bluuebunny/crossref_metadata_2025 huggingface dataset:
Colored Water Causes and Control Strategies - Pilot Test Experiences of a US Water Provider
Authors: Kommineni Sunil , Mishra Dhananjay , MacPhee Mike
Published: April 2009

A large water provider in the Southwest United States of America (US) has been experiencing an increased number of colored water complaints during the summer months. Authors conducted a comprehensive evaluation to identify the causes for colored water and develop strategies to mitigate colored water occurrence. The evaluation included pilot tests with iron pipes harvested from the distribution system. Pilot tests were conducted to evaluate the effects of water quality (pH, alkalinity etc) and distribution system operation (pipe flow velocity and flow reversal) on the release of corrosion by-products. Alkalinity and pH were found to have a significant impact on the corrosion by-product releases. A half unit decrease in the distribution system water pH resulted in a 300 percent (%) increase in iron release and a 200% decrease in turbidity. Doubling of the pipe flow velocity resulted in 250% increase in iron release and 300% increase in turbidity. Tests were also conducted to study the benefits of corrosion inhibitor addition. Addition of dipotassium orthophosphate and stannous chloride corrosion inhibitors at low dosages reduced the iron release by approximately 40%.
A System for Treating Rainwater Collected for Human Use in Rural Communities in Mexico
Authors: Garrido S. , Aviles M. , Ramirez A. , Gonzalez A. , Barrera L.A. , Montellano L. , Ramirez R.M. , Cervantes O.
Published: April 2009

The northern area of the State of Morelos is facing serious problems with water supply for human use and consumption mainly due to geographic conditions and the type of subsoil that predominates in the area, which is made of permeable materials that allow rainwater infiltration to the impermeable layers (800-2342 mm year−1), more than 500 meters deep, making the extraction of this vital liquid difficult and costly. The aim of this project was to develop a system for the treatment of collected rainwater for the rural community Villa Nicolas Zapata in the State of Morelos, Mexico. Considering the limited hydraulic infrastructure and management in this community of 300 inhabitants, which does not receive services from the centralized water systems, a modified pilot multi-stage filtration (MMSF) system for producing drinking water for human use was selected, designed, built, and evaluated. The efficiencies obtained by this treatment system were: real color 96.3%, turbidity 98.0%, pH 6.5 and absence in total and fecal coliforms. The modified multi-stage filtration technology (MMSF) is suitable for treating collected rainwater, obtaining an effluent with water quality that complies with Mexican Official Standard NOM-127-SSA1-1994.
Assessing desalination as a sustainable alternative using a multiple criteria decision support model
Authors: Fernandes M. B. , Almeida M. C. , Henriques A. G.
Published: April 2009

Desalination technologies provide an alternative for potable water production, having significant potential for application where fresh water scarcity exists. Potential benefits have to be balanced with other factors, such as high costs, high energy consumption, and significant environmental impacts, for the understanding of real risks and gains of desalination within the context of integrated water resources management. Multiple factors can be considered when analysing the viability of a desalination project but often a limited approach is used. The complexity in the analysis lies in finding the alternatives that obey to multiple objectives (e.g. reduced environmental impact, social acceptance, less cost associated). In this paper, development of a methodology based on multiple criteria decision support system for the evaluation and ranking the potential of desalination technologies is described and applied to a Portuguese case study. Relevant factors to the selection of desalination technologies were identified using SWOT analysis and the MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) approach was applied. Technical alternatives considered include reverse osmosis and multi-effect desalination (MED), together with energy production by fossil fuels or solar energy. Production of water by conventional approaches was also considered. Results, for non-economic benefits, show higher score for MED solar but, in the cost-benefit analysis, conventional methods of water production have higher ranking since costs of renewable energies are not yet competitive. However, even if not preferred in economic terms, desalination is ranked significantly above the conventional approaches for non-economic criteria.
Capacitive Deionization for RO brine recovery in NEWater production
Authors: Lee L.Y. , Ng H.Y. , Ong S.L. , Hu J.Y. , Tao G. , Kekre K. , Viswanath B. , Lay W. , Seah H.
Published: April 2009

Reverse osmosis (RO) brine from water reclamation facility is a potential untapped water source, provided a feasible and economical treatment process is available to recover this waste stream. Organic and inorganic compounds are two major groups of pollutants in the RO brine. In this study, an integrated treatment scheme consisting of a biological activated carbon (BAC) column and a low pressure Capacitive Deionization (CDI) process was investigated. BAC was used as a pretreatment to remove the organic compounds prior to the inorganic removal using the CDI process. Two empty bed contact times, namely 20 min and 40 min tested in the BAC columns provided similar TOC removal efficiency within the range of 15–21%. High ions removals of more than 85% from the RO brine were achieved in the CDI process when operated with water recovery up to 89%. This study has successfully demonstrated that the integrated BAC with CDI process has high potential to increase water recovery of a water reclamation plant while gaining the advantage of a reduced volume of RO brine for disposal. This system could further contribute to enhancement of sustainable water reclamation practice.
Recent Advances in Membrane Bioreactors
Authors: Watanabe Yoshimasa , Kimura Katsuki
Published: April 2009

This paper describes the current situation and technological progress on the MBR .The first part deals with the future trends of world water use and need of water recycling. Based on the White Paper published by the AMEDIUS project, MBR has a great potential as a key technology for the water recycling.

