bluuebunny/crossref_metadata_2025 huggingface dataset:
A critical assessment of screening methods for cervical neoplasia
Authors: Sankaranarayanan R. , Gaffikin L. , Jacob M. , Sellors J. , Robles S.
Published: March 2005

The objective of cervical cancer screening is to reduce cervical cancer incidence and mortality by detecting and treating precancerous lesions. Conventional cytology is the most widely used cervical cancer screening test. Although cytology has been effective in reducing the incidence of and mortality from cervical cancer in developed countries in both opportunistic and—more dramatically—organized national programs, it has been less successful and largely ineffective in reducing disease burden in low‐resource settings where it has been implemented. Liquid‐based cytology, testing for infection with oncogenic types of human papillomaviruses, visual inspection with 3–5% acetic acid, magnified visual inspection with acetic acid, and visual inspection with Lugol's iodine have been evaluated as alternative tests. Their test characteristics, and the applications and limitations in screening, are discussed with an emphasis on the work of the Alliance for Cervical Cancer Prevention over the past 5 years.
Delivering cervical cancer prevention services in low‐resource settings
Authors: Bradley J. , Barone M. , Mahé C. , Lewis R. , Luciani S.
Published: March 2005

The goals of any cervical cancer prevention program should be threefold: to achieve high coverage of the population at risk, to screen women with an accurate test as part of high‐quality services, and to ensure that women with positive test results are properly managed. This article focuses on the experiences of the Alliance for Cervical Cancer Prevention (ACCP) in delivery of screening and treatment services as part of cervical cancer prevention projects in Africa, Latin America, and Asia. Research and experience show that cervical cancer can be prevented when strategies and services are well planned and well managed and when attention is paid to program monitoring and evaluation. Coordination of program components, reduction of the number of visits, improvement of service quality, and flexibility in how services are delivered are all essential features of an effective service.
Adolescents and consent to treatment
Authors: Dickens B.M. , Cook R.J.
Published: March 2005

Adolescents, defined by WHO as 10 to 19 years old, can give independent consent for reproductive health services if their capacities for understanding have sufficiently evolved. The international Convention on the Rights of the Child, almost universally ratified, limits parental powers, and duties, by adolescents' “evolving capacities” for self‐determination. Legal systems may recognize “mature minors” as enjoying adult rights of medical consent, even when consent to sexual relations does not absolve partners of criminal liability; their consent does not make the adolescents offenders. There is usually no chronological “age of consent” for medical care, but a condition of consent, meaning capacity for understanding. Like adults, mature minors enjoy confidentiality and the right to treatment according to their wishes rather than their best interests. Minors incapable of self‐determination may grant or deny assent to treatment for which guardians provide consent. Emancipated minors' self‐determination may also be recognized, for instance on marriage or default of adults' guardianship.
Midwifery's Research Heritage: A Delphi Survey of Midwife Scholars
Authors: Farley Cindy L.
Published: March 2005

A Delphi survey was conducted with midwife scholars to determine the top 10 midwifery studies worthy of recognition in 2005, the 50th anniversary of the American College of Nurse‐Midwives (ACNM). This survey was undertaken by students of Philadelphia University's Graduate Midwifery Program as a service‐learning project on behalf of the ACNM Division of Research. Selected midwife scholars participated in 2 or 3 rounds of response and feedback to achieve consensus about research deemed historically or currently important to midwifery practice. The top 10 studies, as determined by the 19 participating midwife scholars, are presented here. These results are offered as reflection on research that has helped to shape and define the discipline of midwifery in the United States.
Doubling Back Over Roads Once Traveled: Creating a National Organization for Nurse‐Midwifery
Authors: Dawley Katy
Published: March 2005

The quest for a new national organization began in 1940 and concluded in November 1955 in Kansas City, Missouri, with the founding meeting of the American College of Nurse‐Midwifery. This article looks at the conflicts with organized nursing about the place and role of nurse‐midwives in the newly reorganized American Nurses Association and the National League for Nursing. Discussions and disagreements within nurse‐midwifery over the need for a nonexclusive national organization that would set professional standards are examined.
The History and Evolution of the Core Competencies for Basic Midwifery Practice
Authors: Avery Melissa D.
Published: March 2005

The Core Competencies in Nurse‐Midwifery were first published in 1978 to provide a standard approach to nurse‐midwifery education and now serve as the template for curriculum in nurse‐midwifery/midwifery education. This article is an expansion of an earlier publication documenting the development of the Core Competencies document and describes its history and use in midwifery education and professional practice. The development and continued revision of this document are a significant part of ACNM and midwifery history in the United States. It defines the competencies essential to basic practice and can be used to define the scope of midwifery practice in both professional and policy arenas.
Inventory evaluation and product slate management in large‐scale continuous process industries
Authors: Cooke David L. , Rohleder Thomas R.
Published: March 2005

