bluuebunny/crossref_metadata_2025 huggingface dataset:
Subchronic effects of ochratoxin A on young adult rat brain and partial prevention by aspartame, a sweetener
Authors: Belmadani A , Tramu G , Betbeder A M , Creppy E E
Published: January 2017

1. Ochratoxin A (OTA) is a mycotoxin produced by several fungi, especially Aspergillus and Penicillium species. Many food and foodstuffs can be contaminated by ochratoxin A, which is consequently found in blood of animals and humans.

2. The distribution into the brain of young adult rats fed OTA for 1 to 6 weeks and some consequences have been investigated in the present study.

3. Our results on rats given OTA (289 mg/kg/48 h) indicated that OTA accumulated in the whole brain as function of time according to a regression curve, Y=78.723 a+16.72 with a correlation coefficient of r=0.989, where Y-axis is the OTA concentration in ng/ g of brain and X-axis is the duration of the treatment in weeks. The brain OTA contents was 11.95+2.2, 23.89+4.4, 39.9+4.5, 50.3+7.3, 78.8+6.3, 94+16 ng/g of brain in the mycotoxin-treated animals for respectively 1, 2, 3, 4, 5 and 6-weeks treatment. OTA induced modifications of free amino-acid concentrations in the brain, mainly, Tyrosine (Tyr) and phenylalanine (Phe). Tyr decreased significantly as compared to control (p50.05). Phe increased signifi-cantly as compared to control (p<50.05).

4. Aspartame, (25 mg/kg/48 h) a structural analogue of OTA largely modified the distribution and prevented the accumulation of OTA in the brain since the respective brain OTA contents decreased respectively to 9.6+7.9, 19.2+3.0, 26.8+4.2, 19.7+1.9, 13.7+5.6 and 11.0+6.0 ng/g of tissue, for the same duration of treatment. It also prevented the modifications of Tyr and Phe levels.

5. The histological investigations showed several necrotic cells with pyknotic nucleus, detected in OTA treated animals with higher frequency as compared to the controls and Aspartame treated ones. Aspar-tame appeared to significantly prevent this nuclear effect as well, the meaning of which is discussed.
Protection of human upper respiratory tract cell lines against sulphur mustard toxicity by glutathione esters
Authors: Andrew D J , Lindsay C D
Published: January 2017

1 Human and animal lung cells have been used successfully to model the toxic effects of inhaled sulphur mustard (HD). The epithelia of the upper respiratory tract are, however, the primary targets of inhaled HD. The aim of this study was to assess the potential of the mono- and di-isopropyl esters of glutathione (MIPE and DIPE respectively) as cytoprotectants in the human upper respiratory tract cell lines BEAS-2B and RPMI 2650.

2 The optimal concentrations for cytoprotection were shown to be 1.0 mg/ml for both DIPE and MIPE. Both compounds were found to protect cells by pretreatment, slightly less protection was observed in cells simultaneously exposed to sulphur mustard. The greatest protection was shown where MIPE or DIPE were in in situ atthetimeofexposuretoHD.The optimum pre-treatment times were found to be 1 h for MIPE and 2 h for DIPE. Limited protection of cells treated with MIPE or DIPE immediately following HD exposure was also demonstrated. No protection was observed if MIPE or DIPE were not administered immediately following HD exposure.

3 Results suggest that MIPE and DIPE may be effective treatments for exposure to HD by inhalation.
Unique cerebral dysfunction following triphenyltin acetate poisoning
Authors: Lin Tzeng-Jih , Hung Dong-Zong , Kao Chia-Hung , Hu Wei-Hsiung , Yang Dar-Yu
Published: January 2017

1 In animal studies, TPTA was found to be neurotoxic. In humans, variable CNS pictures have been described with or without significant EEG findings. Brain CT does not usually reveal any abnormalities.

2 Our patient presented with intermittent unique spontaneous involuntary movement of hands, facial twitching, silly smile and crying. Diplopia, drowsiness, giddiness, vertigo, bidirectional nystagmus, impairment of calculation ability, as well as disorientation to time, people and place also developed. EEG showed mild cortical dysfunction without seizures. MRI and Tc-99m HMPAO brain SPECT revealed no significant findings. TPTA may cause cellular dysfunction of brain without structural damage, which results in variable CNS clinical presentations.

