bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the content of two physiotherapy approaches for stroke
Authors: van Vliet Paulette M , Lincoln Nadina B , Robinson Elisabeth
Published: May 2003

Objective: To identify similarities and differences between a Bobath-based (BB) and a movement science-based (MSB) approach.

Design: Direct observation by a trained observer was used to record behaviours during treatments.

Setting: An acute stroke ward.

Subjects: Twenty-two stroke patients.

Interventions: Behaviours were recorded during 12 treatment sessions by three therapists, for each treatment approach. Physical and communication behaviours were recorded in pre-defined categories. The equipment used was recorded and a semi-structured interview conducted with the therapist after treatment to identify follow-up actions by the therapist.

Main outcome measures: Frequency of occurrence of each category was compared between the approaches.

Results: Treatment in the BB group contained more social conversation (p = 0.004), and more use of physiotherapy equipment (p = 0.02) and a physiotherapy assistant (p = 0.01). In the MSB group there was more detailed feedback given to the patient (p = 0.002) more use of everyday objects in training (p = 0.001), therapists more frequently listed specific components as the patient's main problems (p = 0.003) and relatives were involved more in positioning to stretch muscles (p = 0.03). Training walking was given more emphasis in the BB group and training of sit-to-stand in the MSB group.

Conclusions: The study indicates that there are differences in content between the Bobath-based and movement science-based approaches to treatment.
Social context as a focus for rehabilitation
Authors: Wade Derick T
Published: May 2003

In some illnesses activity limitation is determined as much (or even more) by cultural factors as it is by the specific disease pathology or impairments experienced. There is now some evidence that cultural attitudes and expectations can be changed to reduce the burden of disability. This empirical evidence supports the WHO ICIDH-2 model of illness and the importance of contexts as intervening variables in the development and maintenance of disability.
Visual gait analysis: the development of a clinical assessment and scale
Authors: Lord S E , Halligan P W , Wade D T
Published: May 2003

Objectives: To develop and evaluate a four-point scale visual gait assessment form, the Rivermead Visual Gait Assessment (RVGA), for clinical use with patients with neurological deficits.

Design: Preliminary clinical testing of reliability, validity and sensitivity to change.

Setting: Patients were recruited from the Rivermead Rehabilitation Centre (RRC), a centre specializing in rehabilitation for patients with neurological disease.

Patients: Ten inpatients were assessed by up to seven physiotherapists for the main reliability study, and eight different patients were also assessed by two raters one week apart. Twenty outpatients with multiple sclerosis (MS) who were receiving physiotherapy to improve their mobility and 27 inpatients with various neurological conditions were also assessed and the data used to examine validity, reliability and sensitivity to change.

Outcome: The other comparative measures used were walking time, stride length, step length asymmetry, balance and the Rivermead Mobility Index.

Results: Inter-rater reliability between multiple raters was reasonable both for the global scores from the gait assessment form (Kendall's coefficient of concordance; p <0.001), and for individual items (complete agreement occurred on 63.8% of all observations). There was a significant correlation between the global RVGA score and the various criterion measures ( r = 0.53–0.79; p <0.001) and between change in the RVGA score and change in walking time in patients who received treatment ( r = 0.68; p <0.01).

Conclusions: The RVGA provides the clinician with a clinical assessment of the quality of gait which may be used in conjunction with other measures to inform and monitor the value of physiotherapy treatment for people with MS and stroke, and possibly other neurological deficits.
Intensive dynamic training for females with chronic neck/shoulder pain. A randomized controlled trial
Authors: Randløv Annette , Østergaard Mikkel , Manniche Claus , Kryger Peter , Jordan Alan , Heegaardand Susanne , Holm Bente
Published: May 2003

Objectives: To compare the clinical effectiveness of an intensive three-month training programme with a less intensive programme on females suffering from chronic neck/shoulder pain.

Study design: A prospective observer-blinded clinical trial including 12-month pretreatment follow-up.

Setting: Patients were referred to the Departments of Rheumatology and Physical Medicine at Hvidovre Hospital by their general practitioners. Training was undertaken at a satellite clinic for physiotherapy of Hvidovre Hospital.

Subjects: Female patients aged 18–65 years suffering from chronic neck/shoulder pain for a minimum of six months.

Intervention: Patients were examined by a physician in order to exclude serious diseases. They were then randomized to either an intensive neck/shoulder training programme or a programme of lesser intensity but of similar duration.

Main outcome measures: Scales measuring pain and activities of daily living (ADL) were used, and strength and endurance measurements of the cervical and shoulder muscles were carried out at baseline and completion of the study. Follow-up measurements were carried out by postal questionnaire at 6 and 12 months after inclusion, and included pain, ADL and treatment satisfaction measurements.

