bluuebunny/crossref_metadata_2025 huggingface dataset:
Behavioral and Cognitive Aspects of Tuberous Sclerosis Complex
Authors: Prather Penny , de Vries Petrus J.
Published: July 2017

Tuberous sclerosis complex is a multisystem genetic disorder. Of all the possible manifestations of this complex disorder, the cognitive and behavioral problems represent the area of greatest concern to parents and caregivers. This review outlines the current evidence regarding global intellectual abilities, behavioral problems, psychiatric diagnoses, learning disorders, and specific neuropsychologic deficits for which individuals with tuberous sclerosis complex are at particularly increased risk, and outlines approaches to intervention. Approximately half of individuals diagnosed with tuberous sclerosis complex present with global intellectual impairment and developmental psychopathologies. Those with normal intellectual abilities are also at high risk of specific neuropsychologic deficits and behavioral, learning, and other psychiatric disorders. There is no evidence for an inevitable decline in cognition or behavior, and any such changes should be investigated. The evolving neurocognitive literature suggests that frontal brain systems might be most consistently disrupted by tuberous sclerosis complex—related neuropathology, thus leading to abnormalities in regulatory and goal-directed behaviors. ( J Child Neurol 2004;19:666—674).
Autism and Tuberous Sclerosis
Authors: Wiznitzer Max
Published: July 2017

The co-occurrence of autism spectrum disorder and tuberous sclerosis complex has been recognized for decades. The prevalence of tuberous sclerosis complex in the autism spectrum disorder population is 1 to 4%, whereas features of autism spectrum disorder are present in 25 to 50% of individuals with tuberous sclerosis complex. The underlying reason for this association might be a nonspecific disruption of brain function owing to tuberous sclerosis complex, including tuber location, seizures and their effect on brain development, cognitive impairment, a disturbance in brain development in regions associated with autism spectrum disorder, or, less likely, a linkage between a TSC gene and an autism susceptibility gene. Awareness of the relationship between autism spectrum disorder and tuberous sclerosis complex is important during the evaluation of individuals with either disorder. Better delineation of the association and its causative factors is needed for the development of possible interventions. ( J Child Neurol 2004;19:675—679).
Molecular Genetic Basis of Tuberous Sclerosis Complex: From Bench to Bedside
Authors: Au Kit-Sing , Williams Aimee T. , Gambello Michael J. , Northrup Hope
Published: July 2017

Tuberous sclerosis complex is an autosomal dominant disease of benign tumors occurring in multiple organ systems of the body. Either of two genes, TSC1 or TSC2, can be mutated, resulting in the tuberous sclerosis complex phenotype. The protein products of the tuberous sclerosis complex genes, hamartin ( TSC1) and tuberin ( TSC2), have been discovered to play important roles in several cell-signaling pathways. Knowledge regarding the function of the tuberin-hamartin complex has led to therapeutic intervention trials. Numerous pathogenic mutations have been elucidated in individuals affected with tuberous sclerosis complex. Information on the type and distribution of nearly 1000 mutations in the two genes is discussed. Mosaicism for tuberous sclerosis complex mutations has been documented, complicating provision of genetic counseling to families. Emerging genotype-phenotype correlations should provide guidance for better medical care of individuals with tuberous sclerosis complex. ( J Child Neurol 2004;19:699—709).
Aberrant Cellular Differentiation and Migration in Renal and Pulmonary Tuberous Sclerosis Complex
Authors: Astrinidis Aristotelis , Petri Henske Elizabeth
Published: July 2017

This review is focused on pathways and mechanisms that might provide molecular links between the pathogenesis of renal and pulmonary disease in tuberous sclerosis complex and the pathogenesis of the neurologic manifestations of tuberous sclerosis complex. Tuberous sclerosis complex is an autosomal dominant disorder in which the manifestations can include seizures; mental retardation; autism; benign tumors of the brain, retina, skin, and kidneys; and pulmonary lymphangiomyomatosis. Lymphangiomyomatosis is a life-threatening lung disease affecting almost exclusively young women. Genetic data have demonstrated that the cells giving rise to renal angiomyolipomas, the most frequent tumor type in patients with tuberous sclerosis complex, exhibit differentiation plasticity. Genetic studies have also shown that the benign smooth muscle cells of angiomyolipomas and pulmonary lymphangiomyomatosis have the ability to migrate or metastasize to other organs. These findings indicate that hamartin and tuberin play functional roles in the regulation of cell migration and differentiation. The biochemical pathways responsible for these effects are not yet fully understood but might involve dysregulation of the small guanosine triphosphatase Rho. Similar pathways might contribute to aberrant neuronal differentiation and migration in tuberous sclerosis complex. ( J Child Neurol 2004;19:710—715).
Molecular Pathogenesis of Tuber Formation in Tuberous Sclerosis Complex
Authors: Crino Peter B.
Published: July 2017

