bluuebunny/crossref_metadata_2025 huggingface dataset:
The significance of graft-versus-host disease and pretransplantation minimal residual disease status to outcome after allogeneic stem cell transplantation in patients with acute lymphoblastic leukemia
Authors: Uzunel Mehmet , Mattsson Jonas , Jaksch Marie , Remberger Mats , Ringdén Olle
Published: July 2002

Relapse is the major cause of treatment failure after allogeneic stem cell transplantation (SCT) in patients with acute lymphoblastic leukemia. Minimal residual disease (MRD) was analyzed before SCT in 30 patients with acute lymphoblastic leukemia. The aim was to determine whether the level of MRD before transplantation was correlated with outcome. Fifteen patients were found to have high-level MRD (10−2 to 10−3), 10 had low-level MRD (< 10−3), and 5 were MRD−. Among MRD− patients the probability of relapse was 0 in 5, which was less than in MRD+ patients (13 of 25) (P = .05). No major difference was found between the high- and low-level MRD+ groups. Among the MRD+ patients, only 2 of 11 with acute and chronic graft-versus-host disease had a relapse, versus 11 of 14 without (P = .005). In conclusion, for patients entering transplantation while they have residual disease, a combination of acute and chronic graft-versus-host disease may be needed to decrease the risk of relapse after SCT.
Functional expression of receptor activator of nuclear factor κB in Hodgkin disease cell lines
Authors: Fiumara Paolo , Snell Virginia , Li Yang , Mukhopadhyay Asok , Younes Mamoun , Gillenwater Ann Marie , Cabanillas Fernando , Aggarwal Bharat B. , Younes Anas
Published: July 2002

The malignant Hodgkin and Reed-Sternberg (H/RS) cells of Hodgkin disease (HD) express several members of the tumor necrosis factor (TNF) receptor family, including CD30 and CD40, and secrete several cytokines and chemokines. However, little is known about what regulates cytokine and chemokine secretion in H/RS cells. Although H/RS cells are predominantly of B-cell origin, they frequently share phenotypic and functional features with dendritic cells (DCs). Previous studies reported that receptor activator of nuclear factor κB (NF–κB) (RANK), a member of the TNF receptor family, is expressed on DCs, and that RANK ligand (RANKL) enhances DC survival and induces them to secrete cytokines. This study reports that, similar to DCs, cultured H/RS cells expressed RANK. However, unlike DCs, H/RS cells also expressed RANKL. Soluble RANKL activated NF-κB and induced messenger RNA expression of interferon-γ, interleukin-8 (IL-8), IL-13, IL-9, IL-15, and RANTES, in addition to the receptors for IL-9, IL-13, IL-15, and CCR4. RANKL increased IL-8 and IL-13 levels in the supernatants of H/RS cell lines, an effect that was blocked by soluble RANK. Furthermore, soluble RANK decreased the basal level of IL-8 in one cell line, suggesting that IL-8 was induced by an autocrine RANKL/RANK loop. RANKL had no effect on H/RS cell survival in culture, and it did not modulate the expression of bcl-2, bcl-xL, bax, or inhibitors of apoptosis proteins. These data provide evidence of further functional similarities between DCs and H/RS cells. The coexpression of RANK and RANKL in H/RS cells suggests that they may regulate cytokine and chemokine secretion in H/RS cells by an autocrine mechanism.
Reduced von Willebrand factor survival in type Vicenza von Willebrand disease
Authors: Casonato Alessandra , Pontara Elena , Sartorello Francesca , Cattini Maria Grazia , Sartori Maria Teresa , Padrini Roberto , Girolami Antonio
Published: July 2002

Type Vicenza variant of von Willebrand disease (VWD) is characterized by a low plasma von Willebrand factor (VWF) level and supranormal VWF multimers. Two candidate mutations, G2470A and G3864A at exons 17 and 27, respectively, of the VWF gene were recently reported to be present in this disorder. Four additional families, originating from northeast Italy, with both mutations of type Vicenza VWD are now described. Like the original type Vicenza subjects, they showed a mild bleeding tendency and a significant decrease in plasma VWF antigen level and ristocetin cofactor activity but normal platelet VWF content. Unlike the original patients, ristocetin-induced platelet aggregation was found to be normal. Larger than normal VWF multimers were also demonstrated in the plasma. Desmopressin (DDAVP) administration increased factor VIII (FVIII) and VWF plasma levels, with the appearance of even larger multimers. However, these forms, and all VWF oligomers, disappeared rapidly from the circulation. The half-life of VWF antigen release and of elimination was significantly shorter than that in healthy counterparts, so that at 4 hours after DDAVP administration, VWF antigen levels were close to baseline. Similar behavior was demonstrated by VWF ristocetin cofactor activity and FVIII. According to these findings, it is presumed that the low plasma VWF levels of type Vicenza VWD are mainly attributed to reduced survival of the VWF molecule, which, on the other hand, is normally synthesized. In addition, because normal VWF-platelet GPIb interaction was observed before or after DDAVP administration, it is proposed that type Vicenza VWD not be considered a 2M subtype.
Tissue inhibitor of metalloproteinases 1 is an autocrine and paracrine survival factor, with additional immune-regulatory functions, expressed by Hodgkin/Reed-Sternberg cells
Authors: Oelmann Elisabeth , Herbst Hermann , Zühlsdorf Michael , Albrecht Oliver , Nolte Annette , Schmitmann Christiane , Manzke Oliver , Diehl Volker , Stein Harald , Berdel Wolfgang E.
Published: July 2002

