Malnutrition continues to be recognized as the most common and serious form of children’s dietary disease in the developing countries and is one of the principal factors affecting brain development. The purpose of this paper is to review human and animal studies relating malnutrition to cognitive development, focusing in correlational and interventional data, and to provide a discussion of possible mechanisms by which malnutrition affects cognition. AlthougNutrition early in life represents one of the major important variables directly related to formation, growth, and functional organization of the organism. An inadequate diet during the first period of life has the potential to influence adversely the development of the brain, which is genetically programmed to grow more quickly than the rest of the body, resulting in changes to its structure and hence functioning. Malnutrition has been recognized to cause reductions in the numbers of neurons, synapses, dendritic arborization, and myelination, all of which result in decreased brain size. Also, the cerebral cortex is thinned and brain growth slowed. All these central nervous system alterations are associated with delays in motor and cognitive functions, such as attention deficit disorder, impaired school performance, decreased IQ scores, memory and learning deficiencies, and reduced social skills.i.e., ethics, economical).Historically, the effects of malnutrition on cognitive development have been studied in both humans and animals, although the animal studies began earlier than human studies and are more abundant in the literature. Research involving humans is mainly conducted in children in developing countries and comprises correlational and interventional studies. On the other hand, experimental animal studies are essential to understand the mechanisms involved in these relationships, since some points cannot be elucidated in humans by several reasons , so the purpose of this paper is to present studies conducted with humans and animals relating malnutrition to cognitive development in an attempt to provide evidences for a discussion of the possible biological and/or environmental mechanisms by which malnutrition affects cognition.It is important to highlight that there are few areas on the field of malnutrition studies where it is possible to establish a link between basic research conducted with animals and that more applied studies conducted with human subjects. However, it is possible to compare studies with animals and humans malnourished in early life if we focus in the basic psychological processes involved in the cognitive development  [Besides being considered a major cause of death among children, nutritional inadequacy is one of the principal factors affecting the development of the brain. Several studies conducted in Barbados ,3, Indiahension) ,5,8; vishension) ,7 and edet al. [, ad libitum, whole cow’s milk and prepared baby food in quantities sufficient to maintain adequate rates of growth. After a few weeks, supplemented children developed a different pattern of interaction with both the mother and the environment, e.g., they were sleeping less, refusing to use the cradle and to be carried wrapped up, and playing more. By 9 months, the supplemented children were receiving more stimulation and rewards, from both parents. At 18 months of intervention, the mothers of supplemented children displayed more complex interactions with their children, who were more restless, playful, demanding and disobedient than nonsupplemented ones.Based on these previously and currently evidences on the relationship between malnutrition and cognition, several studies have being conducted in developing countries since the late 1970s to evaluate the possible effects of dietary interventions programs (supplementation studies) on children’s cognitive performance. One classical example in the literature is the longitudinal study of Chavez These results suggest that supplementation was effective in elevating the children’s activity level and influencing the behavior patterns within the family, with the more active children eliciting greater stimulation from their parents. Another study, conducted in Guatemala by Pollitt and colleagues , demonstper se contributes more or less to impair cognitive development of previously malnourished children than do adverse social and environmental conditions. That way, the presumed link between malnutrition and cognitive development are challenged by the findings of numerous investigations of the influence of the physical and social environment on the child’s cognitive functioning.Studies like these provide evidence that food supplements can improve children’s development and show concurrent benefits to cognitive ability. However, still remains unclear if malnutrition A study conducted in four Guatemalan villages ,14 evaluet al. [ad libitum three times a day); health care and an educational treatment  on language usage, immediate memory, manual dexterity and motor control, information and vocabulary, quantitative concepts, spatial relations, and logical thinking, with a balance between verbal and nonverbal production. The authors concluded that environmental deprivation retards general cognitive development and that combined nutritional, health, and educational treatments can prevent large losses of potential cognitive ability, with significantly greater effect the earlier the treatments begin. Similarly, Waber and colleagues [Two other experimental studies were carried out in Colombia to evaluate the effects of a program of treatment combining nutritional supplementation and/or educational features on children’s cognitive development. McKay et al.  tested alleagues  tested tThe effects of nutritional supplementation and early childhood psychosocial stimulation were also evaluated in Jamaican children –21. The Although the human studies are clear on the effects of early protein-calorie malnutrition on behavior and cognition, with a special role for environmental factors concurrent to nutrition deprivation, it also clear that we continue depending on experimental animals studies to understand the nutritional-environmental-behavioral relationships. As previously commented, certainly, some questions on the area can not be answered without animal studies that, by ethical, economic and time reasons, are not possible to be conducted using human subjects.3.According to behavioral data reported in the last decades, most evident changes observed in prenatal and postnatal malnourished rats leads to increased motivation for food or water in response to privation ,23, emotThe time length and magnitude of nutritional insult is directly related to the severity and duration of its effects on body development and on behavioral changes. Protein and/or protein-calorie malnutrition are the most commonly used experimental models of early malnutrition in animal studies. Most of these studies are developed in rodents. Like other mammalian species studied, rats exhibit a sequence of development of the central nervous system similar to humans with specific differences in relation to the maturing brain in each species . The shoThere are several techniques of experimental malnutrition developed to be used in rodents. The techniques that induce malnutrition during the post-natal life (mainly during the lactation period) produce significant impairments in the development of the animals with a great decrease in the growth of pups that will remain even after a prolonged period of nutritional recovery. The mainly cause for this important growth retardation is the reduction in the quantity and quality of the mother’s milk suckled by pups –38.Protein and/or protein-calorie malnutrition during the lactation period can be produced by a low-protein diet (reduction of the protein amount present in diet composition); reduction or inadequate amount of diet available; large litters  and malnutrition by separation . All of these techniques are efficient to produce significant effects both on physical and behavioral developments in rats, as demonstrated by Hernandes and her co-workers .Protein or protein-calorie malnutrition imposed during lactation changes the quantity and quality of mother-pup interactions and may lead to long-lasting adverse effects on the behavior of rats in the adult life –42. RepoAlthough many animal techniques of early malnutrition have been studied and widely described in the past 50 years, there are few studies of postnatal protein malnutrition and its effects on cognition, learning and memory processes. For this reason, we will briefly present and discuss some studies from the last 10 years which presents new and relevant discoveries about the consequences of postnatal protein malnutrition on cognition, learning and memory.A study conducted in our group showed that rats malnourished in early life presented significant alterations in social interaction behaviors in childhood and these behaviors were related to dominance behaviors in adulthood . During Even after a period of nutritional rehabilitation, rats malnourished early in life may show behavioral changes relevant to adulthood and these changes may hamper the adaptation of animals to the environment in adult life. In addition to changes in typical behaviors of social interaction, malnourished rats have learning difficulties in tasks that involved complex strategies or required the animal’s attention to many environmental stimuli, as shown in previous studies by our group ,32,34,46The malnutrition technique used in most of our studies consists in treatment with low-protein diets (6% protein) or protein-calorie malnutrition  from the day of pups birth until the weaning or, in some cases, until 49 days of age, to access the effects of severe and long-lasting nutritional insults.et al. [Fukuda et al.  studied The navigation in the ‘distal cue’ version is based in the relation among the rat, the goal and the extra-maze visual cues, suggesting that learning is mediated by the hippocampal formation. Malnourished rats spent more time swimming in circles or scanning the maze wall during the first trials of the test, in contrast with well-nourished animals that were faster in extinguishing this pattern of behavior and orienting the navigation in the direction of the center of the maze. The authors suggested that the present results can be due to alterations produced by protein malnutrition in the hippocampal formation or also to reflect the higher emotionality of rats following early malnutrition, especially considering the fact that postnatal malnourished rats are more reactive to unpleasant or aversive stimuli as cold water. It is also suggested that early malnutrition could produce behavior rigidity in the animals, impairing the extinction of behaviors that is not efficient to escape from the cold water  and this prolonging this behavior in detriment of others more efficient directed to the center of the water-maze where the escape platform is localized.In another study conducted later by Fukuda and colleagues  the conset al. [Ser133 level within hippocampal CA1 region. Although the malnourished group demonstrated decreased levels of pCREBSer133, no distinguishable changes in the cognitive deficit and hippocampal neuronal loss were detected.In 2003, Li-Tung Huang et al.  investigAnother study about the effects of malnourishment and seizures on memory and spatial learning in a model of developing brain was carried out by Hemb and colleagues . MalnourMartínez and her co-workers  reportedA last study from our group  demonstrThe revised data above suggest that protein or protein-calorie malnutrition when imposed early in life is a significant biological variable that in conjunction with several environmental variables can lead to learning and memory impairments, depending on the severity and period of malnutrition paradigm imposed. Impairments in brain and body development as well in behavioral and cognition are the results of a malnutrition insult, and alterations in learning and memory is believed to reflect changes in hippocampal structures.4.The studies described above have shown that any change or manipulation capable to lead to severe or long-lasting malnutrition, early in life or during prenatal period, promotes changes known primarily as growth deficits and cognitive impairments, which are quite similar in humans and rodents .There are some possible explanations for the role that malnutrition in early life plays on cognitive development in both species. One is related to the critical period of brain development. During the development of central nervous system a sequential series of changes with a high degree of regulation occurs through chemical reactions, including cell