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CBS deficient individuals undergoing betaine supplementation without sufficient dietary methionine restriction can develop severe hypermethioninemia and brain edema. Brain edema has also been observed in individuals with severe hypermethioninemia without concomitant betaine supplementation. We systematically evaluated reports from 11 published and 4 unpublished patients with CBS deficiency and from additional four cases of encephalopathy in association with elevated methionine. We conclude that, while betaine supplementation does greatly exacerbate methionine accumulation, the primary agent causing brain edema is methionine rather than betaine. Clinical signs of increased intracranial pressure have not been seen in patients with plasma methionine levels below 559 μmol/L but occurred in one patient whose levels did not knowingly exceed 972 μmol/L at the time of manifestation. While levels below 500 μmol/L can be deemed safe it appears that brain edema can develop with plasma methionine levels close to 1000 μmol/L. Patients with CBS deficiency on betaine supplementation need to be regularly monitored for concordance with their dietary plan and for plasma methionine concentrations. Recurrent methionine levels above 500 μmol/L should alert clinicians to check for clinical signs and symptoms of brain edema and review dietary methionine intake. Levels approaching 1000 μmol/L do increase the risk of complications and levels exceeding 1000 μmol/L, despite best dietetic efforts, should be acutely addressed by reducing the prescribed betaine dose.

We analyzed determinants of women's employment with data for 40,792 women living in 103 districts of 6 Arab countries. We tested a new theoretical framework that addresses the roles of needs, opportunities, and values at multiple levels. At the microlevel (individual, family), socioeconomic factors, care duties, and traditionalism were important; at the macrolevel (district), economic development and societal norms were important. Women's education seemed most influential. Interaction analyses showed that returns on women's education depended on their partner's education and on the economic development, labor market structure, urbanization, and strength of traditional norms in the district in which women live. Our results stress the importance of a comprehensive approach toward women's employment in these countries.

Although the Muslim world is sometimes depicted as a homogeneous civilization lacking democracy and gender equality, Muslim countries show tremendous economic, political and cultural variation. In this paper, this variation is used to gain insight into the determinants of women's labor market participation (LMP) in the Muslim world. We use data on 45 Muslim countries and apply SEM models to determine effects of modernization, democracy, cultural background, and state Islamization on women's participation in the formal economy (absolute LMP) and on the share of women in the labor force (relative LMP). Women's absolute LMP is higher in Muslim countries with higher levels of economic development and in the oil-exporting countries. For women's relative LMP, practical democracy (the degree to which people actively participate in the system) takes in a key position. It has a strong positive effect on women's relative LMP and mediates the effects of economic development (positive), formal democratic structures (positive) and state Islamization (negative) on women's relative LMP. Results indicate that in these countries modernization may lead to empowerment of women by increasing their absolute LMP, but that for attaining gender equality the political opportunity structures is most important.

Here we propose a new methodology for learning from conflict, referred to as a ‘phenomenology of change’ approach. This framework can be used to ascertain how, why, and under what conditions conflicts can lead to social, spatial, and political transformations in the urban built environment. This approach builds on examination of ongoing struggles and actions undertaken by citizens and urban governing officials during conflict. It uses this evidence to document whether and how authority is renegotiated as well as the conditions under which the issues under contention and the identity positions of stakeholders will positively or negatively impact the likelihood of built environmental change. Drawing on the five case studies in the special issue, we come to four general conclusions. 1. Change is more likely when actors strategically combine one action repertoire with another. 2. Conflicts over space are particularly well suited to the formation of institutionalized engagement processes for renegotiating authority, thus making change more probable. 3. Despite the importance of negotiating with institutions during conflict, opportunities to engage in such processes are not equally distributed among all races and classes of citizen. 4. The temporality of conflict – that is, the length of struggle – has a direct bearing on both the likelihood and durability of change. The article concludes with a focus on the roles of urban professionals in mediating conflict, reflecting on their relations with both citizens and governing authorities, and discussing how insights drawn from a phenomenology of change framework can be used by professionals to enhance desired transformations in the urban built environment. [ABSTRACT FROM AUTHOR]

Describes a computerized information network, Vocational and Occupational Information Center for Educators (VOICE), that was designed to disseminate vocational education materials to practitioners throughout the state of California. (Author/CS)

Abstract Background Arterial ischemic stroke is rare in childhood. Often, the diagnosis is made after considerable delay. A thorough workup to pinpoint the underlying etiology is necessary, as a correct diagnosis is the determining factor in treatment decision. In case of primary angiitis of the central nervous system, treatment with corticosteroids and immunosuppressive agents is indicated. Case study We described an eleven-year-old boy who presented at the age of six years with left hemiparesis and hemianopia. Cerebral imaging showed acute ischemia in the right posterior cerebral artery territory. Extensive workup was negative. In the following eight months, he had recurrent strokes on three separate occasions due to progressive arteriopathy involving multiple large- and medium-sized vessels. A presumed diagnosis of primary angiitis of the central nervous system was made. Pulse intravenous methylprednisolone therapy was started followed by oral prednisolone. After the fourth stroke, a six-month treatment with cyclophosphamide was given which was followed by maintenance treatment with azathioprine. Shortly after cessation of corticosteroids and cyclophosphamide the subject relapsed. Cyclophosphamide was restarted in combination with corticosteroids and subsequently replaced by mycophenolate mofetil. Under mycophenolate mofetil maintenance treatment combined with low-dose corticosteroids, the patient achieved disease control with a relapse-free period of more than four years. Conclusion A guideline for current treatment of relapsing central nervous system angiitis in childhood is missing in the literature. We describe a subject with multiple relapses despite treatment with corticosteroids and immunosuppressive agents, and stabilization of his clinical condition and of the radiological signs under mycophenolate mofetil treatment. Highlights • Childhood PACNS is a difficult diagnostic and therapeutic challenge. • Evidence in the treatment of relapsing angiitis of the CNS in childhood is limited. • The presented case achieved disease control under mycophenolate mofetil therapy. [ABSTRACT FROM AUTHOR]