bluuebunny/crossref_metadata_2025 huggingface dataset:
Occupational allergy in laboratory workers caused by the African migratory grasshopper Locusta migratoria
Authors: Lopata A. L. , Fenemore B. , Jeebhay M. F. , Gäde G. , Potter P. C.
Published: August 2005

Background:  Recent reports of fatal asthma cases associated with swarms of locusts affecting African countries have highlighted the importance of this insect in causing asthma morbidity and mortality. However, only limited information is available about the allergic health outcomes such as asthma and its determinants in exposed individuals. In this study, workers exposed to the African migratory locust Locusta migratoria were evaluated for allergic health outcomes as well as the nature of the offending allergens.

Methods:  Ten scientists and technicians exposed to locusts in a laboratory were investigated for locust‐related allergy using questionnaires and immunological tests. The presence of allergy was determined by quantification of specific IgE and IgG to L. migratoria using the UniCAP® system and via skin‐prick testing (SPT). The allergens were characterized by Western blot and ImmunoCAP inhibition assays.

Results:  Six of the 10 workers experienced symptoms ranging from urticaria and rhinoconjuctivitis to asthma. Seven individuals demonstrated sensitivity on SPT and five had specific IgE antibodies to L. migratoria. Significant cross‐reactivity was demonstrated for allergens in the locust faeces, body and wings but not to cockroach allergens. Novel allergens with molecular weights of approximately 70 kDa were identified in locust wings, which are distinctly different from other known allergen sources from locusts.

Conclusion:  Exposure to L. migratoria allergens is a potential sensitizer in exposed individuals. Raised levels of locust‐specific IgE can be readily quantified. The wings of this insect species have been identified as a novel allergen source.
Bahia grass pollen specific IgE is common in seasonal rhinitis patients but has limited cross‐reactivity with Ryegrass
Authors: Davies J. M. , Bright M. L. , Rolland J. M. , O'Hehir R. E.
Published: August 2005

Background:  Perennial Ryegrass is a major cause of rhinitis in spring and early summer. Bahia grass, Paspalum notatum, flowers late into summer and could account for allergic rhinitis at this time. We determined the frequency of serum immunoglobulin (Ig)E reactivity with Bahia grass in Ryegrass pollen allergic patients and investigated IgE cross‐reactivity between Bahia and Ryegrass.

Methods:  Serum from 33 Ryegrass pollen allergic patients and 12 nonatopic donors were tested for IgE reactivity with Bahia and Ryegrass pollen extracts (PE) by enzyme‐linked immunosorbent assay (ELISA), western blotting and inhibition ELISA. Allergen‐specific antibodies from a pool of sera from allergic donors were affinity purified and tested for IgE cross‐reactivity.

Results:  Seventy‐eight per cent of the sera had IgE reactivity with Bahia grass, but more weakly than with Ryegrass. Antibodies eluted from the major Ryegrass pollen allergens, Lol p 1 and Lol p 5, showed IgE reactivity with allergens of Ryegrass and Canary but not Bahia or Bermuda grasses. Timothy, Canary and Ryegrass inhibited IgE reactivity with Ryegrass and Bahia grass, whereas Bahia, Johnson and Bermuda grass did not inhibit IgE reactivity with Ryegrass.

Conclusions:  The majority of Ryegrass allergic patients also showed serum IgE reactivity with Bahia grass PE. However, Bahia grass and Ryegrass had only limited IgE cross‐reactivity indicating that Bahia grass should be considered in diagnosis and treatment of patients with hay fever late in the grass pollen season.
Effect of budesonide and montelukast in asthmatic children exposed to relevant allergens
Authors: Peroni D. , Bodini A. , Miraglia Del Giudice M. , Loiacono A. , Baraldi E. , Boner A. L. , Piacentini G.
Published: August 2005

Background: Montelukast has been shown to be effective in controlling the increase in exhaled NO in asthmatic children re‐exposed to house dust mite (HDM). This study compared the effect of low dose inhaled budesonide and oral montelukast in preventing the expected relapse of airway inflammation and reactivity in a group of 24 mild asthmatic children allergic to HDM after a brief period of exposure to relevant allergens.

Methods: Lung function, bronchial hyperresponsiveness (BHR) to methacholine (PC20), fractional exhaled nitric oxide (FeNO) levels and sputum eosinophilia were evaluated.

Results: Pulmonary function remained stable. The BHR was unchanged after exposure in the group treated with budesonide, whereas a significant increase (P = 0.028) was observed in the patients receiving montelukast. No significant difference was observed in FeNO levels after exposure to mite antigen in the two groups. In both the groups of asthmatic children we observed a significant increase in sputum eosinophil % after the exposure to mite antigen.

Conclusions: The significant increase in BHR level observed in the group of children receiving montelukast suggests a more comprehensive effect as disease controller by inhaled steroids than by leukotriene antagonist in allergic asthmatic children re‐exposed to relevant allergens.
Analysis of exhaled leukotrienes in nonasthmatic adult patients with seasonal allergic rhinitis
Authors: Čáp P. , Pehal F. , Chládek J. , Malý M.
Published: August 2005

Background:  Leukotrienes (LTs) are increased in exhaled breath condensate (EBC) in patients with asthma. So far no data have been reported about LT levels in nonasthmatic patients with seasonal allergic rhinitis (SAR). The aim of the study was to find out whether the LT levels in EBC were increased in the nonasthmatic adult patients with SAR both during and after the pollen season in comparison with healthy controls and to assess the changes of the LT levels after the pollen season.

