bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship Between Race and Mortality and Morbidity After Valve Replacement Surgery
Authors: Taylor Nyali E. , O’Brien Sean , Edwards Fred H. , Peterson Eric D. , Bridges Charles R.
Published: March 2005

Background—

Previous studies have shown that black race is an independent predictor of increased operative mortality after coronary artery bypass surgery. Given the higher incidence of hypertension and hypertension-associated left ventricular hypertrophy in blacks, we hypothesized that black race might be associated with increased risk of mortality and morbidity after aortic valve replacement (AVR) or mitral valve replacement (MVR). We could not identify a previous study that used a multivariable model to evaluate the association between race and operative mortality after AVR or MVR.

Methods and Results—

The Society of Thoracic Surgeons National Cardiac Database was used for a retrospective review of 3137 black and 46 249 white patients who underwent MVR alone or AVR alone from 1999 through 2002. Multivariate logistic regression was used to assess the association between race and mortality and 6 other adverse outcomes (stroke, renal failure, prolonged ventilation, prolonged postoperative stay, sternal infection, and bleeding) after adjustment for covariates. Unadjusted operative mortality for MVR only was 5.60% for blacks versus 6.18% for whites (OR 0.90 [95% CI 0.71 to 1.14]) and 4.60% for blacks versus 3.62% for whites for AVR only (OR 1.28 [95% CI 1.02 to 1.62]). After adjustment for other risk factors, black race was not a significant predictor of operative mortality after AVR or MVR; however, black race was associated with an increased risk of several complications: prolonged ventilation after AVR or MVR, postoperative stay >14 days after AVR or MVR, reoperation for bleeding after AVR, and postoperative renal failure after MVR. There was no significant association between race and the risk of stroke or deep sternal wound infection for either AVR or MVR.

Conclusions—

In contrast to previously published results that defined race as an independent risk factor for operative mortality after coronary artery bypass surgery, race does not appear to be a significant predictor of operative mortality after isolated AVR or MVR; however, there is evidence of an association between race and certain complications.
Prosody-driven Sentence Processing: An Event-related Brain Potential Study
Authors: Pannekamp Ann , Toepel Ulrike , Alter Kai , Hahne Anja , Friederici Angela D.
Published: March 2005

Four experiments systematically investigating the brain's response to the perception of sentences containing differing amounts of linguistic information are presented. Spoken language generally provides various levels of information for the interpretation of the incoming speech stream. Here, we focus on the processing of prosodic phrasing, especially on its interplay with phonemic, semantic, and syntactic information. An event-related brain potential (ERP) paradigm was chosen to record the on-line responses to the processing of sentences containing major prosodic boundaries. For the perception of these prosodic boundaries, the so-called closure positive shift (CPS) has been manifested as a reliable and replicable ERP component. It has mainly been shown to correlate to major intonational phrasing in spoken language. However, to define this component as exclusively relying on the prosodic information in the speech stream, it is necessary to systematically reduce the linguistic content of the stimulus material. This was done by creating quasi-natural sentence material with decreasing semantic, syntactic, and phonemic information (i.e., jabberwocky sentences, in which all content words were replaced by meaningless words; pseudoword sentences, in which all function and all content words are replaced by meaningless words; and delexicalized sentences, hummed intonation contour of a sentence removing all segmental content). The finding that a CPS was identified in all sentence types in correlation to the perception of their major intonational boundaries clearly indicates that this effect is driven purely by prosody.
“Where to?” Remote Memory for Spatial Relations and Landmark Identity in Former Taxi Drivers with Alzheimer's Disease and Encephalitis
Authors: Rosenbaum R. Shayna , Gao Fuqiang , Richards Brian , Black Sandra E. , Moscovitch Morris
Published: March 2005

Recent research suggests that the hippocampus is not needed for the maintenance and recovery of extensively used environments learned long ago. Instead, a network of neo-cortical regions differentially supports memory for location-navigation knowledge and visual appearance of well-known places. In this study, we present a patient, S. B., who was diagnosed with probable Alzheimer's disease long after retiring from his 40 years as a taxi driver in downtown Toronto, a place that he has visited rarely, if ever, in the last decade. His performance was compared to that of two other retired taxi drivers, L. R., who developed encephalitis after retirement, and I. L., who is without neurological illness, and a group of eight healthy control participants who were never taxi drivers but all of whom worked or lived in downtown Toronto until at least 10 years ago. Despite S. B.'s widespread atrophy, which has affected mainly his hippocampus and part of his occipitotemporal cortex, he performed at least as well as all other participants on remote memory tests of spatial location and mental navigation between well-known Toronto landmarks. Unlike the comparison populations, however, he was unable to discriminate between the appearances of landmarks that he had visited frequently in his many years as a taxi driver from unknown buildings. This profound deficit extended to famous world landmarks but not to famous faces and does not appear to be semantic in nature. These findings add further support to the claim that the hippocampus is not necessary for mental navigation of old environments and suggest that expertise is not sufficient to protect against landmark agnosia.
Integration of Visual and Auditory Information by Superior Temporal Sulcus Neurons Responsive to the Sight of Actions
Authors: Barraclough* Nick E. , Xiao* Dengke , Baker Chris I. , Oram Mike W. , Perrett David I.
Published: March 2005

