bluuebunny/crossref_metadata_2025 huggingface dataset:
An empirical investigation of the metrics alignment process
Authors: Melnyk Steven A. , Calantone Roger J. , Luft Joan , Stewart Douglas M. , Zsidisin George A. , Hanson John , Burns Laird
Published: August 2005

Purpose

To understand the use of metrics to attain alignment between the needs of the customer, strategic objectives, and the execution system. This paper examines the process by which metrics at the various levels are developed and the factors affecting this process.

Design/methodology/approach

The paper draws on a series of “deep” case studies and 45 interviews of key managers at various levels within three related businesses. Open and axial coding on the data was performed and themes reported.

Findings

The findings show how metrics can generate two types of synergy, financial, and strategic and that numerous factors affect metrics deployment and alignment. There also exists a tension between those metrics that encourage sales growth through innovation and market development (i.e. the so‐called top line metrics) and those metrics that reduce costs or asset investments (i.e. bottom line metrics).

Research limitations/implications

Selective coding of the data to develop theoretical insight has yet to be performed.

Practical implications

Alignment is affected by both the goals used and the processes used in developing and implementing metrics. Furthermore, the study shows that those actions that foster cost reduction (e.g. through lean systems) may unintentionally hinder and limit those actions aimed at encouraging innovation.

Originality/value

The metrics alignment process is vital to effective management, yet the mechanisms of this process leading from understanding of the customer goals appropriate metrics for the execution system is effectively unexplored – a shortcoming that this paper begins to rectify.
Resources that drive performance: an empirical investigation
Authors: Rocha Fernandes Bruno H. , Mills John F. , Tereza L. Fleury Maria
Published: August 2005

Purpose

To investigate in an empirical situation the resources that drive organizational performance, considering as resources HR practices, human competencies and other tangible resources and evaluating performance according to the balanced scorecard (BSC) model.

Design/methodology/approach

After literature review, a case study in a Brazilian water company was chosen. Methodology consisted of in‐depth interviews with managers; collection of information from company's database and questionnaires; factor analysis to identify underlying factors that explain the majority of variance for each BSC perspective; regression analysis to find association between factors and resources.

Findings

In general, resources seemed to be correlated to performance, but further details appeared: employee competency presented no correlation with performance; environmental factors related to demand seemed to be the strongest performance determinant; employee satisfaction showed association with all BSC perspective.

Research limitations/implications

The research circumstances are quite particular and should not be generalized to other organizations. Future research should focus on more knowledge intensive firms and use a longitudinal research design.

Practical implications

The results for practitioners, especially those in the investigated company, included the need to review part of their indicators, choosing formulae that are better connected to business results.

Originality/value

This paper helps to understand how resources and competencies convert into performance and proposes a methodology to be used under particular conditions of organizations with multiple and comparable business units.
Local government financial key performance indicators – not so relevant, reliable and accountable
Authors: Pilcher Robyn
Published: August 2005

Purpose

Local government in Australia has a complex system of accountability, part of which includes the publication of financial comparative performance measures. The purpose of this paper is to demonstrate how questionable financial figures not only distort the reported “bottom line” of local councils but can also be included in a number of financial key performance indicators (FKPIs) upon which council performance is judged. Valuation and depreciation of transport infrastructure assets form the basis for the evaluation.

Design/methodology/approach

A longitudinal study of all New South Wales (NSW) councils (170) from 1999‐2000 to 2002‐2003 was conducted using archival research combined with in‐depth case study analysis and interviews (New South Wales (NSW) is the largest of Australia's eight states and territories). This paper provides detailed analysis of 28 local government councils classified as being on “financial watch” by the Department of Local Government and a comparative sample of 28 councils not classified as at risk but reporting figures considered to be contestable (At risk, or financially challenged councils, are defined as “having issues of concern with their financial operations”).

Findings

Of the 170 councils in NSW, up to 98 per cent recorded an error in depreciation of some component of transport infrastructure during 1999‐2000 and 2002‐2003. The error margin ranged from 11 to 73,520 per cent significantly impacting on the three targeted FKPIs.

Practical implications

Future research will examine preparation of possible alternative policies for local government addressing the issue of internal benchmarking and external performance measures.

Originality/value

This research offers some reparation for the relative lack of empirical research literature on local government FKPIs and, in particular, those that do not meet the underlying accountability focus of performance measurement.
Regional activation in the rat brain during visceral stimulation detected by c‐fos expression and fMRI
Authors: Lazovic J. , Wrzos H. F. , Yang Q. X. , Collins C. M. , Smith M. B. , Norgren R. , Matyas K. , Ouyang A.
Published: August 2005

Abstract  Aim:  The aim of the study was to determine and compare the areas of brain activated in response to colorectal distention (CRD) using functional magnetic resonance imaging (fMRI) and c‐fos protein expression.

Methods:  For fMRI study (3.0 T magnet), anaesthetized rats underwent phasic CRD, synchronized with fMRI acquisition. Stimulation consisted of eight cycles of balloon deflation (90 s) and inflation (30 s), at 40, 60 or 80 mmHg of pressure. For c‐fos study two sets of experiments were performed on anaesthetized rats: comparing (A) brain activation in rats with the inserted colorectal balloon (n = 5), to the rats without the balloon (n = 5); and (B) rats with inserted balloon (n = 10), to the rats with inserted and distended balloon (n = 10). The pressure of 80 mmHg was applied for 2 h of 30 s inflation and 90 s deflation, alternating cycles.

