Efficiency and safety of bilateral contemporaneous pallidal stimulation (deep brain stimulation) in levodopa-responsive patients with Parkinson's disease with severe motor fluctuations: a 2-year follow-up review.

OBJECT: The aim of this study was to evaluate the long-term safety and efficacy of bilateral contemporaneous deep brain stimulation (DBS) in patients who have levodopa-responsive parkinsonism with untreatable motor fluctuations. Bilateral pallidotomy carries a high risk of corticobulbar and cognitive dysfunction. Deep brain stimulation offers new alternatives with major advantages such as reversibility of effects, minimal permanent lesions, and adaptability to individual needs, changes in medication, side effects, and evolution of the disease. METHODS: Patients in whom levodopa-responsive parkinsonism with untreatable severe motor fluctuations has been clinically diagnosed underwent bilateral pallidal magnetic resonance image-guided electrode implantation while receiving a local anesthetic. Pre- and postoperative evaluations at 3-month intervals included Unified Parkinson's Disease Rating Scale (UPDRS) scoring, Hoehn and Yahr staging, 24-hour self-assessments, and neuropsychological examinations. Six patients with a mean age of 55 years (mean 42-67 years), a mean duration of disease of 15.5 years (range 12-21 years), a mean "on/off' Hoehn and Yahr stage score of 3/4.2 (range 3-5), and a mean "off' time of 40% (range 20-50%) underwent bilateral contemporaneous pallidal DBS, with a minimum follow-up period lasting 24 months (range 24-30 months). The mean dose of levodopa in these patients could not be changed significantly after the procedure and pergolide was added after 12 months in five patients because of recurring fluctuations despite adjustments in stimulation parameters. All but two patients had no fluctuations until 9 months. Two of the patients reported barely perceptible fluctuations at 12 months and two at 15 months; however, two patients remain without fluctuations at 2 years. The mean improvements in the UPDRS motor score in the off time and the activities of daily living (ADL) score were more than 50%; the mean off time decreased from 40 to 10%, and the mean dyskinesia and complication of treatment scores were reduced to one-third until pergolide was introduced at 12 months. No significant improvement in "on" scores was observed. A slight worsening after 1 year was observed and three patients developed levodopa- and stimulation-resistant gait ignition failure and minimal fluctuations at 1 year. Side effects, which were controlled by modulation of stimulation, included dysarthria, dystonia, and confusion. CONCLUSIONS: Bilateral pallidal DBS is safe and efficient in patients who have levodopa-responsive parkinsonism with severe fluctuations. Major improvements in motor score, ADL score, and off time persisted beyond 2 years after the operation, but signs of decreased efficacy started to be seen after 12 months.

Iowa Supreme Court Improvement Project for Child in Need of Assistance Cases: Annual Report and Proposed Policy Revisions.

The first part of a three year plan to evaluate and recommend improvements to Iowa's Juvenile Courts.

Placement of Students Ages 3-21 with Disabilities Under the Individuals with Disabilities Education Act (IDEA): A Policy Discussion, May 2010

The provision of free appropriate public education (FAPE), an Individualized Education Program (IEP), and the least restrictive environment (LRE) have been important cornerstones of educating students with disabilities since the enactment of the Education of All Handicapped Children Act (EAHCA), Public Law 94-142, in 1975, and its subsequent reauthorizations, the Individuals with Disabilities Education Act (IDEA) in 1990, 1997, and 2004. It is impossible to consider any one of these cornerstones without the others, when determining an appropriate educational placement for a student with a disability. The Iowa Department of Education has identified several practice issues regarding the interplay between FAPE, LRE, and the IEP in placement decisions for students with disabilities. To that end, this document will provide guidance for administrators of local education agencies (LEAs) and area education agencies (AEAs), as well as IEP teams (or other placement teams) within Iowa LEAs and AEAs when making placement decisions for eligible children with disabilities. This guidance will specifically discuss ten LRE and FAPE placement/program policy questions that have been identified by the Iowa Department of Education as needing attention. The policy discussions are consistent with the legal provisions of the 2004 reauthorization of IDEA (IDEA 2004) and its 2006 final federal implementing regulations issued by the U.S. Department of Education, Office of Special Education Programs (OSEP). This document is also consistent with the Iowa Administrative Rules of Special Education (2007) [hereinafter “Iowa Rules”]. In addition, the term local education agency (LEA) is used interchangeably for school district throughout this document. Prior to the discussion of specific policy questions, a federal and state legal framework for providing FAPE for students with disabilities within the LRE is briefly outlined. Pertinent FAPE and LRE court decisions that impact Iowa LEAs and AEAs are also included within Section II.

