bluuebunny/crossref_metadata_2025 huggingface dataset:
PS04 Validity of Cancer Diagnosis in a Primary Care Database Compared with Linked Cancer Registrations in England. Population-Based Cohort Study
Authors: Dregan A , Murray-Thomas T , Moller H , Gulliford M
Published: September 2012

Background

Electronic health records from primary care are increasingly utilised as a resource for epidemiological research in cancer. The present study aimed to evaluate the validity of cancer diagnoses recorded in a primary care database compared with cancer registry data in England.

Methods

Eligible cancer codes were reviewed and agreed by two epidemiologists with experience in cancer and primary care. The eligible cohort comprised 42,556 participants, registered with English general practices in the General Practice Research Database (GPRD) that consented to cancer registry linkage, who presented with haematuria, haemoptysis, dysphagia or rectal bleeding or were diagnosed with cancer of the lung, urinary tract, oesophagus/stomach, or colon/rectum between 2002 and 2006. Cancer registry (CR) records were linked through a unique identifier by a third party. Cancer registry and primary care records were compared for cancer diagnosis, date of cancer diagnosis and death.

Results

There were 5,429 cancer diagnoses in GPRD and 5,710 in the CR, with 5,216 (91% of CR total) diagnosed in both sources. There were 494 (9%) diagnosed in CR but not in GPRD and 213 (4%) that were diagnosed in GPRD but not CR. The predictive value of a GPRD cancer diagnosis was 96% for lung cancer, 92% for urinary tract cancer, 96% for gastro-oesophageal cancer and 98% for colorectal cancer. ‘False negative’ primary care records were sometimes accounted for by registration end dates being shortly before cancer diagnosis dates. The median (interquartile range) difference in date of cancer diagnosis (CR minus GPRD) was -11 (-30 to 6) days. Death records were consistent for the two sources for 3,337/3,397 (99%) of cases.

Conclusion

Recording of cancer diagnosis and mortality in primary care electronic records is generally consistent with cancer registrations in England. Linkage studies must pay careful attention to selection of codes to define eligibility and timing of diagnoses in relation to beginning and end of record.
PS07 Trends in Blood Pressure in England: Good Treatment or Good Luck?
Authors: DeWilde SJ , Carey IM , Shah SM , Harris T , Rudnicka AR , Whincup PH , Cook DG
Published: September 2012

Background

For 30 years, adult blood pressure (BP) has declined in many developed countries. This is likely to have contributed to declining cardiovascular disease mortality. However, the reasons for this, particularly the impact of increased antihypertensive treatment, have been little studied. Diagnostic criteria have changed, meaning that more patients are treated at lower levels of BP than previously; and treatment intensity is greater. Accounting for the effects of treatment on BP trends is complex and open to misinterpretation.

Methods

Using the Health Survey for England we examined BP measures and treatment in white subjects aged 18+ years over two periods, 1994–2002 and 2003–2009. To examine trends independent of anti-hypertensive treatment, untreated BP was estimated from the recorded BP on treatment. To do this, a model was derived using published data on the effect of anti-hypertensives used singly and in combination at differing pre-treatment BP levels. BP untreated with statins was similarly estimated.

Results

Among an average 9,147 subjects per year, mean systolic BP (SBP) in men declined by 0.55 mmHg annually (95% CI 0.46 to 0.64) between 1995–2002; 0.34 mmHg annually (95% CI 0.21 to 0.46) between 2003–2009. Similar trends occurred in women. The decline was greater in older groups, but present in young, largely untreated groups, although the trend was greatly reduced in young men by 2009. Trends in estimated SBP adjusting for the influence of treatment, where present, exhibited only slightly lower declines; for men: 0.47 mmHg annually (95% CI 0.37 to 0.57) between 1995–2002; 0.27 mmHg annually (95% CI 0.13 to 0.41) between 2003–2009. Statin therapy had little additional effect. Diastolic blood pressure showed similar but weaker trends.

Conclusion

For 15 years, BP declined in English adults. The overall decline in SBP of nearly 5 mmHg over the study period is likely to be of clinical significance in reducing CVD events. For an individual aged 40–49 a 5 mmHg reduction in SBP, as seen here, would be expected to reduce the risk of stroke by 23% and of IHD by 16%. It is therefore of concern that, in recent years, the decline has essentially ceased in the youngest age groups, particularly in younger men. The effect of treatment was modest; less than 25% of the male SBP decline is attributable to it. Other explanations for this fall, occurring whilst obesity has increased, need further exploration, but reduced salt intake is a likely candidate.
PS25 Discontinuation of Antiepileptic Drugs in Pregnancy: A UK Population Based Study in the Health Improvement Network (THIN)
Authors: Man S , Petersen I , Thompson M , Nazareth I
Published: September 2012

Background

Since the thalidomide tragedy in the 1960s, many women are concerned with the use of drugs in pregnancy. Antiepileptic drugs (AEDs) are commonly used to treat epilepsy and bipolar disorders in women of child bearing age. However, some AEDs are associated with an increased risk of major congenital malformations. Untreated epilepsy and bipolar disorders in pregnancy may lead to devastating consequences for both mother and child. This leaves women and health care professionals with a dilemma as whether to continue AED medication in pregnancy. Using data from THIN, a UK primary care database, we examined pregnancy as a determinant for ceasing AED treatment.

