bluuebunny/crossref_metadata_2025 huggingface dataset:
Is healthy eating all about nutrition?
Authors: Young Ian
Published: March 2003

Summary This paper reviews some of the factors, in addition to nutrition, which require to be integrated into policy‐making on healthy eating. A historical perspective includes issues such as school meals and the re‐emergence of infectious diseases and food safety as issues in the 1980’s. Issues related to genetics, the environment, sustainability and the increasing power of consumers are explored.
A hybrid Bacillus thuringiensis delta‐endotoxin gives resistance against a coleopteran and a lepidopteran pest in transgenic potato
Authors: Naimov Samir , Dukiandjiev Stefan , De Maagd Ruud A.
Published: March 2003

Expression of Bacillus thuringiensis delta‐endotoxins has proven to be a successful strategy for obtaining insect resistance in transgenic plants. Drawbacks of expression of a single resistance gene are the limited target spectrum and the potential for rapid adaptation of the pest. Hybrid toxins with a wider target spectrum in combination with existing toxins may be used as tool to mitigate these problems.

 In this study, Desiree potato plants were genetically modified to resist attack by insect species belonging to the orders Coleoptera and Lepidoptera, through the insertion of such a hybrid gene, SN19. Transgenic plants were shown to be resistant against Colorado potato beetle larvae and adults, potato tuber moth larvae, and European corn borer larvae. These are the first transgenic plants resistant to pests belonging to two different insect orders. In addition, the target receptor recognition of this hybrid protein is expected to be different from Cry proteins currently in use for these pests. This makes it a useful tool for resistance management strategies.
Transcriptional control of nutrient partitioning during rice grain filling
Authors: Zhu Tong , Budworth Paul , Chen Wenqiong , Provart Nicholas , Chang Hur‐Song , Guimil Sonia , Su Wenpei , Estes Bram , Zou Guangzhou , Wang Xun
Published: March 2003

Cereal grains accumulate carbohydrates, storage proteins and fatty acids via different pathways during their development. Many genes that participate in nutrient partitioning during grain filling and that affect starch quality have been identified. To understand how the expression of these genes is coordinated during grain development, a genomic approach to surveying the participation and interactions of all the pathways is necessary. Using recently published rice genome information, we designed a rice GeneChip microarray that covers half the rice genome. By monitoring the expression of 21 000 genes in parallel, we identified genes involved in the grain filling process and found that the expression of genes involved in different pathways is coordinately controlled in a synchronized fashion during grain filling. Interestingly, a known promoter element in genes encoding seed storage proteins, AACA, is statistically over‐represented among the 269 genes in different pathways with diverse functions that are significantly up‐regulated during grain filling. By expression pattern matching, a group of transcription factors that have the potential to interact with this element was identified. We also found that most genes in the starch biosynthetic pathway show multiple distinct spatial and temporal expression patterns, suggesting that different isoforms of a given enzyme are expressed in different tissues and at different developmental stages. Our results reveal key regulatory machinery and provide an opportunity for modifying multiple pathways by manipulating key regulatory elements for improving grain quality and quantity.
Long‐term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999
Authors: Ayyad C. , Andersen T.
Published: March 2003

Methods: MEDLINE surveys were carried out and reference lists were cross‐checked to identify publications on long‐term outcome for dietary treatment of obesity. 898 papers were identified, 17 fulfilled our planned criteria for inclusion (dietary treatment; adults; follow‐up period ≥ 3 years; follow‐up rate ≥ 50% of original study group; information on one of the success criteria: maintenance of all weight initially lost (or further weight reduction) or maintenance of at least nine to 11 kg of initial weight loss; obesity complications of the patient group not over‐represented; English, German or Scandinavian languages). Results: The 17 included publications (hereof three publications on randomized clinical trials with control group relevant for this review) reported on 21 study groups, comprising 3030 patients. Of these 2131 (70%) were followed‐up for 3–14 years (median 5 years). Mean initial weight loss ranged from four to 28 kg (median 11 kg). Overall, 15% (median, range 0–49%) of followed‐up patients fulfilled one of the criteria for success. Overall, success rates seemed stable for up to 14 years of observation. Diet combined with group therapy lead to better long‐term success rates (median 27%) than did diet alone (median 15%) or diet combined with behaviour modification (median 14%). Active follow‐up was generally associated with better success rates than was passive follow‐up (19% vs. 10%). Conventional diet seemed to be most efficacious in addition with group therapy, whereas VLCD apparently was most efficacious if combined with behaviour modification and active follow‐up. Conclusion: The literature on long‐term follow‐up of dietary treatment of obesity, although limited and inhomogeneous, points to an overall median success rate of 15% and a possible adjuvant effect of group therapy, behaviour modification and active follow‐up.
Metabolically active components of fat‐free mass and resting energy expenditure in humans: recent lessons from imaging technologies
Authors: Müller M. J. , Bosy‐Westphal A. , Kutzner D. , Heller M.
Published: March 2003

