bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of a novel optimal control algorithm to a benchmark fed - batch fermentation process
Authors: Becerra V.M. , Roberts P.D.
Published: November 2007

A novel algorithm for solving nonlinear discrete time optimal control problems with model-reality differences is presented. The technique uses Dynamic Integrated System Optimisation and Parameter Estimation (DISOPE) which has been designed to achieve the correct optimal solution in spite of deficiencies in the mathematical model employed in the optimisation procedure. A method based on Broyden's ideas is used for approximating some derivative trajectories required. Ways for handling con straints on both manipulated and state variables are described. Further, a method for coping with batch-to- batch dynamic variations in the process, which are common in practice, is introduced. It is shown that the iterative procedure associated with the algorithm naturally suits applications to batch processes. The algorithm is success fully applied to a benchmark problem consisting of the input profile optimisation of a fed-batch fermentation process.
On-line stress calculation and life monitoring systems for boiler components
Authors: Siqing Lu  , Wilson Bruce
Published: November 2007

The increasing prevalence of two-shifting of power station operation can cause fatigue problems, particularly on boiler thick-wall pressure components such as headers and manifolds. To deal with the problems, a life monitoring system has been developed in which stresses within selected components are computed and displayed on-line to plant operators. Since the stresses affect the fatigue damage in the components, the operator can use this information to maximise the start-up rates on the plant and, provided the displayed stresses are within the prescribed limits, fatigue cracking will not occur.

The most serious locations of fatigue cracking in a thick-wall component are at the crotch corners of the inner surfaces. However, the measurement of inner-wall temperature or strain is impractical. On-line methods have been proposed in this paper which calculate the inner surface temperature and thermal stress by using the temperature on the outer surface of the component or its tube legs. This can be easily measured. One is the recursive identification method in which the outer surface tempera tures are used to identify on-line the coefficients of the series solution of thermal diffusivity equation. The other method is based on Laplace transform through which the transfer functions between the fluid, inner and outer wall temperatures are derived. The comparisons of the simula tion results by these methods to the accurate results have shown that they are fast, reasonably accurate and suitable for uses in cost-effective stress monitoring and control systems.
Rapid static headspace sampler for automated odour analysis
Authors: Craven Mark A. , Gardner Julian W.
Published: November 2007

This paper describes the design and performance of an automated rapid static headspace sampler and a new axisymmetric temperature- controlled sensor chamber. The system is controlled via a virtual instrument embedded within a microcomputer and is capable of taking several hundred measurements per day. The headspace sampler has a repeatability of better than 1% with a dead-volume of only 3.1 ml and lag time of about 470 ms. The new sensor chamber operated at a constant temperature to better than ± 0.1° and gave a marked improvement in both sensor stability and response time, This new design of analytical instrument should provide for the superior analysis of odorant materials.
Some remarks on the subset principle in second language acquisition
Authors: van Buren Paul
Published: November 2007

In his stimulating paper, 'Configurationality and the subset principle: the acquisition of V' by Japanese Learners of English' (to appear) Zobl concludes on the basis of experimental evidence that, as currently defined, the so-called 'subset principle' - which has recently been proposed for first language acquisition (see Berwick, 1985; Wexler and Manzini, 1986; Manzini and Wexler, 1987) - is inapplicable to second language acquisition. He also concludes that, given certain adaptations, it may have a role to play in second language acquisition. This latter conclusion is potentially of considerable importance to the study of second language acquisition if only because 'principles' are rather thin on the ground in this field of research. However, in what follows I shall argue that the conclusion in question is unwarranted in the theoretical context in which it is drawn. For the sake of brevity I shall refer to Zobl's paper as CSP.
Report- COMOLA: a computer system for the analysis of interlanguage data
Authors: Jagtman Margriet , Bongaerts Theo
Published: November 2007

In a recent contribution to Second Language Research, Pienemann (1992) described a computational system for the analysis of interlanguage data, termed COALA. In this report we will introduce another computer system for the analysis of L2 acquisition data, which has been developed independently. This system we have named COMOLA. This report contains: (1) a description of the COMOLA system, followed by an illustration of the type and scope of analyses yielded by COMOLA; (2) a brief description of COALA; and (3) a comparison of COMOLA and COALA pointing out the major differences between the two systems.
The effect on intermediary metabolism of open-heart surgery with deep hypothermia and circulatory arrest in infants of less than 10 kilograms body weight. A preliminary study
Authors: Milne Emg , Elliott MJ , Pearson DT , Holden MP , Ørskov H. , Alberti Kgmm
Published: November 2007

The effects of hypothermic open-heart surgery with circulatory arrest upon intermediary metabolism and endocrine function in small children are still poorly understood. This report presents data obtained in a preliminary study in which seven children of <10 Kg body weight were investigated during and after such procedures. Frequent blood samples were taken from one day preoperatively to seven days postoperatively for estimation of hormone concentrations (insulin, growth hormone, glucagon, cortisol), and intermediary metabolites (glucose, lactate, pyruvate, alanine, glycerol, and 3- hydroxybutyrate).