Methods:  Twenty‐nine nonasthmatic adult patients with SAR underwent measurement of exhaled LTs in the EBC during and after the pollen season. Leukotrienes B4, C4, D4 and E4 were analysed by a specific and sensitive gas chromatography/mass spectrometry (GC/MS) assay and compared with 50 healthy nonsmoking controls. Spirometry, skin prick tests and nonspecific IgE were evaluated.

Results:  Leukotrienes concentrations (B4, E4 but not D4) were significantly increased in and after the pollen season in patients with SAR in comparison with healthy controls. In most of the samples, LT C4 was undetectable. The values of all exhaled LTs were significantly decreased after the pollen season compared with the seasonal baseline: LTB4 (P = 0.023), LTD4 (P = 0.020), LTE4 (P = 0.047).

Conclusions:  Levels of exhaled LTB4 and LTE4 were higher in SAR patients than in healthy controls and decreased after the pollen season as compared with levels in season. The SAR patients with the highest in season LT levels had also the post‐season levels elevated and this may be an early marker of inflammatory process in the lower airways despite the absence of clinical symptoms of asthma.
Immediate hypersensitivity to Malassezia furfur and Candida albicans mannans in vivo and in vitro
Authors: Kosonen J. , Lintu P. , Kortekangas‐Savolainen O. , Kalimo K. , Terho E. O. , Savolainen J.
Published: August 2005

Background:  Elevated and correlative Malassezia furfur (M. furfur) and Candida albicans (C. albicans) mannan‐specific IgE have been demonstrated in atopic eczema dermatitis syndrome (AEDS) of the head, neck and shoulder (HNS) region of the skin. The significance of these antibodies in vivo has not been demonstrated.

Methods:  Sixty‐five AEDS patients with HNS distribution were included. Serum total IgE (S‐IgE) and yeast antigen‐specific (Cetavlon‐purified mannan and whole extract antigens of M. furfur and C. albicans) IgE were measured and skin prick tests (SPT) were performed with the yeast antigens.

Results:  Mannan‐specific IgE and SPT were positive in 51 and 48% of patients with M. furfur and in 42 and 22% with C. albicans, respectively. Whole extract‐specific IgE and SPT were positive in 85 and 95% of patients with M. furfur and in 91 and 57% with C. albicans, respectively. The highest correlation between specific IgE and SPT was seen with M. furfur mannan (r = 0.60; P < 0.0001). Both M. furfur mannan‐specific IgE (r = 0.76; P < 0.0001) and SPT (r = 0.44; P = 0.0005) correlated with S‐IgE.

Conclusions:  Mannan‐induced immediate hypersensitivity in vivo was demonstrated in SPT. The significant correlation between M. furfur mannan‐specific IgE and SPT suggests that mannan is an important allergen in yeast hypersensitive AEDS in vivo.
Management of hypersensitivity reactions to iodinated contrast media
Authors: Brockow K. , Christiansen C. , Kanny G. , Clément O. , Barbaud A. , Bircher A. , DeWachter P. , Guéant J.‐L. , Rodriguez Guéant R.‐M. , Mouton‐Faivre C. , Ring J. , Romano A. , Sainte‐Laudy J. , Demoly P. , Pichler W. J. ,   ENDA,   the EAACI interest group on drug hypersensitivity
Published: August 2005

All iodinated contrast media (CM) are known to cause both immediate (≤1 h) and nonimmediate (>1 h) hypersensitivity reactions. Although for most immediate reactions an allergic hypersensitivity cannot be demonstrated, recent studies indicate that the severe immediate reactions may be IgE‐mediated, while most of the nonimmediate exanthematous skin reactions, appear to be T‐cell mediated. Patients who experience such hypersensitivity reactions are therefore advised to undergo an allergologic evaluation. Several investigators have found skin testing to be useful in confirming a CM allergy, especially in patients with nonimmediate skin eruptions. If a patient with confirmed allergy to a CM needs a new CM exposure, a skin test negative CM should be chosen and premedication may be tried. However, none of these precautional measures is a guarantee against a repeat reaction. More research focusing on pathomechanisms, diagnostic testing and premedication is therefore clearly needed in order to prevent CM‐induced hypersensitivity reactions in the future.
Investigation into relative slip during fretting fatigue under partial slip contact condition
Authors: SABELKIN V. , MALL S.
Published: August 2005

