contexto do Sistema Único de Saúde
Authors: Backes Vânia Marli Schubert , Martins Sabrina Telma , Ferraz Fabiane , Schmidt Sandra Marcia Soares , Prado Marta Lenise do , Lino Mônica Motta , Marcelino Silvana Romagna
Published: January 2008

Este estudo objetiva avaliar o impacto gerado no processo de trabalho dos Enfermeiros que participaram do curso de Especialização em Projetos Assistenciais em Enfermagem, referente à competência de problematizar a realidade do serviço de saúde em que está inserido face ao Sistema Único de Saúde. Realizou-se um estudo qualitativo, do tipo ex-post facto, com a amostra proposital de 32 enfermeiros de cinco Instituições Federais de Ensino Superior da Região Sul do Brasil. Os dados foram coletados por entrevistas, sendo a análise de conteúdo o procedimento analítico adotado. Os resultados apontam impacto significativo em relação à competência, visto que a relação entre Sistema Único de Saúde e o serviço de saúde ficaram mais claras, fato possibilitado pelo desenvolvimento dos processos de problematização e contextualização necessários para demarcar uma nova postura e forma de trabalhar coletivamente com profissionais, usuários e gestores, haja vista o desafio de reunir diferentes idéias, percepções e práticas.
Evaluation of incapacity level in leprosy: a strategy to sensitize and train the nursing team
Authors: Silva Sobrinho Reinaldo Antonio da , Mathias Thais Aidar de Freitas , Gomes Eunice Alves , Lincoln Patrícia Barbosa
Published: January 2008

The main problems caused by leprosy are physical incapacities. This study evaluated the level of patients' incapacity in treatment and in discharge in 11 municipal districts of the14th Regional of Health of Paraná, at the same time it promoted discussion and qualified nursing professionals of local teams. It was verified that 79.8% of the population evaluated presented some degree of incapacity and that some of the professionals ignored the evaluation technique. The percentage of patients with incapacity levels I and II was high, fact that corroborates the late diagnosis of cases. The need of a permanent self-care process associated to polichemotherapy and continuous evaluation of new and old cases in order to avoid the illness physical incapacities is highlighted.
Surdez e linguagem escrita: um estudo de caso
Authors: Guarinello Ana Cristina , Massi Giselle , Berberian Ana Paula
Published: January 2008

Partindo do pressuposto de que ao considerar a língua de sinais como a primeira língua do surdo é possível perceber sua inserção no mundo letrado, esse trabalho objetiva analisar produções escritas de um sujeito surdo em momento inicial de apropriação da escrita. Para tanto, concebendo a linguagem como atividade dialógica, como trabalho social e histórico, constitutivo dos sujeitos e da língua, foram analisados cinco textos produzidos, entre os anos de 1998 e 2002, por um sujeito surdo, reconhecido pela inicial R, em conjunto com a sua fonoaudióloga. Cabe esclarecer que tal profissional, proficiente em língua de sinais, atuou como interlocutora e intérprete, priorizando a natureza interativa da linguagem e interferindo nas produções escritas quando solicitada. Durante os anos trabalhados com R, observou-se que ele passou a refletir sobre seus textos e mudou sua postura perante a escrita. O fato de R e a fonoaudióloga compartilharem a língua de sinais permitiu que ele dividisse suas histórias e experiências, levando-os a registrá-las a partir da língua escrita. Deste modo, R passou a fazer uso da escrita com alternâncias e justaposições entre as duas línguas envolvidas: a língua portuguesa e a língua de sinais. A escrita tornou-se, assim, uma possibilidade a mais de manifestação da singularidade de R, que passou a reconstruir a história de sua relação com a linguagem.
O dilema cooperação-competição em mercados concorrenciais: o conflito do oligopólio tratado em um jogo de empresas
Authors: Sauaia Antonio Carlos Aidar , Kallás David
Published: January 2008

O objetivo deste estudo é discutir o dilema sempre atual enfrentado por firmas formadoras de preços: cooperar tacitamente pelos lucros (conluio) ou competir agressivamente pelo mercado (combate). Um experimento adotado como método de investigação produziu dados primários coletados num Jogo de Empresas (MMG). A análise descritiva, apoiada nos modelos de Atratividade de Indústrias, Análise Microeconômica, Teoria dos Jogos e Análise de Stakeholders, comparou os resultados na cooperação e na competição, mostrou que a competição prejudicou gestores (lucros negativos), governo (menos tributos) e investidores (preço das ações 23% menor). Em contrapartida produziu alguns benefícios não sustentáveis: consumidores compraram 22% mais produtos a preços 10% menores; duplicou o número de centros de distribuição e de vendedores e estes elevaram sua renda (46%); produziu-se 21% mais computadores e 5% mais placas de memória; contratou-se 13% mais operários e investiu-se 63% mais recursos em tecnologia (P&D). Conclui-se que para neutralizar os malefícios da competição e promover crescimento econômico sustentável deve-se buscar formas legais de cooperar na competição, assegurando atratividade ao setor, melhoria salarial com responsabilidade social, criação e manutenção de empregos, produtos de qualidade, preços baixos e direitos do consumidor.
Deterministic and reliability-based design: veneer cover soil stability
Authors: Sia A. H. I. , Dixon N.
Published: January 2008

