bluuebunny/crossref_metadata_2025 huggingface dataset:
Three‐dimensional imaging of the prostatic urethra—an exciting new tool
Authors: NG K.J. , Gardener J.E. , RICKARDS D. , LEES W.R , MILORY E.J.G.
Published: December 2008

Objeactive To evalute the technique of three‐dimensional (3‐D) ultrasound imaging of the urethra and its application in both research and clinical practice.

Patients and techniques The study involved 23 patients: 10 with benign prostatic hyperplasia, four with urethral strictures, three post‐insertion of prostatoc stents, one with bladder neck dyssuyner, three post‐transurethral resection of the prostate, and two with non‐urological conditions. A transrectal ultrasound scan was initially performed to acquire a series of images of the urethra. These images were then reconstruicted into a 3‐D format.

Results The 3‐D image of the urethra could be rotated on screen and viewed from any angle. The image could also be sliced at any plane to reveal the sectional view.

Conclusion This new tool represents a major advance in imaging techniques and promises to provide new knowledge in understanding the hydrodynamics of knowledge in understanding the hydrodynamics of the lower urinary tract. The precise geometry of the 3‐D urethra will also help in the design of new stents.
Perineal versus retropubic radical prostatectomy for T1, T2 prostate cancer
Authors: HAAB F. , BOCCON‐GIBOD LAURENT , DELMAS V. , BOCCON‐GIBOD LILIANNE , TOUBLANC M.
Published: December 2008

Objective To compare retrospectively the efficacy of radical perineal and retropubic prostatectomy in patients with T1, T2 cancer of the prostate.

Patients and methods From January 1991 to January 1993, 71 patients with T1, T2 carcinoma of the prostate aged 52–74 years underwent radical retropubic prostatectomy (36) or radical perineal prostatectomy (35); this was preceded by endosurgical lymphadenectomy. The two groups were identical with regard to age (64 vs 66 years), clinical stage (Tla 17% vs 25%, T2 82% vs 74%), mean and median pre‐operative prostate‐specific antigen (PSA) (20 vs 26, 11 vs 15 using the YANG polyclonal assay n<2.5 ng/ml). Radical retropubic prostatectomy and radical perineal prostatectomy were performed using standard procedures. Specimens were inked and analysed: operative time, volume of blood transfusions, duration of hospital stay, peri‐operative complications, sexual function, urinary continence and quality of the specimens were assessed retrospectively.

Results Both groups were identical as far as operation time, hospital stay, complications (one rectal injury in each group), specimen weight and pathology were concerned. The proportions of organ‐confined (54% in radical perineal prostatectomy group vs 55% in radical retropubic prostatectomy group) and margin‐positive cancers (37% in radical perineal prostatectomy group vs 39% in radical retropubic prostatectomy group) were identical. The volume of blood transfusion was significantly less in the radical perineal prostatectomy group: 54% required transfusion compared with 100% in the radical retropubic prostatectomy group), 7% of radical perineal prostatectomy patients received homologous transfusion vs 38% of the radical retropubic prostatectomy patients: 11 and 3% of the patients were potent 3–6 months after surgery. Two anastomotic strictures developed after radical retropubic prostatectomy and none after the radical perineal prostatectomy. Continence was achieved at 3 months in 71% of the radical perineal prostatectomy group and in 82% of the radical retropubic prostatectomy group; by 6 months 88% of the patients were dry in both groups.

Conclusion When nodal status has been assessed by lymph node dissection (open or endosurgical), radical perineal prostatectomy is a reasonable, minimally invasive alternative to radical retropubic prostatectomy provided that impotence and a slower return to full continence are accepted.
Conservative management with symptomatic treatment and delayed hormonal manipulation is justified in men with locally advanced carninoma of the prostate
Authors: RANA A. , CHISHOLM G. D. , KHAN M. , RASHWAN H. M. , ELTON R. A.
Published: December 2008

Objective To examine the clinical course following surveillance and symptomatic treatment, and compare the outcomes of immediate and delayed hormonal treatment in men with locally advanced prostatic cancer.

Patients and methods Of a consecutive series of 199 men (mean age 74 years) with T2‐T4 Nx MO prostatic cancer, 110 (55%) were followed until death and the rest had a mean follow‐up of 4.2 years. Fifty‐one men received immediate orchidectomy, 88 had this treatment delayed until metastatic progression, and 60 had the treatment in the intervening period. The actuarial survival was compared with the expected survival for an age‐matched healthy population in Scotland. The adjusted effect of the timing for hormonal manipulation was assessed by including it with age, Gleason score and clinical stage in a multiple Cox regression.

Results The actuarial survival for the whole group was 17% less at 5 years and 15% less at 10 years when compared with the expected survival for an age‐matched population in Scotland. This was despite the fact that their nodal status was unknown and also those with occult metastasis (elevated serum prostatic acid phosphatase, M1a) at presentation were not excluded. In terms of metastatic progression, overall survival and cause‐specific survival, there was no significant difference between immediate and delayed hormonal treatment.

