Emerging therapies for treatment of multiple sclerosis

In the last decade, a new armamentarium of immune-based therapies have been developed and tested in patients with multiple sclerosis. Some of these therapies are showing a high level of efficacy, with an acceptable adverse effect profile. Because present therapies have significant limitations in slowing disease progression, require injections, are sometimes associated with significant side effects of immunosuppression, and do little to reverse disability, identifying more effective treatments is an important goal for clinical research in multiple sclerosis. However, in order to improve our current approach to disease-modifying therapies, it is imperative to promote the development of individualized therapy strategies

Perspectives on Place-Based Local Leadership Programs: Fostering Leadership and Community Attachment in Youths

Leadership development, service learning, place-based education, and economic revitalization are topics relevant to Extension. We performed an evaluation to determine whether a place-based leadership program in Clermont County, Ohio, helps students develop leadership skills and encourages their return to the community. Program evaluation data collected via a web-based survey indicated that 80% of youths planned to return to the area to live and work, an action that would contribute to revitalization of the community. Extension professionals can use findings from our evaluation as a basis for improving existing programs, structuring new youth leadership initiatives, and communicating the value of place-based youth leadership programs to stakeholders

An evaluation of the CAST program using a conceptual model of school-based implementation

Therapeutic prevention and/or early intervention programs for children at risk of developing disruptive behaviour disorders are increasingly being implemented in schools. One such Australian school-based program is CAST: CAMHS (Child and Adolescent Mental Health Service) and Schools Together, an evidenced-based program treating children with emerging disruptive behaviour disorders in the early primary school years. The current evaluation examines the process of implementation of the CAST program in primary schools. By using a conceptual model of school-based implementation (developed by Greenberg, Domitrovich, Graczyk & Zins, 2005) the wide array of factors that can affect successful implementation at the school level were identified, and those elements critical to implementation quality were examined. Semi-structured individual and group interviews were conducted with a sample of 69 school personnel across 16 schools in the City of Ballarat and wider Grampians region of Victoria, in both government and Catholic primary schools. Results showed that schools were highly satisfied with the quality of CAST resources and personnel, and the implementation and delivery of sessions as planned. Aspects that impacted negatively on the implementation process were the lack of parental engagement; the lack of classroom follow-up in some schools; the level of readiness and pre-planning by the schools; and the availability of technical support. Greenberg’s conceptual model appears to be a useful framework to utilise in examining the implementation of the CAST model, as it allowed close examination of how the program was implemented within naturally occurring constraints. It allowed the identification of elements within the CAST model and the associated support system that must be maintained and nurtured by the collaborating parties, in addition to the factors at a school level that are potential barriers to effective implementation. Identification and examination of such factors assist in ensuring quality outcomes for school-based interventions in the future.C

Survey on Visual Impairment and Refractive Errors on Ta’u Island, American Samoa

Purpose: To assess the prevalence of presenting visual impairment and refractive errors on the isolated island of Ta′u, American Samoa. Methods: Presenting visual acuity and refractive errors of 124 adults over 40 years of age (55 male and 69 female) were measured using the Snellen chart and an autorefractometer. This sample represented over 50% of the island′s eligible population. Results: In this survey, all presenting visual acuity (VA) was uncorrected. Of the included sample, 10.5% presented with visual impairment (visual acuity lower than 6/18, but equal to or better than 3/60 in the better eye) and 4.8% presented with VA worse than 6/60 in the better eye. Overall, 4.0% of subjects presented with hyperopia (+3 D or more), 3.2% were myopic (‑1 D or less), and 0.8% presented with high myopia (‑5 D or less). There was no significant difference between genders in terms of visual impairment or refractive errors. Conclusion: This study represents the first population-based survey on presenting visual acuity and refractive errors in American Samoa. In addition to providing baseline data on vision and refractive errors, we found that the prevalence of myopia and hyperopia was much lower than expected

The effects of test-enhanced learning on long-term retention in AAN annual meeting courses.

OBJECTIVE: We measured the long-term retention of knowledge gained through selected American Academy of Neurology annual meeting courses and compared the effects of repeated quizzing (known as test-enhanced learning) and repeated studying on that retention. METHODS: Participants were recruited from 4 annual meeting courses. All participants took a pretest. This randomized, controlled trial utilized a within-subjects design in which each participant experienced 3 different postcourse activities with each activity performed on different material. Each key information point from the course was randomized in a counterbalanced fashion among participants to one of the 3 activities: repeated short-answer quizzing, repeated studying, and no further exposure to the materials. A final test covering all information points from the course was taken 5.5 months after the course. RESULTS: Thirty-five participants across the 4 courses completed the study. Average score on the pretest was 36%. Performance on the final test showed that repeated quizzing led to significantly greater long-term retention relative to both repeated studying (55% vs 46%; t[34] = 3.28, SEM = 0.03, p = 0.01, d = 0.49) and no further exposure (55% vs 44%; t[34] = 3.16, SEM = 0.03, p = 0.01, d = 0.58). Relative to the pretest baseline, repeated quizzing helped participants to retain almost twice as much of the knowledge acquired from the course compared to repeated studying or no further exposure. CONCLUSIONS: Whereas annual meeting continuing medical education (CME) courses lead to long-term gains in knowledge, when repeated quizzing is added, retention is significantly increased. CME planners may consider adding repeated quizzing to increase the impact of their courses