division (neurogenesis and gliogenesis), migration of neurons and glial cells, cellular differentiation, myelinization, synapse formation, and synthesis and release of neurotransmitters. These sequences occur differently in various brain regions and even within a particular region. They also vary in time from one animal species to another, but do not vary fundamentally among mammals, though they are different in human and rodents with respect of the timing of birth in relation to the stage of brain maturation . This coOne of the consequences of malnutrition during the critical period is a diffuse cortical involvement, which could explain some of the consequences previously described. For example, the right parietal cortex is related to visouspatial functions, and children’s poor performance on related tests  could beAnother structure of the brain particularly affected by early malnutrition in all mammals is hippocampus, which have been widely studied because it is directly involved with learning and memory processes ,62,64,66Although some studies do not show significant differences in performance between well-nourished and early malnourished rats in spatial learning and memory tasks –55; someWhen we assessed the studies conducted in recent decades, some general considerations can be made: (a) malnourished rats usually require more time to learn the task in learning tests; (b) when they learn, they take longer to extinguish the behavior, especially if the task involves food reward delivered as a consequence of the behavior; (c) malnutrition promotes an increased emotional reactivity to aversive or painful events and in situations where the animal’s performance depends on complex or subtle attentional processes. These behavioral changes observed in malnourished animals are explained as resulting from behavioral rigidity or cognitive inflexibility, characteristic of organisms malnourished during critical periods of central nervous system development and consists of difficulties in adaptation or processing of information in complex or changeable contexts.Overall, the changes produced by malnutrition are determined by the type of nutritional insult to which the organism is submitted, the severity of this insult, its duration and the period of life where it happens. Severe malnutrition during the beginning of life, during critical periods of central nervous system development, produces some significant and lasting behavioral changes observable in the course of a lifetime, as demonstrated in human and animals studies discussed in the present review. Among the most significant cognitive changes we find learning difficulties and memory deficits.Taking these finds together, we can assume that, in fact, supplement programs beginning early in life may play a critical role in improving the brain development and hence cognitive functioning, as previously demonstrated. However, some studies also demonstrated that psychosocial/environmental stimulation can lead to more permanent gains than nutritional supplementation alone. While some authors argue that benefits provided by psychosocial stimulation programs are transient, others affirm that these interventions are more efficient to long term life than just nutritional supplementation, suggesting that environment plays a more important role than nutrition itself. The question then is how the environment affects the developmentof cognition?The most plausible argument is related to the sensitive period of brain development, which can be observed in children, and that is a concept different of the concept of critical periods. The sensitive period is seen as offering a broader window during which the brain is sensitive to a particular type of stimulation and represents periods in development during which certain capacities are readily shaped, e.g., language development , attentiIn that way, a child living in an environment which is social and culturally deprived could develop several cognitive problems, which is very common to observe in most of developing countries. Some important environmental characteristics associated with children’s poor cognitive performance are poorly educated parents and absent father , family Another possible explanation is that malnourished children have insufficient energy to take advantage of opportunities for social contacts and learning processes . There aper se produces behavior inconsistent with information from the external environment necessary for optimum cognitive development. These authors affirm that in malnourished animals the behavior is primarily food-oriented, while in children, the behavior may be expressed as apathy and social isolation, like already demonstrated here.The mechanism through which early malnutrition and environmental stimulation may interact to produce cognitive problems both in humans and animals seems to have a clear and dependent relation. Levitsky and Barnes  proposedIn summary, there is overwhelming evidences that malnutrition, especially imposed in early life, has significant and lasting implications for the development of cognition both in humans and animals. Malnutrition is typically associated with social and cultural deprivation and it is very difficult to distinguish the influence of one from another. So, strategies for reducing the effects of child malnutrition should address both nutritional supplementation and psychosocial stimulation during the early life for improving cognitive functions. It is suggested that future studies on this area should be focused on the mechanisms through which malnutrition interferes in social and environmental interaction and causes cognitive deficits. Once that mechanisms are established then it will be possible the implementation of more efficient large-scale intervention programs.Although this review had shown that, in fact, malnutrition affects cognitive development in humans and animals, there are a small number of studies in this area of research. The authors call attention to the need to expand the research in this field, taking into account the importance of the effects of early malnutrition on cognitive functioning of both animals and humans. Special attention should be directed to the efforts in developing experimental behavior models in humans that allow us to correlate with those already well developed and described in the literature of animal studies, especially with rodents that comprise the great majority of data showing impairments of early malnutrition on cognitive processes.


Subjects who have frequent migraine attacks (≥ 2 / month) are in need of a preventive anti-migraine treatment. Available preventive drugs have incomplete efficacy and/or unpleasant side effects.Supraorbital transcutaneous neurostimulation (STNS) has shown encouraging results for migraine prevention in pilot studies and has no side effects -3. We asFive Belgian tertiary headache clinics participated to the study. After a 1-month run-in, patients with ≥ 2 migraine attacks/month were randomized to verum or sham stimulation, and applied the Cefaly® device daily for 20 minutes during 3 months. Primary outcome measures were change in monthly migraine days and 50% responder rate, i.e. the percentage of subjects having a ≥ 50% reduction of monthly migraine days. Patients and enrolling neurologists were blinded from the randomization.Sixty-seven patients were randomized and included in the intention-to-treat analysis. Between run-in and 3rd month of treatment the mean number of migraine days decreased significantly in the verum , but not in the sham group . The 50% responder rate was significantly greater (p=0.023) in the verum (38.1%) than in the sham group (12.1 %). Monthly migraine attacks (p=0.044), monthly headache days (p=0.041) and monthly acute anti-migraine drug intake (p=0.007) were also significantly reduced in the verum but not in the sham group. There were no adverse events in either group.STNS with the Cefaly® device is effective as a preventive therapy for migraine. The therapeutic gain (26%) is within the range of those reported for other preventive drug and non-drug anti-migraine treatments ,5, and tLH: Allergan. JS: ATI Redwood California, St Jude Medical USA, Allergan USA, ATI USA, Medtronic USA and Cyberonics USA.


Existing functional evaluation tools do not accurately reveal the improved function following botulinum toxin A (BTX-A) injection for post-stroke upper limb spasticity. With the aim of developing an alternate method of measuring functional improvement following BTX-A injection, this study tested the feasibility, validity and reliability of video clip analysis performed by the clinicians. Seventy-nine patients administered BTX-A due to post-stroke upper limb spasticity, were retrospectively evaluated using video clip analysis. Pre- and post-injection video clips recorded at 1-month intervals were randomly allocated and sent to three blinded physician evaluators who were asked to choose the one that seemed more improved in terms of hand motion and associated upper limb reaction during gait. The three physicians chose the post-injection video clip as depicting improved hand motion  and associated upper limb reaction during gait . Kappa and intraclass correlation coefficient as a measure of interrater reliability among the three physicians was 0.86 and 0.79 for the hand, and 0.92 and 0.92 for associated upper limb reaction during gait, respectively. The percent overall agreement of the physicians was 78.1% and 71.7% for hand function and associated upper limb reaction, respectively. Retrospective pre- and post-BTX-A injection video clip analyses is a clinically feasible alternative method to evaluate the improvement following BTX-A injection for post-stroke upper limb spasticity, especially in busy clinical practice setting.  Stroke is a leading cause of mortality and long-term morbidity . Stroke Spasticity is defined as a velocity dependent increase in muscle resistance to imposed movement  and the Treatment goals for spasticity include pain relief, reducing muscle frequency of spasm and involuntary movement associated reactions, decreasing care giver burden, improving body image by enhancing aesthetic and postural appearance, preventing contractures and deformities, and improving active function. Active functions that are desirable to improve are dexterity, reaching, activities of daily living such as washing, dressing, eating, drinking, sexual activity, and mobility functions such as transfer and gait.Botulinum toxin type A (BTX-A), one of the most potent and yet safe biological toxins, blocks acetylcholine release from motor neuron and lead to reversible paralysis of the injected spastic muscle with its effect lasting for two to four months . It has There are many approaches measuring spasticity. These include indirect measures, predominantly using scales such as the Modified Ashworth Scale, which has documented validity and reliability , and dirWe investigated the use of video clips as a new evaluation tool for analyzing pre- and post-BTX-A injection. Our aim was to determine whether this video clip analysis could be used as an alternative method for evaluating the effects of BTX-A injection for post-stroke upper limbs spasticity by demonstrating its validity and reliability.Medical records and video clips of pre- and post-BTX-A injection into spastic upper limbs of 79 stroke patients at the Department of Rehabilitation of (blinded) hospital between May 2005 and August 2009 were retrospectively collected. Data on gender, age, diagnosis, stroke onset, mean duration from stroke onset to BTX-A injection, degree of spasticity, injection site, and dosage were reviewed. This study was approved by the institutional review board of the (blinded) hospital. One vial  was reconstituted with 4.0 mL or 5.0 mL of normal saline. Total doses administered to the spastic upper limb were 100 to 400 IU for Botox and 500 to 2000 IU for Dysport. Injected forearm and upper arm muscles were biceps brachii (BB), brachioradialis (BR), brachialis, flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), flexor pollicis longus (FPL), and adductor pollicis (AP). The dosage and muscle selection was individualized based on the severity and distribution of the involved hemiplegic spastic limb. Procedure was carried out using portable electromyography guided and/or nerve stimulation guided by the one same physician. Before injection and 1 month following injection, functional measurement was performed using modified Rankin Scale (mRS) , Korean k = (Po − Pc)/(100 − Pc), and is standardized to lie on a −1 to 1 scale, where 1 is perfect agreement. Kappa coefficients and ICC values were interpreted based on recommendation by Cicchetti [Interrater reliability or agreement