Marked hyperglycaemia (34·8 ±3·3 mmol/L) was observed during cardiopulmonary bypass probably as a result of the glucose content of the pump prime. Moderate hyperglycaemia persisted for at least seven days postoperatively. A significant increase in lactate concentrations (p < 0·02) was observed during circulatory arrest and peak concentrations of 6·77 +0.87 mmol/L were measured at the end of the operation. Very high blood lactate concentrations were observed at the end of cardiopulmonary bypass in two patients who subsequently died. Peak insulin concentrations (20·7 ± 5·2 mU/L) were lower than those (30-40 mU/L) reported in adults undergoing similar procedures. Glucagon concentrations were significantly elevated during bypass ( p<0·05) to approximately twice the levels reported in adults. Unlike the other hormones, growth hormone concentrations revealed remarkably uniform change, similar to those reported in 'high responding' adults with peak values of 124 ± 26 mU/L, observed during cardiopulmonary bypass. Cortisol concentrations showed no significant changes throughout the study.

Thus, the response of small infants to these procedures differed both qualitatively and quantitatively from that reported in adults. The results suggest that the nature of the prime fluid may be of major importance in the metabolic consequences of such surgery and that glucose and lactate may be better avoided in the pump prime.
Neutrophil function and cardiopulmonary bypass in humans. The effects of glucose and non-glucose containing bypass pump priming fluids
Authors: Conroy PT , Elliott MJ , Platt PN , Holden M.
Published: November 2007

Defective polymorphonuclear neutrophil function during cardiopulmonary bypass (CPB) has been implicated as a cause of postoperative infection following open-heart surgery. Neutrophil function is known to be impaired in poorly controlled diabetics with elevations of blood glucose concentrations of the order which occur frequently during CPB when glucose containing priming fluids are used. Neutrophil function, as measured by bactericidal assay, and neutrophil and whole blood luminol dependent chemiluminescence, was studied in two groups of 1 2 patients undergoing coronary artery bypass graft surgery. Patients received either a glucose or non-glucose containing bypass pump-priming fluid. Postoperatively neutrophil luminol-dependent chemiluminescence was significantly increased in both groups (glucose prime groups p < 0.01, non-glucose prime group p < 0.01). Whole blood chemiluminescence was increased significantly intra and postoperatively in the glucose prime group ( p < 0.02, p < 0.02 respectively) but the increase was not significant in the non-glucose prime group. Bactericidal activity remained unchanged during and after surgery in both groups (mean bactericidal index intraoperatively 96.4 glucose group, 96.2 non-glucose group; postoperatively 99.7 glucose group, 99.7 non-glucose group). These data suggest that glucose containing bypass priming fluids do not modulate significantly the function of circulating neutrophils after CPB. Neutrophil function was not decreased after surgery, and other factors may be responsible for the reported higher incidence of bacterial infection after CPB.
Performance characteristics of a new arterial line filter
Authors: Gourlay T. , Gibbons M. , Fleming J. , Taylor KM
Published: November 2007

A new 40 micron polyester screen arterial line filter with integral automatic blood gas separator has been designed with the potential for improved removal characteristics for gas microbubbles and massive air. A simple in vitro evaluation has been carried out comparing the new filter (Pall EC+) against a standard widely-used reference arterial line filter (Pall EC 3840). The filters have been compared in terms of their haemodynamic performance, specifically pressure drop at incremental flow rates and haemolysis characteristics measuring generated plasma free haemoglobin. In addition, the relative abilities of the test and reference filters to remove gaseous microbubbles, and also to vent massive air introduced into the test circuits have been assessed using an ultrasound based microbubble detection system. The results of the studies indicate that the test and reference filters are identical in terms of haemodynamics, with maximal pressure drops of 30 mmHg at 4-5 litres mean flow rate. Neither filter is associated with significant haemolysis in bovine blood test circuits flowing at 4 I/min for 60 minutes. However, the EC+ filter has significantly superior performance over the reference EC 3840 filter in both microbubble removal and in removal of nitrogen gas introduced directly into the test circuit at up to 5 litres gas/min ( p < 0.01). The new EC+ filter appears to offer safety in terms of haemodynamics and haemolysis, while providing maximal protection against massive arterial gas embolism.
Plasma levels of glucose, insulin and cortisol in children undergoing cardiac surgery: effects of pulsatile and nonpulsatile perfusion
Authors: Vigneswaran W.T. , Pollock J.C.S. , Jamieson M.P.G. , Torsney B. , Beastal G.H.
Published: November 2007

The effects of pulsatile and nonpulsatile perfusion on the plasma glucose, insulin and cortisol levels were studied in 12 children undergoing intracardiac repair of congenital heart defects. Hyperglycaemia was noted in both subgroups during the operation but plasma glucose returned to normal levels at 24 hours. Insulin secretion was suppressed during the period of extracorporeal circulation (ECC) and this was pronounced while the aorta was crossclamped. Cortisol levels were elevated during the whole period of study and remained elevated at 24 hours. In the pulsatile group cortisol levels were higher than the nonpulsatile group. However there was no significant difference between the groups.