Imaging technologies, i.e. magnetic resonance imaging (MRI), computer tomography (CT) and dual‐energy X‐ray absorptiometry (DEXA), are precise and accurate techniques used to study lean body mass and adipose tissue distribution. CT and MRI can also be used to assess metabolically active components of fat‐free mass (FFM). (Throughout this article, metabolic activity is defined with respect to oxidative metabolism.) To date a total of 116 in vivo measurements of organ masses (OM), in combination with the measurement of resting energy expenditure (REE), have been reported. These data suggest that MRI‐ or CT‐derived OM explains part (≈5–10%) of the interindividual variance in REE. The data also suggest that REE can be reconstructed from detailed body composition analysis. Calculating REE from the sum of individual OM multiplied by a constant organ tissue‐respiration rate showed a high correlation between calculated and measured REE, with only small and non‐significant differences of 83–96 kJ d–1. In addition to CT‐ and MRI‐derived OM, data are available of 244 obese and non‐obese subjects regarding the association between regional components of lean body mass (LBM, assessed by DEXA) and REE. These results suggest that measurement of LBM distribution also provides the opportunity to adjust for the non‐linearity of REE on body mass. Assessment of metabolically active components of FFM or LBM may also add to our understanding of malnutrition‐, obesity‐ and disease states‐related variance in REE. There is need for [1] standardization of imaging technology in body composition research; [2] reference data on detailed body composition, also including more recent autopsy data; [3] reducing the number of assumptions in model‐based predictions; and [4] a combination of imaging technologies with in vivo measurements of individual OM respiration.
Approaching healthy body mass index norms for children and adolescents from health‐related physical fitness
Authors: Chen W. , Lin C.‐C. , Peng C.‐T. , Li C.‐I. , Wu H.‐C. , Chiang J. , Wu J.‐Y. , Huang P.‐C.
Published: March 2003

Current body mass index (BMI) norms for children and adolescents are developed from a reference population that includes obese and slim subjects. The validity of these norms is influenced by the observed secular increase in body weight and BMI. We hypothesized that the performance of children in health‐related physical fitness tests would be negatively related to increased BMIs, and therefore fitness tests might be used as criteria for developing a more appropriate set of BMI norms. We evaluated the existing data from a nation‐wide fitness survey for students in Taiwan (444 652 boys and 433 555 girls) to examine the relationship between BMI and fitness tests. The fitness tests used included: an 800/1600‐m run/walk; a standing long jump; bent‐leg curl‐ups; and a sit‐and‐reach test. The BMI percentiles developed from the subgroup whose test scores were better than the ‘poor’ quartile in all four tests were compared with those of the whole population and linked to the adult criteria for overweight and obesity. The BMIs were significantly related to the results of fitness testing. A total of 43% of students had scores better than the poorest quartile in all of their tests. The upper BMI percentile curves of this fitter subgroup were lower than those of the total population. The 85th and 95th BMI percentile values of the fitter 18‐year‐old‐students (23.7 and 25.5 kg m−2 for boys; 22.6 and 24.6 kg m−2 for girls) linked well with the adult cut‐off points of 23 and 25 kg m−2, which have been recommended as the Asian criteria for adult overweight and obesity. Hence, the BMI norms for children and adolescents could be created from selected subgroups that have better physical fitness. We expect that the new norms based on this approach will be used not only to assess the current status of obesity or overweight, but also to encourage activity and exercise.
Physical activity and its impact on health outcomes. Paper 2: prevention of unhealthy weight gain and obesity by physical activity: an analysis of the evidence
Authors: Erlichman J. , Kerbey A. L. , James W. P. T.
Published: March 2003

The current guidelines for physical activity are based on the prevention of cardiovascular disease. In this article the magnitude and type of physical activity required to prevent unhealthy weight gain are assessed. Five categories of analyses are considered, ranging from the most rigorous analyses (based on D2O18 measures of energy expenditure) to socio‐ecological associations. To standardize the approach, published work on the extent of exercise was expressed as a physical activity level (PAL), i.e. the ratio of total expenditure to the measured or estimated basal metabolic rate. D2O18, direct monitoring and measurements of activity patterns and detailed prospective studies of substantial population groups all suggest that a PAL of ≥1.8 is required to limit the proportion of overweight and obese adult men. Data on women are more difficult to interpret because women are less active and the relationship with physical activity is usually less clear. Post‐obese women with a PAL of >1.75 do not regain weight and other data are consistent with the need for a PAL of ≥1.8. The analyses in both sexes are based predominantly on adults living in a Western society with the ready availability of energy‐dense foods. Vigorous activity is more clearly linked to weight stability, allows a higher intensity of exercise for general activities and shortens the time needed for achieving a PAL of 1.8. This activity level is equivalent to an additional 60–90 min of brisk walking in adults who normally undertake only modest exercise. These demands are greater than the current suggested levels for cardiovascular benefit and imply the need for different environmental policies, rather than health education policies, if societies are to become generally more active and avoid unhealthy weight gain.
ALLOGENEIC STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA
Authors: Bellucci Roberto , Ritz Jerome
Published: March 2003

