Showing papers by "Danube University Krems published in 2011"

Physical activity attenuates the influence of FTO variants on obesity risk: A meta-analysis of 218,166 adults and 19,268 children

Abstract: Background: The FTO gene harbors the strongest known susceptibility locus for obesity. While many individual studies have suggested that physical activity (PA) may attenuate the effect of FTO on obesity risk, other studies have not been able to confirm this interaction. To confirm or refute unambiguously whether PA attenuates the association of FTO with obesity risk, we meta-analyzed data from 45 studies of adults (n=218,166) and nine studies of children and adolescents (n=19,268). Methods and Findings: All studies identified to have data on the FTO rs9939609 variant (or any proxy [r(2)>0.8]) and PA were invited to participate, regardless of ethnicity or age of the participants. PA was standardized by categorizing it into a dichotomous variable (physically inactive versus active) in each study. Overall, 25% of adults and 13% of children were categorized as inactive. Interaction analyses were performed within each study by including the FTOxPA interaction term in an additive model, adjusting for age and sex. Subsequently, random effects meta-analysis was used to pool the interaction terms. In adults, the minor (A-) allele of rs9939609 increased the odds of obesity by 1.23-fold/allele (95% CI 1.20-1.26), but PA attenuated this effect (p(interaction) = 0.001). More specifically, the minor allele of rs9939609 increased the odds of obesity less in the physically active group (odds ratio = 1.22/allele, 95% CI 1.19-1.25) than in the inactive group (odds ratio = 1.30/allele, 95% CI 1.24-1.36). No such interaction was found in children and adolescents. Conclusions: The association of the FTO risk allele with the odds of obesity is attenuated by 27% in physically active adults, highlighting the importance of PA in particular in those genetically predisposed to obesity.

Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis.

Abstract: BACKGROUND: Second-generation antidepressants dominate the management of major depressive disorder (MDD), but evidence on the comparative benefits and harms of these agents is contradictory.PURPOSE ...

Frequency of stroke and embolism in left ventricular hypertrabeculation/noncompaction.

Abstract: Left ventricular hypertrabeculation/noncompaction (LVHT/NC) is associated with stroke or embolism (S/E). The aim of this retrospective study was to assess the rate, risk factors, and cause of S/E in patients with LVHT/NC. The medical records of patients with LVHT/NC were retrospectively screened for S/E. For stroke classification, the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria were applied, and for peripheral embolism, angiographic findings were used. Baseline clinical, echocardiographic, and electrocardiographic data were compared between patients with and without S/E. In 22 of 144 patients (15%), stroke (n = 21) or peripheral embolism (n = 1) had occurred. The cause of S/E was cardioembolic (n = 14), atherosclerotic (n = 5), or undetermined (n = 3). S/E occurred before (n = 14) and after (n = 8) the diagnosis of LVHT/NC. Only mean age (60 vs 53 years, p <0.05) and the prevalence of hypertension (32% vs 59%, p <0.05) were higher in patients with S/E than in those without S/E. Among patients with cardioembolic S/E, 13 of 14 had either atrial fibrillation (AF) or systolic dysfunction, and AF as well as systolic dysfunction were found in 4 of 14 patients. In conclusion, S/E in patients with LVHT/NC is not always cardioembolic but may also have an atherosclerotic cause. In the absence of AF or left ventricular systolic dysfunction, cardioembolic S/E is rare in patients with LVHT/NC. These findings suggest that patients with LVHT/NC with systolic dysfunction or AF should receive oral anticoagulation as primary prophylaxis against S/E.

Poststroke chronic disease management: towards improved identification and interventions for poststroke spasticity‐related complications

Abstract: This paper represents the opinion of a group of researchers and clinicians with an established interest in poststroke care and is based on the recognised need for long-term care following stroke, especially in view of the global increase of disability due to stroke. Among the more frequent long-term complications following stroke are spasticity-related disabilities. Although spasticity alone occurs in up to 60% of stroke survivors, disabling spasticity affects only 4-10%. Spasticity further interferes with important functions of daily life when it occurs in association with pain, motor impairment, and overall declines of cognitive and neurological function. It is proposed that the aftermath of stroke be considered a chronic disease requiring a multifactorial and multilevel approach. There are, however, knowledge gaps related to the prediction and recognition of poststroke disability. Interventions to prevent or minimise such disabilities require further development and evaluation. Poststroke spasticity research should focus on reducing disability and be considered as part of a continuum of chronic care requirements and should be recognised as a part of a comprehensive poststroke disease management programme.

