bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epilepsy Care in Zambia: A Study of Traditional Healers
Authors: Baskind Roy , Birbeck Gretchen 
Published: June 2005

Summary:  Purpose: Most people with epilepsy (PWE) reside in developing countries with limited access to medical care. In sub‐Saharan Africa (SSA), traditional healers (THs) play a prominent role in caring for PWE, yet little is known about epilepsy care by THs. We conducted a multimethod, qualitative study to better understand the epilepsy care delivered by THs in Zambia. Methods: We conducted focus‐group discussions with THs, in‐depth semistructured interviews with a well‐recognized TH at his place of work, and multiple informal interviews with healthcare providers in rural Zambia. Results: THs recognize the same symptoms that a neurologist elicits to characterize seizure onset (e.g., olfactory hallucinations, jacksonian march, automatisms). Although THs acknowledge a familial propensity for some seizures and endorse causes of symptomatic epilepsy, they believe witchcraft plays a central, provocative role in most seizures. Treatment is initiated after the first seizure and usually incorporates certain plant and animal products. Patients who do not experience further seizures are considered cured. Those who do not respond to therapy may be referred to other healers. Signs of concomitant systemic illness are the most common reason for referral to a hospital. As a consequence of this work, our local Epilepsy Care Team has developed a more collaborative relationship with THs in the region. Conclusions: THs obtain detailed event histories, are treatment focused, and may refer patients who have refractory seizures to therapy to other healers. Under some circumstances, they recognize a role for modern health care and refer patients to the hospital. Given their predominance as care providers for PWE, further understanding of their approach to care is important. Collaborative relationships between physicians and THs are needed if we hope to bridge the treatment gap in SSA.
Origin and Propagation of Epileptic Spasms Delineated on Electrocorticography
Authors: Asano Eishi , Juhász Csaba , Shah Aashit , Muzik Otto , Chugani Diane C. , Shah Jagdish , Sood Sandeep , Chugani Harry T. 
Published: June 2005

Summary:  Purpose: Ictal electrographic changes were analyzed on intracranial electrocorticography (ECoG) in children with medically refractory epileptic spasms to assess the dynamic changes of ictal discharges associated with spasms and their relation to interictal epileptiform activity and neuroimaging findings. Methods: We studied a consecutive series of 15 children (age 0.4 to 13 years; nine girls) with clusters of epileptic spasms recorded on prolonged intracranial subdural ECoG recordings, which were being performed for subsequent cortical resection, and in total, 62 spasms were analyzed by using quantitative methods. Results: Spasms were associated with either a “leading” spike followed by fast‐wave bursts (type I: 42 events analyzed quantitatively) or fast‐wave bursts without a “leading” spike (type II: 20 events analyzed quantitatively). Twenty‐three of the 42 type I spasms but none of the 20 type II spasms were preceded by a focal seizure. A “leading” spike had a focal origin in all 42 type I spasms and involved the pre‐ or postcentral gyrus within 0.1 s in 37 of these spasms. A leading spike was associated with interictal spike activity >1/min in 40 of 42 type I spasms and originated within 2 cm from a positron emission tomography glucose hypometabolic region in all but two type I spasms. Failure to resect the cortex showing a leading spike was associated with poor surgical outcome (p = 0.01; Fisher's exact probability test). Fast‐wave bursts associated with spasms involved neocortical regions extensively at least in two lobes within 1.28 s in all 62 spasms and involved the pre‐ or postcentral gyrus in 53 of 62 spasms. Conclusions: Epileptic spasms may be triggered by a focal neocortical impulse in a subset of patients, and a leading spike, if present, might be used as a marker of the trigger zone for epileptic spasms. Rapidly emerging widespread fast‐wave bursts might explain the clinical semiology of epileptic spasms.
A Comparative Study of the Effect of Carbamazepine and Valproic Acid on the Pharmacokinetics and Metabolic Profile of Topiramate at Steady State in Patients with Epilepsy
Authors: Mimrod Dorit , Specchio Luigi M. , Britzi Malka , Perucca Emilio , Specchio Nicola , Neve Angela La , Soback Stefan , Levy René H. , Gatti Giuliana , Doose Dennis R. , Maryanoff Bruce E. , Bialer Meir 
Published: June 2005