Conclusion A conservative approach with surveillance and symptomatic treatment for locally advanced prostatic cancer is justified by the present evidence on disease progression and survival, which do not differ from alternative methods of treatment as reported in contemporary literature. This study has the limitations relative to the ideal of a prospective randomized trial on immediate versus delayed hormonal treatment, but the lack of significant differences in outcome even after adjustment for other established prognostic factors does suggest that there may be little to be gained from an immediate orchidectomy.
The management of bilateral ureteric obstruction and renal failure in advanced prostate cancer
Authors: PAUL A. B. , LOVE C. , CHISHOLM G. D.
Published: December 2008

Objectives To investigate the effect of upper tract decompression on the prognosis of uraemia secondary to bilateral ureteric obstruction in prostate cancer, with particular reference to the hormone dependency of the tumour.

Patients and methods Prospectively collected data, over the period 1978–1993, were selected from the departmental database and from hospital case code data. Inclusion criteria were: blood urea ≥15 mM, radiological evidence of bilateral ureteric obstruction, a histological diagnosis of prostate cancer, and the exclusion of out‐flow tract obstruction. Of the 820 patients recorded in the departmental database, 27 (3.3%) fulfilled the criteria. Thirty‐six patients were identified in total. Statistical analysis was by the Mann‐Whitney non‐parametric test.

Results Of the 36 patients with bilateral ureteric obstruction and renal failure, in those in whom androgen depletion had been undertaken after ureteric obstruction (i.e. androgen depletion was a treatment option), the mean survival was 646 days (n=12, SD=786). Among these patients upper tract decompression improved survival and reduced the amount of time patients spent in hospital. In those in whom androgen depletion had been carried out before obstruction (i.e. the tumour had escaped from hormonal control), survival was significantly worse (80 days, n=24, SD=86.8, P<0.01.) In this group the use of decompression improved survival little. Percutaneous nephrostomy was the commonest means of decompression (nephrostomy, 9: stent, 5: ureteroneocystostomy, 2).

Discussion In patients for whom hormonal therapy remains an option, upper tract decompression offers a worthwhile improvement in terms of increased survival and reduced in‐patient time. However, if ureteric obstruction is diagnosed after hormone manipulation has been used, upper tract decompression has little effect on survival and should only be used in exceptional circumstances.
Walk‐in, walk‐out day case genito‐scrotal surgery with sedation reversal. A survey of patient attitudes and morbidity
Authors: BIRCH B. R. P. , MILLER R. A.
Published: December 2008

Objective To survey patient attitudes and assess the extent of patient morbidity in the first 24 h follwoing walk‐in, walk‐out day case genito‐scrotal surgery with sedation reversal.

Patients and methods One hundred patients who were undergoing genito‐scrota1 surgery were eligible for inclusion in the study. All patients walked into theatre, positioned themselves on the operating table and were sedated with intravenous (i.v.) midazolam (Hypnovel, Roche Products Ltd, Welwyn, UK) following which the appropriate local anaesthetic block was performed. One minute before the end of surgery sedation was reversed with an i.v. injection of 0.5 mg flumazenil (Anexate, Roche Products Ltd). When conscious and alert (approx. 2 min), patients were allowed to get themselves up off the operating table and walk from theatre. All patients were given a questionnaire to complete and were reviewed 2 weeks after surgery.

Results Eighty‐six of 100 patients returned questionnaires. Fifty‐five patients were asymptomatic and no patient experienced nausea or vomiting in the first 24 h post‐operatively. Other symptoms such as headache (2%), drowsiness (20%) and dizziness (11%) were uncommon and significantly less frequent than seen with general anaesthetic procedures. Seventeen patients described minor wound complications and one patient with a scrotal haematoma was readmitted for overnight observation. Nearly all patients (98%) expressed their satisfaction with the technique.

Conclusion Walk‐in, walk‐out day case surgery as described is a well‐tolerated technique with a low morbidity and towards which patients have a positive attitude.
THE MORAL OBLIGATION TO CREATE CHILDREN WITH THE BEST CHANCE OF THE BEST LIFE
Authors: SAVULESCU JULIAN , KAHANE GUY
Published: December 2008

According to what we call the Principle of Procreative Beneficence (PB), couples who decide to have a child have a significant moral reason to select the child who, given his or her genetic endowment, can be expected to enjoy the most well‐being. In the first part of this paper, we introduce PB, explain its content, grounds, and implications, and defend it against various objections. In the second part, we argue that PB is superior to competing principles of procreative selection such as that of procreative autonomy. In the third part of the paper, we consider the relation between PB and disability. We develop a revisionary account of disability, in which disability is a species of instrumental badness that is context‐ and person‐relative. Although PB instructs us to aim to reduce disability in future children whenever possible, it does not privilege the normal. What matters is not whether future children meet certain biological or statistical norms, but what level of well‐being they can be expected to have.
ETHICAL DEBATE OVER ORGAN DONATION IN THE CONTEXT OF BRAIN DEATH
Authors: BRESNAHAN MARY JIANG , MAHLER KEVIN
Published: December 2008

This study investigated what information about brain death was available from Google searches for five major religions. A substantial body of supporting research examining online behaviors shows that information seekers use Google as their preferred search engine and usually limit their search to entries on the first page. For each of the five religions in this study, Google listings reveal ethical controversy about organ donation in the context of brain death. These results suggest that family members who go online to find information about organ donation in the context of brain death would find information about ethical controversy in the first page of Google listings. Organ procurement agencies claim that all major world religions approve of organ donation and do not address the ethical controversy about organ donation in the context of brain death that is readily available online.
ARE MORAL PHILOSOPHERS MORAL EXPERTS?
Authors: GESANG BERNWARD
Published: December 2008