Helicopter Transport of Stroke Patients and Its Influence on Thrombolysis Rates Data From the Austrian Stroke Unit Registry

Abstract: Background and Purpose—Acute stroke management requires minimization of prehospital time. This study addresses the value of helicopter transport compared with other means of transportation to a stroke unit and compares their rates of thrombolysis on a nationwide basis. Methods—Prospective data collection and prespecified evaluation of data from 32 stroke units between 2003 and 2009 were used. We distinguished between patients transported either directly to a stroke unit or transferred indirectly via a peripheral hospital. Thus, there were 6 transport groups: helicopter emergency service (HEMS) direct and indirect, ambulance accompanied by an emergency physician direct and indirect, and ambulance without physician direct and indirect. Demographic and clinical factors, time delays, and rates of thrombolysis of patients transported by helicopter were compared with factors of patients transported otherwise. Results—Of 21 712 ischemic stroke patients, 905 patients (4.1%) were transported by helicopter. Of thes...

Enrichment of circulating tumor cells from a large blood volume using leukapheresis and elutriation: Proof of concept

Abstract: Background: The aim of this study was to determine the applicability of a sequential process using leukapheresis, elutriation, and fluorescence-activated cell sorting (FACS) to enrich and isolate circulating tumor cells from a large blood volume to allow further molecular analysis. Methods: Mononuclear cells were collected from 10 L of blood by leukapheresis, to which carboxyfluorescein succinimidyl ester prelabeled CaOV-3 tumor cells were spiked at a ratio of 26 to 106 leukocytes. Elutriation separated the spiked leukapheresates primarily by cell size into distinct fractions, and leukocytes and tumor cells, characterized as carboxyfluorescein succinimidyl ester positive, EpCAM positive and CD45 negative events, were quantified by flow cytometry. Tumor cells were isolated from the last fraction using FACS or anti-EpCAM coupled immunomagnetic beads, and their recovery and purity determined by fluorescent microscopy and real-time PCR. Results: Leukapheresis collected 13.5 × 109 mononuclear cells with 87% efficiency. In total, 53 to 78% of spiked tumor cells were pre-enriched in the last elutriation fraction among 1.6 × 109 monocytes. Flow cytometry predicted a circulating tumor cell purity of ∼90% giving an enrichment of 100,000-fold following leukapheresis, elutriation, and FACS, where CaOV-3 cells were identified as EpCAM positive and CD45 negative events. FACS confirmed this purity. Alternatively, immunomagnetic bead adsorption recovered 10% of tumor cells with a median purity of 3.5%. Conclusions: This proof of concept study demonstrated that elutriation and FACS following leukapheresis are able to enrich and isolate tumor cells from a large blood volume for molecular characterization. © 2010 International Clinical Cytometry Society

Recruiting South Asians to a lifestyle intervention trial: experiences and lessons from PODOSA (Prevention of Diabetes & Obesity in South Asians)

Abstract: Background: Despite the growing emphasis on the inclusion of ethnic minority patients in research, there is little published on the recruitment of these populations especially to randomised, community based, lifestyle intervention trials in the UK. Methods: We share our experience of recruitment to screening in the PODOSA (Prevention of Diabetes and Obesity in South Asians) trial, which screened 1319 recruits (target 1800) for trial eligibility. A multi-pronged recruitment approach was used. Enrolment via the National Health Service included direct referrals from health care professionals and written invitations via general practices. Recruitment within the community was carried out by both the research team and through our partnerships with local South Asian groups and organisations. Participants were encouraged to refer friends and family throughout the recruitment period. Results: Health care professionals referred only 55 potential participants. The response to written invitations via general practitioners was 5.2%, lower than reported in other general populations. Community orientated, personal approaches for recruitment were comparatively effective yielding 1728 referrals (82%) to the screening stage. Conclusions: The PODOSA experience shows that a community orientated, personal approach for recruiting South Asian ethnic minority populations can be successful in a trial setting. We recommend that consideration is given to cover recruitment costs associated with community engagement and other personalised approaches. Researchers should consider prioritising approaches that minimise interference with professionals’ work and, particularly in the current economic climate, keep costs to a minimum. The lessons learned in PODOSA should contribute to future community based trials in South Asians.

Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents

Abstract: Background Abdominal pain-related functional gastrointestinal disorders (FGIDs) are among the most common medical problems in paediatric medicine Frequently, physicians prescribe antidepressants as a second-line treatment for children and adolescents with FGIDs To date, the evidence on the benefits and harms of antidepressants for the treatment of abdominal pain-related FGIDs has not been assessed systematically Objectives The primary objectives were to conduct a systematic review to evaluate the efficacy and safety of antidepressants for the treatment of abdominal pain-related FGIDs in children and adolescents Search methods We searched The Cochrane Library, PubMed, EMBASE, IPA, CINAHL, PsycINFO, ISI Web of Science, Biosis Previews and the International Clinical Trials Registry Platform of the World Health Organization with appropriate filters (from inception to January 31, 2011) Selection criteria For efficacy we included double-blind, randomised controlled trials (RCTs) of antidepressants for treatment of abdominal pain-related FGIDs in children and adolescents 18 years or younger Open-label and uncontrolled experimental studies, as well as observational studies were eligible for the assessment of harms The minimum study duration was 4 weeks The minimum study size was 30 participants Data collection and analysis Two authors independently assessed all abstracts and full text articles, and rated the risk of bias for included studies Data were extracted independently by one author and checked for accuracy by another author Data were analysed using RevMan 5 Main results Two RCTs (123 participants), both using amitriptyline, met the pre-specified inclusion criteria These studies provided mixed findings on the efficacy of amitriptyline for the treatment of abdominal pain-related FGIDs The larger, publicly-funded study reported no statistically significant difference in efficacy between amitriptyline and placebo in 90 children and adolescents with FGIDs after 4 weeks of treatment On intention-to-treat (ITT)- analysis, 59% of the children reported feeling better in the amitriptyline group compared with 53% in the placebo group (RR 112; 95% CI: 077 to 163; P = 054) The risk of bias for this study was rated as low The second RCT enrolled 33 adolescents with irritable bowel syndrome Patients receiving amitriptyline experienced greater improvements in the primary outcome, overall quality of life, at weeks 6, 10, and 13 compared with those on placebo (P= 0019, 0004, and 0013, respectively) No effect estimates were calculated for the quality of life outcome because mean quality of life scores and standard deviations were not reported For most secondary outcomes no statistically significant differences between amitriptyline and placebo could be detected The risk of bias for this study was rated as unclear for most items However, it was rated as high for other bias due to multiple testing The results of this study should be interpreted with caution due to the small number of patients and multiple testing The larger study reported mild adverse events including fatigue, rash and headache and dizziness On ITT analysis, 4% of the amitriptyline group experienced at least one adverse event compared to 2% of the placebo group There was no statistically significant difference in the proportion of patients who experienced at least one adverse event (RR 191; 95% CI 018 to 2035; P = 059) The smaller study reported no adverse events The methods of adverse effects assessment was poorly reported in both studies and no clear conclusions on the risks of harms of amitriptyline can be drawn Authors' conclusions Clinicians must be aware that for the majority of antidepressant medications no evidence exists that supports their use for the treatment of abdominal pain-related FGIDs in children and adolescents The existing randomised controlled evidence is limited to studies on amitriptyline and revealed no statistically significant differences between amitriptyline and placebo for most efficacy outcomes Amitriptyline does not appear to provide any benefit for the treatment of FGIDs in children and adolescents Studies in children with depressive disorders have shown that antidepressants can lead to substantial, sometimes life-threatening adverse effects Until better evidence evolves, clinicians should weigh the potential benefits of antidepressant treatment against known risks of antidepressants in paediatric patients

When Men Become Fathers: Men’s Identity at the Transition to Parenthood

Abstract: Men in the transition to parenthood have to integrate fatherhood into their self-concepts and identities. Contemporary societies, in particular, provide two contradictory discourses for fathersto-b...

