bluuebunny/crossref_metadata_2025 huggingface dataset:
Built Environment and Mobility of Older Adults: Important Policy and Practice Efforts
Authors: Yen Irene H. , Anderson Lynda A.
Published: May 2012

As people age, they prefer to “age in place.” The concept of aging in place refers to the ability to live in one's own home, wherever that might be, for as long as one can feel confident and comfortable. Where people live and whether these environments can support them are critical questions for public health and public policy, especially since the baby boomers began to turn 65 on January 1, 2011. Equally important for public policy, those aged 85 and older are the fastest growing population group in the United States. The Health and Aging Policy Fellows Program, with the Centers for Disease Control and Prevention Healthy Aging Program, has supported a project to determine how design features of the built environment can support the mobility of older adults. Mobility refers to physical activity, usually walking, but also encompasses the ability to stay connected to nearby community resources and services. The project's purpose is to investigate features that support mobility in built environments. This policy brief introduces the realist synthesis method used in the project and selected national initiatives and activities to place this work in a broader context. Given the importance of mobility concerns to older adults, it must be determined without delay which design features support mobility and how local areas can better prepare to support the health of their aging populations.
Experiencing Simulated Aging Improves Knowledge of and Attitudes Toward Aging
Authors: Yu Chiu‐Yen , Chen Kuei‐Min
Published: May 2012

Nursing assistants provide 90% of the functional and psychosocial care of older adults in nursing homes. Without knowledge of the normal physical changes of aging, it would be difficult to provide them with appropriate quality care. This quasi‐experimental study aimed to test the effects of the Elderly Simulation Program on nursing assistants' knowledge about aging, attitudes toward older adults, and the motivation to care for older adults in nursing homes. The program has two parts: a 1‐hour lecture about aging changes and a 1‐hour simulation of the roles of an older adult, a caregiver, and a “rusher” (20 minutes for each role). A convenience sample of 83 full‐time nursing assistants was recruited from nursing homes in Taiwan. The participants were assigned to an experimental (n = 43) or a control group (n = 40). The experimental group received the Elderly Simulation Program intervention, whereas the control group did not participate in any educational programs. Data were collected before the intervention and 4 wk after the program was completed. Results indicated that 4 wk after the intervention, the experimental group participants' knowledge about aging and attitudes toward older adults had significantly improved (all P < .001). The experimental group participants also had greater knowledge of aging than the control group at posttest (P < .001). It is recommended that the program be incorporated into the regular on‐the‐job continuing education of nursing assistants in long‐term care facilities to enhance their knowledge about aging and their attitudes towards older adults.
Cadaver Treasure Hunt: Introducing Geriatrics Concepts in the Anatomy Class
Authors: McNicoll Lynn , Fulton Ana Tuya , Ritter Dale , Besdine Richard W.
Published: May 2012

The objective of this study was to develop an educational program introducing geriatrics to medical students during anatomy. Observational study of an educational intervention in medical school was the design utilized. First‐year medical students in an anatomy laboratory were participants.

The program consists of a lecture and a workshop. First, a geriatrics lecture early in the course presents demographic data on the cadavers, followed by comparison with national data on leading causes of death. Second, there is a “treasure hunt” in the anatomy laboratory conducted by geriatricians. Each geriatrician spends 45 minutes with one‐four‐student cadaver group at a time, reviewing anatomical findings and facilitating a discussion of clinical correlations and implications. A list of common anatomical findings, aging‐ and disease‐related, is distributed to the students as an aid in identifying findings of interest. Students have been surprised to learn that the mean age of the 24 cadavers exceeded 80 years (mean 81, median 85 for 2 years), and that causes of death mirrored national data. The students begin understanding aging and appreciate the valuable resource of cadavers. The students acquire a new holistic perspective regarding their cadavers that is not apparent during the dissections. Students and faculty find the experience valuable in understanding the interplay of disease and aging. Evaluations have been mostly positive (82–87% positive responses). The anatomy lecture and “treasure hunt” experience are unique strategies for using cadavers to introduce geriatrics principles into the medical school.
Flood Risk Management: US Army Corps of Engineers and Layperson Perceptions
Authors: Wood Matthew , Kovacs Daniel , Bostrom Ann , Bridges Todd , Linkov Igor
Published: May 2012

Recent severe storm experiences in the U.S. Gulf Coast illustrate the importance of an integrated approach to flood preparedness planning that harmonizes stakeholder and agency efforts. Risk management decisions that are informed by and address decision maker and stakeholder risk perceptions and behavior are essential for effective risk management policy. A literature review and two expert models/mental models studies were undertaken to identify areas of importance in the flood risk management process for layperson, non‐USACE‐expert, and two USACE‐expert groups. In characterizing and mapping stakeholder beliefs about risks in the literature onto current risk management practice, recommendations for accommodating and changing stakeholder perceptions of flood risks and their management are identified. Needs of the U.S. Army Corps of Engineers (USACE) flood preparedness and response program are discussed in the context of flood risk mental models.
Performance Testing of the New AMPAC Fire Debris Bag Against Three Other Commercial Fire Debris Bags*
Authors: Grutters Michiel M. P. , Dogger Judith , Hendrikse Jeanet N
Published: May 2012