Processing of complex visual stimuli comprising facial movements, hand actions, and body movements is known to occur in the superior temporal sulcus (STS) of humans and nonhuman primates. The STS is also thought to play a role in the integration of multimodal sensory input. We investigated whether STS neurons coding the sight of actions also integrated the sound of those actions. For 23% of neurons responsive to the sight of an action, the sound of that action significantly modulated the visual response. The sound of the action increased or decreased the visually evoked response for an equal number of neurons. In the neurons whose visual response was increased by the addition of sound (but not those neurons whose responses were decreased), the audiovisual integration was dependent upon the sound of the action matching the sight of the action. These results suggest that neurons in the STS form multisensory representations of observed actions.
Hardware-Based Collision and Self-Collision for Rigid and Deformable Surfaces
Authors: Wong Wingo Sai-Keung , Baciu George
Published: March 2005

The interactive requirements of 3D games and physically driven virtual environments add strong constraints to the simulation of natural cloth collisions and self-collisions. In order to achieve interactive rates, we first define smoothness conditions over small patches of deformable surfaces and then resort to image-based collision-detection algorithms that we have developed. Our collision-detection system achieves interactive rates as it accurately tracks collisions and self-interactions of objects consisting of highly deformable surfaces. This method makes use of a novel technique for dynamically generating a hierarchy of cloth bounding boxes in order to perform object-level culling and image-based intersection tests using conventional graphics hardware support. Our results show that, for complex deformable surfaces with an excess of 50,000 triangular elements, we can track collisions at nearly interactive rates.
Friends Reunited? Evolutionary Robotics and Representational Explanation
Authors: Wheeler Michael
Published: March 2005

Robotics as practiced within the artificial life community is no longer the bitter enemy of representational explanation in the way that it sometimes seemed to be in the heady, revolutionary days of the 1990s. This rapprochement is, however, fragile, because the field of evolutionary robotics continues to pose two important challenges to the idea that real-time intelligent action must or should be explained by appeal to inner representations. The first of these challenges, the threat from nontrivial causal spread, occurs when extra-neural factors account for the kind of adaptive richness and flexibility normally associated with representation-based control. The second, the threat from continuous reciprocal causation, occurs when the causal contributions made by the systemic components collectively responsible for behavior generation are massively context-sensitive and variable over time. I argue that while the threat from nontrivial causal spread can be resisted, the threat from continuous reciprocal causation provides a stern test for our representational intuitions.
Transient Phenomena in Learning and Evolution: Genetic Assimilation and Genetic Redistribution
Authors: Wiles Janet , Watson James , Tonkes Bradley , Deacon Terrence
Published: March 2005

Deacon has recently proposed that complexes of genes can be integrated into functional groups as a result of environmental changes that mask and unmask selection pressures. For example, many animals endogenously synthesize ascorbic acid (vitamin C), but anthropoid primates have only a nonfunctional version of the crucial gene for this pathway. It is hypothesized that the loss of functionality occurred in the evolutionary past when a diet rich in vitamin C masked the effect of the gene, and its loss effectively trapped the animals in a fruit-eating lifestyle. As a result, the complex of abilities that support this lifestyle were evolutionarily bound together, forming a multilocus complex. In this study we use evolutionary computation simulations to explore the thesis that masking and unmasking can transfer dependence from one set of genes to many sets, and thereby integrate the whole complex of genes. We used a framework based on Hinton and Nowlan's 1987 simulation of the Baldwin effect. Additional gene complexes and an environmental parameter were added to their basic model, and the fitness function extended. The simulation clearly demonstrates that the genetic redistribution effect can occur in silico, showing an initial advantage of endogenously synthesized vitamin C, followed by transfer of the fitness contribution to the complex of genes that together allow the acquisition of vitamin C from the environment. As is well known in the modeling community, the Baldwin effect only occurs in simulations when the population of agents is “poised on the brink” of discovering the genetically specified solution. Similarly, the redistribution effect occurs in simulations under specific initial conditions: too little vitamin C in the environment, and its synthesis it is never fully masked; too much vitamin C, and the abilities required to acquire it are not tightly integrated. The Baldwin effect has been hypothesized as a potential mechanism for developing language-specific adaptations like innate universal grammar and other highly modular capacities. We conclude with a discussion of the relevance of genetic assimilation and genetic redistribution to the evolution of language and other cognitive adaptations.
Flight muscles and flight dynamics: towards an integrative framework
Authors: Taylor Graham
Published: March 2005