A visual analytics approach to dynamic social networks

Abstract: The visualization and analysis of dynamic networks have become increasingly important in several fields, for instance sociology or economics. The dynamic and multi-relational nature of this data poses the challenge of understanding both its topological structure and how it changes over time. In this paper we propose a visual analytics approach for analyzing dynamic networks that integrates: a dynamic layout with user-controlled trade-off between stability and consistency; three temporal views based on different combinations of node-link diagrams (layer superimposition, layer juxtaposition, and two-and-a-half-dimensional view); the visualization of social network analysis metrics; and specific interaction techniques for tracking node trajectories and node connectivity over time. This integration of visual, interactive, and automatic methods supports the multi-faceted analysis of dynamically changing networks.

EFNS guidelines for the molecular diagnosis of neurogenetic disorders: motoneuron, peripheral nerve and muscle disorders.

Abstract: Objectives:These EFNS guidelines on the molecular diagnosis of motoneuron disorders, neuropathies and myopathies are designed to summarize the possibilities and limitations of molecular genetic techniques and to provide diagnostic criteria for deciding when a molecular diagnostic work-up is indicated.Search strategy:To collect data about planning, conditions and performance of molecular diagnosis of these disorders, a literature search in various electronic databases was carried out and original papers, meta-analyses, review papers and guideline recommendations reviewed.Results:The best level of evidence for genetic testing recommendation (B) can be found for the disorders with specific presentations, including familial amyotrophic lateral sclerosis, spinal and bulbar muscular atrophy, Charcot-Marie-Tooth 1A, myotonic dystrophy and Duchenne muscular dystrophy. For a number of less common disorders, a precise description of the phenotype, including the use of immunologic methods in the case of myopathies, is considered as good clinical practice to guide molecular genetic testing.Conclusion:These guidelines are provisional and the future availability of molecular-genetic epidemiological data about the neurogenetic disorders under discussion in this article will allow improved recommendation with an increased level of evidence.

Visual exploration of time-oriented patient data for chronic diseases: design study and evaluation

Abstract: Medical care, particularly for chronic diseases, accumulates a huge amount of patient data over extensive time periods that needs to be accessed and analyzed accordingly. Information Visualization methods hold great promises in turning data deluge into improved quality of medical care. Yet, patient data management systems mostly provide documents, form-based displays, or static visualizations. We present a design study of an interactive visualization system, called VisuExplore, to support long-term care and medical analysis of patients with chronic diseases. VisuExplore offers interaction techniques for effective exploration of time-oriented data and employs simple, but intuitive visualization techniques. It was developed in close cooperation with physicians. We conducted two user studies with nine physicians and 16 students, which indicate that our design is useful and appropriate for particular tasks.

IAGG Workshop : Health promotion program on prevention of late onset dementia

Abstract: IAGG, WHO, and SFGG organized a international workshop on Health promotion programs on prevention of late on-set dementia. Thirty world specialists coming from Europe, North America, Asia, South America, Africa and Australia, shared their experience on methods and results of large epidemiological interventions to reduce incidents of dementia or delay its on-set. Chaired by Laura FRATIGLIONI, an expert in Epidemiological studies on dementia issues, the workshop gave opportunity for discussions and controversies about the state-of-the-art. Based on different national and international trials (ADAPT, MAPT, FINGER, GUDIAGE, GEM etc) the questions remained opened for different aspects of methodology, the choice of domain or multi domain intervention, the choice and the definition of the target populations, the best age of candidates, the issues related to the discrepancy between late effects, and interventions' duration. We are please to publish in the Journal, the presentations presented to this workshop. These publications will complete previously task force published in the journal in the last two years on methodological issues for Alzheimer's trials including end point, biomarkers, and the experience of past therapeutic trials.

Visually exploring multivariate trends in patient cohorts using animated scatter plots

Abstract: The effectiveness of animation in visualization is an interesting research topic that led to contradicting results in the past. On top of that, we are facing three additional challenges when exploring patient cohorts: irregular sampling, data wear, and data sets covering different portions of time. We present TimeRider, an improved animated scatter plot for cohorts of diabetes patients that tackles these challenges along with its evaluation with physicians. Results show that animation does support physicians in their work and provide further domain-specific evidence in the discussion on the effectiveness of animation.

