bluuebunny/crossref_metadata_2025 huggingface dataset:
The Benefit of Force Feedback in Surgery: Examination of Blunt Dissection
Authors: Wagner Christopher R. , Stylopoulos Nicholas , Jackson Patrick G. , Howe Robert D.
Published: May 2007

Force feedback is widely assumed to enhance performance in robotic surgery, but its benefits have not yet been systematically assessed. In this study we examine the effects of force feedback on a blunt dissection task. Twenty subjects used a telerobotic system to expose an artery in a synthetic model while viewing the operative site with a video laparoscope. Subjects were drawn from a range of surgical backgrounds, from inexperienced to attending surgeons. Performance was compared between three force feedback gains: 0% (no force feedback), 37%, and 75%. The absence of force feedback increased the average force magnitude applied to the tissue by at least 50%, and increased the peak force magnitude by at least 100%. The number of errors that damage tissue increased by over a factor of 3. The rate and precision of dissection were not significantly enhanced with force feedback. These results hold across all levels of previous surgical experience. We hypothesize that force feedback is helpful in this blunt dissection task because the artery is stiffer than the surrounding tissue. This mechanical contrast serves to constrain the subject's hand from commanding inappropriate motions that generate large forces.
Perceived Instability of Virtual Haptic Texture: III. Effect of Update Rate
Authors: Choi Seungmoon , Tan Hong Z.
Published: May 2007

This study investigates the effect of update rate on the quality of haptic virtual textures, with the goal to develop a guideline for choosing an optimal update rate for haptic texture rendering. Two metrics, control stability and perceived quality of the virtual haptic texture, were used. For control stability, we examined the effect of update rate on the “buzzing” of virtual haptic textures. For perceived quality, we measured the discriminability of virtual haptic textures rendered at different update rates. Our study indicates that update rates much higher than the conventional 1 kHz are needed in order to achieve a stable rendering of “clean and hard” textured surfaces. We also found that our ability to distinguish textures rendered with different update rates depends on whether the virtual textures contain perceived instability. Based on these results, we provide a general guideline for selecting an optimal update rate for rendering virtual textured surfaces.
MACVE: A Mobile Agent Based Framework for Large-Scale Collaborative Virtual Environments
Authors: Zhang Liang , Lin Qingping
Published: May 2007

The Collaborative Virtual Environment (CVE) is a promising technology which provides an online shared virtual world for geographically dispersed people to interact with each other. However, the scalability of existing CVE systems is limited due to the constraints in processing power and network speed of each participating host. In this paper, a mobile agent based framework for large-scale CVE, MACVE, is proposed to support a large number of concurrent participants in a CVE with a large amount of evolving virtual entities. In MACVE, the CVE system is decomposed into a group of collaborative mobile agents, each of which is responsible for an independent system task. These agents can migrate or clone dynamically at any suitable participating host including traditional servers and qualified user hosts to avoid the potential bottleneck, which can improve the scalability of CVE. Our prototype system has demonstrated the feasibility of the proposed framework.
Interactions between Simulated Tropical Cyclones and an Environment with a Variable Coriolis Parameter
Authors: Ritchie Elizabeth A. , Frank William M.
Published: May 2007

Numerical simulations of tropical cyclones are performed to examine the effects of a variable Coriolis parameter on the structure and intensity of hurricanes. The simulations are performed using the nonhydrostatic fifth-generation Pennsylvania State University–National Center for Atmospheric Research Mesoscale Model using a 5-km fine mesh and fully explicit representation of moist processes. When a variable Conolis parameter ( f ) environment is applied to a mature tropical cyclone, a persistent north-northwesterly shear develops over the storm center as a result of an interaction between the primary circulation of the storm and the gradient in absolute vorticity. As a result, the variable-f storm quickly develops a persistent wavenumber-1 asymmetry in its inner-core structure with upward motion and rainfall concentrated on the left side of the shear looking downshear, in agreement with earlier studies. In comparison, the constant-f storm develops weak transient asymmetries in structure that are only partially related to a weak vertical wind shear. As a result, it is found that the tropical cyclone with variable f intensifies slightly more slowly than that with constant f, and reaches a final intensity that is about 5 mb weaker. It is argued that this “beta shear” is not adequately represented in large-scale analyses and so does not figure into calculations of environmental shear. Although the effect of the beta shear on the tropical cyclone intensity seems small by itself, when combined with the environmental shear it can produce a large net shear or it can reduce an environmental shear below the apparent threshold to impact storm intensity. If this result proves to be generally true, then the presence of an additional overlooked beta shear may well explain differences in the response of tropical cyclone intensification to westerly versus easterly shear regimes.
Kinematic Observations of Misocyclones along Boundaries during IHOP
Authors: Marquis James N. , Richardson Yvette P. , Wurman Joshua M.
Published: May 2007

