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Purpose The purpose of this study is to assess the opportunity for a distributed, networked open biomedical repository (OBR) using a knowledge management system (KMS) conceptual framework. An innovative KMS conceptual framework is proposed to guide the transition from a traditional, siloed approach to a sustainable OBR. Design/methodology/approach This paper reports on a cycle of action research, involving literature review, interviews and focus group with leaders in biomedical research, open science and librarianship, and an audit of elements needed for an Australasian OBR; these, along with an Australian KM standard, informed the resultant KMS framework. Findings The proposed KMS framework aligns the requirements for an OBR with the people, process, technology and content elements of the KM standard. It identifies and defines nine processes underpinning biomedical knowledge – discovery, creation, representation, classification, storage, retrieval, dissemination, transfer and translation. The results comprise an explanation of these processes and examples of the people, process, technology and content dimensions of each process. While the repository is an integral cog within the collaborative, distributed open science network, its effectiveness depends on understanding the relationships and linkages between system elements and achieving an appropriate balance between them. Research limitations/implications The current research has focused on biomedicine. This research builds on the worldwide effort to reduce barriers, in particular paywalls to health knowledge. The findings present an opportunity to rationalize and improve a KMS integral to biomedical knowledge. Practical implications Adoption of the KMS framework for a distributed, networked OBR will facilitate open science through reducing duplication of effort, removing barriers to the flow of knowledge and ensuring effective management of biomedical knowledge. Social implications Achieving quality, permanency and discoverability of a region’s digital assets is possible through ongoing usage of the framework for researchers, industry and consumers. Originality/value The framework demonstrates the dependencies and interplay of elements and processes to frame an OBR KMS.

Even though the COVID-19 pandemic has helped to accelerate the switch to a full digital environment, Future directions in digital information still offers library and information science (LIS) prof...

STUDY OBJECTIVE: The objective of this trial—Biomarkers in Autism of Aripiprazole and Risperidone Treatment (BAART)—was to provide support and guidance for an evidence-based approach for the selection and monitoring of initial pharmacotherapy in patients with autism by assessing predictors of efficacy, tolerability, and safety. DESIGN: Randomized, double-blind, parallel-group study. SETTING: Three academic medical centers and a single private pediatric practice. PATIENTS: Eighty children or adolescents (aged 6–17 years) with autistic disorder were enrolled, and 61 patients were randomized to study drug. Of those patients, 51 completed the 10-week trial, and 31 completed an optional 12-week blinded extension phase. INTERVENTION: All patients were treated with 2 weeks of placebo before random assignment to receive aripiprazole (31 patients) or risperidone (30 patients) for 10 weeks. Sixteen placebo responders (20%) were excluded from further analysis. Drug dosing followed United States Food and Drug Administration (FDA) labeling, and weekly dosage adjustments were allowed until week 4; patients were then maintained on a fixed dose for 6 additional weeks. MEASUREMENTS AND MAIN RESULTS: Safety, physical, and psychological assessments were recorded weekly or every two weeks. No significant differences in severity of illness between the aripiprazole and risperidone groups were noted at baseline. All patients significantly improved on the Aberrant Behavior Checklist irritability subscale after one week and continued for the remaining 9 weeks and the extension phase. Improvement was greatest in the risperidone group at every assessment period and was statistically significantly better than that in the aripiprazole group at weeks 3 and 6 (p