between physicians A, B, and C were evaluated with kappa coefficients, interclass correlation coefficient (ICC) and percent overall agreement. The degree of agreement between 79 ratings of the three physicians of upper limb motion and gait associated upper limb posture were separately calculated. The kappa coefficient of agreement is expressed as icchetti   are summarized in Rating of the video clips by physicians A, B, and C was validated for each hand motion and gait associated hand postural appearance over post-injection video clip operationally defined as being the more improved one . PhysiciKappa coefficients for hand motion and gait associated hand posture were 0.86 and 0.92, respectively, both falling in the excellent range. Intraclass correlation coefficient (ICCs) were also high, falling within the excellent range for both the hand motion (0.79) and gait associated hand posture (0.92). The percent overall agreement between physicians A, B, and C for hand motion and gait associated hand posture were 78.1% and 71.7%, respectively . The study was not designed to demonstrate the beneficial effect of BTX-A injection for post-stroke spastic upper limb function, but rather to demonstrate the feasibility of physician video clip analysis as an alternative outcome measure for assessing improvement following BTX-A injection by estimating its validity and reliability.Current management of post-stroke upper limb spasticity can often be challenging and unsatisfactory for patients and clinicians, despite the ease of diagnosis. Goals of spasticity management for post-stroke upper limb spasticity include increase in passive/active range of motion, decrease in frequency of muscle spasm and involuntary movements, pain relief, attaining better hygiene, improving splint wear, and improvement of dexterity and other functional activities such as self care and eating . In addiSpasticity control using focal injections such as phenol or BTX-A injection enhances the effects of conventional rehabilitative treatments and reduces the use of systemic anti-spastic medications. Furthermore, benefits of BTX-A injection for the treatment of post-stroke upper limb spasticity have been established with a statistically significant decrease of spasticity following its use when measured with MAS , withoutTo overcome this limitation, the Goal Attainment Scale (GAS) has been recently adopted as a measurement tool to demonstrate the effect of BTX-A injection. This scale is more responsive and flexible across the domains of impairment, disability, and participation than the previously used standard instruments . Goal sek = 0.857, ICC = 0.795) and gait associated hand posture . It was also feasible and time-cost effective in routine clinical practice, considering that video recording can be easily done during the routine physical and neurological examinations in the out-patient clinic without the need of a greater number of staff and more space, and, therefore, does not require extra time and cost for the patient and the clinician. Our results suggest that, although video clip analysis cannot be used as a primary outcome measurement tool, it is applicable as an alternative or additional secondary outcome measure for functional evaluation. We also suggest that video clip analysis is a useful and realistic evaluation tool following BTX-A injection that can be easily applied in private practice where resources such as time, evaluators, measuring instrument, and space are limited. Therefore, there is a need for an alternative method of measuring the effect of BTX-A injection on spasticity and functional improvement. To our knowledge, no report on the video clip analysis as an improved measurement tool following BTX-A injection for post-stoke upper limb spasticity has been published. This is the first feasibility study of video clip analysis as an outcome measure following BTX-A injection for post-stoke upper limb spasticity. To provide supporting evidence to demonstrate video clip analysis as an objective tool for evaluation of functional improvement following BTX-A injection, we tested the validity and interrater reliability of ratings by three blinded evaluators. The interrater agreement for video analysis was satisfactory, falling in the excellent range for both the hand motion (There are a few limitations that warrant mention. First, we adopted a forced choice paradigm as to whether patients had improved or not, and regarded the post-injection video clips of more improved ones. Secondly, spontaneous recovery over time between the injection and follow-up should be taken into account as a partial explanation of the improvement, which could play an important role in improving function and reducing spasticity not necessarily due to the effect of BTX-A injection alone. In this study, the mean duration from injection to follow up was 4.21 weeks, which may not be sufficient to bring about the maximal change in either spasticity or functional improvement because timing of improvement of spasticity and active function may not coincide. Third, we did not compare video-clip analysis with standard spasticity grading results and did not grade the level of improvement from watching the video clip, such as much “improved” or “less improved”, so could not find compare pre- and post-treatment video images with pre- and post-questionnaires. However, we found that the patients who were mismatched for motion showed less change in MAS score than those who were matched, but without significance. Further evaluation on time-cost effectiveness of video clip analysis in comparison with the standard functional measurement tools or GAS would further contribute to validating the video clip analysis as a useful measurement tool. Demonstrating an effect of BTX-A injection for functional improvement was beyond the purpose of this study.Many measurement tools are used for evaluation of the effects of BTX-A injection for post-stroke spastic upper limb function, but each has its limitations. Here, we suggest pre- and post-injection video clip analysis by physicians as a valid and reliable measure of improvement of function following BTX-A injection. Video clip analysis allows evaluation of the effects of BTX-A injection for post-stroke spastic upper limb function with high validity and reliability, and is useful, clinically feasible, efficient and less time consuming, even in a clinical setting with limited resources such as time, separate evaluators, measuring instruments, or space, as is often the case in private practices.


Controversial results have been reported on the relationship between alcohol intake and metabolic syndrome (MetS). We examined the association of average volume of alcohol consumed and drinking patterns with MetS and its components.This study was conducted as a baseline survey for the Dong-gu Study of adults aged 50 years or older. Drinking patterns were assessed using a structured interview, and average volume of alcohol consumed was calculated. MetS was defined according to the updated version of the National Cholesterol Education Program.Compared with individuals who never drank, the adjusted odds ratio (OR) for the prevalence of MetS was significantly higher in men who consumed 2.1 to 4.0 drinks/day  and greater than 4.0 drinks/day , whereas no significant association was observed in women. Significant dose-response relationships between average volume of alcohol consumed and all metabolic components were observed in men. A usual quantity of 5 to 6 drinks/drinking day , 7 or more drinks/drinking day , and binge drinking on at least 1 occasion/week  were associated with a significantly higher OR for prevalence of MetS in men; however, none of these drinking patterns were associated with MetS in women.Unhealthy drinking patterns such as high usual quantity and binge drinking were significantly associated with MetS, suggesting that the effect of alcohol consumption on MetS should be considered in the context of drinking pattern, particularly in men. Epidemiologic studies have shown that MetS is a strong indicator for the increased risk of cardiovascular morbidity and mortality.Thus, we investigated the association of average volume of alcohol consumed with MetS and its components among community-dwelling adults aged 50 years or older. In addition, we evaluated the effect of drinking patterns, such as drinking frequency, usual quantity consumed, and frequency of binge drinking, on MetS and its components.This study was conducted as a baseline survey within the framework of the Dong-gu Study, which is an ongoing prospective population-based cohort study that was designed to investigate the prevalence, incidence, and risk factors for chronic disease in an urban population. National resident registration records were used to identify potential participants. From 2007 to 2010, 34 040 eligible subjects who were aged 50 years or older and resided in the Dong-gu district of Gwangju Metropolitan City in South Korea were invited to participate by mail and telephone. A total of 9260 subjects were enrolled .A total of 848 with a self-reported history of cerebrovascular disease or coronary heart disease were excluded from the analysis. Ultimately, 8181 subjects (3178 men and 5003 women) were included in the analyses after excluding an additional 192 subjects who did not provide information on their alcohol consumption and 39 subjects who did not provide information on anthropometric or metabolic measures. This study was conducted in accordance with the Declaration of Helsinki guidelines. All subjects were fully informed of the study content and gave written informed consent for the use of their data. The present study was approved by the institutional review board of Chonnam National University Hospital.34The current drinking status of each subject was assessed using the following 2 questions: “Before the date of this study, have you ever drunk any alcoholic beverages?” and “In the last 12 months have you drunk any alcoholic beverages?”. Participants who answered “no” to both questions were classified as never drinkers (lifetime abstainers). Participants who answered “yes” to the first question and “no” to the second question were classified as former drinkers. Current drinkers were defined as participants who answered “yes” to both questions. Current drinkers were asked 2 related questions: “On a day when you drink alcohol, how many drinks do you usually have ?” and “How often do you have a drink containing alcohol, per month (drinking frequency)?”. The average volume of alcohol consumed per day (drinks/day) was calculated from the average number of alcoholic beverages consumed by current drinkers. The number of standard drinks of each beverage type on a single occasion was assessed. We used the additional questions to differentiate former drinkers  from lifetime abstainers (never drinkers). On the basis of the average volume of alcohol consumed, we classified subjects as never drinkers (lifetime abstainers), former drinkers, and current drinkers. Current drinkers were further classified .Drinking frequency was classified as less than 1 day/week, 1 to 2 days/week, and 3 or more days/week. Usual quantity of alcohol consumed was classified as 1 to 2 drinks/drinking day, 3 to 4 drinks/drinking day, 5 to 6 drinks/drinking day, and 7 or more drinks/drinking day for men and as 1 to 2 drinks/drinking day, 3 to 4 drinks/drinking day, and 5 or more drinks/drinking day for women. All subjects who currently drank were also asked about their frequency of binge drinking, which was defined as the consumption, on a single occasion, of 7 or more standard drinks for men and 5 or more drinks for women. Current drinkers were classified into 3 categories according to binge drinking frequency: none, low binge drinkers (<1 occasion/week), and high binge drinkers (≥1 occasion/week).2). Waist circumference was measured to the nearest 0.1 cm at the midpoint between the lower border of the rib cage and the upper hip bone during expiration. Blood pressure was measured with an appropriate size cuff on the right upper arm using a standard mercury sphygmomanometer  after at least 5 min of rest in a sitting position. Three consecutive systolic and diastolic blood pressure readings, which were determined to the nearest 2 mm Hg, were recorded at an interval of 1 min, and the average was used for the analysis.During the period 2007–2010, all participants underwent a yearly standardized physical examination conducted by experienced research staff in the Gwangju Dong-gu health center between April and July. Anthropometric measurements were made in light clothing and without shoes. Body mass index was calculated as weight (kg) divided by height squared , and fasting blood