During the International H2O Project, mobile radars collected high-resolution data of several 0.5–2-km-wide vertically oriented vortices (or misocyclones) along at least five mesoscale airmass boundaries. This study analyzes the properties of the misocyclones in three of these datasets—3, 10, and 19 June 2002—to verify findings from finescale numerical models and other past observations of misocyclones and to further the understanding of the role that they play in the initiation of deep moist convection and nonsupercell tornadoes. Misocyclones inflect or disjoint the swath of low-level convergence along each boundary to varying degrees depending on the size of their circulations. When several relatively large misocyclones are next to each other, the shape of low-level convergence along each boundary is arranged into a staircase pattern. Mergers of misocyclones are an important process in the evolution of the vorticity field, as a population of small vortices consolidates into a smaller number of larger ones. Additionally, merging misocyclones may affect the mixing of thermodynamic fields in their vicinity when the merger axis is perpendicular to the boundary. Misocyclones interact with linear and cellular structures in the planetary boundary layers (PBLs) of the air masses adjacent to each boundary. Cyclonic low-level vertical vorticity generated by both types of structures makes contact with each boundary and sometimes is incorporated into preexisting misocyclones. Intersections of either type of PBL structure with the boundary result in strengthened pockets of low-level convergence and, typically, strengthened misocyclones.
Comparison of 10-m Wind Forecasts from a Regional Area Model and QuikSCAT Scatterometer Wind Observations over the Mediterranean Sea
Authors: Accadia Christophe , Zecchetto Stefano , Lavagnini Alfredo , Speranza Antonio
Published: May 2007

Surface wind forecasts from a limited-area model [the Quadrics Bologna Limited-Area Model (QBOLAM)] covering the entire Mediterranean area at 0.1° grid spacing are verified against Quick Scatterometer (QuikSCAT) wind observations. Only forecasts within the first 24 h in coincidence with satellite overpasses are used. Two years of data, from 1 October 2000 to 31 October 2002, have been considered, allowing for an adequate statistical assessment under different wind conditions. This has been carried out by analyzing the fields of the mean wind vectors, wind speed bias, correlation, difference standard deviation, steadiness, gustiness, and mean wind direction difference, in order to investigate spatial variability. Statistics have been computed on a seasonal basis. A comparison of satellite and forecast winds with measurements from three buoys was also performed. Some critical areas of the Mediterranean Sea where wind forecast quality is lower than average have been identified. Such areas correspond to semienclosed basins surrounded by important orography and to small regions at the lee side of the main islands. In open-sea regions the model underestimates wind strength from about 0.5 m s−1 in spring and summer to 1.0 m s−1 in winter, as evidenced by the existing biases against scatterometer data. Also, a wind direction bias (scatterometer minus model) generally between 5° and 15° exists. A survey of the identified and likely sources of forecast error is performed, indicating that orography representation plays an important role. Numerical damping is identified as a likely factor reducing forecast wind strength. The need for a correction scheme is envisaged to provide more accurate forcing for numerical sea state forecasting models, wind energy evaluation, and latent and/or sensible heat exchanges.
Urban Canopy Modeling of the New York City Metropolitan Area: A Comparison and Validation of Single- and Multilayer Parameterizations
Authors: Holt Teddy , Pullen Julie
Published: May 2007

High-resolution numerical simulations are conducted using the Coupled Ocean–Atmosphere Mesoscale Prediction System (COAMPS)1 with two different urban canopy parameterizations for a 23-day period in August 2005 for the New York City (NYC) metropolitan area. The control COAMPS simulations use the single-layer Weather Research and Forecasting (WRF) Urban Canopy Model (W-UCM) and sensitivity simulations use a multilayer urban parameterization based on Brown and Williams (BW-UCM). Both simulations use surface forcing from the WRF land surface model, Noah, and hourly sea surface temperature fields from the New York Harbor and Ocean Prediction System model hindcast. Mean statistics are computed for the 23-day period from 5 to 27 August (540-hourly observations) at five Meteorological Aviation Report stations for a nested 0.444-km horizontal resolution grid centered over the NYC metropolitan area. Both simulations show a cold mean urban canopy air temperature bias primarily due to an underestimation of nighttime temperatures. The mean bias is significantly reduced using the W-UCM (−0.10°C for W-UCM versus −0.82°C for BW-UCM) due to the development of a stronger nocturnal urban heat island (UHI; mean value of 2.2°C for the W-UCM versus 1.9°C for the BW-UCM). Results from a 24-h case study (12 August 2005) indicate that the W-UCM parameterization better maintains the UHI through increased nocturnal warming due to wall and road effects. The ground heat flux for the W-UCM is much larger during the daytime than for the BW-UCM (peak ∼300 versus 100 W m−2), effectively shifting the period of positive sensible flux later into the early evening. This helps to maintain the near-surface mixed layer at night in the W-UCM simulation and sustains the nocturnal UHI. In contrast, the BW-UCM simulation develops a strong nocturnal stable surface layer extending to approximately 50–75-m depth. Subsequently, the nocturnal BW-UCM wind speeds are a factor of 3–4 less than W-UCM with reduced nighttime turbulent kinetic energy (average < 0.1 m2 s−2). For the densely urbanized area of Manhattan, BW-UCM winds show more dependence on urbanization than W-UCM. The decrease in urban wind speed is most prominent for BW-UCM both in the day- and nighttime over lower Manhattan, with the daytime decrease generally over the region of tallest building heights while the nighttime decrease is influenced by both building height as well as urban fraction. In contrast, the W-UCM winds show less horizontal variation over Manhattan, particularly during the daytime. These results stress the importance of properly characterizing the urban morphology in urban parameterizations at high resolutions to improve the model’s predictive capability.
Short-Range Probabilistic Quantitative Precipitation Forecasts over the Southwest United States by the RSM Ensemble System
Authors: Yuan Huiling , Mullen Steven L. , Gao Xiaogang , Sorooshian Soroosh , Du Jun , Juang Hann-Ming Henry
Published: May 2007