A finite element analysis based methodology was developed to compute local relative slip on contact surface from the measured global relative slip away from contact surface. A set of springs was included in finite element model to simulate fretting fatigue test system. Compliance of springs was calibrated by comparing experimental and computed global relative slips. This methodology was then used to investigate local relative slip during fretting fatigue in cylinder‐on‐flat contact configuration under partial slip contact condition for unpeened and shot‐peened titanium alloy, Ti–6Al–4V. Relative slip on contact surface is significantly smaller (about one order) than the measured global relative slip by using a conventional extensometer near the contact surface. Effects of coefficient of friction, rigidity of fretting fatigue system and applied stress to specimen on the global and local relative slips were characterized. Coefficient of friction and contact load have considerable effect on local relative slip, and practically no effect on global relative slip. Gross slip condition can develop at some locations on contact surface in spite of overall partial slip condition. Increase in rigidity of fretting fatigue system increases local relative slip but decreases global relative slip. Finally, fatigue life diagrams based on relative slip on contact surface are established for both unpeened and shot‐peened titanium alloy. These show the same characteristics as of the conventional S–N diagram where fatigue life decreases with increase of relative slip.
Basic Mechanisms of Gabitril (Tiagabine) and Future Potential Developments
Authors: Meldrum Brian S. , Chapman Astrid G.
Published: August 2005

Summary: Gabitril (tiagabine) is a potent selective inhibitor of the principal neuronal γ‐aminobutyric acid (GABA) transporter (GAT‐1) in the cortex and hippocampus. By slowing the reuptake of synaptically‐released GABA, it prolongs inhibitory postsynaptic potentials. In animal models of epilepsy, tiagabine is particularly effective against kindled (limbic) seizures and against reflexly‐induced generalized convulsive seizures. These data are predictive of its efficacy in complex partial seizures in humans. Possible clinical applications outside the field of epilepsy include bipolar disorder and pain.
Surgical Outcome of Epilepsy Patients Evaluated with a Noninvasive Protocol
Authors: Özkara Çigdem , Özyurt Emin , Hanoglu Lütfü , Eskazan Esat , Dervent Aysin , Koçer Naci , Özmen Mine , Onat Filiz , Öz Büge , Kuday Cengiz
Published: August 2005

Summary: Surgery is now an accepted treatment for some medically intractable epilepsies. Presurgical evaluation is particularly important for the localization of the epileptogenic zone, which may necessitate sophisticated imaging techniques and intracranial electroencephalogram (EEG) recordings. If patients are carefully selected, however, successful results can be achieved with noninvasive evaluation methods. Seventy‐seven patients were operated on for intractable seizures. All patients underwent EEG, neuropsychological, psychiatric, and magnetic resonance imaging investigations. Ictal EEG‐video recording was performed in all nonlesional and in some lesional cases that had discordant data. Selective amygdalo‐hippocampectomy was performed on patients with mesial temporal lobe epilepsy (MTLE), an extended or a limited lesionectomy was performed on patients with structural lesions, and a lesionectomy with deafferentation was performed on two patients with West syndrome. Electrocorticography was not used. Temporal lobe directed surgery was performed in 63·6% of the cases. The pathological examinations of all cases showed hippocampal sclerosis (HS) in 43%, tumor or tumor‐like lesions in 36%, and cortical dysplasia in 5% of patients. After a mean follow‐up of 17 months (range, 2–53), 75% of the patients were seizure‐free with or without aura and 15% had a marked improvement, whereas 10% did not benefit from surgery. Neuropsychological outcome of patients with MTLE and HS also showed worthwhile results. Our patients, who were evaluated without pre‐ and perioperative intracranial recordings and other sophisticated techniques, had an outcome comparable to those in other series from more experienced centers. Our experience indicates that successful results, especially for patients with MTLE‐HS and lesion‐related epilepsies, can be obtained at centers with limited resources if the diagnoses and evaluation procedures are performed carefully.
Quality of Phenobarbital Solid‐dosage Forms in the Urban Community of Nouakchott (Mauritania)
Authors: Laroche Marie‐Laure , Traore Hamidou , Merle Louis , Gaulier Jean‐Michel , Viana Marylene , Preux Pierre‐Marie
Published: August 2005

Summary:  Purpose: Epilepsy is a major public‐health problem in Africa. The quality of available drugs is a limiting factor for an adequate management. The aim of this study was to describe the proportion of poor‐quality phenobarbital (PB) solid‐dosage forms and evaluate the factors associated with its quality in Nouakchott (Mauritania).

Methods: A cross‐sectional study was carried out within pharmacies, hospitals, and on the parallel market in March 2003. PB samples were bought by a native person and then assayed by a liquid chromatography method. A package was considered to be of good quality if the active‐substance average content was between 85 and 115% of the stated content printed on the packet.

Results: Forty‐five pharmaceutical stores were visited, enabling us to collect 146 samples of PB. Three brand names were available in Nouakchott. They originated from France, Morocco, Senegal, and Egypt.

Results: A prevalence of 13.7%[95% confidence interval (CI), 8.8–20.0] of poor‐quality PB was found. All samples from Morocco were underdosed. The generic active content was satisfactory, but saccharose, an excipient with a potential side effects, was identified. Two factors associated with the good quality of PB have been put forward: tablets manufactured in France and loose packaging as generics conditioned in such a way were of good quality.

Conclusions: This study shows that the quality of antiepileptic drugs in Africa is still worrying. The setting up of medicine quality control in Mauritania is legitimate. Considering the good quality of generic PB and its lower cost, this type of medicine should be promoted in this region.
Management of Women with Epilepsy: Are Guidelines Being Followed? Results from Case‐note Reviews and a Patient Questionnaire
Authors: Kampman Margitta T. , Johansen Stein‐Vegar , Stenvold Helge , Acharya Ganesh
Published: August 2005

Summary:  Purpose: Several international guidelines for the management of women with epilepsy (WWE) have been developed since 1989. We aimed to determine whether guidelines for the management of WWE are followed and whether active implementation of such guidelines makes a difference to clinical practice.