Open biomedical repositories, such as PubMed Central (PMC), are a means to make research discoverable and permanently accessible. Assessing the potential interest of key stakeholders in an Australasia PubMed Central was the objective of this research. The investigation is novel, assisting in the development of open science infrastructure through its systematic analysis of the potential interest in, and viability of a biomedical repository for managing openly accessible research outputs for the Australasia region. The research adopted a qualitative approach based on semi-structured interviews and a focus group. Forty-four stakeholders located throughout Australia and New Zealand participated in the research. Participants expanded upon their experience of PubMed, MEDLINE, PMC and their use of information resources for research and clinical practice. The Evidence Based Healthcare (EBHC) pyramid was the theoretical model adopted to explain open biomedical repository processes. A strengths, weaknesses, opportunities and threats (SWOT) analysis identified support for exploring membership of an international PMC system, in particular Europe PMC. Lessons learnt from PMC US, Europe PMC and PMC Canada (collectively known as PubMed Central International) informed the investigation. A major strength identified was that PubMed Central International has been able to achieve high levels of compliance way beyond that of most institutional repositories. A great threat faced is overcoming the difficulties of working together with other major world bodies and financially sustaining an Australasia PMC. Improving Australasian biomedical knowledge management processes may be possible from adopting a PMC for retrieving and transferring research, linked to the data underlying the research. This in turn could help put regional research under a brighter spotlight, potentially leading to improvements in research quality. There is an opportunity for a potential Australasia PMC to harvest biomedical research from the National Library of Australia's aggregator database, Trove and work closely with Europe PMC to avoid duplication of effort. Overall, establishment of an Australasia permanent biomedical digital open repository is perceived as important, with significant potential flow-on benefits to healthcare, industry and society.

The present study scrutinizes how hospitality firms’ internal branding influences the service performance of frontline employees in a progressive way. More specifically, based on social influence and social exchange theories, this study examines if organizational commitment mediates the link between hospitality frontline employees’ perceptions of brand authenticity (BA) and brand-value fit (BVF) and their service-related behaviors such as generating ideas for service improvement (GISI) and service-oriented citizenship behavior. With a matched sample of 286 customer-contact frontline employees and 33 of their supervisors from five-star hotels in South Korea, this study found that the higher employees’ perceptions of BA and BVF, the more likely they were to generate ideas for service improvement and engage in service-oriented citizenship behavior, as they were more likely to be committed to the firm. Based on the findings, implications are discussed for hospitality practitioners and researchers alike in terms of internal branding with frontline employees.

If I was starting out as a newly qualified knowledge manager or even for the more experienced practitioners working in diverse organisations, I would add this easy to read and very practical book t...

A two-zone solar reactor concept for the steam-based gasification of biomass particles using concentrated solar energy has been developed and experimentally evaluated with particles of sugarcane bagasse at a 1.5 kW solar input scale. The gasifier has been designed with the objective to provide pyrolysis and gasification conditions yielding high carbon conversion into syngas and suppressing the formation of tars and gaseous hydrocarbons. It consists of two zones. In the upper drop-tube zone, a high radiative heat flux to the dispersed particles induces their fast pyrolysis. In the lower trickle bed zone, a structured packing provides the residence time and temperature required for the char gasification and the decomposition of the other pyrolysis products. A series of 20 min gasification experiments comparing the two-zone reactor vs. a drop-tube reactor were performed in a high-flux solar simulator with a maximum particle flux of 16 g/s m 2 . It has been demonstrated that the former allows for more efficient decomposition of CH 4 and C 2 hydrocarbons at comparable reactor temperatures. The LHV of the product gas leaving the two-zone gasifier was significantly higher than those typically obtained in conventional autothermal gasifiers. Solar energy was chemically stored in the product gas, resulting in energetic upgrade of the biomass by 5% and a maximum energy conversion efficiency of 21%.

Syngas production via steam-based thermochemical gasification of Brazilian sugarcane bagasse, using concentrated solar energy for process heat, was thermodynamically and experimentally investigated. Energy and exergy analyses revealed the potential benefits of solar-driven over conventional autothermal gasification that included superior quality of syngas composition and higher yield per unit of feedstock. Reaction rates for the gasification of fast pyrolyzed bagasse char were measured by thermogravimetric analysis and a rate law based on the oxygen exchange mechanism was formulated. In order to provide residence times long enough for adequate char conversion, a laboratory-scale entrained flow reactor that combines drop-tube and fixed-bed concepts was developed. Testing was performed in an electric furnace with the final aim to supply heat by concentrated solar radiation. Experimental runs at reactor temperatures of 1073–1573 K and a biomass feed rate of 0.48 g/min yielded high-quality syngas of molar ratios H2/CO = 1.6 and CO2/CO = 0.31, and with heating values of 15.3–16.9 MJ/kg, resulting in an upgrade factor (ratio of heating value of syngas produced over that of the feedstock) of 112%. Theoretical upgrade factors of up to 126%, along with the treatment of wet feedstock and elimination of the air separation unit, support the potential benefits of solar-driven over autothermal gasification.