The National Centers for Environmental Prediction (NCEP) Regional Spectral Model (RSM) is used to produce twice-daily (0000 and 1200 UTC), high-resolution ensemble forecasts to 24 h. The forecasts are performed at an equivalent horizontal grid spacing of 12 km for the period 1 November 2002 to 31 March 2003 over the southwest United States. The performance of 6-h accumulated precipitation is assessed for 32 U.S. Geological Survey hydrologic catchments. Multiple accuracy and skill measures are used to evaluate probabilistic quantitative precipitation forecasts. NCEP stage-IV precipitation analyses are used as “truth,” with verification performed on the stage-IV 4-km grid. The RSM ensemble exhibits a ubiquitous wet bias. The bias manifests itself in areal coverage, frequency of occurrence, and total accumulated precipitation over every region and during every 6-h period. The biases become particularly acute starting with the 1800–0000 UTC interval, which leads to a spurious diurnal cycle and the 1200 UTC cycle being more adversely affected than the 0000 UTC cycle. Forecast quality and value exhibit marked variability over different hydrologic regions. The forecasts are highly skillful along coastal California and the windward slopes of the Sierra Nevada Mountains, but they generally lack skill over the Great Basin and the Colorado basin except over mountain peaks. The RSM ensemble is able to discriminate precipitation events and provide useful guidance to a wide range of users over most regions of California, which suggests that mitigation of the conditional biases through statistical postprocessing would produce major improvements in skill.
High-Resolution Observations of the Trowal–Warm-Frontal Region of Two Continental Winter Cyclones
Authors: Grim Joseph A. , Rauber Robert M. , Ramamurthy Mohan K. , Jewett Brian F. , Han Mei
Published: May 2007

This paper compares the structure of the trough of warm air aloft (trowal)–warm-frontal region of two continental wintertime cyclones. The cyclones were observed over the central Great Lakes region during the Lake-Induced Convection Experiment/Snowband Dynamics Project field campaign. The cyclones had different origins, with the first forming east of the Colorado Rockies and the second forming over the Gulf of Mexico. They were associated with different upper-level flow regimes, one located just north of a nearly zonal jet and the other located just west of a nearly meridional jet. Both storms produced heavy swaths of snow across the states of Illinois, Wisconsin, and Michigan. High-resolution observations of frontal structure were made during flights of the National Center for Atmospheric Research Electra aircraft using dropsondes and the Electra Doppler Radar tail radar system. The high-resolution observations suggest a different arrangement of air masses in the trowal region compared with the classical occlusion model, where the trowal axis forms at the intersection of a warm front and a cold front that has overtaken and subsequently ascended the warm front. In both cyclones dry air intruded over the warm front, isolating the warm, moist airflow within the trowal airstream. Very sharp moisture gradients were present at the leading edge of the dry air in both cyclones. In each case, relative humidity differences of over 50% were observed over distances of 10–20 km. The thermal gradient near the leading edge of the dry air in one cyclone was diffuse, so that the moist–dry boundary could best be characterized as an upper-level humidity front. In the other cyclone, the thermal gradient was sharper and aligned with the moisture boundary and was best characterized as a cold front aloft. The analyses suggest that the classical conceptual model of the trowal, at least in some cyclones such as the two illustrated here, needs to be revised to include the possibility that the warm moist airstream aloft may sometimes be bounded on its south side by an upper-level front rather than a surface-based cold front. Since the two cyclones discussed here had different origins, tracks, and flow regimes, the similarity of their structure suggests that these features may be common.
Further Results on the Sensitivity of Simulated Storm Precipitation Efficiency to Environmental Temperature
Authors: Cohen Charles , McCaul Eugene W.
Published: May 2007

