bluuebunny/crossref_metadata_2025 huggingface dataset:
ULTRASONIC EVALUATION OF ANTERIOR SHOULDER TRANSLATION IN NORMAL SHOULDERS
Authors: Yeap Joo Seng , McGregor Alison H. , Humphries Keith , Wallace Andrew L.
Published: December 2003

Anterior translation in the right shoulders of 23 volunteers was evaluated using ultrasound from an anterior approach with a 10 MHz, 6 cm wide linear transducer. A translatory force of 90 N was used to translate the humeral head in the adduction and internal rotation position, while a translatory force of 60 N was used in the more clinically relevant position of 90° abduction and external rotation position. The overall intra-observer coefficients of variation ranged from 0–13.0% (mean 3.8 ± 2.5%) for examiner I and 0.5–20.9% (mean 5.1 ± 3.9%) for examiner II. The overall inter-observer variation ranged from 0–29.8% (mean 9.3 ± 7.3%). The anterior translation of the humeral head in adduction and internal rotation following 90 N displacement force ranged from -2.6 to 12.9 mm (mean 2.1 ± 3.1 mm) for examiner I and from -4.1 to 4.7 mm (mean 1.1 ± 2.2 mm) for examiner II. The anterior translation of the humeral head in abduction and external rotation following 60 N displacement force ranged from -3.3 to 3.7 mm (mean 0.3 ± 1.9 mm) for examiner I and from -8.3 mm to 4.5 mm (mean -0.7 ± 2.6 mm) for examiner II. The intra-class correlation coefficients (r) for the measured anterior translation between the two examiners for the 2 positions were 0.029 and -0.058 respectively. We concluded that the inter-observer coefficient of variation remained excessive and the agreement in the measured anterior translation between the two examiners was poor. The finding of negative values in the measured anterior translation despite the use of 90 N and 60 N translatory force raises further concerns about the prospective clinical use of this technique at the present moment.
EFFICACY OF HARTSHILL FIXATION WITH SUBLAMINAR WIRING IN MAINTAINING ANATOMICAL CORRECTION AND NEUROLOGICAL RECOVERY IN BURST FRACTURES OF THORACOLUMBAR SPINE
Authors: Garg Manish , Arora Shobha S. , Singh Girish Kumar
Published: December 2003

Hartshill fixation of thoracolumbar burst fractures is justified on grounds of providing early stabilization and correction of deformity. It is important to answer the question of whether it is able to sustain correction so that the costs and risks of surgery of this disabling problem can be justified. Reliable answers are also needed in view of the costs and risks of surgery prognostication.

This before-after study is on 49/61 consecutive cases of burst fractures of thoracolumbar spine, admitted during October 1998 to November 2000. Patients were treated with Hartshill segmental spinal fixation two segments above and below the fracture and bone grafting, and followed-up for a mean of 28 months (18–43 months) to determine the fate of radiological parameters indicating correction of kyphosis and clinical indicators predicting neurological recovery.

The mean pre-operative kyphosis angle of 19.59° (17.93–21.24) initially improved by 9.73° (8.07–11.39), p < 0.05 but reverted to 19.71° (17.73–21.69) during follow-up. Vertebral height measurements indicated similar findings. Mild pain persisted in 48/49 patients while 1/49 needed analgesics. Improvement of neural function was seen in 37/44 patients having a pre-operative deficit. 6/16 variables had a significant univariate relation with neurological recovery at p < 0.3 levels; namely initial Frankel's grade 1.85 (0.81–4.22), p = 0.14; fracture level 3.83 (0.58–25.10), p = 0.16; initial kyphosis 1.11 (0.93–1.32), p = 0.24; age 1.03 (0.96–1.11), p = 0.28; sex 0.39 (0.06–2.23), p = 0.29 and post-operative kyphosis 1.07 (0.93–1.22), p = 0.30. When combined, these variables were able to correctly classify recovery in 77.78% of cases at the probability cut-off of 0.75, sensitivity of 0.77 and specificity of 0.75, while the pre-test probability of recovery of 0.84 improved to 0.93 post-test, Negative Predictive Value (NPV) was 0.42., +Likelihood Ratio (LR) was 3.11 and -LR was 0.29. 77% of the area was under the Receiver Operator Characteristic (ROC) Curve.

Although Hartshill fixation with segmental sub-laminar wiring failed to maintain kyphosis correction in thoracolumbar burst fractures, it resulted in reducing the recumbence and hospital stay, and facilitating early rehabilitation. However, the costs and the risks of such procedures have to be carefully weighed before they are recommended for wider use. We also have a rule for predicting neurological recovery in such patients.
INFLUENCE OF HEAD MASS ON THE ACCELERATION OF THE HEAD AND NECK COMPLEX IN AUTOMOBILE REAR-END COLLISIONS USING A THREE-DIMENSIONAL FINITE ELEMENT METHOD
Authors: Chosa Etsuo , Totoribe Koji , Tajima Naoya
Published: December 2003

