bluuebunny/crossref_metadata_2025 huggingface dataset:
Drop-out predictors in cardiac rehabilitation programmes and the impact of sex differences among coronary heart disease patients in an Iranian sample: a cohort study
Authors: Sarrafzadegan Nizal , Rabiei Katayoun , Shirani Shahin , Kabir Ali , Mohammadifard Noushin , Roohafza Hamidreza
Published: July 2007

Objective : To determine whether patients who subsequently drop out of a structured cardiac rehabilitation programme could be prospectively distinguished from those who remain in the programme based upon their initial baseline characteristics.

Design : A cohort study.

Setting : A referral rehabilitation department in a cardiovascular research and training institute.

Subjects : One thousand one hundred and fifteen coronary heart disease patients including patients with ischaemic heart disease, and those undergoing bypass surgery or percutaneous coronary interventions.

Interventions : Demographic characteristics, coronary heart disease risk factors, ejection fraction, functional capacity and laboratory tests were considered at baseline.

Main measures : Patients who completed all 24 sessions of the cardiac rehabilitation programme were compared with drop-out cases who did not.

Results : Four hundred and ninety-nine patients (44.8%) completed the whole cardiac rehabilitation programme. Women (adjusted odds ratio (AOR) 1.817, P < 0.001), older patients (AOR 1.015, P = 0.047), patients with lower risk of coronary heart disease (AOR 1.573, P = 0.008) or lower body mass index (BMI) (AOR 0.945, P = 0.001) and higher waist-to-hip ratio (AOR 12.871, P = 0.009) and those who were non-smokers (AOR 1.779, P = 0.001) were significantly more likely to complete cardiac rehabilitation.

Conclusions : Developing interventions to address special needs of young, obese, smoker male patients who have a lower waist-to-hip ratio and higher clinical risk may be important, especially in attempts to retain this high-risk group in cardiac rehabilitation therapy.
Early physiotherapy after injection of botulinum toxin increases the beneficial effects on spasticity in patients with multiple sclerosis
Authors: Giovannelli M. , Borriello G. , Castri P. , Prosperini L. , Pozzilli C.
Published: July 2007

Objective : To determine whether additional physiotherapy increases botulinum toxin type A effects in reducing spasticity in patients with multiple sclerosis.

Design : A single-blind, randomized, controlled pilot trial with a 12-week study period.

Subjects : Thirty-eight patients with progressive multiple sclerosis affected by focal spasticity and who were observed at the Multiple Sclerosis Centre operating in the S. Andrea Hospital in Rome.

Interventions : For intervention all patients received botulinum toxin type A; the treatment group also received additional physiotherapy to optimize management through passive or active exercise and stretching regimens.

Main measures : To measure objective and subjective level of spasticity, patients were assessed at baseline, 2, 4 and 12 weeks post treatment by Modified Ashworth Scale and visual analogue scale.

Results : When compared with the control group, we found a significant decrease of spasticity by Modified Ashworth Scale (P < 0.01 by t-test) in the treatment group at week 2 (2.73 versus 3.22), week 4 (2.64 versus 3.33) and week 12 (2.68 versus 3.33). The mean (%) difference in Modified Ashworth Scale score between baseline and the end of follow-up was —0.95 (26.1) in the treatment group and —0.28 (7.7) in the control group (P < 0.01). The combined treatment proved also to be more effective by visual analogue scale (P < 0.01) at week 4 (6.95 versus 5.50) and at week 12 (7.86 versus 6.56) but not at week 2 (5.18 versus 5.50; P = 0.41).

Conclusions : Our data suggest that physiotherapy in combination with botulinum toxin type A injection can improve overall response to botulinum toxin.
Agreement between clinical and electromyographic assessments during the course of peripheric facial paralysis
Authors: On Arzu Yagiz , Yaltirik Hurrem Pelin , Kirazli Yesim
Published: July 2007

Objective : To examine the agreement between clinical and electromyographic assessments during the course of facial paralysis, in order to determine whether electromyography adds more information to the clinical examination in determining voluntary and synkinetic movement.

Design : Serial clinical and electromyographic assessments were performed.

Settings : Physical Medicine and Rehabilitation Department of a university hospital.

Subjects : Thirty patients with acute complete idiopathic facial paralysis were included.

Main measures : Voluntary and synkinetic movements of the orbicularis oculi and orbicularis oris muscles were graded by Facial Grading System and by needle electromyography at three weeks, and two, three and six months after the onset of paralysis. Weighted kappa ( κ) statistics were performed to measure the agreement between clinical and electromyographic assessments.

Results : Agreement between assessments yielded an overall κ value of 0.87 for the orbicularis oculi and 0.59 for the orbicularis oris in identifying voluntary movement. electromyography revealed no voluntary movement in the orbicularis oculi, in 65% of the patients in whom slight movement was considered by clinical assessment. In identifying synkinetic movements, an overall κ value was 0.70 for the orbicularis oculi and 0.85 for the orbicularis oris. Electromyography demonstrated many cases of slight synkinesis that were missed through visual inspection in both muscles.

