bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonlinear dynamic characteristics of rotating ramjet rotor supported by hybrid gas bearing
Authors: Zhang Guang-hui , Liu Zhen-xing , Kang Wei-jia , Liu Zhan-sheng , Xin Tian
Published: December 2012

The nonlinear dynamic characteristics of rotating ramjet rotor supported by hybrid gas bearing are studied. The compression inlet flow field at different back pressure levels is analyzed and the normal working back pressure level is determined. The periodic movement phenomenon of normal shock wave in compression inlet is presented. The influence on the compression inlet flow field with the variation of structure dimension is introduced. Then, the nonlinear compression inlet flow force generated from the whirling of the rotor is obtained. The model for the rotating ramjet rotor supported by the hybrid gas bearing is established by the finite element method. The equation of motion for the rotating ramjet rotor is numerically solved and coupled with the gas lubricated Reynolds equation considering the time terms. The vibration characteristics of the rotating ramjet with different supply pressure and unbalanced mass eccentricities are solved by the Newmark method. The orbit trajectory diagram, frequency spectrum diagram, and time response diagram are obtained. Then, the stability of the rotating ramjet rotor system is discussed. The results indicate that the compression inlet is under the condition of high adverse pressure gradient, the shock wave, expansion wave, reflections and crossings of the shock waves, boundary layer–shock wave interference, and separation of the flow, which lead to the unstable flow of the compression inlet. The nonlinear compression inlet flow force can cause sub-synchronous vibration. If the supply pressure and eccentricities are properly designed, the vibration amplitudes can be decreased and the stability will be improved, which will make the foundation for the vibration control of the rotating ramjet system.
Near efficient target allocations in response-adaptive randomization
Authors: Biswas Atanu , Bhattacharya Rahul
Published: December 2012

Traditionally optimal target allocation proportions for response-adaptive designs are derived by completely ignoring the actual adaptive randomization procedure. Considering efficiency of the allocation designs, we derive near efficient target proportions to balance between individual and collective ethics. Performance of the derived allocation targets are assessed numerically for binary, normal and exponential responses. Generalization for multiple treatments is also addressed.
Bayesian multiple imputation for missing multivariate longitudinal data from a Parkinson's disease clinical trial
Authors: Luo Sheng , Lawson Andrew B , He Bo , Elm Jordan J , Tilley Barbara C
Published: December 2012

In Parkinson's disease (PD) clinical trials, Parkinson's disease is studied using multiple outcomes of various types (e.g. binary, ordinal, continuous) collected repeatedly over time. The overall treatment effects across all outcomes can be evaluated based on a global test statistic. However, missing data occur in outcomes for many reasons, e.g. dropout, death, etc., and need to be imputed in order to conduct an intent-to-treat analysis. We propose a Bayesian method based on item response theory to perform multiple imputation while accounting for multiple sources of correlation. Sensitivity analysis is performed under various scenarios. Our simulation results indicate that the proposed method outperforms standard methods such as last observation carried forward and separate random effects model for each outcome. Our method is motivated by and applied to a Parkinson's disease clinical trial. The proposed method can be broadly applied to longitudinal studies with multiple outcomes subject to missingness.
Acute phase protein quantitation in serum samples from healthy Atlantic bottlenose dolphins (Tursiops truncatus)
Authors: Cray Carolyn , Arheart Kristopher L. , Hunt Michael , Clauss Tonya , Leppert Lynda L. , Roberts Kevin , McCulloch Stephen D. , Goldstein Juli D. , Gonzalez Christie , Sweeney Jay , Stone Rae , Fair Patricia A. , Bossart Gregory D.
Published: December 2012

Acute phase proteins (APPs) have been studied in many companion and large animals and have been reported to have a differential sensitivity to traditional markers of inflammation. Studies have been performed indicating the conservation of these proteins as well as the application and cross-reactivity of automated assays among different species, but few reports have detailed APPs in marine mammal species. In the present study, automated assays were utilized to generate reference intervals for C-reactive protein, haptoglobin, and serum amyloid A using 44 serum samples from healthy Atlantic bottlenose dolphins ( Tursiops truncatus). A total of 25 samples were obtained from dolphins under human care and 19 samples were obtained from free-ranging dolphins. Mild yet statistically significant differences were observed in levels of haptoglobin and serum amyloid A between these groups. The reference intervals from the combined groups were as follows: C-reactive protein 3.1–19.7 mg/l, haptoglobin 0–0.37mg/ml, and serum amyloid A 17.5–42.9 mg/l. These baseline data should provide an important foundation for future studies of the application of APP quantitation in monitoring the health and stressors of dolphins under human care and with live capture of free-ranging dolphins.
Voting Technology, Vote-by-Mail, and Residual Votes in California, 1990–2010
Authors: Alvarez R. Michael , Beckett Dustin , Stewart Charles
Published: December 2012

