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Purpose To describe a novel technique in unfolding an endothelium-in Descemet membrane (DM) graft. Methods New surgical technique description Results We describe a novel technique that allows immediate and controlled unfolding of the endothelium-in Descemet membrane graft that was successful in 5 of our DMEK patients. It is essential to acquire this “side press-and-release” technique when the graft does not unfold spontaneously as expected. Conclusions This controlled and simple manoeuvre is an efficient and safe method of unfolding an endothelium-in DM graft.

Paediatric trigger finger is a rare condition distinct from paediatric trigger thumb and adult trigger digits. We performed a systematic review of paediatric trigger finger presentation and aetiology in order to guide workup and management. Fifty-one studies with 193 patients and 398 trigger fingers were included. Most patients had a single, unilateral trigger finger (54%). Fifty-five patients (29%) had an underlying condition, such as mucopolysaccharidosis; these cases appeared to be associated with multiple or bilateral trigger fingers or with carpal tunnel syndrome. All patients with mucopolysaccharidosis were treated surgically. Conservative management was reported in 33% of all patients, and two-thirds of these did not need further intervention. Patients undergoing surgical release infrequently had recurrence of triggering (6%). We propose an algorithmic approach for patients presenting with paediatric trigger finger. Presence of bilateral or multiple trigger digits or concomitant carpal tunnel syndrome should raise suspicion for an atypical underlying pathology.

Ulcers of mixed etiology are diagnostically elusive and challenging to treat, especially when rare conditions are superimposed. Pyoderma gangrenosum (PG) is an autoinflammatory, ulcerative skin disease that is difficult to diagnose. Diagnostic criteria exist but there are no specific clinical tests to identify it. We discuss a case of PG initially diagnosed as venous ulcer in the setting of peripheral artery disease, complicated by superinfection, refractory to standard wound care, multiple surgical debridements, revascularization, negative pressure therapy, and parenteral antibiotics. Findings differentiating PG from other wound etiologies are explored, with the aim of improving clinical recognition of this condition.

Objective: To determine whether there are differences in the facial soft tissue morphology between participants with mild (up to two) or severe (six or more) hypodontia. Design and Setting: A prospective hospital-based cohort study. Participants and Methods: Ninety-two participants, aged 11–16 years, with confirmed hypodontia were recruited. Participants were sub-grouped based on the severity (mild, two or less and severe, six or more) and distribution of the missing teeth and age. They underwent a three-dimensional (3D) optical surface scan of the facial soft tissues. Facial surface scans were compared quantitatively, applying landmark measurements and surface-based analysis. Results: In total, 92 participants, with an equal distribution between the mild (n=46) and severe (n=46) categories, were recruited. Patients with severe hypodontia displayed a reduced alar base, lower facial height, nasolabial angle ( P = 0.02) and transgonial width ( P < 0.001) compared to those with milder hypodontia. Furthermore, significant differences were observed between mild-male and severe-female groups regarding alar base, lower anterior face height and transgonial width and between mild-male and mild-female groups regarding nasolabial angle and transgonial width. Conclusion: Significant reductions were seen in the 3D soft tissue morphology of participants with severe hypodontia, in terms of the nasolabial angle, lower facial height, alar base and transgonial widths, emphasising the importance of using facial scanning as a relatively simple non-invasive method of assessment.

Background Laparoscopic Heller myotomy (LHM) and esophageal balloon dilation (BD) are the two mainstays of achalasia treatment—this study examines the outcomes when they are performed simultaneously without fundoplication. Methods All patients undergoing LHM&BD were reviewed for demographic and procedural data, and to see if additional procedures for achalasia had been performed. Patients were surveyed using the Eckardt score and the GERD quality-of-life score (GERD-HRQL) to assess the durability of repair. Results From 2013-2020, 66 patients underwent LHM&BD. There were no esophageal perforations and a median LOS of 1 day. Seven patients have required additional operations or procedures at median 4-years follow up. 31 patients (47%) responded to the survey. The average Eckardt score was 2.9 (goalConclusions LHM&BD allows for a safe, durable repair of achalasia. Reflux symptoms are manageable with PPI without fundoplication and the re-intervention rate similar to published values.

The purpose of this study was to determine the efficacy of a dental nurse–delivered intervention—the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI)—in reducing the recurrence of dental caries in children who have a primary tooth extracted. It was based on a 2-arm multicenter randomized controlled trial with blinded outcome assessment. Participants were 5- to 7-y-old children ( n = 241) scheduled to have primary teeth extracted in 12 UK centers. Test intervention parents ( n = 119) received DR-BNI led by trained dental nurses. DR-BNI is a 30-min structured conversation informed by motivational interviewing with a forward focus to prevent future caries. Preventive goals are agreed, and a review appointment is made with child’s general dental practitioner, who is advised to treat the child as being at high caries risk. The control intervention ( n = 122) was a parent-nurse conversation about child’s future tooth eruption, with advice given to visit a general dental practitioner as usual. At baseline, the DR-BNI group’s mean dmft was 6.8, and the control group’s was 6.3. A median of 5 teeth were extracted, mainly under general anesthesia. Final dental assessments were conducted by a single examiner visiting 189 schools 2 y after intervention; 193 (80%) of 241 children were examined. In the control group, 62% developed new caries in teeth that were caries-free or unerupted at baseline, as compared with 44% in the test group, a significant reduction ( P = 0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group as compared with control. There was a 29% decrease in the relative risk of new caries experience in the DR-BNI group as compared with control. This single low-cost, low-intensity intervention was successful in significantly reducing the risk of recurrence of dental caries in children. This trial has implications for changing pediatric dental practice internationally. Training in and implementation of a motivational interviewing–informed brief intervention provides opportunities for dental nurses to facilitate behavior change improving the oral health of children at high caries risk (ISRCTN 24958829).