Conclusions : Clinical evaluation provides sufficient information about recovery in voluntary movement in the orbicularis oris, whereas, in the orbicularis oculi, electromyography adds to the clinical evaluation in determining the extent of paralysis.
Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy?
Authors: Srbely John Z. , Dickey James P.
Published: July 2007

Objective : To investigate whether therapeutic ultrasound modulates the pain sensitivity of myofascial trigger points.

Design : Repeated measures, single-blinded randomized controlled trial of ultrasound treatment of trigger points.

Setting : Outpatient injury rehabilitation clinic.

Subjects : Forty-four patients (22 males, 22 females) with trigger points identified within the trapezius muscle.

Interventions : Five-minute therapeutic intensity of ultrasound versus 5-min low-intensity application of ultrasound to a trapezius myofascial trigger point locus.

Main measures : Pain pressure threshold readings were measured at the trapezius trigger point site before and after exposure to the ultrasound intervention.

Results : Pain pressure threshold scores increased an average of 44.4 (14.2)% after therapeutic exposure to ultrasound (pre-ultrasound test 35.4 (8.5) N, post-ultrasound test 51.1 (12.8) N). No significant difference in pain pressure threshold scores was observed with low-intensity ultrasound exposures (pre-ultrasound 36.1 (6.1) N, post-ultrasound 36.6 (4.8) N).

Conclusions : Therapeutic exposures to ultrasound reduce short-term trigger point sensitivity. Ultrasound may be a useful clinical tool for the treatment and management of trigger points and myofascial pain syndromes.
Overestimation of stability limits leads to a high frequency of falls in patients with Parkinson's disease
Authors: Kamata Noriyuki , Matsuo Yoshimi , Yoneda Toshihiko , Shinohara Hideki , Inoue Satoru , Abe Kazuo
Published: July 2007

Objectives : To test a hypothesis that patients with Parkinson's disease may not notice discrepancies between their perceived and actual stability limits and cannot keep their centre of gravity within the stability region.

Settings : Outpatients with neurological disorders in rehabilitation service.

Subjects : Twenty-one patients with Parkinson's disease (11 men, 10 women; mean duration 5.9 ± 3.9 years) and age- and sex-matched healthy volunteers were recruited.

Methods : Each subject's right arm length was subtracted from the distance between the right acromion and the perceived reachable boundary. This was called `perceived reach'. The figure given by subtracting the right arm length from the maximum forward reach length measured by the Functional Reach Test was named `actual reach', and is an index of actual stability limits in each subject. The difference between actual and perceived stability limits (DAP) is given by actual reach minus perceived reach. The motor score of the Unified Parkinson's Disease Rating Scale were used to evaluate disease severity.

Results : The mean DAP for the Parkinson's disease group was negative ( —1.8 ± 5.7 cm) and significantly different from that of controls (3.3 ± 9.2 cm) (P < 0.05). In Parkinson's disease, DAP was significantly correlated with the Unified Parkinson's Disease Rating Scale score (correlation coefficient = —0.39, P < 0.05).

Conclusions : These results indicated that patients with Parkinson's disease overestimated their stability limits, which may result in falls. In addition, the results demonstrate that patients with Parkinson's disease develop overestimation of stability limits in parallel with their disease progression.
Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review
Authors: Pollock Alex , Baer Gillian , Langhorne Peter , Pomeroy Valerie
Published: July 2007

Objectives : To determine whether there is a difference in global dependency and functional independence in patients with stroke associated with different approaches to physiotherapy treatment.

Data sources : We searched the Cochrane Stroke Group Trials Register (last searched May 2005), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2005), MEDLINE (1966 to May 2005), EMBASE (1980 to May 2005) and CINAHL (1982 to May 2005). We contacted experts and researchers with an interest in stroke rehabilitation.

Review methods : Inclusion criteria were: (a) randomized or quasi-randomized controlled trials; (b) adults with a clinical diagnosis of stroke; (c) physiotherapy treatment approaches aimed at promoting postural control and lower limb function; (d) measures of disability, motor impairment or participation. Two independent reviewers categorized identified trials according to the inclusion/exclusion criteria, documented the methodological quality and extracted the data.

Results : Twenty trials (1087 patients) were included in the review. Comparisons included: neurophysiological approach versus other approach; motor learning approach versus other approach; mixed approach versus other approach for the outcomes of global dependency and functional independence. A mixed approach was significantly more effective than no treatment control at improving functional independence (standardized mean difference (SMD) 0.94, 95% confidence interval (CI) 0.08 to 1.80). There were no significant differences found for any other comparisons.

Conclusions : Physiotherapy intervention, using a `mix' of components from different `approaches' is more effective than no treatment control in attaining functional independence following stroke. There is insufficient evidence to conclude that any one physiotherapy `approach' is more effective in promoting recovery of disability than any other approach.
A national survey of occupational therapy students' and physiotherapy students' attitudes to disabled people
Authors: Stachura Kay , Garven Frances
Published: July 2007

Objective : To investigate the possible influence of curricular and non-curricular activities on the attitudes of occupational therapy and physiotherapy students towards disabled people at the beginning and end of their pre-registration education.

