bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between the unilateral TMJ osteoarthritis/osteoarthrosis, mandibular asymmetry and the EMG activity of the masticatory muscles: a retrospective study
Authors: MATSUMOTO R. , IOI H. , GOTO T. K. , HARA A. , NAKATA S. , NAKASIMA A. , COUNTS A. L.
Published: December 2009

Summary  The purpose of this retrospective study was to investigate the relationship between the unilateral temporomandibular joint (TMJ) osteoarthritis/osteoarthrosis (OA), mandibular asymmetry and electromyographic (EMG) activity of the masticatory muscles. Twenty‐two Japanese women (aged 23·2 ± 5·4 years) and 10 Japanese men (aged 22·4 ± 2·8 years) exhibiting unilateral TMJ OA were included in this study. Two angular and seven linear measurements were obtained for the analysis of the skeletal hard tissues. The cephalometric measurement values (CV) were normalized using the CV ratio for the evaluation of the degree of mandibular asymmetry. The EMG was recorded during maximal voluntary clenching efforts for 10 s in the intercuspal position. The average values of integral EMG (iEMG) of three trials were normalized using the iEMG ratio for the evaluation of the functional balance of the masticatory muscles. The mandibular midline was shifted to the TMJ OA side with a median value of 9·85 mm. The CV ratio of the ramus height of the TMJ OA side was significantly smaller than that of the non‐OA side. For the masseter muscle, the iEMG ratio of the TMJ OA side was significantly larger than that of the non‐OA side (P < 0·05). These results suggest that unilateral TMJ OA is related to the dentofacial morphology, thus resulting in a mandibular midline shift to the affected side and it is associated with a masticatory muscle imbalance.
Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis
Authors: WINOCUR E. , REITER S. , KRICHMER M. , KAFFE I.
Published: December 2009

Summary  The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94·4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20·0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11·1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD.
Salivary flow rate and clinical characteristics of patients with xerostomia according to its aetiology
Authors: CHO M.‐A. , KO J.‐Y. , KIM Y.‐K. , KHO H.‐S.
Published: December 2009

Summary  The purpose of the present study was to investigate the differences in salivary flow rates and dry mouth‐related subjective symptoms and behaviours in patients with xerostomia according to its aetiology. One hundred and forty patients (24 men and 116 women, mean age, 58·1 ± 13·3 years) with a chief complaint of xerostomia were included. The patients were divided into five groups; Sjögren’s syndrome (n = 34), post‐radiation therapy in the head and neck region (n = 16), antipsychotic medications (n = 30), systemic diseases or medications affecting salivary flow (n = 35), and unknown aetiology (n = 25). The patients were asked a standardized series of questions concerning dry mouth, and their whole salivary flow rates were measured. Patients with a history of radiation therapy displayed the most decreased values of salivary flow rates and the most severe associated symptoms and behaviours while patients with unknown aetiology displayed the least decreased values of salivary flow rates and relatively favourable symptoms and behaviours. A burning sensation in the mouth was the most prevalent in patients with systemic diseases or those who were taking medications while altered taste perception was the most prevalent in patients taking antipsychotics. In conclusion, patients with xerostomia displayed various degrees of discomfort related to the quality of life according to the aetiology of their conditions.
Eosinopenia as a marker of mortality and length of stay in patients admitted with exacerbations of chronic obstructive pulmonary disease
Authors: HOLLAND Mat , ALKHALIL Mohammad , CHANDROMOULI Siram , JANJUA Ali , BABORES Marta
Published: December 2009

Background and objective:  Blood eosinopenia has long been known as a marker of acute infection, and has recently been shown to be a better predictor of sepsis than CRP in critically ill patients. This study examines the usefulness of eosinopenia (≤0.04), for predicting the severity of exacerbations of COPD using inpatient mortality and length of stay as markers of severity.

Methods:  Retrospective review of the case‐notes of patients admitted with an exacerbation of COPD from March 2007 to April 2008. Patients with radiographic evidence of pneumonia and those having steroids in the previous week were excluded. Data were collected for age, length of stay, pH, WCC and mortality.

Results:  Sixty‐five patients fulfilled the inclusion criteria, 42 with a normal eosinophil count and 23 with eosinopenia. No significant differences were seen between the two groups' age, total WCC and admission pH. However, significant differences were seen in mortality (4/23 (17.4%) vs 1/42 (2.4%), P = 0.049) and length of stay (8 vs 5 days, P = 0.005) when the eosinopenia group compared with those with normal eosinophils.

