bluuebunny/crossref_metadata_2025 huggingface dataset:
Vocabulary profiles of children with specific language impairment
Authors: Hick Rachel F , Joseph Kate L , Conti-Ramsden Gina , Serratrice Ludovica , Faragher Brian
Published: October 2002

This study investigates vocabulary development over one year for three young children with specific language impairment (SLI). Rate of vocabulary development and use of nouns and verbs relative to total vocabulary is compared with a larger sample of younger, typically developing children. Communicative Development Inventory (CDI) data were collected and results provided a typically developing trajectory against which the children with SLI could be compared. The two groups show similar growth curves at these early stages. Findings are discussed with reference to previous work on vocabulary development and methodological differences between parental report and naturalistic data collection.
Inflammatory mediator removal by zero-balance ultrafiltration during cardiopulmonary bypass
Authors: Tallman Richard D , Dumond Mark , Brown David
Published: October 2002

The abnormal conditions to which blood is subjected during cardiopulmonary bypass (CPB) trigger an activation of the inflammatory response in all patients to varying degrees. Both complement activation and the release of cytokines characterize this response. Most inflammatory mediators have a molecular weight that is below the membrane pore size of commonly used ultrafilters, which should allow them to be freely filtered. However, some mediators have been shown to fail to cross through the membrane even though they are small enough to cross. The purpose of the present study was to determine whether certain inflammatory mediators could be removed by ultrafiltration when performed during the rewarming phase of CPB. Thirty adult patients undergoing a single, open-heart procedure were randomized to either control (no ultrafiltration) or to the zero-balance ultrafiltration (ZBUF) group. ZBUF was performed by removing 3 l/m2 blood using a 65-kDa ultrafilter with 1.3-m2 surface area. A volume of a balanced salt crystalloid solution (Plasmalyte) equal to the filtered blood volume was given to replace the fluid removed. Patient data was taken before CPB (T1), immediately following CPB (T2), and 12 h following the procedure (T3). The average volume of filtrate removed during ZBUF was 6405 ml, which was analyzed for the presence of interleukin (IL)-1, IL-6, tumor necrosis factor-alpha (TNF-α), C3a, and C5a. The average concentrations of the mediators measured in the effluent were: IL-1, 0.17 pg/ml; IL-6, 0.64 pg/ml; TNF-α, 1.25 ng/ml; C3a, 782.6 ng/ml; C5a, 25.6 ng/ml. In every case except for IL-1, the amounts of mediators removed were significantly greater than zero. This study demonstrates that ultrafiltration is a strategy that can be used during CPB in the adult to remove significant amounts of inflammatory mediators.
Hemofiltration and inflammatory mediators
Authors: FitzGerald Daniel J , Cecere Giovanni
Published: October 2002

Hemofiltration used in conjunction with cardiac surgery and cardiopulmonary bypass (CPB) was first reported in 1976. Since then, the technology has been routinely used in this context. This review attempts to restate the basic principles governing hemofiltration, the strategies or timing of the use of the technology, and the indications. Particular attention will be focused on the role of hemofiltration in an attempt to reduce the plasma levels of some of the mediators of the Systemic Inflammatory Response Syndrome (SIRS).
The rationale for fat filtration during cardiac surgery
Authors: de Vries A J , Gu Y J , van Oeveren W
Published: October 2002

Improved filter technology may enable the removal of specific substances such as lipids from the blood. Lipids form a heterogeneous group of compounds, but during surgery, the main interest is focussed on triglycerides, glycerol and free fatty acids. Fat emboli have been demonstrated in the brain after cardiac surgery and are associated with ischaemic brain injury. Fat emboli have also been demonstrated in lung and kidney tissue.Lung tissue and leucocytes are especially vulnerable to the effects of free fatty acids. The surgical wound suction blood during cardiac surgery contains a considerable quantity of microemboli. Therefore, as a first step to determining the place of fat filtration during cardiac surgery, the use of a fat removal filter for surgical wound suction blood is advocated.
Selective granulocyte/monocyte apheresis in the treatment of HIV-infected patients: short-term and long-term effects on immunological and virological parameters
Authors: Beretta Alberto , Hasson Hamid , Samiabadi Abby , Alfano Massimo , Trabattoni Daria , Lillo Flavia , Ferrante Pasquale , Clerici Mario , Lazzarin Adriano
Published: October 2002

CD4 T cells constitute the major cellular target of HIV infection and, in the natural evolution of the disease, are gradually lost, leading to severe immunodeficiency. Highly active antiretroviral therapy (HAART) is generally effective in reducing HIV replication to undetectable levels and allows the recovery of CD4 T cells in the majority of patients treated. However, some sanctuaries of HIV replication persist even after years of effective HAART and are responsible for the rebound of viral replication when treatment is interrupted. Monocytes/macrophages are also infectable by HIV and are less susceptible to its cytopathic effects compared to CD4 T cells. Replication- competent HIV DNA is detectable in peripheral monocytes of patients under HAART. These cells may therefore contribute to the maintenance of HIV replication during treatment. In addition, both monocytes and granulocytes are abnormally activated during HIV infection and this results in overproduction of some pro-inflammatory cytokines, among them TNF-. For these reasons we tested whether the renewal of the pool of circulating monocytes and granulocytes by selective apheresis (G1 apheresis) could influence some key immunological and virological parameters in HAART-treated patients. The results showed that treatment with G1 apheresis without discontinuation of HAART results in an accelerated immune reconstitution with sustained increases in CD4 T cell counts in those patients who respond virologically to HAART. G1 apheresis is also followed by a strong reduction of TNF- and a reduction of cells bearing integrated HIV DNA. Taken together, the results indicate that G1 apheresis could be used to improve the immunological and virological response to HAART.
The inflammatory response to CPB: the role of leukocyte filtration
Authors: Asimakopoulos George
Published: October 2002

