bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of self‐test items in tape‐slide instruction
Authors: JONES HAZEL C.
Published: January 2009

Two tape‐slide sequences in general pathology were used in an experiment to assess the value of self‐test items and to determine whether it is better to intersperse the self‐test items in the programme or place them all at the end of the sequence. The programmes were presented to a random sample of thirty‐six students from a class of 149 in one of three forms: version 1, tape‐slide programme without self‐test items; version 2, tape‐slide programme with self‐test items interspersed between sections of the sequence; and version 3, tape‐slide programme with all self‐test items at the end of the sequence.

Each student worked a pre‐test before studying versions 1, 2 or 3 of a programme. A week later they worked through the post‐test which was identical to the pre‐test. At the same time they filled in a short attitude questionnaire on the teaching method.

All students learned from the programmes. There was improvement in the post‐test on the mean pretest scores for all versions of both programmes. For one programme there was no significant difference between the mean post‐test scores for students studying versions 1, 2 or 3, but for the other programme there was a significant difference between the versions. In this case the inclusion of self‐test items was better for learning than no self‐test items, and it was better if the self‐test items were placed at the end of the sequence. A highly favourable attitude to the method is reported.
Married women doctors' training and re‐employment schemes in the West Midlands Region, with particular reference to psychiatry
Authors: BLUGLASS KERRY , DUNN T. LESLIE , GASTON F. W.
Published: January 2009

The response of one region to the Department of Health and Social Security recommendations on reemployment of women doctors contained in H.M. 69(6) is described. In many specialities there has been an encouraging return of married women doctors to medical practice within the hospital service. In the field of psychiatry the experience in a local subregional training scheme suggests that graduates of a high calibre can be attracted back to this speciality on a part‐time basis for training; the training has been acceptable for full qualification and the exami‐ nation success rate is high; part‐time appointments, including senior registrar and consultant posts, can be obtained; it would not appear that training need, in the first instance, be confined to those people working in a main teaching centre; the satisfactory resolution of any conflict between trainees' domestic and professional commitments is important, as is a flexible approach to the individual professional needs of the trainees. Such schemes appear to tap a valuable source of potential manpower which hitherto has not been fully utilized.
General practice teaching — within the hospital
Authors: DRURY M.
Published: January 2009

A programme of integrated teaching by consultants and general practitioners is described. The teaching took place in the hospitals used for the purpose by the Medical Faculty of the University of Birmingham.
An economic evaluation of NIOX MINO airway inflammation monitor in the United Kingdom
Authors: Price D. , Berg J. , Lindgren P.
Published: January 2009

Background:  Fractional exhaled nitric oxide (FENO), a marker of eosinophilic airway inflammation, is easily measured by noninvasive means. The objective of this study was to determine the cost‐effectiveness of FENO measurement using a hand‐held monitor (NIOX MINO), at a reimbursement price of £23, for asthma diagnosis and management in the UK.

Methods:  We constructed two decision trees to compare FENO measurement with standard diagnostic testing and guideline recommendations for management. For asthma diagnosis, we compared FENO measurement with lung function and reversibility testing, bronchial provocation and sputum eosinophil count. For asthma management, we evaluated the impact on asthma control, including inhaled corticosteroid use, exacerbations and hospitalizations, of monitoring with FENO measurement vs symptoms and lung function as in standard care. Resource use and health outcomes were evaluated over a 1‐year time frame. Direct costs were calculated from a UK health‐care payer perspective (2005 £).

Results:  An asthma diagnosis using FENO measurement cost £43 less per patient as compared with standard diagnostic tests. Asthma management using FENO measurement instead of lung function testing resulted in annual cost‐savings of £341 and 0.06 quality‐adjusted life‐years gained for patients with mild to severe asthma and cost‐savings of £554 and 0.004 quality‐adjusted life‐years gained for those with moderate to severe asthma.

Conclusions:  Asthma diagnosis based on FENO measurement with NIOX MINO alone is less costly and more accurate than standard diagnostic methods. Asthma management based on FENO measurement is less costly than asthma management based on standard guidelines and provides similar health benefits.
Standardization of allergen products: 1. Detailed characterization of GMP‐produced recombinant Bet v 1.0101 as biological reference preparation
Authors: Himly M. , Nony E. , Chabre H. , Van Overtvelt L. , Neubauer A. , Van Ree R. , Buchheit K.‐H. , Vieths S. , Moingeon P. , Ferreira F.
Published: January 2009

Background:  Standardization of allergen extracts requires the availability of well‐characterized recombinant allergens, which can be used as reference standards provided by the European regulatory authorities. The objective of this study was the detailed physicochemical and immunological characterization of rBet v 1.0101, which shall be used in a ring trial within the framework of the Biological Standardization Programme BSP090 of the European Directorate for Quality of Medicines and Healthcare.

Methods:  Recombinant Bet v 1.0101 Y0487 was produced under good manufacturing practice conditions and analysed by an array of physicochemical and immunological methods for identity, quantity, homogeneity, folding and denaturation, aggregation state and stability in solution, as well as biological activity.

