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Background: Despite advances in surgery and pharmacotherapy, there remains significant residual ischemic risk after coronary artery bypass grafting surgery. Methods: In REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial), a multicenter, placebo-controlled, double-blind trial, statin-treated patients with controlled low-density lipoprotein cholesterol and mild to moderate hypertriglyceridemia were randomized to 4 g daily of icosapent ethyl or placebo. They experienced a 25% reduction in risk of a primary efficacy end point (composite of cardiovascular death, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina) and a 26% reduction in risk of a key secondary efficacy end point (composite of cardiovascular death, myocardial infarction, or stroke) when compared with placebo. The current analysis reports on the subgroup of patients from the trial with a history of coronary artery bypass grafting. Results: Of the 8179 patients randomized in REDUCE-IT, a total of 1837 (22.5%) had a history of coronary artery bypass grafting, with 897 patients randomized to icosapent ethyl and 940 to placebo. Baseline characteristics were similar between treatment groups. Randomization to icosapent ethyl was associated with a significant reduction in the primary end point (hazard ratio [HR], 0.76 [95% CI, 0.63–0.92]; P =0.004), in the key secondary end point (HR, 0.69 [95% CI, 0.56–0.87]; P =0.001), and in total (first plus subsequent or recurrent) ischemic events (rate ratio, 0.64 [95% CI, 0.50–0.81]; P =0.0002) compared with placebo. This yielded an absolute risk reduction of 6.2% (95% CI, 2.3%–10.2%) in first events, with a number needed to treat of 16 (95% CI, 10–44) during a median follow-up time of 4.8 years. Safety findings were similar to the overall study: beyond an increased rate of atrial fibrillation/flutter requiring hospitalization for at least 24 hours (5.0% vs 3.1%; P =0.03) and a nonsignificant increase in bleeding, occurrences of adverse events were comparable between groups. Conclusions: In REDUCE-IT patients with a history of coronary artery bypass grafting, treatment with icosapent ethyl was associated with significant reductions in first and recurrent ischemic events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01492361.

A Avaliacao Global de Mamiferos (GMA) e uma iniciativa da IUCN que gera informacoes sobre o risco de extincao para todas as especies de mamiferos, fornecendo dados importantes as agencias e convencoes nacionais e globais de conservacao. A partir da recente GMA, o Grupo de Especialistas em Pequenos Mamiferos da IUCN SSC (Species Survival Comission) avaliou todas as 234 especies de roedores brasileiros em relacao aos criterios da lista vermelha da IUCN, colocando-as em uma das oito categorias. Embora a ordem Rodentia nao apresente risco elevado de extincao em comparacao com os mamiferos como um todo, varias familias de caviomorfos demonstram altos niveis de ameaca e/ou deficiencia de dados. Para a familia Echimyidae, que possui elevado numero de especies, um terco delas sao preocupantes quanto a conservacao ou com dados insuficientes. Ctenomyidae tambem e motivo de preocupacao a esse respeito. Ademais, existem padroes geograficos consistentes de ameacas e pouco conhecimento. As areas focais para os esforcos de conservacao sao a Mata Atlântica e o Cerrado, e para as especies com deficiencia de dados, a Mata Atlântica, o Cerrado e a Amazonia, em particular o leste da Amazonia. Os resultados destacam a necessidade de pesquisas de campo direcionadas e a aplicacao de dados ecologicos e espaciais no desenvolvimento de acoes de conservacao.

The US Fish and Wildlife Service (USFWS) has initiated a re-envisioned approach for providing decision makers with the best available science and synthesis of that information, called the Species Status Assessment (SSA), for endangered species decision making. The SSA report is a descriptive document that provides decision makers with an assessment of the current and predicted future status of a species. These analyses support all manner of decisions under the US Endangered Species Act, such as listing, reclassification, and recovery planning. Novel scientific analysis and predictive modeling in SSAs could be an important part of rooting conservation decisions in current data and cutting edge analytical and modeling techniques. Here, we describe a novel analysis of available data to assess the current condition of eastern black rail Laterallus jamaicensis jamaicensis across its range in a dynamic occupancy analysis. We used the results of the analysis to develop a site occupancy projection model where the model parameters (initial occupancy, site persistence, colonization) were linked to environmental covariates, such as land management and land cover change (sea-level rise, development, etc.). We used the projection model to predict future status under multiple sea-level rise and habitat management scenarios. Occupancy probability and site colonization were low in all analysis units, and site persistence was also low, suggesting low resiliency and redundancy currently. Extinction probability was high for all analysis units in all simulated scenarios except one with significant effort to preserve existing habitat, suggesting low future resiliency and redundancy. With the results of these data analyses and predictive models, the USFWS concluded that protections of the Endangered Species Act were warranted for this subspecies.