We examine how the growth in vote-by-mail and changes in voting technologies led to changes in the residual vote rate in California from 1990 to 2010. In California’s presidential elections, counties that abandoned punch cards in favor of optical scanning enjoyed a significant improvement in the residual vote rate. We also conduct the first analysis of the effects of the rise of vote-by-mail on residual votes. Regardless of the election, increased use of the mail to cast ballots is robustly associated with a significant rise in the residual vote rate.
Using Picture Books to Guide and Inspire Young Gifted Hispanic Students
Authors: Abellán-Pagnani Luisa , Hébert Thomas P.
Published: December 2012

The gifts and talents of Hispanic young children must be supported in elementary classrooms. High-quality children’s literature and picture book biographies of Hispanics enable educators to address the social and emotional as well as intellectual needs of gifted young Hispanic children. With a search for appropriate literature and sustained efforts in designing lessons that address affective needs, teachers will be better equipped to provide meaningful educational programs for all children.
School Counseling for Gifted Black Males
Authors: Henfield Malik S.
Published: December 2012

Oftentimes, when the subject of how to maximize Black students’ talent in gifted and advanced courses and programs is broached, they are treated as a monolithic entity. Too little scholarship explores gender differences among Black males and females. Yet, there is considerable evidence that unsuccessful attainment of academic excellence may be more troublesome for Black males than females at many points along the educational pipeline. School counselors, trained to understand the intended and unintended consequences of ignoring the importance of race and gender, are well equipped to assist in the efforts to increase the academic performance of gifted and talented Black males. The purpose of this article is to provide a brief introduction of the cumulative risks associated with being Black and male in educational settings as well as a discussion of how these risks are associated with mental health and academic performance. The article concludes with a discussion of implications for school counselors.
Gifted Students and Lyme Disease
Authors: Schuler Patricia A.
Published: December 2012

Lyme disease is a tick-borne illness found throughout North America and other countries. Symptoms range from the physical and cognitive (e.g., severe fatigue; stomach, vision, and balance problems; memory loss; “Lyme fog”) to the social and emotional (e.g., withdrawal, behavior problems, mood swings, anxiety, shame). Gifted and talented students, like all students, are susceptible to the effects of Lyme disease. However, their experiences may be more intense and life altering, depending on the severity of the Lyme disease. In this article, the phenomenological experience of two gifted boys with Lyme disease gives educators, counselors, and parents insight into how this disease impacts the intellectual functioning, social status, and identity of gifted children with this bacterial illness. The author emphasizes the important role that educators, counselors, and parents have in understanding Lyme disease, recognizing the symptoms, and supporting gifted children and their families whose lives are changed by the bite of a tick. They may observe changes in academic performance, a decrease in school attendance, altered social status, an increase in maladaptive perfectionism, and existential depression in those affected gifted children. Potential program modifications, accommodations, and services for this particular group of twice-exceptional students are provided so that educators, counselors, and parents can work collaboratively to promote resiliency at the same time they enact specific strategies for gifted students recovering from Lyme disease.
Optimization of a steaming with liquid smoke smoking process of Mediterranean mussel (Mytilus galloprovincialis)
Authors: Petridis Dimitris , Zotos Anastasios , Kampouris Theodoros , Roumelioti Zoi
Published: December 2012

Mussel samples were brined in 0%, 10% and 20% sodium chloride solutions and steamed with 2%, 5% and 8% liquid smoke at 1 (atmospheric pressure), 1.5 and 2 bar pressures. Sodium chloride and moisture content and instrumental color were analyzed. They were also objectively and hedonically assessed by 35 and 70 panellists, respectively, for their smoked flavor, saltiness, juiciness and color. The sodium chloride content was influenced by the brine concentration and brightness by the smoke and brine concentrations. The smoked flavor significantly and linearly ( p = 0.018) influenced by the liquid smoke and brine concentration. A linear effect ( p < 0.001) of brine concentration ( p < 0.001) on sensory saltiness was expectedly observed. Brine concentration affected not only the saltiness but also the juiciness of the mussel smoked products. All factors of the study produced a significant linear effect ( p = 0.008) on the intensity of color. Brine concentration was the only process variable affecting all the hedonic sensory variables in a curvilinear mode. The optimal hedonic conditions of the mussel products were achieved at smoke concentrations 3.8–8%, brine level from 8.5% to 13.5% at pressure 1 bar and from 11.5% to 16.5% at pressure 1.5 bar. All hedonic variables reached their maximum likeliness between 9 and 13. The optimal objective saltiness and juiciness varied between moderate and adequate salty and juicy product. The physicochemical variables employed in the study were adequately perceived by the panellists’ sensory objective assessment as redundancy analysis revealed. Sodium chloride and moisture were the most important chemical variables ( R2 = 42% and 13%, respectively).
AULA—Advanced Virtual Reality Tool for the Assessment of Attention
Authors: Iriarte Yahaira , Diaz-Orueta Unai , Cueto Eduardo , Irazustabarrena Paula , Banterla Flavio , Climent Gema
Published: December 2012