Bradford's Law of Scattering is a law of diminishing returns and scattering. Bradford formulated the law in 1948 and claimed that for a given subject area “there are a few very productive periodicals, a larger number of more moderate producers, and a still larger number of constantly diminishing productivity” [1]. For any single issue, or subject area, the top third (Zone 1 or core) represents the journals that are the most frequently cited in the literature of that subject and that are, therefore, likely to be of highest interest to researchers in the discipline. The middle third (Zone 2) includes the journals that have had an average amount of citations, and the bottom third (Zone 3 or tail) comprises the long tail of journals that are seldom cited and regarded as of marginal importance to the subject [2]. Researchers have defined a subject area in lexical, semantic, and subject scattering terms [3], and some argue that problems in defining “subject” may not matter, provided it is applied consistently [4]. Bradford's law predicts that the number of journals in the second and third zones will be n and n2 times larger than the first zone respectively [5, 6], and therefore, it should be possible to predict the total number of journals containing papers on a subject once the number in the core and middle zone of journals is known. Once the total number of journals is known, it should be possible to predict how much relevant information is missing from an incomplete search. Given the time-consuming and extensive effort required to identify sources on a subject for a systematic review, accurately predicting the size (and quality, if possible) of the literature from Bradford's law would be useful for such studies. Empirical testing of Bradford's law requires a complete and large bibliography, a well-defined subject, and a limited time frame [5, 7]. Bradford's law has been applied successfully to measure the literature of many subjects, such as nursing [1], science [8], crystallography [9], and occupational therapy [2]. In addition, many librarians will be familiar with Eugene Garfield's Science Citation Index, which is based on Bradford's law [10]. One analysis of all randomized controlled trials (RCTs) in the MEDLINE database found that the journal distribution varied from the standard Bradford's law [11]. However, there have not been any studies on the usefulness of Bradford's law to predict the size of literature in systematic reviews. Other methods to estimate the total number of articles when searching for systematic reviews, such as the Horizon Estimate, have been applied with varying success [12]. This study arose from work with the Acute Respiratory Infections Group, one of the fifty-two entities making up the Cochrane Collaboration. Cochrane Reviews are systematic literature reviews aiming at high quality and, therefore, explicitly striving for completeness. The validity of Bradford's law for systematic reviews has not been addressed in the literature. Accordingly, this study examined whether Bradford's law was valid for the Cochrane Review–identified literature on acute otitis media and pneumonia, conditions that are reported in a wide variety of clinical and health journals [13].

Thermochemical equilibrium calculations indicate the possibility of significantly lowering the onset temperature of aluminum vapor formation via carbothermal reduction of Al2O3 by decreasing the total pressure, enabling its vacuum distillation while bypassing the formation of undesired by-products Al2O, Al4C3, and Al-oxycarbides. Furthermore, the use of concentrated solar energy as the source of high-temperature process heat offers considerable energy savings and reduced concomitant CO2 emissions. When the reducing agent is derived from a biomass source, the solar-driven carbothermal reduction is CO2 neutral. Exploratory experimental runs using a solar reactor were carried out at temperatures in the range 1300 K to 2000 K (1027 °C to 1727 °C) and with total pressures in the range 3.5 to 12 millibar, with reactants Al2O3 and biocharcoal directly exposed to simulated high-flux solar irradiation, yielding up to 19 pct Al by the condensation of product gases, accompanied by the formation of Al4C3 and Al4O4C within the crucible. Based on the measured CO generation, integrated over the duration of the experimental run, the reaction extent reached 55 pct at 2000 K (1727 °C).

