Extension of a typology of alcohol dependence based on relative genetic and environmental loading

Mild, severe, and dyssocial subtypes of alcohol dependence, previously identified among Caucasian men from the Epidemiologic Catchment Area study, were also identified among Caucasian men and women with DSM-IV alcohol dependence from the National Longitudinal Alcohol Epidemiologic Survey (n = 2,703; 1,746 respectively). These subtypes were not identified among African American and Hispanic American men or women with DSM-IV alcohol dependence. Among Caucasians with alcohol dependence, the subtypes were characterized by differential loading on three dimensions: genetic, general environmental, and dyssocial environmental symptom scales developed in a prior twin study. The mild subtype (60% of men and 66% of women) was distinguished by low mean scores on all three scales; the dyssocial subtype (24% of men and 20% of women) by low mean genetic and general environmental scores but high mean dyssocial environmental scores; and the severe subtype (16% of men and 14% of women) by high scores on the genetic and general environmental scales. These subtypes also showed the expected distinctions in clinical characteristics. The severe subtype showed greater comorbid drug dependence and major depression, more treatment seeking, and a higher prevalence of parental alcoholism. The severe subtype also showed significantly greater genetic influence adjusted for overall severity of alcohol dependence (genetic ratio). Only the severe subtype showed a pattern of scale scores and clinical characteristics suggestive of substantial genetic influence. The present study indicates a robustness of the typology originally developed among DSM-III alcohol-dependent Caucasian men by empirical extension of the subtypes to a different sample of Caucasian men and, separately, Caucasian women. The use of this typology may aid in distinguishing between Caucasian alcohol-dependent individuals on the basis of relative genetic influence, enabling genetic, behavioral, and epidemiological investigations to reduce genetic or environmental "noise" and better focus on specific aspects of alcohol dependence.     

Cigarette smoking and the colorectal adenoma-carcinoma sequence: a hypothesis to explain the paradox

As recognized precursor lesions to colorectal cancer, colorectal adenomatous polyps have been studied to enhance knowledge of colorectal cancer etiology. Although most of the known risk factors for colorectal cancer are also associated with the occurrence of colorectal adenomas, cigarette smoking has had a strong, consistent relationship with colorectal adenomas but is generally not associated with colorectal cancer. The explanation for this paradox is unknown. With data collected in 1986-1988 during a large case-control study based on colonoscopy results in New York City, New York, the authors investigated the possibility that the paradox may arise because subjects with colorectal adenomas were included in the control group of cancer case-control studies. The authors found a statistically significant increased risk between heavy cigarette smoking (smokers with > or = 40 pack-years of smoking) and risk of adenoma (odds ratio (OR) = 1.61, 95% confidence interval (CI) 1.06-2.44). They saw no increased colorectal cancer risk from heavy cigarette smoking (OR = 1.02, 95% CI 0.52-1.99) using a "manufactured" control group to simulate a typical unscreened, population-based control group. When the authors compared these colorectal cancer cases with an adenoma-free control group examined by colonoscopy in a polytomous model with several case groups (newly diagnosed adenomas, carcinoma in situ, intramucosal carcinoma, and colorectal cancer), they found that the risk for 20-39 pack-years of smoking was elevated, although not statistically significant, and was similar for all four case groups. The risk for the highest smoking category (> or = 40 pack-years) was more strongly elevated in all four case groups, although it was statistically significant for only the newly diagnosed adenoma and the carcinoma in situ cases (adenomas, OR = 1.59, 95% CI 1.05-2.42; carcinoma in situ, OR = 2.05, 95% CI 1.01-4.15; intramucosal carcinoma, OR = 1.30, 95% CI 0.61-2.77; and colorectal cancer, OR = 1.30, 95% CI 0.64-2.65). While the authors' study is weakened by the lack of statistical significance concerning risk for colorectal cancer, these data offer some support for the hypothesis that the association between cigarette smoking and risk of colorectal cancer may have been masked by inclusion in the control group of subjects with adenomas. They also suggest that the major effect of smoking on the colorectal adenoma-carcinoma sequence occurs in the earlier stages of the formation of adenoma and the development of carcinoma in situ.     