Managing production and inventory for large‐scale continuous processing plants is a key to success in the chemical process industry, particularly in the production of commodity polymers such as polyethylene and polypropylene. When setting up a production schedule, planners must consider the effects of off‐grade production and production rate penalties, which are typically sequence‐dependent as products are transitioned from one to another, as well as inventory holding costs and capacity constraints. We call this the continuous economic lot sizing and scheduling problem (CELSP) to distinguish it from closely related problems found in discrete part production industries. We present a formulation that addresses the particular aspects of the CELSP and apply the proposed mathematical modeling approach to several plants of a chemical processing company. This company was concerned with ensuring the plants were carrying proper amounts of inventory and with evaluating the number of products produced at each plant. Our results show actual overall inventory levels were close to the levels suggested by our model and therefore company plans for further inventory reductions would not be appropriate. However, the company should carefully consider the addition of new products to current plant product slates. Due to the effects of product transitions and inventory levels, even adding products with significant contribution margins may negatively affect the financial performance of the plant.
The effect of multidrug chemotherapy on bone graft augmented prosthesis fixation
Authors: Virolainen Petri , Inoue Nozomu , Nagao Masato , Frassica Frank J. , Chao Edmund Y. S.
Published: March 2005

Use of combination adjuvant chemotherapies have improved the disease free survival rate of tumor patients significantly. However, studies have shown that chemotherapeutic agents have negative effects on bone graft incorporation and fixation of porouscoated prostheses needed for reconstruction of bone defects after wide resection of malignant tumors. Unilateral resection of a 6‐cm segment of the femoral diaphysis and reconstruction with a porous‐coated segmental prosthesis was performed in eight mixed‐breed dogs under perioperative chemotherapy with doxorubicin, cisplatin, and ifosfamide. Eight strips of autogenous cortical bone were evenly placed around the junctions between the femur and the prosthetic surface. Autogenous cancellous bone was placed under and between the strips of cortical bone. Two cycles of the chemotherapy were given preoperatively, and three cycles postoperatively. The animals were followed for 12 weeks, with sequential assessments of weight‐bearing and radiographic evaluation. Biomechanical, histological, and microradiographic analyses of the retrieved specimens were performed. Doxorubicin, cisplatin, and ifosfamide combination chemotherapy showed a significant effect on new bone formation as seen in reduced callus size and lower ultimate strength of extracortical fixation. However, the onlay corticocancellous grafting method provided better biologic fixation of the prosthesis compared with fixation without any bone grafting under non‐chemotherapy condition in a previous study. Extracortical bone grafting is an effective modality for implant fixation even under intensive chemotherapy. © 2005 Published by Elsevier Ltd. on behalf of Orthopaedic Research Society.
Correspondence assertions for process synchronization in concurrent communications
Authors: BONELLI EDUARDO , COMPAGNONI ADRIANA , GUNTER ELSA
Published: March 2005

High-level specification of patterns of communications such as protocols can be modeled elegantly by means of session types (Honda et al., 1998). However, a number of examples suggest that session types fall short when finer precision on protocol specification is required. In order to increase the expressiveness of session types we appeal to the theory of correspondence assertions (Clarke & Marrero, 1998; Gordon & Jeffrey, 2003b). The resulting type discipline augments the types of long-term channels with effects and thus yields types which may depend on messages read or written earlier within the same session. This new type system can be used to check:

source of information,

whether data is propagated as specified across multiple parties,

if there are unspecified communications between parties, and

if the data being exchanged has been modified by the code in an unspecified way.

We prove that evaluation preserves typability and that well-typed processes are safe. Also, we illustrate how the resulting theory allows us to address shortcomings present in the pure theory of session types.
Stack-based access control and secure information flow
Authors: BANERJEE ANINDYA , NAUMANN DAVID A.
Published: March 2005

Access control mechanisms are often used with the intent of enforcing confidentiality and integrity policies, but few rigorous connections have been made between information flow and runtime access control. The Java virtual machine and the .NET runtime system provide a dynamic access control mechanism in which permissions are granted to program units and a runtime mechanism checks permissions of code in the calling chain. We investigate a design pattern by which this mechanism can be used to achieve confidentiality and integrity goals: a single interface serves callers of more than one security level and dynamic access control prevents release of high information to low callers. Programs fitting this pattern would be rejected by previous flow analyses. We give a static analysis that admits them, using permission-dependent security types. The analysis is given for a class-based object-oriented language with features including inheritance, dynamic binding, dynamically allocated mutable objects, type casts and recursive types. The analysis is shown to ensure a noninterference property formalizing confidentiality and integrity.
Noninterference through flow analysis
Authors: HONDA KOHEI , YOSHIDA NOBUKO
Published: March 2005

This paper proposes new syntactic inference rules which can directly extract information flow in a given typed process in the π-calculus. In the flow analysis, a flow in a process is captured as a chain of possible interactions which transform differences in behaviours from one part of its interface to another part of its interface. Polarity in types plays a fundamental role in the analysis, which is elucidated via examples. We show that this inductive flow analysis can be used for giving simple proofs of noninterference in the secrecy analyses for the π-calculus with linear/affine typing, including its concurrent, stateful extensions.
Estimates on Green functions of second order differential operators with singular coefficients
Authors: Haba Z.
Published: March 2005

We investigate the Green functions G(x;x′) of some second order differential operators on Rd+1 with singular coefficients depending only on one coordinate x0. We express the Green functions by means of the Brownian motion. Applying probabilistic methods we prove that when x=(0,x) and x′=(0,x′) (here x0=0) lie on the singular hyperplanes, then G(0,x;0,x′) is more regular than the Green function of operators with regular coefficients.
Collective and self-diffusion coefficients in an ionic critical mixture: 3-methylpyridine+water+NaBr
Authors: Hernández María-Paula , Monroy Francisco , Ortega Francisco , Rubio Ramón G.
Published: March 2005