The second part deals with the recent research results of the authors on the membrane fouling. The following conclusions were derived from the pilot plant study:

1). The PE membrane fouled more rapidly than did the PVDF membrane,

2). Composition of the physically irreversible foulants differed considerably depending on the membrane polymer material,

The third part deals with a newly developed MBR for the nitrogen removal. In the MBR, simultaneous nitrification/denitrification in a single bioreactor is possible by inserting baffles into a normal MBR and controlling the water level to produce the anoxic condition.
Long-term Comparison Testing with Sand Ballasted Flocculation (SBF) and High-rate Dissolved Air Flotation (DAF).
Authors: Cappellen J. Van , Clement J. , Kempeneers S. , Budd G. , Bossaerts W. , Milton G.
Published: April 2009

This paper reports on the investigation conducted by Antwerp Water Works (AWW) in Belgium to make a long term (12 months) comparison between SBF and high-rate DAF to determine which process would be optimal. Three major objectives where put forward at the beginning of the study: technology comparison, gain operational experience and conduct coagulant testing. This paper discusses the result obtained with respect to these objectives. Overall this paper clearly points to the value this type of piloting can bring to water companies.
Achieving Low Unaccounted-For-Water through Reliable Supply to Customers and Efficient Network Management
Authors: Tay T.K. , Singh R. , Lim C.L. , Yeo W.L. , Chong H.C.
Published: April 2009

Since the early 1980s, PUB has been conscious of the need to manage the water supply network efficiently and to account for the amount of water distributed through the network. This concern is primarily motivated by PUB's goal to provide a high level of service to customers with reliable supply of water at affordable cost. With the strong support of the top management and the active participation of everyone in PUB, an Integrated Water Network Management System has been adopted to ensure that leakage in new networks is kept to a minimum through proper planning, design and the use of good quality materials that are installed with good workmanship. Losses in existing network are reduced through network management and leakage controls as well as accounting for water distributed with full and accurate metering. Consequently, these deliberate efforts have enabled Singapore to achieve one of the lowest Unaccounted-For-Water in the world (below 5%).
Biosolids Drying: Solving Municipal Regulation and Cost Problems
Authors: Igoe John , Bina Enzo , Pan Mauro Dal
Published: April 2009

Municipalities around the world are challenged with growing populations, changing regulations and rising costs. Heat drying technologies have been used for many years to reduce biosolids volumes, and recently, there have been developments in the drying industry surrounding safety, air quality, beneficial reuse and heat recovery (Igoe, 2002).

There are two main categories of drying technologies: convective (or direct) and contact (or indirect). In this paper, the direct Convective Thermal Dryer (CTD) system and indirect Ecoflash® Thin Layer Dryer are discussed and illustrated through municipal examples.

The projects discussed in this paper are:The City of Corona, California, USA, which uses a Convective Thermal Dryer (CTD) system to reduce volume and disposal costs of biological biosolids generated at the city's two wastewater treatment plants. The project is unique because the CTD system uses waste heat from the City's power plant to promote the production of beneficial reuse, Class A biosolids.The Dundalk drying plant in Ireland, which is the first plant designed and built by Siemens Water Technologies to be in full compliance with the European ATEX (Atmosphere Explosible) Safety Regulation Directive 94/9/EC.Disposal of dewatered sludge quickly becomes a big problem for Cagliari, a city on Sardinia Island in Italy, whose economy is based on tourism. They use the Ecoflash® dryer to reduce biosolids hauling and disposal costs.
Start-up and Initial Operation of Singapore's 800,000 m3/day Changi Water Reclamation Plant
Authors: Daigger G. T. , Nicholson G. A. , Koh C. L. Y. , Moh W. H. , Young J. C. , Ghani Y. A , Yong W. H.
Published: April 2009

The new Changi Water Reclamation Plant (CWRP) in Singapore is designed for ultimate expansion to 2,400,000 m3/day. Construction of the initial 800,000 m3/day phase began in 2001 and will be completed in mid 2008. Designed as a compact, underground facility, the plant incorporates stacked rectangular primary and secondary clarifiers along with the anoxic step feed process. Solids processing consists of centrifuge thickening, anaerobic digestion, centrifuge dewatering, and thermal drying. A 227,000 m3/day “NEWater® Factory”, or Reclaimed Water Production Plant, will be constructed under a Design Build Own and Operate (DBOO) concession on top of the liquid process modules to produce high grade water for indirect potable and non-potable uses. Phased start-up of the facility began in February, 2007 and has continued through 2008. Initial performance has generally met expectations, resulting in excellent performance when the plant is not hydraulically overloaded, partial nitrification and denitrification as intended with the anoxic step feed process used which provided stable treatment and avoided significant pH depression, and SVI values which averaged 105 mL/g and were consistently below 150 mL/g.
WHO Guidance for Health and Environmental Aspects of Desalination, including Chemical Challenges and Nutrient Minerals
Authors: Cotruvo Joseph A.
Published: April 2009

The World Health Organization, through its Eastern Mediterranean Regional Office (EMRO) has developed guidance on health and environmental aspects of desalinated water production, distribution and water quality. The purpose was to generate a level of consistency in the approach to developing desalination projects, so as to facilitate the introduction of desalination benefits, and avoid unnecessary ad hoc judgments.