Methods

A cohort study of pregnant women receiving AEDs in UK primary care was conducted. We identified women who were prescribed AEDs in the three months before pregnancy. Time to last consecutive AED prescription in pregnancy was estimated whereby discontinuation of therapy was defined by a gap of more than three months between prescriptions. We identified a control group of twice as many non-pregnant women receiving AEDs. These women were randomly selected, but stratified within five year age bands and matched on indication for AEDs as for the pregnant women Cox’s regression was used to compare the likelihood of discontinuing AEDs between pregnant and non-pregnant women.

Results

In total, 934 women were prescribed AEDs three months before pregnancy. Pregnant women with epilepsy were twice as likely to cease AEDs compared to non-pregnant women (Hazard Ratio (HR):2.00, 95% confidence interval (CI:1.62–2.47). Of 745 women with epilepsy, 601 (80.7%) continued treatment into pregnancy and 465 (62.4%) to the end of the second trimester. Of 1,490 non-pregnant women with epilepsy, 1,242 (83.4%) and 1,071 (71.9%) continued for comparable time periods.

Pregnant women with bipolar disorder or depression were three times as likely to cease AEDs compared to non-pregnant women (HR:3.07, 95% CI:2.04–4.62). Of 54 pregnant women with bipolar disorder, 27 (50.0%) continued into pregnancy, and only 8 (14.8%) to the end of the second trimester. In 108 non-pregnant women with bipolar disorder, 82 (75.9%) and 58 (53.7%) continued for comparable periods.

Conclusion

Pregnancy is a determinant for the discontinuation of AEDs during pregnancy, especially in women with bipolar disorder or depression despite the potentially severe consequences associated with not treating the underlying illness in pregnancy.
PS27 Serum Bilirubin and Risk of Cardiovascular Events and Death in a Statin-Treated Population: A Cohort Study
Authors: Horsfall LJ , Petersen I , Nazareth I
Published: September 2012

Background

Serum bilirubin is an endogenous antioxidant with a strong genetic component that may be a marker for future cardiovascular disease (CVD) risk. We examined the relationship between serum bilirubin levels recorded prior to statin prescription, primarily as test for liver function, and the diagnosis or death from CVD. We also examined whether bilirubin levels increased following statin prescription independently of liver enzymes, which has been shown in animal models and could contribute to the purported health benefits of statins in addition to cholesterol reduction.

Methods

All patients with liver function tests three months prior to first statin treatment between January 1st 2000 and December 31st 2010 and no history of liver disease or CVD were extracted from The Health Improvement Network (THIN) primary care database. Restricted cubic spline Poisson regressions were fitted on bilirubin levels and adjusted for traditional cardiovascular risk factors to estimate incidence rate ratios.

Results

In total 130,052 patients met the inclusion criteria and after a median follow-up of 43 months, there were 5,938 coronary heart disease (CHD) events, 2,438 stroke events, and 5,185 deaths from any cause. In men, the incidence of CHD in the lowest decile category of bilirubin (1–6 µmol/L) was 176 per 10,000 person years (PYs) compared with 139 per 10,000 PYs in the highest decile (19–40 µmol/L). The result for stroke was 72 versus 52 per 10,000 PYs and for death 139 versus 92 per 10,000 PYs. Similar differences were seen for women. The adjusted associations with bilirubin were L-shaped with a negative relationship up to around 10–15 µmol/L. The models predicted that, compared to patients with the median bilirubin level (10 µmol/L), those with a similar CVD risk profile but a bilirubin level of 5 µmol/L had a 19% (95% CI: 11–27%) higher rates of CHD, a 22% (95% CI: 10–36%) higher rates of stroke, and a 26% (95% CI: 17–35%) higher rate of death. A dose-dependent increase in mean bilirubin level was seen following atorvastatin prescription but not for simvastatin.

Conclusion

Low bilirubin prior to statin prescription is an independent risk factor for CVD and death. Further work is needed to examine whether pleotrpic effects of statins can be explained by alterations in bilirubin production and/or elimination.
PS39 Alcohol and Harm to Others in Russia: Longitudinal Analysis of Couple Drinking and Subsequent Divorce
Authors: Keenan K , Grundy E , Kenward MG , Leon DA
Published: September 2012

Background

In Russia male drinking patterns have serious negative health effects; however the impact of alcohol on divorce is relatively unexplored. In other settings heavy drinking and discrepant drinking within couples increases the probability of marital breakdown. Longitudinal data, rather than cross-sectional, is preferable to establish the direction of any causal link.

Methods

The association between married couple drinking patterns and subsequent divorce was investigated in a national population-based panel study in Russia. Follow-up data on 4,266 married couples was extracted from 14 consecutive annual rounds (1994–2009) of the Russian Longitudinal Monitoring Survey. The overall follow-up rate of couples was 90%, and loss to follow-up was unrelated to drinking behaviour. At interview couples provided information about family relationships, drinking habits in the last 30 days and socio-demographic variables. Discrete time hazard models were fitted using pooled logistic regression to estimate the probability of divorce among married couples as a function of the previous round’s drinking patterns and other covariates.