Article impact statement: Our scientific knowledge of basic ecology and conservation science is lacking for rodents, which is critical for zoonotic disease research This article is protected by copyright. All rights reserved.

Understanding the perceptions and management practices of local land users is critical to improve conservation programs and sustainable outcomes. Colombia, one of the most megadiverse countries in the world, is also the third largest global producer of coffee. Cafeteros (rural coffee farmers) produce the majority of Colombian coffee. The Sierra Nevada de Santa Marta (SNSM), Colombia, is an isolated mountain on the Caribbean coast and one of the world's most biodiverse regions. Coffee grows in agroforestry matrices alongside high levels of endemic amphibians. Our goal was to understand (1) the perceptions of cafeteros about biodiversity, and (2) how coffee management practices may impact amphibian conservation in the region. We selected coffee communities that were close to concurrent amphibian research sites, to conduct focus groups. Themes, focused on both conservation and development, emerged from the five focus groups, specifically conservation program design and livelihood constraints. These were broken down into generic categories and subcategories ranging from cafetero knowledge of biodiversity and climate change to socioeconomic constraints. We found that although cafeteros have an inherent appreciation for the landscape and conservation, they require economic support to achieve sustainability goals. We recommend three steps to improve sustainability and equitable practices in the SNSM: (1) alleviate the economic strain on local coffee growers through social and economic government programs; (2) improve distribution of updated technology and coffee processing methods and to farmers; and (3) connect local farmers directly with buyers.

International audience; The Convention on Biological Diversity’s post-2020 Global Biodiversity Framework will probably include a goal to stabilize and restore the status of species. Its delivery would be facilitated by making the actions required to halt and reverse species loss spatially explicit. Here, we develop a species threat abatement and restoration (STAR) metric that is scalable across species, threats and geographies. STAR quantifies the contributions that abating threats and restoring habitats in specific places offer towards reducing extinction risk. While every nation can contribute towards halting biodiversity loss, Indonesia, Colombia, Mexico, Madagascar and Brazil combined have stewardship over 31% of total STAR values for terrestrial amphibians, birds and mammals. Among actions, sustainable crop production and forestry dominate, contributing 41% of total STAR values for these taxonomic groups. Key Biodiversity Areas cover 9% of the terrestrial surface but capture 47% of STAR values. STAR could support governmental and non-state actors in quantifying their contributions to meeting science-based species targets within the framework.

Aichi Target 12 of the Convention on Biological Diversity (CBD) contains the aim to ‘prevent extinctions of known threatened species’. To measure the degree to which this was achieved, we used expert elicitation to estimate the number of bird and mammal species whose extinctions were prevented by conservation action in 1993–2020 (the lifetime of the CBD) and 2010–2020 (the timing of Aichi Target 12). We found that conservation action prevented 21–32 bird and 7–16 mammal extinctions since 1993, and 9–18 bird and two to seven mammal extinctions since 2010. Many remain highly threatened and may still become extinct. Considering that 10 bird and five mammal species did go extinct (or are strongly suspected to) since 1993, extinction rates would have been 2.9–4.2 times greater without conservation action. While policy commitments have fostered significant conservation achievements, future biodiversity action needs to be scaled up to avert additional extinctions.

The globalization of Chinese products has been accompanied by questions as to their receptivity in different markets around the world. The body of academic literature on the issue of receptivity of Chinese products has grown with a focus on the consumer perception factors of country-of-origin, consumer nationalism, price sensitivity and quality of product. Prior research findings regarding receptivity, as per these perception factors, has been quite diverse but with studies about Western nations providing the most negative responses. The originality and value of this study is that this is the first academic work performed to assess receptivity of Chinese products by consumers in Myanmar. Applying convenience sampling, students at a national educational institution in Myanmar’s principal city, Yangon, were examined by conducting a self-administered questionnaire containing both close-ended and open-ended questions. Null hypotheses were tested for consistency in the presentation of the findings due to the variability of statistical significance discovered in the literature review. The findings indicated that frequent purchasers of Chinese products were more likely to regard the factors of country-of-origin and consumer nationalism over non-frequent purchases and that no statistically significant differences occurred regarding the perception factors of price sensitivity and product quality. The study also found mixed differentials when assessing by ethnic origins, with Myanmar consumers of Chinese ancestry indicating higher mean differences regarding the perception factors of country-of-origin and product quality over non-Chinese Myanmar. Suggestions for future research were made to provide utilitarian data that will assist practitioners along the supply chain, from manufacturers to retailers.

