bluuebunny/crossref_metadata_2025 huggingface dataset:
Initial treatment of venous thromboembolism
Authors: Becattini Cecilia , Emmerich Joseph , Bura Alessandra , Weitz Jeffrey , Agnelli Giancarlo
Published: October 2006

Immediate anticoagulant treatment is essential to reduce morbidity and mortality in patients with acute venous thromboembolism (VTE). Currently, rapid anticoagulation can only be achieved with parenteral anticoagulants, such as heparin or low-molecular-weight heparin (LMWH).Weight-adjusted LMWH is the treatment of choice, because it produces predictable anticoagulation and does not require coagulation monitoring. If heparin is used, the activated partial thromboplastin time must be monitored and the heparin dose adjusted to ensure a therapeutic level of anticoagulation. Heparin is recommended for patients with renal impairment and for those at high risk of bleeding. The selective factor Xa inhibitor fondaparinux is a recently introduced alternative to heparin or LMWH for initial VTE treatment. Heparin, LMWH, or fondaparinux should be given for at least five to seven days. Vitamin K antagonists should be initiated on the first day, or as soon as possible, in patients who are candidates for an oral anticoagulant. An oral anticoagulant agent to be used without laboratory monitoring for both acute and long-term treatment of VTE remains an unsolved clinical need in the treatment of VTE.
From Grounded Skills to Creativity: On the Transformation of Mining Regions in the Knowledge Economy
Authors: Gustavsson Linda , Laestadius Staffan
Published: October 2006

The aim of this article is to explore the role of creativity for high-performance innovative activity. It is our conjecture that this approach enables us to go beyond the dominant science-focus of the present discourse on the transformation to a knowledge-based society. In line with the first part of the Schumpeterian definition of innovation: creative combination, the ability to be creative draws on dispersed - new and old, external and internal, scientific and non-scientific - knowledge sources. The article is primarily a theoretical and conceptual exercise: however, we relate our discussions to empirical findings from mature manufacturing industries. The discussions are also related to the current industrial transformation in the Iron Ore Belt in Sweden, and the possible challenges this entails for a region characterized by a strong tradition of large-firm domination and natural resource-based industry. In the current transformation, this region must find new ways to both encourage and support economic and technological development - something which may find its base not only in scientific skills in a narrow sense, but also in new attitudes to industrial creativity.
From Employment to Entrepreneurship: Shifting Perspectives in Europe and the US on Knowledge Creation and Labour Market Competition
Authors: Eliasson Gunnar
Published: October 2006

Technology is making smaller scale, distributed production more economical, raising global competition and forcing change on traditional firms in mature markets. Change was gradual for decades but accelerated during the last ten or fifteen years as new computing and communications (C&C) technologies helped coordinate production flows, making firms break up and distribute their value chains over markets of subcontractors and changing the work environment of individuals. I investigate the consequences for individuals of the faster creative destruction process that is taking place through the turnover of firms rather than internally within firms. I conclude that labour market risks are changing such that entrepreneurial ability, intellectual flexibility and a capacity to learn efficiently from experience will become competitive advantages for individuals. I also conclude that efficient education may offer a way of countering the ongoing polarization of labour markets and I derive a platform theory of cumulative learning from experience that emphasizes the acquisition of basic skills during early school years. A varied and advanced job environment to learn from is probably the most important factor, sustaining the competitive advantage of the advanced industrial economies. A stylized comparison of the educational and labour market systems suggests that the European systems are at a disadvantage compared to that of the US.
Learning as Grounding and Flying: Knowledge, Skill and Transformation in Changing Work Contexts
Authors: Fenwick Tara
Published: October 2006

Before activities in workplace skill development and skill transformation can be pursued, what exactly is meant by `skill' requires careful examination. The notion of `skill' is far from consensual or accepted unproblematically, and this article is focused on the various meanings and problems that have arisen around `skill'. Four conventional conceptions of skill are examined critically and rejected: that a skill exists as a discrete competency, that a skill is `acquired' and is centered in the individual, that work skill (and knowledge) is learned through mental reflection on `concrete' experience, and that skill development is about behavior, not politics. Towards expanding conceptions of work learning, contemporary theories applicable to changing work environments are outlined: learning as participation in situated practices, as expansion of objects and ideas, as `translation' and mobilization, and as embodied emergence. Drawing insights from these four perspectives, a conception of work learning embedding a double movement of `flying' and `grounding' is offered. The argument is theory-driven and largely focused on work contexts subject to rapid knowledge transformation.
Comparison of pramipexole and modafinil on arousal, autonomic, and endocrine functions in healthy volunteers
Authors: Samuels E. R. , Hou R. H. , Langley R. W. , Szabadi E. , Bradshaw C. M.
Published: October 2006