Objective: To evaluate the effects of family-based mindfulness intervention (FBMI) to promote the stress management and early development of economically disadvantaged families. Method: Families receiving social security allowance and full textbook allowance and with children aged 5–7 were recruited. Participants were randomized to an FBMI with parallel programs for parents and children ( n = 51) and to a wait-list control condition ( n = 51). Results: Intent-to-treat analyses showed more significant improvements in child attention, self-regulation, and in parenting stress, in the intervention group than in the control group. At-risk group analyses showed that the high stress group benefited in small to moderate effect sizes in parenting stress and depression, and in moderate to large effect sizes in child behavioral problem and self-regulation. Conclusions: The results provide preliminary support that FBMI can alleviate the impact of economic disadvantage. FBMI should be applied in social work practice to support disadvantaged families.

Visual illusions caused by varied orientations of visual patterns may influence the perception of space and size, possibly affecting body stability during locomotion. This study examined the effect of variations in shoe top visual patterns on perception and biomechanical stability while walking and running. Twenty healthy adults performed five walking and running trials along an instrumented walkway when wearing shoes with five different striped patterns (plain, vertical, outward, horizontal, and inward). Before these locomotion trials, participants ranked their perceptions of shoe width. We used synchronized force platform and motion capturing systems to measure ground reaction force, mediolateral center of position displacement, ankle inversion and eversion, ankle excursion, and maximum eversion velocity. We rated stability perception on a 150-mm visual analog scale immediately after each shoe condition. Data analyses indicated that participants perceived plain and horizontal striped shoes as significantly wider than inward and vertical patterned shoes. During walking, participants wearing shoes with plain and horizontal striped patterns demonstrated smaller mediolateral center of position displacement, maximum eversion velocity, and ankle range of motion when compared with walking when wearing outward and vertical striped patterns; when running, we observed a similar effect for maximum eversion velocity. Thus, certain visual patterns on the tops of shoes influence the wearers’ width perception and locomotion in ways that affect ankle stability during walking and running, with implications for risk of injury.

This study tested relationships between foreign language (FL) reading and listening anxiety and learner variables in English as a foreign language (EFL). It tested links between foreign language anxiety (FLA) and its cognitive, affective and behavioral correlates in English (i.e. language learning strategies, learning motivation, and performance). Three-hundred-and-six Chinese undergraduates learning EFL were administered the measures via a questionnaire. Regression analyses indicated that EFL performance and EFL motivation were key factors that uniquely predicted EFL reading and listening anxiety. However, the role of EFL learning strategies was not significant after the effects of EFL performance and EFL motivation were controlled for. Despite this, mediation analyses revealed that EFL learning strategies had a significant indirect effect on EFL reading performance and listening anxiety levels with EFL learning motivation as a mediator. This suggests its secondary role in affecting FL anxieties. These findings provide important implications regarding assessment of students’ FL anxiety level as well as identification of and intervention for those with FL difficulties. These findings have extended past studies by highlighting the relative importance of these cognitive, affective and behavioral correlates on Chinese undergraduates’ EFL anxiety in specific domains.

We conducted a small pilot observational study of the effects of bilateral thoracic paravertebral block (BTPB) as an adjunct to perioperative analgesia in coronary artery bypass surgery patients. The initial ropivacaine dose prior to induction of general anaesthesia was 3 mg/kg, which was followed at the end of the surgery by infusion of ropivacaine 0.25% 0.1 ml/kg/hour on each side (e.g. total 35 mg/hour for a 70 kg person). The BTPB did not eliminate the need for supplemental opioids after CABG in the eight patients studied. Moreover, in spite of boluses that were within the manufacturer's recommendation for epidural and major nerve blocks, and an infusion rate that was only slightly higher than what appeared to be safe for epidural infusion, potentially toxic total plasma ropivacaine concentrations were common. We also could not exclude the possibility that the high ropivacaine concentrations were contributing to postoperative mental state changes in the postoperative period. Also, one patient developed local anaesthetic toxicity after the bilateral paravertebral dose. As a result, the study was terminated early after four days. The question of whether paravertebral block confers benefits in cardiac surgery remains unanswered. However, we believe that the bolus dosage and the injection rate we used for BTPB were both too high, and caution other clinicians against the use of these doses. Future studies on the use of BTPB in cardiac surgery patients should include reduced ropivacaine doses injected over longer periods.