Like adults, children exhibit a metabolic response during open-heart operations. Pulsatile perfusion delivered by a modified Stöckert roller pump during ECC, did not alter the glucose, insulin and cortisol response to cardiac surgery in this study.
The use of Doppler ultrasound in the assessment of microemboli during cardiac surgery
Authors: Pugsley W.
Published: November 2007

Arterial microemboli may contribute to bypass (CPB) related cerebral dysfunction and might be reduced by arterial line filtration. Doppler ultrasonic techniques have been used to detect such emboli in the bypass circuit since 1965. Attention has recently focussed on detecting microemboli which actually reach the cerebral circulation. We evaluated a transcranial Doppler system (TC2-64, EME) on an extracorporeal circuit and confirmed that microemboli can be detected and quantified. In the operating theatre, we measured middle cerebral artery blood velocity and the incidence of microembolic events (MEE) during cardiopulmonary bypass. Twenty patients (median age 56 yrs, range 50-64) with arterial line filters (40 micron, Pall ECplus) and 20 without (56 yrs, 43-70) have been studied. Bypass technique was standardized and a bubble oxygenator (Harvey H 1700) used in all cases. MEE occurred during aortic cannulation and at inception of bypass. On bypass, patients with filters had fewer MEE (0-10 per 30 minutes) than nonfiltered patients (30->250 per 30 minutes).

We conclude that the TC2-64 transcranial Doppler system can detect and quantify microemboll of greater than 40 microns diameter in the middle cerebral artery during cardiac surgery. It cannot differentiate particulate from gaseous microemboli. We have also identified high risk periods for cerebral microembolisation.
Correlates of total perfusion time, clamp time and nonclamp perfusion time in coronary bypass surgery
Authors: Utley Joe R , Morgan Marc S , Johnson Howard D , Wilde Connie M , Bell Michael S
Published: November 2007

Longer perfusion and clamp times are associated with greater mortality and morbidity. We studied the factors which correlate with the duration of perfusion time, clamp time and nonclamp perfusion time in 1078 patients having coronary bypass surgery. Perfusion time correlated significantly ( P≤ 0.05) with female sex, ejection fraction, left ventricular diastolic pressure, number of distal anastomoses, incomplete revascularization, atherosclerotic aorta, aorto-iliac-femoral occlusive disease and date of operation. Only the number of distal anastomoses, incomplete revascularization, atherosclerotic aorta, ejection fraction and date of operation correlated significantly ( P≤ 0.05) with perfusion time with multiple regression analysis. Factors significantly ( P≤ 0.05) correlating with nonclamp perfusion time included age, ejection fraction, left ventricular end diastolic pressure, number of distal anastomoses, incomplete revascularization, atherosclerotic aorta and aorto-iliac-femoral occlusive disease. Multiple regression analysis showed that only ejection fraction, number of distal anastomoses, incomplete revascularization and atherosclerotic aorta significantly ( P≤ 0.05) contributed to the predication of nonclamp perfusion time. The individual correlates ( P≤ 0.05) of clamp time included age (negative correlation), female sex, ejection fraction, height, weight, body surface area, number of distal anastomoses, incomplete revascularization, atherosclerotic aorta and date of operation. Multiple regression analysis shows that clamp time correlates significantly ( P ≤ 0.05) with the number of distal anastomoses, date of operation, age, incomplete revascularization, atherosclerotic aorta and female sex.
Centrifugal blood pumps — a brief analysis: development of new designs
Authors: Leschinsky BM , Itkin GP , Zimin NK
Published: November 2007

Analysis of 350 different sources of information from leading countries of the world enabled us to determine the availability of 20 different designs of centrifugal and rotary blood pumps. Most of them are for extracorporeal applications with radial pumping wheels of disc or vane type. The prospect of improving these designs was suggested by a combination of these two types. Five new designs based on the Biomedicus have been produced. Basic calculations are given for one of these with respect to limitations for shear stresses. It is proposed that the suggested designs will allow reductions in thrombosis and haemolysis which are the main problems for these pump designs.
Support perfusion for liver transplantation
Authors: Gifford David J
Published: November 2007

Addenbrooke's Hospital, Cambridge, UK, has had an ongoing orthotopic liver transplant programme since 1968. Various support bypass techniques have been used intermittently since 1977. In 1990 bypass was needed for 38% of adult liver transplants, and bypass standby was provided for a further 25%. Adult liver recipients (high-risk) are selected for bypass in accordance with a number of surgical and anaesthetic criteria in order to maximize patient benefit and minimize risk. Before the start of the operation two cannulae (8 or 10 Fg) are placed into left and right internal jugular veins and/or the left brachial vein for rapid volume replacement. Femoral and portal vein cannulation (16 to 22 Fg) can quickly be achieved for splanchnic venous drainage to a heparin coated Biomedicus bypass system. This technique provides flows of 1.5 to 2.5 litres per minute with modest perfusion pressures (around 120mmHg) and provides adequate surgical venous decompression and circulatory support during the anhepatic phase.
Red blood cell damage during experimental prolonged perfusion with membrane oxygenation using fresh human blood
Authors: Bergman P. , Friberg G. , Liu B. , Al-Khaja N. , Belboul A. , Mellgren G. , Roberts D.
Published: November 2007