Methods: The study covered a 2‐year period of “passive dissemination” of guidelines followed by a 2‐year period of “active implementation.” Documentation reflecting adherence to the guidelines was abstracted retrospectively from electronic medical records on 215 WWE aged 16–42 years. Data abstracted from case notes included counselling on contraception and pregnancy‐related issues; follow‐up during pregnancy; advice on supplementation of folic acid, calcium, and vitamin D; and serum folate measurements. A questionnaire assessing the knowledge of WWE issues was completed by 112 (71%) of 157 patients.

Results: Documentation that WWE issues had been addressed was found in approximately one third of medical case records with no measurable effect of active implementation. Only the follow‐up during pregnancy seemed to have improved. Serum folate measurements in 51 women treated with enzyme‐inducing antiepileptic drugs (AEDs) revealed folate deficiency in 11 (22%). Respondents to the questionnaire recalled having received information from their neurologists on the interaction between AEDs and oral contraceptives (46%), need to plan pregnancy (63%), and folic acid requirement (56%).

Conclusions: Judged by a review of documentation in case notes, active implementation of guidelines had no measurable effect on clinical practice. However, the follow‐up during pregnancy seemed to have improved. Patients' knowledge of WWE issues compared favorably with published studies. Better strategies are needed to secure successful implementation of guidelines.
Time Course and Mapping of Cerebral Perfusion during Amygdala Secondarily Generalized Seizures
Authors: Chassagnon Serge , De Vasconcelos Anne Pereira , Ferrandon Arielle , Koning Estelle , Marescaux Christian , Nehlig Astrid
Published: August 2005

Summary:  Purpose: Measurement of local cerebral blood flow (LCBF) is routinely used to locate the areas involved in generation and spread of seizures in epilepsy patients. Because the spatial distribution and extent of ictal CBF depends on the epileptogenic network, but also on the timing of injection of tracer, we used a rat model of amygdala‐kindled seizures to follow the time‐dependent changes in the distribution of LCBF changes.

Methods: Rats were implanted in the left amygdala and were fully kindled. LCBF was measured by the quantitative [14C]iodoantipyrine autoradiographic technique bilaterally in 35 regions. The tracer was injected at 30 s before seizure induction (early ictal), simultaneous with the application of stimulation (ictal), at 60 s after stimulation (late ictal), at the end of the electrical afterdischarge (early postictal), and at 6 min after the stimulation (late postictal).

Results: Rates of LCBF increased over control levels during the early ictal phase ipsilaterally in medial amygdala, frontal cortex, and ventromedian thalamus and bilaterally in the whole hippocampus, thalamic nuclei, and basal ganglia. During the ictal phase, all regions underwent hyperperfusion (81–416% increases). By 60 s after stimulation, rates of LCBF returned to control levels in most brain areas, despite ongoing seizure activity. At later times, localized foci of hypoperfusion were observed in hippocampus bilaterally, with a slight predominance in CA1 on the side of origin of the seizures.

Conclusion: This study shows a rapid spread of activation from the stimulated amygdala bilaterally to numerous limbic, cortical, and subcortical structures. The largest hyperperfusion was recorded during the ictal period with tracer injections simultaneous with the stimulation. The unilateral site of origin of seizures led to minor asymmetrical and lateralized findings, merely at early ictal and late postictal times, whereas intermediate tracer injections induced bilateral changes. Only late postictal measurements allowed the identification of significant changes in focal structures: the hippocampus is known to play a critical role in the spread of limbic seizures.
Socioeconomic Status Is a Risk Factor for Epilepsy in Icelandic Adults but Not in Children
Authors: Hesdorffer Dale C. , Tian Hong , Anand Kishlay , Hauser W. Allen , Ludvigsson Petur , Olafsson Elias , Kjartansson Olafur
Published: August 2005

Summary: Purpose:Two earlier population‐based studies provide conflicting information on the association between low socioeconomic status (SES) and risk for epilepsy. Seizure etiologies (e.g., head injury, stroke) associated with low SES were not addressed in prior analyses. We assess the relation between SES indices and incident epilepsy separately for children and adults and in subgroups defined by seizure etiology.

Methods:In this population‐based case–control study, a surveillance system identified incident unprovoked seizure or first diagnosis of epilepsy throughout Iceland (n = 418). Controls were selected from the population registry as the next two same‐sex births alive, residing in Iceland at the time of the index seizure, and without a history of unprovoked seizure on the date of the case's incident seizure (n = 835). The odds ratio measured the association between SES and epilepsy.

Results:An association was found between epilepsy and SES among adults, but not among children. Among adults, low education was associated with an increased risk for epilepsy [odds ratio (OR), 2.29; 95% confidence interval (CI), 1.21–4.34), and home ownership was protective (OR, 0.63; 95% CI, 0.43–0.92). When analyses were repeated by seizure etiology, this association remained only in the group with epilepsy of unknown cause, even after adjusting for alcohol consumption.