In addition to salts, desalination applications must deal with raw water contamination by oil, inorganic and synthetic organic chemicals, microbial contaminants, scale management, membrane leakage, and chemical and biofouling. Stabilization of the finished water to avoid corrosion is a key element. Environmental impacts are possible with any large construction project and desalination projects may also involve coastal zone issues, energy consumption and efficiencies from cogeneration, and disposal of concentrates at sea or on land. Quality of finished water must be maintained during transit to consumers sometimes over long distances and warm temperatures. These goals should consider positive public health consequences, as well as preventing adverse effects.

Several inorganic ions i.e., bromide, borates and bromate, are of particular interest because the first two are not completely removed by membranes, and the third can be present in finished water in large quantities depending upon the treatment processes being employed.

Desalinated water can be considered to be “synthesized” water and, as such, its final composition can be tailored to any specific purpose within technological and financial constraints. Components such as TDS, calcium and magnesium mineralization, fluoride and possibly others can be chosen to reflect possible benefits to the consuming population, as well as to assure corrosion stability.

This new Guidance will also be a component of the 4th edition of the WHO Guidelines for Drinking-water Quality scheduled for 2009. It is expected to have worldwide impact, due to the already extensive and rapidly growing use of desalination. It should contribute to the improvement of the public health and quality of life and to economic growth. The final Guidance will be published in English and Arabic with a translation provided by the Kuwait Foundation for the Advancement of Sciences. The draft is available at http://www.who.int/water_sanitation_health/gdwqrevision/desalination/en/index.html
Emerging Enteric and Potentially Waterborne Pathogens
Authors: Cunliffe D. A.
Published: April 2009

Infectious water-borne pathogens are a major cause of morbidity and mortality. A substantial proportion of water-borne disease is caused by established pathogens. However, emerging pathogens present important challenges to the water and health sectors. The last 30 to 40 years has seen the initial identification of a number of significant pathogens that can be water-borne including rotavirus, norovirus, V.cholerae 0139, Cryptosporidium, Campylobacter and Legionella. Many more are classified as emerging due to detection of increased incidence of disease or detection in areas where they were not previously established. The emergence of infectious diseases, including those that are water-borne, is caused by a number of factors such as population growth, migration, travel, new environments, climate change, improved methodology and drug resistance. Understanding these factors is an important component of establishing effective management of water resources and drinking water safety plans.
Strategic Planning of Urban Water Systems
Authors: Malmqvist Per-Arne
Published: April 2009

The planning of future sustainable water and wastewater system is not a trivial task. It involves all relevant aspects of sustainability such as defined by the Urban Water conceptual framework: health, environment (including use of resources), economy, socio-cultural aspects, and technical function. The Urban Water programme has developed a set of tools for the assessment of the aspects involved. Substance flow simulation models such as URWARE and SEWSYS deliver quantified data on emissions to air, water and land, and the use of energy. Data is interpreted by LCA methodologies, quantifying e.g. eutrophication, acidification, discharge of green-house gases etc.

All information, whether quantitative or qualitative, whether delivered by professionals or laymen, are used in an iterative decision-making process, such as the SCA method (Strategic Choice Approach). The multi-criteria assessment involves a weighting mode and can be made using graphic computer programs or numerically.

The SCA approach and the Urban Water tools have been used for assessing the future sustainable system for handling wastewater and biowaste in Göteborg, Sweden. Among the results were that it was not found to be sustainable to abandon the existing principles and exchange the existing system for source separation systems. Systems that extract pure phosphorus (and nitrogen) fractions at the treatment plant, and systems that aim at producing a very clean sludge by reducing the pollutant sources in the city, got high scores in the assessment.
Essential Elements in the Development of Sustainable Water Services
Authors: Rouse Michael J.
Published: April 2009

The world has changed and reform of the water sector is necessary to meet the growing challenges. It is argued that sustainable water services are unobtainable without consideration of the following elements: separation of delivery of services from the policy function; viable scale of operations; integrated planning; finance and cost recovery to avoid general subsidies; a change from general subsidies to those targeted on the poor; transparency and public participation and some form of independent scrutiny with above all effective leadership and management.