Bilateral extraperitoneal uterosacral vaginal vault suspension: a 2-year follow-up longitudinal case series of 123 patients.

INTRODUCTION AND HYPOTHESIS: The objective of this study is to assess anatomical and functional results of the extraperitoneal uterosacral ligament suspension (USL) in women with post-hysterectomy vaginal vault prolapse. METHODS: One hundred and twenty-three consecutive women were included. Concurrent procedures were anterior colporraphy with fascial repair (20%) and mesh reinforcement (49%), posterior colporraphy with fascial repair (38%) and mesh reinforcement (56%) and a sling procedure (29%). Women were assessed using Baden and Walker and pelvic organ prolapse quantification classification pre- and post-operatively. RESULTS: One hundred and ten patients (89%) were available for follow-up. Mean follow-up was 2 years. Objective success rate regarding the vaginal cuff is 95.4%. Global anatomical success rate was 85.5%. Urinary, coital and bowel symptoms were improved following surgery. Mesh exposure rate was 19.3%, with all cases managed conservatively or with minor interventions. CONCLUSION: Bilateral extraperitoneal USL is an effective operation to restore apical support with low morbidity, which avoids potential risks associated with opening the peritoneal cavity.

Networking the unemployed : Can policy interventions facilitate access to employment through informal channels ?

It is widely known that informal contacts and networks constitute a major advantage when searching for a job. Unemployed people are likely to benefit from such informal contacts, but building and sustaining a network can be particularly difficult when out of employment. Interventions that allow unemployed people to effectively strengthen their networking capability could as a result be promising. Against this background, this article provides some hints in relation to the direction that such interventions could take. First, on the basis of data collected on a sample of 4,600 newly-unemployed people in the Swiss Canton of Vaud, it looks at the factors that influence jobseekers' decisions to turn to informal contacts for their job search. The article shows that many unemployed people are not making use of their network because they are unaware of the importance of this method. Second, it presents an impact analysis of an innovative intervention designed to raise awareness of the importance of networks which is tested in a randomized controlled trial setting.

The EU strategy of policy convergence with its neighbours in the area of trade

The objective of this paper is to ascertain whether the EU is seeking policy convergence with its neighbours in the area of trade by means of EU regulations. For each trade- related topic, we carried out a content analysis of the available official documents to identify the model of relations that has been established between the EU and four neighbouring countries (Morocco, Algeria, Ukraine and Georgia). The findings indicate that Europeanization is the EU strategy in most cases. However, adaptation to European regulations is only a long-term aim. When international regulations exist in a specific area, the EU usually demands the internationalization of a country¿s regulations as a first step. When there are no international regulations, the convergence process is established on the basis of bilaterally developed norms. EU strategy also varies depending on the country. Its relations with Algeria are the most particular. We conclude that the EU is promoting policy convergence with its neighbours in the area of trade mainly on the basis of international and bilaterally-developed regulations.

Las relaciones comerciales de la Unión Europea con sus vecinos: ¿europeización, internacionalización o coordinación?

[spa] La política de Vecindad de la Unión Europea se acostumbra a interpretar como un instrumento de europeización forzada. Gracias a su fuerza de negociación, la Unión Europea impondría a sus vecinos su modelo económico y hasta político y social. Esta sin embargo no es la evidencia que se obtiene en el ámbito del comercio. En consonancia con el modelo teórico de relaciones exteriores desarrollado por varios investigadores bajo la dirección de Esther Barbé, observamos como, en el ámbito comercial, el modelo de relaciones entre la Unión Europea y cuatro países de la política de Vecindad puede ser tanto de europeización como también de internacionalización o de coordinación. El tipo de modelo aplicado viene condicionado, como asevera el marco teórico, por el cumplimiento de las condiciones necesarias que se requieren para que Europa imponga sus normas: legitimidad, incentivos y coherencia interna. Estas condiciones varían en función tanto del tema tratado como del país vecino.