Tuberous sclerosis complex results from mutations in the TSC1 (hamartin) and TSC2 (tuberin) genes. Tubers are cortical developmental malformations in patients with tuberous sclerosis complex that are associated with intractable epilepsy and are composed of histologically distinct cell types, including giant cells and dysplastic neurons. We recently showed that tubers can be dynamic lesions characterized by populations of cells undergoing proliferation, migration, and death. We demonstrate that there is cell-specific activation of the mammalian target of rapamycin (mTOR)/p70S6 kinase/ribosomal S6 cascade in tubers and that giant cells express activated (phosphorylated) p70S6 kinase and ribosomal S6 protein. These findings support impaired hamartin- and tuberin-mediated mTOR pathway regulation. Tubers likely form by constitutive activation of the mTOR cascade during brain development as a consequence of impaired hamartin or tuberin function. ( J Child Neurol 2004;19:716—725).
Topical Review: Cognitive and Behavioral Correlates of Tuberous Sclerosis Complex
Authors: Zaroff Charles M. , Devinsky Orrin , Miles Daniel , Barr William B.
Published: July 2017

Tuberous sclerosis complex is a multisystem disorder in which neurologic problems cause the greatest disability. High rates of mental retardation and autism spectrum disorders are associated with the diagnosis. Early-onset seizures and increased tuber burden are risk factors for cognitive impairment. Early-onset seizures, particularly infantile spasms, are risk factors for autism. Tubers within the temporal lobe and cerebellum are often mentioned as risk factors for autism, although the findings are inconsistent. Seizure control is important for developmental outcome and quality of life. Early behavioral assessment and therapeutic intervention, as well as seizure control, are the most effective means of promoting neurodevelopmental outcome. ( J Child Neurol 2004;19:847—852).
T 2-Weighted Hyperintensities (Unidentified Bright Objects) in Children With Neurofibromatosis 1: Their Impact on Cognitive Function
Authors: Goh Winnie H. S. , Khong Pek-Lan , Leung Connie S. Y. , Wong Virginia C. N.
Published: July 2017

The impact of magnetic resonance imaging (MRI)—identified T2-weighted hyperintensities (unidentified bright objects) on the cognitive function of children with neurofibromatosis 1 is controversial. We recruited 32 right-handed children with neurofibromatosis 1 (22 boys, 10 girls) aged between 5 and 16 years (mean age 10.2 years) for magnetic resonance imaging examinations and neuropsychologic evaluation. Statistical analysis was performed to evaluate the significance of the hyperintensities. Twenty-four children had unidentified bright objects, whereas eight children did not. Using the t-test, thalamic lesions were associated with lower intellectual function ( P = .031). Left globus pallidus hyperintensities were associated with a lower attention score ( P = .04), and right middle cerebellar peduncle hyperintensities were associated with a lower sensorimotor score ( P = .05). The size of the thalamic lesions correlated with cognitive function ( P < .05). Among the group with unidentified bright objects, there was a significant association between more involved sites on the dominant hemisphere and impaired verbal function ( r = —.55; P = .005). Unidentified bright objects in the thalamus, globus pallidus, and middle cerebellar peduncles and the laterality of the lesions had an impact on cognitive function. ( J Child Neurol 2004; 19:853-858).
Diagnosis, Treatment, and Prognosis of Mycoplasma pneumoniae Childhood Encephalitis: Systematic Review of 58 Cases
Authors: Daxboeck Florian , Blacky Alexander , Seidl Rainer , Krause Robert , Assadian Ojan
Published: July 2017

Most of the knowledge on Mycoplasma pneumoniae encephalitis in children is based on case reports or small case series. The aim of this study was to assess the important features of the disease by a systematic review of previously published cases. Overall, 58 cases (22 female, 36 male; median age 10 years, range: 2—17 years), derived from 38 reports, were reviewed. Forty-five patients (76%) had flulike or respiratory symptoms prior to the onset of neurologic disease, and 23 patients (40%) presented with pulmonary infiltrates. Cerebrospinal fluid (CSF) pleocytosis (mostly mononuclear cells) and elevated cerebrospinal fluid protein counts were present in 34 (59%) and 21 (36%) patients, respectively. Cranial computed tomography (CT) or magnetic resonance imaging (MRI) abnormalities were seen in 18 (31%) and 17 (29%) patients, respectively, whereby various different presentations were observed. Forty-four patients (76%) received antimicrobial therapy active against mycoplasmas, most frequently erythromycin ( n = 29) or minocycline ( n = 6). Only in one patient, cure was directly attributed to antimicrobial therapy (with chloramphenicol) by the respective authors. Thirty-three patients (57%) recovered without sequelae, 20 patients (34%) had minor to major sequelae, and 5 patients (9%) died. A high cerebrospinal fluid cell count, cerebrospinal fluid protein elevation, and higher age were associated with an unfavorable outcome. ( J Child Neurol 2004;19:865—871).
Diffusion-Weighted Imaging and Proton Magnetic Resonance Spectroscopy in Perinatal Hypoxic-Ischemic Encephalopathy: Association With Neuromotor Outcome at 18 Months of Age
Authors: Khong Pek-Lan , Tse Catherine , Wong Ivan Y. C. , Lam Barbara C. C. , Cheung Pik-To , Goh Winnie H. S. , Ngai Shan Kwong  , Ooi Gaik-Cheng
Published: July 2017