3 Nadir of leucopenia was noted on the sixth day after consumption of TPTA. Liver impairment occurred on the ninth day. Borderline demyelinated neuropathy developed on the fifty-third day. CNS abnormalities, delayed peripheral neuropathy, hepatitis and leucopenia deserve monitoring for a prolonged period, even when the victim initially presents with GI upset only after consumption of TPTA.
A dose-dependent delayed hypersensitivity reaction to acetaminophen after repeated acetaminophen intoxications
Authors: Huitema A DR , Soesan M , Meenhorst P L , Koks C HW , Beijnen J H
Published: January 2017

We report a case of a 29-year-old woman with a borderline personality disorder who presented with intentional substantial acetaminophen (paracetamol) overdosage on nine occasions during a period of 21 months. In most cases, the patient presented at the hospital within 4 h after ingestion and was treated with gastric lavage, activated charcoal, laxatives and intravenous N-acetylcysteine. During the sixth overdosage the patient developed a rash on her chest and shoulders which was considered an anaphylactoid reaction to N-acetylcysteine. Therefore she was treated with oral methionine subsequently, but developed the rash again. The rash was then ascribed to the repeated high-doses of acetaminophen and treatment with N-acetylcysteine was reinstituted. This case shows that when an anaphylactoid reaction occurs after an acetaminophen overdose and treatment with N-acetylcysteine, acetaminophen must also be taken into account as the cause of the anaphylactoid reaction before effective therapy with N-acetylcysteine is withheld.
Evaluating library signage: A systematic method for conducting a library signage inventory
Authors: Mandel Lauren H. , Johnston Melissa P.
Published: January 2017

While there is much literature that directs libraries to avoid having too much or insufficient signage, there is no clear guidance on how much signage is “enough” or “too much”. Conducting a signage inventory can be the first step toward determining how many signs a library needs, by establishing how many signs are in the library, of which type, and their condition. This paper proposes a ready-to-use method that any library can use to inventory its signage by adapting the inventory worksheet depending on factors related to the library type. The ultimate goal in developing a standardized method is that it would facilitate comparisons across libraries to attempt development of more specific signage guidelines or a formula that could calculate how many signs are “enough” and “too many” for a library given its type, population, and other criteria.
Current management of lupus nephritis: popular misconceptions
Authors: Jayne D
Published: January 2017

The management of lupus nephritis is typified by popular misconceptions: that there is a ‘standard of care’, that treatment has well-defined aims and that the optimum length of treatment is established. In reality, however, uncertainties still exist and the evidence base remains weak.

Until recently, initial therapy for class IV lupus nephritis typically involved intravenous cyclophosphamide, yet although cyclophosphamide is superior to azathioprine in improving renal function, it is not superior in terms of mortality. In fact, recent studies show mycophenolate mofetil to be superior to cyclophosphamide in terms of response rate and safety profile and at least as effective as other immunosuppressants. The role of steroids is unclear. Clearly, no standard of care exists in lupus nephritis.

The Euro-Lupus Nephritis Trial found that treatment response at six months, in terms of reduced serum creatinine and proteinuria, was the best predictor of long-term renal outcome. Proteinuria, however, can take a long time to reach baseline levels, and normalization of urine is not the same as loss of histological disease activity. Response to treatment thus is not the same as disease remission. Although treatment should aim to reduce the risk of end-stage renal disease and death, control of proteinuria and prevention of flares are also important.

Patients who have nephritic flares are almost seven times as likely to progress to end-stage renal disease compared with those who do not. Regimens involving maintenance phases have been developed, but uncertainty remains about the risk of flares and how they can be predicted. The optimum duration of treatment has yet to be determined.
Oxidative stress in systemic lupus erythematosus: relationship to disease activity and symptoms
Authors: Avalos I , Chung C P , Oeser A , Milne G L , Morrow J D , Gebretsadik T , Shintani A , Yu C , Stein C M
Published: January 2017

Oxidative stress may play a role in the pathogenesis of systemic lupus erythematosus (SLE). We examined the hypothesis that oxidative stress was associated with indices of lupus disease activity and severity of symptoms. Urinary F2 isoprostane excretion, a validated marker of oxidative stress, was measured in 95 patients with SLE and 103 healthy controls. Outcome measures included SLEDAI and SLICC scores, the modified health assessment questionnaire, the fatigue severity scale (FSS), and visual analogue scales (VAS) for fatigue, pain and overall disease activity. F2 isoprostane excretion was compared in patients and controls, and its relationship with clinical variables in SLE examined. F2 isoprostane excretion did not differ significantly among patients with lupus (2.7 ± 2.3 ng/mg Cr) and control subjects (2.2 ± 1.4 ng/mg Cr) (P = 0.70). In patients with lupus, F2 isoprostane concentrations were independently associated with higher patient reported disease activity (VAS) (OR = 1.52, P = 0.01), fatigue (FSS, OR = 1.52, P = 0.03) and lower quality of life (OR = 0.73, P = 0.05), but not with objective markers or inflammation or disease activity. In conclusion, F2 isoprostane excretion is associated with patient-reported symptoms in SLE but not with measures of inflammation, SLEDAI or SLICC. Oxidative stress may contribute to debilitating symptoms such as fatigue in SLE.
Sm antibodies increase risk of death in systemic lupus erythematosus
Authors: Hitchon C A , Peschken C A
Published: January 2017