Aportación de la resonancia magnética en un caso de criptorquidia bilateral en un paciente adulto [Contribution of magnetic resonance in a case of bilateral cryptorchism in an adult patient].

Report of one case of bilateral cryptorchism with non-palpable testes in a 26-year old patient with progressive muscle dystrophy. Physical examination and ultrasound study to detect the testicular location were inconclusive. An analysis is made of data obtained with the NMR study as well as a review of the advantages and contributions from this new technique in the location and characterization of undescended testes.

Bilateral olfactory sensory input enhances chemotaxis behavior.

Neural comparisons of bilateral sensory inputs are essential for visual depth perception and accurate localization of sounds in space. All animals, from single-cell prokaryotes to humans, orient themselves in response to environmental chemical stimuli, but the contribution of spatial integration of neural activity in olfaction remains unclear. We investigated this problem in Drosophila melanogaster larvae. Using high-resolution behavioral analysis, we studied the chemotaxis behavior of larvae with a single functional olfactory neuron on either the left or right side of the head, allowing us to examine unilateral or bilateral olfactory input. We developed new spectroscopic methods to create stable odorant gradients in which odor concentrations were experimentally measured. In these controlled environments, we observed that a single functional neuron provided sufficient information to permit larval chemotaxis. We found additional evidence that the overall accuracy of navigation is enhanced by the increase in the signal-to-noise ratio conferred by bilateral sensory input.

The c-Jun N-terminal kinase 1 (JNK1) in spinal astrocytes is required for the maintenance of bilateral mechanical allodynia under a persistent inflammatory pain condition.

Peripheral inflammation induces persistent central sensitization characterized by mechanical allodynia and heat hyperalgesia that are mediated by distinct mechanisms. Compared to well-demonstrated mechanisms of heat hyperalgesia, mechanisms underlying the development of mechanical allodynia and contralateral pain are incompletely known. In this study, we investigated the distinct role of spinal JNK in heat hyperalgesia, mechanical allodynia, and contralateral pain in an inflammatory pain model. Intraplantar injection of complete Freund's adjuvant (CFA) induced bilateral mechanical allodynia but unilateral heat hyperalgesia. CFA also induced a bilateral activation (phosphorylation) of JNK in the spinal cord, and the phospho JNK1 (pJNK1) levels were much higher than that of pJNK2. Notably, both pJNK and JNK1 were expressed in GFAP-positive astrocytes. Intrathecal infusion of a selective peptide inhibitor of JNK, D-JNKI-1, starting before inflammation via an osmotic pump, reduced CFA-induced mechanical allodynia in the maintenance phase but had no effect on CFA-induced heat hyperalgesia. A bolus intrathecal injection of D-JNKI-1 or SP600126, a small molecule inhibitor of JNK also reversed mechanical allodynia bilaterally. In contrast, peripheral (intraplantar) administration of D-JNKI-1 reduced the induction of CFA-induced heat hyperalgesia but did not change mechanical allodynia. Finally, CFA-induced bilateral mechanical allodynia was attenuated in mice lacking JNK1 but not JNK2. Taken together, our data suggest that spinal JNK, in particular JNK1 plays an important role in the maintenance of persistent inflammatory pain. Our findings also reveal a unique role of JNK1 and astrocyte network in regulating tactile allodynia and contralateral pain.

The EU strategy of policy convergence with its neighbours in the area of trade

The objective of this paper is to ascertain whether the EU is seeking policy convergence with its neighbours in the area of trade by means of EU regulations. For each trade- related topic, we carried out a content analysis of the available official documents to identify the model of relations that has been established between the EU and four neighbouring countries (Morocco, Algeria, Ukraine and Georgia). The findings indicate that Europeanization is the EU strategy in most cases. However, adaptation to European regulations is only a long-term aim. When international regulations exist in a specific area, the EU usually demands the internationalization of a country¿s regulations as a first step. When there are no international regulations, the convergence process is established on the basis of bilaterally developed norms. EU strategy also varies depending on the country. Its relations with Algeria are the most particular. We conclude that the EU is promoting policy convergence with its neighbours in the area of trade mainly on the basis of international and bilaterally-developed regulations.