The dynamics of concentration fluctuations of three critical samples of the 3-methylpyridine (3MP)+water+NaBr system have been measured by photon correlation spectroscopy. The collective-diffusion coefficient D shows the usual Ising behavior near the critical temperature Tc. However, as ∣T−Tc∣ increases, the dynamic correlation length calculated from D, ξ, takes values higher than the correlation length of the critical fluctuations calculated from static light scattering, ξs. At the largest ∣T−Tc∣ measured, ξ approaches the value, ξ0,d≈1.13nm, while the amplitude of ξs is ξ0,s=0.38nm. Pulsed-gradient NMR spectroscopy points out the existence of two dynamic contributions. One of them is consistent with the existence of molecular entities of hydrodynamic radius 0.31nm, while the other one indicates the existence of aggregates rich in 3MP of radius 1.16nm. The existence of the aggregates may explain the apparent anomalous behavior of the dynamic light scattering experiments for this system far from the critical point.
Coriolis effects in a rotating Hele-Shaw cell
Authors: Waters S. L. , Cummings L. J.
Published: March 2005

Following Schwartz [Phys. Fluids A 1, 167 (1989)], we consider flow in a rotating Hele-Shaw cell where the Coriolis effect is significant. In that paper the Coriolis term is included in an ad hoc manner. We derive the model with the exact form of the Coriolis term, and show where it differs from that of Schwartz. The linear stability analysis carried out by Schwartz is repeated and the results for the two models are compared.
Testing of mixing models for Monte Carlo probability density function simulations
Authors: Mitarai S. , Riley J. J. , Kosály G.
Published: March 2005

Testing of mixing models widely used for Monte Carlo probability density function simulations of turbulent diffusion flames is performed using the data obtained from direct numerical simulations (DNS) that are specifically designed for the study of local flame extinction and reignition. In particular, the interaction by exchange with the mean (IEM) [J. Villermaux and J. C. Devillon, “Représentation de la coalescence et de la redispersion des domaines de ségrégation dans un fluide per modéle d’interaction phénoménologique,” in Proceedings of the Second International Symposia on Chemical Reaction Engineering (ISCRE, Netherlands, 1972), p. B1], the modified Curl [J. Janicka, W. Kolbe, and W. Kollmann, J. Non-Equilib. Thermodyn. 4, 47 (1979)], and the Euclidean minimum spanning tree (EMST) [S. Subramaniam and S. B. Pope, Combust. Flame 115, 487 (1998)] mixing models are tested. The tests are designed to examine the mixing model performance when implemented in both Reynolds-averaged simulations and large-eddy simulations. The exact value of the mixing frequency is taken from the DNS, so that the model performance can be more accurately determined. It is found that, in general, the EMST mixing model yields much better results than the IEM and the modified Curl mixing models.
Flexible, organic, ion-sensitive field-effect transistor
Authors: Loi Andrea , Manunza Ileana , Bonfiglio Annalisa
Published: March 2005

Organic ion-sensitive field-effect transistors assembled on flexible plastic films have been fabricated. A thin Mylar™ foil acts both as substrate and gate dielectric. The active layer is vacuum-sublimed on one side of the foil, prepatterned with bottom-contact Au source and drain electrodes. The opposite side of the insulating film is in contact with an electrolytic solution that together with a reference electrode forms an ionic gate. A sensitivity of the device to the pH of the electrolyte solution has been observed. Thanks to the flexibility of the substrate and the low cost of the employed technology, this device opens the way for flexible sensors that can be employed in a variety of innovative applications.
Spin injection from the Heusler alloy Co2MnGe into Al0.1Ga0.9As∕GaAs heterostructures
Authors: Dong X. Y. , Adelmann C. , Xie J. Q. , Palmstrøm C. J. , Lou X. , Strand J. , Crowell P. A. , Barnes J.-P. , Petford-Long A. K.
Published: March 2005

Electrical spin injection from the Heusler alloy Co2MnGe into a p-i-nAl0.1Ga0.9As∕GaAs light emitting diode is demonstrated. A maximum steady-state spin polarization of approximately 13% at 2 K is measured in two types of heterostructures. The injected spin polarization at 2 K is calculated to be 27% based on a calibration of the spin detector using Hanle effect measurements. Although the dependence on electrical bias conditions is qualitatively similar to Fe-based spin injection devices of the same design, the spin polarization injected from Co2MnGe decays more rapidly with increasing temperature.
Brillouin light scattering from pumped uniform-precession and low-k magnons in Ni81Fe19
Authors: Johnson Ward L. , Kim Sudook A. , Russek Stephen E. , Kabos Pavel
Published: March 2005

A method is presented for performing Brillouin-light-scattering measurements on uniform-precession and low-wave-number (low-k) magnons excited by a microwave magnetic field in opaque magnetic specimens. The optical configuration is similar to that employed in conventional 180° backscattering measurements, except that the incident and specularly reflected beams pass through the collection lens along different parallel paths. Examples of spectra from a Ni81Fe19 film are presented that include separate detection of light scattered from low-k magnons with the same frequency as the uniform precession.
Enhanced boron activation in silicon by high ramp-up rate solid phase epitaxial regrowth
Authors: Pawlak B. J. , Vandervorst W. , Smith A. J. , Cowern N. E. B. , Colombeau B. , Pages X.
Published: March 2005