The importance of ethnicity, socioeconomic status (SES), and autoantibodies as prognostic indicators in lupus were evaluated in a Canadian cohort. A retrospective review of 330 lupus patients identified demographic features including age and self reported ethnicity, SES, lupus features, antibodies to extractable nuclear antigens (ENAs), organ damage (SDI score), and mortality. ENA (Sm, RNP, Ro, La) associations with lupus features, predictors of final visit SDI score and the contributions of ethnicity, autoantibodies and SES on overall mortality were determined. Three ethnic groups [Caucasians (C), Asian-Orientals (AO), Native American First Nations (FN)] differed in disease severity and SES. FN and AO patients had similarly severe lupus, developing lupus at an earlier age, with more renal and neurological involvement, greater SDI scores at last visit, and more frequently had Sm or RNP antibodies than C. FN had the highest mortality and lowest SES. Sm and RNP antibodies were associated with renal and neurologic involvement. RNP, education and duration of follow-up predicted SDI score. Sm increased risk of death. In conclusion, RNP and lower SES are associated with lupus related organ damage and the presence of Sm is a predictor of mortality in lupus, independent of ethnicity, renal involvement or socioeconomic status.
Cardiovascular autonomic dysfunction in systemic lupus, rheumatoid arthritis, primary Sjögren syndrome and other autoimmune diseases
Authors: Stojanovich L , Milovanovich B , de Luka S R , Popovich-Kuzmanovich D , Bisenich V , Djukanovich B , Randjelovich T , Krotin M
Published: January 2017

Neurological manifestations are known to occur in patients with autoimmune diseases, often subclinically, but autonomic nervous system (ANS) involvement has rarely been studied, and studies have shown conflicting results. We performed cardiovascular ANS assessment in 125 patients with autoimmune diseases in this case-control study, including 54 patients with systemic lupus erythematosus (SLE), 39 with rheumatoid arthritis (RA), 20 with primary Sjögren syndrome (pSS), eight patients with polymyalgia rheumatica (PR), four patients with scleroderma (Ssc) and 35 healthy control subjects. The control group was formed to approximately match the mean age of SLE, RA and pSS patients; controls did not differ significantly by gender from the autoimmune pations. All patients with were in stable condition.

Autonomic nervous system dysfunction was diagnosed by applying cardiovascular reflex tests according to Ewing, and was considered to exist if at least two tests were positive. Vagal dysfunction was established by applying three tests: Valsalva manoeuvre, deep breathing test, and heart rate response to standing. Sympathetic dysfunction was examined by applying two tests: blood pressure response to standing and handgrip test. In all cardiovascular reflex tests, frequencies of abnormal results were significantly higher among the patients than among the controls ( P < 0.05). The difference between the autoimmune patients and the controls was particularly significant in sympathetic and parasympathetic tests, with P < 0.0001.

No correlation was found between disease duration, clinical manifestations, cardiovascular risk factors and diseases activity on the one hand, and ANS dysfunction on the other hand. Cardiovascular autonomic dysfunction was revealed in the majority of autoimmune patients.
Unique hepatic imaging features in a patient with nodular regenerative hyperplasia of the liver associating with systemic lupus erythematosus
Authors: Leung V KS , Ng W-L , Luk I SC , Chau T-N , Chan W-H , Kei S-K , Loke T KL
Published: January 2017

Nodular regenerative hyperplasia (NRH) of the liver, characterized by regenerative nodules distributed throughout the liver in the absence of fibrosis, is a rare but important complication of systemic lupus erythematosus (SLE). The main consequence of NRH is non-cirrhotic portal hypertension. We describe a female patient who had immune thrombocytopenia in association with elevated liver enzymes and evidence of portal hypertension as initial manifestations of SLE. Computed tomographic scan and magnetic resonance imaging of the liver in this patient showed enhancing periportal tubular structures distributed throughout the liver. The diagnosis of NRH was eventually disclosed by transcutaneous needle liver biopsy. The pattern of radiological abnormality in this patient has not been described previously in NRH. In addition, we believe this is a first reported case of SLE presenting with immune thrombocytopenia in association with NRH.
Use of risk-adjusted CUSUM and RSPRTcharts for monitoring in medical contexts
Authors: Grigg O A , Farewell V T , Spiegelhalter D J
Published: January 2017

In this paper we discuss the use of charts derived from the sequential probability ratio test (SPRT): the cumulative sum (CUSUM) chart, RSPRT (resetting SPRT), and FIR (fast initial response) CUSUM. The theoretical development of the methods is described and some considerations one might address when designing a chart, explored, including the approximation of average run lengths (ARLs), the importance of detecting improvements in a process as well as detecting deterioration and estimation of the process parameter following a signal.

Two examples are used to demonstrate the practical issues of quality control in the medical setting, the first a running example and the second a fully worked example at the end of the paper. The first example relates to 30-day mortality for patients of a single cardiac surgeon over the period 1994-1998, the second to patient deaths in the practice of a single GP, Harold Shipman.

