bluuebunny/crossref_metadata_2025 huggingface dataset:
Masterman-Lister and the Capacity to Manage One’s Property and Affairs
Authors: Lush Denzil
Published: December 2015

The judgment of Mr. Justice Wright in Masterman-Lister v Jewell and Home Counties Dairies and Masterman-Lister v Brutton & Co., [2002] EWHC 417 (QB), which was handed down on 15 March 2002, is the most important decision so far in English law on the meaning of the term ‘patient’. This, of course, is one of the two disabilities recognized in CPR Part 21. It is also the cornerstone of the Court of Protection’s jurisdiction under the Mental Health Act 1983.

Section 94(2) of that Act defines a ‘patient’ as someone who is ‘incapable, by reason of mental disorder, of managing and administering his property and affairs.’ There are two prerequisites. A person must (a) have a mental disorder, and (b) as a consequence, be incapable of managing and administering his property and affairs.

‘Mental disorder’ is defined in the legislation, but the incapacity to manage one’s property and affairs is not, and this is where Sir Michael Wright’s decision has filled a void, and possibly opened a debate. In fact, he said nothing startlingly new, but the significance of his judgment is that it will be widely reported, whereas previous decisions on the meaning of incapacity to manage one’s property and affairs have been inaccessible, either because they were unreported, or because they emanated from other common law jurisdictions, whose reports are only available in a few very specialist libraries.
Foreword
Authors: Emmett Charlotte
Published: December 2015

In the final months leading to the publication of a revised Bill in 2003, this issue of the Journal seeks to highlight the many fundamental concerns about the current draft Bill expressed by sectors working in the mental health field, by bringing together a handful of the estimated 2000 or so responses made during its short consultation period last summer. For ease of reference, the articles and commentaries which focus squarely on the implications of the draft Bill have been placed in a separate section at the end of this Journal (when editing this section, we have assumed that readers have some prior knowledge of the contents of the Bill).
Confidentiality and the Sharing of Information
Authors: Morris Fenella
Published: December 2015

This paper considers the nature and extent of the duty of patient confidentiality in the mental health context, and examines the range circumstances in which it might be overridden, and the way in which such decisions may be taken. Particular consideration is given to the justifications given for breaches of patient confidentiality in the name of public safety and victims’ rights. The paper also addresses rights of access to health information in the case of the incapable adult and the applicant to the MHRT.
The Draft Mental Incapacity Bill
Authors: Parker Camilla
Published: December 2015

Despite the general agreement with the Law Commission’s assessment of the failings of the current system for decision-making on behalf of people who lack the capacity to make decisions for themselves, the steps towards achieving comprehensive reform, as recommended in its report, Mental Incapacity, has been a protracted process. Mental Incapacity was followed, two years later, by a consultation paper – 'Who Decides? Making Decisions on Behalf of Mentally Incapacitated People' – in which the Government sought views on the Law Commission’s recommendations for reform. In October 1999, the Lord Chancellor’s Department published 'Making Decisions', which set out the Government’s proposal for reform, "in the light of the responses to the consultation paper Who Decides".

In June of last year the reform process moved to a significant stage with the publication of the Government’s draft Mental Incapacity Bill (‘the Draft Bill’). This set out proposals to reform the law: "in order to improve and clarify the decision making process for those aged 16 and over who are unable to make decisions for themselves." Thus provisions set out in the Draft Bill are based on the Law Commission’s recommendations.
Foreword
Authors: Emmett Charlotte
Published: December 2015

Nobody who works in or writes about this area of the law can fail to acknowledge that we are experiencing a period of explosive change. Since the last issue of the Journal we have seen the publication of two new draft Bills, which together promise to change the shape of mental health care and services in the future. On 18th June 2004, the Mental Capacity Bill was published, reflecting many of the recommendations made by the Joint Parliamentary Scrutiny Committee appointed last summer to consider the Mental Incapacity Bill 2003. More recently, on the 8th September, the new Mental Health Bill 2004 was finally published, and will also be subjected to pre-legislative scrutiny by an expert parliamentary committee which is due to report its findings by March 2005. Finally, this very week, the draft Code of Practice for the Mental Capacity Bill 2004 was announced by the Department of Constitutional Affairs.
Two Bills; Two Agendas
Authors: Richardson Genevra
Published: December 2015

This short article represents, in substance, a memorandum of evidence submitted to the Joint Scrutiny Committee on the Draft Mental Health Bill.
Vindicating the right to bodily security of the incapable in research – Part 2
Authors: Garwood-Gowers Austen
Published: December 2015

The Mental Capacity Act 2005 generally exhibits a stronger ethos of protecting the incapable in intrusive research than the last but one version of the Bill. However, sections 31(5) and 6 of the Act replicate clauses 31(4) and 31(5) of that version. As I noted in Part 1 of this article, these clauses are difficult to reconcile with the primary principle. Here I examine what effect, if any, they will have both on the process of authorising research projects involving intrusive research upon the incapable adult and on the ultimate use of the incapable adult in such research. This will involve analysis of the Act’s provisions in the light of both ordinary rules of statutory interpretation and the interpretative obligation imposed by section 3 of the Human Rights Act 1998.
The Human Rights Act and Mental Health Law: Has it Helped?
Authors: Hale Brenda
Published: December 2015