We investigate the influence of thermal conditions during solid phase epitaxial regrowth (SPER) on the electrical activation level of boron in preamorphized silicon, both with respect to heating ramp rates and the use of low temperature preanneals. Enhancement of electrically active boron concentration by 36% is observed for activation with the fastest ramp rate (487°C∕s) compared to the slowest one (1°C∕s). An important clustering pathway occurs within the amorphous silicon phase (during low temperature preanneal) prior to completion of the SPER process. In these junctions boron deactivation during isochronal post-annealing is almost independent on the maximum boron activation level.
A Si-based quantum-dot light-emitting diode
Authors: Jo M. , Ishida K. , Yasuhara N. , Sugawara Y. , Kawamoto K. , Fukatsu S.
Published: March 2005

A Si-based light-emitting diode (LED) containing strained GaSb quantum dots (QDs) embedded in Si within the active region was fabricated by means of Si molecular-beam epitaxy. An external quantum efficiency of 0.3% was obtained for near bandedge luminescence at 11 K. The high luminosity of Si-based QD-LED was also evidenced by the fact that direct imaging on an infrared camera of standard sensitivity was successful. Characteristics of the QD-LED operating at room temperature are described.
Scintillators based on aromatic dye molecules doped in a sol-gel glass host
Authors: Nikl M. , Solovieva N. , Apperson K. , Birch D. J. S. , Voloshinovskii A.
Published: March 2005

Ultraviolet and x-ray excited luminescence of fluorescein and rhodamine-6G doped sol-gel glasses were studied at room temperature with the aim of characterizing and understanding the scintillation performance of such materials. Fast energy transfer from the glass host to the dye luminescent centers was found. While the overall radioluminescence efficiency was rather low due to nonradiative losses in the glass host, our results demonstrate the potential of sol-gel technology as a versatile tool in controlling the spectral and time response of such unusual organic–inorganic scintillators.
Direct observation of coherent rotational excitation, dephasing and depopulation of methanol and its isotopes using THz pulse radiation
Authors: Yu B. L. , Yang Y. , Zeng F. , Xin X. , Alfano R. R.
Published: March 2005

Coherent transients are directly observed in the time-domain as a sequence of decreasing commensurate pulses in methanol (CH3OH) and its isotopes (CH3OD and CD3OD) gases to yield fundamental information on its dephasing and depopulation. The delay times between coherent pulses of ∼21, 22, and 26ps are measured for the CH3OH, CH3OD, and CD3OD corresponding to the inverse of rotational energy spacing for ΔJ=±1 transitions, respectively. The dephasing time T2=23±0.5ps and depopulation time T1=48±0.5ps were measured for CH3OH at room temperature.
Activation of shallow boron acceptor in C∕B coimplanted silicon carbide: A theoretical study
Authors: Gali A. , Hornos T. , Deák P. , Son N. T. , Janzén E. , Choyke W. J.
Published: March 2005

Ab initio supercell calculations have been carried out to investigate the complexes of boron acceptors with carbon self-interstitials in cubic silicon carbide. Based on the calculated binding energies, the complex formation of carbon interstitials with shallow boron acceptor and boron interstitial is energetically favored in silicon carbide. These bistable boron defects possess deep, negative-U occupation levels in the band gap. The theoretical results can explain the observed activation rates in carbon-boron coimplantation experiments.
HLA-B*5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol
Authors: Hung Shuen-Iu , Chung Wen-Hung , Liou Lieh-Bang , Chu Chen-Chung , Lin Marie , Huang Hsien-Ping , Lin Yen-Ling , Lan Joung-Liang , Yang Li-Cheng , Hong Hong-Shang , Chen Ming-Jing , Lai Ping-Chin , Wu Mai-Szu , Chu Chia-Yu , Wang Kuo-Hsien , Chen Chien-Hsiun , Fann Cathy S. J. , Wu Jer-Yuarn , Chen Yuan-Tsong
Published: March 2005

Allopurinol, a commonly prescribed medication for gout and hyperuricemia, is a frequent cause of severe cutaneous adverse reactions (SCAR), which include the drug hypersensitivity syndrome, Stevens–Johnson syndrome, and toxic epidermal necrolysis. The adverse events are unpredictable and carry significant morbidity and mortality. To identify genetic markers for allopurinol–SCAR, we carried out a case-control association study. We enrolled 51 patients with allopurinol–SCAR and 228 control individuals (135 allopurinol-tolerant subjects and 93 healthy subjects from the general population), and genotyped for 823 SNPs in genes related to drug metabolism and immune response. The initial screen revealed strong association between allopurinol–SCAR and SNPs in the MHC region, includingBAT3(encoding HLA-B associated transcript 3),MSH5(mutS homolog 5), andMICB(MHC class I polypeptide-related sequence B) (P< 10–7). We then determined the alleles of HLA loci A, B, C, and DRB1. The HLA-B*5801 allele was present in all (100%) 51 patients with allopurinol–SCAR, but only in 20 (15%) of 135 tolerant patients [odds ratio 580.3 (95% confidence interval, 34.4–9780.9); correctedPvalue = 4.7 × 10–24] and in 19 (20%) of 93 of healthy subjects [393.51 (23.23–6665.26); correctedPvalue = 8.1 × 10–18]. HLA alleles A*3303, Cw*0302, and DRB1*0301 were in linkage disequilibrium and formed an extended haplotype with HLA-B*5801. Our results indicated that allopurinol–SCAR is strongly associated with a genetic predisposition in Han Chinese. In particular, HLA-B*5801 allele is an important genetic risk factor for this life-threatening condition.
Profilin-mediated Competition between Capping Protein and Formin Cdc12p during Cytokinesis in Fission Yeast
Authors: Kovar David R. , Wu Jian-Qiu , Pollard Thomas D.
Published: March 2005

