bluuebunny/crossref_metadata_2025 huggingface dataset:
Assignment of gender to French nouns in primary and secondary language : a connectionist model
Authors: Sokolik M.E. , Smith Michael E.
Published: November 2007

In French, grammatical gender is often represented phonologically and/or morphologically. Thus, a language learner's competence for gender iden tification might in part reflect the ability to recognize patterns in noun phonology and morphology. We herein describe a computer-based connec tionist-type network model which learned to identify correctly the gender of a set of French nouns. Subsequently, this model was able to generalize from that learning experience and assign gender to previously unstudied nouns with a high degree of reliability. This gender assignment was accomplished by relying solely upon information inherent in the structure of the nouns themselves, and it occurred in the absence of explicit rules for the evaluation of nouns. Instead, the model discovered criterial gender-specific features when shown examples of masculine and feminine nouns during its initial training period. The model's ability to learn these gender-specific features was found to be related both to its initial connectivity state and to a variable learning-rate parameter. These latter results are discussed with respect to their general implications for second language learning.
Sonority and markedness among onset clusters in the interlanguage of ESL learners
Authors: Eckman Fred R. , Iverson Gregory K.
Published: November 2007

This paper is intended as a contribution to an evergrowing body of literature on the role played by principles and parameters of Universal Grammar in second-language acquisition theory.

A recent paper by Broselow and Finer (1991) proposes that markedness as defined in terms of the multivalued Minimal Sonority Distance (MSD) parameter is definitive in their subjects' knowledge of certain consonant clusters in syllable onsets. This parameter provides for the characterization of the various types of consonant clusters allowed in the onsets of syllables in different languages. The object of Broselow and Finer's study was to determine whether L2 learners find clusters which are relatively more marked according to the MSD parameter to be more difficult to learn than cluster types which are relatively less marked.

The present paper, however, argues that it is typological markedness (Hawkins, 1987) rather than sonority distance per se which better explains L2 learners' knowledge of English clusters in syllable onsets. In line with Clements' (1990) comprehensive investigation of sonority relations within the syllable, this paper argues that markedness alone suffices to account for the observed interlanguage patterns. Using Clements' principles, which themselves actually follow from the overall theory of markedness, the interlanguage obstruent results reported by Broselow and Finer fall out automatically.
Segment transfer: a consequence of a dynamic system
Authors: Hancin-Bhatt Barbara
Published: November 2007

This article presents the foundations of the Feature Competition Model (FCM) of segment transfer. The FCM is a proposal to explain how L2 sounds are mapped on to L1 phonological categories. Like previous analyses on segment transfer, the FCM assumes that not all features are of the same prominence in a given phonemic inventory and that feature prominence can be determined through underspecification. Unlike previous analyses, the FCM adopts a dynamic approach to phonology, one which assumes that fea tures do not have discrete values, rather ones which are continuous, of greater or lesser prominence in an inventory. A specific metric for calculat ing prominence is given, and hypotheses for three L1-L2 contexts are gener ated and tested. The results of an experiment suggest that the metric has predictive power, but that certain refinements of the formula are necessary. Finally, implications the FCM has for our understanding of developing L2 speech patterns are discussed.
Against underdetermined reflexive binding
Authors: Hamilton Robert
Published: November 2007

Reflexive binding has for a decade now been a fruitful area of inquiry for researchers seeking to establish that adult second language (L2) learners have access to Universal Grammar (UG), in this case access to the binding conditions. For example, it has been claimed that some L2 learners of English allow English reflexives to be bound by long-distance (LD) antecedents even when such LD binding is underdetermined for these learners with respect to their first language grammar(s) and the L2 input. I present four major reasons why the data underlying this claim do not support UG access. First, there are theoretical and empirical difficulties with the Agr(eement)-based account of reflexive binding assumed by these researchers that undercut the argument for UG access from these studies. Secondly, underdetermination fails to obtain in principle due to the possibility of semantically-based logophoric binding in the relevant languages. Thirdly, there are theoretical and empirical reasons to call into question the assumption (necessary to a UG-access account) that L2 learners mistook polymorphemic English reflexives for monomorphemic reflexives. Finally, there are several methodological factors which likely inflated the rate of LD binding in many of the relevant studies, again undercutting the argument for UG access from putative underdetermination.
Perfusion for cardiac transplantation
Authors: Wheeldon DR , Bethune DW , Gill RD
Published: November 2007

The optimum support of patients undergoing cardiac or cardiopulmonary transplantation requires particular consideration of various aspects of perfusion management. Many of these patients have chronic low cardiac output and consequent renal, hepatic and pulmonary dysfunction. Cyclosporin A is now the cornerstone of most immunosuppressive regimes and a major side effect of this drug is it's nephrotoxicity. 1 A technique is described which is designed to optimize perfusion support for this group of patients.

Cardiac transplantation does not usually present a difficult technical surgical challenge. The subsequent success of the procedure depends largely on appropriate donor and recipient selection and attention to the finer points of patient management, and in particular the fine tuning of immunosuppressive therapy. The provision of optimum perfusion support has a substantial influence on early postoperative progress, particularly in those patients with preoperative multiorgan failure, secondary to a low cardiac output.
Noncardiogenic pulmonary oedema following cardiopulmonary bypass: report of two cases and review of the literature
Authors: Pezzella A Thomas , Ascioti Anthony , Ricardi Patrick
Published: November 2007

Two cases of noncardiogenic pulmonary oedema following cardiopulmonary bypass are presented. The clinical manifestations, postulated pathogenesis and management are discussed. A recent review of the literature fails to yield a unified explanation of this rare but often disastrous entity.
The experimental study of prevention of myocardial reperfusion injury with free radical scavengers
Authors: Hou Di  , Liu Wei-yong , Fang Fo-zhen , Mo Jian  , Sun Su-fen , Shi Wei-ran , Ye Jin-ming , Guan Yan-fang , Liu Jian
Published: November 2007

The change of endogenous superoxide dismutase (ESOD) during myocardial ischaemia and reperfusion and the efficacy of oxygen free radical scavengers in myocardial protection were investigated in an isolated heart model connected to a recirculating nonpulsatile perfusion circuit. Subjected to a two-hour period of global ischaemia at 27°C, the heart was reperfused at 37°C with oxygenated diluted autogenous blood for 60 minutes. Superoxide dismutase plus catalase were added to the cardioplegic solution and reperfusates. ESOD activity was measured by the pyrogallol method. Our experiment demonstrates that ESOD activity after ischaemia and reperfusion is decreased by the addition of free radical scavengers (SOD and CAT) to the cardioplegic solution and the reperfusates. In addition, SOD and CAT addition was also associated with reduced leakage of myocardial enzymes, reduced coronary vascular resistance and lessened ultrastructural damage to the myocardium. These results suggest that the use of SOD and CAT may inhibit myocardial reperfusion injury by scavenging oxygen-derived free radicals.
Clinical evaluation of the Sarns membrane oxygenator
Authors: Zacour Richard K
Published: November 2007

A new membrane oxygenator, developed by Travenol Laboratories, has been introduced by Sarns/3M. The oxygenator is constructed of microporous polypropylene hollow fibres wound into a gas transfer module with an effective surface area of 1.8m2 and a total priming volume of 320ml. This was made possible by using computer-aided design techniques. Blood flow is perpendicular over the fibre in the module while the gas flow is directed within the fibres. The unit contains an integral stainless steel heat exchanger mounted beneath the fibre module. A selection of collapsible venous reservoirs is available to fulfil various patient requirements. The oxygenator and venous reservoir bag are mounted on a wire frame holder that can be arranged in any direction on the heart lung machine. The circuit was primed with 1800ml of a balanced electrolyte solution, 200ml of 25% albumin and 200ml of 25% mannitol, to which 4000 units of beef lung heparin were added. The 1000ml reservoir was used in all cases.

Seventeen consenting adult patients undergoing elective cardiac surgery participated in the clinical evaluation. Haematology and organ function studies indicated no significant changes attributable to the oxygenator. The mean postbypass plasma-free haemoglobin elevation was 8.2mg/dl. The mean postbypass haematocrit and platelet count reduction were 21 % and 27% respectively, indicating that platelet count tended to follow haemodilution with minimal loss. There were no gas exchange nor acid-base problems encountered. The mean PaO2 and PaCO 2 were 267mmHg and 42mmHg respectively with a maximum O2 transfer of 241 ml/min during the study.
Comparison of hollow fibre membrane oxygenators during cardiopulmonary bypass in children: Dideco Masterflo versus Terumo Capiox II
Authors: Leijala M. , Peltola K. , Aronen M. , Meri S. , Louhimo I.
Published: November 2007

This prospective study was planned to compare two different (reversed blood and gaseous compartments) hollow fibre membrane oxygenators, Dideco Masterflo and Terumo Capiox II, in order to find out which of these oxygenators was less injurious during cardiopulmonary bypass (CPB) surgery in small children. Twenty children underwent CPB surgery for complex congenital cardiac malformations. Ten patients were selected for each study group by matching age and weight. Oxygenators were the only variables in the CPB circuit, and special attention was focused on the kinetics of white blood cell count (WBC), complement C3, anaphylatoxin C3a, total haemolytic complement (CH100), C-reactive protein (CRP) and haptoglobin. There were no significant differences between the parameters studied at any sample time. However, there was less intense C3a (peak C3a levels 2506 ± 1187 SD versus 4302 ± 3958 SD; p = 0.19) generation, and also less intense CH100 consumption (percentual drop of initial CH100 values was 30% versus 55.2%) in the Dideco Masterflo group of patients. Moreover, postoperative respiratory treatment was somewhat shorter when using Masterflo oxygenators (2.4 ± 2.41 SD versus 4.0 ± 2.49 SD days; p = 0.16), although statistical significance was not obtained. These findings may be important in high-risk paediatric patients undergoing open-heart surgery.
Glucose, sodium and plasma protein levels during deep hypothermic circulatory arrest using a low volume, minimal glucose priming solution based on washed packed red cells
Authors: Lönnqvist Arne , Dobbs Jeri
Published: November 2007

The effect of a low volume, minimal glucose priming solution based on washed packed red cells on glucose, sodium and plasma protein levels during deep hypothermic circulatory arrest (DHCA) was studied in six patients of less than six months of age undergoing repair of congenital heart disease. Glucose levels during DHCA were not significantly different from prebypass values (6.2mmol/l±2.7 vs 7.1 mmol/l±2.8; p = 0.518), whereas plasma protein levels were significantly decreased (51.0g/l±0.7 vs 20.0g/l± 0.3; P = 0.0001) and sodium levels slightly but significantly increased (142mmol/l±3.8 vs 150mmol±3.8; p = 0.0026). In summary, the priming solution used in this study achieved good control of glucose levels during DHCA, although it needs some modification in regard to sodium and plasma protein content. A discussion of the choice of priming solution and a hypothesis for potential calcium-mediated reperfusion injury are also presented.
Visceral and peripheral tissue perfusion during hypothermic cardiac surgery
Authors: Kuttila Kari , Valtonen Mika , Kostewicz Waldemar , Vänttinen Esko , Niinikoski Juha
Published: November 2007

Central haemodynamics, blood gases, visceral and peripheral tissue perfusion and oxygenation were studied in six patients undergoing coronary artery bypass grafting (CABG) - including one patient with aortic valve reconstruction and another with CABG and aortic valve reconstruction. The patients were operated upon under moderate haemodilution and systemic hypothermia. Visceral perfusion was indirectly assessed by determining the gastric intramucosal pH (pHi). Peripheral tissue perfusion was assessed by continuous recording of subcutaneous tissue PO 2 (PscO2), laser-Doppler skin red cell flux (RCF), transcutaneous PO2 (PtcO2) and fingertip temperature (Tft) in the upper extremity. During cardiopulmonary bypass (CPB) at the deepest hypothermia, pHi, PaO2 and PtcO2 reached maximum values simultaneously with the lowest calculated oxygen utilization: pHi reached its minimum at the end of the operation. During CPB, PscO2, RCF and Tft decreased markedly, rose during rewarming and fell again at the end of surgery. These data suggest that the patients' visceral perfusion is well maintained during CPB, and the patients develop hypoperfusion and hypoxia of peripheral tissues at the same time. After closing the wounds, pHi, PtcO2 index (=PtcO 2/PaO2) and other peripheral tissue perfusion parameters gained the lowest values indicating impending residual hypothermia and tissue hypoperfusion after rewarming.
Use of a heat exchanger in liver transplantation
Authors: Butler Kevin T , Raskin Steven A , Whisennand Hartwell H , Lowell William R , Gay Joseph R , Cornelius Gary F
Published: November 2007

Of the first 16 patients who underwent orthoptic liver transplantation, 81 % were observed to be hypothermic at termination of bypass (X = 34.5°C, n = 16). In response, an in-line heat exchangerwas added to the bypass circuit. Subsequently, 72% of the next 11 patients terminated bypass normothermic (x = 37.0°C, n = 11). By removing from the sample those patients who incurred low blood flows, 100% of the patients terminated bypass normothermic (X = 38.2°C, n = 8). At temperatures of 30-33°C cardiac arrhythmias have been observed. Hypothermia has been documented to cause thrombocytopenia and neutropenia which can lead to blood loss. These low counts are only partially reversible with platelet infusion and white blood cells (WBC). The use of an in-line heat exchanger during liver transplantation is essential in preventing hypothermia in our experience.
Effects of Alprostadil (synthetic prostaglandin E1) on red and white cell filterability during cardiopulmonary bypass
Authors: El-Gatit Abdusalam , Belboul Ali , Al-Khaja Najib , Radberg Göran , El-Bishry Ahmed , Roberts Donald , William-Olsson Göran
Published: November 2007

Reduced blood cell rheology due to mechanical blood trauma is associated with reduced microcirculation and organ dysfunction during and following cardiac surgery using cardiopulmonary bypass (CPB). The influence of prostaglandin E1 (PGE1) on the blood cell rheology was studied in 24 patients undergoing coronary artery bypass grafting surgery with the use of CPB. Intra-operative infusion of PGE1 was given to 12 patients in a dose of 20ng/kg/min; the other 12 patients served as controls. Red and white cell rheology were measured by red and white cell filtration rate (RFR and WFR) respectively, applying a standard bulk filtration technique. Blood samples were collected pre-operatively, at the start of CPB, after 30 minutes, 60 minutes, 90 minutes and at the end of CPB. Results showed that the mechanical trauma of CPB was better tolerated in the PGE1 group, where RFR and WFR showed significant lower losses during CPB (p < 0.001, p < 0.001). These results indicate that PGE1 has beneficial effects on red and white cell deformability during CPB. The improvement of blood rheology would be expected to lead to better microcirculation in the vital organs.
Review article : What's new in monitoring the coronary surgery patient?
Authors: Hessel Eugene A
Published: November 2007

Monitoring has been extensively reviewed in most textbooks of cardiothoracic surgery and anaesthesia, particularly in the recent textbooks on monitoring edited by Carol L Lake1 and Casey D Blitt2 and in the Journal of Clinical Monitoring. Although monitoring properly includes both pre- and postoperative periods, this review will concentrate exclusively on the operative period. I will also concentrate on new approaches or information which relate to more traditional approaches to monitoring. The emphasis in this review will not be on what we can monitor, but rather on what we should monitor. In this regard, I will analyse accuracy and identify sources of error and try to answer the following questions. Does the device or parameter measure (monitor) what we want to know? Does it improve patient outcome and safety? Is it cost-effective? Unfortunately, data are not always available to answer all these questions at present, but hopefully the discussions will make us aware of what we do and do not know, and what we should look for in the near future.
Plasma protein binding of lidocaine during hypothermic conditions
Authors: Lönnqvist PA , Herngren L.
Published: November 2007

The effect of hypothermia on the protein binding of lidocaine in plasma from six healthy volunteers was studied in vitro. A significant increase (p <0.001) in the unbound fraction of lidocaine was found at 24°C (38.3 [SD 7.0] %) compared to 37°C (30.7 [SD 6.0] %). A further reduction in temperature to 10°C resulted in a slight but not statistically significant increase in the free fraction of the drug (39.9 [SD 10.2] %). As a conclusion, hypothermia enhances the transfer of lidocaine over the blood-brain barrier. In order to avoid unwanted side effects or frank toxicity, caution is recommended when administering highly protein-bound drugs during hypothermic conditions.
A survey of priming solutions used for cardiopulmonary bypass
Authors: Hett D.A. , Smith Shackleton D.C.
Published: November 2007

We conducted a postal survey of all National Health Service centres where cardiac surgery is performed. We requested information about the priming solutions and additives used in the cardiopulmonary bypass circuit, and specifically asked whether changes were made in priming solutions for diabetic patients. Hartmann's solution was used by 63% of respondents, either alone or mixed with colloid. Heparin was added to the prime by 89% of respondents. Only two centres and one anaesthetist at a third centre altered the prime for diabetic patients.
Pulsatile compared with nonpulsatile perfusion using a centrifugal pump for cardiopulmonary bypass during coronary artery bypass grafting. Effects on systemic haemodynamics, oxygenation, and inflammatory response parameters
Authors: Driessen JJ , Dhaese H. , Fransen G. , Verrolst P. , Rondelez L. , Gevaert L. , van Becelaere M. , Scheistraete E.
Published: November 2007

The present study investigated the influence of pulsatile or nonpulsatile flow delivery with a centrifugal pump for cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) in two randomized groups of 19 patients each. All patients received a standard anaesthetic and surgical protocol. Pulsatile perfusion during CPB was created by accelerating the baseline pump speed of the Sarns centrifugal pump at a rate of 50 cycles per minute. Measurements included perioperative systemic haemodynamics and oxygen exchange, total haemolytic complement (CH 50), polymorphonuclear (neutrophil) granulocyte (PMN) count and plasma granulocyte elastase bound to α1-proteinase inhibitor (E-α 1-PI). Laboratory measurements were corrected for haemodilution. During and after CPB there were only a few significant differences between the groups in systemic haemodynamics and oxygenation, i.e. a lower mean arterial blood pressure after the end of CPB in the nonpulsatile group (65 mmHg, SD = 11 vs 76 mmHg, SD = 11) and a lower SvO2 during rewarming on CPB in the nonpulsatile group (62%, SD = 8 vs 67%, SD = 8). The decrease in percentage of PMNs in the total white blood cell count during CPB was greater in the nonpulsatile group than in the pulsatile group (from 61 to 46% vs 63 to 53% of prebypass value). The steep increase of PMN count at the end of CPB and postoperatively was comparable in both groups. The maximal decrease of CH50 levels, occurring after surgery, was significantly higher in the nonpulsatile group (70%, SD = 15 vs 79%, SD = 16, of baseline value), suggesting a greater complement activation. E-α1-PI levels increased significantly in both groups during and after CPB with higher peak levels, obtained at one hour after admission to an intensive care unit, in the nonpulsatile group (316 μg/l, SD = 102) than in the pulsatile group (247 μg/l, SD = 106). There was a partly inverse correlation between the peak postoperative elastase levels and the PaO2/FiO2 ratios at the first postoperative morning. This ratio was significantly lower in the nonpulsatile group (211, SD = 56) than in the pulsatile group (247, SD = 62). Postoperative respiratory tract infection was more frequent in the nonpulsatile group (n = 9) than in the pulsatile group (n = 2).

Adding a pulsatile component to centrifugal blood pumping during CPB may have benefits with regard to the possibly detrimental whole body inflammatory response to CPB. Further studies are warranted to investigate whether these differences will affect clinical outcome.
Retrograde cerebral perfusion: overview, techniques and results
Authors: Raskin Steven A , Coselli Joseph S
Published: November 2007

Cardiovascular surgical repair of arch aneurysms is taking a step forward by going backwards by utilizing retrograde cerebral perfusion. Drs ME DeBakey, ES Crawford, DA Cooley and GC Morris first reported successful resection and repair of a fusiform aneurysm of the aortic arch with replacement graft in 1957.1 Since then, Crawford and Coselli have pursued materials and techniques which have made this procedure, one which generally resulted in high morbidity and mortality, more viable with decreased morbidity and mortality. Increased numbers of patients are now having this repair and are resuming normal healthy lives after the operation. From February 1992 to October 1993, 88 patients were surgically treated by Coselli who utilized retrograde cerebral perfusion with profound hypothermia and circulatory arrest, thus allowing for repairs that under any other conditions probably could not have been achieved successfully. It is evident that a major determinant for the successful clinical results, in addition to surgical technique and skill, was the employment of profound hypothermia and circulatory arrest. This article will review the techniques and results of aortic arch repair utilizing retrograde cerebral perfusion during circulatory arrest with profound hypothermia to lessen the chance of neurological morbidity following surgical replacement of the transverse aortic arch.
Laboratory studies of the effect of Pall extracorporeal leucocyte filters LG6 and AV6 on patients undergoing coronary bypass grafts
Authors: Thurlow PJ , Doolan L. , Sharp R. , Sullivan M. , Smith B. , Andersen LW
Published: November 2007

A total of 14 patients with ischaemic heart disease undergoing coronary artery bypass grafts were studied for the effect of AV6 control filter and LG6 neutrophil filter, used in the extracorporeal circulation, on different laboratory parameters. There was no statistical difference between the effects of AV6 and LG6 filters on total white cells, neutrophils, monocytes, lymphocytes, platelets or haemoglobin. The expression of neutrophil activation antigens identified with a panel of monoclonal antibodies demonstrated that for the LG6 filter the leucocyte tyrosine phosphate CD45Ro fell during the procedure, whilst there were no significant changes in any of the other neutrophil antigens. The AV6 filter did not significantly diminish the expression of any of the neutrophil antigens. An indirect measure of superoxide production using Dihydrorhodamine 123 identified that the more activated cells appeared to be depleted across the LG6 filter which was not evident with the AV6 filter. These studies indicate that the LG6 is not capable of significantly depleting the neutrophil load generated during extracorporeal circulation but may be capable of selectively removing the more activated forms.
Use of opiates in terminally ill children
Authors: Burne R. , Hunt A.
Published: November 2007

The records of 21 children receiving morphine ordiamorphine during terminal care at a children's hospice were reviewed to examine the use of these drugs. Twelve children with neoplastic disease required one of these drugs during the last week of life. The main indication in every case was pain. Among children with other diagnoses morphine or diamorphine was used in nine cases for a variety of indications. The experience described here suggests that strong opiates may be used in the terminal care of children following the principles developed in adult hospices.
The mortality associated with respite care in a hospice
Authors: Dewi W.
Published: November 2007

Of 156 patients referred to a hospice for respite care, 11 % died whilst awaiting admission. Of the 125 patients admitted, 12% died in the hospice. The distribution of deaths was not even, with cancer patients more likely to die during respite admission, than patients with other diseases (p<0.05).
Laser palliation of tracheobronchial tumours: a review
Authors: Hetzel MR
Published: November 2007

Photoresection of obstructing or bleeding bronchial tumours using lasers is rapid, lacks toxicity, can be repeated and does not preclude later radiotherapy. This review considers the techniques involved, results of clinical trials and the patients most likely to benefit.
Patients' perceptions of their care at Our Lady's Hospice, Dublin
Authors: McDonnell Mary M
Published: November 2007

Fifty patients were interviewed prior to admission to Our Lady's Hospice, to identify their needs, expectations, awareness of their illness and awareness of the hospice. A second interview eight days after admission ascertained how these feelings had been affected by their experience of being at the hospice. Prior to admission, over half the patients seemed unaware they were going to the hospice. Not quite half showed awareness of dying. All had one or more distressing physical complaints. Patients expressed hopes of physical relief but many did not expect that it was possible. The second interview indicated that nearly all the patients were satisfied that the hospice care met their needs. The hospice had changed the focus of attention for the patients in the study, so they no longer dwelt on their physical distress and fears for the future.
Physical dependence of cancer patients at home
Authors: Beck-Friis Barbro , Strang Peter , Eklund Gunnar
Published: November 2007

During the period 1977-1986, a total of 179 patients with terminal cancer were cared for by the hospital-organized home care programme in Motala. At the time of their registration, 78 patients needed assistance with 0-3 ADL (activities of daily living) functions and 101 needed help with 4-6 functions. Altogether 168 (94%) patients could be classified according to groups A-G in the ADL classification by Katz, whereas only 11 were classified to the 'Others' category. Consequently, the loss of function among the terminal cancer patients followed a predetermined, hierarchical order, as described by Katz.

The mental stress, need of assistance and length of care required by the patients, as well as survival periods, correlated significantly with the ADL level. Neither age, sex, nor type of cancer diagnosis influenced the ADL status, which

is thus a tangible measure of the function impairment of cancer patients.
When a demented patient refuses food - ethical arguments of nurses in Israel
Authors: Hirschfeld MJ , Ziv L.
Published: November 2007

There can be difficult ethical dilemmas to face for nurses confronting a patient with dementia. In Israel these dilemmas exist within a culture and religion where life is considered of the utmost value. It was apparent that nurses had difficulties choosing between feeding without consent, and the possibility of death due to lack of nutrition. Nurses working with demented patients tended to follow traditional religious ethics, even if this meant using force, and all but one nurse placed the sanctity of life above the autonomy of the patient. Other nurses, however, felt unable to abide by such rules, although it usually meant they had to work in a different clinical setting. Such changing attitudes could have profound effects on nursing care in Israel.
Decision-making in the management of advanced cancer of the head and neck. Differences in perspective between doctors and patients: future avenues for research
Authors: Maher EJ , Goodman S. , Jefferis A.
Published: November 2007

Twenty surgeons and 20 radiotherapists were questioned about the management of three theoretical patients with advanced cancers: 119 management plans were proposed, 46 of which were described as'palliative' in intent. Radiotherapywas the most common palliative therapy proposed (44%) and less than 10% involved supportive care only (i.e. involving no radiotherapy, chemotherapy or surgery). Radiotherapists were asked to rank 10 common symptoms, considered by the authors to be the most frequent and distressing in their patients, and these results were compared with ranking by a sample of 35 patients. All doctors considered symptom relief to be the most important aim of palliative therapy. There was variation as to which symptoms were perceived to be the most troublesome (and therefore in need of palliation) and a trend towards doctors overestimating the more objective 'treatable' symptoms and underestimating more subjective problems of anorexia and fear of growing cancer when patients and doctors were compared. Results suggest a need for more structured analysis of patients' concerns, clarification of the aims of therapy, and evaluation of outcome in the management of advanced head and neck cancer. The potential value of involving nurses in the initial decision-making process is discussed.
The use of laxatives at a palliative care centre
Authors: Twycross Robert G , Harcourt Jean MV
Published: November 2007

The drug charts of 100 inpatients with terminal cancer were reviewed to determine laxative use at the beginning of week 2. Sixty-two per cent of patients received an oral laxative regularly. Of these, 37 (60%) received codanthrusate or codanthramer, 14 (23%) received senna and 13 (21 %) lactulose. Eight patients received two laxative preparations concurrently. Thirty-seven patients needed rectal measures. About half of those not taking a strong opioid required a regular laxative, compared with three-quarters of those on a strong opioid. The median daily dose of codanthrusate was two capsules for patients not on an opioid and four capsules for patients on a strong opioid (range 1-6). There was no correlation between the dose of morphine and that of codanthrusate. All patients on a strong opioid who did not receive a regular laxative had a specific reason for not doing so.
Long-term compliance with treatment in obstructive arm lymphoedema in cancer
Authors: Rose Karen E , Taylor Helen M , Twycross Robert G
Published: November 2007

A survey of 33 cancer patients with stable chronic lymphoedema of the arm was conducted to ascertain which modalities of treatment were best complied with in the long term. Of the patients, 67% continued to moisturize the skin, though only half of these did so daily, while 97% continued to wear a compression sleeve, though not all did so daily. Almost 75% carried out the recommended arm exercises (though not all did so daily) and/or used the affected arm for all normal household tasks. Massage was used by 15 patients with truncal oedema. The form and area of massage varied considerably. Pneumatic compression was used by only four patients (12%). The most common continuing problem was finding clothes to fit the swollen arm (approximately 80%). About half the patients considered that they had reduced arm and hand function and half continued to experience pain. Continued attendance at the lymphoedema clinic was considered by many patients (73%) to be psychologically supportive.
Cultural boundaries in care
Authors: Clarke Margaret , Finlay Ilora , Campbell lan
Published: November 2007

It can be difficult to understand the verbal and nonverbal clues offered from those of a different culture. A Korean patient and her family are described to illustrate these difficulties.
Regular subcutaneous bolus morphine via an indwelling cannula for pain from advanced cancer
Authors: McDonald P. , Graham P. , Clayton M. , Buhagiar A. , Stuart-Harris R.
Published: November 2007

The analgesia and toxicity of regular four-hourly subcutaneous bolus morphine were assessed prospectively in 164 patients with pain from advanced cancer; each had received oral morphine for a minimum of 48 hours. World Health Organization (WHO) scores for pain, nausea and vomiting, and drowsiness taken at the time of change to subcutaneous bolus morphine and 48 hours later indicated that subcutaneous morphine provided significantly better analgesia than similar doses of oral morphine (p<0.001) and was associated with significantly less nausea and vomiting (p < 0.005). Scores for drowsiness were similar for both forms of morphine. Minor erythema or thickening at the injection site was noted in 86 patients (52%), but more severe local reactions occurred in seven patients (4%). Twenty-five patients (15%) were discharged home on subcutaneous bolus morphine given by themselves or relatives. Regular four-hourly subcutaneous bolus morphine is an effective and well tolerated method of parenteral morphine administration.
Can home care maintain an acceptable quality of life for patients with terminal cancer and their relatives?
Authors: Hinton John
Published: November 2007

This prospective study was designed to assess whether patients with terminal cancer, and their relatives, find that competent home care sufficiently maintains comfort and helps adjustment. A random sample from a home care service with readily available beds comprised 77 adults and their relatives who were able and willing to be interviewed separately each week. They were asked the nature and degree of current problems and regular assessments were made of some qualities of life including mood, attitude to the condition, perceived help and preferred place of care. These patients had 90% of their care at home; 29% died at home but 30% were finally admitted for one to three days and 41 % for longer.

In the final eight weeks, tolerable physical symptoms were volunteered by a mean of 63% each week and psychological symptoms by 17%. Some distress was felt by 11 % of patients; this was usually from pain, depression, dyspnoea, anxiety or weakness, and generally did not persist. Relatives suffered grief, strain or their own ill health. Patients' and relatives' reports generally matched except for the strain on carers.

Regular assessments found that 64% of patients thought death certain or probable, and 27% thought it possible. Various proportions coped by optimism, fighting their disease, partial suppression or denial, but 50% reached positive acceptance. Relatives were more aware and accepting. About three-quarters of patients and half the relatives were composed, often enjoying life. Serious depression affected 5% of patients and anxiety 4%, but relatives' manifest depression in the later stages increased to 17% and anxiety to 14%. Many consciously disguised their feelings. Treatment was usually praised but realistic preference for home care fell steadily from 100% to 54% of patients and 45% of relatives. At follow-up most relatives approved of where patients had received care and died.
Clinical trial of a mucin-containing oral spray for treatment of xerostomia in hospice patients
Authors: Sweeney MP , Bagg J. , Baxter WP , Aitchison TC
Published: November 2007

Thirty-five hospice patients complaining of dry mouth entered a double-blind, single- phase placebo-controlled trial of a mucin-containing oral spray (Saliva Orthana) for the relief of xerostomia. The sprays were administered ad libitum for two weeks by the patients themselves, with nursing help as necessary. A detailed history and examination were undertaken, together with collection of microbiological specimens, at entry and after seven and 14 days of spray usage, respectively. Thirty-one patients were available for follow-up at seven days and 26 patients after 14 days. Relief of oral dryness during the day was reported by 9/15 patients on Saliva Orthana and 10/16 patients on placebo by day 7, with a similar degree of improvement maintained to day 14. The corresponding figures by day 7 for relief of dryness at night were 8/15 for Saliva Orthana and 8/16 for placebo. There were no statistically significant differences between those on active and those on placebo spray for any of the oral symptoms recorded. Neither spray had any major impact on the oral microflora. However, the majority of patients in both treatment groups wished to continue using a mouth spray at the end of their involvement in the trial. Whilst the data from this study provide no evidence for increased benefit of a mucin-containing spray over a mucin-free placebo among xerostomic hospice patients, it is clear that both sprays provided worthwhile symptomatic relief of oral dryness for many of the participants.
Medical student teaching in a hospice - what do the patients think about it?
Authors: Franks Alison , Rudd Nicky
Published: November 2007

Hospital inpatients are regularly involved in medical student teaching. The Leicestershire Hospice recently became more involved in such undergraduate activity by teaching second-year students basic clinical skills. As this was a new venture for the unit, it was thought important to seek the patients' feelings about taking part. This was done by questionnaire following each teaching session. Overall, the patients seemed enthusiastic, enjoyed the experience and had clear ideas on what hospice staff should particularly aim to pass on to the students.
Palliative home care — the Calicut experience
Authors: Ajithakumari K. , Sureshkumar K.
Published: November 2007

A three-year-old palliative care unit in Calicut, in the south Indian state of Kerala, started a home care service in June 1996. This paper reviews the first year of operation of the service; in this period 340 home visits were made. The service aims to deliver palliative care to the patients who are unable to reach the hospital, to empower patients to care for themselves and to empower the family to care for patients. One doctor and a few trained volunteers form the team. In addition to control of physical symptoms and emotional support, the home visits permitted minor procedures including nasogastric intubation, catheterization of bladder, dressing of wounds and intravenous fluid therapy. In some cases, the visits helped to change the attitude of families towards the patients - for example, allaying fear of contagion. In some instances, the visits changed the attitude of the neighbourhood towards the patient for the better. In spite of problems like the distances involved and bad roads, the experience of this team shows that a home care system is possible and essential for delivery of palliative care in India.
The language of images in geography
Authors: Philips R.S.
Published: November 2007

In the cities in which we live, all of us see hundreds of publicity images every day of our lives.... In no other form of society has there been such a concentration of images, such a density of visual messages (Berger, 1972: 129).

My first image of the Canadian West was from a picture on a calendar in our farmhouse in southern Ontario. The image was of a field of golden wheat blowing in the wind under a sunny and azure sky (Francis, 1989: xv).

A strong corporate image influences the predisposition to buy a company's products, speak favourably of it, believe its statements, apply for a job with it, and the like (Worcester, 1986: 604).

The spectacle is capital to such a degree of accumulation that it becomes an image (Debord, 1977: thesis 34).

With the emergence of a truly spectacular body of experiments, imagery is one of the hottest topics in cognitive science (Block, 1981: 1).
The European drought of I975-76 and its climatic context
Authors: Kelly P.M. , Wright P.B.
Published: November 2007

Drought is undoubtedly one of man's worst natural enemies. Its beginning is subtle, its progress is insidious and its effects can be devastating. Drought may start any time, last indefinitely and attain many degrees of severity. It can also occur in any region of the world, with an impact ranging from slight personal inconvenience to endangering nationhood (Hounam et al., 1975)
Ice in the shore zone and the geomorphology of cold coasts
Authors: Forbes D.L. , Taylor R.B.
Published: November 2007

Approximately 90% of Canada's ocean coastline is affected by seasonal or multiyear sea ice and winter ice develops on most lakes. Recent studies of ice effects in the shore zone have included investigations of ice-congested and protected shores in the north-west Canadian Arctic Archipelago, processes involved in the construction by ice of large shore ridges in the same region, direct ice scour and enhanced hydrodynamic scour in the presence of ice (strudel scour and ice wallow), particularly as potential hazards to buried pipelines in the Beaufort Sea, and the dynamics of boulder-strewn tidal flats and boulder barricades in eastern Canada. The extent and frequency of shore nourishment by ice and details of the processes involved, including the relative importance of ride-up versus pile-up, remain important research questions. Reports emphasizing the contribution of ice rafting to shoreface retreat along the Alaskan coast of the Beaufort Sea suggest the need for quantitative studies of this phenomenon in Canada, in particular with respect to prodelta sedimentation at the mouth of the Mackenzie River. The coastal zone in the Beaufort Sea is particularly sensitive to climate change through effects on thermokarst processes, rising sea level, the relation between ice cover and wave energy through fetch limitation, and potential changes involving ice dynamics and freeze-up processes.
Imaging spectrometry
Authors: Curran Paul J.
Published: November 2007

A basic aim of remote sensing is to identify and characterize objects on the Earth's surface by means of radiation that has interacted with that surface. In the optical region of the spectrum this could best be achieved using an imaging spectrometer that records a finely sampled and continuous spectrum of radiation over the entire 400 nm to 2400 nm wavelength range. This article outlines the airborne imaging spectrometers of today and the space-borne imaging spectrometers of tomorrow, the techniques for processing data from imaging spectrometers and the roles that imaging spectrometry is finding in those areas of geological, aquatic, ecological and atmospheric research which are of interest to physical geographers.
Radiation and energy budgets of alpine tundra environments of North America
Authors: Saunders I.R. , Bailey W.G.
Published: November 2007

Recent physical climatology research from North American alpine tundra environments is summarized and directions for further research suggested. Despite a rather limited database, the essential themes in the physical climatology of alpine tundra are understood. With numerous permutations of slope angle, azimuth and surface types in the alpine zone, generalizations of alpine tundra radiation and energy balances are hard to define. Several aspects of the alpine tundra radiation budget are very similar to nonalpine ones, such as the controls exerted on net radiation by atmospheric and surface conditions, and the strong relation between global solar radiation and net radiation. The larger inputs of solar radiation experienced at high altitudes are typically offset by the moderating effects of orographic clouds. Turbulent energy flux partitioning is dependent upon both the effects of macroscale weather and microscale variations in surface soil moisture. Evaporation regimes tend to be moisture-limiting in the dry tundra and energy-limiting in wetter alpine/ subalpine meadows, but there are also significant season-to-season variations. Theory suggests that the surface heterogeneity common to the alpine zone must at times stimulate vigourous horizontal heat advection at a wide range of spatial scales, but the true significance of this process remains almost entirely undocumented. Suggested future research directions include analyses of the spatial variations of albedo, the role of sloping surfaces, and the relative importance of atmospheric and surface controls on the energy balance.
Intra-annual variations in glacier motion: a review
Authors: Willis Ian C.
Published: November 2007

Variations in glacier horizontal and vertical motion occur at a variety of intra-annual timescales: monthly, daily and even hourly. These variations have been identified from measurements made both beneath and on the surface of glaciers. They must be associated with variations in basal motion rather than changes in internal ice-deformation rates. Variations in basal motion result from changes in sliding rates over a 'hard bed' (i.e., rigid bedrock) or changes in deformation rates within a 'soft bed' (i.e., unlithified permeable till). Changes in both sliding and bed deformation rates are related to variations in subglacial water pressures and therefore depend critically on the structure of the subglacial drainage system and the hydraulics of individual drainage passageways. Thus changes in subglacial drainage system structure and drainage passageway hydraulics can cause intra-annual variations in glacier motion. However, intra-annual variations in glacier motion will also be influenced by variations in longitudinal stress gradients as a result of changes in the rate of longitudinal extension and compression.