Abstract:  Fire debris evidence is collected and stored in a wide range of containers, including various polymer bags. Four different polymer bags have been investigated, including the NYLON, DUO, ALU, and AMPAC bags. The latter is the successor of the Kapak Fire DebrisPAK™. Microscopy and infrared spectroscopy were used to elucidate the composition of the bags. Gas chromatography/mass spectrometry was used to investigate performance parameters such as background volatiles, leak rate, cross‐contamination, recovery, and sorption. The NYLON bag was susceptible for leakage and cross‐contamination and showed decreased recoveries. The DUO and ALU bags showed some background volatiles, sorption, and poor recoveries. The AMPAC bag performed excellent: low background, no leakage or cross‐contamination, good recoveries, and only traces of sorption. Heat sealing proved to be the best method of closure. Preliminary studies on AMPAC bags showed that polyethylene clamps are easy to use on‐site and preserve ignitable liquids adequately for a limited period of time.
The Characterization of 3,4‐Dimethylmethcathinone (3,4‐DMMC)
Authors: Locos Oliver , Reynolds Dominic
Published: May 2012

Abstract:  Analogs and derivatives of traditional illicit drugs are ever increasing in variety and creativity. Staying abreast of the new developments is a constant challenge for every forensic laboratory. Recently, a seizure from Australian Customs Service presented our laboratory with the designer cathinone 3,4‐dimethylmethcathinone (3,4‐DMMC). Gas chromatography/mass spectrometry (GC/MS), liquid chromatography/mass spectrometry (LC/MS), nuclear magnetic resonance (NMR) spectroscopy, infrared (IR) spectroscopy, and ultraviolet (UV) spectrophotometry were employed to analyze the spectroscopic characteristics of this cathinone. As an analog, 3,4‐DMMC exhibits similar if not identical IR and UV profiles to mephedrone (4‐MMC) and methcathinone; however, the retention time from GC is unique as expected, and the electron impact fragmentation pattern is consistent with the fragmentation pattern of other cathinones. The chemical shifts of the carbons and hydrogens were assigned by both one‐ and two‐dimensional NMR techniques, while the molecular weight was confirmed by LC/MS.
KGF‐2 targets alveolar epithelia and capillary endothelia to reduce high altitude pulmonary oedema in rats
Authors: She Jun , Goolaerts Arnaud , Shen Jun , Bi Jing , Tong Lin , Gao Lei , Song Yuanlin , Bai Chunxue
Published: May 2012

High altitude pulmonary oedema (HAPE) severely affects non‐acclimatized individuals and is characterized by alveolar flooding with protein‐ rich oedema as a consequence of blood‐gas barrier disruption. Limited choice for prophylactic treatment warrants effective therapy against HAPE. Keratinocyte growth factor‐2 (KGF‐2) has shown efficiency in preventing alveolar epithelial cell DNA damages in vitro. In the current study, the effects of KGF‐2 intratracheal instillation on mortality, lung liquid balance and lung histology were evaluated in our previously developed rat model of HAPE. We found that pre‐treatment with KGF‐2 (5 mg/kg) significantly decreased mortality, improved oxygenation and reduced lung wet‐to‐dry weight ratio by preventing alveolar‐capillary barrier disruption demonstrated by histological examination and increasing alveolar fluid clearance up to 150%. In addition, KGF‐2 significantly inhibited decrease of transendothelial permeability after exposure to hypoxia, accompanied by a 10‐fold increase of Akt activity and inhibited apoptosis in human pulmonary microvascular endothelial cells, demonstrating attenuated endothelial apoptosis might contribute to reduction of endothelial permeability. These results showed the efficacy of KGF‐2 on inhibition of endothelial cell apoptosis, preservation of alveolar‐capillary barrier integrity and promotion of pulmonary oedema absorption in HAPE. Thus, KGF‐2 may represent a potential drug candidate for the prevention of HAPE.
Occurrence of potentially pathogenic bacteria on the hands of hospital patients before and after the introduction of patient hand disinfection
Authors: Hedin Göran , Blomkvist Annika , Janson Marianne , Lindblom Anders
Published: May 2012

The leading cause of nosocomial infections and spread of multiresistant bacteria is considered to be the failure of healthcare workers to perform appropriate hand hygiene. The role of the hands of hospital patients in the spread of infection has received little attention. The aim of the present study was to investigate the occurrence of potentially pathogenic bacteria on the patients' hands. Quantitative cultures were repeatedly taken from the fingertips of patients at a rehabilitation clinic before and after an intervention in which patient hand disinfection was introduced and promoted. Before the intervention, the occurrence on the hands of Escherichia coli, Klebsiella spp., enterococci, Staphylococcus aureus and yeast was a common finding. The colony counts of S. aureus were often higher than the counts of other organisms. After the intervention, the level of hand contamination was lower. The difference was statistically significant (p < 0.05) concerning Enterobacteriaceae, both when the patients were resting and at lunch time, for enterococci and total bacterial counts at lunch time, and for yeast when they were resting. Concerning S. aureus, the difference was not statistically significant, neither while resting nor at lunch time. The role of the patients in the spread of pathogenic bacteria merits more discussion.
Swimming pool contact dermatitis caused by 1‐bromo‐3‐chloro‐5,5‐dimethyl hydantoin
Authors: Dalmau Gaspar , Estela Martínez‐Escala Maria , Gázquez Vanessa , Pujol‐Montcusí José Antonio , Canadell Laura , Espona Quer Mercé , Pujol Ramón M. , Vilaplana Joan , Gaig Pere , Giménez‐Arnau Ana
Published: May 2012

