bluuebunny/crossref_metadata_2025 huggingface dataset:
A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery
Authors: Su E. P. , Perna M. , Boettner F. , Mayman D. J. , Gerlinger T. , Barsoum W. , Randolph J. , Lee G.
Published: November 2012

Pain, swelling and inflammation are expected during the recovery from total knee arthroplasty (TKA) surgery. The severity of these factors and how a patient copes with them may determine the ultimate outcome of a TKA. Cryotherapy and compression are frequently used modalities to mitigate these commonly experienced sequelae. However, their effect on range of motion, functional testing, and narcotic consumption has not been well-studied.

A prospective, multi-center, randomised trial was conducted to evaluate the effect of a cryopneumatic device on post-operative TKA recovery. Patients were randomised to treatment with a cryopneumatic device or ice with static compression. A total of 280 patients were enrolled at 11 international sites. Both treatments were initiated within three hours post-operation and used at least four times per day for two weeks. The cryopneumatic device was titrated for cooling and pressure by the patient to their comfort level.

Patients were evaluated by physical therapists blinded to the treatment arm. Range of motion (ROM), knee girth, six minute walk test (6MWT) and timed up and go test (TUG) were measured pre-operatively, two- and six-weeks post-operatively. A visual analog pain score and narcotic consumption was also measured post-operatively.

At two weeks post-operatively, both the treatment and control groups had diminished ROM and function compared to pre-operatively. Both groups had increased knee girth compared to pre- operatively. There was no significant difference in ROM, 6MWT, TUG, or knee girth between the 2 groups. We did find a significantly lower amount of narcotic consumption (509 mg morphine equivalents) in the treatment group compared with the control group (680 mg morphine equivalents) at up to two weeks postop, when the cryopneumatic device was being used (p < 0.05). Between two and six weeks, there was no difference in the total amount of narcotics consumed between the two groups. At six weeks, there was a trend toward a greater distance walked in the 6MWT in the treatment group (29.4 meters versus 7.9 meters, p = 0.13). There was a significant difference in the satisfaction scores of patients with their cooling regimen, with greater satisfaction in the treatment group (p < 0.0001). There was no difference in ROM, TUG, VAS, or knee girth at six weeks. There was no difference in adverse events or compliance between the two groups.

A cryopneumatic device used after TKA appeared to decrease the need for narcotic medication from hospital discharge to 2 weeks post-operatively. There was also a trend toward a greater distance walked in the 6MWT. Patient satisfaction with the cryopneumatic cooling regimen was significantly higher than with the control treatment.
Strategies for the prevention of periprosthetic joint infection
Authors: Adeli B. , Parvizi J.
Published: November 2012

Periprosthetic joint infection (PJI) is a devastating complication which can follow a total joint arthroplasty (TJA). Although rare, this ongoing threat undermines the success of TJA, a historically reputable procedure. It has haunted the orthopedic community for decades and several ongoing studies have provided insights and new approaches to effectively battle this multilayered problem.
Patient specific cutting blocks are currently of no proven value
Authors: Barrack R. L. , Ruh E. L. , Williams B. M. , Ford A. D. , Foreman K. , Nunley R. M.
Published: November 2012

Patient specific cutting guides generated by preoperative Magnetic Resonance Imaging (MRI) of the patient’s extremity have been proposed as a method of improving the consistency of Total Knee Arthroplasty (TKA) alignment and adding efficiency to the operative procedure. The cost of this option was evaluated by quantifying the savings from decreased operative time and instrument processing costs compared to the additional cost of the MRI and the guide. Coronal plane alignment was measured in an unselected consecutive series of 200 TKAs, 100 with standard instrumentation and 100 with custom cutting guides. While the cutting guides had significantly lower total operative time and instrument processing time, the estimated $322 savings was overwhelmed by the $1,500 additional cost of the MRI and the cutting guide. All measures of coronal plane alignment were equivalent between the two groups. The data does not currently support the proposition that patient specific guides add value to TKA.
The Role of Decitabine for the Treatment of Acute Myeloid Leukemia
Authors: Ganetsky Alex
Published: November 2012

OBJECTIVE:

To review the available literature addressing the role of decitabine for the treatment of acute myeloid leukemia (AML).

DATA SOURCES:

Relevant literature was identified by a PubMed search (January 1970-March 2012) of English-language literature using the terms decitabine, acute myeloid leukemia, and DNA methyltransferase inhibitors.

STUDY SELECTION AND DATA EXTRACTION:

All published studies and abstracts, as well as relevant consensus guidelines, evaluating the current literature about the role of decitabine for the treatment of AML were included.

DATA SYNTHESIS:

Decitabine has been evaluated for the treatment of AML in several different settings. In patients with newly diagnosed AML who are not candidates for standard remission induction chemotherapy, a Phase 2 trial of decitabine administered for 5 days per cycle demonstrated a 24% complete remission rate (CR). A subsequent Phase 3 trial comparing decitabine and low-dose cytarabine or best supportive care in a similar patient population showed a greater CR rate (18% vs 8%; p = 0.001) but no overall survival benefit. A Phase 2 trial demonstrated a 47% CR rate with decitabine initially administered for 10 days per cycle, with subsequent doses customized to individual response and toxicity. This novel dosing schedule has yet to be evaluated in a Phase 3 trial. Decitabine is also being investigated for the treatment of relapsed/refractory AML and as bridge therapy to allogeneic hematopoietic stem cell transplantation.

