bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated Framework for the Simulation of Biological Invasions in a Heterogeneous Landscape
Authors: Ming Peng , Albrecht Jochen
Published: May 2004

In the integrated framework presented in this article, a geographical information system serves as a shell to integrate spatial, dynamic and stochastic perspectives of biological invasions in a coherent workflow. A decision tree model stratifies the landscape with respect to spatial susceptibility and builds the spatial biophysical structure for the simulation of species invasion. A dynamic diffusion model evaluates the temporal changes of species to provide the dynamic parameters for the simulation. A simulation model derived from percolation theory simulates species invasion by combining spatial and dynamic information, and explicitly representing spatio‐temporal patterns of invasions within the GIS‐percolation environment. The simulation illustrates the great influence of spatial structure and connectivity of landscape on the diffusion of the species.
Selection of Streets from a Network Using Self‐Organizing Maps
Authors: Jiang Bin , Harrie Lars
Published: May 2004

We propose a novel approach to selection of important streets from a network, based on the technique of a self‐organizing map (SOM), an artificial neural network algorithm for data clustering and visualization. Using the SOM training process, the approach derives a set of neurons by considering multiple attributes including topological, geometric and semantic properties of streets. The set of neurons constitutes a SOM, with which each neuron corresponds to a set of streets with similar properties. Our approach creates an exploratory linkage between the SOM and a street network, thus providing a visual tool to cluster streets interactively. The approach is validated with a case study applied to the street network in Munich, Germany.
A Hybrid Spatio‐Temporal Data Model and Structure (HST‐DMS) for Efficient Storage and Retrieval of Land Use Information
Authors: Sengupta Raja , Yan Chen
Published: May 2004

While the incorporation of geographical and environmental modeling with GIS requires software support for storage and retrieval of spatial information that changes over time, it continues to be an unresolved issue with modern GIS software. Two complementary approaches have been used to manage the spatial and temporal heterogeneity within datasets that use a field‐based representation of the world. Some researchers have proposed new data models that partition space into discrete elements on an as‐needed basis following each temporal event, while others have focused on eliminating duplication of repeated data elements present in spatio‐temporal information. It is proposed in this paper that both approaches have merit and can be combined to create a Hybrid Spatio‐Temporal Data Model and Structure (HST‐DMS) that efficiently supports spatio‐temporal data storage and querying. Specifically, Peuquet and Duan's (1995) Event‐based Spatio‐Temporal Data Model (ESTDM) and the Overlapping R‐tree (Guttman 1984, Tzourmanis et al. 2000) are utilized to create a prototype used to store information about urban expansion for the town of Carbondale, Illinois.
GIS Methodology for Characterizing Historical Conditions of the Willamette River Flood Plain, Oregon
Authors: Oetter Doug R , Ashkenas Linda R , Gregory Stanley V , Minear Paula J
Published: May 2004

Recent environmental developments have stimulated an interest in conservation and restoration of the historical Willamette River flood plain, both to protect against flooding and to provide wildlife habitat. In order to best utilize scarce resources, we characterized historical and modern river channel and flood‐plain conditions to evaluate changes and help prioritize restoration sites. Using cartographic and photographic data sources, we developed a Geographic Information System (GIS) to map active channels, side channels, islands and tributaries for four separate dates, as well as riparian and flood‐plain vegetation characteristics for pre‐European settlement and modern time periods. Coverages based on flood records and other boundaries were used to partition the flood plain into spatial subsets for analysis. The GIS allowed comparisons between historical and present conditions for a variety of environmental factors. Much of the pre‐settlement channel complexity has been removed. Total channel length in 1995 was 26% less than in 1850, with almost 58% of the river's side channels disconnected from the system. In addition, we found a 72% loss of flood‐plain forest from 1850 to 1995, since it was converted to agricultural and urban land uses. Selected river and flood‐plain variables were made available for a spatial model to prioritize potential locations for flood‐plain restoration.
Incompletely informed policymakers and trade policy in oligopolistic industries
Authors: Caglayan Mustafa , Usman Murat
Published: May 2004

We study strategic trade policy design when governments are incompletely informed about the market demand. Two symmetric, homogeneous product Cournot firms, one in each country, compete in a third country market. Contrary to what common sense would suggest, we show that if governments are less informed on the stochastic market demand both countries will be better off. Also contrary to findings in the literature, we show that when the government is partially informed, although quantity controls would be optimal for both high and low levels of demand uncertainty, subsidies are preferred for intermediate levels.
Why are realignments postponed? A model of exchange rate revisions with opportunistic governments
Authors: Méon Pierre‐Guillaume
Published: May 2004

In this paper we investigate the consequences of elections on the willingness of office‐motivated governments to defend a pre‐announced parity in the presence of output shocks in a fixed exchange rate regime with an escape clause. Knowing that voters rationally interpret realignments as a sign of incompetence, incumbents refrain from realigning before elections. They can do so either when they are competent or when shocks are small enough. Realignments are therefore more likely and output is less volatile on the morrow than on the eve of elections. The welfare impact of elections is ambiguous.
Ethnicity, educational attainment and the transition from school
Authors: Bradley Steve , Taylor Jim
Published: May 2004