In this paper I examine the question of whether ethicists are moral experts. I call people moral experts if their moral judgments are correct with high probability and for the right reasons. I defend three theses, while developing a version of the coherence theory of moral justification based on the differences between moral and nonmoral experience:

The answer to the question of whether there are moral experts depends on the answer to the question of how to justify moral judgments. Deductivism and the coherence theory both provide some support for the opinion that moral experts exist in some way. I maintain – within the framework of a certain kind of coherence theory – that moral philosophers are ‘semi‐experts’.
The Effect of Construal Level on Subjective Probability Estimates
Authors: Wakslak Cheryl , Trope Yaacov
Published: December 2008

In a series of studies, we examined novel predictions drawn from a conceptualization of probability as psychological distance. Manipulating construal level in a number of different ways and examining a variety of probability judgments, we found that participants led to adopt a high-level-construal mind-set made lower probability assessments than did those led to adopt a low-level-construal mind-set. Moreover, this occurred even when construal level was manipulated in a context separate from the judgment task and the manipulation was unrelated in content to the events being judged. These findings suggest that broad processing variables can exert a widespread influence on probability judgment.
Signs of Socioeconomic Status
Authors: Kraus Michael W. , Keltner Dacher
Published: December 2008

Socioeconomic status (SES) is a primary determinant of health vulnerabilities and social affiliations. To ascertain if SES is signaled in brief patterns of nonverbal behavior, we had participants of varying SES backgrounds engage in a brief interaction with a stranger. Videos of 60-s slices of these interactions were coded for nonverbal cues of disengagement and engagement, and estimates of participants' SES were provided by naive observers who viewed these videos. As predicted by analyses of resource dependence and power, upper-SES participants displayed more disengagement cues (e.g., doodling) and fewer engagement cues (e.g., head nods, laughs) than did lower-SES participants. Results were also consistent with the thin-slicing literature, in that observers' estimates of SES were reliable with each other and accurately predicted targets' family income, maternal education, and subjective SES. Finally, nonverbal displays of disengagement and engagement predicted observers' estimates of SES, which suggests that these cues are systematic signs of SES. These results have implications for understanding the effect of SES on social interactions and patterns of disengagement and engagement in other realms.
Divorce and Death
Authors: Sbarra David A. , Nietert Paul J.
Published: December 2008

Forty years of follow-up data from the Charleston Heart Study (CHS) were used to examine the risk for early mortality associated with marital separation or divorce in a sample of more than 1,300 adults assessed on several occasions between 1960 and 2000. Participants who were separated or divorced at the start of the study evidenced significantly elevated rates of early mortality, and these results held after adjusting for baseline health status and other demographic variables. Being separated or divorced throughout the CHS follow-up window was one of the strongest predictors of early mortality. However, the excess mortality risk associated with separation or divorce was completely eliminated when participants who had ever experienced a marital separation or divorce during the study were compared with all other participants. These findings suggest that a key predictor of early death is the amount of time people live as separated or divorced. It is possible that the mortality risk conferred by marital dissolution is due to dimensions of personality that predict divorce as well as a decreased likelihood of future remarriage.
Factors affecting fluid flow in strike–slip fault systems: coupled deformation and fluid flow modelling with application to the western Mount Isa Inlier, Australia
Authors: FORD A. , BLENKINSOP T.G. , McLELLAN J.G.
Published: December 2008

Deformation and focused fluid flow within a mineralized system are critical in the genesis of hydrothermal ore deposits. Dilation and integrated fluid flux due to coupled deformation and fluid flow in simple strike–slip fault geometries were examined using finite difference analysis in three dimensions. A series of generic fault bend and fault jog geometries consistent with those seen in the western Mount Isa Inlier were modelled in order to understand how fault geometry parameters influence the dilation and integrated fluid flux. Fault dip, fault width, bend/jog angle, and length were varied, and a cross‐cutting fault and contrasting rock types were included. The results demonstrate that low fault dips, the presence of contrasts in rock type, and wide faults produce highest dilation and integrated fluid flux values. Increasing fault bend lengths and angles increases dilation and integrated fluid flux, but increasing fault jog length or angle has the opposite effect. There is minimal difference between the outputs from the releasing and restraining fault bend and jog geometries. Model characteristics producing greater fluid flows and/or gradients can be used in a predictive capacity in order to focus exploration on regions with more favorable fault geometries, provided that the mineralized rocks had Mohr–Coulomb rheologies similar to the ones used in the models.
PKG activity causes photoreceptor cell death in two retinitis pigmentosa models
Authors: Paquet‐Durand François , Hauck Stefanie M. , Van Veen Theo , Ueffing Marius , Ekström Per
Published: December 2008