Tissue inhibitor of metalloproteinases (TIMP)-1 and TIMP-2 are proteins with proteinase-inhibiting and cytokine properties. TIMP-1 is active primarily in B cells and B-cell lymphomas, whereas TIMP-2 expression is restricted to T cells. The expression of TIMP-1 and TIMP-2 in lymph nodes from patients with Hodgkin disease (HD) and in Hodgkin-derived cell lines was investigated. In situ hybridization showed TIMP-1 RNA expression in 3% to 80% of Hodgkin/Reed-Sternberg (H/R-S) cells from 14 of 15 patients, with results in one patient being at the lowest detection limit; no expression of TIMP-2 in H/R-S cells; and only weak expression of TIMP-2 in reactive lymphoid tissue. Production of TIMP-1 protein by H/R-S cells was accordingly found on immunohistochemical analysis of lymph nodes from patients with HD. There was only low expression of matrix metalloproteinase (MMP)-2, which is mainly inhibited by TIMP-2; no expression of MMP-1 and MMP-3 in reactive lymphoid tissue; and no expression of these MMPs in H/R-S cells. Thus, TIMP-1 expression in lymph nodes was not correlated with metalloproteinase expression. Five of 7 Hodgkin-derived cell lines expressed TIMP-1 at the protein level. Only one of these cell lines expressed TIMP-2, at the lowest detection limit. TIMP-1 levels in plasma from patients with HD were within the same range as those in plasma from healthy controls. Recombinant human TIMP-1 inhibited induced cell death in Hodgkin-derived cell lines in vitro. TIMP-1 and TIMP-2 inhibited T-cell cytotoxicity against autologous cells presenting tumor-associated antigens and in allogeneic mixed lymphocyte cultures. Thus, TIMP-1, aside from its role in proteinase equilibrium, is an autocrine and paracrine survival factor for H/R-S cells and an immunosuppressive protein expressed in Hodgkin lymphomas.
Factor V Leiden: a genetic risk factor for thrombotic microangiopathy in patients with normal von Willebrand factor–cleaving protease activity
Authors: Raife Thomas J. , Lentz Steven R. , Atkinson Bonnie S. , Vesely Sara K. , Hessner Martin J.
Published: July 2002

Thrombotic microangiopathy (TM) is associated with abnormalities of von Willebrand factor–cleaving protease (VWCP) and other hemostatic factors. This study hypothesized that TM patients might have genetically determined thrombotic risk factors that predispose them to aberrant microvascular thrombosis. DNA samples from 30 white and 12 African American adult TM patients were analyzed for genetic alleles associated with vascular thrombosis, and plasma samples were analyzed for levels of VWCP activity. DNA was analyzed by using allele-specific polymerase chain reaction for factor V 1691A (Leiden), factor II 20 210A, methylenetetrahydrofolate reductase 667T, type 1 plasminogen activator inhibitor 4G/5G, and platelet GPIa 807T. Patients were segregated by race (white or African American) and plasma level of VWCP activity (normal or deficient). The prevalence of factor V Leiden was significantly increased among the white TM patients that had normal VWCP activity: 4 (36%) of 11 patients compared with 6 (3%) of 186 white control subjects possessed the factor V Leiden allele (P < .001; odds ratio, 17.1; 95% confidence interval, 5.4-54.0). No factor V Leiden alleles were detected in 19 white TM patients with intermediate or deficient levels of VWCP activity or in any of 12 African American patients. The prevalence of other thrombosis-associated alleles did not differ between TM patients and control subjects. These findings suggest that factor V Leiden may be a pathogenic risk factor in TM patients that have normal VWCP activity.
Signal transducer and activator of transcription 6 is frequently activated in Hodgkin and Reed-Sternberg cells of Hodgkin lymphoma
Authors: Skinnider Brian F. , Elia Andrew J. , Gascoyne Randy D. , Patterson Bruce , Trumper Lorenz , Kapp Ursula , Mak Tak W.
Published: July 2002

The unique clinicopathologic features of Hodgkin lymphoma (HL) are due to the multiple cytokines produced by its neoplastic cells, the Hodgkin and Reed-Sternberg (HRS) cells. Cytokine signaling is mediated through the signal transducer and activator of transcription (STAT) family of transcription factors. Immunoblotting and immunohistochemistry were used to examine cell lines and tissue sections derived from patients with HL and non-Hodgkin lymphoma (NHL) for expression of activated STAT proteins. Constitutive phosphorylation of STAT6 and STAT3 was common in HL. STAT6 was constitutively phosphorylated in 5 of 5 HL cell lines and in HRS cells from 25 of 32 (78%) classical HL cases. STAT3 was constitutively phosphorylated in 4 of 5 HL cell lines and in HRS cells from 27 of 31 (87%) classical HL cases. Only 4 of 24 NHL cases demonstrated constitutive STAT6 activation, whereas STAT3 activation was observed in 6 of 13 (46%) cases of B-cell NHL and 8 of 11 (73%) cases of T-cell NHL. Constitutive STAT5 phosphorylation was not a common feature of HL or NHL. STAT6 mediates signaling by interleukin 13 (IL-13), a cytokine frequently expressed by HRS cells. Antibody-mediated neutralization of IL-13 resulted in significant decreases in both cellular proliferation and levels of phosphorylated STAT6 of HL cell lines. In conclusion, constitutive STAT6 phosphorylation is a common and distinctive feature of HRS cells in classical HL, whereas STAT3 activation was regularly present in both HL and NHL. These results suggest that IL-13 signaling is largely responsible for the constitutive STAT6 activation observed in HRS cells and further implicate IL-13 as an important growth factor in classical HL.
Classical Hodgkin lymphoma is characterized by recurrent copy number gains of the short arm of chromosome 2
Authors: Joos Stefan , Menz Christiane K. , Wrobel Gunnar , Siebert Reiner , Gesk Stefan , Ohl Sibylle , Mechtersheimer Gunhild , Trümper Lorenz , Möller Peter , Lichter Peter , Barth Thomas F. E.
Published: July 2002

Hodgkin- and Reed-Sternberg (HRS) cells microdissected from 41 classical Hodgkin lymphomas (cHL) of 40 patients comprising 8 lymphocyte-rich (cHL-LR), 16 nodular sclerosis (cHL-NS), 15 mixed-cellularity (cHL-MC), and 2 lymphocyte-depletion (cHL-LD) subtypes were analyzed by comparative genomic hybridization for recurrently imbalanced chromosomal subregions. Chromosomal gains most frequently involved chromosome 2p (54%), 12q (37%), 17p (27%), 9p and 16p (24% each), and 17q and 20q (20% each), whereas losses primarily affected chromosome 13q (22%). Using fluorescence in situ hybridization, amplification of the REL oncogene was demonstrated within a distinct 2p15-p16 amplicon. The high frequency of 2p overrepresentations including REL, particularly in cHL-NS (88%), suggests that an alternative mechanism of constitutive activation of nuclear factor NF-κB is a hallmark of HRS cells. Hierarchical cluster analysis of chromosomal imbalances revealed a closer relationship among cHL-NS than other subtypes. Furthermore, there is a tendency for different subtypes of cHL-MC tumors characterized by different ages at the time of tumor onset and gain of chromosome 17p. The imbalance pattern of cHL subtypes suggests that different molecular pathways are activated, with REL or other genes on chromosomal band 2p15-p16 playing a fundamental role in the pathogenesis of classical Hodgkin lymphoma.
Thrombin induces increased expression and secretion of angiopoietin-2 from human umbilical vein endothelial cells
Authors: Huang Yao-Qi , Li Jian-Jun , Hu Liang , Lee Merlin , Karpatkin Simon
Published: July 2002

Angiogenesis is required for tumor growth and metastasis. It has recently been suggested that thrombin is a potent promoter of angiogenesis. We therefore examined the possibility that thrombin could be inducing the expression of angiopoietin-2 (Ang-2), necessary for remodeling. Human umbilical vein endothelial cells were incubated with or without thrombin (1 U/mL) for 1 to 24 hours and then examined for messenger RNA (mRNA) by Northern analysis. Enhanced mRNA expression (about 4-fold over baseline) was noted at 4 hours. Enhanced expression of Ang-2 mRNA was secondary to enhanced transcription (about 4-fold), with no effect on stabilization. Enhanced Ang-2 mRNA transcription was inhibited by H7 and PD98059, indicating the requirement of serine/threonine kinases as well as the mitogen-activated protein kinase pathway. Up-regulation of mRNA was associated with enhanced Ang-2 protein synthesis and secretion as assayed by immunoblot. Thrombin-induced secreted Ang-2 inhibited the binding of recombinant 35S–Ang-1 to its Tie-2–Fc receptor, demonstrating functionality. Hirudin reversed this effect, demonstrating thrombin specificity. Thus, thrombin-induced tumorigenesis and metastasis is associated with enhanced Ang-2 protein synthesis and secretion via enhanced transcription of Ang-2. This could help explain how thrombin promotes angiogenesis.
Narrative as a tool for the assessment of linguistic and pragmatic impairments
Authors: Botting Nicola
Published: July 2002

Narrative ability is one of the most interesting and ecologically valid ways in which to measure communicative competence both in normal populations and in clinical groups, since narratives form the basis of many childhood speech acts. Narrative may also prove to be a good tool for distinguishing clinical groups who show overlapping symptoms but who are thought to experience subtly different impairments. This article gives an overview of some of the theoretical reasons for using narrative to assess both linguistic and pragmatic impairments. As part of a preliminary investigation examining possible similarities and differences across groups, five children with severe pragmatic language impairments (PLI) and five with more typical specific language impairments (SLI) completed short picture based narratives using the Bus Story and the Frog Story. These illustrative data are included throughout the paper to highlight features of use to clinicians, particularly with respect to differences in the narratives of children with PLI compared to their peers with SLI. Furthermore, when compared to Tager-Flusberg’s (1995) data from children with autism, SLI narratives seem to be more similar to those of the group with autism than did PLI narratives. Narrative ability was found to relate directly to pragmatic skill but in different ways according to clinical subgroup. Implications for both theory and practice are discussed.
Percutaneous cardiopulmonary support for the treatment of right ventricular thrombus
Authors: Inoue Takehiro , Oka Hiroshi , Oku Hidetaka
Published: July 2002