Differences between ethnic groups in educational attainment and transition from school are investigated using pooled cross‐sectional data for the period 1992–98 obtained from the Youth Cohort Studies, School Performance Tables and the Schools’ Census. After controlling for family background, peer group, schooling and neighbourhood, ethnic minority youths (except for Afro‐Caribbeans) perform substantially better in national exams than whites. Staying on is influenced by prior educational attainment, peer group, schooling and ethnic origin. Non‐whites are more likely to stay on and less likely to enter the labour market. The results vary between boys and girls.
Industrial output and stock price revisited: an application of the multivariate indirect causality model
Authors: Huang Bwo‐Nung , Yang Chin‐Wei
Published: May 2004

This paper presents an analysis of the empirical relationship between stock returns, industrial production, money supply, inflation and interest rates across five countries—Canada, France, Japan, Taiwan and the USA. Specifically, we estimate a five‐variable vector autoregression model in order to answer the question: does industrial production predict stock returns directly or indirectly (i.e. does industrial production help predict a variable that itself predicts stock returns)? The key result is that there is no direct and significant statistical relationship in any of the five countries, but there is strong evidence of an indirect relation in Taiwan (via money supply) and another indirect relation in the USA (via interest rate). This indirect causality is verified by examining the relative predictability of stock returns both with and without the additional information. Predictability increases when the indirect relationship is exploited.
The profitability of european banks: a cross‐sectional and dynamic panel analysis
Authors: Goddard John , Molyneux Phil , Wilson John O. S.
Published: May 2004

The profitability of European banks during the 1990s is investigated using cross‐sectional, pooled cross‐sectional time‐series and dynamic panel models. Models for the determinants of profitability incorporate size, diversification, risk and ownership type, as well as dynamic effects. Despite intensifying competition there is significant persistence of abnormal profit from year to year. The evidence for any consistent or systematic size–profitability relationship is relatively weak. The relationship between the importance of off‐balance‐sheet business in a bank's portfolio and profitability is positive for the UK, but either neutral or negative elsewhere. The relationship between the capital–assets ratio and profitability is positive.
On (Ultra) rationality and the corporate and government veils
Authors: Monogios Yannis A. , Pitelis Christos
Published: May 2004

The idea of (ultra) rationality in the context of changes in corporate and/or government savings stimulating offsetting responses in household savings has been the subject of theoretical and empirical controversy. This paper provides fresh evidence of the (ultra) rationality hypothesis, in the context of a generalized version of the life‐cycle hypothesis of saving, for the case of the UK. The results suggest partial personal savings adjustment to government and corporate saving changes in the short and (to a lesser extent) the long run. This has important implications on the issues of ‘rationality’, ‘fiscal policy’ and financial capital accumulation.
Habit formation, work ethics and technological progress
Authors: Faria João Ricardo , León‐Ledesma Miguel A.
Published: May 2004

Work ethics affect labour supply. This idea is modelled assuming that work is habit forming. We introduce working habits in a neoclassical growth model and compare its outcomes with a model without habit formation. In addition, we analyse the impact of different forms of technical progress. The findings are that (i) labour supply in the habit formation case is higher than in the neoclassical case; (ii) unlike in the neoclassical case, labour supply in the presence of habit formation depends on the kind of technical progress; and (iii) the kind of technical progress will hence affect the steady‐state levels of consumption, capital stock and output.
A note on capolupo's ‘output taxation, human capital and growth’
Authors: Minniti Antonio
Published: May 2004

This note intends to show that the solution of Capolupo's model (‘Output Taxation, Human Capital and Growth’, The Manchester School, Vol. 68, 2000, No. 2, pp. 166–183) is not satisfactory for two reasons: first it is possible to tackle the question of optimal taxation in the steady state analytically without applying numerical simulations; second I highlight a mistake of the author which crucially affects the paper's result.
Fibrates or statins and lipid plasma levels in 245 patients treated with highly active antiretroviral therapy. Aquitaine Cohort, France, 1999–2001
Authors: Bonnet F , Balestre E , Thiébaut R , Mercié P , Dupon M , Morlat P , Dabis F ,   for the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA)
Published: May 2004

Objectives

To describe the effect and tolerance of lipid‐lowering drugs (LLD; fibrates and statins) in patients treated with highly active antiretroviral therapy (HAART).

Methods

A prospective study was performed in a large cohort of HAART‐treated HIV‐infected patients using guidelines for case management of dyslipidaemia. Inclusion criteria were: age over 18 years; HIV infection treated with HAART including at least one protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI); total cholesterol (TC)>5.5 mmol/L and/or triglycerides (TG)>2.2 mmol/L; and initiation of fibrates or statins. Viral load, CD4 cell count, plasma lipid levels and liver enzymes were measured at baseline (M0) and 3(M3) and 12(M12) months thereafter. Muscular enzymes were not assessed.

Results

Fibrates were prescribed to 179 patients and statins to 66 patients. There was a significant mean decrease of TG in the fibrates group between M0 and M3 [−2.29 mmol/L; 95% confidence interval (CI)=−3.53, −1.05; P<10−4] and between M0 and M12 (−2.25 mmol/L; 95% CI:−4.23, −0.29; P<10−4); a significant decrease of TC was also noticed between M0 and M3 (−0.55 mmol/L; 95% CI:−0.95, −0.15; P=0.008) but not at M12 (−0.33 mmol/L; 95% CI:−0.94, 0.26; P=0.27). In the statins group, TC significantly decreased between M0 and M3 (−0.78 mmol/L; 95% CI:−1.3, −0.27; P=0.004) and between M0 and M12 (−0.70 mmol/L; 95% CI:−1.31, −0.09; P=0.03). There was no significant difference between the decreases of TG or TC observed in patients treated with PI or NNRTI. There were no significant modifications of viral load, CD4 cell count or liver enzymes during the 12 months of followup.