The charts’ performances relative to each other are shown to be sensitive to the definition of the ‘out of control’ state of the process being monitored. In light of this, it is stressed that a suitable means by which to compare charts is chosen in any specific application.
Medical image analysis with fuzzy models
Authors: Bezdek J C , Hall L O , Clark M C , Goldgof Dmitri B , Clarke L P
Published: January 2017

This paper updates several recent surveys on the use of fuzzy models for segmentation and edge detection in medical image data. Our survey is divided into methods based on supervised and unsupervised learning (that is, on whether there are or are not labelled data available for supervising the computations), and is organized first and foremost by groups (that we know of) that are active in this area. Our review is aimed more towards `who is doing it' rather than `how good it is'. This is partially dictated by the fact that direct comparisons of supervised and unsupervised methods is somewhat akin to comparing apples and oranges. There is a further subdivision into methods for two-and three-dimensional data and/or problems. We do not cover methods based on neural-like networks or fuzzy reasoning systems. These topics are covered in a recently published companion survey by Keller et al.
The registration of multiple medical images acquired from a single subject: why, how, what next?
Authors: Little J A , Hawkes D J
Published: January 2017

This paper reviews some of the recent techniques which have been used to register multiple images of the same patient. Image registration is a problem which has been receiving significant attention from the medical image processing community in recent years. A successful image registration can aid in patient diagnosis, treatment assessment, image guided interventions, surgery planning and surgery. At present the majority of work has focused on rigid body transformations of images. We shall discuss some of the approaches used and outline a key automatic method in detail. In order to allow image registration of parts of the body which do not remain rigid, either due to patient movement or a change in pathology, nonlinear deformation techniques are being developed. We shall talk of the history of these methods before explaining deformations using landmarks and a recent extension to allow the definition of rigid structures in such warps in more detail. Validation of these methods is of great importance and we shall discuss work which has already been carried out on this topic for rigid body registrations as well as ideas for the validation of deformation algorithms.
Population modelling in drug development
Authors: Sheiner Lewis , Wakefield Jon
Published: January 2017

In this paper we discuss the vital role that population (hierarchical) modelling can play within the drug development process. Specifically, population pharmacokinetic/pharmacodynamic models can provide reliable predictions of an individualized dose-exposure-response relationship. A predictive model of this kind can be used to simulate and hence design clinical trials, find initial dosage regimens satisfying an optimality criterion on the population distribution of responses, and individualized regimens satisfying such a criterion conditional on individual features, such as sex, age, etc. Throughout we emphasize prediction and advocate mechanistic as opposed to empirical modelling, and argue that the Bayesian approach is particularly natural in this setting.
The Bayesian analysis of a pivotal pharmacokinetic study
Authors: Rahman N J , Wakefield J C , Stephens D A , Falcoz C
Published: January 2017

The aim of this paper is to carry out a detailed Bayesian population pharmacokinetic analysis of a three-period cross-over study of the drug fluticasone propionate carried out in 12 healthy male volunteers. The study was carried out to characterize the pharmacokinetics of the drug, in particular to investigate dose proportionality. We examine the appropriateness of modelling assumptions via a variety of diagnostic techniques. We also examine the effect of deleting time points at which the concentration was recorded as below the limit of quantification, as opposed to including these points as censored observations. We assess dose proportionality before carrying out a final combined analysis of data from all three doses.
The impact of compliance in pharmacokinetic studies
Authors: Vrijens B , Goetghebeur E
Published: January 2017

In population pharmacokinetic (PK) studies, one observes just a few concentration measures spread out in time, on a sizable sample of the target population. Common-sense dictates that for estimation of a drug exposure-plasma concentration relationship, one needs accurate information on drug intake history besides the concentration measures. The population PK literature is well aware of this. Studies of simulated compliance behaviour have helped quantify the problem with naive compliance estimators and pointed towards a solution. In this paper we look at actually observed compliance patterns recorded via electronic monitoring. We simulate a documented pharmacokinetic model from the hypertensive literature on top of these and come to some interesting findings. In this clinical trial the problem of noncompliance is much more dramatic than simulated compliance patterns suggested so far. The systematic errors made by compliance naive estimators can be corrected when using timing explicit hierarchical nonlinear models and accurate information on a number of previous dose timings. When it is possible to observe irregular drug intake times in a well-controlled study, a substantial amount of precision is retrieved from the same number of data points. In general, the estimators of PK parameters benefit greatly from information that enters through greater variation in the drug-exposure process. Here we find support for the claim that noncompliance as a rich natural experiment of dosing variation can be a blessing rather than a curse from the information/learning point of view.
Clinical cross-over trials in phase I
Authors: Senn Stephen , Ezzet Farkad
Published: January 2017

We review the role of cross-over trials in pharmacokinetic and pharmacodynamic studies, in particular as applied in phase I. Design and analysis considerations are covered. We also consider the use of pharmacokinetic and pharmacodynamic theories in planning cross-over trials. Finally some practical considerations are covered.
Tacit knowledge and risk perceptions: Tullow Oil and lay publics in Ghana’s offshore oil region
Authors: Ofori-Parku Sylvester Senyo
Published: January 2017