Conclusions:Low SES, indexed by low education or lack of home ownership, is a risk factor for epilepsy in adults, but not in children, suggesting a cumulative effect of SES on risk for epilepsy. This association is not explained by established risk factors for epilepsy (e.g., head injury, stroke). We find no evidence of a downward social drift among cases whose parents had epilepsy.
Prognostic Factors for the Surgery for Mesial Temporal Lobe Epilepsy: Longitudinal Analysis
Authors: Jeong Sang‐Wuk , Lee Sang Kun , Hong Keun‐Sik , Kim Kwang‐Ki , Chung Chun‐Kee , Kim Ho
Published: August 2005

Summary:  Purpose: Determining long‐term prognostic factors of surgery for mesial temporal lobe epilepsy (MTLE) is important for identifying ideal candidates and predicting the prognosis for individual patients. We tried to identify the prognostic factors of anterior temporal lobectomy (ATL) for MTLE with longitudinal multivariate analysis.

Methods: Two hundred twenty‐seven patients with MTLE were included in this study. The primary outcome variable was patient status 1–5 years after surgery: seizure free, or not. Clinical characteristics and recent diagnostic modalities were considered as prognostic factors. Univariate and standard multiple logistic‐regression analysis for outcome at 1 and 5 years after surgery and the generalized estimation equation (GEE) model for longitudinal multiple logistic regression of the 5‐year follow‐up period were used.

Results: The seizure‐free rate at 1 year was 81.1% and decreased to 75.2% at 5 years after surgery. By the univariate or standard multiple logistic‐regression analysis, age at surgery or hippocampal sclerosis on magnetic resonance imaging (MRI) ipsilateral to surgery was significant for the postsurgical outcome. However, the longitudinal analysis by the GEE model revealed that younger age at surgery [odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43–0.81], absence of secondarily generalized tonic–clonic seizure (2°GTCS; OR, 0.45; 95% CI, 0.26–0.79), and hippocampal sclerosis on MRI (OR, 2.44; 95% CI, 1.11–5.26) were significant predictors of a good surgical outcome.

Conclusions: Age at surgery, presence of 2°GTCS, and hippocampal sclerosis on MRI are independent prognostic factors for ATL in MTLE. These findings suggest that MTLE is a progressive disorder, and surgical outcome is better when early ATL is performed.
Separation of Antiepileptogenic and Antiseizure Effects of Levetiracetam in the Spontaneously Epileptic Rat (SER)
Authors: Yan Hai‐Dun , Ji‐qun Cai , Ishihara Kumatoshi , Nagayama Takashi , Serikawa Tadao , Sasa Masashi
Published: August 2005

Summary: Purpose:The long‐lasting antiseizure effects of levetiracetam (LEV) have been observed in the spontaneously epileptic rat (SER) that expresses both tonic and absence‐like seizures. Furthermore, the antiepileptogenic effects of LEV in addition to antiseizure effects have been reported in the amygdala‐kindling model in rats. This suggests that the long‐lasting seizure protection of LEV may be at least partly due to its antiepileptogenic effects. Therefore this study aimed to differentiate the antiseizure and potential antiepileptogenic effects of LEV by administering LEV continuously to SERs before the appearance of any seizure expression.

Methods:LEV was administered to the SERs at 80 mg/kg/day (i.p.) from postnatal weeks 5 to 8. The period of observation for tonic convulsions was from postnatal week 5 to 13. Absence‐like seizures were recorded by using conventional EEG in weeks 12 and 13.

Results:After age 7–8 weeks, SERs exhibit spontaneous tonic convulsions. Development of tonic convulsions was significantly inhibited in the LEV group, compared with the control group, by the middle of week 9. A significant reduction of tonic convulsions also was observed in the LEV group until week 13 (5 weeks after termination of the administration). In week 12, the absence‐like seizures were significantly lower in the LEV group, compared with the control group.

Conclusions:This study demonstrates a significant inhibition of seizures after prolonged treatment with LEV before the developmental expression of seizure activity in SERs. This effect is suggested to be due to an antiepileptogenic effect and not an antiseizure effect of LEV, because the half‐life of the drug in plasma is short (2–3 h in rats) after single and long‐term administration. Furthermore, the inhibition of seizure expression in SERs was still apparent 5 weeks after termination of LEV treatment. These results further suggest that LEV possesses not only antiseizure effects but also antiepileptogenic properties.
Antiglial Cell Autoantibodies and Childhood Epilepsy: A Case Report
Authors: Roubertie Agathe , Boukhaddaoui Hassan , Sieso Victor , De Saint‐Martin Anne , Lellouch‐Tubiana Arielle , Hirsch Edouard , Echenne Bernard , Valmier Jean
Published: August 2005

Summary:  We report the case of a patient with severe partial epilepsy associated with a focal rolandic, pathologically proven, cortical dysplasia. By measuring intracellular calcium concentrations, functional antiglial non–glutamate receptor 3 (GluR3) autoantibodies were identified in the serum of this patient. Antineuronal autoantibodies, which interfere with GluR3‐receptor function, also were detected. This observation provides new clues about the involvement of immunologic mechanisms in epileptic disorders.
Transient Left Ventricular Basal Dysfunction without Coronary Stenosis in Acute Cerebral Disorders: A Novel Heart Syndrome (Inverted Takotsubo)
Authors: Ennezat Pierre V. , Pesenti‐Rossi David , Aubert Jean Marc , Rachenne Virginie , Bauchart Jean Jacques , Auffray Jean Luc , Logeart Damien , Cohen‐Solal Alain , Asseman Philippe
Published: August 2005