Conclusions

In this HAART‐treated cohort, fibrates and statins were safe and associated with a favourable but moderate effect on lipid plasma levels.
A multicentre, randomized, double‐blind, placebo‐controlled trial of primary cryptococcal meningitis prophylaxis in HIV‐infected patients with severe immune deficiency
Authors: Chetchotisakd P , Sungkanuparph S , Thinkhamrop B , Mootsikapun P , Boonyaprawit P
Published: May 2004

Objectives

To assess the efficacy and survival benefit of low‐dose fluconazole (400 mg weekly) for primary prophylaxis for cryptococcal meningitis in patients with advanced HIV infection.

Methods

A prospective multicentre, randomized, double‐blind, placebo‐controlled study was carried out in HIV‐infected patients with CD4 counts <100 cells/μL.

Results

Of 90 patients enrolled, 44 received fluconazole and 46 received placebo. The baseline characteristics were similar in the two groups. On an intent‐to‐treat basis, 10 cases of cryptococcal meningitis developed, three (6.8%) in the fluconazole group and seven (15.2%) in the placebo group. Patients in the placebo group were more likely to develop cryptococcal meningitis than those in the fluconazole group [hazard ratio=2.23; 95% confidence interval (CI): 0.58–8.63; P=0.245]. The survival benefit of fluconazole was greater than that of the placebo. The number of deaths per 10 000 person‐days was 2.7 for the fluconazole group (2/7342) and 11.7 for the placebo group (9/7713) (rate difference=9; 95% CI: 0.4–17.5; P=0.046). Based on survival analysis, patients in the placebo group were 4.3 times more likely to die than those in the fluconazole group (95% CI: 0.9–19.8; P=0.065).

Conclusion

Fluconazole 400 mg once weekly for primary prophylaxis for cryptococcal meningitis in Thailand should be considered in HIV‐infected patients, as our study suggested a survival benefit. However, a larger study should be conducted to confirm our findings.
Association of hypocholesterolaemia with hepatitis C virus infection in HIV‐infected people*
Authors: Polgreen PM , Fultz SL , Justice AC , Wagner JH , Diekema DJ , Rabeneck L , Weissman S , Stapleton JT
Published: May 2004

Objective

To study the impact of hepatitis C virus (HCV) status on serum cholesterol levels in HIV‐infected patients.

Methods

We retrospectively analysed data from the 881 participants of the Veterans Ageing Cohort 3 Site Study. Four different models were constructed using total cholesterol, low‐density lipid (LDL) cholesterol, high‐density lipid (HDL) cholesterol and triglycerides as dependent variables. The relevant covariates included HCV antibody status, HIV medication class, CD4 count, HIV viral load, glucose level, lipid‐lowering drug use, gender, race, age, liver function test results, ethanol use, drug use, and HIV exposure category. Variables excluded from the final model included niacin use, gender, race, age, current ethanol use, and HIV exposure category.

Results

Of the 881 HIV‐positive patients enrolled in the study, 700 (79%) were screened for HCV antibody, with 300 (42.8%) HCV antibody positive and 400 (57.2%) HCV antibody negative. A positive HCV antibody status was independently associated with lower total cholesterol levels (P=0.001) and LDL cholesterol levels (P<0.001) but not with lower HDL cholesterol or triglyceride levels. HCV‐positive patients had predicted LDL levels 19 mg/dL lower than those of HCV‐negative subjects. HCV infection was also associated with a decreased use of lipid‐lowering medication, and protease inhibitor use was associated with increased LDL and total cholesterol levels.

Conclusions

HCV infection has been associated with lower cholesterol levels in HIV‐negative individuals, and the same appears to be true with HIV‐infected patients. This is an interesting finding given that HCV particles bind to LDL receptors in vitro and also because HCV–lipid interactions appear to be important in the HCV replication cycle.
Low plasma levels of dehydroepiandrosterone sulphate in HIV‐positive patients coinfected with hepatitis C virus
Authors: Mauboussin JM , Mahamat A , Peyrière H , Rouanet I , Fabbro‐Peray P , Daures JP , Vincent D
Published: May 2004

Objectives

To evaluate plasma levels of dehydroepiandrosterone sulphate (DHEAS) in a cohort of HIV‐infected patients and to analyse factors associated with DHEAS levels.

Methods

We conducted a cross‐sectional survey in the Nîmes University Hospital cohort of HIV‐infected patients in south‐eastern France. All HIV‐infected patients with at least one outpatient visit between 1 January and 1 September 2002 were included in the study. Sociodemographic, clinical, therapeutic, immuno‐virological and plasma DHEAS level data were collected during this period. Hepatitis C virus (HCV) coinfection was defined as the presence of HCV antibody with positive RNA. To identify factors associated with plasma DHEAS levels, Spearman's rank correlation and univariate and multivariate linear regression analyses were used.