Results: Seventy-seven patients were included in the trial, of whom 27 (69%) completed the intensive programme and 25 (61%) the lighter programme. Forty-one (>80%) completed the follow-up questionnaires. The patients in the two groups did not differ with regard to age, pain, ADL scores and physical measurements prior to training. Patients in both groups that completed the trial demonstrated statistically significant improvements in nearly all of the outcome measurements at completion. ADL scores maintained statistical significance at 12 months in both groups, but pain scores were only significantly improved in the intensive group at 12 months follow-up. There was no statistically significant difference between groups regarding pain or ADL, but overall 50% of all patients showed improvement.

Conclusions: The type of low-tech dynamic training used in either of our two programmes resulted in both subjective and objective improvements in patients suffering from chronic neck/shoulder pain, but there were no statistically significant differences in outcome between the two approaches. The subjective improvements were maintained throughout the follow-up period.
Ten-metre walk, with or without a turn?
Authors: van Herk Irene EH , Arendzen J Hans , Rispens Piet
Published: May 2003

Objective: To compare results obtained using different procedures to measure 10-metre walking time.

Design: Walking was timed over a straight 10 m, and over 5 m with return. Further, the time taken to turn was measured directly.

Setting: Rehabilitation department of a university hospital.

Subjects: Patients who had walking disability after stroke.

Results: In the group of 43 patients, the time taken to walk 5 m and return was 3.3 (SD 5.0) s longer than the time to walk 10 m straight, but there was a large variation with some patients walking faster. The measured time to turn in a second group of 27 patients was 3.2 (SD 1.6) s. The times taken to walk 10 m straight and 5 m and return, and the time taken to turn were all highly correlated ( r = 0.69 or more).

Conclusions: Timing walking over 5 m with a return is an acceptable alternative to the 10 m straight walk, but the actual time taken varies. On average, the walk with a turn is 3.2 s longer but in individual patients the difference may be much more or less. Sometimes the walk with a turn is even faster than that without.
The Northwick Park Dependency Score (NPDS): a measure of nursing dependency in rehabilitation
Authors: Turner-Stokes Lynne , Tonge Pauline , Nyein Kyaw , Hunter Maggie , Nielsona Stuart , Robinson Ian
Published: May 2003

Background: Disability scores, such as the Functional Independence Measure (FIM) and Barthel Index, have been shown to correlate with care needs but cannot be used to assess them directly, as they do not indicate the number of people required to help with a task, nor the time taken. The Northwick Park Dependency Score (NPDS) is an ordinal scale that can be used to assess impact on nursing time. It takes 3–5 minutes to complete. Together with a short set of additional questions, it may be used directly to assess care needs in the community and to facilitate discharge planning.

Aims: To develop and evaluate the NPDS for use in a rehabilitation setting.

Methods: (1) Development: Following a survey of existing instruments, tasks were selected on the basis of their impact on nursing time and divided into Basic Care Needs (BCN) and Special Nursing Needs (SNN). Cut-off points were devised to reflect the number of helpers needed and time taken. Following evaluation of the NPDS version 5, minor changes were made to produce version 6 which was re-evaluated on a smaller scale. (2) Evaluation: Inter-rater and intra-rater reliability were tested in a cohort of 23 inpatients using five senior nurses. Analysis included assessment of degree of association, significant differences, absolute agreement, and agreement ±1 level. Although there is no gold standard, the BCN section should correlate inversely with independently assessed Barthel scores. Re-evaluation of version 6 was undertaken using the same method of analysis in a cohort of 21 patients using three senior nurses.

Results: On initial evaluation inter-rater reliability testing showed an excellent level of association in total composite score between each pair of nurses (rho = 0.73–0.92, p <0.01) and agreement ±1 level for individual items ranged from 73 to 100%. Significant disagreements were in six items. On reevaluation following minor modification, high levels of association were still seen for total BCN, SNN and composite scores both between and within raters, with very satisfactory levels of agreement for individual items. The BCN section of the NPDS showed good inverse correlation with Barthel scores (rho = 0.91, p <0.01).
Reliability of stroke patients' reports on rehabilitation services received
Authors: Luther A , Lincoln N B , Grant F
Published: May 2003

Objective: To compare stroke patients' reports with service providers' reports on the rehabilitation services patients receive.

Setting: Community, predominantly urban.

Subjects: Ninety-three stroke patients who had not been admitted to hospital.

Method: Between August 1994 and August 1996, 54 general practitioner practices in Nottingham (population 344 200) were requested to notify the Nottingham Community Stroke Project of all cases of stroke. Patients were visited one month after stroke and asked to report on whether they had received any hospital, social, community or voluntary services. Some departments were contacted and asked if the patients were known to them and whether they had been seen.

Results: Patients reported having little contact with hospital or social services. Comparison of patients' reports with that of the appropriate service department showed poor agreement for community care assistants (kappa = 0.18), fair agreement for social workers (kappa = 0.59), speech therapy (kappa = 0.48), hospital outpatient appointments (kappa = 0.55) and admissions to hospital (kappa = 0.48) and good agreement for social services occupational therapists (kappa = 0.64).