Connected speech produced by native speakers poses a challenge to second language learners. Video subtitles have been found to assist the decoding of English connected speech for learners of English as a foreign language (EFL). However, the presence of subtitles may divert the listeners’ attention to the visual cues while paying less attention to the speech signals. To test this proposal, we employed a bi-modal audio-visual listening test and examined whether EFL listeners were able to correctly identify the connected speech when misleading subtitles were present. We further tested whether connected speech with words of lower frequency further reduced the accuracy rate. Twenty-eight adolescent EFL learners, all with more than 10 years of experiences in learning English in schools, were tested with three major types of connected speech phonological processes, namely assimilation, elision, and juncture. The results of statistical analyses showed that matched and mismatched subtitles facilitated the comprehension of both familiar and unfamiliar connected speech. Error analyses revealed the degree of item-specific variations across the three types of connected speech processes as well as across the three subtitling conditions. This research provides insights on the immediate and long-term impact of subtitles on the decoding of English connected speech.

Malaysia has an abortion law, which permits termination of pregnancy to save a woman’s life and to preserve her physical and mental health (Penal Code Section 312, amended in 1989). However, lack of clear interpretation and understanding of the law results in women facing difficulties in accessing abortion information and services. Some health care providers were unaware of the legalities of abortion in Malaysia and influenced by their personal beliefs with regard to provision of abortion services. Accessibility to safer abortion techniques is also an issue. The development of the 2012 Guidelines on Termination of Pregnancy and Guidelines for Management of Sexual and Reproductive Health among Adolescents in Health Clinics by the Ministry of Health, Malaysia, is a step forward toward increasing women’s accessibility to safe abortion services in Malaysia. This article provides an account of women’s accessibility to abortion in Malaysia and the health sector response in addressing the barriers.

The investigation of lattice strains has proven to be a viable method for probing the crystal level stress state in deforming polycrystalline samples. Building on the recent availability of high-rate X-ray detectors, we have developed a new technique that combines diffraction data with crystal-based finite element simulations to estimate the lattice strain uncertainty for each measurement. To estimate the uncertainty, we combine the probable number of crystals expected for each measurement with the simulated lattice strain standard deviation. Under this framework, the uncertainty is related not just to the number of diffracting crystals but also to the variability in the lattice strain between these crystals. An estimate of uncertainty for each measurement enables both the investigation of previously inaccessible phenomena where the lattice strain evolution is expectantly small and the application of lattice strain measurement techniques to materials with more complex microstructures. The new approach was demonstrated for an aluminum alloy 7075-T6 sample undergoing uniaxial tensile loading.

Previous studies suggested that patients with mild cognitive impairment (MCI) or dementia can have impaired and declining financial skills and abilities. The purpose of this study is to test a clinically applicable method, based on the contemporary legal standard, to examine directly the mental capacity to make financial decisions and its component decision-making abilities among patients with MCI and early dementia. A total of 90 patients with mild Alzheimer disease (AD), 92 participants with MCI, and 93 cognitively normal control participants were recruited for this study. Their mental capacity to make everyday financial decisions was assessed by clinician ratings and the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED). Based on the clinician ratings, only 53.5% were found to be mentally competent in the AD group, compared with 94.6% in the MCI group. However, participants with MCI had mild but significant impairment in understanding, appreciating, and reasoning abilities as measured by the ACED. The ACED provided a reliable and clinically applicable structured framework for assessment of mental capacity to make financial decisions.

Trauma patients have unknown comorbidities, multiple injuries, and incomplete laboratory testing, yet require contrast-enhanced imaging to identify potentially life-threatening problems. Our goal was to characterize contrast-induced nephropathy (CIN) in this population. We retrospectively reviewed characteristics of 402 patients who presented to a Level II trauma center and received contrast-enhanced imaging. CIN was defined as creatinine rise of 0.5 mg/dL or greater or 25 per cent or greater from baseline within 48 hours. CIN occurred in 7.7 per cent and four patients required hemodialysis. Patients with CIN were older, had lower admission hemoglobin, higher Injury Severity Score, and received more blood products. Factors that predicted CIN included: male sex, age older than 46 years, body mass index less than 27 kg/m2, glomerular filtration rate less than 109 mL/min/1.73 m2, hemoglobin less than 12 mg/dL, hematocrit less than 36 per cent, proteinuria, 2 units or more of fresh-frozen plasma in 48 hours, and alcohol use. Odds ratio for developing CIN with two, five, or six of these factors was 3.39, 6.54, and 8.38, respectively. A match-controlled analysis for Injury Severity Score and age in patients with CIN versus non-CIN patients revealed the strongest predictor of CIN was proteinuria (relative risk, 2.5; confidence interval, 1.1 to 5.8). Although it is difficult to truly differentiate CIN from renal dysfunction related to injury severity in trauma patients, proteinuria may be an important factor in identifying nephropathy in this population.