CONCLUSIONS:

Decitabine offers a promising alternative therapeutic option for patients with AML who are not candidates for standard remission induction chemotherapy. Because of its acceptable safety profile, research is investigating the clinical benefit of decitabine in combination with other antileukemic therapies. The potential roles of decitabine in the treatment of AML continue to be explored in numerous clinical trials.
Continuous and Extended Infusions of β-Lactam Antibiotics in the Pediatric Population
Authors: Walker Mary Covington , Lam Weng Man , Manasco Kalen B
Published: November 2012

OBJECTIVE:

To conduct a systematic review of available data on the use of extended or continuous infusion of β-lactam and monobactam therapy in the pediatric population (aged 0–18 years).

DATA SOURCES:

A literature search was performed using PubMed (1975-May 2012), International Pharmaceutical Abstracts (1970-May 2012), and Web of Science (1977-May 2012) to identify studies for inclusion. In addition, reference citations from identified publications were reviewed. The following search terms were used: pediatric, children, neonate, infant, adolescent, β-lactam, cephalosporin, carbapenem, penicillin, monobactam, continuous infusion, extended infusion, and/or prolonged infusion. Individual names of drugs in each class of antibiotics were also included in the search.

STUDY SELECTION AND DATA EXTRACTION:

Randomized controlled clinical trials, pharmacokinetic/pharmacodynamic studies, observational studies, and case reports involving pediatric patients who received extended or continuous infusion of β-lactam or monobactam antibiotics were reviewed. Only English-language publications were included.

DATA SYNTHESIS:

One randomized controlled clinical trial, 5 pharmacokinetic studies, 2 pharmacodynamic studies using Monte Carlo simulation, 1 case series, and 7 case reports were included in the analysis. The cephalosporin class has been studied the most and currently represents the only clinical trial using a continuous infusion dosing strategy in pediatric patients. There is limited clinical evidence available to support the use of extended or continuous infusion of β-lactam antibiotics in the pediatric population. Pharmacodynamic studies conducted in this population mirror the current evidence in adults for cefepime and meropenem. The single prospective clinical trial using continuous infusion of ceftazidime failed to demonstrate any clinical benefit over traditional dosing; however, there was equal efficacy.

CONCLUSIONS:

More well-designed prospective clinical trials are required to determine the role of extended or continuous infusion of β-lactam antibiotics in treatment of pediatric patients.
Evaluation of Vitamin B12 Monitoring in a Veteran Population on Long-Term, High-Dose Metformin Therapy
Authors: Pierce Sarah A , Chung Amy H , Black Karen Korch
Published: November 2012

BACKGROUND:

Metformin can result in vitamin B12 deficiency, potentially leading to complications such as neuropathy. Annual monitoring of vitamin B12 has been suggested; however, it is unknown whether current practice reflects this recommendation.

OBJECTIVE:

To identify vitamin B12 monitoring patterns in patients on long-term, high-dose metformin. Secondary objective was to determine the frequency of new vitamin B12 deficiency, anemia, and neuropathy documented after initiation of high-dose metformin.

METHODS:

Electronic medical records of veterans treated at the Veterans Affairs Maryland Healthcare System with high-dose metformin (≥2000 mg/day) as of November 1, 2010, were reviewed. Data regarding metformin treatment, vitamin B12 measurements, and documentation of vitamin B12 deficiency, cyanocobalamin supplementation, anemia, and neuropathy were collected. Subjects treated with metformin for less than 1 year or those with documented peripheral neuropathy, megaloblastic anemia, vitamin B12 deficiency, or a condition associated with vitamin B12 malabsorption prior to metformin initiation were excluded.

RESULTS:

Subjects (N = 235) had a mean metformin dose of 2050 mg/day and mean duration of treatment of 5.2 years. Sixty percent did not have vitamin B12 measured. Of subjects receiving metformin for 10 years or more, nearly half (46%) never had vitamin B12 measured. New documentation of vitamin B12 deficiency or cyanocobalamin supplementation was found in 5.5% of the population, and anemia was found in 12%. Of the 14% with new neuropathy, 42% did not have vitamin B12 measured.

CONCLUSIONS:

Vitamin B12 was not routinely monitored in patients on high-dose metformin, even in those at highest risk (≥10 years of therapy), or in those with potential manifestations of vitamin B12 deficiency (neuropathy). Cases of vitamin B12 deficiency and resulting anemia or neuropathy may be undiagnosed and untreated because of lack of monitoring. Prospective studies examining the effect of increased vitamin B12 monitoring on identification and treatment of vitamin B12 deficiency in patients on metformin are warranted.
A Probable Interaction between Warfarin and the Antiretroviral TRIO Study Regimen
Authors: Liedtke Michelle D , Vanguri Amulya , Rathbun R Chris
Published: November 2012

OBJECTIVE:

To report a probable drug interaction between the antiretroviral TRIO regimen (ritonavir-boosted darunavir, etravirine, and raltegravir) and warfarin in an HIV-infected patient.