Photoreceptor degeneration in retinitis pigmentosa is one of the leading causes of hereditary blindness in the developed world. Although causative genetic mutations have been elucidated in many cases, the underlying neuronal degeneration mechanisms are still unknown. Here, we show that activation of cGMP‐dependent protein kinase (PKG) hallmarks photoreceptor degeneration inrd1andrd2human homologous mouse models. When induced in wild‐type retinae, PKG activity was both necessary and sufficient to trigger cGMP‐mediated photoreceptor cell death. Target‐specific, pharmacological inhibition of PKG activity in bothrd1andrd2retinae strongly reduced photoreceptor cell death in organotypic retinal explants. Likewise, inhibition of PKGin vivo,using three different application paradigms, resulted in robust photoreceptor protection in therd1retina. These findings suggest a pivotal role for PKG activity in cGMP‐mediated photoreceptor degeneration mechanisms and highlight the importance of PKG as a novel target for the pharmacological intervention in RP.
Interleukin‐6 is required for the early induction of glial fibrillary acidic protein in Schwann cells during Wallerian degeneration
Authors: Lee Hyun Kyoung , Seo In Ae , Suh Duk Joon , Hong Jeong‐In , Yoo Young Hyun , Park Hwan Tae
Published: December 2008

Signal transducer and activator of transcription 3 (STAT3) regulates gene transcription in response to cytokines and growth factors. In the central nervous system, STAT3 plays a role in neuroprotection and reactive gliosis after lesions. During peripheral nerve regeneration, a nerve injury‐induced up‐regulation of cytokines and growth factors accompanies STAT3 activation in sensory neurons and Schwann cells (SCs) even though its molecular details and functions are unknown. We then analyzed the ligands and functions of STAT3 activation in RT4 schwannoma cells and adult SCs in vitro and in vivo. We have identified that interleukin‐6 (IL‐6), but not ciliary neurotrophic factor, leukemia inhibitory factor, or ligands for receptor tyrosine kinases, activates STAT3 in SCs. The IL‐6/STAT3 signaling in primary SCs and RT4 cells induced the gene expression of glial fibrillary acidic protein (GFAP), which is known to be required for the proper regeneration of the injured nerves. Finally, the GFAP induction in the sciatic nerves after injury was significantly delayed in IL‐6‐deficient mice. These findings indicate that IL‐6 plays an important role in STAT3‐dependent GFAP induction in SCs during peripheral nerve regeneration.
Acetylcholine‐induced neuronal differentiation: muscarinic receptor activation regulates EGR‐1 and REST expression in neuroblastoma cells
Authors: Salani Monica , Anelli Tonino , Tocco Gabriella Augusti , Lucarini Elena , Mozzetta Chiara , Poiana Giancarlo , Tata Ada Maria , Biagioni Stefano
Published: December 2008

Neurotransmitters are considered part of the signaling system active in nervous system development and we have previously reported that acetylcholine (ACh) is capable of enhancing neuronal differentiation in cultures of sensory neurons and N18TG2 neuroblastoma cells. To study the mechanism of ACh action, in this study, we demonstrate the ability of choline acetyltransferase‐transfected N18TG2 clones (e.g. 2/4 clone) to release ACh. Analysis of muscarinic receptors showed the presence of M1–M4 subtypes and the activation of both IP3 and cAMP signal transduction pathways. Muscarinic receptor activation increases early growth response factor‐1 (EGR‐1) levels and treatments with agonists, antagonists, and signal transduction enzyme inhibitors suggest a role for M3 subtype in EGR‐1 induction. The role of EGR‐1 in the enhancement of differentiation was investigated transfecting in N18TG2 cells a construct for EGR‐1. EGR‐1 clones show increased neurite extension and a decrease in Repressor Element‐1 silencing transcription factor (REST) expression: both these features have also been observed for the 2/4 clone. Transfection of this latter with EGR zinc‐finger domain, a dominant negative inhibitor of EGR‐1 action, increases REST expression, and decreases fiber outgrowth. The data reported suggest that progression of the clone 2/4 in the developmental program is dependent on ACh release and the ensuing activation of muscarinic receptors, which in turn modulate the level of EGR‐1 and REST transcription factors.
Communication between neurons and astrocytes: relevance to the modulation of synaptic and network activity
Authors: Fellin Tommaso
Published: December 2008

Neuromodulation is a fundamental process in the brain that regulates synaptic transmission, neuronal network activity and behavior. Emerging evidence demonstrates that astrocytes, a major population of glial cells in the brain, play previously unrecognized functions in neuronal modulation. Astrocytes can detect the level of neuronal activity and release chemical transmitters to influence neuronal function. For example, recent findings show that astrocytes play crucial roles in the control of Hebbian plasticity, the regulation of neuronal excitability and the induction of homeostatic plasticity. This review discusses the importance of astrocyte‐to‐neuron signaling in different aspects of neuronal function from the activity of single synapses to that of neuronal networks.
l‐DOPA activates ERK signaling and phosphorylates histone H3 in the striatonigral medium spiny neurons of hemiparkinsonian mice
Authors: Santini Emanuela , Alcacer Cristina , Cacciatore Silvia , Heiman Myriam , Hervé Denis , Greengard Paul , Girault Jean‐Antoine , Valjent Emmanuel , Fisone Gilberto
Published: December 2008