Design : A cross-sectional survey.

Setting : United Kingdom.

Participants : Two thousand two hundred and ninety-nine students.

Main outcome measures : Interaction with Disabled Persons' Scale.

Results : Occupational therapy and physiotherapy programmes attract different types of student. Occupational therapy students' attitudes to disabled people were significantly more positive than those of physiotherapy students at the beginning (P < 0.0001) and end (P < 0.0001) of their respective programmes. Students with disabled family members (P < 0.0001) and informal social contact with disabled people (P < 0.0001) had significantly more positive attitudes than those without such contact, and such students tend to choose occupational therapy as a career. Work experience with disabled people did not significantly influence the attitudes towards disabled people of occupational therapy students at the end of their programme (P = 0.187) but did for all other students. A significantly higher proportion of occupational therapy students undertake extracurricular employment and socialize with disabled people than their physiotherapy counterparts.

Conclusion : Physiotherapy students hold less positive attitudes to disabled people than occupational therapy students at both the beginning and end of their pre-registration education. Physiotherapy educators need to give greater credit for work experience with disabled people and to ensure the provision of appropriate disability training to counteract possible overemphasis on physical impairments in the curricula.
The reliability of the Movement Assessment Battery for Children for preschool children with mild to moderate motor impairment
Authors: Van Waelvelde Hilde , Peersman Wim , Lenoir Matthieu , Smits Engelsman Bouwien CM
Published: July 2007

Objectives : To provide further evidence of the test—retest reliability and agreement of the Movement Assessment Battery for Children (M-ABC), a standardized motor test used for identification and evaluation of children with mild to moderate motor impairment. Both the stability of total test scores and classification according to specified cut-off points were examined.

Design and setting : Children were tested on the M-ABC, three times with an interval of three weeks between each assessment.

Participants : Thirty-three 4- and 5-year-old children with poor motor performance, 24 boys and 9 girls.

Results : A systematic practice effect between three consecutive testing sessions was shown. This was significant for the total score and two of the three subscores. Test—retest reliability of the total test score yielded an intraclass correlation coefficient (ICC) of 0.88. The total impairment score ranged between 0 and 40. The standard error of measurement (SEM) of this score was 2.4, resulting in a least detectable difference of 6.6 (with alpha set at 5%). The agreement over three testing sessions ( κ) was 0.72.

Conclusions : The total impairment score of the M-ABC is a reliable measure for identification of mild to moderate motor impairment in young children. Repeated testing on the M-ABC at intervals of three weeks results in a systematic measurement error and is not recommended. The SEM is substantial. Follow-up of preschool children with the M-ABC as a single outcome measure is not appropriate.
Clinical tools to measure trunk performance after stroke: a systematic review of the literature
Authors: Verheyden Geert , Nieuwboer Alice , Van de Winckel Ann , De Weerdt Willy
Published: July 2007

Objective : To give a systematic review of clinical measurement scales used to assess trunk performance after stroke.

Data sources : The databases CINAHL, Cochrane, Pedro and PubMed were searched with the terms `sitting balance' plus `stroke' and `trunk' plus `stroke' mentioned in the title or abstract. Databases were searched from inception to January 2006.

Review methods : All articles were selected which reported or included a clinical measure of trunk performance used in an adult stroke population. Reference lists were searched as secondary sources of articles.

Results : A total of 458 articles resulted from the database search. Thirty-two articles were eligible for inclusion. Earlier studies mentioned ordinal single items or a combination of items which are part of a larger scale used to assess sitting balance as a derived measure of trunk performance. Three clinical tools were available which specifically evaluated trunk performance after stroke; the Trunk Control Test and two Trunk Impairment Scales.

Conclusion : Ordinal single items or subscales of existing larger scales lack a systematic evaluation of psychometric characteristics. Both Trunk Impairment Scales have been extensively examined. A comparative study assessing psychometric properties of the Trunk Control Test and two Trunk Impairment Scales could determine which should be the measure of choice when assessing trunk performance after stroke.
One question as a screening instrument for depression in people with multiple sclerosis
Authors: Vahter L. , Kreegipuu M. , Talvik T. , Gross-Paju K.
Published: July 2007

Objective : To evaluate how effectively one question `Are you depressed?' works as a screening tool for depression in people with multiple sclerosis.

Design : The results from a single question were compared with formal clinical diagnosis and the classification from a standard questionnaire.

Setting : Estonian Multiple Sclerosis Centre, from October 2001 to April 2002.

Subjects : One hundred and thirty-four consecutive inpatients with multiple sclerosis.

Intervention : During two weeks of inpatient stay the mood disorder was analysed. On the basis of clinical interview and Beck Depression Inventory the diagnosis of depression was confirmed.

Main measures : Beck Depression Inventory and structured clinical interview.

Results : Fifty-seven per cent (77/134) of people with multiple sclerosis answered `Yes' to the question `Are you depressed?'. The diagnosis of depression was confirmed in 94% (72/77) of people with multiple sclerosis and not confirmed in 6% (5/77). Hence, the screening test sensitivity was 91%. Forty-three per cent (57/134) answered `No'; 70% (40/57) did not have depression. In this case the sensitivity was 54%. In this group 30% (17/57) were actually depressed according to tests and clinical impression. The age, sex, duration of disease, cognitive abilities and physical disability did not influence consistency of the answers with test results and clinical opinion.

Conclusions : One-question interview is a useful tool for screening for depression in people with multiple sclerosis as it confirms existing depression (sensitivity 91%), but the results should be treated with caution if the person denies mood problems.
Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation
Authors: Langhammer Birgitta , Lindmark Birgitta , Stanghelle Johan K.
Published: July 2007

Objective : To find out if there were any differences in improvement and maintenance of motor function, activity of daily living and grip strength between patients with first-ever stroke receiving two different strategies of physical exercise during the first year after stroke.

Design : A longitudinal randomized controlled stratified trial.

Setting : Rehabilitation institutions, community, patients' homes and nursing homes.

Subjects : Seventy-five male and female first-time-ever stroke patients: 35 in an intensive exercise group and 40 in a regular exercise group.

Intervention : The intensive exercise group received physiotherapy with focus on intensive exercises in four periods during the first year after stroke. The regular exercise group patients were followed up according to their subjective needs during the corresponding year.

Main outcome measures : Motor Assessment Scale, Barthel Index of Activities of Daily Living, and grip strength.

Results : Both groups improved significantly up to six months when function stabilized. The groups did not differ significantly on any test occasions. The difference of improvement from admission to discharge was significant in favour of the intensive exercise group, in the Motor Assessment Scale total score (intensive exercise group 7.5; regular exercise group 1.7, P = 0.01), and in the Barthel Index of Activities of Daily Living total score (17.4 versus 8.9, P = 0.04).

Conclusion : Motor function, activities of daily living functions and grip strength improved initially and were maintained during the first year after stroke in all patients irrespective of exercise regime. This indicates the importance of motivation for regular exercise in the first year following stroke, achieved by regular check-ups.
Can the Northwick Park Care Needs Assessment be used to estimate nursing staff requirements in an inpatient rehabilitation setting?
Authors: Williams Heather , Harris Ruth , Turner-Stokes Lynne
Published: July 2007

Aim : To determine whether the Northwick Park Care Needs Assessment (NPCNA) could be used to estimate nursing staff requirements in an inpatient rehabilitation setting.

Design : Retrospective analysis of NPCNA data in comparison with nursing staff provision over a six-month period from 1 April 2003 to 30 September 2003. Setting : A specialist neurorehabilitation unit.

Methods : Daily care requirements for the ward were calculated at two-week intervals by summing the NPCNA care-hour estimates for all inpatients. Nursing staff hours provided were identified from the unit's duty rota and agency records for each corresponding period.

Results : In total, 271 care-hour recordings were extracted from 59 patients. There was a poor relationship between the calculated total ward care-hour requirements and nursing staff hours provided (Pearson's r = 0.31, P = 0.29); but staff hours provided fell significantly short of estimated daily care requirements (mean shortfall 6.2 hours/day, SD 8.6 (95% confidence interval (CI) 0.73, 11.1), P = 0.03)). The shortfall was most obvious during peak care periods in the morning and at bedtime, which resonates with experience reported by nursing staff that they are overstretched at these times. A marked discrepancy between qualified nursing staff hours provided and NPCNA-estimated `special nursing' care requirements highlights a failure to address important facets of the rehabilitation nursing role.

Conclusions : The NPCNA, which was designed to assess only direct care needs in a community setting, requires the further development of a new algorithm before it could be used to estimate nursing staff requirements in a rehabilitation ward setting.
Frailty modifies effectiveness of psychosocial intervention in recovery from stroke
Authors: Ertel K.A. , Glymour M.M. , Glass T.A. , Berkman L.F.
Published: July 2007

Objective : To evaluate the impact of a psychosocial intervention on instrumental activities of daily living, physical performance, cognition and mortality after stroke.

Design : A randomized clinical trial.

Setting : Patients were recruited from hospitals and rehabilitation centres; the intervention took place in subjects' homes.

Subjects : Two-hundred and ninety-one stroke survivors over age 45. One-hundred and forty-six subjects were assigned to the intervention and 145 subjects were assigned to usual care.

Intervention : Up to 16 meetings conducted over six months in the patient's home (approximately weekly for 12 weeks, followed by tri-weekly sessions for another 12 weeks). Sessions lasted approximately 1 hour and included, when possible, the entire support system (stroke survivor, primary caregiver, additional family and friends, and professional caregivers).

Main outcome measures : Instrumental activities of daily living, physical performance, and cognition were assessed six months post stroke; mortality was assessed at an average of 47 months post stroke.

Results : No significant differences in outcomes were observed between the intervention and usual care groups when analysing the total study population. Among non-frail participants (n = 156), subjects randomized to treatment had better scores on instrumental activities of daily living (mean score among treated = 12.4 (standard deviation (SD) = 2.1), mean score among usual care subjects = 11.3 (SD = 2.9), P-value for difference in means = 0.01) and reduced risk of mortality (P = 0.03) than subjects randomized to usual care.

Conclusion : While there is evidence that the treatment benefited healthier subgroups, results also show evidence that the treatment was not effective, and possibly harmful, in frail subgroups.
Harmful effects and acute lethal toxicity of intravenous administration of low concentrations of hydrofluoric acid in rats
Authors: Mitsui Go , Dote Tomotaro , Adachi Kazuya , Dote Emi , Fujimoto Keiichi , Shimbo Yukari , Fujihara Michiko , Shimizu Hiroyasu , Usuda Kan , Kono Koichi
Published: July 2007

The acute toxicity of hydrofluoric acid (HFA) was investigated in a 24-h lethal dose study of intravenous infusion in rats. The lethal dose lowest (LDLo) and LD50 were 13.1 and 17.4mg/kg, respectively. Harmful systemic effects were also studied 1 h after acute sublethal exposure to HFA. The maximum dose was set at 9.6mg/kg (LD 5). Rats were injected with HFA (1.6, 3.2, 6.4 or 9.6mg/kg), saline, sodium fluoride (NaF) or HCl solution. NaF and HCl solution concentrations corresponded to the F— and H+ concentrations of 9.6mg/kg HFA. Blood urea nitrogen (BUN) and Cr were significantly increased in response to HFA concentrations greater than 3.2mg/kg. Acute glomerular dysfunction also occurred at HFA concentrations greater than 3.2mg/kg. HCO 3 — and base excess (BE) were significantly decreased in the 6.4 and 9.6mg/kg groups. Ca2+ was significantly decreased, and K + was increased in the 9.6mg/kg group. BUN was significantly increased in the NaF and HFA groups and was increased in the HFA group compared with that in the NaF group. Cr was significantly increased in the HFA group only. HCO3 — and BE were significantly decreased in the NaF and HFA groups and were increased in the HFA group compared with values in the NaF group. Ca2+ was significantly decreased in the NaF and HFA groups, and K+ was significantly increased in the NaF and HFA groups. F— exposure directly affected serum electrolytes. Mortality was thought to be due to cardiac arrhythmia resulting from hypocalcemia and hyperkalemia. Metabolic acidosis and renal failure were more severe in response to HFA exposure than in response to NaF exposure because of more free F—, which has strong cytotoxicity, in the HFA group than in the NaF group. Lethal effects of HFA are promoted by exposure routes such as inhalation that cause rapid absorption into the body. Even low exposure to HFA can cause acute renal dysfunction, electrolyte abnormalities and metabolic acidosis. These complications result in a poor prognosis. Toxicology and Industrial Health 2007; 23: 5—12.
Pharmacologic Considerations in the Treatment of Repetitive or Prolonged Seizures
Authors: Cloyd James
Published: July 2007

Seizure emergencies are relatively common; however, in-hospital emergency care often is delayed by a variety of factors. Home-based treatment is effective at interrupting prolonged or repetitive seizures, but this option is underused despite its wide availability. The choice of agent used to treat seizure emergencies will depend chiefly on differences among the properties of the available drugs, particularly with regard to route of administration, lipid solubility, formulation characteristics, and the relative size of the absorptive surface area. These factors also can play a part in the decision to use one route of administration over another. Intravenous administration is the fastest and most reliable method of drug delivery, but alternative methods of drug delivery include oral, intramuscular, buccal, nasal, and rectal routes.
Overview: Definitions and Classifications of Seizure Emergencies
Authors: Pellock John M.
Published: July 2007

Seizure emergencies are potentially life-threatening events that are under-recognized. Status epilepticus is associated with considerable rates of morbidity and mortality. Experts currently believe that any episode of seizure activity lasting 5 minutes or longer should be considered status epilepticus. Treatment should be initiated as early as possible; evidence has shown that once seizures persist for 5 to 10 minutes, they are unlikely to stop on their own in the subsequent few minutes. Prehospital treatment with benzodiazepines has been shown to reduce seizure activity significantly compared with seizures that remain untreated until the patient reaches the emergency department. The consequences of delayed treatment of status epilepticus include a serious risk of subsequent prolonged seizure activity or epileptogenesis, memory deficits, and learning difficulties. The importance of timely intervention in generalized tonic-clonic status epilepticus must be emphasized. Recent research has found that emergency department personnel fail to recognize the condition in children in 34% of cases.
Who Is at Risk for Prolonged Seizures?
Authors: Shinnar Shlomo
Published: July 2007

This article reviews how long seizures last and how frequently seizures are prolonged, risk factors for prolonged seizures, and a conceptual framework that links them. These data are derived from studies of patients with a first unprovoked seizure, studies of children with febrile seizures, studies of population-based and community-based cohorts with newly diagnosed epilepsy and patients with refractory epilepsy, and treatment trials. Prolonged seizures that exceed 5 to 10 minutes are relatively common, and the key factor in the identification of those at risk is a history of a prior prolonged seizure. A subgroup of patients with seizures is predisposed to prolonged although not necessarily frequent seizures, which are associated with increased morbidity, increased emergency department visits, and a decreased quality of life. This article also addresses criteria used to justify treatment of a seizure once it has continued longer than 5 minutes and the rationale for such treatment.
The Personal and Financial Impact of Repetitive or Prolonged Seizures on the Patient and Family
Authors: O'Dell Christine , Wheless James W. , Cloyd James
Published: July 2007