The sensitivity of myeloma cells to high dose chemotherapy has led to the use of allogeneic hematopoietic stem cell transplantation (HSCT) as a therapeutic modality in this disease. In addition to providing more effective chemotherapy, the transplantation of allogeneic stem cells also initiates the development of an allogeneic immune response directed against residual myeloma cells. Direct evidence for a graft vs. myeloma (GVM) effect is provided by the ability of donor lymphocyte infusion (DLI) to induce significant responses in 30–50% of patients with myeloma who have relapsed after allogeneic HSCT. Nevertheless, allogeneic stem cell transplantation is also associated with a high incidence of transplant related toxicities, including regimen‐related toxicities, graft vs. host disease (GVHD) and opportunistic infections. DLI has been shown to enhance immune reconstitution after allogeneic HSCT in addition to inducing a GVM response. Current efforts are directed at reducing the toxicities associated with allogeneic HSCT, identification of the target antigens of GVM and the development of new strategies to selectively enhance the immune response to myeloma cells.
Hydroxyurea‐induced nail pigmentation in HIV patients
Authors: Joyner S. , Lee D. , Hay P. , Lau R.
Published: March 2003

Summary Hydroxyurea (HU), a cytotoxic agent used in myeloproliferative disorders, has recently been introduced as an adjunct to combination anti‐retroviral therapy. We describe abnormal nail pigmentation in four HIV‐seropositive patients treated with HU and discuss the likely factors associated with its development.
Chronic erosive herpes simplex virus infection of the penis, a possible immune reconstitution disease
Authors: Fox PA. , Barton SE. , Francis N. , Youle M. , Henderson DC. , Pillay D. , Johnson MA. , Fearfield L. , Gazzard BG. , Bunker CB.
Published: March 2003

Objective To report a novel clinical presentation: a chronic erosive herpes simplex virus (HSV) infection of the penis which developed in AIDS patients following the commencement of highly active antiretroviral therapy (HAART). The lesions were unresponsive to antiviral treatments which had previously been effective, and this could not be accounted for in terms of increased antiviral resistance.

Design Detailed case‐note review and investigation of three cases which presented at two large HIV units in London.

Methods Review of all histology with immunohistochemistry for HSV, HSV drug susceptibility assays, tissue typing and measurement of in vitro lymphocyte functional activity against HSV.

Results The histology of the lesions was the same in each case, with the presence of HSV on immunohistochemistry and an unusual prominence of plasma cell and eosinophils in the inflammatory infiltrate. HSV‐specific lymphoproliferative responses were normal in two cases, but subnormal in a third case. All individuals shared the HLA class I molecules B72 and Cw0202 and the class II allele DRB4.

Conclusion We believe this to be a previously unreported adverse consequence of HAART, the result of partial immune restoration, reminiscent of the the recently described syndrome of immune recovery vitritis.
Heterozygosity for CCR5‐DΔ32 but not CCR2b‐64I protects against certain intracellular pathogens
Authors: Ashton LJ , Stewart GJ , Biti R , Law M , Cooper DA , Kaldor JM
Published: March 2003

Objective

To determine the association between CCR5 and CCR2b genotype and the clinical manifestation of first and subsequent AIDS‐defining illnesses (ADIs).

Methods

The distribution of ADIs was examined by CCR5 and CCR2b genotype in a subset of homosexual men enrolled in the Sydney AIDS Prospective Study. The expected number of ADIs was calculated from rates observed in the same tertiary hospital over the same period.

Results

Information on initial ADI was collected for 117 homosexual men diagnosed with AIDS before January 1998. Of these individuals, 17 were heterozygous for the CCR5‐DΔ32 mutation and 11 were heterozygous for CCR2b‐64I. The number of observed cases of Pneumocystis carinii pneumonia (PCP), toxoplasmosis, Mycobacterium avium complex (MAC) and cryptosporidiosis reported as a first ADI was substantially fewer in people heterozygous for the CCR5‐DΔ32 mutation than for those without the mutation, despite similar age, CD4 T‐cell count at AIDS diagnosis, year of AIDS diagnosis and receipt of antiretroviral treatment. In addition, among individuals heterozygous for CCR5‐DΔ32 there were fewer cases of PCP, toxoplasmosis, MAC, and cryptosporidiosis observed as subsequent ADIs compared to the number expected, based on rates measured in the same hospital during the same period (seven observed vs. 24 expected, RR = 0.3, 95% CI = 0.01–0.6). The distribution of first and subsequent ADIs did not differ from the number expected in individuals heterozygous for the CCR2b‐64I mutation.

Conclusion

Results from this study show that heterozygosity for CCR5‐DΔ32 but not CCR2b‐64I appears to protect against opportunistic infections.
Lepromatous leprosy in an HIV‐positive patient in Spain
Authors: Moreno‐Giménez Jc , Valverde F , Rios Jj , Logroño C , Rubio F Lopez
Published: March 2003

We report a 35‐year‐old HIV‐positive male affected by lepromatous leprosy which, to our knowledge, is the first case of its kind in Spain. The relationship between the two conditions is discussed.
Activation of cutaneous sarcoidosis following Mycobacterium marinum infection of skin
Authors: Gudi Vs , Campbell Sm , Gould Dj , Marshall R , Winterton Mc
Published: March 2003

Sarcoidosis has long been associated with mycobacterial infection, especially with Mycobacterium tuberculosis, although a causal association has not been proven. Atypical mycobacteria have also been implicated in causing sarcoidosis, but there is as yet no conclusive evidence. We report the activation of cutaneous sarcoidosis following infection with M. marinum, raising further questions about the role of these bacteria in causing this chronic granulomatous disorder.
The natural history of hidradenitis suppurativa
Authors: Von Der Werth JM , Williams HC
Published: March 2003

Aim To investigate aspects of the natural history of hidradenitis.