In the dopamine‐depleted striatum, extracellular signal‐regulated kinase (ERK) signaling is implicated in the development of l‐DOPA‐induced dyskinesia. To gain insights on its role in this disorder, we examined the effects of l‐DOPA on the state of phosphorylation of ERK and downstream target proteins in striatopallidal and striatonigral medium spiny neurons (MSNs). For this purpose, we employed mice expressing enhanced green fluorescent protein (EGFP) under the control of the promoters for the dopamine D2 receptor (Drd2‐EGFP mice) or the dopamine D1 receptor (Drd1a‐EGFP mice), which are expressed in striatopallidal and striatonigral MSNs, respectively. In 6‐hydroxydopamine‐lesioned Drd2‐EGFP mice, l‐DOPA increased the phosphorylation of ERK, mitogen‐ and stress‐activated kinase 1 and histone H3, selectively in EGFP‐negative MSNs. Conversely, a complete co‐localization between EGFP and these phosphoproteins was observed in Drd1a‐EGFP mice. The effect of l‐DOPA was prevented by blockade of dopamine D1 receptors. The same pattern of activation of ERK signaling was observed in dyskinetic mice, after repeated administration of l‐DOPA. Our results demonstrate that in the dopamine‐depleted striatum, l‐DOPA activates ERK signaling specifically in striatonigral MSNs. This regulation may result in ERK‐dependent changes in striatal plasticity leading to dyskinesia.
Cellular senescence in pretransplant renal biopsies predicts postoperative organ function
Authors: McGlynn Liane M. , Stevenson Karen , Lamb Kelly , Zino Samer , Brown Michaela , Prina Alberto , Kingsmore David , Shiels Paul G.
Published: December 2008

Older and marginal donors have been used to meet the shortfall in available organs for renal transplantation. Post‐transplant renal function and outcome from these donors are often poorer than chronologically younger donors. Some organs, however, function adequately for many years. We have hypothesized that such organs are biologically younger than poorer performing counterparts. We have tested this hypothesis in a cohort of pre‐implantation human renal allograft biopsies (n = 75) that have been assayed by real‐time polymerase chain reaction for the expression of known markers of cellular damage and biological aging, including CDKN2A, CDKN1A, SIRT2 and POT1. These have been investigated for any associations with traditional factors affecting transplant outcome (donor age, cold ischaemic time) and organ function post‐transplant (serum creatinine levels). Linear regression analyses indicated a strong association for serum creatinine with pre‐transplant CDKN2A levels (p = 0.001) and donor age (p = 0.004) at 6 months post‐transplant. Both these markers correlated significantly with urinary protein to creatinine ratios (p = 0.002 and p = 0.005 respectively), an informative marker for subsequent graft dysfunction. POT1 expression also showed a significant association with this parameter (p = 0.05). Multiple linear regression analyses for CDKN2A and donor age accounted for 24.6% (p = 0.001) of observed variability in serum creatinine levels at 6 months and 23.7% (p = 0.001) at 1 year post‐transplant. Thus, these data indicate that allograft biological age is an important novel prognostic determinant for renal transplant outcome.
“Midwife to Myself”: Birth Narratives among Women Choosing Unassisted Homebirth*
Authors: Miller Amy Chasteen
Published: December 2008

Most pregnant women in the United States today choose a normative physician‐guided pregnancy followed by a medically managed hospital birth. Some, however, choose the care of a midwife during pregnancy and birth, whether in the hospital or, more rarely, at home. Despite growing research on both these paths, a third option chosen by some women has rarely been studied: a planned birth at home with neither a doctor nor a midwife assisting. In this article, I examine the stories told by women in this under‐researched population to consider how they make and explain this highly unusual choice. Analysis of online birth stories and in‐depth interviews with women who planned and had an unassisted homebirth reveal ways in which these women rely on competing discourses of midwifery and medicine to craft a unique sense of agency in birth.
Debate: When does a seizure imply epilepsy?
Authors: Fisher Robert S. , Leppik Ilo
Published: December 2008

Epilepsy recently has been defined conceptually as a condition of at least one seizure, with an enduring predisposition to have seizures. It is not yet clear how to make this definition operational and practical. A diagnosis of epilepsy has potentially serious consequences for health, psychosocial well‐being, and economics, and, therefore, it should be made with a high level of certainty. A definite diagnosis of epilepsy can be made with two unprovoked seizures at least 24 h apart. This method has the benefit of simplicity and consistency with past epidemiologic studies. Nevertheless, certain circumstances suggest a high likelihood of having a second seizure, as evidenced by common clinical practice of considering treatment after a first unprovoked seizure in conjunction with additional risk factors (surrogate markers). One unifying approach is an operational definition of “definite epilepsy” after two unprovoked seizures at least 24 h apart. An operational definition of “probable epilepsy” can be established with one unprovoked seizure and clinical, electroencephalography (EEG), neuroimaging, genetic, or other information to suggest greater than a 50% chance of having another seizure. “Possible epilepsy” operationally would exist with a single unprovoked seizure and insufficient evidence to predict a high likelihood of recurrence. Future clinical and epidemiologic evidence would allow refinements of the operational definitions.
Antiepileptic drugs during pregnancy: What is known and which AEDs seem to be safest?
Authors: Pennell Page B.
Published: December 2008