A method is devised for diagnosing the condensation rate in simulations using the Regional Atmospheric Modeling System (RAMS) model, where ice-liquid water potential temperature is a prognostic variable and an iterative procedure must be used to diagnose the temperature and water vapor mixing ratio from ice-liquid water potential temperature. The condensation rate is then used to compute the microphysical precipitation efficiency (PE), which is defined as the ratio of the precipitation rate at the ground to the sum of the condensation and deposition rates. Precipitation efficiency is compared for pairs of numerical simulations, initialized with soundings having all key environmental parameters identical except for their temperature. The authors’ previous study showed that with a colder initial sounding, the conversion of cloud water to precipitation is relatively inefficient, but updrafts are stronger and there is relatively less evaporation of precipitation, with the net result being a larger climatological PE in the colder environment. Here, the authors consider the time lag between condensation and precipitation and demonstrate that in calculating a properly lagged microphysical PE, the combined effect of the decreased production of precipitation and the decreased evaporation is that the temperature of the initial soundings has no significant influence on the microphysical PE. To the authors’ knowledge, this is the first time that the lag has been used to compute PE. These results concerning PE are relevant only to deep convection.
Numerical Simulations of the Effects of Coastlines on the Evolution of Strong, Long-Lived Squall Lines
Authors: Lericos Todd P. , Fuelberg Henry E. , Weisman Morris L. , Watson Andrew I.
Published: May 2007

This study develops conceptual models of how a land–water interface affects the strength and structure of squall lines. Two-dimensional numerical simulations using the Advanced Regional Prediction System model are employed. Five sets of simulations are performed, each testing eight wind shear profiles of varying strength and depth. The first set of simulations contains a squall line but no surface or radiation physics. The second and third sets do not contain a squall line but include surface and radiation physics with a land surface on the right and a water surface on the left of the domain. The land is either warmer or cooler than the sea surface. These three simulations provide a control for later simulations. Finally, the remaining two simulation sets examine squall-line interaction with a relatively cool or warm land surface. The simulations document the thermodynamic and shear characteristics of squall lines interacting with the coastline. Results show that the inclusion of a land surface did not sufficiently affect the thermodynamic properties ahead of the squall line to change its overall structure. Investigation of ambient shear ahead of the squall line revealed that the addition of either warm or cool land reduced the strength of the net circulation in the inflow layer as measured by ambient shear. The amount of reduction in shear was found to be directly proportional to the depth and strength of the original shear layer. For stronger and deeper shears, the reduction in shear is sufficiently great that the buoyancy gradient circulation at the leading edge of the cold pool is no longer in balance with the shear circulation leading to changes in squall-line updraft structure. The authors hypothesize two ways by which a squall line might respond to passing from water to land. The weaker and more shallow the ambient shear, the greater likelihood that the squall-line structure remains unaffected by this transition. Conversely, the stronger and deeper the shear, the greater likelihood that the squall line changes updraft structure from upright/downshear to upshear tilted.
A Convective Line with Leading Stratiform Precipitation from BAMEX
Authors: Storm Brandon A. , Parker Matthew D. , Jorgensen David P.
Published: May 2007

On 31 May 2003, a front-fed convective line with leading stratiform precipitation (FFLS) was observed during the Bow Echo and Mesoscale Convective Vortex Experiment (BAMEX). The high-resolution BAMEX measurements provided one of the first opportunities to thoroughly observe the characteristics of an FFLS system. The 31 May system had an overturning updraft during its early stages, and produced leading stratiform precipitation. As the system matured, a jump updraft developed and the system began to produce trailing stratiform precipitation. It appears that this transition was facilitated by a local decrease in the low-level line-perpendicular vertical wind shear over time, as well as an increase in the surface cold pool’s strength. The BAMEX data further help to address the question of how FFLS systems can be long lived when their inflow passes through the line-leading precipitation: preline soundings suggest a destabilization mechanism resulting from the vertical profile of cooling within the leading stratiform precipitation. This destabilization also helps to explain the 31 May convective system’s persistence in an environment with very low CAPE.
Here, There, and Everywhere: Place Branding and Gastronomical Globalization in a Macromarketing Perspective
Authors: Askegaard Søren , Kjeldgaard Dannie
Published: May 2007

In this article, the authors discuss the role branding can play in regional development in the context of the global cultural economy. They base their discussion on a set of studies of various initiatives having in common the aim of establishing the island of Funen, Denmark, as a region of particular gastronomic quality and competence. The article illustrates how processes of globalization not only result in the dissolving of local cultures by homogenizing forces but also enable the construction of places by way of marketing. In that way, the authors show that marketing not only represents a homogenization of culture through global corporate business but also that the principles of marketing and branding can be used in the service of creating sustainable small-scale production-consumption relations and, therefore, local cultural sustainability.
Food Marketing and Obesity in Developing Countries: Analysis, Ethics, and Public Policy
Authors: Witkowski Terrence H.
Published: May 2007

Obesity and the chronic diseases with which it is associated constitute a serious global health problem that will rapidly worsen given current trends. This article introduces a model of how development processes, biological factors, and food marketing practices are influencing the human energy equation in the less affluent world. The discussion then turns to an ethical analysis of food marketing and obesity and to a formulation of broad ethical guidelines derived from marketing theory. Finally, alternative public policy and social marketing strategies are considered.
Rising Markets and Failing Health: An Inquiry into Subaltern Health Care Consumption under Neoliberalism
Authors: Varman Rohit , Ram Manohar Vikas
Published: May 2007