Background The natural history of hidradenitis suppurativa (HS) is not well known. There is incomplete published data on the average age of disease onset, progression of the disease, average monthly incidence and duration of boils, and factors that relieve or exacerbate disease symptoms.

Study design Questionnaire‐based survey among HS patients identified from hospital records of three hospitals in Nottinghamshire, UK.

Results One hundred and ten of 156 questionnaires (70.5%) were returned, 93 from females and 17 from males. The average patient’s age was 40.1 years and the average reported age of disease onset was 21.8 years. At the time of the survey patients had suffered an average disease duration of 18.8 years. Most patients (98 of 110) still had experienced active disease within the past year. There was some evidence that in women the condition has a tendency to ease or subside after the menopause. Forty‐four per cent of women felt that their condition was aggravated by menstruation. Thirty‐eight per cent of patients gave a positive family history of the disorder. The average duration of painful boils was 6.9 days. In addition, 62% of patients acknowledged the presence of permanently painful boils that failed to subside. Patients developed a median of two boils per month. Factors that could aggravate the condition were primarily sweating or heat, stress or fatigue and tight clothing or friction. Factors that could improve the condition consisted largely of a variety of medical treatments and a number of life‐style measures, such as swimming or baths. Twenty‐four per cent of patients had failed to find anything at all to help their condition, despite an average disease duration of almost 19 years.

Conclusions The study highlights several of the factors that make HS one of the most distressing dermatological diseases, such as the average monthly incidence of painful lesions, their average duration and the chronicity of the disease. It seems striking that the mean duration of an HS boil (6.9 days) roughly equals the duration of an average course of antibiotics. The postulated response of HS to oral antibiotics may thus simply have its explanation in the natural history of the condition itself.
Photodynamic therapy for in situ squamous cell carcinoma on chronic radiation dermatitis after photosensitization with 5‐aminolaevulinic acid
Authors: Guillen Carlos , Sanmartin Onofre , Escudero Angel , Botella‐Estrada Rafael , Sevila Amparo , Castejon Pilar
Published: March 2003

The accessibility of the skin to light treatment, as well as the developments made by dermatologists in photodynamic therapy (PDT), creates an exciting apportunity to include it as a part of our standard therapeutic armamentarium. We report a 63‐year‐old man with an in situ squamous cell carcinoma located on a chronic radiodermitis area in a finger, treated successfully with PDT. PDT appears to be a viable alternative to conventional therapy for in situ squamous cell carcinoma as well as for other superficial tumours of the skin.
Malignant atrophic papulosis (Degos’ disease): clinicopathological correlations
Authors: Chave TA , Varma S , Patel GK , Knight AG
Published: March 2003

Malignant atrophic papulosis (MAP) is a rare disease characterized by pathognomonic cutaneous lesions and frequently fatal systemic involvement. Dermatologists should have a high index of suspicion for systemic complications in a patient presenting with MAP. We report a case of malignant atrophic papulosis to highlight the clinicopathological features and review this important dermatological diagnosis.
Rosacea fulminans triggered by high‐dose vitamins B6 and B12
Authors: Jansen T , Romiti R , Kreuter A , Altmeyer P
Published: March 2003

Rosacea fulminans is a rare variant of rosacea conglobata that occurs almost exclusively in women well past adolescence. The aetiology is unknown, although immunological, hormonal, and vascular factors have been suggested. We report the case of a 17‐year‐old girl with rosacea fulminans that was temporally associated with daily ingestion of high‐dose vitamin B supplements. The onset was sudden and cosmetically disabling. The eruption improved when the vitamin supplement was discontinued and a therapeutic regimen including isotretinoin and methylprednisolone was introduced. It seems appropriate to consider the possibility of such a vitamin B‐triggered condition in cases of subjects presenting new or exacerbating facial eruptions.
Evaluation of sexual function in subjects taking finasteride for the treatment of androgenetic alopecia
Authors: Tosti A , Piraccini BM , Soli M
Published: March 2003

Background

Our practical experience indicates that sexual side‐effects in subjects taking finasteride 1 mg (Propecia®) for androgenetic alopecia are much less common than reported in the literature.

Objective

To evaluate the sexual function in subjects taking finasteride (1 mg) compared with age‐matched controls using the International Index of Erectile Function (IIEF).

Methods

The IIEF, a brief, reliable questionnaire, was self‐administered to 236 patients taking Propecia® and 236 age‐matched males attending the Department of Dermatology of the University of Bologna.

Results

Statistical analysis showed no differences between scores obtained with the IIEF in subjects taking finasteride and controls.