Many roads lead to Rome: mapping users' problem-solving strategies

Abstract: There is more than one path to a solution, especially when it comes to ill-defined problems like complex, realworld tasks. Until now, the evaluation of information visualizations has often been restricted simply to a measuring of outcomes (time and error] or insights into the data set. A more detailed look into the processes that facilitate or hinder task completion is provided by analysing user problem-solving strategies. The study presented in this paper illustrates how such processes can be assessed and how the resulting knowledge can be used in participatory design to improve a visual analytics tool. For users to be equipped with a problem solving scaffold, the tools used should allow them to choose their own path to the solution - their own route to Rome. We also discuss how the evaluation of problem-solving strategies can shed more light on the 'exploratory minds' of users.

Second‐generation antidepressants for seasonal affective disorder

Abstract: Background Seasonal affective disorder (SAD) is a seasonal pattern of recurrent depressive episodes that is often treated with second-generation antidepressants (SGAs), light therapy or psychotherapy. Objectives To assess the efficacy and safety of SGAs for the treatment of SAD in adults in comparison with placebo, light therapy, other SGAs or psychotherapy. Search methods We searched the Cochrane Depression, Anxiety and Neuorosis Review Group's specialised register (CCDANCTR) on the 26 August 2011. The CCDANCTR contains reports of relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). In addition, we searched pharmaceutical industry trials registers via the Internet to identify unpublished trial data. Furthermore, we searched OVID MEDLINE, MEDLINE In-process, EMBASE and PsycINFO to 27July 2011 for publications on adverse effects (including non-randomised studies). Selection criteria For efficacy we included randomised trials of SGAs compared with other SGAs, placebo, light therapy or psychotherapy in adult participants with SAD. For adverse effects we also included non-randomised studies. Data collection and analysis Two review authors screened abstracts and full-text publications against the inclusion criteria. Data abstraction and risk of bias assessment were conducted by one reviewer and checked for accuracy and completeness by a second. We pooled data for meta-analysis where the participant groups were similar and the studies assessed the same treatments with the same comparator and had similar definitions of outcome measures over a similar duration of treatment. Main results For efficacy we included three randomised trials of between five and eight weeks duration with a total of 204 participants. For adverse effects we included two randomised trials and three observational (non-randomised) studies of five to eight weeks duration with a total of 225 participants. Overall, the randomised trials had low-to-moderate risk of bias, and the observational studies had a high risk of bias (due to small size and high attrition). The participants in the studies all met DSM (Diagnostic and Statistics Manual of Mental Disorders) criteria for SAD. The average age was approximately 40 years and 70% of the participants were female. Results from one trial with 68 participants showed that fluoxetine was not significantly more effective than placebo in achieving clinical response (risk ratio (RR) 1.62, 95% confidence interval (CI) 0.92 to 2.83). The number of adverse effects were similar between the two groups. We located two trials that contained a total of 136 participants for the comparison fluoxetine versus light therapy. Our meta-analysis of the results of the two trials showed fluoxetine and light therapy to be approximately equal in treating seasonal depression: RR of response 0.98 (95% CI 0.77 to 1.24), RR of remission 0.81 (95% CI 0.39 to 1.71). The number of adverse effects was similar in both groups. Two of the three randomised trials and three non-randomised studies contained adverse effect data on 225 participants who received fluoxetine, escitalopram, duloxetine, reboxetine, light therapy or placebo. We were only able to obtain crude rates of adverse effects, so any interpretation of this needs to be undertaken with caution. Between 22% and 100% of participants who received a SGA suffered an adverse effect and between 15% and 27% of participants withdrew from the studies because of adverse effects. Authors' conclusions Evidence for the effectiveness of SGAs is limited to one small trial of fluoxetine compared with placebo, which shows a non-significant effect in favour of fluoxetine, and two small trials comparing fluoxetine against light therapy, which suggest equivalence between the two interventions. The lack of available evidence precludes the ability to draw any overall conclusions on the use of SGAs for SAD. Further larger RCTs are required to expand and strengthen the evidence base on this topic, and should also include comparisons with psychotherapy and other SGAs. Data on adverse events were sparse, and a comparative analysis was not possible. Therefore the data we obtained on adverse effects is not robust and our confidence in the data is limited. Overall, up to 27% of participants treated with SGAs for SAD withdrew from the studies early due to adverse effects. The overall quality of evidence in this review is very low.