Most infants born to women with epilepsy are healthy, but there are increased risks related to in utero antiepileptic drug (AED) exposure and seizures. Emerging data from pregnancy registries and other studies allow us to better balance the anatomic teratogenic and neurodevelopmental effects of AEDs against the need to maintain maternal seizure control. Several large prospective pregnancy registries demonstrate a consistent pattern of increased risk for major congenital malformations (MCMs) with valproate (VPA) use as monotherapy, compared to nonexposed populations and to other AEDs used in monotherapy. AED polytherapy likely increases risk for MCMs, but the risk is more pronounced if VPA is included. Reduced cognitive outcomes have been reported with AED polytherapy, and with use of VPA, phenobarbital (PB), and PHT as monotherapy. Dose‐dependent risk has been demonstrated with VPA for MCMs and cognitive consequences. CBZ groups show normal neurodevelopment. Increased clearance of most of the AEDs occurs during pregnancy. Use of therapeutic drug monitoring during pregnancy with LTG reduces the risk for seizure worsening. The consistent findings of increased teratogenic risk for VPA should discourage use of this medication as first‐line treatment in women of childbearing age.
Hippocampal epileptogenesis in animal models of mesial temporal lobe epilepsy with hippocampal sclerosis: The importance of the “latent period” and other concepts
Authors: Sloviter Robert S.
Published: December 2008

Prolonged chemoconvulsant‐induced status epilepticus in rats has long been promoted as an animal model of mesial temporal lobe epilepsy with hippocampal sclerosis, under the assumption that these animals involve: (1) pathology similar to that of the human neurologic condition; (2) a seizure‐free, “preepileptic” latent period of several weeks duration after injury, during which a secondary epileptogenic process gradually develops; and (3) a chronic epileptic state in which the hippocampus, in general, and the dentate gyrus, in particular, becomes a source of the spontaneous behavioral seizures that define these animals as “epileptic.” Retrospective analysis suggests that all of these assumptions are in doubt. Neuropathologic studies have shown that prolonged status epilepticus causes greater extrahippocampal than hippocampal damage, and does not produce classic hippocampal sclerosis. In vivo electrophysiologic studies suggest that the hippocampus of these animals may not be “epileptic.” Most importantly, studies using continuous video monitoring to detect spontaneous behavioral seizures indicate that these rats become epileptic soon after insult, before any delayed secondary processes have time to develop. High mortality, significant variability, and the lack of an extended “therapeutic window” after brain injury suggest the need to develop animal models that more closely resemble the human neurologic condition.
Should all patients be told about sudden unexpected death in epilepsy (SUDEP)? Pros and Cons
Authors: Brodie Martin J. , Holmes Gregory L.
Published: December 2008

Despite being a relatively rare event, sudden unexpected death in epilepsy (SUDEP) can tragically cut short a young person’s life, particularly if seizures are not well controlled or when concordance with the antiepileptic drug regimen is less than optimal. Both the Scottish Intercollegiate Guidelines Network (SIGN) and the UK National Institute of Clinical Excellence (NICE) recommend universal discussion of SUDEP and support the view of one of the authors (MJB) and that of the Joint Epilepsy Council of UK charities that patients and their families have the right to know about the risks of epilepsy and the reasons for treatment. However, the risk of SUDEP is not uniform across all patient populations. Most people with newly diagnosed epilepsy will stop having seizures, and SUDEP is very rare among them. The highest risk groups are those with a young age of onset, frequent generalized tonic–clonic seizures, and medical intractability. The mechanisms underlying SUDEP are unclear, and there are no effective preventative therapies. It is the contention of the other author (GLH) that it is not necessary, or advisable, to discuss SUDEP with all patients. Rather, he contends that SUDEP should be discussed only with those patients who are at high risk. In particular, patients who have generalized tonic–clonic seizures and who are non‐compliant with antiepileptic drugs should be counseled about their risk‐taking behavior. Both authors agree that additional studies into the pathophysiology and prevention of SUDEP are urgently needed.
Knowledge, Skill, and the Inculcation of the Anthropologist: Reflections on Learning to Sew in the Field
Authors: Prentice Rebecca
Published: December 2008

This article explores employment as a mode of participant observation, by analyzing the complex relationship between skill acquisition, embodiment, and anthropological analysis. It highlights the importance of thinking critically about the body, including the ethnographer's own body in the field. I describe working in a garment factory and learning to sew as part of my doctoral research on the garment industry in Trinidad, West Indies. I argue that disciplining the body into a particular craft is also a process of incorporating (or “taking into the body”) the ideologies of work that structure skill's meaning and practice. By describing my own difficulties “disembodying” what I learned in the field (in order to intellectualize the experience) I show how learning practical skills and enacting them everyday can be both a vigorous and perilous form of ethnographic research.
Combination of DNA methylation inhibitor 5‐azacytidine and arsenic trioxide has synergistic activity in myeloma
Authors: Chen Guanghua , Wang Yi , Huang Haiwen , Lin Fengru , Wu Depei , Sun Aining , Chang Huirong , Feng Yufeng
Published: December 2008