We evaluated early diffusion-weighted imaging findings, the quantitative apparent diffusion coefficient, and magnetic resonance spectroscopy (the presence of lactate and ratios of N-acetylaspartate to total creatine and choline to total creatine) in the prediction of the 18-month neuromotor outcome of term newborns with hypoxic-ischemic encephalopathy. Conventional T1- and T2-weighted and diffusion-weighted imaging was performed in 20 asphyxiated term newborns, with additional basal ganglia magnetic resonance spectroscopy in 15 newborns between 2 and 18 days of life (mean 7.3 days). Neuromotor outcome was dichotomized into normal and abnormal for statistical analysis. Statistically significant differences in the ratios of N-acetylaspartate to total creatine, but not apparent diffusion coefficient values and ratios of choline to total creatine, were found between infants with a normal and an abnormal outcome (Mann-Whitney U-test, P = .010). There was a significant association between the presence of a lactate peak and an abnormal outcome (chi-square test, P = .017). The presence of a lactate peak for predicting an abnormal outcome had a sensitivity of 100% and a specificity of 80%, and the odds ratio was 37.4. Ischemic lesions were more conspicuous and/or extensive on diffusion-weighted imaging in all except one neonate. The presence of normal findings on both diffusion-weighted imaging and conventional magnetic resonance imaging is predictive of a normal neuromotor outcome, whereas lactate and a reduced ratio of N-acetylaspartate to total creatine in the basal ganglia, but not an apparent diffusion coefficient, are associated with an abnormal outcome at 18 months of age. ( J Child Neurol 2004;19:872—881).
Intra- and Interrater Reliabilities of the Myotonometer When Assessing the Spastic Condition of Children With Cerebral Palsy
Authors: Aarrestad Desiree D. , Williams Misty D. , Fehrer Steven C. , Mikhailenok Eugene , Leonard Charles T.
Published: July 2017

The purposes of this study were to assess intra- and interrater reliabilities by novice users of the Myotonometer® (Neurogenic Technologies, Inc., Missoula, MT), a portable electronic device that quantifies muscle tone (stiffness) and paresis, in assessing children with cerebral palsy. Two raters used the Myotonometer to assess the biceps brachii and medial gastrocnemius muscles of 10 children with spastic-type cerebral palsy. Muscles were measured in a relaxed state and during a voluntary isometric contraction. Intraclass correlation coefficients and repeatability coefficients were calculated for each muscle and for each condition (relaxed and contracted). Intrarater reliabilities ranged from 0.82 to 0.99 (biceps brachii muscles) and 0.88 to 0.99 (medial gastrocnemius muscles). Interrater reliabilities ranged from 0.74 to 0.99 (biceps brachii muscles) and 0.84 to 0.99 (medial gastrocnemius muscles). Repeatability coefficients indicated a 98% level of agreement between raters across all conditions. Novice users of the Myotonometer, with few exceptions, had high to very high intra- and interrater reliabilities for measurements of the biceps brachii and medial gastrocnemius muscles of children with spastic-type cerebral palsy. ( J Child Neurol 2004;19:894—901).
Short-Term Intellectual Outcome After Arterial Ischemic Stroke and Sinovenous Thrombosis in Childhood and Infancy
Authors: Hetherington Ross , Tuff Larry , Anderson Peter , Miles Brenda , deVeber Gabrielle
Published: July 2017

Arterial ischemic stroke is approximately four times more prevalent than sinovenous thrombosis and has been associated with a worse neurologic outcome than sinovenous thrombosis; however, no data are available comparing intellectual outcome after pediatric arterial ischemic stroke and sinovenous thrombosis. We report the short-term intellectual outcome (mean 5.8 months since stroke) in a sample of 72 children, 47 with arterial ischemic stroke, and 25 with sinovenous thombosis. Intellectual outcome measures were the Full-Scale IQ of the age-appropriate Wechsler intelligence test for older children and the Mental Developmental Index of the Bayley Scales of Infant Development for younger children. Stroke type did not directly influence intellectual outcome. Intellectual outcome was in the normal range whether the children had suffered an arterial ischemic stroke or a sinovenous thrombosis. ( J Child Neurol 2005;20:553—559).
Traumatic Epidural Hematoma in Children
Authors: Rocchi Giovanni , Caroli Emanuela , Raco Antonino , Salvati Maurizio , Delfini Roberto
Published: July 2017

The purpose of this study was to investigate the characteristics of childhood acute epidural hematoma and to report our experience in recent years. A series of 35 patients below the age of 15 years treated for acute epidural hematoma at our institution between June 1991 and December 2000 was analyzed in detail. Pediatric epidural hematoma presents both age-related and atypical features when compared with epidural hematoma in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Outcomes seem to be directly related to the patient's preoperative neurologic status and the presence of associated intracranial lesions. ( J Child Neurol 2005;20:569—572).
Glutaric Aciduria Type I: A Neuroimaging Diagnosis?
Authors: Santos Cesar C. , Roach E. Steve
Published: July 2017