CASE SUMMARY:

In January 2010, a 50-year-old transgender female with HIV infection and recurrent deep vein thrombosis began treatment with the TRIO study regimen. Treatment had been maintained with warfarin for the past 5 years and emtricitabine monotherapy for the preceding 22 months. Emtricitabine was discontinued when the TRIO regimen was started. The mean weekly warfarin dose while the patient was receiving emtricitabine monotherapy was 13.3 mg (95% CI 12.7 to 13.8), with a mean international normalized ratio (INR) of 2.8 (95% CI 2.5 to 3.1). Following the initiation of the TRIO regimen, the mean weekly warfarin dose was increased to 19.3 mg (95% CI 18.5 to 20.1) and was maintained over the ensuing 71 weeks with a mean INR of 2.6 (95% CI 2.2 to 3.0).

DISCUSSION:

Information on the effect of newer antiretrovirals on warfarin metabolism, as well as the collective contribution of combination antiretroviral therapy including multiple agents that may alter warfarin metabolism, is limited. We predicted that warfarin dose requirements would change upon initiation of the TRIO regimen. Given the variability in INR that can occur with chronic warfarin treatment, weekly warfarin doses were averaged during emtricitabine monotherapy (90 weeks) and TRIO regimen (71 weeks) periods. Mean weekly warfarin doses increased by 45% (p < 0.001) following initiation of the TRIO regimen. Mean INR results for the 2 time periods were not significantly different, demonstrating that stable anticoagulation was maintained. The Horn drug interaction probability scale score to assess causation indicated a probable interaction.

CONCLUSIONS:

An increased weekly warfarin dose requirement is predicted when warfarin is used concurrently with the antiretroviral TRIO regimen. Increased INR monitoring is prudent when the combination is administered.
Bevacizumab-Induced Oral Mucositis in Background of Cutaneous Plaque-Type Psoriasis
Authors: Popa Andra M , Valla Kelly , Radhakrishnan Latha , Cuellar Sandra , Villano J Lee
Published: November 2012

OBJECTIVE:

To report the serial development of oral mucositis following infusion of bevacizumab in a young woman with a malignant brain tumor and history of cutaneous psoriasis.

CASE SUMMARY:

A 29-year-old woman with a history of active cutaneous psoriasis and a malignant glioneuronal tumor was treated with bevacizumab for 2.5 years. With each infusion of bevacizumab, she developed oral mucositis within 36 hours. She received temozolomide as part of concurrent therapy with radiation and as maintenance therapy; it was discontinued after continuous therapy for 1.5 years. Bevacizumab 10 mg/kg was added after 7 cycles of maintenance temozolomide, as the tumor had minimal response and evidence of increased perfusion with angiogenesis on imaging studies. All medication, including temozolomide, was evaluated and eventually discontinued, with the exception of bevacizumab, which remained the drug suspected of causing the mucositis.

DISCUSSION:

Oral mucositis is a frequent adverse effect of cytotoxic chemotherapy, but has not been reported with bevacizumab. The Naranjo probability scale indicated a probable adverse drug reaction. This likely indicates that bevacizumab is one of many drugs known to induce exacerbation of psoriatic disease. We speculate that oral mucositis developed as bevacizumab-induced generation of proinflammatory cytokines within the vascular endothelium, leading to mucosal damage and ulceration. In addition, interruption of reparative angiogenic pathways with bevacizumab likely contributed to the severity of mucositis.

CONCLUSIONS:

Clinicians should be aware that bevacizumab can potentially exacerbate psoriatic disease.
Immunohistochemical Analysis of IA-2 Family of Protein Tyrosine Phosphatases in Rat Gastrointestinal Endocrine Cells
Authors: Gomi Hiroshi , Kubota-Murata Chisato , Yasui Tadashi , Tsukise Azuma , Torii Seiji
Published: November 2012

Islet-associated protein–2 (IA-2) and IA-2β (also known as phogrin) are unique neuroendocrine-specific protein tyrosine phosphatases (PTPs). The IA-2 family of PTPs was originally identified from insulinoma cells and discovered to be major autoantigens in type 1 diabetes. Despite its expression in the neural and canonical endocrine tissues, data on expression of the IA-2 family of PTPs in gastrointestinal endocrine cells (GECs) are limited. Therefore, we immunohistochemically investigated the expression of the IA-2 family of PTPs in the rat gastrointestinal tract. In the stomach, IA-2 and IA-2β were expressed in GECs that secrete serotonin, somatostatin, and cholecystokinin/gastrin-1. In addition to these hormones, secretin, gastric inhibitory polypeptide (also known as the glucose-dependent insulinotropic peptide), glucagon-like peptide-1, and glucagon, but not ghrelin were coexpressed with IA-2 or IA-2β in duodenal GECs. Pancreatic islet cells that secrete gut hormones expressed the IA-2 family of PTPs. The expression patterns of IA-2 and IA-2β were comparable. These results reveal that the IA-2 family of PTPs is expressed in a cell type–specific manner in rat GECs. The extensive expression of the IA-2 family of PTPs in pancreo-gastrointestinal endocrine cells and in the enteric plexus suggests their systemic contribution to nutritional control through a neuroendocrine signaling network.
Noninvasive Prenatal Determination of Twin Zygosity by Maternal Plasma DNA Analysis
Authors: Qu James ZZ , Leung Tak Y , Jiang Peiyong , Liao Gary JW , Cheng Yvonne KY , Sun Hao , Chiu Rossa WK , Chan KC Allen , Lo YM Dennis
Published: November 2012

BACKGROUND

The current methods for distinguishing the zygosities of twins include ultrasound scanning, which is nondefinitive, and amniocentesis, which is invasive. We explored the use of massively parallel sequencing of maternal plasma DNA for the noninvasive prenatal assessment of the zygosities of twin pregnancies.