Results:  Batch Y0487 was shown to contain monomeric and well‐folded protein being identical with rBet v 1.0101, as determined by mass spectrometry. SDS‐PAGE, isoelectric focusing, deamidation analysis and size‐exclusion chromatography with light scattering revealed sample homogeneity of >99.9%. Upon storage at +4°C batch Y0487 retained the monomeric state up to 3 months. Protein quantification determined by amino acid analysis was found coinciding with half‐maximal inhibition of serum IgE in ELISA. Biological activity of batch Y0487 was shown to be comparable to natural Bet v 1 by IgG and IgE immunoblotting, as well as basophil and T‐cell activation.

Conclusion:  Recombinant Bet v 1.0101 Y0487 was characterized extensively by physicochemical and immunological methods. It was shown highly stable, monomeric and immunologically equivalent to its natural counterpart. Thus, it represents an appropriate candidate reference standard for Bet v 1.
The outcome of patients with unclassified hypogammaglobulinemia in early childhood
Authors: Kutukculer Necil , Gulez Nesrin
Published: January 2009

Symptomatic hypogammaglobulinemia in childhood may be the initial finding of primary immunodeficiency (PID) or may be due to delay in maturation of immunoglobulin synthesis. The aim of this study was to review the clinical and laboratory records of patients with unclassified hypogammaglobulinemia and to evaluate whether these children experience changes in serum immunoglobulin concentrations during long‐term followup and have an exact diagnosis in natural course of disease. We reviewed the data of 412 patients who were diagnosed as PID with symptomatic hypogammaglobulinemia. Thirty‐seven patients with hypogammaglobulinemia [19 males (51.4%) and 18 females (48.6%), with a followup of 34.1 ± 22.0 months] who were not classified according to European Society for Immunodeficiencies diagnostic criteria were included in this study. The mean age at the beginning of the symptoms was 21.4 ± 20.6 months and the mean age at admission was 51.5 ± 25.8 months. The commonest clinical presentations were recurrent upper (94.6%) and/or lower (40.5%) respiratory infections, urinary infection (27%) and gastroenteritis (10.8%). Percentage of consanguinity was 8%. Of the initial 37 patients, 18 (48.6%) spontaneously corrected their immunoglobulin abnormalities during followup. Clinical symptoms of these patients were also improved. IgG, IgA and IgM levels reached to normal levels at ages 62.5 ± 21.8, 72.0 ± 11.2, 55.2 ± 7.8 months, respectively. In remaining 19 patients with undefined/unclassified hypogammaglobulinemia, three partial IgA deficiency, seven IgG subclass deficiency, two selective IgM deficiency and two common variable immunodeficiency (CVID) were diagnosed by long‐term monitoring of immunoglobulin levels. Five (13.5%) of the 37 unclassified patients could not be exactly diagnosed while two of them might have a T‐cell defect and three of them still had low IgG and IgA levels but adequate antibody responses against vaccine antigens. In conclusion, it is important to monitor symptomatic patients with hypogammaglobulinemia periodically. Some children may spontaneously correct their immunoglobulin abnormalities not in the first 30 months of age, but during the first decade of life and some of them may have a severe PID like CVID.
Effects of Alendronate on A Disintegrin and Metalloproteinase with Thrombospondin Motifs Expression in the Developing Epiphyseal Cartilage in Rats
Authors: Kim M. S. , Kim J. H. , Lee M. R. , Kang J. H. , Kim H. J. , Ko H. M. , Choi C. H. , Jung J. Y. , Koh J. T. , Kim B. K. , Oh H. K. , Kim W. J. , Lee E. J. , Kim S. H.
Published: January 2009

A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) have been reported to play a role in the degradation of aggrecan, a major component of cartilage. This study was performed to examine the effects of alendronate on the expression of ADAMTS in developing femoral epiphyseal cartilage. Primary cultured chondrocytes from this cartilage were treated with alendronate in vitro and postnatal day 1 rats were injected subcutaneously with alendronate (1 mg/kg) every second day in vivo. The number of cultured chondrocytes and their aggrecan mRNA levels were unaffected by the alendronate treatment at 10−6 to 10−4 m concentrations. The mRNA levels of ADAMTS‐1, ‐2 and ‐9 in chondrocytes were also unaffected. However, the levels of ADAMTS‐5 and ‐4 were reduced significantly by the same treatment. The thickness of the proliferating chondrocyte layers and the aggrecan mRNA levels in the epiphysis were unaffected by the alendronate treatment in vivo. However, the hypertrophied chondrocyte layers became significantly thicker, and the size of the secondary ossification centre was reduced significantly by the same treatment (P < 0.05). Both ADAMTS‐4 and ‐5 mRNA expressions were also reduced significantly in vivo. The immunoreactivity against ADAMTS‐4 was seen in hypertrophied chondrocytes and reduced significantly by the alendronate treatment. These results suggested that alendronate can inhibit the degradation of aggrecan in the articular cartilage by downregulating the expression of matrix enzymes such as ADAMTS‐4 and ‐5.
Contribution of Pathogens to Peach Fruit Rot in Northern Greece and their Sensitivity to Iprodione, Carbendazim, Thiophanate‐methyl and Tebuconazole Fungicides
Authors: Thomidis Thomas , Michailides Themis , Exadaktylou Efstathia
Published: January 2009