The public-private argument is unproductive and energies should be focussed on the fundamental reforms. Suppliers to utilities can be most effective working in partnership to achieve win-win situations.
Major Water Industry Reform in Australia: A Case Study from Queensland
Authors: Adams W.B.
Published: April 2009

The State Government of Queensland, Australia, has recently embarked on unparalleled reform of the water industry in the populous South-East corner of the state. This reform goes well beyond that previously seen in either the Australian electricity or water industries, and involves the geographic aggregation of 25 separate local government-owned water authorities into a five-tiered, vertically disaggregated series of new water supply and delivery businesses. Particular priority has been placed on establishing the bulk and manufactured water, trunk distribution and grid management entities that will be crucial to meeting the short and long-term water supply needs of this rapidly-growing region, however the scope of reforms covers the full water supply chain through to the consumer. The scale and pace of the reform poses significant challenges for both the industry and its regulators. To achieve the Government's aggressive timetable and delivery outcomes, all parties have had to mobilise quickly and manage the complex task of business transformation while maintaining service continuity - and against a backdrop of severe drought, unprecedented capital works programs, ongoing population growth and concurrent local government amalgamations and boundary changes. If executed properly, however, the reforms offer many potential benefits for the Government, the water authorities, and the community. This paper examines the progress of the Queensland reforms to date, and discusses the approaches taken, key observations, and challenges and opportunities for both the water businesses and the regulators.
Understanding the Obama Presidency
Authors: Schier Steven E
Published: April 2009

This article provides a variety of concepts for understanding the Obama presidency as it proceeds. One can fruitfully comprehend the next four years in terms of Obama's theory of presidential power, amount of political capital, progress in establishing a political regime, demonstration of political skills and ability to preserve and expand his political authority. The strengths and weaknesses of Obama's personality -- in terms of its levels of extraversion, neuroticism, agreeableness, openness and conscientiousness -- will be come evident in time. Together, these concepts will explain much about his presidency.
The Leadership Style of Barack Obama: An Early Assessment
Authors: Greenstein Fred I.
Published: April 2009

This article presents a highly distilled account of the formative experiences and political rise of Barack Obama. It draws on the sources that were available at the time of his inauguration. The article concludes by examining Obama's leadership qualities in the realms of public communication, organizational capacity, political skill, policy vision, cognitive style, and emotional intelligence. The article went into production one month after Obama entered the White House.
Obama and the Federal Judiciary: Great Expectations but Will He Have a Dickens of a Time Living up to Them?
Authors: Goldman Sheldon
Published: April 2009

This essay speculates on what an Obama judiciary might look like and how the selection process is likely to play out. This is presented against the backdrop of past experience. First, the essay traces the demographic diversification of the federal bench from the presidencies of Franklin Roosevelt through George W. Bush. Second, this essay considers ideological diversity and presents voting data from the first three completed terms of the Roberts Court. Third, the essay considers the selection process, including confirmation of lower-court judges by the Senate. It concludes that President Obama can be expected to promote further gender, race, and ethnic diversification as well as to seek to moderate the current ideological imbalance on the courts. He will likely keep the existing institutional apparatus of judicial selection and will restore the American Bar Association to the role it had prior to George W. Bush's presidency. Confirmation may well prove to be a challenge in a Senate that is not filibuster-proof.
Mandates, Honeymoons, and the Obama Administration
Authors: Dominguez Casey B. K.
Published: April 2009

This paper considers whether President Obama won a mandate during the 2008 election, and whether he is experiencing the expected honeymoon with the press, public, and Congress in 2009. It finds that the electorate did instruct him to "fix" the economy, but that given his relatively narrow victory and the electorate's indecisive rejection of conservative principles, the limited mandate he won is not necessarily going to help him govern. This paper also argues that he is experiencing a normal first-year honeymoon with the press and public, while his partisan advantage in Congress overwhelms any Republican reluctance to be deferential to him. Between the limited mandate, high public approval ratings, and large partisan majorities in Congress, prospects for his first year in office look fairly good.
Barack Obama, the Democratic Party, and the Future of the "New American Party System"
Authors: Milkis Sidney M. , Rhodes Jesse H
Published: April 2009

Ascending to the presidency in the midst of a severe economic crisis and an ongoing war on terrorism, Barack Obama faces numerous political and policy challenges. We examine an oft-obscured facet of presidential leadership: the president's relations with his party. We argue that Obama has benefited from and abetted the development of a new relationship between the president and the parties that features presidents as strong party leaders who invest heavily in mobilizing voters, raising campaign funds, and articulating party doctrine. As we show, Obama's party leadership may hold both promise and peril for the practice of American democracy. Just as previous Republican presidents such as Ronald Reagan and George W. Bush used their powers in ways that bolstered their parties, Obama's exertions have strengthened the Democratic Party's capacity to communicate with constituents, mobilize voters, and raise funds. However, Obama must take care to avoid the pitfalls of presidential party leadership that ultimately undermined Reagan's and Bush's presidencies. In particular, recent history suggests that Obama must avoid forms of administrative aggrandizement that alienate citizens from government; and that he must forego leadership strategies that threaten the independence and integrity of the party apparatus.
Who Gets What Now? Interest Groups under Obama
Authors: Grossmann Matt
Published: April 2009