A novel miniaturized 3-D cubic antenna for use in a wireless sensor network (WSN) and RFIDs for environmental sensing is introduced. The antenna produces a truly omnidirectional pattern in both E-plane and H-plane, which allows for non-intermittent communication that is orientation independent. The frequency of operation lies in the UHF RFID band, 902 MHz-928 MHz (centered at 915 MHz). The ultra-compact cubic antenna has dimensions of 3 cm times 3 cm times 3 cm (27 cm3), which features a length dimension of lambda/11 . The cubic shape of the antenna allows for ldquosmartrdquo packaging, as sensor equipment may be easily integrated inside the cube's hollow (or Styrofoam-filled) interior. The prototype fabrication was performed on six (planar) sides on liquid crystal polymer (LCP) substrate, and then folded into the cubic structure. The geometry of the design is inspired by the RFID inductively coupled meander line structures, which are folded around the sides of the cube. Due to the large number of freedom degrees, this antenna concept may be easily reconfigured for many values of impedances and design parameters. Experimental data verify the simulation results.

Background: The importance of family health history data in health care is widely acknowledged. Few individuals report having collected this information from their own family. Methods: This project implemented a community-based approach to design and pilot a linguistically and culturally appropriate family health history collection toolkit for two minority populations in Harrisburg, Pa. Results: The toolkit relied on oral traditions and family stories as a way to successfully introduce genetics education and family health history to these populations. Participants not only found the tool engaging and culturally appropriate, they were also able to obtain information that they were likely to share with their physician. Conclusion: While limited in scope, this project provides a model to other communities for the design, pilot testing, and implementation of a community-based public health initiative regarding family health histories.

Recent violent events in schools in the United States have underscored the need for an examination of efforts aimed at mass education of school professionals on issues related to violence prevention and crisis intervention. A CD-ROM (“Team Up to Save Lives: What Your School Should Know About Preventing Youth Suicide”) was mass mailed to schools throughout the United States in January 1997. We conducted an initial evaluation of this intervention in the Chicago area and found that the scope of the CD's impact was relatively narrow: Only 39% of all schools with informants that were contacted actually reviewed the CD-ROM and provided feedback for the evaluation. Insufficient time, computer equipment, and training were the major obstacles to CD-ROM use and to participation in the evaluation. Among those reviewing the CD-ROM, overall perceptions regarding its utility were extremely favorable. Multiple instances in which the CD had been used to address actual crisis situations were identified.

Biologic and psychosocial approaches to treatment of childhood psychiatric disorders are improving. The quality of trials and their reporting is integral to this improvement. As demonstrated efficacy and effectiveness increase, the need to address dissemination, transferability, and ethical issues i

Objective To determine prospectively whether parental receipt of injury prevention education is associated with new action limiting access to lethal means and if so, what action was taken for which means. Method Prospective follow-up of 103 adults whose children made an emergency department visit for mental health assessment or treatment. Record review assessed whether hospital staff provided injury prevention education. Logistic regression was used to determine the likelihood of new caretaker action limiting access to the following potentially lethal means: firearms, alcohol, prescription medications, and over-the-counter medications. Results Significant associations were found between exposure to injury prevention education and action to limit access (adjusted odds ratio=3.6, 95% confidence interval=1.1–12.1, p = .04). Five of 8 adults whose households contained firearms took new action to limit access after injury prevention education, whereas none of the 7 firearm-owning families who did not receive injury prevention education took new action to limit firearm access. Similar patterns were seen for other means. Adults more often chose to lock up rather than dispose of lethal means. Conclusions Injury prevention education should be provided to parents during child/adolescent emergency department mental health-related visits. Potential for violence prevention is real because parents do take new action to limit access to lethal means when means restriction education is provided.

A large proportion of suicide attempts result in injuries requiring medical attention, but little is known about youth presenting to rural emergency departments (EDs) for suicide-related behavior. We conducted a chart review of youth receiving mental health (MH) evaluations during 1994 in an ED serving rural counties. Forty percent of the these visits were for suicide-related events. These youth were more likely to be older, female and white than youth receiving MH evaluations for reasons not related to suicide. No differences were found on recent substance use, non-suicidal aggression, or MH service contact when comparing suicidal to non-suicidal youth. Youth receiving MH evaluations were homogenous with respect to suicide risk factors. Chart reviews provided no evidence that means restriction education was provided. We discuss broader implications of these findings for the role of means restriction in EDs.

Nine of NASA's current planetary exploration missions will each continue for at least another two years – provided that the US federal budget allocates the financial resources.

Disruptive behavior, a leading referral complaint to child psychiatry outpatient clinics, and aggressive states are the targeted pathologies for this article. Some of the newer pharmacologic agents being employed to reduce the problem behaviors are described. Comorbidity and prevalence practices of prescribing physicians are also discussed.

The board of the American Geophysical Union (AGU) is to meet early this month to decide whether to reject future sponsorship from the oil and gas giant ExxonMobil.

The use of medications in the young requires special attention to nuances of risk versus benefit because data from carefully controlled studies are limited.

This study reports the findings of research undertaken by health sciences librarians at the University of Queensland Library into how medical students use information for their studies, particularly resources and services provided by the Library. The methods utilized were an online survey and focus groups. Results indicated that students favor print resources over electronic, value accessing resources on a one-stop basis, and prefer training to be delivered flexibly. The implication of these results for future resource selection, service provision, and instructional design and delivery is discussed.

‘Putting Evidence-Based Practice into Action: EBP Journal Clubs’ was the theme of one of the workshops at the recent 10th International Congress on Medical Librarianship held in Brisbane, Australia. The workshop's focus was the role of librarians in providing a non-threatening environment that would encourage clinicians to make evidence-based practice (EBP) a core part …

Settings such as hospital wards and emergency departments, general practices and remote outreach clinics are the classrooms for medical students undertaking rural clinical placements. The Rural Clinical School (RCS) at the University of Queensland (UQ) coordinates a compulsory eight-week Rural Medicine Rotation (RMR) in year three of the four-year graduate entry program. Rural placements are mainly in Central and Southwest Queensland, but include remote sites such as Central Australian Aboriginal communities and the Top End of Northern Australia. Working as part of a clinical team, students need to access information and fill knowledge gaps at the point of need, wherever they are located. Despite recent improvements with wireless broadband availability in rural areas, students of the ‘net generation’ used to medical libraries and fast reliable Internet,1 experience the inconvenient reality of restricted access on rural attachments. Since 2006, the RCS and the UQ Library have provided students on rural placement with personal digital assistants (PDAs) loaded with medical information resources. Use of PDAs in medical education, particularly in North America, has been reported widely.2,3 Studies of use in rural clinical settings by medical students are less common.4 An earlier UQ project showed how PDAs supported ‘patient based’ learning, improved access to information on rural placement, enhanced management of time and learning tasks and provided the opportunity to try the device in a supported environment.5 This article presents a snapshot of student opinion on the usefulness of the RMR PDA service as an adjunct teaching and learning resource during their RMR clinical placements.© 2010 The AuthorsJournal compilation © 2010 National Rural Health Alliance Inc.

The individual components comprising a low-cost, low-power, small-form-factor wireless sensor node for simultaneous ECG and temperature monitoring over wireless personal area networks of dramatically increased range, have been successfully designed, tested and presented. A circular patch antenna has been created that can be integrated, the substrate material of which has been chosen in order to optimize size and reduce radiation lost from interactions with the body. In the future, our work will focus on adding extra reliability measures related to data traffic issues, introducing security layers in the WPAN and optimizing the design of the patch antenna for further miniaturization.