Influence of hypertonic saline solution infusion on defibrillation efficacy

BACKGROUND: Transplantation of lung allografts from the same donor into 2 recipients ("twinning") provides an opportunity to study recipient and donor factors that influence early allograft function. METHODS: Twenty-seven pairs of recipients were identified and evaluated using multivariate logistic regression analysis (p < 0.05). Four measures of early graft function were analyzed: alveolar-arterial gradient in the operating room, first alveolar-arterial gradient in the intensive care unit, alveolar-arterial gradient at 24 hours, and days of mechanical ventilation. RESULTS: Analysis of the pooled data without regard to pairing showed that alveolar-arterial gradient in the operating room was influenced by donor age, length of donor hospitalization, recipient mean pulmonary artery (PA) pressure at unclamping, and transplantation of a left lung. The alveolar-arterial gradient in the intensive care unit was correlated with donor age, donor cause of death, and mean PA pressure on arrival in that unit. Only mean PA pressure remained significant at 24 hours. Days of mechanical ventilation was determined by mean PA pressure on arrival in the intensive care unit, drop in mean PA pressure during operation, and diagnosis of the recipient. In the paired analysis, receiving a left lung, recipient diagnosis (pulmonary hypertension worse than others), and need of cardiopulmonary bypass were significantly associated with immediate graft dysfunction, although these influences did not persist beyond the immediate postoperative period. Donor arterial oxygen tension and time of ischemia were not significant predictors in any analysis. CONCLUSIONS: Immediate allograft function was associated with donor-related characteristics initially, but these lost importance over the ensuing 24 hours. Recipient PA pressure was an immediate and persisting influence. In the analysis of differences in function between the members of each pair, transplantation of the left lung, recipient diagnosis, and cardiopulmonary bypass were identified, but their influence did not persist beyond the first 6 hours.     

The effect of urinary tract reconstruction on neurologically impaired women previously treated with an indwelling urethral catheter

PURPOSE: We investigated the changes in sexuality and quality of life that evolve after lower urinary tract reconstruction in neurologically impaired women previously treated with an indwelling urethral catheter. MATERIALS AND METHODS: A total of 18 neurologically impaired women treated with an indwelling urethral catheter underwent bladder reconstruction. Pubovaginal sling urethral compression was required to restore perineal dryness in 13 patients and was the only operation required in conjunction with intermittent catheterization in 3. Eight patients underwent ileocystostomy, that is creation of a "bladder chimney," and 4 underwent augmentation cystoplasty with creation of a continent catheterizable stoma. In 3 patients ileocystoplasty alone with intermittent urethral catheterization was performed. All patients were followed 6 to 40 months (mean 18) after reconstructive surgery using a 9-part questionnaire to score numerically the effect of surgical reconstruction on sexuality and quality of life issues. RESULTS: On a scale of 0 (worst) to 5 (best) mean score for self-esteem improved from 1 preoperatively to 4 postoperatively, self-image from 1 to 4, sexual desire from 2 to 4 and ability to cope with disability from 1 to 4, respectively. In 4 of the 15 women who were sexually active preoperatively the frequency of sexual intercourse doubled from a mean of 3 to 6 times per month, respectively, and all 4 women reported improved sexual satisfaction. All 13 patients with pelvic pain and 5 with symptoms of autonomic dysreflexia noticed significant improvement if not complete resolution of the symptoms. CONCLUSIONS: Neurogenic lower urinary tract dysfunction treated with an indwelling urethral catheter is detrimental to sexuality and quality of life in neurologically impaired women. Urinary tract reconstruction restores not only quality of life but also sexuality by improving self-image, self-esteem and the ability to cope. Indwelling catheterization as a method of long-term urinary treatment should be avoided in women.     