Results

The DHEAS plasma level was measured in 137 patients (104 men and 33 women), 37 (27.0%) of whom were HCV coinfected. The median age of the patients was 39.1 years [interquartile range (IQR): 34.9–48.7] for women and 41.8 years (36.5–47.7) for men. The median DHEAS level was 5.5 μmol/L (IQR: 2.3–8.8) for the whole sample of 137 patients, and was lower in women (2.4 μmol/L; 1.5–6.6) than in men (6.1 μmol/L; 2.5–9.0) (P<0.01), and lower in patients coinfected with HCV (2.1 μmol/L; 0.6–6.7) than in those not coinfected (6.6 μmol/L; 3.0–9.1) (P<0.01). Of all prognostic factors studied in the variance covariance analysis, three factors were associated with DHEAS: age, gender and HCV coinfection. Subgroup analysis revealed that the age‐adjusted mean of the DHEAS level was lower in HCV coinfected patients for both women (1.3±1.1 μmol/L) and men (4.0±0.7 μmol/L), compared with patients not HCV coinfected (women, 5.3±0.7 μmol/L; men, 7.2±0.4 μmol/L) (P<0.01).

Conclusions

This is the first report of the determination of DHEAS plasma levels in HIV/HCV coinfected patients. When age and sex were taken into account, the DHEAS plasma level was found to be significantly lower in HCV coinfected patients. To date, the pathophysiology of such findings is unknown.
Castleman's disease and HIV infection in Australia
Authors: Loi S , Goldstein D , Clezy K , Milliken ST , Hoy J , Chipman M
Published: May 2004

Objectives

To describe, retrospectively, the Australian experience of muti‐centric Castleman's disease (MCD) in the setting of HIV infection, specifically with the advent of HAART, and newer chemotherapeutic agents.

Patients and methods

HIV‐infected patients diagnosed with MCD since 1994, were identified from three major HIV treatment centres in Australia. Demographic and disease characteristic variables were collated by the National Centre in HIV Epidemiology and Clinical Research.

Results

Eleven patients were identified with MCD. Medial follow up was 46 (18–57) months. All had CD4 cell counts less than 500 cells/μL. All but one patient was receiving HAART at the time of diagnosis. Nine of the 11 patients had Kaposi's sarcoma (KS) and two patients also developed non‐Hodgkin's Lymphoma (NHL). All patients received chemotherapy for MCD. The response rate from Chemotherapy was 64%. Only two patients achieved sustained remissions. The median survival was 21.9 (1–52) months. The mortality was 45% from MCD and its related complications.

Conclusion

MCD in HIV infected patients is a rare and life‐threatening disorder. There is limited recent information on optimal treatment for MCD. MCD in our series appeared to be a chemo‐responsive disease. In our experience, treatment with liposomal anthracycline was associated with good response rates and acceptable toxicity in several patients, and therefore merits further exploration to establish its role. Treatment in the future may concentrate on novel agents such as anti‐interleukin 6, anti‐CD20 antibodies, thalidomide and viral ablation.
The AIDS epidemic in Lyon: patient characteristics and defining illnesses between 1985 and 2000
Authors: Gayet‐Ageron A , Baratin D , Marceillac E , Allard R , Peyramond D , Chidiac C , Trepo C , Livrozet J‐M , Touraine J‐L , Ritter J , Sepetjan M , Fabry J , Vanhems P
Published: May 2004

Objectives

To define the characteristics of 1899 patients diagnosed with AIDS at Lyon University Hospitals (LUH) across four time periods corresponding to different antiretroviral eras, and to analyse the evolution of specific AIDS‐defining illnesses (ADIs) with time.

Methods

All AIDS patients at LUH between 1 January 1985 and 31 December 2000 were included in the study. The data were compared using the χ2 test and one‐way analysis of variance.

Results

The absolute number of new AIDS cases increased by 30.3% between 1985 and 1995 but decreased by 26.5% between 1996 and 2000. The proportion of women with AIDS increased significantly (P<0.001) and mean age at diagnosis also increased significantly over time (P<0.001). The proportion of infection through heterosexual contact increased dramatically, while that through homo/bisexual intercourse or injection drug use (IDU) decreased significantly (P<0.001). The absolute number of ADIs declined with the introduction of highly active antiretroviral therapies (HAART) (P<10–6). Pneumocystis carinii pneumonia remained the leading ADI in 1996–2000 (23.3%). A significant increase in the proportion of non‐Hodgkin's lymphoma (NHL) was observed over time (P<10–5) but the number of new NHL cases decreased during HIV infection after 1996.

Conclusions

The decline in the incidence of AIDS with the advent of HAART was confirmed in our hospital cohort. The gradual increase in the proportion of NHL among ADIs underscores the long latency period between infection with HIV and the achievement of an effect of HAART on HIV‐associated lymphomagenesis.
Isolated antibodies against the core antigen of hepatitis B virus in HIV‐infected patients
Authors: Neau D , Winnock M , Galpérine T , Jouvencel AC , Castéra L , Legrand E , Tranchant E , Balestre E , Lacoste D , Ragnaud JM , Dupon M , Lafon ME , Dabis F ,   for the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA)
Published: May 2004

