bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Clay Surface Modification on Morphology and Rheology of Polyethylene Glycol/Montmorillonite Nanocomposites
Authors: Işçi Sevim , Güngör Nurfer , Alemdar Ayse , Isik Ece Ö.
Published: July 2007

The effects of surface modification of Na-montmorillonite (Na-MMT) on morphology and the rheological properties of polyethylene glycol/ organoclay nanocomposites are investigated. Dodecyltrimethylammonium bromide (DTABr) is used to modify the clay surface. Adsorption of DTABr on Na-MMT is monitored by zeta potential measurements. From zeta potential measurements, three DTABr concentrations, 1 × 10—3, 7.5 × 10— 3, and 5 × 10—2 mol/L, are chosen to fabricate the polyethylene glycol/organoclay composites. The morphology of three sets of organoclays (OMMT1, OMMT2, and OMMT3) is studied by X-ray diffraction (XRD) technique. The increase of basal spacing is found to be 0.2 nm as the DTABr concentration is increased to 7.5 × 10— 3 mol/L. The rheological properties of polyethylene glycol (PEG)/ organoclay nanocomposites are studied for three organoclays at different PEG concentrations. All nanocomposites show Bingham plastic flow behavior. The OMMT3 shows maximum viscoelastic properties in the polymer matrix. The morphology and electrokinetic properties of the PEG/organoclay nanocomposites are also investigated.
A Semi-analytical Method for Determining the Strain Energy Release Rate of Cracks in Adhesively-bonded Single-lap Composite Joints
Authors: Yang Chihdar , Sun Wenjun , Tomblin John S. , Smeltzer Stanley S.
Published: July 2007

A semi-analytical method for determining the strain energy release rates due to a prescribed crack in an adhesively-bonded, single-lap composite joint subjected to axial tension is presented. The field equations in terms of displacements within the joint are formulated by using first-order shear deformable, laminated plate theory together with kinematic relations and force equilibrium conditions. The stress distributions for the adherends and adhesive are determined after the appropriate boundary and loading conditions are applied and the equations for the field displacements are solved. Based on the adhesive stress distributions, the forces at the crack tip are obtained and the strain energy release rates of the crack are determined by using the virtual crack closure technique (VCCT). Additionally, the test specimen geometry from both the ASTM D3165 and D1002 test standards are utilized during the derivation of the field equations in order to correlate analytical models with future test results. The system of second-order differential field equations is solved to provide the adherend and adhesive stress response using the symbolic computation tool, Maple 9. Finite element analyses using J-integral as well as VCCT were performed to verify the developed analytical model. The finite element analyses were conducted using the commercial finite element analysis software ABAQUSTM. The results determined using the analytical method correlated well with the results from the finite element analyses.
Fabrication and Mechanical Properties of Completely Biodegradable Hemp Fiber Reinforced Polylactic Acid Composites
Authors: Hu Ruihua , Lim Jae-Kyoo
Published: July 2007

Biodegradable composite materials can be produced by the combination of biodegradable polymers and natural fibers. In this study, a new biodegradable composite of hemp fiber reinforced polylactic acid (PLA) was fabricated using the hot press method. Mechanical properties of composites with different fiber volume fractions were tested. The optimum fiber content was determined according to the test results. Effects of alkali treatment on the fiber surface morphology and the mechanical properties of the composites were investigated. Test results show that the composite with 40% volume fraction of alkali treated fiber has the best mechanical properties. The tensile strength, elastic modulus, and flexural strength of the composite with 40% treated fiber are 54.6 MPa, 8.5 Gpa, and 112.7 MPa respectively, which are much higher than those of PLA alone. The composites have lower densities, which were measured to be from 1.19 g/cm3 to 1.25 g/cm3. Specific strengths were also calculated. Surface morphologies of fiber and fracture surfaces of the composites were observed using the SEM method.
`What's the Big Idea?': Oswald Mosley, the British Union of Fascists and Generic Fascism
Authors: Love Gary
Published: July 2007

This article examines the value of Roger Griffin’s concept of ‘palingenetic populist ultra-nationalism’ as a means of defining fascism as an international movement and ideology. Through an analysis of the development of both native and derivative influences on Oswald Mosley’s British Union of Fascists (BUF), it argues that Griffin’s ‘essentialist’ definition of generic fascism allows scholars to identify distinct common linkages between all interwar fascist movements, including German nazism. Simultaneously, it warns against the danger of relying too heavily on generic definitions to describe individual fascist movements. Operating in the shadow of the Italian and German regimes, the BUF struggled to convince a suspicious British public of the basic vernacular character of its own ideology. While imitating successful fascisms abroad was never an option for the Italians, Mosley could not resist the temptation of foreign ideas, symbols and resources. Such contradictions were further exposed on the eve of war in 1939. In addition, Mosley believed that the West’s rapid descent into permanent decadence could only be arrested by a ‘fascistized’ Europe based on a ‘Four Power Bloc’ of fascist nations — Britain, France, Germany and Italy — a vision not shared by all fascists. Recognition of a fascist willingness to co-operate against Bolshevism and the old ‘plutocracies’ does, however, seem to justify the characterization of fascism as an international movement. This vindicates the heuristic value of Griffin’s definition of fascism, despite the fundamental unviability of a fascist ‘International’.
Power and Glory: Concentrated Power in Top Management Teams
Authors: Greve Henrich R. , Mitsuhashi Hitoshi
Published: July 2007