The management of patients with acute pulmonary embolism (PE) remains controversial, despite an improved understanding of its pathogenesis and diagnosis. Haemodynamic instability due to right ventricular failure and hypoxia following PE is associated with a high mortality rate. This report describes a case of a 22-year-old woman with leukaemia in which percutaneous cardiopulmonary support (PCPS) was used as an adjunct to thrombolytic therapy in the treatment of right ventricular thrombus with acute PE. The patient has since undergone regular follow-up on an outpatient basis without showing any recurrence of thromboembolism at 2 years postoperatively. This experience suggests that supportive PCPS may provide favourable clinical outcomes in high-risk patients with severe PE.
Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study
Authors: Bevilacqua Stefano , Matteucci Sacha , Ferrarini Matteo , Kacila Mirsad , Ripoli Andrea , Baroni Alessandra , Mercogliano Domenico , Glauber Mattia , Ferrazzi Paolo
Published: July 2002

Aims of the study: In this prospective, randomized study, we investigate the potential advantages of vacuum-assisted venous drainage (VAVD), compared to gravitational drainage (GD), in patients undergoing first-time coronary artery bypass graft (CABG) surgery, concerning biochemical markers of organ and blood cell damage.

Materials and methods: Seventy-two consecutive patients were randomized into two groups [‘Vacuum’ (VAVD) n= 36; ‘Not vacuum’ (GD) n= 36]. VAVD was achieved using a wall vacuum source and with a suction regulator connected to the vent port of the hardshell venous reservoir. In the VAVD group, we used 28-French venous cannulas, and 36-French in the GD group. In the VAVD group, we measured arterial perfusion flow (APF) and the venous reservoir volume (VRV) with and without vacuum application just after starting extracorporeal circulation (ECC). Six blood samples were drawn at different times before, during and after ECC. Routine blood tests were performed to evaluate hemolysis, and hepatic and renal function.

Results: The two groups were similar in terms of preoperative and operative characteristics. There were no significant differences in biochemical markers of organ function or hemolysis between the two groups. In the VAVD patients, platelet count was higher at 24 h after the end of the operation (VAVD 151.77± 50.28 μl versus Not vacuum 124.93± 41.60 μl, p= 0.028). With the narrower venous cannulas (28-French), only VAVD achieved a satisfactory APF (VAVD 2.35± 0.38 l/min/m2 versus GD 1.88± 0.27 l/min/m2, p= 0.002), with a larger VRV (VAVD 1091.67± 421 ml versus GD 808.33± 284.31 ml, p= 0.025).

Conclusion: Vacuum-assisted venous drainage is a technique comparable to gravitational drainage with regard to hemolysis and organ perfusion. It allows better perfusion flow and heart decompression with smaller venous cannulas. This study suggests reduced platelet consumption with VAVD.
Validity of the TEMPA for the measurement of upper limb function in multiple sclerosis
Authors: Feys P , Duportail M , Kos D , Van Aschand P , Ketelaer P
Published: July 2002

Objective: To investigate concurrent and construct validity of the TEMPA (Test d'Evaluation de la performance des Membres Supérieurs des Personnes Âgées) in patients with upper limb dysfunction due to multiple sclerosis.

Subjects: Forty-three patients with upper limb dysfunction due to multiple sclerosis.

Design: Patients performed upper limb tests and were assessed on measures of functional independence.

Setting: National Multiple Sclerosis Centre, Melsbroek, Belgium.

Main outcome measures: TEMPA, Jebsen Handfunction Test, Nine Hole Peg Test, Functional Independence Measure (FIM) and activities of daily living (ADL) self-questionnaire.

Results: The correlation between TEMPA and Jebsen Handfunction and the Nine Hole Peg test respectively is good (0.56–0.87) and high (0.79–0.9). The correlation between TEMPA and the FIM and ADL self-questionnaire was moderate (0.44–0.61) although mostly higher than the correlation between the Jebsen Handfunction and the Nine Hole Peg test respectively and the measures of functionality (0.22–0.55/0.1–0.47).

Conclusions: This study provides data supporting the concurrent validity of the TEMPA with the Jebsen Handfunction and the Nine Hole Peg Test in patients with multiple sclerosis. The results suggest construct validity of the TEMPA for the measurement of functionality during activities of daily life in patients with upper limb dysfunction due to multiple sclerosis.
Stroke patients' and therapists' opinions of constraint-induced movement therapy
Authors: Page Stephen J , Levine Peter , Sisto Sueann , Bond Quin , Johnston Mark V
Published: July 2002

Objective: To determine the opinions of patients with stroke and therapists about constraint-induced movement therapy (CIT).

Subjects and intervention: Two hundred and eight patients with stroke in the northeastern USA responded to a self-report questionnaire administered through the mail and via telephone interviews. A similar questionnaire was administered to 85 physical and occupational therapists in the northeastern USA during their clinical staff meetings. The questionnaire described CIT to participants using excerpts from a recently published CIT study. Subjects then responded to various statements concerning their opinions of the protocol and supplied rationale for their opinions.

Results: Sixty-eight per cent of patients said they were not interested in participating in CIT, citing concerns with the practice schedule and the restrictive device schedule. Therapists cited concerns about patient adherence and safety, and speculated that facilities may not have the clinical resources to provide CIT.