glucose (FBG) levels were measured using enzymatic techniques. Low-density lipoprotein cholesterol (LDL-C) was calculated by the Friedewald formula. Aspartate aminotransferase (AST) and γ-glutamyl transpeptidase (GGT) activity were measured using commercial reagent kits . All samples were analyzed using an automatic analyzer .35 We defined ABO using the Korean Society for the Study of Obesity criteria.36 We applied a new cut-off point for impaired FBG, as defined by the American Diabetes Association.37MetS was defined by the presence of 3 or more of the following 5 conditions: abdominal obesity , high triglycerides , low HDL-C , high BP , and high FBG .Information on age, education level, marital status, healthcare service, cigarette smoking, exercise, self-reported medical history, and medication use of each subject was assessed by research staff, using a standardized questionnaire. Education level was classified as at least 6 years, 7–12 years, and 13 years or more. Marital status was dichotomized into married or other . Healthcare service was categorized as National Health Insurance or Medical Aid. Smoking status was classified into never smoker, former smoker, and current smoker. Exercise was categorized as none, irregular, and regular based on the frequency of recreational activity and exercise during a week.All analyses were performed separately by sex because of the difference in amounts of alcohol consumed, and because of the significant interaction between sex and alcohol consumption with MetS. Demographic, anthropometric, and metabolic variables were expressed as mean ± SD or as a ratio based on the sex-specific alcohol consumption categories. Analysis of variance and the chi-square test were used to identify statistical differences in continuous and categorical variables, respectively. After adjusting for age, smoking status, exercise, educational level, marital status, and healthcare service, odds ratios (ORs) and 95% CIs of sex-specific alcohol consumption categories for MetS and its components were calculated using multiple logistic regression analysis and compared with never drinkers (reference). After excluding former drinkers, the alcohol consumption categories were treated as a continuous term in the multiple logistic regression analysis to test for a linear trend in the relationship between alcohol intake and MetS and metabolic components. In addition, ORs of the sex-specific alcohol consumption categories for MetS were calculated to compare with current nondrinkers (never and former drinkers).After excluding never and former drinkers, ORs were calculated and compared to the reference groups in order to examine the association between drinking patterns and MetS in 3 models. Model 1 was unadjusted, model 2 was adjusted for age, smoking status, exercise, educational level, marital status, and healthcare services, and model 3 was further adjusted for usual quantity consumed in the analysis for drinking frequency, for drinking frequency in the analysis for usual quantity, and for average volume of alcohol consumption in the analysis for binge drinking frequency. Because usual quantity and frequency may reflect different aspects of alcohol drinking, we hypothesized that drinking frequency would be significantly associated with MetS, independent of usual quantity. Thus, to investigate the independent association between drinking frequency and MetS, usual quantity was further controlled in model 3. Equally, we examined the independent association between usual quantity and MetS, while further controlling for frequency in model 3. Additionally, we hypothesized that binge drinking would be significantly associated with MetS independent of the average volume of alcohol consumed.P value of less than 0.05 was considered statistically significant. All statistical analyses were performed using PASW statistics 18 .A Demographic, anthropometric, and metabolic variables according to alcohol consumption and sex are shown in Table P-trend <0.001 and 0.131, respectively). After adjusting for age, smoking status, exercise, educational level, marital status, and healthcare service, a significant dose-response relationship between average volume of alcohol consumed and MetS was observed in men but not in women . Compared with never drinkers, the ORs for MetS were significantly higher in men who consumed 2.1 to 4.0 drinks/day  and greater than 4.0 drinks/day , whereas ORs did not significantly differ in women.MetS was present in 45.1% of the study population (38.3% of men and 49.5% of women). The prevalence and ORs for MetS associated with average volume of alcohol consumed are presented in Table Significant dose-response relationships between alcohol consumption and all metabolic components were observed in men; however, LHDLC was the only component that showed a dose-response relationship in women. Among metabolic components, the ORs for HBP, HTG, and ABO were significantly higher in men who consumed 2.1 to 4.0 drinks/day and greater than 4.0 drinks/day, and the OR for HFBG was significantly higher in men who consumed 1.1 to 2.0 drinks/day, 2.1 to 4.0 drinks/day, and greater than 4.0 drinks/day, as compared with never drinkers. The ORs for LHDLC were significantly lower in men who consumed 1.1 to 2.0 drinks/day, 2.1 to 4.0 drinks/day, and greater than 4.0 drinks/day. The ORs for ABO and HFBG were significantly higher in women who consumed 0.5 drinks/day or less and 0.6 to 1.0 drinks/day, respectively. The ORs for LHDLC were significantly lower in women who consumed 0.6 to 1.0 drinks/day, 1.1 to 2.0 drinks/day, and greater than 2.0 drinks/day.Data on the association between MetS and light drinking (≤2.0 drinks/day for men and ≤1.0 drinks/day for women) and heavy drinking (>2.0 drinks/day for men and >1.0 drinks/day for women) are shown in Table The relationship between drinking pattern  and MetS was examined among current drinkers Tables  and 6. IIn men, high drinking frequency was significantly associated with a higher OR for HBP and HFBG and a lower OR for LHDLC. A high usual quantity was significantly associated with a higher OR for HBP, HFBG, HTG, and ABO, and a lower OR for LHDLC. Also, a high frequency of binge drinking was significantly associated with a higher OR for HTG and ABO. In women, high drinking frequency was significantly associated with a lower OR for LHDLC, and high usual quantity was significantly associated with a higher OR for HBP and ABO and a lower OR for LHDLC Table .5–7 findings from epidemiologic studies of the association between alcohol consumption and MetS are controversial. Some studies have found that moderate alcohol consumption is associated with a lower risk of MetS, whereas heavy alcohol drinking increases the risk of MetS (J- or U-shaped relation).17–19 Recently, a systematic literature review of published observational studies showed that alcohol consumption less than 40 g/day in men and less than 20 g/day in women  significantly reduced MetS risk.20 However, no significant association was found between alcohol drinking and MetS in other studies.21–23 In our study, heavy drinking, namely, 2.1 to 4.0 drinks/day or greater than 4.0 drinks/day, was significantly associated with a higher OR for prevalence of MetS, whereas no significant association was found between light drinking (<1.0 drinks/day or 1.1–2.0 drinks/day) and MetS prevalence in men. Compared with never drinkers, mild to moderate alcohol drinking and drinking pattern had no significant beneficial effect on MetS in either sex. This inconsistent relationship across studies might be due to the multifaceted and complex mechanistic relationship between alcohol consumption and each of the MetS components.24–30We found a significant dose-response relationship—not a J-shaped relationship—between average volume of alcohol consumed and MetS and its components in men, whereas only LHDLC and ABO were associated with MetS in women. Compared with light drinkers, male heavy drinkers but not female heavy drinkers had a significantly higher OR for prevalence of MetS and metabolic components. In men, unhealthy drinking patterns such as higher drinking intensity and binge drinking were significantly associated with an increased OR for prevalence of MetS and its components, whereas, in women, unhealthy drinking patterns were significantly associated with an increased OR for the prevalence of some metabolic components, but not MetS. We found that not only average daily alcohol volume but also drinking patterns was significantly associated with MetS and related components of MetS, especially in men. Although light to moderate alcohol intake has protective effects on cardiovascular disease morbidity and mortality,31 Recently, the 1999–2002 National Health and Nutrition Examination Survey of 1529 current drinkers found that people with unhealthy drinking patterns, such as higher than usual drinking quantity, drinking exceeding dietary guidelines, and frequent binge drinking, were at a significantly increased risk for MetS, even after controlling for drinking frequency.32 Significant associations between unhealthy drinking patterns and individual metabolic components were also observed.32 Evidence from a meta-analysis showed that drinking patterns modify the effect of alcohol consumption on coronary heart disease (CHD) risk.33 Binge and heavy irregular drinking is associated with increased CHD risk, whereas the well-established protective or beneficial effect of alcohol on CHD risk has been confirmed among regular drinkers.33Most studies of the relationship of alcohol intake with cardiovascular outcomes or MetS have collected information on average volume of alcohol consumption. Because few epidemiologic studies included information on drinking patterns, the association between drinking patterns and diseases is unclear. The Western New York Health Study of 2818 lifetime drinking adults showed that drinking intensity (drinks per drinking day), but not drinking frequency (drinking days per week), was significantly associated with MetS and all MetS components.31–33 we observed that unhealthy drinking patterns, such as higher usual quantity and binge drinking, were significantly associated with an increased OR for the prevalence of MetS and its components among men. Although there was no significant association between drinking patterns and MetS among women, some metabolic components were related to drinking patterns in our study. The LHDLC component of MetS was inversely associated with drinking pattern in both sexes. LHDLC was more strongly associated with drinking frequency than with usual quantity in men. This association was not apparent in women. The beneficial effect of high drinking frequency on HDL cholesterol was diminished by the detrimental effect on other MetS components. In contrast, the potent harmful effect of high usual quantity on abdominal obesity and blood pressure affected the significant association between usual quantity and MetS. Similar associations were observed in women; however, the results were not statistically significant.In agreement with previous studies,r = 0.794 for drinking frequency and r = 0.673 for usual quantity; P for difference <0.001). In our study, 30.0% of male binge drinkers (≥1 day/week) and 34.4% of female binge drinkers (≥1 occasion/week) were classified as light drinkers (<2.0 drinks/day for men and <1.0 drink/day for women) when only average volume of alcohol consumed was used. Previous epidemiologic studies using average volume as an indicator of alcohol intake were limited in detecting the effects of usual quantity (drinks per drinking day) or binge drinking. Therefore, it is important to include drinking pattern measures in epidemiologic studies of alcohol-related health problems and to consider drinking patterns when defining moderate drinking.32It has been suggested that drinking frequency is more highly correlated than usual quantity consumed with average volume of alcohol consumed. In our correlational analysis, we also examined this phenomenon . Analysis using nondrinkers as a reference group might have resulted in biased or weakened results as compared with the results obtained by using lifetime abstainers and former drinkers separately.In conclusion, there was a significant association between average volume of alcohol consumed and MetS in older men but not women. Unhealthy drinking patterns such as higher usual quantity and binge drinking were significantly associated with MetS in men but not women. Therefore, the effect of alcohol consumption on MetS should be considered in the context of drinking patterns, especially in men. From a public health perspective, we recommend that heavy drinkers and binge drinkers stop or control their unhealthy drinking habits.