This study identified the main pathogens causing fruit rots of mature peaches in northern Greece, the major peach producing area of Greece. The brown rot pathogen Monilinia laxa was responsible for approximately 70% and 78% of rotted peaches in 2005 and 2006 respectively. Serious damage (up to 5%) was also caused with the fungus Phomopsis amygdali. Other pathogens isolated from rotted peaches at a low percentage were Alternaria alternata, Aspergillus niger, Aspergillus flavus, Botrytis cinerea, Sclerotinia sclerotiorum, Fusarium spp., Colletotrichum gloeosporioides, Rhizopus stolonifer and Gilbertella persicaria. Most fungal isolates originated from the rotted peaches were tested for their sensitivity to the fungicides iprodione, carbendazim, thiophanate methyl and tebuconazole at label recommended concentrations. All fungicides inhibited the growth of M. laxa, A. niger, A. flavus, S. sclerotiorum, P. amygdali and B. cinerea on poisoned agar. Apart from iprodione, all other fungicides inhibited the mycelium growth of the pathogen Fusarium sp. The mycelium growth of Fusarium sp. was significantly less with iprodione than control. Only iprodione and tebuconazole were effective against A. alternata and R. stolonifer. Tebuconazole inhibited the mycelium growth of R. stolonifer, while iprodione reduced significantly in comparison to control. The mycelium growth of the fungus C. gloeosporioides was inhibited by tebuconazole and reduced significantly by the fungicides thiophanate methyl, carbendazim and iprodione. Among all the fungi tested, only M. laxa and B. cinerea isolates were found resistant to benzimidazoles [the EC50 (50% effective concentration) value was 100–200 mg/l and 200–300 mg/l for the largest number of thiophanate methyl‐ and carbendazim‐resistant M. laxa isolates respectively, while the biggest number of B. cinerea thiophanate methyl‐ and carbendazim‐resistant isolates showed EC50 value 200–300 mg/l and 300–400 mg/l, respectively]. However, these strains were sensitive to tebuconazole and iprodione. Therefore, these fungicides can be used as an alternative method to control benzimidazole‐resistant Monilinia and Botrytis isolates.
Safety of endoscopic retrograde cholangiopancreatography during pregnancy
Authors: Bani Hani Mohammed N. , Bani‐Hani Kamal E. , Rashdan Abdullah , AlWaqfi Nizar R. , Heis Hussein A. , Al‐Manasra Abdel‐Rahman A.
Published: January 2009

Background:  The risk of choledocholithiasis is expected to be higher during pregnancy. This is attributed to alteration in bile composition as well as biliary stasis that take place during gestation. There is significant concern regarding application of endoscopic procedures especially the more invasive ones for treatment of choledocholithiasis during pregnancy. Our aim was to provide an additional support to the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the management of biliary diseases during pregnancy.

Methods:  The medical records of 10 pregnant patients who underwent ERCP at King Abdullah University Hospital, during the period from 2002 to 2007 were reviewed. Pregnancy course and outcomes were followed up in all cases. Results were analysed and compared with published data on safety and efficacy of this procedure.

Results:  The mean age for mothers was 24.3 years. The mean duration of gestation was 18.4 weeks. Two patients were in the first trimester, five were in their second trimester and another three in the third trimester. The main indication for ERCP was obstructive choledocholithiasis on ultrasound and liver function tests. Fetal radiation exposure was not routinely measured. During, or after, the procedure there was no need for tocolytic agents. Also there was no intrauterine fetal distress. Screening for congenital anomalies was negative in all cases.

Conclusion:  Major complications of biliary obstruction have been prevented through this procedure. Short‐term follow up for all neonates whom mothers underwent ERCP during pregnancy supports its safety. However, specific long‐term fetal complications of radiation exposure have not been investigated yet.
Intrinsic and extrinsic determinants of mountain pine beetle population growth
Authors: Trzcinski M. Kurtis , Reid Mary L.
Published: January 2009

1 Mountain pine beetleDendroctonus ponderosaepopulations have large, economically significant outbreaks. Density dependence and environmental variability are expected to have important effects on their dynamics. We analysed time series data from an outbreak in the 1930s to determine the relative importance of population density and environmental variability on local population growth rates.

2 Resource depletion occurred rapidly at the scale of 0.4 ha and population growth rates were strongly density dependent. Annual environmental changes did not have detectable effects on population growth rates, leading to the conclusion that intrinsic processes influenced local population density more than extrinsic factors during this outbreak.

3 Our calculated value ofrmax(1.16) does not suggest intrinsically cyclic population dynamics. Our estimate ofrmaxand density dependence will be useful in developing applied models of mountain pine beetle outbreaks, and the subsequent evaluation of management strategies.
A comparison of management options for leatherjacket populations in organic crop rotations using mathematical models
Authors: Blackshaw Rod P.
Published: January 2009

1 Pest management in organic systems is challenged by the paucity of options for direct interventions to control damaging populations compared with conventional agriculture. Consequently, a greater emphasis has to be placed on managing pest numbers through a rotation. In the present study, simulation modelling is used to evaluate the effects of different management options on populations of Tipula paludosa (leatherjackets) in organic rotations.