Results:  Functional MRI revealed significant activation in the amygdala, hypothalamus, thalamus, cerebellum and hippocampus. Significant increase in c‐fos expression was observed in amygdala and thalamus in the first set of experiments, and hypothalamus and parabrachial nuclei in the second.

Conclusion:  The two methods are not interchangeable but appeared to be complementary: fMRI was more sensitive, whereas c‐fos had much greater resolution.
Neural and non‐neural mediation of propionate‐induced contractile responses in the rat distal colon
Authors: Mitsui R. , Ono S. , Karaki S. , Kuwahara A.
Published: August 2005

Abstract  Short‐chain fatty acids (SCFAs), including propionate, butyrate and acetate, are fermentation products of carbohydrates in the colon. We investigated the contractile effects of SCFAs on the rat distal colon. Mechanical activity of the circular muscle in strip preparations was recorded in vitro. Propionate and butyrate concentration‐dependently (10 μmol L−1–10 mmol L−1) induced rapid, large amplitude phasic contractions (the first phase) followed by tonic contractions (the second phase). Acetate itself had no effect on muscle activity, although preincubation with acetate attenuated both phases of the propionate‐induced response. The propionate‐induced phasic contraction was attenuated by atropine, tetrodotoxin and the 5‐HT4 receptor antagonist SB‐204070. The propionate‐induced tonic contraction was attenuated by the cyclo‐oxygenase inhibitor piroxicam. Antagonists of 5‐HT1A, 5‐HT2A and 5‐HT3 receptors had no effect on the responses. Propionate‐induced responses were not observed in mucosa‐free preparations. These results suggest that propionate acts on receptors in the mucosa causing the release of 5‐HT from enterochromaffin cells. 5‐HT acts through 5‐HT4 receptors on the endings of intrinsic primary afferent neurones that in turn activate cholinergic motor neurones that contract the circular muscle. Propionate also causes tonic contraction, via prostaglandin release, in the rat distal colon.
Subjective and objective sleep indices in women with irritable bowel syndrome
Authors: Heitkemper M. , Jarrett M. , Burr R. , Cain K. C. , Landis C. , Lentz M. , Poppe A.
Published: August 2005

Abstract  Patients with irritable bowel syndrome (IBS) commonly report sleep disturbances. This study examined self‐report (Pittsburgh Sleep Quality Inventory) sleep quality and polysomnography (PSG) sleep variables in 18 women with mild‐to‐moderate IBS, 18 with severe IBS and 38 with age‐ and gender‐matched controls. All women were studied on two consecutive nights in a sleep research laboratory where PSG data were collected. Retrospective and daily measures were obtained of self‐reported sleep quality, psychological distress and gastrointestinal symptoms across one menstrual cycle. Self‐report measures of psychological distress and sleep quality were significantly worse in the IBS‐severe (IBS‐S) group compared with controls. Rapid eye movement (REM) latency was higher in the two IBS groups on Night 1 than the control group (P = 0.06). Percentage time in REM was highest in the IBS‐S on Night 2. All groups demonstrated greater sleep disruption on Night 1 (adaptation) when compared with Night 2. These results highlight the importance of considering the ‘first‐night effect’ in those with IBS and the lack of concordance between self‐report and objective indices of sleep in women with IBS.
A comparative study of superoxide dismutase, catalase, and glutathione peroxidase activities and nitrate levels in vitiligo patients
Authors: Hazneci Ersoy , Karabulut Aysun Bay , Öztürk Çetin , Batçioğlu Kadir , Doğan Gürsoy , Karaca Şemsettin , Eşrefoğlu Muammer
Published: August 2005

Background  Several groups have shown the involvement of oxidative stress in the pathophysiology of vitiligo.

Methods  In this study, we examined the erythrocyte and plasma activities of glutathione peroxidase and Cu/Zn superoxide dismutase, plasma nitrite/nitrate levels, and erythrocyte catalase activity in 23 vitiligo patients and 25 controls.

Results  The results show that erythrocyte superoxide dismutase activity and plasma nitrite/nitrate levels are high in vitiligo patients.

Conclusions  Our study confirms that oxidative stress is involved in the pathophysiology of vitiligo, as indicated by the high levels of erythrocyte superoxide dismutase activity and plasma nitrite/nitrate.
Cyclosporine controls epidermolysis bullosa acquisita co‐occurring with acquired factor VIII deficiency
Authors: Maize John C. , Cohen Jack B.
Published: August 2005

Background  Epidermolysis bullosa acquisita (EBA) is a rare antibody‐mediated autoimmune blistering disease of adults. Likewise, acquired factor VIII deficiency is a rare antibody‐mediated disease of adulthood. Both diseases can be exceedingly difficult to treat and refractory to immunomodulatory therapies.

Methods  Herein, we report a challenging case of EBA and acquired factor VIII deficiency in the same patient.

Results  Cyclosporine 4 mg/kg/day rapidly controlled both disease processes after the patient failed to respond to prednisone, colchicine, and pulse cyclophosphamide. The EBA relapsed when the cyclosporine was decreased to 2 mg/kg/day and the patient wore snuggly fitting new shoes, but it cleared quickly when the dose was increased. Cyclosporine has since been decreased gradually to 1.5 mg/kg/day without relapse of either condition or detectable side‐effects.

Conclusions  Cyclosporine should be considered when EBA and/or acquired factor VIII deficiency fail to respond to conservative therapy. Both conditions usually respond rapidly to cyclosporine 4–6 mg/kg/day.
Nasal and bronchial response to exercise in patients with asthma and rhinitis: the role of nitric oxide
Authors: Valero A. , Serrano C. , Valera J. L. , Barberá A. , Torrego A. , Mullol J. , Picado C.
Published: August 2005

Background:  Physical exercise is associated with a decrease in nasal resistance in rhinitis and an increase in bronchial resistance in asthma. The objective was to evaluate the relationship between the levels of nasal nitric oxide (nNO) and exhaled bronchial nitric oxide (eNO) with bronchial responses to exercise in patients with rhinitis and asthma.

Methods:  We submitted 24 subjects with asthma and rhinitis to an exercise test. A decrease in FEV1≥15% was considered positive. The volume of the nasal cavity and the minimal cross‐sectional area (MCA) was evaluated by means of acoustic rhinometry (AR), and nNO and eNO were evaluated by chemoluminiscence. The measurements were recorded at baseline, 15 and 50 min after the end of the exercise test.

Results:  The exercise test was positive in 17 cases. Fifteen minutes after exercise test, the nasal volume increased by 57% (P < 0.0001) and was still increased by 30% after 50 min (P < 0.0001). There was no correlation between decrease in FEV1 and increase in nasal volume. The baseline value of nNO was 1185 ± 439 ppb, and the value at 15 and 50 min was 1165 ± 413 and 1020 ± 368 ppb, the latter value being significantly lower (P < 0.01) than the baseline. The baseline value of eNO was 21 ± 19 ppb, with no significant differences at 15 and 50 min. There was no significant correlation between either the decrease in FEV1 and the nasal response, or the baseline eNO and nNO values.

Conclusions:  The nasal and bronchial response to exercise is completely different in rhinitis and asthma; in the former, an increase in nasal volume occurs, while in the latter there is a drop in FEV1. There is no relationship between the values of nasal or exhaled NO and the nasal and bronchial response after exercise.
Undergraduate nursing students’ attitudes towards smoking health promotion
Authors: McCann Terence V. , Clark Eileen , Rowe Kathy
Published: August 2005

Abstract  Despite the fact that nurses have a key role in health promotion, many continue to smoke at much the same rate as the general population. This paper investigates the influence of smoking status, gender, age, stage of education, and smoking duration on undergraduate nursing students’ attitudes towards smoking health promotion. The study took place in one university's School of Nursing in Victoria, Australia. Respondents completed the Smoking and Health Promotion instrument. Researchers obtained ethics approval prior to commencing the study. Smoking status was the main factor that affected respondents’ attitudes towards smoking health promotion, with age and education stage having a minor effect, and gender and smoking duration not significant. Nurses have an important role in modeling non‐smoking behaviors for patients. There needs to be consistency between personal and professional beliefs for nurses to properly engage in smoking health promotion. The findings have implications for undergraduate nursing education curricula, nursing practice and research, and these are discussed.
Long‐term survival outcomes following breast cancer surgery in Western Australia
Authors: Spilsbury Katrina , Semmens James B. , Saunders Christobel M. , Holman C. D. J.
Published: August 2005

Background:  Mortality rates from breast cancer are stabilizing or falling in many developed countries including Australia, however, survival outcomes are known to vary by social, demographic and treatment related factors. The aim of the present study was to investigate how hospital, social and demographic factors were associated with survival outcomes from surgically treated breast cancer for all women living in Western Australia.

Methods:  The WA Data Linkage System was used to access hospital morbidity, death and cancer information for all women diagnosed with invasive breast cancer in Western Australia 1982−2000. Relative survival and Cox proportional hazards regression analyses were used to identify social, demographic and hospital factors associated with an increased risk of dying from breast cancer or dying from any cause.

Results:  Survival outcomes improved in all women diagnosed in more recent calendar periods. However, a significantly increased risk of dying was observed for women who underwent initial surgical treatment in regional public hospitals outside of the state capital, Perth. Consistent with other reports, women aged greater than 80 years and younger than 35 years at diagnosis also had poorer survival outcomes. Residential location, socioeconomic status and race were not associated with survival after adjusting for treatment, health and hospital related factors.

Conclusions:  Despite overall improvements in survival of women diagnosed with breast cancer in Western Australia, initial surgical treatment in public hospitals outside of Perth was associated with significantly poorer outcomes.
Naturalistic Evaluation of the Effectiveness of Psychodynamic Psychotherapy with Adults with Intellectual Disabilities
Authors: Beail Nigel , Warden Sharon , Morsley Kim , Newman David
Published: August 2005

Background  Despite repeated calls for research on the efficacy and effectiveness of psychotherapy with people with intellectual disabilities there has been little progress in this area. This paper reports a naturalistic study of the effectiveness of individual psychodynamic psychotherapy provided in routine clinical practice.

Method  The study was an open trial design with a 3‐month follow‐up period. Widely available and used psychotherapy outcome measures were adopted, but administered in an assisted completion format at intake, outcome and follow‐up. Data were analyzed using repeated measures ANOVA. Effect sizes were also computed.

Results  The results show statistically significant reductions in recipients’ levels of psychological distress and interpersonal problems and an increase in self‐esteem. Effect sizes were modest to large.