This article focusses on two questions in relation to the interplay of the Human Rights Act and the Mental Health Law: the right to choose, and the process of compulsion.
Outpatient Commitment. Some Reflections on Ideology, Practice and Implications for Research
Authors: Høyer Georg , Ferris Robert J.
Published: December 2015

Over the recent years, increased attention has been paid to non-compliance by mentally disordered patients living in the community with outpatient treatment. To deal with this problem many countries are now revising relevant legislation, to introduce a broader base for involuntary treatment in the community. This paper focuses both on the problems concerning the ideology and implementation of involuntary outpatient treatment, and on some of the research problems related to the evaluation of both the efficacy and effectiveness of outpatient commitment.
Relação entre Natureza e Graça – Breve apresentação histórica
Authors: Bernardes Matheus
Published: December 2015

A relação natureza e graça tem sido objeto de estudo de muitos teólogos. Ainda não se pode afirmar que exista uma compreensão total do tema; permanece tema aberto para a reflexão teológica. A breve apresentação que se segue trata somente das reflexões principais que surgiram na história do estudo antropológico-teológico: as contribuições de Agostinho de Hipona e Tomás de Aquino, a controvérsia sobre o estado da natura pura, os desvios do agostiniasmo e do tomismo e os estudos dos séculos XIX e XX sobre o tema, especialmente o pensamento de Henri De Lubac. Não pôde deixar de lado toda a reflexão que nasce do giro teológico pós-conciliar, especialmente a partir da Constituição Pastoral Gaudium et spes e a consideração do ser humano concreto e sua história de vida em relação com Aquele que é o rosto da graça, Jesus Cristo.
Mechanisms of Simultaneous Hydraulic-Fracture Propagation From Multiple Perforation Clusters in Horizontal Wells
Authors: Wu Kan , Olson Jon E.
Published: December 2015

Simultaneous multiple-fracture treatments in horizontal wellbores are becoming a prevalent approach to economically develop unconventional resources in shale reservoirs. One challenge to efficiently use the technique is the generation of effective hydraulic fractures from all perforation clusters. In this work, we conducted a fundamental study of physical mechanisms controlling simultaneous multiple-fracture propagation and discussed the potential approaches to improve nonuniform development of multiple fractures. This study was investigated by our recently developed 3D fracture-propagation model that captures the coupled elastic deformation of the rock with fluid flow in the horizontal wellbore and within the fractures. The model demonstrated that fracture geometry was controlled by both the stress-shadow effects and dynamic partitioning of flow rate. The analysis results indicated that the nonuniform development of a multiple-fracture array, for example, a three-fracture array in this study, was induced by the uneven partitioning of flow rate into each fracture, which was dependent on the flow resistance from wellbore friction, perforation friction, and fracture propagation. Furthermore, the stress shadowing from the exterior fractures exerted additional stress on the interior fractures and increased the resistance of fracture propagation, resulting in the interior fractures receiving much less fluid. To minimize the negative effects of stress shadowing and favor more-uniform fracture growth, we investigated potential approaches to promote uniform partitioning of flow rate through adjusting the flow resistance between multiple fractures. The results showed that adjusting perforation friction can provide an effective way to modify the partitioning of flow rate and mitigate the negative effects of stress shadowing. The mechanisms investigated in this study are consistent with field observations. Our approach can help field operators to improve the effectiveness of multiple fracturing treatments and maximize the production.
Sidedress Nitrogen Application Rates to Sorghum Intercropped with Tropical Perennial Grasses
Authors: Mateus G. P. , Crusciol C. A. C. , Pariz C. M. , Borghi E. , Costa C. , Martello J. M. , Franzluebbers A. J. , Castilhos A. M
Published: December 2015

Intercropping sorghum [Sorghum bicolor (L.) Moench] with tropical perennial grasses and using the appropriate rate of sidedress N application can maximize grain yield (GY) and revenue and can improve land‐use efficiency (LUE). The effects of monocropped sorghum (MS) or sorghum intercropped with palisadegrass (Urochloa brizantha cv. Marandu; SPG) or guineagrass (Panicum maximum cv. Mombaça; SGG) and sidedress N application rates of 0, 50, 100, and 200 kg ha−1 on leaf nutrient concentration, sorghum GY, revenue, and LUE were investigated during three growing seasons at Botucatu, SP, Brazil, on a clay, kaolinitic, thermic Typic Haplorthox. The SGG treatment had lower leaf N, P, and K concentrations and lower 1000‐grain weight, shoot dry matter, and GY than MS and SPG at all sidedress N rates; MS and SPG at 200 kg ha−1 of sidedress N resulted in greater sorghum GYs (3.80 and 3.81 Mg ha−1, respectively). The forage dry matter production (FDMP) and crude protein of tropical perennial grasses were higher as a function of the sidedress N rate. The SGG treatment resulted in negative net profits for all sidedress N rates. The MS and SPG treatments (independent of sidedress N rates) resulted in similar net profits (approximately US$85 and $60 ha−1, respectively). The SPG treatment using 200 kg ha−1 of sidedress N resulted in a higher land equivalent ratio and relative N yield (1.27 and 123%, respectively) than SGG (0.96 and 107%, respectively). The SPG treatment with 200 kg ha−1 of sidedress N is the best option for increasing sorghum GY, revenue, and FDMP from autumn to part of the spring and for improving LUE.
Signal Detection and their Assessment in Pharmacovigilance
Authors: Kumar Anoop , Khan Henna
Published: December 2015