Here a conceptual framework is provided for analysing the role of the flight muscles in stability and control. Stability usually refers to the tendency of a system to return to a characteristic reference state, whether static, as in gliding, or oscillatory, as in flapping. Asymptotic Lyapunov stability and asymptotic orbital stability as formal definitions of gliding and flapping flight stability, respectively, are discussed and a limit cycle control analogy for flapping flight control proposed. Stability can arise inherently or through correctional control. Conceptually, inherent stability is that which would arise if all body parts were rigid and all articulation angles were constants (gliding) or periodic functions (flapping), both of which require muscular effort. Pose can be maintained during disturbances by neural feedback or isometric contraction of tonic muscles: cyclic pose changes can be buffered by neural feedback or viscous damping by phasic muscles. Correctional control serves to drive the system towards its reference state, which will usually involve a phasic response, if only because of the tendency of flying bodies to oscillate during disturbances. Muscles involved in correctional control must therefore be tuned to the characteristic frequencies of the system. Furthermore, in manoeuvre control, these frequencies set an upper limit on the timescales on which control inputs can be effective. Flight muscle physiology should therefore be evolutionarily co-tuned with the morphological parameters of the system that determine its frequency response. Understanding this fully will require us to integrate internal models of physiology with external models of flight dynamics.
Motor unit recruitment during vertebrate locomotion
Authors: Wakeling James , Rozitis Antra
Published: March 2005

Vertebrate skeletal muscles act across joints and produce segmental accelerations and therefore animal movement when they contract. Different muscles and different motor units vary in their mechanical contractile properties. Early studies on motor unit recruitment demonstrated orderly recruitment of motor units from the slowest to the fastest during a graded contraction. However, many subsequent studies illustrate conditions when alternative recruitment strategies may exist. Motor unit recruitment during locomotion is thus multifactorial and more complex than typically thought.Different types of motor unit vary in their mechanical properties, including rates of force activation and deactivation, maximum unloaded shortening velocities and the shortening velocities at which maximum mechanical power output and maximum mechanical efficiency occur. In short, it would make mechanical sense to perform fast activities with the faster motor units and slow activities with the slower motor units. However, determining patterns of motor unit recruitment during locomotion has presented experimental challenges.Comparisons between distinct muscles have shown that fast fish swimming and the cat paw shake are activities which employ predominantly the fast and not the slower muscle. Glycogen depletion studies have showed that jumping in the bushbaby uses fast without slow motor units within the vastus lateralis and gastrocnemius muscles. Studies in man show that differential recruitment of the different types of muscle fibre occurs at different times within each running stride. It is suggested that vertebrates may have a strategy of recruiting the motor units that are most mechanically suited for the different locomotor demands. However, we have much to learn about motor recruitment patterns during locomotion.
Biomechanical aspects of peak performance in human swimming
Authors: Toussaint Huub , Truijens Martin
Published: March 2005

Peak performances in sport require the full deployment of all the powers an athlete possesses. How factors such as mechanical power output, technique and drag, each individually, but also in concert, determine swimming performance is the subject of this enquiry. This overview of swimming biomechanics focuses on three performance factors: (i) generation of propulsion in water; (ii) drag encountered by the body during swimming; and (iii) propulsive efficiency. Theoretical considerations will be put to use by predicting individual power requirements for swimming a world record in the 50 m freestyle based on experimental data.
Moving a generalised limb: a simulation with consequences for theories on limb control
Authors: Otten
Published: March 2005

The movement control of articulated limbs in vertebrates has been explained in terms of equilibrium points and moving equilibrium points or virtual trajectories. These hypotheses state that the nervous system makes the control of multi-segment limbs easier by simply planning in terms of these equilibrium points and trajectories. The present paper elaborates on a planar computer simulation of an articulated three-segment limb, controlled by pairs of muscles. The nature of the virtual trajectory is analysed when the limb is required to make fast movements with endpoint movements along a straight line with bell-shaped velocity profiles. It appears that the faster the movement, the more the virtual trajectory deviates from the real trajectory, becoming up to eight times longer. The complexity of the shape of the virtual trajectories in these fast movements makes it unlikely that the nervous system plans to use these trajectories. It seems simpler to set up the required bursts of muscle activation, coupled in the nervous system to the direction of movement, the speed and the place in workspace. Finally, it is argued that the two types of explanation do not contradict each other: when a relation is established in the nervous system between muscle activation and movements, equilibrium points and virtual trajectories are implicitly part of that relation.
Mining, Protection of the Environment, Scientific Research and Bioprospecting: Some Considerations on the Role of the International Sea-Bed Authority
Authors: Scovazzi Tullio
Published: March 2005