The aim of this study was to describe the frequency and significance of isolated antibodies against the hepatitis B virus (HBV) core antigen (HBc) in 2185 HIV‐infected patients of the Aquitaine Cohort. Antibodies against HBc were found in 372 subjects (17%). Patients with isolated anti‐HBc antibodies were more frequently coinfected with hepatitis C virus (HCV) (58.2%) than those who were anti–HB surface (HBs) antibody positive (22.9%, P<0.001) and those who were dually reactive anti‐HBs/anti‐HBc antibody positive (27.3%, P<0.001). These results suggest interactions between HBV and HCV. As observed in patients not infected with HIV, the ‘anti‐HBc‐alone’ serological profile could reflect essentially late immunity with undetectable anti‐HBs antibodies. However, an occult HBV infection cannot be ruled out.
HIV and hepatitis C coinfection within the CAESAR study
Authors: Amin J , Kaye M , Skidmore S , Pillay D , Cooper DA , Dore GJ
Published: May 2004

The declining incidence of AIDS‐related opportunistic diseases among people with HIV infection has shifted the focus of clinical management to prevention and treatment of comorbidities such as chronic liver disease. The increased risk of hepatitis C virus (HCV)‐related advanced liver disease in people with HIV infection makes early HCV diagnosis a priority. To assess HCV prevalence and predictors of HIV/HCV coinfection, we have conducted a retrospective analysis of people enrolled in the CAESAR (Canada, Australia, Europe, South Africa) study, a multinational randomized placebo‐controlled study of the addition of lamivudine to background antiretroviral therapy. The impact of HCV on HIV disease progression was also examined. Anti‐HCV antibody testing on 1649 CAESAR study participants demonstrated a HIV/HCV coinfection prevalence of 16.1%, which varied from 1.9% in South Africa to 48.6% in Italy. The strongest predictor of HIV/HCV coinfection was HIV exposure category (P<0.0001), with odds ratios (ORs) compared to homosexual as follows: injecting drug use (IDU), 365 [95% confidence interval (CI): 179–742]; transfusion or blood products, 32.2 (95% CI: 15.2–67.6); homosexual and IDU, 22.9 (95% CI: 8.5–62.1). The prevalence of HIV/HCV was low (3.7%) among homosexual men without reported IDU. Other predictors of HIV/HCV coinfection were alanine aminotransferase (ALT), country of residence, ethnicity and stage of HIV disease. A history of IDU or ALT ≥40 U/L at baseline had a positive predictive value (PPV) of 35%, negative predictive value (NPV) of 96%, sensitivity of 82% and specificity of 71% for HIV/HCV coinfection. HIV disease progression was similar in HIV monoinfected and HIV/HCV coinfected patients. People with HIV and a history of IDU or elevated liver function tests should be targeted for HCV testing. The low prevalence of HIV/HCV coinfection among homosexual men without a history of IDU suggests low efficiency of sexual HCV transmission.
Clinical implications of stopping nevirapine‐based antiretroviral therapy: relative pharmacokinetics and avoidance of drug resistance
Authors: Mackie NE , Fidler S , Tamm N , Clarke JR , Back D , Weber JN , Taylor GP
Published: May 2004

Objective

To determine the pharmacokinetics of cessation of nevirapine (NVP) in order to design clinical protocols which will reduce the risk of resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs).

Methods

In a case study, NNRTI genotypic resistance was demonstrated in a patient discontinuing therapy for toxicity. Subsequently, nine patients receiving NVP‐containing antiretroviral regimens and stopping treatment were recruited. Patients were advised to continue the nucleoside analogue reverse transcriptase inhibitor (NRTI) backbone for 5 days following cessation of NVP. Plasma NVP concentrations were determined over 7–10 days after the last dose. HIV‐1 reverse transcriptase genotyping was performed at viral load rebound (approximately day 21 following cessation) to detect mutations associated with reduced NNRTI sensitivity.

Results

The median predicted time for plasma NVP concentration to fall below the inhibitory concentration (IC)50 of wild‐type virus was 168 h (range 108–264 h). De novo genotypic mutations conferring resistance to NRTIs or NNRTIs were not demonstrated following cessation of therapy.

Conclusions

The prolonged elimination half‐life of NVP compared with NRTIs, which persists even after 20 weeks of therapy, raises concern over the development of NNRTI resistance if all three drugs are stopped together. Continuation of the NRTI backbone for a further 5 days, allowing the elimination of NVP, may avoid the development of drug resistance.
Peyronie's disease in men with HIV responding to highly active antiretroviral therapy
Authors: Rogers GD , French MA
Published: May 2004

The pathogenesis of Peyronie's disease (induratio penis plastica) is unclear, but immune phenomena appear likely to be involved. Two cases are presented where the condition developed in temporal association with a virological response to highly active antiretroviral therapy (HAART) in men with HIV infection. It is suggested that this may represent another manifestation of immune restoration disease.
High‐resolution sonography of the peripheral nervous system – a review of the literature
Authors: Beekman R. , Visser L. H.
Published: May 2004

High‐resolution sonography is capable of depicting peripheral nerves and the brachial plexus. In this study we review the literature on this subject. Normal peripheral nerves have a characteristic echotexture. Most nerves are readily visualized, although this is not always the case with the nerves of the lower extremity. The main pathological changes that can be demonstrated are nerve enlargement and increased hypoechogenicity. In order to demonstrate nerve enlargement, measurements should be performed and compared with a set of reference values. Several neuropathies have been studied by means of ultrasonography. However, many studies concern case reports and show methodological shortcomings. The best studied peripheral neuropathy is the carpal tunnel syndrome in which ultrasonography seems to have an additional value when combined with nerve conduction studies. Nerve enlargement has also been demonstrated in radial neuropathy at the humerus and in ulnar neuropathy at the elbow. The role of sonography in various hereditary and inflammatory neuropathies is uncertain although diffuse nerve thickening could be demonstrated. Further systematic studies are needed to determine the role of sonography in the diagnostic process of the various neuropathies. It would be important to study the subcategories of patients in whom electrodiagnostic studies are normal or show equivocal findings.
Chlamydia pneumoniae infection in young stroke patients: a case–control study
Authors: Anzini A. , Cassone A. , Rasura M. , Ciervo A. , Beccia M. , Di Lisi F. , Fieschi C.
Published: May 2004