A very low cost substrate, paper makes one of the best substrate candidates for applications of Radio Frequency Identification (RFID), wireless and ubiquitous sensing due to the fact that it is the lowest cost materials, is environmentally friendly and can be easily used for mass reel-to-reel processing while having good flexibility, minimal water absorption if treated with an appropriate coating and is suitable for fast printing processes such as direct write methodologies instead of the traditional metal etching techniques. In this paper, three modules are presented: a paper based wireless sensor module, a wifi antenna on paper via, and a paper based three dimensional RFID antennas. These modules prove paper and inkjet printing as a candidate for the first ultra low cost paper based wireless electronics.

This paper presents a methodology for characterizing and building antennas on a three-dimensional cubic structure for the first time. By first modeling the inductively coupled non-uniform meander line antenna on a planar substrate, it becomes easier to design the antenna when folded on a cube. The loop size and proximity to meander line, meander line length, and microstrip width are used as independent entities that can be modified for the desired specifications of the RFID application of interest. The 3D antenna discussed in this paper can be applied to the realization of truly ubiquitous dasiaad-hocpsila networks of wireless nodes on low-cost flexible passive UHF RFIDpsilas.

Disruptive behavior disorders and obsessive-compulsive disorder have been associated with serotonergic dysfunction as well as particular body habitus findings in pediatric patients. Somatostatin, a peptide which stimulates serotonin release and inhibits growth hormone release, was measured in the cerebrospinal fluid (CSF) of 10 children with disruptive behavior disorders and in 10 age-, sex-, and race-matched pairs of obsessive-compulsive disorder patients. Decreased concentrations of somatostatin were found in disruptive behavior disorder patients relative to obsessive-compulsive children, even after controlling for differences in Tanner stage. In contrast to studies in adults, those patients in a depressed state did not have lower CSF somatostatin concentration.

About half of adults volunteering as normal control research subjects may be rejected because of significant psychopathology, but no parallel study has been done to date for pediatric subjects. Of 152 applicants (ages 6 to 18) for participation as paid normal controls, 44% were found ineligible and at least 31.8% of the child volunteers had probable or certain psychiatric disorders. Successive screenings, including rating scales and structured interviews, were necessary to obtain controls meeting a defined standard of psychiatric health. Careful scrutiny of child volunteers in biological psychiatric research is needed to assure meaningful comparisons.

US president Barack Obama has nominated physicist Cherry Murray for the role of director of the Office of Science in the Department of Energy (DOE).

Professional Issues Poster Presentation Design An intervention study on staff attitudes and beliefs with the use of a reliable and valid tool was conducted with nursing staff. Labor and delivery and postpartum nurses from a large midwestern urban hospital responded to the Breastfeeding Beliefs, Bottle Feeding Beliefs, and Breastfeeding Attitudes Attitude Survey at baseline and following intervention. Following the initial survey, staff were provided with a 5-hour educational intervention “Bridges to Breastfeeding” provided by members of the Illinois Department of Health, Special Supplemental Nutrition Program for Women, Infants, and Children program and breastfeeding advocates.

This study evaluated the impact of a mail information campaign on emergency department (ED) professionals' knowledge about the lethal role of firearms in suicide, knowledge of appropriate strategies for warning caregivers of adolescents who have attempted suicide about firearms, and practices with respect to the delivery of such warnings. Responses obtained from physicians and nurses working in ED sites within the targeted city (Chicago) were compared with responses from ED professionals employed in a comparison city (Detroit). In Chicago, the percentage of respondents recommending firearm removal strategies increased from 60% at pretest to 76% at posttest. Individual reports of caregiver warnings per adolescent suicide exposure showed a significant decline in Chicago and a marginally significant decline in Detroit. Gains in knowledge about firearm warning strategies persisted in multivariate analyses controlling for subject demographic characteristics. The pattern of results suggests that the intervention may have effected changes in knowledge while having little impact on behavior. More intensive, interactive educational strategies may be needed to effect behavioral changes among ED professionals.

The study objectives were to ascertain whether caretakers of suicidal children and adolescents received emergency department (ED) injury prevention education and to determine if injury prevention education and the medical outcome after a drug overdose are associated with caretakers restricting access to means of suicide. Participants were adult caretakers of children and adolescents who deliberately ingested a drug and received ED evaluation. Information was obtained by poison center chart review and phone interview. Fourteen percent of caretaker reported receiving injury prevention education concerning restriction of access to potential means of suicide at home. ED injury prevention education is significantly associated with caretakers restricting access to suicidal means, even when controlling for medical outcome from the attempt. Because parents are less likely to restrict access to means of suicide without education, injury prevention education about restricting access to means of suicide should be given in the ED.

An 81-year-old woman with postmenopausal onset of a bipolar disorder had multiple individual manic and depressive episodes over the span of 31 years. Autopsy disclosed widespread periventricular demyelinated plaques. Although the late age at onset of bipolar symptoms suggested an underlying organic disorder, the multiple affective episodes and lack of additional neurological manifestations make the case atypical. The authors stress the use of modern imaging modalities such as MRI in investigating secondary mood disorders.

Levels of calcium in plasma, red blood cells, and mononuclear blood cells, levels of calcium in plasma, and the plasma calcium-to-magnesium ratio were measured at baseline and after 3 weeks of each drug phase of a double-blind, placebo-controlled study of methylphenidate and dextroamphetamine in hyperactive boys. Levels of magnesium in plasma were significantly higher after 3 weeks of dextroamphetamine treatment, and the calcium-to-magnesium ratio was significantly lower after 3 weeks of either drug compared with the baseline or placebo condition. There was no change in magnesium levels in red blood cells or mononuclear blood cells. These measures were obtained 30 minutes before the morning dose and at 9 a.m., 9:30 a.m., 10:30 a.m., 11:00 a.m., and noon on the last day of each 3-week phase. Analysis of variance revealed a drug effect on plasma magnesium and on the calcium-to-magnesium ratio but no drug x time interaction. Although these changes were not correlated with the time course of acute symptomatic response to stimulant therapy, the decrease in the ratio may be relevant to side effects and treatment resistance associated with stimulant use.

Chronic fatigue syndrome is characterized by persistent or relapsing debilitating fatigue for at least 6 months in the absence of a medical diagnosis that would explain the clinical presentation. Because primary glucocorticoid deficiency states and affective disorders putatively associated with a deficiency of the arousal-producing neuropeptide CRH can be associated with similar symptoms, we report here a study of the functional integrity of the various components of the hypothalamic-pituitary-adrenal axis in patients meeting research case criteria for chronic fatigue syndrome. Thirty patients and 72 normal volunteers were studied. Basal activity of the hypothalamic-pituitary-adrenal axis was estimated by determinations of 24-h urinary free cortisol-excretion, evening basal plasma total and free cortisol concentrations, and the cortisol binding globulin-binding capacity. The adrenal cortex was evaluated indirectly by cortisol responses during ovine CRH (oCRH) stimulation testing and directly by cortisol responses to graded submaximal doses of ACTH. Plasma ACTH and cortisol responses to oCRH were employed as a direct measure of the functional integrity of the pituitary corticotroph cell. Central CRH secretion was assessed by measuring its level in cerebrospinal fluid. Compared to normal subjects, patients demonstrated significantly reduced basal evening glucocorticoid levels (89.0 +/- 8.7 vs. 148.4 +/- 20.3 nmol/L; P less than 0.01) and low 24-h urinary free cortisol excretion (122.7 +/- 8.9 vs. 203.1 +/- 10.7 nmol/24 h; P less than 0.0002), but elevated basal evening ACTH concentrations. There was increased adrenocortical sensitivity to ACTH, but a reduced maximal response [F(3.26, 65.16) = 5.50; P = 0.0015). Patients showed attenuated net integrated ACTH responses to oCRH (128.0 +/- 26.4 vs. 225.4 +/- 34.5 pmol/L.min, P less than 0.04). Cerebrospinal fluid CRH levels in patients were no different from control values (8.4 +/- 0.6 vs. 7.7 +/- 0.5 pmol/L; P = NS). Although we cannot definitively account for the etiology of the mild glucocorticoid deficiency seen in chronic fatigue syndrome patients, the enhanced adrenocortical sensitivity to exogenous ACTH and blunted ACTH responses to oCRH are incompatible with a primary adrenal insufficiency. A pituitary source is also unlikely, since basal evening plasma ACTH concentrations were elevated. Hence, the data are most compatible with a mild central adrenal insufficiency secondary to either a deficiency of CRH or some other central stimulus to the pituitary-adrenal axis. Whether a mild glucocorticoid deficiency or a putative deficiency of an arousal-producing neuropeptide such as CRH is related to the clinical symptomatology of the chronic fatigue syndrome remains to be determined.