Conclusion: Stroke patients' and service providers' reports on rehabilitation services may not always agree. Care should be taken when interpreting information on service provision.
Neck semispinalis capitis muscle size in sitting and prone positions measured by real-time ultrasonography
Authors: Rezasoltani Asghar , Kallinen Mauri , Mälkiä Esko , Vihko Veikko
Published: May 2003

Objective: To examine the reliability of measurements of semispinalis capitis muscle (SECM) cross-sectional area (CSA) in prone and sitting positions, and to compare the muscle size in these two positions.

Design: Semispinalis capitis CSA was measured twice a day on two successive days with a real-time ultrasound apparatus.

Subjects: Eighteen males (aged 19–34 years) and 28 females (aged 19–34 years) were studied for the reliability test. Seven males and 12 females were randomly selected to compare SECM size in sitting and prone positions.

Results: The intraclass correlation coefficient (ICC) for repeatability measurements was r = 0.98 for the two positions. The correlation of the CSA in sitting and in prone positions was r = 0.93 ( p <0.01). There were no significant differences between CSA, linear dimensions and shape ratio of SECM in the two positions.

Conclusions: In this study SECM ultrasonography appeared to be an accurate method in both positions, and position as such had no significant effects on the SECM cross-sectional size. Such accuracy allows neck muscle evaluation in clinical diagnosis and in follow-up studies during neck rehabilitation programmes.
Clinical applications of the Adelaide Activities Profile
Authors: Bond Malcolm J , Clark Michael S
Published: May 2003

Objective: The Adelaide Activities Profile (AAP) was developed from the Frenchay Activities Index, and has been shown to be a valid measure of the lifestyle activities of elderly people. The goals of the current study were to illustrate the value of applying the AAP in the clinical setting, and to demonstrate the relationship of the AAP to the use of formal services.

Design: Data were collected as part of the Australian Longitudinal Study of Ageing (ALSA). A community sample, stratified by age and sex, was chosen to be representative of the elderly population of Adelaide, South Australia.

Participants: A sample of 1799 community-dwelling people aged 70 years and over.

Measures: Lifestyle activities were assessed with the AAP, which provides measures of activity on four scales: domestic chores, household maintenance, service to others, and social activities. Participants were defined as users of formal services if they were active clients of any of the Domiciliary Care and Rehabilitation Services, Meals-on-Wheels, or the Royal District Nursing Society.

Results: Age and sex norms for the AAP were provided, and the clinical value of using these norms was illustrated by two contrasting case studies. Users of formal services had lower activity levels than nonusers for all AAP scales, particularly household maintenance and domestic chores.

Conclusions: The AAP is a valuable addition to the standard battery of instruments used in the assessment of elderly people, and has clinical application as both a health outcome measure and an indicator of the need for intervention.
A patient-centred study of the consequences of stroke
Authors: Pound Pandora , Gompertz Patrick , Ebrahim Shah
Published: May 2003

Objective: To explore subjective accounts of the consequences of stroke.

Design: Qualitative methods using depth interviews.

Participants and setting: Forty people sampled ten months post stroke from a hospital stroke register which was established in two adjacent health districts in North Thames Regional Health Authority.

Results: Interviewees reported a number of ways in which the stroke had affected their daily lives, including difficulty with leaving the house, doing the housework, pursuing former leisure activities, inability to walk in the way they wanted, problems with communicating, washing, bathing and dressing, and with confusion and deteriorating memory. In all these areas people described the loss of social contact that accompanied these changes, and the loss of valued roles which had been embedded in the everyday functions they had previously performed. In general, people over the age of 70 were more seriously affected.

Conclusion: The type of changes which people reported would not easily have been captured using standardized outcome measures, pointing to the value of qualitative methods in providing subjective accounts. In terms of clinical practice, there is a need to reduce people's isolation after stroke by providing home visits after discharge, particularly to those living alone, and also by reducing disability through rehabilitation and by tackling the environmental obstacles which can imprison people in their homes. The findings suggest that many people with stroke would benefit from being able to talk about the changes which have occurred. Imaginative proposals are needed to develop ways to help replace the loss of activities, social contacts and social roles, particularly among older people with stroke.
The development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA)
Authors: Cardol Mieke , de Haan Rob J , van den Bos Geertrudis A M , de Jong Bareld A , de Groot Imelda J M
Published: May 2003

Objective: To report on the feasibility and psychometric properties in terms of homogeneity and construct validity of a newly developed handicap questionnaire focusing on person-perceived handicaps: the Impact on Participation and Autonomy (IPA).

Design: Cross-sectional.

Setting, subjects and outcome measure: One hundred consecutive individuals from the outpatient clinic of the department of rehabilitation of an academic hospital administered the new questionnaire IPA.

Results: The results show good homogeneity and construct validity of the IPA. Factor analysis showed that the scale consists of four factors, explaining 68% of the total variance: social relationships, autonomy in self-care, mobility and leisure, and family role. Homogeneity of the four subscales was considered good, Cronbach's α ranged from 0.84 (family role) to 0.87 (social relationships). Feasibility in terms of the number of missing values and administration time needed was satisfactory.

Conclusion: The first results suggest that the IPA promises to be a useful handicap questionnaire. Further research is needed to establish test–retest reliability, convergent validity and responsiveness to change.
Persisting symptoms and carers' views of outcome after subarachnoid haemorrhage
Authors: Hellawell Deborah J , Taylor Robert , Pentland Brian
Published: May 2003

Objective: To report the outcome of aneurysmal subarachnoid haemorrhage (SAH) in terms of subjective symptoms and carers' perspective over a period of two years.

Design: Forty-four consecutive patients admitted to a Regional Neurosurgical Unit and who survived aneurysmal SAH were invited for outpatient assessment at 6, 12 and 24 months post haemorrhage.

Measures: The Glasgow Outcome Scale (GOS) was used to measure global outcome; the Hospital Anxiety and Depression Scale (HAD) to screen for affective symptoms; the Head Injury Symptom Checklist (HISC) to detect symptoms commonly reported after head trauma; and information was collected from a close friend or relative of the patient using the Relative's Questionnaire (RQ).

Results: GOS outcome was significantly related to the severity of the original haemorrhage, as classified by the World Federation of Neurological Surgeons (WFNS) Grading Scale, on admission to hospital. However, even in cases where patients had made a good recovery according to the GOS, a variety of problems were frequently reported by patients and relatives, and many of these persisted for the duration of the study. The three most common and persistent symptoms were tiredness (63%, 59% and 59% at 6, 12 and 24 months respectively), memory disturbance (50%, 52% and 56%) and passivity (61%, 47% and 46%). In contrast, the prevalence of disturbed mood, as reported using the HAD, was similar to that of the general population.

Conclusions: Studies of outcome following SAH should address these subtle disturbances, and information pertaining to potential long-term problems should be provided to patients and relevant others.
Predictive model of functional independence in stroke patients admitted to a rehabilitation programme
Authors: Sánchez-Blanco I , Ochoa-Sangrador C , López-Munaín L , Izquierdo-Sánchez M , Fermoso-García J
Published: May 2003

Objective: To develop a prognostic model to estimate the probability of patients being independent in ambulation and in activities of daily living (ADL) after six months of stroke.

Design: Cohort analytical study. Setting: Rehabilitation departments of two district general hospitals. Subjects: Ninety-two consecutive stroke patients admitted to a rehabilitation programme. Main outcome measures: Independent ambulation was defined as a Functional Ambulation Classification (FAC) ≥4, and the independence in ADL as a Barthel Index (BI) ≥85. All patients were assessed on admission to rehabilitation, and in the first, second, third, fourth and six months after stroke.

Results: Prognostic factors were identified by means of a multivariate survival analysis using Cox regression. Three variables were predictors for a FAC ≥4: (1) The patients in the motor (M), motor-sensitive (MS) and motor-sensitive with hemianopsia (MSH) groups (relative risk (RR) 5.43 of M with respect to MSH, and 2.41 of MS to MSH). (2) A Motricity Index >25 (RR 3.19). (3) An age <70 years old (RR 1.99). For a BI ≥85 three predictors were selected: (1) The classification M–MS–MSH (RR 6.02 M to MSH, and 1.52 MS to MSH). (2) An initial BI >20 (RR 3.45); the highest contribution in the achievement of an initial BI >20 was bowel and bladder continence. (3) The antecedent of previous independence (RR 2.68). The predictive models, constructed by means of multiple logistic regression correctly classified 77% and 79% of the patients who obtained FAC ≥4 and a BI ≥85 respectively.

Conclusions: The syndromic classification M, MS and MSH, together with other routinely available data, such as the Motricity Index, BI, the age and the previous functionality, can be used to obtain a patient prognosis level with regard to ambulation and ADL independence.
Unpacking the black box of therapy – a pilot study to describe occupational therapy and physiotherapy interventions for people with stroke
Authors: Ballinger C , Ashburn A , Low J , Roderick P
Published: May 2003

Objective: To describe the components used in the practice of occupational therapy and physiotherapy for people with stroke and to examine variability between services.

Design: A time-sampling strategy in which therapists recorded their face-to-face interventions with stroke patients during 12 weeks over a total of 17 months.

Settings and subjects: Six occupational therapists and seven physiotherapists from four services (three day hospitals and one domiciliary stroke rehabilitation service) recorded interventions with 89 stroke patients recruited to a larger randomized controlled trial.

Main outcome measures: Frequencies of use of interventions, together with other details about delivery of therapy, were recorded using a data collection booklet and coding system designed by the participating therapists.