METHODS

Plasma DNA was extracted from blood collected from 8 women pregnant with twins. Target enrichment and massively parallel sequencing were performed for each plasma DNA library. Apparent fractional fetal DNA concentrations were calculated for multiple genomic regions by determining the ratio of minor to major alleles among single-nucleotide polymorphism sites. Variations in the apparent fractional fetal DNA concentrations between genomic regions were used to infer whether individual fetuses in a twin pair were genotypically different and hence dizygotic.

RESULTS

The extent of the variation in the apparent fractional fetal DNA concentration across chromosomes was 0.82–1.35 SDs for monozygotic twin pregnancies and 2.42–4.80 SDs for dizygotic twin pregnancies. The proportions of apparent fractional fetal DNA concentration values that deviated beyond the range expected for stochastic variation were 0.00%–1.93% for monozygotic twin pregnancies and 36.2%–78.1% for dizygotic twin pregnancies. After identifying a pair of twins as likely dizygotic, the method also allowed determination of the fractional fetal DNA concentrations contributed by the individual fetuses of a dizygotic twin pair.

CONCLUSIONS

Noninvasive prenatal determination of twin zygosity by maternal plasma DNA sequencing is feasible. It is also possible to determine the relative fractional fetal DNA concentrations for each fetus for dizygotic twin pregnancies.
Mass Transfer, Adsorption and Kinetics of the Photo-catalytic Degradation Reaction of the Dye Reactive Orange 16 on TiO2 Aqueous Suspension
Authors: Elkanzi Elamin Mohamed , Al-Aseeri Mohamed , Kadhem Ali Abdulhussain , Shamlooh Mohamed Abdulnabi
Published: November 2012

Laboratory research in the photo-catalytic degradation of dyes in aqueous slurry of TiO2 under UV light radiation has been shown to be potentially applicable in the treatment of wastewater effluents from textile plants. Therefore, reliable kinetic data that are free from mass transfer limitations are required for the design and scale-up of the photo reactor. In this study, batch experiments were designed to measure the mass transfer coefficient, adsorption equilibrium constant and chemical reaction rate constant for the dye reactive orange 16. The mass transfer coefficient was determined for mixing speeds of 240 - 660 rpm with corresponding values of 3.0x10-5 to 2.8 x10-4 1/s, respectively. The mass transfer coefficient became constant for mixing speeds at or greater than 600 rpm. The adsorption equilibrium constant was determined using the Langmuir Isotherm model, and a value of 1.09x10-4 l/mg was determined. The integrated form of the Langmuir-Hinshelwood model was used to describe the photo-oxidation kinetics. The rate constant was determined at different UV light intensities of 8.8 - 26.4 mW/cm2 and the corresponding values were 146.38 - 381.20 mg/l.min, respectively. The relation between the rate constant and UV light intensity can be described by the formula: 1/kr=a/I^0.5 +b .
The Cross-National Adaptability of EMS Protocols for Mass Casualty Incidents
Authors: Agiv-Berland Adi , Ashkenazi Isaac , Aharonson-Daniel Limor
Published: November 2012

Background: On 11/3/2004, ten explosive devices detonated on board four different commuter trains in Madrid. Over 2000 casualties and 191 deaths were recorded. This study examines the adaptability of Israeli EMS protocols for Mass-Casualty-Incidents to the event.Methods: Detailed conduct of Madrid EMS during the terror attack was mapped based on interviews and published data. Three topics, in which shortfalls were described in the literature, were examined: Emergency preparedness, Leadership and Management, and Organization.Results: An event manager was not predefined, resulting in too many or no leaders on-site. Lack of familiarity with protocols led to inaccurate triage and uneven distribution of casualties among hospitals. Organizations had not exercised collaboration previously thus lacked familiarity with each others operations.Conclusions: Multi-organizational familiarity and training is of utmost importance. EMS protocols for MCIs are adaptable to the different systems worldwide. However, these must be drilled, examined and revised in order to ensure emergency preparedness.
Genome Reduction Promotes Increase in Protein Functional Complexity in Bacteria
Authors: Kelkar Yogeshwar D , Ochman Howard
Published: November 2012

Obligate pathogenic and endosymbiotic bacteria typically experience gene loss due to functional redundancy, asexuality, and genetic drift. We hypothesize that reduced genomes increase their functional complexity through protein multitasking, in which many genes adopt new roles to counteract gene loss. Comparisons of interaction networks among six bacteria that have varied genome sizes (Mycoplasma pneumoniae, Treponema pallidum, Helicobacter pylori, Campylobacter jejuni, Synechocystis sp., and Mycobacterium tuberculosis) reveal that proteins in small genomes interact with proteins from a wider range of functions than do their orthologs in larger genomes. This suggests that surviving proteins form increasingly complex functional relationships to compensate for genes that are lost.
Heritable Loss of Replication Control of a Minichromosome Derived from the B Chromosome of Maize
Authors: Masonbrink Rick E , Fu Shulan , Han Fangpu , Birchler James A
Published: November 2012