The innovative concept of the common heritage of mankind is embodied in the 1982 LOSC for the seabed beyond the limits of national jurisdiction (the Area). It has been subsequently adapted to meet further political and economic realities. Despite the present uncertain situation, the mandate of the International Seabed Authority (ISBA) is already broader than it is commonly believed. The legal condition of the space (the Area), its being the common heritage of mankind, may have an effect also on matters and activities that (though different from minerals and mining activities) are located in that space. While bioprospecting is not specifically regulated by the UNCLOS, there is an inextricable factual link between the protection of the deep seabed environment (including its biodiversity), marine scientific research and bioprospecting. the ISBA, the principles that it represents, as well as its existing competences and responsibilities, need to be taken into consideration when States decide to fill the legal gap of bioprospecting. The role of the ISBA could be expanded in the future to meet new objectives under commonly agreed cooperative schemes.
Zonal and Integrated Management Approaches to Ocean Governance: Reflections on a Dual Approach in International Law of the Sea
Authors: Tanaka Yoshifumi
Published: March 2005

Traditionally, international law of the sea has been based on the zonal approach. The traditional approach purports in essence to divide the ocean into several jurisdictional spaces on the basis of two opposing principles, namely, the principle of sovereignty and the principle of freedom. It is now apparent, however, that the traditional zonal approach is insufficient to resolve the problems encountered in the management of ocean space. Hence, the need for a new integrated management approach is increasingly emphasised in international instruments as well as in the opinions of writers. Nevertheless, it appears that the concept of the integrated management approach remains obscure in international law. Thus, this study purports to examine this concept at three levels: the ecological, normative and implementation levels. Finally, on the basis of these considerations, this study will present a perspective that the international law of the sea should be considered as a dialectic legal system between the zonal approach and the integrated management approach.
Induction of tolerance to factor VIII inhibitors by gene therapy with immunodominant A2 and C2 domains presented by B cells as Ig fusion proteins
Authors: Lei Tie Chi , Scott David W.
Published: March 2005

Up to 30% of patients with hemophilia A given therapeutic factor VIII (fVIII) can make inhibitory antibodies, the majority of which are reactive with its C2 and A2 domains. We have previously demonstrated that antigen-specific tolerance to several antigens can be induced by lipopolysaccharide (LPS)-activated B-cell blasts transduced with immunoglobulin (IgG)-antigen fusion constructs. To apply this system to hemophilia A inhibitor formation, we created retroviral vectors expressing fVIII amino acids S2173-Y2332 (C2 domain) and S373-R740 (A2 domain) in frame with an IgG heavy chain backbone. These vectors were transduced into B-cell blasts to induce tolerance in both naive and fVIII-primed hemophilic (E16 fVIII-/-) mice. Thus, treatment of E16 fVIII-/- mice with B cells expressing fVIII C2 and A2 domains led to tolerance in terms of specific humoral response (including inhibitory antibody titers) and cellular responses to fVIII and its C2 or A2 domains. Moreover, a significant reduction in immune responses to fVIII could be achieved in immunized hemophilic mice with existing anti-fVIII titers. This hyporesponsive state persisted for at least 2 months and withstood additional challenge with fVIII. Further experiments, in which mice were treated with a depleting monoclonal anti-CD25, suggested that a regulatory T cell may be required for the tolerogenic effect of transduced B cells. These findings demonstrate that B-cell presentation of fVIII domains on an Ig backbone specifically prevents or decreases existing antibodies in hemophilia A mice. (Blood. 2005;105:4865-4870)
In silico microdissection of microarray data from heterogeneous cell populations
Authors: Lähdesmäki Harri , Shmulevich llya , Dunmire Valerie , Yli-Harja Olli , Zhang Wei
Published: March 2005

Background

Very few analytical approaches have been reported to resolve the variability in microarray measurements stemming from sample heterogeneity. For example, tissue samples used in cancer studies are usually contaminated with the surrounding or infiltrating cell types. This heterogeneity in the sample preparation hinders further statistical analysis, significantly so if different samples contain different proportions of these cell types. Thus, sample heterogeneity can result in the identification of differentially expressed genes that may be unrelated to the biological question being studied. Similarly, irrelevant gene combinations can be discovered in the case of gene expression based classification.

Results

We propose a computational framework for removing the effects of sample heterogeneity by "microdissecting" microarray data in silico. The computational method provides estimates of the expression values of the pure (non-heterogeneous) cell samples. The inversion of the sample heterogeneity can be facilitated by providing accurate estimates of the mixing percentages of different cell types in each measurement. For those cases where no such information is available, we develop an optimization-based method for joint estimation of the mixing percentages and the expression values of the pure cell samples. We also consider the problem of selecting the correct number of cell types.

Conclusion

The efficiency of the proposed methods is illustrated by applying them to a carefully controlled cDNA microarray data obtained from heterogeneous samples. The results demonstrate that the methods are capable of reconstructing both the sample and cell type specific expression values from heterogeneous mixtures and that the mixing percentages of different cell types can also be estimated. Furthermore, a general purpose model selection method can be used to select the correct number of cell types.
Time on wait lists for coronary bypass surgery in British Columbia, Canada, 1991 – 2000
Authors: Levy Adrian R , Sobolev Boris G , Hayden Robert , Kiely Michael , FitzGerald J Mark , Schechter Martin T
Published: March 2005

Background

In British Columbia, Canada, all necessary medical services are funded publicly. Concerned with growing wait lists in the mid-1990s, the provincial government started providing extra funding for coronary artery bypass grafting (CABG) operations annually. Although aimed at improving access, it is not known whether supplementary funding changed the time that patients spent on wait lists for CABG. We sought to determine whether the period of registration on wait lists had an effect on time to isolated CABG and whether the period effect was similar across priority groups.