Results

Increased odds of divorce were associated with greater frequency of husband drinking (P<0.001) and greater frequency of wife drinking (P<0.001), and remained significant after mutual adjustment. Wife’s hazardous drinking was also associated with a higher risk of divorce (OR 1.45, 95% CI 1.06–1.92) after adjustment for husband’s drinking. Husbands who were abstainers also had raised odds of divorce compared to moderate drinkers (OR 1.36, CI 1.01–1.84). There was a significant positive relationship between husband’s maximum daily volume of ethanol from vodka and divorce, after adjustment for frequency. After testing for interaction between husband’s and wife’s drinking, there was no evidence that couples with discrepant drinking frequencies had increased risk of divorce.

Conclusion

This study adds to the very sparse literature investigating the association of drinking with divorce using longitudinal data. The results suggest that in Russia heavy and frequent drinking of both husbands and wives put couples at greater risk of future divorce. The thresholds where frequency and volume adversely affect marital stability are higher in husbands, than in wives. Male abstainers have a higher degree of marital dysfunction, lending support to the idea that many Russian male abstainers are ex-drinkers. More research is needed to understand the causal pathways from drinking to marital breakdown in Russia, and the overall population-level impact of drinking on partnerships.
PS41 Characteristics Associated with Statin Prescribing for Primary Prevention of Cardiovascular Disease Among People with Diabetes
Authors: Jones NRV , Wild SH
Published: September 2012

Background

Diabetes is a risk factor for cardiovascular disease (CVD) and guidelines recommend that people with diabetes ought to have their blood lipid levels monitored and, if necessary, controlled to ensure that they are at a safe level to prevent avoidable morbidity and mortality resulting from CVD. Guidelines are not necessarily followed and the differences in treatment which this leads to could give rise to health inequalities according to socio-economic status, sex, or other patient characteristics. This study investigated the association between patient characteristics and statin prescribing in people who were eligible to receive a statin for primary prevention of CVD according to the contemporary Scottish Intercollegiate Guideline Network guidelines (SIGN 55).

Methods

Data from the Scottish Care Information – Diabetes Collaboration dataset for the period 2000–2007 were used. This dataset contains socio-demographic and prescribing data for 203,528 people, which is almost every person with diagnosed diabetes in Scotland. The analyses were based on people over 40 years of age, with complete data, with no history of CVD, and with total serum cholesterol exceeding 5mmol/l.

Logistic regression was used to calculate odds ratios (OR) for ever having a record of a statin prescription by age, sex, socio-economic status (defined using quintiles of the Scottish Index of Multiple Deprivation, SIMD, where Q1 reflects the most deprived and Q5 the most affluent), smoking habits, body mass index, diastolic blood pressure, and type of diabetes.

Results

Of 83,666 people identified as eligible for statin treatment as defined by SIGN 55 guidelines, 29% had no record of a statin prescription. In both men and women, the OR for having a statin prescribed when compared to Q1 from multi-variate models were ORmen0.93 ORwomen0.91 for Q2, ORmen0.77 ORwomen0.77 for Q3, and ORmen0.71 ORwomen0.71 for Q4. Current and former smokers, overweight and obese people, and people with high blood pressure or treated hypertension had greater odds of statin prescription, whereas underweight people and women with type one diabetes had reduced odds of being prescribed a statin than each comparison group.

Conclusion

Almost one third of people with diagnosed diabetes have no record of having ever received a statin prescription as recommended by SIGN 55. The odds of having a record of treatment were higher among more deprived people even after adjusting for potential confounding factors.
PS43 What is Important to the Quality of Life of People with Multiple Myeloma? Implications for the Design Of Quality of Life Questionnaires
Authors: Osborne TR , Ramsenthaler C , Higginson IJ
Published: September 2012

Background

Multiple myeloma is an incurable cancer, although recent treatment advances have improved expected survival from months to years in some cases. Increasing survival has elevated the importance of understanding and measuring patients’ quality of life (QOL) in research and clinical settings. A number of QOL questionnaires exist for use in myeloma, yet there is a paucity of research to understand what issues are important to QOL from the patients’ perspective.

This study explores the issues important to the QOL of people with myeloma, and how QOL is affected by the disease and its treatment. Implications for the design of QOL questionnaires are discussed.

Methods

In-depth qualitative interviews with 20 myeloma patients to identify issues important to QOL and explore the impact of disease and treatment. Participants recruited from King’s College Hospital and St. Christopher’s Hospice, London. Purposive sampling by age, gender, performance status and disease stage. Thematic content analysis of interview transcripts was conducted.

Results

Many participants started by discussing the importance of physical function and independence. There appeared to be a dominant role for participatory function in determining QOL – family life, leisure pursuits and other social activities were often identified as important. Physical symptoms such as pain or fatigue were frequently said to be affecting QOL, but often this was through their affect on social and participatory function. Sometimes symptoms were reported, but they did not affect QOL because functional and participatory aspects were maintained. Issues that prevented social engagement or participation were often therefore most deleterious to QOL – such as reduced mobility; susceptibility to infection; and fear of low-trauma fractures. Participants also often discussed the importance of quality, accessible healthcare – particularly good communication and receiving the right amount of information from professionals.

