Atorvastatin combined to interferon to verify the efficacy (ACTIVE) in relapsing-remitting active multiple sclerosis patients: a longitudinal controlled trial of combination therapy.

A large body of evidence suggests that, besides their cholesterol-lowering effect, statins exert anti-inflammatory action. Consequently, statins may have therapeutic potential in immune-mediated disorders such as multiple sclerosis. Our objectives were to determine safety, tolerability and efficacy of low-dose atorvastatin plus high-dose interferon beta-1a in multiple sclerosis patients responding poorly to interferon beta-1a alone. Relapsing–remitting multiple sclerosis patients, aged 18–50 years, with contrast-enhanced lesions or relapses while on therapy with interferon beta-1a 44 mg (three times weekly) for 12 months, were randomized to combination therapy (interferon+atorvastatin 20mg per day; group A) or interferon alone (group B) for 24 months. Patients underwent blood analysis and clinical assessment with the Expanded Disability Status Scale every 3 months, and brain gadolinium-enhanced magnetic resonance imaging at screening, and 12 and 24 months thereafter. Primary outcome measure was contrast-enhanced lesion number. Secondary outcome measures were number of relapses, EDSS variation and safety laboratory data. Forty-five patients were randomized to group A (n 1⁄4 21) or B (n 1⁄4 24). At 24 months, group A had significantly fewer contrast-enhanced lesions versus baseline (p 1⁄4 0.007) and significantly fewer relapses versus the two pre-randomization years (p < 0.001). At survival analysis, the risk for a 1-point EDSS increase was slightly higher in group B than in group A (p 1⁄4 0.053). Low-dose atorvastatin may be beneficial, as add-on therapy, in poor responders to high-dose interferon beta-1a alone

Post- and peritraumatic stress in disaster survivors: An explorative study about the influence of individual and event characteristics across different types of disasters

Background: Examination of existing research on posttraumatic adjustment after disasters suggests that survivors’ posttraumatic stress levels might be better understood by investigating the influence of the characteristics of the event experienced on how people thought and felt, during the event as well as afterwards. Objective: To compare survivors’ perceived post- and peritraumatic emotional and cognitive reactions across different types of disasters. Additionally, to investigate individual and event characteristics. Design: In a European multi-centre study, 102 survivors of different disasters terror attack, flood, fire and collapse of a building were interviewed about their responses during the event. Survivors’ perceived posttraumatic stress levels were assessed with the Impact of Event Scale-Revised (IES-R). Peritraumatic emotional stress and risk perception were rated retrospectively. Influences of individual characteristics, such as socio-demographic data, and event characteristics, such as time and exposure factors, on post- and peritraumatic outcomes were analyzed. Results: Levels of reported post- and peritraumatic outcomes differed significantly between types of disasters. Type of disaster was a significant predictor of all three outcome variables but the factors gender, education, time since event, injuries and fatalities were only significant for certain outcomes. Conclusion: Results support the hypothesis that there are differences in perceived post- and peritraumatic emotional and cognitive reactions after experiencing different types of disasters. However, it should be noted that these findings were not only explained by the type of disaster itself but also by individual and event characteristics. As the study followed an explorative approach, further research paths are discussed to better understand the relationships between variables

Challenges in Creating a Disaster Resilient Built Environment

With the increase in occurrences of high impact disasters, the concept of risk reduction and resilience is widely recognised. Recent disasters have highlighted the exposure of urban cities to natural disasters and emphasised the need of making cities resilient to disasters. Built environment plays an important role in every city and need to be functional and operational at a time of a disaster and is expected to provide protection to people and other facilities. However, recent disasters have highlighted the vulnerability of the built assets to natural disasters and therefore it is very much important to focus on creating a disaster resilient built environment within cities. However the process of making a disaster resilient built environment is a complex process where many challenges are involved. Accordingly the paper aims at exploring the challenges involved in building a disaster resilient built environment. Paper discusses the findings of some expert interviews and three case studies which have been conducted in Sri Lanka by selecting three cities which are potentially vulnerable to threats posed by natural hazards. The empirical evidence revealed, lack of regulatory frameworks; unplanned cities and urbanisation; old building stocks and at risk infrastructure; unauthorised structures; institutional arrangements; inadequate capacities of municipal councils; lack of funding; inadequacy of qualified human resources; and corruption and unlawful activities as major challenges for creating a disaster resilient built environment within Sri Lankan cities. The paper proposes a set of recommendations to address these prevailing concerns and to build a more resilient built environment within cities

Complex phenotype in an Italian family with a novel mutation in SPG3A.

Mutations in the SPG3A gene represent a significant cause of autosomal dominant hereditary spastic paraplegia with early onset and pure phenotype. We describe an Italian family manifesting a complex phenotype, characterized by cerebellar involvement in the proband and amyotrophic lateral sclerosis-like syndrome in her father, in association with a new mutation in SPG3A. Our findings further widen the notion of clinical heterogeneity in SPG3A mutations

Emergent organization and responsive technologies in crisis: Creating connections or enabling divides

I articulate and employ a situational boundary-making approach to study the emergence of organization and technology at a shelter during Hurricane Katrina. My analysis of qualitative data shows how emergent organization occurred at the shelter as situational entanglements consisting of three main elements: a salient moment in time, key actors, and boundary-making practices. Key actors' responses to salient moments in time enacted both distinction and dependency between organizational and technological actors, resulting in a divided organization. This analysis extends emergent approaches by showing how organization and technology are situationally organized and emerges through the (in)determinacy of meaning. Implications are also discussed for disaster managers to assess the success and failure of technology during a response. © The Author(s) 2012