Signal detection and its assessment is the most important aspect in pharmacovigilance which plays a key role in ensuring that patients receive safe drugs. For detection of adverse drug reactions, clinical trials usually provide limited information as they are conducted under strictly controlled conditions. Some of the adverse drug reactions can be detected only after long term use in larger population and in specific patient groups due to specific concomitant medications or disease. The detection of unknown and unexpected safety signals as early as possible from post marketing data is one of the major challenge of pharmacovigilance. The current method of detecting a signal is predominantly based on spontaneous reporting, which is mainly helpful in detecting type B adverse effects and unusual type A adverse effects. Other sources of signals detection are prescription event monitoring, case control surveillance and follow up studies. Signal assessment is mainly performed by using Upsala Monitoring scale & Naranjo scale of probability to analyze the cause and effect analysis. Signal detection and their assessment is very vital and complex process. Thus, the main objective of this review is to provide a summary of the most common methods of signal detection and their assessment used in pharmacovigilance to confirm the safety of a drug. Recent developments, challenges, & future needs have also been discussed.
Exploring the Relationship between Animal Behavior and Consumer Products: Developing Critical Awareness through Classroom and Home-Based Experimentation
Authors: Kieson Emily , Abramson Charles I.
Published: December 2015

This article presents a series of exercises using consumer products to teach students and children basics of the scientific method. Ants and honey bees are used to test the effectiveness of popular magnetic field insect repellents, domestic house cats are used to determine preferences for litter and litter box sizes, and earthworms are used to determine the significance and effect of soil additives and compression. Suggestions on possible variations in experimental designs are included. Ethical questions raised by the use of animals in product development and environmental effects are discussed, as are issues related to critical awareness of how consumer products are marketed.
Players' Perceptions of Home Advantage in the Australian Rugby League Competition
Authors: McGuckin Teneale A. , Sinclair Wade H. , Sealey Rebecca M. , Bowman Paul W.
Published: December 2015

This study was designed to pilot a survey to explore players' perception of home advantage in a rugby league. Twenty-seven players from one team with an identified home advantage believed a home advantage existed as a result of their home crowd (52%), family and friends' support (41%), normal travel (45%) and sleeping arrangements (37%), home weather conditions (48%), and familiarity with playing amenities (37%). However, the players were less definite about influences while playing away from home. The current sample of players identified differing influences, highlighting individual variations in perceived determinants. Individual interviews or focus groups will be required for further exploration.
Effect of Sex, Age, and BMI on the Development of Locomotor Skills and Object Control Skills among Preschool Children
Authors: Yang Shu-Chu , Lin Shu-Jung , Tsai Chia-Yen
Published: December 2015

Purposive sampling was used to recruit 1,200 preschoolers between the ages of three and seven from 12 preschools throughout Taiwan in order to examine locomotor skills, object control skills, and fundamental motor skills with respect to sex, age, and body mass index (BMI). Fundamental motor skills were measured using the TGMD–2. Only age had a significant influence on locomotor skills, object control skills, and fundamental motor skills; sex had a small influence on object control skills, and BMI had a very limited influence on all three categories. The difference from previous studies related to BMI may be due to the different items included in the various tests, the number of trials conducted, and ways in which BMI was categorized.
Is Suicide Terrorism Really the Product of an Evolved Sacrificial Tendency? A Review of Mammalian Research and Application of Evolutionary Theory
Authors: Lankford Adam
Published: December 2015

Academic debates persist about the psychology of suicide terrorists, with one view being that they are psychologically healthy individuals who primarily engage in altruistic self-sacrifice to serve their family, organization, or cause. Some proponents of this view now argue that suicide attackers are actually responding to their evolved sacrificial tendencies. However, the present review questions this hypothesis. For one thing, it appears inconsistent with the evidence on which individuals become suicide bombers and why. More broadly, research from the animal kingdom suggests that there is an important limit to “selfless” or “altruistic” behavior among non-human mammals, which appear to have been naturally selected to save themselves rather than deliberately give up their lives to protect offspring from predation, infanticide, or starvation. Furthermore, kin selection theory suggests that intentional self-sacrifice would be maladaptive for virtually all mammals, including human beings, and that this behavioral tendency would not have been naturally selected after all.
Creativity of Preschool and Elementary School Teachers and Their Students
Authors: Sali Güneş , Akyol Aysel Köksal
Published: December 2015

Although creativity provides a considerable number of advantages, many teachers have direct and indirect prejudices against creative students since they may display distracting and disruptive behaviors toward teachers and classmates. To determine how teachers' creativity affects their students' creative development, 90 preschool and elementary school teachers and 90 pupils were assessed for creative thinking. The children's sex was not correlated with creativity scores. There were small, significant relationships between various measures of preschool teachers' and students' creativity.
Controlling Absolute Frequency of Feedback in a Self-Controlled Situation Enhances Motor Learning
Authors: Tsai Min-Jen , Jwo Hank
Published: December 2015

The guidance hypothesis suggested that excessive extrinsic feedback facilitates motor performance but blocks the processing of intrinsic information. The present study tested the tenet of guidance hypothesis in self-controlled feedback by controlling the feedback frequency. The motor learning effect of limiting absolute feedback frequency was examined. Thirty-six participants (25 men, 11 women; M age = 25.1 yr., SD = 2.2) practiced a hand-grip force control task on a dynamometer by the non-dominant hand with varying amounts of feedback. They were randomly assigned to: (a) Self-controlled, (b) Yoked with self-controlled, and (c) Limited self-controlled conditions. In acquisition, two-way analysis of variance indicated significantly lower absolute error in both the yoked and limited self-controlled groups than the self-controlled group. The effect size of absolute error between trials with feedback and without feedback in the limited self-controlled condition was larger than that of the self-controlled condition. In the retention and transfer tests, the Limited self-controlled feedback group had significantly lower absolute error than the other two groups. The results indicated an increased motor learning effect of limiting absolute frequency of feedback in the self-controlled condition.
The Effect of Chronotype on Psychophysiological Responses during Aerobic Self-Paced Exercises
Authors: Rossi Alessio , Formenti Damiano , Vitale Jacopo A. , Calogiuri Giovanna , Weydahl Andi
Published: December 2015

It was hypothesized that an individual's chronotype might influence the response to physical activity at a given time of day. This study aimed to analyze the psychophysiological responses during a walking task at different times of day in individuals with different chronotypes. 46 students ( M age = 24.8yr., SD = 7.2) filled in the Morningness-Eveningness Questionnaire to determine chronotypes. Heart rate, walking time, and the rating of perceived exertion (RPE) were measured during two self-paced walking sessions: one in the morning (08:30) and one in the afternoon (15:30). A multivariate analysis of variance found a significant interaction between chronotype and time of day. The post hoc analysis showed a significant difference for RPE in the morning session, with evening types reporing a higher RPE compared with the morning types. The chronotype and the time of day when a physical task is undertaken can influence the RPE response, although it might not influence physiological or performance parameters. This has to be taken into account, because it can affect test reliability as well as possibly have a negative influence on the affective responses to a given task.
Serial Ascitic Fluid Analysis – Prognostic Marker for Adverse Outcome in Spontaneous Bacterial Peritonitis in Liver Cirrhosis?
Authors: Pathak Rahul , Von Thun Annette , Singh Kumar Vikram , Khadga Prem , Sharma Shashi
Published: December 2015

Background: Cirrhosis is a frequent cause of hospital admissions in Nepal with spontaneous bacterial peritonitis (SBP) being a major determinant of mortality. Limited diagnostic options preclude early risk stratification to improve patient outcomes. We assessed the predictive value of polymorphonuclear leukocyte counts (PMNs) and its association with mortality in hospitalized SBP patients.Methods: We examined 51 cirrhotic patients diagnosed with SBP in a prospective case-control study admitted to a Nepali tertiary care facility from February 2010 to November 2012. Serial paracentesis and ascitic fluid analysis were performed at admission, 24, and 48 hours. Receiver operating characteristic (ROC) curves, repeated measures analysis of variance, and logistic regression evaluated ascitic PMNs as predictors of mortality.Results: Deceased patients demonstrated significantly elevated mean circulating and ascitic PMNs. Ascitic PMNs in the non-survivors were significantly elevated upon admission and at 24 and 48 hours. These differences were significant based on absolute counts, relative differences and trends across time. ROC curves provided diagnostic thresholds (1600, 860, 500 cells/mm3) distinguishing the two groups upon presentation, at 24 and 48 hours respectively, with high sensitivities (100%), specificities (82.5-97.5%), and positive predictive values (52.4-84.6%). After adjusting for age and case severity, there was a 9.1-fold greater odds of mortality upon admission, for every increase of 500 ascitic PMNs.Conclusion: In this study of cirrhotic patients with SBP, in-hospital mortality was associated with persistently elevated ascitic PMNs. Ascites PMN thresholds offer a quick, low-tech option to risk stratify patients, prognosticate mortality, and guide patient care in low resourced settings. Journal of Advances in Internal Medicine 2015;04(01):6-12
Immunology of the gut and oral tolerance
Authors: Shrestha Umid Kumar
Published: December 2015