The ten nation members of the Association of Southeast Asian Nations (ASEAN) utilize English as the official working language for the organization. This study focused on the nation of Thailand to examine the assessed level of English proficiency of its workforce in relation to its ability to interact within ASEAN’s economic community (AEC). This is the first academic study to utilize a sample population consisting of human resources personnel from the top 100 private companies in Thailand who are in charge of employee training for learning English. Self-administered questionnaires were used to obtain self-assessments on the issues of level of English proficiency, language training, resource allocation for communication preparedness in AEC, and overall perceptions of the importance of mastering English within their respective companies. The results indicate that the acquisition of English as an economic lingua franca was considered important regardless of the demographic factors of the company examined. A majority of the respondents expressed the belief that their businesses had provided adequate resource allocation for English preparedness and a majority also indicated that their respective workforces possessed adequate English skills. However, a majority also expressed assessments that the employees in their companies did not find it easy to learn English and that Thais in general, and their employees in particular, did not like learning the language.

The planet has gone through five major extinction events throughout time. The most recent was the Cretaceous–Tertiary extinction approximately 65 million years ago, marking the end of dominance of dinosaurs and opening the way for the radiation of mammals. There is great concern among conservation scientists that we might be entering the 6th mass extinction in the Anthropocene, one driven almost exclusively by the expanding environmental footprint of humanity. The papers assembled in this volume tackle many of the issues and concerns facing our global natural heritage. We offer an overview of the trends in various aspects of biodiversity, including population declines, increases in extinction risks, and the potential collapse of ecosystem functions and the associated human services. There are also multiple drivers of these impacts, including habitat conversion and loss, increasing human populations and consumption, and the longer-term threat of climate change. Given available sources of data a number of authors have presented troubling scenarios about the fate of the planet. There are, however, both short- and long-term actions that we can pursue to mitigate the impacts of the Anthropocene.

Global wetland degradation and loss are occurring at a rapid rate, and in the United States over 50 % of wetlands in the lower 48 states have been altered since European settlement. In some cases, wetlands that were historically transformed for agriculture are now managed as wetland habitat. We conducted occupancy surveys for black rails (Laterallus jamaicensis) in managed and unmanaged areas of coastal South Carolina. We modeled landscape and local variables potentially influencing black rail occupancy and we assessed whether these habitat associations indicated vulnerability following expected alterations from sea level rise. Black rails occupied 17 of 344 surveyed sites. Landscape factors had the strongest influence on black rail occupancy. Occupancy was associated with impounded marshes, decreasing distance to forest, and greater proportion of marsh landscape within a 200 m buffer. We mapped parameters from our top model to predict the amount of current and future suitable habitat under various sea level rise scenarios at Bear Island Wildlife Management Area, a black rail hotspot. Suitable habitat decreases in tidal marshes but increases in impounded areas. The current use of impoundments by black rails could represent a new management strategy for mitigating the loss of black rail habitat.

ASEAN Journal of Management & Innovation, 4, 1

Background Little is known about the effectiveness of inpatient care for young people with co-morbid mental illness and intellectual disability (ID). This study aims to compare the demographics and outcome of young people with mental illness with or without ID admitted to psychiatric hospital. A secondary aim is to look into the outcome of those with ID admitted to general mental health young people's units. Method Data were collected on the outcome of young people's admissions to specialist ID and general adolescent mental health units as part of a larger quality improvement project run by the College Centre for Quality Improvement. Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) scores were completed by local clinical staff at admission and discharge on 38 young people with and 113 people without ID from 14 units. Results Young people with mental disorders significantly improved clinically over the admission whether or not they had ID. There were no differences between the groups in age or use of the Mental Health Act but people admitted with ID were more likely to be male and had longer lengths of stay. Admission to a general adolescent unit was associated with clinical improvement for people with ID. Conclusions This study needs replication because of the small sample and incomplete data but it suggests that young people with ID and mental disorders significantly improve clinically when admitted to hospital as do their non-disabled peers.

Objective To describe parents' experience of organ donation decision making in the case of donation after circulatory determination of death. Design Qualitative exploratory analysis. Setting Participants were recruited from the ICU of a single children's hospital located in the western United States. Participants Thirteen parents, 11 families who consented to donate their child's organs. Interventions Interviews (average 82 min). Measurements and main results Transcribed interviews were analyzed using the constant comparative method to identify themes that reflected similarities in parents' experiences. The themes we found included 1) factors contributing to parental decision making, 2) under the circumstances of the child dying, and 3) donation decision and its impact on parental grief. Factors that influenced the decision making all related to the child dying, including protecting the child's body and helping the child to die peacefully. Finally, parents made recommendations about the organ donation process, including empathy, attend to end-of-life concerns, and the provision of relevant information for donation decisions. Conclusions Parents' decision making was related directly to end-of-life experience and grief process. Providers need to orient to parents' end-of-life concerns to support parents' decision-making process and improve donation after circulatory determination of death procedures.