Background. Bromo‐3‐chloro‐5,5‐dimethylhydantoin (BCDMH) is a chemical used as a disinfectant for recreational water. BCDMH was described as being responsible for an epidemic of irritant contact dermatitis in the UK (1983), and its sensitizing capacity was also discussed.

Objectives. The aim of this study was to assess whether BCDMH used to disinfect swimming pools and spas can cause allergic contact dermatitis among its users.

Methods. Ten patients suffering from dermatitis associated with using swimming pools disinfected with BCDMH and 40 controls were studied. Several dilutions of BCDMH, 10% to 1 ppm, were patch tested.

Results. All 10 patients studied showed a positive patch test reaction to BCDMH 1% in petrolatum. At least one case showed occupational relevance, with a positive reaction even at 1 ppm.

Conclusion. On the basis of the clinical findings, the positive patch test reactions to BCDMH, and the negative patch test reactions in controls, the suggested diagnosis was allergic contact dermatitis caused by BCDMH used as a disinfectant in the swimming pool water. Contact allergy should be taken into consideration when patients suffer from swimming pool‐associated itchy dermatitis.
Anaphylaxis and severe systemic reactions caused by skin contact with persulfates in hair‐bleaching products
Authors: Hoekstra Margriet , van der Heide Sicco , Coenraads Pieter Jan , Schuttelaar Marie Louise Anna
Published: May 2012

Background. Persulfates have been reported to cause both delayed‐type and immediate skin reactions. They may also cause immediate reactions of the mucous membranes of the bronchial system through inhalation, leading to asthma and rhinitis. Anaphylactic reactions caused by contact with persulfates are rare. The mechanism of immediate reactions caused by persulfates is unclear.

Objectives. To report 2 cases with systemic reactions after skin contact with persulfates, and to propose a test protocol for diagnosing immediate reactions caused by persulfates.

Methods. Prick tests with serial dilutions of ammonium and potassium persulfate were performed. Patch tests were also performed with the two agents. Persulfate‐specific IgE was detected with two different IgE immunoblotting techniques.

Results. Prick tests were positive with ammonium and potassium persufate, but no specific IgE was detected in the serum. Patch tests showed early positive reactions to both persulfates in 1 patient.

Conclusions. Prick tests and patch tests can be valuable in the testing of patients with a suspicion of an immediate‐type reaction caused by persulfates. The mechanism of these reactions remains unclear.
Neonatal lupus erythematosus and its clinical variability
Authors: Inzinger Martin , Salmhofer Wolfgang , Binder Barbara
Published: May 2012

Neonatal lupus erythematosus (NLE) is a rare disease affecting newborns that is caused by maternal autoantibodies transmitted across the placenta. The disease may affect the skin, the heart, and rarely the hepatobiliary or hematological systems. A serious complication affecting some patients with NLE is atri‐oventricular heart block (AV block).

The clinical picture of cutaneous NLE varies considerably. NLE presents with confluent, scaly, periorbital erythema, or erythematous infiltrated plaques with central vesicles and lesions resembling seborrheic eczema or fungal infection. In any newborn with such skin lesions, NLE should be included in the differential diagnosis. Dermatologists play an important role in the diagnosis. We review different skin lesions occurring in neonatal lupus erythematosus based on five patients from our own clinic.
Conservative Management of Gingival Recession: The Gingival Veneer
Authors: GOPAKUMAR ASHISH , SOOD BANOO
Published: May 2012

Gingival recession is apical migration of the gingival tissues resulting in exposure of the underlying root surface. This can cause significant esthetic concerns for the patient, especially when it affects the anterior teeth. The gingival veneer is a prosthesis indicated for challenging clinical situations where there are esthetic concerns because of gingival recession, particularly loss of interdental papillae. Replacement crowns, surgery, or extraction of teeth, and provision of a removable partial denture are other treatment options; however, these have a significant biologic and financial cost compared with gingival veneers. This article aims to revisit the gingival veneer: its uses, advantages, disadvantages, and its fabrication. The cases discussed here highlight two different clinical situations where the gingival veneer prosthesis helped in achieving optimum esthetics and patient satisfaction thus proving to be a feasible and simple treatment modality in certain clinical cases. This may offer a good interim solution for patients who may wish to have time to consider their options of more advanced and complex treatment. Some patients may choose to wear the veneer as a long‐term solution when the burden/risk of further advanced treatment may outweigh the benefits, as perceived by the patients.

CLINICAL SIGNIFICANCE

The gingival veneer is a viable treatment option for restoring anterior esthetics in clinical situations where there are esthetic concerns caused by significant gingival recession. Case selection is important for a predictable and successful outcome.