Results: The median treatment time for a session was 45 minutes. The most frequently recorded components of physiotherapy intervention were ‘walking’, ‘standing balance’ and ‘upper limb movement pattern’, and of occupational therapy ‘physical function’, ‘social and leisure activities' and ‘other’. There was variability between the services in terms of median treatment time, use of intervention codes, frequency of treatment sessions, amount of time spent working with assistance and amount of group work.

Conclusions: The findings support the view that occupational therapy and physiotherapy with people with stroke are not homogeneous activities, and vary between therapists and services. Recommendations include further development of the tool, and use of other methodologies to explore the process and nature of stroke rehabilitation.
The Northwick Park Care Needs Assessment (NPCNA): a directly costable outcome measure in rehabilitation
Authors: Turner-Stokes Lynne , Nyein Kyaw
Published: May 2003

Background: The Northwick Park Dependency Score (NPDS) has been shown to be valid, reliable and practical to use. It was designed to be used together with a short set of additional questions to inform care needs in the community and facilitate discharge planning.

Aim: To develop a conversion formula to translate information derived from the NPDS into a generic assessment of care needs in the community – the Northwick Park Care Needs Assessment (NPCNA) – and to evaluate its potential as a directly costable measure of outcome in rehabilitation. Setting: An inpatient neurorehabilitation unit for young patients with brain injury.

Method: Part 1, Development: For each task in the NPDS, a set of assumptions was developed to reflect the number of people, the time taken and the frequency of help required. Tasks were collected into a daily timetable and minimum and maximum allocations made for each time slot. From this the weekly care hours can be calculated. A range of care package categories and their approximate costs were identified, and a simple set of criteria developed with experienced community care planners to determine the circumstances under which each category is applied. Part 2, Evaluation: The assumptions and derived care package were evaluated in a prospective comparative study in 35 cases. Timetables of care needs were drawn up using (a) the NPDS-derived Care Needs Assessment (NPCNA) and (b) detailed structured interview with an independent assessor. The weekly hours of care, care package and approximate cost were then determined for each set of timetables, by a third independent assessor, applying the formula described according to strict rules.

Results: Assessment of the total weekly hours of care showed an excellent correlation between the two methods (rho 0.90, p<0.01) with no significant differences. There was also a high correlation in the category of care package allotted and thus the weekly cost of care (rho 0.73, p<0.01).

Conclusion: The NPCNA provides a simple measure of care needs in total care hours, as well as a timetable of care from which a care package can be directly planned and costed. It has potential use, therefore, as an instrument that can demonstrate directly the effectiveness of rehabilitation in reducing the cost of continuing care in the community.
Randomized controlled study of ultrasound therapy in the management of acute lateral ligament sprains of the ankle joint
Authors: Nyanzi C S , Langridge J , Heyworth J RC , Mani R
Published: May 2003

Objective: To determine the efficacy of a fixed dose of ultrasound energy to treat acute lateral ligament sprains of the ankle joint.

Study design: Double-blind randomised controlled trial.

Setting: Accident and Emergency department of University Teaching Hospital.

Subjects: Patients presenting at Accident and Emergency with ankle injuries.

Intervention: Ultrasound or placebo, and Tubigrip.

Outcome measures: Pain measured with visual analogue scales, swelling using a tape measure, range of movement using a fluid-filled goniometer, and weight bearing using two scales simultaneously.

Results: Patients in both groups improved symptomatically. There were no statistically significant differences between groups in any outcome measure. Within groups, statistically significant differences were detected in pain perceived, and range of movement (dorsiflexion).

Conclusion: At the dose and duration used, ultrasound therapy is no better than placebo in the management of lateral ligament injuries.
Luteinizing Hormone Receptor Knockout (LuRKO) Mice and Transgenic Human Chorionic Gonadotropin (hCG)-Overexpressing Mice (hCG αβ+) Have Bone Phenotypes
Authors: Yarram S. J. , Perry M. J. , Christopher T. J. , Westby K. , Brown N. L. , Lamminen T. , Rulli S. B. , Zhang F.-P. , Huhtaniemi I. , Sandy J. R. , Mansell J. P.
Published: May 2003

Considerable attention has been paid to the role of sex steroids during periods of major skeletal turnover, but the interaction of the gonadotropic hormones, which include LH, FSH, and human chorionic gonadotropin (hCG), within bone tissue have been overlooked. The question is pertinent due to the recent detection of extragonadal expression of gonadotropin receptors. Western blotting, immunolocalization, and RT-PCR supported the presence of osteoblast LH receptors. However, osteoblast cells failed to bind [125I]hCG and treatment with hCG failed to generate either cAMP or phosphorylated ERK 1/2. Bone mineral density (BMD) and bone histomorphometry were examined in the following models: 1) LH receptor null mutant (LuRKO) mice; 2) transgenic mice overexpressing hCG (hCG αβ+); and 3) ovariectomized (OVX) hCG αβ+ model. Male LuRKO mice showed a decrease in BMD after 5 months, apparently secondary to suppressed gonadal steroid production. Similarly, 9- to 10-wk-old female LuRKO mice exhibited decreases in histomorphometric parameters tested. The data indicate that loss of LH signaling results in a reduction in bone formation or an increase in bone resorption. By contrast, there were significant increases in BMD and histomorphometric indices for female, but not male, hCG αβ+ mice, indicating that chronic exposure to hCG results in bone formation or a decrease in bone resorption. However, OVX of the hCG αβ+ mice resulted in a significant reduction in BMD comparable to OVX WT controls. Although gonadotropin levels are tightly linked to sex steroid titers, it appears that their effects on the skeleton are indirect.
Impact of rapid manufacturing on design for manufacture for injection moulding
Authors: Mansour S , Hague R
Published: May 2003