During an accumulation regime of a small telomere-truncated B chromosome, a derivative with large variations in size and multiple punctate centromere loci exhibiting amplified copy numbers was discovered. Multiple centromere satellite loci or transgene signals were documented in amplified chromosomes, suggesting over-replication. Immunolocalization studies revealed multiple foci of biochemical markers characteristic of active centromeres such as CENP-C and phosphorylation of histones H3S10 and H2AThr133. The amplified chromosomes exhibit an absence of chromosome disjunction in meiosis I and an infrequent chromosome disjunction in meiosis II. Despite their unusual structure and behavior these chromosomes were observed in the lineage for seven generations during the course of this study. While severely truncated relative to a normal B chromosome, the progenitor minichromosome is estimated to be at least several megabases in size. Given that the centromere and transgene signals at opposite ends of the chromosome generally match in copy number, the replication control is apparently lost over several megabases.
Educational Perspectives
Authors: Brodsky Dara , Smith C. Christopher
Published: November 2012

Neonatology fellows must become competent at performing medical procedures during their fellowship training, and neonatology faculty members need to continue to maintain these skills. However, technical proficiency is challenging to attain and sustain. In this review, we present an overview of the cognitive theory of learning a technical skill and provide a structured, practical approach to teaching and supervising medical procedures. This educational paradigm can be tailored on the basis of learner experience, learner aptitude, and type of procedure. This review also summarizes potential strategies to assess procedural competence.
The Relationship Between Sleep Problems and Daytime Behavior in Children of Different Ages With Autism Spectrum Disorders
Authors: Sikora Darryn M. , Johnson Kyle , Clemons Traci , Katz Terry
Published: November 2012

BACKGROUND

The purpose of the current study was to evaluate the relationships among sleep problems and daytime behaviors in a large, well-defined cohort of children with autism spectrum disorder (ASD).

METHODS

Out of a registry population of 3452 children with ASDs, a subset of 1193 children aged 4 to 10 years of age from 14 centers across the country was used to evaluate the relationship between varying levels of sleep problems and daytime behavior. Measures included Children’s Sleep Habits Questionnaire, Vineland Adaptive Behavior Scales, Survey Interview Form, Second Edition, and Child Behavior Checklist. Multiple analysis of covariance was used to assess the association between sleep and behavior.

RESULTS

Results suggest that sleep problems, as identified by parent report by use of the Children’s Sleep Habits Questionnaire, have a negative relationship with daytime behavior. More specifically, children with ASDs and sleep problems had more internalizing and externalizing behavior problems, as measured by the Child Behavior Checklist, and poorer adaptive skill development, as measured by the Vineland Adaptive Behavior Scales, than children with ASDs and no sleep problems. Children with moderate to severe sleep problems had greater behavior difficulties, but not necessarily poorer adaptive functioning, than children with mild to moderate sleep problems. Both preschool- and school-aged children demonstrated a negative relationship between behavior and sleep, whereas the relationship between sleep and adaptive functioning was much more variable.

CONCLUSIONS

These results suggest that, although sleep has a negative relationship with internalizing and externalizing behavior, it may have a different relationship with the acquisition of adaptive skills.
Management of Constipation in Children and Adolescents With Autism Spectrum Disorders
Authors: Furuta Glenn T. , Williams Kent , Kooros Koorosh , Kaul Ajay , Panzer Rebecca , Coury Daniel L. , Fuchs George
Published: November 2012

OBJECTIVES

To develop a practical, readily applied algorithm for primary health care providers to identify, evaluate, and manage constipation in children with autism spectrum disorders (ASDs).

METHODS

The Gastroenterology Committee of the Autism Speaks Autism Treatment Network (ATN), a multisite consortium of centers dedicated to improving standards of medical care for children with ASDs, guided the development of the constipation algorithm through expert opinion and literature review. The algorithm was finalized based on results of field testing by nongastrointestinal, ATN autism medical specialists at 4 ATN sites. A systematic review and grading of the literature pertaining to constipation and children with ASDs was also performed.

RESULTS

Consensus among the ATN Gastroenterology Committee identified that in children with ASDs, (1) subtle or atypical symptoms might indicate the presence of constipation; (2) screening, identification, and treatment through a deliberate approach for underlying causes of constipation is appropriate; (3) diagnostic-therapeutic intervention can be provided when constipation is documented; and (4) careful follow-up after any intervention be performed to evaluate effectiveness and tolerance of the therapy. Literature review revealed limited evidence for the clinical evaluation or treatment strategies of children with ASD and constipation.

CONCLUSIONS

Constipation and its underlying etiology have the potential to be effectively identified and managed using a systematic approach. Lack of evidence on this topic in the literature emphasizes the need for research.
Clinical Practice Pathways for Evaluation and Medication Choice for Attention-Deficit/Hyperactivity Disorder Symptoms in Autism Spectrum Disorders
Authors: Mahajan Rajneesh , Bernal Maria Pilar , Panzer Rebecca , Whitaker Agnes , Roberts Wendy , Handen Benjamin , Hardan Antonio , Anagnostou Evdokia , Veenstra-VanderWeele Jeremy
Published: November 2012

BACKGROUND AND OBJECTIVE

Hyperactivity, impulsivity, and inattention (referred to as “ADHD [attention-deficit/hyperactivity disorder] symptoms”) occur in 41% to 78% of children with autism spectrum disorders (ASDs). These symptoms often affect quality of life, interfering with learning or interventions that target primary ASD symptoms. This practice pathway describes the guidelines for evaluation and treatment of children and adolescents with ASD and comorbid ADHD symptoms.