(J Esthet Restor Dent ••:••–••, 2012)
Improved Microwave Dielectric Properties of La(Mg0.5Sn0.5)O3 Ceramics with Yb3+ Doping
Authors: Chen Yih‐Chien
Published: May 2012

The La1−xYbx(Mg0.5Sn0.5)O3 ceramics were prepared by the conventional solid‐state method with various sintering temperatures. The X‐ray diffraction patterns of the La0.97Yb0.03(Mg0.5Sn0.5)O3 ceramics revealed no significant variation of phase with sintering temperatures. An apparent density of 6.65 g/cm3, a dielectric constant (εr) of 20.2, a quality factor (Q × f) of 56,800 GHz, and a temperature coefficient of resonant frequency (τf) of −76.9 ppm/°C were obtained for La0.97Yb0.03(Mg0.5Sn0.5)O3 ceramics that were sintered at 1550°C for 4 h.
The dorid nudibranchs Peltodoris lentiginosa and Archidoris odhneri as predators of glass sponges
Authors: Chu Jackson W.F. , Leys Sally P.
Published: May 2012

The dorid nudibranchs
Peltodoris lentiginosa and
Archidoris odhneri were found on glass sponges (Porifera, Hexactinellida) during remotely operated vehicle surveys of three reefs in the Strait of Georgia, British Columbia, Canada. Eight nudibranchs were sampled from 2009 to 2011. Identification of sponge spicules found in their gut and fecal contents confirmed the nudibranchs to be predators of the reef‐forming hexactinellids
Aphrocallistes vastus and
Heterochone calyx, as well as of the demosponge
Desmacella austini, which encrusts skeletons of the glass sponges. Four of five nudibranchs dissected for gut content analysis had stomachs containing sponge spicules. Counts from high‐definition video footage taken during systematic surveys done in 2009 showed that nudibranchs were found in only two of the three glass sponge reefs. These data provide the first quantitative evidence of a molluscan predator on glass sponges found outside of Antarctica, and establish the first trophic link between glass sponges and their associated community of animals in a sponge reef ecosystem on the western Canadian continental shelf.
DETERMINING SEQUENTIAL DIFFERENCE THRESHOLDS FOR SODIUM CHLORIDE REDUCTION
Authors: BOBOWSKI NUALA , VICKERS ZATA
Published: May 2012

In response to the Institute of Medicine's suggestion for an industry‐wide mandate on salt reduction via gradual stepwise decline of salt in foods, the objective of this study was to determine a set of sequential difference thresholds for sodium chloride reduction in plain water, and in water with added taste stimuli (sucrose, citric acid, caffeine, monosodium glutamate, disodium 5′‐ inosinate and disodium 5′‐ guanylate) to simulate a more complex‐flavored broth. Ten subjects were recruited from a trained descriptive analysis panel of 6‐n‐propylthiouracil tasters and supertasters. Using paired‐comparison tests, difference thresholds were established for each of the two described solutions starting at a salt concentration comparable with that of commercially available soup, and ending at a concentration required to meet the Food and Drug Administration's low‐sodium guidelines. From these thresholds, two series of concentrations were established: a 26‐step reduction for salt in water, and a 12‐step reduction for salt in water with added stimuli. The difference in the number of steps illustrates the importance of product complexity in determining sensitivity to sodium reduction and provides basic information for manufacturers interested in gradually decreasing salt content of foods without being noticed by consumers.

PRACTICAL APPLICATIONS

The series of salt concentrations determined in this study provides a foundation for food manufacturers interested in reducing salt content of processed foods, and basic information for people interested in reducing their personal dietary salt intake without adversely impacting product acceptability. The strategy of gradually decreasing salt content of foods is currently being considered by the Food and Drug Administration for industry‐wide application, and if successful, has the potential to significantly reduce rates of health conditions related to overconsumption of salt.
Creating and Using Index Scores in the Analysis of School Policy Implementation and Impact
Authors: Phillips Martha M. , Goodell Melanie , Raczynski James M. , Philyaw Perez Amanda G.
Published: May 2012

BACKGROUND: Epidemic increases in childhood obesity and associated health risks are resulting in efforts to implement school policies related to nutrition and physical activity (NPA). With multicomponent policy efforts, challenges exist in characterizing the extent of policy change across the breadth of NPA policies.

METHODS: Aggregated policy indices were created to characterize NPA policy implementation in Arkansas public schools from 2004 through 2009. Index scores are presented by year, domain, and school level.

RESULTS: Both mean and median index scores increased over time, with greater changes seen in nutrition than in physical activity policy scores. The composite index score was heavily dependent on the nutrition index score and, thus, is relatively less useful for the purposes of our evaluation. Policy index scores varied by school level, rurality, enrollment size, and percentage of students eligible for federal meal programs.

CONCLUSIONS: The policy index approach facilitates the consideration of the effect of school policy change in a holistic, aggregated way. School characteristics influence policy adoption, and thus, should be taken into consideration in the promotion of policy change.
Strength and Comprehensiveness of District School Wellness Policies Predict Policy Implementation at the School Level*
Authors: Schwartz Marlene B. , Henderson Kathryn E. , Falbe Jennifer , Novak Sarah A. , Wharton Christopher M. , Long Michael W. , O'Connell Meghan L. , Fiore Susan S.
Published: May 2012

BACKGROUND: In 2006, all local education agencies in the United States participating in federal school meal programs were required to establish school wellness policies. This study documented the strength and comprehensiveness of 1 state's written district policies using a coding tool, and tested whether these traits predicted school‐level implementation and practices.

METHODS: School wellness policies from 151 Connecticut districts were evaluated. School principal surveys were collected before and after the writing and expected implementation of wellness policies. Sociodemographic variables were assessed for each district, including enrollment, population density, political climate, racial composition, and socioeconomic status. Changes in school‐level policy implementation before and after the federal wellness policy mandate were compared across districts by wellness policy strength; policies were compared based on district‐level demographics.

RESULTS: Statewide, more complete implementation of nutrition and physical activity policies at the school level was reported after adoption of written policies. Districts with stronger, more comprehensive policies were more successful in implementing them at the school level. Some sociodemographic characteristics predicted the strength of wellness policies.

CONCLUSIONS: Written school wellness policies have the potential to promote significant improvements in the school environment. Future regulation of school wellness policies should focus on the importance of writing strong and comprehensive policies.
School‐Based BMI and Body Composition Screening and Parent Notification in California: Methods and Messages
Authors: Madsen Kristine A. , Linchey Jennifer
Published: May 2012

BACKGROUND: School‐based body mass index (BMI) or body composition screening is increasing, but little is known about the process of parent notification. Since 2001, California has required annual screening of body composition via the FITNESSGRAM, with optional notification. This study sought to identify the prevalence of parental notification when screening is required but notification is optional, and the methods and messages used.

METHODS: Researchers conducted phone interviews with 851 school districts (89%) in California and reviewed notification materials from 54 districts.

RESULTS: As of 2008, 53% of California districts notified parents of screening results. Many districts (24%) did not know the reason for their notification policy. Most districts notified parents via a letter mailed home (70%) or sent home with the child (18%). Whereas 79% of sample letters provided students' BMI, only 12% provided an explanation of BMI, and only half provided tips on what parents should do if concerned about their child's results.

CONCLUSIONS: In California, where body composition screening is required but parent notification is not, approximately half of school districts elect to notify parents of results, most commonly via letter. Most letters do not explain BMI or percent body fat scores, nor do they suggest what parents should do for a child identified as at‐risk. Further research to identify interpretable and actionable notification messages for parents will be critical if school‐based BMI and body composition screening and notification is to reduce childhood obesity.
Cardiorespiratory Fitness after Stroke: A Systematic Review
Authors: Smith Alexandra C. , Saunders David H. , Mead Gillian
Published: May 2012

Cardiorespiratory fitness programs are increasingly used in stroke rehabilitation. Maximal oxygen uptake is the gold standard measurement of cardiorespiratory fitness; however, no recent publications have collated evidence about maximal oxygen uptake levels following stroke. We therefore performed a systematic review of maximal oxygen uptake in stroke survivors, aiming to observe changes in levels over time, and associations with severity of stroke. We searched Medline and Embase until April 2011, and included cross-sectional studies, longitudinal studies, and baseline data from intervention trials. Studies had to recruit at least 10 stroke survivors, and report direct measurement of maximal/peak oxygen uptake. We then compared maximal oxygen uptake with published data from age and gender-matched controls. The search identified 3357 articles. Seventy-two full texts were retrieved, of which 41 met the inclusion criteria. Time since stroke ranged from 10 days to over seven-years. Peak oxygen uptake ranged from 8 to 22 ml/kg/min, which was 26–87% of that of healthy age- and gender-matched individuals. Stroke severity was mild in most studies. Three studies reported longitudinal changes; there was no clear evidence of change in peak oxygen uptake over time. Most studies recruited participants with mild stroke, and it is possible that cardiorespiratory fitness is even more impaired after severe stroke. Maximal oxygen uptake might have been overestimated, as less healthy and older stroke survivors may not tolerate maximal exercise testing. More studies are needed describing mechanisms of impaired cardiorespiratory fitness and longitudinal changes over time to inform the optimal ‘prescription’ of cardiorespiratory fitness programs for stroke survivors.
The Influence of Anterior Cerebral Artery Flow Diversion Measured by Transcranial Doppler on Acute Infarct Volume and Clinical Outcome in Anterior Circulation Stroke
Authors: Zareie Hossein , Quain Debbie A. , Parsons Mark , Inder Kerry J. , McElduff Patrick , Miteff Ferdinand , Spratt Neil J. , Levi Christopher
Published: May 2012

Introduction

Anterior cerebral artery flow diversion, measured by transcranial Doppler ultrasound, is correlated with leptomeningeal collateral flow on digital subtraction angiography in the setting of middle cerebral artery occlusion. We aimed to assess the influence of flow diversion as a marker of leptomeningeal collateralization on infarct size and penumbral volume.