Glutaric aciduria type I is an autosomal recessive disorder of organic acid metabolism secondary to glutaryl—coenzyme A (CoA) dehydrogenase deficiency. We report a previously healthy 17-month-old girl who presented with acute dystonia. Conventional T2-weighted and fluid-attenuated inversion recovery magnetic resonance images of the brain showed hyper-intensity in the caudates and putamina bilaterally with subtle involvement of the medial frontal lobes. Diffusion-weighted magnetic resonance images showed striking restricted diffusion in the caudates and putamina consistent with acute necrosis. Single-voxel hydrogen magnetic resonance spectroscopy of the involved areas was normal. The clinical diagnosis of glutaric aciduria type I was confirmed by elevation of 3-hydroxyglutaric and glutaric acids. Diffusion-weighted magnetic resonance imaging is a sensitive indicator of basal ganglia necrosis in glutaric aciduria type I. ( J Child Neurol 2005;20:588—590).
Diagnostic Significance of Membrane Attack Complex and Vitronectin in Childhood Dermatomyositis
Authors: Sakuta Ryoichi , Murakami Nobuyuki , Jin Yuko , Nagai Toshiro , Nonaka Ikuya , Nishino Ichizo
Published: July 2017

In the current study, whether particular histologic distributions of membrane attack complex and vitronectin are correlated to clinical characteristics of patients with childhood dermatomyositis was investigated. The specimens from 11 patients with childhood dermatomyositis were examined immunocytochemically and compared with those taken from 6 adult dermatomyositis and 5 childhood polymyositis patients. Four out of five membrane attack complex -positive specimens were derived from patients who were within 1 to 3 months from the onset of childhood dermatomyositis and were not treated with prednisone. There were two patients at early stages of childhood dermatomyositis without pathologic characteristics of the disease. However, marked deposits of membrane attack complex on capillaries were seen in one of them. The immunoreactivity of vitronectin was detected at locations similar to those of membrane attack complex. Our results suggest that the detection of membrane attack complex and vitronectin in muscle capillaries will help us diagnose childhood dermatomyositis at an early stage. ( J Child Neurol 2005;20:597—602).
Correlation of Functional Independence Measure for Children (WeeFIM) With Developmental Language Tests in Children With Developmental Delay
Authors: Wong Virginia , Au-Yeung Yick-Cheung Trevor , Law Ping-Keung
Published: July 2017

The Functional Independence Measure for Children (WeeFIM) is a simple tool for assessing the functional independence of three domains: mobility, self-care, and cognition. Children are usually apprehensive about performing standardized structured language or developmental tests, and only licensed professionals can administer standardized tests. We attempted to apply the Functional Independence Measure for Children for assessing children with developmental delay and to assess for any correlation of these scores with standardized language tests. We recruited 49 children with developmental delay, and the Functional Independence Measure for Children was administered. Two standardized language tests (Symbolic Play Test and Reynell Language Developmental Scale) were administered to assess language age. There was a significant correlation between Functional Independence Measure for Children scores with both verbal comprehension age and verbal expression age. There was no correlation of Functional Independence Measure for Children scores with gender, age, or having domestic helpers. Having trained staff administer the Functional Independence Measure for Children can reliably correlate the current language ability of a child with developmental delay; thus, the test can be used as a quick screening tool for targeted training. ( J Child Neurol 2005;20:613—616).
Magnetoencephalographic Analysis in Children with Panayiotopoulos Syndrome
Authors: Sugita Kiyoko , Kato Yutaka , Sugita Katsuo , Kato Motoichiro , Tanaka Yoko
Published: July 2017

The aims of this study were to identify the generator of the paroxysmal partial discharges in Panayiotopoulos syndrome by means of magnetoencephalography and to determine the significance of these formations in the epileptogenesis of the developing nervous system. We report magnetoencephalographic data for two cases of Panayiotopoulos syndrome showing the rapid generalization of the source of interictal spikes that explains extraoccipital manifestations such as ictal vomiting and consciousness disturbance. ( J Child Neurol 2005;20:616—618).
Antiepileptic Drug Withdrawal in Childhood: Does the Duration of Tapering Off Matter for Seizure Recurrence?
Authors: Serra Jessica Guerra , Montenegro Maria Augusta , Guerreiro Marilisa M.
Published: July 2017

There is no consensus on how long the duration of antiepileptic drug withdrawal after seizure control should be. The objective of the present study was to verify if the duration of tapering off matters for seizure recurrence in children with controlled epilepsy. In this prospective study, patients were randomized to taper the antiepileptic drug during a period of 1 or 6 months. Fifty-seven patients met the inclusion criteria; 24 were girls, and ages ranged from 2 to 16 years (mean 9.45 years). There was no difference between the two groups according to age, gender, type of epileptic syndrome, electroencephalogram abnormality, and antiepileptic drug ( P > .05). In the 1-month group, seizure recurred in 10 patients, as opposed to 12 patients in the 6-month group. The analysis of seizure recurrence in each group showed no difference ( P > .05). We conclude that the duration of antiepileptic drug tapering off does not influence the risk of seizure recurrence in childhood. ( J Child Neurol 2005;20:624—626).
Incidence and Treatment of Recurrent Hepatitis C after Liver Transplantation
Authors: Harren Patricia , Rudow Dianne LaPointe , Teperman Lewis W , Dieterich Douglas , Diflo Thomas
Published: July 2017