Methods

Using records from a population-based registry, we studied the wait-list time before and after supplementary funding became available. We compared the number of weeks from registration to surgery for equal proportions of patients in synthetic cohorts defined by five registration periods in the 1990s.

Results

Overall, 9,231 patients spent a total of 137,126 person-weeks on the wait lists. The time to surgery increased by the middle of the decade, and decreased toward the end of the decade. Relative to the 1991–92 registration period, the conditional weekly probabilities of undergoing surgery were 30% lower among patients registered on the wait lists in 1995–96, hazard ratio (HR) = 0.70 (0.65–0.76), and 23% lower in 1997–98 patients, HR = 0.77 (0.71–0.83), while there were no differences with 1999–2000 patients, HR = 0.94 (0.88–1.02), after adjusting for priority group at registration, comorbidity, age and sex. We found that the effect of registration period was different across priority groups.

Conclusion

Our results provide evidence that time to CABG shortened after supplementary funding was provided on an annual basis to tertiary care hospitals within a single publicly funded health system. One plausible explanation is that these hospitals had capacity to increase the number of operations. At the same time, the effect was not uniform across priority groups indicating that changes in clinical practice should be considered when adding extra funding to reduce wait lists.
Constructing design weather data for future climates
Authors: Belcher SE , Hacker JN , Powell DS
Published: March 2005

We develop a method, here called ‘morphing’, to produce design weather data for building thermal simulations that accounts for future changes to climate. Morphing combines present-day observed weather data with results from climate models. The procedure yields weather time series that encapsulate the average weather conditions of future climate scenarios, whilst preserving realistic weather sequences. In this sense the method ‘downscales’ coarse resolution climate model predictions to the fine spatial and temporal resolutions required for building thermal simulations. The morphing procedure is illustrated by application to CIBSE design weather years and climate change scenarios for the UK. Heating degree days calculated from the weather series morphed to future climates show a marked reduction compared to present day, by an amount that agrees well with results calculated directly from the climate model. This agreement gives confidence that the morphing technique faithfully transforms the weather sequences.

Practical application: There is overwhelming consensus amongst the scientific community that the Earth's climate is warming. This warming will have implications for building services in the UK that should be considered now. This article describes a method for producing weather data with best current estimates of future climate that can be used to quantify the risk of building overheating.
A novel approach to achieving airtightness in drylined load-bearing masonry dwellings
Authors: Roberts D , Johnston D , Isle JA
Published: March 2005

This paper describes a novel approach that can be used to construct airtight drylined load-bearing masonry dwellings. This involves the application of a thin layer of ‘parging’ to the internal blockwork leaf of all external walls. Whilst this approach has so far only been undertaken on a field trial using one dwelling, the results suggest that the application of the parging layer improves the airtightness of the dwelling substantially and air leakage rates of less than 5 m3/h per m2at 50 Pa can be achieved. The paper also identifies a number of additional measures which, if undertaken, could reduce the air leakage of this dwelling even further.

Practical application: Airtight construction techniques are increasingly required in order to comply with Part L of the building regulations. Wet plastering is very successful in reducing air leakage through load-bearing masonry construction but is rarely used nowadays because of its longer drying time compared with drylining. The novel approach described in this paper provides the advantages, of both systems by applying a quick-drying airtight barrier before drylining.
Gait and calf muscle endurance in patients with chronic venous insufficiency
Authors: van Uden C JT , van der Vleuten C JM , Kooloos J GM , Haenen J H , Wollersheim H
Published: March 2005

Objective: To gain insight in gait and calf muscle endurance in patients with severe chronic venous insufficiency.

Methods: Fifteen patients with severe chronic venous insufficiency (healed or active ulcers) and 19 healthy controls were selected for this study. Subjects had to perform eight trials at preferred walking speed and eight trials at instructed walking speed (1.25 m/s) during which the gait parameters were recorded. The calf muscle endurance was tested by use of the heel-rise test.

Results: Patients had a significantly lower preferred walking speed (1.25 m/s9 /± 0.31) compared with healthy controls (1.44 m/s± 0.0.15) (p=0.039). During preferred walking speed patients had a wider base of support (p=0.003), a bigger step time (p=0.005), and a bigger stride time (p=0.004) compared with healthy controls. At instructed walking speed only base of support was different between the two groups (p=0.016). Patients had a significantly (p=0.003) smaller number of heel rises (14.69 ± 7.34), indicating decreased calf muscle endurance compared with controls (23.59 ±6.54).