Current Neuropharmacology. Their efforts have contributed greatly to the high quality and continuous growth of the journal. Given below is the list of reviewers who reviewed articles for the Journal during 2012:A. Barth (USA)A.A. Glaser (USA)A. López-Pousa (Spain)A.V. Mulder (Spain)B.N.R. Maldonado (USA)C.K. Uys (USA)D. Zou (USA)D.A. Nation (USA)E. Basha (India)E. Behrends (USA)G. Braunewell (USA)G.A. Buratti H. Capogna (UK)I. Carare (UK)J. Chakrabarti (India)J. Chuang (Taiwan)J. Czernuszka (UK)J. Deb (India)J. Foley (UK)J.R. Gervasoni (France)J.T. Horvath (USA)J.L.J. Smith (USA)J. James (Sweden)J.M. Kalia (Canada)Karl-Heinz Kalueff (USA)L. Kozan (Istanbul)L.V. Kumar (USA)M. Lockridge (USA)M. Mallick (India)M. Matés (Spain)O. Mongin (USA)P. Moss (USA)P.E.A. Mukhopadhyay (India)P. Mustufa (USA)R. Norkiene (Lithuania)R. Papaconstantinou (USA)R. Pasterski (UK)R. Payne (USA)S. Pellerin (Switzerland)S.R. Roberts (USA)S. Rosenberg (USA)S.S. Bourne (UK)T.S. Wilson (USA)T.I. Steinert (UK)T.L. Strekalova (The Netherlands)V. Swanson (USA)V.B. Patravale (India)Wen-Quan Tang (USA)Yao-Chung Uzbay (Turkey)Bentham Science Publishers would like to thank and appreciate the co-operation from all reviewers for their constructive comments and feedback on the manuscripts submitted to


We use generalized linear model (GLM), generalized additive model (GAM) and maximum entropy (MAXENT) to build models based on co-located occurrence datasets derived from two underwater video methods (i.e. baited and towed video) and fine-scale multibeam sonar based seafloor habitat variables. Overall, this study found that the choice of modeling approach did not considerably influence the prediction of distributions based on the same occurrence dataset. However, greater dissimilarity between model predictions was observed across the nine fish taxa when the two occurrence datasets were compared (relative to models based on the same dataset). Based on these results it is difficult to draw any general trends in regards to which video method provides more reliable occurrence datasets. Nonetheless, we suggest predictions reflecting the species apparent distribution (i.e. a combination of species distribution and the probability of detecting it). Consequently, we also encourage researchers and marine managers to carefully interpret model predictions.Planning for resilience is the focus of many marine conservation programs and initiatives. These efforts aim to inform conservation strategies for marine regions to ensure they have inbuilt capacity to retain biological diversity and ecological function in the face of global environmental change – particularly changes in climate and resource exploitation. In the absence of direct biological and ecological information for many marine species, scientists are increasingly using spatially-explicit, predictive-modeling approaches. Through the improved access to multibeam sonar and underwater video technology these models provide spatial predictions of the most suitable regions for an organism at resolutions previously not possible. However, sensible-looking, well-performing models can provide very different predictions of distribution depending on which occurrence dataset is used. To examine this, we construct species distribution models for nine temperate marine sedentary fishes for a 25.7 km Worldwide human activity is having adverse impacts on the structure and function of marine ecosystems In this context, predictive modeling of species’ distribution has become a fundamental tool Lepidopsetta polyxystra (northern rock sole) abundance and environmental variables  in five near-shore nursery grounds. The value of these data is not questioned; however the representativeness of these occurrence localities is dependent on which survey technique is used. For example, a comparison between baited and unbaited video, found that a greater number of individuals and species were recorded by the baited system; especially carnivorous fishes Often in the marine environment species distribution models (SDMs) are based on occurrence data collected by the researcher. This often results in predictions that are reasonable depictions of the focal species distribution. While there are many different methods available to provide occurrence datasets for demersal fishes in the marine environment, baited and towed systems are being used as they overcome many issues associated with traditional survey methods  are applied to the baited and towed video occurrences datasets for the nine fish taxa. This will provide a comparison of survey method as well as determine how these datasets potentially influence both types of SDMs (i.e. presence/absence and presence-only). With increasing application of SDMs in the marine environment, this paper will bring into focus the need for careful interpretation of predictions.The Area Under the receiver-operating characteristic Curves (AUC) was used to evaluate the models of habitat suitability for the nine demersal fish taxa. All of the 54 models of habitat suitability returned AUC values >0.5 . Of thesI statistic I values were grouped by thresholds adapted from Roubicek et al. I values <0.7 as low, 0.7–0.8 moderate, and >0.8 as highly degree of similarity between predictions of habitat suitability.The similarity between predictions of habitat suitability for the nine demersal fish taxa from the two observation techniques was assessed using the Generally, all three modeling approaches provided predictions with a high degree of similarity for the nine focal fish taxa based on the baited-video dataset . Similarly, comparison between MAXENT and the other two modeling approaches showed a high degree of similarity for five of the nine fish taxa. For U. vlamingii GAM was moderately different to both GLM and MAXENT, but no difference was observed between GLM and MAXENT (I  =  1). Similarly, both GAM and GLM were moderately different to MAXENT for Parequula melbournensis (silverbelly), but no difference was observed between GAM and GLM (Meuschenia scaber (cosmopolitan leatherjacket) showed the same trend as P. melbournensis, albeit to a greater degree .When compared to the baited-video datasets, more variation in similarity between the three modeling approaches was observed across the nine fish taxa based on the towed-video datasets . Similar and GLM . MeuscheCaesioperca spp. (perch) was the only taxa to exhibit a high degree similarity for all modeling approaches between the two observation datasets (Cheilodactylus nigripes (magpie morwong) that showed a high degree of similarity with towed-video-derived MAXENT, models for this species had a moderate degree of similarity between observation datasets irrespective of modeling approach (M. scaber (Notolabrus tetricus (blue-throated wrasse) a high degree of similarity was observed between the two observation datasets for GAM, GLM and MAXENT. Towed-video-derived MAXENT, however, showed a moderate degree of similarity with baited-video-derived GAM, GLM and MAXENT . A moderate degree of similarity between the two observation datasets was observed for all models for Pseudolabrus psittaculus , greater dissimilarity were observed when the predictions of habitat suitability based on the two video observation techniques were compared . Caesiopdatasets . With exapproach . Identic. scaber . A high . scaber . Towed-vd MAXENT . Predictdatasets . Baited-d models . A low diradiata .This study explored two commonly used underwater video techniques to provide occurrence data to develop and compare presence/pseudo-absence and presence-only fine-scale, habitat suitability models for nine species of temperate marine sedentary fishes. The habitat suitability models built in this study performed considerably better than random when assessed by AUC. The AUC values recorded in this study are similar to those observed in previous marine and terrestrial habitat suitability modeling studies e.g. . DespiteWhile numerous studies have compared modeling approaches in terms of model performance  was more evident when exposed to sounds from outboard motors. Further, Stoner et al. There are many factors that potentially influence the reliability of occurrence data of fishes, including traits such as; body size, crypticity, schooling behavior, habitat, camera avoidance and observer biases v. moving). Consider habitat patches with comparable fish population density but varying in natural shelters such as crevices or macroalgae. Sampling that relies on the use of a moving platform (e.g. an obliquely angled towed-video camera that is flown 2 m above the seafloor) to provide visual observations could result in incomplete detection in habitat patches with more natural cavities or canopy forming macroalgae (e.g. kelp). By contrast, sampling that relies on a stationary platform (e.g. baited-video) to provide a visual observation dataset may allow time for species that are hiding amongst the crevices or canopy forming macroalgae to be observed. However, the use of bait in these systems is well documented to increase the number of pelagic or epibenthic carnivores in the vicinity of the camera deployment Another possible explanation for the disparity between predictions of habitat suitability may be attributed to the deployment differences between the surveying methods  potentially reduces the issue of non-detections, the fact still remains that if a species is less detectable in a subset of its niche by a particular survey method, then this may influence model predictions. As highlighted by the differences between MAXENT model predictions observed in this study, the two video survey methods detected presences in slightly different environmental niches. For example, the fish taxon that provided predictions that were most similar was rca spp. . These a methods . This tiWhilst all model predictions for the nine fish taxa reflect aspects of their known ecology, the results from this study suggest that differences between model predictions are actually reflecting the apparent species distribution  to ensure that model outputs reflect as close to the actual distribution of suitable habitat for marine fishes as possible.This study has demonstrated that the characteristics of the video-derived occurrence data are potentially more important than the chosen modeling technique in developing fine-scale models of habitat suitability for temperate marine fishes. However, based on the results in the present study it is difficult to draw any general trends in regards to which circumstances what survey method provides more reliable occurrence datasets. Nonetheless, the main objective here was not to directly compare model performance, or even emphasize which of the two video methods compared is better for building models of habitat suitability for marine fishes. Instead, the purpose of this paper was to raise awareness that interpretation of habitat suitability models needs to account for the potential influence that the choice of survey method used to provide occurrence datasets may have. Whilst limitations within the datasets used in the present study precluded the use of site-occupancy models, which incorporate measures of detectability, it is suggested that these models may provide a practical alternative to conventional SDMs to predict the distribution of suitable habitat for demersal fishes. However, in the absence of repeat surveys (which would enable the use of enable site-occupancy models), researchers should select the method that is most