The noradrenergic locus coeruleus is a major wakefulness-promoting nucleus of the brain, which is also involved in the regulation of autonomic and endocrine functions. The activity of the locus coeruleus is believed to be tonically enhanced by a mesocoerulear dopaminergic pathway arising from the ventral tegmental area of the midbrain. Both modafinil, a wakefulness-promoting drug, and pramipexole, a D2/D3receptor agonist with sedative properties, may act on this pathway, with modafinil increasing and pramipexole decreasing locus coeruleus activity. The aim of this study was to compare the two drugs on alertness, autonomic and endocrine functions in healthy volunteers. Pramipexole (0.5mg), modafinil (200mg), and their combination were administered to 16 healthy males in a double-blind, placebo-controlled design. Methods included tests of alertness (pupillographic sleepiness test, critical flicker fusion frequency, visual analogue scales), autonomic functions (resting pupil diameter, light and darkness reflex responses, heart rate, blood pressure, salivation, core temperature), and endocrine functions (blood concentrations of prolactin, growth hormone, and thyroid stimulating hormone). Data were analysed by ANOVA. Pramipexole reduced alertness, caused pupil dilatation, increased heart rate, reduced prolactin and thyroid stimulating hormone, and increased growth hormone level. Modafinil caused small increases in blood pressure and core temperature, and reduced prolactin levels. The sedative effect of pramipexole and the autonomic effects of modafinil are consistent with altered activity in the mesocoerulear pathway; the pupil dilatation following pramipexole suggests reduced dopaminergic excitation of the Edinger-Westphal nucleus.
Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained ‘mentally demanding’ tasks
Authors: Reay Jonathon L. , Kennedy David O. , Scholey Andrew B.
Published: October 2006

Single doses of the traditional herbal treatment Panax ginseng have recently been shown to lower blood glucose levels and elicit cognitive improvements in healthy, overnight-fasted volunteers. The specific mechanisms responsible for these effects are not known. However, cognitive improvements may be related to the glycaemic properties of Panax ginseng.

Using a double-blind, placebo-controlled, balanced-crossover design, 27 healthy young adults completed a 10 minute “cognitive demand” test battery at baseline. They then consumed capsules containing either ginseng (extract G115) or a placebo and 30 minutes later a drink containing glucose or placebo. A further 30 minutes later (i.e. 60 minutes post-baseline/capsules) they completed the “cognitive demand” battery six times in immediate succession. Depending on the condition to which the participant was allocated on that particular day, the combination of capsules/drink treatments corresponded to a dose of: 0mg G115/0mg glucose (placebo); 200mg G115/0mg glucose (ginseng); 0mg G115/25g glucose (glucose) or 200mg G115/25g glucose (ginseng/glucose combination). The 10 minute “cognitive demand” battery comprised a Serial Threes subtraction task (2 min); a Serial Sevens subtraction task (2 min); a Rapid Visual Information Processing task (5 min); and a “mental fatigue” visual analogue scale. Blood glucose levels were measured prior to the day's treatment, and before and after the post-dose completions of the battery.

The results showed that both Panax ginseng and glucose enhanced performance of a mental arithmetic task and ameliorated the increase in subjective feelings of mental fatigue experienced by participants during the later stages of the sustained, cognitively demanding task performance. Accuracy of performing the Rapid Visual Information Processing task (RVIP) was also improved following the glucose load. There was no evidence of a synergistic relationship between Panax ginseng and exogenous glucose ingestion on any cognitive outcome measure. Panax ginseng caused a reduction in blood glucose levels 1 hour following consumption when ingested without glucose.

These results confirm that Panax ginseng may possess glucoregulatory properties and can enhance cognitive performance.
Computation and Graphical Characterization of Robust Multiple-Contact Postures in Two-Dimensional Gravitational Environments
Authors: Or Yizhar , Rimon Elon
Published: October 2006

This paper is concerned with computation and graphical characterization of robust equilibrium postures suited to quasistatic multi-legged locomotion. Quasistatic locomotion consists of postures in which the mechanism supports itself against gravity while moving its free limbs to new positions. A posture is robust if the contacts can passively support the mechanism against gravity as well as disturbance forces generated by its moving limbs. This paper is concerned with planar mechanisms supported by frictional contacts in two-dimensional gravitational environments. The kinematic structure of the mechanism is lumped into a rigid body B having the same contacts with the environment and a variable center of mass. Inertial forces generated by moving parts of the mechanism are lumped into a neighborhood of wrenches centered at the nominal gravitational wrench. The robust equilibrium postures associated with a given set of contacts become the center-of-mass locations of B that maintain equilibrium with respect to all wrenches in the given neighborhood. The paper formulates the computation of the robust center-of-mass locations as a linear programming problem. It provides graphical characterization of the robust center-of-mass locations, and gives a geometric algorithm for computing these center-of-mass locations. The paper reports experiments validating the equilibrium criterion on a two-legged prototype. Finally, it describes initial progress toward computation of robust equilibrium postures in three dimensions.
The Cobotic Hand Controller: Design, Control and Performance of a Novel Haptic Display
Authors: Faulring Eric L. , Colgate J. Edward , Peshkin Michael A.
Published: October 2006