The effects of prolonged perfusion of oxygenated blood have previously been studied with respect to haemolysis and cell morphology. The aim of this study was to examine the effect of mechanical trauma on the microrheology of red blood cells during experimental prolonged perfusion with membrane oxygenation (PPMO). Red blood cell damage was assessed by blood rheological parameters using a St George's filtrometer. Red blood cell filtration rate (RFR, μl/s), clogging rate (RBC-CR, 102%/ml), clogging particle (RBC-CP, 106/ml), mean corpuscular volume (MCV) and haematocrit (Hct) were analysed at the start of PPMO and after 24, 48 and 72 hours. RFR values were 81.3 ± 3.7 at the start, 79.2 ± 7.6 (24 h, p < 0.01), 42.3 ± 8.4 (48 h, p < 0.001) and 25.1 ± 7.0 (72 h, p < 0.001). The mean RBC-CR was 2.45 ± 0.53 at the start; this increased to 3.58 ± 0.9, 6.62 ± 0.92 and then reduced to 4.77 ± 1.39 at 24 (p < 0.0001), 48 (p < 0.0001) and 72 (p < 0.02) hours respectively. Mean RBC-CP at the start was 3.29 ± 0.55; this increased to 3.42 ± 0.72, 5.29 ± 0.68 and 6.09 ± 1.07 at 24, 48 and 72 hours respectively (NS at 24 h and 48 h, p < 0.04 at 72 h). The mean MCV (fl) at the start was 86 ± 4; this increased to 101 ± 2, 111 ± 4 and 119 ± 4 at 24, 48 and 72 hours respectively (p < 0.001). Mean Hct (%) at the start was 33 ± 2; this increased to 38 ± 2, 38 ± 2 and 48 ± 2 at 24, 48 and 72 hours respectively (p < 0.05 at 24 and 48 hours, p < 0.001 at 72 hours). The mean pH and CO 2 (kPa.s) levels were 7.38 ± 0.04 and 4.1 ± 0.7 respectively. This study suggested that there was a continuous loss of red cell rheology during PPMO, which could lead to disturbed microcirculation, thereby increasing the risk of organ ischaemia, hypoxia, dysfunction and failure.
Leucocyte depleting filters and cardiothoracic surgery
Authors: Hart S. , Roe JA
Published: November 2007

Leucocyte filtration technology is now beginning to be used in cardiothoracic surgery. The leucocyte depletion of banked homologous blood has been shown to reduce its immunosuppressive effects, along with a range of other benefits. Use of such a blood product appears to be an attractive option during cardiopulmonary bypass (CPB) as this procedure is recognized as causing immune disturbance and long-term immunosuppression.

White-cell removal filters also appear to have a novel application in the reduction of neutrophil-mediated damage associated with CPB procedures. A strong database from animal work has been recently supplemented by human data that shows clinical benefits from autologous white-cell removal by filtration.
Influence of different flow modi during extracorporeal circulation on endothelial-derived vasoactive substances
Authors: Knothe CH , Boldt J. , Zickmann B. , Konstantinov S. , Dick P. , Dapper F. , Hempelmann G.
Published: November 2007

Influences of shear stress on endothelin (ET) as well as prostacyclin (PGF) levels are common findings in different experimental settings. Thus, plasma levels of both substances seem to be a good tool to verify if different flow modi can be produced in blood vessels by generating pulsatile flow with a roller pump. In the present study, 20 patients scheduled for elective aortocoronary bypass operation were divided into two groups at random. One group was perfused with nonpulsatile (CON-group) and the other with pulsatile flow (PULS-group) during extracorporeal circulation. ET and PGF plasma levels were monitored perioperatively together with parameters of renal function and haemodynamic data. ET values were only slightly elevated at the end of extracorporeal circulation (mean baseline value; CON 3.1 μg/ml and PULS 3.2 μg/ml; mean maximal values at the end of cardiopulmonary bypass (CPB) 4.0 μg/ml and 3.9 μg/ml respectively). Prostacylin values (median baseline values: CON 56.7 μg/ml and PULS 57.1 μg/ml) peaked at the end of operation (median CON 117.8 μg/ml and PULS 137.5 μg/ml respectively) with a subsequent small decrease. No differences between the groups could be observed at any time point with respect to vasoactive substances, urine output (CON 6.5 ml/min and PULS 6.2 ml/min) or haemodynamics during CPB. This confirms studies emphasizing that no effective microvascular pulsatile flow is generated by conventional pulsatile flow-generating devices. In the present study, normothermia and a constant flow rate were maintained during CPB. Aortic cannulae (body-surface-related not maximal large diameters) were inserted. Altering these procedures may have led to more pronounced differences between the groups. All patients had an uneventful course after the operation. Similar to other reports, the present study was not able to demonstrate any benefit of pulsatile perfusion during extracorporeal circulation.
Complement activation during and after open-heart surgery is only marginally affected by the choice of fluid for volume replacement
Authors: Svennevig JL , Tølløfsrud S. , Kongsgaard U. , Noddeland H. , Mohr B. , Øzer M. , Mollnes TE
Published: November 2007

Forty patients undergoing CPB for coronary artery surgery, using a standardized technical setting, were randomized to receive either Ringer's acetate, dextran 70 (Macrodex), polygeline (Haemaccel) or albumin 4% for volume replacement during and after surgery. The choice of fluid did not affect early complement activation (C3 activation products). Higher values of the terminal complement complex (TCC) were found only at the end of the operation in patients receiving polygeline. There were no differences between any two of the four groups during the postoperative course. The use of blood transfusion or autotransfusion and the degree of haemodilution and hypothermia did not affect complement activation.