Hybrid FRP-concrete-steel double-skin tubular columns (DSTCs) are a new form of hybrid columns recently proposed by the third author. The new column consists of an inner steel tube and an outer FRP tube, with the space between them filled with concrete. The new column possesses many advantages over existing columns including its good ductility, corrosion resistance and ease for construction. This paper presents the results of an experimental study on the behavior of the new hybrid DSTCs subject to eccentric compression as well as results from a corresponding theoretical model using the fiber element approach. A so-called “variable confinement model” was adopted in the theoretical analysis for the concrete in the hybrid DSTCs, to account for the effect of strain gradient on the confinement effectiveness. The theoretical model was shown to provide accurate predictions of the test results, and was used in a subsequent parametric study.

Spiral Vortex Ventricular Assist Device (SV-VAD) supports cardiac patients with refractory heart failure. Unfortunately, thrombus formation and risk of stroke due to flow complications may lead to aggravated conditions. The hemodynamics of a continuous flow in the ventricular chamber of a SV-VAD can be analyzed using numerical simulation. Particle image velocimetry and laser Doppler anemometry are utilized for validating the simulated spiral flow in a transparent acrylic SV-VAD replica based on its cross-sectional averaged axial and tangential velocities. After validation, the relationship between swirling flow and blood cell damage is established by evaluating flow effect on thrombosis due to high shear stress. Based on our analysis, stagnancy of the flow within the SV-VAD is insignificant and its low shear stress minimizes hemolysis.

Gender inequalities in health and gender bias in medicine are interrelated challenges facing health care providers and educators. Women and girls are disadvantaged in accessing health care because of their low social status and unequal treatment in medical care. Gender bias has long been inherent in clinical practice, medical research, and education. This can be traced to the medical curriculum that shapes the perceptions, attitudes, and behavior of the future doctor. The author advocates medical curricula change to address gender inequalities in health and gender bias in medicine. She analyses the reasons for integration of gender competencies in the medical curriculum, discusses what gender competencies are, and reviews ways to in-build gender competencies and their assessment. Efforts to change and gender sensitize medical curricula in developed and developing countries are also reviewed. The review hopes to contribute to strategic medical curriculum reform, which would lead to gender-sensitive health services and equity in health.

Transnational identities, practices, and institutions are not really new and have likely existed in some form over the past few hundred years and perhaps back to the peace of Westphalia in the mid iooos. While the technological transformations in previous centuries facilitated transnationalism, such as trans-oceanic steamships and the telegraph, it has only been recently that the cost of bridging long geographic distances has been cut dramatically.1 As a result what is new is the emergence of transnationalism on a mass scale. Technological conditions for earlier immigrants did not make transnational practices rapid or easy but now they have and this has only been a relatively recent and new phenomenon.2 This has had an affect on the types of communities with which individuals and institutions identify and in which they participate. Economic globalization over the past several decades has led to the rise of a global economy with a plethora of transnational and multinational corporations. Following this economic globalization has been a cultural globalization that includes an ethnoscape with an increasing multitude of diasporic and transnational communities. As many people in these communities engage in transnational identities and practices, questions arise as to their rights and responsibilities of citizenship within a particular nation. Further, with criticisms of multiculturalism becoming more prevalent in recent years-particularly in the post 9/11 era-including the Madrid train bombings of 2004, the London bombings of 2005, and the Canadian suspected terrorism case of 2006-the "darker" side of transnational practices has been prominent in public discourse. This discourse is based on the perception that multiculturalism is not working and, along with transnational practices, leads to fragmentation and segregation rather than the integration of diverse racial, ethnic, and religious groups. The argument is made that multiculturalism and transnationalism make social cohesion in Canadian society difficult if not impossible to achieve. More specifically, those engaged in transnational identities and practices are viewed as practicing a "thin" citizenship with limited active citizenship engagement within Canada and minimal shared values, cultural identity, and sense of belonging to Canada. This article begins with a discussion of how transnationalism and active citizenship are conceptualized. It then examines how these two processes are allegedly divergent and contradictory. This is followed by an empirical investigation of these allegations comprising three research questions. I outline the methodology used to answer the questions, how the key variables of transnationalism are measured, and present the findings.CONCEPTUALIZING TRANSNATIONALISMWhile the introduction and popularization of the term transnationalism emerged in the social sciences over the past decade and a half, sociologist Anthony Richmond coined a somewhat similar term-transilience-in 1969- Transilience referred to the exchanges of skilled and highly qualified migrants between advanced industrial societies. The migrants themselves were referred to as transilients; he predicted they would become numerically more important in the future. These terms were used in his writings up to the mid-1990s and by that time Richmond was using the term more broadly to apply to a wide range of movers whose permanence in one locale was neither expected nor necessary.3 Transilients do not necessarily assimilate, acculturate, or integrate fully into the receiving society but rather maintain close ties with family and friends; are aware of changing economic, political, and social conditions in their former country and elsewhere; and have high rates of remigration and return. As such, the concept of transilience can be considered the forerunner to contemporary notions of transnationalism.With the publication of Nina Glick Schiller's, Linda Basch's, and Christina Blanc-Szantoris books Towards a Transnational Perspective on Migration in 1992, and Nations Unbound in 1994, the transnationalism paradigm emerged as a "new" perspective to characterize processes of immigrant settlement, adaptation, and integration, particularly in Britain and the United States. …