METHODS

Current research in this area is limited, and, therefore, these recommendations are based on a systematic literature review and expert consensus in the Autism Speaks Autism Treatment Network Psychopharmacology Committee.

RESULTS

The recommended practice pathway includes the Symptom Evaluation Pathway for systematic assessment of ADHD symptoms across settings; examination for comorbid sleep, medical, or psychiatric comorbidities that may contribute to symptoms; and evaluation of behavioral interventions that may ameliorate these symptoms. For children for whom medication is being considered to target the ADHD symptoms, the medication choice pathway provides guidance on the selection of the appropriate agent based on a review of available research, assessment of specific advantages and disadvantages of each agent, and dosing considerations.

CONCLUSIONS

These recommendations provide a framework for primary care providers treating children who have ASD and ADHD symptoms. Our systematic review of the current evidence indicates the need for more randomized controlled trials of the medications for ADHD symptoms in ASD. There will also be a need for studies of the effectiveness of these practice pathways in the future.
Nutrient Intake From Food in Children With Autism
Authors: Hyman Susan L. , Stewart Patricia A. , Schmidt Brianne , Cain Usa , Lemcke Nicole , Foley Jennifer T. , Peck Robin , Clemons Traci , Reynolds Ann , Johnson Cynthia , Handen Benjamin , James S. Jill , Courtney Patty Manning , Molloy Cynthia , Ng Philip K.
Published: November 2012

OBJECTIVE

The impact of abnormal feeding behaviors reported for children with autism spectrum disorders (ASDs) on their nutritional status is unknown. We compared nutrient intake from food consumed by children with and without ASD and examined nutrient deficiency and excess.

METHODS

Prospective 3-day food records and BMI for children (2–11 years) with ASD participating in the Autism Treatment Network (Arkansas, Cincinnati, Colorado, Pittsburgh, and Rochester) were compared with both the National Health and Nutrition Examination Survey data and a matched subset based on age, gender, family income, and race/ethnicity (N = 252 analyzed food records).

RESULTS

Children with ASD and matched controls consumed similar amounts of nutrients from food. Only children with ASD aged 4 to 8 years consumed significantly less energy, vitamins A and C, and the mineral Zn; and those 9 to 11 years consumed less phosphorous. A greater percentage of children with ASD met recommendations for vitamins K and E. Few children in either group met the recommended intakes for fiber, choline, calcium, vitamin D, vitamin K, and potassium. Specific age groups consumed excessive amounts of sodium, folate, manganese, zinc, vitamin A (retinol), selenium, and copper. No differences were observed in nutritional sufficiency of children given restricted diets. Children aged 2 to 5 years with ASD had more overweight and obesity, and children 5 to 11 years had more underweight.

CONCLUSIONS

Children with ASD, like other children in America, consume less than the recommended amounts of certain nutrients from food. Primary care for all children should include nutritional surveillance and attention to BMI.
Iron Status in Children With Autism Spectrum Disorder
Authors: Reynolds Ann , Krebs Nancy F. , Stewart Patricia A. , Austin Harriet , Johnson Susan L. , Withrow Nikki , Molloy Cynthia , James S. Jill , Johnson Cynthia , Clemons Traci , Schmidt Brianne , Hyman Susan L.
Published: November 2012

BACKGROUND AND OBJECTIVES

Children with autism spectrum disorders (ASDs) often have food selectivity and restricted diets, putting them at risk for nutritional deficiencies. Previous studies have demonstrated a high prevalence of iron deficiency (ID) in children with ASDs living in Wales, Canada, and Turkey. The objectives of this study were to determine the prevalence of ID and the adequacy of iron intake in children with ASD in the United States.

METHODS

Participants (age 2–11 years recruited from the Autism Treatment Network Diet and Nutrition Study) completed a 3-day diet record (n = 368) and had laboratory measures of serum ferritin (SF), complete blood count, iron, total iron binding capacity, and transferrin saturation (TS) (n = 222).

RESULTS

Of the 222 participants with laboratory data, 18 (8%) had SF <12 µg/L and 2 (1%) had ID defined by both low SF and TS (3 children with low SF had missing TS data). One subject had iron deficiency anemia. Fewer than 2% of subjects had iron intake below the estimated average requirement.

CONCLUSIONS

Although the determination of iron status is complex, these data do not support previous reports that children with ASD are at greater risk for ID than the general population; however, 8% percent of the sample did demonstrate low SF despite <2% of the sample demonstrating iron intake below the estimated average requirement. The prevalence of low SF may be an underestimate, because SF is an acute phase reactant and the study included no measure of inflammation.
Is Inclusivity an Indicator of Quality of Care for Children With Autism in Special Education?
Authors: Foster E. Michael , Pearson Erin
Published: November 2012

OBJECTIVE

To determine whether the proportion of time spent in an inclusive educational setting, a process indicator of the quality of schooling for children with autism, improves key outcomes.

METHODS

Patients were 484 children and youth educated in special education with a primary diagnosis of autism in the National Longitudinal Transition Study-2. These individuals were ages 20 to 23 in 2007. We used propensity-score inverse probability of treatment weights to eliminate the effect of multiple confounders. A causal interpretation of the effect of inclusivity on key educational and functional outcomes still depends on a critical assumption, that inclusivity is not confounded by remaining, omitted confounders.

RESULTS

Compared with children with autism who were not educated in an inclusive setting (n = 215), children with autism who spent 75% to 100% of their time in a general education classroom (n = 82) were no more likely to attend college (P = .40), not drop out of high school (P = .24), or have an improved functional cognitive score (P = .99) after controlling for key confounders.