A design chart is a graphical tool that provides solutions to different scenarios of a system. In this paper, two types of design chart are developed based on deterministic and reliability-based analyses for determining the interface shear strength required for stability of a cover system to achieve a target safety factor of 1.5 and failure probability of 1 × 10−2. The deterministic design chart assists in the selection of different types of geosynthetic for lining materials based on the required interface shear strength for stability, and the reliability-based design chart enhances decision-making by taking into account the uncertainties in the design parameters, such as the variability of interface shear strength parameters. Additionally, the latter chart can also be used to determine the optimum slope angle for a containment facility that will satisfy both the target factor of safety and acceptable failure probability. Examples are provided to illustrate the use of the design charts in estimating the minimum required interface shear strength and their allowable variability for a given veneer cover, and the optimum slope inclination corresponding to different interface shear strengths and their associated variability.
Rapid Textural Analysis for Saline and Alkaline Soils with Different Physical and Chemical Properties
Authors: Chaudhari S. K. , Singh R. , Kundu D. K.
Published: January 2008

In most soil testing laboratories, textural analysis is performed by the pipette method (PM) or by hydrometer. Objectives of this study were (i) to evaluate simplified methods that can be used for soils of various textures, and (ii) to modify a rapid method for reliable and accurate textural analysis of saline and alkaline soils. One hundred soils were collected from different agro‐ecological regions of India. Coefficients of variation for sand, silt, and clay of soil samples by the rapid method varied across a range of 0 to 5% with a mean value <3% for all soils. Absolute differences between the PM and the rapid method for sand, silt, and clay fractions ranged from −1.8 to 1.7, −1.8 to 5.3, and −2.9 to 1.8%, with averages across the sites of −0.04, 2.92, and −6.52%, respectively. Among various methods, regression analysis between the rapid and pipette methods produced the highest coefficient of determination (r2) values of 0.9989, 0.9927, and 0.9930 for sand, silt, and clay fractions, respectively. A rapid method with modified sodium hexametaphosphate concentrations and soil shaking periods produced mean, standard error, and standard deviation values very close to the PM, with r2 values >0.99 with small intercepts <0.5, <0.3, and <0.7 for saline, saline–alkaline, and alkaline soils, respectively. The rapid method with proposed modifications provides the most accurate and fast estimation of texture for saline–alkaline soils.
Plant Availability of Phosphorus in Four Superphosphate Fertilizers Varying in Water‐Insoluble Phosphate Compounds
Authors: Prochnow L. I. , Chien S. H. , Carmona G. , Dillard E. F. , Henao J. , Austin E. R.
Published: January 2008

There is concern that the use of lower quality phosphate rock can result in elevated amounts of Fe–Al–P water‐insoluble compounds in fertilizers and, consequently, low agronomic effectiveness. Therefore, studies were conducted to evaluate the effect of some of these compounds on plant growth. Four commercial superphosphates varying in chemical composition (two single and two triple superphosphates) were selected for the study. Fertilizer impurities were collected as water‐insoluble residues by washing each P source with deionized water. A modal analysis, based primarily on elemental chemical analysis and x‐ray diffractometry, was used to estimate the chemical composition of each P source. Water‐soluble monocalcium phosphate (MCP) and the water‐leached fertilizer residues were prepared to give a range of fertilizers in terms of water‐soluble phosphorus (WSP) (0–100% of the available P as MCP). The water‐leached fractions, MCP, and the mixtures of MCP with water‐leached fractions were applied to supply 40 mg available P kg−1 to a thermic Rhodic Kanhapludult with pH values of 5.2 ± 0.05 (unlimed) and 6.4 ± 0.08 (limed). Wheat (Triticum aestivum L.) grown in a greenhouse for 101 d served as the test crop. The requirement for WSP was source and pH dependent. At a soil pH of 5.2, the fertilizers required 73 to 95% WSP to reach the maximum dry‐matter yield, while they required 60 to 86% WSP at pH 6.4. To reach 90% of the maximum yield, all superphosphate fertilizers required <50% WSP. These results show that it is not always necessary to have high water solubility as required by legislation in many countries.
Maximum Bulk Density of British Columbia Forest Soils from the Proctor Test: Relationships with Selected Physical and Chemical Properties
Authors: Zhao Yihai , Krzic Maja , Bulmer Chuck E. , Schmidt Margaret G.
Published: January 2008