Background. Falls are common in older adults and have many adverse consequences. In an attempt to prevent further incidents, elder fallers may consciously monitor and control their movements. Ironically, conscious movement control may be one factor that contributes to disruption of automaticity of walking, increasing the likelihood of subsequent falls. Objective. The Movement Specific Reinvestment Scale (MSRS), which aims to measure the propensity for movement-related self-consciousness and for conscious processing of movement, was used to try to discriminate elder fallers from non-fallers. Methods. Fifty-two volunteer older adults, aged 65 or above, participated. In addition to the 10-item MSRS, participants completed the Mini-Mental State Examination questionnaire, Timed “Up & Go” test, and Four Word Short-Term Memory test. Demographics including age, gender, and history of falling were collected. Results. Elder fallers scored significantly higher than non-fallers on both the movement self-consciousness and conscious motor processing components of the MSRS. Logistic regression revealed a significant association between the MSRS (conscious motor processing component) and “faller or non-faller” status. Conclusions. Elder fallers may have a higher propensity to consciously control their movements. The MSRS shows potential as a clinical tool with which to predict falls in the elderly, as well as to gain insight into the perception of safety during walking in any impaired patient.

Although individual PCs of a cluster are used by their owners to run sequential applications (local jobs), the cluster as a whole or its subset can also be employed to run parallel applications (cluster jobs) even during working hours. This implies that these computers have to be shared by parallel and sequential applications, which could lead to the improvement of the execution performance and resource utilization. However, there is a lack of experimental study showing the behavior and performance of executing parallel and sequential applications concurrently on a non-dedicated cluster. The result of such research would be beneficial for the development of new global scheduling algorithms. We present the result of an experimental study into scheduling of a mixture of parallel and sequential applications on a non-dedicated cluster. The aim of this study is to learn how the concurrent execution of a communication intensive parallel application and sequential applications influences their execution performance and utilization of the cluster.

The study assessed variation in cultural orientation among Asian American adolescents by age and ethnic density in the community. A total of 128 students at a public high school in Oakland, California, participated in the study. Of these early and middle adolescents, 86 were Chinese American and 42 were Southeast Asian American. They completed the General Ethnicity Questionnaire—Ethnic and American versions, which assessed cultural orientation in the domains of cultural pride, language, social affiliation, food, and recreation. Middle adolescents reported a stronger ethnic orientation in the domains of social affiliation and recreation and weaker American orientation in the domains of food and language use (English) than early adolescents. Furthermore, Chinese Americans, residing in an ethnically dense community, reported a stronger ethnic orientation in the domains of language and food and a weaker American orientation in language than their Southeast Asian American peers with less access to their ethnic community.

We followed 1000 sex workers in Madagascar for 18 months to assess whether adding female condoms to male condom distribution led to increased protection levels and decreased sexually transmitted infections (STIs). For months 1–6, participants had access to male condoms only; in the final 12 months, they had access to male and female condoms. We interviewed participants about condom use every two months and tested for chlamydia, gonorrhoea and trichomoniasis every six months. Following six months of male condom distribution, participants used protection in 78% of sex acts with clients. Following female condom introduction, protection at months 12 and 18 rose to 83% and 88%, respectively. Aggregate STI prevalence declined from 52% at baseline to 50% at month 6. With the female condom added, STI prevalence dropped to 41% and 40% at months 12 and 18, respectively. We conclude female condom introduction is associated with increased use of protection to levels that reduce STI risk.

Drying shrinkage and creep are two of the most important time-dependent properties of concrete, and the health monitoring of any large-scale concrete structure is practically the monitoring of the combined effects of these two physical properties. We present a fibre-optic sensing technique using fibre Bragg grating (FBG) sensors for the experimental investigation of drying shrinkage and creep of structural grade (40 MPa) concrete. It offers many advantages over the conventional electrical and mechanical methods for both structural health monitoring and standard tests of the mechanical properties. The FBG sensors are directly embedded into concrete specimens and the data are obtained by an optical measurement system. Standard mechanical method, as specified by the Australian Standards, is also used for comparison. Good agreements between the two methods are achieved for both drying shrinkage and creep. The long-term behaviours are predicted from the experimental data, and the accuracies of prediction are discussed. This optical technique can yield a strain resolution of better than 3 μɛ.