President Obama, like countless politicians before him, has pledged to cleanse Washington of the unseemly influence of interest groups on the policymaking process. His plan is to expand the scope of group participation and eliminate quid pro quo exchanges. Yet early signals indicate that he has brought the same previously prominent interest groups (both conservatives and liberals) into policy discussions over the stimulus bill, children's health insurance, health care reform, and entitlement control. Early policy changes also appear to offer substantial benefits to interest groups and constituencies associated with the Democratic Party.I argue that these patterns are typical and should be expected to continue. The involvement of various interest groups and constituencies in Washington policymaking is governed by their relative organizational mobilization, independent of ideology. Yet the extent to which party leaders heed their advice follows largely from their ties to partisan coalitions and their views. Despite campaign claims that interest group influence must be hindered before policy proposals can move forward, policy change comes much more easily to Washington than changes in the role of interest groups in the policymaking process.
Turning the Tables: Individual Contributions, Member Contributions, and the Changing Campaign Finance Environment
Authors: Magleby David B. , Jones Bradley , Lassen David
Published: April 2009

The BCRA soft money ban enacted in 2002 posed a serious challenge to Democrats. Could they compete in fundraising with the Republicans in a hard money only environment? Some even went so far as to suggest that BCRA was a "suicide bill" for the Democrats. Such dire predictions have not proven true. Democrats have exploited good candidates, strong party committee leadership, messaging, and technology to be competitive with the Republican Party overall in fundraising among individuals. The surge in individual donors to the Democrats is most pronounced in the 2008 presidential race but extends to the two congressional campaign committees as well.
The Legitimacy of Inexperience: Leadership from Outside
Authors: Jones Charles O.
Published: April 2009

Experience in politics and administration is typically thought of as legitimizing leadership. However, what if those with experience are judged to be poor performers in the premier leadership post in American politicsthe presidency? History provides a number of such casesindeed, nearly a quarter of the presidents can be so designated. This article identifies these instances and the successions to those presidents with little or no national-level political or executive experience. The conclusion: greater legitimacy is accorded to inexperience, with all of its accompanying risks. The cases are comparatively analyzed and lessons identified for the forty-fourth presidentBarack Obama.
Modeling and Energetic Analysis of Soybean Meal Drying in the Indirect Rotary Dryer
Authors: Luz Gianini R. , Paraíso Paulo R. , Jorge Luiz M. M. , Andrade Cid M. G.
Published: April 2009

The process of soybean meal industrial drying requires a high consumption of energy, and it is usually performed in an indirect rotary dryer. A study aiming for the reduction of this energy consumption is vital for the competitiveness of this product. Thus, the purpose of this work was to develop a mathematical model of soybean meal drying, in permanent regime, in order to assess the optimal operational conditions of the dryer and its energetic performance. The developed model is based on balances of mass and energy, and using constitutive and empirical equations. The model validation was carried out through operational data. From this, the influences of the initial temperature, initial moisture, and relative humidity of air, as well as the dryer energetic performance, were investigated.
The Effect of Price on Pharmaceutical R&D
Authors: Civan Abdulkadir , Maloney Michael T.
Published: April 2009

This work extends prior research that finds drug development is driven by demand factors such as mortality rates of the diseases new drugs are aimed at. Here we find that the number of drugs in the development pipeline is strongly positively related to the price of existing drugs treating those diseases. This gives us a direct price elasticity measure from which we can draw some inference about the effect on new drug development that might occur if the pricing regime in the United States were to change.
Grading Across Schools
Authors: Dardanoni Valentino , Modica Salvatore , Pennsi Aline
Published: April 2009

This paper reports some facts about grading standards across a varied sample of 16 countries participating in the 2003 OCSE-PISA Survey. Our main finding is that in all countries except Ireland and the USA there is conspicuous heterogeneity in standards across schools (Table 3, Figures 1 & 2). In most of the countries where heterogeneity is present a grading-on-a-curve practice emerges, with grading standards increasing with average competence of the school's students (Table 4, Figures 3 & 4). Where this phenomenon is more pronounced, it may be related to existence of a tracking (as opposed to comprehensive) school system (Table 5, Figure 5).
Standardization of the Continuing Care Activity Measure: A Multicenter Study to Assess Reliability, Validity, and Ability to Measure Change
Authors: Huijbregts Maria P.J. , Teare Gary F. , McCullough Carolyn , Kay Theresa M. , Streiner David , Wong Steve K.C. , McEwen Sara E. , Otten Ingrid
Published: April 2009

Background: There is a lack of standardized mobility measures specific to the long-term care (LTC) population. Therefore, the Continuing Care Activity Measure (CCAM) was developed.

Objective: This study determined levels of reliability, validity for clinical utilization, and sensitivity to change of this measure.

Design: This was a prospective longitudinal cohort study among elderly people with primarily physical or medical impairments who were residing in LTC institutions that provide nursing home and more-complex care, with access to physical therapy services.

Method: The CCAM, the Clinical Outcome Variables Scale (COVS), the Social Engagement Scale (SES) of the Resident Assessment Instrument—Minimum Data Set (RAI-MDS) 2.0 instrument, and the Resource Utilization Groups, version 3, (RUG-III) were administered by clinical and research physical therapists, with timing dictated by the study purpose.