Leukocyte activation is a significant component of the systemic inflammatory response to cardiopulmonary bypass (CPB). Various strategies have been developed aiming to reduce leukocyte activation and its deleterious effects on organ function after cardiac surgery. Leukocyte filtration aims to physically remove activated leukocytes from the circulation during CPB. The technique has been used since the mid-1990s but its efficacy in attenuating the effects of inflammatory response remains controversial. This article presents a review of published trials investigating the effects of leukocyte filtration on humans undergoing cardiac surgery.
Sensitivity of the Tinetti Gait Assessment for detecting change in individuals with Parkinson’s disease
Authors: Behrman Andrea L , Light Kathye E , Miller Gloria M
Published: October 2002

Objective: To determine the Tinetti Gait Assessment’s sensitivity for detecting changes in verbally instructed gait in patients with Parkinson’s disease.

Design: Two-group comparison study with sample of convenience. Setting: Motor Behavior Lab, Department of Physical Therapy, University of Florida.

Subjects: Twenty community-dwelling, elderly adults: 10 with moderately disabling Parkinson’s disease (PD) recruited from local Parkinson Support Groups and 10 gender and age-matched adults without PD recruited from the local community.

Main outcome measures: Tinetti Gait Assessment (TGA) overall scores. All subjects were assessed while walking under ”ve verbally instructed conditions: (1) usual walking, (2) swing arms, (3) take large steps, (4) walk fast, (5) count aloud.

Results: A 2 x 5 analysis of variance (group x instructional set) was performed. The PD group scored less than the control group on the TGA regardless of the instructed walking conditions ( p < 0.05), however, there was no signi”cant difference in the TGA scores across conditions. The effect size of the instructional set measured by the TGA was greatest for the swing arms condition, though small at 0.25.

Conclusion: The TGA is not sensitive for detecting change in the gait impairments observed in moderately disabling PD and, therefore, is not adequate as an assessment to establish short-term goals, guide treatment, or assess the effects of intervention for clients with PD.
Diagnosis in rehabilitation: woolly thinking and resource inequity
Authors: Wade Derick T
Published: October 2002

The diagnostic process in rehabilitation has traditionally been termed assessment. However the goals of assessment are no different to the goals of diagnosis in traditional medical practice. The purpose is, in both instances, to acquire sufficient information to understand the cause(s) of the presenting problem(s), to allow more-or-less specific intervention(s) to be undertaken and, where appropriate, to allow a prognosis to be given. The main difference is that in rehabilitation the presenting problems are limitations in activities and the main items investigated are impairment and contextual matters, whereas in medicine the presenting problems are symptoms, and the goals are the diagnosis and treatment of the underlying disease. Unfortunately it is commonly assumed that rehabilitation diagnosis is simple and unimportant. Consequently few resources are allocated by purchasers to the process of making a rehabilitation diagnosis, in comparison to the huge resources devoted to achieving disease diagnosis.
Hypnotic imagery as a treatment for phantom limb pain: two case reports and a review
Authors: Oakley David A , Whitman Lionel Gracey , Halligan Peter W
Published: October 2002

Objective: To provide a theoretical background, to review existing literature and to present new case material relevant to the treatment of phantom limb pain using hypnotic imagery.

Method: This paper presents two new case reports involving the use of hypnotic imagery procedures in the alleviation of phantom limb pain and reviews 10 previous clinical studies which have involved a similar approach. The earlier studies were identified by electronic and manual searches of the relevant literature.

Results: Two main treatment strategies can be identified: (1) ipsative/ imagery-based approaches and (2) movement/imagery-based approaches. A common finding is the need to treat the phantom limb as a fireal’ body part, to accept its existence as a valid mental representation and to avoid treating the amputation stump as the sole source of the phantom pain sensations.

Conclusion: Hypnotic procedures appear to be a useful adjunct to established strategies for the treatment of phantom limb pain and would repay further, more systematic, investigation. Suggestions are provided as to the factors which should be considered for a more systematic research programme.
Intramuscular neurolysis with alcohol to treat post-stroke finger fiexor spasticity
Authors: Kong K H , Chua K SG
Published: October 2002

Objective: To evaluate the effectiveness of intramuscular neurolysis with alcohol for the treatment of finger fiexor spasticity in individuals with stroke.

Design: Case series.

Setting: Outpatient clinic of a tertiary rehabilitation facility.

Subjects: Thirty patients with a mean age of 60.2 years and post-stroke duration of 8.3 months with finger fiexor spasticity.

Interventions: Intramuscular neurolysis or motor point blocks of the finger fiexors of the hemiplegic upper extremity with 50% ethyl alcohol.