Aim To establish prevalence, sequelae and documentation of potentially inappropriate medication (PIM) use in older hospital in-patients. Methods Notes of all patients ≥65 years old, admitted to our tertiary teaching hospital (January 2013), were retrospectively reviewed, and the Screening Tool of Older Persons' potentially inappropriate Prescriptions applied. Results Amongst 534 patients, 54.8% (284) were on ≥1 PIM at admission, 26.8% on multiple; 60.8% were discharged on a PIM. Six percent of all admissions were potentially attributable to a PIM; falls associated with risk therapies were commonest (23/30), and often (65.2%) associated with serious injury. Pre-specified subgroup analysis (n = 100) identified 101 PIMs-at-discharge amongst 47 patients. In 82.2%, a clinical rationale for continued prescription was documented, with this communicated to the GP by letter in 71.1%. Conclusion PIMs were common, and contributed to admission and injury. Hospitalisation provides an opportunity for medication rationalisation, and documentation of rationale for any PIM use.

ASEAN Journal of Management & Innovation, 3, 2

Introduction Urologists, like any specialists within their field, consistently strive for the highest standards of clinical and research practice. Dissemination of clinical outcomes, basic research and ideas, both locally and internationally, through publications helps achieve this goal. The USANZ, recognising this, moved its official publication from the bi-nationally based ANZ Journal of Surgery (ANZJS) to the BJU International (BJUI) in 2009 [1]. This move consolidated an affiliation which started in 2005, when the BJUI became the journal used for publishing abstracts of the USANZ National Scientific Meeting [2]. The BJU International Australia and New Zealand Supplement was created as a platform for publications from USANZ members and trainees, with the first edition published in 2011 [3]. To date, there have been six editions of this supplement, which almost solely publishes the work of Australian and New Zealand authors, promoting their international exposure.

This study presents a large multicenter cohort of children with cerebral venous thrombosis from 5 centers in the United States and analyzes their clinical findings and risk factors. Seventy patients were included in the study (25 neonates, 35%). The age ranged from 6 days to 12 years. Thirty-eight (55%) were younger than 6 months of age, and 28 (40%) were male. Presenting features included seizures (59%), coma (30%), headache (18%), and motor weakness (21%). Common neurological findings included decreased level of consciousness (50%), papilledema (18%), cranial nerve palsy (33%), hemiparesis (29%), and hypotonia (22%). Predisposing factors were identified in 63 (90%) patients. These included infection (40%), perinatal complications (25%), hypercoagulable/hematological diseases (13%), and various other conditions (10%). Hemorrhagic infarcts occurred in 40% of the patients and hydrocephalus in 10%. Transverse sinus thrombosis was more common (73%) than sagittal sinus thrombosis (35%). Three children underwent thrombolysis, 15 patients received anticoagulation, and 49 (70%) were treated with antibiotics and hydration. Nine (13%) patients (6 of them neonates) died. Twenty-nine patients (41%) were normal, whereas 32 patients (46%) had a neurological deficit at discharge. Seizures and coma at presentation were poor prognostic indicators. In conclusion, cerebral venous thrombosis predominantly affects children younger than age 6 months. Mortality is high (25%) in neonatal cerebral venous thrombosis. Only 18 (25%) patients were treated with anticoagulation or thrombolysis.

Plants belonging to the genus Aspidosperma, a member of the family Apocynaceae, provide a rich source of β-carboline alkaloids, which makes them potentially poisonous. However, some of these alkaloids possess antitumor and antimicrobial activity. The present review is a survey of the β-carboline alkaloids and shows that they comprise of a diverse array of structural modifications.

In an attempt to utilize the Maclnnis and Price (1987) framework, an experimental design manipulating the concreteness of wording and familiarity of the stimulus is conducted using a print ad. Concreteness is found to affect attitude toward the ad and toward the brand; whereas, familiarity is not found to affect these variables. The implications of these results as well as suggestions for enlightened future research are provided by the authors.

