New insights into Brunner syndrome and potential for targeted therapy

We report two families with Brunner syndrome living in one state of Australia. The first family had a predicted protein-truncating variant of monoamine oxidase A (MAOA) (p.S251KfsX2). Affected males had mild intellectual disability (ID), obsessive behaviour, limited friendships and were introverted and placid during clinical interview. The family disclosed episodic explosive aggression after a diagnosis was made. The second family had a missense variant in MAOA (p.R45W). Affected males had borderline-mild ID, attention deficit disorder and limited friendships. One had a history of explosive aggression in childhood and episodic symptoms of flushing, headaches and diarrhoea. Their carrier mother had normal intelligence but similar episodic symptoms. Characteristic biochemical abnormalities included high serum serotonin and urinary metanephrines and low urinary 5-hydroxyindoleacetic acid (5-HIAA) and vanillylmandelic acid (VMA). Symptomatic individuals in the second family had particularly high serotonin levels, and treatment with a serotonin reuptake inhibitor and dietary modification resulted in reversal of biochemical abnormalities, reduction of 'serotonergic' symptoms and behavioural improvement. Brunner syndrome should be considered as a cause of mild ID with paroxysmal behavioural symptoms. It can be screened for with serum/urine metanephrine and serotonin measurement. Cautious treatment with a serotonin reuptake inhibitor, dietary modifications and avoidance of medications contraindicated in patients on monoamine oxidase inhibitors can improve symptoms.

No Neuron Left Behind: A genetic approach to higher precision topological mapping of self-organizing maps

Self-organizing maps are extremely useful in the field of pattern recognition. They become less useful, however, when neurons fail to activate during training. This phenomenon occurs when neurons are initialized in areas of non-input and are far enough away from the input data to never move toward the input. These neurons effectively misrepresent the data set. This results in, among other things, patterns becoming unrecognizable.We introduce an algorithm called No Neuron Left Behind to solve this problem.We show that our algorithm produces a more accurate topological representation of the input space.We also show that no neuron clusters form in areas of noninput and that mapping quality of the SOM increases drastically when our algorithm is implemented. Finally, the running time of NNLB is better or comparable to classic SOM without it.

Preliminary evidence of an effect of cerebellar volume on postural sway in FMR1 premutation males

Recent evidence suggests that early changes in postural control may be discernible among females with premutation expansions (55-200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene at risk of developing fragile X-associated tremor ataxia syndrome (FXTAS). Cerebellar dysfunction is well described in males and females with FXTAS, yet the interrelationships between cerebellar volume, CGG repeat length, FMR1 messenger RNA (mRNA) levels and changes in postural control remain unknown. This study examined postural sway during standing in a cohort of 22 males with the FMR1 premutation (ages 26-80) and 24 matched controls (ages 26-77). The influence of cerebellar volume, CGG repeat length and FMR1 mRNA levels on postural sway was explored using multiple linear regression. The results provide preliminary evidence that increasing CGG repeat length and decreasing cerebellar volume were associated with greater postural sway among premutation males. The relationship between CGG repeat length and postural sway was mediated by a negative association between CGG repeat size and cerebellar volume. While FMR1 mRNA levels were significantly elevated in the premutation group and correlated with CGG repeat length, FMR1 mRNA levels were not significantly associated with postural sway scores. These findings show for the first time that greater postural sway among males with the FMR1 premutation may reflect CGG repeat-mediated disruption in vulnerable cerebellar circuits implicated in postural control. However, longitudinal studies in larger samples are required to confirm whether the relationships between cerebellar volume, CGG repeat length and postural sway indicate greater risk for neurological decline.

Historical change in fish species distribution: shifting reference conditions and global warming effects

Species distributions models (SDM) that rely on estimated relationships between present environmental conditions and species presence-absence are widely used to forecast changes of species distributions caused by global warming but far less to reconstruct historical assemblages. By compiling historical fish data from the turn to the middle of the twentieth century in a similar way for several European catchments (Rhône, Danube), and using already published SDMs based on current observations, we: (1) tested the predictive accuracy of such models for past climatic conditions, (2) compared observed and expected cumulated historical species occurrences at sub-catchment level, and (3) compared the annual variability in the predictions within one sub-catchment (Salzach) under a future climate scenario to the long-term variability of occurrences reconstructed during an extended historical period (1800-2000). We finally discuss the potential of these SDMs to define a "reference condition", the possibility of a shift in baseline condition in relation with anthropogenic pressures, and past and future climate variability. The results of this study clearly highlight the potential of SDM to reconstruct the past composition of European fish assemblages and to analyze the historical ecological status of European rivers. Assessing the uncertainty associated with species distribution projections is of primary importance before evaluating and comparing the past and future distribution of species within a given catchment.

Descriptive epidemiology of race-day jockey falls and injuries in New Zealand

The objective of the study was to determine the incidence of race-day jockey falls and describe the reporting of injuries occurring during Thoroughbred racing in New Zealand. Details on jockey falls and injuries were extracted from official stipendiary stewards' reports and denominator data on all race starts were obtained for all races that occurred between 1 August 2008 and 28 February 2013. A fall included any event of the jockey being dislodged from the horse, once the jockey had mounted to start the race proceedings. Incidence rates for jockey falls stratified by type of race were calculated for race-level variables of interest: year, season, race number, race distance and track condition. During the study period there were 816 jockey falls, of which 92 occurred before the race and resulted in the horse being scratched (withdrawn) from the race. The incidence of jockey falls was 2.2 per 1000 rides (95% confidence interval (CI)=1.9-2.5) for flat races and 84.7 per 1000 rides (95% CI=76.6-93.5) for jump races. Just under half of the jockey falls in flat races occurred pre-race (195/418; 46.6%), 42% (179/418) of falls occurred during the race and 10.5% (44/418) of falls occurred post-race. In total, 19.1% (80/418) and 17.3% (69/398) of jockey falls resulted in injury to the jockey in flat and jump races, respectively. Nearly 90% (69/80) of jockeys injured in flat races were stood down from their next race and most injured jockeys required a medical certificate before racing again. The incidence of jockey falls was higher in jump races than flat races, but was comparable to those reported internationally. Incidence rates for falls in flat races were lower than those reported in Europe and Australia.

Are we there yet? On a journey towards more contextually relevant resources in speech-language therapy and audiology

Audiologists and speech-language therapists working in developing contexts like South Africa have the opportunity to address a range of needs through their research. One of these needs is the development of assessments and therapy materials that are appropriate for their clients' particular language needs and cultural background. This editorial paper aims to introduce original research in speech-language therapy and audiology, which has been carried out in South Africa and other developing contexts and is presented in this volume of the journal. In addition we suggest that while the focus of much research is on the destination or end product that is developed, there is a need to share the methodologies that are used to reach that goal so that more research can be carried out by a wider pool of students, researchers and clinicians. We describe some of the methods that we have used in our research--often in small scale projects with budgetary constraints, which would be feasible for clinicians in their routine clinical contexts. Our hope is that others can build on these approaches, critique and share their own strategies for the ultimate advancement of the professions in southern Africa.

Developing a strategy for accreditation of clinical services

Accreditation is one method of assuring quality. Accreditation requires the setting of standards and the creation of a robust and reliable process for assessing them. Accreditation offers different advantages to different groups, eg quality assurance to commissioners and the boards of provider organisations, confidence and choice for patients, and a quality improvement pathway for services to follow. This paper is focused on service accreditation and it proposes that service accreditation be professionally led.

Evaluation of mammographic surveillance services in women aged 40-49 years with a moderate family history of breast cancer: a single-arm cohort study

BACKGROUND

Women with a significant family history of breast cancer are often offered more intensive and earlier surveillance than is offered to the general population in the National Breast Screening Programme. Up to now, this strategy has not been fully evaluated.