Fission yeast capping protein SpCP is a heterodimer of two subunits (Acp1p and Acp2p) that binds actin filament barbed ends. Neither acp1 nor acp2 is required for viability, but cells lacking either or both subunits have cytokinesis defects under stressful conditions, including elevated temperature, osmotic stress, or in combination with numerous mild mutations in genes important for cytokinesis. Defects arise as the contractile ring constricts and disassembles, resulting in delays in cell separation. Genetic and biochemical interactions show that the cytokinesis formin Cdc12p competes with capping protein for actin filament barbed ends in cells. Deletion of acp2 partly suppresses cytokinesis defects in temperature-sensitive cdc12-112 cells and mild overexpression of capping protein kills cdc12-112 cells. Biochemically, profilin has opposite effects on filaments capped with Cdc12p and capping protein. Profilin depolymerizes actin filaments capped by capping protein but allows filaments capped by Cdc12p to grow at their barbed ends. Once associated with a barbed end, either Cdc12p or capping protein prevents the other from influencing polymerization at that end. Given that capping protein arrives at the division site 20 min later than Cdc12p, capping protein may slowly replace Cdc12p on filament barbed ends in preparation for filament disassembly during ring constriction.
FXYD3 (Mat-8), a New Regulator of Na,K-ATPase
Authors: Crambert Gilles , Li Ciming , Claeys Dirk , Geering Käthi
Published: March 2005

Four of the seven members of the FXYD protein family have been identified as specific regulators of Na,K-ATPase. In this study, we show that FXYD3, also known as Mat-8, is able to associate with and to modify the transport properties of Na,K-ATPase. In addition to this shared function, FXYD3 displays some uncommon characteristics. First, in contrast to other FXYD proteins, which were shown to be type I membrane proteins, FXYD3 may have a second transmembrane-like domain because of the presence of a noncleavable signal peptide. Second, FXYD3 can associate with Na,K- as well as H,K-ATPases when expressed in Xenopus oocytes. However, in situ (stomach), FXYD3 is associated only with Na,K-ATPase because its expression is restricted to mucous cells in which H,K-ATPase is absent. Coexpressed in Xenopus oocytes, FXYD3 modulates the glycosylation processing of the β subunit of X,K-ATPase dependent on the presence of the signal peptide. Finally, FXYD3 decreases both the apparent affinity for Na+and K+of Na,K-ATPase.
Is Cognitive Reserve Applicable to Epilepsy? The Effect of Educational Level on the Cognitive Decline After Onset of Epilepsy
Authors: Pai Ming‐Chyi , Tsai Jing‐Jane
Published: March 2005

Summary:  Purpose: The aim of this study was to know the effect of education level (EL) on the cognitive change after onset of epilepsy. The rationale is that people with high EL may have more cognitive reserve and show resistance to damage brought about by epilepsy.

Methods: Patients were from an outpatient epilepsy clinic of a national university hospital. All received initial and repeated neuropsychological tests and the Cognitive Ability Screening Instrument (CASI), at an interval of 12 months. CASI consists of nine items, with a total score of 100. We compared the differences between the two tests, in terms of z‐scores. The EL was divided into high and low with a cut‐off at 12 years, and age at entry was divided with a cut‐off at 38 years. Epilepsy severity was divided into intractable and nonintractable.

Results: A total of 64 patients completed the study, including 31 with high EL and 33 with low EL, with no differences in gender and epilepsy severity between groups. In general, patients had cognitive impairment in multiple domains. At the baseline, the effect of EL was found for all items except remote memory and orientation, whereas the effect of age was observed for remote and recent memory. At the 12‐month follow‐up, subjects with high EL showed deterioration in mental manipulation, whereas subjects with low EL showed improvement in verbal fluency but deterioration in attention.

Conclusions: Patients with high EL have better cognitive functioning than those with low EL after epilepsy has developed, which supports the cognitive reserve theory. However, 1‐year follow‐up might be too short to see significant changes between groups.
Intellectual Disability and Psychotic Disorders of Adult Epilepsy
Authors: Matsuura Masato , Adachi Naoto , Muramatsu Reimi , Kato Masaaki , Onuma Teiichi , Okubo Yoshiro , Oana Yasunori , Hara Tsunekatsu
Published: March 2005

Summary:  Purpose: To investigate the prevalence, psychopathology, and cognitive functions associated with psychotic disorders among adult epilepsy patients with intellectual disability (ID) based on a multicenter study in Japan.

Methods: The study was divided into three phases; a prevalence study of psychotic disorders among new referrals of epilepsy, a polydiagnostic comparative study of patients with psychotic epilepsy and those with schizophrenia, and a neuropsychological study of patients with psychotic epilepsy and education level–matched controls.