Background: Familial hemiplegic migraine (FHM) is an unusual migraine syndrome characterised by recurrent transient attacks of unilateral weakness or paralysis as part of the migraine aura. Genetically and clinically heterogeneous, FHM1 is caused by mutations in CACNA1A and FHM2 by mutations in ATP1A2 . Aim: Three children with prolonged hemiplegia were tested for mutations in CACNA1A or ATP1A2 . Methods: Mutations in CACNA1A and ATP1A2 were screened for by denaturing high performance liquid chromatography and confirmed by sequencing. Expression studies were performed to characterise the functional consequences of these mutations. Results: No mutation was found in the FHM1 gene while three mutations were identified in the FHM2 gene. All three mutations were missense: two were novel and one was de novo; none was found in controls. Functional studies in HeLa cells showed complete loss of mutant pump function without interfering with the wild-type pump, consistent with haploinsufficiency. Conclusion: We identified novel disease causing mutations in the FHM2 gene. Genetic screening for FHM should be considered in a child with prolonged hemiplegia even if there is no prior history or family history of migraine or hemiplegic episodes.

A goal of runtime software-fault monitoring is to observe software behavior to determine whether it complies with its intended behavior. Monitoring allows one to analyze and recover from detected faults, providing additional defense against catastrophic failure. Although runtime monitoring has been in use for over 30 years, there is renewed interest in its application to fault detection and recovery, largely because of the increasing complexity and ubiquitous nature of software systems. We present taxonomy that developers and researchers can use to analyze and differentiate recent developments in runtime software fault-monitoring approaches. The taxonomy categorizes the various runtime monitoring research by classifying the elements that are considered essential for building a monitoring system, i.e., the specification language used to define properties; the monitoring mechanism that oversees the program's execution; and the event handler that captures and communicates monitoring results. After describing the taxonomy, the paper presents the classification of the software-fault monitoring systems described in the literature.

A rigorous description of the magnitude and direction of the 3D force vector each thumb muscle produces at the thumb-tip is necessary to understand the biomechanical consequences to pinch of a variety of paralyses and surgical procedures (such as tendon transfers). In this study, we characterized the 3D force vector each muscle produces at the thumb-tip, and investigated if these thumb-tip force vectors scaled linearly with tendon tension. In 13 cadaver specimens, we measured the output 3D thumb-tip force vector produced by each tendon acting on the thumb, plus two common tendon transfers, as a function of input tendon tension. After fixing the hand to a rigid frame, we mounted the thumb by configuring it in standardized key or opposition pinch posture and coupling the thumb-tip to a rigidly held 6 degree-of-freedom force/torque sensor. Linear actuators applied tension to the distal tendons of the four extrinsic thumb muscles, and to six Nylon cords reproducing the lines of action of (i) the four intrinsic thumb muscles and (ii) two alternative tendon transfers commonly used to restore thumb opposition following low median nerve palsy. Each computer-controlled linear actuator ramped tendon tension from zero to 1/3 of predicted maximal muscle force expected at each tendon, and back to zero, while we measured the 3D force vector at the thumb-tip. In test/re-test trials, we saw thumb-tip force vectors were quite sensitive to mounting procedure, but also sensitive to variations in the seating of joint surfaces. We found that: (i) some thumb-tip force vectors act in unexpected directions (e.g., the opponens force vector is parallel to the distal phalanx), (ii) the two tendon transfers produced patently different force vectors, and (iii) for most muscles, thumb-tip force vectors do not scale linearly with tendon tension--likely due to load-dependent viscoelastic tendon paths, joint seating and/or bone motion. Our 3D force vector data provide the first quantitative reference descriptions of the thumb-tip force vectors produced by all thumb muscles and two tendon transfers. We conclude that it may not be realistic to assume in biomechanical models that thumb-tip force vectors scale linearly with tendon tensions, and that our data suggest the thumb may act as a "floating digit" affected by load-dependent trapezium motion.

Five new cassane diterpenoids (1-5) were isolated from the roots of Caesalpinia pulcherrima, along with the known isovouacapenol C (6), pulcherrimin A (11), and 6beta-cinnamoyl-7beta-hydroxyvouacapen-5alpha-ol (12). Compounds 3-5 possess the alpha,beta-butenolide moiety, whereas compounds 1 and 2 contain a more usual 2,3-disubstituted furan unit. Compounds 7 and 8 were derived from hydrolysis of 6, while 9 and 10 were derived from acetylation and oxidation of 6, respectively. The (1)H and (13)C NMR spectra of all compounds were completely assigned using a combination of 2D NMR experiments, including (1)H-(1)H COSY, HSQC, HMBC, and T-ROESY sequences.