XAF1 is a newly identified candidate tumour‐suppressor gene that can antagonise XIAP and sensitise cells to cell death triggers. This study was undertaken to study the effect of 5‐azacytidine (AZA) on XAF1 expression in myeloma cells and efficacy of 5‐AZA and arsenic trioxide (ATO) combination treatment in myeloma in vivo and in vitro. XAF1 expression was analysed by semi‐quantitative PCR and western blotting. Methylation specific PCR was used to detect methylation status of XAF1 promoter CpG islands. RPMI 8226 and XG‐7 cells were treated with various concentrations of 5‐AZA and ATO. Expression of XAF1 mRNA variants were confirmed by gel electrophoresis and sequencing. Untreated RPMI 8226 cell expresses two variants of XAF1 mRNA. Untreated XG‐7 cell has no expression of XAF1. Hypermethylation of XAF1 promoter CpG islands was detected in both cell lines. Both cell lines express full‐length XAF1 transcript after treated with 2.5 μmol/L 5‐AZA for 72 h. Our studies demonstrated that 5‐AZA exhibits anti‐myeloma synergy with ATO. In addition, ATO alone, 5‐AZA alone, or combination of 5‐AZA and ATO was effective in slowing myeloma growth and prolonging survival of myeloma‐loaded nude mice. The findings suggested that 5‐AZA and ATO may be an effective combination in the therapy of myeloma patients.
Echocardiographic finding in beta‐thalassemia intermedia and major: absence of pulmonary hypertension following hydroxyurea treatment in beta‐thalassemia intermedia
Authors: Karimi Mehran , Borzouee Mohammad , Mehrabani Alireza , Cohan Nader
Published: December 2008

Objectives:  The aim of this study was to investigate the echocardigraphic finding in β‐thalassemia intermedia (TI) and β‐thalassemia major (TM) and to compare this finding together and with healthy control subjects.

Methods:  Fifty TI, who have been treated with hydroxyurea (HU) for 7 yrs and 51 transfusion dependent TM were compared with 50 age and sex matched healthy control subjects. Left and right ventricular parameters, systolic and diastolic functions, stroke volume, cardiac index and indices of pulmonary hypertension (PHT) were determined by two‐dimensional, M‐mode echocardiography and Doppler echocardiography.

Results:  Left ventricular parameters such as left ventricular end diastolic diameter, left ventricular end systolic diameter and also interventricular septal diameter in systole and diastole were significantly higher in TI patients compared with TM and control group (P < 0.05). There was elevated left ventricular mass (LV mass) in TI and TM patients compared with controls (P < 0.05). Regarding the LV diastolic function indices, E and A were significantly higher in TI patients compared with TM patients and control which were compatible with high output state. Measurement of pulmonary acceleration time and tricuspid and pulmonary valve continuous‐wave Doppler tracing in patients with tricuspid regurgitation and pulmonary insufficiency showed no difference between TI, TM and control group.

Conclusion:  Both TI and TM patients who have no clinical signs of cardiac involvement have significant abnormalities in volume, mass and shape of the LV which may be the consequence of chronic anemia. We found the unexpected absence of PHT in TI patients who have been treated with HU. In conclusion Low dose HU treatment of TI patients may prevent the devastating complication of PHT.
Food Price Surges: Possible Causes, Past Experience, and Longer Term Relevance
Authors: Alexandratos Nikos
Published: December 2008

The food price surges of recent years have created much misery and raised once again the Malthusian specter. Increases in the demand for food in the emerging economies, particularly China and India, have frequently been identified as the dominant factor behind a perceived shock on the demand side. Use of crops for biofuels was listed as an additional, though less important, factor. Yet global cereals utilization without biofuels has been growing at slowly decelerating rates, as in the past. It is the addition of biofuels that has resulted in its growing faster than in the past. In parallel, global production had been falling behind utilization for several years, leading to declining stocks. Weather shocks, depreciation of the dollar, and turbulence in the financial markets were added to these fundamentals of the supply–demand balance to generate the price surges. If energy prices remain high and/or rising and pro‐biofuel policies remain in place, the diversion of crops to biofuels is likely to continue. This could prevent the current commodity cycle from unfolding in the “normal” way over the short to medium term with prices trending back toward their pre‐surge levels. Conclusions are drawn about how these developments should influence the way we assess long‐term food and agriculture prospects.
Retiring in an Australian Country Town
Authors: Dempsey Ken
Published: December 2008

Findings from an enquiry into retirement in an Australian country town show that whilst there was often some sense of loss associated with retirement in the great majority of cases it proved a positive experience. It is argued that a satisfactory transition from work to retirement was facilitated by the small size of the community, the presence of lifelong friends, and opportunities for substitutionary or new sources of pleasure and usefulness.
TRANSIENT IMPROVEMENT OF MEMORY IN SENILE DEMENTIA FOLLOWING MNEMONIC TRAINING
Authors: Koch Carol , Luszcz Mary A. , Overstreet David H. , Henschke Philip J.
Published: December 2008

The effect of Levodopa administration and mnemonic strategy training in the treatment of memory deficits associated with denile dementia of the Alzheimer type was investigated in a short‐term longitudinal study. Levodopa administration exerted no significant effect upon memory functioning whereas training in the chunking of information and in visual association led to a significant, but temporary, improvement in memory functioning. Training raised performance of demented subjects to about 58% of that of non‐demented controls, compared to the 38% observed at baseline. No significant interactions between the drug and training manipulation were indicated.
HEALTH AND AUTONOMY IN OLD AGE
Authors: Vanclay F. M. , Selby J. , Hall A.
Published: December 2008

This paper examines theories on the health status of aged people by reference lo a survey of healthy, active, mobile elderly in Brisbane. In particular, theories relating to relationships between the aged person's self perception of health, their actual state of health, their subjective well being, and their autonomy and independence are considered.
IMPROVING EFFICIENCY AND COVERAGE IN SURVEY RESEARCH ON THE AGED
Authors: Rowland D. T. , Kendig H. L. , Jones R. G.
Published: December 2008

This paper discusses approaches to survey design applied in a large scale study of the aged in Sydney. The subject matter concerns methods of (i) achieving an adequate coverage of topics and rare sub‐populations while minimising the need for prolonged interviews and sample weighting; (ii) locating a widely dispersed target population economically, (iii) maintaining control over respondent selection and (iv) ensuring the attainment of objectives despite cost constraints and uncertainty.
FRACTURED NECK OF FEMUR — WHOSE RESPONSIBILITY?
Authors: Warne Roger , Nade Sydney , McKechnie John , Warne Roger W.
Published: December 2008

Fracture of the neck of femur is a common disorder in our elderly population. The number of fractures of the neck of femur are likely to increase, placing an ever‐increasing burden on our health care system.