OBJECTIVE

To evaluate the benefit of mammographic surveillance for women aged 40-49 years at moderate risk of breast cancer due to family history. The study is referred to as FH01.

DESIGN

This was a single-arm cohort study with recruitment taking place between January 2003 and February 2007. Recruits were women aged < 50 years with a family history of breast or ovarian cancer conferring at least a 3% risk of breast cancer between ages 40 and 49 years. The women were offered annual mammography for at least 5 years and observed for the occurrence of breast cancer during the surveillance period. The age group 40-44 years was targeted so that they would still be aged < 50 years after 5 years of surveillance.

SETTING

Seventy-four surveillance centres in England, Wales, Scotland and Northern Ireland.

PARTICIPANTS

A total of 6710 women, 94% of whom were aged < 45 years at recruitment, with a family history of breast cancer estimated to imply at least a 3% risk of the disease between the ages of 40 and 50 years.

INTERVENTIONS

Annual mammography for at least 5 years.

MAIN OUTCOME MEASURES

The primary study end point was the predicted risk of death from breast cancer as estimated from the size, lymph node status and grade of the tumours diagnosed. This was compared with the control group from the UK Breast Screening Age Trial (Age Trial), adjusting for the different underlying incidence in the two populations.

RESULTS

As of December 2010, there were 165 breast cancers diagnosed in 37,025 person-years of observation and 30,556 mammographic screening episodes. Of these, 122 (74%) were diagnosed at screening. The cancers included 44 (27%) cases of ductal carcinoma in situ. There were 19 predicted deaths in 37,025 person-years in FH01, with an estimated incidence of 6.3 per 1000 per year. The corresponding figures for the Age Trial control group were 204 predicted deaths in 622,127 person-years and an incidence of 2.4 per 1000 per year. This gave an estimated 40% reduction in breast cancer mortality (relative risk = 0.60; 95% confidence interval 0.37 to 0.98; p = 0.04).

CONCLUSIONS

Annual mammography in women aged 40-49 years with a significant family history of breast or ovarian cancer is both clinically effective in reducing breast cancer mortality and cost-effective. There is a need to further standardise familial risk assessment, to research the impact of digital mammography and to clarify the role of breast density in this population.

TRIAL REGISTRATION

National Research Register N0484114809.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 11. See the HTA programme website for further project information.

Localized pulses for the quintic derivative nonlinear Schrödinger equation on a continuous-wave background

Quintic derivative nonlinear Schrödinger equations arise in various physical contexts, notably in the study of hydrodynamic wave packets and media with negative refractive index. A procedure to isolate propagating wave patterns in such nonlinear Schrödinger equations is proposed which is based on two integrals of motion. As an illustration of the method, a "gray" solitary pulse, a "dark" localized mode with nonzero minimum in intensity on a continuous-wave background is identified.

Clinical evaluation of posterior canal benign paroxysmal positional vertigo

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) is a mechanical peripheral vestibular disorder which may involve any of the three semicircular canals but principally the posterior. In as much as the literature has described theories to explain the mechanism of BPPV and also contains scholarly works that elucidate BPPV; its management remains an enigma to most clinicians. To this end, this work was aimed at outlining an evidence-based best practice for most common form of BPPV.

MATERIALS AND METHODS

A systematic review of the literature was conducted between 1948 and June 2011 in PubMed, Embase, Ovid, and Cochrane database through the online Library of the University of Cape Town. Seventy-nine worthy articles that addressed the study were selected on consensus of the two authors.

CONCLUSION

There is consensus for the use of canalith repositioning procedures as the best form of treatment for posterior canal canalolithiasis. However, successful treatment is dependent on accurate identification of the implicated canal and the form of lithiasis. Furthermore, clinicians should note that there is no place for pharmacological treatment of BPPV; unless it is to facilitate repositioning.