bluuebunny/crossref_metadata_2025 huggingface dataset:
Negotiating the right to stay in the city
Authors:   ACHR
Published: March 2006

This paper describes a joint programme in Phnom Penh involving the municipality, a local NGO and a federation of the urban poor together with support from UN–Habitat and the Asian Coalition for Housing Rights. The programme sought to influence change in the city and to explore ways of managing processes more effectively and equitably. Research was undertaken to understand local development forces and trends as they directly affected the poorest, and results were shared among communities, academics, professionals and officials. The paper explains how this shared information led to active training through pilot community upgrades and city-wide settlement planning, contributing to policy change and illustrating an alternative and participatory governance system for the city.
Community federations and city upgrading: the work of Pamoja Trust and Muungano in Kenya
Authors: Weru Jane
Published: March 2006

This paper describes the work of the Kenyan NGO Pamoja Trust and the urban poor federation in Kenya (Muungano wa Wanvijiji) in the informal settlements where a high proportion of Kenya’s urban population lives. This work centres on developing a consensus among the inhabitants of informal settlements around issues of land and structure entitlements, and building community capacity to address these, before negotiating with government for land and infrastructure. Building a consensus within informal settlements is particularly important in Kenya because of the conflicting priorities of landlords (the “structure owners”) and their tenants. The paper describes the support provided for community-based savings schemes, ”slum” enumerations and house modelling, which help build consensus among the inhabitants on upgrading and tenure, and develop community capacity to manage these. This also helps to build a critical mass of communities which seek to engage municipal authorities or national government while building internally the capacity of their leadership to work on a large scale. The paper also describes the housing programmes that are underway and the community-to-community exchange programmes through which the savings groups learn from each other and which help build an urban poor federation that can negotiate with the government and develop partnerships with it. This paper discusses how an international network of community federations seeds such processes and provides peer learning to the communities.
The politics of engagement: gains and challenges of the NGO coalition in Cebu City
Authors: Etemadi Felisa
Published: March 2006

This paper describes the efforts of the NGO coalition, Kaabag, to push forward the concerns of the urban poor in the local governance processes of Cebu City in the Philippines. In the 12 years since it was established, Kaabag has engaged and collaborated with city government on a range of issues, including housing, livelihoods, governance, children and women. The paper outlines the strategies, issues and progress in each of these areas, detailing the contribution of specific NGOs. It offers an analysis of the outcomes of this engagement, and concludes with a discussion of the challenges and lessons learned over the decade.
Local empowerment through community mapping for water and sanitation in Dar es Salaam
Authors: Glöckner Heike , Mkanga Meki , Ndezi Timothy
Published: March 2006

This paper describes a community enumeration and mapping programme in five low-income settlements in Dar es Salaam. The inhabitants documented their settlement and its problems in detail, especially for water and sanitation, with support from the UK charity Water Aid and PEVODE, a Tanzanian NGO. The paper describes the planning and implementation of the enumeration and mapping, the information gathered, and how it was used. It also describes the way in which the process helped establish links between these communities and government agencies, and stimulated local action to address some of the problems identified.
Migration to and from Mexico City, 1995–2000
Authors: Izazola Haydea
Published: March 2006

This paper examines migratory flows in and out of Mexico City between 1995 and 2000, and discusses the social and economic characteristics of the individuals involved. Over recent decades, there have been changes in migratory patterns, as the earlier influx of migrants to Mexico City appeared to decrease, and to be overtaken in 1990 by net out-migration. However, figures from the 2000 Mexican census indicate that there is now relative migratory equilibrium. The city continues to be a destination for migrants from poorer states in the country, but it is also an important source of migration to the central and northern states. An examination of the characteristics of the migrants demonstrates that migratory processes are dynamic and complex, responding to a range of economic, environmental, social, cultural and political factors at both origins and destinations.
A new apartheid? The spatial implications of fear of crime in Cape Town, South Africa
Authors: Lemanski Charlotte
Published: March 2006

This paper examines the fear of crime in post-apartheid South Africa and its impact on urban space and form, focusing in particular on Cape Town. South African statistics point to alarming increases in serious crime over recent years and, although such statistics are considered unreliable, reflecting to some extent increases in the rate of crime reporting, the public perception is nonetheless one of decreased security. Attempts to mitigate fear have resulted increasingly in the creation of fortified enclaves and a withdrawal from public space. Although the more extreme manifestations are restricted to affluent areas, levels of residential protection have increased among all groups. As in other parts of the world, this “architecture of fear” results in growing danger within the public domain and the increasing polarization of social groups. The paper argues that this trend in South Africa perpetuates the social divisions that were inherent in the apartheid state into the post-apartheid context, with the fear of crime being used as a justification for a predominantly racist fear of difference.
“Disembedding” the city: crime, insecurity and spatial organization in Managua, Nicaragua
Authors: Rodgers Dennis
Published: March 2006

This paper explores the emergence of a new pattern of spatial segregation linked to rising urban insecurity in Managua, the capital city of Nicaragua, during the past decade and a half. Rather than fragmenting into an archipelago of isolated “fortified enclaves”, as has been the case in other cities around the world, Managua has undergone a process whereby a whole layer of the metropolis has been “disembedded” from the general fabric of the city through the constitution of an exclusive “fortified network” for the urban elites, based on the privatization of security and the construction of high-speed roads and roundabouts. This pattern of urban governance diverges significantly from Managua’s historical experience, and rests upon new urban developments that have explicitly favoured the urban elites, both directly and indirectly. These raise critical questions about the nature of relations between social groups within the city.
Community police stations in Mumbai's slums
Authors: Roy A. N. , Jockin A. , Javed Ahmad
Published: March 2006

This paper describes how an alliance between slum dwellers’ federations and the police has set up community police stations in the slums of Mumbai and Pune, and explains how these operate.
Pitting the polluted against the flooded: water resource management in Tigre, Buenos Aires
Authors: Suárez Francisco , Lombardo Ruben J
Published: March 2006

People residing on the banks of the lower stretches of the Reconquista and Luján rivers, as well as in the first section of islands in the Tigre delta bordering Greater Buenos Aires, are affected by the water-management operations carried out in the Reconquista. This paper presents the findings of a study to analyze the perception and actual risk of water pollution, drawing on a survey of the population’s social vulnerability and an analysis of surface water quality. Exposure to the consumption of polluted water was examined using various parameters, including water quality, pH, turbidity, dissolved oxygen and surface temperature, so as to establish a hazard gradient. A focal area of risk was established, where there was spatial overlapping of social vulnerability with higher hazard levels. Systematic household sampling sought to identify water use and consumption habits, the level of perception of the quality of the resource and the degree of community organization. The level of social conflict relating to the water engineering works was also analyzed. This study demonstrates the need for integrated water resource management at an ecosystem-wide level, with a concern for a fairer distribution of the socio-environmental costs and benefits.
Cities for Life revisited: capacity-building for urban management in Peru
Authors: Miranda Liliana
Published: March 2006

This paper describes the work undertaken by the Cities for Life Forum (CLF) in Peru and by many of its members (from local governments, NGOs, universities and the private sector) in supporting the development and implementation of Local Agenda 21s in cities in Peru over the last ten years. It also describes the many means employed to develop the possibilities for local stakeholders to work together in developing and implementing a shared vision of sustainable development.
Drugs, alcohol and community tolerance: an urban ethnography from Colombia and Guatemala
Authors: McIlwaine Cathy , Moser Caroline O. N.
Published: March 2006

Drug and alcohol abuse is identified increasingly in Latin America as a significant source of insecurity. Yet, there has been little research on consump- tion and on the social norms surrounding it. This paper explores the nature of drugs and alcohol consumption among urban poor communities in Colombia and Guatemala, where use is widespread. It also looks at levels of community tolerance of drug and alcohol use, and in particular at the complex ways in which these atti- tudes relate to levels of violence and insecurity. The paper, drawing on the percep- tions of the poor themselves, argues for the need to take the issue of community tolerance into account in designing responses which, in order to be effective, should also be linked with wider sustainable development goals.
Young people’s views on how to tackle gang violence in “post- conflict” Guatemala
Authors: Winton Ailsa
Published: March 2006

This paper describes gang culture in post-conflict Guatemala, and makes the case for including the views of young people in responding to the issue. Participatory research with young people from two low-income communi- ties in Guatemala City revealed that gang violence was in fact a most critical issue in their lives, and a number of recommendations were generated. These young people identified a range of causes for gang membership, most of them related to a lack of family and social support and to the need for a sense of belong- ing. Proposed solutions stressed the importance of holistic, preventative responses, with organizations for youth being identified as the most effective approach. Two brief case studies describe the contributions of the Pentecostal Protestant Church and of a youth organization, Jovenes Adelante.
What does history teach us about factors associated with relapse in bipolar affective disorder?
Authors: Tyrer Stephen
Published: March 2006

When investigating treatments for any chronic condition it is essential to know the usual course of the illness concerned. The natural history of bipolar affective disorder has only been established relatively recently. This review examines the factors that affect the course of bipolar disorder from an historical perspective. These include the affective nature of the episodes and the influence of psychotic symptoms, age at onset of illness, length of episodes and cycles, gender, ethnicity, concurrent drug and alcohol use, occupational status and factors leading to chronicity. The pioneering work of Kraepelin and Angst established that episodes of illness in bipolar disorder increased in frequency over time and that earlier age of onset predicted more frequent episodes. More recent work has established that female subjects have a later onset of illness, that the frequency of episodes often decreases over time and that rapid cycling has a poorer response to treatment. Suggested criteria for inclusion of subjects into trials examining manic relapse are listed based on the findings from earlier work.
Relapse prevention in bipolar disorder: a critical review of current guidelines
Authors: McAllister-Williams R. Hamish
Published: March 2006

Bipolar disorder is an important and serious mental illness associated with significant morbidity and mortality. However, unfortunately, the evidence base regarding treatment is less than satisfactory. In such circumstances clinicians often resort to reputable sets of guidelines. A number of these currently exist; in the United Kingdom the most prominent being that produced by the British Association of Psychopharmacology (BAP). This paper reviews the methodology of this guideline and its recommendations regarding the long-term treatment of bipolar disorder and compares this with guidelines produced by the American Psychiatric Association (APA), the Canadian Network for Mood and Anxiety Treatments (CANMAT) and the Texas Implementation of Medication Algorithms (TIMA) for bipolar I disorder. It is concluded that the BAP guidelines continue to be a reasonable set of recommendations, though there are new data available since their publication. All the guidelines reviewed place lithium and valproate at the top of the list of options for long-term treatment. There is a trend to increasingly recognize atypical antipsychotics, particularly olanzapine, as an additional alternative and an increasing prominence of lamotrigine for prevention of depressive relapses. All other treatment options currently have an extremely limited evidence base and do not feature consistently in the published guidelines.
The use of anticonvulsants in the aftermath of mania
Authors: Cookson John , Elliott Brent
Published: March 2006

This paper reviews the evidence for the efficacy of anticonvulsants in the continuation and maintenance phases of treatment of bipolar disorder, when there has been an episode of mania (Bipolar-I disorder). The evidence to be considered is primarily that arising from randomized controlled trials.

A literature search was performed to identify all randomized controlled trials of anticonvulsants used as maintenance treatment for bipolar-I disorder. Placebo-controlled studies were preferred, however there have been relatively few of these and clinical practice must therefore be guided by evidence carrying a lower level of conviction.

Valproate monotherapy lacks a convincing evidence base. The view that valproate is more effective than lithium in rapid cycling has not been borne out. Lamotrigine is effective in preventing depression after an episode of mania. As monotherapy, lithium appears superior to carbamazepine in bipolar patients not previously treated with either drug. The combination of lithium and carbamazepine may be superior to either drug alone, in certain treatment-resistant patients, but is associated with increased side effects. Other anticonvulsants lack evidence supporting their use in bipolar disorder except in treating co-morbid alcohol dependence, anxiety and bulimic symptoms.

Valproate continues to be recommended by most current guidelines despite the lack of evidence.
A review of the evidence for the use of antipsychotics in the maintenance treatment of bipolar disorders
Authors: Hellewell Jonathan S. E.
Published: March 2006

Antipsychotic agents have long had a place in the clinical treatment of bipolar disorder, in both acute and maintenance phases. Recent clinical research conducted with the new generation of antipsychotic agents has contributed enormously to the data available on antipsychotic agents in bipolar disorder. Even now, however, the clinical trial data relates principally to the short-term treatment of acute mania. With the exception of recent data generated during the clinical trial programme for olanzapine, studies of maintenance treatment, conducted with antipsychotic agents, both established and newly-introduced, have generally been small and prone to methodological weakness. As a result, many important clinical questions, concerning the utility of antipsychotic agents in bipolar maintenance, can not be answered by reference to the data. Taken together, the findings of the clinical trials in bipolar maintenance, conducted with antipsychotic agents other than olanzapine, can be regarded only as tentative. As was conducted with olanzapine, larger, more rigorously designed studies are required to provide definitive evidence of efficacy in longer-term treatment. Due to the logistical complexity and expense of these sorts of study, it is likely that, for many antipsychotic agents with a potential role in long-term treatment in bipolar disorder, the definitive studies will never be undertaken.
Psychotherapy for bipolar disorders - efficacy and effectiveness
Authors: Scott Jan
Published: March 2006

This paper explores the development of psychological treatments as an adjunct to medication in bipolar disorders. Randomized controlled treatment trials of specific therapy models, such as cognitive therapy, that tackle a spectrum of complex psychological and social problems associated with bipolar disorders are reviewed. A systematic review of the most recent treatment outcome studies suggest that adjunctive psychological therapies reduce overall rates of relapse, but are more effective for depression than for mania. There is no evidence that any particular therapy has a unique mechanism of action or any specific advantages over any other approach. Finally, it is suggested that gaps in the theory and available evidence for effectiveness need to be addressed if we are to enable clinicians to target psychological therapies towards those individuals with bipolar disorder who are most likely to benefit.
A staged screening strategy for prenatal alcohol exposure and maternal risk stratification
Authors: Burd Larry , Klug Marilyn G , Martsolf John T , Martsolf Cathy , Deal Eric , Kerbeshian Jacob
Published: March 2006

Aims: To present an incremental process for a staged screening strategy to identify women at increased risk of having a child with fetal alcohol spectrum disorder (FASD) and to enhance the management of women using alcohol during pregnancy. We include an illustrative example of the development of a screening component using an existing data set.

Methods: We describe a seven-step protocol to screen for alcohol use during pregnancy. The screening process begins with a one-question initial screen, followed by exposure assessment, maternal risk stratification to estimate risk for FASD, and concludes with recommendations for intervention and monitoring of exposure for women drinking during pregnancy.

Conclusions: This screening process has very modest time commitments in the early stages. Time commitments increase for women drinking during pregnancy and the process focuses on the population at highest risk of having a child with FASD. The process has the benefit of risk specificity, since the process refines risk estimates for an adverse outcome specific for FASD. The process concludes with a programme to facilitate intervention and to monitor changes in prenatal alcohol exposure during pregnancy.

Prevention of FASD is an important public health priority. In addition to the ongoing study of clinical strategies to improve detection rates of alcohol exposure at all stages of pregnancy, additional research on the tools and the process used in screening efforts is urgently needed. The efforts should also include research on both the screening tools and the outcome of the screening process in routine prenatal care settings.
Protein protein interactions, evolutionary rate, abundance and age
Authors: Saeed Ramazan , Deane Charlotte M
Published: March 2006

Background

Does a relationship exist between a protein's evolutionary rate and its number of interactions? This relationship has been put forward many times, based on a biological premise that a highly interacting protein will be more restricted in its sequence changes. However, to date several studies have voiced conflicting views on the presence or absence of such a relationship.

Results

Here we perform a large scale study over multiple data sets in order to demonstrate that the major reason for conflict between previous studies is the use of different but overlapping datasets. We show that lack of correlation, between evolutionary rate and number of interactions in a data set is related to the error rate. We also demonstrate that the correlation is not an artifact of the underlying distributions of evolutionary distance and interactions and is therefore likely to be biologically relevant. Further to this, we consider the claim that the dependence is due to gene expression levels and find some supporting evidence. A strong and positive correlation between the number of interactions and the age of a protein is also observed and we show this relationship is independent of expression levels.

Conclusion

A correlation between number of interactions and evolutionary rate is observed but is dependent on the accuracy of the dataset being used. However it appears that the number of interactions a protein participates in depends more on the age of the protein than the rate at which it changes.
SNA – a toolbox for the stoichiometric analysis of metabolic networks
Authors: Urbanczik Robert
Published: March 2006

Background

Despite recent algorithmic and conceptual progress, the stoichiometric network analysis of large metabolic models remains a computationally challenging problem.

Results

SNA is a interactive, high performance toolbox for analysing the possible steady state behaviour of metabolic networks by computing the generating and elementary vectors of their flux and conversions cones. It also supports analysing the steady states by linear programming. The toolbox is implemented mainly in Mathematica and returns numerically exact results. It is available under an open source license from: http://bioinformatics.org/project/?group_id=546.

Conclusion

Thanks to its performance and modular design, SNA is demonstrably useful in analysing genome scale metabolic networks. Further, the integration into Mathematica provides a very flexible environment for the subsequent analysis and interpretation of the results.
Extraction of phylogenetic network modules from the metabolic network
Authors: Yamada Takuji , Kanehisa Minoru , Goto Susumu
Published: March 2006

Background

In bio-systems, genes, proteins and compounds are related to each other, thus forming complex networks. Although each organism has its individual network, some organisms contain common sub-networks based on function. Given a certain sub-network, the distribution of organisms common to it represents the diversity of its function.

Results

We extracted such "common" sub-networks, defined as "phylogenetic network modules," using phylogenetic profiles and cluster analysis. The enzymes in the same "phylogenetic network module" have similar phylogenetic profiles and related functions. These modules are shown to be phylogenetic building blocks. Furthermore, the network of the modules illustrated hierarchical feature as well as the network of enzymes involved in the metabolism.

Conclusion

We conclude that phylogenetic network modules are evolutionary conserved functional units in the metabolic network. We claim that our concept of phylogenetic modules provides a more accurate understanding of the evolution of biological networks.
Paths of lateral gene transfer of lysyl-aminoacyl-tRNA synthetases with a unique evolutionary transition stage of prokaryotes coding for class I and II varieties by the same organisms
Authors: Shaul Shaul , Nussinov Ruth , Pupko Tal
Published: March 2006

Background

While the premise that lateral gene transfer (LGT) is a dominant evolutionary force is still in considerable dispute, the case for widespread LGT in the family of aminoacyl-tRNA synthetases (aaRS) is no longer contentious. aaRSs are ancient enzymes, guarding the fidelity of the genetic code. They are clustered in two structurally unrelated classes. Only lysine aminoacyl-tRNA synthetase (LysRS) is found both as a class 1 and a class 2 enzyme (LysRS1-2). Remarkably, in several extant prokaryotes both classes of the enzyme coexist, a unique phenomenon that has yet to receive its due attention.

Results

We applied a phylogenetic approach for determining the extent and origin of LGT in prokaryotic LysRS. Reconstructing species trees for Archaea and Bacteria, and inferring that their last common ancestors encoded LysRS1 and LysRS2, respectively, we studied the gains and losses of both classes. A complex pattern of LGT events emerged. In specific groups of organisms LysRS1 was replaced by LysRS2 (and vice versa). In one occasion, within the alpha proteobacteria, a LysRS2 to LysRS1 LGT was followed by reversal to LysRS2. After establishing the most likely LGT paths, we studied the possible origins of the laterally transferred genes. To this end, we reconstructed LysRS gene trees and evaluated the likely origins of the laterally transferred genes. While the sources of LysRS1 LGTs were readily identified, those for LysRS2 remain, for now, uncertain. The replacement of one LysRS by another apparently transits through a stage simultaneously coding for both synthetases, probably conferring a selective advantage to the affected organisms.

Conclusion

The family of LysRSs features complex LGT events. The currently available data were sufficient for identifying unambiguously the origins of LysRS1 but not of LysRS2 gene transfers. A selective advantage is suggested to organisms encoding simultaneously LysRS1-2.
Identification of Enterobacter sakazakii from closely related species: The use of Artificial Neural Networks in the analysis of biochemical and 16S rDNA data
Authors: Iversen Carol , Lancashire Lee , Waddington Michael , Forsythe Stephen , Ball Graham
Published: March 2006

Background

Enterobacter sakazakii is an emergent pathogen associated with ingestion of infant formula and accurate identification is important in both industrial and clinical settings. Bacterial species can be difficult to accurately characterise from complex biochemical datasets and computer algorithms can potentially simplify the process.

Results

Artificial Neural Networks were applied to biochemical and 16S rDNA data derived from 282 strains of Enterobacteriaceae, including 189 E. sakazakii isolates, in order to identify key characteristics which could improve the identification of E. sakazakii. The models developed resulted in a predictive performance for blind (validation) data of 99.3 % correct discrimination between E. sakazakii and closely related species for both phenotypic and genotypic data. Three main regions of the partial rDNA sequence were found to be key in discriminating the species. Comparison between E. sakazakii and other strains also constitutively positive for expression of the enzyme α-glucosidase resulted in a predictive performance of 98.7 % for 16S rDNA sequence data and 100% for phenotypic data.

Conclusion

The computationally based methods developed here show a remarkable ability in reducing data dimensionality and complexity, in order to eliminate noise from the system in order to facilitate the speed and reliability of a potential strain identification system. Furthermore, the approaches described are also able to provide valuable information regarding the population structure and distribution of individual species thus providing the foundations for novel assays and diagnostic tests for rapid identification of pathogens.
Methodological quality of systematic reviews of animal studies: a survey of reviews of basic research
Authors: Mignini Luciano E , Khan Khalid S
Published: March 2006

Background

Systematic reviews can serve as a tool in translation of basic life sciences research from laboratory to human research and healthcare. The extent to which reviews of animal research are systematic and unbiased is not known.

Methods

We searched, without language restrictions, Medline, Embase, bibliographies of known reviews (1996–2004) and contacted experts to identify citations of reviews of basic science literature which, as a minimum, performed search of a publicly available resource. From these we identified reviews of animal studies where laboratory variables were measured or where treatments were administered to live animals to examine their effects, and compared them with reviews of bench studies in which human or animal tissues, cell systems or organ preparations were examined in laboratories to better understand mechanisms of diseases.

Results

Systematic reviews of animal studies often lacked methodological features such as specification of a testable hypothesis (9/30, 30%); literature search without language restriction (8/30, 26.6%); assessment of publication bias (5/30, 16.6%), study validity (15/30, 50%) and heterogeneity (10/30, 33.3%); and meta-analysis for quantitative synthesis (12/30, 40%). Compared to reviews of bench studies, they were less prone to bias as they specified the question (96.6% vs. 80%, p = 0.04), searched multiple databases (60% vs. 26.6%, p = 0.01), assessed study quality (50% vs. 20%, p = 0.01), and explored heterogeneity (33.3% vs. 2.2%, p = 0.001) more often.

Conclusion

There seems to be a gradient of frequency of methodological weaknesses among reviews: Attempted systematic reviews of whole animal research tend to be better than those of bench studies, though compared to systematic reviews of human clinical trials they are apparently poorer. There is a need for rigour when reviewing animal research.
Optimal management of adults with pharyngitis – a multi-criteria decision analysis
Authors: Singh Sonal , Dolan James G , Centor Robert M
Published: March 2006

Background

Current practice guidelines offer different management recommendations for adults presenting with a sore throat. The key issue is the extent to which the clinical likelihood of a Group A streptococcal infection should affect patient management decisions. To help resolve this issue, we conducted a multi-criteria decision analysis using the Analytic Hierarchy Process.

Methods

We defined optimal patient management using four criteria: 1) reduce symptom duration; 2) prevent infectious complications, local and systemic; 3) minimize antibiotic side effects, minor and anaphylaxis; and 4) achieve prudent use of antibiotics, avoiding both over-use and under-use. In our baseline analysis we assumed that all criteria and sub-criteria were equally important except minimizing anaphylactic side effects, which was judged very strongly more important than minimizing minor side effects. Management strategies included: a) No test, No treatment; b) Perform a rapid strep test and treat if positive; c) Perform a throat culture and treat if positive; d) Perform a rapid strep test and treat if positive; if negative obtain a throat culture and treat if positive; and e) treat without further tests. We defined four scenarios based on the likelihood of group A streptococcal infection using the Centor score, a well-validated clinical index. Published data were used to estimate the likelihoods of clinical outcomes and the test operating characteristics of the rapid strep test and throat culture for identifying group A streptococcal infections.

Results

Using the baseline assumptions, no testing and no treatment is preferred for patients with Centor scores of 1; two strategies – culture and treat if positive and rapid strep with culture of negative results – are equally preferable for patients with Centor scores of 2; and rapid strep with culture of negative results is the best management strategy for patients with Centor scores 3 or 4. These results are sensitive to the priorities assigned to the decision criteria, especially avoiding over-use versus under-use of antibiotics, and the population prevalence of Group A streptococcal pharyngitis.

Conclusion

The optimal clinical management of adults with sore throat depends on both the clinical probability of a group A streptococcal infection and clinical judgments that incorporate individual patient and practice circumstances.
HLA-B8 association with late-stage melanoma – an immunological lesson?
Authors: Fensterle Joachim , Trefzer Uwe , Berger Thomas , Andersen Mads Hald , Ugurel Selma , Becker Jürgen C
Published: March 2006

Background

Differences in HLA allele frequencies between the diseased and healthy populations may signify efficient immune responses, a notion that has been successfully tested for infectious diseases or for association with genetic elements involved in a distinct type of immunity. This retrospective study is intended to detect differences in MHC class I carrier frequencies of advanced melanoma patients compared to healthy bone marrow donors.

Methods

The HLA-A and -B carrier frequencies of 748 stage IV melanoma patients retrieved from serotyping at 6 different centers in Germany were compared using a chi-square test to 13,386 fully HLA typed bone marrow donors registered in the German national bone marrow donor registry.

Results

The comparison of HLA carrier frequencies in advanced cancer patients with healthy bone marrow donors revealed a significant decrease in HLA-B8 carrier frequencies, which was also apparent in patients with advanced disease compared to patients with loco-regional disease.

Conclusion

The data suggest that protective immune responses restricted to distinct MHC class I molecules may be operational in a subset of melanoma patients, which is the prerequisite for a large scale screen for the corresponding epitopes. Alternatively, the known association of the ancestral haplotype HLA-A1, -B8 and -DR3 with genetic elements such as distinct TNF-α alleles might have a protective effect on disease progression. In any case, identification of the cause of protection within this patient subset might lead to a significant improvement in the efficacy of current immunotherapeutic approaches.
Evaluation of the effect of energy conservation techniques in the performance of activity of daily living tasks
Authors: Ip W M , Woo J , Yue S Y , Kwan M , Sum S MW , Kwok T , Hui S SC
Published: March 2006

Objective: To determine whether energy conservation techniques during common activity of daily living tasks actually result in lower energy expenditure, and to document subjective comments regarding any differences in the perceived level of effort.

Design: Descriptive study comparing energy expenditure in three tasks with and without energy conservation techniques, taking into account the effect of age.

Setting: Occupational therapy department of a rehabilitation hospital in Hong Kong.

Subjects: One hundred and eight subjects (30 < 60 years; 78 ≥ 60 years) were recruited from staff and members of an elderly social centre in the community.

Measurements: Energy expenditure was measured using a portable indirect calorimetry system for three tasks (shopping, washing clothes and hanging laundry) with and without energy conservation techniques. Dyspnoea, fatigue and perceived exertion were measured using visual analogue scales.

Results: Reduction in energy expenditure using energy conservation techniques for shopping and hanging laundry was documented in younger subjects only (O2 consumption fell from 13.89±3.7 to 12.29±3.8 mL/min per kg for shopping, P < 0.001 and 5.9±1.2 to 5.0±1.2 mL/min per kg, P < 0.001 for hanging laundry), although the older subjects experienced less perceived exertion with the energy conservation techniques. For washing clothes, no reduction in energy expenditure was observed in either age groups.

Conclusion: Measurable benefits were observed with use of labour-saving equipment and avoidance of overhead reaching in younger subjects only.
Implicit learning of a motor skill after mild and moderate stroke
Authors: Pohl P S , McDowd J M , Filion D , Richards L G , Stiers W
Published: March 2006

Objective: To determine if adults in the subacute phase post moderate or mild stroke could learn a motor task under implicit practice conditions.

Design: Non-randomized, between-group design.

Setting: Subjects' homes.

Subjects: Sample of convenience of 15 adults with moderate stroke, 22 adults with mild stroke, and 32 age-matched controls. Stroke severity was determined using the Orpington Prognostic Scale.

Intervention: Practice of movements to target switches in two conditions, a repeated series and a random series. Practice was organized into a single session of six blocks of 80 trials such that blocks 1 and 2 were the random series, blocks 3 and 4 the repeated series, block 5 the random series, and block 6 the repeated series. Explicit knowledge of the two conditions was not provided.

Main measures: The mean response time and the coefficient of variation were calculated for each block for each group.

Results: Regardless of group, participants had a slower response time when practice was unexpectedly switched from the repeated to random condition. The response time and coefficient of variation for those with moderate stroke were persistently greater than those with mild stroke and controls, who were not different from each other.

Conclusions: Implicit motor learning is preserved in adults with moderate stroke and may be a viable strategy for teaching motor skills in rehabilitation. The clinician should be aware that subjects with moderate stroke, even when performing with the less affected upper extremity, have significantly slower and more variable movements than those with mild stroke and controls.
Identification of healthy elderly fallers and non-fallers by gait analysis under dual-task conditions
Authors: Toulotte C , Thevenon A , Watelain E , Fabre C
Published: March 2006

Objective: We compared falling and non-falling healthy elderly subjects to identify balance disorders associated with falling. Gait parameters were determined when carrying out single and dual tasks.

Design: Case comparison study.

Setting: Subjects were studied in the gait laboratory at Hopital Roger Salengro, Lille, France.

Subjects: A group of 40 healthy elderly women were assigned to one of two groups according to their falling history: 21 fallers aged 70.4±6.4 years and 19 non-fallers aged 67.0±4.8 years. All subjects performed first a single leg balance test with two conditions (eyes open/closed). Then, gait parameters were analysed under single-task and dual motor-task conditions (walking with a glass of water in the hand).

Main measures: Falls, number of times suspended foot touched the floor during the single leg balance test, cadence, speed, stride time, step time, single-support time, stride length and step length during walking under single- and dual-task conditions.

Results: During the single leg balance test, fallers placed their feet on the floor three times more often than non-fallers under eyes open conditions (P < 0.05) and twice as often under eyes closed conditions (P < 0.05). In the single-task condition, no significant difference in gait parameters was reported between fallers and non fallers. There was a significant difference (P < 0.05) in the gait parameters (cadence, speed, stride and step time, single-support time) between fallers and non-fallers under dual-task conditions.

Conclusions: Dual tasks perturb walking in fallers, who exhibit deteriorated static balance. Consequently, walking under dual-task conditions plus a single leg balance test could be helpful in detecting walking disorders and planning physiotherapy to prevent falls.
Motor relearning programme for stroke patients: a randomized controlled trial
Authors: Chan Dora YL , Chan Chetwyn CH , Au Derrick KS
Published: March 2006

Objective: To study the efficacy of the motor relearning approach in promoting physical function and task performance for patients after a stroke.

Design: Matched-pair randomized controlled trial.

Setting: An outpatient rehabilitation centre in Hong Kong.

Participants: Fifty-two outpatients with either a thrombotic or haemorrhagic stroke who completed either the study or control group.

Interventions: The patients received 18 2-h sessions in six weeks of either the motor relearning programme or a conventional therapy programme.

Main outcome measures: The Berg Balance Scale, the Timed Up and Go Test, the Functional Independence Measure (FIM), the modified Lawton Instrumental Activities of Daily Living (IADL) test, and the Community Integration Questionnaire.

Results: Patients in the motor relearning group showed significantly better performance on all but the Timed Up and Go Test when compared with the control group ( F(1,150)=6.34-41.86, P ≤ 0.015). The interactions between group and occasion were significant on all five outcome measures, indicating that the rates of change across time between the motor relearning and control groups differed ( F(3,150)=3.60-33.58, P < 0.015).

Conclusion: The motor relearning programme was found to be effective for enhancing functional recovery of patients who had a stroke. Both ‘sequential’ and ‘function-based’ concepts are important in applying the motor relearning approach to the rehabilitation of stroke patients.
The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders - a randomized controlled trial
Authors: Bunketorp Lina , Lindh Malin , Carlsson Jane , Stener-Victorin Elisabet
Published: March 2006

Objective: To evaluate the effects of a physical training programme which is supervised and tailored to meet the needs of patients with subacute whiplash-associated disorders.

Design: A randomized controlled trial with follow-up at three and nine months after randomization.

Setting: An interdisciplinary rehabilitation centre.

Subjects: Forty-seven patients with subacute disorders following a whiplash trauma.

Interventions: Patients were randomized to a supervised training group or a self-administered home training group.

Main measures: Primary outcome measures were the Self-Efficacy Scale, the Tampa Scale for Kinesiophobia and the Pain Disability Index. Secondary outcome measures were neck pain intensity, sensory and affective dimensions of pain, pain location and duration, muscle tenderness, grip strength, cervical mobility, sick leave and analgesic consumption.

Results: Forty patients (85%) completed the intervention period, and the drop-outs were followed up by intention-to-treat. The results showed that supervised training was significantly more favourable than home training, with a more rapid improvement in self-efficacy (P=0.03), fear of movement/(re)injury (P=0.03) and pain disability (P=0.03) at three months. Further, supervised training significantly reduced the frequency of analgesic consumption (P=0.03). The improvements were partly maintained at nine months, even though there was no amelioration in pain and physical disorders. Despite the favourable outcome, supervised intervention did not reduce sick leave.

Conclusions: The findings indicate a treatment approach that is feasible in the rehabilitation of patients with subacute whiplash-associated disorders in the short term, but additional research is needed to extend these findings and elucidate treatment strategies that also are cost effective.
Effect of compensation procedures for velocity on repeatability and variability of gait parameters in normal subjects
Authors: Shimada Seiichiro , Kobayashi Shigeru , Wada Makoto , Sasaki Shinichi , Kawahara Hideo , Uchida Kenzo , Yayama Takafumi , Baba Hisatoshi
Published: March 2006

Objective: To evaluate the effects of a mathematical procedure that adjusts for gait velocity on the variability seen in gait analysis.

Design: Evaluation before and after compensation.

Setting: Gait laboratory, Fukui University Hospital, Japan.

Subjects: Fourteen normal volunteers.

Outcome measures: A computerized gait analysis system with two forceplates and a light source spot measuring device was used. Gait measurement in each subject was performed on three different days.

Results: The gait parameters measured on three different days were significantly different, particularly step length, stride length, velocity, the components of floor-reaction forces and hip motion. In these parameters, intraclass correlation coefficient, ICC (1,1) was not high (range 0.05-0.71). However, there was a high correlation between these parameters and velocity and high repeatability was obtained following compensation for velocity (ICC (1,1), range 0.73-0.97). In contrast, compensation of parameters whose measurement was not significantly different before compensation did not improve ICC (1,1). Variability of all parameters was acceptable, however CV (an index of variability) improved significantly after compensation compared with that before compensation in six of 15 parameters.

Conclusions: Our findings suggest that low repeatability in gait parameters should be considered even when the gait of normal subjects is measured on different days. A high repeatability and more acceptable variability were obtained when the data were compensated for velocity.
Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use
Authors: Brogårdh Christina , Sjölund Bengt H
Published: March 2006

Objective: (1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome.

Design: A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers.

Setting: A university hospital rehabilitation department.

Participants: Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb.

Intervention: Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment.

Outcome measures: Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log.

Results: The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P B=0.001). However, no additional effect was seen from wearing a mitt for another three months.

Conclusion: Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.