Recurrence of hepatitis C is a significant problem after liver transplantation. This prospective study was done to assess the rate of recurrence and discuss two possible treatment modalities that have been successful in avoiding retransplantation. Twenty-one patients underwent orthotopic liver transplantation for hepatitis C at a metropolitan medical center over a 34-month period. The mean follow-up interval was 13.4 ±2.2 months (range 5–28 months). The patients were routinely evaluated with clinic visits and liver function tests, specifically total bilirubin, serum glutamic-oxaloacetic transaminase, and gamma-glutamyl transpeptidase. If values were elevated, the patient was admitted to the hospital for liver biopsy. Ten of the 21 patients demonstrated recurrence on biopsy. Two of 10 patients required no therapy. Interferon A was initiated in the remaining eight. Three of the eight patients had no significant response to interferon and were given intravenous ribavirin under an experimental protocol. Two of these three showed significant improvement in liver function values. The third died of chronic rejection. The incidence of recurrent hepatitis C after liver transplantation is significant. Many centers have had to resort to retransplantation. Our results show that with early detection and aggressive treatment with interferon and ribavirin, hepatitis C can be controlled and retransplantation may be avoided.
Ten Years of Orthoclone OKT3 (Muromonab-CD3): A Review
Authors: Smith Susan L
Published: July 2017

Many important advances in transplantation have been made during the last decade. The introduction of Orthoclone OKT3 into clinical trials and its subsequent approval by the Food and Drug Administration in 1985 for use as an antirejection agent for renal transplantation were landmarks in the field of clinical transplantation of solid organs. In the decade since the approval of OKT3 for clinical use, much has been learned and written about OKT3. OKT3 now is considered a safe and effective agent for prophylaxis and first-line treatment of acute rejection of solid organ allografts. In this article, the development and use of OKT3 over the last 10 years, as well as the present status and future implications of immune therapy with OKT3, are reviewed.
Relationship between Donor/Recipient Lung Size Mismatch and Functional Outcome in Single Lung Transplantation for COPD
Authors: Hayden Ann M , Scarlett Mary V , Fox Kate
Published: July 2017

Single lung transplantation is an effective treatment for patients with severe chronic obstructive pulmonary disease. Pulmonary hyperinflation, which is seen in most patients with severe chronic obstructive pulmonary disease, makes the task of appropriately matching the donor and recipient difficult. It seems that the optimal matching strategy remains undefined. No correlation between donor/recipient size match (actual and predicted) and the degree of functional improvement after single lung transplantation was found. There were no significant differences noted when comparing the functional outcomes of right and left lung transplant recipients. It was concluded that the chronic hyperinflation associated with severe chronic obstructive pulmonary disease allows for the use of significantly larger donors. The use of expanded donor/recipient size match criteria in patients with severe chronic obstructive pulmonary disease may shorten the waiting period prior to single lung transplantation and provide better utilization of donor organs.
Acute Bereavement Services and Routine Referral as a Mechanism to Increase Donation
Authors: Duckworth Robert M , Sproat Gary W , Morien Marsha , Jeffrey Timothy B
Published: July 2017

Efforts to develop a mechanism that improves donation rates and provides better service to patients and staff are presented in this article. The University of Nebraska Medical Center has incorporated a routine referral process into its acute bereavement services requiring representatives to respond to each in-house death to provide consistent support and management for the decedent's family and the hospital staff. Every family was offered bereavement support and the opportunity to consent to autopsy as well as to organ and tissue donation if medically appropriate. Key data related to death and consent discussions were documented, routinely reviewed, and reported to a central location. Appropriate and timely access of these data helped to modify the program and assess its need for additional education or intervention.
Family Caregivers' Burden, Quality of Life, and Health following Patients' Renal Transplantation
Authors: Wicks Mona Newsome , Milstead E. Jean , Hathaway Donna K. , Cetingok Muammer
Published: July 2017

Improved quality of life and physical functioning among renal transplant recipients have been documented; however, little of the literature has addressed the effects of transplantation on family caregivers. The purpose of this exploratory descriptive study was to characterize the level of subjective burden, quality of life, and self-rated health of caregivers who assist family members prior to transplantation as well as at 6 months following. The study sample included 19 caregivers of 19 renal transplant recipients. In general, caregiver burden, quality of life, and self-rated health did not improve following patients' transplants. In addition, 9 of 19 family caregivers reported increased burden. Because much of healthcare is family-based and greater reliance on family support seems inevitable, further studies are needed to examine the impact of transplantation on the family as well as the impact of the family on patients' posttransplant outcomes.
Analysis of Organ Donation in Italy
Authors: Quintieri Francesca , Pugliese Orsola , Chistolini Pietro
Published: July 2017