CONCLUSIONS

We find no systematic indication that the level of inclusivity improves key future outcomes. Research on educational and functional outcomes for children with autism can benefit from data on large samples of children educated in real-world settings, such as the National Longitudinal Transition Study-2, but more nuanced indicators should be developed to measure the quality of special education for children with autism.
Long-term Outcomes of Toddlers With Autism Spectrum Disorders Exposed to Short-term Intervention
Authors: Landa Rebecca J. , Kalb Luther G.
Published: November 2012

OBJECTIVES

To examine long-term outcomes of toddlers with autism spectrum disorder (ASD) who received a 6-month early intervention at age 2.

METHODS

Forty-eight toddlers diagnosed with an ASD received a 6-month evidence-based intervention. Cognitive (IQ) and communication ability, as well as severity of autism symptoms, were assessed by using standardized measures at preintervention (Time 1 [T1]; mean [M] age = 27 months), postintervention (T2; M age = 35 months), short-term follow-up (T3; M age = 41 months), and long-term follow-up (T4; M age = 72 months).

RESULTS

From pre- to postintervention, significant gains in IQ and Vineland Communication domain standard scores as well as a reduction in ASD severity were achieved (all P < .01). Between T2 and T3, the 6-month period immediately after completion of the intervention, IQ and Communication scores stabilized and ASD severity increased significantly (P < .05). During the long-term follow-up period (T3–T4), IQ and Communication scores significantly increased again, but ASD severity increased significantly as well (all P < .05). For overall trajectory (T1–T4), robust gains were observed for both IQ and communication; ASD severity did not change.

CONCLUSIONS

Findings highlight the potential for positive long-term outcomes in toddlers with ASD. Additional research is needed to understand the relation between early exposure to uninterrupted intervention and developmental gains, and whether initial reduction in ASD symptom severity can be sustained through targeted intervention.
Survey and prevalence of species causing Alternaria leaf spots on brassica species in Pernambuco
Authors: Michereff Sami J , Noronha Marissônia A , Xavier Filha Maria S , Câmara Marcos PS , Reis Ailton
Published: November 2012

Brassicaceae family comprises plant species that are very important as vegetable crops, such as the species complex Brassica oleracea and Brassica rapa. Alternaria brassicicola and A. brassicae are among the most important pathogens of Brassicaceae causing Alternaria leaf spot disease. The occurrence and prevalence of Alternaria species causing leaf spots in brassica crops in Pernambuco was acessed, as well as the existence of a possible preference by vegetable host for these pathogens. Twenty-eight fields were surveyed in the Agreste region of Pernambuco state, in the 2005 and 2006 growing seasons. In each year, 10 Chinese cabbage, six cabbage, six cauliflower and six broccoli fields were visited. In each field, 50 leaves showing at least five lesions were randomly collected. Species identification was performed taking into account morphology of the conidia that was compared with literature data. Among the two Alternaria species found, A. brassicae was found in all Chinese cabbage fields while A. brassicicola was found in all fields of cabbage, cauliflower and broccoli. Overall, A. brassicicola was more prevalent than A. brassicae. In Chinese cabbage there was predominance of A. brassicae, with mean prevalence of 91.0% and 96.5% in 2005 and 2006. On the other hand, in broccoli and cabbage there was high predominance of A. brassicicola, with mean prevalence between 95.1% and 99.8%. In cauliflower, although the prevalence has been of A. brassicicola, high frequency of A. brassicae was noted. The frequency of co-occurrence of both Alternaria species was very low. The results of this study reinforce the hypothesis of existence of host preference within species of Alternaria that cause leaf spots in brassica crops, especially when Chinese cabbage, broccoli and cabbage are considered. This information is critical to developing strategies for managing Alternaria leaf spots in Brassicaceae species.
The use of Salvinia auriculata as a bioindicator in aquatic ecosystems: biomass and structure dependent on the cadmium concentration
Authors: Wolff G. , Pereira GC , Castro EM , Louzada J , Coelho FF
Published: November 2012

This study shows, in a multiple-level approach, the responses of Salvinia auriculata to Cd pollution in aquatic ecosystems. S. auriculata ramets were cultivated in nutrient solution and subjected to five treatments with Cd for ten days. At the end of the experiment, the number of new ramets and the dry biomass were determined. For ultrastructural observations, the leaves of S. auriculata were analyzed using a scanning electron microscope and transmission electron microscope. At the end of the experiment, the plants exposed to Cd showed damage in the leaves including necrosis and chlorosis, stomate deformations and damaged trichomes. We observed a decrease in the number of new ramets and dry biomass of S. auriculata following the increase in Cd concentration in the solution. At the ultrastructural level, leaves exposed to Cd presented chloroplast deformations and deterioration in the cell wall. All the symptoms of toxicity were directly proportionate to the concentration of Cd in the solution. The results suggests that S. auriculata shows good potential for use as a bioindicator and it can be used in the biomonitoring of aquatic ecosystems contaminated by Cd.
Paleoecologic and Biostratigraphic Significance of Trace Fossils From Shallow- to Marginal-Marine Environments From the Middle Cambrian (Stage 5) of Jordan
Authors: Hofmann Richard , Mángano M. Gabriela , Elicki Olaf , Shinaq Rafie
Published: November 2012