Background Epidemiological studies suggest that raised plasma concentrations of total homocysteine (tHcy) may be a common, causal and treatable risk factor for atherothromboembolic ischaemic stroke, dementia and depression. Although tHcy can be lowered effectively with small doses of folic acid, vitamin B12 and vitamin B6, it is not known whether lowering tHcy, by means of B vitamin therapy, can prevent stroke and other major atherothromboembolic vascular events. Aim To determine whether the addition of B-vitamin supplements (folic acid 2 mg, B6 25 mg, B12 500 μg) to best medical and surgical management will reduce the combined incidence of stroke, myocardial infarction (MI) and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. Design A prospective, international, multicentre, randomised, double blind, placebo-controlled clinical trial. Setting One hundred and four medical centres in 20 countries on five continents. Subjects Eight thousand (6600 recruited as of 5 January, 2006) patients with recent (7 months) stroke (ischaemic or haemorrhagic) or TIA (brain or eye). Randomisation Randomisation and data collection are performed by means of a central telephone service or secure internet site. Intervention One tablet daily of either placebo or B vitamins (folic acid 2mg, B6 25 mg, B12 500 μg). Primary outcome The composite of stroke, MI or death from any vascular cause, whichever occurs first. Outcome and serious adverse events are adjudicated blinded to treatment allocation. Secondary outcomes TIA, unstable angina, revascularisation procedures, dementia, depression. Statistical power With 8000 patients followed up for a median of 2 years and an annual incidence of the primary outcome of 8% among patients assigned placebo, the study will have at least 80% power to detect a relative reduction of 15% in the incidence of the primary outcome among patients assigned B vitamins (to 6·8%/year), applying a two-tailed level of significance of 5%. Conclusion VITATOPS aims to recruit and follow-up 8000 patients between 1998 and 2008, and provide a reliable estimate of the safety and effectiveness of folic acid, vitamin B12, and vitamin B6 supplementation in reducing recurrent serious vascular events among a wide range of patients with TIA and stroke throughout the world.

This paper examines business migration to Australia, Canada and the United States by integrating the concepts of a global immigration marketplace and the commodification of citizenship into global political economy theory. It finds that state business migration policies constitute “offers” to potential businesspersons, in a discourse of “competition” and simultaneously regulate the process. In the sorting process of potential migrants across countries many businesspersons have a rational “choice” of the country they want to emigrate to. This competition and choice provide evidence of a global immigration marketplace and data show that only Australia and Canada are active competitors with Canada having an advantage. An analysis of Chinese business migration from China, Hong Kong, Macao, Taiwan, Malaysia and Singapore indicate substantial numbers in the tens of thousands in the early 1990s but this has decreased in recent years due to several economic and political factors. Currently there are moderate levels of Chinese business migration with China now as the major source country. Since businesspersons are not a homogenous group the paper concludes with some suggested policy changes to make business migration more accessible and transformative.

Aim: To compare the accuracy of MR-determined cerebral blood volume (CBV) maps with SPECT imaging with thallium-201 in pre-operative grading of intracranial glioma. Material and Methods: Nineteen patients (7 female and 12 male, mean age 46.8 years) with intracranial gliomas were examined with MR perfusion imaging pre-operatively. Sixteen of these patients were also examined with SPECT imaging with thallium-201. The tumour to contralateral white matter NI (negative integral) and tracer uptake ratios were evaluated. The ratios in high-grade and low-grade tumours were compared. Results: The maximum CBV ratios of grades I and II gliomas (2.958±2.217) were significantly lower than the maximum CBV ratio of grades III and IV (9.484±4.520), p Conclusion: MR-determined NI was useful for pre-operative grading of intracranial gliomas but SPECT thallium-201 imaging was not.

Systemic lupus erythematosus (SLE) is characterized by autoantibodies, including antibodies to the nucleosides of DNA. Guanosine is the most immunogenic nucleoside. In this study serum antiguanosine antibody levels were compared with disease activity, determined by their SLEDI score, in 86 patients with SLE. Sera from these patients were tested, by ELISA, for autoantibodies to guanosine, single-stranded DNA (ssDNA), and double-stranded DNA (dsDNA). Anti-doublestranded DNA levels were also measured by RIA. Resultant values from these assays were correlated with SLE disease activity, and compared with specific features of SLE. The strongest correlation was higher levels of antiguanosine antibodies in patients with active lupus nephritis and polyserositis compared to patients with inactive disease (P < 0.0001). Antiguanosine levels also correlated with arthritis (P < 0.006), CNS lupus (P < 0.005), and hematologic manifestations of SLE (P < 0.002). To test the validity of this association in chronic SLE, serum antiguanosine antibodies were measured in patients with SLE at various phases of disease activity. Twelve patients with SLE had serum samples drawn at active, active-improved, and inactive phases over a 3–7 y period. Differences were significant for serum antiguanosine antibodies in the active group compared to the inactive group (P < 0.05) and the active vs the active-improved group (P < 0.02), unlike those for dsDNA and ssDNA by ELISA or RIA. Antiguanosine antibodies correlated more closely with disease activity in SLE patients in this longitudinal study than either anti-dsDNA or ssDNA antibodies. Thus, antibodies to guanosine correlated as well or better with disease activity than the other anti-DNA antibodies measured and should be considered to contribute to the pathology of SLE, especially lupus nephritis.