Main outcome measures: The severity of spasticity as measured by the Modified Ashworth Scale (MAS) and the passive range of motion of the proximal interphalangeal joints of the second to fifth digits.

Results: The mean baseline MAS score was 4.0 ± 0.5 and this improved to 2.0 ± 0.6, 2.2 ± 0.6 and 2.6 ± 0.6 at four weeks, three months and six months post neurolysis respectively. The gains in range of motion were 18.5 ± 6.7, 17.5 ± 6.4 and 14.9 ± 4.8 degrees at four weeks, three months and six months post neurolysis respectively. These improvements were statistically significant ( p < 0.05). Two subjects developed temporary dysesthetic pain of the forearm and palm.

Conclusion: Intramuscular neurolysis with alcohol provides good relief of finger fiexor spasticity in hemiplegic individuals.
Learner-centred education in end-of-life care improved well being in home care staff: a prospective controlled study
Authors: Thulesius Hans , Petersson Christer , Petersson Kerstin , Håkansson Anders
Published: October 2002

The aim of this controlled study was to evaluate a 1-year learner-centred educational project in end-of-life care for home care staff in a rural district of Sweden. Another rural district in the same region served as a control area. A 20-item questionnaire measuring attitudes towards end-of-life care was designed, and the Hospital Anxiety and Depression (HAD) scale was used to measure mental well being. Increased agreement to 18 of 20 attitude statements was seen in the education group, while 2 of 20 items showed a decreased agreement in the control group. Test retest reliability of the 20-item questionnaire was good (r =0.92). The total HAD score decreased from 8.3 pretest to 5.3 post-test in the education group (95% CI=2.1– 3.7; P<0.001), and was 6.8 for both years in the control group. Our study shows that a comprehensive educational programme not only improved attitudes towards end-of-life care, but also the mental well being of the home care staff.
Truth may hurt but deceit hurts more: communication in palliative care
Authors: Fallowfield L J , Jenkins V A , Beveridge H A
Published: October 2002

Healthcare professionals often censor their information giving to patients in an attempt to protect them from potentially hurtful, sad or bad news. There is a commonly expressed belief that what people do not know does not harm them. Analysis of doctor and nurse/patient interactions reveals that this well-intentioned but misguided assumption about human behaviour is present at all stages of cancer care. Less than honest disclosure is seen from the moment that a patient reports symptoms, to the confirmation of diagnosis, during discussions about the therapeutic benefits of treatment, at relapse and terminal illness. This desire to shield patients from the reality of their situation usually creates even greater difficulties for patients, their relatives and friends and other members of the healthcare team. Although the motivation behind economy with the truth is often well meant, a conspiracy of silence usually results in a heightened state of fear, anxiety and confusion not one of calm and equanimity. Ambiguous or deliberately misleading information may afford short-term benefits while things continue to go well, but denies individuals and their families opportunities to reorganize and adapt their lives towards the attainment of more achievable goals, realistic hopes and aspirations. In this paper, some examples and consequences of accidental, deliberate, if well-meaning, attempts to disguise the truth from patients, taken verbatim from interviews, are given, together with cases of unintentional deception or misunderstandings created by the use of ambiguous language. We also provide evidence from research studies showing that although truth hurts, deceit may well hurt more. ‘I think the best physician is the one who has the providence to tell to the patients according to his knowledge the present situation, what has happened before, and what is going to happen in the future’ (Hippocrates).
Effects of polychlorinated biphenyls on development and reproduction
Authors: Faroon Obaid M , Keith Sam , Jones Dennis , De Rosa Christopher
Published: October 2002

As part of its mandate, the Agency for Toxic Substances and Disease Registry (ATSDR) prepares toxicological profiles on hazardous chemicals found at Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) National Priorities List (NPL) sites that have the greatest public health impact. These profiles comprehensively summarize toxicological and environmental information. This article, which constitutes the release of an important section of the Toxicological Profile for Polychlorinated Biphenyls (ATSDR 2000) into the scientific literature, focuses on the developmental and reproductive effects of this group of synthetic organic chemicals (PCBs) in humans and animals. Information on other health effects, toxicokinetics, mechanisms of toxicity, biomarkers, interactions, chemical and physical properties, potential for human exposure, and regulations and advisories is detailed in the profile. Interested readers are encouraged to consult the original toxicological profile for more information. Profiles can be requested from ATSDR’s Information Center by telephone (1-888-42-ATSDR [1-888-422-8737] or E-mail: (atsdric@cdc.gov).
Carcinogenic effects of polychlorinated biphenyls
Authors: Faroon Obaid M , Keith Sam , Jones Dennis , De Rosa Christopher
Published: October 2002

As part of its mandate, the Agency for Toxic Substances and Disease Registry (ATSDR) prepares toxicological profiles on hazardous chemicals found at Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) National Priorities List (NPL) sites that have the greatest public health impact. These profiles comprehensively summarize toxicological and environmental information. This article constitutes the release of an important section of the Toxicological profile for polychlorinated biphenyls [ATSDR. 2000: Toxicological profile for polychlorinated biphenyls. Atlanta, GA: US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry.] into the scientific literature. This article focuses on the carcinogenic effects of this group of synthetic organic chemicals (polychlorinated biphenyls) in humans and animals. Information on other health effects, toxicokinetics, mechanisms of toxicity, biomarkers, interactions, chemical and physical properties, potential for human exposure, and regulations and advisories is detailed in the profile.
Rapid sea-level rise in the Gulf of Maine, USA, since AD 1800
Authors: Gehrels W. Roland , Belknap Daniel F. , Black Stuart , Newnham Rewi M.
Published: October 2002