The design, control and performance of the Cobotic Hand Controller, a novel, six-degree-of-freedom, admittance controlled haptic display is examined. A highly geared admittance architecture is often used to render high impedances with reasonable sized actuators for a haptic display. The Cobotic Hand Controller is an extremely faithful realization of an admittance display, since it is capable of obtaining an infinite gear ratio and can render infinite impedances (up to its own structural stiffness). The incorporation of continuously variable transmissions utilizing hardened steel elements in dry-friction rolling contact provide the Cobotic Hand Controller with high bandwidth, low power requirements, and an extremely wide stable dynamic range. Here, an admittance based control algorithm for powered cobots, a novel solution to the actuation redundancy of this device, and a heuristic to avoid slip in the transmissions are described. The performance of the Cobotic Hand Controller is measured in terms of dynamic range.
Direct Fusion between Poly(ethylene oxide)-lipid Modified Liposomes and Murine Mitotic B16 Melanoma Cells
Authors: Haratake Mamoru , Sunamoto Junzo
Published: October 2006

The interactions between the poly(ethylene oxide)-bearing lipid (PEO-lipid) were investigated with the average number of ethylene oxide units of 5, 15 and 32-reconstituted egg PC liposomes and murine mitotic B16 melanoma cells. Water-soluble FITC-dextran (20kDa) and lipophilic octadecyl rhodamine B (OD-RhoB) were encapsulated in liposomes to study the interaction modes with these cells by fluorescence microscopic techniques. Both fluorescent probes loaded in the PEO-lipid (n 32, 20mol%)-reconstituted liposome were specifically transferred to the mitotic cells. This process was not inhibited at 4°C or after the treatment of endocytosis inhibitor cytochalasin B or D. Confocal fluorescence microscopic observation of the cells treated with the liposome at 4°C revealed that FITC-dextran and OD-RhoB were transferred to the cytosol and the plasma membrane, respectively. In addition, when the mitotic cells were treated with the PEO-lipid (n 32, 20mol%)-reconstituted liposome encapsulated diphtheria toxin fragment A (DTA), approximately 30% of the cells were killed by the DTA-dependent cytotoxicity. These data indicate that the PEO-lipid (n 32, 20mol%)-reconstituted liposome directly fused with the plasma membrane of the murine mitotic B16 melanoma cells.
Heat Shock Protein-like Activity of a Nanogel Artificial Chaperone for Citrate Synthase
Authors: Sawada Shin-Ichi , Nomura Yuta , Aoyama Yasuhiro , Akiyoshi Kazunari
Published: October 2006

Molecular chaperone–like activity for the refolding of citrate synthase (CS) was investigated using nanometer-sized (<100nm) polymer hydrogels (nanogels) composed of cholesterol-bearing pullulan (CHP). We reported that CHP nanogels selectively interact with proteins (guests) as the host. CHP nanogels effectively prevented protein aggregation upon heating by complexation with denatured proteins. The enzyme activity of CS recovered in high yields after the addition of cyclodextrins. CHP nanogels assisted protein refolding in a manner similar to the mechanism with molecular chaperones such as GroEL. The present nanogel system could be a useful tool for the refolding and stabilization of unstable proteins.
Genette meets Vygotsky: narrative embedding and distributed intelligence
Authors: Herman David
Published: October 2006

Framed tales, or stories within stories, have garnered considerable attention from theorists of narrative in recent years. By and large, however, story analysts have not sought to account for why the practice of narrative embedding has persisted so long - or why it is so widespread - in the world’s folk traditions and written literatures. Using William Wordsworth’s The Ruined Cottage as its tutor-text, this article advances a broadly cognitive explanation for the pervasiveness and persistence of narrative embedding across so many different storytelling situations. My central claim is that, in conjunction with the cognitive activities of their interpreters, framed narratives such as The Ruined Cottage constitute intelligent systems - systems that both stage and facilitate the process of shared thinking about past events and about one’s own and other minds. Such systems propagate experiential frames - specifically, the experiences of character-narrators - across time and space. By contrast, in a story that does not involve narrative embedding, there will be a net decrease in the capacity of the system to communicate representations originating from sources potentially quite widely separated in space and time. Narrative embedding thus increases the distributional reach of a framed tale, enhancing the overall power of the knowledge-generating system to which it lends structure. Adapting Barbara Rogoff’s (1990) definition of intelligence as the socially supported ability to solve problems grounded in particular domains of activity, I explore how framed narratives can help distribute intelligence both synchronically (across regions of space and participants and material artifacts within those regions) and diachronically (across different temporal phases of a given spatial region).
The first 10 years of Accounting History as an international refereed journal: 1996–2005
Authors: Williams Brian , Wines Graeme
Published: October 2006