Results: Among 336 new referrals of epilepsy, a higher prevalence of psychotic disorders was found among patients with ID (24%) than among those with normal intelligence (6%). The psychotic symptoms and operational diagnoses of psychotic epilepsy patients with ID were similar to those of patients with normal intelligence. A wide range (7–86%) of psychotic epilepsy patients was diagnosed as having schizophrenia, depending on the operational criteria used. Patients with psychotic epilepsy had more disturbances in verbal memory and attention functions than did the controls.

Conclusions: Epilepsy patients with ID show a predisposition to develop psychotic disorders. Distinguishing their psychotic symptoms from those of schizophrenia is difficult. Subtle cognitive disturbances predispose to psychotic disorders in epilepsy.
From Precipitation to Inhibition of Seizures: Rationale of a Therapeutic Paradigm
Authors: Wolf Peter
Published: March 2005

Summary:  Epileptic seizures can be triggered by both nonspecific facilitating factors such as sleep withdrawal, fever, or excessive alcohol intake, and specific reflex epileptic mechanisms. These consist of sensory or cognitive inputs activating circumscribed cortical areas or functional anatomic systems that, due to some functional instability, respond with an epileptic discharge. Interruption of seizure activity at the stage of the aura (i.e., locally restricted discharge) also can be achieved by nonspecific (e.g., relaxation or concentration techniques or vagal nerve stimulation) or by specific focus‐targeted sensory or cognitive inputs. The latter, again, activate circumscribed cortical areas. Intriguingly, in some patients, the same stimulus can either precipitate or abort a seizure. The response depends on the state of cortical activation: seizure precipitation occurs in the resting condition, and seizure interruption occurs when the epileptic discharge has begun close to the activated area. These relations can be understood on the background of experimental data showing that an intermediate state of neuronal activation is a precondition for the generation of paroxysmal depolarization shifts, whereas a hyperpolarized neuron will remain subthreshold, and a depolarized neuron that already produces action potentials is not recruitable for other activity. Sensory input meeting an intermediately activated pool of potentially epileptic neurons is adequate to produce a seizure. In another condition, the same stimulus can depolarize a neuron pool in the same area sufficiently to block the further propagation of nearby epileptic activity. Understanding these interactions facilitates the development of successful nonpharmaceutical therapeutic interventions for epilepsy.
The Role of Cognitive–Motor Function in Precipitation and Inhibition of Epileptic Seizures
Authors: Matsuoka Hiroo , Nakamura Masaki , Ohno Takashi , Shimabukuro Jin , Suzuki Takeshi , Numachi Yohtaro , Awata Shuichi
Published: March 2005

Summary:  Purpose: To examine the effects of cognitive–motor function on EEG discharges and the neuropsychological mechanisms of seizure induction in patients sensitive to cognitive–motor tasks.

Methods: Four hundred eighty patients with epilepsies were subjected to cognitive tasking, termed “neuropsychological EEG activation (NPA).” It consisted of reading, speaking, writing, written calculation, mental calculation, and spatial construction. Furthermore, patients showing a provocative NPA effect were subjected to a detailed NPA protocol to identify the possible precipitating factors, which consisted of simple hand movements, action programming requiring hand movement, and thinking activity not requiring hand movement.

Results: NPA had an inhibitory effect on EEG discharges in 133 (63.9%) of 208 patients with discharges in the awake EEG. Conversely, NAP had a provocative effect in 38 (7.9%) of 480 patients. In 32 of the 38 patients, the precipitating factor was action programming. Among them, five showed a precipitating factor restricted to linguistic activity, and the remaining 27 were affected by various action‐programming factors including both linguistic and praxic activities. In four of 38 patients, the precipitating factor was thinking, predominantly linguistic tasks in one patient and spatial tasks in three patients. No patient had a precipitating factor identified as motor activity.

Conclusions: These results suggest that cognitive–motor function has an inhibitory effect on EEG discharges in the majority of epilepsy patients and a provocative effect in some patients, and that seizures of the patients showing a provocative NPA effect are precipitated by action programming or thinking activity.
Surgical Outcome of Epilepsy Caused by Cortical Dysplasia
Authors: Chung Chun Kee , Lee Sang Kun , Kim Ki Joong
Published: March 2005

Summary:  Purpose: Cortical dysplasia (CD) is the second most common pathologic entity in surgically treated epilepsy. To delineate its surgical outcome and prognostic factors, we performed a retrospective analysis of patients operated on at a single institute.

Methods: Between September 1994 and December 2000, 128 cases with CD were operated on at our institute. The male/female ratio was 85:43, and the mean age was 27 years (SD, 7.6 years). The mean postoperative follow‐up period was 26.9 months (SD, 12.0 months). Seizure outcome and severity of CD were classified according to Engel's and Mischel's classifications, respectively. Severity of CD was mild in 69, moderate in 21, and severe in 38. Lobar distribution was temporal in 54, frontal in 48, and others in 26. Cortical resection, lobectomy, or hemispherectomy was done in all patients. Univariate analysis was done followed by multivariate analysis by using computerized statistical software.

Results: Postoperative seizure outcome was Engel class I in 58 (45.3%), II in 17 (13.3%), III in 16 (12.5%), and IV in 37 (28.9%). Transient postoperative complications occurred in 14 (10.9%) patients without mortality or permanent neurologic impairment. Multivariate analysis revealed severity of CD and frontal lobe resection as independent prognostic factors for worse outcome (p = 0.001 and 0.003, respectively).

Conclusions: Epilepsy surgery for CD achieved 45.3% seizure‐free rate with 10.9% transient postoperative complications in our institute. Worse postoperative seizure outcome was observed in cases with mild CD and frontal lobe resection.
Genetics of Idiopathic Epilepsies
Authors: Hirose Shinichi , Mitsudome Akihisa , Okada Motohiro , Kaneko Sunao ,   The Epilepsy Genetic Study Group, Japan
Published: March 2005

Summary:  Purpose: To search for clues to molecular genetics of common idiopathic epilepsy syndromes. Genetic defects have been identified recently in certain inherited epilepsy syndromes in which the phenotypes are similar to those of common idiopathic epilepsies.

Methods: Mutations identified as the causes of inherited idiopathic epilepsies were reviewed.

Results: Mutations of the genes encoding two subunits of the neuronal nicotinic acetylcholine receptor were found in autosomal dominant nocturnal frontal lobe epilepsy. Mutations of two K+‐channel genes were identified in benign familial neonatal convulsions. Mutations of the genes encoding several subunits of the voltage‐gated Na+‐channel and γ‐aminobutyric acid (GABA)A receptor also were identified as the underlying causes of various epilepsy syndromes, such as autosomal dominant epilepsy with febrile seizures plus, benign familial neonatal infantile seizures, and autosomal dominant juvenile myoclonic epilepsy. Mutations within the same gene may result in different epilepsy phenotypes. Thus, the Na+ channel, GABAA receptor, and their auxiliaries may be involved in the pathogenesis of various types of epilepsy. Some forms of juvenile myoclonic epilepsy, idiopathic generalized epilepsy, and absence epilepsy may result from mutations of Ca2+ channels. Mutations of the Cl− channel have been recently found to be associated with a certain type of epilepsy. The recent discovery that mutations of LGI1, a gene encoding a nonchannel molecule, are associated with autosomal partial epilepsy with auditory features may provide a new insight into our understanding of the genetics of idiopathic epilepsy.

Conclusions: These findings suggest the involvement of brain channelopathies in the pathogenesis of certain types of idiopathic epilepsy.
Knowledge, Attitudes, and Perceptions of Epilepsy in Asia: Toward a Uniform Study Protocol
Authors: Lim Shih‐Hui , Pan Andrew
Published: March 2005

Summary:  Purpose: Knowledge, attitudes, and perceptions of epilepsy (KAPE) among the public play a major role in determining the extent to which people with epilepsy can be integrated into their society.

KAPE Surveys in Asia: Surveys conducted among Chinese in China, Taiwan, Malaysia, Singapore, and Hong Kong demonstrated similarities as well as differences in certain aspects of KAPE. These suggest that KAPE might not be uniform among other racial groups in the same or different regions of Asia. For KAPE to have usefulness to a country or community, it has to be location specific.

Toward a Uniform Study Protocol: There are several advantages of using a uniform study protocol. Collection of KAPE data could be faster for any country or community that chooses to use any existing study protocol. Intraregional, interregional, intercontinental, interethnic, intercommunity, and longitudinal comparison within any subgroup could be carried out. Sharing of common information would enhance the regional effort in improving the quality of life of people affected by epilepsy. However, survey methods need not be uniform. Regional adaptation and flexibility of a unified protocol should be encouraged. After the study, concerted local and regional efforts in epilepsy education must be carried out systematically for the general public as well as for strategic groups.

Conclusions: Determination of the KAPE in different parts of Asia would help to define the magnitude of and be the first step toward alleviating social discrimination against people with epilepsy in Asia.
Quality‐Controlled Education in Epileptology: Experiences from Europe and Possible Developments for Other Regions
Authors: Wolf Peter
Published: March 2005

Summary:  As a consequence of the political system shift in Eastern Europe in the early 1990s, the new International League Against Epilepsy (ILAE) Commission on European Affairs (CEA) had to face the task of ensuring an equally good quality of epilepsy care across the whole region. A high standard of epileptologic education being the most important precondition for that, the decision was taken to make quality‐controlled education a first priority. To reach this aim, an “European Epilepsy Academy” (Eurepa) was founded in 1996. Its activities comprise organization of its own educational courses, certification of other educational courses, responsibility for education at European Congresses, training of trainers in epilepsy (now 45 trainers from 27 countries), adoption of a curriculum to become a certified European epileptologist, establishment of a multinational educational network, and a “Website Academy” as a forum for discussion. In the first two years of its activity, the Academy received financial support from the ILAE (money generated by the European Congresses) but has since been self‐supporting, with income from membership fees, participation fees at courses, and moderate support from pharmaceutical companies. The interest in the Academy is high, especially in those parts of Europe where epileptology was until recently not well developed. This should encourage other regional ILAE commissions to implement similar strategies, even if different regional structures will require variable regional approaches. Thus, in regions with long distances, it may be useful to include methods of distant learning and other specific features.
What We Confront with Employment of People with Epilepsy in Korea
Authors: Lee Sang‐Ahm
Published: March 2005

Summary:  Purpose: To investigate the current status of employability in people with epilepsy (PWE) in Korea.