2 The growth of leatherjacket populations in grass was simulated over 5 years for different starting numbers. A significant risk of leatherjacket attack to subsequent crops can be avoided by limiting the fertility building phase of a rotation to a maximum of 2 years.

3 The effect of cultural control through additional cultivation interventions was compared in rotations comprising a grass/clover fertility building phase with host and/or nonhost crops. It is concluded that the effects are marginal and that prophylactic use cannot be recommended.

4 The prophylactic use of biological control agents in permanent grass and grass/arable rotations was investigated. Maximum population reductions in grass were achieved through annual autumn applications but the optimal economic strategy was less frequent than this. Application in the autumn preceding a spring‐sown arable crop provided the best risk reduction.

5 A model decision support system for the control of pests in organic systems using data for leatherjacket damage to spring barley is presented. Economic threshold concepts are used to define when cultural control (as additional cultivation) and biocontrol applications should be used.

6 The present study shows the potential benefits of simulation modelling for the rapid evaluation of a wide range of pest management options. Any conclusions drawn from such simulations, however, are provisional until they can be tested experimentally.
Three-Dimensional Information in Face Representations Revealed by Identity Aftereffects
Authors: Jiang Fang , Blanz Volker , O'Toole Alice J.
Published: January 2009

Representations of individual faces evolve with experience to support progressively more robust recognition. Knowledge of three-dimensional face structure is required to predict an image of a face as illumination and viewpoint change. Robust recognition across such transformations can be achieved with representations based on multiple two-dimensional views, three-dimensional structure, or both. We used face-identity adaptation in a familiarization paradigm to address a long-standing controversy concerning the role of two-dimensional versus three-dimensional information in face representations. We reasoned that if three-dimensional information is coded in the representations of familiar faces, then learning a new face using images generated by one three-dimensional transformation should enhance the robustness of the representation to another type of three-dimensional transformation. Familiarization with multiple views of faces enhanced the transfer of face-identity adaptation effects across changes in illumination by compensating for a generalization cost at a novel test viewpoint. This finding demonstrates a role for three-dimensional information in representations of familiar faces.
Acute Stress Modulates Risk Taking in Financial Decision Making
Authors: Porcelli Anthony J. , Delgado Mauricio R.
Published: January 2009

People's decisions are often susceptible to various demands exerted by the environment, leading to stressful conditions. Although a goal for researchers is to elucidate stress-coping mechanisms to facilitate decision-making processes, it is important to first understand the interaction between the state created by a stressful environment and how decisions are performed in such environments. The objective of this experiment was to probe the impact of exposure to acute stress on financial decision making and examine the particular influence of stress on decisions with a positive or negative valence. Participants' choices exhibited a stronger reflection effect when participants were under stress than when they were in the no-stress control phase. This suggests that stress modulates risk taking, potentially exacerbating behavioral bias in subsequent decision making. Consistent with dual-process approaches, decision makers fall back on automatized reactions to risk under the influence of disruptive stress.
Inertial Particle Motion in Recirculating Stokes Flow
Authors: Laine‐Pearson F. E. , Hydon P. E.
Published: January 2009

Recirculation occurs in many cavity flows. In particular, alveolar flow models have been shown to exhibit recirculation patterns. However, many particles that are inhaled by the lungs do not follow this flow. Instead, they may diffuse into the surrounding flow or possess enough inertia to propel them from fluid particle paths. In this study, we construct a minimal model to observe the behavior of inertial particles caught within a recirculating Stokes flow. We find that, given favorable conditions, inertial particles can be cleared from the cavity or deposited on walls. This depends on the strength of inertia in zero gravity, but can be enhanced when gravity and the orientation of the cavity are taken into account. It is also possible for these effects to balance one another, producing a skewed limit cycle. These combined effects may play a significant part in the retention, deposition, and clearance of aerosols and particulates from alveolar cavities.
Individual versus Household Migration Decision Rules: Gender and Marital Status Differences in Intentions to Migrate in South Africa
Authors: Gubhaju Bina , De Jong Gordon F.
Published: January 2009

This research tests the thesis that the neoclassical microeconomic and the new household economic theoretical assumptions on migration decision‐making rules are segmented by gender, marital status, and time frame of intention to migrate. Comparative tests of both theories within the same study design are relatively rare. Utilizing data from the Causes of Migration in South Africa national migration survey, we analyse how individually held “own‐future” versus alternative “household well‐being” migration decision rules effect the intentions to migrate of male and female adults in South Africa. Results from the gender and marital status specific logistic regressions models show consistent support for the different gender‐marital status decision rule thesis. Specifically, the “maximizing one’s own future” neoclassical microeconomic theory proposition is more applicable for never married men and women, the “maximizing household income” proposition for married men with short‐term migration intentions, and the “reduce household risk” proposition for longer time horizon migration intentions of married men and women. Results provide new evidence on the way household strategies and individual goals jointly affect intentions to move or stay.
Variants in Intron 13 of the ELMO1 Gene are Associated with Diabetic Nephropathy in African Americans
Authors: Leak T. S. , Perlegas P. S. , Smith S. G. , Keene K. L. , Hicks P. J. , Langefeld C. D. , Mychaleckyj J. C. , Rich S. S. , Kirk J. K. , Freedman B. I. , Bowden D. W. , Sale M. M.
Published: January 2009