This study evaluated the influence of head mass on the acceleration of the head and neck complex in automobile rear-end collisions using a three-dimensional finite element method. The geometry of the finite element model is based on a cervical (C2–7) motion segment of a 20-year-old man that was obtained by computed tomography. Four types of models were prepared by changing the parameters of mass for an examination of the effects of head mass. Simulated loads were applied at the lower end of the C7 vertebra, with the axial direction constrained. Each model was loaded, and the head acceleration and distribution of von Mises stress were analyzed. Stress was observed to concentrate on the C2/3, C5/6 and C6/7 intervertebral discs. With a large head mass, the delay of the initial rise of the acceleration curve was large and the value of acceleration was small. On the contrary, when the head mass was small, the acceleration curve started to rise earlier. The acceleration curve of the model with the head mass of 1.0 kg was the closest to that of the experiments by Severy. Head mass is an important factor which influences the dynamic response of the head in rear-end collisions.
INFLUENCE OF PRE-CONDITIONING LOADS ON BOVINE ARTICULAR CARTILAGE STRESS RELAXATION BEHAVIOR IN CONFINED COMPRESSION
Authors: Correa Diego , Cullinane Dennis , Briceño Juan Carlos
Published: December 2003

Articular Cartilage is a load bearing tissue whose microarchitecture, electrochemical composition, and fluid interactions afford it unique mechanical properties. It consists of an extracellular matrix (ECM) interspersed with a sparse population of chondrocytes, varying in density by depth. The structure and mechanical properties of this highly specialized tissue also vary depending on depth from the articular surface; with three specialized zones, each with unique material properties. Typically this tissue is mechanically modeled as a biphasic material, consisting of a solid phase and a fluid phase, which can redistribute itself under loading, altering hydrostatic pressure within the material. Thus, articular cartilage exhibits a time-dependent viscoelastic behavior when subjected to constant loading or deformation, and will reach an equilibrium via stress relaxation and creep behavior. The objective of this study was to test a custom designed confined compression chamber. We characterize the ability of the test chamber to generate curves capable of quantifying the stress relaxation level and equilibrium state in bovine articular cartilage, and to show the preliminary results of a comparison between the equilibrium aggregate modulus (HA) obtained from pre- conditioned and non-conditioned tissues. Using fresh bovine articular cartilage samples, stress relaxation tests were conducted in compression, obtaining equilibrium stress and HA through a linear relation between the initial strain and the equilibrium stress. The test specimens were divided into two groups, one with a pre-conditioning load and the other without. The tests resulted in equilibrium stresses of 0.015 ± 0.0067 MPa for the non-conditioned and 0.067 ± 0.012 MPA for the pre-conditioned, and HA values of 0.205 ± 0.100 MPa for the unconditioned group and 0.878 ± 0.160 MPa in the pre-conditioned group. Our confined compression chamber successfully produced the stress relaxation curve characterizing the mechanical behavior of articular cartilage, defining both the equilibrium stress and HA. Our results suggest that pre-conditioning correlates with a higher equilibrium stress and aggregate modulus based on the fact that pre-loading the specimens reduces the effects of viscoelasticity.
BUCKLING OF COLUMNS WITH INTERNAL SLIDE RELEASE: A RECENT ERRONEOUS CONCLUSION AND LESSONS FROM IT
Authors: WILLIAMS F. W.
Published: December 2003

A recent paper derived equations which showed that the clamped–clamped and clamped–pinned buckling loads of columns with a transverse slider were invariant, with the values π2EI/L2 and π2EI/4L2, respectively, regardless of the position of the slider. It is shown that these results are both wrong, partly due to transverse force being confused with shear force. It is also shown that the basic equation used to obtain these erroneous results has a much simpler form than the one in the recent paper and that when used properly is a powerful tool for understanding and solving rapidly a range of buckling problems. These include cantilever and symmetric pinned–pinned stepped columns and symmetrical and symmetrically loaded, rigidly jointed, unbraced, single bay, multi-storey, plane frames.
ONE DIMENSIONAL ASYNCHRONOUS COOPERATIVE PARRONDO'S GAMES
Authors: MIHAILOVIĆ ZORAN , RAJKOVIĆ MILAN
Published: December 2003

A discrete-time Markov chain solution with exact rules for general computation of transition probabilities of the one-dimensional cooperative Parrondo's games is presented. We show that winning and the occurrence of the paradox depends on the number of players. Analytical results are compared to the results of the computer simulation and to the results based on the mean-field approach.
BUYING VERSUS BUILDING COMPETENCE: ACQUISITION PATTERNS IN THE INFORMATION AND TELECOMMUNICATIONS INDUSTRY 1995–2000
Authors: WARNER ALFRED G.
Published: December 2003

Acquisitions are widely argued to be an increasingly common solution for technology needs. This paper uses the information and telecommunications industry as background for assessing how technical knowledge and absorptive capacity, the rate of invention and prior acquisition experience affect the likelihood of acquisition. The results indicate that in this standards-based industry, even firms with relevant patent portfolios and R&D expenditures are as likely as less knowledgeable firms to acquire rather than enter the market with internally developed products. The strong predictors of acquisition are experience in acquisitions and the ability to pay. Thus, while the number of acquisitions has increased dramatically, the use of this approach is limited to a small group of firms and is not a widespread solution.
IDEA MANAGEMENT FOR ORGANISATIONAL INNOVATION
Authors: FLYNN M. , DOOLEY L. , O'SULLIVAN D. , CORMICAN K.
Published: December 2003

Modern organisations are under ever increasing competitive pressure to maintain market share, enhance product range, improve efficiency and reduce cost. The process by which organisations attain these improvements is through innovation. Over recent years, significant research has focused on the issue of managing the process of developing ideas towards eventual organisational innovations. However, the process by which these ideas are generated and effectively managed is one which currently operates in an "ad hoc" fashion.