Methods

We assessed consecutive patients presenting within six-hours of ischaemic stroke. Anterior cerebral artery flow diversion, defined as ipsilateral mean velocity of at least 30% greater than the contralateral artery, was used as the Doppler index of leptomeningeal collateralization. Multivariable regression analysis was performed to assess the impact of anterior cerebral artery flow diversion, controlling for other important clinical variables. Leptomeningeal collateralization was also graded on computed tomography angiography. Infarct core and penumbral volumes were defined using computed tomography perfusion thresholds of cerebral blood volume and mean transit time. Infarct volume, reperfusion, and vessel status were measured at 24 h using magnetic resonance techniques.

Results

Fifty-three patients qualified for analysis. Anterior cerebral artery flow diversion was associated with good collateral flow on computed tomography angiography ( P < 0·001) and was an independent predictor of admission infarct core volume ( P < 0·001), and 24 h infarct volume ( P < 0·001). The likelihood of a favourable outcome (modified Rankin Score 0–2) was higher (odds ratio = 27·5, P < 0·001) in those with flow diversion.

Conclusions

Anterior cerebral artery flow diversion indicates effective leptomeningeal collateralization as measured by computed tomography angiography, and independently predicts acute infarct size and 90-day clinical outcome. Flow diversion appears to provide penumbral perfusion, offering some protection against infarct expansion. Acute bedside transcranial Doppler assessment of flow diversion aids prognostication and therapeutic decision making in anterior circulation stroke.
Respiratory Muscle Strength and Training in Stroke and Neurology: A Systematic Review
Authors: Pollock Ross D. , Rafferty Ged F. , Moxham John , Kalra Lalit
Published: May 2012

We undertook two systematic reviews to determine the levels of respiratory muscle weakness and effects of respiratory muscle training in stroke patients. Two systematic reviews were conducted in June 2011 using a number of electronic databases. Review 1 compared respiratory muscle strength in stroke and healthy controls. Review 2 was expanded to include randomized controlled trials assessing the effects of respiratory muscle training on stroke and other neurological conditions. The primary outcomes of interest were maximum inspiratory and expiratory mouth pressure (maximum inspiratory pressure and maximum expiratory pressure, respectively). Meta-analysis of four studies revealed that the maximum inspiratory pressure and maximum expiratory pressure were significantly lower ( P < 0·00001) in stroke patients compared with healthy individuals (weighted mean difference −41·39 and −54·62 cmH2O, respectively). Nine randomized controlled trials indicate a significantly ( P = 0·0009) greater effect of respiratory muscle training on maximum inspiratory pressure in neurological patients compared with control subjects (weighted mean difference 6·94 cmH2O) while no effect on maximum expiratory pressure. Respiratory muscle strength appears to be impaired after stroke, possibly contributing to increased incidence of chest infection. Respiratory muscle training can improve inspiratory but not expiratory muscle strength in neurological conditions, although the paucity of studies in the area and considerable variability between them is a limiting factor. Respiratory muscle training may improve respiratory muscle function in neurological conditions, but its clinical benefit remains unknown.
Two-Year Direct Medical Costs of Stroke in Korea: A Multi-Centre Incidence-Based Study from Hospital Perspectives
Authors: Rha Joung-Ho , Koo Jaseong , Cho Ki Hyun , Kim Eung-Gyu , Oh Gun Sei , Lee Se Jin , Cha Jae Kwan , Oh Jin-Jeong , Ham Gyoung-Rye , Seo Hyun-Soo , Kim Jong S.
Published: May 2012

Background

Despite increasing socio-economic burden of stroke, few studies have investigated the costs associated with the stroke care in Korea. We estimated the two-year direct medical costs associated with stroke.

Methods

This was a multi-centre, incidence-based, retrospective observational study. We examined the records of all adult patients who were admitted in eight large hospitals throughout Korea due to acute stroke [I60: sub-arachnoid haemorrhage; I61: intracerebral haemorrhage; I62: other nontraumatic haemorrhage; I63: cerebral infarction, by The International Statistical Classification of Diseases and Related Health Problems (ICD)-10] between 1 November and 31 December 2006. Direct medical inpatient and outpatient cost of each patient was extracted from the medical record and the reimbursement claim data of the hospital.

Results

Out of 908 studied patients (14% diagnosed as I60, 18% as I61, 3% as I62, and 65% as I63), 460 (50·7%) were assessed for more than one-year. The annual average direct medical costs were Korean ₩ 8 114 471 US$8732) for the first year, and Korean ₩ 431 527 for the second year. The first year costs for haemorrhagic stroke (I60–I62) (Korean ₩ 13 090 179) were significantly higher than those associated with cerebral infarction (I63) (Korean ₩ 5 460 459), whereas the second year costs were not different. Factors independently associated with high cost were female gender, young age, and first stroke.

Conclusions

Direct medical costs for stroke in Korea were determined, which seem to be lower than those of other developed countries. Female gender, young age, and first stroke were factors related to higher stroke cost.
Single Subcortical Infarction Associated with Parental Arterial Disease: Important Yet Neglected Sub-Type of Atherothrombotic Stroke
Authors: Kim Jong S. , Yoon Youngshin
Published: May 2012

Background

Traditionally, single subcortical infarction has been considered to be caused by lipohyalinosis of small perforating arteries. However, atherosclerosis in the parental artery produces similar single subcortical infarction by blocking the orifice of branching arteries. The purpose of this paper is to review the evolving concepts, clinical characteristics, and classification issues of single subcortical infarction associated with parental artery disease.