Strategic change is one of the most critical decisions that organizations make. We focus on the role of groups at the upper echelon of hierarchies and propose that concentrated power either in the CEO or the top management team is prone to be exercised, leading to a high rate of strategic change. We derive hypotheses on how formal and informal power concentration in top management teams have an effect on changes in corporate diversification. The findings suggest that power concentration strongly affects decision making.
Toxicity and the Unconscious Experience of the Body at the Employee—Customer Interface
Authors: Stein Mark
Published: July 2007

While the literature on front-line service work utilizes a variety of productive images, I argue that these images do not capture certain of the more problematic experiences of front-line service employees. Drawing on words used by these workers themselves, and using concepts from psychoanalysis and its application to organizational dynamics, I therefore propose a new image, that of toxicity. I argue that — especially when under severe pressure from customers — front-line workers may have the unconscious fantasy that they have been polluted by toxic substances. The unconscious experience of the entry of toxic material is likely to result in further contagion of relationships such as those among employees and between employees and customers. This may also result in workers retaliating against customers by exacting revenge on them. A downward spiralling of relationships may follow, with the result that large parts of the work environment are experienced as toxic. The implications for theory are explored. In conclusion, I argue that the theme of toxicity helps us connect the employee—customer interface with a deep reservoir of primordial human experience that links the body with emotions.
Effect of facial neuromuscular re-education on facial symmetry in patients with Bell's palsy: a randomized controlled trial
Authors: Manikandan N.
Published: July 2007

Objective: To determine the effect of facial neuromuscular re-education over conventional therapeutic measures in improving facial symmetry in patients with Bell's palsy.

Design: Randomized controlled trial.

Setting: Neurorehabilitation unit.

Subjects: Fifty-nine patients diagnosed with Bell's palsy were included in the study after they met the inclusion criteria. Patients were randomly divided into two groups: control (n = 30) and experimental (n = 29).

Interventions: Control group patients received conventional therapeutic measures while the facial neuromuscular re-education group patients received techniques that were tailored to each patient in three sessions per day for six days per week for a period of two weeks.

Main measures: All the patients were evaluated using a Facial Grading Scale before treatment and after three months.

Results: The Facial Grading Scale scores showed significant improvement in

both control (mean 32 (range 9.7-54) to 54.5 (42.2-71.7)) and the experimental (33 (18-43.5) to 66 (54-76.7)) group. Facial Grading Scale change scores showed that experimental group (27.5 (20-43.77)) improved significantly more than the control group (16.5 (12.2-24.7)). Analysis of Facial Grading Scale subcomponents did not show statistical significance, except in the movement score (12 (8-16) to 24 (12-18)).

Conclusion: Individualized facial neuromuscular re-education is more effective in improving facial symmetry in patients with Bell's palsy than conventional therapeutic measures.
Assessment of arm function in stroke patients: Rivermead Motor Assessment arm section revised with Rasch analysis
Authors: Van de Winckel Ann , Feys Hilde , Lincoln Nadina , De Weerdt Willy
Published: July 2007

Objective : To investigate the construct validity and unidimensionality of the Rivermead Motor Assessment, arm section, using Rasch analysis which transforms the ordinal scale into an interval scale with hierarchical ordering of items.

Setting : Twelve stroke units and rehabilitation centres across Belgium, Germany and Switzerland.

Subjects : Two hundred fifty-two stroke patients, average (SD) age of 63.5 (13.22) years.

Main measures : Principal component analysis on the Rasch data gave additional information on unidimensionality. Differential item functioning established the stability of items for gender, age, country, hemiplegic side, stroke type, and time since stroke.

Results : Four items did not meet the requirements for the Rasch model and were removed. These were `Lying, protract shoulder with arm in elevation', `Pick up tennis ball from table, release on midthigh, return to table, release', `Same exercise with pencil' and `Pick up piece of paper from table. Release five times'. Principal component analysis of the remaining 11 items revealed two dimensions in the scale, `static and dynamic control of movement', and `coordination'. All items were stable among the subgroups of the sample.

Conclusion : The Rivermead Motor Assessment, revised arm section meets the required criteria for validity and unidimensionality. It consists of 11 individual items, which yield two subtotals of overall upper limb ability of the patients. It is a valid tool to evaluate upper limb function after stroke.
Differences between patient and proxy reports in the assessment of disability after stroke
Authors: Chen Mei-Hsiang , Hsieh Ching-Lin , Mao Hui-Fen , Huang Sheau-Ling
Published: July 2007

Objective : To determine whether the assessment of disability level including basic activities of daily living (ADL) and instrumental ADL varies between patients' and proxy respondents' reports, and to explore the factors influencing proxy agreement.