This paper strives to present a structured and holistic approach to managing idea generation. A literary survey of both innovation and creativity is undertaken to determine their inter-relationships and core traits. Following this, a methodology is presented to facilitate the organisational management of the "Idea Generation" process. An integrated software tool to support the process is also introduced. The purpose of this tool is to provide an infrastructure for the effective management of ideas and their transfer to the larger innovation process.
NEW PRODUCT DEVELOPMENT PRACTICES AND EXPORT INVOLVEMENT: AN INITIAL INQUIRY
Authors: LIM JEEN-SU , SHARKEY THOMAS W. , HEINRICHS JOHN H.
Published: December 2003

This study is an exploratory investigation into the role of new product development practices in the internationalisation process. Specifically, the relationship among five identified new product development practices and three export involvement stages is explored.

The analysis of survey data obtained from a national sample of U.S. manufacturing firms provide support for the contention that certain new product development capabilities must exist at all stages of the internationalisation process. The results further support the argument that a subset of new product development capabilities must exist for the firm to pursue strategies that will result in a higher degree of export involvement.
NEW WINE IN OLD BOTTLES: A CASE STUDY OF INNOVATION TERRITORIES IN "NEW WORLD" WINE PRODUCTION
Authors: AYLWARD DAVID , TURPIN TIM
Published: December 2003

This article applies the concept of "innovation territories" to explain the recent export success of the Australian Wine Industry. Recent data collected from four "New World" wine producing countries are contrasted in order to investigate "innovation territories" that in the Australian context transcend geographic and policy boundaries. The international comparison shows that these territories can be mapped and their interaction compared. A major finding from the study is that one of the major contributors to Australia's success in gaining comparative advantage in this industry is the way local and national investments in R&D have transcended geographic and policy boundaries. Coordination driven by strong national policies is required to make this happen. This suggests that "knowledge intensive clusters" driven by national policies can be turned to advantage for regional development. The present study serves to sketch out how the idea of innovation territories might be operationalised for the purpose of future industry policy research.
A COMPARATIVE ANALYSIS ON TECHNOLOGY INNOVATION & DIFFUSION SYSTEM AND INDUSTRIAL INNOVATION BETWEEN TAIWAN AND MAINLAND CHINA
Authors: LIU CHANG-YUNG , YANG JIE
Published: December 2003

Backwardness at technological capabilities is a common problem for all developing regions. Among catching-up economies in the developing world, Taiwan and Mainland China have achieved remarkably rapid growth in the science and technology development. More interestingly, they have done so by adopting distinctly different model of innovation and diffusion strategy.

In this study, we compare the performance of industrial innovation between Mainland China and Taiwan by using the framework of national technological capabilities which includes technology push, market pull, S&T and industrial policies, factor market, innovation and diffusion system. By considering the close relationship across the Taiwan Strait, implications of cooperation on technology innovation and high-tech industry development for these two regions are also explored.
DO CORPORATIONS PERCEIVE MANDATORY PUBLICATION OF POLLUTION INFORMATION FOR KEY STAKEHOLDERS AS A LEGITIMACY THREAT?
Authors: CUNNINGHAM STACEY , GADENNE DAVID
Published: December 2003

In recent decades several researchers have investigated the relationship between corporate environmental performance and environmental disclosures. A number of these studies have also investigated the positive/negative content of the disclosures, particularly following the occurrence of negative environmental events or media coverage. Limited research has investigated the usefulness of regulated public external disclosures of corporate environmental performance information as a driver of annual report environmental disclosure behaviour. The mandatory Australian National Pollutant Inventory now provides interested parties with access to information on corporate pollution emissions. This represents a change to the corporate operating environment and represents a potential threat to corporate legitimacy. This paper reports the results of research investigating the release of corporate pollution emission information on the National Pollutant Inventory and changes in corporate environmental disclosures in annual reports.
STRATEGIC ENVIRONMENTAL ASSESSMENT (SEA) OF WASTEWATER REUSE POLICY: A CASE STUDY FROM TIANJIN IN CHINA
Authors: HE XU , TAN ZHU , SHUGUI DAI
Published: December 2003

China is one of the thirteen countries in the world that lacks water. Rapid economic growth and urbanisation over the past two decades have exerted enormous pressure on China's water resources. The shortage of water resources and serious water pollution have become important factors restraining the sustainable development in the cities. Wastewater reuse has been proven to prevent water pollution and ameliorate the pressure on the water environment. Moreover, wastewater reuse can make up for the lack of funds in wastewater treatment. So, wastewater reuse is a viable choice to realise the sustainable utilisation of water resource in China. There still remain many uncertainties in wastewater reuse. It is strongly recommended that a wastewater reuse policy be pushed forward considering the necessity and the implications to society, the economy and the environment. Strategic environmental assessment (SEA) is seen as an important tool for integrating the environmental factors into decision-making. This paper illustrates a case study for SEA — aimed at Tianjin Wastewater Reuse Policy (TWRP). The process of SEA at the policy level and the related problems are presented within this case study. It provides a good framework for carrying out SEA of waste reuse at the national level. The study will support the Chinese Government in developing a national strategy on urban wastewater reuse through an investigation of the existing situations, evaluation of policy options in different areas, and offering recommendations.
DEALING WITH CONTINUOUS REFORM: TOWARDS ADAPTIVE EA POLICY SYSTEMS IN COUNTRIES IN TRANSITION
Authors: CHERP ALEG , ANTYPAS ALEXIOS
Published: December 2003