Objective: The present study describes the obtention of normative data for the AULA test, a virtual reality tool designed to evaluate attention problems, especially in children and adolescents. Method: The normative sample comprised 1,272 participants (48.2% female) with an age range from 6 to 16 years ( M = 10.25, SD = 2.83). The AULA test administered to them shows both visual and auditory stimuli, while randomized distractors of ecological nature appear progressively. Results: Variables provided by AULA were clustered in different categories for their posterior analysis. Differences by age and gender were analyzed, resulting in 14 groups, 7 per sex group. Differences between visual and auditory attention were also obtained. Conclusion: Obtained normative data are relevant for the use of AULA for evaluating attention in Spanish children and adolescents in a more ecological way. Further studies will be needed to determine sensitivity and specificity of AULA to measure attention in different clinical populations. (J. of Att. Dis. 2016; 20(6) 542-568)
Dispositional Trait Types of ADHD in Young Children
Authors: Martel Michelle M.
Published: December 2012

Objective: This study evaluated a novel person-centered approach to parsing ADHD heterogeneity using dispositional traits. Method: Participants were one hundred nine 3- to 6-year-olds, and their primary caregivers and day care providers/teachers who completed a multi-informant diagnostic procedure with longitudinal follow-up. Results: Based on latent profile analysis, young children with ADHD could be divided into low control, high surgency, and high negative affect subgroups. The low control and high surgency groups exhibited increased parent- and teacher-rated hyperactive-impulsive and oppositional-defiant disorder (ODD) symptoms. Although the low control group exhibited the worst response inhibition, the high surgency group exhibited the worst working memory. Furthermore, the high surgency group exhibited high aggression and increasing levels of hyperactivity-impulsivity and ODD symptoms over time. Conclusion: A subgroup of young children with ADHD with high surgency may be at particular risk for comorbid psychopathology and longitudinal worsening of symptoms.
The Effects of Solve It! on the Mathematical Word Problem Solving Ability of Adolescents With Autism Spectrum Disorders
Authors: Schaefer Whitby Peggy J.
Published: December 2012

General education placement of students with autism spectrum disorders (ASD) has increased at a rate faster than all other disability categories combined. As more children are diagnosed with ASD and expected to meet the same academic standards as their neurotypical peers, there is a demand for effective educational strategies. Using a multiple-baseline across participants design, seven cognitive strategies and three meta-cognitive strategies from the Solve it! Problem Solving Routine were taught to three adolescents with ASD. Percent of correct responses on word problems improved immediately upon implementation of the intervention. A peer comparison validation strategy was used to compare participants’ accuracy with the class average. All three participants got more problems correct during intervention when compared with their peers; this effect persisted for two participants during maintenance. The impact of the characteristics of ASD on the use of each strategy implemented within the Solve It! Problem Solving Routine is discussed.
A Community-Based, Environmental Chronic Disease Prevention Intervention to Improve Healthy Eating Psychosocial Factors and Behaviors in Indigenous Populations in the Canadian Arctic
Authors: Mead Erin L. , Gittelsohn Joel , Roache Cindy , Corriveau André , Sharma Sangita
Published: December 2012