This article undertakes a content analysis of publications in the first 10 years of the new series of the journal Accounting History. In so doing, it adds to the prior literature examining publishing patterns in the accounting history discipline. The article commences by providing an historical background to the introduction of the new series and the journal's editorial team. This is followed by a content analysis of the journal's research publications. This analysis examines patterns of authorship, the journal's most published authors, institutional and geographical affiliations of authors, author gender and article classifications.
Using accounting records to enhance an understanding of a seventeenth-century Italian feudal community: the case of the Commune of Penne (1664–90)
Authors: Sargiacomo Massimo
Published: October 2006

Through the analysis of recently discovered accounting records of the Commune of Penne, this study is concerned with enhancing an understanding of a seventeenth-century Southern Italian feudal commune. Surviving public records and other primary sources are used to both elucidate the commune's organization, administration and accounting procedures and to portray key aspects of community life through a classification analysis of the entries contained in the town Register of the Exchequer. The analysis of these original documents discloses the ways in which money was spent in the Commune of Penne in the period 1664–90, thus specifying the major homogeneous groups of expenses of the Commune and thereby elucidating the adopted social priorities and concerns of the time. Such studies are important in enhancing an understanding of life and times in specific local, time-specific contexts, thus offering the potential to augment our literature on social history.
Scalability Modeling For Deterministic Particle Transport Solvers
Authors: Dahmani Mohamed , Roy Robert
Published: October 2006

In this paper, we propose a new parallel solver for the large-scale 3D neutron transport problems used in nuclear reactor simulations. Modern large-memory computers have made possible direct application of transport methods to large-scale computational models. However, many numerical acceleration techniques common to lattice transport codes are not applicable to heterogeneous geometry, especially high-dominance ratio when eigenvalue problems are solved. Consequently, large heterogeneous reactor problems have remained computationally intensive and impractical for routine engineering applications. Based on the characteristics method, this new code solves the transport equation by following neutron tracks. Due to the excessive number of these tracks in the demanding context of 3D large-scale calculations, the parallelization of the solver is the only way to obtain a fast solution. The parallelization is based on distributing a group of tracks, generated by a common ray tracing procedure, on several processors. An analytical model for the communication/ computation ratio is presented in order to predict the specific performance on different kind of architectures. A scalability analysis based on the isoefficiency function is performed on our parallel code when we increase the size of the problem and the number of processors. Tests are done to validate the analytical model by comparing the results to those given by the empirical tests. Results show that our parallel code is scalable and portable.
A Detailed Performance Analysis of the Interpolation Supplemented Lattice Boltzmann Method on the Cray T3E and Cray X1A Detailed Performance Analysis of the Interpolation Supplemented Lattice Boltzmann Method on the Cray T3E and Cray X1
Authors: Sunder C. Shyam , Baskar G. , Babu V. , Strenski David
Published: October 2006

A detailed study of the parallel performance of the interpolation supplemented lattice Boltzmann (ISLB) method using SHMEM and MPI on the Cray T3E-900 and Cray X1 architectures is presented. The noteworthy feature of the present implementation of the ISLB method is that it is able to achieve a sustained speed of 4.2 Tflop/s while using 504 processors on a Cray X1. The code is shown to achieve super-linear speedups on the Cray T3E-900. It is shown through detailed profiling that the computation and the communication scale well on the Cray X1, although the overall speedup is adversely affected by the cost of barrier synchronization.
On Parallelization of a Spatially-Explicit Structured Ecological Model for Integrated Ecosystem Simulation
Authors: Wang Dali , Berry Michael W. , Gross Louis J.
Published: October 2006

Spatially explicit landscape population models are widely used to analyze the dynamics of an ecological species over a realistic landscape. These models may be data intensive applications when they include the age and size structure of the species in conjunction with spatial information coming from a geographic information system (GIS). We report on parallelization of a spatially explicit landscape model (PALFISH), in a component-based simulation framework, utilizing different parallel architectures. A multithreaded programming language (Pthread) is used to deliver high scalability on a symmetric multiprocessor (SMP), and a message-passing library is deployed for parallel implementation on both an SMP and a commodity cluster. The PALFISH model delivers essentially identical results as a sequential version but with high scalability: yielding a speedup factor of 12 as the runtime is reduced from 35 hours (sequential ALFISH) to 2.5 hours on a 14processor SMP. Hardware performance data were collected to better characterize the parallel execution of the model on the different architectures. This is the first documentation of a high performance application in natural resource management that uses different parallel computing libraries and platforms. Due to the diverse needs for computationally intensive multimodels in scientific applications, our conclusions arising from a practical application which brings the software component paradigm to highperformance scientific computing, can provide guidance for appropriate parallelization approaches incorporating multiple temporal and spatial scales.
Automatic Middleware Deployment Planning On Clusters
Authors: Chouhan Pushpinder Kaur , Dail Holly , Caron Eddy , Vivien Frédéric
Published: October 2006

The use of remotely distributed computing resources as a single system offers great potential for compute-intensive applications. Increasingly, users have access to hundreds or thousands of machines at once and wish to utilize those resources concurrently. To provide a reasonable user experience, such systems must provide an effective, scalable scheduling system. Unfortunately, the great majority of job schedulers are centralized and many do not scale well to thousands or even hundreds of nodes.

In this paper we study how distributed scheduling systems can be designed most effectively; we focus on the problem of selecting an optimal arrangement of schedulers, or a deployment, for hierarchically organized systems. We show that the optimal deployment is a complete spanning d-ary tree; this result conforms with results from the scheduling literature. More importantly, we present an approach for determining the optimal degree d for the tree. To test our approach, we use DIET, a middleware system that uses hierarchical schedulers. We develop detailed performance models for DIET and validate these models in a real-world environment. Finally, we demonstrate that our approach selects deployments that are near-optimal in practice.
A Pragmatic Analysis Of Scheduling Environments On New Computing Platforms
Authors: Eyraud Lionel
Published: October 2006

Today, large scale parallel systems are available at relatively low cost. Many powerful such systems have been installed all over the world and the number of users is always increasing. The use of such clusters requires special administration tools, which have been developed recently and most frequently rely on intuitive heuristics to solve the underlying difficult scheduling problems. On the other hand, recent theoretical work has designed a number of models, such as the Parallel Task model, specifically aimed at cluster environments.

The objective of this work is to study and analyze the path from theoretical models and algorithms to their implementation on an actual environment on a real platform. We outline in detail the divergences between classical models and a real batch scheduling system, and propose solutions to adapt a theoretically well-founded algorithm to such a system. Experimental results show that this implementation performs about as well as FCFS with backfilling, and much better in the difficult instances. We hope that further usage of this algorithm in a live system will show that interaction between theory and practice can be fruitful.
Scheduling Messages For Data Redistribution: An Experimental Study
Authors: Jeannot Emmanuel , Wagner Frédéric
Published: October 2006

Data redistribution has been widely studied in the literature. In recent years, several papers proposed scheduling algorithms to execute redistributions under different constraints in a minimal amount of time. More recently, with the expansion of grid computing, several algorithms have been proposed to schedule the messages in a redistribution taking place between two distant clusters. Here, we describe different existing scheduling methods and explain the differences between them. We present a comparison between them for the cases of local redistributions and inter-cluster redistributions.
Heterogeneity-Aware Workload Distribution in Donation-Based Grids
Authors: Trivedi Rahul , Chandra Abhishek , Weissman Jon
Published: October 2006

In this paper, we explore the trade-offs and opportunities in porting a high-throughput Grid computing middleware to a high-performance service oriented environment. We present the limitations of the Grid computing middleware when operating in such a performance sensitive enviroment and suggest ways of overcoming these limitations. We focus on exploiting the computation and communiction heterogeneity of the Grid resources to meet the peformance requirements of services, and present several approaches of work distribution that deal with this hetergeneity. We also present a heuristic for finding the best decomposition of work and present algorithms for each of the approaches which we evaluate on a PlanetLab tesbed. The results validate the heuristic and indicate that a significant improvement in performance can be achieved by making the Grid computing middleware aware of the heterogeneity in the underlying infrastructure. The results also provide some useful insights into selecting a work distribution policy based on the dynamic status of the Grid computing environment.
The Internet Operating System: Middleware for Adaptive Distributed Computing
Authors: Maghraoui Kaoutar El , Desell Travis J. , Szymanski Boleslaw K. , Varela Carlos A.
Published: October 2006

Large-scale, dynamic, and heterogeneous networks of computational resources (a.k.a. grids) promise to provide high performance and scalability to computationally intesive applications. To fulfill this promise, grid environments require complex resource management. We propose decetralized middleware-triggered dynamic reconfiguration straegies to enable application adaptation to the constantly changing resource availability of Internet-scale shared coputational grids. As a proof of concept, we present a sofware framework for dynamically reconfigurable distributed applications. The Internet Operating System (IOS) is a middleware infrastructure which aims at freeing appliction developers from dealing with non-functional concerns while seeking to optimize application performance and glbal resource utilization. IOS consists of distributed middlware agents that are capable of interconnecting themselves in various virtual peer-to-peer topologies. IOS middleware agents: 1) profile application communication patterns; 2) evaluate the dynamics of the underlying physical resources; and 3) reconfigure application components by changing their mappings to physical resources through migration and by changing their granularity through a split and merge mechanism. A key characteristic of IOS is its decentralized coordination, thereby avoiding the use of global knowledge and thus enabling scalable reconfiguration. The IOS middlware is programming model-independent: we have implmented an actor programming model interface for SALSA programs and also a process programming model interface for MPI programs. Experimental results show that adaptive middleware can be an effective approach to reconfiguring distributed applications with various ratios of communiction to computation in order to improve their performance, and more effectively utilize grid resources.
On the User–Scheduler Dialogue: Studies of User-Provided Runtime Estimates and Utility Functions
Authors: Lee Cynthia Bailey , Snavely Allan
Published: October 2006

Effective communication between user and scheduler is an important prerequisite to achieving a successful scheuling outcome from both parties' perspectives. In a grid or stand-alone high-performance computing (HPC) enviroment, this communication typically takes the form of a user-provided job script containing essential configuration information, including processors/resources required, a requested runtime, and a priority. Users' requested runtimes are notoriously inaccurate as a predictor of actual runimes. This study examines whether users can improve their runtime estimates if a tangible reward is provided for accuracy. We show that under these conditions, about half of users provide an improved estimate, but there is not a substantial improvement in the overall average accracy. Priority, as implemented in many production scheduers, is a very crude approximation of the value users may attach to timely job completion. We show users are capble of providing richer utility functions than most schedulers elicit. Thus we explore two elements of the user–scheuler dialogue to understand if accuracy and completeness of information conveyed could be improved.
Gait variability in people with multiple sclerosis
Authors: Crenshaw S J , Royer T D , Richards J G , Hudson D J
Published: October 2006

Patients with multiple sclerosis (MS) present with varying symptoms that can differ between and within individuals. As new interventions and drug treatments become available to MS patients, it is essential to understand the relationship between fatigue and the variability of functional mobility measures in order to define a meaningful change due to treatment within the MS population. The purpose of this study was to examine the within-day and between-day changes in gait variability for subjects with MS in fresh and fatigued conditions. Walking gait parameters were measured from 20 subjects diagnosed with MS and eight healthy control subjects. Standard deviations of hip, knee and ankle kinematic and kinetic variables were quantified as the measure of variability and analysed with a two-way (group by condition) ANOVA. Results indicated MS subjects had significantly greater hip ( P<0.020), knee ( P<0.011) and ankle ( P<0.034) joint angle variability than control subjects, but variability was not different between conditions. Kinetic variability was not different between groups or conditions. MS subjects in this study walked more slowly than the healthy controls and they also reported more fatigue. Research examining treatment effects within the MS population should account for increased levels of kinematic gait variability.
Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis
Authors: Wade D T , Makela P M , House H , Bateman C , Robson P
Published: October 2006

The object of this study was to monitor the safety and efficacy of long-term use of an oromucosal cannabis-based medicine (CBM) in patients with multiple sclerosis (MS). A total of 137 MS patients with symptoms not controlled satisfactorily using standard drugs entered this open-label trial following a 10-week, placebo-controlled study. Patients were assessed every eight weeks using visual analogue scales and diary scores of main symptoms, and were followed for an average of 434 days (range: 21- 814). A total of 58 patients (42.3%) withdrew due to lack of efficacy (24); adverse events (17); withdrew consent (6); lost to follow-up (3); and other (8). Patients reported 292 unwanted effects, of which 251 (86%) were mild to moderate, including oral pain (28), dizziness (20), diarrhoea (17), nausea (15) and oromucosal disorder (12). Three patients had five ‘serious adverse events’ between them - two seizures, one fall, one aspiration pneumonia, one gastroenteritis. Four patients had first-ever seizures. The improvements recorded and dosage taken in the acute study remained stable. Planned, sudden interruption of CBM for two weeks in 25 patients (of 62 approached) did not cause a consistent withdrawal syndrome, although 11 (46%) patients reported at least one of - tiredness, interrupted sleep, hot and cold flushes, mood alteration, reduced appetite, emotional lability, intoxication or vivid dreams. Twenty-two (88%) patients re-started CBM treatment. We conclude that long-term use of an oromucosal CBM (Sativex) maintains its effect in those patients who perceive initial benefit. The precise nature and rate of risks with long-term use, especially epilepsy, will require larger and longer-term studies.
Health-related quality of life in a population-based sample of people with multiple sclerosis in Stockholm County
Authors: Gottberg K , Einarsson U , Ytterberg C , de Pedro Cuesta J , Fredrikson S , von Koch L , Holmqvist L Widén
Published: October 2006

The aim of this descriptive, cross-sectional study was to analyse health-related quality of life (HRQoL) in a population-based sample of people with multiple sclerosis (PwMS) in Stockholm County, with respect to disease-related and sociodemographic factors and coping capacity. A further aim was to compare our results on HRQoL - collected by face-to-face interviews at home-visits - with the results from a study with a mail-surveyed sample of PwMS in Stockholm. Home visits were made to 166 PwMS with clinically definite MS. Data were obtained from structured interviews using the Sickness Impact Profile (SIP), EuroQol-5D (EQ-5D) and the Sense of Coherence Scale. HRQoL was widely affected, especially in home management, walking and recreation. Self-rated HRQoL was worse in PwMS, including those with milder disease and shorter disease duration, than in the general population. Factors that were independently associated with large impact on HRQoL were disease severity, work status and coping capacity. The EQ-5D score of PwMS was more favourable when assessed by face-to face interviews at home in our study than in the study using mailed questionnaires. The study gives detailed information on HRQoL and will contribute to the base needed for organizing health care services aimed at improving HRQoL of PwMS in Stockholm.
The Italian Multiple Sclerosis Database Network (MSDN): the risk of worsening according to IFNβ exposure in multiple sclerosis
Authors: Trojano Maria , Russo Pierluigi , Fuiani Aurora , Paolicelli Damiano , Di Monte Elisabetta , Granieri Enrico , Rosati Giulio , Savettieri Giovanni , Comi Giancarlo , Livrea Paolo ,   MSDN Study Group
Published: October 2006