Conclusions:  The eosinophil count might be a useful marker of severity inpatients admitted with an exacerbation of COPD independent of the WCC and pH. As it is routinely given in the full blood count in all patients admitted to hospital, there is no extra cost for this beneficial test.
Management of complications of minimally invasive thoracic surgery
Authors: HSIN Michael K.Y. , YIM Anthony P.C.
Published: December 2009

Minimally invasive thoracic surgery (MITS) has become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic and therapeutic procedures, and over the past one and a half decades, the scope of MITS has undergone rapid evolution. The role of MITS is well established in the management of pleural and mediastinal conditions, and it is beginning to move beyond diagnostic procedures for lung parenchyma conditions, to gain acceptance as a viable option for primary lung cancer treatment. However MITS poses technical challenges that are quite different from the conventional open surgical procedures. After a brief review of the history of MITS, an overview of the scope of MITS is given. Important examples of diagnostic and therapeutic indications are then discussed, with special emphasis on the potential complications specific to MITS, and their prevention and management.
Clinical characteristics of acute respiratory deterioration in pulmonary fibrosis associated with lung cancer following anti‐cancer therapy
Authors: ISOBE Kazutoshi , HATA Yoshinobu , SAKAMOTO Susumu , TAKAI Yujiro , SHIBUYA Kazutoshi , HOMMA Sakae
Published: December 2009

Background and objective:  To clarify the clinical characteristics and risk factors for acute respiratory deterioration following anti‐cancer therapy in patients with pulmonary fibrosis (PF) and lung cancer.

Methods:  Patients with primary lung cancer and PF were identified by review of medical records. Of the 865 consecutive patients with primary lung cancer who had been treated between June 1999 and September 2007, 53 were diagnosed as having PF. This retrospective study analysed the prevalence of and risk factors for acute respiratory deterioration after treatment of lung cancer in these patients.

Results:  Acute respiratory deterioration was found in 10 (24%) of the 41 patients who received anti‐cancer therapy, and six (60%) of these patients died of respiratory failure. The incidence of acute respiratory deterioration was 28% (8/29) after chemotherapy and 16% (2/12) after surgery. Mortality after acute respiratory deterioration was 50% (4/8) among patients with idiopathic PF and 100% (2/2) among the patients with PF associated with rheumatoid arthritis. Logistic regression analysis revealed that a higher smoking index (cigarettes smoked per day × years of smoking) was a significant risk factor for acute respiratory deterioration (odds ratio: 1.002, P = 0.025).

Conclusions:  Patients with lung cancer who have pre‐existing PF should be carefully managed because of their high risk for developing acute respiratory deterioration after anti‐cancer therapy.
Sleep‐disordered breathing in spinal cord‐injured patients: A short‐term longitudinal study
Authors: TRAN Khoa , HUKINS Craig , GERAGHTY Timothy , ECKERT Brenton , FRASER Lynne
Published: December 2009

Background and objective:  Previous studies have demonstrated an increased incidence of sleep apnoea in spinal cord‐injured patients. Many of these studies were performed in long‐term, stable spinal cord injury (SCI). The aims of this study were: (i) to determine the prevalence of sleep‐disordered breathing (SDB) in acute SCI; (ii) to document the change in SDB over time during the rehabilitation period; and (iii) to correlate the degree of SDB with ventilatory parameters.

Methods:  Sixteen subjects with an acute SCI level T12 and above with complete motor impairment (American Spinal Injury Association impairment scale A or B) were recruited. Assessment, including polysomnography, respiratory function testing, and hypoxic and hypercapnic ventilatory responses, were performed 6–8 weeks post SCI, and repeated 6 months post SCI.

Results:  Eleven of 16 subjects (73%) had evidence of sleep apnoea, five of whom were moderate to severe. This high incidence persisted during the acute admission, with 9 of 12 subjects (75%) having sleep apnoea on polysomnography 20 weeks following injury. There was no correlation between the severity of SDB and other measures, such as level or completeness of injury, respiratory function tests or measures of ventilatory responses.

Conclusions:  We have demonstrated a high incidence of sleep apnoea in the acute phase of SCI that persisted during the acute admission. Despite the high incidence of sleep apnoea, patients were relatively asymptomatic. Screening of this population would appear worthwhile given the high prevalence, although the significance of the sleep apnoea and clinical impact is not known.
Effects of antisense interleukin‐5 gene transferred by recombinant adeno‐associated virus to allergic rats
Authors: ZENG Daxiong , CAO Yong , SONG Qingfeng , CAO Chao , LIU Xiansheng , XU Yongjian , XIONG Weining
Published: December 2009

Background and objective:  The accumulation of eosinophils in airways is an important characteristic of asthma. The process is primarily mediated by interleukin‐5 (IL‐5) secreted by Th2 lymphocytes. This study explored a new approach to asthma therapy in which allergic rats were transfected with the IL‐5 antisense gene delivered by the recombinant adeno‐associated virus (rAAV‐ASIL‐5).

Methods:  The viral vector rAAV‐ASIL‐5 was constructed and the IL‐5 antisense gene transfected into allergic rats. The levels of IL‐5, IgE, eotaxin and eosinophilic cationic protein (ECP) in sera and bronchoalveolar lavage fluid (BALF) were measured by ELISA. The inflammatory responses in lung tissues were evaluated by histological study.

Results:  The levels of IL‐5 protein in serum and BALF were significantly decreased in the allergic rats treated with rAAV‐ASIL‐5 (P < 0.05). Serum ovalbumin‐specific IgE was reduced in treated rats compared with untreated rats (P < 0.05). rAAV‐ASIL‐5 treatment also reduced eosinophils in the peripheral blood and BALF, as well as the ECP and eotaxin levels in serum and BALF (P < 0.05). There was significantly less inflammation in the lungs of rAAV‐ASIL‐5‐treated rats than in those of untreated rats. No obvious pathological damage to the kidneys and livers of the rats treated with rAAV was observed.

