bluuebunny/crossref_metadata_2025 huggingface dataset:
Research into rehabilitation. What is the priority?
Authors: Wade Derick T
Published: May 2003

Research into rehabilitation must not be confused with research that is of importance to the clinical practice of rehabilitation. The priorities in rehabilitation research should focus on the activities and processes that are central to rehabilitation and that together define the unique nature of rehabilitation. These are multidiscipli- nary teamwork and goal-setting; working within a systematic framework that recognizes the inter- actions of many different factors upon an individual's illness; and changing behaviour. In the next decade we should investigate ways of improving the key rehabilitation processes of goal-setting and assessment, we should aim to understand the important inter-relationships between disease, impairment and contextual factors on the one hand and disability and participation on the other, and we should investigate the best ways to modify behaviour (i.e. optimize activities) in the context of disabling illness.
Nurses’ perceptions of physiotherapists as rehabilitation team members
Authors: Dalley Jayne , Sim Julius
Published: May 2003

Objective: To investigate nurses’ perceptions of physiotherapists as members of the rehabilitation team. This study arose from the current emphasis that is placed on good multidisciplinary teamwork for effective rehabilitation and the awareness that different team members often have different perceptions of their respective roles within the team.

Design: Semi-structured interviews, the results of which were then subject to content analysis.

Setting and subjects: Experienced rehabilitation nurses in two rehabilitation wards within a National Health Service Trust.

Results: Nurses perceived the role of physiotherapists as being concerned with mobility and movement, and valued the therapists’ knowledge and skills in these areas. They felt, however, that physiotherapists had insufficient understanding of the demands and pressures of nursing practice and lacked recognition of the nurses’ professional autonomy in decision-making in rehabilitation. Nurses viewed nursing and physiotherapy as two quite distinct and different roles within rehabilitation, despite some role overlap. Physiotherapy was perceived as specific and measurable, while nursing was perceived as generalized and undefined. These perceptions extended to their views on patient–staff interactions and organizational structures. Some of the differences, such as organizational structures, created barriers to rehabilitation. Others, such as physiotherapy expertise in mobility, were valued for their contribution to rehabilitation. Areas were identified where the two professions can assist each other in professional skills.

Conclusion: Nurses valued the role and contribution of physiotherapists, but identified areas in which barriers existed to effective interprofessional working, particularly in relation to organizational factors and interprofessional relationships.
Stroke: an exploration of the experience of informal caregiving
Authors: Kerr Susan M , Smith Lorraine N
Published: May 2003

Objective: To explore the experience of caregiving in informal carers of stroke patients.

Design: The research approach was qualitative. Data were collected one year after the stroke occurred using a semi-structured interview. The audio-taped interviews were transcribed and following this process were analysed thematically using constant comparative procedures.

Setting: West of Scotland.

Subjects: Twenty-two informal carers of stroke patients.

Results: The results are presented under the headings: Preparation for discharge/feelings about discharge; The early weeks/months at home; A year of caring; and The future. The main themes identified within these broad areas were as follows: physical preparation; emotional support; the supply of information and advice; and the provision of appropriate services (both social and health service provision).

Conclusions: The data gathered in this small-scale study suggest that the physical and emotional toll associated with caregiving was great. Unfortunately, the help and support provided by the health and social services was often inadequate, inappropriate and poorly tailored to their individual needs. There was little evidence of a seamless flow of care between the secondary and primary care settings.
Reality Orientation Therapy to delay outcomes of progression in patients with dementia. A retrospective study
Authors: Metitieri Tiziana , Zanetti Orazio , Geroldi Cristina , Frisoni Giovanni B , De Leo Diego , Buono Marirosa Dello , Bianchetti Angelo , Trabucchi M
Published: May 2003

Objective: To evaluate the impact of continued Reality Orientation Therapy (ROT) in delaying the outcomes of dementia progression.

Design: Retrospective study. Data collection was based on review of clinical charts and on telephone interviews performed with patients or primary caregivers.

Setting: Day hospital of the Alzheimer's Disease Unit, Brescia (Italy).

Subjects: Seventy-four patients enrolled in at least one cycle of ROT from 1994 to 1998 were studied.

Interventions: Rehabilitative intervention based on formal ROT.

Main outcome measures: This study analysed the time to the occurrence of any of the following: cognitive decline on Mini-Mental State Examination scores, urinary incontinence as an index of functional decline, institutionalization, and death.

Results: Data on a 30-month period after the first ROT session were analysed. We compared 46 patients (treatment group) who completed from 2 to 10 ROT cycles (corresponding to 8–40 weeks of training; mean = 15.48) with 28 patients (control group) who completed only one ROT cycle (4 weeks). Treatment group showed higher estimated survival rates than control group on cognitive decline (p = 0.022) and institutionalization (p = 0.002). The relative risks for cognitive decline and institutionalization in the control group compared with treatment group were 0.60 (p = 0.014), and 0.42 (p = 0.021), respectively.

Conclusions: Continued ROT classes during the early to middle stages of dementia may delay nursing home placement and slow down the progression of cognitive decline.
Psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q)
Authors: Middel Berrie , Bouma Jelte , de Jongste Mike , van Sonderen Eric , Niemeijer M G , van den Heuvel Wim
Published: May 2003

Objective:To evaluate the psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q) in patients with atrial fibrillation.

Design: A prospective study of the patients who underwent DC electrical cardioversion.

Setting: Clinics of cardiology and thoracic surgery of the University Hospital in Groningen, the Netherlands.

Main outcome measures: The disease-specific MLHF-Q and generic measures of quality of life were administered. The sensitivity to change over time was tested with effect sizes (ES). Internal consistency of MLHF-Q scales was estimated with Cronbach's alpha. To evaluate the construct validity multitrait–multimethod analysis was applied. The ‘known group validity’ was evaluated by the comparison of mean scores and effect sizes between two groups of the New York Heart Association (NYHA) classification (NYHA I versus II–III). Stability of MLHF-Q scales was estimated in a subgroup of patients who remained stable. Perfect congruence analysis and factor analysis were applied to confirm the a priori determined structure.

Results: Cronbach's alpha was ≥0.80 of the MLHF-Q scales. Perfect congruence analysis (PCA) showed that the results resemble quite well the a priori assumed factor structure. Multitrait–multimethod analysis showed convergent validity coefficients ranging from 0.59 to 0.73 (physical impairment dimension) and 0.39 to 0.69 (emotional dimension). The magnitude of change can be interpreted as medium (ES = 0.50). The results of a ‘test–retest’ analysis in a stable group can be valued as satisfactory for the MLHF-Q scales (Pearson's r > 0.60). The physical dimension and the overall score of the MLHF-Q discriminated significantly between the NYHA I and II–III groups (p < 0.001) with large effect sizes (ES > 1.0).

Conclusions: The MLHF-Q has solid psychometric properties and the outcome of the current study indicates that the MLHF-Q is an effective and efficient instrument.
A preliminary report on the effectiveness of trunk targeting in achieving independent sitting balance in children with cerebral palsy
Authors: Butler Penelope B
Published: May 2003

Objective: To assess the potential of Targeted Training in initiating or accelerating improved movement control of the trunk and hip joints in children with cerebral palsy so that independent sitting balance without specialized seating could be achieved.

Design: Six single case studies.

Setting: Assessment and review were undertaken in a specialized centre with intervention in the subjects' home or school.

Subjects: Children between the ages of two years five months and seven years five months (mean four years seven months) with an established diagnosis of cerebral palsy. None had independent sitting balance at the start of the study.

Intervention: Targeted Training using specialized equipment was directed at the appropriate few joints of the trunk as determined by initial testing and progressed when control at those joints had become automatic. The equipment provided support and challenged control learning. Periods of no intervention and placebo intervention, when the equipment was inappropriately set up, were also used. Two of the children ceased their traditional physiotherapy input while Targeted Training or placebo training took place.

Main outcome measure: A new test was devised and validated to determine the most caudal extent of control of the vertical posture. In addition, a functional test of independent sitting balance was defined.

Results: All six children showed an increase in movement control and all gained independent sitting balance within 12–25 weeks (mean 16 weeks). This was irrespective of the continuation or cessation of traditional physiotherapy.

Conclusion: These preliminary findings suggest that Targeted Training may be an effective means of promoting movement control and functional ability. Confirmation of these findings by other investigators would be of value.
Outcome of strategy training in stroke patients with apraxia: a phase II study
Authors: van Heugten C M , Dekker J , Deelman B G , van Dijk A J , Stehmann-Saris J C , Kinebanian A
Published: May 2003

Objective: Evaluation of a therapy programme for stroke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists.

Design: The outcome was studied in a pre–post test design. Measurements were conducted at baseline and 12 weeks later.

Subjects: Thirty-three stroke patients with apraxia were treated at occupational therapy departments in general hospitals, rehabilitation centres and nursing homes.

Main outcome measures: The following measurements were conducted: an apraxia test, a motor functioning test, observation of activities of daily living (ADL), Barthel Index, and an ADL questionnaire for the therapist and the patient.

Results: The patients showed large improvements in ADL functioning on all measures and small improvements on the apraxia test and the motor functioning test. The effect sizes for the disabilities, ranging from 0.92 to 1.06, were large compared to the effect sizes for apraxia (0.34) and motor functioning (0.19). The significant effect of treatment is also seen when individual improvement and subjective improvement are considered. Measured with the Barthel Index for instance, 71% of the patients improved.

Conclusions: These results suggest that the programme seems to be successful in teaching patients compensatory strategies that enable them to function more independently, despite the lasting presence of apraxia.
The effects of depression and abnormal illness behaviour on outcome following rehabilitation from stroke
Authors: Clark Michael S , Smith Dennis S
Published: May 2003

Objective: To examine the relative effects of depression and abnormal illness behaviour (AIB) on long-term rehabilitation outcome following stroke.

Design: A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and twelve months after discharge.

Setting: The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia.

Subjects: Ninety-four twelve-month stroke survivors who had undergone an inpatient rehabilitation programme.

Main outcome measures: AIB was assessed using the Illness Behaviour Questionnaire, and depression with the Zung Self-Rating Depression Scale. The General Health Questionnaire and a visual analogue mood scale were also used. Functional outcome was assessed with the competence and performance assessments of the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index.

Results: Multivariate analysis of outcome controlled for age and stroke severity. AIB was a better predictor of functional competence and performance than either age or stroke severity, at rehabilitation discharge and both six and twelve months later. Depression was not related to functional competence and performance at any assessment, but was strongly predictive of an inactive lifestyle at both six and twelve months. By contrast, lifestyle activities were not related to AIB.

Conclusions: Depression and AIB appear to have quite distinct effects on outcome. AIB emerged as a key determinant of long-term functional disability, while depression was associated with poorer social functioning. The early recognition and treatment of AIB and depression is important for the ultimate social and functional outcomes of stroke rehabilitation patients.
Association between amputation, arthritis and osteopenia in British male war veterans with major lower limb amputations
Authors: Kulkarni Jai , Adams Judith , Thomas Elaine , Silman Alan
Published: May 2003

Objectives: To investigate the association between amputation, osteoarthritis and osteopenia in male war veterans with major lower limb amputations. Specific questions were to determine whether lower limb amputees following trauma are at subsequent risk of developing osteoarthritis (OA) and osteoporosis of the hip on both the amputated and nonamputated sides.

Design: Retrospective cohort study in British Male Second World War veterans with major unilateral lower limb amputations.

Subjects: Seventy-five male Second World War veterans with major lower limb amputations known to be alive were invited to participate from a subregional rehabilitation centre. After exclusions, 44 agreed to attend for examination and radiological screening.

Methods: The presence of hip OA was determined from a single anterior posterior pelvic X-ray using two approaches: minimum joint space and the Kellgren and Lawrence (K&L) scoring system. Bone mineral density (BMD) was measured by a dual energy X-ray absorptiometry (DXA) scan and prosthetic rehabilitation outcome measures were recorded.

Results: Twenty-seven (61%) hips on the amputated side and 10 (23%) on the nonamputated side were positive for OA (based on Kellgren and Lawrence grade of >2). Using a minimum joint space threshold of below 2.5 mm, 24 (55%) hips on the amputation side and 8 (18%) on the nonamputated side were also positive for OA. There was a threefold increased risk of OA for those with above-knee compared to a below-knee amputation. By contrast, from published general population surveys only 4 (11%) cases of hip OA would have been expected on both the amputated and nonamputated hips.

There was a significant decrease in femoral neck BMD in the amputated side ( p <0.0001) and significantly lower BMD in above-knee amputees than in below-knee amputees ( p = 0.0027) as compared to normal age and sexmatched population.
An audit of anthropometric measurements by medical and physiotherapy staff in patients with ankylosing spondylitis
Authors: Lubrano Ennio , Butterworth Mike , Hesselden Anne , Wells Suzanne , Helliwell Philip
Published: May 2003

Background: The main treatments for ankylosing spondylitis (AS) are physical (exercise and stretching), and one way of measuring the effectiveness of these therapies is to record spinal movements in a standardized way. Patients are often seen in both medical (rheumatology) and physiotherapy clinics where duplicate information on their progress may be obtained. The purpose of this study was to assess the completeness of data collection for patients attending both medical and physiotherapy clinics.

Design: An audit of data recorded in medical and physiotherapy notes.

Subjects: Patient records identified either from computerized databases (Huddersfield and Bradford) or from a clinic at which only AS patients attended (Leeds). Data from attendances over a defined period were retrieved and recorded on a standard form. All patients thus identified were then cross-matched against those patients attending for physiotherapy during the same period and, where a match occurred, the same data were retrieved from the physiotherapy notes.

Minimum data set for audit: Before data collection started all participants agreed on the minimum data set required for adequate monitoring of patients with AS. The anthropometric measurements included height, chest expansion, cervical rotation, tragus to wall, modified Schober's flexion, extension, lumbar side flexion, intermalleolar abduction, and interfingertip abduction.

Results: Of 182 medical notes screened, 46 patients had not been seen in the defined period, leaving 136 notes to be reviewed. Of these, 52 patients had been seen in physiotherapy in the same period. In general, measurements were infrequently found in medical notes (only chest expansion in 58%, Schober's flexion in 48% and tragus to wall in 47% were measured with any regularity by medical staff). In contrast, corresponding data from physiotherapy notes were more complete (Schober's flexion and lumbar side flexion in 96%, height in 87%, intermalleolar distance in 87% and cervical rotation in 83%).

Conclusions: Follow-up and monitoring of AS patients in these medical clinics is clearly inadequate. Physiotherapy-led clinics have already been started in one of the study hospitals and the other centres are reviewing their arrangements for AS follow-up, including the possibility of a combined approach to patient management.
Designing a Back Management Service: the Exeter experience and first year results
Authors: Rae S A , Smyth J Blood , Ivens M , Penney C
Published: May 2003

Background: The recent British Clinical Standards Advisory Group report on back pain highlighted the importance of primary care in the active management of acute back pain and, at the same time, recommended the establishment of rehabilitation services for those with subacute and chronic back pain.

Objective: To describe a new Back Management Service (BMS) in Exeter and to review the first year's results.

Methods: Analysis of observational data collected from the clinic and therapy database.

Assessments: Clinic outcome assessed by diagnostic and referral patterns as well as by general practitioner questionnaire. The Back Management Programme was assessed by Short Form 36 (SF36), Hospital Anxiety and Depression score (HAD) and Oswestry Disability Index (ODI).

Results: In the first year 297 patients were seen in the clinic; clinic triage resulted in confirmation of primary care diagnosis in 235 (79%) of patients, with diagnosis revised in 62 (21%). One hundred and eighty-nine (63.6%) patients were referred for therapy. Of these, 54 were referred for one-to-one therapy and 135 were referred for multidisciplinary review with 29 patients subsequently recruited into the Back Management Programme for rehabilitation. Two out of three outcome measures were significantly improved at the end of the 36-hour, four-week course.

Conclusions: A Back Management Service can provide useful diagnostic reassessment of patients with chronic low back pain, and can focus therapeutic effort for the effective management of their pain.
Cognitive assessment in elderly patients admitted to hospital: the relationship between the Abbreviated Mental Test and the Mini-Mental State Examination
Authors: Swain David G , O'Brien Alicia G , Nightingale Peter G
Published: May 2003

Objective: To determine the relationship between Abbreviated Mental Test (AMT) and the Mini-Mental State Examination (MMSE) in elderly patients admitted to hospital.

Design: Prospective study of 364 consecutive admissions to an elderly medicine unit. Eighty-eight (24.2%) patients were excluded. The AMT and MMSE were administered to the remaining 276 patients and the relationship between the two tests evaluated statistically.

Setting: Inner city teaching hospital. Subjects: Two hundred and seventy-six patients admitted to the elderly medicine unit during October and November 1997. Main outcome measures: Predictive efficiency of the AMT for cognitive state by MMSE (the percentage of patients whose cognitive state by the MMSE was correctly categorized by the AMT). Association and predictive relationship between individual AMT and MMSE scores.

Results: There was a significant relationship between cognitive state as determined by the AMT and MMSE:2 = 101.3, df = 1, p <0.001. The predictive efficiency of the AMT was 79.0% (218/276). A strong association was found between the AMT and MMSE (Somers' d statistic 0.75: p <0.001). Simple linear regression allowed prediction of the MMSE score from the AMT score as follows: MMSE score = 7.06 + (1.94 × AMT score); p <0.001.

Conclusions: In patients admitted to the elderly medicine unit, the AMT gave predictive information about cognitive status as determined by the MMSE, and also a prediction of likely MMSE score.
A randomized controlled trial of day hospital and day centre therapy
Authors: Burch Sarah , Longbottom Jenny , McKay Maggie , Prevost Toby
Published: May 2003

Objective: To compare the outcome of day hospital to day centre rehabilitation.

Design: Single blind randomized controlled trial with home assessments at baseline (twice), six weeks and three months.

Setting: Mainly rural health district. Day hospital and social services day centres in market towns.

Subjects: One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discharge from hospital (66) or referred as outpatients (39).

Interventions: Day hospital treatment or day centre rehabilitation by a physiotherapist and two health support workers.

Main outcome measures: Barthel Index, Philadelphia Geriatric Morale Scale and Caregiver Strain Index.

Results: More day centre (23/55) than day hospital patients (6/50) ( p <0.001) withdrew from allocated treatment by choice or because of operational difficulties. Both groups improved significantly in functional ability and reduction of care-giver strain by three months but there was no significant difference between groups. The mean improvement in Barthel Index (standard error) for day hospital = +1.5 (0.41) ( n = 34) and day centres = +1.5 (0.48) ( n = 38). The mean difference (95% confidence interval) between day hospital and day centre was 0 (–1.28, +1.28). Likewise the mean Philadelphia Geriatric Morale Scale improvement for day hospital +1.8 (0.66) ( n = 35) and day centres was +0.9 (0.63) ( n = 38). The mean difference was –0.88 (–2.7, +0.95). The mean reduction in Caregiver Strain for day hospital was –1.45 (0.5) ( n = 23) and day centre was –1.59 (0.47) ( n = 27). The difference was –0.14 (1.52,+1.24). (These analyses are all on an intention-to-treat basis.)

Conclusion: Whilst the improvement in functional ability and care-giver strain was similar in both groups, day centre rehabilitation was less popular and had practical difficulties. If these difficulties can be overcome the model should be tested elsewhere.
Post-stroke depression and functional outcome: a cohort study investigating the influence of depression on functional recovery from stroke
Authors: van de Weg F B , Kuik D J , Lankhorst G J
Published: May 2003

Objective: To investigate the influence of depression on functional recovery after stroke.

Design: Multicentre cohort study of 85 patients admitted for clinical rehabilitation. A two-stage case-finding procedure was used to identify patients with depression. For the control group, consecutive nondepressed stroke patients were enrolled. Patients were interviewed at 3–6 weeks and six months after stroke onset.

Setting: Three rehabilitation centres in the vicinity of Amsterdam.

Main outcome measures: Functional outcome was determined by the Functional Independence Measure (FIM) and the Rehabilitation Activities Profile (RAP).

Results: The prevalence of depression (35%) was comparable with the findings of earlier studies in other settings. Patients classified as depressed according to DSM III R criteria (American Psychiatric Association Diagnostic and statistical manual of mental disorders) had a significantly lower functional score, both at onset and after follow-up (FIM and RAP). There was, however, no significant difference in functional improvement between the depressed and the nondepressed group. Mean functional improvement in the six patients treated with antidepressants was 30% better than in the untreated (depressed) patients; numbers were too small for the results to attain statistical significance. Subset analysis showed a significantly higher outcome for nondepressed patients for the FIM subitems personal care and transfers. However, functional improvement was not significantly different for any of the subitems in depressed versus nondepressed patients.

Conclusion: Stroke patients with depression have significantly lower functional scores both at onset and after six months. Our results suggest under-recognition of post-stroke depression and a possible beneficial effect of antidepressant medication in depressed stroke patients. Further studies are required to determine the effect of antidepressants.
Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function
Authors: Boissy Patrick , Bourbonnais Daniel , Carlotti Marie Madeleine , Gravel Denis , Arsenault Bertrand A
Published: May 2003

Objectives: Previous studies have shown that recovery of recordable grip strength in acute stroke subjects is one of the most sensitive assessments of initial upper limb recovery and a good prognostic factor for latter recovery. The objectives of this study were to test the reliability of maximal voluntary grip force (MVGF) measures and evaluate the relationship between paretic grip strength deficit and paretic upper extremity function in chronic stroke subjects.

Design: Over a three-week period, bilateral MVGF was assessed three times with a modified strain gauge dynamometer in 15 chronic stroke subjects and 10 control subjects. The paretic MVGF deficit was expressed in relation to the MVGF of the nonaffected hand.

Outcome measures: Upper extremity function in stroke subjects was measured using the Fugl-Meyer, the upper extremity performance test for the elderly (TEMPA), Box and Block and finger-to-nose tests.

Results: MVGF measures in both groups of subjects demonstrated good reliability (intraclass correlation, ICC >0.86) and low standard error measurements (SEM). The paretic MVGF of the stroke subjects was greatly impaired in comparison to the control subjects. Results of linear and quadratic regressions analyses show that this impairment was significantly correlated ( p <0.01) with the performance of the stroke subjects on the four upper extremity function tests. The percentages of variances explained by the MVGF deficit on all four upper extremity tests varied from 62% to 78% for the linear regressions and from 72% to 93% for the quadratic regressions.

Conclusions: These results suggest that the paretic maximal grip strength, normalized with the maximal grip strength on the nonaffected side, appears to be a valuable outcome measure of upper extremity function in chronic stroke subjects.
The UK FIM+FAM: development and evaluation
Authors: Turner-Stokes Lynne , Nyein Kyaw , Turner-Stokes Tabitha , Gatehouse Claire
Published: May 2003

Background and aims: The aim of this study was to develop and evaluate the UK version of the Functional Assessment Measure (UK FIM+FAM).

Design: Before and after evaluation of inter-rater reliability.

Development: Ten ‘troublesome’ items in the original FIM+FAM were identified as being particularly difficult to score reliably. Revised decision trees were developed and tested for these items over a period of two years to produce the UK FIM+FAM.

Evaluation: A multicentre study was undertaken to test agreement between raters for the UK FIM+FAM, in comparison with the original version, by assessing accuracy of scoring for standard vignettes.

Methods: Baseline testing of the original FIM+FAM was undertaken at the start of the project in 1995. Thirty-seven rehabilitation professionals (11 teams) each rated the same three sets of vignettes – first individually and then as part of a multidisciplinary team. Accuracy was assessed in relation to the agreed ‘correct’ answers, both for individual and for team scores. Following development of the UK version, the same vignettes (with minimal adaptation to place them in context with the revised version) were rated by 28 individuals (nine teams).

Results: Taking all 30 items together, the accuracy for scoring by individuals improved from 74.7% to 77.1% with the UK version, and team scores improved from 83.7% to 86.5%. When the 10 troublesome items were taken together, accuracy of individual raters improved from 69.5% to 74.6% with the UK version (p<0.001), and team scores improved from 78.2% to 84.1% (N/S). For both versions, team ratings were significantly more accurate than individual ratings (p<0.01). Kappa values for team scoring of the troublesome items were all above 0.65 in the UK version.

Conclusion: The UK FIM+FAM compares favourably with the original version for scoring accuracy and ease of use, and is now sufficiently well-developed for wider dissemination.
Fear of falling in patients with stroke: a reliability study
Authors: Hellström Karin , Lindmark Birgitta
Published: May 2003

Objective: To examine the scaling properties and test–retest reliability of an expanded version of the Falls Efficacy Scale (FES) and to compare group differences in the scores. The expanded version focuses on more basic, primary activities of daily living (ADL), which makes the scale more suitable for subjects with moderate to low functional ability, e.g. patients with stroke.

Design: A test–retest reliability study with one group convenience sample.

Setting: Two day-care units: a rehabilitation unit and a geriatric rehabilitation unit.

Subjects: A volunteer sample of 30 patients (mean age 65 years, SD 11 years) who had sustained stroke between 5 and 84 months prior to the investigation.

Main outcome measure: A 13-activity questionnaire (the Swedish modification of the Falls Efficacy Scale (FES(S)) comprising the 10 activities of the original FES and three additional activities was used. Falls efficacy was rated on a 10-point visual analogue scale for each activity on two occasions, 5–22 (mean 10, Md 7) days apart.

Results: The overall test–retest reliability of the FES(S) was high (intraclass correlation coefficient (ICC) = 0.97). The ICC for the personal ADL (items 1–6) scores was 0.93 and for the instrumental ADL (items 8–13) 0.97. ICC for the individual items ranged from 0.76 to 0.97.

Conclusions: On the basis of these preliminary findings, the FES(S) appears to have acceptable test–retest reliability. The test may be a reasonable addition for assessing stroke patients with balance disturbances and risk for falls.
Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke
Authors: Baskett Jonathan J , Broad Joanna B , Reekie Gabrielle , Hocking Clare , Green Geoff
Published: May 2003

Objective: To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists.

Design: A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital.

Setting: A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand.

Main outcome measures: (1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit.

Results: No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group ( p = 0.003).

Conclusions: A supervised home-based programme is as effective as outpatient or day hospital therapy.
Modelling and measuring the thermal behaviour of the molten pool in closed-loop controlled laser-based additive manufacturing
Authors: Hu D , Kovacevic R
Published: May 2003

Laser-based additive manufacturing (LBAM) is a promising manufacturing technology that can be widely applied in solid freeform fabrication (SFF), component recovery and regeneration, and surface modification. The thermal behaviour of the molten pool is one of the critical factors that influences laser deposition indices such as geometrical accuracy, material properties and residual stresses. In this paper, a three-dimensional finite element model is developed using ANSYS to simulate the thermal behaviour of the molten pool in building a single-bead wall via a closed-loop controlled LBAM process in which the laser power is controlled to keep the width of the molten pool constant. The temperature distribution, the geometrical feature of the molten pool and the cooling rate under different process conditions are investigated. To verify the simulation results, the thermal behaviour of the molten pool is measured by a coaxially installed infrared camera in experimental investigations of a closed-loop controlled LBAM process. Results from finite element thermal analysis provide guidance for the process parameter selection in LBAM, and develop a base for further residual stress analysis.
Prediction of collapsibility of moulds and cores of CO2 sands using a neural network
Authors: Ohdar R K , Pushp P T
Published: May 2003

The CO2 process of making sand moulds and cores is a well-established process and suitable for all types of foundry. However, the collapsibility of CO2 sand is quite poor. A variety of additives are used to improve collapsibility of CO2 sands. Several other process parameters also affect collapsibility of CO2 sands. In the present investigation an attempt has been made to use an artificial neural network (ANN) model for prediction of the collapsibility of CO2 sand. Experiments were conducted with various input process parameters, such as binder content, gassing time, temperature and additive content using three different additives, namely coal dust, dextrin and alumina. The objective of the experiments was to generate basic data to train a back-propagation ANN model and finally predict collapsibility in terms of retained compressive strength of CO2 sands for the test data. A three-layer neural network model with six input neurons corresponding to six input process parameters, one output neuron corresponding to collapsibility and 19 hidden neurons has been suggested, which gives a maximum error of 2 per cent in prediction of test data. Results indicate that prediction of the collapsibility of CO2 sand with an ANN model is feasible. Predicted values match experimental values quite closely.
IPCC Sres Revisited: A Response
Authors: Nakicenovic Nebojsa , Grübler Arnulf , Gaffin Stuard , Jung Tae Tong , Kram Tom , Morita Tsuneyuki , Pitcher Hugh , Riahi Keywan , Schlesinger Michael , Shukla P. R. , van Vuuren Detlef , Davis Ged , Michaelis Laurie , Swart Rob , Victor Nadja
Published: May 2003

Mr. Castles and Mr. Henderson have criticized the Special Report on Emissions Scenarios (SRES) and other aspects of IPCC assessments. It is claimed that the methodology is “technically unsound” because market exchange rates (MER) are used instead of purchasing power parities (PPP) and that the scenarios themselves are flawed because the GDP growth in the developing regions is too high.

The response is: The IPCC SRES reviews existing literature, most of which is MER based, including that from the World Bank, IEA and USDoE. Scenarios of GDP growth are typically expressed as MER (the preferred measure for GDP growth, as opposed to PPP which is a preferred measure for assessing differences in economic welfare). IPCC scenarios did include PPP-based scenarios, which Mr. Castles and Mr. Henderson have conveniently ignored. Contrary to what Mr. Castles and Mr. Henderson claim, IPCC scenarios are consistent with historical data, including that from 1990 to 2000, and with the most recent near term (up to 2020) projections of other agencies. Long-term emissions are based on multiple, interdependent driving forces, and not just economic growth. Mr. Castles and Mr. Henderson need to look beyond GDP. The IPCC scenarios provided information for only four world regions, and not for specific countries. Mr. Castles' and Mr. Henderson's critique is not of IPCC scenarios but of ongoing unpublished work in progress that is not part of SRES.

We therefore show that Mr. Castles and Mr. Henderson have focused on constructing a “problem” that does not exist. SRES scenarios are sound and the IPCC has responded seriously and conscientiously.

We detail our response below in nine sections. After an introduction (Section 1), we outline the SRES methodology for measuring economic output (Section 2). Section 3 compares SRES to long-historical economic development and provides five responses to the critics. Section 4 addresses the issue of country-level economic projections even if not part of SRES. Sections 5, 6 and 7 validate the SRES scenarios by comparing them with recent trends for economic and CO2 emission growth, as well as more recent scenarios available in the literature. Section 8 refutes the argument that lower economic growth in developing countries would lower GHG emissions correspondingly. Section 9 concludes.
Lambertian Enclosures — A First Step towards Fast Room Acoustics Simulation
Authors: Alarcão D. , Coelho J. L. Bento
Published: May 2003

A statistical method for calculation of the acoustical parameters of lambertian enclosures (that is, enclosures with diffusely reflecting boundaries) is presented. The theory considers the distribution of sound particles over the boundaries of the enclosures. The method includes the familiar Kuttruff Integral Equation. A homogeneous Markov Chain of first order is obtained through the time discretisation of the equations. Applications of this method are demonstrated for the case of a long enclosure and for the case of a real-shaped room. Decay calculations as well as steady-state sound distributions are obtained. The results show that the method is reliable, flexible, and that computation times are low.
An Integrated Acoustic/Microseismic Approach to Monitoring Low Frequency Noise & Vibration — A Case Study
Authors: Rushforth Ian , Moorhouse Andy , Styles Peter
Published: May 2003

It is proposed that low frequency noise/vibration problems are best tackled by a combination of acoustic and microseismic methods, rather than using each method in isolation. A new integrated method was devised and it was demonstrated that ‘the whole is greater than the sum of the parts’. The benefits and versatility of the new method are illustrated with reference to a case study. Unmanned monitoring took place at several houses near to an industrial site, using a multi-channel recording technique. Comparison of various components of the sound and vibration fields in each house was then carried out, which allowed various propagation paths to be distinguished. A range of further signal processing analyses was also employed to aid source determination.
Erroneous verbalizations and risk taking at video lotteries
Authors: Caron Anne , Ladouceur Robert
Published: May 2003

This study examined the effect of erroneous perceptions verbalized by a game accomplice on participants' gambling. The sample consisted of 22 men and 10 women, aged 18 and older, who did not show excessive gambling problems, but who had played video lotteries at least once during the last 6 months. The participants were randomly assigned into one of three groups, where they gambled in the presence of an accomplicewho verbalized three types of perceptions: (1) the accomplice emitted erroneous thoughts about gambling,(2) the accomplice verbalized adequate thoughts about gambling, or (3) the accomplice did not speak. Results showed that players exposed to an accomplice's erroneous verbalizations took significantly more risksthan players in the other two groups. Erroneous perceptions appear to be easily transmissible and have impacts on gambling behaviour. The practical and theoretical implications of these results are discussed.
Mental undoing of actions and inactions in the absence of counterfactuals
Authors: Avni‐Babad Dinah
Published: May 2003

Three studies investigated the emotional impact of actions and inactions in the long term when no counterfactuals were provided. Using the investment scenario, Byrne and McEleney (2000) showed that people did not regret inaction more than action in the long term when they knew the counterfactuals of both. In the present Experiments 1 and 2, it was found that when both counterfactuals were not known, people still judged that actions would be regretted more than inactions not only in the short term but also in the long term. In Experiment 3, the actor and the non‐actor were judged separately. As expected, no emotional difference was found between them, but the actor was attributed worse feelings in the long term than in the short term.
An hp‐adaptive finite element method for electromagnetics. Part 3: A three‐dimensional infinite element for Maxwell's equations
Authors: Cecot W. , Rachowicz W. , Demkowicz L.
Published: May 2003

This paper is a continuation of Reference [26] (Cecot, Demkowicz and Rachowicz, Computer Methods in Applied Mechanics and Engineering 2000; 188: 625–643) and describes an implementation of the infinite element for three‐dimensional, time harmonic Maxwell's equations, proposed in Reference [15] (Demkowicz and Pal, Computer Methods in Applied Mechanics and Engineering 1998; 164: 77–94). The element is compatible with the hp finite element discretizations for Maxwell's equations in bounded domains reported in References [16–18] (Computer Methods in Applied Mechanics and Engineering 1998; 152: 103–124, 1999; 169: 331–344, 2000; 187: 307–337). Copyright © 2003 John Wiley & Sons, Ltd.
Knowledge continuity: The new management function
Authors: Beazley Hamilton , Boenisch Jeremiah , Harden David
Published: May 2003

It is obvious that everything that happens in an organization happens because of someone's knowledge.
It's not so obvious, however, that many inefficiencies, breakdowns, and even business failures could be
traced to knowledge not having resided in the right place. Either knowledge is not shared,
person‐to‐person, or it is lost when its possessor leaves the firm—and has to be
re‐created the hard way by that person's successor. Because of all the forces today that require
business to be better, faster, and smarter to survive, it becomes critical for managers to recognize the
precious value of knowledge—and protect it by disseminating it. © 2003 Wiley Periodicals,
Inc.
Deregulation of the RB pathway in human testicular germ cell tumours
Authors: Bartkova Jirina , Lukas Claudia , Sørensen Claus S , Meyts Ewa Rajpert‐De , Skakkebæk Niels E , Lukas Jiri , Bartek Jiri
Published: May 2003

Deregulation of the RB pathway is shared by most human malignancies. Components upstream of the retinoblastoma tumour suppressor (pRB), namely the INK4 family of cyclin‐dependent kinase (CDK) inhibitors, the D‐type cyclins, their partner kinases CDK4/CDK6, and pRB as their critical substrate, are differentially targeted in diverse types of cancer. An ‘unorthodox’ spectrum of defects within this cascade occurs in testicular germ cell tumours (TGCTs), including silencing of pRB transcription, overexpression of cyclin D2, and loss of p18INK4c. To improve understanding of the role of this pathway in spermatogenesis, and its subversion in TGCTs, we examined immunohistochemical expression patterns of CDK4, p16INK4a, p15INK4b, and pRB, and established an in situ assay for cyclin D‐mediated phosphorylation of serine795, a phosphorylation event critical for neutralization of pRB's growth‐restraining ability. pRB was expressed throughout adult spermatogenesis and was detectable in teratomas, but was absent or grossly reduced in carcinoma in situ (CIS) and most seminomas and embryonal carcinomas. Unexpectedly, we also found that pRB was absent from fetal human gonocytes, the candidate target cell for all types of TGCTs. Thus, rather than a tumorigenesis‐promoting loss of pRB, the lack of pRB in TGCTs likely reflects its developmental control. Widespread expression of p15INK4b, found in normal testes, was preserved in TGCTs. In contrast, p16INK4a was lost or reduced in large subsets of TGCTs. CDK4 was expressed in normal spermatogonia, CIS, and invasive TGCTs, as was serine795‐phosphorylated pRB. Our data on expression of pRB support the plausible origin of TGCTs from fetal gonocytes, and the serine795 phosphorylation demonstrates that the cyclin D‐dependent kinases are active, and neutralize pRB in spermatogonia and in those TGCTs that express pRB. We hope that this study will inspire further immunohistochemical applications of phosphospecific antibodies in pathology, and examination of the RB pathway defects in relation to curability of TGCTs. Copyright © 2003 John Wiley & Sons, Ltd.
Role of Preoperative Plasma CA 15‐3 and Carcinoembryonic Antigen Levels in Determining Histopathologic Conventional Prognostic Factors for Breast Cancer
Authors: Seker Duray , Kaya Oskay , Adabag Aysegul , Necipoglu Gaye , Baran Ismet
Published: May 2003

Abstract

Breast cancer is one of the leading causes of cancer death among women all over the world, with about one million new breast cancer cases diagnosed per year. This large number of cases make the diagnosis, treatment, and determination of the factors affecting the survey extremely important. The aim of this study was to evaluate the importance of the preoperative plasma CA 15‐3 and carcinoembryonic antigen (CEA) levels when determining the conventional histopathologic prognostic factors (tumor grade, lymphatic infiltration, stromal invasion, vessel invasion, tumor necrosis, elastosis, and number of positive lymph nodes in levels I and II). We believe that with this protocol doctors can add to their knowledge about the prognosis of patients. After examining the serum tumor marker levels and the histopathology results of 29 patients and submitting them to statistical calculations, we strongly believe that preoperative serum CA 15‐3 levels can be taken into consideration when evaluating the prognosis because the CA 15‐3 level is directly and positively correlated with the gold standard prognostic factor: the number of level I and II positive lymph nodes.