Two sea-level records from salt marshes in coastal Maine are derived from foraminiferal analyses and AMS 14C, 210Pb, 137Cs and pollen chronology. Both records cover the period from AD 800 until the present and show corresponding patterns of sea-level change when corrected for trends which could accommodate millennial-scale isostatic adjustments. The records provide a detailed sea-level chronology for the last few centuries and thus link the instrumental (tide-gauge) record with the long-term geological record of sea-level change. Results show that sea level was relatively stable between AD 800 and 1300 and reached a lowstand around AD 1800, which was preceded by an oscillation in the eighteenth century. Since AD 1800, sea levels in the Gulf of Maine have risen by 0.3-0.4 m. The onset of this rise corresponds with regional climatic warming and could be interpreted as thermal expansion of the Gulf of Maine and North Atlantic sea surface. Sea-level rise possibly slowed temporarily during the mid-nineteenth century, but twentieth-century rates are unprecedented in the last millennium and correspond with hemispheric warming.
Pollen indications of Holocene palaeoenvironments at Florisbad spring in the central Free State, South Africa
Authors: Scott Louis , Nyakale Makisang
Published: October 2002

Mid- to late-Holocene pollen data from Florisbad in the central Free State, South Africa, reveal a number of moisture fluctuations. Commencing at c. 6500 BP the pollen sequence indicates an arid climate but shows more availability of moisture under grassy conditions from summer rain at c. 6300 BP and again at c. 4420 BP. The interval between these dates is characterized by a dry episode with karroid shrubs some time between 5500 and 4500 BP, possibly as a result of less marked summer seasonality. After 4220 BP, moisture conditions gradually fluctuated in intensity or seasonal availability until c. 2100-1700 BP when strong summer evaporation is indicated at the upper end of the sequence. The data are complemented by previously published results on environmental change from the nearby Deelpan site to the west. Although some distinct events correlate regionally over South Africa, summer rains appear to have been significant at Florisbad at an earlier stage in the mid-Holocene than in the Karoo to the south.
Potential anti-inflammatory treatments against cutaneous sulfur mustard injury using the mouse ear vesicant model
Authors: Dachir S , Fishbeine E , Meshulam Y , Sahar R , Amir A , Kadar T
Published: October 2002

In spite of several decades of research, no effective treatment to skin injuries following exposure to sulfur mustard (HD) has yet been found. In the present study, the mouse ear vesicant model was applied to awake mice in order to evaluate the efficiency of potential anti-inflammatory treatments in preventing HD-induced skin damages. Clinical follow-up and histological evaluation were used to characterize the injuries to the skin and to evaluate the efficiency of the drugs that were applied. Thus, the extent of mouse ear oedema and the histopathological changes following a single application of 0.2 or 1 L of neat HD for 10 min (representing moderate and severe lesions, respectively), were monitored. Typical HD skin lesions were observed including epithelial and dermal damage. The development of the injury in mouse ears was found to be very similar to that reported in human skin. Screening of post-exposure topical steroids and non-steroidal anti inflammatory drugs (NSAIDs) proved that HD-induced inflammation could be diminished significantly as long as the treatment was applied during the early stages following exposure. A combined application of these drugs approved to be particularly effective in reducing inflammation.
Systemic uptake of inhaled arsenic in rabbits
Authors: Beck B D , Slayton T M , Farr C H , Sved D W , Crecelius E A , Holson J F
Published: October 2002

Human occupational exposure to sufficiently high levels of arsenic in air has been associated with lung cancer, but generally not other types of cancer. Thus, a better understanding of the relationship between airborne arsenic exposures and systemic uptake is essential. In this study, rabbits were exposed to one of four levels of arsenic trioxide in air for 8 h/day, 7 days/week, for 8 weeks (0.05, 0.1, 0.22, or 1.1 mg/m3). Plasma levels of inorganic arsenic, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were measured following the last exposure. Although there was a dose-related increase in plasma levels of methylated arsenic metabolites, statistically significant increases in mean inorganic arsenic levels in plasma were observed only in male rabbits exposed to 0.22 mg/m3, and in both males and females exposed to 1.1 mg/m3. Mean inorganic arsenic levels in plasma in males and females exposed to 0.05 and 0.1 mg/m3, and females exposed to 0.22 mg/m3, were not significantly elevated compared to controls. These results suggest that arsenic inhalation has a negligible impact on body burden of inorganic arsenic until air levels are significantly elevated. Based on plasma measurements of inorganic arsenic, the two lowest exposure levels in this study (0.05 and 0.1 mg/m3) are indistinguishable from background.
Sustained normalization of cerebral blood-flow after iloprost therapy in a patient with neuropsychiatric systemic lupus erythematosus
Authors: Mathieu A , Sanna G , Mameli A , Pinna C , Vacca A , Cauli A , Passiu G , Piga M
Published: October 2002