Although numerous studies have demonstrated that sentinel lymph node (SLN) biopsy can accurately determine the axillary nodal status for early breast cancer some studies have suggested that SLN biopsy may be less reliable for tumors >2 cm in size. This analysis was performed to determine whether tumor size affects the accuracy of SLN biopsy. The University of Louisville Breast Cancer Sentinel Lymph Node Study is a prospective multi-institutional study involving 226 surgeons. The study was approved by the Institutional Review Board of each institution, and informed consent was obtained from all patients. Patients with clinical stage T1–2 N0 breast cancer were eligible for the study. Some patients with T3 tumors were included because they were clinically staged as T2 but on final pathology were found to have tumors >5 cm. This analysis includes 2148 patients who were enrolled from August 1997 through October 2000. All patients underwent SLN biopsy using a combination of radioactive colloid and blue dye injection followed by completion Level I/II axillary dissection. Statistical comparison was performed by chi-square analysis. The SLN identification rate, false negative rate, and overall accuracy of SLN biopsy were not significantly different among tumor stages T1, T2, and T3. We conclude that SLN biopsy is no less accurate for T2–3 breast cancers compared with T1 tumors.

Amelogenesis imperfecta (AI) is a heterogeneous group of inherited disorders of defective enamel formation. The major protein involved in enamel formation, amelogenin, is encoded by a gene located at Xp22.1-Xp22.3. This study investigated the molecular defect producing a combined phenotype of hypoplasia and hypomineralization in a family with the clinical features and inheritance pattern of X-linked amelogenesis imperfecta (XAI). Genomic DNA was prepared from buccal cells sampled from family members. The DNA was subjected to the polymerase chain-reaction (PCR) in the presence of a series of oligonucleotide primers designed to amplify all 7 exons of the amelogenin gene. Cloning and sequencing of the purified amplification products identified a cytosine deletion in exon VI at codon 119. The deletion resulted in a frameshift mutation, introducing a premature stop signal at codon 126, producing a truncated protein lacking the terminal 18 amino acids. Identifying mutations assists our understanding of the important functional domains within the gene, and finding another novel mutation emphasizes the need for family-specific diagnosis of amelogenesis imperfecta.

A review of the studies of the caries prevalence and periodontal health of patients with cleft lip and palate (CLP) revealed that only five investigations of caries prevalence in CLP patients included children. One reported that CLP children did not have a higher caries prevalence in the permanent dentition, whereas more recent studies have reported a higher caries prevalence in both the primary and permanent dentitions of CLP children than in those of noncleft children. However, there is wide variation in the teeth examined and the method of presenting data on caries prevalence. Six papers have reported on the periodontal health of adult CLP patients, and only one has done so on that of children. The adult CLP patients had poorer oral hygiene and more gingivitis, but there is no conclusive evidence that they have a higher risk of developing periodontal disease. No data on the oral hygiene of CLP children were available, but it has been emphasized that they have significantly more gingivitis than noncleft children, especially in the maxillary anterior teeth.

This article utilizes the perspective of transnationalism to explain Chinese capitalist migration from the Asian Pacific to Canada in the context of globalization. It is argued that transnationalism, and particularly the process of transmigration, provides a new and useful way of theorizing the international migration of capitalists. The focus is on Chinese migrants who enter Canada under the auspices of the Canadian Business Immigration Program as investors and entrepreneurs. The article presents two levels of analysis in theorizing this transnational migration. At the macro level, this migration is explained in the context of global capitalism and capital accumulation. Statistical data are presented illustrating the participation of Chinese from Hong Kong and Taiwan in the programme. These data include a trend analysis of the number of transmigrants and the amount of capital brought to Canada. At the micro level, some transnational social fields are examined utilizing survey research data from interviews with 284 Chinese business migrants who have set up a residence and a business in the city of Vancouver in Canada. More specifically, preliminary evidence of transnational social fields is presented and includes: family and personal social fields, ethnic social fields and business fields.

We describe a 27 y old female systemic lupus erythematosus (SLE) patient with salmonella bacteraemia who presented with fever, back pain and an enlarging heart size. A two dimensional echocardiogram (2D Echo) showed a mass in the right atrium. Subsequent computer tomographic (CT) and magnetic resonance imaging (MRI) studies showed that this had become a ring shaped lesion at the posterior end of the interventricular septum with an area communicating with the right atrial cavity. At operation a ruptured mycotic aneurysm of the right coronary artery was found. This is the first report of an SLE patient with a coronary artery mycotic aneurysm due to salmonella and the first reported case of survival following rupture of such an aneurysm.

This article describes three years of research in intensive long-term writing intervention with adolescents with learning disabilities (LD) and low achievement. The rationale, the process of strategy development, the intervention procedures, and data obtained are all summarized, and research and practical implications presented. More important, reflections on the interventions are offered that may resonate with other intervention researchers.