Individuals with epilepsy consistently report diminished quality of life. The clinical characteristics of seizures and the unpredictable nature of seizure occurrences are some factors that affect quality of life. Prolonged or repetitive seizures can impose psychologic comorbidities, social issues, and lifestyle restrictions that can affect quality of life of patients and their caregivers and family members, who also bear the considerable indirect costs of seizures, including time away from work or school, and even loss of employment. The availability and use of an at-home medication to terminate prolonged or repetitive seizures or in seizure emergencies improves quality of life for patients and their families. Fewer visits to the emergency department are associated with a reduction in the financial burden to families and the health care system. This article discusses factors that contribute to the personal and financial impact of prolonged seizures on adult and pediatric patients, their families, and caregivers.
Cell viability and proteomic analysis in cultured neurons exposed to methylmercury
Authors: Vendrell Iolanda , Carrascal Montserrat , Vilaró Maria-Teresa , Abián Joaquín , Rodríguez-Farré Eduard , Suñol Cristina
Published: July 2007

Methylmercury is an environmental contaminant with special selectivity for cerebellar granule cells. The aim of this study was to determine the effect of long-term methylmercury exposure on cell viability and cellular proteome in cultured cerebellar granule cells. Primary cultures of mice cerebellar granule cells were treated with 0-300 nM methylmercury at 2 days in vitro (div) and afterwards the cells were harvested at 12 div. 100 nM methylmercury produced loss of cell viability, reduced intracellular glutamate content and increased lipid peroxidation. Glutamate transport was not modified by methylmercury treatment. Cell death induced by 300 nM methylmercury at 8 div was apoptotic without producing activation of caspase 3. Extracts of total protein were separated by 2D electrophoresis. Around 800 protein spots were visualized by silver staining in SDS-polyacrylamide gels. Gel images were digitized and protein patterns were analysed by image analysis. Several spots were identified through a combination of peptide mass fingerprinting and matrix-assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS). The mitochondrial protein 3-ketoacid-coenzyme A transferase I was decreased up to 39% of controls at concentrations of methylmercury that did not produce cytotoxic effects, whereas the cytoplasmic proteins lactate dehydrogenase chain B and actin did not change. Human & Experimental Toxicology (2007) 26, 263-272
Postnatal exposure to cocaine in rats housed in an enriched environment: effects on social interactions
Authors: Magalhães Ana , Summavielle Teresa , Tavares Maria Amélia , de Sousa Liliana
Published: July 2007

This study was undertaken to evaluate the effects of environmental enrichment (EE) in rats exposed to cocaine during the first month of postnatal life by examining several categories of social behaviour (play fighting, social investigation, comfort behaviours and invitation to play). Wistar rats were divided in four groups: pups exposed to cocaine hydrochloride (15 mg/kg body weight/day), sc, in two daily doses, from postnatal day (PND) 1 to 28 and reared in EE; exposed to cocaine as previously described and reared in standard environment (SE); saline-exposed and reared in EE; pups saline-exposed and reared in SE. On PND 21, 24 and 28, social interactions were examined for 10 min. Results show that cocaine animals reared in SE decreased the frequency of play solicitation. Control animals reared in EE exhibited decreased play fighting and social investigation behaviours compared to SE-reared rats. Animals postnatally exposed to cocaine when reared in EE displayed more comfort and invitation to play behaviours and decreased social investigation compared with SE-reared animals. The results suggest that in rats postnatally exposed to cocaine, EE rearing elicited differences in both processing of environmental stimuli and a response to social challenges. Human & Experimental Toxicology (2007) 26, 303-309
Biosensor assay of neuropathy target esterase in whole blood as a new approach to OPIDN risk assessment: review of progress
Authors: Makhaeva Galina F , Malygin Vladimir V , Strakhova Nadezhda N , Sigolaeva Larisa V , Sokolovskaya Lidia G , Eremenko Arkady V , Kurochkin Ilya N , Richardson Rudy J
Published: July 2007

Organophosphates (OPs) that inhibit neuropathy target esterase (NTE) with subsequent ageing can produce OP-induced delayed neuropathy (OPIDN). NTE inhibition in lymphocytes can be used as a biomarker of exposure to neuropathic OPs. An electrochemical method was developed to assay NTE in whole blood. The high sensitivity of the tyrosinase carbon-paste biosensors for the phenol produced by hydrolysis of the substrate, phenyl valerate, allowed NTE activity to be measured in diluted samples of whole blood, which cannot be done using the standard colorimetric assay. The biosensor was used to establish correlations of NTE inhibitions in blood with that in lymphocytes and brain after dosing hens with a neuropathic OP. The results of further studies demonstrated that whole blood NTE is a reliable biomarker of neuropathic OPs for up to 96 hours after exposure. These validation results suggest that the biosensor NTE assay for whole blood could be developed to measure human exposure to neuropathic OPs as a predictor of OPIDN. The small blood volume required (100 μL), simplicity of sample preparation and rapid analysis times indicate that the biosensor should be useful in biomonitoring and epidemiological studies. The present paper is an overview of our previous and ongoing work in this area. Human & Experimental Toxicology (2007) 26, 273-282
Integration of in vitro neurotoxicity data with biokinetic modelling for the estimation of in vivo neurotoxicity
Authors: Forsby Anna , Blaauboer Bas
Published: July 2007