We report the case of a 30-year-old caucasian woman affected by SLE who developed neurological symptoms (prosopagnosia and visual-spatial agnosia) after nine years of disease. Brain MRI showed no abnormalities while a brain SPECT scan showed diffuse uptake defects and hypoperfusion areas in the right and left frontal-parietal regions. At that time the patient was on hydroxychloroquine (400 mg/day) and oral prednisolone (0.5 mg/kg/day) as maintenance therapy. One year later the patient showed worsening of Raynaud's phenomenon with digital dystrophic lesions and was therefore treated with an intravenous infusion of Iloprost (1.5 ng/kg/min per 6h/ day for 10 days consecutively), while baseline treatment remained unchanged. One month later the patient showed a dramatic improvement in her cognitive function and subsequent SPECT scans showed the gradual disappearance of perfusion abnormalities. This first report of Iloprost treatment in CNS lupus suggests the potential therapeutic usefulness of this drug in patients with SLE and functional CNS involvement.
Primary anetoderma associated with primary Sjögren's syndrome
Authors: Herrero-González J-E , Herrero-Mateu C
Published: October 2002

We report the case of a woman with a primary Sjögren's syndrome who developed asymptomatic anetoderma lesions with no other pathology responsible. This dermatosis has been associated with many autoimmune disorders, in particular lupus erythematosus and lupus-like syndromes. Our literature review found only one previous description of primary anetoderma associated with primary Sjögren's syndrome.
Cyclophosphamide type I hypersensitivity in systemic lupus erythematosus
Authors: Thong Byh , Leong K P , Thumboo J , Koh E T , Tang C Y
Published: October 2002

Cyclophosphamide is an important immunosuppressive agent in the treatment of many rheumatic diseases. Urticaria and anaphylaxis to intravenous cyclophosphamide (i.v. CYC) have been reported in patients with haematological and solid organ malignancies. This is the first report in the rheumatology literature of a type I hypersensitivity reaction following monthly i.v. CYC. An 18-year-old girl with systemic lupus erythematosus (SLE) developed generalized urticaria (without concomitant angioedema or anaphylaxis) following i.v. CYC. She had previously developed life threatening angioedema following a respiratory tract infection. She successfully completed regular pulse i.v. CYC with pre-medication with anti-histamine. In the absence of a severe type I hypersensitivity reaction and other suitable immunosuppressive agents, i.v. CYC may be safely continued with pre-medication and careful monitoring during each infusion.
Abdominal crisis in a young man with systemic lupus erythematosus
Authors: Kong K-O , Koh E-T , Lee H-Y , Wee K-P , Feng P-H
Published: October 2002

Medium-sized artery aneurysms are rare in patients with systemic lupus erythematosus (SLE). We report on a 21-year-old Chinese man with SLE and secondary antiphospholipid syndrome (APS) who presented with acute abdominal pain due to a ruptured right hepatic artery aneurysm. He was also found to have aneurysms of the left hepatic artery and splenic artery on autopsy. There have been only eight cases of hepatic artery aneurysm and one case of splenic artery aneurysm associated with SLE in the English literature. Abdominal aneurysm must be suspected in SLE patients presenting with acute abdominal pain, haemoperitoneum or occult bleeding.
Antiphospholipid antibodies do not a syndrome make
Authors: Stone S , Langford K , Nelson-Piercy C , Khamashta M A , Bewley S , Hunt B J
Published: October 2002

The association of antiphospholipid antibodies (aPLs) with a poor obstetric history and/or thrombotic event is typical of the antiphospholipid syndrome (APS). We report four cases of poor pregnancy outcome where a diagnostic label of APS resulted in delayed recognition of other causes of pregnancy loss. Pregnancy outcomes in these women were not improved with antithrombotic therapy alone. Successful outcomes were achieved only when other causes of recurrent miscarriage were considered and treated.
Acute intermittent porphyria and systemic lupus erythematosus: report of a case and review of the literature
Authors: Filiotou A , Vaiopoulos G , Capsimali V , Stavrianeas N , Kaloterakis A
Published: October 2002

The case of a Greek woman with acute intermittent porphyria (AIP) associated with systemic lupus erythematosus (SLE) is described and the literature on this association is reviewed. The coexistence of these two diseases may be determined by unknown mechanisms or could be fortuitous.
Changes in the clinical and laboratory features of lupus patients after the big earthquake in Taiwan
Authors: Chou C T , Hwang C M
Published: October 2002

In order to understand the impact of the massive earthquake on disease activity, 60 patients with systemic lupus erythematosus (SLE) living in the earthquake area (group 1) and 31 patients living away from the area (group 2) were enrolled in this study. A questionnaire was used to record demographic data and clinical manifestations before and 6 months after the earthquake. Laboratory tests, including serum C3, C4, creatinine, anti-DNA antibody, CBC and 24 h urine protein were taken. The results showed that nine patients in group 1 had obvious disease flare-up as evidenced by fever, arthralgia, malar rash and photosensitivity, increased protein loss or edema, and other symptoms. However, there were no significant changes in either group 1 or 2 patients. In contrast, the comparison of laboratory parameters in group 1 patients before and after the earthquake showed a significant decrease of C4 from 17.3§ 15.3 to 14.1§ 7.33 and a significant increase of creatinine from 1.20§ 1.54 to 1.27§ 1.70 (P < 0.05), respectively. No significant difference for either C4 or creatinine was found in group 2 patients. In conclusion, there was no striking change in the clinical aspects for lupus patients. However, some laboratory results became abnormal in group 1 patients after the earthquake, indicating that their lupus status may have worsened.
Nodular invasive tracheobronchitis due to Aspergillus in a patient with systemic lupus erythematosus
Authors: Angelotti T , Krishna G , Scott J , Berry G , Weinacker A
Published: October 2002