In 1995 the Italian Institute of Health began assembling information regarding organ donors, recipients, and transplants. Data on more than 3000 transplants were collected and recorded to date. In addition to characteristics of donors and donating hospitals, this article describes donation activity and organ procurement in Italy from 1992 to 1996. Despite the encouraging results, the donation situation in Italy remains a challenge due to the nonhomogeneous distribution of organ donation throughout the country. It is hoped that an increase in the rate of organ donation and procurement in some regions will enable Italy to reach the European mean.
When Donor Families and Organ Recipients Meet
Authors: Clayville LaRhonda
Published: July 2017

Medical decisions about organ donation and transplantation are considered by a growing number of individuals. The complex issue of whether and to what extent organ recipients and donor families should interact or communicate has gained increasing public awareness, thereby creating an area of major ethical and legal concern for the transplant community. Communication issues have traditionally been decided by transplant coordinators and guided by personal beliefs, agency guidelines, and organizational policies. Organizations are often inconsistent in their practices, and this in turn causes frustration and confusion for both donor families and transplant recipients. This study explored how the experience of meeting the recipient(s) of a loved one's organ affected the grieving process of donor families and altered their lives. The information from this study might be useful to transplant professionals to develop guidelines and policies that lessen the confusion and frustration felt by those involved with the transplant process.
Medication Nonadherence and its Relation to Financial Restriction
Authors: Paris Wayne , Dunham Shonda , Sebastian Anthony , Jacobs Cheryl , Nour Bakr
Published: July 2017

The question of patient nonadherence has always been an important factor in determining candidate suitability for organ transplantation. Data that explore the association of financial problems and posttransplant medication nonadherence are limited. Findings suggest that medication nonadherence was more likely to occur when recipients did not have insurance coverage and had to rely on Medicaid or indigent drug programs. Our center developed a formalized program within the outpatient pharmacy, including a full-time medication counselor who helped recipients secure resources to pay for pre- and posttransplant medications. To determine whether the availability of posttransplant medications could reduce medication nonadherence, we conducted a survey with 50 consecutive liver transplant recipients in the outpatient clinic. Nonadherence rates were significantly reduced from 25% to 10% ( P<.01) compared with recipients who had been transplanted before the development of our drug program. These results suggest that optimum medication adherence can be obtained when recipients are provided guidance in securing their necessary medications without financial restriction.
Ethical Dilemmas in Living Donor Organ Transplantation
Authors: Nolan Marie T.
Published: July 2017

Living related donors are an increasing source of organs for transplantation. Although the use of this type of donation is widespread in the United States, the practice of placing donors at risk for injury or illness without physical benefit can create ethical dilemmas for health professionals dedicated to healing and avoiding harm. It is important for transplantation professionals to be familiar with the risks and benefits associated with living donation within their own specialty area. Placing living donation within an ethical framework can allow for careful consideration and guide decision making in each individual case. Drawing upon the literature for examples from several of the transplantation specialty areas, this article reviews some of the risks and benefits associated with living donation and identifies the limits of the utilitarian and casuistic ethical frameworks in guiding decision making in living donation. An ethical framework of virtue-principlism is offered as one which is grounded in an understanding of what it is to be human and in the nature of the health professional–patient relationship.
Reliability of sequential systems using the cause—consequence diagram method
Authors: Andrews J D , Ridley L M
Published: July 2017

In many industrial systems, where safety is of the utmost importance, it is necessary that expedient tools for accident analysis are available and employed at the design stage. Such tools must be able to handle large systems in a systematic way and display the factors that are of vital importance for the functionality of the system. The technique of fault tree analysis (FTA) is commonly used to assess the failure probability of such systems. The fault tree represents the failure logic of the system in an inverted tree structure and has the advantage that it provides very good documentation of the way the failure logic was developed. Conventional fault tree quantification requires a number of assumptions regarding the system. One of these is that the basic events in the tree occur independently. This condition is not satisfied when sequential failures are encountered. Employing alternative methods, such as Markov methods, can result in the loss of the documentation that represents the failure logic of the system.

The cause-consequence diagram method is a tool that, like fault tree analysis, documents the failure logic but has the extra capability enabling the analysis of systems subject to sequential failures. In addition, the cause-consequence diagram identifies the complete set of system responses to any given initiating event.

This paper is concerned with the cause-consequence diagram method and its application to sequentially operating systems. It extends previous work by providing more rigorous guidelines to enable the construction of the diagram and an analysis methodology that can be used when dependencies exist between the events featured in the decision boxes. A new symbol distinguishing between events that exist at a specified point in time and those that occur at that time is introduced to facilitate the analysis.
Maintenance modelling for computer-based systems
Authors: Meshkat L , Dugan J B , Andrews J
Published: July 2017

A framework is presented for incorporating maintenance into a dependability analysis methodology for computer-based systems. Two types of maintenance are considered: failure-driven maintenance and time-driven maintenance. Failure-driven maintenance or repair is carried out when the system (or component) performance deviates from its expected performance and consists of all tasks performed to restore the functional capabilities of failed items, principally diagnosis and repair. Time-driven or scheduled maintenance is conducted on a specific time schedule in order to prevent system failure.

There may be dependencies between different components of a system with regard to their maintenance plans. These dependencies arise either because a component has maintenance priority over one or more components or because the maintenance of a certain component implies the maintenance of other components. Constructs are presented for modelling these dependencies in the context of dynamic fault tree analysis and a methodology is developed for solving the fault tree. The dynamic fault tree constructs effectively capture the failure dependencies between components. The approach is illustrated with an example based on a water deluge system.
A study of hydraulic impacts caused by condensate in steam distribution systems
Authors: Owen I , Amini A , Stephens D J
Published: July 2017

This paper describes an investigation into a problem associated with steam distribution systems where condensate is swept through a pipeline by high-velocity steam, causing considerable damage when it impacts upon an obstruction. Two cases have been considered. The first is where an isolated slug of water is swept through a pipeline by high-velocity steam and impacts against an orifice plate. In experimental tests compressed air was used to propel a slug of water through a pipeline 13 m in length and 50 mm in diameter; impact pressures of up to 300 bar were generated. The second case was more specific and considered the damage that occurs in steam traps. Tests were carried out in which damage was inflicted upon a float trap and a bucket trap by slug impact and by water hammer generated in the main pipeline. Although direct impacts by water slugs are often blamed for steam trap failures, the damage inflicted by this mechanism was not consistent with that found in practice and it has been concluded that they are not responsible. Water hammer in the main pipeline could, however, be the cause of failure. During the tests it was observed that the internal design of the body of the trap could produce a beneficial cushioning effect and this, together with the improved construction techniques for float traps, may overcome the problem of collapsing floats.
Putin's India Policy: Mutual Gains for Future
Authors: Thomas Biju
Published: July 2017

The importance of India in the foreign policy of Russia increased after Putin became the president. Despite Putin's westward orientation much of the contradictions remain. In the east, the improvement of relations with China is accompanied by views of China's possible geopolitical domination in Far East and Central Asia. Putin's policy is to retain India as a major strategic partner not only to balance China, but also because of India's unique geographical position in the Indian Ocean. The past history good of relations coupled with similarity of views with respect to what ought to be the world order and extensive defence cooperation has laid down a firm basis for their relations. It is gainful for India as its relations with the US remain unpredictable and Russian support is essential to take part in the political and economic developments in Central Asia. Russia could also satisfy the arms and energy requirements of India.
India, Ussr and East Europe: Emerging Trends Under Rajiv Gandhi
Authors: Kaushik Devendra
Published: July 2017

When Mrs. Gandhi fell to the assassins' bullets on 31 October 1984, India's relations with the Soviet Union and the East European countries had already begun to show signs of strains despite an outward affirmation in official documents of an identity of views on various major global and regional issues. The earlier perception of mutually converging interests was gradually beginning to give way to relations between India and the USSR in terms of the rules of realpolitik. The USSR began increasingly to perceive its interests as a global power and India as a regional power which gave rise to an undercurrent of caution in Indo-Soviet relations which in turn is bound to influence the course of India's relations with East European countries as well.
Foreign Policy Issues Before the New Government: The Sri Lanka Problem
Authors: Gangal S. C.
Published: July 2017

Sri Lanka's ethnic problem—the problem of the political and socioeconomic status and related questions concerning the large number of Tamil settlers in its northern and eastern districts—dates from the time that India and Sri Lanka (earlier called Ceylon) got their independence in the late forties, or even earlier.

The Tamils in Sri Lanka have contributed greatly to the country's tea plantations and industry and have made many other useful inputs into the island's economy. But they have, for long, been subjected to innumberable disabilities—such as lack of full civil and property rights, non-assimilation into the national mainstream and even statelessness—and have been the target of periodic violence and killings. In order to protect themselves from these orgies of violence and to advance their legitimate interests, they have, from time to time, formed various associations or organizations. Of these, the Tamil United Liberation Front (TULF) — currently led by A. Amirthalingam — has been about the most organized and well-known at home and abroad. In view of the fact that generally the Tamils had migrated from India during the past seven or eight decades, they tend to look up to India for sympathy and moral and material support during periods of crisis, severe harrassment and violence.

By the same token—and also on account of its concern for peace and good neighbourly relations in the region—the Government and people of India could not be totally unconcerned about developments touching on this problem. Most recently, President Zail Singh expressed this concern in his address to the joint sitting of the two Houses of Parliament on 17 January 1985: “The ethnic violence in Sri Lanka is a matter of deep concern to us. We are convinced that use of force cannot lead to a solution. A political process, in which all the concerned parties are involved, can alone lead to a just settlement. Conditions must be created in Sri Lanka to enable the return of the large number of refugees (estimated to be over 40,000) who have been forced to take shelter in India.” A week earlier, the Sri Lankan Minister of Rural Industries, S. Thondaman had met Prime Minister Rajiv Gandhi, who reportedly took the opportunity to express his concern at the continuing violence and tension-prone situation in Sri Lanka.
Cultural Dimensions of Development
Authors: Singh Man Mohan
Published: July 2017

The basic idea expounded in this presentation is refining of linkages between development and culture. A semantic point has been raised to the effect that the word “dimension” may be a limiting factor. In this context traditional flourishing of arts and culture has been related to the village community with reference to the institutional changes brought about by breaking up of village communities. The role of tradition has been defined in terms of technological changes. The relevance of traditional values particularly in the context of conservation concerns has been duly stressed. In yet another sense, the institutional implications of cultural dimension have been concretely illustrated in terms of Indian experiences and formulations. In an elaborate reference to “Plan of Action relating to Cultural Perspectives” as a part of “New Education Policy,” various concepts and their concretisation in grassroot schemes and projects have been illustrated. The initial clashes that result from technological impacts have been highlighted though at the same time it has been suggested that over a period of time cultural perceptions of a people will overcome tensions produced by technological changes.
A Meta-Analysis of Malingering on the MMPI-2
Authors: Rogers Richard , Sewell Kenneth W. , Salekin Randall T.
Published: July 2017

With the widespread adoption of the MMPI-2 as an assessment tool, psychologists are frequently required to make important decisions regarding the validity of its clinical profiles and a determination of malingering. Ten MMPI-2 fake-bad scales/indexes are reviewed with respect to their potential usefulness in the evaluation of feigning mental illness. In addition, a meta-analysis of the MMPI-2 was performed. Of the six indicators with sufficient research, we found that the instrument's F, F-K, and O-S had very strong effect sizes, which were maintained across both nonclinical controls and psychiatric groups. Specific recommendations are made for clinical practice and applied research.
Reliability of WISC-III Subtest Composites
Authors: Siegel Don J. , Piotrowski Richard J.
Published: July 2017

The reliability of subtest composites corresponding to the 46 abilities and influences presented by Kaufman (1979) was examined for the WISC-III using standardization sample data at ages 6, 11, and 16. Recategorized subtests demonstrated consistently high reliability. Increasing composite reliability was associated with the number of member subtests and the inclusion of Verbal Scale subtests in a composite. Some age fluctuations in composite reliability were noted. A table containing composite reliability for the entire standardization sample and at three age levels is provided for the clinician's reference. Partial psychometric support for use of these composites in WISC-III profile analysis was demonstrated.
The Category Test: A Comparison of Computerized and Standard Versions
Authors: Berger Steven G. , Chibnall John T. , Gfeller Jeffrey D.
Published: July 2017

As part of a comprehensive neuropsychological assessment, subjects completed either the standard or computerized version of the Category Test. The groups receiving the two versions of the Category Test were compared on demographic, neuropsychological, and intelligence measures. Significant differences between the groups were found for the Category Test only, with subjects who completed the computerized version exhibiting a greater number of errors than subjects who completed the standard version. The results suggest that the computerized version may be a more difficult task than the standard version. Further research is needed to confirm this finding and to identify which specific test variables contribute to differential performance.
Test-Retest Stability and Concurrent Validity of Two Reading Tests With a Drug-Abusing Population
Authors: Johnson Mark E. , Fisher Dennis G. , Rhodes Fen , Booth Robert
Published: July 2017

The Wide Range Achievement Test—Revised (WRAT-R) and Woodcock Reading Mastery Tests—Revised (WRMT-R) were administered twice to 269 current drug abusers over an average time interval of 204.20 days. Stability coefficients were very strong, ranging from .84 to .94. Correlations between the two instruments, ranging between .72 and .90, demonstrated strong concurrent validity. Average reading scores and grade equivalent scores were significantly higher at the second test. Exploratory data analyses revealed no demographic or drug-taking variables related to this increase. No relationship between length of interval and difference scores was found. Overall, this study demonstrated that the two instruments have strong psychometric properties and that the results obtained from current drug abusers are reliable.
Test-Retest Stability of the Wisconsin Card Sorting Test
Authors: Paolo Anthony M. , Axelrod Bradley N. , Tröster Alexander I.
Published: July 2017

Eighty-seven normal older persons were administered the Wisconsin Card Sorting Test (WCST) on two occasions an average of 1.1 years apart. Means for age and education were 68.79 years ( SD = 6.21) and 14.80 years ( SD = 2.42), respectively. Stability coefficients ranged from .12 on the Learning to Learn scale to .66 for the Total Number of Errors scale. The majority of individuals improved on retest with five WCST scores demonstrating significant average retest gains of 5 to 7 standard score points. The standard error of prediction, standard error of difference, and abnormal test-retest discrepancy scores were calculated to assist clinicians in detecting possible meaningful changes in WCST scores on retest.
Assessing Self-Rated Memory Impairment in Persons with Posttraumatic Headache
Authors: Gfeller Jeffrey D. , Gripshover Daniel L. , Chibnall John T.
Published: July 2017

Forty-two patients with persistent posttraumatic headache and postconcussion symptomatology following a motor vehicle accident completed the Self-Rating Scale of Memory Functions (SRSM), the Beck Depression Inventory (BDI), and brief memory testing. SRSM scores indicated that patients rated their memory as significantly impaired relative to their preinjury status. SRSM scores were not affected by such factors as age, education, gender, and loss of consciousness. However, significantly depressed patients rated their memory as more impaired on 14 of 18 SRSM items when compared with nondepressed patients. After controlling for depression, SRSM scores correlated significantly with objective performance on several memory tests. The implications of these findings are discussed.