Conclusion: This study indicates a disturbed gait and decreased calf muscle endurance in patients with severe chronic venous insufficiency.
Is inspiratory muscle training effective for individuals with cervical spinal cord injury? A qualitative systematic review
Authors: Brooks Dina , O'Brien Kelly , Geddes E Lynne , Crowe Jean , Reid W Darlene
Published: March 2005

Objective: To perform a systematic review to determine the effect of inspiratory muscle training (IMT) in adults with cervical spinal cord injury (CSCI).

Design: A systematic search of the literature on IMT and CSCI according to the Cochrane Collaboration protocol was performed. We searched electronic databases up to August 2003 including MEDLINE and CINAHL, searched reference lists from pertinent articles and books, made personal contact with authors, and hand searched targeted journals to identify potential studies for inclusion.

Study selection: Inclusion criteria for the review included randomized controlled trials published in English comparing IMT with another comparison group among adults with CSCI.

Data extraction: Two reviewers abstracted relevant data from included studies. Methodological quality of the studies was assessed using criteria developed by Jadad et al. We also assessed whether the comparison groups were similar at baseline and whether an intention-to-treat analysis was performed.

Results: Forty articles were retrieved and three met the inclusion criteria. All studies used inspiratory resistance muscle trainers for at least 15 min, twice daily, five to seven days per week for six to eight weeks. Meta-analysis could not be performed due to differences in study design and outcomes. Only one study reported a positive effect of IMT compared to control for measures of dyspnoea and pulmonary function.

Conclusion: Literature on the effect of IMT among adults with CSCI is scarce and an overall effect could not be confirmed.
Evidence of the efficacy of occupational therapy in different conditions: an overview of systematic reviews
Authors: Steultjens Esther MJ , Dekker Joost , Bouter Lex M , Leemrijse Chantal J , van den Ende Cornelia HM
Published: March 2005

Objective: To summarize the research evidence available from systematic reviews of the efficacy of occupational therapy (OT) for practitioners, researchers, purchasing organizations and policy-makers.

Data source: The search for systematic reviews was conducted in PubMed and the Cochrane Library (October 2004).

Methods: The reviews included were those that utilized a systematic search for evidence with regard to OT for specific patient groups. Data were summarized for patient group, interventions, outcome domains, type of study designs included, method of data synthesis and conclusions.

Results: Fourteen systematic reviews were included. Three reviews related to rheumatoid arthritis, four reviewed stroke and four focused on elderly people. Reviews of Parkinson's disease, multiple sclerosis, Huntington's disease, cerebral palsy and mental illnesses were also identified. The reviews of rheumatoid arthritis, stroke and elderly people showed evidence of the efficacy of OT in increasing functional abilities. Positive results were presented for quality of life and social participation in elderly people and stroke respectively. The efficacy of OT in all other patient groups is unknown due to insufficient evidence.

Conclusion: This summary shows that elderly people and people with stroke or rheumatoid arthritis can expect to benefit from comprehensive OT. Evidence of the efficacy of specific interventions is sparse and should be addressed in future research. The evidence that does exist should be incorporated into OT practice.
Randomized clinical trials in Clinical Rehabilitation
Authors: Wade Derick T
Published: March 2005

A randomized clinical trial (RCT) is currently the strongest method for evaluating interventions in clinical practice. RCTs also provide the politically most powerful form of evidence. However it is not necessarily agreed what constitutes an RCT. This editorial explores what might be included within the rubric of ‘randomized clinical trial' (and randomized controlled trial) by considering the reasons for using randomization and controls, and by discussing the definitions of clinical and trial. It suggests that the definition used in the Cochrane Glossary is too restricted and needs revision.
Case report Tamoxifen for retroperitoneal fibrosis
Authors: Chambers J C , McGovern K
Published: March 2005

Retroperitoneal fibrosis is characterised by diffuse inflammatory proliferation of fibroblasts and the deposition of collagen fibrils throughout the retroperitoneum, especially in perivascular sites. This results in blockage of the ureters and other tubular retroperitoneal structures such as the vasculature and lymphatic channels. Left untreated, it typically follows a progressive and fatal course. The condition responds favourably to tamoxifen and several case reports describe an improvement in renal function on this therapy. This case report describes a subjective and objective functional improvement of lymphoedema secondary to retroperitoneal fibrosis with the use of tamoxifen.
Low dose diamorphine reduces breathlessness without causing a fall in oxygen saturation in elderly patients with end-stage idiopathic pulmonary fibrosis
Authors: Allen Stephen , Raut Satru , Woollard Jane , Vassallo Michael
Published: March 2005