Conclusions:  Treatment with rAAV‐ASIL‐5 inhibited the accumulation of eosinophils and airway inflammation in the rat model of allergic asthma by suppressing IL‐5 production. These results suggest that rAAV‐ASIL‐5‐based gene therapy may be used for the treatment of allergic asthma.
Gene therapy for diseases of the cornea – a review
Authors: Williams Keryn A , Coster Douglas J
Published: December 2009

Abstract

The cornea is particularly suited to gene therapy. The cornea is readily accessible, normally transparent, and is somewhat sequestrated from the general circulation and the systemic immune system. The principle of genetic therapy for the cornea is to use an appropriate vector system to transfer a gene to the cornea itself, or to the ocular environs, or systemically, so that a transgenic protein will be expressed that will modulate congenital or acquired disease. The protein may be structural such as a collagen, or functionally active such as an enzyme, cytokine or growth factor that may modulate a pathological process. Alternatively, gene expression may be silenced by the use of modalities such as antisense oligonucleotides. Interestingly, despite a very considerable amount of work in animal models, clinical translation directed to gene therapy of the human cornea has been minimal. This is in contrast to gene therapy for monogenic inherited diseases of the retina, where promising early results of clinical trials for Leber's congenital amaurosis have already been published and a number of other trials are ongoing.
Anterior lamellar keratoplasty: ‘Back to the Future’– a review
Authors: Tan Donald TH , Anshu Arundhati
Published: December 2009

Abstract

Newer forms of lamellar keratoplasty techniques have emerged in the last decade or so revolving around the concept of targeted replacement of diseased corneal layers. These include anterior lamellar keratoplasty (ALK) techniques that aim to selectively replace diseased corneal stroma and, endothelial keratoplasty techniques aiming to replaced damaged endothelium in endothelial disorders. ALK surgery has a distinct advantage over penetrating keratoplasty (PK) in that it minimizes unnecessary replacement of the unaffected healthy endothelial layer thereby almost eliminating the risk of endothelial rejection, a major cause of graft failure in PK. Overall it provides increased life expectancy to the graft and with advancements in the surgical technique and instrumentation for ALK, the visual outcomes are now comparable if not better to standard PK. There are several forms of ALK procedures that have evolved to cater to a wide range of stromal disorders. This article reviews the various emerging techniques of anterior lamellar surgery, its indications and visual outcomes, to emphasize the shift from PK to ALK for stromal disorders with a healthy endothelium.
Transcervical hysteroscopic sterilization using cyanoacrylate: A long‐term experimental study on sheep
Authors: Bigolin Sergio , Fagundes Djalma José , Rivoire Henri Chaplin , Fagundes Anna Tereza Negrini , Fagundes Anna Luiza Negrini
Published: December 2009

Aim:  We investigated the transcervical hysteroscopy application of n‐butyl‐2‐cyanoacrylate in the uterine tube lumen of a non‐rodent animals (sheep) with fallopian tube dimensions similar those in humans.

Methods:  Standard hysteroscopic procedures were performed on female Texel sheep (n = 26). The right and left ostia were identified. For each ewe, a urethral catheter (5Fr) was used for the delivery of 0.5 mL of saline or an equal volume of n‐butyl‐2‐cyanoacrylate into the uterine tube. Following the procedure, ewes were housed with males of proven fertility for 90 days (equivalent to 5.5 estrous cycles). Postmortem (dye and burst pressure) and in vivo (hysterosalpingogram) testing for tube patency were both performed 90 days and 180 days following the procedure.

Results:  All animals receiving the saline treatment became pregnant. Gross inspection of uterine tubes following n‐butyl‐2‐cyanoacrylate treatment revealed no visceral adhesions or fibrosis. However, postmortem testing revealed total obstruction within the fallopian tubes. This was confirmed by hysterosalpingogram, in that iodine contrast did not escape into the abdominal cavity.

Conclusion:  The cyanoacrylate promoted a reliable fallopian tube obstruction without fibrosis in an animal model exhibiting a similar tube diameter to that found in women. The technique can be evaluated for efficacy in vivo using hysterosalpingography.
Long‐term use of dienogest for the treatment of endometriosis
Authors: Momoeda Mikio , Harada Tasuku , Terakawa Naoki , Aso Takeshi , Fukunaga Masao , Hagino Hiroshi , Taketani Yuji
Published: December 2009

Aim:  To investigate the safety and efficacy of 52 weeks of dienogest treatment in patients with endometriosis.

Methods:  One hundred and thirty‐five patients with endometriosis received 2 mg of dienogest orally each day for 52 weeks. Adverse drug reactions and bone density were evaluated. Global improvement was assessed based on the changes in severity categories of five subjective symptoms during non‐menstruation (lower abdominal pain, lumbago, dyschezia, dyspareunia, and pain on vaginal examination) and two objective findings (induration involving the pouch of Douglas and limited uterine mobility).