The widespread use of heavy equipment during timber harvesting and site preparation can lead to reduced soil productivity and warrants development of new methods to assess compaction. We evaluated the effects of soil particle density, organic matter, particle size distribution, extractable oxides, and plastic and liquid limits on the maximum bulk density (MBD) of forest soils in British Columbia. Soil samples were collected from 33 sites throughout British Columbia, covering the major forest and soil types of the province. The standard Proctor test was used to determine MBD and related parameters, including the gravimetric water content (WMBD) and porosity (fMBD) at which MBD was achieved. The significance levels of single soil properties in predicting MBD were in the order plastic and liquid limits, organic matter, oxalate‐extractable oxides, and particle size distribution. For all samples, liquid limit and clay were most closely related to MBD (R2 = 0.83). Addition of organic matter to the model increased the regression coefficients, and oxidizable organic matter caused a greater increase than did total C. Stratification of the sample set into groups based on plasticity led to higher R2 values in multiple regressions, and different soil properties were important for nonplastic soils than for those with high, moderate, and low plasticity. Prediction with multiple regression explained the most variation in MBD for nonplastic soils, while properties of highly plastic soils explained the least variation in MBD and moderately plastic soils were intermediate. Based on our findings, we propose an approach for using MBD to help better interpret bulk density data in forest soil compaction studies.
Role of Smectite Quasicrystal Dynamics in Adsorption of Dinitrophenol
Authors: Pereira Tanya R. , Laird David A. , Thompson Michael L. , Johnston Cliff T. , Teppen Brian J. , Li Hui , Boyd Stephen A.
Published: January 2008

Understanding sorption mechanisms and processes is critical for predicting the fate of organic pollutants in soils and for development of effective remediation strategies for contaminated soils. A novel suspension x‐ray diffraction (XRD) technique was used to elucidate the influence of the size and swelling of K‐ and Ca‐smectite quasicrystals in aqueous suspensions on adsorption of 4,6‐dinitro‐o‐cresol (DNOC). X‐ray diffraction patterns of randomly oriented smectite quasicrystals in aqueous suspensions were compared with diffraction patterns for air‐dried and oven‐dried oriented films of the same smectites. The XRD patterns reveal that the phenolate form of DNOC, which is predominant in solution with pH ≥ 4.4, is primarily adsorbed on external surfaces of K‐smectite quasicrystals in aqueous suspensions and may enter the interlayers as a K‐DNOC complex when K‐smectite quasicrystals coalesce. In Ca‐smectite suspensions with pH > 4.4, the phenolate form of DNOC is adsorbed only on external surfaces; however, DNOC may become entrapped between substacks within Ca‐smectite quasicrystals as the smectite suspension dries to form an oriented film. The neutral form of DNOC (pH ≤ 4.4) was adsorbed in the interlayers of a low‐charge‐density Ca‐smectite in aqueous suspension but not in the interlayers of the high‐charge‐density Ca‐smectite, apparently due to steric restrictions. Clearly, XRD analysis is a valuable tool for gaining insight into interactions between smectites and organic molecules, but caution must be used in extrapolating data based on XRD patterns of air‐dried and oven‐dried smectite films to processes that may occur in aqueous smectite suspensions.
Fractionation and Long‐Term Laboratory Incubation to Measure Soil Organic Matter Dynamics
Authors: Haile-Mariam S. , Collins H. P. , Wright S. , Paul E. A.
Published: January 2008

Soil organic matter (SOM) in agricultural soils comprises a significant part of the global terrestrial C pool. It has often been characterized by utilizing a combination of chemical dispersion of the soil followed by physical separation. We fractionated soil samples under continuous corn (Zea mays L.) rotations at four long‐term sites in the Corn Belt to determine the concentration of C and N associated with soil fractions (light fraction [LF], particulate organic matter [POM], silt size, clay size, and Bradford reactive soil protein [BRSP]) and to identify the change in C concentration and δ13C signal of each fraction using laboratory incubations. Light fractions comprised 3 to 5% of the soil organic carbon (SOC), with no significant difference between conventional tillage (CT) and no‐till (NT) treatments. The POM fraction accounted for 5 to 11% of the SOC in the soils with >30% clay and 17 to 23% for the soils with <20% clay. The clay‐size fraction contained the highest proportion of SOC. Measurement of 13C during long‐term incubation showed that the average mean residence time (MRT) of corn‐derived C in the LF was 3.5 yr, whereas the POM fractions ranged from 6 to 12 yr. The 13C changes during incubation show that both fractions consist of a mixture of active and resistant materials, with movement between fractions. The BRSP has long MRTs except in the NT Hoytville soil. Measurement of the dyna mics of these fractions provides a basis for C models to test the impacts of land use and management on C sequestration.
Laboratory Study of Immiscible Contaminant Flow in Unsaturated Layered Sands
Authors: Kechavarzi C. , Soga K. , Illangasekare T. , Nikolopoulos P.
Published: January 2008