Conclusions

The sexual and erectile function of subjects taking finasteride does not significantly differ from that of age‐matched controls. This is consistent with the experience of many dermatologists who do not see sexual or erectile dysfunction in patients taking Propecia®.
Multicentric reticulohistiocytosis
Authors: Luz FB , Gaspar AP , Kalil‐Gaspar N , Ramos‐e‐Silva M
Published: March 2003

Background Multicentric reticulohistiocytosis (MR) is a rare histiocytic systemic disease mainly affecting the skin and synovia.

Objective To present the main and newest aspects of MR.

Method A review of the current medical literature, composing a retrospective study of 96 case reports published world‐wide since 1977.

Results Facial and hand skin nodules with symmetric arthritis were the most frequent clinical presentation. The pathognomonic sign of ‘coral beads’ and vermicular erythematous lesions bordering nostrils, seems to be very characteristic of MR. There is a significant association with cancer. Histiocytic cells of MR are best characterized on immunohistochemistry by its immunoreactivity for vimentin, CD68 and CD45 and non‐reactivity for S‐100 protein, CD34 and factor XIIIa. Although the outcome of the disease is usually very limiting for the patients, treatment with immunosuppressive drugs may be useful.

Conclusion MR is a unique histiocytic proliferative disease with a peculiar immunophenotypic pattern and distinctive clinical and histopathological aspects.
Keratosis pilaris atrophicans in mother and daughter
Authors: Khumalo NP , Loo WJ , Hollowood K , Salvary I , Graham RM , Dawber RPR
Published: March 2003

We report two cases of keratosis follicularis spinulosa decalvans in a Caucasian family involving a 28‐year‐old woman and her mother. This is an unusual family in that no male relatives are similarly affected. Secondly, both patients have no significant eye changes but quite extensive scarring alopecia. To the best of our knowledge this is the second reported family in the UK.
Inoculation (tattoo) leprosy: a report of 31 cases
Authors: Ghorpade A
Published: March 2003

Thirty‐one female patients with leprosy lesions starting over tattoo marks observed over a period of 16 years are reported. All the patients belonged to the Chhattisgarh State, which is highly endemic for leprosy. Most of the patients were in the third decade of life. All of them had ornamental tattooing done by roadside tattoo artists, who used unsterile needles for tattooing a large gathering one after another with the same needles. In all of them, the first lesion of leprosy started over a tattoo mark. Twenty‐five cases had only single lesion of leprosy exclusively confined to tattoo marks. The duration between tattooing and appearance of first lesion in most of the cases varied from 10 to 20 years. Paucibacillary leprosy was the commonest type observed in 29 cases, while two had multibacillary leprosy. The diagnosis was confirmed by histopathology in all cases. The present report supports the hypothesis of transmission of leprosy in these cases through tattooing. To the best of our knowledge, such a large collection of leprosy cases subsequent to tattooing has not been reported so far.
A case of giant congenital nevocytic nevus with neurotization and onset of vitiligo
Authors: Shin J‐H , Kim M‐J , Cho S , Whang K‐K , Hahm J‐H
Published: March 2003

The authors report the case of a 21‐year‐old woman with a giant congenital nevocytic nevus (GCNN) who developed vitiligo at the age of 16 years on skin areas remote from the GCNN. This is the first reported case of GCNN developing neurotization combined with vitiliginous changes within the GCNN lesion. Treatment with PUVA achieved repigmentation of the vitiligo lesions, except for the hypochromic areas within the area of the nevus that were shielded from UVA radiation.
Psychiatric morbidity in vitiligo: prevalence and correlates in India
Authors: Mattoo SK , Handa S , Kaur I , Gupta N , Malhotra R
Published: March 2003

Background Vitiligo, a common pigmentary disorder, is recognized to be associated with a high psychiatric morbidity, yet compared to other dermatological disorders like leprosy, psoriasis, etc., it has not been subjected to detailed evaluation of its psychological consequences. The data from the developing countries on this aspect in particular is meager.

Methods One hundred and thirteen cases with vitiligo were evaluated along with 55 healthy controls comparable for sociodemographic profile and matched on attitude to appearance scale. Clinical details, impact of illness, associated dysfunction and psychological morbidity were additionally assessed.

Results Twenty‐eight patients with vitiligo were found to have psychiatric morbidity, a clinic prevalence rate of 25% (95% confidence interval 20.3–29.3%). The majority of the cases had a diagnosis of adjustment disorder. Psychiatric morbidity was significantly correlated with dysfunction arising out of illness.