Results:  The most common adverse drug reactions included metrorrhagia (71.9%), headaches (18.5%), and constipation (10.4%). No clinically significant changes were noted in the incidence or severity of reactions associated with the course of the treatment period (52 weeks). Changes from the baseline bone mineral density of the lumbar spine measured by dual‐energy X‐ray absorptiometry were −1.6 ± 2.4% and −1.7 ± 2.2% (mean ± standard deviation) at 24 and 52 weeks, respectively, which were statistically significant decreases; however, there was no cumulative decrease. The proportions of patients assessed as marked or moderate improvement in terms of global improvement were 72.5% (95/131 cases) at 24 weeks and 90.6% (106/117 cases) at 52 weeks.

Conclusion:  The long‐term effect of dienogest on bone mineral density was slight, whereas the efficacy increased cumulatively.
Efficacy of octyl methoxycinnamate in preventing postoperative peritoneal adhesions: An experimental model
Authors: Aysan Erhan , Bektas Hasan , Kaygusuz Arslan
Published: December 2009

Aim:  To evaluate the effect of octyl methoxycinnamate on preventing postoperative peritoneal adhesions (PPA).

Methods:  Forty outbred Wistar albino female rats (mean weight, 230 ± 25 g; mean age, 6 months) were divided into four equal groups. In Group 1, 0.1 mL octyl methoxycinnamate was injected into the peritoneal cavity. In Group 2, only an adhesion model was generated. In Group 3, an adhesion model was generated, and then this area was covered with 0.1 mL octyl methoxycinnamate. In Group 4, an adhesion model was generated after the area was covered with 0.1 mL octyl methoxycinnamate. All rats were sacrificed on postoperative day 10, and adhesions were scored both macroscopically and microscopically.

Results:  The macroscopic adhesion score of Group 2 differed significantly from the scores in Groups 3 and 4 (P < 0.05), but there was no difference between Groups 3 and 4 (P > 0.05). Microscopic evaluation showed that the mean histopathological fibrosis score of Group 3 differed significantly from the score in Group 4 (P = 0.029).

Conclusion:  Octyl methoxycinnamate covering peritoneal surfaces effectively decreases adhesion formation, but the effect is more pronounced if octyl methoxycinnamate is applied before trauma induction. These results indicate that covering of peritoneal surfaces with viscous liquids, such as octyl methoxycinnamate, which have no toxic effects on vital tissues and especially on peritoneal mesothelial cells, prior to peritoneal trauma (e.g. laparotomy) may decrease PPA formation by preventing or decreasing the trauma.
Prenatal spontaneous disruption of the dividing membrane in monochorionic diamniotic twins detected at the time of fetoscopic laser photocoagulation
Authors: Yoshimura Kazuaki , Aiko Yukiyo , Inagaki Hirohide , Nakata Masahiko , Hachisuga Toru
Published: December 2009

Spontaneous antepartum rupture of the dividing membrane occurring in monochorionic diamniotic twins (MD twin) is an extremely rare complication and difficult to diagnose prenatally. We present a case of pseudo‐monoamniotic twins derived from an MD twin gestation, which was suspected by ultrasound and was confirmed by antepartum fetoscopy. A 28‐year‐old woman, gravida 1, para 1 at 24 weeks of gestation was referred because of suspected polyhydroamnios in an MD twin. Ultrasound suggested twin–twin transfusion syndrome stage III, spontaneous rupture of the dividing membranes and cord entanglement. Fetoscopic laser photocoagulation (FLP) was performed using the Nd:YAG laser on 12 placental vascular connections. Fetoscopy revealed the spontaneous rupture of the dividing membrane and cord entanglement. The remainder of the pregnancy was managed as a monoamniotic twin gestation. Elective cesarean section was performed at 32 weeks of gestation following antenatal steroids and concordantly grown healthy male infants were delivered.
Folk theory of social change
Authors: Kashima Yoshihisa , Bain Paul , Haslam Nick , Peters Kim , Laham Simon , Whelan Jennifer , Bastian Brock , Loughnan Stephen , Kaufmann Leah , Fernando Julian
Published: December 2009

People have a folk theory of social change (FTSC). A typical Western FTSC stipulates that as a society becomes more industrialized, it undergoes a natural course of social change, in which a communal society marked by communal relationships becomes a qualitatively different, agentic society where market‐based exchange relationships prevail. People use this folk theory to predict a society's future and estimate its past, to understand contemporary cross‐cultural differences, and to make decisions about social policies. Nonetheless, the FTSC is not particularly consistent with the existing cross‐cultural research on industrialization and cultural differences, and needs to be examined carefully.
Do birds of a feather universally flock together? Cultural variation in the similarity‐attraction effect
Authors: Heine Steven J. , Foster Julie‐Ann B. , Spina Roy
Published: December 2009

Three experiments explored the similarity‐attraction effect (SAE) among North American and Japanese samples. In all studies, North Americans showed a significantly more pronounced SAE than the Japanese. The North Americans consistently revealed a strong SAE whereas the Japanese effect was only significant in the methods with the most power. The cultural differences emerged across different methods, and for the domains of personality, activities, attitudes and demographics. The cultural difference was mediated by self‐esteem, indicating that a motivation for positive self‐views is a mechanism underlying the SAE.
Intergroup attribution bias in the context of extreme intergroup conflict
Authors: Ariyanto Amarina , Hornsey Matthew J. , Gallois Cindy
Published: December 2009