The pathogens and harmless antigens from the bacterial flora and food constantly expose the mucosal surface of the gastrointestinal tract. The mucosal epithelial cells act not only as a physical barrier, but also as a local immune system, which plays a vital role in defense and self-tolerance. The gut mucosal immune system comprises several compartments: Peyer’s patches and lymphoid follicles in the colonic mucosa, and lymphocytes in the lamina propria and intraepithelial lymphocytes. Peyer’s patches mediate antigen uptake via specialized epithelial cells (M cells) and are rich in B cells for class switching into IgA-secreting cells. IgA secretion is one of the primary defenses against pathogens at mucosal surfaces. The lamina propria contains a high proportion of activated and memory T cells that allows rapid immune response against pathogens. In the physiological situation, mucosally encountered antigens induce tolerance of lamina propria and intraepithelial lymphocytes by modified antigen presentation, antigen-induced anergy, or deletion of T cells, or regulation of effector T cells by regulatory or suppressor T cells. Costimulatory molecules mediate cellular interaction and induce regulatory cytokines. While the absence of gut immune privilege to food results in food allergy, the consequences of immune privilege collapse to commensal gut flora is Inflammatory Bowel Disease (IBD). Hence, the knowledge of the homeostatic regulation of the intestinal immune system paves the way for the development of the new immunomodulatory drugs in the therapy of IBD. Moreover, the generation of immune mediated cells through orally fed antigens could be the area of research in the treatment of certain autoimmune diseases.Journal of Advances in Internal Medicine 2015;04(01):16-24
School Choice and Travel Patterns in Northern Ireland
Authors: Smyth Austin , Kelleher Luke , McEldowney Malachy
Published: December 2015

The Northern Ireland government is implementing policy reforms to its education system. These reforms have generated much heated debate and division along political party lines. However, none of the controversy has addressed the implications of the current or potential arrangements for travel and sustainability. This paper considers the implications of the planned reform of the education system in Northern Ireland, some potential alternatives for school choice and travel behavior, and the financial, economic, and environmental impacts on society. The study is informed by in-depth household-based surveys that encompass school choice and travel patterns, attitudinal questions, and stated preference experiments. Northern Ireland offers an indication of the potential pitfalls other areas may encounter when emphasizing increased choice in education systems.
Optic nerve mobilization to enhance the exposure of the pituitary stalk during craniopharyngioma resection: early experience
Authors: Metwali Hussam , Gerganov Venelin , Fahlbusch Rudolf
Published: December 2015

OBJECT

Preservation of the pituitary stalk and its vasculature is a key step in good postoperative endocrinological outcome in patients with craniopharyngiomas. In this article, the authors describe the surgical technique of medial optic nerve mobilization for better inspection and preservation of the pituitary stalk.

METHODS

This operative technique has been applied in 3 patients. Following tumor exposure via a frontolateral approach, the pituitary stalk could be seen partially hidden under the optic nerve and the optic chiasm. The subchiasmatic and opticocarotid spaces were narrow, and tumor dissection from the pituitary stalk under direct vision was not possible. The optic canal was therefore unroofed, the falciform ligament was incised, and the lateral part of the tuberculum sellae was drilled medial to the optic nerve. The optic nerve could be mobilized medially to widen the opticocarotid triangle, which enhanced visualization of and access to the pituitary stalk.

RESULTS

By using the optic nerve mobilization technique, the tumor could be removed completely, and the pituitary stalk and its vasculature were preserved in all patients. In 2 patients, vision improved after surgery, while in 1 patient it remained normal, as it was before surgery. The hormonal status remained normal after surgery in 2 patients. In the patient with preoperative hormonal deficiencies, improvement occurred early after surgery and hormonal levels were normal after 3 months. No approach-related complications occurred.

CONCLUSIONS

This early experience shows that this technique is safe and could be used as a complementary step during microsurgery of craniopharyngiomas. It allows for tumor dissection from the pituitary stalk under direct vision. The pituitary stalk can thus be preserved without jeopardizing the optic nerve.
Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval
Authors: Martinez-del-Campo Eduardo , Kalb Samuel , Soriano-Baron Hector , Turner Jay D. , Neal Matthew T. , Uschold Timothy , Theodore Nicholas
Published: December 2015

OBJECT

Atlantooccipital dislocation (AOD) in adults cannot be diagnosed with adequate specificity and sensitivity using only CT or plain radiography, and the spine literature offers no guidelines. In children, the most sensitive and specific radiographic measurement for the diagnosis of AOD is the CT-based occipital condyle–C1 interval (CCI). The goal of the current study was to identify the normal CCI in healthy adults and compare it with the CCI in adults with AOD to establish a highly sensitive and specific cutoff value for the neuroimaging diagnosis of AOD.