Conclusions  The study shows that adults with intellectual disabilities can benefit from individual psychotherapy provided in routine clinical practice. The method has obvious limitations because of its uncontrolled, open trial design. However, the study had a recipient group that represents the client population and thus has greater generalisability to clinical practice. This study also provides some suggestions for routine audit and evaluation exercises and more rigorous designs.
Surgical Treatment for Epilepsy in Cerebral Tuberous Sclerosis
Authors: Bebin Elizabeth M. , Kelly Patrick J. , Gomez Manuel R.
Published: August 2005

Summary: Tuberous sclerosis (TS) is an autosomal dominant hamartiosis and hamartomatosis with variable expression that is commonly associated with medically intractable seizures. Patients with TS complex (TSC) frequently have multiple brain lesions that can give rise to seizure activity. We report 9 patients with TSC who underwent epilepsy surgery at the Mayo Clinic between 1986 and 1990. Surgical procedures performed included cortical resection (n = 2) and stereotaxic lesionectomy (n = 7). Neuropathologic diagnoses were cortical tubers (n = 7) and glioneural hamartomas (n = 2). Three of 9 patients had multifocal interictal scalp epileptiform EEG activity; however, ictal recordings identified the focus of seizure activity, which in all cases corresponded to a prominent neuroimaging abnormality. Our patients have been followed for 10–72 months (mean 35 months). Four patients are seizure‐free with medication, 2 are seizurefree without medication, 2 had >80% reduction in seizure frequency, and 1 experienced only an initial temporary reduction in seizure frequency. Postoperative EEG recordings showed absence of epileptiform abnormalities in the 5 patients who are seizure‐free; the other 4 patients continue to have multifocal abnormalities. These data suggest that epilepsy surgery may be beneficial in selected patients with TSC despite multifocal EEG and neuroimaging abnormalities.
Visual Inattention in West Syndrome: A Neuropsychological and Neurofunctional Imaging Study
Authors: Jambaqué I. , Chiron C. , Dulac O. , Raynaud C. , Syrota P.
Published: August 2005

Summary: Visual behavior is frequently impaired at onset of West syndrome (WS). We studied the neuropsy‐ chological outcome of eight children who had cryptogenic WS and moderate to severe visual impairment at the onset of epilepsy. At the last examination, a regional cerebral blood flow study using SPECT (single photon emission computed tomography) was performed. The behavior abnormalities observed initially evolved to various defects of cognitive function. Three patients had severe mental retardation with autistic features. Two had marked speech disorders but one had global cognitive impairment. Three patients had specific visual‐spatial deficits. SPECT showed perfusion defects involving the parieto‐occipital areas in 6 of 8 patients. These abnormalities were restricted to parieto‐occipital regions in the three patients with selective visual‐spatial deficits, whereas they were associated with other perfusion defects in the three remaining patients. This study demonstrates that the visual inattention observed at the onset of WS is frequently associated with long‐term cognitive and/ or perfusion defects involving the parieto‐occipital regions.
Temporal Lobe Epilepsy in Early Childhood
Authors: Wyllie Elaine , Chee Michael , Granstrom Marja‐Liisa , DelGiudice Ennio , Estes Melinda , Comair Youssef , Pizzi Margaret , Kotagal Prakash , Bourgeois Blaise , Lüders Hans
Published: August 2005

To explore the electroclinical features of temporal lobe epilepsy (TLE) in early childhood, we studied results of video‐EEG and other tests of 14 children aged 16 months to 12 years selected by seizure‐free outcome after temporal lobectomy. Four children had mesiotemporal sclerosis, 1 had cortical dysplasia, and 9 had low‐grade temporal neoplasms. The children had complex partial seizures (CPS) with symptomatology similar to that of adults with TLE, including decreased responsiveness and automatisms. Automatisms tended to be simpler in the younger children, typically limited to lip smacking and fumbling hand gestures. Scalp/sphenoidal EEC showed anterior/inferior temporal interictal sharp waves and unilateral temporal seizure onset in the 4 children with mesiotemporal sclerosis and in the child with cortical dysplasia, but EEG findings in 9 children with low‐grade temporal tumors were complex, including multifo‐cal interictal sharp waves or poorly localized or falsely lateralized EEG seizure onset. In children without tumors, video‐EEG was critical to localization of the epi‐leptogenic zone for resection, but in patients with tumors video‐EEG was less localizing and its main value was to confirm that the reported behaviors were epileptic seizures with semiology typical of temporal lobe onset.
Temporal Lobe Epilepsy After Prolonged Febrile Convulsions: Excellent Outcome After Surgical Treatment
Authors: Abou‐Khalil Bassel , Andermann Eva , Andermann Frederick , Olivier Andre , Quesney L. Felipe
Published: August 2005

We studied 47 consecutive patients who underwent temporal resection for seizure control. Nineteen (40%) had febrile convulsions preceding onset of their habitual seizures. In 17 of 18 patients whose disease duration was known, the febrile convulsions were prolonged (mean 4 h). As compared with patients without preceding febrile convulsions, patients with antecedent febrile convulsions had a significantly higher prevalence of positive family history of febrile convulsions, an increased incidence of retrospectively identified gestational or perinatal complications, and no foreign tissue lesions. Pathologic studies showed gliosis and cell loss in mesiotemporal structures, usually moderate, in addition to usually mild gliosis in lateral temporal cortex. These patients had an excellent outcome after temporal resection: 84% were seizure‐free, had residual auras only, or occasional convulsions with medication discontinuation. One patient (5%) had >90% improvement. Two patients (11%) in whom the hippocampus was totally spared continued to have complex partial seizures: in both, seizures stopped after reoperation and hippocampal resection. Thus, 95% of these patients had an excellent result. Only 16% required invasive preoperative studies to confirm lateralization. These results were significantly better than those of the group without preceding febrile convulsions (p= 0.0013).
Increasing Plasma Concentration Tolerability Study of Flunarizine in Comedicated Epileptic Patients
Authors: Treiman David M. , Pledger Gordon W. , DeGiorgio Christopher , Tsay Jia‐Yeong , Cereghino James J.
Published: August 2005

Twelve patients with intractable partial seizures [4 receiving carbamazepine (CBZ), 4 phenytoin (PHT), and 4 both] entered a study of the tolerability of flunarizine (FNR) at specified plasma concentrations. After an 8‐week baseline period, a single‐dose pharmacoki‐netic study was performed for each patient to calculate a loading dose and maintenance dosage necessary to achieve a target plasma FNR concentration of 30 ng/ml. The first 8 patients received the loading dose (as divided doses) during a 1‐week hospitalization and the maintenance dosage for the ensuing 8 weeks. These patients proceeded to treatment periods with target concentrations of 60 and then 120 ng/ml, using doses based on an assumed linear relation between dose and plasma concentration. The last 4 patients were studied only at the 120‐ng/ml target level. Results indicated that this procedure successfully approximated target levels of 30 and 60 ng/ ml, but observed concentrations in the last period exceeded the 120‐ng/ml target level and continued to increase with time, often necessitating a dosage reduction owing to intolerability. Calculated doses for a given target concentration varied by a factor of 12. The most frequently reported adverse experiences were sedation and increased fatigue; reports of dizziness, headache, and lethargy were also common. Based on this study, a target concentration of at least 60 but <120 ng/ml is recommended for a controlled clinical trial of the antiepileptic efficacy of FNR.
Association of Ipsilateral Head Turning and Dystonia in Temporal Lobe Seizures
Authors: Fakhoury Toufic , Abou‐Khalil Bassel
Published: August 2005

Summary: We evaluated head turning in 239 complex partial seizures (CPS) with or without generalization in 32 patients with unilateral temporal lobe epilepsy (TLE). Head turns occurred in 187 seizures of 31 patients, more than once in 71 seizures. The first head turn was ipsilatera1 to the focus in 162 seizures (87%), with a mean latency of 22 s, as compared with 83 s for contralateral first head turns. Concomitant dystonic posturing of the arm occurred with 71% of all ipsilateral head turns and with 16% of all contralateral head turns. The mean difference in absolute latency between the first head turn and concomitant dystonic posturing was 6 s. Examination of all instances of concomitant head turning and dystonic posturing (160) showed them to be contralateral to each other in 154 (96%). Furthermore, the dystonia was contralateral and head turning was ipsilateral to the focus in 149 (93%). Forty‐one seizures secondarily generalized, with transitional tonic head deviation contralateral to the focus in 35. Early head turning suggests an ipsilateral temporal seizure focus, particularly when associated with contralateral dystonic posturing. Similar mechanisms may account for both. Tonic head deviation preceding secondary generalization probably has a different mechanism.
It Is Not Harmful for Patients with Epilepsy to View Their Own Seizures
Authors: Sanders Pamela T. , Bare Mary A. , Lesser Ronald P.
Published: August 2005

Summary: Having a seizure in public is a concern to people with epilepsy and can represent a barrier to psychosocial adjustment. Seeing his or her own seizures might help the patient deal with seizures more realistically, but also could be emotionally detrimental. We therefore showed patients videos of their own seizures before their discharge from our inpatient epilepsy monitoring unit. One of the investigators was present to answer questions. The Spielberger State Trait Anxiety Scale (SSTAS) was administered before and after viewing and 1 month later together with a questionnaire related to the patients' feelings and attitudes about viewing their own seizures. Results using one‐way repeated‐measures multivariate analysis of variance (MANOVA) showed no differences for the items in the pre‐ and posttest questionnaire. For the SSTAS, no significant differences were detected among the pretest and the two posttests by one‐way repeated ANOVA (p = 0.10). These results suggest that it is not harmful to view one's own seizures in a controlled setting.
Near‐Patient Rapid Assay of Phenytoin Concentration
Authors: Scheyer Richard D. , Hochholzer Jane M. , Mattson Richard H.
Published: August 2005

Summary: The Biotrack 516 is a simple, automated whole blood phenytoin (PHT) assay that reports corresponding total serum concentrations in 3 min. We compared Biotrack results in 58 patients with the total and unbound serum PHT concentrations measured by the standard TDx fluorescence polarization immunoassay. Correlation with total TDx concentration was high (r = 0.98); median absolute error was 1.4 μg/ml. Correlation of unbound PHT with Biotrack (r = 0.95) was comparable to correlation of unbound and total TDx (r = 0.94). The Biotrack assay is a promising method for clinical monitoring of PHT concentrations.
Subsequent Epilepsy in Very‐Low‐Birthweight Infants: A Long‐Term Follow‐up Study from Birth
Authors: Ishikawa Tatsuya , Kishi Shinji , Inukai Kazuhisa , Kono Chikahiko , Kitoh Hideyuki , Awaya Atsuko , Nishio Kimio , Saito Satsuki , Kamiya Yasuji , Yokochi Kenji
Published: August 2005

Summary: We studied 197 survivors of 290 very‐low‐birthweight (VLBW, <1,500g) infants admitted to our neonatal intensive care unit from 1977 through 1982. The children were all followed until at least age 6 years (mean 10 years 6 months). Eight children (4.1%) had epilepsy: 5 had generalized, 2 had unilateral, and 1 had partial seizures. Two (1.0%) had active and poorly controlled epilepsy. Three had a history of epileptic seizures, but none for ≥ 6 years, and 3 were no longer receiving antiepileptic drug (AED) treatment. Most (5 of 8) were severely multiply handicapped. As compared with VLBW children without epileptic seizures and neurodevelopmental abnormalities, VLBW children with epileptic seizures had a gestational age <27 weeks, a weight <1,000 g, severe perinatal complications as indicated by an Apgar score of <4 at 5 min, and the need for long‐term oxygen administration.
Cerebrospinal Fluid Purine Metabolites and Pyrimidine Bases After Brief Febrile Convulsions
Authors: Castro‐Gago M. , Cid E. , Trabazo S. , Pavón P. , Camiiia F. , Rodríguez‐Segade S. , Puñal J. Einís , Rodríguez‐Nuñez A.
Published: August 2005