Conclusions: Patients with stroke and therapists in some environments may hold sceptical views about the utility of CIT. Although it has been shown to be effective in laboratory research, CIT may have low clinical practicality in some environments.
Evaluation of cognitive assessment in stroke rehabilitation
Authors: McKinney M , Blake H , Treece K A , Lincoln N B , Playfordand E D , Gladman J RF
Published: July 2002

Objective: To assess the effect of cognitive assessment on the functional outcome of stroke patients and quality of life for both patients and their carers.

Design: A multicentre, single-blind, randomized controlled trial.

Setting and participants: Two hundred and twenty-eight stroke patients were recruited from hospital wards in three UK centres.

Interventions: Patients were screened for cognitive impairment and randomly allocated to either routine care (116 patients) or routine care plus a detailed cognitive assessment (112 patients).

Main outcome measures: Outcome was assessed three and six months after recruitment by an independent assessor blind to the intervention on Extended ADL, Cognitive Failures Questionnaire, General Health Questionnaire-28 for patients and carers and Carer Strain Index.

Results: There was no signi”cant difference between the two groups in patients’ functional outcome, perceived cognitive ability, level of psychological distress or satisfaction with care. There was a trend for the assessment group to have lower levels of carer strain ( p = 0.06).

Conclusions: The provision of information about cognitive assessment in stroke rehabilitation may decrease carer strain.
Reliability of gait speed measured by a timed walking test in patients one year after stroke
Authors: Green John , Forster Anne , Young John
Published: July 2002

Objective: To assess the reliability of gait speed in late-stage stroke patients.

Design: Test–retest reliability of three timed walks to 10 metres repeated during two assessments one week apart.

Setting: The patient's home.

Subjects: Twenty-two stroke patients with mobility problems more than one year after stroke.

Main outcome measure: Gait speed measured in seconds taken to walk 10 metres.

Statistical analysis: Intraclass correlations (ICCs) with 95% con”dence interval (CI) and the Bland and Altman method for assessing agreement by calculating the mean difference between measurements ( d–); the 95% CI for d–; the standard deviation of the difference (SDdiff); a reliability coef”cient and the 95% limits of agreement.

Results: There was a trend for decreased times taken to walk 10 metres both within each assessment and between assessments. ICCs for within assessment reliability were 0.95–0.99. The d– (SDdiff) for the second and third walks for assessment 1 was –1.00 (2.63) seconds and for assessment 2 was –0.70 (1.58) seconds. The reliability coef”cient was 5.26 for assessment 1 and 3.17 for assessment 2. ICCs for between-assessment reliability were 0.87–0.88. The d – (SDdiff) for the comparison of the third walks at assessment 1 and assessment 2 was –0.90 (5.01) seconds. The reliability coef”cient was 10.02 and the 95% limits of agreement were –10.92 to +9.12 seconds.

Conclusion: Within-assessment gait speed measured at home is highly reliable. The between-assessment reliability of gait speed measurement is less reliable but comparable with other studies.
Assessing education in palliative medicine: development of a tool based on the Association for Palliative Medicine core curriculum
Authors: Rawlinson F , Finlay I
Published: July 2002

The Association for Palliative Medicine (APM) of Great Britain and Ireland has developed a core curriculum for palliative medicine. To establish the appropriateness of this core curriculum as a standard against which training can be measured, we have examined how doctors from different medical, social and cultural backgrounds view its various elements. In 1998, we succeededin tracing 304 of 390 doctors, past students of the University of Wales College of Medicine's Diploma in Palliative Medicine. Each was sent a postal questionnaire that asked them to rate the importance to their own clinical practice of each element of the APM core curriculum. Two-hundred sixty-three questionnaires were returned a response rate of 87%. The ages rangedfrom 30 to 71 (mean 44) years; 56% (147) were female. Forty per cent (105) were general practitioners, and 37% (97) hospice and 23% (61) hospital-based. Eighty-three per cent (220) were fromthe UK, 5% (14) from the rest of Europe, 8% (21) from the Far East and 3% (8) from other countries. The majority of respondents agreed that all elements of the APM core curriculum were of ‘very great' or ‘great' importance to their current clinical practice. Respondents' medical, social or cultural setting had only very minor effects on their attitude to individual elements. The elements of the curriculum perceived as being of greatest importance were: communication with patients and their families, assessment, diagnosis and treatment of pain, multiprofessional team working and psychological responses to illness and bereavement. Clinicians from a wide variety of backgrounds confirm the relevance of the APM core curriculum. This justifies its adoption as the audit standard against which the quality of training and educational programmes in Palliative Medicine should be judged.
Palliative care and policy in England: a review of health improvement plans for 1999–2003
Authors: Seymour J , Clark D , Marples R
Published: July 2002

Since 1987 health authorities in England have been required to make plans for palliative care provision, but their record in doing so has been patchy. The production of health improvement plans (HImPs), in which each health authority must set out its priorities and actions designed to improve the health and well-being of its local population, provides an opportunity to examine the extent to which palliative care provision in the NHS is regarded as a priority by policy makers in England. This paper reports on a structured documentary review of the HImPs published by the 99 health authorities in England. The review indicates that at the moment, in spite of the longstanding duty placed on health authorities to develop strategic plans for palliative care and to assess the level of local palliative care needs, not all have made significant progress in this direction. Among those that do have plans for palliative care, the vast majority of these plans are for people with cancer. What emerges most clearly is a sense in which specialist palliative care, especially for non-cancer patients, is perceived as an ‘optional extra’ by many health authorities rather than an integral and essential part of the overall supportive care strategy which they clearly are at pains to develop.
Analysing space-time behaviour: new approaches to old problems
Authors: Timmermans Harry , Arentze Theo , Joh Chang-Hyeon
Published: July 2002

Time geography had led geographers to analyse and model activity-travel patterns since the 1970s. The notion that activity-travel patterns are highly constrained has been frequently used in analytical studies and models of space-time behaviour. The popularity of this field of research lost most of its momentum in geography in the 1990s, but is now the dominant approach among civil engineers in transportation research. This paper critically reviews these developments. It briefly summarizes recent developments in space-time research, focusing on empirical and modelling studies. Potential strengths and weakness of the various modelling approaches are discussed.
Glacier mass balance: the first 50 years of international monitoring
Authors: Braithwaite Roger J.
Published: July 2002

The paper reviews measurements of glacier mass balance in the period 1946-95. There are data for 246 glaciers but most records are quite short. The available mass-balance data are biased to Western Europe, North America and the former USSR with too few measurements from other parts of the world. The data are also biased towards wetter conditions with too few data from the dry-cold glaciers that are typical of many regions. There is no sign of any recent global trend towards increased glacier melting, and the data mainly reflect variations within and between regions. The ‘direct method’ of measuring glacier mass balance is with stakes and snowpits but it is a very laborious way of measuring long-term glacier changes. Stake/snowpit measurements should be more integrated in future with geodetic and remote sensing methods, especially laser profiling, and with modelling.
The Holocene vegetation history of Northern Pirin Mountain, southwestern Bulgaria: pollen analysis and radiocarbon dating of a core from Lake Ribno Ban derishko
Authors: Tonkov Spassimir , Panovska Hristina , Possnert Goran , Bozilova Elissaveta
Published: July 2002

Pollen analysis was performed on a 343 cm long core recovered from Lake Ribno Banderishko (2190 m) on Northern Pirin Mountain (southwestern Bulgaria), supplemented by six '4C AMS dates. The lower part of the sequence (343-290 cm) was deposited during the Lateglacial when mountain-steppe vegetation with Artemnisia, Poaceae, Chenopodiaceae and other herbs, and with stands of Pinus and Juniperus, dominated at high altitudes. The identification of pollen of mesophilous trees suggests that local populations may have survived in refuges below 1000 m where environmental conditions were favourable for their growth. The reforestation dynamics in early-Holocene times (11200-8400 cal. BP) started with Betula forests at high altitudes and deciduous forests with Quercus, Ulmus, Tilia and Fraxinus excelsior at lower altitudes. The time of the maximal spread of Corylus at c. 8000 cal. BP coincided with the establishment of Abies alba in the forests, and the beginning of the formation of a coniferous belt, dominated by pines (Pinus sylvestris, P. peuce, P. nigra and P. heldreichii). The late immigrants Fagus sylvatica and Picea abies invaded the mountain slopes at c. 4400 cal. BP and 3300 cal. BP, respectively. Palynological traces of anthropogenic activity and landscape management began after c. 2200 cal. BP.
Interactions of climate and land use documented in the varved sediments of Seebergsee in the Swiss Alps
Authors: Hausmann S. , Lotter A. F. , van Leeuwen J. F.N. , Ohlendorf Ch. , Lemcke G. , Grönlund E. , Sturm M.
Published: July 2002

This paper presents a multiproxy high-resolution study of the past 2600 years for Seebergsee, a small Swiss lake with varved sediments at the present tree-line ecotone. The laminae were identified as varves by a numerical analysis of diatom counts in the thin-sections. The hypothesis of two diatom blooms per year was corroborated by the 210Pb and 137Cs chronology. A period of intensive pasturing during the ‘Little Ice Age’ between ad 1346 and ad 1595 is suggested by coprophilous fungal spores, as well as by pollen indicators of grazing, by the diatom-inferred total phosphorus, by geochemistry and by documentary data. The subsequent re-oligotrophication of the lake took about 88 years, as determined by the timelag between the decline of coprophile fungal spores and the restoration of pre-eutrophic nutrient conditions. According to previous studies of latewood densities from the same region, cold summers around ad 1600 limited the pasturing at this altitude. This demonstrated the socio-economic impact of a single climatic event. However, the variance partitioning between the effects of land use and climate, which was applied for the whole core, revealed that climate independent of land use and time explained only 1.32% of the diatom data, while land use independent of climate and time explained 15.7%. Clearly land use in‘ uenced the lake, but land use was not always driven by climate. Other factors beside climate, such as politics or the introduction of fertilizers in the seventeenth and eighteenth centuries also in‘ uenced the development of Alpine pasturing.
Severe fenthion intoxications due to ingestion and inhalation with survival outcome
Authors: Tsatsakis A M , Bertsias G K , Liakou V , Mammas I N , Stiakakis I , Tzanakakis G N
Published: July 2002