Tumor vascular density may provide a prognostic indicator of metastatic potential or survival. The purpose of this study was to develop 99mTc-ethylenedicysteine-endostatin (99mTc-EC-endostatin) for the evaluation of anti-angiogenesis therapy.99mTc-EC-endostatin was prepared by conjugating ethylenedicysteine (EC) to endostatin, followed by adding pertechnetate and tin chloride. Radiochemical purity was95%. In vitro cell viability, affinity and TUNEL assays were performed. Tissue distribution and planar imaging of radiolabeled endostatin were determined in tumor-bearing rats. To assess anti-angiogenic treatment response, rats were treated with endostatin, paclitaxel and saline, followed by imaging with 99mTc-EC-endostatin. Tumor response to endostatin therapy in tumor-bearing animal models was assessed by correlating tumor uptake dose with microvessel density, VEGF, bFGF and IL-8 expression during endostatin therapy.In vitro cell viability and TUNEL assays indicated no marked difference between EC-endostatin and endostatin. Cellular uptake assay suggests that endostatin binds to endostatin receptor. Biodistribution of 99mTc-EC-endostatin in tumor-bearing rats showed increased tumor-to-tissue count density ratios as a function of time. Tumor uptake (%ID/g) of 99mTc-EC-endostatin was 0.2-0.5. Planar images confirmed that the tumors could be visualized clearly with 99mTc-EC-endostatin. The optimal time for imaging using radiolabeled endostatin was 2 hrs. 99mTc-EC-endostatin could assess treatment response. There was a correlation between tumor uptake and cellular targets expression.The results indicate that it is feasible to use 99mTc-EC-endostatin to assess efficiency of anti-angiogenesis therapy.

The Student Attitudes Toward School Safety Measures (SATSSM) instrument was developed as a new tool to assess high school students' attitudes towards school safety promotion methods. A theory-based pool of statements was scaled using Thurstone's equal appearing interval method by 186 student judges to yield a 30-item instrument. The draft version was operationalized into a 5-point, Likert scale format, using a new sample of 182 students. Exploratory factor analysis suggested three factors: mediation, surveillance, and searching methods. The SATSSM was reduced to six items for each scale with a five-item social desirability scale added, and piloted with 66 new students. Final administration of the SATSSM to 166 new students yielded scale and overall internal consistencies exceeding .80 with low interscale correlations. A simultaneously administered questionnaire measuring perceptions of school safety suggested students possessed increased awareness of school violence, but they believed improving school safety is beyond their school's control. Language: en

Species distribution models have been applied across a wide range of spatial scales to generate information for conservation planning. Understanding how well models transfer through space and time is important to promote effective species–habitat conservation. Here, we assess model transferability in coastal tidal marshes of the southeastern United States using count data of a widespread marsh bird: the Clapper Rail (Rallus crepitans). We developed species–habitat models at a state level in both South Carolina and Georgia, and then assessed how well top models from each state predicted abundance in the other state. Internally (locally) validated models performed well with reasonable fit (SC: R2 = 0.35, GA: R2 = 0.14), and high significance (P = 0.0005); however, both models performed poorly when predicting abundance from the other state (R2 = 0.03 and 0.003). To assess the consequences of this lack of transferability, we applied the South Carolina- and Georgia-derived parameter estimates to habitat features in South Carolina and identified the top 25% of tidal marsh habitat that each model predicted within the state. There was minimal overlap between model habitat quality predictions (

The optimal location for insertion of the transferred tendon in opposition transfer is controversial. The purpose of this study was to examine 4 commonly used insertion sites into the thumb and determine which maximizes thumb opposition. The flexor digitorum superficialis of the ring finger was used as a donor tendon and was attached in random order to the abductor pollicis brevis (APB) tendon, the APB and extensor pollicis longus, the flexor pollicis brevis (FPB) and dorsal radial extensor hood, and the ulnar extensor hood at the base of the proximal phalanx. As normal opposition was simulated, the minimum distance between the thumb and little finger and the pinch force were measured. The FPB and radial dorsal extensor hood site resulted in the statistically highest pinch force. The FPB and radial dorsal extensor hood and the APB sites had statistically smaller minimum distances between the thumb and little finger than the ulnar extensor hood site. A subjective evaluation of the 3-dimensional thumb path of motion revealed that the FPB and radial dorsal extensor hood site and the APB insertion site allowed the closest approximation of normal thumb opposition. This biomechanical study supports the use of the FPB and radial dorsal extensor hood insertion site or APB insertion site for opposition transfers.