METHODS

A total of 81 patients, 59 without AOD and 22 with AOD, were included in this study. Measurements obtained from thin-slice CT scans of the craniovertebral joint to assess atlantooccipital dislocation included the CCI, condylar sum, the Wholey and Harris intervals, Powers and Sun ratios, Wackenheim line, and Lee X-lines.

RESULTS

The group of patients without AOD included 30 men (50.8%) and 29 women (49.2%) with a mean age of 42.4 ± 16 years (range 19–87 years). The group of patients with AOD included 10 men (45.5%) and 12 women (54.5%) with a mean age of 38.2 ± 9.7 years (range 20–56 years). Interrater reliabilities within a 95% CI were all greater than 0.98 for CCI measurements. A total of 1296 measurements of the CCI were made in 81 patients. The mean CCI for non-AOD patients was 0.89 ± 0.12 mm, the single largest CCI measurement was 1.4 mm, and the largest mean for either right or left CCI was 1.2 mm. The mean condylar sum was 1.8 ± 0.2 mm, and the largest condylar sum value was 2.2 mm. Linear regression with age predicted an increase in CCI of 0.001 mm/year (p < 0.05). The mean CCI in AOD patients was 3.35 ± 0.18 mm (range 1.5 mm–6.4 mm). The shortest single CCI measurements in the AOD patients were 1.1 mm and 1.2 mm. The mean condylar sum for all 22 AOD patients was 6.7 ± 2.7 mm and the shortest condylar sums were 3.0 mm. Cutoff values for AOD were set at 1.5 mm for the CCI and 3.0 mm for the condylar sum, both with a sensitivity of 1 and false-negative rate of 0. Sensitivity for the Powers, Wholey, Harris, Sun, Wackenheim, and Lee criteria were determined to be 0.55, 0.46, 0.27, 0.23, 0.41, and 0.41, respectively.

CONCLUSIONS

The CCI is shorter in adult patients as opposed to the pediatric population. The revised CCI (1.5 mm) and condylar sum (3.0 mm) cutoff values have the highest sensitivity and specificity for the diagnosis of AOD in the adult population.
Simultaneous bilateral stereotactic procedure for deep brain stimulation implants: a significant step for reducing operation time
Authors: Fonoff Erich Talamoni , Azevedo Angelo , Angelos Jairo Silva dos , Martinez Raquel Chacon Ruiz , Navarro Jessie , Reis Paul Rodrigo , Sepulveda Miguel Ernesto San Martin , Cury Rubens Gisbert , Ghilardi Maria Gabriela dos Santos , Teixeira Manoel Jacobsen , Lopez William Omar Contreras
Published: December 2015

OBJECT

Currently, bilateral procedures involve 2 sequential implants in each of the hemispheres. The present report demonstrates the feasibility of simultaneous bilateral procedures during the implantation of deep brain stimulation (DBS) leads.

METHODS

Fifty-seven patients with movement disorders underwent bilateral DBS implantation in the same study period. The authors compared the time required for the surgical implantation of deep brain electrodes in 2 randomly assigned groups. One group of 28 patients underwent traditional sequential electrode implantation, and the other 29 patients underwent simultaneous bilateral implantation. Clinical outcomes of the patients with Parkinson's disease (PD) who had undergone DBS implantation of the subthalamic nucleus using either of the 2 techniques were compared.

RESULTS

Overall, a reduction of 38.51% in total operating time for the simultaneous bilateral group (136.4 ± 20.93 minutes) as compared with that for the traditional consecutive approach (220.3 ± 27.58 minutes) was observed. Regarding clinical outcomes in the PD patients who underwent subthalamic nucleus DBS implantation, comparing the preoperative off-medication condition with the off-medication/on-stimulation condition 1 year after the surgery in both procedure groups, there was a mean 47.8% ± 9.5% improvement in the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) score in the simultaneous group, while the sequential group experienced 47.5% ± 15.8% improvement (p = 0.96). Moreover, a marked reduction in the levodopa-equivalent dose from preoperatively to postoperatively was similar in these 2 groups. The simultaneous bilateral procedure presented major advantages over the traditional sequential approach, with a shorter total operating time.

CONCLUSIONS

A simultaneous stereotactic approach significantly reduces the operation time in bilateral DBS procedures, resulting in decreased microrecording time, contributing to the optimization of functional stereotactic procedures.
Diagnosis of a growing radiation-induced skull lesion in a patient: an unusual scar
Authors: Perera Andrea P. , Mehta Gautam U. , Pratt Drew , Quezado Martha M. , Gilbert Mark R. , Heiss John D.
Published: December 2015