This research highlights some of the fundamental weaknesses in the market-based economic approach for a developing society. This study of health care consumption by subaltern groups in India reveals that consumers believe that greater reliance on a market-based system has contributed to a decline in the state health institutions, proliferation of private clinics, and a close physician—pharmaceutical firm nexus. Accordingly, instead of creating a more efficient system of health care delivery, market forces are instrumental in marginalization of the subaltern sections of the population. Ramifications of these findings include a suggested expansion in quality of life marketing framework to include the concept of consumer empowerment with specific emphases on dimensions of control and exclusion.
FGFR3 Mutations and Medial Temporal Lobe Dysgenesis Lobe Dysgenesis
Authors: Kannu Peter , Aftimos Salim
Published: May 2007

The authors describe a child who has hypochondroplasia due to an N540K mutation and who has medial temporal lobe dysgenesis. This association has been reported only twice before. FGFR3 is expressed in the brain during development and plays a role in hippocampal formation, and FGFR3 mutations could cause cerebral malformations in hypochondroplasia. Further neuroimaging studies of patients with hypochondroplasia and epilepsy or developmental delay may clarify the proportion of patients with hypochondroplasia with this pattern of central nervous system abnormalities.
Hereditary Spastic Paraplegia with Hypoplastic Corpus Callosum in a Turkish Family
Authors: Gucuyener Kivilcim , Hirfanoglu Tugba , Ok Ikbal , Cansu Ali , Serdaroglu Ayse
Published: May 2007

Hereditary spastic paraplegia is composed of a heterogeneous group of neurodegenerative disorders and is classified as pure or complicated due to its clinical variability. Autosomal recessive hereditary spastic paraplegia with hypoplastic corpus callosum is a rare form of complicated hereditary spastic paraplegia. In complicated hereditary spastic paraplegia, autosomal dominant, autosomal recessive, and X-linked modes of inheritance have been noted. The diagnostic criteria of autosomal recessive hereditary spastic paraplegia with hypoplastic corpus callosum are inheritance consistent with autosomal recessive trait, slowly progressive spastic paraparesis and mental detoriation, hypoplasia of corpus callosum revealed by brain computerized tomography or magnetic resonance imaging, and exclusion of other disorders by magnetic resonance imaging of the spine and brain as well as other laboratory tests. In this report, the authors present the case of 3 affected siblings in a family from Turkey, whereas 1 child and the con-sanguineous parents were healthy. To the authors' knowledge, it is the first reported case of autosomal recessive hereditary spastic paraplegia with hypoplastic corpus callosum from Turkey.
Dravet Syndrome (Severe Myoclonic Epilepsy in Infancy): A Retrospective Study of 16 Patients
Authors: Korff Christian , Laux Linda , Kelley Kent , Goldstein Joshua , Koh Sookyong , Nordli Douglas
Published: May 2007

To report the authors' experience with diagnosis and management of Dravet syndrome, or severe myoclonic epilepsy in infancy, in the era of commercially available genetic testing, the authors performed a retrospective study of 16 patients diagnosed with Dravet syndrome at a tertiary care pediatric epilepsy center. They analyzed their clinical presentation, electroencephalographic findings, genetic ( SCN1A gene) results, and treatment responses and compared the findings to previous reports. The patients presented with all the previously described characteristics of Dravet syndrome. Six of the 7 patients (86%) who were tested for SCN1A mutations had positive results. The best treatment combinations included topiramate, valproate, or the ketogenic diet. Dravet syndrome is a well-defined epileptic syndrome that needs larger recognition, particularly because commercial testing for SCN1A gene mutations is now available in the United States. Despite its reputation for seizure intractability, several treatment options may be particularly helpful, whereas others need to be avoided.
Does Albendazole Affect Seizure Remission and Computed Tomography Response in Children With Neurocysticercosis? A Systematic Review and Meta-analysis
Authors: Mazumdar Maitreyi , Pandharipande Pari , Poduri Annapurna
Published: May 2007

A recent trial suggested that albendazole reduces seizures in adults with neurocysticercosis. There is still no consensus regarding optimal management of neurocysticercosis in children. The authors conducted a systematic review and meta-analysis to assess the efficacy of albendazole in children with neurocysticercosis, by searching the Cochrane Databases, MEDLINE, EMBASE, and LILACS. Three reviewers extracted data using an intent-to-treat analysis. Random effects models were used to estimate relative risks. Four randomized trials were selected for meta-analysis, and 10 observational studies were selected for qualitative review. The relative risk of seizure remission in treatment versus control was 1.26 (1.09, 1.46). The relative risk of improvement in computed tomography in these trials was 1.15 (0.97, 1.36). Review of observational studies showed conflicting results, likely owing to preferential administration of albendazole to sicker children.
Intra-arterial Thrombolysis in a 2-Year-Old with Cardioembolic Stroke
Authors: Benedict Susan L. , Ni Oliver K. , Schloesser Peter , White Keith S. , Bale James F.
Published: May 2007