Summary:  Purpose: To compare the influence of enzyme‐inducing comedication and valproic acid (VPA) on topiramate (TPM) pharmacokinetics and metabolism at steady state. Methods: Three groups were assessed: (a) patients receiving TPM mostly alone (control group, n =13); (b) patients receiving TPM with carbamazepine (CBZ; n = 13); and (c) patients receiving TPM with VPA (n = 12). TPM and its metabolites were assayed in plasma and urine by liquid chromatography–mass spectrometry (LC‐MS). Results: No significant differences were found in TPM oral (CL/F) and renal (CLr) clearance between the VPA group and the control group. Mean TPM CL/F and CLr were higher in the CBZ group than in controls (2.1 vs. 1.2 L/h and 1.1 vs. 0.6L/h, respectively; p < 0.05). In all groups, the urinary recovery of unchanged TPM was extensive and accounted for 42–52% of the dose (p > 0.05). Urinary recovery of 2,3‐O‐des‐isopropylidene‐TPM (2,3‐diol‐TPM) accounted for 3.5% of the dose in controls, 2.2% in the VPA group (p > 0.05), and 13% in the CBZ group (p < 0.05). The recovery of 10‐hydroxy‐TPM (10‐OH‐TPM) was twofold higher in the CBZ group than in controls, but it accounted for only <2% of the dose. The plasma concentrations of TPM metabolites were severalfold lower than those of the parent drug. Conclusions: Renal excretion remains a major route of TPM elimination, even in the presence of enzyme induction. The twofold increase in TPM‐CL/F in patients taking CBZ can be ascribed, at least in part, to stimulation of the oxidative pathways leading to formation of 2,3‐diol‐TPM and 10‐OH‐TPM. VPA was not found to have any clinically significant influence on TPM pharmacokinetic and metabolic profiles.
The First Case of Invasive EEG Monitoring for the Surgical Treatment of Epilepsy: Historical Significance and Context
Authors: Almeida Antonio N. , Martinez Victor , Feindel William 
Published: June 2005

Summary:  Purpose: Controversy persists about when EEG became a fundamental tool in the preoperative investigation for epilepsy surgery. We revisit Penfield's first use of invasive EEG monitoring, emphasizing its historical importance for the evolution of epilepsy surgery. Methods: Patients' hospital charts and articles published before 1940 regarding EEG and epilepsy or EEG and cerebral lesions were reviewed to evaluate the historical context of the surgery. Results: In April 1939, Penfield performed trephination over both temporal regions and placed electrodes on the dura, intending to lateralize seizure origin in a patient with bitemporal epilepsy. The patient underwent serial EEGs with this technique. The final report of the recordings from epidural leads was “continued random delta activity in the left temporal region indicating a cortical lesion on this side.” The pneumoencephalogram showed “the presence of diffuse cerebral atrophy, particularly in the left cerebral hemisphere.” Based on these findings, the patient underwent surgery on April 21, revealing a meningocerebral scar in the posterior part of the left temporal lobe. Brain stimulation and electrocorticography delineated the extent of resection, while preserving the speech area. Seizures did not improve. Conclusions: We revisit the first case of epidural EEG monitoring for epilepsy surgery and show that the concept of EEG‐directed surgery was already present at the Montreal Neurological Institute in the late 1930s.
Peripheral blood progenitor cell collection in chronic myeloid leukemia patients with complete cytogenetic response after treatment with imatinib mesylate
Authors: Perseghin Paolo , Gambacorti‐Passerini Carlo , Tornaghi Lucia , Dassi Maria , Pioltelli Pietro , Parma Matteo , Colnaghi Federica , Giudici Giovanni , Elli Elena , Fumagalli Monica , Ponchio Luisa , Biondi Andrea , Pogliani Enrico M. 
Published: June 2005

BACKGROUND:  Imatinib mesylate (IM) was introduced in chronic myeloid leukemia (CML) treatment in the late 1990s and substantially changed the therapeutic approach to the disease, by inducing complete cytogenetic response (CCR) in approximately 60 percent of cases. Nevertheless, some concerns exist about the duration of response to treatment and the onset of resistance to IM.STUDY DESIGN AND METHODS:  Twenty‐five chronic‐phase CML patients in stable CCR (>6 months) treated for at least 1 year with IM at the standard dose (400 mg/day) were mobilized with recombinant human granulocyte–colony‐stimulating factor (Filgrastim) at 10 µg per kg for 4 to 6 days, with the aim of collecting at least 2 × 106 CD34+ cells per kg. Standard cytogenetic analysis and first‐round and/or nested polymerase chain reaction were performed in basal and postmobilization samples to examine the presence of bcr‐abl transcripts.RESULTS:  CD34+ cells collection was successful in 16 patients, yielding a median of 3.01 × 106 ± 1.09 × 106 CD34+ cells per kg at the first attempt, and in 4 of the 9 remaining patients who were remobilized after a temporary withdrawal of IM, yielding a median of 2.65 × 106 ± 0.7 × 106 CD34+ cells per kg, with an overall 80 percent success rate. No correlation between mobilization and duration of the disease, length of IM treatment, or previous interferon‐α and/or hydroxyurea treatment was found.CONCLUSIONS:  Autologous CD34+ cells may be mobilized and collected in most CML patients who achieve CCR after IM treatment, with a view to possible use in the event that resistance to IM occurs in patients not eligible for allogeneic peripheral blood progenitor cell transplantation or those lacking an HLA‐matched donor.
Characterization of the alloreactive helper T‐cell response to the platelet membrane glycoprotein IIIa (integrin‐β3) in human platelet antigen‐1a alloimmunized human platelet antigen‐1b1b women
Authors: Sukati Hosea , Bessos Hagop , Barker Robert N. , Urbaniak Stanislaw J. 
Published: June 2005

BACKGROUND: The aims were to characterize the helper T‐cell response to platelet (PLT) glycoprotein (GP) IIIa, which stimulates the alloimmune antibody response to human PLT antigen (HPA)‐1a, to identify immunodominant epitopes and to examine the HLA Class II associations.STUDY DESIGN AND METHODS: Peripheral blood mononuclear cells (PBMNCs) were obtained from 21 HPA‐1b1b women who had an HPA‐1a–mismatched pregnancy, 14 of whom developed anti‐HPA‐1a, and 11 control donors. PBMNCs were stimulated with two panels of 15‐mer peptides corresponding to the HPA‐1a/1b polymorphic region, with either Leu33 (‐1a) or Pro33 (‐1b) at each possible position, and the proliferative responses were measured. HLA Class II and HPA genotyping was by conventional polymerase chain reaction–sequence‐specific priming.RESULTS: Peptides with Leu33 at, or near, the C‐terminus contained an immunodominant epitope, stimulating proliferation by helper T cells from all nine women who had anti‐HPA‐1a at the time of testing; peptide L1 (Val19‐Leu33) stimulated a response in 50 percent of these women. Their T cells did not respond to the corresponding HPA‐1b Pro33 peptides, and responses to either peptide panel were rare in unimmunized women and controls. HLA‐DRB3*01+ was significantly overrepresented (p = 0.014) in alloimmunized women whose T cells responded to the major HPA‐1a Leu33‐containing epitope. Conversely, HLA‐DRB1*15 was negatively associated (p = 0.014) with this response.CONCLUSIONS: The HPA‐1a polymorphic region of GPIIIa contains both the linear T‐cell and the conformational B‐cell epitopes. The immunodominant T‐cell epitope is constrained by HLA‐DRB3*01+, and if presented by a tolerogenic route, a peptide containing this epitope may form the basis for the prevention or reversal of the alloimmune response to HPA‐1a.
Factors affecting the formation of white particulate matter in red blood cell components
Authors: Patel Hina D. , Byrne Karen M. , Horne McDonald , Leitman Susan F. , Stroncek David F. 
Published: June 2005

BACKGROUND: Recently white particulate matter (WPM) in red blood cell (RBC) components has received increased attention. The nature and causes of WPM formation were investigated.STUDY DESIGN AND METHODS: Whole‐blood units were collected from 18 healthy subjects with three different types of collection sets. Six units were collected into each type. Units were divided into four equal parts and stored for 4 hours: two parts at room temperature and two at 4°C. RBCs were prepared from each quarter‐unit: two by heavy centrifugation (5000 × g) and two by light centrifugation (2000 × g). Whole blood was inspected for WPM over 4 hours and RBCs over 1 hour.RESULTS: No WPM was detected in whole blood, but WPM was detected in at least one RBC component from 9 of the 18 donations. The 36 components prepared by heavy centrifugation were more likely to contain WPM than the 36 prepared by light centrifugation (50% vs. 19%; p < 0.02). The incidence of WPM was similar among RBCs stored at room temperature and 4°C. Donors of RBCs with WPM had higher total cholesterol levels than donors of components without WPM (191 ± 20 mg/dL vs. 163 ± 32 mg/dL; p < 0.04), but there was no difference in triglyceride levels between the two groups.CONCLUSIONS: WPM is an expected consequence of standard RBC manufacturing methods, but it is more frequent in RBCs prepared by heavy centrifugation and from donors with higher cholesterol levels.
MO‐A‐I‐609‐01: The Role of the Physicist in the Planning and Design of Digital Image Management Systems (PACS)
Authors: Peck D , Flynn M 
Published: June 2005

A Digital Image Management System encompasses all information related to Diagnostic or Therapeutic images used in a clinical setting. This includes the order entry process, movement of the order information to a Modality, image acquisition and processing, movement of the image data to an archive, movement of the images and order data to Radiologist and Clinician viewing stations, and reporting the interpretation of the images. Note that a Digital Image Management System includes more than just image storage and viewing inferred by the title Picture Archive and Communication System (PACS). Therefore when a Physicist is asked to consult in planning a PACS they should be thinking about the workflow and data required to produce the final product, i.e. the Radiologist Report with associated images, and so they are actually consulting on the implementation of a Digital Image Management System. The areas that a Physicist should provide information to a site when planning such systems include:1. Digital image acquisition/modality options for each study,2. Modality integration and testing,3. Bandwidth and storage requirements,4. Radiologist and clinician softcopy viewing requirements,5. Digital imaging Quality Assessment (QA) protocolsThe needs in each of these areas relative to planning a Digital Image Management System will be reviewed with suggestions on further educational resources.Educational Objectives:1. Understand the workflow and Modality requirements in a Digital Image Management System.2. Understand softcopy reading requirements compared to film based and considering the increasing image size and volume.3. Consider the QA needs and methodologies with digital imaging systems.
MO‐A‐T‐6C‐01: Managing Respiratory Motion in Radiation Oncology
Authors: Keall P , Mageras G 
Published: June 2005

Intrafraction motion is an issue that is becoming increasingly important in the era of image‐guided radiotherapy. Intrafraction motion can be caused by the respiratory, skeletal muscular, cardiac and gastrointestinal systems. Of these three systems, much research and development to date has been directed towards accounting for respiratory motion. Respiratory motion causes deleterious effects during the imaging, planning and delivery of radiation therapy. The management of respiratory motion in radiation oncology is the subject of this continuing education class which aims to advise medical physicists involved in the external beam radiation therapy of patients with thoracic and abdominal tumors that move due to respiratory motion. This session will describe the magnitude of respiratory motion, discuss radiotherapy‐specific problems caused by respiratory motion, explain techniques that explicitly manage respiratory motion during radiotherapy and give recommendations in the application of these techniques for patient care, including quality assurance guidelines for these devices. The techniques to be described include respiratory gating, breath‐hold techniques, forced shallow breathing and respiration‐synchronized radiotherapy. This session intends to reflect the current state of the scientific understanding and technical methodology in imaging, treatment planning and radiation delivery for radiation oncology patients with tumors affected by respiratory motion. Issues requiring further study will also be raised. The educational objectives of this course include:1. Appreciate the effects of respiratory motion during the imaging, planning and delivery of radiotherapy.2. Learn the various techniques that have been clinically applied to manage respiratory motion.3. Understand the general and specific quality assurance requirements for different respiratory management techniques.4. Describe the clinical process for managing patients with tumors affected by respiratory motion.
MO‐B‐I‐611‐01: The Role of the Medical Physicist in Preparing for Radiation Disasters
Authors: Hartman M 
Published: June 2005

Since 9/11, hospitals have seen the need to examine their emergency management plans to ensure that radiation disasters are adequately addressed. Hospitals need to be ready to deal with radiation casualties in addition to the possibility of many self‐presenters who want to know whether they are contaminated. Hospitals need to be prepared to handle this situation in the first day or two after a disaster until state and federal agencies can mobilize. Medical physicists will play a vital role as responders and sources of accurate information for hospital staff, patients and the public. Medical physicists will be asked to assist in the decision‐making process if an event does occur. This course provides information on the handling of patients who are injured and may be irradiated and/or contaminated with radioactive material. The Center for Disease Control website has guidance on ways to handle self‐presenters who may exceed the number of radiation casualties. The psychosocial considerations after a disaster will be discussed and its effects on staff, patients and the public. The course will also address issues to be anticipated for facility recovery after a disaster.Educational Objectives:1. To provide resources that are available for developing emergency plans that address radiation disasters and their unique policy considerations.2. To show how to utilize radiation protection procedures and practices and know how to prepare the facility for radiological emergency medical response.3. To provide a framework for handling self‐presenters who will seek help from their local hospital to determine whether they are contaminated.4. To understand the psychosocial considerations in responding to a radiological emergency.5. To know what activities can occur during facility's recovery from a radiation disaster.
WE‐C‐I‐611‐01: Basic System Design and Application
Authors: Rudin S 
Published: June 2005

The use of real‐time or rapid sequence x‐ray imaging has been increasing. Not only are the GI and cardiology applications to diagnostic procedures of continuing interest, but new image guided interventional procedures are being developed which rely on the combination of high spatial and temporal resolution x‐ray imaging. In particular, rotational angiographic sequences combined with cone‐beam computed tomography have enabled advances in minimally invasive endovascular interventional procedures to often replace invasive surgical procedures. In this symposium, after a review of some of the clinical applications of dynamic x‐ray imaging including fluoroscopy and angiography, we will discuss some of the unique problems associated with image quality evaluation for such total x‐ray imaging systems, as well as review some of the new developments in detector design with a comparison of flat panel and image intensifier‐based systems. Also we will discuss developments in cone‐beam computed tomography with specific application to angiography and ultimately to the potential for changing the treatment paradigm for vascular disease through the combination of computerized blood flow analysis and angiographic image guided interventions.Educational Objectives:1. To appreciate the widening clinical application of dynamic x‐ray imaging to diagnostic and interventions.2. To indicate the quality evaluation issues in total x‐ray imaging systems as well as the new developments of digital detectors and cone‐beam computed tomography.(Partial support: NIH Grants R01EB002873 and R01NS43924, Toshiba Medical Systems Corp., UB Foundation, UB‐STOR, Guidant Corp.).
Sexism vs. Superhuman Agency in the Theravada Buddhist Ritual System
Authors:   Jason Slone, Mort Joel 
Published: June 2005

AbstractThere are currently no fully ordained nuns in the Theravada Buddhist system. The doctrinal reason is because ordination ritual guidelines require the presence of senior nuns (of which, due to the dissolution of the nun orders, there are none) at a female's ordination. A more critical reason offered by feminists is that sexism (textual, traditional, and institutional) maintains the status quo. We argue that the Ritual Form Hypothesis of McCauley and Lawson (2002) best explains the continued lack of nun ordinations by making claims about cognitive constraints on ritual efficacy. Furthermore we predict that the institutional prevention of full nun ordinations will persist unless a new superhuman agent (i.e. a new Buddha) emerges with a new doctrine or unless Buddhists discover a different teaching that stipulates new conditions for ordination. Both are unlikely, however, given Theravada's theological conservatism.