Characterization and functionalization of cellulose microbeads for extracorporeal blood purification

Abstract: In the frame of this work, cellulose microbeads with an average particle size of 2.3 μm were characterized with respect to porosity using a batch solute exclusion method and two groups of model substances, namely proteins and polystyrene sulfonates. The pores of the microbeads were almost completely accessible to proteins with Stokes radii below 2.5 nm. More than 60% of the pores were accessible to albumin, which is relevant for the application in blood purification, since many target substances are albumin bound. Activation of the microbeads with increasing amounts of sodium metaperiodate yielded matrices with dialdehyde contents between 100 and 1,000 μmol/g. The activated beads were well suited for the covalent attachment of functional ligands, such as antibodies. Immobilization of antibodies against the pro-inflammatory cytokine TNF-α resulted in efficient TNF-α adsorbents which possess application potential in extracorporeal blood purification, e.g. for the modulation of cytokine levels as supportive therapy for sepsis and other inflammatory disorders.

Linked open data: a means for public sector information management

Abstract: Currently information management in public administration is discussed under the aspects of information production, effective information provision and information logistics. The authors point out why the provision of Open Government Data shall be seen as a core element of strategic information management in the public sector and why extensive literature on the subject will be needed in future. The authors have designed an architectural model for Linked Open Government Data based on Good Practice Models in administration and economics. The proposed model is based on current wide spread technologies of Semantic Web, using Tim Berners-Lee 5-star Model. Simple APIs based on RESTful Services are necessary to take advantage of benefits of Peer Production and to guarantee compatibility with the growing market of mobile applications. Issues concerning licencing and legal liability are discussed in the concluding section.

Parkinson's syndrome and Parkinson's disease in mitochondrial disorders.

Abstract: In the majority of cases, mitochondrial disorders are multisystem conditions that most frequently affect the skeletal muscle, followed by the central nervous system. One of the clinical manifestations of central nervous system involvement is Parkinson's syndrome (PS). Evidence for an association of mitochondrial defects with PS comes from mitochondrial disorder patients who have developed Parkinson's syndrome and from Parkinson's syndrome patients who have developed a mitochondrial disorder. In addition, there are a number of patients with Parkinson's syndrome or Parkinson's disease (PD) who later develop subclinical immunohistological or biochemical indications of mitochondrial defects or accumulates mitochondrial DNA mutations within various cerebral regions. There are also Parkinson's syndrome patients who present with elevated cerebrospinal-fluid lactate by magnetic resonance spectroscopy. Furthermore, it has been shown that mutations in genes causing PD, such as PINK1, parkin, DJ1, alpha-synuclein, and LRRK2, also cause mitochondrial dysfunction, which is one of the reasons why they are called mitochondrial nigropathies. Parkinson's syndrome in patients with a mitochondrial disorder may also result from oxidative stress or exogenous toxins. Treatment of mitochondrial Parkinson's syndrome is not at variance with the treatment of Parkinson's syndrome due to other causes, but because of the multisystem nature of mitochondrial disorders, mitochondrial Parkinson's syndrome requires additional therapeutic support.

Advances in Brain Recovery and Rehabilitation 2010

Abstract: Discoveries in the past year have impacted the understanding of brain recovery and there is more of a need than ever for a foothold in recovery and rehabilitation This review reports on translational efforts, new (and old) potential drugs, various approaches to neurorehabilitation, and brain imaging that demonstrate reorganization in the human brain during stroke rehabilitation.

Preparation and characterization of cellulose microspheres

Abstract: The aim of this work was to synthesize and characterize cellulose microspheres with a particle size below 5 μm and narrow size distribution. After activation and functionalization with antibodies, these particles shall be applied as adsorbents in suspension-based extracorporeal blood purification systems, such as the Microspheres-Based Detoxification System. In the frame of this work such microspheres were developed and synthesized with reproducible properties. Besides using well-established methods for characterization of this kind of bead cellulose, additional procedures for the examination of its properties were developed and applied.