Design : Patient—proxy agreement study.

Setting : Hospital settings.

Subjects : Fifty-two stroke patients with mild or without cognitive impairments and their primary caregivers voluntarily participated in this study.

Main measures : The self-administered versions of the Barthel Index and Frenchay Activities Index were completed by the patients and their proxy respondents concurrently, yet separately, to assess the level of disability.

Results : The proxy agreement on total scores of the self-administered Barthel Index and self-administered Frenchay Activities Index demonstrated moderate to good agreement (self-administered Barthel Index: intraclass correlation coefficient (ICC) = 0.71; self-administered Frenchay Activities Index: ICC = 0.6). There were no significant differences between patient and proxy reports on self-administered Barthel Index and self-administered Frenchay Activities Index scores (paired

t = —0.22, P = 0.83; paired t = 0.88, P = 0.39, respectively). However, limits of agreement of patient and proxy reports on the self-administered Barthel Index and self-administered Frenchay Activities Index were notable. Stepwise regression analysis found no significant variables associated with proxy agreement.

Conclusions : These results indicate that it is appropriate for research purposes, but not appropriate for clinical usage, to use proxy reports to measure disability levels in patients with stroke. Furthermore, the two methods should not be used interchangeably to monitor patients because of the wide limits of agreement between patient and proxy reports on the self-administered Barthel Index and self-administered Frenchay Activities Index.
The effects of upper body exercise on the physical capacity of people with a spinal cord injury: a systematic review
Authors: Valent Linda , Dallmeijer Annet , Houdijk Han , Talsma Eelkje , van der Woude Luc
Published: July 2007

Objective : To describe the effects of upper body training on the physical capacity of people with a spinal cord injury.

Data sources : The databases of PubMed, CINAHL, Sport Discus and Cochrane were searched from 1970 to May 2006.

Review methods : The keywords `spinal cord injury', `paraplegia', `tetraplegia' and `quadriplegia' were used in combination with `training'. The methodological quality of the included articles (both randomized controlled trials and controlled clinical trials) was assessed with the modified `van Tulder et al.' checklist. Studies were described with respect to population, test design, training protocol and mode of training. The training effects on physical capacity, reflected by peak power output (POpeak) and oxygen uptake (VO2peak), were summarized.

Results : Twenty-five studies were included with a mean score of 8.8 out of 17 items on the quality checklist. The methodological quality was quite low, mostly because of the absence of randomized controlled trials. Therefore no meta-analysis was possible. In the 14 articles of acceptable quality the mean (SD) increase in VO 2peak and POpeak, following a period of training, was 17.6 (11.2)% and 26.1 (15.6)%, respectively.

Conclusions : Due to the overall low quality of studies it is not possible to draw definitive conclusions on training effects for different lesion groups or training modes. The results of the relatively few studies with an acceptable quality seem to support the view that upper body exercise may increase the physical capacity of people with spinal cord injury. The magnitude of improvement in PO peak and VO2peak, however, varies considerably among studies.
The lived body — experiences from adults with cerebral palsy
Authors: Sandström Karin
Published: July 2007

Objective : To get a deeper understanding into how adults with cerebral palsy experience living with a disability and how they manage daily life.

Design : Interviews with open-ended questions were carried out. They were analysed by one person according to the Empirical Phenomenological Psychological method (EPP).

Setting and subjects : Twenty-two community-living adults (35—68 years) with cerebral palsy from five counties in Sweden participated. All had mobility problems and all had cognitive abilities making it possible to carry on a conversation.

Results : The varied experiences resulted in themes including (1) perceptions of living with a disability and (2) strategies used for managing the described perceptions. The perceptions were: a dys-appearing body, a not-appearing body, difference, being in-between, normality, restricted autonomy and autonomy. The strategies were: to fight one's way, to plan, to get used to it, to hide and to give one's all.

Conclusion : These interviews expressed heterogeneity in lived experiences showing the importance for professionals to meet people with cerebral palsy as individual subjects in relation to functional problems, self-image and autonomy together with seeing the consequences of different coping strategies.
Adaptation process, participation and depression over six months in first-stroke individuals and spouses
Authors: Rochette Annie , Bravo Gina , Desrosiers Johanne , St-Cyr/Tribble Denise , Bourget Annick
Published: July 2007

Objective : To describe changes in the adaptation process (appraisal and coping) in the six months after a first stroke and identify domains of the adaptation process related to participation and depressive symptoms for both affected individuals and spouses.

Design : A short-longitudinal study where data of the two groups were collected at three times: in the first two weeks post stroke (T1), at three months (T2) and six months (T3) post stroke.

Subjects : Individuals with a first stroke and spouses.

Main measures: The Stress Appraisal Measure (SAM) for appraisal, Revised Ways of Coping Questionnaire (RWCQ) for coping strategies, Assessment of Life Habits (LIFE-H) for participation, and Beck Depression Inventory (BDI) for depressive symptoms.