The Hanneh Member (Cambrian Stage 5) of the Burj Formation and the Umm Ishrin Formation of Jordan represent a transgressive-regressive succession that contains twenty-eight ichnotaxa, including vertical burrows (Arenicolitesisp.,Diplocraterionisp.,Gyrolithes polonicus,Rosseliaisp.,Skolithos linearis, escape trace fossils), horizontal simple burrows and trails (Archaeonassa fossulata,Gordia marina,Helminthoidichnites tenuis,Palaeophycus tubularis,Planolites beverleyensis,P. montanus), plug-shaped burrows (Bergaueria sucta), horizontal branched burrows (Asterosomaisp.,Phycodesisp.,Treptichnuscf.T. pedum), bilobate structures (various ichnospecies ofCruzianaandRusophycus), and trackways and scratch marks (Diplichnitesisp.,Dimorphichnuscf.D. obliquus,Monomorphichnusisp.). Eleven trace-fossil assemblages are identified. TheArenicolitesisp. andDiplocraterionisp. assemblages occur in transgressive tidal dunes and bars whereas theRosseliaisp. assemblage characterizes areas between tidal dunes. TheCruziana salomonisassemblage reflects a wide variety of environmental settings including channels within tidal-bar complexes, bottomsets of tidal dunes, and interdune areas. TheGordia marinaassemblage is present between dune patches. TheGyrolithes polonicusassemblage penetrates into firmground mudstone below the maximum flooding surface. TheBergaueria sucta,Archaeonassa fossulata,Rusophycus aegypticusandCruziana problematicaassemblages occur in different subenvironments of the progradational delta.Cruziana salomonisandRusophycus burjensis, originally considered indicative of an early Cambrian age, are actually middle Cambrian in their type locality. Occurrences ofCruziana jordanicaandRusophycus aegypticusprovide evidence that these ichnospecies are of the same age in Jordan and may co-exist in terms of stratigraphic distribution withC. salomonisandR. burjensis.
Error analysis of Ordnance Survey map tidelines, UK
Authors: Sutherland James
Published: November 2012

Historical trend analysis is often used at the coastline to provide rates of coastal erosion or accretion as part of shoreline or beach management studies. The long-term data for historical trend analysis at UK sites often come from tidelines (representing high or low water) from Ordnance Survey (or older) maps. Recent Ordnance Survey (OS) digital maps no longer retain the date of survey, which is needed for historical trend analysis. An alternative is to use datum-based tidelines from survey data, although these are different from the proxy-based tidelines on OS maps. The plotting of tidelines on OS maps is reviewed and the errors involved in establishing the positions of tidelines are divided into source uncertainty, interpretation uncertainty and natural shoreline variability. Methods of calculating these errors are presented and examples provided. The methods for including uncertainties in historical trend analysis are introduced. Adoption of these methods would allow the significance of changes in tidelines to be assessed, which will assist coastal management.
Horizontal, but not vertical, biotic interactions affect fine‐scale plant distribution patterns in a low‐energy system
Authors: le Roux Peter C. , Lenoir Jonathan , Pellissier Loïc , Wisz Mary S. , Luoto Miska
Published: November 2012

Studies of species range determinants have traditionally focused on abiotic variables (typically climatic conditions), and therefore the recent explicit consideration of biotic interactions represents an important advance in the field. While these studies clearly support the role of biotic interactions in shaping species distributions, most examine only the influence of a single species and/or a single interaction, failing to account for species being subject to multiple concurrent interactions. By fitting species distribution models (SDMs), we examine the influence of multiple vertical (i.e., grazing, trampling, and manuring by mammalian herbivores) and horizontal (i.e., competition and facilitation; estimated from the cover of dominant plant species) interspecific interactions on the occurrence and cover of 41 alpine tundra plant species. Adding plant–plant interactions to baseline SDMs (using five field‐quantified abiotic variables) significantly improved models' predictive power for independent data, while herbivore‐related variables had only a weak influence. Overall, abiotic variables had the strongest individual contributions to the distribution of alpine tundra plants, with the importance of horizontal interaction variables exceeding that of vertical interaction variables. These results were consistent across three modeling techniques, for both species occurrence and cover, demonstrating the pattern to be robust. Thus, the explicit consideration of multiple biotic interactions reveals that plant–plant interactions exert control over the fine‐scale distribution of vascular species that is comparable to abiotic drivers and considerably stronger than herbivores in this low‐energy system.
Chemical and Allied Products
Authors: Hung Yung‐Tse , Butler Erick , Yeh Ruth Yu‐Li , Liu Lian‐Huey , Ahmad Mohammed Al , Fu Yen‐Pei
Published: November 2012

A review of the literature published in 2011 on topics related to chemicals and allied products is presented. The review considered several sections such as waste management, physicochemical treatment, aerobic treatment, anaerobic treatment, air emissions, soils and groundwater, and reuse.
Gaseous Emissions from Wastewater Facilities
Authors: Shaw Andrew R. , Koh Sock‐Hoon
Published: November 2012

A review of the literature published in 2011 on topics relating to gaseous emissions from wastewater facilities is presented. This review is divided into the following sections: odorant emissions from wastewater treatment plants (WWTPs); greenhouse gas (GHG) emissions from WWTPs; emissions from wastewater collection systems, physiochemical emission control methods; biological odor control methods; odor monitoring; and odor impacts.