Environmental assessment (EA) systems in the countries-in-transition (CITs) in Central and Eastern Europe, Caucasus and Central Asia have been significantly reformed over the last decade. Considerable research efforts have focused on the degree to which EA in this region conforms to best international practice, functions well and results in environmental and democratic improvements. This article examines the evolution of such research and proposes to expand its agenda and methodology to include a policy-systems approach that would more accurately take account of the complexity of EA systems, especially in the constantly changing and institutionally volatile environment of the CITs.
High Mobility Thin Film Transistors with Transparent ZnO Channels
Authors: Nishii Junya , Hossain Faruque M. , Takagi Shingo , Aita Tetsuya , Saikusa Koji , Ohmaki Yuji , Ohkubo Isao , Kishimoto Shuya , Ohtomo Akira , Fukumura Tomoteru , Matsukura Fumihiro , Ohno Yuzo , Koinuma Hideomi , Ohno Hideo , Kawasaki Masashi
Published: December 2003

We have fabricated high performance ZnO thin film transistors (TFTs) using CaHfOxbuffer layer between ZnO channel and amorphous silicon–nitride gate insulator. The TFT structure, dimensions, and materials set are identical to those of the commercial amorphous silicon (a-Si) TFTs in active matrix liquid crystal display, except for the channel and buffer layers replacing a-Si. The field effect mobility can be as high as 7 cm2·V-1·s-1for devices with maximum process temperature of 300°C. The process temperature can be reduced to 150°C without much degrading the performance, showing the possibility of the use of polymer substrate.
Atomical Grothendieck categories
Authors: Năstăsescu C. , Torrecillas B.
Published: December 2003

Motivated by the study of Gabriel dimension of a Grothendieck category, we introduce the concept of atomical Grothendieck category, which has only two localizing subcategories, and we give a classification of this type of Grothendieck categories.
On a few Diophantine equations, in particular, Fermat′s last theorem
Authors: Levesque C.
Published: December 2003

This is a survey on Diophantine equations, with the purpose being to
give the flavour of some known results on the subject and to describe a few open problems. We will come across Fermat′s last theorem and its proof by Andrew Wiles using the modularity of elliptic curves, and we will exhibit other Diophantine equations which were solved à la Wiles. We will exhibit many families of Thue equations, for which Baker′s linear forms in logarithms and the knowledge of the unit groups of certain families of number fields prove useful for finding all the integral solutions. One of the most difficult conjecture in number theory, namely, the ABC conjecture, will also be described. We will conclude by explaining in elementary terms the notion of modularity of an elliptic curve.
Characterization of the automorphisms having the lifting property in the category of abelian p‐groups
Authors: Abdelalim S. , Essannouni H.
Published: December 2003

Let p be a prime. It is shown that an automorphism α of an abelian p‐group A lifts to any abelian p‐group of which A is a homomorphic image if and only if α = π idA, with π an invertible p‐adic integer. It is also shown that if A is torsion group or torsion‐free p‐divisible group, then idA and −idA are the only automorphisms of A which possess the lifting property in the category of abelian groups.
Nagata rings and directed unions of Artinian subrings
Authors: Karim D.
Published: December 2003

We investigate when a Nagata ring R(X) can be written as a directed union of Artinian subrings. For a family of zero‐dimensional rings , we show that ∏α∈ARα(Xα) is not a directed sum of Artinian subrings.
On Dedekind′s criterion and monogenicity over Dedekind rings
Authors: Charkani M. E. , Lahlou O.
Published: December 2003

We give a practical criterion characterizing the monogenicity of the integral closure of a Dedekind ring R, based on results on the resultant Res (p, pi) of the minimal polynomial p of a primitive integral element and of its irreducible factors pi modulo prime ideals of R. We obtain a generalization and an improvement of the Dedekind criterion (Cohen, 1996), and we give some applications in the case where R is a discrete valuation ring or the ring of integers of a number field, generalizing some well‐known classical results.
Costs of Stroke Care according to Handicap Levels and Stroke Subtypes
Authors: Spieler Jean-François , Lanoë Jean-Louis , Amarenco Pierre
Published: December 2003

Background: If new advances in stroke management are to be put into practice, crucial information about their costs needs to be considered in relation to clinically pertinent variables (e.g. handicap level and stroke subtypes). Details of costs throughout the entire period of stroke care are essential in the political decision-making process, in order to avoid other budget-balancing approaches, which are not always satisfactory. Our aim was to perform an in-depth evaluation of the direct medical cost of stroke care in a large cohort. Methods: We included 435 consecutive patients with brain infarction in 12 primary-care and referral neurology departments. Information on acute care was prospectively collected. Information on postacute care was collected by research nurses’ visits to the patient’s or a relative’s home 18–40 months after the stroke onset. We thus collected detailed information on handicap levels, stroke subtypes, acute hospitalization costs, rehabilitation, nursing care and ambulatory costs. This enabled us to calculate costs over an 18-month period after the initial acute hospital discharge. Results: By the 12th month after discharge, the costs amounted to 17,799 euros (16,440–19,158) per patient; the initial hospitalization accounted for 42% of this cost, rehabilitation for 29% and ambulatory care for 8%. These costs were mostly concentrated within the first 3- to 6-month period. After 46 months without recurrence, the cost of ambulatory care outweighed the cost of the first 6 months. Handicap levels explained 43% of the variance of costs (p < 0.0001) and, according to the Rankin scale divided into 3 classes (0–2, 3 and 4–5), cumulative costs over time differed considerably. Stroke subtypes were not discriminating variables except for lacunar strokes, which were significantly less costly than the other groups. Conclusions: By providing a fairly comprehensive figure for the details of direct costs of stroke care over time, our study gives some clues about the economic burden of stroke care which is mostly driven by a high handicap level. This suggests that any early intervention aimed at reducing the handicap level will probably dramatically reduce this burden.
Plaque Volume Measurement by Magnetic Resonance Imaging as an Index of Remodeling of Middle Cerebral Artery: Correlation with Transcranial Color Doppler and Magnetic Resonance Angiography
Authors: Lam W.W.M. , Wong K.S. , So N.M.C. , Yeung T.K. , Gao S.
Published: December 2003

Background: The feasibility of a noninvasive evaluation of remodeling of the middle cerebral artery (MCA) by magnetic resonance imaging (MRI) was assessed. The results were correlated with magnetic resonance angiography (MRA) and transcranial color Doppler (TCD) findings. Methods: 26 patients (13 male and 13 female, age ranged from 46 to 82 years) who presented with symptoms of cerebrovascular accidents had TCD, MRA and MRI assessment of the MCA. The TCD and MRA findings of 40 MCAs accessible by TCD were correlated with the ratio of cross-sectional area of the vessel (VA), luminal area of the vessel (LA) and plaque load (PL). Results: The VA ratio and LA showed no correlation with TCD or MRA results. PL however was shown to be associated with both TCD and MRA. Conclusions: MRI could be used to assess remodeling in MCAs. PL was found to be associated with TCD and MRA findings.
Changes in Cardiac Thrombus Status after Cerebral Ischemia
Authors: Sen Souvik , Lima Joao A.C. , Oppenheimer Stephen M.
Published: December 2003

Background and Purpose: Intracardiac thrombi are a potential source of cerebral embolism. The disposition of intracardiac thrombi in ischemic stroke/transient ischemic attack (TIA) patients was investigated over a 10-month period using omniplanar transesophageal echocardiography (TEE). Methods: One hundred and five patients underwent TEE examination at <1 month and again at 9–12 months (mean 10 months) after symptom onset. TEEs were evaluated for thrombi in the left atrium, left atrial appendage and left ventricle. Stroke risk factors and TEE findings were compared between patients with and without new thrombi on follow-up TEE. Similar comparisons were made in patients with and without disappearance of thrombi on the follow-up TEE. The effect of anticoagulants was evaluated. Results: Intracardiac thrombi were found initially in 18% (95% CI 11–25%) of patients in 79% (95% CI 61–97%) of whom the thrombi disappeared on the follow-up TEE; this significantly correlated with warfarin anticoagulation (p = 0.037). In the remainder 82% (95% CI 75–89%) patients, new thrombi were detected on the follow-up TEE in 8% (2–14%). These were older (p = 0.009), and not on anticoagulation. Patients with aortic atheroma ≧4 mm were also more likely to develop new intracardiac thrombi (p = 0.001). Conclusions: Anticoagulation with warfarin for 10 months is associated with conditions leading to disappearance of intracardiac thrombi after a cerebral ischemic event and hence has a probable therapeutic role. Older patients, not anticoagulated, and those with significant aortic atheroma ≧4 mm may have increased probability for de novo thrombus development. These patients may be at risk of cardiac embolization and could be considered for prophylactic anticoagulation.
Right-to-Left-Shunts Detected by Transesophageal Echocardiography and Transcranial Doppler Sonography
Authors: Droste Dirk W. , Schmidt-Rimpler Carsten , Wichter Thomas , Dittrich Ralf , Ritter Martin , Stypmann Jörg , Ringelstein E. Bernd
Published: December 2003

Background: Transesophageal echocardiography (TEE) and transcranial Doppler sonography (TCD) can identify right-to-left-shunts that predispose to paradoxical embolism. In a large cohort we compared the results of both techniques. Methods: 222 patients were investigated by both techniques using the contrast agent Echovist®-300 and performing each test once without and once with the Valsalva maneuver (VM). Results: TEE-proven right-to-left-shunts were detected by TCD with a high sensitivity of 94%. In addition, TCD revealed shunts not noted during TEE in about 20% of all patients studied. These shunts are in general smaller than those concordantly identified; however, 9% of the patients without a TEE-proven shunt presented with a shunt that allows a considerable amount of contrast medium to pass. There were 12% more microbubbles detected in the right middle cerebral artery than in the left middle cerebral artery during the TCD test performed with VM, but not during the TCD test performed without VM. Conclusions: Contrast-enhanced TEE and TCD are complementary methods in the assessment of stroke and stroke-prone patients. The side difference of microbubbles may indicate a selective streaming of cardiac emboli during VM.
Apolipoprotein H Gene Polymorphisms and Risk of Primary Cerebral Hemorrhage in a Chinese Population
Authors: Xia Jian , Yang Qi-dong , Yang Qi-ming , Xu Hong-wei , Liu Yun-hai , Zhang Le , Zhou Yan-hong , Wu Zhi-guo , Cao Gui-fang
Published: December 2003

Background and Purpose: Apolipoprotein H (ApoH) has been implicated in several physiologic pathways including lipid metabolism, coagulation and the production of hypertension, which are related to the pathogenesis of primary cerebral hemorrhage (PICH). The gene coding for ApoH is polymorphic, with the occurrence of several common alleles in the general population. This genetically determined variation can effect lipid metabolism and the production of hypertension. We determined the distribution of ApoH gene polymorphisms in Chinese people and investigated whether these polymorphisms were associated with increased risk of PICH in a Chinese population. Methods: We studied polymorphisms of the ApoH gene by the polymerase chain reaction-single strand conformation polymorphism technique and DNA sequencing in 140 PICH patients and 100 healthy control subjects. Serum antiphospholipid antibodies and lipid levels were also examined in all subjects. Results: Four polymorphisms of the ApoH gene have been identified in Chinese people. No difference in genotype frequencies of G817T (Leu247Val) polymorphism, G1025C (Try316Ser) polymorphism and C1080T polymorphism was observed between PICH patients and control subjects (p > 0.05). The G341A (Ser88Asn) polymorphism correlated significantly with PICH. The frequencies of the A allele were significantly higher in PICH patients than in controls, especially in PICH patients with hypertension and a family history of stroke. Conclusions: Our results suggest that the G341A (Ser88Asn) polymorphism might be associated with increased risk of PICH in a Chinese population. The association appeared to be mediated by the generation of hypertension.
Validity and Reliability of Estimating the Scandinavian Stroke Scale Score from Medical Records
Authors: Barber Mark , Fail Michael , Shields Melanie , Stott David J. , Langhorne Peter
Published: December 2003

Background: Reliable estimation of severity of neurological impairments early after stroke is essential for research and audit of acute stroke care. Obtaining this information prospectively requires significant resources. We wished to assess the reliability of estimating the Scandinavian Stroke Scale (SSS) score retrospectively from routine hospital admission records. Methods: Acute stroke admissions to a large urban hospital were examined and had their SSS scored by an experienced physician within 4 h of the examination performed by the medical admissions team. Two examiners (a trained research nurse and a second physician), blinded to the patients’ clinical condition, later independently estimated retrospective SSS scores using information documented in the medical admission notes. Results: Fifty patients were recruited [median age 73 years (interquartile range 61, 79)]. Weighted kappa statistics for agreement between domains of the face-to-face and retrospective SSS were as follows: consciousness 0.73, eye movements 0.60, arm motor power 0.83, hand motor power 0.71, leg motor power 0.81, orientation 0.81, speech 0.80, and facial palsy 0.53. The intraclass correlation coefficient for face-to-face and retrospective SSS composite scores was 0.97 (95% CI 0.96–0.98), p < 0.0001. Interobserver reliability for the different components of the retrospective SSS was excellent (kappa values greater than 0.75) apart from consciousness (0.71) and eye movements (0.58). Conclusions: The composite SSS score and most of its individual components can be reliably estimated retrospectively from routine hospital admission records. This method is potentially useful both in observational studies and in case-mix adjustment for audit purposes.
Attenuated Lipid Peroxidation in Preterm Infants during Subsequent Doses of Intravenous Lipids
Authors: Pitkänen Olli M. , Luukkainen Päivi , Andersson Sture
Published: December 2003

The aim of this study was to determine whether the administration of a lipid emulsion containing less polyunsaturated fatty acids but rich in monounsaturated fatty acids causes less in vivo lipid peroxidation in preterm infants. The prospective intervention study included 13 infants with birth weights and gestational ages ranging between 1,100 and 2,660 g and from 28.4 to 32.9 weeks. All were in a stable condition and randomly allocated for a 3-hour infusion (0.16 g/kg/h) of an olive oil-based and a soybean oil + medium chain fatty acid (MCT) emulsion on 2 consecutive days. Expired pentane and plasma triglycerides (TGs) were measured before, during, and after the 3-hour infusion. Basal exhaled pentane averaged 9.4 ± 7.0 pmol/kg/min (mean ± SD). During the olive oil-based emulsion, exhaled pentane increased to 95.2 ± 56.7, and during soybean oil + MCT it increased to 110 ± 93.9 pmol/kg/min (p < 0.05 both from basal, n.s. between preparations). One hour after discontinuation of the infusion, exhaled pentane returned to 21.1 ± 12.6 pmol/kg/min (p < 0.05 vs. basal). Combined data on expired pentane measurements demonstrated that on day 1 pentane peaked at 124 ± 87.0 pmol/kg/min which was significantly attenuated to 57.5 ± 24.4 pmol/kg/min after an identical dose of lipid on day 2 (p < 0.05). No difference in peak TGs was detected between the two preparations or the study days. Infusion of a constant dose of intravenous lipids on 2 subsequent days to the newborn infants is associated with a reduction in lipid peroxidation. This finding may be dependent on normal postnatal maturation or may represent an appropriate adaptive response aiming at a reduction in oxidative stress. Peroxidation of soybean oil + MCT and olive oil-based lipid emulsions was similar in the newborn infants.
The Effect of a Nebulized NO Donor, DPTA/NO, on Acute Hypoxic Pulmonary Hypertension in Newborn Piglets
Authors: Young Karen C. , Ladino John , Navarrete Cristina , Dabrowska Katarzyna , Hehre Dorothy , Bancalari Eduardo , Suguihara Cleide
Published: December 2003

NONOates, novel NO donors, are complexes of NO with nucleophiles which spontaneously and nonenzymatically release NO in aqueous solution. This study sought to determine the cardiopulmonary effects of the nebulized NONOate dipropylenetriamine (DPTA)/NO in newborn piglets with acute hypoxia-induced pulmonary hypertension. Twenty sedated and mechanically ventilated piglets (4–10 days old) exposed to hypoxia (FiO2 = 0.14) were randomly assigned to receive nebulized saline as placebo (PL) or DPTA/NO (75 mg) after 30 min of hypoxia. Pulmonary artery (Ppa) and wedge pressures, systemic (Psa) and right atrial pressures, cardiac output (CO) and arterial blood gas were measured at baseline and every 15 min for 2 h. Methemoglobin levels were measured at baseline and 1 h after drug nebulization. Data (means ± SD) were analyzed by repeated-measures analysis of variance. Acute hypoxia resulted in an increase in Ppa and pulmonary vascular resistance (PVR), which was significantly attenuated by DPTA/NO nebulization as compared to the PL group (p < 0.0001). Changes in Psa, CO, systemic vascular resistance (SVR), arterial blood gas and methemoglobin levels were not different between groups. In contrast to the increase in PVR/SVR observed during hypoxia in the PL group, there was a significant decrease in this ratio after NONOate administration (p < 0.0001). These data show that acute hypoxic pulmonary hypertension in newborn piglets is markedly attenuated by NONOate nebulization. This response is predominantly in the pulmonary vasculature as the PVR/SVR was significantly lower in the treated group. We speculate that NONOates may have clinical application in the treatment of persistent pulmonary hypertension of the newborn.
Early and Long-Term Results of Surgery for Severe Necrotising Pancreatitis
Authors: Tzovaras George , Parks Rowan W. , Diamond Thomas , Rowlands Brian J.
Published: December 2003

Background: Necrotising pancreatitis is a challenging problem for the surgeon, as it is associated with considerable morbidity and mortality. The indications, timing of surgical intervention and type of procedure continue to be debated in an effort to improve the outcome of this devastating disease process. Methods: A retrospective analysis of early and long-term results in a series of 44 consecutive patients (34 men, 10 women, median age 46.5, range 13–74 years) who underwent necrosectomy for severe necrotising pancreatitis. In 16 patients necrosectomy and primary abdominal closure with drains was performed, 14 patients had planned staged necrosectomy and delayed abdominal closure with drains, and in 14 patients necrosectomy with open laparostomy was undertaken. Results: There were 8 deaths (18%) and 14 cases (32%) of significant hospital morbidity (fistula 10, pseudocyst 2, renal failure 2). Variables which correlated with mortality were: high APACHE II score, acute renal failure requiring dialysis, and requirement for surgical intervention at an early stage (within the first two weeks). A total of 28 late complications occurred in 21 of the surviving patients (endocrine pancreatic insufficiency 10, exocrine pancreatic insufficiency 2, pseudocyst 2, chronic renal failure 2, incisional hernia 10, recurrent pancreatitis 1, and chronic pain 1). Conclusions: Low mortality can be achieved in patients with severe necrotizing pancreatitis with aggressive surgical intervention and careful perioperative management. Long-term morbidity remains high, and emphasises the need for prolonged follow-up.
Modified Reduction Surgery for Adenomyosis
Authors: Fujishita Akira , Masuzaki Hideaki , Khan Khaleque Newaz , Kitajima Michio , Ishimaru Tadayuki
Published: December 2003

We describe the preliminary clinical results of a modified method of reduction surgery for easy approach and effective removal of lesions in women with adenomyosis. Old classical reduction surgery was performed in 5 women with imaging diagnosis of adenomyosis who were selected retrospectively among 104 patients undergoing conservative surgery. A transverse H incision method in the reduction surgery was applied to 6 of 83 patients wishing to preserve fertility. Benefit in operative procedure, complications, patients’ compliance, and pregnancy outcome were analyzed and compared between 5 women with the classical method and 6 women with the H incision method for adenomyosis. No apparent difference was observed in the operation time, blood loss and volume of excised specimens between these two groups. The major complication of perforation during surgery occurred in 2 patients (40%) by the classical method and in only 1 patient (17%) by the H incision technique. The subjective relief of pain was relatively more evident in the modified than in the classical group. There was no case of pregnancy in the classical group; however, 1 patient conceived spontaneously 4 months after operation by this H incision procedure. Our H incision technique may be considered a useful method for an easy surgical approach and satisfactory removal of adenomyotic lesions and may be better than the old classical method of reduction surgery.
Investigation of Conscious Recollection, False Recognition and Delusional Misidentification in Patients with Schizophrenia
Authors: Edelstyn Nicola M.J. , Drakeford Justine , Oyebode Femi , Findlay Chris
Published: December 2003

Background: Recognition memory (RM) is impaired in patients with schizophrenia, as they rely largely on feelings of familiarity rather than conscious recollection. It has been suggested that this abnormality may reflect a breakdown in strategic memory processes involved in both encoding and retrieval. By studying 2 patients with false recognition (FR; patient C.T.) and delusional misidentification (DM; patient B.C.), and a group of psychotic control patients, we examined proposals that FR and DM exist on a continuum of increasingly severe impairment in strategic memory function. Methods: Executive function, autobiographical memory and verbal and facial RM were assessed using standard neuropsychological tests and the remember/know paradigm. Results: The psychotic control group displayed a significantly reduced reliance on remember judgements and compensatory elevation in know judgements on both RM tasks compared with the normal control group. Patient B.C. also followed this trend, but in a much more pronounced manner. In contrast, patient C.T. displayed a qualitatively different performance profile, which was marked by an increased dependence on remember responses. Conclusions: We have presented evidence which support proposals that a breakdown in strategic memory and executive dysfunction are more pronounced in DM than FR. However, the small sample size precludes any firm conclusions being drawn.
Maternal Treatment with Propofol Attenuates Lipid Peroxidation after Transient Intrauterine Ischemia in the Neonatal Rat Brain
Authors: Solaroglu Ihsan , Okutan Ozerk , Solaroglu Ayse , Kaptanoglu Erkan , Beskonakli Etem , Kilinc Kamer
Published: December 2003

The purpose of this study was to investigate whether propofol has a neuroprotective effect on the fetal brain after intrauterine ischemia-reperfusion (I/R) injury in the rat fetus. Fetal brain ischemia was induced by clamping the utero-ovarian artery bilaterally for 30 min and reperfusion was achieved by removing the clamps for 2 h. A 40-mg/kg single dose of propofol was administered intraperitoneally 15 min before I/R injury. Lipid peroxidation in the brain tissue was determined as the concentration of thiobarbituric acid reactive substances (TBARS) for each fetal rat. Results showed that lipid peroxidation byproducts increased after I/R injury. Maternal treatment with propofol reduced TBARS compared to the I/R group. Propofol has been shown to have neuroprotective effects in intrauterine I/R-induced fetal brain damage in rats.
Diffusion-Weighted Imaging of Intravascular Clots in Cerebral Venous Thrombosis
Authors: Favrole Pascal , Guichard Jean-Pierre , Crassard Isabelle , Bousser Marie-Germaine , Chabriat Hugues
Published: December 2003

Background and Purpose—

Hyperintensities on diffusion-weighted MRI at the site of venous occlusion have previously been reported in cerebral venous thrombosis (CVT). The frequency of these signal changes according to late venous recanalization was not determined yet.

Methods—

In a series of 28 patients with recent CVT, the frequency of hyperintense signals as seen on diffusion-weighted MRI in vein(s) or sinus(es) (HSVdwi) was assessed at the time of diagnosis, as was rate of recanalization 2 to 3 months after anticoagulation.

Results—

HSVdwi was detected in 20 occluded vein(s) or sinus(es) in 12 patients (41%) with recent CVT. The mean apparent diffusion coefficient measured in 5 patients within HSVdwi in the superior sagittal sinus was 4.88±1.49×10
−4
mm
2
/s. The delay since clinical onset was larger in the presence than in the absence of HSVdwi as detected at the time of diagnosis. No HSVdwi was visible at the second MRI although some vessels remained occluded. Complete recanalization of the vessel was less frequent when HSVdwi was observed on the first MRI (35% versus 88%,
P
=0.005).

Conclusions—

Results of this study suggest that the movements of water molecules are more or less restricted within the venous clot according to the stage of thrombus formation in CVT. The presence of HSVdwi in occluded veins at the time of diagnosis might be predictive of a low rate of vessel recanalization 2 or 3 months later.
Digital Development and Disruption in South Africa: Balancing Growth and Equity in National ICT Policies
Authors: Benner Chris
Published: December 2003

Information and communication technologies (ICTs) are both critical for economic development and highly disruptive to existing employment opportunities. Maximizing the potential of ICTs requires both promoting their use and addressing the inequality and dislocation they may cause. This paper examines South African national policy efforts that have an explicit goal of both growth and equity in the promotion of ICT use. Through an examination of two particularly high profile programs, the paper argues that national policy underestimates the potentially negative impact of ICTs on traditional employment sectors and fails to address the volatile nature of employment and skill requirements in ICT industries themselves. As a result, unless these shortcomings are addressed, national ICT policy in South Africa seems likely to further contribute to the disruption of existing employment opportunities while contributing to growing inequality.
The Impact of Globalization on Agricultural Biotechnology in Iran: A Model for Regional Intellectual Property Rights
Authors: Haghiri Morteza , Phillips Peter
Published: December 2003

The increasing population of developing countries, which creates an increasing demand for food, is severely challenging traditional agricultural practices. Recent scientific developments have introduced biotechnology techniques to agriculture. To increase the benefits from implementing biotechnology, countries need both to continuously invest in research and development in their biotechnology sector and to implement a series of complementary policies. Establishing and enforcing the intellectual property rights of plant breeders are among of these policies. The successful institution of plant breeders' rights is influenced by market institutions and the legal system, which together comprise the environmental structure of the economy. Since property rights are not well established in most developing and developed countries, individual research and innovations cannot be protected from intellectual property piracy. As a result, there is little incentive to continue investment in research and development in biotechnology in those markets. This paper proposes a model of regional intellectual property rights for developing countries where individual intellectual property rights are not enforceable.