Limited research has examined attributional biases in the context of extreme intergroup conflict, and the research that does exist contains methodological shortcomings. To remedy this, 282 Indonesians read a newspaper article describing a violent incident in Ambon. Christians (but not Muslims) used stronger situational attributions for violent ingroup acts than for violent outgroup acts. In contrast, both Muslims and Christians used stronger dispositional attributions for violent outgroup acts than for violent ingroup acts. This latter tendency emerged independently of who was described in the article as the perpetrators of the violence. Implications for our understanding of intergroup conflict are discussed.
Belief in common fate and psychological well‐being among Chinese immigrant women
Authors: Tang Taryn N. , Oatley Keith
Published: December 2009

Three studies were conducted to develop and test a construct of Chinese marital commitment in the context of immigration. ‘Belief in common fate’ refers to an unfailing devotion to a Confucian ideal of the marital union as hierarchical without regard for external contingencies or individual needs. Women who did not believe in common fate reported a more positive affect. When women reported the occurrence of a severe life stressor, a strong belief in common fate was associated with psychological distress and negative affect. We discuss the importance of considering contextual factors, such as migration and life adversity, in interpreting the significance of cultural belief systems.
Good Effects of Bad Feelings: Negative Affectivity and Group Decision‐making
Authors: Kooij‐de Bode Hanneke J. M. , Van Knippenberg Daan , Van Ginkel Wendy P.
Published: December 2009

Extending the growing interest in the relationship between affect and workgroup processes, we propose that groups make better use of their distributed information and therefore make better decisions when group members are higher in negative affectivity. In an experiment, we studied the influence of negative affectivity when information was distributed among group members and when group members had fully shared information. Results indicated that negative affectivity indeed stimulates group information processing and decision quality when information is distributed among group members.
Predicting school readiness from neurodevelopmental assessments at age 2 years after respiratory distress syndrome in infants born preterm
Authors: PATRIANAKOS‐HOOBLER ATHENA I , MSALL MICHAEL E , HUO DEZHENG , MARKS JEREMY D , PLESHA‐TROYKE SUSAN , SCHREIBER MICHAEL D
Published: December 2009

Aim  To determine whether neurodevelopmental outcomes at the age of 2 years accurately predict school readiness in children who survived respiratory distress syndrome after preterm birth.

Method  Our cohort included 121 preterm infants who received surfactant and ventilation and were enrolled in a randomized controlled study of inhaled nitric oxide for respiratory distress syndrome. Abnormal outcomes at the age of 2 years were defined as neurosensory disability (cerebral palsy, blindness, or bilateral hearing loss) or delay (no neurosensory disability but Bayley Scales of Infant Development mental or performance developmental index scores <70). School readiness (assessed at a mean age of 5y 6mo, SD 1y) was determined using neurodevelopmental assessments of motor, sensory, receptive vocabulary, perceptual, conceptual, and adaptive skills.

Results  The mean birthweight of the cohort (57 males, 64 females) was 987g (SD 374), and the mean gestational age was 27.3 weeks (SD 2.6). At the age of 2 years, the neurodevelopmental classification was ‘disabled’ in 11% and ‘delayed’ in 23%. At the age of 5 years 6 months, intensive special education was required for 11% and some special education for 21%. Disability and delay at the age of 2 years were 92% and 50% predictive of lack of school readiness respectively, whereas only 15% of children who were normal at the age of 2 years were not school ready at the later assessment. Children with delay at 2 years were more likely to need special education if they were socially disadvantaged.

Interpretation  Without preschool developmental supports, preterm survivors living in poverty will require more special education services.
Relationship between gross motor capacity and daily‐life mobility in children with cerebral palsy
Authors: SMITS DIRK‐WOUTER , GORTER JAN WILLEM , KETELAAR MARJOLIJN , VAN SCHIE PETRA EM , DALLMEIJER ANNET J , LINDEMAN ELINE , JONGMANS MARIAN J
Published: December 2009

Aim The aim of this study was to examine the relationship between gross motor capacity and daily‐life mobility in children with cerebral palsy (CP) and to explore the moderation of this relationship by the severity of CP.

Method Cross‐sectional analysis in a cohort study with a clinic‐based sample of children with CP (n=116; 76 males, 40 females; mean age 6y 3mo, SD 12mo, range 4y 8mo–7y 7mo) was performed. Gross motor capacity was assessed by the Gross Motor Function Measure (GMFM‐66). Daily‐life mobility was assessed using the Pediatric Evaluation of Disability Inventory (PEDI): Functional Skills Scale (FSS mobility) and Caregiver Assistance Scale (CAS mobility). Severity of CP was classified by the Gross Motor Function Classification System (48% level I, 17% level II, 15% level III, 8% level IV, 12% level V), type of motor impairment (85% spastic, 12% dyskinetic, 3% ataxic), and limb distribution (36% unilateral, 49% bilateral spastic).

Results Scores on the GMFM‐66 explained 90% and 84% respectively, of the variance of scores on PEDI‐FSS mobility and PEDI‐CAS mobility. Limb distribution moderated the relationship between scores on the GMFM‐66 and the PEDI‐FSS mobility, revealing a weaker relationship in children with unilateral spastic CP (24% explained variance) than in children with bilateral spastic CP (91% explained variance).