Silicon as a Millimeter-Wave Monolithically Integrated Substrate - A New Look

Materials suitable for use as monolithic substrates are summarized. A study of the properties of silicon substrates as transmission line media shows that serious consideration should be given to them for use at mm-wave frequencies. It is concluded that for silicon resistivities of 2000 ohm-cm or greater, microstrip loss in silicon at mm-wave frequencies is only slightly higher than that in GaAs or alumina. The cross section width of a transmission line represents an appreciable part of a wavelength when microstrip is used as an impedance transformer at mm-wave frequencies. Therefore, substrate thickness (using the latest dispersion characteristics) is especially considered in circuit design. These effects on the design of 3-dB interdigitated and branch-line couplers are demonstrated. Fabrication of silicon IMPATT diodes operating up to 200 GHz has been ac­complished by novel techniques that maintain the silicon\u27s high resistivity. We report on diodes yielding 25 mW cw at 102 GHz, 16 mW cw at 132 GHz, and 1 mW at 195 GHz. The techniques described are ion implantation, laser annealing, unique secondary-ion mass spectrometry (SIMS) profile diagnostics, and novel wafer thinning. The utilization of these technologies paves the way for the pro­cessing of silicon monolithic mm-wave integrated circuits

Adjustments in Torque Steadiness During Fatiguing Contractions Are Inversely Correlated With IQ in Persons With Multiple Sclerosis

Fatigue is one of the most debilitating symptoms of multiple sclerosis (MS), and the underlying mechanisms are poorly understood. When exposed to a physical or cognitive challenge, individuals with MS tend to exhibit greater declines in task performance (performance fatigability) and increased levels of self-reported fatigue (perceived fatigability), but these effects may be attenuated by greater intellectual capacity. The purpose of our study was to examine the influence of intelligence on fatigability in persons with MS. We hypothesized that greater intellectual capacity confers some protection against heightened levels of fatigue and fatigability associated with MS. Twelve adults with relapsing-remitting MS were compared with 12 control (CO) subjects who were matched for age, sex, and premorbid intellectual capacity. Performance fatigability was measured as the decline in maximal voluntary contraction (MVC) torque after 60 isometric contractions (10 s contraction at 25% MVC, 5 s rest) performed with the knee extensor muscles. Perceived fatigability was assessed with the modified fatigue impact scale (MFIS) questionnaire (trait fatigability) and the Borg rating of perceived exertion (RPE, state fatigability). Persons with MS reported greater MFIS scores (MS: 43 ± 14; CO: 11 ± 8, P ≤ 0.001). Initial MVC torque for the knee extensors did not differ between the groups (MS: 112 ± 38 N⋅m; CO: 107 ± 44 N⋅m) and the decline (performance fatigability) was similar for both groups (MS: -16 ± 19 N⋅m; CO: -13 ± 16 N⋅m). RPE increased during the fatiguing contraction for both groups (P < 0.001) but was significantly greater in magnitude (main effect for group, P = 0.03) and increased more for the MS group (group × time interaction, P = 0.05). Torque steadiness declined during the fatiguing contractions (main effect for time, P = 0.05) and was less steady for the MS group (main effect for group, P = 0.02). Performance and full-4 IQ was correlated with the decline in torque steadiness for the MS group (r = -0.63, P < 0.05; r = -0.64, P < 0.05). Intellectual capacity was not associated with fatigability in persons with MS but was associated with adjustments in muscle activation during the fatiguing contractions

Predictors of support service use by rural and regional men with cancer

Objective: The current study examined how sociodemographic, psychological, physical and social support variables predict participation in formal support services. Design: Cross-sectional study. Setting: Participants were recruited from oncology clinics, cancer specialist clinics and cancer support groups. Participants: Seventy-six men living outside major Australian cities, the majority with prostate cancer (n=55). Main outcome measures: Participants completed the Brief Symptom Inventory, the List of Physical Complaints, the Social Support Subscale of the Coping Resources Inventory and questionnaires related to levels of awareness of, and participation in support services. Results: Most (82%) of the men were aware of at least one formal service offering emotional support, and 49% of the men had used such a service. Telephone- and Internet-based services were the most used type of support. The only predictor of participation in a formal service was lower age. Conclusions: Use of a support service was not predicted by psychological or physical symptoms, levels of social support or distance from service centres. Attitudes to different types of services, and support services in general, might be more predictive of actual use. The current findings point to the potential of telephone- and Internet-based support as an acceptable means of formal support for rural and regional men who experience cancer-related distress. © 2011 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc