bluuebunny/crossref_metadata_2025 huggingface dataset:
Toward a Psychology of Human Agency
Authors: Bandura Albert
Published: May 2006

This article presents an agentic theory of human development, adaptation, and change. The evolutionary emergence of advanced symbolizing capacity enabled humans to transcend the dictates of their immediate environment and made them unique in their power to shape their life circumstances and the courses their lives take. In this conception, people are contributors to their life circumstances, not just products of them. Social cognitive theory rejects a duality between human agency and social structure. People create social systems, and these systems, in turn, organize and influence people's lives. This article discusses the core properties of human agency, the different forms it takes, its ontological and epistemological status, its development and role in causal structures, its growing primacy in the coevolution process, and its influential exercise at individual and collective levels across diverse spheres of life and cultural systems.
Community‐acquired methicillin‐resistant Staphylococcus aureus skin infections: Report of a local outbreak and implications for emergency department care
Authors: Fleming Scott W. , Brown Lauren Hinson , Tice Sarah E.
Published: May 2006

Purpose: To report a local outbreak of community‐associated methicillin‐resistant Staphylococcus aureas (CA‐MRSA), discuss the incidence and the high rates of CA‐MRSA–related skin and soft tissue infections in our outpatient and emergency department (ED) population, and also review the diagnosis and management of CA‐MRSA in outpatients.

Data sources: Case report, diagnostic evidence, scientific literature, published treatment guidelines, and a retrospective chart review.

Conclusions: Clinical suspicions of high rates of CA‐MRSA–related skin and soft tissue infections in our institution’s outpatient and ED population was supported. Hospital‐acquired MRSA (HA‐MRSA) was also more prevalent than expected. Recognizing high‐risk settings, patients and clinical features of CA‐MRSA is essential for early identification and proper management. The most common clinical manifestation of CA‐MRSA we identified was a skin or soft tissue infection.

Implications for practice: It is important that clinicians have an awareness of high‐risk patients, perform routine culturing of soft tissue infections, and prescribe antibiotics based on culture and sensitivities. Awareness, prevention, early diagnosis, and implementation of effective antibiotic management by nurse practitioners can help limit an epidemic of CA‐MRSA.
How we do it: Tissue adhesives in osseointegrated implantation surgery
Authors: Koppana V. , Kalaiselvan R. , Snow D.G.
Published: May 2006

Keypoints

• Success of a percutaneous osseointegrated implants depends on the integrity and stability of surrounding soft tissues.

• Tissue adhesives are widely used to close minor lacerations of skin in children and after some elective procedures.

• Cyanoacrylate‐based tissue glues were found to be safe with low complication rates.

• We describe our technique and experience of using cyanoacrylate‐based tissue adhesives to stabilise split thickness skin grafts following osseointegrated implantation.
How we do it: Reinsertion of the stylet into the nucleus contour cochlear implant to facilitate second insertion. A helpful technique salvaging the cochlear implant device
Authors: Grolman W. , Verdam F.J. , Tange R.A.
Published: May 2006

Keypoints

• There are several causes for failure of appropriate position of the electrode array of the nucleus cochlear implant, e.g. incomplete insertion, extrusion, luxation, curling of the device, deviation, or false route.

• If the position of the electrode array in relation to the modiolus is unsatisfactory, in order to salvage the cochlear implant one can reload the cochlear implant array with its stylet.

• In order to reload the electrode array, primarily it needs to be removed from the cochlea and inserted into a small size suction tube (lubricated with just water). Then the stylet needs to be carefully straightened and inserted into the lumen of the array.

• This technique is a relatively simple solution for unsatisfactory placement of the electrode array and can prevent discarding the precious cochlear implant.
Deterioration in quality‐of‐life of late (10‐year) survivors of head and neck cancer
Authors: Mehanna H.M. , Morton R.P.
Published: May 2006

Objectives:  To determine 10‐year quality‐of‐life (QOL) in head and neck cancer patients and to examine the potential predictors of late QOL.

Design:  Prospective 10‐year (QOL) assessment in a cohort of head and neck cancer patients.

Setting:  Tertiary referral head and neck cancer centre in Auckland, New Zealand.

Participants:  Two hundred patients diagnosed and were treated for head and neck cancer. Exclusion criteria were blindness, learning difficulties or inability to understand or read English.

Main outcome measures:  Quality‐of‐life at 10 years measured by Auckland QOL questionnaire, and analysed for associations with the following co‐variates: age, gender; co‐morbidities (alcohol intake and smoking), type and stage of disease; treatment modality; and QOL measures.

Results:  At 10 years following diagnosis, overall QOL (life satisfaction), decreased significantly by an average of 11% (95% CI: −5, −17) compared with before treatment, and by 15% when compared with years 1 and 2. Pre‐treatment QOL significantly predicted late QOL, whilst QOL 1 year after treatment did not. None of the socio‐demographic, disease‐ or treatment‐related factors predicted long‐term QOL on univariate analysis, but this may be due to the small sample size.

Conclusions:  This observed, late drop in the QOL of head and neck cancer patients requires further corroboration and investigation. Due to small sample sizes associated with long‐term studies in head and neck cancer cohorts, studies of predictors of long‐term QOL will only be likely to succeed if done as multi‐centre studies. As there is some evidence to suggest that psychosocial interventions improve the QOL of head and neck cancer patients, it may be appropriate to consider screening for risk of a late deterioration in QOL in order to plan appropriate psycho‐social intervention.
Graphic‐visual adaptation of House–Brackmann facial nerve grading for peripheral facial palsy
Authors: Lazarini P. , Mitre E. , Takatu E. , Tidei R.
Published: May 2006

Objective:  To determine if the diagram with schematic drawings of the face based on House–Brackmann facial nerve grading scale can be of easier use than the original grading scale for facial palsy patients.

Study design:  Prospective case study of 32 patients with facial palsy.

Setting:  Tertiary referral center‐university hospital.

Patients:  Patients with different degrees of acute peripheral facial palsy from any cause.

Main outcome measures:  The patients were photographed and then classified by degree of facial palsy through analysis of the pictures. At first, three of the authors individually utilised the original classification described by House–Brackmann facial nerve grading and then, after 7 days, they employed the illustration table proposed. After 30 days, the same methods were again used by the same authors for both House–Brackmann facial nerve grading and the illustration table.

Results:  The analysis of the obtained data reveals that the classification described by House and Brackmann (Otolaryngol. Head Neck Surg. 1985;93:146) presents several items to be evaluated, making it difficult to use and demanding greater time for correct application. On the contrary, the proposed illustration table allows faster evaluation and easier memorisation, not being subject to possible interpretation or translation mistakes, as illustrations are a universal language. Neither method presented absolute reproducibility, however, we found slightly larger concordance indexes among the authors for the proposed illustration table. We noticed average values of reproducibility were ≈65% in the House–Brackmann classification, and 75% in the evaluation using the diagram of the schematic drawings.

Conclusions:  The authors concluded that the illustration table could be utilised in substitution for the original description of House–Brackmann facial nerve grading; they also concluded that the illustration table allows faster evaluation and easier memorisation.
Intra‐operative parathyroid hormone monitoring in secondary hyperparathyroidism: is it useful?
Authors: Roshan A. , Kamath B. , Roberts S. , Atkin S.L. , England R.J.A.
Published: May 2006

Objectives:  To assess the use of intra‐operative parathyroid hormone (PTH) level monitoring as a predictor of persistent hypoparathyroidism after total parathyroidectomy in renal hyperparathyroidism.

Setting:  University Teaching Hospital Otorhinolaryngology and Head and Neck Surgery Unit.

Participants:  All patients with renal hyperparathyroidism undergoing parathyroidectomy between January 2004 and July 2005. Twenty‐nine patients were identified.

Main outcome measures:  Comparison is made between pre‐ and intra‐operative PTH levels (ioPTH) in patients who at 3 months postoperatively maintained hypoparathyroidism and patients who did not. Results were analysed to see whether ioPTH predicts maintenance of the hypoparathyroid state.

Results:  The mean preoperative PTH level was 932 pg/L (range: 58–1808). The mean postoperative PTH level was 147 pg/L (range: 16–498). The mean 3‐month PTH level was 47 pg/L (range: <1–515). The mean postoperative PTH level for patients with a persistently high PTH level at 3 months was 286 pg/L (range: 272–299), compared with 63 pg/mL (16–160) in patients remaining normparathyroid, and 159 pg/L (range: 39–498) for patients with persistent hypoparathyroidism. If the normoparathyroid state is strictly considered to be failure following total parathyroidectomy, ioPTH is not predictive of hypoparathyroidism. However, ioPTH is indicative of biochemical resolution of the hyperparathyroid state (normo‐ or hypoparathyroidism).

Conclusion:  We conclude that the use of ioPTH monitoring in the surgical management of secondary hyperparathyroidism fails to predict persistent hypoparathyroidism following total parathyroidectomy, but does predict biochemical resolution of hyperparathyroidism.
Systematic review of the follow‐up of oral dysplasia
Authors: Rattay T. , Smith J. , Sandhu R. , Mehanna H.M.
Published: May 2006

Objectives. To assess effectiveness, safety, and acceptability of follow‐up regimens for oral dysplasia with regards to malignant transformation rate and duration to transformation.

Method. Study design–Systematic literature review with criteria for identifying studies, assessing quality and data extraction.

Selection criteria–Cohort studies, case‐control studies, or randomised‐controlled trials (RCTs).

Interventions–Clinical follow‐up and surveillance, surgical and non‐surgical treatment, modification of aetiological factors.

Outcome measures–Malignant transformation rate, predictive value of clinical prognostic indicators.

Data collection and analysis–Using selection criteria, we identified published data by electronic searching. The validity of studies and extracted data was independently assessed by two authors. Quantitative data is compared and summarized in a table. Qualitative data is also discussed.

Results. There are no RCTs assessing follow‐up strategies. Nineteen cohort studies (level II and III evidence) reported follow‐up, of which 12 were included in the meta‐analysis. The malignant transformation rate varies widely between studies (6.6–36.0%). Surgical treatment appears to be more effective than non‐surgical modalities, but recurrence is high. Tobacco and alcohol use, site and histological grade of the lesion are associated with progression to cancer.

Conclusions. There is currently no evidence‐based or consensus strategy for malignant risk quantification and follow‐up of patients with oral dysplasia. We present a follow‐up protocol based on best evidence. Large randomised‐controlled trials are needed to assess these new strategies, including the use of molecular markers to quantify risk and follow‐up these lesions.
Does surgical treatment improve behaviour in OME?
Authors: Haggard Mark ,   MRC Multi‐centre Otitis Media Study Group
Published: May 2006

Background. For older children with OME, the acknowledged presentation includes behaviour problems. However, it has never been specified which aspects of behaviour are most affected, nor whether treatments improving physical health and hearing (efficacy) also improve such indirect outcomes (effectiveness).

Methods. We developed a parent‐reported, age‐appropriate, 18‐item measure (BEH‐18) of developmental behaviour problems and showed it to be affected by otitis media with effusion (OME) in a large‐sample case‐control comparison. (SD effect size 0.72, both ns >500) Correlations with hearing level (HL) and ear infection scores in cases showed a maximum with behaviour lagging in time by at least 3 months. The TARGET database offers follow‐up times 6 and 12 months after randomisation so provides a fair test of benefits from ventilation tubes (VTs – grommets). We pooled over grommets‐alone and grommets plus adenoidectomy (+ad), as +ad showed no effects on BEH‐18. We adjusted for baselines and for expectancy and halo biases by analysis of covariance. On top of the usual attendance bias with sample attrition, a social desirability reporting bias in offspring's behaviour and the lagged outcome period led to much missing data, making imputation essential. We partially imputed the two‐occasion outcome for missing data by simple part‐whole regression, raising the used sample from 263 with complete data on all variables to 328 (70 up to 87% of the 376 randomised).

Results. An unimputed analysis with the most favourable bias adjustment, admitting some earlier beneficial effects on HL and ear infections into the estimated treatment effect suggested a marginally significant reduction in behaviour problems (P = 0.14, 0.15 for 6 and 12 months). However with the same favourable adjustment, the combined and imputed analysis produced a Bias‐adjusted Treatment Effect Size (BaTES) of only 0.10 SD (P = 0.423). It is known, and increasingly heeded, that misleading results (in either direction) can be obtained in trials that fail to impute for missing data (when over about 10% of cases).

Conclusions. Wider benefits from grommets (beyond those to hearing and ear infections) exist but those are limited and do not include benefits to behaviour, so should not be oversold.
Event related potentials – are they useful in paediatric cochlear implant patients?
Authors: Singh S. , Liasis A. , Rajput K. , Luxon L.
Published: May 2006

Background. The use of cochlear implants in profoundly deaf children is increasing with a trend towards earlier implantation. However, tools used at present to assess outcome are primarily based on behavioural tests, which are difficult to use effectively in young children. Event related potentials (ERP) such as Mismatch Negativity (MMN) have been proposed to have potential in assessing central processing in cochlear implant patients.1

Objective. The main objective of this study was to assess the correlation of ERP measures with behavioural assessment data to identify if they can be used to predict performance in cochlear implant patients.

Methods. We carried out a prospective, blinded, non‐randomised study investigating auditory ERPs to speech stimuli in 35 cochlear implanted children. We compared P1, N2 and MMN parameters with behavioural outcome, assessed at the time of recording ERPs and 2 years later.

Results. Auditory ERPs were identifiable in 30 out of 35 patients. MMN was recorded in 85% of star performers but in only 20% of poor performers. At behavioural reassessment 2 years later, 50% of poor performers who had demonstrated a MMN progressed to achieve ‘star’ performance in comparison to 25% of those who had not.

Conclusion. These results indicate that MMN can be used to assess the functional status of auditory cortex in young children with cochlear implants and may provide an objective measure to predict future performance. However a large longitudinal study is needed to establish its sensitivity and specificity before using it as a clinical tool.

Reference

1 Singh S., Liasis A., Towell A., et al. (2004) Event related potentials in cochlear implant patients. Ear and Hearing25(6), 598‐‐610
Can symptoms patterns distinguish patients with post‐nasal drip, reflux or globus?
Authors: Cathcart R.A. , Steen I.N.S. , Ali K.H.M. , McInally K.G. , Wilson J.A.
Published: May 2006

The Glasgow Edinburgh Throat scale (GETS) was developed to assess severity and therapy outcomes in globus sensation. The Reflux Symptom Index (RSI) was similarly derived to assess the possible spectrum of cervical symptoms due to laryngopharyngeal reflux. Both were physician derived tools with little published data on their factor structure, and nothing published to date on their ability to generate whether or not they capture similar pharyngeal phenomena.

Aim. To assess the consistency and factor structure of the two questionnaires.

Methods. Subjects completing: both questionnaires 134 catarrh clinic patients; RSI only: 32 chronic chest clinic attenders; GETS only 168 volunteer ophthalmology outpatients. All items of both questionnaires were stored in SPSS. The analysis included Cronbach's α, correlation coefficients, Scree slope plots with derivation of Eigenvalues, principal components analysis using Varimax rotation with Kaiser Normalisation.

Results. The GETS was completed by 302 subjects (Cronbach's α = 0.81, confirming good internal consistency of the scale overall. Three factors were identified which accounted for over 70 % of the total variance. Factor 1 was much the strongest (49% of the total variance) and included ‘catarrh’ or post‐nasal drip, globus, can't empty throat, continually want to swallow, irritation. Factor 2 had obstructive items‐ dysphagia, food sticking / throat closing. Factor three was a 2 item pain and swelling component. The RSI was completed by 168 individuals, also with acceptable overall consistency (α = 0.72). The optimum factorisation showed 2 main factors: (i) The first (α = 0.71) included coughing, choking, difficulty swallowing and heartburn/dyspepsia. (ii) The second appeared mostly to reflect post‐nasal drip and included catarrh, throat clearing, globus, and voice disorder (α = 0.62). Finally we performed a combined analysis of all 19 items – 10 GETS and nine RSI – derived from 134 subjects. This showed that heartburn mapped poorly to the overall combined factor structure which, as might be now predicted, showed factors similar to the two component tools – i.e. (i) obstruction / cough; (ii) post‐nasal drip / clearing the throat.

Conclusion. The RSI and GETS emerge as reliable tools of symptom intensity: but what do these symptoms actually indicate? Both tools generate principal domains of ‘cough and block’ and ‘globus/drip/throat clearing’. In other words RSI and GETS both appear to identify similar symptom patterns, nor can the place of symptomatic gastro‐oesophageal reflux be clarified from the history. Indeed it appears that there can be little specific aetiological inference from the isolated assessment of post‐nasal or pharyngeal symptoms.

References

1 Deary I.J., Wilson J.A. et al. (1995) J Psychosom Res. 39, 203–213

2 Belafsky P.C., Postma G.N. & Koufman J.A. (2002) Validity and reliability of the reflux symptom index (RSI). J Voice16, 274–277
Sadé and Tos classifications of the tympanic membrane: not reliable?
Authors: Pothier D.
Published: May 2006

Objectives. Retraction pockets of the tympanic membrane may progress to cholesteatoma.1 To assess and describe the condition of retraction pockets and to monitor their progress, classification systems are used; this classification is of particular importance when follow‐up is conducted by more than one clinician. The Sadé classification is used for the pars tensa and the Tos classification system for the pars flaccida. Although widely used, neither method has been validated or evaluated for reliability when applied by different users.

Method. A series of 20 standardised slides of retraction pockets (10 each of PT and PF retractions) was shown to 22 Otolaryngologists. Participants were asked to classify each lesion using the appropriate classification according to supplied, printed definitions.

Results. Overall inter‐rater reliability was very low (mean kappa of 0.39), with very high levels of variability. Levels of agreement between raters was lower when classifying PF retractions than PT retractions (P = 0.01). No slide was classified unanimously as a single grade. Some slides even had an equal distribution of classifications spread between all grades of the classification system. No significant difference in inter‐rater reliability was found between grades (P = 0.7).

Conclusions. This is the first attempt at validation of the Tos and Sadé classification systems for retraction pockets. Despite the reliance on classification of retraction pockets, it would appear from this study that the value of these classification systems may be limited. Clinical decisions based on classifications may be flawed, particularly when made on the basis of a classification made by another clinician.

Reference

1 Akyildiz N., Akbay C., Ozgirgin O.N., et al. (1993) The role of retraction pockets in cholesteatoma development: an ultrastructural study. Ear Nose Throat J.72, 210‐‐212
Variations in the application procedures for the specialist registrar post in otolaryngology
Authors: Doshi J. , Anari S.
Published: May 2006

Objective. To compare the application process and person specification requirements for each deanery in the United Kingdom for a Type I specialist registrar post in otolaryngology.

Method. All 18 deaneries listed by the Joint Committee of Higher Surgical Training were contacted by email to send their most up to date person specification, job description and details of their application process. Those deaneries that did not respond were contacted by telephone. The person specification, application process and content of the application forms from each deanery were critically reviewed and compared.

Results. 14/18 deaneries responded; four classified the information requested as confidential. Results included (number of deaneries in brackets): Application method: application form (8), curriculum vita (3), both (3). Submission method: post (13), e‐mail (1). Examples of the variable degree of objective assessment of achievements included: prizes (9), temporal bone course (2), validated logbook (6), peer‐review publications as essential (3), European Computer Driving License (2). Publication, presentation, audit, medical/surgical courses, management and Membership of a Royal College of Surgeons (MRCS) were the only common themes amongst all deaneries.

Conclusions. There was a wide variation in the application process and the information wanted by different deaneries. Many criteria within the person specification were not objectively assessed. With the introduction of modernising medical careers (MMC) and the change in higher surgical training, deaneries will need to re‐examine their application process and criteria. A nationally agreed application form and process should be considered to provide a more objective measure of distinguishing between applicants.
2‐Dimensional gel electrophoresis and MALDI‐MS of cystic cervical metastasis from head and neck squamous cell carcinoma
Authors: Beer H.L. , Jenkins R.E. , Gutowska‐Owsiak D. , Pazmany L. , Birchall M.A. , Kitteringham N.R.
Published: May 2006

Objectives. Proteomics could provide important insights into pathogenesis and potential new targets for diagnosis, prognosis, prediction and therapy for head and neck squamous cell carcinoma (HNSCC). However, study of solid tissue is problematic.1 Cystic degeneration that occurs in advanced nodal metastasis can be difficult to differentiate from benign disease, especially in the absence of primary tumour.2 As with other malignant effusions, HNSCC cystic fluid may prove a rich source of novel tumour associated proteins: possible targets for immunotherapy, diagnosis, prediction or prognosis.

Design. Feasibility study of 2D‐gel electrophoresis (2DGE) and matrix‐assisted laser desorption‐ionisation mass spectrometry (MALDI‐MS) to analyse cyst fluid within squamous metastasis.

Method. Cystic fluid was aspirated from a cervical metastasis in a patient with advanced squamous cancer. Proteins were separated by 2DGE, stained with Coomassie brilliant blue and identified by MALDI‐MS.

Results. Initial analysis showed an abundance of haemoglobin, albumin and immunoglobulin, as expected. The gel also revealed unexpected proteins, particularly periredoxin‐2. There were also some unidentified spots, possibly containing novel proteins. In order to increase the potential for identifying lower abundance proteins, albumin and immunoglobulin were depleted by affinity chromatography and further 2DGE undertaken.