Retrospective and cross‐sectional studies have suggested that both bacterial and viral infections may be risk factors for atherosclerosis, ischemic stroke and acute coronary events. The correlation between Chlamydia pneumoniae and atherosclerosis remains a source of controversy. Our case–control study is aimed at evaluating the frequency of C. pneumoniae infection in a cohort of young adults with recent cerebrovascular disease and in particular etiologic stroke subtypes. Chlamydia pneumoniae IgG, IgM and IgA antibodies were evaluated by microimmunofluorescence method and antibody titers to both recombinant antigens chlamydial outer protein 2 and 60‐kDa chlamydial heat shock protein (HSP60) by ELISA. The two groups differed with regard to the prevalence of C. pneumoniae IgA (P < 0.001) and IgG (P < 0.0001), as well as the titer of anti‐R‐HSP60 IgG (P < 0.001). We found an increase in IgA titers, suggestive of persistent, chronic active infection, in 16 patients in whom the etiology of the cerebral ischemic event was large‐vessel atherothrombosis. Persistent, active C. pneumoniae infection may be an additional risk factor for ischemic stroke mainly of atherotrombotic origin in young subjects. However, a large‐scale prospective confirmation of our findings is required.
Significance of serum soluble thrombomodulin level in acute cerebral infarction
Authors: Nomura E. , Kohriyama T. , Kozuka K. , Kajikawa H. , Nakamura S. , Matsumoto M.
Published: May 2004

The purpose of the present study was to investigate sequential changes in serum soluble thrombomodulin (sTM) concentrations in patients with acute cerebral infarction (ACI), and to correlate sTM concentrations with the severity of ACI evaluated by Japan Stroke Scale. Eighty‐three consecutive patients with ACI were enrolled, and blood examinations were carried out soon after admission and 1 month after. sTM concentrations at admission in patients with cardioembolic infarction (3.2 ± 1.2 ng/ml) were significantly lower than those of lacunar infarction (3.9 ± 1.2) (P < 0.05). Serial examinations revealed that sTM concentrations increased significantly 1 month after admission (3.8 ± 1.2), compared with those at admission (3.6 ± 1.2) (P = 0.02). Of three ACI subtypes, sTM concentrations during 1 month significantly increased in atherothrombotic infarction (P = 0.002) or, not significantly, in cardioembolic infarction (P = 0.09). The sTM concentrations at admission showed a significant inverse correlation with the severity of ACI (P = 0.04). Although sTM concentrations serve as a useful marker for endothelial cell damage, they are decreased in patients with severe ACI, especially in atherothrombotic and cardioembolic infarctions. Lower sTM concentrations may play some important role in disease progression or in the recurrence following ACI, although the exact mechanism of this unique result should be clarified.
Patients with multiple sclerosis prefer early diagnosis
Authors: Janssens A. C. J. W. , de Boer J. B. , Kalkers N. F. , Passchier J. , van Doorn P. A. , Hintzen R. Q.
Published: May 2004

The new diagnostic criteria for multiple sclerosis (MS) allow for a definite diagnosis in earlier stages of the disease. Yet, clinicians may hesitate to pursue a diagnosis of multiple sclerosis at the presentation of first symptoms because they consider an early diagnosis of limited benefit to patients. It is unknown whether patients themselves prefer to be informed in an early phase. We studied satisfaction with the timing of diagnosis in patients recently diagnosed with MS and found that 75% was satisfied, 24% favoured an earlier, and only 6% a later disclosure of the diagnosis. Patients who preferred an earlier diagnosis had a significantly longer interval between their first visit to the neurologist and the disclosure of diagnosis (P < 0.001). The probability that the patient was satisfied with the timing of diagnosis did not substantially decrease in the months following the first visit to the neurologist, leaving ample opportunity for a thorough evaluation of the early clinical course. We conclude that patients with MS prefer an early diagnosis.
Unusual neurological presentations of vitamin B12 deficiency
Authors: Ahn T.‐B. , Cho J.‐W. , Jeon B. S.
Published: May 2004

Vitamin B12 deficiency (B12D) has a wide variety of neurological symptoms and signs. However, cerebellar dysfunction and cranial neuropathies other than optic neuropathy have been rarely reported. Herein, we describe two cases of unusual neurological manifestations of B12D. One patient showed prominent hoarseness with vocal cord paralysis, myelopathy, and peripheral neuropathy. The other had gait disturbance, lateral gaze limitation and cerebellar dysfunction in addition to the typical manifestations of subacute combined degeneration. Vitamin B12 deficiency can rarely affect cerebellum and cranial nerves other than optic nerve.
Creutzfeldt–Jakob disease presenting as progressive supranuclear palsy
Authors: Josephs K. A. , Tsuboi Y. , Dickson D. W.
Published: May 2004

Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by an akinetic rigid syndrome with vertical supranuclear ophthalmoplegia, early falls, and levodopa resistance. The pathological substrate of PSP consists of filamentous tau degenerative lesions affecting neurons and glia. Other disorders can present with a similar clinical picture, most commonly corticobasal degeneration and multiple system atrophy. Non‐neurodegenerative disorders are rare causes of the PSP syndrome. In this report we describe clinical and pathological features of two cases of Creutzfeldt–Jakob disease (CJD) presenting with the PSP syndrome and discuss which features may help prevent misdiagnosis. To our knowledge, this is the first report of cases of CJD with autopsy confirmation that presented with a PSP syndrome.
Psychiatric comorbidity in a population of Parkinson's disease patients
Authors: Nuti A. , Ceravolo R. , Piccinni A. , Dell'Agnello G. , Bellini G. , Gambaccini G. , Rossi C. , Logi C. , Dell'Osso L. , Bonuccelli U.
Published: May 2004

Behavioural disturbances are frequently observed in Parkinson's disease (PD), including mood and anxiety disorders. The existence of a comorbidity between such psychiatric disorders in PD patients has been suggested only in a few studies. To assess the prevalence of mood and anxiety disturbances, and the rate of comorbidity of such disorders in PD. Secondary aim was to correlate the prevalence of psychiatric disorders in PD with age, sex, laterality of motor symptomatology, clinical features, severity of disease, age of onset and PD duration, and anti‐parkinsonian therapy. Ninety consecutive PD outpatients, and 90 age‐ and sex‐matched controls were included. All PD patients enrolled were non‐fluctuating (21 de novo, 69 treated with levodopa or dopamine agonists). PD patients and controls with Mini Mental State Examination score <23 were excluded. Psychiatric diagnosis was performed by semistructured interview according with DSM‐IV criteria and the severity of depressive and anxious symptoms was rated with clinical rating scales. Major depression was found in 21.1% PD patients vs. 3.3% controls (P < 0.01, chi‐square analysis), dystimia in 18.8% PD patients vs. 4.4% controls (P < 0.05), panic disorders in 30% PD patients vs. 5.5% controls (P < 0.01). No difference in the prevalence of other anxiety disorders was observed between the two groups. The comorbidity of mood and anxiety disorders was found in 19.3% PD patients vs. 8.6% controls (P < 0.01). No correlation was reported between the prevalence of behavioural disturbances and any of the demographic, clinical or pharmacological data taken into account. Our findings might suggest the existence of a wide spectrum of psychiatric disorders in PD ranging from pure depressive disorders, comorbid depressive and anxiety disorders, and pure anxiety disorders, presumably linked to the same neurobiological substrate.
A registry‐based, case–control investigation of Parkinson's disease with and without cognitive impairment
Authors: Papapetropoulos S. , Ellul J. , Polychronopoulos P. , Chroni E.
Published: May 2004

In approximately 40% of the patients, Parkinson's disease (PD) is complicated by cognitive impairment. The objective of this study was to evaluate the impact of cognitive impairment on disease severity and motor function in idiopathic PD patients. Forty‐one PD patients with cognitive impairment (PD‐CI) (Mini‐Mental State Examination ≤24) and 41 PD patients without cognitive impairment (PD‐Control) matched for age at onset and duration of the disease were examined using the Unified Parkinson's Disease Rating Scale (UPDRS). PD patients with cognitive impairment had overall poorer motor function, worse rigidity (both axial and limb) and bradykinesia, as well as worse performance in activities of daily living compared with matched PD patients without cognitive impairment. This could either be attributed to a direct effect of cognitive impairment on parkinsonian symptoms or to decreased compliance of patients during clinical examination. PD patients should be routinely and carefully screened for dementia and caregivers should be aware of the effect of dementia on PD.
Education in the broader sense*
Authors: Grisold W. , Baker M. G. , Newton A. M. , Mueller E. , Sipido E. M.
Published: May 2004

Education is the key element in medical science. It is generally divided into pre‐graduate, postgraduate and continuing medical education, with the physician as the main target. It usually covers aetiology, diagnosis, treatment, prognosis, outcome and long‐term effects. Neurology is a large field in medical science, focusing on diseases of the brain, the spinal cord, the peripheral nerves and muscles. They tend to be chronic and, often progressive, leading to long‐term disability and handicap for the individual, frequently associated with personal, social and emotional consequences. In the time span of a patient with a neurological disease, interaction with physicians is important and often vital, but interaction with other health groups and relatives or other caregivers is longer and more intensive. The knowledge and experience of the patient and caregiver is equally important, in that an informed patient or caregiver is more likely to participate actively and be of greater benefit in disease management. This paper promotes the concept that education in neurology should be integrated to include the physicians and other professionals as well as patients, caregivers and public. A broader awareness of neurological diseases will draw support and improve the approach of society to the provision of resources and management of these illnesses, as well as public attitude towards the symptoms and to those who live with them. Two bodies have collaborated in writing this article: the education committee of the EFNS and the EFNA.
Guidelines for the diagnosis and management of neurological complications of HIV infection
Authors: Portegies P. , Solod L. , Cinque P. , Chaudhuri A. , Begovac J. , Everall I. , Weber T. , Bojar M. , Martinez‐Martin P. , Kennedy P. G. E.
Published: May 2004