Variants in the engulfment and cell motility 1 (ELMO1) gene are associated with nephropathy due to type 2 diabetes mellitus (T2DM) in a Japanese cohort. We comprehensively evaluated this gene in African American (AA) T2DM patients with end‐stage renal disease (ESRD). Three hundred and nine HapMap tagging SNPs and 9 reportedly associated SNPs were genotyped in 577 AA T2DM‐ESRD patients and 596 AA non‐diabetic controls, plus 43 non‐diabetic European American controls and 45 Yoruba Nigerian samples for admixture adjustment. Replication analyses were conducted in 558 AA with T2DM‐ESRD and 564 controls without diabetes. Extension analyses included 328 AA with T2DM lacking nephropathy and 326 with non‐diabetic ESRD. The original and replication analyses confirmed association with four SNPs in intron 13 (permutation p‐values for combined analyses = 0.001–0.003), one in intron 1 (P = 0.004) and one in intron 5 (P = 0.002) with T2DM‐associated ESRD. In a subsequent combined analysis of all 1,135 T2DM‐ESRD cases and 1,160 controls, an additional 7 intron 13 SNPs produced evidence of association (P = 3.5 × 10−5– P = 0.05). No associations were seen with these SNPs in those with T2DM lacking nephropathy or with ESRD due to non‐diabetic causes. Variants in intron 13 of the ELMO1 gene appear to confer risk for diabetic nephropathy in AA.
Candidate Gene Association Study for Noise‐induced Hearing Loss in Two Independent Noise‐exposed Populations
Authors: Konings A. , Van Laer L. , Wiktorek‐Smagur A. , Rajkowska E. , Pawelczyk M. , Carlsson P. I. , Bondeson M. L. , Dudarewicz A. , Vandevelde A. , Fransen E. , Huyghe J. , Borg E. , Sliwinska‐Kowalska M. , Van Camp G.
Published: January 2009

Millions of people are daily exposed to high levels of noise. Consequently, noise‐induced hearing loss (NIHL) is one of the most important occupational health hazards worldwide. In this study, we performed an association study for NIHL based on a candidate gene approach. 644 Single Nucleotide Polymorphisms (SNPs) in 53 candidate genes were analyzed in two independent NIHL sample sets, a Swedish set and part of a Polish set. Eight SNPs with promising results were selected and analysed in the remaining part of the Polish samples. One SNP in PCDH15 (rs7095441), resulted in significant associations in both sample sets while two SNPs in MYH14 (rs667907 and rs588035), resulted in significant associations in the Polish sample set and significant interactions with noise exposure level in the Swedish sample set. Calculation of odds ratios revealed a significant association of rs588035 with NIHL in the Swedish high noise exposure level group. Our studies suggest that PCDH15 and MYH14 may be NIHL susceptibility genes, but further replication in independent sample sets is mandatory.
Testing for linkage and Hardy‐Weinberg disequilibrium
Authors: Kulinskaya E. , Lewin A.
Published: January 2009

This paper concerns several important points when testing for Hardy‐Weinberg equilibrium (HWE) and linkage disequilibrium (LD) in genetics. First, we challenge the necessity of using exclusively two‐sided tests for LD. Next, we show that the exact 2‐sided tests based on the most popular measures of LD are not equivalent, and neither are the standard statistical tests even though the 1‐sided tests are equivalent. We show how this results in different inference about LD for two data sets consisting of small groups of markers. Finally, we advocate the use of the conditional p‐value for both LD and HWE testing. An important advantage of this p‐value is that equivalent 1‐sided tests are transformed into equivalent 2‐sided tests.
CRACK‐NP, development of a model for predicting pollutant transport in cracking clay soils
Authors: Matthews A.M. , Portwood A.M. , Armstrong A.C. , Leeds‐Harrison P.B. , Harris G.L. , Catt J.A. , Addiscott T.M.
Published: January 2009

Abstract. In cracking clay soils the movement of water and solutes is greatly influenced by the arrangement of cracks and aggregates in the soil profile. It is essential that a model to simulate leaching from clay soils takes into account the routes of water movement and the interaction between water in the macropores and the soil aggregates. This paper describes modification of the CRACK model, which includes an explicit description of the structure of an aggregated clay soil and can simulate the movement of water and solutes, to create CRACK‐NP, which incorporates nitrogen transformations and pesticide sorption and degradation. The application of the model to data from the Brimstone Farm experimental site in Oxfordshire, UK, is described. Results show that the model provides good simulations of both nitrate and pesticide leaching at the site but further testing is required to evaluate its performance over a wider range of hydrological conditions at this and other sites.
Lennox‐Gastaut syndrome with late‐onset and prominent reflex seizures in trisomy 21 patients
Authors: Ferlazzo Edoardo , Adjien Constant K. , Guerrini Renzo , Calarese Tiziana , Crespel Arielle , Elia Maurizio , Striano Pasquale , Gelisse Philippe , Bramanti Placido , Di Bella Paolo , Genton Pierre
Published: January 2009