Conclusion

These results support the broad consensus that quality of life is multidimensional, involving physical, psychological and social domains. The presence of symptomsper sedid not necessarily impair QOL in this group. QOL questionnaires for use in myeloma should perhaps focus less on the presence, absence or severity of a symptom, but consider how much of a problem the symptom is in terms of its broader impact on function. This is particularly important when tools are applied in clinical practice, when the wider burden of symptoms is perhaps of greater interest. Tools for use in myeloma clinical practice should also consider items about the quality of healthcare – since this appears important to patients’ QOL.
PS45 Addressing Child Poverty – The Role of the NHS Workforce
Authors: Egan JA
Published: September 2012

Background

Glasgow, like other UK cities, faces the challenge of addressing high child poverty levels - 52% of children, in some parts of the city, live in poverty. Within NHS Greater Glasgow and Clyde, the Healthier, Wealthier Children (HWC) project was set up to create referral pathways between the NHS and money advice services to support pregnant women and families at risk of child poverty. The 15 month project, launched in October 2010, was funded by the Scottish Government.

The evaluation, being undertaken by the Glasgow Centre for Population Health, will conclude in April 2012. This paper aims to describe the HWC evaluation findings with a focus on two key objectives: development of the NHS workforce role and mainstreaming child poverty action within this role.

Methods

A mixed methods approach to the HWC evaluation included capturing and describing the changes in the NHS workforce roles through documentary analysis, an NHS workforce survey and outcomes from money advice services.

Results

An HWC website was set up to provide staff materials, case studies and practical recommendations on child poverty work as an NHS workforce resource. Other ongoing work includes creating midwife/patient web-based scenarios to be used as a national resource.

Although not part of the existing NHS performance framework (i.e. HEAT targets), there is evidence that HWC work is being embedded. Most referrals to advice services were made by health visitors (51%) and midwives (29%). The majority of both workforces (81/84; 96%) intend to continue referring post-HWC. Moreover, health visitors ranked clients’ money worries as a priority above three national HEAT targets.

To date, 2,516 referrals were made to money advice services which resulted in uptake of 54% (n=1,347) among pregnant women and families with young children. More than seven out of 10 people accessing advice services were eligible for Healthy Start vouchers (benefits related) which can be exchanged for milk, fresh fruit and vegetables. There was a total recorded annual gain of just over £2.7 million and £328,000 in one-off lump sums. Other reported client outcomes included immigration advice, addressing fuel poverty and onward homelessness referrals.

Conclusion

This paper will suggest that HWC has resulted in positive outcomes towards mitigating the impact of child poverty. Midwives and health visitors have played an active role and there is scope to develop this work across the wider Early Years workforces.
PS48 Processes Of Change: What Are The Specific Pathways And Project Components That Have A Positive Impact On The Well-Being Of Participants In A ‘Well London’ Project?
Authors: Derges J , Draper A , Clow A , Lynch R , Jain S
Published: September 2012

Background

This paper presents follow-up data from a qualitative study of a Big Lottery funded ‘Well London’ project; an initiative set up to improve the health and well-being of Londoners living in areas historically marked by social, economic and environmental deprivation. The project introduced a series of health interventions: healthy eating, physical activity, and mental health and well-being, across a total of 20 areas within London. An evaluation of the interventions was conducted through a series of in depth semi-structured interviews with residents in 3 of the areas. Participants were interviewed twice: initially at the start of the interventions and again twelve months later. The interviews explored which of the project components acted positively on participant’s sense of well-being and lead to changes in health behaviour. The methodology used, placed emphasis on the opinions and reflections of study participants and responds to Popay’s call for research to be centred not only on theoretical concerns, but also to be attentive to ‘lay’ theories of health.

Methods

Two sets of 60 semi-structured interviews, taking place a year apart were conducted across three locations identified as Census Lower Super Output Areas (LSOAs). These measured changes in health behaviour and residents’ perceptions of ‘well-being’ that arose following the Well London interventions. Residents were interviewed about their experiences and perceptions of the neighbourhood; also their health and views of the Well London interventions. Residents who had not taken part in the project interventions were also selected and interviewed, for comparison.

Results

The study found that the project objectives succeeded where there were at least one of the following present; a) high levels of individual motivation; b) the involvement of external agencies in the form of key worker and/or agency support; c) where residents were involved in the organisation and dissemination of the projects, often as volunteers; and d) where the environment was made accessible, safe and conducive to a sense of belonging and ‘community ownership’.

Conclusion

The findings indicate that the Well London project increased perceptions of well-being in populations defined by inner city social disadvantage. However, the pathways to change are complex and not easily generalized. Success is dependent on multiple interacting interpersonal, social and contextual factors, as well as the actual type of interventions themselves.
PS49 Food For Thought! The Role Of Dietary Choices On Cognitive Behaviour
Authors: Cadar D , Pikhart H , Mishra G , Stephen AM , Kuh D , Richards M
Published: September 2012

Background

Cognitive decline indicates the first sign of dementia and a major public health impact associated with ageing. Evidence suggests that dietary patterns are associated with cerebrovascular and cardiovascular risk factors.