 Methods: Data were collected from 543 adult epilepsy patients. Housewives and students were excluded. Information was obtained from self‐completed questionnaires.

 Results: The unemployment rate for Korean PWE was as high as 31%. This figure was five times higher than that of the general population. The unemployed PWE had significantly lower quality of life than the employed PWE. The employability of PWE was significantly affected by certain factors: the frequency and severity of seizures; age at onset; interseizure psychosocial disabilities including self‐esteem, personality, and problem‐solving style; and social discrimination. Actual discriminatory practices in the employment of the PWE were prevalent in Korea. Overall, 24.5% of respondents believed they had ever been treated unfairly at work or when trying to get a job. More than half of those who disclosed their disease to employers reported that they were refused a job because of epilepsy. About 75% of the patients surveyed said that they had never disclosed their disease in applying for a job.

 Conclusions: In Korea, PWE have faced many difficulties in employment. The discrimination against PWE and negative social attitudes toward epilepsy might play an important role in the employability of PWE. We need active participation in the “Out of the Shadows” world campaign.
Intercountry Exchange and Support Within the Region
Authors: Seino Masakazu
Published: March 2005

Summary:  The foundation of the Asian and Oceanian Epilepsy Organization dates back to the 25th Annual Meeting of the Japan Epilepsy Society held in Shizuoka, Japan, in 1991, to which roughly a dozen epilepsy specialists were invited from neighboring countries. The objectives of this volunteers' group were to strengthen kinship among medical professionals involved in epilepsy in the region. Since then, visitors to the National Epilepsy Center in Shizuoka, some for weeks and some for months or years, joined us to establish in‐service training. In the 1990s, epilepsy societies or research groups were founded in individual countries. On the occasion of meetings, mutual exchange of faculty members has become more and more frequent. This is a grass‐roots movement to nuture colleagues interested in epileptology. In 1995, the International League Against Epilepsy officially launched the Commission on Asian and Oceanian Affairs to stimulate epileptology and enhance chapter formation. The Asian and Oceanian Congress was inaugulated in Seoul, Korea, in 1996, followed by the 2nd congress in Taipei, Taiwan, in 1998; the 3rd, in New Delhi, India, in 2000; and the 4th in Nagano, Japan, in 2002. The Commission also organized Epilepsy Teaching Courses in Vietnam, Indonesia, Myanmar, Mongolia, and Nepal to reinforce infrastructures of epilepsy management. The Asian and Oceanian Epilepsy Academy, now being organized, will bring about more active programs in exchange and support for medical professionals in the region.
Does thyroid subspecialization alter practice and outcome? A completed 4‐year audit loop
Authors: Agada F.O. , King‐Im J.U. , Atkin S.L. , England R.J.A.
Published: March 2005

Objective:  To assess the effect of subspecialization on thyroid surgical practice and outcome.

Design:  The multidisciplinary thyroid clinic was established in November 2000. A retrospective study of all thyroid surgery covering the period November 1998 to November 2000 was carried out. Best practice principles were implemented and prospective data were collected over a further 2 years to complete the audit loop. Practice and results were compared.

Setting:  The project was carried out through the Hull and East Yorkshire Multidisciplinary Thyroid Clinic, a tertiary referral clinic for the management of thyroid disease.

Participants:  All patients who underwent thyroid surgery through the Department of Otolaryngology Head and Neck Surgery for 2 years before the establishment of the thyroid clinic (39 patients) and all patients who underwent thyroid surgery through the department for 2 years after the establishment of the clinic (108 patients) were included.

Main outcome measures:  Referral patterns, preoperative workup, types of surgery, histopathological diagnosis and complications rates were compared.

Results:  The audit loop revealed that permanent vocal cord palsy rates had fallen from 8% to 0%, haematoma rates had fallen from 5% to 2% and permanent hypoparathyroidism rates had fallen from 8% to 2%. In addition, caseload had markedly increased, preoperative investigations were reduced and types of surgery standardized.

Conclusion:  It is clear that thyroid subspecialization is beneficial as far as overall outcome is concerned. However, this may lead to increased throughput which must be borne in mind for future activity planning.
Treatment of hypopharyngeal carcinoma: analysis of nationwide study in the Netherlands over a 10‐year period
Authors: Sewnaik A. , Hoorweg J.J. , Knegt P.P. , Wieringa M.H. , van der Beek J.M.H. , Kerrebijn J.D.F.
Published: March 2005

Objective:  To analyse different treatment strategies and treatment results of hypopharyngeal carcinoma in the Netherlands.

Design:  Retrospective study.

Setting:  Eight head and neck centres in the Netherlands.

Participants:  A total of 893 patients were treated between 1985 and 1994. Patients were mostly treated with radiotherapy alone, combined surgery and radiotherapy and surgery alone.

Results:  The 5‐year survival for the whole group was 26%. The 5‐year survival for patients treated with curative intention was 32% and treated with palliative intention was 5%. The 5‐year disease‐free survival after radiotherapy alone was 37%, after surgery alone 41% and after combined therapy 47%. The role of chemotherapy could not be investigated because of a small number of patients treated with chemotherapy in this period.

Conclusion:  Combined therapy with surgery and radiotherapy has a better survival for patients with a hypopharyngeal carcinoma in comparison with radiotherapy alone. The N‐stage is more important for the prognosis than the T‐stage.