BACKGROUND. Thalidomide has been shown to have antiangiogenic effects in preclinical models as well as a significant antitumor effect in hematologic tumors such as multiple myeloma. The authors performed this Phase II study to determine the activity, toxicity profile, and antiangiogenic effect of thalidomide in patients with locoregionally recurrent or metastatic squamous cell carcinoma of the head and neck. METHODS. Twenty-one patients with recurrent or metastatic squamous cell carcinoma of the head and neck were treated with single-agent thalidomide. All patients had received radiation therapy, and most had undergone surgery (95%) and/or chemotherapy (90%). Thalidomide was initiated at 200 mgdaily and increased to a target dose of 1000 mg daily. Patients continued treatment until disease progression, unacceptable toxicity, or death occurred. RESULTS. All 21 patients eventually developed progressive disease. Median time to progression was 50 days (95% confidence interval, 28-70), with median overall survival time of 194 days (95% lower confidence boundary, 151), similar to the progression and survival times reported for this patient group with other agents. Thalidomide was generally well tolerated, with few patients experiencing Grades 3 to 4 toxicities. Serum vascular endothelial growth factor and basic fibroblast growth factor levels increased in six of seven patients, for whom paired serum samples were available and all of whom had progressive disease. CONCLUSIONS. In this heavily pretreated population of patients with advanced squamous cell carcinoma of the head and neck, thalidomide does not appear to have single-agent antitumor activity. Further evaluation of the mechanism of action of thalidomide is indicated. Potentially, future evaluations of thalidomide may be performed in combination with other antiangiogenic or cytotoxic agents in patients with earlier stage disease or in patients with minimal residual disease.

Tuberous sclerosis complex is an autosomal dominant disorder that causes significant complications in multiple organ systems. Both basic science and clinical research on tuberous sclerosis complex have flourished in recent years, improving our understanding of its molecular genetics and pathophysiology. Two tuberous sclerosis complex genes cause nearly identical phenotypes, and great progress has been made towards understanding how each of these genes functions. The recognition of tuberous sclerosis complex improved with revised diagnostic criteria, and the management of many of the complications of tuberous sclerosis complex has improved.

PCR-based detection of minimal residual disease (MRD) in children with precursor B cell acute lymphoblastic leukemia (pre-B ALL) by amplification of clone-specific antigen gene rearrangements has been labor-intensive. In this study we present a simpler, yet accurate, method to assess and quantitate MRD in pediatric pre-B ALL that utilizes these markers. From the sequence of the immunoglobulin heavy chain (IgH) and T cell receptor (TcR) gene rearrangements characterized at the time of diagnosis or relapse, primers were designed and tested in a clone-specific, single-round PCR assay, then analyzed by fluorescence staining of the PCR products. The most critical step involved an adherence to a new set of guidelines for the design of clone-specific primers. Application of this method to 54 IgH and 13 TcR (nine Vdelta2Ddelta3 and four Ddelta2-Ddelta3) gene rearrangements in 47 patients resulted in an intense band within the region of the predicted molecular weight, confirming the reproducibility of the assay. Quantitative applications of the approach were examined by performing a 10-replicate limiting dilution clone-specific PCR on six diagnostic samples and an asymptotic response model of the Von Krogh form was found to fit the data well. From this model, estimation of leukemic cells of remission bone marrow samples was achieved at a detection sensitivity of 2 x 10(-6). The method is demonstrated on 18 patients whose marrows were prospectively analyzed during therapy. We conclude this methodology is useful in the quick and accurate assessment of MRD in children with pre-B ALL, and could be applied to other DNA quantitation assays.

At the recent Tuberous Sclerosis Consensus Conference, a subcommittee proposed recommendations to guide the rational use of diagnostic studies in patients with tuberous sclerosis complex. Recommendations were made for diagnostic evaluation at the time of diagnosis, when testing helps both to establish the diagnosis and to identify potential complications. Additional guidelines were proposed for the ongoing surveillance of established patients to detect later complications of tuberous sclerosis complex. In the absence of comprehensive population studies to govern the use of diagnostic studies in individuals with tuberous sclerosis complex, the panel developed guidelines based on the disorder's natural history, concentrating on complications that are common, clinically significant, and more easily managed when found early. Finally, the group made suggestions for the use of diagnostic tests to identify family members who have tuberous sclerosis complex. Although these recommendations should standardize and improve our use of diagnostic studies in individuals with tuberous sclerosis complex, the clinical approach in a given patient must remain flexible enough to meet the needs of individual patients and families. (J Child Neurol 1999;14:401-407).

At the recent tuberous sclerosis complex consensus conference, the clinical diagnostic criteria for tuberous sclerosis complex were simplified and revised to reflect both new clinical information about tuberous sclerosis complex and an improved understanding of the disorder derived from molecular genetic studies. Based on this new information, some clinical signs once regarded as pathognomonic for tuberous sclerosis complex are now known to be less specific. No single sign is present in all affected patients, and there is no proof that any single clinical or radiographic sign is absolutely specific for tuberous sclerosis complex. Accordingly, the clinical and radiographic features of tuberous sclerosis complex have now been divided into major and minor categories based on the apparent degree of specificity for tuberous sclerosis complex of each feature. A definitive diagnosis of tuberous sclerosis complex now requires two or more distinct types of lesions, rather than multiple lesions of the same type in the same organ system. Although diagnosis on purely clinical grounds can continue to be difficult in a few patients, there should be little doubt about the diagnosis for those individuals who fulfill these strict criteria. Couples with more than one child with tuberous sclerosis complex, no extended family history, and no clinical features of tuberous sclerosis complex are more likely to have germline mosaicism for tuberous sclerosis than nonexpression of the mutation. Germline mosaicism, while fortunately rare, will not be suspected from either diagnostic criteria or molecular testing until a couple has multiple affected children. Genetic counseling for families with one affected child should include a small (1% to 2%) possibility of recurrence, even for parents who have no evidence of tuberous sclerosis complex after a thorough diagnostic evaluation. ( J Child Neurol 1998;13:624-628).

1. Balbir V. Singh, MD* 2. E. S. Roach, MD* 1. 2. *Division of Pediatric Neurology, Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX. Headache is an age-old problem that affects both children and adults; it is mentioned as far back as 5000 BC in Babylonian and Sumarian writings and later is described by Hippocrates and Galen. In spite of more than 50 epidemiologic studies, there is no consensus on the prevalence of headache. The prevalence of chronic headache varies widely in different studies, probably due to differences in case definition, selection criteria, and demographics of the study populations. Most recent studies suggest rates close to 5% for migraine, 15% for tension-type headache, and about 30% for infrequent nonmigrainous headaches. Nevertheless, most children who suffer migraines never come to medical attention. The International Headache Society’s classification system has replaced the old and somewhat confusing terminology with more descriptive terms (Table 1⇓ ). Migraine is divided into three types: migraine without aura (Table 2⇓ ), migraine with aura (Table 3⇓ ), and complicated migraine. Tension and muscle contraction headache have been replaced by tension-type headache, admitting our ignorance of the pathophysiology of the disorder (Tables 4⇓ and 5⇓ ). Operational diagnostic criteria are used to increase both the sensitivity and the specificity of diagnosis. View this table: Table 1. Etiology of Recurrent Headaches View this table: Table 2. International Headache Society Diagnostic Criteria for Migraine Without Aura View this table: Table 3. International Headache Society Diagnostic Criteria for Migraine With Aura View this table: Table 4. International Headache Society Diagnostic Criteria for Episodic Tension-type Headache View this table: Table 5. International Headache Society Diagnostic Criteria for Chronic Tension-type Headache Migraine is an episodic syndrome characterized by headaches of varying intensity, duration, and frequency. Before puberty, migraine is slightly more common in boys; after puberty, it is two to three times more common in girls. Eighty percent of all migrainous headaches are comprised of migraine without aura. The headache often is unilateral (35%) and throbbing (55%), but it may be diffuse and continuous in more than …

Accurate identification of parental plants and their hybrids is essential for an effective breeding programme. Traditional classification of cocoa varieties relies on the characterisation of agricultural traits at plant maturity. A rapid and reliable method is described, based on genotypic analysis. An efficient DNA isolation procedure was developed, yielding unsheared DNA of high purity. Two genetic fingerprinting techniques, RAPD and AFLP™, were evaluated for their suitability in distinguishing cocoa varieties. RAPD analysis was unsatisfactory due to the low frequency of polymorphisms and poor reproducibility. AFLP™ was reliable in distinguishing phenotypically identical, known varieties of cocoa. Importantly, AFLP™ also revealed intra- and inter-varietal variation.

The rice Waxy gene encodes a granule-bound starch synthase (GBSS) necessary for the synthesis of amylose in endosperm tissue. We have previously shown that a CT microsatellite near the transcriptional start site of the GBSS gene can distinguish 7 alleles that accounted for more than 80% of the variation in apparent amylose content in an extended pedigree of 89 US rice cultivars (Oryza sativa L.). Furthermore, all the cultivars with 18% or less amylose were shown to have the sequence AGTTATA at the putative leader intron 5' splice site, while all cultivars with a higher proportion of amylose had AGGTATA. Here we demonstrate that this single-base mutation reduces the efficiency of GBSS pre-mRNA processing and results in alternate splicing at three cryptic sites. The predominant 5' splice site in CT18 low-amylose varieties is 93 bp upstream of the splice site used in intermediate and high amylose varieties and is immediately 5' to the CT microsatellite that we previously demonstrated to be tightly correlated with amylose content. Use of the leader intron 5' splice site at either -93 or -1 in conjunction with the predominant 3' splice site results in formation of a small open reading frame 38 bp upstream of the normal ATG and out of frame with it. This open reading frame is not produced when any of the 5' leader intron splice sites are used in conjunction with an alternate 3' splice site five bases further downstream which was observed in all rice varieties tested.