Factors affecting the response to hepatitis B vaccination in a primary care setting were examined by means of a review of case notes of patients attending 22 sexually transmissible disease services. Where not available from the notes, presence of antibody to hepatitis B surface antigen (anti-HBs) was determined by testing available stored serum. One hundred and ninety-five patients completed a course of 3 injections and had an anti-HBs assay performed. The highest response rate (anti-HBs > or = 10 IU/L) was found in human immunodeficiency virus (HIV)-negative heterosexual women (16 of 17, 94.1%) followed by HIV-negative heterosexual men (11 of 12, 91.7%); HIV-negative homosexual men (105 of 120, 87.5%); and HIV-positive homosexual men (6 of 14, 42.9%). (For HIV-positive vs HIV-negative homosexual men, P = 0.0003). Eleven of 14 (78.6%) homosexual men of unknown HIV status responded to vaccination. There was a trend to lower CD4+ lymphocyte counts among HIV-infected patients who responded to hepatitis B vaccination (mean 482 cells/cm2) when compared to those that did not respond (632 cells) but this difference was not statistically significant (P = 0.330). Neither the type of vaccine (recombinant, plasma-derived or mixed) nor the length of vaccination course (mean 6.2 months; range 2 to 18) affected response. This study confirmed that vaccination against hepatitis B is much less effective in HIV-infected homosexual men and marginally less effective for HIV-negative homosexual men, though the mechanism for this reduced response is uncertain. Reassuringly vaccine response was not affected by common variables in primary care settings such as vaccine type or delays in the vaccine schedule.

A total of 38 problem learners comprising adolescents with learning disabilities and low achievers participated in this study. Of these, 20 were untrained control participants; the remainder were trained to plan, write, and revise opinion essays. Trainees were randomly divided into pairs and taught to collaboratively use interactive dialogues to plan and revise their essays (but they wrote their essays separately). The results from multivariate analyses of variance (MANOVAs) and effect sizes indicated that trainees improved significantly from pretest to posttest in clarity and cogency of written opinion essays, and maintained such gains. Additional analyses indicated that they surpassed the untrained control group. Questionnaire data indicated trainees improved in self-efficacy of writing only. The same finding held true in comparison with untrained participants. The discussion integrates the trainees' performance data with the questionnaire data and considers the research implications and limitations of the study.

This article examines Chinese capitalist migration from Hong Kong and Taiwan to Canada which took place under the auspices of the Canadian Business Immigration Program. It begins by setting the context of this migration of Chinese capitalists and their capital through a description of the Program and applying sociological theory to explain the process. More specifically, structural models of migration, world systems, political economy and transnationalism are applied which provide an insight and explanation for this migration. Then the role of the state is examined in relation to mediation and social reproduction. The article ends with a trend analysis of this Chinese capitalist migration and its effect on class, cultural transformation, and race and ethnic relations in Canada.

This paper reports the cross-validation in Singapore of the Science Laboratory Environment Inventory, which assesses students' perceptions of psychosocial aspects of their science laboratory classroom environments. The sample consisted of 1,592 final year secondary school, i.e., Grade 10, chemistry students from 56 intact classes from 28 randomly selected coeducational government secondary schools in Singapore. This instrument, which has separate forms measuring students' perceptions of the actual and ideal (preferred) learning environment, comprises five scales: Student Cohesiveness, Open-endedness, Integration, Rule Clarity, and Material Environment. The study provided cross-validation support for use in Singapore in either its actual or preferred form and with either the individual student or the class mean as the unit of analysis. Each scale exhibited satisfactory internal consistency reliability, discriminant validity, factorial validity, predictive validity, and ability to differentiate among classes.

Sucrose, 5% and 10% (w/v), supplemented with between 0 and 5 ppm fluoride (F), was tested for its influence in vitro on plaque-induced experimental in vitro enamel caries and plaque pH. Plaque growth on bovine enamel was initiated from saliva inocula and sustained in a multiple plaque growth system for up to 31 days by means of a basal medium with periodic applications of sucrose or sucrose supplemented with F. Change in enamel mineralization was assessed, before and after plaque growth, by microhardness testing and microradiography; pH was monitored with microelectrodes. It was found that enamel demineralization was inversely related to the F concentration in the range 2 to 5 ppm, for both 5% and 10% sucrose. Plaque pH responses were unaffected by the F supplements.

This article addresses the problem of facilitating student transfer of learned strategies, presenting what may be two essential instructional parameters: (a) mediated mindfulness during strategy learning and at transfer (b) and transfer-promoting instruction. Mediated mindfulness integrates two concepts: Feuerstein's concept of mediated learning and Salomon and Globerson's concept of mindfulness. The notion of transfer-promoting instruction originates from Larkin. The author explicates how inculcating mediated mindfulness in students with learning disabilities and engineering transfer-promoting instruction is likely to enhance strategy transfer in these students.

This study compared the subtests and summary scores of the Shipley Institute of Living Scale with that of a modified version of the Wechsler Adult Intelligence Scale—Revised (WAIS—R) in predicting college grades for 34 men and 42 women. None of the Shipley or WAIS—R scores correlated significantly with GPA and no combination of scores served as predictors of GPA. The implications of the results and limitations of the study were discussed.