likely to best detect their focal species; given the known behavior and ecology of the species (e.g. will the species react to bait? Or will the species respond to a moving camera?). Alternatively, conventional SDMs could be built utilizing occurrence datasets derived from different survey methods deployed at the same study site in a single field season. The similarity between these predictions can then be assessed , south-eastern Australia (Ecklonia radiata and Phyllospora comosa). A large sandy area in the north-western region of the study site also supported a sparse cover of seagrass (Zosteraceae).The study site encompassed an area 25.7 kmustralia . The sitThis study was undertaken in strict accordance with the recommendations and procedures determined by the Prevention of Cruelty to Animals Act 1986 and its Regulations, and the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes. This protocol was approved by the Deakin University Animal Welfare Committee (permit number A9-2009).Two video methods were deployed; (1) baited and (2) towed. The sampling strategy for each method was designed to provide adequate spatial coverage of the study site and to be representative of the dominant substrata types and benthic biological habitats, whilst also being appropriate for SDM analysis.The sampling strategy for the baited-video drops was a stratified random design. Stratified deployments were allocated utilizing the multibeam sonar bathymetry and accurately predicted biotic habitat map available for the study area. The validation test for this biota map returned overall accuracy of 83%. Detailed descriptions of the method used to validate the biota map are available in Ierodiaconou et al. Sardinops sagax (pilchard) in a closed plastic-coated wire mesh basket, suspended 1.2 m in front of the two cameras. Adjacent concurrent drops were separated by at least 250 m to avoid overlap of bait plumes and reduce the likelihood of fish moving between sites within the 1 h sampling period The baited-video systems used comprised two Sony HC 15E video cameras mounted 0.7 m apart on a base bar inwardly converged at 8° to gain an optimized field of view with visibility of ∼7 m distance  and converted to presence/pseudo-absence and presence-only datasets (see ‘Data Treatment’).Fish were sampled from February to March 2009, with a total of 219 60-min baited-video deployments precisely positioned with a differential GPS to ensure accurate spatial location . However−1 (1–2 knots). The oblique angled camera was maintained approximately 2 m from the bottom with a field of view of ∼7 m distance (water clarity dependent). The distance from the seafloor was monitored and maintained using live-feed video and a vessel-mounted winch system. A text overlay containing a time stamp and transect ID were recorded with the video using a Sony MiniDV recorder. The video footage was interrogated to identify fish species and the spatial position of each occurrence locality was then determined by matching the time stamp of the video with the corresponding survey positional data. The towed-video system was geo-located by integrating vessel location (Omnistar satellite dGPS), motion sensor (KVH) and acoustic camera positioning (Tracklink Ultra Short Baseline). The total propagated error at the maximum depth of the study site was ±5 m accuracy.Twenty nine towed-video transects were used to provide fish occurrence data. The 29 transects were selected to encompass the main physical gradients of the study site . Additional transects were undertaken throughout the shallow heterogeneous regions of the site to ensure adequate representation of habitats throughout the study site. The 29 transects covered 68 linear km of the study area . Over eiThe SDMs were built for the nine most common fish taxa  across tR’  multibeam sonar derived seafloor habitat variables as predictors  I statistics were built using SAM  to check all model residuals for spatial autocorrelation. Only very weak spatial auto-correlation  was found and corrections were not needed Semi-variograms and Moran’s F1, 161  =  2.28, P(perm) > 0.05). This evidence, combined with aforementioned research, indicates that time within and between video datasets is not a confounding factor.It is accepted that the collection of the two datasets three years apart is not ideal. Research suggests that many of the nine species used were highly territorial and maintain strict territories year round . Barrett I) allows quantitative similarity assessments between distribution predictions (i.e. GIS grid layers) by computing the differences between them cell by cell. The I-values range from 0, indicating that the two predictions are completely different, to 1, suggesting that both are equal. The I-statistic is independent of sample size and predicted range sizes, making it superior to other metrics that have been proposed earlier I values >0.8 are indicative of high degree of prediction overlap, values between 0.7 and 0.8 are moderate and values <0.7 indicate low similarity.As proposed by Warren et al.


There is unequal access to health care in Australia, particularly for the one-third of the population living in remote and rural areas. Video consultations delivered via the Internet present an opportunity to provide medical services to those who are underserviced, but this is not currently routine practice in Australia. There are advantages and shortcomings to using video consultations for diagnosis, and general practitioners (GPs) have varying opinions regarding their efficacy.The aim of this Internet-based study was to explore the attitudes of Australian GPs toward video consultation by using a range of patient scenarios presenting different clinical problems.Overall, 102 GPs were invited to view 6 video vignettes featuring patients presenting with acute and chronic illnesses. For each vignette, they were asked to offer a differential diagnosis and to complete a survey based on the theory of planned behavior documenting their views on the value of a video consultation.A total of 47 GPs participated in the study. The participants were younger than Australian GPs based on national data, and more likely to be working in a larger practice. Most participants (72%-100%) agreed on the differential diagnosis in all video scenarios. Approximately one-third of the study participants were positive about video consultations, one-third were ambivalent, and one-third were against them. In all, 91% opposed conducting a video consultation for the patient with symptoms of an acute myocardial infarction. Inability to examine the patient was most frequently cited as the reason for not conducting a video consultation. Australian GPs who were favorably inclined toward video consultations were more likely to work in larger practices, and were more established GPs, especially in rural areas. The survey results also suggest that the deployment of video technology will need to focus on follow-up consultations.Patients with minor self-limiting illnesses and those with medical emergencies are unlikely to be offered access to a GP by video. The process of establishing video consultations as routine practice will need to be endorsed by senior members of the profession and funding organizations. Video consultation techniques will also need to be taught in medical schools. Australia is a geographically dispersed country in which one-third of the population lives in rural and remote locations. Inequity in health care is thought to be linked to the cost of medical appointments and to the shortage of medical manpower in rural and remote areas ,2. In otIn theory, access to doctors can also be efficiently facilitated by online video technology . HoweverPeople who consult doctors in general practice are heterogeneous . The reaIn a face-to-face consultation, the doctor can use all 5 senses; however, in an Internet-based video consultation access to sensory information is limited, and the information that is available may be hampered by download speeds and/or the performance of computer hardware. Furthermore, there is no scope to intervene in person if the patient requires immediate resuscitation. Many of these limitations also apply to telephone consultations; yet, in parts of the world telephone consultations in primary care are considered routine and time saving ,11.This Internet-based pilot study aimed to explore Australian general practitioners’ attitudes to video consultation with a range of patients who may not be known to them previously. The survey tool used in this study was based on the theory of planned behavior (TPB) .This study was approved by the Curtin Human Research Ethics Committee (No: RD-61-12).Participants were recruited from members of the Curtin Health Innovation Research Network (CHIReN), a virtual network of general practitioners (GPs) across Australia who have already consented to be invited to participate in studies with standardized patients. The study took place over approximately 12 weeks. Each participant was remunerated AUS $50 as recompense for his/her time to participate in the study.Participants answered questions after viewing video-recorded monologs by actor-patients. Video scenarios were produced and validated by a team of 6 GPs. Six videos were produced, each featuring an actor-patient presenting a range of clinical problems. Information on medical history, family history, and drug history were offered at the outset of each video. The range of scenarios is consistent with those reported in the GP activity reports ,13. ScenThis theory postulates that a person’s behavior is determined by his/her intention to perform the behavior. This intention is determined by their attitude toward the specific behavior, their subjective norms, and their perceived behavioral control. These 3 domains were explored in this study with reference to scenarios depicting clinical challenges regularly presented to GPs in Australia . The iteThe respondents were presented with a video scenario and asked whether they would continue with the video consultation. They were also asked to suggest the level of difficulty of making a diagnosis on a scale from 1 to 7, with 1 being not at all difficult and 7 being extremely difficult. The higher the number, the stronger the intention to perform the behavior. For diagnosis difficulty, we calculated the mean of responses for each participant  or the mean for all participants across each scenario (which may reflect differences between scenarios).Direct measurement of attitude involved the use of bipolar adjectives , which are evaluative . We calculated the mean of the item scores to give an overall attitude score. The attitude items were also scored for internal consistency .Direct measurement involves the use of questions referring to the opinions of important people in general. The subjective norm items were scored for internal consistency . We calculated the mean of the item scores to give an overall subjective norm score.This was achieved by assessing the respondent’s self-efficacy and their beliefs about the controllability of the behavior. Self-efficacy was assessed by asking people to report how (1) difficult it was to perform the behavior, and (2) confident they were that they could do it. Controllability was assessed by asking people to report whether (1) performing the behavior was up to them, or (2) factors beyond their control determined their behavior.We checked that the subjective norm items had high internal