Summary of review

Single subcortical infarction associated with parental artery disease is an important cause of subcortical infarction, more so in the posterior than in anterior circulation stroke. It is one of the major causes of brainstem infarction. Single subcortical infarction associated with parental artery disease seems to be common in Asian population where intracranial atherosclerosis is prevalent. Although the clinical characteristics of single subcortical infarction associated with parental artery disease are similar to single subcortical infarction caused by small artery disease, single subcortical infarction associated with parental artery disease is more often associated with characteristics of atherosclerosis, and fluctuating and poorer outcomes. With advanced imaging techniques such as high-resolution cross-sectional magnetic resonance imaging, single subcortical infarction associated with parental artery disease emerges as an even more important stroke sub-type. Nevertheless, it has been neglected in previous stroke sub-type classifications, being erroneously classified as small artery disease or cryptogenic stroke. Prevention and treatment trials focusing on single subcortical infarction associated with parental artery disease are not available.

Conclusion

Single subcortical infarction associated with parental artery disease is an important stroke sub-type, distinct from small artery disease, illustrating that greater efforts should be made in its accurate diagnosis. Studies are needed to investigate the prevalence of single subcortical infarction associated with parental artery disease in various parts of the world and to design a stroke classification system that includes single subcortical infarction associated with parental artery disease. Prevention and treatment trials should consider this important sub-group of stroke, so that tailored strategies can be applied in clinical practice.
Cerebral Vasospasm after Sub-arachnoid Hemorrhage as a Clinical Predictor and Phenotype for Genetic Association Study
Authors: Kim Hyungsuk , Crago Elizabeth , Kim Mirim , Sherwood Paula , Conley Yvette , Poloyac Samuel , Kerr Mary
Published: May 2012

Background

A typology of cerebral vasospasm has been proposed based on distinct clinical manifestations: delayed cerebral ischemia, symptomatic ‘vasospasm’, angiographic vasospasm, and transcranial Doppler vasospasm. We examined each distinct clinical manifestation in a nonparametric genetic association study.

Aims

The purpose of this study was to examine and compare each four distinct acute clinical manifestations and test its perspectives in genetic association studies.

Methods

Two hundred forty-five Caucasian patients with sub-arachnoid hemorrhage were evaluated for these four distinct clinical manifestations along with 906 600 single-nucleotide polymorphisms across the human genome.

Results

The four clinical manifestations were significantly associated with each other as P-values ranged from 3·31 × 10−4 to 8·10 × 10−15. Transcranial Doppler vasospasm showed significant genetic association with single nucleotide polymorphism (SNP) (rs999662, P = 3·39 × 10−8). Statistical P-value of rs999662 in association with delayed cerebral ischemia, symptomatic ‘vasospasm’, and angiographic vasospasm was 0·0017, 0·0017, and 0·19, respectively.

Conclusions

Despite different criteria for each of the four clinical manifestations, they are significantly associated with each other. Our results suggest transcranial Doppler vasospasm may be an appropriate intermediate but still clinically relevant phenotype for genetic association studies. Association with SNP rs999662 indicates a potential role for the region containing the solute carrier family 12 member 3 (SLC12A3) gene in transcranial Doppler vasospasm following sub-arachnoid hemorrhage.
A Method to Simulate the Impact of Acid Mine Drainage on River Systems
Authors: whitehead P. g. , mccartney M. p. , WILLIAMS R. J. , ISHEMO C. A. L. , THOMAS R.
Published: May 2012

Abandoned mines create pollution problems in rivers as minewater levels rise and discharges of metal‐rich acidic waters occur. Mines adjacent to rivers can cause serious pollution problems, reducing fish stocks and preventing restocking. A computer model has been used to simulate the impact of these discharges and to devise an optimal treatment strategy to meet river quality objectives. The use of this model, through application to two case studies, is described.
The Design of Disinfection Contact Tanks
Authors: stevenson D. g.
Published: May 2012

The basic concept of chemical reaction engineering, as applied to the disinfection of water in a continuous flowing system, is summarized, and the effect of flow dispersion (i.e. the spread of residence time) on the efficiency of the process is highlighted. It is shown that deficiencies compared with the ideal batchwise situation can be offset by adjustments to the residence time or the disinfectant concentration, provided that the design is reasonable. The term ‘compensation factor’ is offered as a means of characterizing tanks which are intended for a specific duty.