There is very little evidence regarding the safety and efficacy of opioids for the control of dyspnoea in the terminal stages of idiopathic pulmonary fibrosis (IPF). We conducted an open case series study of 11 elderly opioid-naive patients referred for management of severe breathlessness before and after their first injection of 2.5 mg diamorphine subcutaneously. Subjective breathlessness, measured by a 100 mm visual analogue scale, fell by a mean of 47 mm in the first 15 min (PB 0.0001) and the mean heart rate fell by 12/min (P-0.007). There were small non-significant falls in the mean respiratory rate (2/min), systolic blood pressure (6 mmHg) and oxygen saturation (1%). These changes were maintained at 30 min. Follow up treatment with oral morphine remained effective in reducing the symptom of breathlessness and no patient showed signs of respiratory depression. Low dose opioids are effective and safe in the palliative management of IPF in frail elderly patients.
A dynamic simulation of bisphenol A dosimetry in neuroendocrine organs
Authors: Hutter Joseph C , Luu Hoan My , Kim Chung S
Published: March 2005

Bisphenol A (BPA) is a known xenoestrogen with similar properties to 17b-estradiol. BPA and estrogen are hydrophobic compounds, and this affects the pharmacokinetics of both compounds in mammals. In a previous study we measured the distribution of BPA in female F344 rats exposed to oral doses of 0.1, 10 and 100 mg/kg. The results showed distribution to target neuroendocrine organs at all doses tested. Using these results, we developed a pharmacokinetic model to predict the dynamic uptake and excretion of BPA by various routes of exposure (po, iv, sc, ip). The model was able to simulate the entire time course (48 h) following various routes of exposure in rats over the dose ranges tested. The model indicated that the ultimate tissue uptake of BPA was established by the rapid initial transfer of free BPA into tissues. After free BPA enters the systemic circulation, metabolism and excretion reactions cause a relatively short duration and rapid decline. This period is followed by a slower long-term decline characteristic of BPA’s biphasic pharmacokinetics. Plasma protein and tissue binding reactions established the long-term half-life of BPA in the body. Route differences in tissue uptake were directly related to the competition between transfer and binding reactions during the absorption phase.
Comparing study of the effect of nanosized silicon dioxide and microsized silicon dioxide on fibrogenesis in rats
Authors: Chen Ying , Chen Jie , Dong Jing , Jin Yihe
Published: March 2005

This study compares the effect of nanosized silicon dioxide (nanosized SiO2) and microsized silicon dioxide (microsized SiO2) particles on fibrogenesis in rats. Wistar rats were instilled intratracheally with saline, 20 mg of nanosized SiO2 or 20 mg of microsized SiO2, and were sacrificed at 1 and 2 months after instillation. The lungs of rats were analysed for the changes of lung/body coefficient and hydroxyproline content. Changes in pathology and fibrotic grade were observed by use of hematoxylin and eosin and Van Gieson dyeing. The expression of interleukin-4 (IL-4) and transforming growth factor-b1 (TGF-b1) was observed by use of immunohistochemical technique, and protein expression quantitatively analysed by image analysis. The lung/body coefficient and hydroxyproline content of nanosized SiO2 groups were significantly lower than those of microsized SiO2 groups at both 1 and 2 months after instillation (PB / 0.05 or PB / 0.01), but without significant differences from those of saline control groups. At 1 month after instillation, there were mainly cellular nodules (Stage I) in nanosized SiO2 group, while in microsized SiO2 group Stage II, II of silicotic nodules were observed. At 2 months after instillation, there were still Stage I of silicotic nodules in nanosized SiO2 group. In microsized SiO2 group mainly Stage II, III of silicotic nodules were found. Quantity image analysis showed that the expressions of IL-4 and TGF-b1 in nanosized SiO2 groups were significantly lower than those in microsized SiO2 groups (PB / 0.01), but without significant difference from those of saline control groups. Our experiment revealed that the effect of fibrogenesis of nanosized SiO2 might be milder than that of microsized SiO2 in rats, potentially resulting from nanoparticals tending to be diffused and easily translocated due to their ultrafine particle size compared to microsized particles.
Holocene mean July temperature and winter precipitation in western Norvay inferred from palynological and glaciological lake-sediment proxies
Authors: Bjune Anne Elisabeth , Bakke Jostein , Nesje Atle , Birks H. J.B.
Published: March 2005

Reconstructions of mean July temperature (Tjul) and winter precipitation (Pw) for the last 11/500 years on the Folgefonna peninsula are presented. Tjul was reconstructed using pollen-climate transfer functions and Pw was reconstructed based on the exponential relationship between mean solid winter precipitation and ablation-season temperature at the equilibrium-line altitude (ELA) with a reconstructed former ELA, using Tjul as the proxy for ablation-season temperature. The reconstructions from the Folgefonna peninsula suggest that the early Holocene was relatively cool and dry until c. 8000 cal. yr BP, followed by a warm and humid mid-Holocene until c. 4000 cal. yr BP with inferred Tjul above 12°C and Pw reaching as high as 225% of the present day. Subsequent to c. 4000 cal. yr BP a reduction is seen in both inferred Tjul and Pw with large fluctuations during the last 500 years. In addition, new calculations of Pw from two glaciers (Hardangerjøkulen and Jostedalsbreen) in southern Norway are presented. The results show that Pw varied in phase at all glaciers, probably as a response to the same climate forcing factor. During the early Holocene a major shift is suggested between winds from the west and the east.
Mycophenolate Mofetil and Systemic Lupus Erythematosus: An Overview
Authors: Pisoni CN , Karim Y , Cuadrado MJ
Published: March 2005