Recombinant tissue plasminogen activator, although the standard of care for the management of acute ischemic stroke in adults, is used infrequently in children. The authors describe the use of intra-arterial recombinant tissue plasminogen activator in a young child with embolic stroke. Thrombolysis restored flow to the affected middle cerebral artery and appeared to limit the extent of the infarction and the severity of the subsequent neurologic deficits.
A Long-term, Epidemiological Survey of Outcome and Adjustment of Children with Developmental Disabilities
Authors: Leitner Yael , Yifat Rachel , Mesterman Ronit , Gilutz Gabi , Levi-Hakeini Ofra , Bitchonsky Ora , Harel Shaul
Published: May 2007

The medical, educational, and psychosocial outcomes of 3224 subjects (age range, 7-33 years; mean age, 20.06 years; SD, 5.74) diagnosed and treated in the Institute for Child Development in Tel Aviv between the years 1975 and 1994 were assessed by a telephone interview. Results indicate that only 9% of the subjects are seriously disabled, and 8% are mentally retarded. Over the years, subjects were referred to the Child Development Center at an increasingly younger age, probably reflecting greater professional and parental awareness of the importance of early intervention. The nature of interventions changed, so that physiotherapy, occupational therapy, and psychological guidance were more often provided. While more children were referred to special education at kindergarten, the percentage of those graduating from regular schools has increased. Most completed 12 years of schooling and successfully acquired full or partial matriculation certificates. As adults, most function independently; fulfill civic obligations, such as their army service; are fully employed; and express satisfaction with their life. These results suggest that children with developmental disabilities who receive early intervention are likely to be functionally independent and to be satisfied with their lives, although they continue to need medical services and require some government support. Further studies are essential to examine the correlation of specific risk factors and early interventions with outcome.
Phenotype and Management of Aicardi Syndrome: New Findings from a Survey of 69 Children
Authors: Glasmacher Margaret A. K. , Sutton V. Reid , Hopkins Bobbi , Eble Tanya , Lewis Richard A. , Park Parsons Denise , Van den Veyver Ignatia B.
Published: May 2007

Aicardi syndrome is a rare neurodevelopmental disorder characterized by agenesis of the corpus callosum, other developmental brain abnormalities, chorioretinal lacunae, and severe seizures. Current clinical knowledge is derived from small series that focus on these major defects. The authors performed a health survey on a large number of affected children to expand this knowledge and to uncover previously unrecognized features of Aicardi syndrome. Responses received from caregivers of 69 children with Aicardi syndrome met inclusion criteria for data analysis. Ages ranged from 5 months to 32 years (mean, 88 months). All subjects were girls, except for 1 boy with a 47,XXY karyotype. The authors found that the growth rate in Aicardi syndrome slows at age 10 years to below the 5th percentile and that weight gain slows at age 7 years to below the 25th percentile. The median age of survival was estimated at 18.5 (±4) years, more favorable than previously reported. The most common complication aside from seizures was gastrointestinal dysfunction, present in >90%. The results from this survey contribute new information on Aicardi syndrome that will benefit clinical management, and collected data will benefit phenotype-driven research toward its underlying cause.
Contrast Sensitivity—An Unnoticed Factor of Visual Perception in Children with Developmental Delay: Normal Data of the Cambridge Low Contrast Gratings Test in Children
Authors: Nielsen Lisbeth Sandfeld , Nielsen Sidse Kringelholt , Skov Liselotte , Jensen Hanne
Published: May 2007

Contrast sensitivity is one of several factors necessary to obtain good visual quality. The aim of this study was to develop normal data on the Cambridge Low Contrast Gratings test in children and to compare these data with data from a group of children with developmental delay. Ninety-nine normal children (aged 2-14 years) and 146 children with developmental delay were tested with the contrast sensitivity test. All children had normal visual acuity and stereopsis. The normal children had an age-dependent development in contrast sensitivity, and adult level was reached after the age of 10 years. A significantly lower score was found in children with developmental delay compared to normal children. The Cambridge Low Contrast Gratings test is suitable for preschool children and children with developmental delay because of its simplicity, and it might be a valuable tool in diagnosing ophthalmologic diseases in children with developmental delay.
Added Utility of Gadolinium in the Magnetic Resonance Imaging (MRI) Workup of Seizures in Children Younger Than 2 Years
Authors: Petrou Myria , Foerster Bradley , Maly Pavel V. , Eldevik Odd P. , Leber Steven , Sundgren Pia C.
Published: May 2007

The purpose of this study was to evaluate the added utility of gadolinium administration in the magnetic resonance imaging (MRI) workup of seizures in children younger than 2 years. A computerized retrospective search of the radiology information system identified all brain MRI examinations performed at the authors' institution from 1995 to 2002 for children younger than 2 years. Review of the clinical records revealed that 437 of a total 1466 brain magnetic resonance examinations performed on this subset of the pediatric population were performed as part of an initial seizure workup. Magnetic resonance reports and clinical notes were reviewed. MRI studies with enhancing lesions as well as those with equivocal findings were also reviewed in a consensus fashion by 2 senior neuro-radiologists and 2 radiology residents. Contrast administration was rated as essential, helpful, or not helpful for each study. Administration of contrast medium was felt to be essential in formulating a diagnosis in a total of 8 (1.8%) studies, all of which involved documented or highly suspected cases of infection. In an additional 26 cases (5.9%), which included 4 cases of neoplasm, contrast was felt to be useful but not essential in reaching a diagnosis. Contrast was judged not helpful in making the diagnosis in the other 403 studies (92.3%).
Risk Factors Predicting Refractoriness in Epileptic Children with Partial Seizures
Authors: Altunbasak Sakir , Herguner Ozlem , Burgut H. Refik
Published: May 2007