We conclude that complement activation in association with open-heart surgery is only marginally affected by the choice of fluid for volume replacement.
Medical undergraduates
Authors: Benton TF
Published: November 2007

We have much to learn about the contribution of palliative medicine to undergraduate teaching. When should it be introduced and where should it be taught? Who should teach it and what methods should be used? How can the various practical skills be demonstrated? There is a need for an increased awareness of palliative medicine in those involved in undergraduate education.
Nonmetastatic manifestations of malignancy: cutaneous
Authors: Proby Charlotte M , Mortimer Peter S , Badger Caroline
Published: November 2007

This article deals with cutaneous manifestations of malignancy. The skin, as the largest and most visible organ, frequently reflects underlying disease including neoplasia. Cutaneous signs may be directly, or indirectly, related to the underlying cancer and appreciation of established associations will hopefully prove useful to both general and specialized physicians.
Attitudes and perceptions afifecting Scottish clergy in their care of the dying
Authors: Murray Derek B
Published: November 2007

This paper sheds further light on the education and training of Scottish clergy in the care of the dying. In particular, it examines the problems of interdisciplinary co-operation, the attitudes of clergy to other professionals, and the perceived reactions of doctors and nurses to clergy.
Terminal restlessness in patients with advanced malignant disease
Authors: Back Ian N
Published: November 2007

So-called 'terminal restlessness' may have many causes often difficult to diagnose but with specific treatment for a minority of cases. Some of the possible causes and their management are reviewed, including motor restlessness and mental unrest.
Which patients with terminal cancer are admitted from home care?
Authors: Hinton John
Published: November 2007

The factors related to admission of patients with terminal cancer who had been referred to a reputable home care service were examined in 415 patients referred in a two-year period and in a prospective study of a randomized one in three sample of the 232 adults still alive one week after referral, who were able to converse and be at home with caring relatives. The reasons given by staff for intermediate admissions were mostly to improve symptom control or provide respite; for final admissions the reasons were symptom control, patients' deteriorated state and relatives needing relief. Independent weekly assessments usually concurred in showing increasing problems or distress preceding final admission, particularly patients' weakness, pain, depression and anxiety, and relatives' fatigue, anxiety or depression.

Examination of selected demographic and illness factors indicated that few patients living alone or with unfit relatives stayed at home; breast cancer led to more deaths as an inpatient, whereas stomach cancer favoured deaths at home. The proportion of patients admitted steadily increased as care lengthened. Assessments of psychological factors showed that initial attitudes of denial, conscious fighting of disease, and optimism were linked with increased late admissions; earlier awareness of dying in patients and stoicism in relatives favoured home deaths. A growing preference for inpatient care usually preceded or accompanied admission. Recognition of both immediate and underlying causes of admission can indicate where further treatment or assistance is needed and also improve understanding so that patients and relatives may be suitably supported or helped to adjust.
Handling difficult questions in palliative care-a flow diagram
Authors: Faulkner Ann , Regnard Claud
Published: November 2007

Patients with advanced disease ask many difficult questions, some of which have painful answers, some of which have answers which contain uncertainty, and some of which have no answers. They should be able to ask their questions in an environment that allows them to disclose their true worries, have the opportunity to talk them through, and look for options. Health professionals need to develop the relevant skills to help patients and their families to disclose and discuss difficult issues, while handling their own emotions.
Thiamine deficiency in patients admitted to a palliative care unit
Authors: Barbato Michael , Rodriguez Paul J
Published: November 2007

This study looks at the clinical and thiamine status of 50 terminally ill patients who were admitted to a palliative care unit. Thiamine levels were found to be abnormally low in 28% of the patients and borderline in a further 36%. Cognitive impairment, as measured by the mini-metal state examination (MMSE) of Folstein, Folstein and McHugh, was present in 68% of those tested and a significant correlation was found between the MMSE status and thiamine levels.
Staff stress in hospice/palliative care: a review
Authors: Vachon Mary LS
Published: November 2007

A review of the research in the area of staff stress in hospice/palliative care since the start of the modern hospice movement shows that, while high stress was identified as a problem in the early days of the movement, later studies have shown that stress and burnout in palliative care are by no means universal. Staff stress and burnout in hospice/palliative care has been demonstrated to be less than in professionals in many other settings. However, other studies have noted suicidal ideation, increased alcohol and drug usage, anxiety, depression, and difficulty in dealing with issues of death and dying. It is hypothesized that part of the reason that stress may be lower than expected in some settings was the early recognition of the potential stress inherent in this field and the development of appropriate organizational and personal coping strategies to deal with the identified stressors. Staff in hospice/palliative care have been found to have increased stress when mechanisms such as social support, involvement in work and decision-making, and a realistic work-load are not available.