Enquete sur le prix des medications psychotropes utilisees dans le traitement des maladies psychiatriques de l'enfant et de l'adolescent (3 classes: stimulants, antidepresseurs, neuroleptiques) dans le secteur de Washington DC. Importance du cout dans l'acceptation du traitement par le patient

• Cerebrospinal fluid hormones, monoaminergic metabolites, and dynorphin A (1-8 sequence) were examined in 43 children with severe, primary obsessive-compulsive disorder. Cerebrospinal fluid levels of 5-hydroxyindoleacetic acid were positively correlated with one of eight obsessivecompulsive disorder severity ratings and three of seven measures of improvement following 5 weeks of treatment with clomipramine hydrochloride. Arginine vasopressin concentration was significantly and negatively correlated with several ratings of obsessive-compulsive disorder symptom severity, while oxytocin concentration was positively correlated with depressive symptoms. The ratio of arginine vasopressin to oxytocin was also negatively correlated with obsessive-compulsive disorder and depressive symptoms. Comorbid affective disorder was associated with decreased arginine vasopressin concentrations, while concomitant anxiety disorder was associated with increased oxytocin. Dynorphin A (1-8 sequence), homovanillic acid, corticotropin, 3-methoxy-4-hydroxyphenylglycol, and corticotropin releasing hormone were not significantly related to obsessive-compulsive disorder symptoms. These results seem to indicate that arginine vasopressin may be related to obsessive-compulsive disorder symptom severity, while 5-hydroxyindoleacetic acid might be associated with drug response.

Lumbar punctures are a common clinical procedure in pediatric populations, yet little systematic information about side effects or the child's perspective of the procedure is available. In a subset ( n =20) of a sample of children and adolescents with disruptive behavior disorders, we recorded children's ratings of research lumbar puncture in comparison to other hospital experiences of blood sampling, electroencephalography, and going to school. Lumbar puncture did not differ from the other procedures in terms of preference. (School attendance was the last choice of 50% of our patients.) Postlumbar puncture headache occurred in 13 of 60 (22%) patients (age 6.5–19.8 years). Adults may overestimate the relative noxiousness of lumbar punctures in children.

As any science matures, the role of measurement, analysis and experimentation grows. The software engineering community has seen the continued development of new software development methods and tools and their use in various environments. The evaluation of methods and tools began with subjective criteria and has been developing toward more objective data collection, measurement and controlled experiments. While this trend is encouraging, these evaluation studies have largely been on a one-shot basis. What has been missing is a systematic approach which defines a longe-range program for the study, analysis and evaluation of a specific method or tool. The emergence of Ada provides a focal point for developing such a systematic study. As a first step, research teams from the University of Maryland and General Electric have embarked upon an eighteen-month collaborative effort. The purpose of this effort is to monitor the use of Ada on a realistically large and complex software development project within industry.