Purpose:  Lennox‐Gastaut syndrome (LGS) is a severe epileptic condition characterized by multiple seizure types including tonic seizures, slow spike‐and‐wave discharges on electroencephalography (EEG), and cognitive impairment. LGS can occur in apparently healthy subjects or in patients with preexisting brain damage. The onset peaks between 3 and 5 years of age and the prognosis is usually poor. Herein we report 13 subjects with trisomy 21 who developed LGS.

Methods:  We retrospectively reviewed the clinical and EEG data of consecutive patients with LGS and trisomy 21 referred to five epilepsy centers over the last 30 years.

Results:  Data for 13 patients (8 male, 5 female) were collected. The mean age at onset was 9.1 years (range 5–16). The mean age at last follow‐up was 23.5 years (range 11–43 years). Seizure onset was after age 8 years in eight (62%) patients and between age 5 and 8 in the other five. In none of the cases did a West syndrome precede the onset of LGS. Nine of 13 patients (69%) had unambiguous reflex seizures, mostly precipitated by sudden unexpected sensory stimulations, usually preceding or accompanying the onset of a full‐blown LGS picture. Interictal and ictal EEG findings were typical for LGS. All patients were drug‐resistant.

Discussion:  Patients with trisomy 21 may present a peculiar LGS, characterized by late onset and high occurrence of reflex seizures. Mechanisms underlying this particular presentation of LGS may include dendritic rarefaction and decreased interneurons, as well as functional abnormalities leading to overall decreased brain inhibition in these patients.
The Role of Washing Machines in Life Cycle Assessment Studies
Authors: Cullen Jonathan M. , Allwood Julian M.
Published: January 2009

A key requirement for those in industry and elsewhere who wish to reduce the environmental impact of a product is to develop priorities for action. Life cycle assessment (LCA) is increasingly used to identify such priorities but can be misleading. This article draws attention to two effects that can occur when the system boundary for a product LCA is not defined correctly. We illustrate the “washing machine effect” by showing that in separate life cycle studies of clothing, detergents, and washing machines, the use of energy is dominated by operation of the washing machine. All three studies prioritize the use phase for action, but in an aggregated study, double counting of the use‐phase impact occurs. We demonstrate the “inverse washing machine effect” with an example related to energy used in transport. We show that some activities that are significant on a cumulative basis consistently fall outside the chosen system boundary for individual products. A consequence is that when LCA studies are used for prioritization, they are in danger of overemphasizing the use‐phase impacts and overlooking the impacts from indirect activities. These effects, which are broadly understood by LCA developers, appear not to be understood properly by those who use LCA to direct priorities for action. Therefore, practitioners should be wary of using LCA for prioritizing action, and LCA guidance documents should reflect this caution.
Systematic Review of Measures of Clinical Significance Employed in Randomized Controlled Trials of Drugs for Dementia
Authors: Molnar Frank J. , Man‐Son‐Hing Malcolm , Fergusson Dean
Published: January 2009

The ability to define thresholds for the clinical significance (clinical importance) of outcome measures in dementia drug research is critical to determining the changes on outcome measures that patients and families would consider worth the cost and worth risking the side effects of medications (i.e., clinical importance is central to informed consent when starting such medications). Thresholds for clinical significance are also required for drug trial sample size calculation (if the studies are to be powered to detect clinically important difference) and for decisions regarding whether medications should be accepted on formularies and should be funded. To better understand what measures of clinical significance have been employed in dementia drug research, a systematic review was performed of double‐blind randomized controlled trials (RCTs) of cholinesterase inhibitors and memantine in subjects with Alzheimer's disease, vascular dementia, mixed dementia, and mild cognitive impairment. Of the 57 dementia drug RCTs reviewed, only 46% discussed the clinical significance of their results. The most commonly cited measures of clinical significance were a 4‐point change in the Alzheimer's Disease Assessment Scale—Cognitive Subscale and changes on global scales. The majority of measures of clinical significance were opinion based. Only one study empirically measured patient perspective regarding thresholds for clinical significance. Despite being central to the interpretation of trial results and to decisions regarding whether to employ trial findings in clinical practice, patient‐ and caregiver‐centered measures of clinical significance have not been adequately studied and integrated into dementia drug RCTs. It is recommended that discussions of clinical importance receive greater emphasis in research standards published by organizations such as the CONSORT group (http://www.consort‐statement.org). Drug formulary review committees and licensing agencies (e.g., U.S. Food and Drug Administration, European Agency for the Evaluation of Medicinal Products, Health Canada) should consider requiring an assessment of clinical significance of the drugs they review. To move this field forward, funding agencies should consider initiating requests for proposals focused on the determination of the minimally clinically important difference (MCID) of outcome measures employed in dementia research. Once empirical data on MCIDs are available, then these funding agencies should consider supporting a consensus conference to review and select the optimal measures of clinical importance in dementia research. A preliminary organizational framework of measures of clinical significance is presented in this article to facilitate the work of such a consensus forum.
Inconsistency in Classification and Reporting of In‐Hospital Falls
Authors: Haines Terry P. , Massey Bernadette , Varghese Paul , Fleming Jennifer , Gray Len
Published: January 2009

OBJECTIVES: To investigate agreement between hospital staff on what constitutes a fall and should be recorded on an incident report, to identify factors that influence whether a scenario is classified as a fall, and to examine the effect of providing a definition of a fall on interrater agreement.

DESIGN: Two interrater agreement trials with pre–postintervention design.

SETTING: Seven hospitals.

PARTICIPANTS: Four hundred forty‐six hospital staff (nursing 76%, physiotherapy 14%, occupational therapy, 6%) working on participating wards over a 24‐hour period.

MEASUREMENTS: Fourteen video scenarios were played before participants, who were asked whether they would classify each scenario as a fall and whether they would complete an incident report in that scenario. A definition of a fall was then provided and the video scenarios replayed. Two definitions were investigated; the World Health Organization definition and a custom definition.

RESULTS: Consensus was not evident in five of the 14 scenarios examined. Falls onto surfaces higher than the ground were less likely to be recorded on incident reports. Hospital and ward type influenced whether a scenario was classified as a fall. Overall agreement in classifying scenarios as a fall was only marginally greater after provision of the definition in both phases, although neither had an effect on whether staff would complete an incident report.

CONCLUSION: Disagreement between hospital staff in what constitutes a fall may contribute to inconsistent research findings in this field and is not meaningfully improved through provision of a definition.
Long‐Term Function in an Older Cohort—The Cardiovascular Health Study All Stars Study
Authors: Newman Anne B. , Arnold Alice M. , Sachs Michael C. , Ives Diane G. , Cushman Mary , Strotmeyer Elsa S. , Ding Jingzhong , Kritchevsky Stephen B. , Chaves Paulo H. M. , Fried Linda P. , Robbins John
Published: January 2009

OBJECTIVES: To evaluate shared and unique risk factors for maintaining physical and cognitive function into the ninth decade and beyond.

DESIGN: Longitudinal cohort study.

SETTING: Four U.S. communities.

PARTICIPANTS: One thousand six hundred seventy‐seven participants in the Cardiovascular Health Study All Stars Study, assessed in 2005/06. Median age was 85 (range 77–102), 66.5% were women, and 16.6% were black.

MEASUREMENTS: Intact function was defined as no difficulty with any activities of daily living and a score of 80 or higher on the Modified Mini‐Mental State Examination. Baseline characteristics assessed in 1992/93 included demographics, behavioral health factors, chronic disease history, subclinical disease markers, cardiovascular risk factors, and inflammatory markers. Multinomial logistic regression was used to compare risk for physical disability, cognitive impairment,and combined impairments with no functional impairment.

RESULTS: Of the 1,677 participants evaluated in both domains, 891 (53%) were functionally intact. Continuous measures of function, including the Digit Symbol Substitution Test and gait speed, showed that all groups, including the most functional, had declined over time. The functional group had less decline but also tended to have higher starting values. Functional individuals had a higher baseline health profile than those with either or cognitive impairment or both impairments combined. Women and individuals with greater weight had higher rates of physical impairment but not cognitive impairment. Risk factors common to both types of impairment included cardiovascular disease and hypertension.

CONCLUSION: Intact function was found in only approximately half of these older adults in the ninth decade and beyond. High baseline function and low vascular disease risk characterized functional aging.
Loss of Life Caused by the Flooding of New Orleans After Hurricane Katrina: Analysis of the Relationship Between Flood Characteristics and Mortality
Authors: Jonkman Sebastiaan N. , Maaskant Bob , Boyd Ezra , Levitan Marc Lloyd
Published: January 2009

In this article a preliminary analysis of the loss of life caused by Hurricane Katrina in the New Orleans metropolitan area is presented. The hurricane caused more than 1,100 fatalities in the state of Louisiana. A preliminary data set that gives information on the recovery locations and individual characteristics for 771 fatalities has been analyzed. One‐third of the analyzed fatalities occurred outside the flooded areas or in hospitals and shelters in the flooded area. These fatalities were due to the adverse public health situation that developed after the floods. Two‐thirds of the analyzed fatalities were most likely associated with the direct physical impacts of the flood and mostly caused by drowning. The majority of victims were elderly: nearly 60% of fatalities were over 65 years old. Similar to historical flood events, mortality rates were highest in areas near severe breaches and in areas with large water depths. An empirical relationship has been derived between the water depth and mortality and this has been compared with similar mortality functions proposed based on data for other flood events. The overall mortality among the exposed population for this event was approximately 1%, which is similar to findings for historical flood events. Despite the fact that the presented results are preliminary they give important insights into the determinants of loss of life and the relationship between mortality and flood characteristics.
A Model of Exposure to Rotavirus from Nondietary Ingestion Iterated by Simulated Intermittent Contacts
Authors: Julian Timothy R. , Canales Robert A. , Leckie James O. , Boehm Alexandria B.
Published: January 2009