Nodular or pseudomembranous tracheobronchitis due to infection by Aspergillus species is an uncommon presentation of invasive aspergillosis. Most cases have been described in severely immunocompromised hosts. We describe the case of a 23-year-old woman, with recently diagnosed systemic lupus erythematosus, who developed worsening respiratory function. Bronchoscopy revealed rapid developmentand progression of multiple nodular plaques in her trachea and bronchi. Endobronchial biopsy demonstrated invasive fungal infection with tissue necrosis and the presence of hyphal elements consistent with aspergillosis. To the best of our knowledge, this is only the second report of fulminant invasive tracheobronchitis due to Aspergillus in a patient with an autoimmune disease.
Unilateral tumid lupus erythematosus
Authors: Pacheco T R , Spates S T , Lee L A
Published: October 2002

Few cases of inflammatory blaschkolinear dermatoses have been described. We report a case of blaschkolinear cutaneous tumid lupus erythematous and discuss the potential association between cutaneous genetic mosaicism, Blaschko lines and lupus susceptibility.
Analysis of data with excess zeros
Authors: Lachenbruch Peter A
Published: October 2002

This paper is an introduction to a set of papers on two-part models that were presented at the 2000 Joint Statistical Meetings of American Statistical Association, International Biometric Society (ENAR), International Biometric Society (WNAR), Institute of Mathematical Statistics, and Statistical Society of Canada. The second part of the paper summarizes results of a study of the size and power of two-part models. It proposes that two-part models are a useful alternative to the t-test and the Wilcoxon test.
Analysis of repeated measures data with clumping at zero
Authors: Tooze Janet A , Grunwald Gary K , Jones Richard H
Published: October 2002

Longitudinal or repeated measures data with clumping at zero occur in many applications in biometrics, including health policy research, epidemiology, nutrition, and meteorology. These data exhibit correlation because they are measured on the same subject over time or because subjects may be considered repeated measures within a larger unit such as a family. They present special challenges because of the extreme non-normality of the distributions involved. A model for repeated measures data with clumping at zero, using a mixed-effects mixed-distribution model with correlated random effects, is presented. The model contains components to model the probability of a nonzero value and the mean of nonzero values, allowing for repeated measurements using random effects and allowing for correlation between the two components. Methods for describing the effect of predictor variables on the probability of nonzero values, on the mean of nonzero values, and on the overall mean amount are given. This interpretation also applies to the mixed-distribution model for cross-sectional data. The proposed methods are illustrated with analyses of effects of several covariates on medical expenditures in 1996 for subjects clustered within households using data from the Medical Expenditure Panel Survey.
Prisons and Prisoners: some observations, comments and ethical reflections based on a visit to a prison hospital in the Ukrainian Republic
Authors: Brykczyñska Gosia
Published: October 2002

The Republic of the Ukraine has a huge prison population and a large prison health care system. Like all other public services in that country it is lacking in sufficient funds to operate adequately and with due respect to the human rights of the prisoners and its health care employees. This report and observations are based on my knowledge of the Ukrainian health care system and a visit to a Ukrainian prison hospital. It includes some ethical reflections stemming from this experience. Although problem-solving exercises can often help to point to areas of potential intervention that could ameliorate a troublesome situation, in this case prison health care conditions cannot be substituted for economic growth, political stability or increased awareness of societal moral obligations.
HIV/AIDS and Professional Freedom of Expression in Japan
Authors: Matsuda Masami
Published: October 2002

A senior physician with a government role in Japan made a widely reported and misleading statement about Thailand’s policy on HIV/AIDS patients. He claimed that in Thailand the policy is to spend public money on the prevention of HIV infection while allowing AIDS patients to die untreated. The author, a community nursing specialist in Japan with first-hand knowledge of HIV/AIDS policy in Thailand, thought that this statement would influence attitudes negatively in Japan. However, speaking out about this misrepresentation of the facts carried certain risks. Although freedom of expression is valued in Japan, in practice it is not easy to contradict senior medical professionals. The author uses his experience of this difficult professional situation to teach nurses how to approach speaking out in the public interest.
Zoledronic acid versus pamidronate as palliative therapy in cancer patients: A Canadian time and motion analysis
Authors: Dranitsaris George , Castel Liana D , Baladi Jean Francois , Schulman Kevin A
Published: October 2002

Pamidronate was an important advance in the palliative treatment of patients with cancer. However, pamidronate must be infused over at least 2 hours in most patients. Zoledronic acid represents the next-generation bisphosphonate with a potential for improved efficacy in the palliative care setting. One important advantage of zoledronic acid is that it can be administered over a 15-minute infusion. To measure the overall efficiency of zoledronic acid as compared with pamidronate in the outpatient setting, a USA microcosting model was adapted to Canadian inputs.

Time and motion data were collected from six patients being treated with zoledronic acid or pamidronate in three USA outpatient cancer clinics. Resource use and time impact on outpatient clinical staff were reanalyzed using Canadian cost estimates. This included the evaluation of fixed, variable, and labour costs obtained from Canadian sources. The manufacturer provided drug costs. The base case analysis assumed a 5300-ft2 out-patient chemotherapy clinic with eight infusion chairs designated for bisphosphonate administration in the province of Ontario.

Mean treatment times in the original USA data collected were 2 hours, 52 minutes for pamidro-nate, and 1 hour, 6 minutes for zoledronic acid (a difference of 1 hour, 46 minutes). In the Canadian version of the microcosting model, the overall treatment cost was Can$673 for pamidronate and Can$682 for zoledronic acid (2001 Canadian dollars). Findings suggest that the shorter zoledronic acid infusion time would allow an additional 27 bisphosphonate patients to be treated per day. Alternatively, approximately one additional hour of chair time could be made available with each zoledonic acid infusion. Sensitivity analyses revealed that (a) the base case results were consistent when geographic region was varied, and (b) the shorter the infusion time for zoledronic acid relative to pamidronate, the lesser the cost difference and more patients could be treated daily.

In conclusion, zoledronic acid may enhance the overall efficiency of outpatient chemotherapy clinics by reducing patient waiting time for bisphosphonate administration. These benefits would be obtained at an incremental cost of Can$9 per infusion.
Fluency in multiple sclerosis: which measure is best?
Authors: Beatty W W
Published: October 2002

Tests of verbal fluency provide brief and sensitive measures of the deficits in rapidly retrieving overlearned information common in multiple sclerosis (MS). Production of words that begin with the letters F, A, and S is the verbal fluency measure most often used with patients who are fluent in English. However, because of frequency of words beginning with certain letters varies from one language to another, it is unlikely that any fixed set of letters will be appropriate for multicenter trials that involve patients who are fluent in different languages. A possible alternative involves using semantic fluency categories that contain such a large number of exemplars that no fluent speaker of any language could exhaust the category in the allotted response time. To examine the potential usefulness of semantic fluency measures, 203 MS patients and 87 healthy controls generated words that begin with F, A, or S or were exemplars of the categories animals and parts of the body. Receiver operating characteristic (ROC) curve analyses indicated that sensitivities and specificities for the three fluency measures in discriminating patients from controls were quite similar, especially if patients with global cognitive impairment were excluded.
Symptoms in individuals with small cutaneous veins
Authors: Kröger K , Ose C , Rudofsky G , Roesener J , Hirche H
Published: October 2002

The clinical relevance of small cutaneous veins (SCV) is still being discussed. In the Duesseldorf/Essen civil servants study, the prevalence of SCV and the individual symptoms and age-dependent changes were analysed.

This cross-sectional study recruited 9935 employees; 9100 could be finally evaluated for this analysis. All volunteers were asked to fill out the questionnaire and were clinically examined. Primarily the clinical findings were documented, adapted to the Basel Study and later modified according to the CEAP classification: (a) class 0 - no visible or palpable clinical signs of venous disease, (b) class 1 - small cutaneous veins, (c) class 1 - reticular veins, (d) class 2 - varicose veins. In all, 64% of the volunteers had no signs of venous disease (class 0: age 41 10 years); 10% had small cutaneous veins (class 1: age 44 10 years).

SCV was more frequent in females (25%) than in males (6%). Only 5% of those with SCV had already consulted a physician. A striking result was that individuals with SCV generally complained about more leg symptoms, of which ‘leg swelling’ and ‘muscle cramps during the night’ were the most frequent. ‘Continual leg swelling’ was reported by 24% of individuals with SCV as opposed to 10% of those without. ‘Leg cramps’ and ‘restless legs’ also were more often documented in individuals with SCV (29% vs 22% and 10% vs 7%). These findings were all statistically significant (p 0.001). After adjusting for age and sex, though, there were few or no differences between groups (leg swelling: odds ratio (OR) 1.3; 95% confidence interval (95% CI) 1.1-1.6 and cramps: OR 1.1; 95% CI 0.9-1.3). A gender separate estimation of the rates showed that females suffer more often from any symptom. Regarding ‘leg cramps’, ‘restless legs’ and ‘itching’, the OR were not different for females and males. For ‘leg swelling’ the age-adjusted OR were significant for women (OR 1.4; 95% CI 1.1-1.7) compared with men (OR 1.1; 95% CI 0.7-2).

Individuals with SCV seem to have more symptoms compared with healthy people. However, this analysis shows that age and sex are the most relevant explanations for these symptoms.
Field measurements of direct and rearview-mirror glare from low-beam headlamps
Authors: Sivak M , Flannagan MJ , Schoettle B , Nakata Y
Published: October 2002

This study measured direct and rearview-mirror glare illuminances produced by low-beam headlamps in a sample of 22 passenger vehicles. The glare illuminances were measured for 12 common glare situations that were defined by a full factorial combination of three scenarios (oncoming driver, center rearview mirror of a preceding driver, or driver-side mirror of a preceding driver one lane to the right), two longitudinal distances (25 m or 50 m), and two vertical locations (illuminated vehicle being either a car or a light truck/van/sport utility vehicle). The measurements were made outdoors at night on asphalt pavement. The median illuminances (not taking into account window transmittance or mirror reflectance) ranged from 0.5 lux for an oncoming driver of a light truck/van/sport utility vehicle at a distance of 50 m, to 3.4 lux at the driver-side mirror of a preceding car at 25 m one lane to the right. The ratios of the maxima and the minima measured for each of the 12 glare situations were large, ranging from about 5:1 to 36:1. The median actual illuminances were compared to the median expected illuminances based on a recent, laboratory-measured, representative sample of US low-beam patterns, taking into account the possible effects of dirt, voltage, misaim, and pavement reflectance. This analysis indicates that the actual illuminances could be very well modeled using the laboratory-measured beam patterns and assuming a linear relationship between the light output of clean and dirty headlamps. Additional analyses evaluated the relationships between headlamp mounting height and glare illuminance.
Battlefield use of depleted uranium and the health of veterans
Authors: Bolton JPG , Foster CRM
Published: October 2002

Depleted uranium munitions have been used in recent military operations in both the Gulf and the Balkans and there have been concerns that exposure to depleted uranium may be a cause of `Gulf War Syndrome’ and cancer clusters. We recount the properties of depleted uranium, its military uses, and the situations in which personnel may be exposed. Following a review of scientific literature, the health effects of depleted and natural uranium exposure are described and the major outcomes of research into Gulf Veterans’ Illnesses are summarised. We conclude that, although there is the potential for uranium exposures to cause renal damage or lung cancer, the risk of harm following depleted uranium exposure in military settings seems to be low. We advise on the management of casualties exposed to depleted uranium and suggest control measures that may be appropriate to protect personnel who provide casualty care.
The common structure of several models for non-ignorable dropout
Authors: Crouchley Rob , Ganjali Mojtaba
Published: October 2002

This paper presents a multivariate generalization of the classical Heckman selection model and applies it to non-ignorable dropout in repeated continuous responses. Many of the recent models for dropout in repeated continuous responses can be written as special forms of this generalized Heckman model. To illustrate this, we present the parameterizations needed to obtain the form of dropout model that occurs when (1) the separate models for the response and dropout are linked by common random parameters, (2) the dropout model is an explicit function of the previous responses and the possibly unobserved current response, (3) the dropout model is both a function of the current response and a common random parameter, and (4) there is a covariance between the stochastic disturbances of the response and dropout processes. We present the joint likelihood of the generalized Heckman model and a residual for the responses. We contrast two of the dropout models in a simulation study. We compare the results obtained from several dropout models on the well known mastitis data.
D.H. Lawrence’s Cornwall: dwelling in a precarious age
Authors: Westland Ella
Published: October 2002

This paper is a case study in the relationship between people and place based on D.H. Lawrence’s experience of living in Cornwall during the Great War. The first part shows the extent to which Lawrence’s heavily Celticized vision was woven from a wider ideological web of Edwardian constructions of Cornwall. The second part goes beyond the borders of cultural construction to consider how far Lawrence’s 20-month engagement with West Penwith departed from his ‘imagined Cornwall’. His experience is contrasted both with the gaze of the passing tourist and with the traditional way of life of his farming neighbours. In maintaining his connections beyond Cornwall, and in his role of migrant, Lawrence can be productively compared with the Cornish people. Understanding the bond which Lawrence formed with his temporary home contributes to our broader comprehension of different ways of ‘dwelling’ in the modern world.
Validation of the Canadian Clinical Probability Model for Acute Venous Thrombosis
Authors: Shields G. Patrick , Turnipseed Sam , Panacek Edward A. , Melnikoff Norman , Gosselin Robert , White Richard H.
Published: October 2002

Objective: To validate the predictive value of the Canadian clinical probability model for acute venous thrombosis, which, to the best of the authors' knowledge, has not been done in emergency department (ED) settings outside of Canada. Methods: Demographic and clinical information, rapid D‐dimer testing, and venous ultrasound imaging were obtained among patients presenting with clinically suspected venous thrombosis at a university‐affiliated ED. A diagnosis of deep venous thrombosis (DVT) was made based on venous ultrasound test results or objectively documented venous thromboembolism during a 12‐week follow‐up period. The probability of venous thrombosis was calculated using the Canadian clinical probability model. Results: Among 102 patients, 17 (17%) were diagnosed as having venous thrombosis initially or during the three‐month follow‐up period. The frequency of venous thrombosis among patients categorized as having high probability was 10 of 17 [59%, 95% confidence interval (95% CI) = 35% to 82%], 6 of 44 (14%, 95% CI = 4% to 24%) with intermediate probability, and 1 of 41 (2%, 95% CI = 0.1% to 11%) with low probability. This compares with respective values of 49%, 14%, and 3%, reported by Canadian researchers in an ED study. Forty‐one of 102 (40%) patients had an alternate diagnosis as likely or more likely than venous thrombosis, but only three (7%, 95% CI = 2% to 18%) of these had venous thrombosis. Conclusions: Use of the Canadian probability model for DVT in this ED resulted in effective risk stratification, comparable to previously published results.