Rapid manufacturing (RM) employs similar technologies and processes to rapid prototyping (RP), hence resulting in a tool-less manufacturing process. This is achieved by assuming that RP machines have been converted to proper manufacturing machines. The current approaches to the design process, product development cycle and manufacturing considerations at the design stage within a concurrent engineering environment are closely examined. An attempt is then made to investigate the effect of the RM processes on the design process and product development cycle. This is further expanded to consider the impact of RM on rules and guidelines that have been established for design for manufacturing (DFM). This paper is limited to a comparison of RM with regards to injection moulding as RM is most likely to compete with this process in the first instance. This is the first research work to investigate the impact of RM on the design process.
Relative effectiveness of mechanisms for simulating uncertainty in quantitative systems
Authors: Pons D J , Raine J K
Published: May 2003

Simulation of engineering systems may involve high uncertainty, especially at the early stage of design. It is often necessary to explore the performance of systems under the influence of random events or when probabilistic rather than deterministic input data are known. This paper introduces a probabilistic computational tool that exists within a general methodology called design for system integrity (DSI). DSI supports engineers in design and manufacture by providing an assessment mechanism to analyse system design at all stages including early conceptual design. DSI is compared with the algebra of random variables, the Monte Carlo method and fuzzy theory.
A pragmatic approach to interactive assembly sequence evaluation
Authors: Barnes C J , Jared G E M , Swift K G
Published: May 2003

An assembly-oriented design system has been developed which includes several analysis tools to improve product assemblability during product development. One of these tools supports the parallel development of the product design and the assembly sequence, thus exploiting the benefits of concurrent consideration of product and process. However, this approach requires some method for evaluating the sequence against requirements. Previous work on assembly sequence evaluation has concentrated on identifying the best from a set of ranked alternatives. When a single sequence is constructed, as with this tool, another method is needed.

This paper reports the development of this novel methodology for evaluating individual assembly sequences. A review of the relevant literature has found several measures for identifying good assembly sequences from a ranked list and the fundamental sequence attributes extrapolated and aggregated. This leads to the proposal of four new indices: insertion index, stability index, difficulty index and complexity index. A large number of assembly sequences have been analysed to define limiting values for the indices such that they can quantify the potential of an incomplete sequence resulting in a satisfactory solution. The application of these indices in concurrent design and assembly planning is illustrated through an industrial case study.
Alternative design specifications of prismatic parts for manufactur ability
Authors: Lin J , Thimm G , Britton G A
Published: May 2003

It is argued that design dimension specifications contribute to the manufacturability of a part and should therefore be subjected to optimization, targeting minimal tolerance stacks in a process plan. The optimality of a process plan, and therefore of a design, depends on the manufacuring environment. As this may change or be unknown at the deisgn stage, this paper proposes a mathematical approach to redimension a design without imparing the functionality of the part. The calculation of tolerances for substitute dimensions is emphasized, depending on the role of a dimension in the design.
Quality systems implementation in Welsh small- to medium-sized enterprises: A global comparison and a model for change
Authors: Thomas A J , Webb D
Published: May 2003

This paper initially investigates the rate of development and subsequent implementation of structured quality management systems (e.g. ISO 9000, EFQM, etc.) within small- to medium-sized enterprises (SMEs) in South Wales. While the effective implementation of quality systems in SMEs is seen as a major priority to the supply chain and quality professionals alike [1], the implementation of formal quality systems within SMEs in South Wales is still very low. The common reasons of high cost, high effort and limited effectiveness are given by SMEs for the poor implementation rate, but a wider set of arguments that go beyond these issues are presented. This naturally raises the question as to whether it is at all possible to implement such formal systems within SMEs, or whether there is a need to develop an effective model specifically for small-to-medium manufacturing enterprises. The findings from a survey of some 500 manufacturing-based SMEs in South Wales are used alongside comparative studies conducted by academics in the United States, Sweden, Australia and New Zealand into SME activities in order to provide a broader explanation for the poor implementation level of quality management systems. The paper then goes on to developing a conceptual framework for the development of a specific SME quality model.
Climate Change — A Natural Hazard
Authors: Kininmonth William
Published: May 2003