Interpretation In children aged 4 to 7 years with unilateral spastic CP, dissociation between gross motor capacity and daily‐life mobility can be observed, just as in typically developing peers.
Pyruvate dehydrogenase complex deficiency: four neurological phenotypes with differing pathogenesis
Authors: BARNERIAS CHRISTINE , SAUDUBRAY JEAN‐MARIE , TOUATI GUY , DE LONLAY PASCALE , DULAC OLIVIER , PONSOT GERARD , MARSAC CÉCILE , BRIVET MICHÈLE , DESGUERRE ISABELLE
Published: December 2009

Aim  To describe the phenotype and genotype of pyruvate dehydrogenase complex (PDHc) deficiency.

Method  Twenty‐two participants with enzymologically and genetically confirmed PDHc deficiency were analysed for clinical and imaging features over a 15‐year period.

Results  Four groups were identified: (1) those with neonatal encephalopathy with lactic acidosis (one male, four females; diagnosis at birth); (2) those with non‐progressive infantile encephalopathy (three males, three females; age at diagnosis 2–9mo); (3) those with Leigh syndrome (eight males; age at diagnosis 1–13mo); and (4) those with relapsing ataxia (three males; 18–30mo). Seventeen mutations involved PDHA1 (a hotspot was identified in exons 6, 7, and 8 in seven males with Leigh syndrome or recurrent ataxia). Mutations in the PDHX gene (five cases) were correlated with non‐progressive encephalopathy and long‐term survival in four cases.

Interpretation  Two types of neurological involvement were identified. Abnormal prenatal brain development resulted in severe non‐progressive encephalopathy with callosal agenesis, gyration anomalies, microcephaly with intrauterine growth retardation, or dysmorphia in both males and females (12 cases). Acute energy failure in infant life produced basal ganglia lesions with paroxysmal dystonia, neuropathic ataxia due to axonal transport dysfunction, or epilepsy only in males (11 cases). The ketogenic diet improved only paroxysmal dysfunction, providing an additional argument in favour of paroxysmal energy failure.
A comparison of Hausman's and Breslaw–Smith's methods in estimating consumer welfare loss because of fuel taxes
Authors: Shin Sang‐Cheol , Burke Dock
Published: December 2009

In this paper, we investigate the welfare effect of US gasoline consumption caused by fuel taxes. Using two different economics approaches – the Hausman method and the Breslaw and Smith method – in measuring consumer welfare loss, we calculate compensating variation (CV) and the corresponding dead weight loss (DWL) assuming there are changes in motor gasoline tax. Our analysis shows that tax revenue, CV and DWL increases as motor gasoline tax increases, but the social welfare loss measured in DWL increases far more rapidly than the other two.
De novo epileptic confusion in the elderly: A 1‐year prospective study
Authors: Veran Olivier , Kahane Philippe , Thomas Pierre , Hamelin Sophie , Sabourdy Cecile , Vercueil Laurent
Published: December 2009

Purpose: Nonconvulsive status epilepticus (NCSE) is clinically difficult to diagnose, especially in old patients without epilepsy, and requires electroencephalography (EEG) for diagnosis. Its incidence among elderly patients with confusion of unknown origin (CUO) remains undetermined.

Methods: A 1‐year prospective study was conducted in patients aged 60 years or older, for whom EEG was requested because of confusion considered to be of unknown origin after initial clinical, biologic, and imaging investigations. Diagnosis criteria included a validated clinical assessment scale to confirm confusion.

Results: Of 44 patients with confirmed CUO, 7 presented with de novo NCSE. NCSE population had a mean age of 76 years (range, 60–97 years). No statistically significant differences were found between NCSE patients and others for age, drugs, presence of myoclonia, eyelid myoclonia, tachycardia, or agitation. In contrast, an acute onset (<24 h), gender (100% female among NCSE patients), and lack of clinical response to simple commands were significantly associated with NCSE. No differences between the two groups were evidenced for mortality and morbidity (length of hospitalization, social outcome, and so on).

Discussion: Almost 16% of patients aged 60 or older with confusion of unknown origin had NCSE, according to this first prospective study. Female patients with rapid onset (<24 h) of symptoms and lack of response to simple commands were at a higher risk of presenting with NCSE.
Inhibition of long‐term potentiation by valproic acid through modulation of cyclic AMP
Authors: Chang Pishan , Chandler Kate E. , Williams Robin S.B. , Walker Matthew C.
Published: December 2009

Purpose: Valproic acid (VPA) is widely used clinically in epilepsy, bipolar disorder, and migraine. In experimental models, it has also been shown to have neuroprotective and antiepileptogenic effects. Its mechanisms of action in these diverse conditions are, however, unclear, but there is some evidence indicating an effect of VPA upon protein kinase A (PKA) activity. We, therefore, asked whether VPA modulates cyclic adenosine monophosphate (cAMP)/PKA–dependent synaptic plasticity and whether this mode of action could explain its anticonvulsant effect.

Methods: We first tested the effects of VPA on PKA‐dependent synaptic plasticity at mossy fiber to CA3 synapses in rat hippocampus slices following very high‐frequency stimulation or application of the adenylyl cyclase activator forskolin. Using biochemical assays, we then tested whether VPA had a direct effect on PKA activity or an indirect effect through modulating cAMP production. Lastly, VPA and inhibitors of adenylyl cyclase (SQ22536) and PKA (H89) were tested in in vitro models of epileptiform activity induced in hippocampal–entorhinal cortex slices using either pentylenetetrazol (2 mM) or low magnesium.