Conclusions Vitiligo is associated with high psychiatric morbidity. There is a need to develop cross‐cultural database on psychosocial aspects and psychiatric morbidity associated with vitiligo.
Treatment and Management of Challenging Behaviours in Residential Settings
Authors: Emerson E. , Robertson J. , Gregory N. , Hatton C. , Kessissoglou S. , Hallam A. , Hillery J.
Published: March 2003

Aspects of the treatment and management of challenging behaviour were investigated among 500 adults with intellectual disabilities receiving various forms of residential supports. The present results indicated that: (1) 53% of participants were reported to have shown at least one ‘moderately serious’ or ‘severe’ form of challenging behaviour in the previous month; (2) the most commonly employed management strategies were physical restraint (used with 44% of people showing challenging behaviour), sedation (35%), seclusion (20%) and mechanical restraint (3%); (3) the most commonly employed ‘treatment strategies’ were goal setting within individual programme plans (used with 62% of people showing challenging behaviour), antipsychotic medication (49%), written intervention programmes (23%) and written behaviourally orientated intervention programmes (15%); and (4) factors identified through logistic regression analyses to be associated with the use of specific treatment and management strategies included personal characteristics of the person with intellectual disabilities (e.g. age and diagnosis of autism), resources (e.g. type of accommodation, cost of provision and staffing levels), the organization of resources (e.g, planning of support to residents) and the nature of the challenging behaviour (e.g. more sustained episodes of challenging behaviour).
Evaluation of the Dissemination of Active Support Training and Training Trainers
Authors: Jones Edwin , Felce David , Lowe Kathy , Bowley Clare , Pagler Jane , Strong Gwyneth , Gallagher Barry , Roper Adrian , Kurowska Katrina
Published: March 2003

The aim of the present study was to replicate active support (AS) and train the service managers of community housing services as trainers in so doing. Training was conducted in three phases: (1) in 22 houses, it was led by one of the researchers, with identified managers assisting (Apprenticeship); (2) in 16, it was led by a manager who had participated in the previous phase, assisted by the researcher (Supervision); and (3) in 36 houses, it was undertaken independently by managers who had participated in the previous two phases (Independent). Changes in the extent of planned activity, resident involvement in domestic, social and community activities, the observed staff:resident interaction, and observed resident engagement in activity were evaluated. Resident views about the introduction of AS were canvassed. Active support training was fully implemented in the first two phases, but not in the third. There was an increase in planned activity in all phases after AS training. Significant increases in assistance and resident engagement in activity were found in the first two phases, but not in the third. Active support was shown to be of greater benefit to people with more severe disabilities. The resident feedback was positive. The approach taken to training managers as trainers was not sufficient to enable them to implement the training in its entirety during the third phase. The absence of change in this phase indicated the necessity of the practical interaction training, which was the element mainly missed out. Since AS was once again shown to be an effective approach for people with more severe intellectual disabilities, the challenge of creating a widespread ability to train staff within community housing services requires further effort.
A Treatment Service for Sex Offenders and Abusers with Intellectual Disability: Characteristics of Referrals and Evaluation
Authors: Lindsay William R. , Smith Anne H. W. , Law Jacqueline , Quinn Kathleen , Anderson Andrew , Smith Astrid , Overend Tim , Allan Ronald
Published: March 2003

Background  Several authors have documented the problem of sex offenders and abusers with intellectual disability. With the advent of community care policies, alternative systems for treatment and management are needed to deal with the problems associated with this client group. The current paper describes such a service which attempts to maintain clients' community placements.

Methods  A database was set up drawing on information from a wide variety of professions. Data are reported on 62 sex offenders and abusers with intellectual disability.

Results  Information is reported on age, IQ, mental illness, medication, referral characteristics, current and previous sexual offending, forensic status and the range of problems identified during assessment. Re‐offending data are reported up to 4 years following discharge. Re‐offending rates increase from 4% after 1 year to 21% after 4 years. Unplanned discharge was significantly associated with re‐offending.

Conclusions  It is possible to set up a relatively cost‐effective community service for sex offenders with intellectual disability. In terms of re‐offending, the outcomes for this service are favourable when compared to the outcomes for alternative disposals reported in the literature.
Issues of Informed Consent in Conducting Medical Research Involving People with Intellectual Disability
Authors: Iacono Teresa , Murray Vanessa
Published: March 2003

Background People with severe intellectual disability are considered vulnerable to exploitation in research. Discovery of exploitative practices in recent history has motivated the development of guidelines for informed consent and proxy decision‐making procedures when involving these individuals in research.

Methods Issues for determining capability to provide informed consent and the proxy decision process are reviewed according to the literature, current ethics guidelines and recent legislature in Victoria, Australia.

Results The complex process of involving in research people with severe intellectual disability who are particularly vulnerable by virtue of their institutionalized residential status is discussed within the context of a recent project into examining potential nutritional determinants of Pica behaviour (i.e. the eating of inedible items).

Conclusions This example serves to highlight the role of legislation, various government bodies and researchers in balancing principles of protection of vulnerable groups and rights to self‐determination.
Resident Involvement in Activity in Small Community Homes for People with Learning Disabilities
Authors: Mansell Jim , Beadle‐Brown Julie , Macdonald Susan , Ashman Bev
Published: March 2003

Background  Determining the relative importance of variables including client characteristics, setting features, staffing and care practices on the lives of people with learning disabilities in residential care continues to be a relevant topic for research.

Methods  Measurements were made of the adaptive and problem behaviour of 343 adults with intellectual disabilities living in 76 residential homes and of various aspects of staffing, care practices (extent of active support) and resident engagement in meaningful activity. Ordinal and logistic regression was used to identify variables best predicting engagement and care practices.