Conclusions. 2DGE is applicable to the study of fluid from cystic cervical metastases. Unexpected proteins identified in this pilot study require confirmation in a larger series. Depletion of abundant proteins will allow unidentified spots to be characterised. These approaches are likely to open a new window to proteins ‘at the coal‐face’ of head and neck cancer.

References

1 Wu W., Tang X., Hu W., et al. (2002) Clin. Exp. Metastasis19, 319‐‐326

2 Raghavan U. & Bradley P.J. (2003) Curr. Opin. Otolaryngol. Head Neck Surg. 11(2), 124‐‐128
PTTG promotes a novel VEGF‐KDR‐ID3 autocrine mitogenic pathway in thyroid cancer
Authors: Kim D.S. , Buchanan M.A. , Stratford A.L. , Watkinson J.C. , Eggo M.C. , Franklyn J.A. , McCabe C.J.
Published: May 2006

Background. VEGF exerts its effects by binding to tyrosine kinase receptors, KDR and VEGFR1. KDR is critical for transmitting signals for proliferation of endothelial cells but is also expressed in several non‐endothelial cells suggesting existence of autocrine stimulatory pathways.

Study‐design. We investigated VEGF and KDR expression in human thyroid epithelial cells in vitro and thyroid cancers samples ex vivo.

Results. Expression of KDR was demonstrated using Taqman RT‐PCR and Western blotting in a human follicular thyroid cancer line (FTC133) and primary thyroid epithelial cells. Further, VEGF‐specific and dose‐dependent activation of KDR‐dependent MAPK signalling and KDR‐dependent mitogenesis was demonstrated. KDR mRNA expression was elevated in thyroid cancers (2.5‐fold, n = 38, P < 0.001), and immunohistochemistry demonstrated stronger phosphorylated‐KDR staining in thyroid cancer cells. Further, we showed that PTTG, an oncogene known to promote angiogenesis, up‐regulates KDR (2.2‐fold, P = 0.006) and VEGF (2.4‐fold, P < 0.001) expression in FTC133 thyroid cells. Next, we examined expression of ID3, known to be important in VEGF‐dependent angiogenesis, and VEGF mRNA expression in a series of thyroid cancers. We observed a strong positive correlation between expression of these genes (R2 = 0.62, P < 0.001). Stimulation of FTC133 cells with exogenous VEGF increased ID3 expression (2.1‐fold, P < 0.001), an effect abrogated by a KDR‐specific inhibitor, suggesting VEGF regulation of ID3 is KDR‐dependent.

Conclusion. We suggest the presence of a VEGF‐KDR‐ID3 dependent autocrine pathway in thyroid cells. By up‐regulating both VEGF and KDR expression, we propose that PTTG may promote this autocrine proliferative pathway which may in turn be critical to thyroid cancer progression.
The role of lung resistance protein in radiation treated head and neck carcinoma
Authors: Silva P. , Slevin N. , Sloan P. , Price P. , West C. , Homer J. , Hampson I. , Hampson L.
Published: May 2006

Objectives. Vault proteins are ribonucleotide proteins composed largely of a single large protein termed major vault protein. (MVP) The (MVP) LRP gene is located on chromosome 16 close to the genes coding for multidrug resistance‐associated protein and protein kinase c‐β. The role of MVP (LRP) in cancer drug resistance has been demonstrated in various cell lines as well as in ovarian carcinomas and acute myeloid leukaemia, however little is known about its possible role in radiation resistance.1,2 Our aim was to examine this in head and neck squamous carcinoma (HNSCC).

Method. One hundred and thirty three patients with proven squamous cell carcinoma of the oropharynx were recruited into the study, looking at two subsites of posterior tongue and tonsil. These patients received primary radiotherapy with curative intent. Archived biopsy material was obtained for 78 patients. Immunohistochemistry was used to detect LRP expression. Locoregional failure and cancer specific survival were estimated using Kaplan Meier method.

Results. On analysis of the whole group together LRP expression was strongly associated with locoregional failure (P < 0.0001) however, on subgroup analysis there was an obvious difference between the two sites, with increased LRP expression being associated with poor prognosis in the tongue group (P < 0.0001), but not the tonsil group. (P = 0.14).

Conclusion. This is the first reported study of LRP as a prognostic marker in radiotherapy treated HNSCC suggesting it may play an important role not just in cancer drug resistance but also in radiation resistance. Of added interest is the difference in prognostic significance between the two subsites.

References

1 Scheffer G.L., Wijngaard P.L., Flens M.J., et al. (1995) The drug resistance‐related protein LRP is the human major vault protein. Nature Med.1, 578–582

2 Kozlov G., Vavelyuk O., Ovidiu M., et al. (2005) Solution structure of a two‐repeat fragment of major vault protein. J. Mol. Biol.7
A randomised controlled trial comparing rapid rhino with netcell packs after routine nasal surgery
Authors: McDonald S. , Slater J. , Garth R.
Published: May 2006

Objectives. To determine whether there is a difference in discomfort between Netcell and Rapid Rhino (RR) packs following routine nasal surgery.

Methods. LREC approval for the study was granted. Patients aged 16‐‐65 undergoing septal and inferior turbinate surgery, who did not meet the exclusion criteria, were approached for consent to participate in the trial. Post‐operatively, one nasal cavity was packed with Netcell, and the other with Rapid Rhino (a methodological design used by Arya et al.1). The type of pack inserted on the left side was decided using sequentially numbered opaque envelopes, which were block‐randomised in groups of 4 and 8. By default, the pack used for the right nasal cavity was the other type. Nursing staff removed the packs at 7 am the following day. Prior to and immediately following removal, patients recorded their pain scores for each side on a standard 100 mm visual analogue scale. The left pack was always removed first. A power calculation ensured that enough patients were recruited to provide 90% power for a difference in VAS of 10 mm with a se of 20 mm at the 5% significance level.

Results. Primary outcome: RR was significantly more painful on removal than netcell (difference = 10.6 mm, P < 0.001, Wilcoxon signed ranks test). Secondary outcome: There was no significant difference in mean VAS for the packs in situ. One Netcell pack was removed due to bleeding, and replaced with Merocel.

Conclusion. The packs are equally comfortable in situ, and RR is more painful on removal.

Reference

1 Arya A.K., Butt O. & Nigam A. (2003) Double‐blind randomised controlled trial comparing Merocel with rapid rhino nasal packs after routine nasal surgery. Rhinology41, 241‐‐243
Synthesis of 6-Amino-, 6-Methyl- and 6-Aryl-2-(hydroxymethyl)purine Bases and Nucleosides
Authors: Šilhár Peter , Pohl Radek , Votruba Ivan , Klepetářová Blanka , Hocek Michal
Published: May 2006

An efficient methodology of the synthesis of 6-substituted 2-(hydroxymethyl)purine derivatives (bases and nucleosides) was developed. Regioselective Pd-catalyzed cross-coupling reactions of 6-chloro-2-iodopurines with [(benzoyloxy)methyl]zinc iodide gave 2-[(benzoyloxy)-methyl]-6-chloropurines that were converted to 2-(hydroxymethyl)adenines by reactions with ammonia and to 6-methyl- or 6-aryl-2-(hydroxymethyl)purines by cross-coupling reactions with trimethylaluminium or arylboronic acids followed by deprotection. The title 6-substituted 2-(hydroxymethyl)purine bases and nucleosides did not exhibit significant cytostatic or anti-HCV activity.
Cognitive deterioration associated with an expedition in an extreme desert environment
Authors: Maruff P , Snyder P , McStephen M , Collie A , Darby D
Published: May 2006

Background:Prolonged exposure to extreme environments may result in cognitive changes that may influence decision making ability and increasing risk of injury or death.

Objective:To measure the cognitive performance of a healthy man as he completed a 17 day desert expedition.

Method:A computer based cognitive test battery, subjective cognitive rating scale, and measures of physical characteristics were used. Objective cognitive performance was compared with the performance of eight age matched men who remained in their own homes.

Results:The speed of psychomotor, attentional, and executive functions decreased as the expedition progressed, but the accuracy of performance remained unaffected. Although some impairments were large, they resolved completely once the expedition was completed. Subjective ratings indicated that the subject had insight into his failing cognitive performance during the expedition.

Conclusions:Cognitive performance can be measured repeatedly throughout an expedition in an extreme environment. Cognitive impairment may occur.
Low back pain investigations and prognosis: a review
Authors: Refshauge K M , Maher C G
Published: May 2006

Low back pain is reviewed in terms of when investigations are useful and its clinical course. Despite the extensive evaluation of the accuracy of investigations such as radiography, magnetic resonance imaging, and myelography, there is a surprising dearth of research to inform their use in primary care. There is no clear evidence on which to base judgments for selection of appropriate tests to confirm or exclude low back pain pathology. It appears that investigations are rarely necessary for low back pain. Specific investigations should be ordered to identify a particular pathology but should not be ordered routinely for general screening. In the absence of pathology, low back pain and its associated disability improve rapidly in the first weeks after onset, but, in contradiction to all guidelines, both commonly persist and the best evidence suggests that recurrences are common.
Does history of concussion affect current cognitive status?
Authors: Collie A , McCrory P , Makdissi M
Published: May 2006

The association between self reported history of concussion and current neurocognitive status is controversial. Some football studies suggest that athletes with a history of concussion display cognitive impairment relative to athletes with no history of concussion, but other studies have not been able to reproduce such findings. This study shows that there is no relation between the number of previous self reported episodes of concussion and current cognitive state, directly contradicting the findings of previous research.
Breathless in the bath
Authors: Whyte G P , Harries M , Dickinson J , Polkey M I
Published: May 2006

The case is reported of a male track and field athlete with breathing difficulties at rest and during exercise, which were exacerbated in the supine position and during water immersion. Right hemidiaphragmatic paralysis was diagnosed. The cause of this relatively benign disorder is not known and there are no serious clinical implications. There is no treatment, but a continuation of exercise together with interventions to strengthen the subsidiary inspiratory muscles is recommended.
The effects of creatine supplementation on selected factors of tennis specific training
Authors: Pluim B M , Ferrauti A , Broekhof F , Deutekom M , Gotzmann A , Kuipers H , Weber K
Published: May 2006

Background:Creatine supplementation is popular among tennis players but it is not clear whether it actually enhances tennis performance.

Objectives:To examine the effects of creatine supplementation on tennis specific performance indices.

Methods:In a randomised, double blind design, 36 competitive male tennis players (24 creatine, mean (SD) age, 22.5 (4.9) years; 12 placebo, 22.8 (4.8) years) were tested at baseline, after six days of creatine loading, and after a maintenance phase of four weeks (14 creatine, 10 placebo). Serving velocity (10 serves), forehand and backhand velocity (three series of 5×8 strokes), arm and leg strength (bench press and leg press), and intermittent running speed (three series of five 20 metre sprints) were measured.

Results:Compared with placebo, neither six days nor five weeks of creatine supplementation had a significant effect on serving velocity (creatine: +2 km/h; placebo: +2 km/h, p = 0.90); forehand velocity (creatine: +4 km/h; placebo: +4 km/h, p = 0.80), or backhand velocity (creatine: +3 km/h; placebo: +1 km/h, p = 0.38). There was also no significant effect of creatine supplementation on repetitive sprint power after 5, 10, and 20 metres, (creatine 20 m: −0.03 m/s; placebo 20 m: +0.01 m/s, p = 0.18), or in the strength of the upper and lower extremities.

Conclusions:Creatine supplementation is not effective in improving selected factors of tennis specific performance and should not be recommended to tennis players.
Stress fractures of the femoral shaft in athletes: a new treatment algorithm
Authors: Ivkovic A , Bojanic I , Pecina M
Published: May 2006

Background:Femoral shaft stress fractures in athletes are not common but pose a great diagnostic challenge to clinicians. Because of few clinical signs, diagnosis and treatment are often delayed. Furthermore, if not treated correctly, these fractures are well known for complications and difficulties.

Objective:To develop a well structured and reproducible treatment algorithm for athletes with femoral shaft stress fractures.

Methods:The proposed algorithm is carried out in four phases, each lasting three weeks, and the move to the next phase is based on the result of the tests carried out at the end of the previous phase. Over nine years, we treated seven top level athletes, aged 17–21. In all athletes, diagnosis was based on physical examination, plain radiographs, and bone scan.

Results:As a result of the treatment method, all the athletes were fully engaged in athletic activity 12–18 weeks after the beginning of treatment. After completion of the treatment, the athletes were followed up for 48–96 months. During the follow up, there was no recurrence of discomfort or pain, and all the athletes eventually returned to competition level.

Conclusion:These results and data available from the literature suggest that the algorithm is the optimal treatment protocol for femoral shaft stress fractures in athletes, avoiding the common complications and difficulties.
ON SATURATED DISTINGUISHED CHAINS OVER A LOCAL FIELD III: The Case of p-Extensions with Two Proper Higher Ramification Groups
Authors: OTA KAORI
Published: May 2006

This is a continuation of the papers [5, 6] on saturated distinguished chains (SDCs) over a local field K. We consider a totally ramified Galois extension L of K whose Galois group is a p-group and has exactly two proper higher ramification groups, where p is the characteristic of the residual field. Take a prime element π of L, and set πi = NL/Mi(π), where Mi are the corresponding fields to higher ramification groups such that K ⊂ M1 ⊂ M2 ⊂ L and NL/Mi denotes the norm map from L to Mi for each i. We consider a SDC for α = π1 + π1π2 + π1π2π over K, and the result is given as Main Theorem. There are thirteen cases according to sizes of extension degrees [L : M2], [M2 : M1] and [M1 : K].
A NON-QUASINILPOTENT OPERATOR WHICH COMMUTES WITH A QUASINILPOTENT SHIFT
Authors: HEDAYATIAN K.
Published: May 2006

We will use a result of Bade, Dales and Laursen to construct a quasinilpotent weighted shift and an operator commuting with it with spectrum more than one point.
KODAIRA DIMENSION OF SUBVARIETIES II
Authors: PETERNELL THOMAS
Published: May 2006

This paper continues the study of non-general type subvarieties begun in a joint paper with Schneider and Sommese [14]. We prove uniruledness of a projective manifold containing a submanifold not of general type whose normal bundle has positivity properties and study moreover the rational quotient. We also relate the fundamental groups and a prove a cohomological criterion for a manifold to be rationally connected (weak version of a conjecture of Mumford).
DEVELOPMENT OF HIGHLY STABLE HYDROGENATED AMORPHOUS SILICON FILMS FOR APPLICATION IN SOLAR CELLS
Authors: LEI Q. S. , WU Z. M. , XI J. P. , GENG X. H. , ZHAO Y. , SUN J.
Published: May 2006

Highly stable hydrogenated amorphous silicon (a- Si:H ) films were developed by very high frequency plasma enhanced chemical vapor deposition (VHF PECVD). Their electrical and structural properties were studied. The films were applied as i-layers for p-i-n solar cells. The stability of intrinsic films as well as solar cells was studied. Results suggest that a- Si:H films prepared at high hydrogen dilution ratio (R) and low plasma power (PW) have low hydrogen content (CH) and small microstructure factor (RH) and show high stability against light illumination. The device with i-layer prepared at PW=5 W and R=10 shows a high stability with degradation in fill factor and efficiency of 3.23% and 11.64%, respectively, over 1000 hours illumination. However, the device with i-layer prepared at higher plasma power (PW=25 W ) and lower hydrogen dilution ratio (R=5) was much less stable. The stability of the devices is directly related to the stability of the intrinsic materials.
STUDY OF MOLECULAR MOTIONS IN TWO LIQUID CRYSTAL FORMING COMPOUNDS EMPLOYING PLS
Authors: CHANDRAMANI SINGH K. , SHARMA M. , JAIN P. C.
Published: May 2006