Diet-related chronic diseases are highly prevalent among indigenous populations in the Canadian Arctic. A community-based, multi-institutional nutritional and lifestyle intervention—Healthy Foods North—was implemented to improve food-related psychosocial factors and behaviors among Inuit and Inuvialuit in four intervention communities (with two comparison communities) in Nunavut and the Northwest Territories, Canada, in 2008. The 12-month program was developed from theory (social cognitive theory and social ecological models), formative research, and a community participatory process. It included an environmental component to increase healthy food availability in local stores and activities consisting of community-wide and point-of-purchase interactive educational taste tests and cooking demonstrations, media (e.g., radio ads, posters, shelf labels), and events held in multiple venues, including recreation centers and schools. The intervention was evaluated using pre- and postassessments with 246 adults from intervention and 133 from comparison communities (311 women, 68 men; mean age 42.4 years; 78.3% retention rate). Outcomes included psychosocial constructs (healthy eating knowledge, self-efficacy, and behavioral intentions), frequency of healthy and unhealthy food acquisition, healthiness of commonly used food preparation methods, and body mass index (kg/m2). After adjustment for demographic, socioeconomic status, and body mass index variables, respondents living in intervention communities showed significant improvements in food-related self-efficacy (β = 0.15, p = .003) and intentions (β = 0.16, p = .001) compared with comparison communities. More improvements from the intervention were seen in overweight, obese, and high socioeconomic status respondents. A community-based, multilevel intervention is an effective strategy to improve psychosocial factors for healthy nutritional behavior change to reduce chronic disease in indigenous Arctic populations.
Copy number variation in pediatric multiple sclerosis
Authors: McElroy JP , Krupp LB , Johnson BA , McCauley JL , Qi Z , Caillier SJ , Gourraud PA , Yu J , Nathanson L , Belman AL , Hauser SL , Waubant E , Hedges DJ , Oksenberg JR
Published: December 2012

Background:

Pediatric onset multiple sclerosis (MS) accounts for 2-4% of all MS. It is unknown whether the disease shares the same underlying pathophysiology found in adult patients or an extreme early onset phenotype triggered by distinct biological mechanisms. It has been hypothesized that copy number variations (CNVs) may result in extreme early onset diseases because CNVs can have major effects on many genes in large genomic regions.

Objectives and methods:

The objective of the current research was to identify CNVs, with a specific focus on de novo CNVs, potentially causing early onset MS by competitively hybridizing 30 white non-Hispanic pediatric MS patients with each of their parents via comparative genomic hybridization (CGH) analysis on the Agilent 1M CGH array.

Results and discussion:

We identified 10 CNVs not overlapping with any CNV regions currently reported in the Database of Genomic Variants (DGV). Fifty-five putatively de novo CNVs were also identified: all but one common in the DGV. We found the single rare CNV was a private variation harboring the SACS gene. SACS mutations cause autosomal-recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) disease. Additional clinical review revealed that the patient with the SACS gene CNV shared some features of both MS and ARSACS.

Conclusions:

This is the first reported study analyzing pediatric MS CNVs. While not yielding causal variation in our initial pediatric dataset, our approach confirmed diagnosis of an ARSACS-like disease in addition to MS in the affected individual, which led to a more complete understanding of the patient’s disease course and prognosis.
Screening for anxiety symptoms and social desirability in children and adolescents living with chronic illnesses in Jordan
Authors: Arabiat Diana H , Jabery Mohammad Al , Wardam Lina
Published: December 2012

This research aims to investigate the rate and nature of anxiety symptoms in a group of children and adolescents living with chronic illnesses in Jordan, and their relation to social desirability in a cultural sample not previously researched. Using the Revised Children’s Manifest Anxiety Scale (R-CMAS), anxiety and social desirability data were obtained from 114 children diagnosed with chronic illnesses and 162 healthy control participants. Based on children’s self-report, participants were categorized according to their adaptive style paradigm as either high anxious, low anxious, or repressor. It was proposed that children who score high on social desirability and low on anxiety are repressors. The prevalence of these categories was compared across the two groups. Anxiety was reported in 9.64 percent of the chronic illnesses and 12.34 percent of the healthy peers. Using the data obtained in the present study, the rate and nature of anxiety in children with chronic illnesses were lower for children in Jordan when compared to previous studies. However, social desirability values were similar to those established in Western societies suggesting a significantly higher percentage of children identified as repressors in children with long-term illnesses. These results supported the hypothesis regarding the relationship between social desirability and expressed anxiety symptoms.
Obesity in childhood
Authors: Ernst Manon AB , Gerver Willem JM , Simons Michelle YG , Jansen M W J , Hoeven Mark AHBM van der , Zimmermann Luc JI
Published: December 2012

The concern about obesity in children has increased worldwide. The question arises, whether this trend to obesity already starts during the prenatal period and to what extent the increase of weight is related to a secular trend in height.

For neonatal data, three studies, performed in The Netherlands, with neonatal data of birth weights were compared. For postnatal data, weight, height and body mass index (BMI) of two nationwide studies, performed in the Netherlands, were analyzed.

No differences between birth weights were found between 1970 and 2007. In postnatal data a trend of increasing weight and BMI in both boys and girls starts from five years onwards. The secular trend in height starts from the age of two and a half years onward in both boys and girls. The increase in weight is more pronounced than the increase in height.