Results  Only adaptive behaviour and care practices predicted resident engagement in meaningful activity; only age and adaptive behaviour predicted care practices.

Conclusions  Given the limited scope for changing resident adaptive behaviour, attention should be given to improve active support in residential homes in order to promote greater engagement in meaningful activity by people with learning disabilities.
Intrafollicular blood flow during human ovulation
Authors: Bourne T. H. , Jurkovic D. , Waterstone J. , Campbell S. , Collins W. P.
Published: March 2003

Transvaginal ultrasonography with color flow mapping has been used to study changes in intrafollicular blood flow and morphology during follicular rupture and presumed ovulation in one human volunteer. Detailed monitoring started on day 11 of the menstrual cycle and the follicle began to rupture at 14.30 on day 13. This event was preceded by a defined rise and peak in the level of immunoreactive serum luteinizing hormone (LH) by 42 h and 17 h 20 min, respectively. Blood vessels were clearly visible in the inner ring of the follicle (the granulosa layer) at the time of the LH peak and part of the granulosa (probably containing the oocyte) started to detach before the follicle ruptured. The maximum value for the peak blood velocity in the inner vessels was observed 10 s after the start of follicular rupture and there was a concurrent increase in the impedance to blood flow, as reflected by the resistance index and the pulsatility index. The follicle took 14 min 29 s to empty and the corpus haemorrhagicum started to form about 1 min later. These preliminary data suggest that intrafollicular angiogenesis and changes in blood flow can be monitored by a relatively non‐invasive technique. Changes in vascularity might be used to predict imminent ovulation and could possibly be identified or modified biochemically to help achieve or avoid a pregnancy. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic indications for karyotyping procedures. An international questionnaire
Authors: Degani S. , Gonen R. , Shapiro I. , Borochowitz Z. , Dar H. , Sharf M.
Published: March 2003

An international survey was conducted to investigate attitudes to karyotyping procedures in cases of fetal anomalies detected by ultrasound. A questionnaire was sent to 111 current members of the International Society of Ultrasound in Obstetrics and Gynecology. The overall response rate was 48%.

Analysis of the replies reflects a wide variation in the criteria for the definition of a sonographic abnormality, the indication for a diagnostic procedure, and the timing for intervention.

The results emphasize the need for additional data on several sonographic findings (e.g. choroid plexus cysts, renal pyelectasis, short limbs) and for improved selection of patients for chromosomal investigation. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound diagnosis of fetal macrosomia
Authors: Rosati P. , Exacoustós C. , Caruso A. , Mancuso S.
Published: March 2003

Macrosomic infants and their mothers are at increased risk for intrapartum injury and perinatal morbidity and mortality. This study investigates the effectiveness of individual ultrasound fetal measurements, ponderal indices and estimated fetal weight in the identification of macrosomia in 732 pregnant patients who underwent ultrasound examination within 7 days of delivery. All the indices evaluated were compared for accuracy in predicting birth weight. Statistical comparison revealed that estimated fetal weight predicted macrosomia better than single ultrasound parameters and ponderal indices. The formulae tested yielded an accuracy of 94% and a positive predictive value of 90%. Abdominal diameter and abdominal circumference values above the 90th centile correctly predicted macrosomia in 82% and 72% of cases, respectively. Fetal length showed a sensitivity of 61% with a predictive positive test of 41%. Femur length‐to‐abdominal circumference ratio detected macrosomia with a sensitivity of 80% and an accuracy of 82%. The other single ultrasound parameters and ponderal indices were significantly less indicative of macrosomia. The combined use of four indices (growth profile) did not improve the effectiveness of ultrasound in detecting fetal macrosomia. We conclude that the optimal prediction of fetal macrosomia is obtained from mathematical formulae for fetal weight estimation, based on several fetal measurement parameters and adjusted for different gestational periods. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
The natural history of isolated fetal hydrothorax
Authors: Estoff J. A. , Parad R. B. , Frigoletto F. D. , Benacerraf B. R.
Published: March 2003

We reviewed the prenatal course and outcome of 11 fetuses with isolated unilateral or bilateral hydro thoraces identified between 14 and 34 weeks' gestation, in the absence of invasive fetal intervention. Four of these fetuses died, three in utero and one in the newborn period. Six of seven survivors had resolution of hydrothorax before birth. Eight of the 11 fetuses had unilateral and three bilateral hydrothoraces. Six of the eight fetuses with unilateral hydrothorax survived, whereas one of the three with bilateral hydrothoraces lived. Six of the 11 pregnancies were complicated by polyhydramnios; four of these six fetuses died. One fetus was found to have trisomy 21. It is difficult to draw firm conclusions from the small number of patients in this report because of the wide range of outcomes found for the sonographic variables described. This series shows, however, a tendency to complete resolution of primary unilateral fetal hydrothorax, with good outcome, particularly in second‐trimester fetuses without polyhydramnios. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Biometry of early pregnancy with transvaginal sonography
Authors: Grisolia G. , Milano K. , Pilu G. , Banzi C. , David C. , Gabrielli S. , Rizzo N. , Morandi R. , Bovicelli L.
Published: March 2003