Methods

To examine the association between dietary choices and 20 years cognitive decline from 43 to 60+.; 1018 study members from the MRC National Survey of Health and Development regularly followed up since birth in 1946 were included in the study.

Cognitive functioning was measured at 43 and 60+ years using two tests: verbal memory (maximum words recalled 45) and visual search (maximum letter searched: 600).

Dietary data was obtained using a 5 days diet diary at age 36 and 43y. An overall score representing level of healthy food choice was derived, by summing scores from five separate criteria: 1. consumption of breakfast (0 no consumption to 2 all days); 2.type of milk (from 0 whole to 3 skim milk); 3. type of bread (from 0 white to 4 wholemeal); 4. number of daily portions of fruit and vegetables (from 0 none to 5 portions/day) and percentages of energy from daily intakes (0-more than 45% energy to 5 -less than 30% energy). A total score was derived and further classified as 0 low or 1 higher choice, subject to median split at each age. A cumulative midlife score was further derived as 0 low choice at either age or 1 higher choice at least at one age or both. The confounding variables were father’s social class, childhood cognition, education, adult social class and depression.

Results

There was a cross sectional positive association between a higher choice of diet and verbal memory scores at age 43y compared to a lower choice 1.83 (95% CI 1.12 to 2.54). This association was maintained after adjusting for all covariates. There was also a significant association between a midlife cumulative healthier choice of diet and a slower verbal memory from 43 to 60+ in a fully adjusted model 0.69 (1.10 to 1.27) compared to midlife lower choice. There was no association between dietary choice and visual search or visual search decline.

Conclusion

Our results suggest that a healthy dietary option based on high intake of fruit and vegetables, complex carbohydrates and cereals made in early midlife is protective of verbal memory decline from mid to later life. Public health interventions based on healthy diets and the prevention of nutritional deficiencies should be considered an important line of defence against cognitive decline and dementia.
KLEIN TUNNELING IN THE PRESENCE OF RANDOM IMPURITIES
Authors: PALPACELLI S. , MENDOZA M. , HERRMANN H. J. , SUCCI S.
Published: September 2012

In this paper, we study Klein tunneling in random media. To this purpose, we simulate the propagation of a relativistic Gaussian wave packet through a disordered medium with randomly distributed potential barriers (impurities). The simulations, based on a relativistic quantum lattice Boltzmann (QLB) method, permit to compute the transmission coefficient across the sample, thereby providing an estimate for the conductivity (or permeability) as a function of impurity concentration and strength of the potentials. It is found that the conductivity loss due to impurities is significantly higher for wave packets of massive particles, as compared to massless ones. A general expression for the loss of conductivity as a function of the impurity percentage is presented and successfully compared with the Kozeny–Carman law for disordered media in classical fluid-dynamics.
SELF-ORGANIZATION OF LÖSCH'S HEXAGONS IN ECONOMIC AGGLOMERATION FOR CORE-PERIPHERY MODELS
Authors: IKEDA KIYOHIRO , MUROTA KAZUO , AKAMATSU TAKASHI
Published: September 2012

Hexagonal population distributions of several sizes are shown to be self-organized from a uniformly inhabited state, which is modeled by a system of places (cities) on a hexagonal lattice. Microeconomic interactions among the places are expressed by a core-periphery model in new economic geography. Lösch's ten smallest hexagonal distributions in central place theory are guaranteed to be existent by equivariant bifurcation analysis on D 6 ∔ (ℤn × ℤn), and are obtained by computational analysis. The missing link between central place theory and new economic geography has thus been discovered in light of the bifurcation analysis.
LIMIT CYCLE BIFURCATIONS NEAR A DOUBLE HOMOCLINIC LOOP WITH A NILPOTENT SADDLE
Authors: HAN MAOAN , YANG JUNMIN , XIAO DONGMEI
Published: September 2012

Homoclinic bifurcation is a difficult and important topic of bifurcation theory. As we know, a general theory for a homoclinic loop passing through a hyperbolic saddle was established by [Roussarie, 1986]. Then the method of stability-changing to find limit cycles near a double homoclinic loop passing through a hyperbolic saddle was given in [Han & Chen, 2000], and further developed by [Han et al., 2003; Han & Zhu, 2007]. For a homoclinic loop passing through a nilpotent saddle there are essentially two different cases, which we distinguish by cuspidal type and smooth type, respectively. For the cuspidal type a general theory was recently established in [Zang et al., 2008]. In this paper, we consider limit cycle bifurcation near a double homoclinic loop passing through a nilpotent saddle by studying the analytical property of the first order Melnikov functions for general near-Hamiltonian systems and obtain the conditions for the perturbed system to have 8, 10 or 12 limit cycles in a neighborhood of the loop with seven different distributions. In particular, for the homoclinic loop of smooth type, a general theory is obtained as a consequence. We finally consider some polynomial systems and find a lower bound of the maximal number of limit cycles as an application of our main results.
UNCOVERING MISSING SYMBOLS IN COMMUNICATION WITH FILTERED CHAOTIC SIGNALS
Authors: REN HAI-PENG , BAPTISTA MURILO S. , GREBOGI CELSO
Published: September 2012