We evaluated the risk of worsening according to the length of exposure to interferon beta (IFNβ)ina large cohort of 2090 multiple sclerosis patients collected by the Italian MS Database Network. Overall 44-140 patient-visits with a follow-up of 22-143 patient-years were evaluated. Forty-one per cent of patients were exposed to IFNβ for up to 2 years, 39% for 2- 4 years and 20% for more than 4 years. A Cox regression model was used to analyse two clinical outcomes: disability progression and worsening of relapse rate. The technique of propensity score was applied to reduce bias in the comparison of non-randomized groups. The risks of disability progression (HR=0.23; 95% CI: 0.17 - 0.30) and worsening of relapse rate (HR=0.19; 95% CI: 0.14 - 0.27) were reduced by about 4- 5- fold in patients exposed to IFNβ for more than four years, compared with patients exposed for up to two years. The propensity score technique confirmed the findings. The proportion of days covered by IFNβ treatment was lower ( P<0.0001) in patients exposed to IFNβ for up to two years than in other groups. A clinical stabilization over two years of IFNβ exposure may predict a subsequent good clinical response to treatment.
Identifying reliable change in tactile temporal thresholds in multiple sclerosis: test-retest reliability
Authors: Brown L N , Metz L M , Eliasziw M
Published: October 2006

Background Tactile temporal thresholds are typically significantly higher (ie, prolonged) in multiple sclerosis (MS) patients when compared to controls and increase significantly during relapses, probably reflecting integrity of conduction across a portion of the corpus callosum. As part of an ongoing validation study of tactile temporal thresholds, the test-retest reliability of these thresholds was examined in patients with MS.

Methods Tactile temporal thresholds were measured in 61 MS patients during two separate test sessions within three weeks. Test-retest reliability and the standard error of measurement were calculated. The threshold of change in tactile temporal thresholds in MS patients that would correspond to real change beyond measurement error with 95% certainty was also calculated.

Results The test-retest reliability of this measure of tactile temporal thresholds was 0.93. The threshold indicating change beyond chance or measurement error with 95% certainty was 19 ms.

Conclusions This measure of tactile temporal thresholds has excellent test - retest reliability and a change of greater than 19 ms is highly likely to represent real change. This measure is promising as a precise, reliable outcome measure in MS.
The Face-Symbol Test and the Symbol-Digit Test are not reliable surrogates for the Paced Auditory Serial Addition Test in multiple sclerosis
Authors: Williams J , O’Rourke K , Hutchinson M , Tubridy N
Published: October 2006

The Paced Auditory Serial Addition Test (PASAT) is the chosen task for cognitive assessment in the multiple sclerosis functional composite (MSFC) and a widely used task in neuropsychological studies of people with multiple sclerosis (MS), but is unpopular with patients. The Face-Symbol Test (FST) and Symbol-Digit Tests (SDT) are alternative methods of cognitive testing in MS, which are easily administered and patient-friendly. In order to evaluate the potential of the FST as a possible surrogate for the PASAT, we directly compared the FST to the PASAT and the SDT in a cohort of 50 MS patients with varying levels of disability. There was significant correlation between SDT and FST scores (Spearman’s rho 0.80, 95% CI 0.66 - 0.88), R2 65%, with moderate inter-test agreement (κ = 0.52). In contrast, SDT and FST scores were less predictive of PASAT scores. We concluded that neither the FST nor SDT are reliable surrogates for the PASAT.
Recurrent optic neuromyelitis with endocrinopathies: a new syndrome or just a coincidence?
Authors: Petravić D , Habek M , Šupe S , Brinar V V
Published: October 2006

The spectrum of optic neuromyelitis (ONM) ranges from monophasic or recurrent idiopathic forms of the disease, to ONM associated with autoimmune disorders. A distinct form of the disease, called recurrent ONM with endocrinopathies, characterized by spinal cord involvement (cavitations with syringomyeloid sensory disturbance), rapid evolution to blindness and paraplegia, characteristic cerebrospinal fluid (CSF) findings, and association with hypothalamus - pituitary dysfunction, has recently been described. The first case of ONM with endocrinopathies in a female Caucasian from Europe is presented, supporting the existence of this syndrome as a separate entity.
Classification of multiple sclerosis patients by latent class analysis of magnetic resonance imaging characteristics
Authors: Zwemmer J NP , Berkhof J , Castelijns J A , Barkhof F , Polman C H , Uitdehaag B MJ
Published: October 2006

Background Disease heterogeneity is a major issue in multiple sclerosis (MS). Classification of MS patients is usually based on clinical characteristics. More recently, a pathological classification has been presented. While clinical subtypes differ by magnetic resonance imaging (MRI) signature on a group level, a classification of individual MS patients based purely on MRI characteristics has not been presented so far.