Little quantitative experimental data are available describing the behavior of immiscible contaminants in unsaturated heterogeneous porous media. Such data are, however, essential to the fundamental understanding of the processes governing nonaqueous phase liquid behavior and for the validation of modeling tools. The effect of macro‐heterogeneity on light nonaqueous phase liquid (LNAPL) flow and distribution in the unsaturated zone was investigated experimentally by simulating LNAPL spills in layered soil systems consisting of sands with various textures. Two multiphase flow experiments were conducted in a two‐dimensional flume (180 × 120 × 8 cm). The vertical distribution of water and LNAPL pressure were measured using hydrophilic and hydrophobic tensiometers. An image analysis technique was used to estimate the saturation distribution of the fluids in a two‐dimensional vertical plane. The experiments show that LNAPL entrapment, which contributes to long‐term soil and water contamination, depends strongly on the initial water saturation and water pressure at the layer interfaces and on the texture contrasts between the soil layers, which lead to permeability and capillary barrier effects. Thus, the knowledge of the initial water pressure and saturation distribution in unsaturated layered soil formations is critical to the correct prediction of LNAPL infiltration and drainage.
Estimation of a Critical Spatial Discretization Limit for Solving Richards' Equation at Large Scales
Authors: Vogel H.‐J. , Ippisch O.
Published: January 2008

Water dynamics in soil at spatial scales larger than the representative elementary volume (REV) of the porous structure are typically described by Richards' equation, which relates the flux law of Buckingham–Darcy to the mass balance of soil water. It is based on the soil water retention characteristics and the hydraulic conductivity function as constitutive material properties. In hydrological modeling, Richards' equation is also used at large scales up to hundreds of meters. Increasing the scale is typically accompanied by increasing the spatial discretization scale for the numerical solution of the problem. However, due to the underlying assumption of local equilibrium between water content and water potential, there is an upper limit of spatial discretization above which the solution is expected to be biased. We present a simple approach to estimate this limit, which depends on the shape of the soil hydraulic functions and the local gradient of total water potential. It is in the range between millimeters and decimeters.
Numerical Analysis of Solute Transport from Trickle Sources in a Combined Desert Soil–Imported Soil Flow System
Authors: Russo David , Zaidel Jacob , Laufer Asher
Published: January 2008

One of the alternative solutions to the problems associated with the agricultural use of stony desert soils is to apply imported soil material into trenches that are aligned along the crop rows. The purpose of the present study was twofold: first, to analyze the effect of two imported soil materials available in the Arava Valley of Israel on the movement and spread of water and solute originating from multiple trickle line laterals, taking into account the trench geometry, the discharge of the trickle line laterals, the pattern of the plant root distribution, and the spatial heterogeneity of the hydraulic properties of the local soil; and, second, to extend the analyses to hypothetical imported soil materials characterized by different sets of hydraulic parameters (saturated conductivity, Ks, and the van Genuchten soil parameters α and n, related to the soil's pore size distribution). Results of the present study suggest that in the case of relatively low‐conductive imported soil materials, a wide and shallow trench may leach the solute below a horizontal control plane more efficiently than a narrow and deep trench, while the opposite is true for high‐conductive imported soil materials. Combinations of the threshold values of Ks and α above which a narrow and deep trench is more efficient in solute leaching than a wide and shallow trench calculated here suggest that, for a given n, a relatively large threshold value of Ks may compensate for a relatively small threshold value of α, particularly when n is relatively large.
Genetic Variants in the UCP2-UCP3 Gene Cluster and Risk of Diabetes in the Women's Health Initiative Observational Study
Authors: Hsu Yi-Hsiang , Niu Tianhua , Song Yiqing , Tinker Lesley , Kuller Lewis H. , Liu Simin
Published: January 2008

OBJECTIVE—Mitochondrial uncoupling proteins (UCPs) are involved in body weight regulation and glucose homeostasis. Genetic variants in the UCP2-UCP3 gene cluster, located on chromosome 11q13, may play a significant role in the development of type 2 diabetes.

RESEARCH DESIGN AND METHODS—We conducted a comprehensive assessment of common single nucleotide polymorphisms (SNPs) at the 70-kb UCP2-UCP3 gene cluster in relation to type 2 diabetes risk in a prospective, case-control study nested in the Women's Health Initiative Observational Study, an ethnically diverse cohort of postmenopausal women including Caucasian, African, Hispanic, and Asian American subjects. We genotyped 14 tag SNPs in 1,584 incident type 2 diabetes case and 2,198 control subjects matched by age, ethnicity, clinical center, time of blood draw, and length of follow-up.