Mycophenolate mofetil (MMF) is an immunosuppressive agent used in transplantation, with evidence of superior protection against acute transplant rejection compared to azathioprine-containing regimens. Subsequently MMF has been used in a variety of autoimmune conditions. The major experience in systemic lupus erythematosus (SLE) has focused on proliferative lupus nephritis. Following its success in the treatment of lupus nephritis, MMF is now being used to control other SLE manifestations such as, lupus disease activity, haematological manifestations and resistant skin lupus. In this review, we discuss our own experience and the literature report about the use of MMF in SLE.
Lupus Nephritis: Induction Therapy
Authors: Chan TM
Published: March 2005

Effective induction therapy is of pivotal importance in minimizing renal parenchymal damage by the active immune-mediated inflammatory processes in severe proliferative lupus nephritis. Preservation of nephron mass is prerequisite to long-term renal survival. Data from US-based studies have shown improved efficacy with induction treatment comprising corticosteroid and cyclophosphamide, compared with corticosteroid treatment alone. Data from European studies have shown similar efficacy with a modified treatment regimen, in which smaller doses of cyclophosphamide were given at weekly or fortnightly intervals over a shortened treatment duration, and the treatment related adverse effects appeared less frequent with the reduced-dose regimen. We have also reported that sequential immunosuppression with prednisolone and oral cyclophosphamide as induction followed by azathioprine maintenance was associated with a high incidence of remission and relatively favourable long-term renal outcome in Chinese patients. However, cyclophosphamide treatment is associated with considerable adverse effects, which could be potentially fatal. Mycophenolate mofetil selectively inhibits lymphocyte proliferation, and thus targets an instrumental step in the pathogenesis of systemic lupus erythematosus. There is accumulating evidence that the combined use of mycophenolate mofetil and corticosteroid presents an effective treatment for severe proliferative lupus nephritis in different ethnic groups, and is associated with much fewer adverse effects compared with cyclophosphamide-based regimens. Recent data from our group also demonstrate the long-term efficacy of mycophenolate mofetil in preserving renal survival, when used continuously as both induction and maintenance therapy.
Mycophenolate mofetil and myasthenia gravis
Authors: Ciafaloni E
Published: March 2005

Myasthenia gravis (MG) represents the prototypic autoimmune disorder with well characterized immunopathology. Advances in the diagnosis and treatment of this neuromuscular transmission disorder have significantly improved the management of myasthenic patients. Unfortunately the currently available immunomodulating treatments have significant side effects and some patients do not tolerate them or adequately respond to them. Therefore the possibility of a new immunosuppressant agent that is safe, effective and has steroid-sparing effect is very appealing. Mycophenolate mofetil (MMF) has shown promising effects in MG patients in preliminary studies and is currently being studied in two prospective, randomized, double-blind, placebo controlled, multicenter trials to better establish its role in the treatment of MG.
Rethinking task-based language learning: what we can learn from the learners
Authors: Slimani-Rolls Assia
Published: March 2005

To investigate the use, or otherwise, of conversational adjustments (CAs), in a normal instructional setting, the quality of speech generated during meaning negotiation, and learner perception of the task under study, a quantitative and a qualitative analysis was carried out of language produced in a dyadic set-up in a one-way information task, a two-way information task and a decision-making task. The study revealed that the quantitative analysis supported the results usually found in Second Language Acquisition (SLA) studies: that the use of CAs generated by the 10 dyads in the two-way communication task was indeed significantly higher than in the one-way task and the decision-making task. However, while the overall group’s quantitative behaviour confirms the use of CAs, the qualitative analysis shows that the individuals’ performance in their use differs widely within and across task types. Learner idiosyncrasy is therefore perhaps a far more important phenomenon than commonality, and learners’ perception of the task may be much more relevant than its logical construction. Both aspects, learner idiosyncrasy and learner perception of tasks, suggest that predictability will be a perennial problem, not just a temporary technical one that some imaginative task designers will soon resolve. This calls into question the desirability of output predictability as an aim for task-based materials design. The report ends with further emphasis on the value of including learners in the development of understanding of classroom life.
Replantation in trauma
Authors: Webb Jill B
Published: March 2005

Following the first successful digital replant in 1968, replantation after traumatic amputation of the upper limb has become the norm in carefully selected patients. With good communication between the receiving emergency department and microsurgical team, the correct patients can be given appropriate priority and managed smoothly through their complex treatment. This article reviews the indications, initial management, surgical techniques, complications and the ex pected outcomes for upper limb replantation. This will help the nonmicrosurgeon explain to patients who have had an amputation the process of replantation and what they might expect after transfer to the microsurgical team, and it gives an overview of replantation for junior trainee microsurgeons.