The impacts of weather and climate extremes (floods, storms, drought, etc) have historically set back development and will continue to do so into the future, especially in developing countries. It is essential to understand how future climate change will be manifest as weather and climate extremes in order to implement policies of sustainable development. The purpose of this article is to demonstrate that natural processes have caused the climate to change and it is unlikely that human influences will dominate the natural processes. Any suggestion that implementation of the Kyoto Protocol will avoid future infrastructure damage, environmental degradation and loss of life from weather and climate extremes is a grand delusion.
“Global Warming”: Myth or Reality?
Authors: Leroux Marcel
Published: May 2003

The “Global Warming scenario” is a hypothesis derived from theoretical models, asserted but not proven. There are numerous inconsistencies between predictions and actual observed climatic facts. The “global” thermal curve has no real significance in climatic terms. Climatic change is not global, but regional: for example, in the North Atlantic aerological unit, the Western side is cooling while that of the Northeast is warming. The 1970s exhibit a fundamental climatic switch which is not “seen” by the models, but is associated with a gradual increase of violent perturbations and irregularity of weather, linked to a change in the general circulation mode (rapid mode).
Acoustics of Apulian-Romanesque Churches: Correlations between Architectural and Acoustic Parameters
Authors: Cirillo Ettore , Martellotta Francesco
Published: May 2003

This paper concludes the analysis of the results of an acoustic survey carried out on nine Romanesque churches in Apulia (Southern Italy), described in detail in a previous paper. The study was performed taking into account both room-average values and individual position values of monaural and binaural acoustic parameters, measured according to ISO 3382. First the effect of architectural parameters on reverberation time was investigated, showing that volume and materials play an important role. Then room-average values of the other acoustic parameters were investigated, showing that some are mostly correlated with reverberation time and others with total acoustic absorption. Analysis of individual location values showed that monaural parameters can be expressed as functions of the source-receiver distance, and one or two of the following parameters: room volume, total absorbing area, mean absorption coefficient, total length and reverberation time. Furthermore, it was demonstrated that individual position values of acoustic parameters describing clarity, are significantly correlated to each other.
Foundation literacy acquisition in European orthographies
Authors: Seymour Philip H. K. , Aro Mikko , Erskine Jane M. ,   collaboration with COST Action A8 network
Published: May 2003

Several previous studies have suggested that basic decoding skills may develop less effectively in English than in some other European orthographies. The origins of this effect in the early (foundation) phase of reading acquisition are investigated through assessments of letter knowledge, familiar word reading, and simple nonword reading in English and 12 other orthographies. The results confirm that children from a majority of European countries become accurate and fluent in foundation level reading before the end of the first school year. There are some exceptions, notably in French, Portuguese, Danish, and, particularly, in English. The effects appear not to be attributable to differences in age of starting or letter knowledge. It is argued that fundamental linguistic differences in syllabic complexity and orthographic depth are responsible. Syllabic complexity selectively affects decoding, whereas orthographic depth affects both word reading and nonword reading. The rate of development in English is more than twice as slow as in the shallow orthographies. It is hypothesized that the deeper orthographies induce the implementation of a dual (logographic + alphabetic) foundation which takes more than twice as long to establish as the single foundation required for the learning of a shallow orthography.
Absence of lymphangiogenesis and intratumoural lymph vessels in human metastatic breast cancer
Authors: Williams Cory SM , Leek Russell D , Robson Alistair M , Banerji Suneale , Prevo Remko , Harris Adrian L , Jackson David G
Published: May 2003

Early metastasis to lymph nodes is a frequent complication in human breast cancer. However, the extent to which this depends on lymphangiogenesis or on invasion of existing lymph vessels remains controversial. Although proliferating intratumoural lymphatics that promote nodal metastasis have been demonstrated in experimental breast tumours overexpressing VEGF‐C, it has yet to be determined whether the same phenomena occur in spontaneous human breast cancers. To address this important issue, the present study investigated the lymphatics in primary human breast carcinoma (75 cases of invasive ductal and lobular breast cancer) by quantitative immunohistochemical staining for the lymphatic endothelial hyaluronan receptor LYVE‐1, the blood vascular marker CD34, and the nuclear proliferation marker pKi67. None of the breast carcinomas was found to contain dividing lymph vessels, even in areas of active haemangiogenesis. Furthermore, the majority of non‐dividing lymph vessels were confined to the tumour periphery where their incidence was low and unrelated to tumour size, grade or nodal status; rather, their density was inversely correlated with tumour aggressiveness as assessed by macrophage density (p = 0.009), and blood microvessel density (p = 0.05, Spearman Rank), as well as with distance from the tumour edge. Finally, a proportion of the peritumoural lymphatics contained tumour emboli associated with hyaluronan, indicating a possible role for LYVE‐1/hyaluronan interactions in lymphatic invasion or metastasis. These results suggest that naturally occurring breast carcinomas invade and destroy lymph vessels rather than promoting their proliferation; that breast tumour lymphangiogenesis may not always occur at physiological VEGF‐C levels; and that nodal metastasis can proceed via pre‐existing lymphatics. Copyright © 2003 John Wiley & Sons, Ltd.
Resection versus Palliation: Treatment of Stage III and IVA Carcinomas of the Pancreas Employing Intraoperative Radiation
Authors: Okamoto Atsutake , Tsuruta Koji , Karasawa Katsuyuki , Miyanari Nobutomo , Matsumoto Gaku , Kamisawa Terumi , Egawa Naoto
Published: May 2003