RESULTS—We identified a haplotype set (rs591758-rs668514- rs647126-rs1800006, spanning the UCP2-UCP3 intergenic and UCP3 regions) as significantly associated with greater type 2 diabetes risk (nominal P = 0.0011, permutation P = 0.046) in Caucasian women, especially among overweight Caucasians (BMI >25 kg/m2) (nominal P = 0.0006, permutation P = 0.032). Compared with the most common haplotype (h1010 as the referent), haplotype h0001 (19.5% in control subjects) had odds ratios of 2.0 (95% CI 1.13–3.37) in Caucasians and 3.8 (1.44–9.93) in Caucasian overweight women. Similar haplotype–type 2 diabetes association was also observed among Hispanic women who were overweight.

CONCLUSIONS—These findings suggest a role of UCP2-UCP3 gene cluster haplotypes in diabetes; in particular, the effects of the high-risk haplotypes were more apparent in overweight Caucasian women. These data warrant further confirmation in future prospective and experimental studies.
Effect of Glycemic Exposure on the Risk of Microvascular Complications in the Diabetes Control and Complications Trial—Revisited
Authors: Lachin John M. , Genuth Saul , Nathan David M. , Zinman Bernard , Rutledge Brandy N. ,   for the DCCT/EDIC Research Group
Published: January 2008

OBJECTIVE— The Diabetes Control and Complications Trial (Diabetes 44:968–983, 1995) presented statistical models suggesting that subjects with similar A1C levels had a higher risk of retinopathy progression in the conventional treatment group than in the intensive treatment group. That analysis has been cited to support the hypothesis that specific patterns of glucose variation, in particular postprandial hyperglycemia, contribute uniquely to an increased risk of microvascular complications above and beyond that explained by the A1C level.

RESEARCH DESIGN AND METHODS— We performed statistical evaluations of these models and additional analyses to assess whether the original analyses were flawed.

RESULTS— Statistically, we show that the original results are an artifact of the assumptions of the statistical model used. Additional analyses show that virtually all (96%) of the beneficial effect of intensive versus conventional therapy on progression of retinopathy is explained by the reductions in the mean A1C levels, similarly for other outcomes. Furthermore, subjects within the intensive and conventional treatment groups with similar A1C levels over time have similar risks of retinopathy progression, especially after adjusting for factors in which they differ.

CONCLUSIONS— A1C explains virtually all of the difference in risk of complications between the intensive and conventional groups, and a given A1C level has similar effects within the two treatment groups. While other components of hyperglycemia, such as glucose variation, may contribute to the risk of complications, such factors can only explain a small part of the differences in risk between intensive and conventional therapy over time.
Intellectual Handicap in Contemporary Psychiatry
Authors: Einfeld Stewart L.
Published: January 2008

Objective: To apprise readers of the ‘state of play’ in the psychiatry of intellectual handicap.

Method: A review was conducted of relevant journals and conference abstracts covering a range of scientific aspects of intellectual disability. Those developments considered to be most significant were summarised. In addition, consideration is given to issues relevant to the politics of disability affecting psychiatric practice in Australia.

Results: There have been considerable developments in our understanding of the pathogenesis of intellectual handicap in pharmacotherapy and the behavioural therapies, in the taxonomy of psychopathology, in epidemiology, in delineation of behaviour phenotypes, and in assessment and measurement of psychopathology.

Conclusion: Intellectual handicap and psychiatry have had a chequered relationship in Australia, but the two fields are now clearly moving again to a closer and more productive collaboration. Recent scientific advances have provided a stimulating environment for this increased activity and interest.
A Prospective Psychotherapy Outcome Study
Authors: Krawitz Roy
Published: January 2008

Objective: To assess the outcome of 31 patients treated in a day and semi-residential psychotherapy setting.

Method: Patients had moderate to severe personality difficulties and were referred when current therapy was insufficient or because of the severity of their problems. Eighty-one percent had a Cluster C and 19% a Cluster B (Borderline) Personality Disorder diagnosis (DSM-III-R). Therapy was psychodynamically and feminist-informed and included a sociopolitical dimension. Rating scales used were the Symptom Checklist 90, Goal Attainment Scale, Global Assessment Scale and measures of health resource usage, which were completed pre-treatment, post-treatment and at 4-, 12- and 24-month follow-up.

Results: Mean duration of therapy was 4 months (68 therapy days). All clinical rating scales demonstrated marked improvements following treatment (p < 0.0001) which were sustained at 2-year follow-up. There were also improvements of health resource usage.

Conclusions: The results document the clinical efficacy of psychotherapy in this setting, provide support for the philosophy of practice, and suggest that psychotherapy outcome can be evaluated at reasonable financial cost in many settings.
A Survey of Social Outcome in Schizophrenia in Tasmania
Authors: Kirkby Kenneth , Daniels Brett , Jones Ivor , McInnes Michelle
Published: January 2008

Objective: To survey the social outcome of patients with schizophrenia attending State mental health facilities in southern Tasmania.

Method: Using the Statewide Mental Health Register, patients using inpatient and outpatient facilities who received a diagnosis of schizophrenia between 1981 and 1988 were identified (n = 771), and demographic and illness measures, and admissions and length of inpatient stay were compiled. The Life Skills Profile (LSP) was completed by mental health personnel for the 247 who were regular attenders or inpatients in 1991.

Results: Social morbidity as indexed by the LSP was highest in psychiatric hospital inpatients and patients in long-term rehabilitation programs, and lower in patients attending community centres. The majority of patients in suburban settings and attending community centres lived with their families, whereas patients in the inner city or in the rehabilitation service were mainly in hostel accommodation or living alone. Patients with schizophrenia attending State services were of a similar age range but had a longer duration of illness and more admissions, and had spent more days in hospital than patients who were not in regular contact with the service.

Conclusions: The distribution of social morbidity in schizophrenia confirms that the public health system is supporting a group with high social morbidity. Patients with the highest morbidity are receiving the highest levels of care and intervention.
Clozapine in the Management of Bipolar and Schizoaffective Manic Episodes Resistant to Standard Treatment
Authors: Mahmood Tariq , Devlin Mike , Silverstone Trevor
Published: January 2008

Objective: To test the efficacy of clozapine in treatment-resistant manic episodes.

Clinical picture: Three cases, two with bipolar disorder (manic) and one of schizoaffective disorder (manic), were treated with clozapine.

Treatment: Clozapine was used after the failure of standard antipsychotics and mood stabilisers.

Outcome: All three cases were successfully treated.

Conclusion: A controlled trial of clozapine in treatment-resistant bipolar and schizoaffective manic episodes is indicated.
Use of Psychotropic Medications in Breastfeeding Women: Acute and Prophylactic Treatment
Authors: Austin Marie-Paule V. , Mitchell Philip B.
Published: January 2008

Objectives: The postnatal period is a time of increased onset and relapse of mental illness. It poses a clinical dilemma, as many mothers requiring medication acutely or prophylactically will also choose to breast feed. The present paper first reviews the safety of psychotropes in breast-fed infants and the usefulness of prophylaxis for women at risk of postpartum affective relapse and, second, provides guidelines in the use of psychotropic drugs in breast-feeding women.

Methods: A Medline review was conducted reviewing all papers published during the period 1993–1998 (and their associated bibliographies) on the use of psychotropes in breast-feeding women and the prophylactic usefulness of medications in women at risk of affective postpartum relapse.

Results: Findings are based on case reports and small, mostly uncontrolled studies. Both tricyclic antidepressants (TCA) and specific serotonin re-uptake inhibitors (SSRIs) appear to be relatively safe in breast feeding. Antidepressants commenced in the early postpartum period may reduce depressive relapse. While prophylactic lithium appears to significantly reduce relapse of affective psychosis in the puerperium, there have been no studies of the anticonvulsants in the puerperium. Finally, high dose antipsychotics should be avoided, as they may be associated with long-term adverse sequelae in the infant.

Conclusions: On the basis of current knowledge, the use of SSRIs, TCA, carbamazepine, sodium valproate and short-acting benzodiazepines in breast feeding is relatively safe. If lithium is to be used, close collaboration with a paediatrician is essential. The long-term risks of antipsychotics, especially at high doses, remain to be clarified. Before a decision can be made, the risk-benefit ratio must be clearly outlined and discussed with the mother and her partner.
A Review of Comorbidity: Major Mental Illness and Problematic Substance Use
Authors: Siegfried Nandi
Published: January 2008

Objective: The aim of this paper is to critically review the literature on major mental illness and problematic substance use in order to provide clinicians and policymakers with evidence to support proposed directions for management of the above.

Method: The available literature was accessed using computerised databases and manual searching.

Results: The predominantly North American-based literature is largely descriptive. Those studies which attempt empirical evaluation are limited by methodological weaknesses which include small sample sizes, short follow-up periods, inadequate measurement of substance use, lack of experimental design, and treatment drift over time. However, there is consensus among most studies regarding prevalence rates and treatment.