Results: VPA (1 mm) inhibited PKA‐dependent long‐term potentiation of mossy fiber to CA3 pyramidal cell transmission. However, VPA did not directly modulate PKA activity but rather inhibited the accumulation of cAMP. In acute in vitro seizure models, the anticonvulsant activity of VPA is not mediated through modulation of adenylyl cyclase or PKA.

Conclusions: These results indicate that VPA through an action on cAMP accumulation can inhibit synaptic plasticity, but this cannot fully explain its anticonvulsant effect.
Collaborative Problem Solving Using an Industrial Ecology Approach
Authors: Boehme Susan E. , Panero Marta A. , Muñoz Gabriela R. , Powers Charles W. , Valle Sandra N.
Published: December 2009

Over the course of ten years, a consortium of stakeholders (the Harbor Consortium) used a collaborative approach to identify viable pollution prevention (P2) strategies for specific contaminants, namely mercury, cadmium, polychlorinated biphenyls (PCBs), dioxins, and polycyclic aromatic hydrocarbons (PAHs) as well as suspended solids entering the New York/New Jersey Harbor. The project, titled “The New York/New Jersey Harbor Watershed Pollution Prevention and Industrial Ecology Project,” in a very conscious and overt way engaged stakeholders in the process of developing P2 recommendations for the Harbor. The industrial ecology (IE) tools applied by the Harbor Consortium include substance flow analysis (SFA), material flow analysis (MFA), and, to a limited extent, life cycle analysis (LCA) and fate and transport analysis (F&T), to quantify and characterize how the contaminants flow through the regional economy and the Harbor Watershed once released to the environment. The application of these scientific tools to five contaminants at such a large geographical scale, within the context of a broad and inclusive stakeholder process, and with the goal of identifying and implementing pollution prevention strategies, led to a wide range of surprising outcomes and lessons learned. Undertaking this IE research with the key institutions and stakeholders at the table resulted in the identification and the implementation of many P2 opportunities.
Clinical Management Update: Evaluation and Management of Older Patients with Breast Cancer
Authors: Owusu Cynthia
Published: December 2009

Recent gains in life expectancy, coupled with aging as a risk factor for breast cancer, make breast cancer primarily a disease of older women. Evaluation of the biology of breast cancer according to age has suggested that estrogen receptor–positive, low‐S‐phase, low‐tumor‐grade, and human epidermal growth factor receptor 2–negative tumors are more common in older than younger women. However, this has not translated into any major survival advantage for older women with breast cancer over their younger counterparts. Several reasons, including undertreatment and underrepresentation in clinical trials, may account for this age‐related disparity. In this brief review, recent practice‐changing breast cancer updates of relevance to the care of older patients with breast cancer are discussed and summarized. Because the population is aging and the number of older patients with breast cancer will continue to increase, it is imperative that older patients with breast cancer be encouraged to participate in cutting edge research and that state‐of‐the‐art oncology care be provided to this underserved population.
Changing Healthcare Practice for Older Adults with Late‐Stage Non‐Small Cell Lung Cancer: Practical Considerations of Targeted Therapy in Primary Care and Oncology
Authors: Towe Tanyanika Phillips , O'Toole Elizabeth , Engelhardt Kathryn , Nagaiah Govardhanan , Berger Nathan A.
Published: December 2009

Healthcare practice for cancer care is rapidly evolving because of advances in technology, scientific discovery, drug development, and aging demographics in America. Among the substantive changes in science and drug development is targeted therapy. Targeted agents are changing the scope of practice in treating lung cancer—the leading cause of cancer death in older adults. Given the growing use of these agents in cancer management, shared awareness of practical management considerations between specialists and primary care providers is important. This article reviews targeted therapy in late‐stage non‐small cell lung cancer (NSCLC) and shared care concerns in continuity of care of older Americans with this disease. Important practice points for providers caring for older patients with late‐stage lung cancer treated with targeted therapy are presented through an educational guide addressing potential management concerns.
Promoting Healthy Lifestyles in Older Cancer Survivors to Improve Health and Preserve Function
Authors: Demark‐Wahnefried Wendy , Morey Miriam C. , Sloane Richard , Snyder Denise Clutter , Cohen Harvey J.
Published: December 2009

Currently, there are about 7 million cancer survivors in this country aged 65 and older, and this number is expected to increase rapidly, given trends toward aging and improvements in early detection and treatment. Unfortunately, cancer survivors are at risk for several comorbid conditions and accelerated functional decline. A previous cross‐sectional study of 688 older breast and prostate cancer survivors found significant associations between lifestyle practices and levels of physical functioning, with positive associations noted for physical activity and fruit and vegetable consumption and negative associations observed for dietary fat. In a more‐recent cross‐sectional study of 753 older survivors of breast, prostate, and colorectal cancer, significant associations were also observed between physical function, and physical activity (ρ=0.22, P<.001) and diet quality (ρ=0.07, P=.046), and a significant negative association was also found between physical function and body mass index (ρ=−0.29, P<.001). Therefore, lifestyle interventions may be helpful in positively reorienting the trajectory of functional decline in this vulnerable population, although there are substantial barriers, such as travel, that must be overcome in delivering behavioral interventions to older cancer survivors. Previously reported results from the Pepper Center–funded Leading the Way in Exercise and Diet Project intervention development study suggested that an exercise and diet intervention delivered using telephone counseling and mailed materials was readily accepted and appeared to be of benefit. Larger trials, such as Reach‐out to ENhancE Wellness in Older Survivors, have recently produced compelling data.
Needs of Older Caregivers of Patients with Advanced Cancer
Authors: Daly Barbara J. , Douglas Sara , Lipson Amy , Foley Helen
Published: December 2009