No prenatal secular trend could be detected in The Netherlands. Postnatal, the secular trend is obvious for weight, height and BMI. The increase in skewness of the weight distribution may be ascribed to a metabolic disturbance of the population.
Access to patient-centered medical home among Ohio’s Children with Special Health Care Needs
Authors: Conrey Elizabeth J , Seidu Dazar , Ryan Norma J , Chapman DJ Sam
Published: December 2012

Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005–2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination.
A Youth Justice Approach to the Street Children Phenomenon in Brazil: A Critical Review
Authors: Rosenblatt Fernanda Fonseca
Published: December 2012

Drawing on the work of various researchers and on the findings of a recently published national survey on street children, this article first presents a contemporary and systematic review of the street children phenomenon in Brazil. It then turns to recommendations set forth by international experts in the field, particularly in search of ideas on how to make the Brazilian youth justice system more sensitive to, and more efficacious for, this population. Notwithstanding its focus on the Brazilian context, since street children are indisputably a global phenomenon, this article has an inherent universal appeal.
Accuracy of Calendar-Based Methods for Assigning Menstrual Cycle Phase in Women
Authors: Wideman Laurie , Montgomery Melissa M. , Levine Beverly J. , Beynnon Bruce D. , Shultz Sandra J.
Published: December 2012

Background:

Sex steroid hormone fluctuations during the menstrual cycle are considered a risk factor for noncontact anterior cruciate ligament injuries.

Objective:

To determine whether self-reported menstrual history data can be used to accurately categorize menstrual cycle events using calendar-based counting methods.

Study Design:

Descriptive laboratory study.

Methods:

Seventy-three women completed a menstrual history questionnaire and submitted to blood sampling for the first 6 days of menses and 8 to 10 days after a positive ovulation test over 2 consecutive months. Frequency counts determined whether appropriate criterion hormone (progesterone) levels were achieved at predefined calendar days.

Results:

For the criterion of progesterone >2 ng/mL, 18% and 59% of women attained it when counting forward 10 to 14 days after the onset of menses and counting back 12 to 14 days from the end of the cycle, respectively. Most women (76%) attained the criterion for ovulation 1 to 3 days after a positive urinary ovulation test. Regardless of the counting method employed, the criterion of progesterone >4.5 ng/mL for identifying midluteal phase was attained in 67% of cases. Serial blood sampling for 3 to 5 days after the positive urinary ovulation test captured 68% to 81% of the hormone values indicative of ovulation and 58% to 75% indicative of the luteal phase.

Conclusion:

These data suggest that self-reported menstrual history and calendar-based counting methods should not be used alone if accurate identification of ovulation is essential. A urinary ovulation test and serial blood samples for verification of progesterone postovulation enhance the proper identification of menstrual cycle events.

Clinical Relevance:

Given the cost of serial blood sampling on numerous days, the use of urinary ovulation kits and strategically selected serial blood sampling could significantly reduce participant burden and provide cost-effective measures for clinical studies related to anterior cruciate ligament injury epidemiology.
Ontogeny of erythroid gene expression
Authors: Kingsley Paul D. , Greenfest-Allen Emily , Frame Jenna M. , Bushnell Timothy P. , Malik Jeffrey , McGrath Kathleen E. , Stoeckert Christian J. , Palis James
Published: December 2012

Key Points

Comparative global gene expression analysis of primary murine primitive, fetal definitive, and adult definitive erythroid precursors. Primitive erythroblasts contain and accumulate high ROS levels and uniquely express the H2O2 transporting aquaporins 3 and 8.
Some new Gronwall-Bellman type nonlinear dynamic inequalities containing integration on infinite intervals on time scales
Authors: Zheng Bin , Feng Qinghua , Meng Fanwei , Zhang Yaoming
Published: December 2012

In this paper, some new Gronwall-Bellman-type nonlinear dynamic inequalities containing integration on infinite intervals on time scales are established, which provides new bounds on unknown functions and can be used as a handy tool in the qualitative analysis of solutions of certain dynamic equations on time scales.

MSC:26E70, 26D15, 26D10.
Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State
Authors: Reed Peter , Conrad Douglas A , Hernandez Susan E , Watts Carolyn , Marcus-Smith Miriam
Published: December 2012

Background

Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance.

Methods

We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus.

Results

Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation.

Conclusions

Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets and addressing conditions for innovation.
A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial
Authors: Pichierri Giuseppe , Murer Kurt , de Bruin Eling D
Published: December 2012

Background

Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults. This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming. The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults.