New lesions arising from within an area of previous irradiation often present a diagnostic dilemma, with new malignancy or metastasis of particular concern. The authors report a case of reactive fibroblast proliferation emerging from a previous radiation field and presenting as a growing lesion of the frontal and parietal skull. Following complete gross resection of the skull lesion and histopathological analysis, it was discovered that this lesion consisted of dense fibroblast proliferation with areas of osteonecrosis. This unusual reactive phenomenon offers a novel differential diagnosis for a new contrast-enhancing lesion in a region of previous radiation.
Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database
Authors: Gokaslan Ziya L. , Zadnik Patricia L. , Sciubba Daniel M. , Germscheid Niccole , Goodwin C. Rory , Wolinsky Jean-Paul , Bettegowda Chetan , Groves Mari L. , Luzzati Alessandro , Rhines Laurence D. , Fisher Charles G. , Varga Peter Pal , Dekutoski Mark B. , Clarke Michelle J. , Fehlings Michael G. , Quraishi Nasir A. , Chou Dean , Reynolds Jeremy J. , Williams Richard P. , Kawahara Norio , Boriani Stefano
Published: December 2015

OBJECT

A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosis-predicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI.

METHODS

Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling.

RESULTS

A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96–16.6; p < 0.001), although no significant difference in survival was observed.

CONCLUSIONS

EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.
Spinal arteriovenous shunts: accuracy of shunt detection, localization, and subtype discrimination using spinal magnetic resonance angiography and manual contrast injection using a syringe
Authors: Unsrisong Kittisak , Taphey Siriporn , Oranratanachai Kanokporn
Published: December 2015

OBJECT

The object of this study was to evaluate the accuracy of fast 3D contrast-enhanced spinal MR angiography (MRA) using a manual syringe contrast injection technique for detecting and evaluating spinal arteriovenous shunts (AVSs).

METHODS

This was a retrospective study of 15 patients and 20 spinal MRA and catheter angiography studies. The accuracy of using spinal MRA to detect spinal AVS, localize shunts, and discriminate the subtype and dominant arterial feeder of the AVS were studied.

RESULTS

There were 14 pretherapeutic and 6 posttherapeutic follow-up spinal MRA and catheter spinal angiography studies. The spinal AVS was demonstrated in 17 of 20 studies. Spinal MRA demonstrated 100% sensitivity for detecting spinal AVS with no false-negative results. A 97% accuracy rate for AVS subtype discrimination and shunt level localization was achieved using this study's diagnostic criteria. The detection of the dominant arterial feeder was limited to 9 of these 17 cases (53%).

CONCLUSIONS

The fast 3D contrast-enhanced MRA technique performed using manual syringe contrast injection can detect the presence of a spinal AVS, locate the shunt level, and discriminate AVS subtype in most cases, but is limited when detecting small arterial feeders.
Development and initial evaluation of a finite element model of the pediatric craniocervical junction
Authors: Phuntsok Rinchen , Mazur Marcus D. , Ellis Benjamin J. , Ravindra Vijay M. , Brockmeyer Douglas L.
Published: December 2015

OBJECT

There is a significant deficiency in understanding the biomechanics of the pediatric craniocervical junction (CCJ) (occiput–C2), primarily because of a lack of human pediatric cadaveric tissue and the relatively small number of treated patients. To overcome this deficiency, a finite element model (FEM) of the pediatric CCJ was created using pediatric geometry and parameterized adult material properties. The model was evaluated under the physiological range of motion (ROM) for flexion-extension, axial rotation, and lateral bending and under tensile loading.

METHODS

This research utilizes the FEM method, which is a numerical solution technique for discretizing and analyzing systems. The FEM method has been widely used in the field of biomechanics. A CT scan of a 13-month-old female patient was used to create the 3D geometry and surfaces of the FEM model, and an open-source FEM software suite was used to apply the material properties and boundary and loading conditions and analyze the model. The published adult ligament properties were reduced to 50%, 25%, and 10% of the original stiffness in various iterations of the model, and the resulting ROMs for flexion-extension, axial rotation, and lateral bending were compared. The flexion-extension ROMs and tensile stiffness that were predicted by the model were evaluated using previously published experimental measurements from pediatric cadaveric tissues.

RESULTS

The model predicted a ROM within 1 standard deviation of the published pediatric ROM data for flexion-extension at 10% of adult ligament stiffness. The model's response in terms of axial tension also coincided well with published experimental tension characterization data. The model behaved relatively stiffer in extension than in flexion. The axial rotation and lateral bending results showed symmetric ROM, but there are currently no published pediatric experimental data available for comparison. The model predicts a relatively stiffer ROM in both axial rotation and lateral bending in comparison with flexion-extension. As expected, the flexion-extension, axial rotation, and lateral bending ROMs increased with the decrease in ligament stiffness.