Reference is also made to recently available software which now enables tanks to be evaluated at the design stage without resorting to specialist computing services.
The Enhancement of Salmonid Rivers in the Republic of Ireland1
Authors: o'grady M.
Published: May 2012

The paper describes (a) the methodologies which are used to carry out bioengineering baseline surveys of Irish salmonid rivers, and (b) the value of these exercises as a tool to identify the extent and degree of habitat degradation. The role of pilot instream physical enhancement schemes (in assessing the value of particular work schedules) is outlined, and the impact of excessive bankside vegetation on salmonid stocks is illustrated. Costs and benefits in relation to both a number of instream physical enhancement programmes and shrub‐pruning exercises are illustrated and compared with the gains which might be achieved from spending the same amount of money on stocking juvenile salmon. The rationale for undertaking such programmes in the Republic of Ireland is outlined.
Negotiating climate legislation: Policy path dependence and coalition stabilization
Authors: Knox‐Hayes Janelle
Published: May 2012

This article investigates the nature of policy path dependence through analysis of climate policy formation in the United States. In 2008 the US Congress attempted to pass the Lieberman–Warner bill, a comprehensive climate and energy package that would have capped greenhouse emissions and established a nationwide cap and trade program. In the same year, California successfully enacted the Global Warming Solutions Act. This article explores the circumstances of both cases and raises the question of why legislation at the state level was successful and took such a divergent form from legislation at the federal level. The divergence of these cases is used to highlight the nature of coalition formation and policy path dependence in the legislative process. Explanations of policy tend to gravitate toward either the generalizability of game theoretic approaches or the empirical depth of case studies. This article suggests a combined approach that uses case studies to analyze the positions and motivations of actors and to then model policy development over time. The approach examines policy through the formation and negotiation of policy coalitions. Drawing on the Advocacy Coalition Framework and omnibus analysis, the approach expands these coalition theories first by analysing legislative development at the interface of legislators and constituent interest groups, and second by adding temporal dimension to the analysis. The findings suggest that policy is path dependent in that it is negotiated between coalitions that in turn create stability in the policy process and insulate policy fields from external shocks. Policy path dependence suggests that theory alone is insufficient to predict policy outcomes; policy results depend strongly on prior policy efforts, historically and socially contingent coalitions, and the resulting framing of policy possibilities.
Mobile Phones, Livelihoods and the Poor in Sub‐Saharan Africa: Review and Prospect
Authors: Porter Gina
Published: May 2012

This review paper focuses on the potential of widespread access to mobile phones for improving the lives of poor people: the opportunities that mobile phones have already provided, or may soon present, for enhancing their material well‐being. Following a broad review of the diffusion of mobile phones across Africa, discussion is restricted principally to one key issue, livelihoods, due to space constraints. Attention is paid to the linkages between virtual and physical mobility throughout the paper and the final section reflects specifically on possible interactions between expanded virtual mobility and sustainable transportation in the continent, an issue of considerable significance for future development potential in our increasingly carbon‐constrained world.
Urban Geopolitics 8 Years on. Hybrid Sovereignties, the Everyday, and Geographies of Peace
Authors: Fregonese Sara
Published: May 2012

Urban events like 9‐11 and the Arab Spring have deeply marked the first two decades of a century in which the majority of the world population will live in cities. This essay reviews present and potential future debates about the relation between cities and geopolitics, particularly the work of urban geopolitics. I trace three debates centred on three relationships: that between city and sovereignty; between official and everyday urban practices; between violent and peaceful geographies. I point towards three avenues of potential engagement of geographers with the theme of geopolitics and the city. The first avenue leads to appreciating the complex relationships between the state and the non‐state that are nowadays increasingly relevant and visible. The second concerns geographies of the everyday, the unofficial, and the unplanned. The third concerns the possibility for an urban geopolitics of peace and its inclusion, rather than focussing exclusively on war and its avoidance.
Political Ecology: Nonequilibrium Science and Nature‐Society Research
Authors: Grabbatin Brian , Rossi Jairus
Published: May 2012

Political ecology has emerged as an interdisciplinary space where concepts from the physical and social sciences are utilized to understand nature‐society relationships. In this paper, we explore how political ecologists have used concepts from nonequilibrium ecology to address concerns over the interactions between land management and livelihood practices. We begin by demystifying how equilibrium and nonequilibrium have been used in ecology, demonstrating the dialectical relationship between these divergent frameworks and how each impacts understandings of living systems. Then, we review how political ecologists employ these concepts to examine environmental knowledge production, as well as the role of livelihoods and anthropogenic disturbances in conservation and restoration. We also discuss how nonequilibrium ecology has shaped our own research trajectories and finish the paper by offering some reflections on the possibilities and pitfalls for political ecology’s use of nonequilibrium ecology to bridge the physical‐human divide in geography.
Youth Organizing as a Developmental Context for African American and Latino Adolescents
Authors: Kirshner Ben , Ginwright Shawn
Published: May 2012

Research on adolescence has begun to recognize the centrality of ecological context in human development. Ecological approaches, however, need to pay greater attention to the political context of young people's lives, both in terms of how youth interpret their sociopolitical world and how they participate in changing it. Research on youth organizing among African American and Latino youth offers insights about these dimensions of sociopolitical development. Youth organizing enables young people growing up in difficult circumstances to identify the social origins of problems and take action to address those problems. Emerging research suggests that youth organizing has the potential to contribute to youth development, community development, and broader social movements. Youth organizing challenges social constructions of adolescents as apathetic or self‐involved and offers an alternative to deficit‐based orientations toward youth of color.