Methods

Thirty-one participants (mean age ± SD: 86.2 ± 4.6 years), residents of two Swiss hostels for the aged, were randomly assigned to either the dance group (n = 15) or the control group (n = 16). The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming. The control group performed only the strength and balance exercises during this period. Outcome measures were foot placement accuracy, gait performance under single and dual task conditions, and falls efficacy.

Results

After the intervention between-group comparison revealed significant differences for gait velocity (U = 26, P = .041, r = .45) and for single support time (U = 24, P = .029, r = .48) during the fast walking dual task condition in favor of the dance group. No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy.

Conclusions

There was a significant interaction in favor of the dance video game group for improvements in step time. Significant improved fast walking performance under dual task conditions (velocity, double support time, step length) was observed for the dance video game group only. These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program.

Trial registration

This trial has been registered under ISRCTN05350123 (http://www.controlled-trials.com)
The STAR trial protocol: a randomised multi-stage phase II/III study of Sunitinib comparing temporary cessation with allowing continuation, at the time of maximal radiological response, in the first-line treatment of locally advanced/metastatic Renal Cancer
Authors: Collinson Fiona J , Gregory Walter M , McCabe Chris , Howard Helen , Lowe Catherine , Potrata DrBarbara , Tubeuf Sandy , Hanlon Pat , McParland Lucy , Wah T , Selby Peter J , Hewison Jenny , Brown Julia , Brown Janet
Published: December 2012

Background

Over recent years a number of novel therapies have shown promise in advanced renal cell carcinoma (RCC). Internationally the standard of care of first-line therapy is sunitinib™, after a clear survival benefit was demonstrated over interferon-α. Convention dictates that sunitinib is continued until evidence of disease progression, assuming tolerability, although there is no evidence that this approach is superior to intermittent periods of treatment. The purpose of the STAR trial is to compare the standard treatment strategy (conventional continuation strategy, CCS) with a novel drug free interval strategy (DFIS) which includes planned treatment breaks.

Methods/Design

The STAR trial is an NIHR HTA-funded UK pragmatic randomised phase II/III clinical trial in the first-line treatment of advanced RCC. Participants will be randomised (1:1) to either a sunitinib CCS or a DFIS. The overall aim of the trial is to determine whether a DFIS is non-inferior, in terms of 2-year overall survival (OS) and quality adjusted life years (QALY) (averaged over treatment and follow up), compared to a CCS. The QALY primary endpoint was selected to assess whether any detriment in terms of OS could be balanced with improvements in quality of life (QoL). This is a complex trial with a number of design challenges, and to address these issues a feasibility stage is incorporated into the trial design. Predetermined recruitment (stage A) and efficacy (stage B) intermediary endpoints must be met to allow continuation to the overall phase III trial (stage C). An integral qualitative patient preference and understanding study will occur alongside the feasibility stage to investigate patients’ feelings regarding participation or non-participation in the trial.

Discussion

The optimal duration of continuing sunitinib in advanced RCC is unknown. Novel targeted therapies do not always have the same constraints to treatment duration as standard chemotherapeutic agents and currently there are no randomised data comparing different treatment durations. Incorporating planned treatment breaks has the potential to improve QoL and cost effectiveness, hopefully without significant detriment on OS, as has been demonstrated in other cancer types with other treatments.

Trial Registration

Controlled-trials.com ISRCTN 06473203
Spontaneous malignant glaucoma in a patient with patent peripheral iridotomy
Authors: Premsenthil Mallika , Salowi Mohamad Aziz , Siew Chong Min , ak Gudom Intan , Kah Tan
Published: December 2012

Background

To report a case of spontaneous malignant glaucoma in an Asian female. To propose the term “positive vitreous pressure glaucoma” to reflect the pathophysiology, treatment and prognosis of the condition.

Case presentation

A 56-year old Chinese female was diagnosed of primary angle closure glaucoma and had bilateral laser peripheral iridotomy one year ago. She presented with spontaneous onset of malignant glaucoma involving the left eye. The condition was treated successfully; the final best corrected visual acuity was 0.67 (decimal notation).

Conclusion

This case highlights that acute angle closure attack can occur in an eye with patent peripheral iridotomy. Early recognition and treatment is essential for good visual prognosis.
Estimation of human trunk movements by wearable strain sensors and improvement of sensor’s placement on intelligent biomedical clothes
Authors: Tormene Paolo , Bartolo Michelangelo , De Nunzio Alessandro M , Fecchio Federica , Quaglini Silvana , Tassorelli Cristina , Sandrini Giorgio
Published: December 2012

Background

The aim of this study was to evaluate the concept of a wearable device and, specifically: 1) to design and implement analysis procedures to extract clinically relevant information from data recorded using the wearable system; 2) to evaluate the design and placement of the strain sensors.