This study examines how local residents make sense of offshore oil production risks in Ghana’s nascent petroleum industry. From a naturalistic-interpretive perspective, it is primarily based on in-depth interviews with community residents: 8 opinion leaders, 15 residents, and 1 journalist. Residents associate Tullow’s oil activities with health concerns (e.g. conjunctivitis), environmental challenges (e.g. the emergence of decomposed seaweeds along the shore), and socio-economic concerns (e.g. loss of livelihoods, decline in fish harvest, and increased rent and cost of living). Focusing on how the local, practical knowledge of interviewees manifest in their sense of offshore oil risks, the study identifies two strategies—scapegoating and tacit knowing—underlying how residents construe offshore oil risks and benefits. Beyond its theoretical contribution to the social construction of risk process, the study illustrates the challenge the expert-lay publics dichotomy poses (and the potential bridging this dichotomy has) for corporate and societal risk management.
Alfred Caleb Taylor (1860–1927): X-ray pioneer and martyr
Authors: Thomas Martyn
Published: January 2017

Alfred Caleb Taylor was the first radiographer at the Peterborough Infirmary and Dispensary from 1896 to 1923. He constructed the first X-ray apparatus and oversaw the development of the X-ray service in Peterborough. He contracted a chronic radiation dermatitis from exposure to X-rays which was a source of considerable suffering for him. When he died in 1927, X-ray dermatitis was considered to have contributed to his death, and he was recognised as an X-ray martyr and a victim of science. In spite of his achievements and his ill-health from working with X-rays, his name is not included on the Martyrs Memorial in Hamburg.
An analysis of the hospitals of Sultan Suleyman and Hurrem: Two different approaches to healthcare in sixteenth-century Ottoman Empire
Authors: Kayaalp Pinar
Published: January 2017

This study concentrates on two monumental Ottoman pious endowments, each with a major component devoted to healing. The first is the hospital of the Haseki Mosque Complex built by the wife of Sultan Suleyman the Magnificent. An examination of the deed and the modus operandi of this endowment will impart a sense of the role that women of the ruling class played in Ottoman society as builders and healers in the sixteenth century. The analysis of the Haseki Hospital will be followed by an examination of the hospital that is part of the Suleymaniye Mosque Complex built by Sultan Suleyman. The differences between the two perspectives in the promotion of public health will be emphasized, arguing that the Sultan’s approach to healthcare was academic and research-oriented, whereas his wife’s was holistic and devoted to rehabilitation. The endowment deeds and the physical layouts of the two hospitals shed light upon a dual approach to healthcare with gender-specific roles affirmed and shaped by Hurrem and Suleyman the Magnificent, who each built hospitals of their own in Istanbul, the Ottoman capital city.
A medieval physician: Amirdovlat Amasiatsi (1420–1495)
Authors: Gurunluoglu Aslin , Gurunluoglu Raffi , Hakobyan Tatevik
Published: January 2017

We aimed to acquaint the reader with a medieval physician, Amirdovlat Amasiatsi, who lived and practiced in the 15th century Anatolia. Amirdovlat wrote several books on medicine mainly focusing on phytotherapy and pharmacology using medicinal plants, animal-derived products and minerals. All his works were written in Middle Armenian, spoken Armenian language of the time. In his writings, Amirdovlat described unique recipes that represent a portrayal of medical knowledge and practice at the time in Anatolia where he lived and worked. He discussed the physical and therapeutic properties as well as geographic distributions of various plants and minerals, using different languages, mainly Turkish, Greek, Arabic, French and Persian. Amirdovlat’s works not only enhanced our understanding of Armenian medical practices but also provided great deal of information on those of Ancient Greco-Roman as well as Islamic world, demonstrating close relationship of Armenian medicine with Greco-Roman and Islamic medicine. Amirdovlat accomplished this by amalgamating the past and contemporary practices of his time. In this regard, Amirdovlat’s works, in particular “Useless for the Ignorant”, are very unique playing a significant role in preserving traditions and heritage of different cultures.
An amended history of tissue culture: Concerning Harrison, Burrows, Mall, and Carrel
Authors: Ambrose Charles T
Published: January 2017

The origin of tissue culture is commonly dated to 1907 and credited to Ross Harrison at Hopkins Medical School. But an unpublished letter from the 1942 offers a different interpretation and gives priority to Montrose Burrows with important contributions for the development of cell culture by Franklin Mall at Hopkins and Alexis Carrel at the Rockefeller Institute in New York City. The early development of tissue culture is reviewed and its applications in modern biology and medicine are briefly outlined.
Dr. Fraser Macintosh Rose, OBE, MB ChB (Edin), FCGP (1897–1972) co-founder of the Royal College of General Practitioners
Authors: Timmis Christopher
Published: January 2017

Fraser Rose was a general practitioner in Preston, Lancashire, England and a medical politician. He was one of two doctors who in 1951 took the initial steps and subsequently played a major role in the founding of the College of General Practitioners, later to become the Royal College of General Practitioners. This paper examines his life, his career in general practice and medical politics, and his unique contribution to the ‘Steering Committee’ that set up the College.
Testicular Cancer: To Screen or Not to Screen?
Authors: Buetow Stephen A
Published: January 2017

Objectives—

To evaluate the evidence for and against routine testicular cancer screening by primary health care providers and patients (testicular self examination).

Setting—

Low reported frequency of routine screening for testicular cancer attributed to poor knowledge of the disease and how to screen for it.

Methods—

Literature based evaluation of the screening suitability of testicular cancer as a disease and palpation of the testis as the proposed screening test, and of the effectiveness of screening for testicular cancer.

Results—

Testicular cancer is not a major public health problem. Its low prevalence makes routine screening cost ineffective. As a screening test for the disease, palpation has high sensitivity but its levels of specificity and positive predictive value are unacceptable. Palpation of the testes has not been shown to reduce mortality or morbidity.

Conclusion—

There is insufficient evidence to justify routine screening for testicular cancer by health care providers and patients. This lack of evidence may better explain the low reported levels of screening than can ignorance of the evidence available.
Early Mortality and Morbidity in Children with Down's Syndrome Diagnosed in Two Regional Health Authorities in 1989
Authors: Brookes Marion E , Alberman Eva
Published: January 2017

Objectives –

To assess the risk of early mortality and the quality of health of a recent cohort of 5 year old children with Down's syndrome to provide current information on prognosis.

Setting –

A follow up study in 1994 of all live births with a cytogenetic diagnosis of trisomy 21 or related karyotype born in 1989 and diagnosed in the South East Thames and Oxford Regional Health Authorities; these amounted to 100 children.

Results –

Eighteen of the sample of 100 had died in the first three years, and seven were reported as adopted. Fifty six mothers were interviewed, including five of children who had died. High rates of associated congenital defects were reported. The most common were congenital heart defects, which were reported for 29 of the 69 children for whom health information was available, and were certified as the underlying cause of death of 12 and required surgery in 11. At least five children had had gastrointestinal atresia or other gut blockage, most presenting at birth but one case occurring at 3 years, and these had necessitated a colostomy in two cases. Leukaemia had occurred in two children, both of whom had died. As expected mothers also reported high rates of defects of hearing, often treated with grommets; of vision; and frequent severe infections.

Conclusions –

Information of this nature, as well as that regarding the more positive aspects of Down's syndrome, should be made available to those counselling parents considering the offer of diagnostic tests.
Comparison of Radiographer/Radiologist Double Film Reading with Single Reading in Breast Cancer Screening
Authors: Pauli Regina , Hammond Sean , Cooke Julie , Ansell Janet
Published: January 2017

Objectives—

To assess the efficacy of dual film reading in screening mammography with a suitably trained radiographer as the second reader and to determine a suitable decision model for radiographer/radiologist double reading.

Setting—

Three breast screening centres in South Thames (West) region.

Methods—

Seven radiographers with prior film reading training double read 17 202 screening mammograms with a radiologist. Screening performance of radiographers and radiologists was assessed taking into account interval cancers. The efficacy of radiographer/radiologist double reading was assessed in terms of changes in sensitivity and specificity compared with radiologist single reading.

Results—

Radiographers yielded equivalent sensitivity but lower specificity than radiologist film readers. The effect of double reading between radiographer/radiologist pairs was an increase in sensitivity of 6.4%, which was achieved at the cost of a 0.6% decrease in specificity. This was reached by a decision system involving radiologists' review of radiographer queries and recall classifications. If all radiographer queries were recalled a large increase in sensitivity would be counterbalanced by an equally large decrease in specificity.

Conclusions—

Radiographer/radiologist double reading resulted in similar increases in sensitivity as those previously reported in radiologist double reading studies. Radiologist review of radiographer reported abnormalities is a suitable means by which to limit excess recall.
Consequences of Current Patterns of Pap Smear and Colposcopy Use
Authors: Kavanagh Anne M , Santow Gigi , Mitchell Heather
Published: January 2017

Objectives—

To describe age specific frequencies of Pap smear and colposcopy use in the Australian Capital Territory (ACT) and to estimate the cumulative effects of current patterns of use.

Setting—

Frequencies of Pap smear and colposcopy use were estimated for the financial year from 1 July 1989 to 30 June 1990. Eligible women were between the ages of 15 and 74, living in the ACT.

Methods—

Data collected from a 10% sample of subjects enrolled with Medicare and from the only public pathology laboratory in the ACT were used to estimate age specific frequencies. The expected number of deaths from cervical cancer in the ACT in the absence of a screening programme was estimated by applying Australian age specific mortality rates for cervical cancer between 1960 and 1964 to the 1989 ACT population. A life table approach was used to simulate the cumulative risk of colposcopy – given current age specific rates – on a hypothetical cohort of 1000, 15 year old women.

Results—

Forty four per cent (95% confidence interval (CI) 42.9 to 44.9) of women had a Pap smear and 2.5% had colposcopy (95% CI 2.4 to 2.6). Two and a half per cent of 15 to 24 year old women had colposcopy (95% CI 1.9 to 3.1). The ratio of women having Pap smears to women having colposcopy was 17.8:1 (95% CI 17.7 to 17.9). An estimated 247 women had colposcopy for every cervical cancer death; in the 15 to 24 year old age group this ratio was 47 900:1. A 15 year old woman exposed to current rates of colposcopy (adjusted for hysterectomy) has a 76.8% chance of having a colposcopy during her life time.

Conclusions—

Many more women will have colposcopy than will develop cervical cancer, which undermines the cost effectiveness of Australia's cervical cancer screening programme.
Hospital Based Screening of 65–73 Year Old Men for Abdominal Aortic Aneurysms in the County of Viborg, Denmark
Authors: Lindholt Jes S , Henneberg Eskild W , Fasting Helge , Juul Svend
Published: January 2017

Objective—

To analyse the benefits of screening older men for abdominal aortic aneurysms.

Methods—

A hospital based screening trial concerning 13 500 65–73 year old men using B—mode ultrasonographic scanning. To improve the response rate the invited men could change their appointment, and non—responders were reinvited.

Results—

Results from the first year of the trial are presented. Among 4404 invited, 3344 (76%) were scanned. The primary response rate was 64.8%, but a further 11.2% were scanned after revised appointments or reinvitation. The whole infrarenal aorta could be visualised in 97.6%, and the distal part in 99.7% of the scans. The time taken for each scan was 9.7 minutes and the costs per scan were ·9.50. One hundred and fifty three subjects (4.6%) had aortic diameters of 25.29 mm, and 141 (4.2%) had an abdominal aortic aneurysm, 19 (0.6%) above 49 mm in diameter.

Conclusion—

In Denmark the short term costs and benefits of screening older men for abdominal aortic aneurysms seem realistic. Long term costs and benefits need to be investigated.
Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis
Authors: Girgis Afaf , Clarke Philip , Burton Robert C , Sanson—Fisher Rob W
Published: January 2017

Background and design—

Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated.

Results—

Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening.

Conclusion—

The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.
Peers, parents and teachers: A case study on how popular music guitarists perceive support for expertise development from “persons in the shadows”
Authors: Längler Manuel , Nivala Markus , Gruber Hans
Published: January 2017

“Persons in the shadows” may substantially affect how an individual acquires expertise, through, for example, guiding deliberate practice. In the domain of popular music, such persons in the shadows might be peers, parents and teachers. Little research exists on how individuals perceive the impact of persons in the shadows on expertise development, particularly in fields like popular music. This study investigates the perceived impact exerted by peers, parents and teachers on the expertise development of guitarists in the domain of popular music. Interviews were used to investigate nine case studies of guitarists with different expertise levels (experts, sub-experts, amateurs). The main focus was on the roles of “persons in the shadows” concerning practising, learning and motivation. The results show that experts differ from sub-experts and amateurs in the perception of support from persons in the shadows. In particular, peers and the formation of bands were thought of having a strong effect on practising, learning and motivation. The impact of parents and teachers on the expertise development in guitar playing was perceived as more ambiguous, and they were deemed as less important by the expert group.
Refugee and Immigrant Women’s Experience of Postpartum Depression: A Meta-Synthesis
Authors: Tobin Carolyn L. , Di Napoli Pam , Beck Cheryl Tatano
Published: January 2017

The aim of this work is to synthesize qualitative research on refugee and immigrant women’s experiences of postpartum depression (PPD) to gain insight into the unique needs of this group of women. This population is more at risk of developing PPD due to a complexity of issues including pre- and postmigratory stressors; however, there is currently little research on this topic available to health care providers and policy makers. Thirteen articles met inclusion criteria, and five themes emerged from the meta-synthesis: (a) suffering in solitude, (b) the invisible illness, (c) cultural conceptualizations, (d) barriers to help seeking, and (e) facilitators of help seeking. Conclusions suggest immigrant women with PPD may lack understanding of their condition, are often isolated, are alone, fear stigmatization, and risk being considered an unfit mother. Raising awareness with health care providers of the meaning of PPD for immigrant women is key to the provision of effective care.
The Outward Bound Solo: A Study of Participants' Perceptions
Authors: Kalisch Kenneth R. , Bobilya Andrew J. , Daniel Brad
Published: January 2017

Research on wilderness experience programs indicates there is much to learn about specific components of the overall experience. The solo, where students are intentionally separated from their expedition group for an extended time for reflection, has long had an anecdotal reputation for enhancing the quality of participants' experiences. The purpose of this predominately qualitative study was (a) to investigate participants' perceptions of an Outward Bound solo, and (b) to compare these findings with a previous solo study conducted at Wheaton College in Illinois. The results indicate that although participants valued solitude, unstructured time, and reflection in nature, they also found these to be the most difficult aspects of the solo. These results were similar to the previous study. Both studies assist program leaders to better utilize the solo experience as a tool for participant growth.
Perceived Impact of an Outdoor Orientation Program for First-Year University Students
Authors: Wolfe Brent D. , Kay Gregor
Published: January 2017