Existing microbial risk assessment models rarely incorporate detailed descriptions of human interaction with fomites. We develop a stochastic‐mechanistic model of exposure to rotavirus from nondietary ingestion iterated by simulated intermittent fomes‐mouth, hand‐mouth, and hand‐fomes contacts typical of a child under six years of age. This exposure is subsequently translated to risk using a simple static dose‐response relationship. Through laboratory experiments, we quantified the mean rate of inactivation for MS2 phage on glass (0.0052/hr) and mean transfer between fingertips and glass (36%). Simulations using these parameters demonstrated that a child's ingested dose from a rotavirus‐contaminated ball ranges from 2 to 1,000 virus over a period of one hour, with a median value of 42 virus. These results were heavily influenced by selected values of model parameters, most notably the concentration of rotavirus on fomes, frequency of fomes‐mouth contacts, frequency of hand‐mouth contacts, and virus transferred from fomes to mouth. The model demonstrated that mouthing of fomes is the primary exposure route, with hand mouthing contributions accounting for less than one‐fifth of the child's dose over the first 10 minutes of interaction.
Predicting Future Excess Events in Risk Assessment
Authors: Furukawa Kyoji , Cologne John B. , Shimizu Yukiko , Ross N. Phillip
Published: January 2009

Risk characterization in a study population relies on cases of disease or death that are causally related to the exposure under study. The number of such cases, so‐called “excess” cases, is not just an indicator of the impact of the risk factor in the study population, but also an important determinant of statistical power for assessing aspects of risk such as age‐time trends and susceptible subgroups. In determining how large a population to study and/or how long to follow a study population to accumulate sufficient excess cases, it is necessary to predict future risk. In this study, focusing on models involving excess risk with possible effect modification, we describe a method for predicting the expected magnitude of numbers of excess cases and assess the uncertainty in those predictions. We do this by extending Bayesian APC models for rate projection to include exposure‐related excess risk with possible effect modification by, e.g., age at exposure and attained age. The method is illustrated using the follow‐up study of Japanese Atomic‐Bomb Survivors, one of the primary bases for determining long‐term health effects of radiation exposure and assessment of risk for radiation protection purposes. Using models selected by a predictive‐performance measure obtained on test data reserved for cross‐validation, we project excess counts due to radiation exposure and lifetime risk measures (risk of exposure‐induced deaths (REID) and loss of life expectancy (LLE)) associated with cancer and noncancer disease deaths in the A‐Bomb survivor cohort.
The “Ball of Confusion” in Federal Budgeting: A Shadow Agenda for Deliberative Reform of the Budget Process
Authors: Meyers Roy T.
Published: January 2009

The budget process is seriously flawed, as Irene Rubin suggests, but there is little prospect for its effective reform. Current economic and political conditions could open the window for reform, but the excessive partisanship that helped create these conditions also has reduced the pool of institutionalists who could lead reforms. More important is confusion about which reforms might be most effective. Most proposed reforms would create more rules, but they will not work unless politicians commit to meeting the goals such rules are intended to support. Those commitments could be produced by deliberation over critical issues that have been neglected in recent discussions of budget process reform: how the process could support macroeconomic policy making, how improved budget concepts could accurately measure finances and aid in dealing with upcoming policy challenges, how reorganization could enable intelligent priority setting, and how the process could be better aligned with the constitutional sharing of powers and the electoral system.
What Not to Ask of Budget Processes: Lessons from George W. Bush’s Years
Authors: White Joseph
Published: January 2009

Budget reform requires goals that are both good public policy and achievable. The core purpose of budgeting is to consider and relate details and totals. Common demands for reform are dubious because they slight consideration of details. For this reason, too strict a definition of “balance” would be bad policy; the demand for balance over many decades is neither good policy nor realistic; and multiyear discretionary spending caps can be both bad policy and impractical. Concern about passing annual budget resolutions ignores the fact that the major reason for annual totals is no longer endorsed by policy makers and economists. Scorekeeping should be honest and accurate and often can be improved, but possible achievements are limited. Budget reforms will not make government accountable if the governing coalition is united in seeking to avoid that, and if neither the public nor elites demand it.
Presidential Signing Statements and Their Implications for Public Administration
Authors: Pfiffner James P.
Published: January 2009

For most of U.S. history, presidents have issued signing statements to comment on bills being signed into law. These statements often are hortatory and comment on the merits of the new law. In recent decades, presidents also have used signing statements to indicate portions of laws that they consider unconstitutional. Pointing out such parts of new statutes is not a problem, but indicating that the president may not execute part of the law is problematic. President George W. Bush used signing statements in an aggressive way to imply that he might not faithfully execute more than 1,000 provisions of statutes that he signed into law. This essay argues that this practice undermines the rule of law and threatens the separation of powers system.