OBJECTIVES: To determine whether age or stage of cancer can be used to identify caregivers at high risk for excessive burden or distress.

DESIGN: Descriptive data collected as part of a psychosocial research registry, comparing younger caregivers with older and caregivers of early‐stage patients with those of later stage.

PARTICIPANTS: Caregivers of newly diagnosed adult cancer patients.

MEASUREMENTS: Caregiver Reaction Assessment (CRA), the Profile of Mood States (POMS), single‐item indicators from the Patient Reported Outcome Measurement Information System set, and the Medical Outcomes Study Social Support (MOS‐SS) Scale. Patient information was obtained from the medical record.

RESULTS: Younger caregivers and caregivers of patients with Stage I and II cancer identified a greater lack of family support than older caregivers and caregivers of patients with Stage III and IV cancer. Significant regression models were found for three CRA subscales (Disrupted Schedule, Lack of Family Support, and Health Problems), as well as for the POMS depression and fatigue scales. Caregiver social support (MOS‐SS) made the only significant contribution to the models. There were significant differences between caregivers with high and low levels of social support on almost all measures of well‐being.

CONCLUSION: Incorporating formal assessment of social support may be useful in identifying at‐risk caregivers. In addition, there is a need to further investigate which dimensions of social support are most strongly related to measures of well‐being.
Predictors of Engagement in a Coping and Communication Support Intervention for Older Patients with Advanced Cancer
Authors: Rose Julia Hannum , Bowman Karen F. , Radziewicz Rosanne M. , Lewis Steven A. , O'Toole Elizabeth E.
Published: December 2009

OBJECTIVES: To examine patterns and predictors of engagement in a coping and communication support (CCS) intervention tailored to the preferences of middle‐aged and older patients in the early treatment phase for late‐stage cancer.

DESIGN: Randomized controlled trial examining processes and outcomes of a CCS intervention for patients with late‐stage cancer over time.

SETTING: Two ambulatory cancer clinics providing care for underserved populations in Cleveland.

PARTICIPANTS: One hundred nine middle‐aged (MA: aged 40–60) and 101 young‐old (YO: aged 61–80) patients randomized to the CCS intervention, surviving to 3 months after enrollment and averaging 2 months of 24/7 access to the intervention.

MEASUREMENTS: Engagement was assessed in the average number of patient–CCS practitioner (CCSP) contacts per month during the initial 2 months of access to the intervention. Baseline data from patient interviews and chart reviews were used to test a model of prediction.

RESULTS: MA patients averaged more patient–CCSP contacts per month than YO patients (mean 2.6 ± 2.5 vs 2.0 ± 1.2, P=.02), although both age groups were engaged. African‐American patients (P=.007) and those with a higher blunting style (P<.01), reporting more family discord in cancer communication (P=.009), and receiving fewer active cancer treatments (P=.008) were more engaged in the CCS intervention in the initial months.

CONCLUSIONS: Psychooncology interventions individualized to patient preferences can effectively reach older and underserved populations. Such interventions may be especially important to patients using more avoidant behaviors, experiencing more family discord communicating about cancer, or receiving fewer aggressive treatments in the early treatment phase for late‐stage cancer.
Highlights in Emergency Medicine Medical Education Research: 2008
Authors: Farrell Susan E. , Coates Wendy C. , Khun Gloria J. , Fisher Jonathan , Shayne Philip , Lin Michelle
Published: December 2009

Objectives:  The purpose of this article is to highlight medical education research studies published in 2008 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine.

Methods:  Through a PubMed search of the English language literature in 2008, 30 medical education research studies were independently identified as hypothesis‐testing investigations and measurements of educational interventions. Six reviewers independently rated and scored all articles based on eight anchors, four of which related to methodologic criteria. Articles were ranked according to their total rating score. A ranking agreement among the reviewers of 83% was established a priori as a minimum for highlighting articles in this review.

Results:  Five medical education research studies met the a priori criteria for inclusion and are reviewed and summarized here. Four of these employed experimental or quasi‐experimental methodology. Although technology was not a component of the structured literature search employed to identify the candidate articles for this review, 14 of the articles identified, including four of the five highlighted articles, employed or studied technology as a focus of the educational research. Overall, 36% of the reviewed studies were supported by funding; three of the highlighted articles were funded studies.

Conclusions:  This review highlights quality medical education research studies published in 2008, with outcomes of relevance to teaching and education in emergency medicine. It focuses on research methodology, notes current trends in the use of technology for learning in emergency medicine, and suggests future avenues for continued rigorous study in education.