Methods

Different kinds of trunk movements performed by a healthy subject were acquired as a comprehensive data set of 639 multivariate time series and off-line analyzed. The space of multivariate signals recorded by the strain sensors was reduced by means of Principal Components Analysis, and compared with the univariate angles contemporaneously measured by an inertial sensor.

Results

Very high correlation between the two kinds of signals showed the usefulness of the garment for the quantification of the movements’ range of motion that caused at least one strain sensor to lengthen or shorten accordingly. The repeatability of signals was also studied. The layout of a next garment prototype was designed, with additional strain sensors placed across the front and hips, able to monitor a wider set of trunk motor tasks.

Conclusions

The proposed technologies and methods would offer a low-cost and unobtrusive approach to trunk motor rehabilitation.
Metals and trace element concentrations in breast milk of first time healthy mothers: a biological monitoring study
Authors: Björklund Karin Ljung , Vahter Marie , Palm Brita , Grandér Margaretha , Lignell Sanna , Berglund Marika
Published: December 2012

Background

Breast milk is the best source of nutrition for the newborn infant. However, since all infants cannot be breast-fed, there is a need for background data for setting adequate daily intakes. Previously, concentration data on major essential elements and some toxic elements in breast milk, based on different analytical techniques, have been published. There is no recent study on a large number of metals and trace elements in breast milk, using a sensitive analytical method for determination of low element concentrations.

Methods

Breast milk concentrations of 32 metals and elements in early lactation (days 14-21) were determined in a random sample of first time Swedish mothers (n = 60) using inductively coupled plasma mass spectrometry (ICPMS).

Results

There were small inter-individual concentration variations in the macroelements Ca, K, Mg, P and S, and striking similarities across studies and over time, supporting a tight regulation of these elements in breast milk. Large inter-individual and over time differences were detected for Na concentrations, which may reflect an increase in salt consumption in Swedish women. Large inter-individual differences were also detected for the microelements Co, Cr, Mn and Mo, and the toxic metals As, Cd, Pb, Sb and V. Arsenic and B were positively correlated with fish consumption, indicating influence of maternal intake on breast milk concentrations. Observed differences in breast milk element concentrations across studies and over time could be attributed to the timing of sampling and a general decline over time of lactation (Cu, Fe, Mo, Zn), a possible lack of regulation of certain elements in breast milk (As, B, Co, Mn, Se) and time trends in environmental exposure (Pb), or in some cases to differences in analytical performance (Cr, Fe).

Conclusions

This study provides reliable updated information on a number of metals and elements in breast milk, of which some have not previously been reported.
An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion
Authors: Hanvoravongchai Piya , Chavez Irwin , Rudge James W , Touch Sok , Putthasri Weerasak , Chau PhamNgoc , Phommasack Bounlay , Singhasivanon Pratap , Coker Richard ,   the AsiaFluCap Project Consortium
Published: December 2012

Background

There is increasing perception that countries cannot work in isolation to militate against the threat of pandemic influenza. In the Greater Mekong Subregion (GMS) of Asia, high socio-economic diversity and fertile conditions for the emergence and spread of infectious diseases underscore the importance of transnational cooperation. Investigation of healthcare resource distribution and inequalities can help determine the need for, and inform decisions regarding, resource sharing and mobilisation.

Methods

We collected data on healthcare resources deemed important for responding to pandemic influenza through surveys of hospitals and district health offices across four countries of the GMS (Cambodia, Lao PDR, Thailand, Vietnam). Focusing on four key resource types (oseltamivir, hospital beds, ventilators, and health workers), we mapped and analysed resource distributions at province level to identify relative shortages, mismatches, and clustering of resources. We analysed inequalities in resource distribution using the Gini coefficient and Theil index.

Results

Three quarters of the Cambodian population and two thirds of the Laotian population live in relatively underserved provinces (those with resource densities in the lowest quintile across the region) in relation to health workers, ventilators, and hospital beds. More than a quarter of the Thai population is relatively underserved for health workers and oseltamivir. Approximately one fifth of the Vietnamese population is underserved for beds and ventilators. All Cambodian provinces are underserved for at least one resource. In Lao PDR, 11 percent of the population is underserved by all four resource items. Of the four resources, ventilators and oseltamivir were most unequally distributed. Cambodia generally showed higher levels of inequalities in resource distribution compared to other countries. Decomposition of the Theil index suggests that inequalities result principally from differences within, rather than between, countries.