The aim of this retrospective study was to determine the risk factors associated with intractability to therapy in childhood epilepsy. Fifty children with intractable epilepsy as evidenced by at least 1 epileptic fit per month were included in the study group, whereas the control group consisted of children who did not experience any recurrent seizure for at least 1 year at the time of the study. A χ 2 test was used to evaluate the relationship between the test variables for the 2 groups, and the estimated relative risk (odds ratio) for each variable was calculated. The risk factors were subsequently determined by logistic multiple regression analysis. Univariate analysis showed that mental retardation, neurological abnormality, neuroradiological abnormality, perinatal anoxia, neonatal convulsion, presence of status epilepticus, and symptomatic etiology were significant risk factors for the development of refractory epilepsy ( P < .05). For multivariate logistic regression analysis, age at seizure onset, status epilepticus, mixed type of seizures, and history of frequent seizures (more than once a month) were all found to be significant and independent risk factors for refractory epilepsy, and the number of drugs used in the study group was significantly higher than that in the control group ( P < .05). In line with these findings, it was concluded that children who present with epilepsy and have these risk factors should be referred to a center where epileptic surgery is carried out without delay.
Arterial Ischemic Stroke in a Child with β-Thalassemia Trait and Methylentetrahydrofolate Reductase Mutation
Authors: Brankovic-Sreckovic Vesna , Milic Rasic Vedrana , Djordjevic Valentina , Kuzmanovic Milos , Pavlovic Sonja
Published: May 2007

Genetic and acquired disorders that foster a procoagulable state represent risk factors for stroke in childhood. Although an increased incidence of thromboembolic complications has been reported in patients with thalassemia, severe cerebral thromboembolism has rarely been observed in patients with β-thalassemia minor. This article describes a case study of a 1-year-old boy who presented with left-sided hemiparesis, seizures, microcytic anemia, and recent infection with reactive thrombocytosis. Ischemic infarction in the territory of the right middle cerebral artery was confirmed by magnetic resonance imaging and magnetic resonance angiography. Genetic tests showed that the patient was heterozygous for the β°-thalassemia IVS-I-1 mutation and homozygous for the methylentetrahydrofolate reductase C677T mutation. Based on these findings, it was concluded that the synergistic effects of multiple, genetic, and acquired prothrombotic risk factors brought about the hypercoagulable state that resulted in overt stroke in a thalassemic patient in early childhood.
Spinal Cord Demyelination Associated with Biotinidase Deficiency in 3 Chinese Patients
Authors: Yang Yanling , Li Chaoyang , Qi Zhaoyue , Xiao Jiangxi , Zhang Yao , Yamaguchi Seiji , Hasegawa Yuki , Tagami Yasuko , Jiang Yuwu , Xiong Hui , Zhang Yuehua , Qin Jiong , Wu Xi-Ru
Published: May 2007

Biotinidase deficiency is a treatable cause of severe neurological disorders and skin problems. Spinal cord impairment is a rare complication of this disease and is commonly unrecognized. The authors encountered 3 Chinese patients with progressive spinal cord demyelination associated with biotinidase deficiency. Case 1 exhibited fatigue, proximal muscular weakness, and hypotonic paraplegia from the age of 7 years 4 months. Demyelination of cervical and thoracic cord was evident on magnetic resonance imaging (MRI). Case 2 developed visual impairment, blepharoconjunctivitis, and optic nerve atrophy from 5 years of age, which combined with progressive hypertonic paralysis, ataxia, and alopecia from the age of 7 years. His spinal MRI T2-weighted sequence revealed an extensive hyperintense lesion involving the cervical spinal cord C2 to C4. Bilateral optic nerves were significantly thick. In case 3, intercurrent wheezing, tachypnea, dyspnea, and lethargy occurred from the age of 1 year. Medulla and upper cervical spine edema and demyelination were found on MRI. Markedly elevated urine organic acids and decreased blood biotinidase activities were observed in the 3 patients. Biotin supplementation led to a dramatic improvement of clinical symptoms in 3 patients. The findings indicate that biotinidase deficiency should be considered in the differential diagnosis of unexplained spinal cord demyelination because prompt diagnosis and treatment with biotin may enable an excellent recovery.
Sleep Disturbance and its Relation to DSM-IV Psychiatric Symptoms in Preschool-Age Children with Pervasive Developmental Disorder and Community Controls
Authors: DeVincent Carla J. , Gadow Kenneth D. , Delosh Danielle , Geller Lynda
Published: May 2007