Results of molecular motion studies carried out in two liquid crystal forming compounds n-p-cyano-p-hexyloxybiphenyl (M18) and n-p-ethoxybenzylidene-p-butylaniline (EBBA) using positron lifetime spectroscopy (PLS) are presented. Temperature dependent positron lifetime measurements have been performed in each compound during the heating cycle of samples prepared by either quenching or slow cooling from the respective liquid crystalline phase of the compounds. In both the compounds, behaviors of the quenched and slow cooled samples are found to be different. The material in the quenched sample, unlike the slow-cooled sample, exhibits strong temperature dependence before it undergoes a glass transition. In each case, the temperature dependence of o-Ps pick-off lifetime in the quenched sample shows broad peaks at various characteristic temperatures. These peaks have been attributed to various intra- and inter-molecular motions associated with these compounds. The characteristic frequencies of some of the modes observed in the present work agree well with the literature reported values obtained from FIR and Raman studies. The present study demonstrates the usefulness of PLS in the study of molecular motions.
INTERACTIONS FROM SELF-COORDINATION NUMBERS – A PHYSICAL RELATION WITHOUT FORMULA
Authors: HAUCK J. , MIKA K.
Published: May 2006

A large number of homogeneous particles A with different A–A interactions like carbon atoms in diamond, CO 3 ions in CaCO 3, S 6 molecules in rhombic sulphur, colloid or micelle particles are ordered in such a way that the bulk structure can be characterized by the self-coordination numbers Ti, i =1-3 of nearest, second and third neighbors. There are about 500 sets with increased Ti values (aristotypes) and about 500 sets with reduced Ti values, which are obtained from characteristic lattice complexes. The number k=1,2,3, etc. of the (T1 T2 T3) aristotype is added to the Wyckoff letters of standardized structures like 167-b9a9 or 148-a4 for the Ca ( CO 3) or ( S 6) structures with the centers of ( CO 3) or ( S 6) groups. Two or more particles A, B, etc. can belong to the same aristotype like Na and Cl atoms in NaCl or Li , Ag and Sb atoms in Li 2 AgSb . All possible structures of an aristotype are within certain limits of Ti values in a Ti, i = 1-3 coordinate system, the structure map. The location of A, B, etc. positions on structure maps can be related with repulsive or attractive interactions at high or low T2 values. The plate- or rod-like habit of single crystals can frequently be related to layered or rod-like packings (T1 T2 T3) of the constituents.
ON THE PROBLEM OF CONSTRAINTS IN NONEXTENSIVE FORMALISM: A QUANTUM MECHANICAL TREATMENT
Authors: BAĞCI G. B. , ARDA ALTUĞ , SEVER RAMAZAN
Published: May 2006

Relative entropy (divergence) of Bregman type recently proposed by T. D. Frank and Jan Naudts is considered and its quantum counterpart is used to calculate purity of the Werner state in nonextensive formalism. It has been observed that two different expressions arise due to two different forms of quantum divergences. It is then argued that the difference is due to the fact that the relative entropy of Bregman type is related to the first choice thermostatistics whereas one of Csiszàr type is related to the third-choice thermostatistics. The superiority of the third-choice thermostatistics to the first-choice thermostatistics has been deduced by noticing that the expression obtained by using the Bregman type leads to negative values for q ∈ (0, 1) and fidelity F smaller than 1 whereas the one obtained by using Csiszàr type is free from such anomalies. Moreover, it has been noted that these two measures show different qualitative behavior with respect to F. Contrary to the classical case, the violation of the positive definiteness of the relative entropy immediately results in a choice between the two constraints without any need of more abstract Shore–Johnson axioms. The possibility of writing a relative entropy of Bregman type compatible with the third choice has been investigated further. The answer turns out to be negative as far as the usual transformation from ordinary probabilities to the escort probabilities are considered.
MONTE–CARLO THERMODYNAMIC BETHE ANSATZ
Authors: GEPNER DORON
Published: May 2006

We introduce a Monte–Carlo simulation approach to thermodynamic Bethe ansatz (TBA). We exemplify the method on one-particle integrable models, which include a free boson and a free fermions systems along with the scaling Lee–Yang model (SLYM). It is confirmed that the central charges and energies are correct to a very good precision, typically 0.1% or so. The advantage of the method is that it allows the calculation of all the dimensions and even the particular partition function.
QUALITATIVE ANALYSIS OF THE BELOUSOV–ZHABOTINSKII REACTION IN A BATCH REACTOR
Authors: GRAGNANI ALESSANDRA
Published: May 2006

This paper shows how the appearance and disappearance of high-frequency oscillations in a batch reactor can be predicted by means of a minimal model describing the fast dynamics of the reaction. The analysis is based on the bifurcations of the model with respect to the slowly varying species, namely product and reactants. The method of analysis can, in principle, be applied to any slow-fast system provided the evolution of the slow variables is monotonic.
PROPAGATING INTERFACES IN A TWO-LAYER BISTABLE NEURAL NETWORK
Authors: KAZANTSEV V. B. , NEKORKIN V. I. , MORFU S. , BILBAULT J. M. , MARQUIÉ P.
Published: May 2006

The dynamics of propagating interfaces in a bistable neural network is investigated. We consider the network composed of two coupled 1D lattices and assume that they interact in a local spatial point (pin contact). The network unit is modeled by the FitzHugh–Nagumo-like system in a bistable oscillator mode. The interfaces describe the transition of the network units from the rest (unexcited) state to the excited state where each unit exhibits periodic sequences of excitation pulses or action potentials. We show how the localized inter-layer interaction provides an "excitatory" or "inhibitory" action to the oscillatory activity. In particular, we describe the interface propagation failure and the initiation of spreading activity due to the pin contact. We provide analytical results, computer simulations and physical experiments with two-layer electronic arrays of bistable cells.