Myocardial dysfunction without coronary involvement may occur in acute cerebral diseases. We report 4 cases where, in the context of acute cerebral disorder, the echocardiograms revealed an extensive left ventricular circumferential akinesis except at the apex. Besides, for three of those cases no coronary disease has been highlighted. Recognition of such a pattern of LV dysfunction should lead to the search for an acute cerebral disease.
Association between Intraventricular Myocardial Systolic Dyssynchrony and Ventricular Arrhythmias in Patients with Hypertrophic Cardiomyopathy
Authors: D'Andrea Antonello , Caso P. , Severino S. , Scotto di Uccio F. , Vigorito F. , Ascione L. , Scherillo M. , Calabrò R.
Published: August 2005

Background: The distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with hypertrophic cardiomyopathy (HCM), which results in regional heterogeneity of LV systolic and diastolic function. The aim of the study was to evaluate LV regional systolic asynchrony in patients with HCM by pulsed Doppler myocardial imaging (DMI). Methods: We studied 35 HCM patients and 45 age‐ and sex‐matched controls. By the use of DMI, the following five different basal myocardial segments were measured: systolic peak velocity (Sm); early‐ and late‐diastolic peak velocities; pre‐contraction time (Q‐Sm) (from the beginning of Q‐wave of ECG to the onset of Sm); intraventricular systolic delay (IntraV‐Del) (difference of Q‐Sm in different LV myocardial segments); interventricular delay (InterV‐Del) (difference of Q‐Sm between the most delayed LV segment and right ventricular lateral wall). Results: DMI analysis showed in HCM lower myocardial systolic and early‐diastolic peak velocities of all the analyzed segments. As for time intervals, controls showed homogeneous systolic activation of the ventricular walls. Conversely, HCM group, despite the absence of intraventricular conduction defects by surface ECG, showed significant both Inter‐ and IntraV‐Del (P < 0.0001). Linear regression models pointed out independent positive associations of IntraV‐Del with LV outflow gradient and septal wall thickness in HCM (P < 0.001). An IntraV‐Del >30 msec well differentiated controls and HCM. In addition, an IntraV‐Del > 45 msec (ROC curve) identified a subgroup of HCM patients with nonsustained ventricular tachycardia during Holter monitoring (90.9% sensitivity and 95.8% specificity). Conclusions: The impairment of intrarventricular systolic synchronicity is strongly related to increased septal thickness and LV outflow‐tract gradient in HCM. DMI analysis may be able to select subgroups of HCM patients at an increased risk of ventricular tachyarrhythmias.
Korean‐American Mothers’ Perception of Professional Support in Early Intervention and Special Education Programs
Authors: Cho Su‐Je , Gannotti Mary E.
Published: August 2005

Abstract  Twenty Korean‐American mothers of children with disabilities participated in interviews concerning perceptions of the expertise, attitudes, and behavior of social and educational service providers, differences in cultural values and communication styles, and the need and use of translation services. Mothers reported satisfaction with the availability of services and expertise of professionals. Mothers were dissatisfied with repeatedly requesting services, dealing with professionals who disenfranchised and marginalized them, and in managing Individualized Education Plan (IEP) meetings; difficulties to which differences in cultural values and communication styles substantially contribute. Mothers reported on concerns about translators and suggested some attributes that a qualified translator should possess. Sensitivity and respect for parents’ emotions, requests, and need for support from service providers are essential, especially for providers who aim to nurture parental engagement and promote a positive educational experience for children and their families of diverse cultural backgrounds.
African‐American Developmental Disability Discourses: Implications for Policy Development
Authors: Terhune Peggy S.
Published: August 2005

Abstract  Formal developmental disabilities services are often underutilized, especially by low‐income African‐American families. This study examined the basis for interactions and service use preferences of African‐American woman who cared for an adult female child with a disability. Diverse African‐American perspectives were observed by analyzing the discourse of 11 low‐income African‐American carers using a direct informant interview technique. Two distinct discourses were identified: a “secular professional” discourse and a “spiritual kin” discourse. Families using the secular professional discourse made use of formal developmental disabilities services in a manner similar to European‐American heritage families. Families using the spiritual kin discourse tended to rely on natural or informal supports rather than the developmental disabilities service system, as the system did not exemplify the values that these families profess. It was observed that the discourses result in two distinct worldviews, and two distinct ways of accessing the developmental disabilities system. Recommendations are proffered for changes within the developmental disabilities service system to accommodate diverse cultures and families. A key recommendation involves modifying the system to accommodate worldviews of disability other than the currently used scientific biomedical view.
Leisure Education and Later‐Life Planning: A Conceptual Framework
Authors: Mactavish Jennifer , Mahon Michael J.
Published: August 2005