Results : Mean (SD) ages of the stroke group (n = 88) and spouse group (n = 47) were 71.8 (10.8) and 69.2 (11.2) years respectively. The Threat, Challenge and Stressfulness scales of the SAM decreased significantly (P < 0.02) from T1 to T3 in both groups whereas perceived uncontrollability of the situation increased significantly (P = 0.003) for spouses in the first six months. RWCQ Rationalisation and Giving control to others scales decreased in the stroke group (P = 0.008 and 0.002 respectively) but not in the spouse group (P = 0.07 and 0.39 respectively). Several components of adaptation at T1 could explain between 18% and 27% of the variance observed in the LIFE-H and BDI at T3.

Conclusion : Appraisal and coping strategies change over time. Initial adaptation could partially predict participation level and depressive symptoms six months post stroke for affected individuals as well as spouses.
Enhancement of reaching performance via self-speech in people with Parkinson's disease
Authors: Maitra KK
Published: July 2007

Objective : To evaluate the effects of self-speech as an internal cue on reaching performance in people with Parkinson's disease.

Subjects : Eight people with Parkinson's disease were voluntarily recruited from the upstate New York community.

Design and setting : This study was a repeated measure analysis of reaching performance under four randomized counterbalanced vocalization (speech) conditions that include a no vocalization control condition. The study was conducted in a university-based motion analysis laboratory. Participants performed a simple sequential daily reaching performance of reaching for a bottle, grasping and placing it on a simulated cabinet. Under counterbalanced randomized conditions, before each performance, participants either self-vocalized the word `yaah' (self-cue), listened to the word `yaah' vocalized by the experimenter (external cue), imagined vocalizing the word `yaah', or just simply performed the task without any vocalization (control — no vocalization).

Main measures : The following dependent kinematic measures were extracted from the movement: total movement time, total movement unit, peak velocities and durations of reaching and placing segments.

Results : People with Parkinson's disease took significantly shorter time under self-vocalization conditions (2390.00 (326.63) ms) compared with the other three conditions including control — no vocalization conditions (no_voc, 3015.66 (340.83) ms; ext_voc, 2853.12 (376.44) ms; imaginary-voc, 3000.37 (320.54) ms). Under self-vocalization conditions the movements were also significantly smoother as evidenced by significantly lower numbers of movement units (3.43 (0.41)) compared with the other three conditions (no_voc, 4.47 (0.57); ext_voc, 4.16 (0.51); imaginary-voc, 4.16 (0.55)).

Conclusions : Self-vocalization of a positive reinforcing word enabled people with Parkinson's disease to perform a daily upper extremity task faster and more smoothly.
Defining the content of individual physiotherapy and occupational therapy sessions for stroke patients in an inpatient rehabilitation setting. Development, validation and inter-rater reliability of a scoring list
Authors: De Wit L. , Kamsteegt H. , Yadav B. , Verheyden G. , Feys H. , De Weerdt W.
Published: July 2007

Objective : To develop a valid and reliable scoring list to define the content of individual physiotherapy and occupational therapy sessions for stroke patients in inpatient rehabilitation.

Design : A list was developed based on previous lists, neurological textbooks and recorded therapy sessions. Content validity was verified and inter-rater reliability evaluated on videos of treatment sessions. In each of four rehabilitation centres, a researcher recorded and scored five physiotherapy and five occupational therapy sessions. These 40 treatment sessions were also scored by the first author. The scores of the researchers and first author were statistically compared.

Settings and subjects : Forty stroke patients in four European rehabilitation centres.

Results : The scoring list consists of 49 subcategories, divided into 12 categories: mobilization; selective movements; lying (balance); sitting (balance); standing (balance); sensory and visual perceptual training and cognition; transfers; ambulatory activities; personal activities of daily living; domestic activities of daily living; leisure- and work-related activities; and miscellaneous. Comparing the frequency of occurrence of the categories resulted in intraclass correlation coefficients, indicating high reliability for eight categories, good for one, and fair for two. One category was not observed. Spearman rank correlation coefficients were high to very high for 24 subcategories and moderate for four. Twenty-one subcategories contained too few observations to enable calculation of Spearman rank correlation coefficients. Average point-to-point percentage of agreement in time of the treatment sessions equalled 76.6 ± 16.2%.

Conclusions : The list is a valid and reliable tool for describing the content of physiotherapy and occupational therapy for stroke patients.
Sensory re-education after nerve injury of the upper limb: a systematic review
Authors: Oud Tanja , Beelen Anita , Eijffinger Elianne , Nollet Frans
Published: July 2007

Objective : To systematically review the available evidence for the effectiveness of sensory re-education to improve the sensibility of the hand in patients with a peripheral nerve injury of the upper limb.

Data sources : Studies were identified by an electronic search in the databases MEDLINE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, the Physiotherapy Evidence Database (PEDro), and the database of the Dutch National Institute of Allied Health Professions (Doconline) and by screening the reference lists of relevant articles.

Review methods : Two reviewers selected studies that met the following inclusion criteria: all designs except case reports, adults with impaired sensibility of the hand due to a peripheral nerve injury of the upper limb, and sensibility and functional sensibility as outcome measures. The methodological quality of the included studies was independently assessed by two reviewers. A best-evidence synthesis was performed, based on design, methodological quality and significant findings on outcome measures.

Results : Seven studies, with sample sizes ranging from 11 to 49, were included in the systematic review and appraised for content. Five of these studies were of poor methodological quality. One uncontrolled study (N = 1 3 ) was considered to be of sufficient methodological quality, and one randomized controlled trial ( N = 49) was of high methodological quality. Best-evidence synthesis showed that there is limited evidence for the effectiveness of sensory re-education, provided by a statistically significant improvement in sensibility found in one high-quality randomized controlled trial.

Conclusion : There is a need for further well-defined clinical trials to assess the effectiveness of sensory re-education of patients with impaired sensibility of the hand due to a peripheral nerve injury.
Informal carer activities, carer burden and health status in multiple sclerosis
Authors: Forbes Angus , While Alison , Mathes Lucia
Published: July 2007

Objective : To explore the contribution of carer characteristics, activities and disease impact to care burden and health in the multiple sclerosis caregiver population.

Design : A prospective postal survey (24 months).

Setting : The study was conducted in seven treatment centres within England.

Subjects : Two hundred and fifty-seven caregivers of people with multiple sclerosis.

Measures : Carer activity, the Caregivers Reaction Assessment Scale (CRA), the Short Form General Health Survey (SF-36), version 2, and care-related health problems. The carer data were linked to a comprehensive patient data set which permitted dyadic variables to be created measuring shared health.

Results : Carers were engaged in a wide spectrum of physical care activities; lifting was the most frequent, 74% (n = 192). Patient disease impact scores were positively correlated (P < 0.01) with higher carer activity levels (r = 0.66). The carer activity level increased over time (P < 0.001 ) by around 5% with a mean increase of 0.22 (95% confidence interval (CI) 0.12—0.3) in the carer activity summary score (scale 0—4). Disease impact was negatively correlated (P < 0.01) with carer burden r = — 0.44 (CRA composite scale), physical health status r = —0.27 (SF-36 physical component score) and mental health status r = — 0.21 (SF-36 mental component score); and positively correlated with care-related health problems r = 0.44. Hierarchical regression models explaining 39% and 49% of the variance in care burden and health problem respectively showed that disease impact and dyadic health explained most of the variance, with carer activity contributing an additional 2% to 4% of the variance (P < 0.001).

Conclusion : The analysis demonstrated that greater disease impact, lower dyadic health, high carer activity and greater carer burden are related to the level of carer-related health problems. The data suggested the need to develop interventions for assessing carers and reducing their activity levels and care burden (objective and subjective).
Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study
Authors: Swanenburg Jaap , de Bruin Eling Douwe , Stauffacher Marguerite , Mulder Theo , Uebelhart Daniel
Published: July 2007

Objective : To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance.

Design : Randomized clinical trial.

Setting : University hospital physiotherapy department.

Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score (SD) of —1.8 (0.8).

Interventions : A three-month programme consisting of exercise/protein including training of muscular strength, co-ordination, balance and endurance. Calcium/ vitamin D was supplemented in all participants for a 12-month period.

Outcome measures : Assessment took place prior to and following the months 3, 6, 9 and at the end of the study; primary dependent variables assessed were risk of falling (Berg Balance Test) and postural balance (forceplate). Secondary measures included body composition, strength, activity level, number of falls, bone mineral content, biochemical indices, nutritional status and general health.

Results : Significant reductions of risk of falling (repeated measures ANOVA F = 8.90, P = 0.008), an increase in muscular strength (ANOVA F = 3.0, P = 0.03), and an increase in activity level (ANOVA F = 3.38, P = 0.02) were found in the experimental group as compared to the control group. Further on, there was 89% reduction of falls reported in the experimental group (experimental pre/post 8/1 falls; control group pre/post 5/6 falls).

Conclusion : This study provides support for our intervention programme aimed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis. The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger randomized trial.
Brain injury severity and autonomic dysregulation accurately predict heterotopic ossification in patients with traumatic brain injury
Authors: Hendricks Henk T. , Geurts A.C.H. , van Ginneken Bart C. , Heeren Anita J. , Vos Pieter E.
Published: July 2007

Objective : To assess brain injury severity, autonomic dysregulation and systemic infection as risk factors for the occurrence of heterotopic ossification in patients with severe traumatic brain injury.

Design : Historic cohort study.

Setting : Radboud University Medical Centre.

Subjects : All consecutively admitted patients with severe traumatic brain injury (admission Glasgow Coma Scale score 8 or less) during the years 2002—2003.

Main measures : The development of clinically relevant heterotopic ossification, defined as painful swelling of joints with redness and decreased range of motion, confirmed radiographically.

Results : Seventy-six (64%) of the 119 patients survived and were eligible for further follow-up. Nine patients (12%) developed 20 symptomatic heterotopic ossifications, in one or more joints. Patients with heterotopic ossification had sustained more severe brain injuries, compared to the group without heterotopic ossification. The mean coma duration in the heterotopic ossification group was 28.11 days (SD 20.20) versus 7.54 days (SD 7.47) in the patients without heterotopic ossification (P < 0.001). The occurrence of autonomic dysregulation (relative risk (RR) 59.55, 95% confidence interval (CI) 8.39—422.36), diffuse axonal injury (RR 20.68, 95% CI 4.92—86.91), spasticity (RR 16.96, 95% CI 3.96—72.57) and systemic infection (RR 13.12, 95% CI 3.01—57.17) were all associated with an increased risk of developing symptomatic heterotopic ossification. However, only autonomic dysregulation had a high positive (88.9%, 95% CI 51.7—99.7) and negative (98.5%, 95% CI 91.9—99.9) predictive value with regard to heterotopic ossification.

Conclusions : The occurrence of autonomic dysregulation may predict the chance of developing heterotopic ossification in patients with severe head injury.
Life after survival: long-term daily life functioning and quality of life of patients with hypoxic brain injury as a result of a cardiac arrest
Authors: Middelkamp Wietske , Moulaert Veronique RMP , Verbunt Jeanine A , van Heugten Caroline M , Bakx Wilbert G. , Wade Derick T.
Published: July 2007

Objectives : To determine the level of daily functioning and quality of life of patients with hypoxic brain injury after a cardiac arrest and to investigate the predictive value of the duration of coma and post-traumatic amnesia in long-term functioning.

Design : A retrospective cohort study.

Setting : A Dutch rehabilitation centre.

Subjects : Thirty-two patients with hypoxic brain injury caused by a cardiac arrest 2—7 years ago, who were admitted to a brain injury rehabilitation programme.

Main outcome measures : Cognitive Failures Questionnaire (CFQ), Frenchay Activities Index (FAI), Impact on Participation and Autonomy Questionnaire (IPAQ) and Quality of Life after Brain Injury questionnaire (QOLIBRI). Data on duration of coma and post-traumatic amnesia were retrieved from medical files.

Results : A significant association was found between duration of coma, complaints of cognitive functioning (r = 0.57, P < 0.05) and quality of life after brain injury (r = —0.70, P < 0.01). Duration of post-traumatic amnesia was associated with both daily functioning (r = —0.70, P < 0.01) and quality of life (r = —0.70, P < 0.01). Furthermore complaints of cognitive functioning were associated with both the level of participation in society (r = 0.76, P < 0.01) and quality of life (r = 0.77, P < 0.01).

Conclusions : Long-term outcome of patients with hypoxic brain injury after a cardiac arrest shows that this group is limited in cognitive and daily functioning, participation and quality of life. Based on the duration of coma and post-traumatic amnesia, an estimation of daily life functioning and quality of life 2—7 years after a cardiac arrest can be made.
Social roles and long-term illness: is it time to rehabilitate convalescence?
Authors: Wade Derick T , Halligan Peter W
Published: July 2007

The total extent of sickness in the population has increased while disease has decreased. Being sick is a role that offers the patient many advantages both directly, in terms of being absolved from undertaking many daily activities if necessary, and indirectly, through additional financial and other resources that may be offered. Because of these advantages, it is usual for any persistent sickness to be validated by health care professionals. Moreover sick people are expected to make every effort to leave the sick state, especially to make every effort using offered advice and resources such as rehabilitative treatments. However some people are sick longer than anticipated or apparently justified. The sick role developed based on assumptions that may no longer be valid, and the extended World Health Organization's International Classification of Functioning (WHO ICF) model of illness provides a new analysis of the problem, emphasizing that sometimes sickness is caused or perpetuated by factors other than disease. Among other factors, the lack of a way out of the sick role might be one reason for increasing sickness. Therefore re-establishing convalescence as a role might facilitate people in leaving the sick role, and rehabilitation should consider promoting convalescence.
Altered cholinergic metabolism and muscarinic receptor linked second messenger pathways after chronic exposure to dichlorvos in rat brain
Authors: Raheja Geetu , Dip Gill Kiran
Published: July 2007

Chronic dichlorvos exposure (6mg/kg b.wt/day) for a period of 8 weeks resulted in significant reduction in body weight gain of the male Wistar rats. However, the dietary intake remained unchanged in experimental animals following dichlorvos treatment. Activity of the synthesizing enzyme of acetylcholine (ACh) ie, choline acetyltransferase, was found to be significantly increased and the activity of hydrolyzing enzyme, acetyl cholinesterase (AChE), was inhibited in all the three brain regions studied. Chronic dichlorvos treatment also caused significant reduction in both high affinity (HA) and low affinity (LA) choline uptake (CU), with maximal effect being observed in the brain stem followed by cerebellum and cerebrum. Muscarinic receptor binding was significantly decreased in brain stem and cerebellum as reflected in the decreased receptor number (Bmax), without any change in the binding affinity (Kd) of the receptors. Dichlorvos treatment caused marked inhibition in cAMP synthesis as indicated by decreased adenylate cyclase activity as well as cAMP levels in cerebrum, cerebellum and brain stem. Our study shows that organophosphates may interact with muscarinic receptor-linked second messenger system and this could be a potential mechanism for the neurotoxic effects observed after repeated exposure to low levels of organophosphates, which are unexplainable on the basis of cholinergic hyperactivity. Toxicology and Industrial Health 2007; 23: 25—37.
The effects of diazinon on lipid peroxidation and antioxidant enzymes in rat erythrocytes: role of vitamins E and C
Authors: Sutcu Recep , Altuntas Irfan , Buyukvanli Bora , Akturk Onur , Ozturk Ozlem , Koylu Halis , Delibas Namik
Published: July 2007

Reactive oxygen species caused by organophosphates may be involved in the toxicity of various pesticides. Therefore, in this study, we aimed to investigate the effects of acute exposure to organophosphate insecticide diazinon (DI) and possible ameliorating role of vitamins E and C, with the following parameters: lipid peroxidation (LPO) and the activity of the glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) in rat erythrocytes. The experimental groups were arranged as control group, DI-treated group (DI) and DI + vitamin E + vitamin C—treated group (DI + Vit). DI + Vit groups were treated orally with a single dose of 335 mg/kg DI body weight. Vitamins E and C were injected at doses of 150 mg/kg body weight intramuscular (in) and 200 mg/kg body weight intraperitoneal (ip), respectively, 30 min after the treatment of DI in DI + Vit group. Blood samples were taken 24 h after the DI. The results showed that DI administration caused to increase in LPO and the activities of SOD and GSH-Px enzymes in erythrocytes. Also, the combination of vitamins E and C decreased LPO and the activities of GSH-Px and SOD compared with the DI group. In conclusion, although treating rats with single dose DI increases LPO and antioxidant enzyme activities in erythrocytes, vitamins C and E combination can reduce LPO caused by DI. Toxicology and Industrial Health 2007; 23: 13—17.
Predicting human skin absorption of chemicals: development of a novel quantitative structure activity relationship
Authors: Luo Wen , Medrek Sarah , Misra Jatin , Nohynek Gerhard J
Published: July 2007

The objective of this study was to construct and validate a quantitative structure-activity relationship model for skin absorption. Such models are valuable tools for screening and prioritization in safety and efficacy evaluation, and risk assessment of drugs and chemicals. A database of 340 chemicals with percutaneous absorption was assembled. Two models were derived from the training set consisting 306 chemicals (90/10 random split). In addition to the experimental Kow values, over 300 2D and 3D atomic and molecular descriptors were analyzed using MDL's QsarIS computer program. Subsequently, the models were validated using both internal (leave-one-out) and external validation (test set) procedures. Using the stepwise regression analysis, three molecular descriptors were determined to have significant statistical correlation with Kp (R2 = 0.8225): logKow, ×0 (quantification of both molecular size and the degree of skeletal branching), and SsssCH (count of aromatic carbon groups). In conclusion, two models to estimate skin absorption were developed. When compared to other skin absorption QSAR models in the literature, our model incorporated more chemicals and explored a large number of descriptors. Additionally, our models are reasonably predictive and have met both internal and external statistical validations. Toxicology and Industrial Health 2007; 23: 39—45.
Risk assessment of occupational exposure to polycyclic aromatic hydrocarbons by means of urinary1-hydroxypyrene
Authors: Maina Giovanni , Manzari Marco , Palmas Antonio , Passini Valter , Filon Francesca Larese
Published: July 2007

Polycyclic aromatic hydrocarbons have mutagenic and carcinogenic properties and some of them are classified as probable or possible human carcinogens. Aim of this study was to evaluate the genotoxic risk in workers exposed to diesel exaust. Environmental and biological monitoring exposure to polycyclic aromatic hydrocarbons was carried out on fifty-two workers exposed to diesel exhaust. Urinary 1-hydroxypyrene was employed as a biomarker of internal dose. Significant urinary 1-hydroxypyrene differences between smokers and non-smokers were found. Twenty per cent of urinary 1-hydroxypyrene values exceeded benchmark level for genotoxic effect, while the results of environmental monitoring excluded the existence of exposure to polycyclic aromatic hydrocarbons. In the absence of greater knowledge about the relationship between urinary 1-hydroxypyrene and genotoxic effects under the conditions of very low exposure, extreme caution is recommended when this biomarker of internal dose is employed as an indicator of genotoxic risk. Toxicology and Industrial Health 2007; 23: 55—59.
Toxicity of pharmaceutical wastewater on male reproductive system of Mus musculus
Authors: Zhao Dayong , Zhu Chengjun , Sun Shilei , Yu Hongfeng , Zhang Li , Pan Wenyang , Zhang Xuxiang , Yu Hongxia , Gu Jidong , Cheng Shupei
Published: July 2007

This study reports on the toxic effects of 35-days intragastric perfusion of pharmaceutical wastewater on the male reproductive system of Mus musculus. Flow cytometric analyses and staining with fluorescein diacetate (FDA) and propidium iodide (PI) were used to assess the toxicity on spermatogenic cells. Significant depletions in the relative percentages of elongated spermatid (HC), diploid spermatogonia (2C), and S-phase cells were observed. These alterations in different germ cell populations were reflected in the various germ cell ratios. The ratios of 1C : 4C and HC : 2C showed a significant decline after pharmaceutical wastewater treatment, while the 4C : 2C and 1C : 2C ratios increased significantly. FDA and PI staining displayed reduced viability of spermatogenic cells in wastewater treated group. Statistically significant percentages of sperm abnormalities showed the genotoxic potential of this pharmaceutical wastewater. Testicular histopathological studies of treated animals revealed expansion of interstitial space and reduction in the number and size of Leydig cells. Thus, the present study has established the toxicity of pharmaceutical wastewater on the reproductive biology of male mice. Toxicology and Industrial Health 2007; 23: 47—54.
First Aid for Seizures: The Importance of Education and Appropriate Response
Authors: O'Hara Kathryn A.
Published: July 2007

In most circumstances, first aid for seizures aims to protect the individual from harm during a seizure. Many people harbor misconceptions about or simply do not know how to respond to a seizure. Guidelines for seizure first aid from the Epilepsy Foundation are readily available and widely distributed, yet data from surveys and studies illustrate a deep unmet need in seizure first aid education. Lack of knowledge increases the potential for inappropriate or inadequate responses by parents, teachers, coworkers, and the public at large to repetitive or prolonged seizures, and the associated discomfort about how to provide first aid also can contribute to the general stigma associated with epilepsy. Clinicians play a key role in educating patients, parents, caregivers, and the community about how to respond to an individual who is having a seizure. This article reviews the data regarding seizure first aid knowledge among the various groups that may be called on to respond to a repetitive or prolonged seizure, highlights important goals of seizure first aid (including the prevention of status epilepticus) that should be relayed to these groups, and discusses the positive impact of seizure first aid education.
Designing Practical Evidence-Based Treatment Plans for Children With Prolonged Seizures and Status Epilepticus
Authors: Glauser Tracy A.
Published: July 2007

The adverse effects of prolonged seizures and status epilepticus can be reduced through appropriate, prompt, and aggressive intervention. Because most prolonged seizures and status epilepticus episodes begin outside the hospital, it is important to design treatment interventions that can be rendered at home or in school that do not rely entirely on intervention by emergency medical personnel. Factors that make this new approach possible include the use of evidence-based guidelines to inform treatment decisions and the successful development, and government approval, of new formulations of commonly used medications, including rectal diazepam gel and the phenytoin prodrug fosphenytoin. A useful plan should be initiated at the 5-minute to 10-minute mark (not the 30-minute mark) and contain clear, easy-to-read directions that can be implemented by family, school personnel, or emergency medical services who have varying levels of medical sophistication. Four scenarios illustrating these considerations are included and provide examples of plans that fulfill these criteria.
Do Seizures Affect the Developing Brain? Lessons From the Laboratory
Authors: Sankar Raman , Rho Jong M.
Published: July 2007

Laboratory models of prolonged seizures and status epilepticus in developing animals demonstrate age- and model-dependent propensity for brain injury. Even in models without overt brain injury, plasticity, which leads to epileptogenicity as well as to behavioral and cognitive effects, has been demonstrated. Brief, recurrent seizures in the neonatal period not only appear to exhibit plasticity that can be anatomically and physiologically meaningful but also seem to produce cognitive deficits. Translation of these findings into clinical practice is limited by the effects chronic therapy may have on brain development. There is little evidence that available treatments can effectively alter epileptogenesis. However, it is widely agreed that prolonged seizures and status epilepticus can carry negative consequences. Preventing epileptogenesis remains an important goal to modify the development of comorbidities, and it represents an area of research in need of much progress. For now, prevention of prolonged seizures with early intervention is important and is the most effective available option to minimize the potential short- and long-term adverse effects of prolonged seizures and optimize patient outcomes.
Special Issues in the Management of Young Children, Older Adults, and the Developmentally Disabled
Authors: Ramsay R. Eugene , Shields W. Donald , Shinnar Shlomo
Published: July 2007

The very young, the very old, and those with developmental disability have an increased risk of both epilepsy and prolonged and repetitive seizures. The special issues that affect their management are reviewed. Polypharmacy that occurs because of comorbid illnesses requiring chronic medication can result in dangerous drug-drug interactions. The antiepileptic drug's pharmacokinetic profile must be factored when treating young children and older adults. Patients who have taken an older enzyme-inducing antiepileptic drug for years may have a markedly induced hepatic enzyme system that may alter drug metabolism. Overdose or toxicity may occur in older adults who may metabolize and clear antiepileptic drugs more slowly than younger patients. Benzodiazepines are the most rapidly effective acute therapy for repetitive or prolonged seizures. It is important to have a plan for management of prolonged and repetitive seizures. Long-term therapy should be managed in a manner that will eliminate the need for rescue therapies and visits to the emergency department.