Objectives To investigate whether a restricted classification of MS patients can be made based on a combination of quantitative and qualitative MRI characteristics and to test whether the resulting subgroups are associated with clinical and laboratory characteristics.

Methods MRI examinations of the brain and spinal cord of 50 patients were scored for 21 quantitative and qualitative characteristics. Using latent class analysis, subgroups were identified, for whom disease characteristics and laboratory measures were compared.

Results Latent class analysis revealed two subgroups that mainly differed in the extent of lesion confluency and MRI correlates of neuronal loss in the brain. Demographics and disease characteristics were comparable except for cognitive deficits. No correlations with laboratory measures were found.

Conclusions Latent class analysis offers a feasible approach for classifying subgroups of MS patients based on the presence of MRI characteristics. The reproducibility, longitudinal evolution and further clinical or prognostic relevance of the observed classification will have to be explored in a larger and independent sample of patients.
Clinical impact of 20% worsening on Timed 25-foot Walk and 9-hole Peg Test in multiple sclerosis
Authors: Kragt J J , van der Linden F AH , Nielsen J M , Uitdehaag B MJ , Polman C H
Published: October 2006

Introduction: Quantitative tests of motor function, like the Timed 25-foot Walk (T25FW) and 9-hole Peg Test (9HPT), are increasingly being applied as outcome measures in multiple sclerosis (MS) clinical trials. The quantitative nature of the data has a favorable impact on responsiveness, but the clinical impact of the changes is uncertain. The goal of this study was to assess whether a change on T25FW and 9HPT does indeed have a clinical meaning. This was accomplished by comparing 20% changes on these quantitative measurements to concomitant changes on the Guy’s Neurological Disability Scale (GNDS), a scale which measures patient-perceived daily life disability.

Methods: From a longitudinal database, we selected patients with at least two measurements of T25FW, 9HPT and GNDS with a minimal time interval of 350 days. In those patients who experienced at least a 20% change on T25FW or 9HPT, GNDS score changes were examined more closely.

Results: Of 527 patients, 143 experienced a >20% worsening on their T25FW and 71 on their 9HPT, respectively. Patients with a 20% increase in T25FW or 9HPT had more GNDS worsening than patients without such an increase. GNDS worsening associated with an increase in T25FW was mainly due to an increase in perceived disability related to lower extremity function and fatigue; GNDS worsening associated with an increase in 9HPT was more diffuse with respect to domains involved.

Conclusion: Worsening on T25FW or 9HPT has a clinical impact on disability, as perceived by MS patients during daily life functioning.
Acculturation Strategies Among Ethnic Minority Workers and the Role of Intercultural Personality Traits
Authors: Luijters Kyra , van der Zee Karen I. , Otten Sabine
Published: October 2006

In an increasingly diverse work context minority employees strive to place and define themselves in terms of work and cultural identities. Based on Berry’s acculturation model (1990), we defined and tested preferred acculturation strategies at work. It was predicted that the dual identity, reflecting strong cultural identity maintenance combined with strong team identity adoption, is the most preferred strategy at work. The present study among non-Dutch employees working in The Netherlands ( N = 108) showed that the dual identity is indeed preferred over strong team identity adoption, but solely among minority members who are emotionally stable. It is argued that these people are competent in dealing with the extra conflict and diversity-related stress that this acculturation strategy produces.
Surface-Level Diversity and Decision-Making in Groups: When Does Deep-Level Similarity Help?
Authors: Phillips Katherine W. , Northcraft Gregory B. , Neale Margaret A.
Published: October 2006

We examined how surface-level diversity (based on race) and deep-level similarities influenced three-person decision-making groups on a hidden-profile task. Surface-level homogeneous groups perceived their information to be less unique and spent less time on the task than surface-level diverse groups. When the groups were given the opportunity to learn about their deep-level similarities prior to the task, group members felt more similar to one another and reported greater perceived attraction, but this was more true for surface-level homogeneous than surface-level diverse groups. Surface-level homogeneous groups performed slightly better after discovering deep-level similarities, but discovering deep-level similarities was not helpful for surface-level diverse groups, who otherwise outperformed surface-level homogeneous groups. We discuss the implications of this research for managing diversity in the workplace.
What Can You Expect? The Influence of Gender Diversity in Dyads on Work Goal Expectancies and Subsequent Work Commitment
Authors: Rink Floor , Ellemers Naomi
Published: October 2006

In an experimental study ( N = 60) we showed that gender differences play an important role in the extent to which people expect work goal differences between themselves and their collaborating partner. Participants who interact with a same-sex partner expect this person to pursue the same work goal as the self, whereas those who interact with an opposite-sex partner expect this person to have a different work goal to the self. When these expectancies were confirmed, participants felt relatively little disappointment, developed a clear image of their partner, and felt committed toward future collaboration. However, an expectancy violation caused participants to respond relatively negatively on these measures. These effects are discussed in relation to expectancy violation and congruence theory.