Summary: Adenosine monophosphate, inosine monophosphate, inosine, adenosine, guanosine, adenine, guanine, hypoxanthine, xanthine, uric acid, and pyrimidines bases were determined in cerebrospinal fluid (CSF) of 52 children after simple febrile seizures and in a control group of 63 children. There was no statistically significant difference between the two groups for any of these metabolites, suggesting that simple febrile seizures (SFS) neither significantly disturb the metabolism of nucleotides, nucleosides, or bases nor significantly deplete neuron adenosine ATP levels. Therefore, they do not appear to constitute a threat of neuronal damage.
Neuron‐Specific Enolase Is Increased After Nonconvulsive Status Epilepticus
Authors: Rabinowicz Adrian L. , Correale Jorge D. , Bracht Kirsten A. , Smith Thomas D. , DeGiorgio Christopher M.
Published: August 2005

Summary: Serum neuron‐specific enolase (s‐NSE), a marker of brain injury and acute seizures, was increased in 2 patients with nonconvulsive SE. (NCSE) accounting for s‐NSE changes. Increase in s‐NSE provides further in vivo evidence of transient brain injury after NCSE.
Survey of Public Awareness, Understanding, and Attitudes Toward Epilepsy in Taiwan
Authors: Chung Ming‐Yao , Chang Yang‐chyuan , Lai Yen‐Huei C. , Lai Chi‐Wan
Published: August 2005

Summary: A survey of public awareness and understanding of and attitudes toward epilepsy was made in Taipei City and Chin‐San Village, Taiwan in 1992. In a population sample of 2,610 adults, 87% had read or heard about epilepsy, 70% knew someone who had epilepsy, 56% had seen someone having a seizure, 18% would object to having their children associated with persons with epilepsy, 72% would object to having their children marry a person with epilepsy, 31% believed that epileptic persons should not be employed in jobs as other persons are, 7% believed that epilepsy was a form of insanity, 34% did not know the cause of epilepsy, 13% did not know what an epileptic attack was like, and 18% did not know what to recommend if their friends or relatives had epilepsy. Youth, higher education, and upper levels of employment were correlated with answers that were more favorable concerning epilepsy in all survey questions except for the question regarding marriage, for which the reverse was noted. The attitudes toward epilepsy disclosed by this study were more favorable than those detected in a similar survey conducted in Henan Province, China. The comparison suggests that the exposure to Western culture and socioeconomic system in Taiwan might have helped reduce the discrimination against epilepsy.
Cerebral Blood Flow During Spike‐Wave Discharges
Authors: Sperling Michael R. , Skolnick Brett E.
Published: August 2005

Summary We used the 133xenon method to assess cerebral blood flow (CBF) during generalized spike‐wave discharges in a patient with an uncommon form of generalized epilepsy with persistent spike‐wave discharges. CBF measurements were made under four conditions with repeated measures: normal EEG, continuous theta state, continuous spike‐wave state at rest, and continuous spike‐wave discharges during performance of a cognitive activation task. CBF was mildly reduced (5.7%) during the theta state and decreased further (12%) in the spikewave state. Although globally diminished, CBF was less decreased in the frontal lobes and more decreased in the parietal lobes during spike‐wave discharges. CBF increased to baseline levels during the cognitive activation task. The decrease in CBF suggested that the generalized spike‐wave discharges caused a net decrease in cortical metabolic demand and neuronal activity. The differences in lobar CBF during spike‐wave discharges may reflect lobar disparities in neuronal firing patterns. The theta state noted is novel and intermediate between normal and spike‐wave.
Effects of Glutamate, N‐Methyl‐d‐Aspartate, High Potassium, and Hypoxia on Unit Discharges in CA1 Area of Hippocampal Slices of DBA and C57 Mice
Authors: Wang Zhian , Chow Sien‐Yao
Published: August 2005

Summary We studied effects of l‐glutamate, N‐methyl‐d‐aspartate (NMDA), high K+, and hypoxia on spontaneous unit discharges in stratum pyramidale of CA1 region of hippocampal slices in DBA and C57 mice aged 3–4 and 5–6 weeks. Application of l‐glutamate (0.5–2.0 mM), NMDA (5–20 μM), high K+ (8.5 mM), and a brief period of hypoxia (1 min) to the perfused artificial cerebrospinal fluid (ACSF) all produced different degrees of spontaneous high‐frequency discharges from CA1 area of hippocampal slices of both DBA and C57 mice. Two types of responses recorded extracellularly occurred after these manipulations: high‐frequency repetitive single spikes and bursts of multiple population spikes. The rate and type of responses from CA1 region of hippocampal slices after these manipulations were different and depended on the strain and age of mice and the nature of manipulations. In general, hippocampal slices from audiogenic seizure‐susceptible DBA mice were more sensitive than those from audiogenic seizure‐resistant C57 mice, and hippocampal slices from younger animals were more susceptible than those from older ones. Thus, DBA mice aged 3–4 weeks of age were most susceptible and C57 mice aged 5–6 weeks were least susceptible to all these pharmacological, ionic, and hypoxic manipulations. Bursts of multiple population spikes were the most common responses in DBA mice and in younger animals, and repetitive single spikes were the predominant responses in C57 mice and in older animals. In all groups of animals, the average spontaneous discharge rate was highest after l‐glutamate perfusion, next highest after NMDA, and lowest after high K+ and hypoxia. The latency of the appearance of spontaneous epileptiform activity from CA1 region of hippocampal slices was long (>2 min) after NMDA perfusion and short (<1 min) after l‐glutamate, high K+ and hypoxia. The duration of the increased spontaneous discharges was short (−1 min) after l‐glutamate perfusion, long (>3 min) after high K+ and hypoxia, and between short and long after NMDA perfusion. These results suggest that age and strain of animal and nature of stimulus precipitate different patterns of epileptiform activity in CNS.
Lateralization of Event‐Related Potentials During Discontinuation of Antiepileptic Medication
Authors: Tuunainen Arja , Nousiainen Unto , Pilke Antero , Mervaala Esa , Riekkinen Paavo
Published: August 2005

Summary:The effect of short‐term withdrawal of antiepileptic drugs (AEDs) on auditory event‐related potentials (ERPs) was studied in 16 patients undergoing preoperative evaluation for epilepsy surgery. ERPs were performed for all patients during treatment with full medication and after a l‐week period during ongoing tapering of AEDs. To clarify whether AED discontinuation would provide evidence of lateralizing for ERPs, we also studied the subgroup of 9 patients who had already undergone temporal lobectomies (TLE group). In the TLE group, if habitual seizures occurred <30 h before the ERP recording session, auditory N1 and P3 amplitudes across sphenoidal electrodes were markedly decreased on the side ipsilateral to the epileptic focus. If seizures did not occur, asymmetries in amplitudes were equivocal and not of lateralizing value. In the whole group, midline N1 latencies for standard responses decreased significantly during AED discontinuation. At baseline, long‐term habituation of the N1 component for standard responses was attenuated as compared with that of controls. During AED discontinuation, however, enhanced habituation of N1 was observed in TLE patients who did not exhibit seizures before ERP recording.
Differential Susceptibility to Seizures Induced by Systemic Kainic Acid Treatment in Mature DBA/2J and C57BLl6J Mice
Authors: Ferraro Thomas N. , Golden Gregory T. , Smith George G. , Berrettini Wade H.
Published: August 2005

Summary: Mature DBA/2J (D2) and C57BL/6J (B6) mice aged P.10 weeks were studied to determine susceptibility to behavioral seizures induced by kainic acid (KA) and the possible influence exerted by differences in metabolism and blood‐brain barrier (BBB) transport. Mice were observed for 4 h after subcutaneous (s.c.) KA injection. Behavioral seizure parameters included latency to first seizure (clonus), latency to tonic/clonic seizure, and latency to status epilepticus (SE). At a KA dose of 25 mg/kg, 80% of D2 mice exhibited tonicklonic seizures, whereas all B6 mice remained seizure‐free. At 30 mg/kg, tonic/ clonic seizures were observed in 100% of D2 mice and 25% of B6 mice. Of D2 mice exhibiting at least one clonic seizure in response to KA at a dose of 25 mg/kg, 50% entered SE and eventually died. Administration of [3H]KA (6.6 × 106dpm) at doses of 25 mg/kg (convulsive) or 11.1 μ/g (nonconvulsive) to mice of both strains resulted in similar levels of radioactivity in cortex, hippocampus, and cerebellum 30 and 60 min after injection. Bioconversion of [3H]KA to a radiolabeled brain metabolite in vivo could not be documented in mice from either strain. Results confirm previously reported differences between D2 and B6 mice in their relative susceptibility to seizures induced by systemic KA administration and suggest that these differences are not related to strain‐specific variation in metabolism or BBB transport of KA. Further studies of these two strains of mice may be useful for investigating genetic influences upon seizure susceptibility.
Effect of Hypoxia/Ischemia on Bicuculline‐Induced Seizures in Immature Rats: Behavioral and Electrocortical Phenomena
Authors: Cataltepe Oguz , Barron Todd F. , Heitjan Daniel F. , Vannucci Robert C. , Towfighi Javad
Published: August 2005

Summary The relation between hypoxidischemia and subsequent alterations in seizure susceptibility in developing brain remains unclear. We assessed the behavioral and electrocorticographic (ECoG) effects of hypoxicl ischemic brain damage on bicuculline (BIC)‐induced seizures in 7‐day postnatal rats, and determined maturational changes in seizure susceptibility, behavior and ECoG activity. Rat pups were subjected to unilateral common carotid artery ligation, followed by exposure to 8% O2 at 37°C for 2 h, an insult that produces brain damage in the cerebral hemisphere ipsilateral to carotid artery occlusion. The experimental group consisted of rat pups previously subjected to hypoxidischernia; control littermates received neither arterial ligation nor systemic hypoxia. Experimental animals received 4,5, or 6 mg/kg BIC subcutaneously (s.c.) at 2 and 24 h, and at 3, 7, and 21 days of recovery from hypoxidischemia. Two animals at each interval of recovery, 1 each from the experimental and control groups, were used for ECoG monitoring. After BIC injection, animal behavior was observed for 2 h. Behaviors and seizures were classified in five categories based on severity, duration, and character: 1, mild irritability; 2, few clonic seizures and agitation; 3, few tonicclonic seizures with swimming movements; 4, frequent tonic‐clonic seizures with apneic episodes; 5, continuous tonic‐clonic seizures and death. Rat pups previously subjected to hypoxidischernia had lesser seizure susceptibility than controls at 2–h recovery (p <0.05) and greater susceptibility than controls at 24 h (p <0.05). Tonic seizures were prominent at 2 and 24 h in both the experimental and control groups, whereas lesion‐sided circling was prominent only in the hypoxia/ischemic rat pups. At 3 days of recovery, seizure susceptibility was greater in controls (p <0.05), decreasing thereafter through 21 days of age. No significant differences in seizure severity were noted between the 2 groups at 7 and 21 days. A close correlation existed between behaviorally observed seizures and ECoG paroxysmal activity in all groups, although low‐amplitude spike activity occurred without associated behavioral changes, especially at 2 and 24 h of recovery. Hypoxia/ischemia severe enough to produce brain damage probably initially suppresses seizure susceptibility, which thereafter is temporarily increased at 24 h of recovery. The age‐dependent changes in seizure susceptibility after hypoxidischemia presumably relate to injury‐induced imbalance between excitatory and inhibitory neurotransmitter systems.
Kindling of the Interpeduncular Nucleus and Its Influence on Subsequent Amygdala Kindling in Rats
Authors: Chiba Shigeru , Wada Juhn A.
Published: August 2005

Summary We examined the effect of interpeduncular nucleus (IPN) kindling on subsequent amygdala (AM) kindling in rats (n = 9). Eleven to 15 daily IPN stimulations at an afterdischarge (AD)‐inducing threshold (40CL1000 PA, biphasic sine waves, 1–3 s) produced progressive AD growth (9 of 9 rats) and recruitment of behavioral seizures (7 of 9 rats). The final form of the latter was generalized tonic‐clonic seizures with or without a limbic seizure component. The latter was associated with ictal involvement of AM and sensorimotor cortex. Subsequent AM kindling resulted not only in more rapid kindling, but also in tonic seizure associated with a protracted loss of postural control (5–20 s) not observed in animals undergoing AM kindling without previous IPN kindling (n = 5).These findings indicate that the IPN can be kindled and that subsequent AM kindling utilizes the proconvulsant neuroplastic changes that have been already established by IPN kindling.
Age‐Dependent Effects of γ‐Aminobutyric Acid Agents on Flurothyl Seizures
Authors: Velíšek Libor , Velíšková Jana , Ptachewich Yael , Ortíz José , Shinnar Shlomo , Moshé Solomon L.
Published: August 2005

Summary: Behavioral characteristics of seizures have age‐dependent features, which suggests that effective treatment of seizures may be age‐specific as well. In experiments that used the flurothyl seizure model, we examined the effects of several drugs that affect GAB Aergic neurotransmission in rats of various ages. Systemic administration of phenobarbital (PB, a drug that enhances GABA, receptor‐mediated inhibition) was anticonvulsant in most age groups. In contrast, γ‐ vinyl GABA (VGB, a drug that increases endogenous GABA levels and enhances both GABAA and GABAB, receptor transmission) did not have anticonvulsant effects. Baclofen (a GABAB receptor agonist) was proconvulsant in 9‐day‐old rat pups, and anticonvulsant in 15–30‐day‐old rats and lost its anticonvulsant activity in 60‐day‐old rats. CGP 35348 (a GABAB receptor antagonist) was proconvulsant in developing rats but not in 60‐day‐old rats. A novel GABA, receptor antagonist, CGP 36742, was proconvulsant in 9‐ and 15‐day‐old rats but had no effects in 30‐ and 60‐day‐old rats. These results indicate that the effects of presumed GAB Aergic agents are not uniform across the age span. The differences may reflect age‐dependent maturational changes of GAB A receptor subtypes, differential action of the drugs on pre‐ and postsynaptic sites and possible non‐GAB Aergic effects.
Positron Emission Tomography with [11C]Deuterium‐Deprenyl in Temporal Lobe Epilepsy
Authors: Kumlien Eva , Bergström Mats , Lilja Anders , Andersson Jesper , Szekeres Valeria , Westerberg Carl‐Einar , Westerberg Göran , Antoni Gunnar , Långström Bengt
Published: August 2005

Summary: We performed positron emission tomography (PET) with [11C]deuterium‐deprenyl in 9 patients with temporal lobe epilepsy (TLE) undergoing evaluation for possible epilepsy surgery. Seven patients had unilateral and 2 had bilateral mesiotemporal epileptic foci based on the preoperative investigation including ictal EEG discharges and PET with 2‐[18F]fluoro‐2‐deoxyglucose (FDG). Deprenyl is an irreversible inhibitor of mono‐amine oxidase type B (MAO‐B) with a very high affinity for the enzyme. In the brain, MAO‐B is preferentially located in astrocytes, and a previous in vitro study showed increased binding of the ligand in sclerotic hippocampi. Dynamically acquired N‐[methyl‐11C]‐a, a‐di‐deutero‐L‐deprenyl distributions in PET images were analyzed graphically, and the focus regions were assessed visually on the PET images. In addition, the accumulation rate and distribution volume of the tracer relative to the cerebellar cortex were measured in standardized homologous temporal regions by semiquantitative methods. Uptake of [11C]deuterium‐deprenyl was significantly increased in the epileptogenic temporal lobes, both apparently and semiquantitatively. By calculating mean inter‐lobar ratios, we identified the temporal lobe containing the epileptic focus in six unilateral cases. One case was ambiguous but was not falsely localized. The two bilateral cases were correctly identified as such. Our results suggest that PET with [11C]deuterium‐deprenyl might be a useful method for identification of epileptogenic temporal lobes.