Conclusions: Problematic substance use is the most common comorbid condition among people with a major mental illness and is associated with poorer patient outcomes. There is evidence to suggest that the integration of mental health and drug and alcohol services will result in improved detection, assessment and management of comorbidity. Integration refers to the provision of comprehensive services by a single service with staff who are competent in both mental health and drug and alcohol skills. A tolerant, non-confrontational approach to substance use is most appropriate for people with a major mental illness. Treatment programs need to recognise the longitudinal nature of substance abuse and dependence. More research needs to be conducted in this field in order to establish guidelines for effective management.
The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery
Authors: Gharabaghi Alireza , Koerbel Andrei , Samii Amir , Kaminsky Jan , Von Goesseln Henning , Tatagiba Marcos , Samii Madjid
Published: January 2008

Object

Surgical manipulation of the fifth cranial nerve during its intra- or extracranial course may lead to bradycardia or even asystole as well as arterial hypotension, a phenomenon described as the trigeminocardiac reflex (TCR). The authors studied the impact of this reflex on postoperative auditory function in patients undergoing vestibular schwannoma (VS) surgery.

Methods

One hundred patients scheduled for VS surgery were studied prospectively for parameters influencing the postoperative auditory function. The evaluation included sex, age, pre- and postoperative auditory function, preoperative mean arterial blood pressure, preoperative medical diseases or medication (for example, antiarrhythmia drugs), tumor size and localization, and the intraoperative occurrence of the TCR.

The TCR, which occurred in 11% of the patients, influenced the postoperative hearing function in the patients with Hannover Class T3 and T4 VSs.

With an overall hearing preservation of 47%, 11.1% of the patients in the TCR group and 51.4% of those in the non-TCR group experienced preserved hearing function postoperatively. In cases involving larger tumors (Hannover Class T3 and T4), an intraoperative TCR was associated with a significantly worse postoperative hearing function during VS surgery (p = 0.005).

Conclusions

The hypotension following TCR is a negative prognostic factor for hearing preservation in patients undergoing VS surgery. Patients’ knowledge of this can be increased pre- and postoperatively. Further study of this phenomenon will advance the understanding of the underlying mechanisms and may help to improve hearing preservation by controlling the occurrence of the TCR.
Comparison between neuroimaging classifications and histopathological diagnoses using an international multicenter brain tumor magnetic resonance imaging database
Authors: Julià-Sapé Margarida , Acosta Dionisio , Majós Carles , Moreno-Torres Àngel , Wesseling Pieter , Acebes Juan José , Griffiths John R. , Arús Carles
Published: January 2008

Object

The aim of this study was to estimate the accuracy of routine magnetic resonance (MR) imaging studies in the classification of brain tumors in terms of both cell type and grade of malignancy.

Methods

The authors retrospectively assessed the correlation between neuroimaging classifications and histopathological diagnoses by using multicenter database records from 393 patients with brain tumors. An ontology was devised to establish diagnostic agreement. Each tumor category was compared with the corresponding histopathological diagnoses by dichotomization. Sensitivity, specificity, positive and negative predictive values (PPVs and NPVs, respectively), and the Wilson 95% confidence intervals (CI) for each were calculated.

In routine reporting of MR imaging examinations, tumor types and grades were classified with a high specificity (85.2–100%); sensitivity varied, depending on the tumor type and grade, alone or in combination. The recognition of broad diagnostic categories (neuroepithelial or meningeal lesions) was highly sensitive, whereas when both detailed type and grade were considered, sensitivity diverged, being highest in low-grade meningioma (sensitivity 100%, 95% CI 96.2–100.0%) and lowest in high-grade meningioma (sensitivity 0.0%, 95% CI 0.0–65.8%) and low-grade oligodendroglioma (sensitivity 15%, 95% CI 5.2–36.0%). In neuroepithelial tumors, sensitivity was inversely related to the precision in reporting of grade and cellular origin; “glioma” was a frequent neuroimaging classification associated with higher sensitivity in the corresponding category. The PPVs varied among categories, in general being greater than their prevalence in this dataset. The NPV was high in all categories (69.8–100%).

Conclusions

The PPVs and NPVs provided in this study may be used as estimates of posttest probabilities of diagnostic accuracy using MR imaging. This study targets the need for noninvasively increasing sensitivity in categorizing most brain tumor types while retaining high specificity, especially in the differentiation of high- and low-grade glial tumor classes.
Meningothelioma as the predominant histological subtype of midline skull base and spinal meningioma
Authors: Lee Joung H. , Sade Burak , Choi Eugene , Golubic Mladen , Prayson Richard
Published: January 2008

Object

This study was undertaken to test a hypothesis that meningiomas of the midline skull base and spine are predominantly of the meningothelial histological subtype.

Methods

The cases of 794 consecutive patients who underwent resection for meningioma at the Cleveland Clinic between January 1991 and March 2004 were reviewed retrospectively. The authors analyzed the relationship between the tumors’ histological subtypes and sites of origin in the 731 patients from this group who harbored tumors that were determined to be benign histologically (World Health Organization Grade I).