consistency . We calculated the mean of the item scores of the 2 questions related to self-efficacy ; therefore, it was appropriate to include all the items in the composite variables. Using a multiple regression procedure, we entered intention as the dependent variable, and the direct measures of attitude, subjective norm, and perceived behavioral control (self-efficacy and controllability) as the predictor variables.A sample of 47 to 62 GPs would give us 80% power to reject the null hypothesis; that is, 50% of GPs would proceed with the consultation in most cases if the true proportion of GPs who choose to proceed was 70%. Such proportions are consistent with previous research .P values less than .05 were considered statistically significant. Stata version 12.1  was used to perform the analysis. Multiple regression models were adjusted for the lack of independence between individual participants by estimating the clustered standard errors to account for intragroup correlation (vce option in Stata).Multivariable logistic regression was used to determine if any identifiable subgroups of GPs, according to demographic criteria, showed significant differences in their scores. Forty-seven GPs were recruited from the 102 that CHIReN has on file, which is a response rate of 47%. One general practitioner omitted all demographic questions and was excluded from the analysis, resulting in a total sample of 46. The demography of the sample is reported in The GPs offered a differential diagnosis for each video and the level of difficulty in making a diagnosis for that scenario. Data in Data relating to the TPB are presented in P<.05, were retained in the final model and reported. The relative risk (RR) ratio of difficulty of diagnosis and TPB scores associated with the GPs’ intention to continue the consultation within each scenario is presented in General practitioner participants in this study might conduct a video consultation with patients other than those presenting with what could be an acute life-threatening emergency. Participants formed 3 approximately equal groups: those who would continue with the video consultation, those who were ambivalent, and those who would not. The scenario involving the person with anxiety evoked this typical response. GPs who had qualified from an Australian university were more likely to be equivocal about video consultations. Similar opinions were expressed by those medical practitioners who had been qualified for longer. However, those who had been in general practice for longer and those who worked in group practices were more likely to favor video consultations.Compared with the case of the patient presenting with anxiety and depression, GPs were more likely to reject continuing with a video consultation with the patient with alcohol dependence, myocardial infarction, or gall bladder disease. Their objections focused primarily around the inability to physically interact with the patient. Those who had been qualified as a medical practitioner for longer and those who worked longer hours were more likely to express negative views. On the other hand, participants who had been practicing as GPs for longer, GP registrars, those who worked in remote practice, and those from larger group practices were less likely to be negative about video consultations.Practitioners who were ambivalent about continuing with video consultations expressed the view that it was difficult to diagnose the patient presenting with symptoms of a cough, albeit an upper respiratory tract infection. By contrast, they had positive views about managing patients online for all but the chest pain scenario. They were also concerned about the attitude of significant others, such as patients, colleagues, and funders, about conducting video consultations particularly in the case of the patient with anxiety and depression. With regard to the low consistency between self-efficacy and controllability, we postulated that GPs did not feel they were able to conduct video consultations even if they wanted to because such consultations are not subsidized by government funding. However, they felt confident about their ability to conduct video consultations.GPs are unlikely to offer video consultations for patients with a minor self-limiting illness of recent onset. The reticence could be ascribed to the perceived need for a physical examination. The importance of clinical examination to establish a diagnosis for acute cough has been emphasized in previous literature . HoweverThe practitioners who participated in this study were generally younger than most Australian GPs. They were also more likely to be registrars and those working in a larger practice than average. Although the geographical distribution included a representative sample of practitioners from rural and remote areas, there were fewer from some states in Australia. We also acknowledge that the doctors had no opportunity to ask questions or seek clarification from the actor-patients. This was a significant issue, although it would have been difficult within the limitations of technology and the resources available to allow for such interactions in circumstances in which practitioners across Australia, living in different time zones, wished to participate in their own time and actors were only funded to perform a single vignette. Experience from previous studies with live consultations between actors and practitioner were that more limited numbers of practitioners were able and willing to participate. This introduces bias and less generalizable results . SecondlThe greatest strength of this study was the use of Internet-based video vignettes to gauge GP opinion. Video vignettes have significant advantages over other data collection methods, in particular, the advantage of realism, or something closely approximating it -25. VideAustralian GPs may adopt video consultations in their practice, but this is likely to be in larger practices with more established GPs, especially in rural areas. It is also likely that access to video consultations will need to focus on follow-up consultations, where the purpose of the consultation is not primarily to establish a diagnosis. Patients with minor self-limiting illnesses and those with medical emergencies are unlikely to be offered access to a GP by video. Medical practitioners appear confident about their ability to conduct video consultations; however, the process of establishing video consultations as routine practice will need to be endorsed by patients, members of the profession, and funding organizations. Video consultation techniques will also need to be taught in medical schools. Future research on this topic could follow a similar outline with vignettes, but include more interactive video consultations between practitioners and patients.


Existing key-frame extraction methods are basically video summary oriented; yet the index task of key-frames is ignored. This paper presents a novel key-frame extraction approach which can be available for both video summary and video index. First a dynamic distance separability algorithm is advanced to divide a shot into subshots based on semantic structure, and then appropriate key-frames are extracted in each subshot by SVD decomposition. Finally, three evaluation indicators are proposed to evaluate the performance of the new approach. Experimental results show that the proposed approach achieves good semantic structure for semantics-based video index and meanwhile produces video summary consistent with human perception. In the last few years, the prompt increasing of video data needs efficient techniques for browsing and index of this data . HoweverEarly key-frame extraction approaches can be classified into two categories: based on interframe difference and based on clustering. In the approaches based on interframe difference, a new key-frame is extracted only if the interframe difference overtakes a certain threshold –6. ClustThe approaches based on motion think that motion is an intrinsic attribute of video and human eyes are very sensitive to motion; thus they take into account motion events and camera operations in key-frame extraction. In , Liu et The approaches based on visual attention attempt to find the semantically relevant key-frames by simulating human visual perception mechanism. The approaches usually combine several representative feature maps  into a single saliency map  which can be used as an indication of the attention level. Lai and Yi  first coAll existing methods focus on video summary yet ignore the index task of key-frames. A new key-frame extraction approach should be found so as to take account of both tasks. It is the future direction of development and remains an important challenge in which establishing semantic structure for a video is the essential part.Current methods only extract the frame at each peak point which easily leads to content jumps in video summary. Therefore, some intermediate frames, having continuity and similarity in video content, are needed to help viewers to infer the original video content.All semantically relevant methods attempt to find the key-frames by recognizing video semantic content; yet automatic understanding of semantic content is unachievable for contemporary computers, and there are many unsolved problems, especially the following two problems.This paper divides a shot into several clips  in chronological order according to the overall discrepancies between video frames themselves. Each subshot consists of similar content frames, and there are great visual differences between subshots. Since similar video content expresses the same semantic element, subshot segmentation also means semantic structure division which is the basis of video index.m-dimensional vector, the subshot including n frames can be expressed as a m × n matrix A and the key-frame extraction can be seen as subset selection. As singular values can reflect the rank of a matrix, this paper computes the approximate rank of matrix A by singular values to determine the number of key-frames then uses the distance of adjacent frames to determine the specific locations of key-frames.After subshot segmentation, proper key-frames from the same subshot can ensure visual continuity. If each frame is represented as an To address these problems, this paper proposes a new key-frame extraction method, and the basic concept can be described as follows.k of key-frames by SVD decomposition; and (4) extract the k frames with the largest visual differences as key-frames in each subshot.The algorithm can be separated into four steps: (1) extract an HSV color feature vector for each frame; (2) divide the shot into subshots using a dynamic distance separability algorithm; (3) calculate the number The remainder of this paper is organized as follows. The subshot segmentation method is described in H is divided into 7 parts, the saturation S into 2 parts, and the brightness V into 2 parts, and the quantization is shown in , the perceptual color is a black area; therefore the range can be neglected. Similarly, when V is small enough (v < 0.2), it is neglected as a gray area:Compared with other color spaces, HSV color space is the closest to the characteristics of human vision . Becauseshown in  through shown in . When S x by L + 1 and select the preceding L frames as sample set ω1 and the latter L frames as sample set ω2.Establish a sliding window of length 2(2)ωi   according to (ω1 (the preceding L frames), and