Abstract  Older adults with intellectual disability represent a growing segment of the elderly population in developed and, to some extent, in developing nations worldwide. A considerable body of research has addressed this burgeoning demographic over the past 20 years. Although some variations appear within etiological subgroups, the biological processes of aging and related concerns (e.g., changes in health status) are similar for people independent of whether a person has an intellectual disability. The unique life experiences of individuals with intellectual disabilities, however, introduce social and environmental factors and practices that affect healthy aging and life quality, but are less well understood. As such, later‐life planning is an accepted, although not always practiced, mechanism used and directed by adults without disabilities to plan for their futures in later life. Planning for this life stage among older adults with intellectual disabilities, if it is done at all, typically is a parent/family‐driven process with a limited scope of focus (e.g., guardianship, financial security). Drawing on previous research in the areas of later‐life planning and leisure education, the authors present a conceptual rationale for melding these two processes and propose principles and content elements that could facilitate the use of leisure education as a framework for holistically exploring later‐life options and issues.
Impact of a Consumer‐Directed Family Support Program on Reduced Out‐of‐Home Institutional Placement
Authors: Heller Tamar , Caldwell Joe
Published: August 2005

Abstract The impact of a consumer‐directed family support program on actual out‐of‐home placement in one American state was evaluated over an 8‐year period. Under this program, individuals with intellectual disabilities and their families control their own resources and design and direct supports through the use of cash allowances or individualized budgets. It was observed that individuals with disabilities enrolled in the family support program were significantly less likely than individuals with disabilities on a waiting list to move into an out‐of‐home placement, particularly to an institution, after controlling for differences in ethnic group and age.
Audiological Rehabilitation in Adults with Intellectual Disability: Why Does It Fail?
Authors: Meuwese‐Jongejeugd Anneke , Harteloh Peter , Verschuure Hans , Nijs Lau , Koot Hans , Evenhuis Heleen
Published: August 2005

Abstract  Reported here are the preliminary results of a study in the Netherlands to provide service and aid to persons with intellectual disability (ID) and hearing impairment. Participants were people with ID in two residential care centers and three community‐based services. In spite of a planned design the implementation failed or remained incomplete in all five ID services. We conclude from this experience that innovative projects in ID services should not only concentrate on people (available trained professionals) and means (equipment, imbursement, guidelines, procedures), but involvement of the “local care providers,” which requires adequate management, is a factor ultimately determining success or failure.
History of evidence‐based medicine. Oranges, chloride of lime and leeches: Barriers to teaching old dogs new tricks
Authors: Doherty Steven
Published: August 2005

Knowledge translation is the process of taking evidence from research and applying it in clinical practice. In this article I will cite some pivotal moments in the history of medicine to highlight the difficulties and delays associated with getting evidence into practice. These historical examples have much in common with modern medical trials and quality improvement processes. I will also review the reasons why evidence is not used and consider what factors facilitate the uptake of evidence. Understanding these concepts will make it easier for individual clinicians and institutions to change clinical behaviour and provide a starting point for those looking at implementing ‘new’ practices, new therapies and clinical guidelines. Finally, I will offer a list of criteria that clinicians might choose to consider when deciding on whether or not to adopt a new practice, treatment or concept.
Rapid health assessment in Aceh Jaya District, Indonesia, following the December 26 tsunami
Authors: Brennan Richard J ,   Kamaruddin Rimba
Published: August 2005

Objectives:  To rapidly determine the public health impact of the Asian tsunami on the population of three communities in Aceh Jaya District, Indonesia, and to prioritize health interventions.

Methods:  Rapid health assessment, utilizing direct observations, interviews with key informants, a single focus group discussion, town mapping, a review of medical records and a systematic random sample of the entire town of Calang, capital of Aceh Jaya District, Indonesia.

Results:  Almost 100% of dwellings were destroyed in all three communities. For the town of Calang: only 18.2% of the pre‐tsunami population remained 2 weeks following the disaster, with an estimated 70% of the population having died at the time of impact; government estimates of the remaining population were inflated by approximately 250%; mortality rates were not elevated post‐tsunami; 100% of the population lacked access to sanitation and clean water; 85% of children under 5 years reported diarrhoea over the preceding 2 week period; 95% of individuals with a medical complaint reported satisfactory access to clinical care; acute malnutrition was not a significant problem; and over one‐fifth of households were hosting an orphan. For the villages of Rigah and Sayeung: approximately 46.2 and 86.0% of the population survived the tsunami impact, respectively; mortality rates were not elevated post tsunami; 100% of the population lacked access to sanitation and clean water; diarrhoea was the main cause of morbidity; primary care services were available only in Rigah; and only Rigah had received external assistance.

Conclusions:  Almost two‐thirds of the population of the three communities died as a result of the tsunami's impact. Although mortality rates were not elevated post tsunami, significant threats to public health persisted, especially water‐borne diseases. Priority activities included emergent environmental health interventions, mobile clinics to the two villages and a more detailed assessment of the needs of orphans. Data were shared with agencies better placed to address needs in the areas of shelter and food aid.
Substance misuse, anxiety and depression and urgency of presentation to a public emergency department in Australia
Authors: Kinner Stuart A , Alati Rosa , Watt Kerrianne , Najman Jake M , Fowler Greg , Green David
Published: August 2005

Objectives:  To establish the prevalence and comorbidity of substance‐related problems and anxiety and depression, among ED presentations, and to compare the prevalence of these conditions among more and less urgent presentations.