The spectrum of neurological complications of HIV‐infection has remained unchanged through the years, but its epidemiology changed remarkably as a result of the introduction of highly active antiretroviral therapy (HAART). Guidelines for the diagnosis and treatment of cerebral toxoplasmosis, cryptococcal meningitis, progressive multifocal leukoencephalopathy, CMV encephalitis, CMV polyradiculomyelitis, tuberculous meningitis, primary CNS lymphoma, HIV dementia, HIV myelopathy and HIV polyneuropathy are given with a grading of evidence and recommendations.
Accounting for change in public sector industrial relations: the erosion of national bargaining in further education in England and Wales
Authors: Williams Steve
Published: May 2004

The recent transformation of industrial relations in further education in England and Wales is examined, in particular the role of the national ‘Silver Book’ dispute over lecturers’ conditions of service in causing the erosion of national bargaining in the sector. The experience of further education points to the limits of the strategic choice approach as a device for explaining change in public sector industrial relations and to the importance of supplementing it with a perspective that emphasises the role of power.
Book Review
Authors: Maughan Ron
Published: May 2004

Review of Medical Physiology, 18th edn. By William E. Ganong.
Book Reviews
Authors: Thompson Peter , Whipp Brian J.
Published: May 2004

Vision and Action. Edited by Laurence R. Harris and Michael Jenkin.

Respiratory Control Mechanisms and Sensations. Edited by A. S. Paintal and Ashima Anand
Speeds of Actin Translocation in Vitro by Myosins Extracted from Single Rat Muscle Fibres of Different Types
Authors: Canepari M. , Rossi R. , Pellegrino M. A. , Reggiani C. , Bottinelli R.
Published: May 2004

As skeletal muscle fibres mostly express a single myosin isoform, they are a potential source of pure myosin isoforms. A technique is described that allows extraction and identification of pure myosin isoforms from single fibres, and testing of such myosins in an in vitro motility assay (IVMA). The results show that the extraction procedure does not alter myosin function and support the view that single fibres are reliable sources of purified myosin isoforms for IVMA.
Tremulousness ‐ The Perception of Tremor in Man
Authors: Lakie M. , Combes N.
Published: May 2004

The thresholds for detection of a tremor‐like movement are described. Detection is poorest at frequencies which correspond to natural tremor. The results are in accord with the failure of persons often to notice that their hands are tremulous.
Book Review
Authors: Griffiths T. D.
Published: May 2004

Auditory Perception: A New Analysis and Synthesis. By Richard M. Warren
Interaction of Islet Hormones with Cholecystokinin Octapeptide‐Evoked Secretory Responses in the Isolated Pancreas of Normal and Diabetic Rats
Authors: Singh Jaipaul , Adeghate Ernest , Salido Gines M. , Pariente Jose A. , Yago Maria D. , Juma Lubna O. M.
Published: May 2004

This study investigates the effects of the islet hormones, insulin (Ins), glucagon (Glu) and somatostatin (Som) with cholecystokinin octapeptide (CCK‐8) on amylase secretion and intracellular free calcium concentration [Ca2+]i and their pattern of distribution in the isolated pancreas of normal and diabetic rats. Ins and Glu evoked small increases in amylase output from pancreatic segments compared with a much enhanced effect of CCK‐8. In contrast, Som induced a biphasic response comprising an initial decrease followed by a secondary increase and this biphasic response may be dependent upon the concentration. Combining the islet hormones with CCK‐8 resulted in marked potentiation in amylase output compared with either CCK‐8 alone or the individual hormone. Genistein and tyrphostin A25, the tyrosine kinase inhibitors, evoked a small decrease in amylase output from pancreatic segments. They had no effect on the CCK‐8‐evoked secretory response but markedly inhibited the potentiation of the islet hormones with CCK‐8. In pancreatic acini and acinar cells Ins, Glu and Som individually evoked small increases in amylase output compared with a much larger response with CCK‐8. When the islet hormones were combined with CCK‐8 there was no potentiation of amylase output. Similarly, when rats were rendered diabetic by prior treatment with streptozotocin Ins, Glu and Som failed to potentiate the secretory response of CCK‐8. In fura‐2‐loaded pancreatic acinar cells Ins or Glu evoked small increases in [Ca2+]i compared with a much larger elevation with CCK‐8. Ins, Glu and Som each enhanced the CCK‐8‐evoked [Ca2+]i. Genistein elicited a decrease in [Ca2+]i both in the absence and presence of the islet hormones. It also decreased the elevation in [Ca2+]i resulting from the combined presence of CCK‐8 with either Ins or Glu but it had no effect on CCK‐8 in combination with Som. In pancreatic acinar cells from diabetic rat Ins, Glu and Som had no detectable effect on CCK‐8‐evoked elevation in [Ca2+]i compared with the response obtained with CCK‐8 alone. CCK‐8‐immunopositive cells were distributed around the walls of blood vessels, numerous Ins‐positive cells in the central and peripheral parts of the islets of Langerhans, Glu‐immunoreactive cells in the periphery of islets and Som‐positive cells in the outer part of the islets. During diabetes, the number of CCK‐immunopositive cells remained unchanged whereas the number of Ins‐positive cells decreased coupled with an increase in the number of Glu‐positive cells. The results indicate that both tyrosine kinase and cellular Ca2+ seem to be the intracellular mediators involved with the enhanced secretory responses obtained with a combination of the islet hormones with CCK‐8. Moreover, the presence of viable pancreatic islets of Langerhans seems to be associated with the potentiation of the islet hormones with CCK‐8.