CONCLUSIONS

An FEM of the pediatric CCJ was created that accurately predicts flexion-extension ROM and axial force displacement of occiput–C2 when the ligament material properties are reduced to 10% of the published adult ligament properties. This model gives a reasonable prediction of pediatric cervical spine ligament stiffness, the relationship between flexion-extension ROM, and ligament stiffness at the CCJ. The creation of this model using open-source software means that other researchers will be able to use the model as a starting point for research.
Event-driven RBAC
Authors: Bonatti Piero , Galdi Clemente , Torres Davide
Published: December 2015

Context-aware access control systems should reactively adapt access control decisions to dynamic environmental conditions. In this paper we present ERBAC – an event-driven extension of the TRBAC model that allows the specification and enforcement of general reactive policies – and its implementation. While almost all the individual features of ERBAC occur separately in some previous model, the detailed design of the policy language, its implementation in XACML, and its testing contribute to the development of expressive, event-driven policy frameworks by demonstrating that this rich model can be satisfactorily implemented, and that its expressivity and performance are compatible with a variety of realistic application scenarios. In particular, a number of examples illustrate ERBAC’s expressive power, and its ability of handling exceptional situations in a flexible way, while keeping policies compact and manageable. The prototype extends XACML’s language and the implementation of the PDP to support the new model. Systematic scalability experiments show that the computational cost of policy rule evaluation in ERBAC is compatible with real-world applications.
Gender Differences in Navigational Memory: Pilots vs. Nonpilots
Authors: Verde Paola , Piccardi Laura , Bianchini Filippo , Guariglia Cecilia , Carrozzo Paolo , Morgagni Fabio , Boccia Maddalena , Di Fiore Giacomo , Tomao Enrico
Published: December 2015

INTRODUCTION: The coding of space as near and far is not only determined by arm-reaching distance, but is also dependent on how the brain represents the extension of the body space. Recent reports suggest that the dissociation between reaching and navigational space is not limited
to perception and action but also involves memory systems. It has been reported that gender differences emerged only in adverse learning conditions that required strong spatial ability.METHODS: In this study we investigated navigational versus reaching memory in air force pilots
and a control group without flight experience. We took into account temporal duration (working memory and long-term memory) and focused on working memory, which is considered critical in the gender differences literature.RESULTS: We found no gender effects or flight hour effects
in pilots but observed gender effects in working memory (but not in learning and delayed recall) in the nonpilot population (Women’s mean = 5.33; SD= 0.90; Men’s mean = 5.54; SD= 0.90). We also observed a difference between pilots and nonpilots in the maintenance of on-line reaching
information: pilots (mean = 5.85; SD=0.76) were more efficient than nonpilots (mean = 5.21; SD=0.83) and managed this type of information similarly to that concerning navigational space. In the navigational learning phase they also showed better navigational memory (mean = 137.83; SD=5.81)
than nonpilots (mean = 126.96; SD=15.81) and were significantly more proficient than the latter group.DISCUSSION: There is no gender difference in a population of pilots in terms of navigational abilities, while it emerges in a control group without flight experience. We found also
that pilots performed better than nonpilots. This study suggests that once selected, male and female pilots do not differ from each other in visuo-spatial abilities and spatial navigation.Verde P, Piccardi L, Bianchini F, Guariglia C, Carrozzo P, Morgagni F, Boccia M, Di Fiore G, Tomao
E. Gender differences in navigational memory: pilots vs. nonpilots. Aerosp Med Hum Perform. 2015; 86(2):103–111.
Unpredictability of Fighter Pilots’ G Duration Tolerance by Anthropometric and Physiological Characteristics
Authors: Park Myunghwan , Yoo Seunghoon , Seol Hyeongju , Kim Cheonyoung , Hong Youngseok
Published: December 2015

BACKGROUND: While the factors affecting fighter pilots’ G level tolerance have been widely accepted, the factors affecting fighter pilots’ G duration tolerance have not been well understood.METHODS: Thirty-eight subjects wearing anti-G suits were exposed
to sustained high G forces using a centrifuge. The subjects exerted AGSM and decelerated the centrifuge when they reached the point of loss of peripheral vision. The G profile consisted of a +2.3 G onset rate, +7.3 G single plateau, and −1.6 G offset rate. Each subject’s G tolerance
time was recorded and the relationship between the tolerance time and the subject's anthropometric and physiological factors were analyzed.RESULTS: The mean tolerance time of the 38 subjects was 31.6 s, and the min and max tolerance times were 20 s and 58 s, respectively. The correlation
analysis indicated that none of the factors had statistically significant correlations with the subjects’ G duration tolerance. Stepwise multiple regression analysis showed that G duration tolerance was not dependent on any personal factors of the subjects. After the values of personal
factors were simplified into 0 or 1, the t-test analysis showed that subjects’ heights were inversely correlated with G duration tolerance at a statistically significant level. However, a logistic regression analysis suggested that the effect of the height factor to a pilot's
G duration tolerance was too weak to be used as a predictor of a pilot's G tolerance.CONCLUSION: Fighter pilots' G duration tolerance could not be predicted by pilots' anthropometric and physiological factors.Park M, Yoo S, Seol H, Kim C, Hong Y. Unpredictability of fighter
pilots' G duration tolerance by anthropometric and physiological characteristics. Aerosp Med Hum Perform. 2015; 86(4):397–401.