Results: The participants were 136 residents of LTC institutions and 21 physical therapists. The CCAM interrater reliability (intraclass correlation coefficient [ICC]) was .97 (95% confidence interval=.91–1.00), and test-retest reliability (ICC) over a period of 1 week was .99 (95% confidence interval=.93–1.00). Over 6 months, the absolute change in total score was 5.88 for the CCAM and 4.26 for the COVS; the CCAM was 28% more responsive across all participants (n=105) and 68% more responsive for those scoring in the lower half (n=49). The minimal detectable difference of the CCAM was 8.6 across all participants. The CCAM correlated with the COVS, nursing care hours inferred from the RUG-III, and the SES.

Limitations: Some participants were lost to follow-up.

Conclusions: The CCAM is a reliable and valid tool to measure gross motor function and physical mobility for elderly people in LTC institutions. It discriminates among functional levels, measures individual functional change, and can contribute to clinical decision making.
Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas
Authors: Chaichana Kaisorn L. , McGirt Matthew J. , Laterra John , Olivi Alessandro , Quiñones-Hinojosa Alfredo
Published: April 2009

Object

Unlike their malignant counterparts, low-grade gliomas are associated with prolonged survival. However, these tumors have a propensity to progress after resection and ultimately undergo malignant degeneration. The factors associated with recurrence and malignant degeneration remain relatively unknown. The authors set out to determine factors that were independently associated with recurrence and malignant degeneration in patients who underwent resection of a hemispheric low-grade glioma.

Methods

Adult patients who underwent craniotomy and resection of a hemispheric low-grade glioma (WHO Grade II) at the Johns Hopkins Medical Institution's academic tertiary-care institution between 1996 and 2006 were retrospectively reviewed. Multivariate proportional hazards regression analyses were used to identify associations with tumor recurrence and malignant degeneration.

Results

Of the 191 consecutive patients with low-grade gliomas in this series (89 fibrillary astrocytomas, 89 oligodendrogliomas, and 13 mixed gliomas), 83 (43%) and 44 (23%) experienced tumor recurrence and malignant degeneration at last follow-up, respectively. The 5-year progression-free and malignancy-free survival rates were 44 and 74%, respectively. Independent predictors of recurrence were duration of longest lasting symptom (relative risk [RR] 0.978, 95% CI 0.954–0.996, p = 0.01), tumor size (RR 1.328, 95% CI 1.109–1.602, p = 0.002), and preoperative contrast enhancement (RR 2.558, 95% CI 1.241–5.021, p = 0.01). Independent factors associated with malignant degeneration were fibrillary astrocytoma pathology (RR 1.800, 95% CI 1.008–4.928, p = 0.04), tumor size (RR 1.086, 95% CI 1.044–1.358, p = 0.04), and gross-total resection (RR 0.526, 95% CI 0.221–1.007, p = 0.05).

Conclusions

The identification and consideration of factors associated with recurrence and malignant progression may help guide treatment strategies aimed at delaying recurrence and preventing malignant degeneration for patients with hemispheric low-grade gliomas.
Adult craniopharyngiomas: surgical results with a special focus on endocrinological outcomes and recurrence according to pituitary stalk preservation
Authors: Jung Tae-Young , Jung Shin , Choi Jae-Eun , Moon Kyung-Sub , Kim In-Young , Kang Sam-Suk
Published: April 2009

Object

The aim of this study was to evaluate the results of surgical treatment of adult craniopharyngioma with a special focus on the endocrinological outcomes and tumor recurrence in cases of pituitary preservation.

Methods

Between 1993 and February 2008, 41 patients underwent 47 surgical procedures for craniopharyngioma. The male/female ratio was 26:15 and the median age was 45.8 years (range 17–65 years). The median follow-up period was 10.56 years (range 6.2–14.9 years). Patients presented with visual disturbance before 30 (63.8%) of 47 procedures and with endocrinological disturbance before 12 (26%) procedures. Surgery was performed via a subfrontal/pterional approach in 31 procedures (66%), bifrontal interhemispheric in 6 (12.8%), transcallosal/transventricular in 5 (10.6%), combined in 1 (2.1%), and transsphenoidal in 4 (8.5%). The tumor was totally removed in 36 procedures (76.6%), subtotally in 10 (21.3%), and partially in 1 (2.1%).

Results

Postoperatively, the rates of visual improvement and aggravation were 50 and 33.3%, respectively. Of 24 patients in whom the pituitary stalk was preserved, complete hormone replacement was needed in 14 (58.3%), partial replacement in 2 (8.3%), and no replacement in 8 (33.3%). The rate of tumor recurrence was 24.4%. The recurrence-free survival rate was significantly different between patients in whom complete tumor resection was accomplished and those in whom tumor resection was incomplete. Stalk preservation did not affect the recurrence-free survival rate. The morbidity and mortality rates were 8.5 and 2.1%, respectively.