ω2 (the latter L frames), where L is the number of frames in each sample set and x is the feature vector of each frame as given in m−i=(3)Sωi and the between-class dispersion matrix Sb. The within-class dispersion matrix expresses the dispersion of each sample around the mean vector, and the between-class dispersion matrix expresses the distance distribution between two sample sets:There are various definitions of distance separability criteria. In practice, the most widely used criterion is based on the within-class dispersion matrix and the between-class dispersion matrix. Equations  and 8)  8) are, (4)F value reaches the maximum, the middle frame of sliding window coincidently lies on the border of two subshots:The greater the between-class dispersion, the smaller the within-class dispersion and the better the class separability. As shown in , we use F value is calculated according to , where i is the sequence number of the frames in a shot, and f(i) represents the F-value corresponding to the ith frame. The twice-difference method is used to extract the local-maxima as shown inx) represents the sign function:Next, we need to determine the frame number of each local-maximum. Assume a new function F-value curve, the twice-difference results are equal to −2; at local-minimum points, the twice-difference results are equal to 2; in other cases, the twice-difference results are equal to 0 or 1. The twice-difference results are shown in F-values of the last L frames in a video cannot be computed. To prevent the last L frames being a separate subshot because of rapid content changes, the last L frames are classified as a subshot if the last F-value exceeds one-third of the maximum.At local-maximum points of the m-dimensional vector . Concerning SVD, an important property given in A. The complete proof can be found in [Determine the number of key-frames; namely, determine the rank of matrix found in .A ∈ Rm×n, q = min, if k < r = rank(A) andFor A, namely, the number of key-frames to be extracted. As shown in (k that satisfies v(k) ≥ α is selected as the appropriate rank r, where the larger the threshold α, the more the selected key-frames and the more the available video details.We use  to detershown in , this eqA is very small. With the increasing complexity of video content, the nonlinear relationship between frames is enhanced; therefore singular values become more dispersed; that is to say, the rank of matrix A becomes larger and the selected key-frames become more. It is duly in compliance with the common sense that more key-frames should be extracted for the videos with higher complexity:For a static video, as the frames are very close in video content, they are approximate linear relation, which means that the rank of matrix A. The smallest correlation means the largest visual differences, and the video content differences between frames can be represented by inter-frame distance; therefore, this paper uses inter-frame distance to select the frames with the largest visual differences. First we calculate the histogram distance between each frame and its previous frame, as shown in (Pi(j) represents the gray value of jth pixel in the frame and n represents the total number of the frames within a shot; and then we extract the k frames with the largest distance as key-frames in each subshot:Locate key-frames; namely, select linearly independent sub-set of matrix shown in , where PL, λ in  Structure. This is essentially segmentation accuracy. The segmentation in this research is based on semantic meaning, which is determined by subjective criteria. Therefore, each original video was first divided up artificially based on perceived semantic structure, and then this baseline is compared with the experimental results. Continuity. The extracted key-frames must be as continuous as possible. A summary with many jumps is unlikely to be attractive to users. For visual continuity, some intermediate frames should be appended, even though they only play a part in connecting visual impressions and do not include important video content. In α to get more details in the key-frame extraction of the fourth subshot.(3) Repetition. While ensuring the presence of important information and visual continuity, the proposed algorithm attempts to eliminate redundancy and repetitive frames with the same semantic element. As shown in  criterion and recruit twenty testers to give subjective scores to the key-frame extraction results. First, every tester is given five shots, which covered the four types of videos. After viewing the extraction results and the original videos, the testers are asked to assign scores to the extraction results in terms of structure, continuity, and repetition. A scale (0.0–1.0) is used for scoring, where 0 represents great dissatisfaction and 1.0 represents great satisfaction. The scores from each tester are averaged to yield the assessment outcome shown in This paper is the first study to fit both video summary and video index; the new method achieves good semantic structure, good visual continuity, and low redundancy, not only can provide a video summary which is consistent with human perception but also can provide an index for further video operations and analysis.Note that because of the complexity and diversity of videos, the proposed algorithm cannot be proved to be capable of demonstrating good and stable performance on all videos. More experiments should be done to confirm the area of applicability of the algorithm. In addition, the deep reason of oversegmentation is overly simplified feature selection; future researches should also concentrate on composite feature selection to resist scrolling captions.


To assess behavior change in (binge) drinking and its positive /risk factors in adolescents admitted with alcohol intoxication. Multicenter retrospective study screening for underlying psychosocial and cognitive problems with a structural interview and behavioral checklists at follow up 8 weeks after the event. All adolescents < 18 years old, admitted with a BAC > 0.05 g/L and reduced consciousness, seen in the years 2009 & 2010 were invited. Adolescents with medical co-morbidity, or immediate referral to Youth Social Services were excluded. A total of 355 patients were invited and 226 included in the analysis. In total 103 adolescents stopped drinking  years, average BAC 1.88 (1.78 - 1.98) g/L) and 106 continued drinking  years, average BAC 2.00 (1.88 - 2.12) g/L). After multivariate analysis prior binge drinking (OR 5.287 (2.726 - 10.257), p = 0.000) and lack of negative consequences imposed by the parents after the event (OR 3.111 (1.594 - 6.071) p = 0.001) remained strongly associated with persistent drinking at follow up. Sub analysis of ongoing binge drinking identified age older than 16 years as a significant risk factor (OR 3.645 (1.314 - 10.114) p = 0.013). Strikingly, half of the adolescents admitted with alcohol intoxication do not learn from their negative experience. Binge drinking patterns and lack of negative consequences, are significantly associated with persistent alcohol use. Follow up should be directed towards patients and their parents with the aim to intervene and prevent ongoing alcohol use.


The ultimate stable state, says Clark citing Mumford , would bto know the representation: if cognition is a representation, we need a representation to know the previous one, and so on in infinitum. However, inasmuch as cognition goes beyond the mere generation of a prediction, a representation can be compared with the reality that represents. This comparison is a cognitive activity irreducible to the representation itself.In our opinion, the main problem of this view is the description of cognition as prediction, and prediction as some sort of representation. Perception, hence, is just a mean to correct previous predictions. This eludes the question about the very nature of cognition. In fact, if we understand cognition as a representative activity, there are two possible interpretations: cognition could be either (1) the process that generates the representation or (2) the resulting representation itself. In (1) we identify cognition with a causal process, and this neglects the fact that a representative activity is only possible if guided by a previous cognition. In (2) we face the problem of explaining what is representation is not possible without some kind of previous “presentation.” Clark’s example of the black box is very illustrative. He overlooks that cognition itself means the suppression of the “black box problem.” The confinement of an entity into a “black box” is a problem only if that entity is a cognitive system; that is, only a unit with the ability of cognition can be deprived of the possibility of comparing a representation with the external reality that represents. We think this clarification is especially important to understand the more basic sensory and perceptual levels. Vision, for instance, is not a representation of the world, but a codification of some information about the world. This intrinsic relation between cognition and the world can be called intentionality, using a word reintroduced by phenomenology, but only if, unlike phenomenology (Gallagher and Zahavi, In addition, This understanding of the cognitive activity is necessary to accept the existence of representations, which are an important way of knowledge, although they are not the first level. Assuming this, the interaction between the brain and the world has not only an effective or impinging character, as Clark states. The basic and more general level of cognition consists of the abstraction or separation of “information” by sensory systems from the effective causality which transports it Polo, . This prOne of the consequences of this omission is that the unified science of mind and action Clark proposes makes a deficient distinction between cognition and action. Action is a causal intervention of the living being in the world, but it is only an action inasmuch as it is informed by cognition. This leads to a different, although connected, sense of intentionality Moya, . The disHowever, the representational model proposed by Clark could be useful to understand some sort of secondary levels of cognition and practical action. In fact, we would like to propose a neural substrate for the so-called “Bayesian brain.” This should be a brain region able to integrate the top-down prediction with the bottom-up PE. Clark cautiously proposes a possible candidate for such interaction between predictions and PEs citing Friston , 2009 anThe striatum is the main receptor of cognitive, sensory, motor, and emotional information within the basal ganglia, a group of nuclei intimately involved in action from a wide point of view (decision-making, action selection, procedural memory, and instrumental learning, among others; Redgrave and Gurney, In conclusion, a holistic theory of the mind should distinguish cognition from action in a sharper way than Clark does. Action is a causal process arising in the subject and aimed to the outside world, but it is also guided by cognition itself. This is the key feature of action. We also believe there are enough evidences to propose the striatum, part of the basal ganglia, as the neural substrate of Clark’s proposal on practical action. On the other hand, the difficulty of disentangling information from causality in laboratory experiments makes difficult to find a neural substrate for sensory cognition.