Static output feedback sliding mode control for time‐varying delay systems with time‐delayed nonlinear disturbances

In this paper, a robust stabilization problem for a class of linear time‐varying delay systems with disturbances is studied using sliding mode techniques. Both matched and mismatched disturbances, involving time‐varying delay, are considered. The disturbances are nonlinear and have nonlinear bounds which are employed for the control design. A sliding surface is designed and the stability of the corresponding sliding motion is analysed based on the Razumikhin Theorem. Then a static output feedback sliding mode control with time delay is synthesized to drive the system to the sliding surface in finite time. Conservatism is reduced by using features of sliding mode control and systems structure. Simulation results show the effectiveness of the proposed approach. Copyright © 2009 John Wiley & Sons, Ltd.     

Disturbance decoupled fault reconstruction using sliding mode observers

This paper investigates and presents conditions that guarantee disturbance decoupled fault reconstruction using sliding mode observers, which are less stringent than those of previous work, and show that disturbance reconstruction is not necessary. An aircraft model validates the ideas proposed in this paper. Copyright © 2010 John Wiley and Sons Asia Pte Ltd and Chinese Automatic Control Society     

Fuzzy distributed cooperative tracking for a swarm of unmanned aerial vehicles with heterogeneous goals

This article proposes a systematic analysis for a tracking problem which ensures cooperation amongst a swarm of unmanned aerial vehicles (UAVs), modelled as nonlinear systems with linear and angular velocity constraints, in order to achieve different goals. A distributed Takagi–Sugeno (TS) framework design is adopted for the representation of the nonlinear model of the dynamics of the UAVs. The distributed control law which is introduced is composed of both node and network level information. Firstly, feedback gains are synthesised using a parallel distributed compensation (PDC) control law structure, for a collection of isolated UAVs; ignoring communications among the swarm. Then secondly, based on an alternation-like procedure, the resulting feedback gains are used to determine Lyapunov matrices which are utilised at network level to incorporate into the control law, the relative differences in the states of the vehicles, and to induce cooperative behaviour. Eventually stability is guaranteed for the entire swarm. The control synthesis is performed using tools from linear control theory: in particular the design criteria are posed as linear matrix inequalities (LMIs). An example based on a UAV tracking scenario is included to outline the efficacy of the approach.     

Building Agile Systems with Mobile Code

Mobile code has been championed as a solution to a plethora of software problems. This paper describes investigative work undertaken in order to evaluate the mobile code abstractions of Mobile Agents and Mobile Objects, and to understand the implications of using these abstractions to build distributed systems.We describe two systems built to support the Sales Order Process of a distributed manufacturing enterprise, using IBM's Aglets Software Development Kit. The Sales Order Process model and the requirements for agility used as the basis for these implementations are derived from data collected in an industrial case study.Both systems are evaluated using the Goal/Question/Metric methodology. Two new metrics for Semantic Alignment and Change Capability are presented and used to evaluate each system with respect to the degree of system agility supported. The systems are evaluated through a set of scenarios generated during the case study in an attempt to see if they support system integration and agility in the manufacturing domain. Further we examine the implications of using a mobile code abstraction when compared with the abstraction offered by traditional distribution technology.The work described provides evidence that both Mobile Agent and Mobile Object systems have inherent properties that can be used to build agile distributed systems. Further, Mobile Agents with their additional autonomy provide marginally greater support.     

Evolution of 3D mobile games development

3D computer graphics have been an important feature in games development since it was first introduced in the early 80s and there is no doubt that 3D based content is often viewed as more attractive in games than the more abstract 2D graphics. Many games publishers are keen to leverage their success in the console market into the mobile phone platform. However, the resource constraints of mobile phones and the fragmented nature of the environment present considerable challenges for games developers. In this paper we consider some of the current constraints together with current and, probable, future developments both in the software and hardware of mobile phones. As part of this process we benchmark some of the latest and most prevalent software and hardware devices to ascertain both the quality of the graphics produced and the effects upon battery life. Whilst our test results highlight that the current market does indeed present challenges, our research into the future developments highlights the fact we are approaching greater standardization, which will be an important factor for the successful development of 3D mobile games.

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