We investigate the physical modifications caused by a linear filter in a chaotic trajectory. We show that while the filter strongly modifies the topological characteristics of the chaotic signal, it might not alter its information content. We propose a chaos-based communication system that takes advantage of this fundamental characteristic of the dynamics. We devise procedures both to recover all the symbols at the receiver end and to decode the received higher-dimensional filtered chaotic signal by using techniques from the theory of pattern recognition. Our results show that a message bearing chaotic signal can be transmitted over a low bandwidth physical channel and be decoded with a low decoding bit error rate.
SOME COMBINATORIAL PROPERTIES OF ARSHON SEQUENCES OF ARBITRARY ORDERS
Authors: WANG ZHENG-PAN
Published: September 2012

Let [Formula: see text] be the Arshon sequence of order m and let [Formula: see text] be the formal language consisting of all finite subwords of [Formula: see text]. In this paper, we (1) show that the avoidability bound for [Formula: see text] is [Formula: see text], (2) characterize the syntactic congruence of [Formula: see text] as a Rees congruence, thus generalizing the results of Klepinin and Sukhanov [On combinatorial properties of the Arshon sequence, Discrete Appl. Math.114(1–3) (2001) 155–169], (3) show that the isoperimetric profile of [Formula: see text] is a constant.
Transstomal Small Bowel Evisceration after Colonic Perforation Secondary to Ischemic Colitis
Authors: Guner Ali , Kahraman Izzettin , Ozkan Omer Faruk , Aktas Adem , Kece Can
Published: September 2012

Intestinal stomas are commonly used in a temporary or permanent fashion in gastrointestinal surgeries. The complication rate of stomas has been reported to vary between 23 and 50%. There is only one case in the literature involving transstomal small bowel evisceration following colonic perforation. In this paper, we aimed to present a patient with a perforated colon secondary to ischemic colitis, which resulted in small bowel evisceration through this perforation site.
Androgen Receptor on the Move: Boarding the Microtubule Expressway to the Nucleus
Authors: Thadani-Mulero Maria , Nanus David M. , Giannakakou Paraskevi
Published: September 2012

Recent studies have shown that the microtubule-stabilizing drug paclitaxel, which is commonly used for the treatment of prostate cancer, inhibits signaling from the androgen receptor by inhibiting its nuclear accumulation downstream of microtubule stabilization. This mechanism is independent of paclitaxel-induced mitotic arrest and could provide an alternative mechanism of drug action that can explain its clinical activity. In this review, we highlight the importance of signaling and trafficking pathways that depend on intact and dynamic microtubules, and, as such, they represent downstream targets of microtubule inhibitors. We showcase prostate cancer, which is driven by the activity of the androgen receptor, as recent reports have revealed a connection between the microtubule-dependent trafficking of the androgen receptor and the clinical efficacy of taxanes. Identification and further elucidation of microtubule-dependent tumor-specific pathways will help us better understand the molecular basis of clinical taxane resistance as well as to identify individual patients more likely to respond to treatment. Cancer Res; 72(18); 4611–5. ©2012 AACR.
The Effect of Voluntary Training with Family Participation on Early Home Discharge in Patients with Severe Stroke at a Convalescent Rehabilitation Ward
Authors: Hirano Yoshitake , Maeshima Shinichiro , Osawa Aiko , Nishio Daisuke , Takeda Koji , Baba Megumi , Kigawa Hiroshi
Published: September 2012

Background: The purpose of this study was to clarify the effects of voluntary training with family participation in addition to conventional rehabilitation for stroke patients. Methods/Design: The subjects were 49 first-time stroke patients with severe hemiplegia. They were divided into two groups: a family participation group, in which voluntary training was performed with family members (21 patients), and a nonfamily participation group, in which voluntary training was performed with a physical therapist (28 patients). The groups were compared by background, cognitive and physical function, postadmission course, and outcome. Results: There were shortened lengths of stay and higher rates of home discharge in family participation group, but no differences in functional recovery. Conclusions: Voluntary training with family participation was effective in shortening the length of hospital stay and in improving the rate of home discharge in a convalescent rehabilitation ward.
Risk Assessment of Hymenoptera Re-Sting Frequency: Implications for Decision-Making in Venom Immunotherapy
Authors: von Moos Seraina , Graf Nicole , Johansen Pål , Müllner Gerhard , Kündig Thomas M. , Senti Gabriela
Published: September 2012

