Health research in the developing world: a gastroenterological view from Bangladesh

OBJECTIVES: To identify knowledge levels of academic surgeons about Food and Drug Administration (FDA) and Institutional Review Board (IRB) regulations for clinical research and to determine whether being a member in an IRB, conducting or participating in clinical trials, or being a member in surgical societies affected knowledge levels. DESIGN: Survey of surgical department faculty members in 20 universities. RESULTS: Sixty-five responses were received from 14 sites. Overall mean (+/- SEM) correct score was 6.7 +/- 0.2 of a possible 20 points. The best predictor of overall score was being a primary investigator of a clinical trial (P < .001), followed by being or having been a member of an IRB (P < or = .02). The total mean score of members of the Surgical Infection Society (8.2 +/- 0.5) was significantly higher (P < .001) than that of nonmembers (6.1 +/- 0.2), a phenomenon not observed with other surgical societies. In certain hypothetical clinical scenarios, all respondents were mistakenly willing to conduct clinical trials without obtaining appropriate approval from the FDA. Four (22%) of 18 IRB member respondents and 16 (25%) of the 65 respondents were willing to conduct human research without appropriate approval from patients, the IRB, or both. CONCLUSIONS: Knowledge deficits exist in the academic surgical community about the role and requirements of the FDA and local IRBs for conducting clinical research. Further study is required to determine the reasons for this deficit and to identify appropriate interventions.     

Childhood fibrous dysplasia presenting as blindness: a skull base approach for resection and immediate reconstruction

Fibrous dysplasia is an abnormal fibroosseous process of bone of unknown cause. The incidence of skull involvement varies, painless enlargement being the most common presenting symptom. Change in vision is a rare but recognized finding. We report a 3-year-old boy with extreme fibrous dysplasia involving the skull base, who presented with blindness. He underwent exposure osteotomies of the frontal bones and orbits to provide access for skull base tumor removal. The orbital roofs were reconstructed with microplate-fixed cranial grafts. One and one half years after tumor excision followed by immediate reconstruction, the boy retains facial symmetry, and his ocular function has not deteriorated.     

Comparison of three monoclonal antibody pools for the detection of respiratory viral antigen in respiratory secretions

The aim of this study was to compare the sensitivities of commercial monoclonal antibody pools to be used as an initial rapid screen for detection of viral antigens in respiratory secretions. The availability of commercial monoclonal antibodies has dramatically improved the detection of viruses by immunofluorescence techniques in exfoliated cells obtained from respiratory secretions. Several companies have recently introduced monoclonal antibody pools to detect the presence of respiratory viruses in a single preparation. Ninety-four stored slide preparations that had previously been examined by individual monoclonal antibodies were tested using three commercial monoclonal antibody pools produced by Sanofi (UK), Dako (UK), and Quadratech (UK). These monoclonal antibody pools had a sensitivity of 79.6%, 90.9%, and 100%, respectively, when compared with the original results. The overall intensity of immunofluorescence was also examined.     

Lorazepam-valproate interaction: studies in normal subjects and isolated perfused rat liver

Valproate (VPA) has been shown to interact with all the major antiepileptic drugs (AEDs) through two mechanisms of action: displacement from albumin binding sites and inhibition of drug metabolism. More recently, evidence showed that VPA inhibits the elimination of drugs metabolized by glucuronide conjugation. Lorazepam (LZP), which is primarily eliminated by conjugation with glucuronic acid, is administered concurrently with VPA both in treatment of epilepsy and in patients treated with VPA for psychiatric disorders. Therefore, a significant drug interaction is likely. We investigated such interaction both in in vitro isolated perfused rat liver (IPRL) and in normal subjects. LZP [2 mg, intravenous (i.v.) bolus] was administered to 8 normal volunteers before and after chronic dosing with VPA. In 6 of 8 subjects, VPA significantly decreased LZP plasma clearance by an average of 40% (p < 0.05) and increased LZP concentrations by decreasing formation clearance of the LZP glucuronide. In the IPRL studies, VPA also significantly decreased formation of LZP glucuronide (from 0.72 +/- 0.14 to 0.22 +/- 0.15 ml/h/kg, p < 0.05), indicating that IPRL is a useful tool for evaluation of the effect of VPA on drugs eliminated by glucuronide conjugation.     

K-winner networks.

A special class of mutually inhibitory networks is analyzed, and parameters for reliable K-winner performance are presented. The network dynamics are modeled using interactive activation, and results are compared with the sigmoid model. For equal external inputs, network parameters that select the units with the larger initial activations (the network converges to the nearest stable state) are derived. Conversely, for equal initial activations, networks that select the units with larger external inputs (the network converges to the lowest energy stable state) are derived. When initial activations are mixed with external inputs, anomalous behavior results. These discrepancies are analyzed with several examples. Restrictions on initial states are derived which ensure accurate K-winner performance when unequal external inputs are used.     

Practice, working memory, and the ACT* theory of skill acquisition: A comment on Carlson, Sullivan, and Schneider (1989).

The major results reported by R. A. Carlson et al (see record 1989-24864-001) confirm predictions of J. R. Anderson's (1983) ACT* theory. In particular, ACT* predicts the detrimental effects of the transition to randomized practice because of the need to learn new productions, the complexity effect of gate and judgment type because of more complex production conditions, the effects of practice and its interaction with complexity because of the strengthening mechanisms, and the effects of memory load because of the need to hold information active in working memory so that it can be matched by production conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of occlusion in the perception of depth, lightness, and opacity.

A theory is presented that explains how the visual system infers the lightness, opacity, and depth of surfaces from stereoscopic images. It is shown that the polarity and magnitude of image contrast play distinct roles in surface perception, which can be captured by 2 principles of perceptual inference. First, a contrast depth asymmetry principle articulates how the visual system computes the ordinal depth and lightness relationships from the polarity of local, binocularly matched image contrast. Second, a global transmittance anchoring principle expresses how variations in contrast magnitudes are used to infer the presence of transparent surfaces. It is argued that these principles provide a unified explanation of how the visual system computes the 3-D surface structure of opaque and transparent surfaces. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An improved analysis of experimental data from 125 I hot-line autoradiographs: allowing for the effects of background grains

In this paper we suggest a new statistical method of correcting the results of hot-line experiments for the effects of background sources and we use the new method to reassess the adequacy of three probability distributions proposed in the literature for image spread from line sources. The data are from sources labelled with ¹²⁵I in semi-thin resin sections 0·4-0·8 μm in thickness. The new method reveals that two of the models describe the empirical distributions more closely than earlier analysis had suggested, and it confirms an increasing relationship between half distance of image spread and the thickness of the source. However, it also confirms that considerable ‘inter hot-line’ experimental variation remains, even after background correction. This suggests that multiple experiments are needed to produce reliable estimates of half distance.