Conclusions

The pituitary stalk must be preserved with maximal tumor resection whenever possible to increase the chance of intact anterior pituitary function being maintained. The results of the present study show that pituitary stalk preservation may not be related to increased recurrence rates.
Surgical and anatomical landmarks for the perineal branch of the posterior femoral cutaneous nerve: implications in perineal pain syndromes
Authors: Tubbs R. Shane , Miller Joseph , Loukas Marios , Shoja Mohammadali M. , Shokouhi Ghaffar , Cohen-Gadol Aaron A.
Published: April 2009

Object

The perineal branch of the posterior femoral cutaneous nerve (PBPFCN) has received little attention in the literature. Because perineal pain syndromes can be disabling and pudendal nerve surgical decompression/block is often not efficacious, an anatomical study of this cutaneous nerve of the perineum seemed warranted.

Methods

The authors dissected 20 adult cadavers (40 sides) to identify the branching pattern and landmarks for the PBPFCN.

Results

This branch arose directly from the posterior femoral cutaneous nerve in 55% of sides and from the inferior cluneal nerve in 30% of sides. It was absent in 15% of sides. On average, the nerve coursed 4 cm inferior to the termination of the sacrotuberous ligament onto the ischial tuberosity. No PBPFCN was found to pierce the sacrotuberous ligament. The PBPFCN provided 2–3 branches to the medial thigh that continued on to the scrotum and labia major. In general, 2 small ascending branches were identified. In males, one ascending branch traveled inferior to the corpora cavernosum and anterior to the spermatic cord to cross the midline. The other ascending branch traveled to skin at the junction of the perineum and adductor tendon. A single descending branch, approximately 2 mm in diameter, traveled to the inferior scrotum anterior to the testicle in the male specimens and the lower labia majora in the female specimens. Communications between the PBPFCN and the perineal branch of the pudendal nerve were common.

Conclusions

Entrapment of the PBPFCN may be the cause of some forms of the perineal pain syndrome. Specific knowledge of the PBPFCN may assist surgeons in releasing and anesthetizing this cutaneous nerve of the perineum.
Richard Lower (1631–1691): acknowledging his notable contributions to the exploration of the nervous system
Authors: Tubbs R. Shane , Loukas Marios , Hill Michael , Shoja Mohammadali M. , Cohen-Gadol Aaron A.
Published: April 2009

Richard Lower (1631–1691), an anatomist and physician, was born in St. Tudy, Cornwall, England, and became an avid follower of William Harvey and a pupil to Sir Thomas Willis. Unfortunately, little is written of his contributions to the study of the nervous system despite his successful medical career and his regard as one of the most significant English physiologists of the 17th century. Lower was best known for his remarkable studies within the cardiovascular and respiratory disciplines. However, although not as well documented and thus often overlooked, Lower produced noteworthy advancements within the field of neuroscience such as studying the hindbrain innervation of the heart, CSF formation and circulation, cranial nerve function, and the structural sources of seizures. Some have even attributed the results of Willis' anatomical and physiological studies to Lower rather than to Willis himself. Lower has not received the recognition he is owed as a highly skilled and trained anatomist and physician. In this paper, the neurological contributions, with a brief mention of challenges, delivered during the 17th century by this influential historical physician will be highlighted with an emphasis on the impact each contribution made.
Balloon-assisted embolization of skull base meningioma with liquid embolic agent
Authors: Kerim Amr Abdel , Bonneville Fabrice , Jean Betty , Cornu Philippe , LeJean Lise , Chiras Jacques
Published: April 2009

The authors report a novel technique of balloon-assisted embolization of a skull base meningioma supplied by a branch of the cavernous segment of the internal carotid artery using liquid embolic agent. A temporarily inflated balloon distal to the meningioma's feeding vessel may improve the access to this small branch and may reduce the chances of unintended reflux during delivery of the liquid embolic agent.
Angiographic computed tomography with selective microcatheterization in delineating surgical anatomy in the case of a dural arteriovenous fistula
Authors: Eesa Muneer , Sharma Pranshu , Mitha Alim Pyarali , Sutherland Garnette Roy , Goyal Mayank
Published: April 2009

Intracranial dural arteriovenous fistulas (dAVFs) are commonly encountered in centers specializing in cerebrovascular diseases. Knowing the precise site of fistulous communication with the venous structures is essential in targeting the appropriate surgical or endovascular therapy once a decision to treat has been made. Such sites can usually be located with digital subtraction angiography alone. The authors describe a case in which localization was best performed using cone-beam volume CT in the angiography suite after selective microcatheterization of the feeding vessel and injection of a contrast agent in a dAVF related to the petrous temporal bone. Imaging studies showed the lesion was related to the inferior aspect of the tentorium, warranting a suboccipital surgical approach to treat the fistula.
Reduction in programmed cell death and improvement in functional outcome of transient focal cerebral ischemia after administration of granulocyte-macrophage colony-stimulating factor in rats
Authors: Kong TaeHo , Choi Jung-Kyoung , Park Hyeonseon , Choi Byung Hyune , Snyder Brian Jeffrey , Bukhari Shefqat , Kim Na-Kyeong , Huang Xian , Park So Ra , Park Hyung Chun , Ha Yoon
Published: April 2009

Object

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a potent hematopoietic growth factor that both enhances the survival and drives the differentiation and proliferation of myeloid lineage cells. Recent studies have suggested that GM-CSF has a neuroprotective effect against CNS injury. In this paper, the authors investigated the neuroprotective effect of GM-CSF on neuron survival and locomotor behavior in a rat model of focal cerebral ischemic injury.

Materials

To understand its neuroprotective effect in vitro, GM-CSF was administered to a glutamate-induced excitotoxicity neuronal injury cell culture model that mimics the pathophysiology of focal hypoxic cerebral injury. In the animal study, the authors prepared a rat focal cerebral ischemia model by occluding the unilateral middle cerebral artery. They then examined the effects of GM-CSF administration on changes in infarct volume, apoptosis-related gene expression, and improvement in locomotor behavior.

Results

Treatment with GM-CSF significantly increased cell viability in a cell culture model of glutamate-induced neuronal injury. Furthermore, in vivo administration of GM-CSF at 60 μg/kg body weight daily for 5 consecutive days beginning immediately after injury decreased infarction volume, altered the expression of several apoptosis-related genes (Bcl-2, Bax, caspase 3, and p53), and improved locomotor behavior in the focal cerebral ischemia model.

Conclusions

The GM-CSF had neuroprotective effects in in vitro and in vivo experiments and resulted in decreased infarction volume and improved locomotor behavior. Although the specific mechanism involved in stroke recovery was not fully elucidated as it was not the primary focus of this study, administration of GM-CSF appeared to decrease the extent of neuronal apoptosis by modulating the expression of several apoptosis-related genes such as Bcl-2, Bax, caspase 3, and p53. Further investigations are necessary to better understand the role of GM-CSF on neural regeneration during the recovery phase of a stroke, as well as the intracellular signal transduction pathways that mediate neuroprotection.
Clinical and angiographic long-term follow-up of completely coiled intracranial aneurysms using endovascular technique
Authors: Choi Dae Seob , Kim Mun Chul , Lee Seon Kyu , Willinsky Robert A. , Terbrugge Karel G.
Published: April 2009

Object

The anatomical evolution and clinical outcome of completely coiled intracranial aneurysms after endovascular embolization have rarely been studied separately. From their prospective database, the authors reviewed follow-up angiography and clinical outcome of 87 patients whose aneurysms were designated as 100% obliterated on immediate postembolization angiography.

Methods

Ninety-one aneurysms (56 ruptured and 35 unruptured) in 87 patients were included in this study. Clinical outcome was evaluated using the Glasgow Outcome Scale. Follow-up angiographic findings were assessed and categorized as 1 of the following: no recanalization, recanalization with a neck remnant, or recanalization with a body remnant. For statistical analysis, the recanalization rate was correlated with: clinical presentation; the largest aneurysm diameter, aneurysm neck size, and dome-to-neck ratio; aneurysm location; and use of special techniques such as usage of a surface modified coil, balloon remodeling technique, or stent.

Results

At the latest clinical evaluation (mean 34.3 months), 81 (93.1%) of the 87 patients (91 aneurysms) had good clinical outcomes (Glasgow Outcome Scale Score 5). The procedure-related morbidity rate (permanent neurological deficit) was 2.3% (2 of 87), and there were no procedure-related deaths. On the latest follow-up angiography (mean 26.4 months), the recanalization rate was 26.4% (24 of 91 aneurysms): 16 (17.6%) with neck remnants and 8 (8.8%) with body remnants. The neck size of the recanalized aneurysms was statistically significantly larger than that of the nonrecanalized aneurysms (p = 0.006), and aneurysms with wide necks (≥4 mm) had a higher recanalization rate than those with a narrow neck (< 4 mm) (p = 0.002). There was no bleeding after endovascular treatment during the follow-up period.

Conclusions

Completely coiled aneurysms after endovascular embolization demonstrated good clinical outcome, and there was no bleeding episode after endovascular treatment; however, there was a relatively high recanalization rate.
Cluster Analysis for the Impact of Sickle Cell Disease on the Human Erythrocyte Protein Interactome
Authors: Ammann Larry P. , Goodman Steven R.
Published: April 2009

Protein interaction networks provide useful information to assess impacts of disease on cell functions. Statistical clustering methods applied to these networks can reveal impacts on particular functional groups of proteins. In addition, clustering methods can identify subsets of proteins that require additional study to provide updated information regarding their position within an interaction network, and hence increase our understanding of their relationships with other proteins in the network. These ideas are illustrated here by considering the impacts of sickle cell disease on the human erythrocyte interaction network. Statistical cluster analyses are performed based on a measure of similarity for nodes within a network called the Generalized Topological Overlap Measure. These analyses identify clusters of proteins that are similar in terms of shared interaction partners. Identification of clusters that contain proteins whose relative abundances have been significantly altered in sickle cell patients provides specific information about the impact of these proteins on erythrocyte functions.