Talking about Hillsborough: ‘panic’ as discourse in survivors' accounts of the 1989 football stadium disaster

Popular representations of crowd behaviour in disasters are often characterised by irrationalist discourses, in particular ‘mass panic’ despite their rejection by current scientific research. This paper reports an analysis of four survivors' accounts of the 1989 Hillsborough disaster to investigate if and how they used the term ‘panic’. Reference to ‘panic’ occurred frequently, but more detailed analysis found that their accounts did not match the classic criteria for ‘mass panic’ (e.g. uncontrolled emotion and selfish behaviour). Indeed, participants referred to ‘orderly’ behaviour, and cooperation, even when they said the threat of death was present. ‘Panic’ was therefore being used as a description of events that was not consistent. A discourse analysis of usage suggests that participants used ‘panic’ not only to convey feelings of fear and distress but also to apportion culpability towards the actions of the police who they considered responsible for the tragedy (as indeed recent independent research has confirmed). It is concluded that the term ‘panic’ is so deeply embedded in popular discourse that people may use it even when they have reason to reject its irrationalist implications. Alternative discourses that emphasise collective resilience in disasters are suggested

Simulating Dynamical Features of Escape Panic

One of the most disastrous forms of collective human behaviour is the kind of crowd stampede induced by panic, often leading to fatalities as people are crushed or trampled. Sometimes this behaviour is triggered in life-threatening situations such as fires in crowded buildings; at other times, stampedes can arise from the rush for seats or seemingly without causes. Tragic examples within recent months include the panics in Harare, Zimbabwe, and at the Roskilde rock concert in Denmark. Although engineers are finding ways to alleviate the scale of such disasters, their frequency seems to be increasing with the number and size of mass events. Yet, systematic studies of panic behaviour, and quantitative theories capable of predicting such crowd dynamics, are rare. Here we show that simulations based on a model of pedestrian behaviour can provide valuable insights into the mechanisms of and preconditions for panic and jamming by incoordination. Our results suggest practical ways of minimising the harmful consequences of such events and the existence of an optimal escape strategy, corresponding to a suitable mixture of individualistic and collective behaviour.Comment: For related information see http://angel.elte.hu/~panic, http://www.helbing.org, http://angel.elte.hu/~fij, and http://angel.elte.hu/~vicse

Frequency encoding for simultaneous display of multimodality images.

An original method for simultaneous display of functional and anatomic images, based on frequency encoding (FE), merges color PET with T1-weighted MR brain images, and grayscale PET with multispectral color MR images. A comparison with two other methods reported in the literature for image fusion (averaging and intensity modulation techniques) was performed. Methods: For FE, the Fourier transform of the merged image was obtained summing the low frequencies of the PET image and the high frequencies of the MR image. For image averaging, the merged image was obtained as a weighted average of the intensities of the two images to be merged. For intensity modulation, the red, green and blue components of the color image were multiplied on a pixel- by-pixel basis by the grayscale image. A comparison of the performances of the three techniques was made by three independent observers assessing the conspicuity of specific MRI and PET information in the merged images. For evaluation purposes, images from seven patients and a computer-simulated MRI/PET phantom were used. Data were compared with a chi-square test applied to ranks. Results: For the depiction of MRI and PET information when merging color PET and T1-weighted MR images, FE was rated superior to intensity modulation and averaging techniques in a significant number of comparisons. For merging grayscale PET with multispectral color MR images, FE and intensity modulation were rated superior to image averaging in terms of both MRI and PET information. Conclusion: The data suggest that improved simultaneous evaluation of MRI and PET information can be achieved with a method based on FE

Emergency Management for Disasters in Malaysian Hotel Industry

This paper aims to identify major emergencies that have the potential to place Malaysian hotels in emergency and disaster situations; investigate how hotels were prepared for emergencies, how they manage and overcome emergencies when occurred; and limitations and factors influencing successful emergency planning and adoption emergency management in Malaysian hotels. Face-to-face interview with managers from three, four and five star hotels from different backgrounds: local; regional; and International in Kuala Lumpur, Subang, and Putrajaya are undertaken. The result revealed that Malaysian hotels are exposed to a wide range of natural and man-made disasters. Malaysian hotels lack proactive emergency planning and a lot of constraints which impede successful emergency planning for disasters in the hotel industry in Malaysia, with emphasizing on the relevant authority’s role to demonstrate emergency management to hotels convincing them to adopt such practices, so they can be able to cope with emergencies effectively

Reduced intracranial volume in Fabry Disease: Evidence of abnormal neurodevelopment?

Introduction: Lysosomal storage disorders (LSD) are often characterized by abnormal brain development, reflected by a reduction of intracranial volume (ICV). The aim of our study was to perform a volumetric analysis of intracranial tissues in Fabry Disease (FD), investigating possible reductions of ICV as a potential expression of abnormal brain development in this condition. Materials and Methods: Forty-two FD patients (15males,mean age 43.3±13.0 years) were enrolled along with 38 healthy controls (HC) of comparable age and sex. Volumetric MRI data were segmented using SPM12 to obtain intracranial tissue volumes, from which ICV values were derived. Results: Mean ICV of FD patients was 8.1% smaller compared to the control group (p<5·10−5). Unlike what typically happens in neurodegenerative disorders, no significant differences emerged when comparing between the two groups the fractional volumes of gray matter, white matter and CSF (i.e., normalized by ICV), consistent with a harmonious volumetric reduction of intracranial structures. Discussion: The present results suggest that in FD patients an abnormality of brain development is present, expanding the current knowledge about central nervous system involvement in FD, further emphasizing the importance of an early diagnosis