A prospective cross‐sectional study was performed in 248 pregnant women between 5 and 12 weeks' menstrual age with transvaginal sonography to establish biometric charts of the gestational sac, embryonic crown‐rump length and biparietal diameter, amniotic sac and yolk sac to be used for assessment of gestational age and prediction of pregnancy failure. Polynomial regression analysis was applied and demonstrated a statistically significant positive correlation that could be described in all cases as a quadratic function, between gestational age and all the measurements with the exclusion of the yolk sac. Centile charts of both growth models and dating models were tabulated. The interrelationship between different measurements, including the gestational sac, crown‐rump length, biparietal diameter and amniotic sac was also evaluated to produce age‐independent charts. The dating model of the crown‐rump length was found to have mean values similar to those described in transabdominal studies. The 95% reference interval was, however, 8.4 days, which was not lower than those reported in most transabdominal studies. It was concluded that transvaginal sonography was more able than the abdominal route to allow measurement of the crown‐rump length in very early gestation, but did not yield a greater accuracy in predicting gestational age. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Early development of the forebrain and midbrain: a longitudinal ultrasound study from 7 to 12 weeks of gestation
Authors: Blaas H.‐G. , Eik‐Nes S. H. , Kiserud T. , Hellevik L. R.
Published: March 2003

The purpose of this longitudinal study was to describe embryonic development in vivo. Twenty‐nine healthy pregnant women were examined five times with transvaginal ultrasound between 7 and 12 weeks of gestation. Brain structures such as the hemispheres, the choroid plexus of the lateral ventricles, the diencephalon, and the mesencephalon were identified and, if possible, measured.

It was possible to identify the cavities of the hemispheres, the diencephalon and the mesencephalon during week 7. The choroid plexus of the lateral ventricles became visible during week 8. The growth of the length, width and height of the hemispheres and the choroid plexus of the lateral ventricles was curvilinear, that of the mesencephalon and diencephalon was linear except for the width of the diencephalon. The width of the diencephalon, the future third ventricle, was 1.1 mm during week 7. It decreased to 0.8 mm at 12 weeks. Apart from the rhombencephalon, the cavity of the diencephalon was the large dominating brain structure during embryonic development. In early fetal life the cerebral hemispheres took over this dominance.

The study was in full agreement with descriptions in the embryological literature, both concerning the anatomical features and their chronological formation. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Significance of sonographically detected second‐trimester choroid plexus cysts: a series of 211 cases and a review of the literature
Authors: Nava S. , Godmilow L. , Reeser S. , Ludomirsky A. , Donnenfeld A. E.
Published: March 2003

A retrospective analysis of all fetuses with prenatally detected choroid plexus cysts, identified at our institution between 1988 and 1993, was performed. Cytogenetic data, associated sonographic findings, obstetric outcome and pediatric follow‐up was obtained to determine the incidence of aneuploidy and the rate of associated congenital anomalies in second‐trimester fetuses with this finding. There were 211 second‐trimester fetuses identified with a choroid plexus cyst. Amniocentesis was performed in 175 (83%) and postnatal chromosome analysis was performed in one newborn. Follow‐up data are available on 203 (96%). Of the 176 cytogenetically studied fetuses, eight (4.5%) were aneuploid (including four cases of trisomy 18). In four of the aneuploid fetuses, the choroid plexus cyst was the only abnormal sonographic finding identified (including one case of trisomy 18). From this study and a review of the literature, we confirm that choroid plexus cysts are a sonographic marker for trisomy 18, even when identified as an isolated finding in an otherwise normal‐appearing fetus. We conclude that the detection of a choroidplexus cyst merits further careful evaluation of fetal anatomy and consideration of cytogenetic evaluation. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Effect of standing on non‐pregnant uterine blood flow
Authors: Dickey R. P. , Hower J. F. , Matulich E. M. , Brown G. T.
Published: March 2003

Uterine artery blood flow measurements made solely in the recumbent position may miss physiological changes that occur while patients are upright. We evaluated the effect of standing on the minute blood flow volume of the ascending uterine artery, the pulsatility index (PI), resistance index (RI) and waveforms and on the PI and RI of the myometrial spiral arteries and waveforms at 3–8 and at 9–14 min standing in 74 non‐pregnant women. At 9–14 min, the uterine artery blood flow volume had decreased by an average of 34% and the RI had significantly increased in 70% of subjects. Decreased uterine artery blood flow volume was associated with increased distal resistance and with decreased vessel diameter, possibly due to stretching or kinking of the uterine arteries. Changes in the spiral artery PI paralleled changes in the uterine artery PI at 9–14 min, but were less pronounced. Spiral artery PI and RI were not related to the uterine artery blood flow volume while women were recumbent, although they were significantly related while women were standing. The effects of age, uterine mobility and uterine position on uterine artery or spiral artery blood flow were apparent only while women were standing. We conclude that standing as well as recumbent studies are necessary when uterine and myometrial blood flow are evaluated, and that uterine flow volume per minute should be measured whenever possible. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology