bluuebunny/crossref_metadata_2025 huggingface dataset:
Confirmatory Program Evaluation: A Method for Strengthening Causal Inference
Authors: Reynolds Arthur J.
Published: August 2005

This paper discusses current issues in theory-driven evaluation from the perspective of the evaluation practice literature. Applications of theory-driven approaches are not easily found, in part, because there are few procedures for conducting them. I offer confirmatory program evaluation as one way to use theory, in combination with quantitative analytical techniques, to assess the effects of social and educational programs. In contrast to many other approaches, theory-driven evaluation generally emphasizes the explication and testing of a priori program theories in determining effectiveness. Confirmatory program evaluation is an impact assessment that examines the pattern of empirical findings against several causal criteria, including temporality, size, gradient (dosage/response), specificity, consistency, and coherence of the program-outcome relationship. A special emphasis is given to identifying causal mechanisms or active ingredients of programs that yield effects. An illustration of confirmatory program evaluation is provided for a child development intervention called the Child Parent Center Program. The limitations of this method are discussed, as well as the conditions under which it is most useful.
Stakeholder Participation for the Purpose of Helping Ensure Evaluation Validity: Bridging the Gap Between Collaborative and Non-collaborative Evaluations
Authors: Brandon Paul R.
Published: August 2005

Collaborative evaluations, in which program stakeholders participate extensively, typically are conducted for the primary purpose of enhancing the use of evaluation findings, and non-collaborative evaluations, in which stakeholders do not participate extensively, typically are conducted for the primary purpose of generating valid findings. This article shows how the gap can be bridged between these two types of evaluations. The article synthesizes, and elaborates on, a small body of recent research that showed that considerable interaction with stakeholders during the evaluation of small education programs helped achieve the raison d’etre of non-collaborative evaluations-that is, to enhance validity. It is also shown that theories and methods of stakeholder participation for the purpose of enhancing validity, which by and large have been ignored in the collaborative evaluation literature, can improve the quality of collaborative studies.
Stakeholder Collaboration in the Design and Implementation of a Family Literacy Portfolio Assessment
Authors: Johnson Robert L. , Willeke Marjorie J. , Steiner Deila J.
Published: August 2005

Collaborative, participatory, and empowerment forms of evaluation advocate the inclusion of stakeholders in decision-making roles in the evaluation process; however; little in the literature describes the involvement of stakeholders in the design and implementation of evaluative tools for data collection. This case study describes the collaborative process and the lessons learned when the staff of a family literacy program and an evaluator collaborated to design and implement a portfolio assessment that was used to collect program evaluation information over a two-year period. The program, Even Start, provides integrated education and human services to meet the literacy needs of participants. The evaluation offered opportunities to collaborate with stakeholders-the program coordinator and family educators-in each step of the creation and implementation of the portfolio system.
The Meta-Evaluand: The Evaluation of Project TEAMS
Authors: Cooksy Leslie J.
Published: August 2005

In August 1997, a series of messages on EVALTALK, the American Evaluation Association’s electronic discussion group, emphasized the need for meta-evaluation. To prompt public critique and discussion, this description of the evaluation of Project TEAMS was submitted to The American Journal of Evaluation. The evaluation used a program logic model to guide data collection and reporting activities and relied on multiple sources of data. Because of implementation problems in the program and the inability of the evaluation’s methods to support strong inferences, the evaluation’s conclusions about the program were mixed and tentatively stated. The public review by independent evaluators of an evaluation that is not exemplary, but may be typical in its strengths and weaknesses, is expected to demonstrate the utility of meta-evaluation to evaluators and evaluation clients and audiences
Toward an Integrative Framework for Evaluation Practice
Authors: Mark Melvin M. , Henry Gary T. , Julnes George
Published: August 2005

Evaluation has been beset with serious divisions, including the paradigm wars and the seeming segmentation of evaluation practice into distinct evaluation theories and approaches. In this paper, we describe key aspects of an integrative framework that may help evaluators move beyond such divisions. We offer a new scheme for categorizing evaluation methods within four inquiry modes, which are “families” or clusters of methods: description, classification, causal analysis, and values inquiry. In addition, we briefly describe a set of alternative evaluation purposes. We argue that, together with a form of realist philosophy, the framework of inquiry modes and evaluation purposes (1) provides a common lexicon for evaluators, which may help the field in moving beyond past divisions, and (2) offers a useful approach to evaluation planning.
Some Non-Randomized Constructed Comparison Groups for Evaluating Age-Related Outcomes of Intervention Programs
Authors: McCall Robert B. , Ryan Carey S. , Green Beth L.
Published: August 2005

The evaluations of many intervention programs for young children are hampered by the lack of untreated comparison groups. Simple pre-post comparisons or more elaborate growth profile analyses within a single treatment group cannot separate changes associated with the treatment from normal developmental changes typical of the participant population. To address this issue, some non-randomized constructed comparison strategies that can be used to evaluate interventions are outlined and illustrated for outcome variables that would be expected to change over age if no treatment were given. Such a dependent variable might include general indices of developmental progress in young children, which may decline over the first few years of life in low-income, high-risk samples or may increase over age in middle-class groups suffering adverse perinatal circumstances and disorders even without special interventions. The proposed strategy consists of determining an expected age function for the dependent variable using pretest scores (if participants enter the treatment program at different ages) or using pretest scores of older siblings who vary in age at the start of the program, and then calculating an age-adjusted expected posttest score against which actual posttest performance may be evaluated. This approach also permits analysis of participants enrolled in the treatment for varying lengths of time and over somewhat different age spans.
Surveying Through Cyberspace
Authors: Supovitz Jonathan A.
Published: August 2005

This article describes an evaluator’s experience constructing a World Wide Web site to collect evaluation data. Data collection via the Web presents a series of technical and design challenges. Eight lessons surrounding Web site development, including site design, data management, data presentation, and computer platform considerations are discussed. The article concludes that Web-based data collection has several possible advantages over paper-and-pencil forms and is a promising method that does not compromise data quality.
Focus Group Design and Group Dynamics: Lessons from Deaf and Hard of Hearing Participants
Authors: Balch George I. , Mertens Donna M.
Published: August 2005

Focus groups are a common tool in evaluation. Here we report experience conducting focus groups with deaf and hard of hearing people, from which we reflect on lessons learned about how we can more effectively “listen” to people in all focus groups—particularly those that don’t intentionally include people with a hearing loss. We learned that: (1) focus groups with deaf and hard of hearing people can be highly productive on even the most sensitive issues and across disparate socioeconomic and ethnic differences if they share a common interest and mode of communication; (2) the physical environment of group communication may count more than we usually notice; (3) insuring communication requires a very high level of vigilance by moderators and observers; (4) it is hard to “focus” focus groups in some cultures, so one must allow for that; (5) genuine communication may require more time and patience than one might expect; (6) confidentiality in a marginalized community may require special attention; (7) an experienced moderator who is an “outsider” to the group’s culture or experience can be very useful; and (8) feedback from observers, evaluators, and participants can improve communication. Most of all, we learned that focus groups can be much more productive when we are sensitized to invisible communication difficulties.
Minority Issues in Evaluation Revisited: Re-Conceptualizing and Creating Opportunities for Institutional Change
Authors: Hopson Rodney K.
Published: August 2005

This paper, while a commentary on Professor Stanfield’s plenary presentation, is as much a critique of how evaluation researchers, the larger profession, and professional organizations come to terms with research on, issues about, and interests that impact people (and scholars) of color. First, I suggest that we revisit minority issues within a broader context of our American educational and social structure. Second, I focus on ways to create institutional change, such as through recruiting and mentoring junior evaluation researchers of color and from other underrepresented groups. Hardly complete, the ideas in this commentary are intended to highlight encouraging vehicles and initiatives from other educational scholars and peer associations, in the hope of contributing to the rethinking of minority issues in evaluation.
AEA Members’ Opinions Concerning Evaluator Certification
Authors: Jones Steven C. , Worthen Blaine R.
Published: August 2005

Professional certification is sometimes advocated as a means of assuring consumers that they are getting someone who is skilled and knowledgeable within their trade. Certification is also sometimes viewed as advantageous for enhancing professions’ prestige, promoting professionalism, improving academic programs, and helping to define a profession. Without the acceptance by an organization’s members, however, any efforts to implement a certification process are likely instead to be divisive and dysfunctional. This article presents the results of a survey carried out by a recent AEA Task Force on certification.
The Case for a Voluntary System for Credentialing Evaluators
Authors: Altschuld James W.
Published: August 2005

A voluntary system for credentialing evaluators is described. I examine the urgent need for such a system in the field of evaluation, as well as various concerns regarding credentialing. The paper also includes an unabridged and adapted version of a table that was used in a debate on certification at the 1998 annual meeting of the American Evaluation Association in Chicago. The table is helpful in understanding both the pro and con sides of the credentialing issue.
Should AEA Begin a Process for Restricting Membership in the Profession of Evaluation?
Authors: Smith M. F.
Published: August 2005

In this paper I present an argument supporting the position that AEA should not undertake a certification or similar process at the present time, even though I believe the public needs some type of protection from unscrupulous and incompetent evaluators. The problems a certification process would solve have not been substantiated; the public may not support such an endeavor; “evaluation” is not clearly defined, which means the knowledge and skills (K/S) unique to its practice and performance criteria are not agreed upon; and the process for putting a certification system into place is a very complex and costly undertaking (e.g., ensuring the accuracy and integrity of determining who does and does not have the requisite K/S and who is applying them in an effective manner). In addition, certification would require establishing some way to decertify incompetent practitioners, and being able to defend all of these actions when there is disagreement and even litigation. I believe that AEA is not likely to be able to do these things in an effective manner, in the near future.
Durable hematologic complete response and suppression of HTLV-1 viral load following alemtuzumab in zidovudine/IFN-α–refractory adult T-cell leukemia
Authors: Mone Andrew , Puhalla Shannon , Whitman Susan , Baiocchi Robert A. , Cruz Julio , Vukosavljevic Tamara , Banks Amy , Eisenbeis Charles F. , Byrd John C. , Caligiuri Michael A. , Porcu Pierluigi
Published: August 2005

Adult T-cell leukemia (ATL) is a highly chemoresistant and usually fatal T-cell malignancy due to the human T-cell lymphotropic virus-1 (HTLV-1). After chemotherapy failure, antiretrovirals and interferon-α (IFN-α) produce brief responses followed by progression and death. More effective agents and new approaches to detect and treat minimal residual disease are needed. ATL cells express CD52, the target of the antibody alemtuzumab, which is active in a preclinical model of ATL and is cytotoxic for p53-deficient cells. A patient with refractory chronic ATL in transformation achieved longer than a 1-year complete hematologic response following 12 weeks of outpatient subcutaneous alemtuzumab. Persistent suppression of HTLV-1 viral load, even at recovery of T cells, after alemtuzumab and efficient in vitro complement-mediated cytotoxicity of primary ATL cells with mutated TP53 were observed. The unprecedented response and the profound suppression of HTLV-1 viral load observed in this patient suggest that further clinical investigation of alemtuzumab in ATL is warranted.
Ku80 autoantigen as a cellular coreceptor for human parvovirus B19 infection
Authors: Munakata Yasuhiko , Saito-Ito Takako , Kumura-Ishii Keiko , Huang Jie , Kodera Takao , Ishii Tomonori , Hirabayashi Yasuhiko , Koyanagi Yoshio , Sasaki Takeshi
Published: August 2005

Human parvovirus B19 (B19) infects human erythroid cells expressing P antigen. However, some cell lines that were positive for P antigen failed to bind B19, whereas some cell lines had an ability to bind B19 despite undetectable expression of P antigen. We here demonstrate that B19 specifically binds with Ku80 autoantigen on the cell surface. Furthermore, transfection of HeLa cells with the gene of Ku80 enabled the binding of B19 and allowed its entry into cells. Moreover, reduction of cell-surface expression of Ku80 in KU812Ep6 cells, which was a high-sensitive cell line for B19 infection, by short interfering RNA for Ku80 resulted in the marked inhibition of B19 binding in KU812Ep6 cells. Although Ku80 originally has been described as a nuclear protein, human bone marrow erythroid cells with glycophorin A or CD36, B cells with CD20, or T cells with CD3 were all positive for cell-surface expression of Ku80. B19 infection of KU812Ep6 cells and bone marrow cells was inhibited in the presence of anti-Ku80 antibody. Our data suggest that Ku80 functions as a novel coreceptor for B19 infection, and this finding may provide an explanation for the pathologic immunity associated with B19 infection.
Multiple roles of Rap1 in hematopoietic cells: complementary versus antagonistic functions
Authors: Stork Philip J. S. , Dillon Tara J.
Published: August 2005

Small G proteins serve as critical control points in signal transduction, integrating a wide range of stimuli to dictate discrete cellular outcomes. The outcomes of small G-protein signaling can both potentiate and antagonize one another. Studies in hematopoietic cells have uncovered multiple functions for the small G protein, Rap1 (Ras-proximate-1). Because Rap1 can regulate cell proliferation, differentiation, and adhesion through distinct mechanisms, it serves as a paradigm for the need for tight cellular control of small G-protein function. Rap1 has received recent attention for its role in enhancing integrin-dependent signals. This action of Rap1 augments a variety of processes that characterize hematopoietic-cell function, including aggregation, migration, extravasation, and homing to target tissues. Rap1 may also regulate cellular differentiation and proliferation via pathways that are distinct from those mediating adhesion, and involve regulation of the mitogen-activated protein (MAP) kinase or ERK (extracellular signal-regulated kinase) cascade. These actions of Rap1 occur in selected cell types to enhance or diminish ERK signaling, depending on the expression pattern of the MAP kinase kinase kinases of the Raf family: Raf-1 and B-Raf. This review will examine the functions of Rap1 in hematopoietic cells, and focus on 3 cellular scenarios where the multiple actions of Rap1 function have been proposed. Recent studies implicating Rap1 in the maturation of megakaryocytes, the pathogenesis of chronic myelogenous leukemia (CML), and activation of peripheral T cells will receive particular attention.
Immunoglobulin light chain repertoire in chronic lymphocytic leukemia
Authors: Stamatopoulos Kostas , Belessi Chrysoula , Hadzidimitriou Anastasia , Smilevska Tatjana , Kalagiakou Evangelia , Hatzi Katerina , Stavroyianni Niki , Athanasiadou Anastasia , Tsompanakou Aliki , Papadaki Theodora , Kokkini Garyfallia , Paterakis George , Saloum Riad , Laoutaris Nikolaos , Anagnostopoulos Achilles , Fassas Athanasios
Published: August 2005

Immunoglobulin kappa (IGK) and immunoglobulin lambda (IGL) light chain repertoire was analyzed in 276 chronic lymphocytic leukemia (CLL) cases and compared with the relevant repertoires from normal, autoreactive, and neoplastic cells. Twenty-one functional IGKV genes were used in IGKV-J rearrangements of 179 kappa-CLL cases; the most frequent genes were IGKV3-20(A27), IGKV1-39/1D-39(O2/O12), IGKV1-5(L12), IGKV4-1(B3), and IGKV2-30(A17); 90 (50.3%) of 179 IGK sequences were mutated (similarity < 98%). Twenty functional IGLV genes were used in IGLV-J rearrangements of 97 lambda-CLL cases; the most frequent genes were IGLV3-21(VL2-14), IGLV2-8(VL1-2), and IGLV2-14(VL1-4); 44 of 97 IGL sequences (45.4%) were mutated. Subsets with “CLL-biased” homologous complementarity-determining region 3 (CDR3) were identified: (1) IGKV2-30-IGKJ2, 7 sequences with homologous kappa CDR3 (KCDR3), 5 of 7 associated with homologous IGHV4-34 heavy chains; (2) IGKV1-39/1D-39-IGKJ1/4, 4 unmutated sequences with homologous KCDR3, 2 of 4 associated with homologous IGHV4-39 heavy chains; (3) IGKV1-5-IGKJ1/3, 4 sequences with homologous KCDR3, 2 of 4 associated with unmutated nonhomologous IGHV4-39 heavy chains; (4) IGLV1-44-IGLJ2/3, 2 sequences with homologous lambda CDR3 (LCDR3), associated with homologous IGHV4-b heavy chains; and (5) IGLV3-21-IGLJ2/3, 9 sequences with homologous LCDR3, 3 of 9 associated with homologous IGHV3-21 heavy chains. The existence of subsets that comprise given IGKV-J/IGLV-J domains associated with IGHV-D-J domains that display homologous CDR3 provides further evidence for the role of antigen in CLL pathogenesis.
Sample phenotype clusters in high-density oligonucleotide microarray data sets are revealed using Isomap, a nonlinear algorithm
Authors: Dawson Kevin , Rodriguez Raymond L , Malyj Wasyl
Published: August 2005

Background

Life processes are determined by the organism's genetic profile and multiple environmental variables. However the interaction between these factors is inherently non-linear [1]. Microarray data is one representation of the nonlinear interactions among genes and genes and environmental factors. Still most microarray studies use linear methods for the interpretation of nonlinear data. In this study, we apply Isomap, a nonlinear method of dimensionality reduction, to analyze three independent large Affymetrix high-density oligonucleotide microarray data sets.

Results

Isomap discovered low-dimensional structures embedded in the Affymetrix microarray data sets. These structures correspond to and help to interpret biological phenomena present in the data. This analysis provides examples of temporal, spatial, and functional processes revealed by the Isomap algorithm. In a spinal cord injury data set, Isomap discovers the three main modalities of the experiment – location and severity of the injury and the time elapsed after the injury. In a multiple tissue data set, Isomap discovers a low-dimensional structure that corresponds to anatomical locations of the source tissues. This model is capable of describing low- and high-resolution differences in the same model, such as kidney-vs.-brain and differences between the nuclei of the amygdala, respectively. In a high-throughput drug screening data set, Isomap discovers the monocytic and granulocytic differentiation of myeloid cells and maps several chemical compounds on the two-dimensional model.

Conclusion

Visualization of Isomap models provides useful tools for exploratory analysis of microarray data sets. In most instances, Isomap models explain more of the variance present in the microarray data than PCA or MDS. Finally, Isomap is a promising new algorithm for class discovery and class prediction in high-density oligonucleotide data sets.
Comparison of spatial scan statistic and spatial filtering in estimating low birth weight clusters
Authors: Ozdenerol Esra , Williams Bryan L , Kang Su Young , Magsumbol Melina S
Published: August 2005

Background

The purpose of this study is to examine the spatial and population (e.g., socio-economic) characteristics of low birthweight using two different cluster estimation techniques. We compared the results of Kulldorff's Spatial Scan Statistic with the results of Rushton's Spatial filtering technique across increasing sizes of spatial filters (circle). We were able to demonstrate that varying approaches exist to explore spatial variation in patterns of low birth weight.

Results

Spatial filtering results did not show any particular area that was not statistically significant based on SaTScan. The high rates, which remain as the filter size increases to 0.4, 0.5 to 0.6 miles, respectively, indicate that these differences are less likely due to chance. The maternal characteristics of births within clusters differed considerably between the two methods. Progressively larger Spatial filters removed local spatial variability, which eventually produced an approximate uniform pattern of low birth weight.

Conclusion

SaTScan and Spatial filtering cluster estimation methods produced noticeably different results from the same individual level birth data. SaTScan clusters are likely to differ from Spatial filtering clusters in terms of population characteristics and geographic area within clusters. Using the two methods in conjunction could provide more detail about the population and spatial features contained with each type of cluster.
Obstetrical brachial plexus injuries: incidence, natural course and shoulder contracture
Authors: Hoeksma A F , Wolf H , Oei S L
Published: August 2005

The incidence of obstetric brachial plexus injury (OBPI) was investigated and the natural course of this disorder and the frequency of shoulder contracture described. Between 1988 and 1997 13 366 children with a gestational age of 30 weeks or more, were born at the Academic Medical Center, Amsterdam. Of these, 62 had an OBPI (4.6 per 1000). Complete neurological recovery occurred in 72.6% of cases. Half of them had a delayed recovery of more than three weeks (mean recovery time 6.2 ± 3.1 months). Shoulder contracture occurred in at least one-third of the children with delayed recovery and in at least two-thirds of the children with incomplete recovery. The incidence of OBPI in our hospital was found to be higher and to have a less favourable natural course than is usually reported in the literature. Contracture of the shoulder joint is frequently found even in infants with complete neurological recovery.
A pilot study comparing the cognitive demand of walking for transfemoral amputees using the Intelligent Prosthesis with that using conventionally damped knees
Authors: Heller B W , Datta D , Howitt J
Published: August 2005

Objective: To compare the cognitive demand of walking when using a conventional prosthesis with that using a microprocessor-controlled prosthesis.

Design: Ten unilateral transfemoral amputees wearing conventional pneumatic swing phase control (conventional prosthesis) prostheses walked on a treadmill which enforced a pattern of constantly varying speeds. The subjects simultaneously performed a simple or a complex distracting task. Following a period of accustomization, the subjects performed the same test wearing a prosthesis with microprocessor control of swing phase damping (the Intelligent Prosthesis).

Outcome measures: The three-dimensional trajectory (sway) of a retroreflective marker attached to the forehead was measured by a video-based motion analysis system, and used as a measure of gait quality. The ratio of the sway for the complex task over the simple task (the ‘automation index’) was used as a measure of the degree of automation of gait.

Results: No significant differences were found in the automation index between the two devices. However, the total sway for the conventional prosthesis was significantly higher. Sway during the complex distracting task was significantly higher than during the simple task.

Conclusions: The microprocessor-controlled prosthesis was not found to be less cognitively demanding than a conventional prosthesis.
Clinical standards for inpatient specialist rehabilitation services in the UK
Authors: Turner-Stokes Lynne , Williams Heather , Abraham Rachel , Duckett Stephane
Published: August 2005

Objective: To develop a set of clinical standards for specialist inpatient rehabilitation services in the UK and to undertake a preliminary survey of consultants who provide those services.

Design: The proposed set of standards was developed by group consensus followed by an iterative consultation process. A postal survey was conducted on behalf of the British Society for Rehabilitation Medicine (BSRM) amongst its consultant members in the UK (n = 163), who were asked to assess their services in relation to these standards, and to comment on the standards themselves, their usefulness and applicability.

Results: The response rate was 61%, of which 81 respondents ran an inpatient rehabilitation service. Overall, the standards appeared to be acceptable to most, and mainly struck the right level, being attained by the majority of services. Specific suggestions were incorporated into the revised standards. Further work is required to establish agreed outcomes that are systematically measured and recorded: only half the respondents (50%) routinely recorded a standardized outcome measure, and only a quarter (26%) routinely reviewed patients to record long-term outcome.

Conclusions: Clinical standards have been developed for specialist inpatient rehabilitation services in the UK. The BSRM proposes to adopt these standards for a test period of 2–3 years in the first instance. It is likely that they will require further refinement with time, and modification is required to adapt them to different subspecialities and settings.
Balance function and fall-related efficacy in patients with newly operated hip fracture
Authors: Ingemarsson A Hellzén , Frändin K , Hellström K , Rundgren Å
Published: August 2005

Objective: To investigate the relation between fall-related efficacy in daily-life activities and functional as well as instrumental tests of balance in patients with hip fracture.

Design: Analysis of different aspects of balance using the Falls Efficacy Scale, Swedish version FES(S), questions on fear of falling, Functional Reach (FR) and tests on a balance platform (Chattanooga).

Subjects: Fifty-five elderly inpatients (mean age 82.3) with newly operated hip fracture who were assessed during the last week in hospital before discharge.

Results: The results showed a significant relationship between the subjective ability measured with the FES(S) and the objectively measured balance in the Functional Reach test and also between fall-related efficacy measured with FES(S) and fear of falling. Very few significant correlations were found between the results from balance tests on the force platform and those obtained with FES(S) and FR.

Conclusions: Both the Falls Efficacy Scale, Swedish version, and the Functional Reach have been shown to be useful in analysing balance function in elderly patients newly operated on for hip fracture. The Falls Efficacy Scale also indicates which of the daily activities the patient perceives as troublesome and thus require further training.
The effectiveness of community-based rehabilitation for stroke patients who remain at home: a pilot randomized trial
Authors: Wolfe Charles DA , Tilling Kate , Rudd Anthony G
Published: August 2005

Objective: To assess the effectiveness of community-based rehabilitation for stroke patients who were not admitted to hospital in South London.

Design: Randomized controlled trial.

Setting: Patients' homes in South London.

Subjects: Stroke patients not admitted to hospital after a stroke.

Intervention: Rehabilitation at home by rehabilitation team for up to three months or usual care.

Main outcome measures: The primary outcome measure was the Barthel score. Secondary measures included the Motricity Index, Rivermead ADL, Hospital Anxiety and Depression score and Nottingham Health Profile.

Results: Forty-three patients who remained at home were randomized to rehabilitation team (23) or ‘usual’ care (20). The mean number of physiotherapy sessions was three (range 1–14) for the rehabilitation team group and two for the usual care group. Patients (with a deficit) in the rehabilitation arm of the trial were more likely to receive occupational, physical and speech therapy than those in the control arm (p = 0.03, 0.01 and 0.008, respectively). For those patients actually receiving therapy, there was no evidence that the amount received differed between the groups. However, the number of patients in each of these comparisons was very small. The outcome for patients in the rehabilitation team arm of the trial was nonsignificantly higher (0.05 < p < 0.2) than for those in the control arm for the areas of Nottingham Health Profile, anxiety, depression, caregiver strain and the proportion of patients living at home. Based on the data observed here, a trial with approximately 150 patients in each arm would be needed to have adequate power to detect a 33% difference between intervention and control groups in these outcomes.

Conclusion: Community therapy support for patients not admitted to hospital is feasible but to determine whether it is cost- or clinically effective would require trials of adequate size.
Reliability of a measure of post-stroke shoulder pain in patients with and without aphasia and/or unilateral spatial neglect
Authors: Pomeroy Valerie M , Frames Christine , Faragher Eric B , Hesketh Anne , Hill Elizabeth , Watson Paul , Main Chris J
Published: August 2005

Objective: To determine the inter/intra-rater reliability of expert physiotherapists (PTs) measuring post-stroke shoulder pain with 100 mm vertical visual analogue scales (VAS; intensity, frequency and affective response) and a categorical site-of-pain scale.

Design: Three PTs independently rated subjects (normal clinical procedure but with a standardized starting position) on three days, at the same time of day, during one week in a randomized order determined by a nested latin square. Reliability for VAS scores was determined with the intraclass correlation coefficient (ICC) and for site-of-pain with the kappa statistic (. Acceptable reliability was set at 0.75. The limits of agreement were also calculated.

Setting: Community.

Subjects: Thirty-three patients, mean time post stroke 42 months (range 7–360).

Results: Mean inter-rater reliability was 0.79 for intensity, 0.75 for frequency and 0.62 for affective response (ICC). The limits of agreement were wide and rater bias was significant for 6/27 ratings. Mean intra-rater reliability was 0.70 for intensity, 0.77 for frequency and 0.69 for affective response (ICC). For site-of-pain inter-rater reliability ranged from 0.156 (to 0.385 (and intrarater reliability ranged from 0.300 (to 0.559 (.

Conclusions: Although inter-rater reliability was acceptable for intensity and frequency there was a consistently large systematic bias between pairs of raters. Agreement might be improved if a standardized assessment procedure was used and/or if training in pain behaviour interpretation was provided.
Changing patterns of postural hip muscle activity during recovery from stroke
Authors: Kirker Stephen GB , Jenner John R , Simpson Dorothy S , Wing Alan M
Published: August 2005

Objective: To describe the recovery of neurophysiological responses to perturbation of standing balance after stroke.

Methods: Surface electromyography (EMG) from hip abductors and adductors and ground reaction forces (GRF) were measured in response to 20 sideways pushes applied to the pelvis by a linear motor. Each subject's data from pushes in each direction were averaged and the presence of a muscle EMG response was assessed visually.

Subjects: Thirteen acute hemiplegic patients were tested as soon as they could stand after stroke (median six weeks) and serially during recovery.

Results: Four patterns of hip muscle activity were seen: (1) no response at all, (2) no response in hemiparetic muscles but compensation by contralateral muscles, (3) an appropriate, if delayed, response in the hemiparetic abductor but not adductor muscles, and (4) a relatively normal pattern in both hemiparetic muscles. Nine of 13 patients showed a change in pattern of hip muscle activity during recovery. All patients who initially resisted the sideways pushes solely with muscles of the unaffected leg later regained use of the hemiparetic hip abductors

Conclusions: The pattern of hip muscle activation changed towards normal during recovery from stroke in most patients. Use of compensatory strategies early after stroke in these subjects did not prevent return of normal patterns of muscle activation later.
An evaluation of a new pattern of electrical stimulation as a treatment for urinary stress incontinence: a randomized, double-blind, controlled trial
Authors: Jeyaseelan S M , Haslam E J , Winstanley J , Roe B H , Oldham J A
Published: August 2005

Objective: To evaluate a new pattern of electrical of electrical stimulation as a treatment for stress incontinence.

Design: A randomized, double-blind, controlled trial.

Setting: The study took place on three clinical sites.

Subjects: Patients (n= 27) with urodynamically proven stress incontinence recruited via consultant referral.

Interventions: Patients were randomly allocated to one of two groups: the new pattern of stimulation or sham stimulation.

Main outcome measures: Patients were assessed pre, mid and post treatment using: perineometry, digital assessment and pad testing. The following were only used pre and post treatment: seven-day frequency/ volume chart, SF-36, the Incontinence Impact Questionnaire and the Urogenital Distress Inventory.

Results: No significant between-group differences were highlighted except when quality of life was assessed with the Urogenital Distress Inventory (p= 0.01). A significant reduction in scores was observed in the stimulation group (p= 0.03) However, improvements were seen in both the strength and endurance characteristics of the pelvic floor musculature, although these changes were not translated into a reduction in symptoms.

Conclusion: Although promising, the improvement in pelvic floor function did not result in a reduction in symptoms in all patients. Further research is required to investigate the effects of the new stimulation in combination with pelvic floor exercises and to compare the new stimulation pattern with existing forms of electrical stimulation.
Measurement of severity of sports injuries: an epidemiological study
Authors: Dekker R , Kingma J , Groothoff J W , Eisma W H , Duis H J Ten
Published: August 2005

Objective: To evaluate the severity of sports injuries in relation to the severity of injuries due to other causes and in relation to type of sport, using generally applied measures of injury severity.

Subjects: A total of 12 403 patients, 4–50 years old, who were treated in the trauma department of the Groningen University Hospital for a sports injury, from January 1990 until January 1997.

Method: All patients treated because of an injury entered the study. A distinction was made between injuries caused by playing sports, home and leisure accidents, traffic accidents and violence. The severity of the injuries was assessed by using the criteria of rate of admission, Injury Severity Scale (ISS). Finally the sports injuries were analysed with regard to type of sport.

Results: In total, 57 760 injuries were registered. After injuries due to home and leisure accidents (44%; 25 228) sports injuries (21%; 12 403) were the most frequent cause of injury. Of the patients with a sports injury, 7.9% (980) were admitted, which is more than with home and leisure accidents (6.7%; 1690) but less than with traffic accidents (21.5%; 2202) and violence (9.3%; 364). In a majority of cases, admission was related to a limited number of types of sport. The mean ISS of sports injuries was low, as with injuries following home and leisure accidents and violence. The percentage of sports injuries with an ISS higher than or equal to 16 and the percentage mortality were both low in comparison to injuries due to violence or traffic accidents.

Conclusions: Sports injuries rank second highest in terms of cause of injury, after home and leisure accidents; and rank third in terms of severity, after traffic accidents and violence. Even though the ISS is low, sports injuries may have serious consequences.
Assessment of emotional problems in people with multiple sclerosis
Authors: Nicholl Catherine R , Lincoln Nadina B , Francis Valerie M , Stephan Talal F
Published: August 2005

Objective: To investigate the occurrence of emotional problems in multiple sclerosis (MS) patients. The utility of rating scales used to measure such problems was studied to make recommendations for clinical practice.

Design: Questionnaires were both sent by post and completed with an assistant psychologist at a home visit.

Subjects: Ninety-six MS patients in contact with a rehabilitation consultant.

Measures: Patients were assessed using the Guy's Neurological Disability Scale (GNDS), Extended Activities of Daily Living Scale (EADL), Hospital Anxiety and Depression Scale (HAD), Beck Anxiety and Depression Scales (BAI, BDI), Clinical Outcomes in Routine Evaluation Measure (CORE) and the Brief Symptom Inventory (BSI).

Results: Rates of anxiety and depression ranged from 16% to 48% according to the measures used. All mood scales were highly significantly correlated with each other. Disability as measured by the GNDS, but not the EADL, was significantly correlated with all mood measures. Kappa values showed poor correspondence in the classification of cases. Receiver operating characteristic curves indicated an optimum cut-off point of 7/8 on the HAD and 2/3 on the General Health Questionnaire (GHQ-12).

Conclusions: Rates of emotional problems were low given the highly disabled population studied. The HAD was relatively insensitive in comparison with the BAI and BDI. The GHQ-12 was sensitive and therefore recommended as a short screening measure. An alternative short screen, ‘Emotional GNDS’, was proposed.
Risk factors for burn-out in caregivers of stroke patients, and possibilities for intervention
Authors: van den Heuvel Elisabeth TP , Witte Luc P de , Schure Lidwien M , Sanderman Robbert , Jong Betty Meyboom-de
Published: August 2005

Objective: To identify which caregivers of stroke patients living at home experience the highest levels of strain and are at risk of burn-out, and to investigate how support for caregivers of stroke patients could best be organized, and when this support should be offered.

Design and setting: Caregivers of stroke patients were recruited in four regions of the Netherlands. A total of 212 caregivers were interviewed. Multiple stepwise regression analysis was performed to determine the effects of patient and caregiver characteristics, resources, coping strategies and duration of the caregiver role on caregiver strain, mental well-being and vitality.

Subjects:The majority of the caregivers were female spouses. Their mean age was 64 years, and their socioeconomic status middle class. Stroke had occurred about 3.5 years ago on average.

Main outcome measures:The following main outcome measures were used: the Caregiver Strain Index, and two scales of the Short Form-36 to measure caregivers’ mental well-being and vitality.

Results: Severe cognitive, behavioural and emotional changes in the patient constitute the main risk factors for caregiver burn-out. Women, younger caregivers and caregivers in poor physical health were also identified as risk groups. Caregivers with high perceived self-efficacy, satisfied with social support, and frequently using the coping strategy confronting, experience less strain, higher mental well-being and greater vitality. Duration of the caregiver role does not influence caregivers’ strain, mental well-being or vitality.

Conclusions: Women, younger caregivers, caregivers in poor physical health, and caregivers of patients with severe changes are at risk of burn-out. Support programmes should focus on self-efficacy, social support, and the coping strategy confronting. No specific moment could be identified at which support programmes should be offered.
Community rehabilitation
Authors: Wade Derick T
Published: August 2005

Classifying rehabilitation services is not easy, and there is no agreed nomenclature. One way of classifying services to use the WHO ICIDH-2 model of illness. Services could specialize in one or more domains. Those services currently referred to as community rehabilitation services would be classified as services that specialized in intervening at the level of participation, and in the local aspects of physical and social context. They are an important part of a network of specialized services.
Community rehabilitation in the United Kingdom
Authors: Enderby Pam , Wade Derick T
Published: August 2005

Objective: To investigate the extent and nature of community rehabilitation services within the United Kingdom.

Design: A postal survey starting with the Community Rehabilitation Network and extending to any other teams identified or making contact.

Setting: The National Health Service within the UK.

Subjects: Any team who identified themselves as a community rehabilitation service that worked ‘primarily with adults with physical disability’ within the UK.

Intervention: A questionnaire was sent to each team identified with follow-up telephone contact to clarify answers and/or to encourage replies.

Results: One hundred and fifty-two organizations were sent questionnaires and 145 replied, but 47 were excluded for various reasons leaving 98 valid replies. Four types of team were identified: community rehabilitation teams, young disabled community teams, community teams for older adults, and specific client group teams. There were huge variations in management arrangements, team composition, goals of the services and likely lifespan of the service.

Conclusions: Community rehabilitation in the UK is currently characterized by small, often short-term teams with poor identity and the term has no clear or consistent meaning.
A survey of services provided by community neurorehabilitation teams in South East England
Authors: McMillan T M , Ledder H
Published: August 2005

Objective: To survey the role, function and staffing of community rehabilitation teams in London and the South East NHS Region of England who work with neurologically disabled people, with emphasis on services provided for traumatic brain injury.

Design: Telephone survey using a structured interview with team leaders.

Setting: London and South East NHS Regions of England (population 15.6 million).

Subjects: Community rehabilitation teams.

Main outcome measures: A structured interview about service provision.

Results: Thirty-five teams were found in 25 Health Authorities serving 14 million people. In a further five Health Authorities, another five teams did not participate. There were fewer than 1.5 community team professionals for 4000–5000 neurologically disabled. Teams had seen less than 3% of disabled traumatic brain injuries. Most focused on physical disability. Only two teams specialized in consequences of cognitive impairment or personality change. Stroke and multiple sclerosis were the most common referrals. Sixty per cent of teams had no clinical psychologist. The composition of teams is described, as is caseload, clinical role, outcome measures used, professional links, work practice and staffing issues.

Conclusions: Community physical disability teams seem insufficiently resourced to provide a comprehensive service for the neurologically disabled. There are not enough teams generally, and too few specialize in psychosocial problems. All teams should include a clinical psychologist, should have specialist resources for cases from ethnic minorities and formal policies for staff security. There needs to be clarity over the range of services provided and to whom, and this linked to prevalence of disability and team resourcing.
Nonparametric methods for analysing the accuracy of diagnostic tests with multiple readers
Authors: Kaufmann Jorg , Werner Carola , Brunner Edgar
Published: August 2005

The evaluation of diagnostic agents or imaging procedures is governed by the same scientific and regulatory rules as that of other medical products. Receiver operating characteristic (ROC) curves, and especially the area under these ROC curves, are indices for the accuracy of a diagnostic test for continuous as well as ordinal data. The methodology of multivariate rank statistics for the nonparametric Behrens-Fisher problem is used to evaluate the accuracy of a diagnostic test in a complex factorial design with repeated measurements. Hypotheses are formulated by means of relative treatment effects and are tested by a multivariate extension of the Mann-Whitney statistic in a heteroscedastic model. The application of this method is demonstrated by the analysis of a data set from a diagnostic clinical trial.
“My Two‐week‐old Daughter Is Throwing up Blood”
Authors: Moustafa M.H. , Taylor Myiesha , Fletcher Laura
Published: August 2005

Swallowed maternal blood at the time of delivery or from cracked nipples during breastfeeding is the most common cause of suspected gastrointestinal bleeding in the neonate. In this case, the Apt–Downey test is a useful diagnostic tool. The Apt–Downey test can effectively differentiate neonatal from maternal hemoglobin based on the conversion of oxyhemoglobin to alkaline globin hematin when mixed with alkali.