The stress that exists in palliative care is due in large measure to organizational and societal issues, although personal variables were also found to have an influence. Suggestions are given for the direction of future research in the field.
Survey of hospice and palliative care inpatient units in the UK and Ireland, 1993
Authors: Eve Ann , Smith Anthony M.
Published: November 2007

A survey of the inpatient palliative care services throughout Great Britain and Ireland was undertaken, enquiring about activity for the year 1993. This is one in a series of annual surveys of the various aspects of palliative care. Questionnaires were sent out at the end of April 1994, and 174 replies were received from 200 initially sent (87%). Replies were analysed by the Hospice Information Service. The report gives details of admissions, deaths and discharges and considers length of patient stay and bed occupancy. A discussion of the apparent discrepancies in the reported statistics is included. Palliative care for children is separately considered, and admissions of non-cancer patients are detailed.
Problem-solving therapy in palliative care
Authors: Wood BC , Mynors-Wallis LM
Published: November 2007

Emotional syndromes of depression and anxiety are common among palliative care patients. This pilot study evaluated the feasibility and acceptability of using a brief psychological treatment (problem-solving therapy) to treat these syndromes in patients receiving palliative care. Results were encouraging, particularly as regards acceptability to patients. Problems encountered during the study are discussed in the context of planning future research into the efficacy of treatments for emotional disorders in palliative care.
Epidural complications and a case of malignant meningitis
Authors: Jennings AL , Rothwell MP , Naysmith A.
Published: November 2007

We report a case in which the signs of a malignant meningitis could have been confused with complications of an in-dwelling epidural catheter which was being used for analgesia. This confusion could have had disastrous implications for the patient's pain relief. We also discuss some of the issues and problems surrounding the use of in-dwelling epidurals in terminal care patients.
Rock glaciers : II models and mechanisms
Authors: Whalley W. Brian , Martin H. Elizabeth
Published: November 2007

This second part of a review deals with the mechanisms of rock glacier formation and flow. The presence of a copious debris supply is important in all models, although the source of ice necessary for deformation of the debris is in dispute. Evidence for the three main models: permafrost creep, debris-covered glaciers and talus deformation (rockslide), are reviewed. Seismic and resistivity evidence suggests a nonglacial (permafrost) origin where such measurements have been made. There is also good evidence that glacier ice can be seen and its extent determined in other examples. Morphological characteristics are presented; in some cases they seem to be applicable to the permafrost creep model but can also be explained by the debris-covered glacier model. The consequences of both these models are discussed in the light of the appropriate flow law models. Several different ways in which talus deformation have been suggested and these can be applied in some cases. Because of confusion in the designation of 'valley side rock glaciers' these are here termed 'protalus lobes'. The origin of these features is still problematical and may not be the same as for rock glaciers sensu stricto. It is argued that there is still no conclusive evidence for a single flow mechanism for all the features ascribed as rock glacier or protalus lobes.
Dynamics of beach-dune systems
Authors: Sherman Douglas J. , Bauer Bernard O.
Published: November 2007

Beaches and coastal dunes are dynamic geomorphic systems that respond to process forcing over a broad spectrum of spatial and temporal scales. At all scales, there are potential suites of interaction between system forms and processes, and the mechanisms of interaction are stressed in this article. At micro-scales, this interaction is formalized through the concept of morphody namics, and deterministic and probabilistic approaches are used to model sediment transport and landform development over time scales of hours to months and space scales of metres to kilometres. Meso-scale interactions are conceptualized using a sediment-budget approach. Nine characteristic environments comprise the beach and dune sediment-budget ensemble, representing a classifica tion scheme for reciprocating coastal systems.
Progress in the use of drainage network indices for rainfall-runoff modelling and runoff prediction
Authors: Wharton Geraldene
Published: November 2007

Traditional catchment-based approaches to runoff prediction suffer from the problem that it is difficult to interpret the collective physical significance of a large number of intercorrelated drainage basin variables. This has highlighted the need for a sensitive and meaningful index to relate the basin character to the discharge produced. Network routing models also require an appropriate descriptor of drainage basin form to relate to hydrologic response characteristics. An index of the drainage network is potentially the most valuable because it responds to precipitation, reflects the characteristics of the basin and affects runoff. Although a large number of drainage network indices have been developed they have proved inadequate in their failure to describe the dynamic nature of drainage networks. Future research into the use of drainage networks for rainfall- runoff modelling and runoff prediction needs to have as its central aim the development of a dynamic network index which has physical meaning for drainage basins of all sizes and which is quick and easy to calculate from data that are rapidly obtainable. Despite the improved resolution of satellite imagery its high cost still prevents the widespread application of satellite remote sensing techniques to monitoring storm-specific drainage network changes. However, the increased availability of topographic data in digital format and the recent developments in digital elevation models (DEMs) have demonstrated the potential for the rapid derivation of both perennial and extended drainage networks from which network expansion potential can be calculated.
The role of Antarctic sea ice in global climate change
Authors: Hanna Edward
Published: November 2007

Taking a distinct interdisciplinary focus, a critical view is presented of the current state of research concerning Antarctic sea-ice / atmosphere / ocean interaction and its effect on climate on the interannual timescale, with particular regard to anthropogenic global warming. Sea-ice formation, morphology, thickness, extent, seasonality and distribution are introduced as vital factors in climatic feedbacks. Sea-ice / atmosphere interaction is next discussed, emphas izing its meteorological and topographical influences and the effects of and on polar cyclonic activity. This leads on to the central theme of sea ice in global climate change, which contains critiques of sea-ice climatic feedbacks, current findings on the representation of these feedbacks in global climatic models, and to what extent they are corroborated by observational evidence. Sea-ice / ocean interaction is particularly important. This is discussed with special reference to polynyas and leads, and the use of suitably coupled sea-ice / ocean models. A brief review of several possible climatic forcing factors is presented, which most highly rates a postulated ENSO-Antarctic sea-ice link. Sea-ice / atmosphere / ocean models need to be validated by adequate observations, both from satellites and ground based. In particular, models developed in the Arctic, where the observational network allows more reasonable validation, can be applied to the Antarctic in suitably modified form so as to account for unique features of the Antarctic cryosphere. Benefits in climatic modelling will be gained by treating Antarctic sea ice as a fully coupled component of global climate.
Quantitative reconstructions of the last glaciation of the Barents Sea: a review of ice-sheet modelling problems
Authors: Siegert Martin J.
Published: November 2007

Reconstructions of the Late Weichselian ice sheet within the Barents Sea have varied from complete coverage of a large (3 km thick) grounded ice mass, to a situation in which glacier extent was restricted to the Svalbard coast. Recently obtained geological data indicate that 1) glaciation of the Barents Sea occurred after 25 000 years ago; 2) the ice sheet was at its maximum extent at around 20 000 years ago; 3) the maximum-sized ice sheet covered the entire Barents Shelf; and 4) ice-sheet decay began at about 16 500 years ago. The ice sheet was, consequently, one of the last to grow and first to decay during the last glacial. However, this recently derived chronology of glacial events has reintroduced problems concerning the thickness distribution of the maximum- sized ice sheet, and the glaciological processes by which rapid glaciation and ice decay happened. In particular, the situation in which regional glaciation of Bjomoya occurred at the same time as grounded ice (and ice-stream activity) within the relatively deep Bjørnøyrenna is yet to be understood fully. This article provides a review of reconstructions of the last Barents ice mass, and compares these models with geological and palaeoceanographic information from the area in order to provide a summary of what is presently known, and to indicate explicitly what is not known, about the Late Weichselian Barents Sea ice sheet.
Review: Heat Shock Proteins and Systemic Lupus Erythematosus
Authors: Dhillon V. , Latchman D. , Isenberg D.
Published: November 2007

This review briefly defines the heat shock proteins (hsps), their classification and their functions. The hypothesis that links hsps to the development of autoimmunity is explored, together with the rationale for investigation of the relationship between hsps and systemic lupus erythematosus (SLE). Thus, published work on this subject falls into three main categories: the overexpression of hsps in SLE, the development of autoantibodies to hsps in SLE, and the surface expression of hsps in peripheral blood mononuclear cells in SLE. This work is reviewed in detail. In conclusion, we describe areas for further study and outline ways in which this is being approached.
Neonatal Lupus Erythematosus with Multisystem Organ Involvement Preceding Cutaneous Lesions
Authors: Fonseca Eduardo , Contreras Félix , García-Frías Enrique , Carrascosa M. Carmen
Published: November 2007

Here we report a case of neonatal lupus erythematosus syndrome presenting with multisystem organ involvement, including anemia, thrombocytopenia, purpura, bloody diarrhea, enzymatic liver abnormalities, splenomegaly and pneumonitis. These findings preceded the cutaneous rash that was the clue for the diagnosis. The patient's mother had an undiagnosed subacute cutaneous lupus erythematosus.

The various forms of onset of neonatal lupus erythematosus syndrome are emphasized.
Monoclonal Autoantibodies to Cardiolipin Derived from SLE Mice
Authors: Ichikawa Kenji , Suzuki Takahiro , Hashimoto Yoshiko , Sumida Takayuki , Tomioka Hisao , Yoshida Sho , Koike Takao
Published: November 2007

The objective of this study was to clarify the specificity of anticardiolipin antibodies (aCL). Eighteen monoclonal hybridoma aCL from systemic lupus erythematosus (SLE)-prone MRL/Mp-lpr/lpr mice were established, and the reactivity of monoclonal aCL to phospholipids, DNA, nuclei of human epithelial cells, platelets, vascular endothelial cells, heparin, protein C and thrombomodulin was examined.

All the 18 monoclonal aCL reacted with phosphatidylserine and some showed reactivity to phosphatidylinositol and phosphatidylcholine. Six of 16 monoclonal aCL were demonstrated to have the property of lupus anticoagulant. Monoclonal aCL were classified into three categories, in terms of DNA-binding specificity. Ten of 18 aCL had characteristics of antinuclear antibodies. Six of 11 aCL reacted with platelets. Three of 18 aCL were bound to vascular endothelial cells and to heparin. No monoclonal aCL reacted with protein C or thrombomodulin. Therefore, the conclusion was made that monoclonal aCL from SLE mice showed a polyspecific nature.
Anticardiolipin Syndrome, Aspirin Therapy and Fetal Malformation
Authors: Chakravarty K. , Merry P.
Published: November 2007

A patient with systemic lupus erythematosus and elevated cardiolipin antibody levels was given low-dose aspirin therapy prior to and throughout her third pregnancy to minimize the risk of miscarriage. She delivered a boy at 38 weeks with the skeletal deformity of two thoracic hemivertebrae. The putative role of aspirin causing this birth defect is discussed.
Neonatal Lupus Liver Disease
Authors: Lee Lela A. , Reichlin Morris , Ruyle Stephanie Z. , Weston William L.
Published: November 2007

Neonatal lupus erythematosus (NLE) is an autoimmune disease characterized by complete congenital heart block and/or transient skin lesions of subacute cutaneous lupus erythematosus. We report that in approximately 10% of cases of NLE with heart block or skin disease, liver disease also occurs (4 of 35 cases in our series). Cholestasis was the major feature in our cases. Although the cholestasis may be severe, the disease process appears to be transient and surviving babies have been healthy on follow-up. In one liver examined for antibody deposition, IgG antibody deposits, presumably of maternal origin, were present. Three maternal sera were examined for autoantibodies, including liver-specific autoantibodies. No liver-specific autoantibodies were found. Rather, the maternal autoantibodies too were the ubiquitous Ro/SSA-associated autoantigens. The autoantibodies bound the 60 kDa SSA/Ro ribonuclear protein (three of three sera), the 52kDa SSA/Ro protein (two of three sera) and the SSB/La ribonuclear protein (two of three sera).
SLE Anti-DNA Autoantibodies Binding Estradiol-Albumin-DNA Conjugate
Authors: Moinuddin  , Ali Asif
Published: November 2007

The present study was designed to study the possible role of the female sex hormone, estradiol in conjugation with DNA, in the pathogenesis of systemic lupus erythematosus (SLE). Calf thymus DNA fragments (average size 200 bp) were covalently linked to estradiol-albumin (E2-BSA) by treatment with glutaraldehyde. The conjugate was separated from free DNA by gel exclusion chromatography. It was characterized by UV spectroscopy and thermal denaturation studies. The conjugate (E2-BSA-DNA) induced high titer antibodies which were highly specific towards their immunogen. These antibodies also recognize estradiol-albumin and B-estradiol but not native DNA (B-form), brominated DNA (Z-form) or poly(rG).poly(dC) (A-form). The E2-BSA-DNA conjugate showed significant binding with SLE sera known to have a high level of anti-native DNA antibodies. The results indicated the recognition of unique conformation of estradiol-BSA-DNA conjugate by naturally occurring SLE anti-DNA autoantibodies.
Role of IL-3 in the Antiphospholipid Syndrome
Authors: Shoenfeld Yehuda , Fishman Pnina
Published: November 2007

Antiphospholipid syndrome (APLS) is characterized by recurrent thromboembolic phenomena, thrombocytopenia and fetal loss. We describe various methods of induction of experimental APLS. These models were employed to study a variety of therapeutic agents including low dose aspirin, low molecular weight heparin, IVIG and thromboxane receptor antagonist. Because interleukin-3 (IL-3) is a multilineage cytokine affecting also megakaryocytes, is regarded as a 'good' cytokine in various stages of pregnancy and as low levels of IL-3 were recorded in APLS, it was logical to employ IL-3 as a therapy for APLS. Indeed, this treatment completely abrogated all the manifestations of experimental APLS. Furthermore, it was found that low dose aspirin most probably affect positively APLS via inducing an increased production of IL-3 by monocytes.
Antiphospholipid syndrome and the idiotypic network
Authors: Bakimer R. , Blank M. , Kosashvilli D. , Ichikawa K. , Khamashta M.A. , Hughes G.R.V. , Koike T. , Shoenfeld Y.
Published: November 2007

To study whether monoclonal anticardiolipin antibodies (aCL), derived from patients with antiphospholipid syndrome (APS). have similar pathogenic potential, we have employed an experimental model of antiphospholipid syndrome.

Monoclonal aCL were produced by the combined method of EBV transformation and somatic cell hybridization of lymphocytes, derived from patients with APS. The monoclonal aCL were used to immunize mice at the footpads and the mice were followed for serological and clinical manifestations of APS.

The monoclonal antibody EY2C9, was found to bind weakly to cardiolipin and other phospholipids (i.e. phosphatidyl-serine, phosphatidyl-ethanolamine and phosphatidyl-inositol). The antibody TM 1B9, although derived from a patient with SLE and with secondary APS, did not react with phospholipids. Immunization of naive BALB/c mice with EY2C9 was followed by production of sustained high titers of antiphospholipid antibodies associated with prolonged activated partial thromboplastin time (APTT) (46.8 ± 5.0 s vs. 22.4 ± 1.7 s, in the non-immunized mice). Mice immunized with TM 1 B9 had a more moderate titer of antiphospholipid antibodies and did not show prolonged APTT. The pregnant mice, that were immunized with EY2C9, had increased fetal resorption rate (the equivalent of fetal loss in the human) of 36.8 ± 10% (vs. 2 ± 4% in mice immunized with TM 1 B9).

Our results confirm that monoclonal aCL, derived from a patient with APS, can have a pathogenic potential, dysregulating the idiotypic network and leading to the development of characteristic signs of APS. Moreover, our findings suggest that immunization with antibody, although non-reactive with what is thought to be the antigen, but derived from a patient with active disease, can still promote the development of related antibodies, probably because it has other characteristics of pathogenicity (i.e. idiotype).