Treatment of central nervous system manifestations in mitochondrial disorders

Abstract: Central nervous system (CNS) manifestations of mitochondrial disorders (MIDs) are accessible to therapy. Therapy of CNS abnormalities may be categorized as acting on the pathogenic cascade or on the genetic level, which is experimental. Treatment acting on the pathogenic cascade may be classified as non-specific, including antioxidants, electron donors/acceptors, lactate-lowering agents, alternative energy providers, cofactors, avoidance of mitochondrion-toxic drugs, and physiotherapy, or as specific, including drugs against epilepsy, movement disorders, migraine, spasticity, psychiatric abnormalities, hypopituitarism, or bulbar manifestations, ketogenic diet, deep brain stimulation, or artificial ventilation. Stroke-like episodes need to be delineated from ischaemic stroke and require special management. Potentially, mitochondrion-toxic drugs and drug cocktails need to be avoided, seizures should be consequently treated even with mitochondrion-toxic drugs if necessary, and as few drugs as possible should be given. Effective treatment acting on the pathogenic cascade may increase the quality of life and outcome in patients with MID and may prevent a therapeutic nihilism occasionally upcoming with MIDs.

A Source Based On-Demand Data Forwarding Scheme for Wireless Sensor Networks

Abstract: Wireless Sensor Networks WSNs are becoming more important in the medical and environmental field. The authors propose an on-demand routing protocol using sensor attractiveness-metric Pa gradients for data forwarding decisions within the network. Attractiveness-based routing provides an efficient concept for data-centric routing in wireless sensor networks. The protocol works on-demand, is source-initiated, has a flat hierarchy and has its origin in the idea of pheromone-based routing. The algorithm supports node-to-sink data traffic and is therefore a lightweight approach to generalized multihop routing algorithms in WSNs. The performance evaluation of the proposed protocol is done by extensive simulation using a multi-agent based simulation environment called NetLogo. The efficiency of the attractiveness-based routing algorithm is compared in simulations with the well known Dynamic Source Routing algorithm DSR. The authors conclude that the Pabased routing algorithm is well suited for easy to set up WSNs because of its simplicity of implementation and its adaptability to different scenarios by adjustable weighting factors for the node's attractiveness metric.

Patient development at a glance: an evaluation of a medical data visualization

Abstract: This paper describes the results of an evaluation study of a prototype for the visualization of time-oriented medical data. Subjects were nine physicians. The prototype combines well-known visual representation techniques and extensive interaction techniques. The aim of the study was to assess the system's usability and whether the prototype solved relevant problems of physicians in hospitals. It was found that one of the great advantages of the system was that it allowed physicians to see the development of the patients at one glance. It was also shown that users clearly preferred an easy to learn and understand design and familiar visualizations.

E‐participation readiness of Austrian municipalities

Abstract: Purpose – The purpose of this paper is to depict the present situation of e‐participation initiatives of Austrian municipalities and derives recommendations to further enhance the e‐participation sophistication level.Design/methodology/approach – The findings are based on hypotheses we verified against a dataset obtained from an electronic survey among all Austrian municipalities, conducted in 2008.Findings – The technical basis for e‐participation in Austria is well developed, yet accessibility of municipal web sites and the phrasing of information leaves space for improvement. E‐participation in Austria is still in a nascent state and requires the convergence of technical, political, legal and socio‐economic factors, which has not yet fully arrived at the municipal level.Research limitations/implications – The raw material of the survey did not allow a qualitative assessment of e‐services.Practical implications – Change of law and reconsideration of opening hierarchical structures.Social implications – ...

How to Move from Power-Based to Dialogic Relations? Lessons from Roma Women.

Abstract: In its growth strategy for the coming decade, the EU recognises the Roma as one of several groups especially affected by poverty and social vulnerability. So far, many efforts to reverse this social exclusion have failed; imposed solutions based on power relations have ignored Roma voices and suggestions from the community. As a result, the EU now emphasises the urgency of identifying measures that can effectively help their situation. This article draws on data from a qualitative longitudinal case study of predominantly Roma schools in Spain. It shows how the move from power-based relations with Roma families to more dialogic ones has helped overcome both social and educational exclusion. Two dimensions are identified that facilitate this transition: demonopolisation of the expert knowledge and recognition of the Roma culture. By introducing dialogic relations, these schools have encouraged more Roma women to participate in different domains; they have also increased their academic expectations, moved beyond society's prejudice towards the Roma, and helped new role models to emerge.