Risk assessment of neurotoxicity is mainly based on in vivo exposure, followed by tests on behaviour, physiology and pathology. In this study, an attempt to estimate lowest observed neurotoxic doses after single or repeated dose exposure was performed. Differentiated human neuroblastoma SH-SY5Y cells were exposed to acrylamide, lindane, parathion, paraoxon, phenytoin, diazepam or caffeine for 72 hours. The effects on protein synthesis and intracellular free Ca2+concentration were studied as physiological endpoints. Voltage operated Ca2 +channel function, acetylcholine receptor function and neurite degenerative effects were investigated as neurospecific endpoints for excitability, cholinergic signal transduction and axonopathy, respectively. The general cytotoxicity, determined as the total cellular protein levels after the 72 hours exposure period, was used for comparison to the specific endpoints and for estimation of acute lethality. The lowest concentration that induced 20% effect (EC 20) obtained for each compound, was used as a surrogate for the lowest neurotoxic level (LOEL) at the target site in vivo. The LOELs were integrated with data on adsorption, distribution, metabolism and excretion of the compounds in physiologically-based biokinetic (PBBK) models of the rat and the lowest observed effective doses (LOEDs) were estimated for the test compounds. A good correlation was observed between the estimated LOEDs and experimental LOEDs found in literature for rat for all test compounds, except for diazepam. However, when using in vitro data from the literature on diazepam's effect on gamma-amino butyric acid (GABA)A receptor function for the estimation of LOED, the correlation between the estimated and experimental LOEDs was improved from a 10 000-fold to a 10-fold difference. Our results indicate that it is possible to estimate LOEDs by integrating in vitro toxicity data as surrogates for lowest observed target tissue levels with PBBK models, provided that some knowledge about toxic mechanisms is known. Human & Experimental Toxicology (2007) 26, 333—338
Putative proteins involved in manganese transport across the blood-brain barr 1ier
Authors: Fitsanakis Vanessa A , Piccola Greg , Marreilha dos Santos Ana Paula , Aschner Judy L , Aschner Michael
Published: July 2007

Manganese (Mn) is an essential nutrient required for proper growth and maintenance of numerous biological systems. At high levels it is known to be neurotoxic. While focused research concerning the transport of Mn across the blood-brain barrier (BBB) is on-going, the exact identity of the transporter(s) responsible is still debated. The transferrin receptor (TfR) and the divalent metal transporter-1 (DMT-1) have long been thought to play a role in brain Mn deposition. However, evidence suggests that Mn may also be transported by other proteins. One model system of the BBB, rat brain endothelial (RBE4) cells, are known to express many proteins suspected to be involved in metal transport. This review will discuss the biological importance of Mn, and then briefly describe several proteins that may be involved in transport of this metal across the BBB. The latter section will examine the potential usefulness of RBE4 cells in characterizing various aspects of Mn transport, and basic culture techniques involved in working with these cells. It is hoped that ideas put forth in this article will stimulate further investigations into the complex nature of Mn transport, and address the importance as well as the limitation of in vitro models in answering these questions. Human & Experimental Toxicology (2007) 26, 295-302
Neurotoxicant-induced inflammatory response in three-dimensional brain cell cultures
Authors: Monnet-Tschudi F. , Zurich M-G. , Honegger P.
Published: July 2007

Brain inflammatory response is triggered by the activation of microglial cells and astrocytes in response to various types of CNS injury, including neurotoxic insults. Its outcome is determined by cellular interactions, inflammatory mediators, as well as trophic and/or cytotoxic signals, and depends on many additional factors such as the intensity and duration of the insult, the extent of both the primary neuronal damage and glial reactivity and the developmental stage of the brain. Depending on particular circumstances, the brain inflammatory response can promote neuroprotection, regeneration or neurodegeneration. Glial reactivity, regarded as the central phenomenon of brain inflammation, has also been used as an early marker of neurotoxicity. To study the mechanisms underlying the glial reactivity, serum-free aggregating brain cell cultures were used as an in vitro model to test the effects of conventional neurotoxicants such as organophosphate pesticides, heavy metals, excitotoxins and mycotoxins. This approach was found to be relevant and justified by the complex cell—cell interactions involved in the brain inflammatory response, the variability of the glial reactions and the multitude of mediators involved. All these variables need to be considered for the elucidation of the specific cellular and molecular reactions and their consequences caused by a given chemical insult. Human & Experimental Toxicology (2007) 26, 339—346
Differential protein adduction by seven organophosphorus pesticides in both brain and thymus
Authors: Carter Wayne G , Tarhoni Mabruka , Rathbone Alexandra J , Ray David E
Published: July 2007

There is a need for mechanistic understanding of the lasting ill health reported in several studies of workers exposed to organophosphorus (OP) pesticide. Although the acute toxicity is largely explicable by acetylcholinesterase inhibition and the lasting effects of frank poisoning by direct excitotoxicity or indirect consequences of the cholinergic syndrome, effects at lower levels of exposure would not be predicted from these mechanisms. Similarly, reversible interactions with nicotinic and muscarinic receptors in adults would not predict continuing ill health. Many OP pesticides produce protein adduction, and the lasting nature of this makes it a candidate mechanism for the production of continuing ill health. We found significant adduction of partially characterized protein targets in both rat brain and thymus by azamethiphos, chlorfenvinphos, chlorpyrifos—oxon, diazinon—oxon, dichlorvos and malaoxon, in vitro and pirimiphos-methyl in vivo. The diversity in the adduction pattern seen across these agents at low dose levels means that any longer term effects of adduction would be specific to specific organophosphates, rather than generic. This presents a challenge to epidemiology, as most exposures are to different agents over time. However, some adducted proteins are also expressed in blood, notably albumin, and so may provide exposure measures to increase the power of future epidemiological studies. Human & Experimental Toxicology (2007) 26, 347—353
A 30-year follow-up of residual effects on New Zealand School Dental Nurses, from occupational mercury exposure
Authors: Jones Linda , Bunnell Julie , Stillman Jennifer
Published: July 2007

This paper reports possible residual adverse effects from occupational mercury exposure in dentistry, Thirty years ago, the all-women exposed group worked with both silver and copper amalgam filling material without protective gloves or a ventilation system, resulting in chronic mercury exposure. The aim of the study was to test the null hypothesis in a survey of general and reproductive health, and a battery of nine neurobehavioral tests. The population was the 115 graduates of one school for dental nurses from 1968 to 1971. The sample was 43 mercury-exposed women and 32 matched controls. Statistical comparisons revealed that the two groups were equivalent on cognitive tasks and four of the six mood subscales. Significant between-group differences were found in current health symptom experience and reproductive health, especially early hysterectomy experience. Reporting of Occupational Overuse Syndrome was strongly positively correlated with years of work. In general, the study suggests that acute symptoms from mercury exposure may be reversible, while some residual health effects may be becoming more of a concern with the women's increasing age. Human & Experimental Toxicology (2007) 26, 367— 374
Cholesterol homeostasis in the developing brain: a possible new target for ethanol
Authors: Guizzetti M. , Costa LG
Published: July 2007

Cholesterol is an essential component of cell membranes and plays an important role in signal transduction. This brief overview presents evidence from the literature that ethanol may affect cholesterol homeostasis and that, in the developing brain, this may be involved in its developmental neurotoxicity. The effects caused by inborn errors of cholesterol synthesis and by in utero ethanol exposure present several similarities in humans (eg, Smith-Lemli-Opitz syndrome and fetal alcohol syndrome), as well as in animal models. Ethanol has a cholesterol-reducing effect on the cardiovascular system, and a protective effect against Alzheimer's disease, whose pathogenesis has been linked to altered cholesterol homeostasis in the brain. In vitro, ethanol affects several functions that are mediated by cholesterol and important for brain development, such as glial cell proliferation, synaptogenesis, neuronal survival and neurite outgrowth. The brain contains high levels of cholesterol, mostly synthesized in situ. Astrocytes produce large amounts of cholesterol that can be released by these cells and utilized by neurons to form synapses. Ethanol up-regulates the cholesterol transporter ATP binding cassette A1 and cholesterol efflux from primary astrocyte cultures without affecting cholesterol synthesis. Human & Experimental Toxicology (2007) 26, 355-360
School improvement, the school librarian and the process approach
Authors: Collins Judith
Published: July 2007

The school librarian focuses on process rather than product, which makes her a useful contributor to institutional change and improvement. She has three main roles: that of information specialist, developer of reading enthusiasts and manager of a resource centre. This article demonstrates ways in which these roles contribute to the enabling conditions of school improvement at school, classroom and pupil levels, and also the extent to which the librarian contributes to enhanced learning outcomes for students. It discusses some factors which currently inhibit the full participation of the librarian in the journey of the school towards school improvement.
Teachers talking about writing assessment: valuable professional learning?
Authors: Reid Lesley
Published: July 2007

This article argues that the engagement of teachers in collaborative discussions about assessment can provide a fruitful context for valuable professional learning. It is of interest to those who provide Continuous Professional Development (CPD) opportunities for teachers and teachers themselves. It looks particularly at the value of writing assessment moderation meetings, where teachers aim to use exemplars of pupil work to arrive at commonly held understandings about pupil achievement. Teachers' views of participating in the process of assessment moderation were sought. In the case study, two rounds of semi-structured interviews were conducted by the researcher with a project team of one staff tutor and six teachers. Data from these interviews were supplemented by field notes from the project team meetings and a one day writing assessment moderation meeting which was attended by teacher representatives from 10 schools. The results have implications for the organization of assessment moderation meetings within and between primary and secondary schools.