Abstract

Whether advanced pancreatic carcinomas should be surgically removed has been a basic issue because performing an extended resection is futile if it has only a minimum impact on survival. The purpose of this study was to compare the results of pancreatic resection with those of a bypass operation for patients with stage III or IVA pancreatic carcinomas while applying intraoperative radiation therapy (IORT). The therapeutic outcomes of 132 patients who had received IORT for stage III or IVA carcinoma were analyzed retrospectively. The patients were divided into two groups: Group 1 included 68 patients with locally unresectable tumors who underwent a bypass operation; group 2 included 64 patients with resectable tumors who underwent pancreatic resection. Postoperative external beam radiation therapy (EBRT) was also delivered to 90 patients. Multivariate analysis indicated that strong independent predictors of increased survival were EBRT for group 1 (p < 0.0001) and R0 resection for group 2 (p = 0.017). Twenty patients who had been subjected to R0 resection showed the best survival, with a 3‐year survival rate of 45%. The survival of group 1 patients receiving EBRT (n = 47) nearly equaled that of group 2 patients undergoing R1 or R2 resection (n = 44) (p = 0.72); but group 1 patients with tumors ≤ 6 cm (n = 31) had a better survival rate than group 2 patients with tumors > 3 cm (n = 28) (p = 0.03). We concluded that postoperative EBRT is essential for improving the survival outcome, even after administering IORT. Patients with stage III lesions undergoing an R0 resection and receiving IORT demonstrated an excellent 3‐year survival. A bypass operation plus IORT in combination with EBRT is preferred over IORT used as an adjuvant to R1 or R2 resection.
Stripping Operation with Sclerotherapy for Primary Varicose Veins Due to Greater Saphenous Vein Reflux: Three‐year Results
Authors: Miyazaki Keiko , Nishibe Toshiya , Sata Fumihiro , Imai Takahiro , Kudo Fabio A. , Flores Jorge , Miyazaki Yasumasa J. , Yasuda Keishu
Published: May 2003

Abstract

The purpose of this study was to compare the recurrence‐free rates of stripping with varicectomy and stripping with sclerotherapy for the treatment of primary varicose veins due to greater saphenous vein insufficiency. This is a multicenter retrospective analysis of 186 patients and 220 limbs treated for primary varicose veins due to greater saphenous vein reflux from January 1996 to December 1997. The difference between the two groups was evaluated by the Χ2 test or t‐test. The recurrence‐free rates were estimated by the Kaplan‐Meier life‐table method. The mean follow‐up period was 3.2 ± 1.1 years. The clinical backgrounds of patients with varicectomy stripping and sclerotherapy stripping were not significantly different between the two groups. The overall recurrence‐free rates at 1 and 3 years were 97.0% and 91.4%, respectively. The recurrence‐free rates at 3 years were 93.5% for stripping with varicectomy and 88.6% for stripping with sclerotherapy. No statistical difference was found between the two groups. The recurrence rate after stripping with sclerotherapy was equivalent to that after stripping with varicectomy. Thus concurrent varicectomy can be replaced with sclerotherapy.
Surveillance of Surgical Site Infections: Decade of Experience at a Colombian Tertiary Care Center
Authors: Arias Cesar A. , Quintero Gustavo , Vanegas Blanca E. , Rico Clara Luz , Patiño Jose Felix
Published: May 2003

Abstract

A protocol for surveillance of surgical site infections (SSIs) was established in a tertiary care center in 1991 in Bogota, Colombia and followed for 10 years. Wounds were classified according to the Centers for Disease Control guidelines. The National Nosocomial Infection Surveillance and Study of the Efficacy of Nosocomial Infection Control scores for risk factors were included from June 1999. A total of 33,027 surgical procedures were followed by the surveillance team. The overall infection rate was 2.6%. Most surgical procedures (70.6%) were classified as clean; 25.3%, 3.8%, and 0.26% were classified as clean/contaminated, contaminated, and dirty, respectively. Infection rates according to wound classification were 1.28%, 3.9%, 15.4%, and 38.4% for clean, clean/contaminated, contaminated, and dirty procedures, respectively. Escherichia coli and coagulase‐negative staphylococci were the most frequently isolated microorganisms from SSI: 23.9% and 22.8% of isolates, respectively. A program of surveillance of SSIs has been successfully implemented in a country with limited resources and has maintained the infection rate within international standards.