Background: Venom immunotherapy is highly efficacious in preventing anaphylactic sting reactions. However, there is an ongoing discussion regarding patient selection and whether and how to apply a cost-benefit analysis of venom immunotherapy. In order to help decision-making, we investigated the re-sting frequency of hymenoptera-venom-allergic patients to single out those at high risk. Methods: In this retrospective study, re-sting data of 96 bee-venom-allergic patients and 95 vespid-venom-allergic patients living mainly in a rural area of Switzerland were analyzed. Hymenoptera venom allergy status was rated according to the classification system of H.L. Mueller [J Asthma Res 1966;3:331–333]. Different risk-groups were defined according to sting exposure and their median sting-free interval was calculated. Results: The risk factors for a wasp or bee re-sting were outdoor occupation, beekeeping and habitation close to a bee-house. Half of all vespid-venom-allergic outdoor workers were re-stung within 3.75 years compared to 7.5 years for indoor workers. Similarly, 50% of the bee-venom-allergic beekeepers or subjects with a bee-house in the vicinity suffered a bee re-sting within 5.25 years compared to 10.75 years for individuals who were not beekeepers. Conclusions: The high degree of exposure of vespid-venom-allergic outdoor workers and bee-venom-allergic beekeepers and subjects living close to bee-houses underlines the high benefit of venom immunotherapy for these patients even if they suffered a non-life-threatening grade II reaction. Yet, bee-venom-allergic individuals with no proximity to bee-houses and with an indoor occupation face a very low exposure risk, which justifies epinephrine rescue treatment for these patients especially if they have suffered from grade II sting reactions.
Association between the Polymorphism A/G at Position 49 of Exon 1 of the CTLA-4 Gene and Antithyroid Antibody Production in Children with Hashimoto’s Thyroiditis
Authors: Kucharska Anna M. , Wisniewska Alicja , Popko Katarzyna , Demkow Urszula
Published: September 2012

CTLA-4 gene is considered to be one of the strongest factors determining the predisposition to antithyroid antibody (Ab) production. The aim of the study was to evaluate the association of the polymorphism A/G of exon 1 of CTLA-4 gene and antithyroid Ab level in children with Hashimoto’s thyroiditis (HT). Material and Methods: 45 children with HT (aged 14.9 ± 2, range 8.1–7.9) and 55 healthy controls (aged 14.8 ± 2.34, range 8.0–17.4) were enrolled. Controls were euthyroid and free from any autoimmune disease. CTLA-4 gene (+49)A/G polymorphism was evaluated by a single-strand conformation polymorphism method and restriction fragment-length polymorphism. Results: The frequency of GG genotype in HT children was significantly higher than in controls: 31 vs. 14.5% respectively (p < 0.04, OR = 2.65, CI = 0.99–7.06). Anti-Tg Ab titers were higher in patients homozygous for G allele than with AA genotype. The GG genotype seemed to be protective from hypothyroidism at the moment of HT diagnosis, but this observation was not statistically confirmed. Conclusions: Our study provides the evidence supporting the association between CTLA-4 gene (+49)A/G polymorphism and the susceptibility to HT in Polish children and confirms the existence of a link between (+49)A/G polymorphism and anti-Tg Ab level.
The Cost of Persistent Asthma in Europe: An International Population-Based Study in Adults
Authors: Accordini Simone , Corsico Angelo G. , Braggion Marco , Gerbase Margaret W. , Gislason David , Gulsvik Amund , Heinrich Joachim , Janson Christer , Jarvis Deborah , Jõgi Rain , Pin Isabelle , Schoefer Yvonne , Bugiani Massimiliano , Cazzoletti Lucia , Cerveri Isa , Marcon Alessandro , de Marco Roberto ,   Therapy and Health Economics Working Group of the European Community Respiratory Health Survey II
Published: September 2012

Background: This study is aimed at providing a real-world evaluation of the economic cost of persistent asthma among European adults according to the degree of disease control [as defined by the 2006 Global Initiative for Asthma (GINA) guidelines]. Methods: A prevalence-based cost-of-illness study was carried out on 462 patients aged 30–54 years with persistent asthma (according to the 2002 GINA definition), who were identified in general population samples from 11 European countries and examined in clinical settings in the European Community Respiratory Health Survey II between 1999 and 2002. The cost estimates were computed from the societal perspective following the bottom-up approach on the basis of rates, wages and prices in 2004 (obtained at the national level from official sources), and were then converted to the 2010 values. Results: The mean total cost per patient was EUR 1,583 and was largely driven by indirect costs (i.e. lost working days and days with limited, not work-related activities 62.5%). The expected total cost in the population aged 30–54 years of the 11 European countries was EUR 4.3 billion (EUR 19.3 billion when extended to the whole European population aged from 15 to 64 years). The mean total cost per patient ranged from EUR 509 (controlled asthma) to EUR 2,281 (uncontrolled disease). Chronic cough or phlegm and having a high BMI significantly increased the individual total cost. Conclusions: Among European adults, the cost of persistent asthma drastically increases as disease control decreases. Therefore, substantial cost savings could be obtained through the proper management of adult patients in Europe.
Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial
Authors: Andersson Gerhard , Paxling Björn , Roch-Norlund Pie , Östman Gunnar , Norgren Anna , Almlöv Jonas , Georén Lisa , Breitholtz Elisabeth , Dahlin Mats , Cuijpers Pim , Carlbring Per , Silverberg Farrell
Published: September 2012

Background: Guided Internet-based cognitive behavior therapy (ICBT) has been tested in many trials and found to be effective in the treatment of anxiety and mood disorders. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). Since there is preliminary support for psychodynamic treatment for GAD, we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet. The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group. Method: A randomized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT (n = 27) and IPDT (n = 27) against a no treatment waiting list control group (n = 27). The primary outcome measure was the Penn State Worry Questionnaire. Results: While there were no significant between-group differences immediately after treatment on the main outcome measure, both IPDT and ICBT resulted in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses. The differences against the control group, although smaller, were still significant for both PDT and CBT when conforming to the criteria of clinically significant improvement. The active treatments did not differ significantly. There was a significant group by time interaction regarding GAD symptoms, but not immediately after treatment. Conclusions: IPDT and ICBT both led to modest symptom reduction in GAD, and more research is needed.
Contributions of Developmental Studies in the Dogfish Scyliorhinus canicula to the Brain Anatomy of Elasmobranchs: Insights on the Basal Ganglia
Authors: Quintana-Urzainqui Idoia , Sueiro Catalina , Carrera Ivan , Ferreiro-Galve Susana , Santos-Durán Gabriel , Pose-Méndez Sol , Mazan Sylvie , Candal Eva , Rodríguez-Moldes Isabel
Published: September 2012