Two cases of severe fenthion intoxication are presented. The first is a case of a psychiatric patient who attempted suicide with ingestion of the compound, and the second case was of a child exposed to the chemical agent by air spraying. Both patients were treated in the intensive care unit with atropine and pralidoxime and finally survived. Fenthion blood levels on admission were 2.7 and 0.95 μg/mL, respectively. Different concentrations of pralidoxime were added to the first patient's poisoned serum in order to assess in vitro the effect of pralidoxime on cholinesterase reactivation. The clinical and toxicological data of the poisonings are discussed, as well as the potential therapeutic use of pralidoxime in organophosphate intoxication.
Analysing longitudinal continuous quality of life data with dropout
Authors: Curran D , Molenberghs G , Aaronson N K , Fossa S D , Sylvester R J
Published: July 2002

Quality of Life (QL) is becoming an increasingly popular endpoint in phase III cancer clinical trials. However, there is still no agreement as to what is the optimal approach to analysis. In this paper we review some concepts which should be considered during a QL analysis. We present two modelling approaches that have been substantively developed in other research fields: selection models and pattern-mixture models. These models are compared using data from an EORTC clinical trial in poor-prognosis prostate cancer patients. It is illustrated that, although selection models and pattern mixture are probabilistically equivalent, they may shed completely different light on data from a modeller’s point of view.
British Frontier Warfare Logistics and the ‘Black Line’, Van Diemen’s Land (Tasmania), 1830
Authors: Connor John
Published: July 2002

The 1825-31 frontier war in Van Diemen’s Land (now Tasmania) shows the importance of logistics to British success in colonial confl ict during the eighteenth and nineteenth centuries. Despite superior numbers and weaponry, the British were unable to defeat the Tasmanian Aborigines until the colonial governor, Colonel George Arthur, mounted the elaborate operation which became known as the `Black Line’. This forced the Aborigines to surrender and accept removal to a reservation. The supply of the Line during the deployment required the mobilization of both the military and civilian infrastructure, especially the colony’s commissariat and survey department.
The Navy Board and Transports for Cartagena, 1740
Authors: Syrett David
Published: July 2002

The movement of British troops across the Atlantic to attack Cartagena during the War of Jenkins’s Ear was the first large British transatlantic troop movement in history. To carry these troops to Cartagena, the British government had to charter merchant ships to serve as transports. It was the responsibility of the navy board, an agency of the civil administration of the Royal Navy, to hire the required number of ships and to establish procedures and policies concerning freight rates, fitting, provisioning and administering the ships that served as transports during the expedition to Cartagena.
Oscillations on the Hotspur-Falstaff Spectrum: Paul Fussell and the Ironies of War
Authors: Darby Robert
Published: July 2002

This article reviews the main arguments of Paul Fussell’s The Great War and Modern Memory and seeks to retrieve the author’s objectives from the wider problems that have subsequently become the subject of scholarly debate, such as the relation of the war to modernism, and to evaluate the strengths and limitations of his survey. It focuses on the issues of `high diction’ in poetry and rhetoric, the persistence of myth, the dynamics of consolation and the uses of irony, and considers particularly the powerful critique of J.M. Winter in Sites of Memory, Sites of Mourning (1995). It concludes with some reflections on the obvious autobiographical elements in Fussell’s work.
The Fundamental Values of Nurses in Poland
Authors: Wrońska Irena , Mariański Janusz
Published: July 2002

Polish society has found itself at a very important point in its history. The transformation from a traditional to a postmodern pluralistic society involves changes in many spheres of social life. These trends give rise to the question of which way the younger generation of Polish nurses will be going. The main objective of this research was to elucidate the opinions of nurses on life and health as basic values, and on their ethical and religious background regarding their nursing care. The study made use of a questionnaire for collection and interpretation of the data. Although this article shows some lack of consistency, and even contradictions, it is possible to conclude that life and health are cherished with affection by the great majority of nurses as positive factors of human existence.
An Observational Study of the Level at Which Parents Participate in Decisions During Their Child’s Hospitalization
Authors: Hallström Inger , Runeson Ingrid , Elander Gunnel
Published: July 2002

When a child is hospitalized, the parents find themselves in an unfamiliar environment and their parental role changes. They are in a stressful and often anxiety-filled situation and it may be difficult for them to participate in decisions. The purpose of this study was to examine the extent to which parents participate in decisions during the course of events when their child is hospitalized. Thirty-five parents of 24 children (aged 5 months to 18 years) were followed by mobile observation during their child’s hospitalization in a paediatric department in Sweden. Three researchers analysed field notes in three steps, using manifest and latent coding. In step 1, 119 situations that included a decision process were identified. In step 2, the situations were assessed according to a five-level scale concerning how the parents’ wishes, desires or values had been respected. In step 3, each situation was scrutinized with respect to factors influencing the extent of the parents’ participation. The results showed that parents have varying ability to be involved in decision making. Professionals need to communicate more openly with them in order to identify and satisfy their needs because some parents are unwilling or incapable of expressing them.
Construction or obstruction: teacher talk and learner involvement in the EFL classroom
Authors: Walsh Steve
Published: July 2002

To what extent do teachers of EFL hinder or facilitate learner contributions by their use of language? How can teachers enhance the quantity and quality of learner output by more careful language use? In what ways do teachers deny learning opportunities by ‘filling in the gaps’ or ‘smoothing over’ learner contributions? Adopting the position that maximizing learner involvement is conducive to second language acquisition, this paper examines the ways in which teachers, through their choice of language, construct or obstruct learner participation in face-to-face classroom communication. From the lesson extracts emerge a number of ways in which teachers can improve their teacher talk to facilitate and optimize learner contributions. The conclusion, that teachers’ ability to control their use of language is at least as important as their ability to select appropriate methodologies, has implications for both teacher education and classroom practices.
Translating culture - a think-aloud protocol study
Authors: Olk Harald Martin
Published: July 2002