Traditional management practices need to be reexamined in order to see whether the impact of this condition can be minimised at the same time as improving patient care. A management team approach was adopted at Sir Charles Gairdner hospital by the Departments of Orthopaedic Surgery and Extended Care.

In this paper the experiences of the Fractured Neck of Femur Management Team's first year of operation are reported.
LONGITUDINAL STUDY OF INTELLIGENCE: THE SIXTEENTH YEAR IN “OPERATION RETIREMENT”
Authors: Harwood Elsie , Enticknap L. E.
Published: December 2008

The serial testing of intelligence in a panel of 405 persons over the age of sixty was commenced in 1966. Analysis of 155 completed progressive scores (WAIS (l), NHAIS (l), WAIS (2), NHAIS (2) obtained over ten years) was reported in 1976. A surviving group of 118 (average age 80) has been re‐tested (WAIS (3)) in 1981. Twenty were then aged between 85 and 95. The 1981 scores have been analyzed by their age‐groups at commencement of the study (60–64, 65–69, 70–74, 75–79). The longitudinal changes have been tested statistically, and show that for all age‐groups (as reported of the larger number in 1976) the average yearly change in the first four tests was negligible until the ninth and tenth decades, when it reached approximately two percent per annum; but that in all groups (regardless of age at commencement) the decline was more marked in the past five years. As before, there was wide variation within age‐groups — some in their eighties actually improving over sixteen years. More detailed analysis of differences between verbal and perceptual abilities will be discussed; and it will be shown that, in the UQOR test, score differences between 1977 and 1981 proved to be unrelated to age.
POLITICAL RHETORIC AND PROGRAM DRIFT: HOUSE AND SENATE DEBATES ON THE AGED OR DISABLED PERSONS‘ HOMES ACT
Authors: Dargavel Ricki , Kendig Hal
Published: December 2008

The Aged Persons' Homes Act 1954 initiated the now extensive involvement of the Commonwealth Government in funding housing and residential care for older Australians. This article reviews the House and Senate debates related to this legislation from early 1950 to the present. The aim is to identify recurrent themes and ideology underlying the political debate, and their relationship to actual program developments. An understanding of these ideas and expectations can assist in considering options for policy reform in the future.
THE LONG‐STAY PSYCHOGERIATRIC NEEDS OF A SUBURBAN COMMUNITY
Authors: Dax E. Cunningham , Morrison Garry
Published: December 2008

A survey was made of the number of people in the Western Sourbs of Melbourne who needed long‐stay psychogeriatric care.

The Directors' of Nursing Homes estimated that about 10% of their patients were in this category, whilst another 50 were in the Mental Health Department Hospitals and some 80 others were known in the Community or Hostels.

With better Government organisation and co‐ordination, with expanded community services, improved nursing home design and utilisation, educational expansion and research much long‐term psychogeriatric care could be avoided.

Problems faced by the various services have been reviewed together with their attempts to overcome their difficulties.
WARD FOR PATIENTS WITH DISTURBED BEHAVIOUR IN A GERIATRIC HOSPITAL — AN EVALUATION
Authors: Tulloch James A.
Published: December 2008

This paper describes the way in which one geriatric hospital attempted to cope with episodes of disturbed behaviour occurring within the hospital. A small ward was adapted for use by these patients, and the results of treatment in the ward were generally good in terms of improvements in behaviour and psychiatric condition.

The problems of the ward and the results of treatment revealed problems in care of elderly patients with disturbed behaviour. There was difficulty arranging permanent care for patients where the behaviour disturbance could not be settled, and there was an increasing demand for admission for disturbed patients at home who were unable to obtain beds in psychogeriatric assessment units.

The results of treatment reveal a need for better coordination between geriatric and psychogeriatric services to allow easier transfer between types of care according to needs. A behavioural approach to the elderly demented patient seemed more appropriate than an approach based on psychiatric diagnosis.
SURVEYING THE AGED IN AUSTRALIA
Authors: Hugo Graeme , Healy Judith , Luszcz Mary
Published: December 2008

Surveys of the aged in Australia are characterised by a limited discussion of the methodology. However it is essential, especially in surveys aiming to discern levels and types of need among older populations, that the degree of representativeness of the survey be clearly established. A move towards needs‐based service delivery systems in Australia will depend upon relevant information being collected from representative samples of older people. The methodology for such data collection needs to be improved. This paper reviews various sampling strategies, and reports upon the methodology employed in obtaining and interviewing a random sample of people aged 70 years or more living at home in Adelaide's “middle suburbs”.