Conclusions

There is considerable heterogeneity in healthcare resource distribution within and across countries of the GMS. Most inequalities result from within countries. Given the inequalities, mismatches, and clustering of resources observed here, resource sharing and mobilization in a pandemic scenario could be crucial for more effective and equitable use of the resources that are available in the GMS.
Current status of health technology reassessment of non-drug technologies: survey and key informant interviews
Authors: Leggett Laura E , Mackean Gail , Noseworthy Tom W , Sutherland Lloyd , Clement Fiona
Published: December 2012

Background

Health Technology Reassessment (HTR) is a structured, evidence-based assessment of the clinical, social, ethical and economic effects of a technology currently used in the health care system, to inform optimal use of that technology in comparison to its alternatives. Little is known about current international HTR practices. The objective of this research was to summarize experience-based information gathered from international experts on the development, initiation and implementation of a HTR program.

Methods

A mixed methods approach, using a survey and in-depth interviews, was adopted. The survey covered 8 concepts: prioritization/identification of potentially obsolete technologies; program development; implementation; mitigation; program championing; stakeholder engagement; monitoring; and reinvestment. Members of Health Technology Assessment International (HTAi) and the International Network of Agencies for Health Technology Assessment (INAHTA) formed the sampling frame. Participation was solicited via email and the survey was administered online using SurveyMonkey. Survey results were analyzed using descriptive statistics. To gather more in-depth knowledge, semi-structured interviews were conducted among organizations with active HTR programs. Interview questions were developed using the same 8 concepts. The hour-long interviews were recorded, transcribed and analyzed using constant comparative analysis.

Results

Ninety-five individuals responded to the survey: 49 were not discussing HTR, 21 were beginning to discuss HTR, nine were imminently developing a program, and 16 participants had programs and were completing reassessments. The survey results revealed that methods vary widely and that although HTR is a powerful tool, it is currently not being used to its full potential. Of the 16 with active programs, nine agreed to participate in follow-up interviews. Interview participants identified early and extensive stakeholder engagement as the most important factors for success. A lack of top-down support and financial and human resources are inhibiting program development.

Discussion

HTR is in its infancy. Although HTRs are being conducted, there are no standardized approaches. However, much can be learned from current international work. Future work should focus on developing a comprehensive methodology, reporting the processes of reassessments and sharing successes and challenges in a common platform.
Dopamine Regulation of Gonadotropin-Releasing Hormone Neuron Excitability in Male and Female Mice
Authors: Liu Xinhuai , Herbison Allan E.
Published: December 2012

Numerous in vivo studies have shown that dopamine is involved in the regulation of LH secretion in mammals. However, the mechanisms through which this occurs are not known. In this study, we used green fluorescent protein-tagged GnRH neurons to examine whether and how dopamine may modulate the activity of adult GnRH neurons in the mouse. Bath-applied dopamine (10-80 μm) potently inhibited the firing of approximately 50% of GnRH neurons. This resulted from direct postsynaptic inhibitory actions through D1-like, D2-like, or both receptors. Further, one third of GnRH neurons exhibited an increase in their basal firing rate after administration of SCH23390 (D1-like antagonist) and/or raclopride (D2-like antagonist) indicating tonic inhibition by endogenous dopamine in the brain slice. The role of dopamine in presynaptic modulation of the anteroventral periventricular nucleus (AVPV) γ-aminobutyric acid/glutamate input to GnRH neurons was examined. Exogenous dopamine was found to presynaptically inhibit AVPV-evoked γ-aminobutyric acid /glutamate postsynaptic currents in about 50% of GnRH neurons. These effects were, again, mediated by both D1- and D2-like receptors. Neither postsynaptic nor presynaptic actions of dopamine were found to be different between diestrous, proestrous, and estrous females, or males. Approximately 20% of GnRH neurons were shown to receive a dopaminergic input from AVPV neurons in male and female mice. Together, these observations show that dopamine is one of the most potent inhibitors of GnRH neuron excitability and that this is achieved through complex pre- and postsynaptic actions that each involve D1- and D2-like receptor activation.
Anachronisms of Authority: Authorship, Exchange Value, and David Foster Wallace’s The Pale King
Authors: Veggian Henry
Published: December 2012

“Anachronisms of Authority: Authorship and Exchange Value in David Foster Wallace’s The Pale King” considers the materiality of the printed book where postmodern theories of culture intersect with the contemporary economics of the print publishing, digital publishing, and antiquarian book industries. The essay elaborates Karl Marx’s writings on exchange value in relation to more recent works of historical-materialist writing by Fredric Jameson, Terry Cochran, and others to build a frame for a reconsideration of Wallace’s incomplete and posthumous novel, thereby proposing a premise for renewed analyses of the contemporary writer and the printed book.