Meningothelial meningiomas (MMs) accounted for 63.5% (464/731) of the Grade I tumors. The incidence of MM according to the site of origin was as follows: 84.9% (186/219) in the midline skull base, 58.3% (35/60) in the lateral skull base, 48.5% (183/377) in a non–skull base location, and 80% (60/75) in spinal locations. The incidence of MM in the midline skull base and spinal locations were significantly higher than in non–skull base or lateral skull base locations.

Conclusions

Meningiomas of the midline neuraxis are predominantly meningotheliomas. Analysis of the increasingly available data on genetic and topographic characteristics of MMs suggests that they may represent a unique entity, contrary to the prevailing belief that all benign meningiomas are identical tumors.
Initial clinical experience with Matrix detachable coils for the treatment of intracranial aneurysms
Authors: Murayama Yuichi , Viñuela Fernando , Ishii Akira , Nien Yih-Lin , Yuki Ichiro , Duckwiler Gary , Jahan Reza
Published: January 2008

Object

The Matrix detachable coil is a new bioactive, bioabsorbable coil used in the endovascular embolization of intracranial aneurysms. It has a platinum core covered with a bioactive, bioabsorbable polymer (polyglycolic acid/lactide). The authors report on their initial midterm clinical experience with the first-generation Matrix detachable coil.

Methods

One hundred twelve patients harboring 118 aneurysms were treated using Matrix coils. Forty-nine aneurysms (41.5%) were associated with acute subarachnoid hemorrhage (SAH). Twenty-four lesions (49%) were harbored by patients with Hunt and Hess Grade I, 11 (23.4%) by patients with Grade II, eight (16.3%) by those with Grade III, and six (12.2%) by those with Grade IV. Four aneurysms (3.4%) were harbored by patients who had presented with nonacute SAH. Sixty-five aneurysms (55%) were unruptured. Fifty-seven lesions (48.3%) were small with a small neck, 29 (24.6%) were small with a wide neck, 30 (25.4%) were large, and two (1.7%) were giant. All patients were followed up to obtain angiography and clinical outcome data.

Technical complications occurred in six patients: two thromboembolic complications and four aneurysm perforations. Of these six patients, the status of two deteriorated because of aneurysm perforation and another two because of thrombus formation (morbidity 3.6%). There were five deaths—one due to rerupture after embolization. Angiography follow-up studies of 87 aneurysms were obtained. Seventy aneurysms demonstrated progressive occlusion or a stable neck (80.5%), and 17 had some degree of recanalization (19.5%). The aneurysms originally diagnosed as a neck remnant showed a 15% rate of recanalization.

Conclusions

Matrix coils can be delivered into aneurysms with technical complications similar to those encountered using GDCs. Midterm anatomical outcomes to date have shown moderate improvement in the recanalization rate when compared with those realized using the GDC system. Because of the increased friction associated with the first-generation Matrix coil, the packing density in most aneurysms was less than that achieved with GDCs. Prolonged angiography follow-up evaluations are needed to document long-term efficacy.
Central brain herniation secondary to fulminant acute disseminated encephalomyelitis: implications for neurosurgical management
Authors: Sekula Raymond F. , Marchan Edward M. , Baghai Parviz , Jannetta Peter J. , Quigley Matthew R.
Published: January 2008

✓ Acute disseminated encephalomyelitis (ADEM), also known as postinfectious encephalomyelitis, is an immunologically mediated demyelinating disorder affecting the central nervous system that typically occurs after infection or vaccination. The prognosis of ADEM is generally favorable. In a small subset of patients with ADEM, however, fulminant cerebral edema requiring neurosurgical intervention will develop. Few recommendations are available to help the neurosurgeon in dealing with such cases. In this report, the authors present the case of a patient with ADEM in whom central brain herniation developed secondary to medically intractable cerebral edema. The authors review the salient features of the disease and suggest a role for neurosurgeons in cases of fulminant ADEM.
Unusual primary secreting germ cell tumor of the spine
Authors: Massimino Maura , Gandola Lorenza , Spreafico Filippo , Biassoni Veronica , Terenziani Monica , Pecori Emilia , Arcella Antonietta , Giangaspero Felice
Published: January 2008

✓ The authors describe a young man with a rare primary spinal germ cell tumor that secreted β–human chorionic gonadotropin. The tumor was resected, and six courses of adjuvant chemotherapy consisting of cisplatin, bleomycin and etoposide were administered together with irradiation to the craniospinal area. An additional dose of radiation was delivered to the tumor site after the first four chemotherapy sessions. The patient was well without any neurological deficit or iatrogenic sequela 33 months after diagnosis. The occurrence of this rare tumor located primarily in the spine warrants attention in pathological studies of spinal tumors in young patients.