The article describes a think-aloud protocol study exploring translation processes of degree-level language students when dealing with culturespecific lexis. The study found that one of the students' main problems was a fixation on questionable word-level parameters at the expense of text-level processes. As this fixation appears likely to be related in some way to teaching practice, which focuses students' attention in translation on small text units, some suggestions are made as to how text-level consideration could be enhanced.
Seen any wildlife? Community conflict and a struggle for the soul of Estes Park, Colorado
Authors: Wondrak Alice K.
Published: July 2002

Recent calls to ‘bring the animals back in’ to geography have produced some excellent explorations of the ‘nature/culture borderlands’. Those borderlands are perhaps never more fluid than in places where a national park meets a so-called ‘gateway community’; and when a private company recently proposed to build a tourist attraction where small local fauna would be displayed in plexiglass environments in Estes Park, Colorado (gateway to Rocky Mountain National Park), a maelstrom of controversy erupted. Although it was approved by the town’s board of trustees, the proposed Rocky Mountain Interpretive Wildlife Center project was stalled after an election in which the town’s citizens passed a measure prohibiting the exhibition of caged animals because their presence was found to be contrary to the ‘character or nature of the Estes Park community’. This paper explores the local process by which what appeared on the surface to be an argument about how and where wild animals should live turned out to be rooted in classic geographical questions of space, sense of place, insiders and outsiders, land use, power, political process, and the veracity of the so-called nature/culture divide. Crucial to the discussion are the roles which competing ways and modes of seeing played in determining the appropriateness of development in the Estes Park landscape.
Thymidylate Synthase Expression in Colorectal Cancer: A Prognostic and Predictive Marker of Benefit From Adjuvant Fluorouracil-Based Chemotherapy
Authors: Edler David , Glimelius Bengt , Hallström Marja , Jakobsen Anders , Johnston Patrick G. , Magnusson Inger , Ragnhammar Peter , Blomgren Henric
Published: July 2002

PURPOSE: We studied the prognostic value of thymidylate synthase (TS) expression in primary colorectal cancer (CRC) and the role of TS expression as a predictor of chemotherapeutic benefit in patients treated with adjuvant chemotherapy.

PATIENTS AND METHODS: TS expression was immunohistochemically assessed on tumor sections from 862 patients with CRC Dukes’ stages B and C enrolled onto randomized trials evaluating fluorouracil (5-FU)-based adjuvant chemotherapy.

RESULTS: TS expression was an independent prognostic factor for disease-free (P = .05) and overall survival (P = .05). In the subgroup treated with surgery alone, TS was an independent prognostic factor for disease-free (P < .001) and overall survival (P = .001), whereas this was not the case in the subgroup of adjuvantly treated patients. Patients whose tumors expressed high TS levels had a tendency to improved outcome after adjuvant therapy (not significant). The group whose tumors expressed the highest TS grade, grade 3 (34% of the patients), had a significantly longer disease-free survival if they were treated with adjuvant therapy compared with surgery alone (multivariate analyses, P = .02), whereas patients whose tumors expressed low TS levels (28% of the patients) had an impaired outcome after adjuvant therapy (multivariate analyses: disease-free survival, P = .01; overall survival, P = .01).

CONCLUSION: TS expression predicts for survival independent of Dukes’ stage in patients with CRC treated with surgery alone. The study indicates that patients with high TS levels may benefit from adjuvant 5-FU–based chemotherapy. However, patients with low TS levels seem to have a worse outcome when treated with adjuvant chemotherapy.
Kyphoplasty in the Treatment of Osteolytic Vertebral Compression Fractures as a Result of Multiple Myeloma
Authors: Dudeney S. , Lieberman I.H. , Reinhardt M-K. , Hussein M.
Published: July 2002

PURPOSE: We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. The principle symptoms in multiple myeloma result from bone destruction, especially the spine. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps (IBT) into the vertebral body. The purpose of the IBT is to restore the vertebral body back toward its original height, while creating a cavity that can be filled with highly viscous bone cement.

PATIENTS AND METHODS: Fifty-five consecutive kyphoplasty procedures were performed in 18 patients with osteolytic vertebral compression fractures resulting from multiple myeloma. Cement leakage and any complications were recorded. Early objective analysis was made by comparing preoperative and latest Short Form 36 Health Survey scores. Height restoration was estimated by measuring vertebral height on lateral radiographs.

RESULTS: The mean age of patients was 63.5 years, mean duration of symptoms was 11 months, and mean follow-up was 7.4 months. There were no major complications related directly to use of this technique. On average, 34% of height lost at the time of fracture was restored. Asymptomatic cement leakage occurred at two (4%) of 55 levels. Significant improvement in SF36 scores occurred for Bodily Pain (23.2 to 55.4, P = .0008), Physical Function (21.3 to 50.6, P = .0010), Vitality (31.3 to 47.5, P = .010), and Social Functioning (40.6 to 64.8, P = .014).

CONCLUSION: Kyphoplasty was efficacious in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. Kyphoplasty is associated with early clinical improvement of pain and function as well as some restoration of vertebral body height.