This study describes the relation between sleep problems and psychiatric symptoms in preschool-age children (3 to 5 years old) with pervasive developmental disorder and a community-based sample of children attending early childhood programs. Parents completed the Early Childhood Inventory—4, a Diagnostic and Statistical Manual of Mental Disorders (fourth edition)—referenced rating scale for 2 samples: children with pervasive developmental disorder (n = 112) and nondisabled youngsters (n = 497). Although children with pervasive developmental disorder had a significantly greater number and severity of sleep problems than the community preschoolers did, sleep-disturbed children in both samples exhibited more severe behavioral difficulties—primarily symptoms of attention-deficit hyperactivity disorder and oppositional defiant disorder—than did children without sleep problems. Sleep problems are an indicator of similar comorbid psychiatric symptoms in both children with and without pervasive developmental disorder, which suggests commonalities in their etiology.
A Pharmacist-Initiated Method to Improve Venous Thromboembolic Prophylaxis Rates in Medically Ill Patients
Authors: Stark Jennifer E. , Vesta Kimi S.
Published: May 2007

Venous thromboembolism (VTE) is among the most preventable causes of hospital death; however, there is a significant underuse of VTE prophylaxis. The purpose of this study was to determine the impact of a pharmacist-initiated screening method on VTE prophylaxis rates. Clinical pharmacists practicing in an internal medicine teaching service at an academic medical center conducted a 6-month pilot project. Consecutive patients admitted to the service were screened for VTE and bleeding risk factors. Pharmacists made recommendations to the physicians in person, provided monthly educational presentations, and monitored patients daily until discharge to confirm continued appropriateness of recommendations. Of the 444 patients who were screened, 107 were identified to be candidates for VTE prophylaxis, and 21 of these patients also had bleeding risk factors. Appropriate use was significantly better after the screening intervention (37% before vs 85% after; P < .05). Moreover, inappropriate use in patients with bleeding risk factors was avoided by the screening intervention (29% before vs 0% after; P < .05). Clear improvements in VTE prophylaxis rates were observed. This pharmacist-initiated screening method presents unique opportunities for pharmacists.
Anti-inflammatory Properties of Macrolide Antibiotics
Authors: Kourlas Helen
Published: May 2007

The use of macrolide antibiotics for other clinical uses outside of their antimicrobial capabilities has been questioned and theorized in both in vitro and animal studies. Several small clinical trials have shown that erythromycin, clarithromycin, and azithromycin possess anti-inflammatory characteristics in patients with respiratory diseases. To determine whether macrolide antibiotics possess this unique characteristic, data from controlled trials involving human subjects were extracted and analyzed. Conclusions from trials suggest that select macrolide antibiotics possess anti-inflammatory properties in patients with respiratory diseases who do not show evidence of a bacterial infection.
Harm Reduction Program and Methadone Poisoning: Implications for Pediatric Public Health in Malaysia
Authors: Babar Zaheer-Ud-Din , Nur Rashidah Mohd Zaini  , Choon Wai Yee
Published: May 2007

In Malaysia, because of an alarming increase in the number of intravenous drug users, the government has started a harm reduction program in which methadone is used as a drug substitution therapy. This article discusses a 19-month-old Malay girl who was brought to the hospital after an episode of accidental ingestion of methadone. The methadone was for her uncle, who was found to be an intravenous drug user. Although methadone has been proven to be cost-effective and useful, it has also been reported that increasing availability of methadone can put children at increased risk of accidental ingestion. In Malaysia, methadone is available at government as well as private medical clinics. Home consumption may be problematic as the drug may be dispensed without adequate patient education and clear instructions on its handling, storage, and indication of use. In this scenario, a greater emphasis on and the adaptation of clear guidelines on the use and storage of methadone are required. There is also a need to create awareness among the public as well as health care professionals regarding the issue.
Prescription for a Stronger FDA
Authors: Guharoy Roy , Cwikla Gregory , Burgdorf Andrew , Joshi Madan
Published: May 2007

Recently, an Institute of Medicine panel concluded that years of negligence, mismanagement, inadequate resources, infighting among staff members, and lack of a systemic drug approval and postmarketing surveillance process have diluted the effectiveness of the Food and Drug Administration (FDA) in protecting public health. The panel was commissioned by the FDA to assess the U.S. drug safety system, and they recommended 25 sweeping changes, most of which would require congressional authorization. The recommendations focus on the life cycle of a drug product, rather than just the approval process, and they would go a long way in protecting public health in the future.
Nicotine Replacement Therapy for Tobacco Use Cessation
Authors: Chu Valery L.
Published: May 2007

Tobacco use is the leading preventable cause of morbidity and mortality in the United States. Nicotine replacement therapy (NRT) remains a first-line pharmacotherapy for tobacco and smoking cessation. Five formulations of NRT for delivery of nicotine were approved by the US Food and Drug Administration between 1984 and 2002, including 3 available without prescription from pharmacies. A table was created as a tool for pharmacists to counsel patients about the NRT products. The table summarizes available doses, dosing regimen and schedules, administration technique, contraindications, and adverse effects.