Design and setting:  Cross‐sectional survey of ED presentations over a 14 day period (24 h/day) at the Gold Coast Hospital Emergency Department in south‐east Queensland, Australia, in October 2002.

Measures:  Usual level of alcohol consumption (Alcohol Use Disorders Identification Test), acute alcohol and illicit drug use (during 24 h prior to interview), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale) and triage category (Australasian Triage Scale).

Results:  Thirty‐one per cent of the sample reported usually consuming alcohol at a hazardous or harmful level. Twenty per cent of participants reported clinically significant levels of anxiety and/or depression, which were in turn significantly associated with hazardous and harmful levels of alcohol use. Hazardous/harmful alcohol consumption was over‐represented among less urgent ED presentations, whereas anxiety and depression were more prevalent among more urgent ED presentations.

Conclusions:  Emergency departments in Australia are appropriate settings for the detection of both substance use and mental health problems in the wider community. The prevalence of these problems in ED settings is high and there is a need for the development of systematic screening and referral processes. The evidence of a link between urgency of presentation and these problems needs to be further explored.
Helicopter primary retrieval: Tasking who should do it?
Authors: Cameron Stephen , Pereira Peter , Mulcahy Richard , Seymour Jamie
Published: August 2005

Background:  Cairns Base Hospital utilizes a helicopter retrieval system, which until 2001 had been tasked and staffed by emergency physicians. Since 2001, the ambulance service has assumed the role of both tasking and staffing the helicopter with intensive care paramedics. The present study examines whether the change has resulted in different activation patterns and patient outcomes.

Method:  A retrospective chart review over 4 consecutive years, comparing the two groups, was carried out examining 30 day mortality, length of in‐hospital stay, transfer rates, the Revised Trauma Score where appropriate and rates of discharge directly from the ED.

Results:  A total of 374 patients were retrieved (211 patients in the emergency physician group from 1 April 1999 to 31 March 2001 and 163 in the ambulance group from 1 April 2001 to 31 March 2003) over the 4 year period. The demographics of the two groups were similar. Fifty‐four patients in the ambulance group (33.1%) were discharged from the ED without admission while 31 (14.7%) were discharged from the physician group. This was statistically significant (P = 0.0001). There were no other significant differences between the two groups. The subgroup of patients admitted also did not show any significant difference in outcomes.

Conclusion:  The similarities in outcomes for admitted patients support the view that both groups have similar tasking criteria for high‐acuity patients and suggest that paramedics are as efficacious as physicians in delivering prehospital care in this group of patients. However, for lower‐acuity patients, there is a statistically significant higher rate of clinically unnecessary taskings by the ambulance group. Given the recent fatal aeromedical accidents in Queensland (Thursday Island 1998, Rockhampton 1999 and Mackay 2003), it would seem prudent to reduce clinically unnecessary retrievals through clinical coordination with appropriately qualified emergency physicians.
Model Tests on Current Forces on a Large Bridge Pier Near an Existing Pier
Authors: Chakrabarti Subrata K. , McBride Mark
Published: August 2005

A suspension bridge is being built over the Tacoma Narrows, Washington. The bridge will be placed on a structure mounted on two large concrete caissons, which will be exposed to strong currents. The piers are of rectangular section with chamfered edges in the upper portion. The caissons are being built at site while floating and moored in high currents. There are no known analytical methods or experimental data available on such structures at high Reynolds number. In order to determine the forces on the caisson due to current, a series of scaled physical model tests of one of the caissons was carried out. The forces on the caisson were measured in the presence of the existing bridge pier and the bottom contours of the Narrows were accurately modeled. The model scale was chosen as 1:100 and the tests were performed for the caisson at different drafts. This paper describes the test setup, and measurement system for a series of fixed caisson tests and demonstrates the consistency of the test data. The measured inline drag and transverse lift forces on the fixed caisson at different drafts are presented and the effect of the fluid velocity and flow vorticity on the frequency contents in the forces is discussed. The interaction effect of the neighboring existing pier on the current forces on the caisson is investigated. Since the measured forces were applied in the design analysis of the caissons, the scaling effect of the model test is also discussed. This paper is accompanied by two other papers, which form a group of three papers related to the project describing the current excitation on the caisson and the associated caisson responses. The other two papers in succession are by Chakrabarti et al. (J. Offshore Mech. Arct. Eng., to be published) and Chakrabarti and McBride (J. Offshore Mech. Arct. Eng., to be published). The paper by Chakrabarti et al. describes the numerical computation of the current forces on the caisson by a three-dimensional analysis, while the paper by Chakrabarti and McBride uses the information from these two papers to determine the motion response of the caissons and the mooring line tensions.
Electrical transport properties of ultrathin metallic films
Authors: Tay Maureen , Li Kebin , Wu Yihong
Published: August 2005

Ultrathin metal films of Al, Au, Cr, Cu, Ru, Ta, Co90Fe10, Ni81Fe19, Ir20Mn80 with or without capping layers have been prepared using ultrahigh vacuum sputtering and their morphological and electrical properties have been studied using atomic force microscopy and four-point probe measurement, respectively. It was found that the capping layer could either enhance or reduce the conductivity, depending on the capping layer thickness and surface roughness of the underlying film. The study of magnetoresistance (MR) dependence on capping and free layer thickness is also carried out on a pseudo spin valve.