Colleges and universities across the United States are struggling with student retention and attrition (Derby & Smith, 2004; Jacobs & Archie, 2008; Tinto, 1993). As a result, theoretically supported interventions designed to encourage retention and persistence are needed. The purpose of this study was twofold: (a) to intentionally create an outdoor orientation program based on supported retention factors and (b) to explore participant perceptions of the designed program. Data were collected via participant observation, participant field notebooks, and follow-up meetings. Findings suggested that at the completion of the program, participants perceived higher commitment to the university (I Love My University!); an enhanced transition to university life (Consequences Rather Than Lectures); emotional, social, and personal growth (Becoming Real); and positive relationships with sophomores, juniors, and seniors (My New Family and Friends). Connections to the literature, limitations, and implications for future research and practice are discussed.
Investigating the Reciprocal Nature of Service-Learning in Physical Education Teacher Education
Authors: Galvan Christine , Parker Melissa
Published: January 2017

Constructivism theory (Crotty, 1998) served as the framework to investigate the reciprocal nature of a service-learning project that involved physical education pre-service teachers and urban underserved youth. Participants included three physical education teacher education (PETE) candidates and 15 youth between the ages of 6 and 13 who were primarily of Latino descent (96%). The service-learning course allowed the teacher candidates to experientially learn subject matter while serving a population in need. Data sources included field notes, participant interviews, and teacher journals. Data analysis identified that teacher candidates gained content knowledge, established protocol techniques, and experienced an enhanced awareness of cultural competence. Additionally, the youth learned sport skills, cooperation, and teamwork, and they established positive adult relationships. These findings suggest that PETE programs consider service-learning as a viable option when designing courses that emphasize authentic learning outcomes, critical reflection, and civic engagement.
Measuring Mindfulness in Summer Camp Staff
Authors: Gillard Ann , Roark Mark F. , Nyaga Lewis Ramsey Kanyiba , Bialeschki M. Deborah
Published: January 2017

Examining mindfulness in a non-clinical and non-therapeutic setting such as a summer camp is an area of growing interest. Our study tested three mindfulness scales with staff in a summer camp setting, and we conducted preliminary reliability and validity analyses for any modifications needed in the scales. Results indicated two major findings: (a) the 5-item camp-Mindful Attention and Awareness Scale showed good reliability and evidence of convergent validity, and (b) the 9-item parent-based and the 6-item teacher-based scales were not reliable or applicable to this study. Analyses of the data shed light on the usefulness of employing mindfulness scales in a camp setting.
Peeling the Onion Arts Propel in the University Classroom
Authors: Hanley Betty , King Gerald
Published: January 2017

A group of graduate students undertook a domain project in the summer of 1992 at the University of Victoria. Here is what happened.
The Treatment of Primary Orthostatic Hypotension
Authors: Hale Genevieve M. , Valdes Jose , Brenner Michael
Published: January 2017

Objective: To review the efficacy and safety of pharmacological and nonpharmacological strategies used to treat primary orthostatic hypotension (OH). Data Sources: A literature review using PubMed and MEDLINE databases searching hypotension, non-pharmacological therapy, midodrine, droxidopa, pyridostigmine, fludrocortisone, atomoxetine, pseudoephedrine, and octreotide was performed. Study Selection and Data Extraction: Randomized or observational studies, cohorts, case series, or case reports written in English between January 1970 and November 2016 that assessed primary OH treatment in adult patients were evaluated. Data Synthesis: Based on the chosen criteria, it was found that OH patients make up approximately 15% of all syncope patients, predominantly as a result of cardiovascular or neurological insults, or offending medication. Nonpharmacological strategies are the primary treatment, such as discontinuing offending medications, switching medication administration to bedtime, avoiding large carbohydrate-rich meals, limiting alcohol, maintaining adequate hydration, adding salt to diet, and so on. If these fail, pharmacotherapy can help ameliorate symptoms, including midodrine, droxidopa, fludrocortisone, pyridostigmine, atomoxetine, sympathomimetic agents, and octreotide. Conclusions: Midodrine and droxidopa possess the most evidence with respect to increasing blood pressure and alleviating symptoms. Pyridostigmine and fludrocortisone can be used in patients who fail to respond to these agents. Emerging evidence with low-dose atomoxetine is promising, especially in those with central autonomic failure, and may prove to be a viable alternative treatment option. Data surrounding other therapies such as sympathomimetic agents or octreotide are minimal. Medication management of primary OH should be guided by patient-specific factors, such as tolerability, adverse effects, and drug-drug and drug-disease interactions.
Career Assessment With the Personality Assessment System
Authors: Krauskopf C.J. , Saunders D.R.
Published: January 2017

The Personality Assessment System (PAS; Gittinger, 1964) is a theory based on differential aptitudes and abilities. Wechsler Scales are used to operationalize the theoretical dimensions. The theory and selected supporting research are described. Some research specific to career assessment is presented, and general principles of using the PAS in career assessment are discussed. The theory can be used in either a job-person match approach or a self-knowledge approach to career counseling.