The basic anatomy of the elasmobranch brain has been previously established after studying the organization of the different subdivisions in the adult brain. However, despite the relatively abundant immunohistochemical and hodologic studies performed in different species of sharks and skates, the organization of some brain subdivisions remains unclear. The present study focuses on some brain regions in which subdivisions established on the basis of anatomical data in adults remain controversial, such as the subpallium, mainly the striatal subdivision. Taking advantage of the great potential of the lesser spotted dogfish, Scyliorhinus canicula, as a model for developmental studies, we have characterized the subpallium throughout development and postembryonic stages by analyzing the distribution of immunomarkers for GABA, catecholamines, and neuropeptides, such as substance P. Moreover, we have analyzed the expression pattern of regulatory genes involved in the regionalization of the telencephalon, such as Dlx2, Nkx2.1, and Shh, and followed their derivatives throughout development in relation to the distribution of such neurochemical markers. For further characterization, we have also analyzed the patterns of innervation of the subpallium after applying tract-tracing techniques. Our observations may shed light on postulate equivalences of regions and nuclei among elasmobranchs and support homologies with other vertebrates.
High Predictability of a Sustained Virological Response (87%) in Chronic Hepatitis C Virus Genotype 1 Infection Treatment by Combined IL28B Genotype Analysis and γ-Glutamyltransferase/Alanine Aminotransferase Ratio: A Retrospective Single-Center Study
Authors: Amanzada A. , Goralczyk A.D. , Schneider S. , Moriconi F. , Lindhorst A. , Mihm S. , Van Thiel D.H. , Ramadori G.
Published: September 2012

Background: Chronic hepatitis C virus genotype 1 (HCV-G1) infection is treated with pegylated interferon-α and ribavirin. Predictive factors for treatment success are even more important now as direct-acting antiviral agents are available. Methods: Clinical and laboratory parameters were analyzed by uni- and multivariate statistical means in 264 patients with HCV-G1 infections with regard to treatment outcome. Results: The overall sustained virological response (SVR) rate was 44%. Univariate analyses revealed SVRs to be associated with age, high alanine aminotransferase (ALT) and low γ-glutamyltransferase (γ-GT) serum activities, a low pretreatment γ-GT/ALT ratio, rapid virological response (RVR), and absence of steatosis. Multivariate analyses unveiled IL28B rs12979860 genotype (CC vs. CT: OR = 2.8, CI: 1.5–4.9, p = 0.001; CC vs. TT: OR = 7.1, CI: 3.1–16.7, p < 0.001), low pretreatment γ-GT/ALT ratio (OR = 2.5, CI: 1.7–3.3, p < 0.001), age (OR = 0.96, CI: 0.94–0.98, p = 0.001) and RVR (OR = 4.18, CI: 2.85–8.65, p < 0.001) to be significantly related to treatment outcome. Patients with the IL28B rs12979860 CC genotype and a low pretreatment γ-GT/ALT ratio achieved the highest rate of a SVR with the highest predictive values (OR = 26.7, 95% CI: 10–71.1, p < 0.0001). Conclusion: The pretreatment γ-GT/ALT ratio significantly enhances the predictability of the IL28B genotype. Employing this combination will help to identify patients who will most likely benefit from an interferon-α-based combination therapy in a nontriaged ordinary setting.
Copy Number Polymorphism of the Salivary Amylase Gene: Implications in Human Nutrition Research
Authors: Santos J.L. , Saus E. , Smalley S.V. , Cataldo L.R. , Alberti G. , Parada J. , Gratacòs M. , Estivill X.
Published: September 2012

The salivary α-amylase is a calcium-binding enzyme that initiates starch digestion in the oral cavity. The α-amylase genes are located in a cluster on the chromosome that includes salivary amylase genes (AMY1), two pancreatic α-amylase genes (AMY2A and AMY2B) and a related pseudogene. The AMY1 genes show extensive copy number variation which is directly proportional to the salivary α-amylase content in saliva. The α-amylase amount in saliva is also influenced by other factors, such as hydration status, psychosocial stress level, and short-term dietary habits. It has been shown that the average copy number of AMY1 gene is higher in populations that evolved under high-starch diets versus low-starch diets, reflecting an intense positive selection imposed by diet on amylase copy number during evolution. In this context, a number of different aspects can be considered in evaluating the possible impact of copy number variation of the AMY1 gene on nutrition research, such as issues related to human diet gene evolution, action on starch digestion, effect on glycemic response after starch consumption, modulation of the action of α-amylases inhibitors, effect on taste perception and satiety, influence on psychosocial stress and relation to oral health.